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Renal Physiology (Module 8) Flashcards

1
Q

A case of a 22 y/o male medical student who was brought to ED with a chief complaint of severe vomiting due to alcohol intoxication. Which of the following manifests the corresponding compensation?

a. Respiratory rate of 25
b. pH of 7.5
c. Respiratory rate of 12
d. Decreased breath sounds

A

Answer: A. Respiratory rate of 25

Patient is experiencing metabolic alkalosis (vomiting). As a compensatory mechanism, patient will have respiratory acidosis (hyperventilation). (Renal Physiology Part III handout by Doc Banzuela, pages 3-4)

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2
Q

This is a case of a 45 y/o male pt. diagnosed with DM type I. Pt. was brought to the hospital after an incident of insulin overdose. Which of the following electrolyte imbalance will be expected?

a. Potassium of 2
b. Potassium of 4
c. Sodium of 130
d. Sodium of 145

A

Answer: A. Potassium of 2

Insulin stimulates K+ uptake into cells by increasing the activity of Na+-K+ ATPase. Overdose of insulin would lead to hypokalemia. (Constanzo, page 281)

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3
Q

The following cause an increase in the potassium secretion except:

a. Hypoaldosteronism
b. Loop diuretics
c. Alkalosis
d. Luminal anions

A

Answer: A. Hypoaldosteronism

Increased distal K+ secretion caused by high K+ diet, hyperaldosteronism, alkalosis, thiazide diuretics, loop diuretics, and luminal anions. (BRS Physiology, page 161)

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4
Q

RDJ, 56 y/o male, was brought to ED with complaint of chest pain and was given morphine sulfate. After several minutes, he was noted to have hypoventilation. Which of the following could be his ABG results?

a. pH = 7.3, PCO2 = 50
b. pH = 7.3, PCO2 = 35
c. pH = 7.5, PCO2 = 35
d. pH = 7.5, PCO2 = 50

A

Answer: A.pH = 7.3, PCO2 = 50

Respiratory acidosis may be brought about with the use of opiates (ex. morphine sulfate). Respiratory acidosis manifests as a decrease in normal pH (7.4) and increase in partial pressure of carbon dioxide (35-45). (Renal Physiology Part III handout by Doc Banzuela, page 3)

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5
Q

In gradient time transport, the rate of transport depends on different factors except:

a. Permeability of the membrane
b. Electrochemical gradient
c. Some substances that are passively reabsorbed demonstrate a transport maximum
d. The time that the fluid containing substances remains in contact with luminal membrane of the tubule

A

Answer: C. Some substances that are passively reabsorbed demonstrate a transport maximum

Gradient time transport does not have transport maximum and threshold. (Guyton and Hall, page 351)

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6
Q

Multiple mechanisms control the amount of sodium and water excreted by the kidney. What are the two primary systems involved in regulating the concentration of sodium and osmolarity of extracellular fluid.
A. RAAS and Thirst Mechanism
B. Fluid Buffer System and RAAS
C. Osmoreceptor–ADH system and Thirst Mechanism
D. Respiratory System and Renal System

A

Answer: C. Osmoreceptor–ADH system and Thirst Mechanism

The kidneys minimize fluid loss during water deficits through the osmoreceptor-ADH feedback system. Adequate fluid intake, however, is necessary to counterbalance whatever fluid loss occur through sweating and breathing and through the gastrointestinal tract. (Guyton and Hall, page 384)

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7
Q 
A patient was brought to the ER due to a massive blood loss. What are the stimulus that could increase the ADH secretion?
A. Increased arterial pressure
B. Decreased blood volume
C. Decreased osmolarity
D. Decreased blood concentration
A

Answer: B. Decrease Blood Volume

Whenever blood pressure and blood volume are reduced, such as during hemorrhage, increased ADH secretion causes increased fluid reabsorption by the kidneys helping to restore blood pressure and blood volume towards normal. (Guyton and Hall, page 668)

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8
Q 
Which factor stimulates activation of angiotensin II to have increase the effects of the thirst mechanism?
A. Hypovolemia
B. Hypertension
C. Hyponatremia
D. Hypokalemia
A

Answer: A. Hypovolemia

Angiotensin II is stimulated by factors associated with hypovolemia and low blood pressure. It helps restore blood volume and blood pressure toward normal after fluid intake. (Guyton and Hall, page 671)

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9
Q 
When the sodium concentration increases about 2 mEq/L above normal, \_\_\_\_\_\_\_\_\_\_\_\_\_ is activated.
A. Osmoreceptor-ADH Mechanism
B. RAAS 
C. Threshold for drinking
D. Thirst Mechanism
A

Answer: D. Thirst Mechanism

High sodium concentration will activate the thirst mechanism to increase blood volume. (Guyton and Hall, page 671)

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10
Q 
Which hormones play an important role in regulating sodium reabsorption by the renal tubules?
A. Angiotensin II and ADH
B. ADH and Aldosterone
C. Aldosterone and Angiotensin I
D. Angiotensin II and Aldosterone
A

Answer: D. Angiotensin II and Aldosterone

When sodium intake is low, increased levels of these hormones stimulate sodium reabsorption by the kidneys. (Guyton and Hall, page 672)

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11
Q

When is the desire to drink only completely satisfied?
A. when plasma osmolarity and blood volume returns to normal
B. when plasma osmolality and sodium concentration returns to normal
C. when sodium concentration and plasma volume returns to normal
D. when blood volume and plasma osmolality returns to normal

A

Answer: A. when plasma osmolarity and blood volume returns to normal

These two affect the activation of thirst mechanism, so when these normalize, thirst mechanism is inactivated. (Guyton, page 671)

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12
Q 
Which of the following hormones inhibits phosphate reabsorption?
A. LH
B. ADH
C. PTH
D. Aldosterone
A

Answer: C. PTH

PTH causes phosphaturia and increased urinary cAMP. It acts on the proximal tubule by activating adenylate cyclase, generating cyclic AMP (cAMP), and inhibiting Na+–PO4 co-transport. (BRS, page 163)

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13
Q 
This causes increased urinary Ca+ excretion.
A. Loop antidiuretics
B. Aldosterone
C. Loop diuretics
D. PTH
A

Answer: C. Loop diuretics

Because Ca++ reabsorption is linked with Na+ reabsorption in the loop of Henle, inhibiting Na+ reabsorption with a loop diuretic also inhibits Ca++ reabsorption. Loop diuretics can be used in the treatment of hypercalcemia. (BRS, page 163)

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14
Q 
Excess water ingestion and a decrease in extracellular fluid osmolarity leads to \_\_\_\_\_\_\_.
A. more ADH formed 
B. less ADH formed
C. no change in ADH levels
D. accumulation of ADH in the kidneys
A

Answer: B. less ADH formed

The renal tubules decrease their permeability for water, less water is reabsorbed, and a large volume of dilute urine is formed. This in turn concentrates the body fluids and returns plasma osmolarity back to normal.
(Guyton and Hall, page 382)

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15
Q

ADH release is also controlled by cardiovascular reflexes that respond to decreases in blood pressure and/or blood volume, including:
A. arterial baroreceptor reflexes and cardiopulmonary reflexes
B. ischemic reflexes and cardiopulmonary reflexes
C. arterial baroreceptor reflexes and muscle stretch reflexes
D. carotid reflexes and ischemic reflexes

A

Answer: A. arterial baroreceptor reflexes and cardiopulmonary reflexes

These reflex pathways originate in high pressure regions of the circulation such as the aortic arch and carotid sinus, and in the low pressure regions, especially in the cardiac atria. (Guyton and Hall, page 383)

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16
Q 
The increased water permeability in the distal nephron segments causes increased water \_\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_\_ of a concentrated urine.
A. filtration, excretion
B. reabsorption, excretion
C. reabsorption, filtration
D. filtration, secretion
A

Answer: B. reabsorption, excretion

Water reabsorption will decrease urine volume, making it more concentrated upon excretion. Furthermore, filtration only occurs in the glomerulus and never in the tubules. (Renal Physiology Handouts by Doc Banzuela)

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17
Q 
If both the \_\_\_\_\_ and thirst mechanisms fail simultaneously, plasma sodium concentration and osmolarity are poorly controlled.
A. ADH
B. Aldosterone
C. RAAS
D. LH
A

Answer: A. ADH

When sodium intake is increased after blocking the total ADH thirst system, relatively large changes in plasma sodium concentration occur. In the absence of the ADH thirst mechanisms, no other feedback mechanism is capable of adequately regulating plasma sodium concentration and osmolarity. (Guyton and Hall, page 385)

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18
Q

In general, the primary stimuli that increase salt appetite are those associated with _______.
A. Sodium deficits and decreased blood volume
B. Potassium deficits and increased blood volume
C. Phosphate deficits and decreased blood volume
D. Calcium deficits and decreased blood volume

A

Answer: A. Sodium deficits and decreased blood volume

The neuronal mechanism for salt appetite is analogous to that of the thirst mechanism. Also, circulatory reflexes elicited by low blood pressure or decreased blood volume affect both thirst and salt appetite at the same time. (Guyton and Hall, page 387)

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19
Q 
If Na+ excretion is less than Na+ intake, where would it be retained and would the volume in the said compartment increase or decrease?
A. ECF, decrease in the ECF volume
B. ECF, increase in the ECF volume
C. ICF, increase in ICF volume
D. ICF, decrease in ICF volume
A

Answer: B. ECF, increase in ECF volume

If Na+ excretion is less than Na+ intake, then the person has a positive Na+ balance. In this case, extra Na+ is retained in the body, primarily in the ECF. When the Na + content of ECF is increased, there is increased ECF volume or ECF volume expansion; blood volume and arterial pressure also increase, and there may be edema. (Constanzo, page 274)

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20
Q

If sodium excretion exceeds sodium intake, what would happen to the ECF volume?
A. ECF volume will increase
B. ECF volume will decrease
C. ECF volume will remain the same
D. ECF volume will increase then decrease

A

Answer: B. ECF volume will decrease

If Na+ excretion is greater than Na + intake, then a person is in negative Na+ balance. When excess Na+ is lost from the body, there is a decreased Na+ content of ECF, decreased ECF volume or ECF volume contraction, and decreased blood volume and arterial pressure (Constanzo, page 273)

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21
Q

Patient with Type I Diabetes Mellitus was taken to the hospital due to hyperkalemia. What could have caused this?
A. Increased dietary intake of potassium
B. The body is producing more potassium
C. Patient has not been taking his insulin shots
D. Decreased excretion of potassium

A

Answer: C. Patient has not been taking his insulin shots

Insulin stimulates K+ uptake into cells by increasing the activity of Na+-K+ ATPase. Physiologically, this effect of insulin is responsible for the uptake of dietary K+ into the cells following a meal. Deficiency of insulin, as occurs in Type I DM, produces the opposite effect: decreased uptake of K+ into cells and hyperkalemia. (Constanzo, page 285)

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22
Q

In a person with low potassium diet, how is the body able to reabsorb K+?
A. through I-cells of the stomach
B. through K-cells of the kidney
C. through principal cell of the nephron
D. through alpha-intercalated cells of the nephron

A

Answer: D. Alpha-intercalated cells

When a person is on a low K+ diet, K+ can be reabsorbed in the terminal nephron segments by the α-intercalated cells. Luminal membrane of these cells contains an H+-K+ ATPase. (Constanzo, page 288)

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23
Q

Patient with history of pyloric ulcer with partial gastric outlet obstruction presented with persistent vomiting for 3 days. Upon examination, has decreased respiratory rate. What is the significance of the decreased respiratory rate?
A. Patient has metabolic acidosis and the decreased respiratory rate is to increase pCO2 levels
B. Patient has respiratory acidosis and decreased respiratory rate is to decrease pH
C. Patient has respiratory alkalosis and decreased respiratory rate is to decrease pH
D. Patient has metabolic alkalosis and decreased respiratory rate is to decrease pH

A

Answer: D. Patient has metabolic alkalosis and decreased respiratory rate is to decrease pH

Loss of HCl from the stomach by vomiting causes metabolic alkalosis. Respiratory acidosis (hypoventilation) is the compensatory reaction to decrease pH back to normal. (Renal Physiology handout by Doc Banzuela)

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24
Q 
What cells in the kidney secretes K+?
A. Mesangial cells
B. Macula Densa
C. Podocyte
D. Principal cells
A

Answer: D. Principal cells

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25
Q 
How does increased cardiac output affect the control of thirst?
A. Decreased thirst
B. Increased thirst
C. No change
D. Increase then decrease
A

Answer: A. decreased thirst

Increased cardiac output means increased in blood pressure, thus decrease in thirst.

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26
Q 
How does decreased blood volume affect thirst?
A. increases thirst
B. decreases thirst
C. no change
D. decrease then an increase
A

Answer: A. increases thirst

Decrease in blood volume –> decrease in blood pressure –> increase in thirst

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27
Q

What does Angiotensin II and Aldosterone do?
A. increase sodium reabsorption and water excretion
B. increase sodium excretion and water reabsorption
C. decrease in both sodium and water excretion
D. increase in both sodium and water reabsorption

A

Answer: D. Increase in both sodium and water reabsorption

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28
Q

Clara a med student, had just finished eating her lunch in school. She ate 1 cup of rice and 1 serving of adobo. In her body, insulin is released by the pancreas to regulate the serum glucose concentration in her blood. What is the other function of insulin?

a. help in K+ balance
b. help in HCO3- balance
c. help in Mg++ balance
d. help in H+ balance

A

Answer: A. help in K+ balance

Insulin not only regulate serum glucose in the blood but also regulate potassium

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29
Q

Dennison joined a triathlon competition. He trained hard months before the event. At the time of the race, he experience muscle weakness in which hinders his moment to finish it. What happened inside his muscles that lead to his fatigue?

a. there is great accumulation of K in the interstitium
b. K is secreted in the urine
c. Mg accumulates in the ECF
d. Mg is secreted in the urine

A

Answer: A. there is great accumulation of K in the interstitium

Exercise contributes in the accumulation of potassium in the interstitium

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30
Q

Benvic, a health conscious person, is a fan of dairy products. Everyday, he drinks a glass of fresh milk before going to his boxing and mixed martial arts class. At night, he drinks a glass of hot milk before going to bed. Under normal calcium concentrations, what happens in the calcium inside his body?

a. His kidneys excrete all the calcium that he take in a day
b. His kidneys use Calcium to synthesize Erythropoietin
c. His kidneys reabsorb all the calcium
d. His kidneys use calcium to build up bone tissues

A

Answer: C. His kidneys reabsorb all the calcium

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31
Q

Raphael, a police officer, suddenly felt tired and unable to move after his long run around Mendiola. He was rushed to a nearby hospital and assess by a physician. He was ordered to have Laboratory Examination and the results show an elevated Potassium. What happened to potassium that lead to Raphael’s fatigue?

a. K was excreted out of his body
b. K was accumulated greatly in the interstitium
c. K was accumulated greatly inside the cell
d. K was reabsorbed

A

Answer: C. K was accumulated greatly in the interstitium

Exercise contributes in the accumulation of potassium in the interstitium

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32
Q

Ronaldo, a 50 year old male, was complaining of weakness and was rushed to the hospital. Upon the assessment of a doctor and acquiring lab results, it showed that he has a potassium serum level of 2.9 mEq/L. In terms of kidney function, what is the effect of low potassium level in the blood?

a. Potassium deficiency leads to secretion of phosphate
b. Potassium deficiency leads to reabsorption of phosphate
c. Potassium deficiency leads to breakdown of phosphate
d. Both A an C

A

Answer: A. Hypokalemia leads to secretion of phosphate

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33
Q

A nephrologist assessed a hypercalcemic patient with renal disease. He found out that it is also associated with an increase of urinary calcium excretion as a consequence of an increase in the filtered load. Beyond that, what is the other effect that hypercalcemia can cause?

a. A decline in tubular reabsorption of calcium by both PTH-dependent and -independent effects
b. An increase in Potassium excretion
c. Homeostasis
d. Paranoia

A

Answer: A. a decline in tubular reabsorption by both PTH-dependent and -independent effects

This occurs to obtain balance in serum calcium levels

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34
Q

Since he was a kid, Ben does not like to drink milk and other food rich in calcium. Upon having a medical and laboratory exam, his doctor diagnosed him of having hypocalcemia. What mechanism will his kidney do to compensate the situation?

a. decrease filtered load and enhance tubular reabsorption of calcium
b. increase filtered load and enhance tubular reabsorption of calcium
c. decrease filtered load and diminish tubular reabsorption of calcium
d. increase filtered load and diminish tubular reabsorption of calcium

A

Answer: A. decrease filtered load and enhance tubular reabsorption of calcium

Hypocalcemia decreases renal calcium excretion by decreasing the filtered load and enhancing the tubular reabsorption of calcium

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35
Q

Clarkson, a hypertensive patient, complains of weakness and loss of appetite. His doctor ordered a laboratory exam upon her consultation. What will be found in the results?

a. Decreased serum phosphate level
b. Increased serum phosphate level
c. Normal serum phosphate level
d. Increased serum sodium level

A

Answer: A. Decreased serum phosphate level

An acute increase in BP leads to decreased renal phosphate reabsorption by inducing removal of sodium-dependent phosphate co-transporter gene (Npt2a)

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36
Q

As the GFR falls, free serum calcium levels fall and serum phosphorus increases. The decrease in free serum calcium and increase in serum phosphorus stimulate the parathyroid glands to produce PTH, which decreases the abundance of Npt2a and Npt2c in what part of the kidney?

a. proximal convoluted tubule
b. distal convoluted tubule
c. loop of Henle
d. collecting duct

A

Answer: A. proximal convoluted tubule

Source: “Renal Control of Calcium, Phosphate, and Magnesium Homeostasis” Blaine et al., Clinical Journal of the American Society of Nephrology”

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37
Q

The importance of the kidney in maintaining normal calcium, phosphorus, and magnesium homeostasis can be seen in _______, in which abnormal levels of these electrolytes are very common clinical findings.

a. renal failure
b. heart failure
c. cerebrovascular accident
d. both b and c

A

Answer: A. renal failure

Source: “Renal Control of Calcium, Phosphate, and Magnesium Homeostasis” Blaine et al., Clinical Journal of the American Society of Nephrology

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38
Q 
Which one prevents the dissipation of the gradient in the renal interstitium?
A. Vasa Recta
B. Loop of Henle
C. Distal Convoluted Tubule
D. Proximal Convoluted Tubule
A

Answer: A. Vasa Recta

Vasa recta is a countercurrent exchanger and maintains the corticocapillary osmotic gradient in the renal interstitium. (Renal Physiology handout by Doc Banzuela)

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39
Q

What is the osmolarity at the tip of the Loop of Henle?

a. 300 mOsm
b. 450 mOsm/L
c. 1000 mOsm/L
d. 1200 mOsm/L

A

Answer: D. 1200 mOsm/L

300 mOsm is the osmolarity as you enter the proximal convoluted tubule. It gradually increases as the ultrafiltrate.

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40
Q

Diuretics such as Furosemide impair the kidney’s ability to concentrate or dilute urine. They act on which part of the kidney?

a. Descending Loop of Henle
b. Ascending Loop of Henle
c. Distal Convoluted Tubule
d. Proximal Convoluted Tubule

A

Answer: B. Ascending Loop of Henle

Furosemide is a loop diuretic that decrease reactive reabsorption in the thick ascending loop of Henle by blocking the Na-K-2Cl pump (Guyton and Hall, page 397)

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41
Q

How does sodium intake affect the tubular reabsorption of sodium?

a. high sodium intake decreases tubular reabsorption
b. high sodium intake increases tubular reabsorption
c. low sodium intake decreases tubular reabsorption
d. no effect

A

Answer: A. high sodium intake decreases tubular reabsorption

High sodium intake suppresses the formation of aldosterone, therefore decreasing tubular reabsorption and allowing the kidneys to excrete larger amounts of sodium. (Guyton and Hall, page 375)

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42
Q

Which of the following is true about the vasa recta?

a. It is a countercurrent Multiplier
b. It is permeable to plasma proteins
c. It is permeable to solutes in the blood
d. At the tip of the vasa recta, the concentration is about 300 mOsm/L

A

Answer: C. It is permeable to solutes in the blood

The vasa recta is a Countercurrent EXCHANGER and is highly permeable to solutes in the blood EXCEPT for plasma proteins, and has an osmolarity of 1200mOsm/L at the tip. (Guyton and Hall, page 351)

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43
Q

What do you expect from the urine concentration of a patient taking vasodilators?

a. Urine concentration is reduced
b. Urine concentration is increased
c. There is no change in urine concentration
d. Urine concentration is not affected

A

Answer: A

Vasodilators increase renal medullary blood flow causing a “washout” of some of the solutes from the renal medulla and REDUCING maximum urine concentrating ability. (Guyton and Hall, page 352)

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44
Q

A patient recovered from an accident with injuries to the head and upper body is suspected to have Diabetes Insipidus. Applying your knowledge regarding the types of DI, which of the following will you not expect to find in the patient?

a. Extreme thirst
b. Large volume of dilute urine
c. Improves with Desmopressin
d. Does not improve with Desmopressin

A

Answer: D. Does not improve with Desmopressin

Central DI is a condition where there is inability to produce or release ADH that can be caused by head injuries (damage to the posterior pituitary or hypothalamus). The large volume of dilute urine is from the distal tubular segments being unable to reabsorb water due to the absence of ADH. Desmopressin is the treatment of choice for Central DI since it is an analog of Vasopressin. (Guyton and Hall, page 354)

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45
Q

Nephrogenic Diabetes Insipidus can be caused by the following except:

a. Being treated for manic-depressive disorders such as Bipolar disorder
b. Failure of the countercurrent mechanism to form a hyperosmotic renal medullary interstitium
c. Damage to the hypothalamus
d. Unresponsive anti-diuretic hormone receptors

A

Answer: C. Damage to the hypothalamus

Damage to the hypothalamus causes an impairment in the production of ADH. Absent or little amount of ADH causes Central Diabetes Insipidus (Guyton and Hall, page 354)

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46
Q

How do you differentiate Central from Nephrogenic Diabetes Insipidus?

a. By measuring the urine volume
b. By judging the degree of dehydration
c. With administration of Desmopressin
d. By measuring the amount of fluid intake and urine output

A

Answer: C. With administration of Desmopressin

Both types of Diabetes Insipidus present with large volumes of diluted urine and both cause dehydration depending on the amount of fluid intake of the patient. 2 hours after injection of Desmopression with a lack of prompt decrease in urine volume and an increase in urine osmolarity indicated Nephrogenic Diabetes Insipidus. (Guyton and Hall, page 354-355)

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47
Q

If the patient has Central Diabetes Insipidus, what should you expect after administration of Desmopressin?

a. Prompt increase in urine volume and increase in urine osmolarity
b. Prompt decrease in urine volume and decrease in urine osmolarity
c. Prompt decrease in urine volume and increase in urime osmolarity
d. Prompt decrease in urine volume and increase in urine osmolarity

A

Answer: B. Prompt decrease in urine volume and decrease in urine osmolarity

The problem with Central DI is that there is absent or little ADH and thus will be responsive to Desmopressin which is an analog of Vasopressin. Administration of Desmopressin is used to distinguish Central from Nephrogenic DI. A prompt decrease in urine volume and an increase in urine osmolarity within 2 hours of injection indicates an effective response to the drug. (Guyton and Hall, page 354-355)

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48
Q

Which of the statement is true?
A. The slower the flow rate of tubular fluid, the lesser the % of Na can be reabsorbed
B. The faster the flow rate of tubular fluid, the greater the % of Na can be reabsorbed
C. The slower the flow rate of tubular fluid, the greater the % of Na can be reabsorbed
D. The slower the flow rate of tubular fluid, there will be equal % of Na can be reabsorbed

A

Answer: C. The slower the flowrate of tubular fluid, the greater the % of Na can be reabsorbed

Rate of transport is dependent on the time that the fluid containing substance remains in contact with the luminal membrane in the tubule. (Guyton and Hall, page 352)

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49
Q 
Which is a function of aldosterone?
A. Inc. H2O secretion
B. Dec K+ Secretion
C. Inc Na+ reabsorption
D. Dec H+ secretion
A

Answer: C. Inc Na+ reabsorption

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50
Q

Where is the site of action of aldosterone?
A. Glomerulus
B. Thick Descending Limb of loop of Henle
C. Collecting Tubule
D. Collecting Duct

A

Answer: C. Collecting Tubule

Aldosterone upregulates epithelial sodium channels in the collecting duct

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51
Q

Which of the following mechanism is correct?
A. Na reabsorption -> H20 reabsorption -> Increase tubular lumen urea concentration -> passive urea excretion
B. Na reabsorption -> H20 reabsorption -> Increase tubular lumen chloride concentration -> passive chloride excretion
C. Na reabsorption -> H20 reabsorption -> Increase tubular lumen chloride concentration -> passive chloride reabsorption
D Na reabsorption -> H20 excretion -> Increase tubular lumen urea concentration -> passive urea excretion

A

Answer: C. Na reabsorption -> H20 reabsorption -> Increase tubular lumen chloride concentration -> passive chloride reabsorption

Where Na goes water follows (Na reabsorption and H2O reabsorption) then leaving the lumen negatively charged rendering a chloride concentration gradient - a factor in passive diffusion causing the chloride to passively reabsorb due to electrical potential and chloride concentration gradient. (Guyton and Hall, page 352)

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52
Q 
Which of the following is the function of principal cells of the distal tubule
A. Absorb Na+, H20
B. Secrete K+
C. Both A and B
D. Absorb K+
A

Answer: C. Both A and B

Principal cells: Absorb Na+, H2O and secret K+
Intercalated cells: Absorb K+ Secrete H+

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53
Q 
What is the main effect in Ca++ if a person has Hypermagnesemia
A. There is no effect in calcium
B. Hypercalcemia
C. Hypocalcemia
D. Hypercalcemia then Hypocalcemia
A

Answer: C. Hypocalcemia

Both Ca++ and Mg++ competes for the same transporter. If one is gets reabsorbed more, the other is less reabsorbed.

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54
Q 
In the loop of henle how does Hydrogen is secreted?
A. Na-K ATPase pump
B. Na-K-2Cl pump
C. Na-H countertransport
D. Na-Ca exchanger
A

Answer: C. Na-H countertransport

Sodium is transported from the lumen into the cell by counter-transport mechanisms that reabsorb sodium while secreting other substances like hydrogen.

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55
Q

Which of the following starling forces increases secretion?
A. Peritubular capillary oncotic pressure
B. High blood pressure
C. Peritubular Capillary hydrostatic pressure
D. Both PCOP and PCHP

A

Answer: C. Peritubular Capillary hydrostatic pressure

It is influenced by the arterial pressure and resistances of the afferent and efferent arterioles, therefore Increase in arterial pressure tend to raise PCHP and decreases reabsorption rate.

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56
Q 
Which of the following would cause a decrease in both glomerular filtration rate (GFR) and renal plasma flow (RPF)?
A. Constriction of afferent arteriole
B. Constriction of efferent arteriole
C. Dilation of afferent arteriole
D. Ureteral stone
A

Answer: A. Constriction of afferent arteriole

It decrease both renal plasma flow (RPF) [because renal vasculature resistance is increased] and glomerular filtration rate (GFR) [because glomerular capillary hydrostatic pressure is decreased].

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57
Q 
What would be the effect of Ureteral stone on glomerular filtration rate (GFR) and renal plasma flow (RPF)?
A. Increase GFR and decrease RPF
B. Decrease GFR and increase RPF
C. Increase GFR and no change on RPF
D. Decrease GFR and no change on RPF
A

Answer: D. Decrease GFR and no change on RPF

The decrease on GFR is caused by the increase in Bowman’s space hydrostatic pressure and no effect on renal plasma flow (RPF).

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58
Q 
It is the movement from Glomerular Capillaries to Bowman's Space?
A. Glomerular Filtration
B. Tubular Reabsorption
C. Tubular Secretion
D. Glomerular Reabsorption
A

Answer: A. Glomerular Filtration

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59
Q 
Which of the following has the highest renal clearance?
A. Para-aminohippuric acid
B. Inulin
C. Glucose
D. Na
A

Answer: A. Para-aminohippuric acid.

PAH has the greatest clearance of all of the substances because it is both filtered and secreted. Inulin is only filtered. The other substances are filtered and subsequently reabsorbed; therefore, they will have clearances that are lower than the inulin clearance. (BRS, page 187)

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60
Q 
What is the Normal Filtration Fraction?
A. 10%
B. 20%
C. 30%
D. 40%
A

Answer: B. 20%

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61
Q 
Substances filtered and partially reabsorbed have a clearance \_\_\_\_\_\_\_ the GFR.
A. greater than
B. less than
C. equal to
D. They are not related.
A

Answer: B. less than

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62
Q 
Clearance of Inulin is \_\_\_\_\_\_ the GFR.
A. greater than
B. lesser than
C. equal to
D. They are not related.
A

Answer: C. equal to

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63
Q 
Which of the following would cause an increase in both glomerular filtration rate (GFR) and renal plasma flow (RPF)?
A. Constriction of afferent arteriole
B. Constriction of efferent arteriole
C. Dilation of afferent arteriole
D. Ureteral stone
A

Answer: C. Dilation of afferent arteriole.

Dilation of afferent arteriole will increase both renal plasma flow (RPF) [because renal vasculature resistance is decreased] and glomerular filtration rate (GFR) [because glomerular capillary hydrostatic pressure is increased]. (BRS, page 186)

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64
Q 
It is the movement from the Peritubular Capillaries to Interstitium to Tubules?
A. Glomerular Filtration
B. Tubular Reabsorption
C. Tubular Secretion
D. Glomerular Reabsorption
A

Answer: C. Tubular Secretion

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65
Q 
Substances that do not appear in the urine have a clearance of \_\_\_\_\_\_\_\_.
A. zero
B. greater than zero, but less than 100%
C. less than zero
D. 100%
A

Answer: A. zero

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66
Q

Osmosis is…
A. Flow of water from high concentration to low.
B. Exhibited by solutes in the body.
C. It always moves depending to concentration and not to volume.
D. It passes through a permeable membrane.

A

Answer: C. It always moves depending to concentration and not to volume.

Flow of water through a semi-permeable membrane is from low to high osmolarity. This property is exhibited only by water.

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67
Q

The following are functions of the kidneys, except
A. Regulation of BP, water, electrolyte balances.
B. Excretion of waste products and foreign chemicals.
C. Hormone secretion.
D. Glycolysis

A

Answer: D. Glycolysis

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68
Q 
The nephron
A. is the functional and structural unit of kidney.
B. can be regenerated. 
C. is around 1 million per kidney.
D. has three types.
A

Answer: A. is the functional and structural unit of kidney.

Nephrons cannot be regenerated, only 1 million per kidney, and it has only two types (Cortical and Juxtamedullary Nephrons).

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69
Q 
Nephrotic Syndrome is characterized by:
A. Hematuria
B. Proteinuria 
C. Glomerulonephritis 
D. Presence of cysts
A

Answer: B. Proteinuria

Hematuria is manifested in patients with Alport’s Syndrome, Glomerulonephritis is in patients with Nephritic Syndrome, Presence of cysts is seen in PKD (Polycystic Kidney Disease).

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70
Q 
Main charged barrier 
A. Capillary Endothelium 
B. Basement Membrane
C. Podocytes
D. Mesangial cell
A

Answer: B. Basement Membrane

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71
Q 
Which pair of part-function is correct? 
A. JG cells: Secretes renin
B. Macula Densa:Filtration of blood 
C. Glomerolus:Absorption of Na+ 
D. Peritubular Capillaries: Responsible for GFR
A

Answer: A. JG cells: Secretes renin

Macula densa monitors Na+ concentration in DT
Glomerulus filters the blood
Peritubular capillaries supplies O2 and glucose to tubular cells

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72
Q

Correct sequence of Renal Circulation:
A. Renal artery-Interlobular artery-Afferent arteriole-Efferent arteriole-Vasa Recta-Renal vein
B. Renal artery-Interlobular artery-Afferent arteriole-Vasa Recta-Efferent arteriole-Renal vein
C. Renal vein-Interlobular vein-Efferent arteriole-Afferent arteriole-Vasa Recta-Renal artery
D. Renal vein-Interlobular vein-Afferent arteriole-Vasa Recta-Efferent arteriole-Renal artery

A

Answer: B. Renal artery-Interlobular artery-Afferent arteriole-Vasa Recta-Efferent arteriole-Renal vein

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73
Q 
Which is the correct pair? 
A. Ascending Limb:Impermeable to solutes 
B. Descending Limb:Permeable to solutes 
C. Ascending Limb:Permeable to solutes  
D. Descending Limb:Impermeable to water
A

Answer: C. Ascending Limb:Permeable to solutes

Mnemonics: ASINding limb

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74
Q 
Increase in ADH will lead to… 
A. Decrease in aquaporins
B. Decrease in water reabsorption 
C. Decrease in urine concentration 
D. Decrease in urine volume
A

Answer: D. Decrease in urine volume

Increase in ADH results in increase in aquaporins, water reabsorption, and urine concentration.

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75
Q 
Renal Tubular System does not include 
A. Proximal Convuluted Tubules 
B. Loop of Henle 
C. Distal Convuluted Tubules 
D. JuxtaGlomerular Apparatus
A

Answer: D. Juxtaglomerular Apparatus

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76
Q 
Part of the Nephron most sensitive to ischemia
A. Proximal Convoluted Tubule
B. Distal Convoluted tubule
C. Thin Ascending loop
D. Thick Descending loop
A

Answer: A. Proximal Convoluted Tubule.

The PCT is the workhorse of the nephron, containing large number of mitochondria. “Ako na nga ang gumagawa ng lahat, pagkakaitan mo pa!” (Dr. Banzuela’s Handouts on Renal Physiology)

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77
Q

“In Conn’s Syndrome which of the following occurs?
A. Increased Na+ secretion, Increased K+ secretion
B. Increased Na+ reabsorption, decreased K+ secretion
C. Increased Na+ reabsorption, increased K+ secretion
D. Decreased Na+ absorption, increased K+ secretion”

A

“Answer: C. Increased Na+ reabsorption, increased K+ secretion

Conn’s disease is also known as primary hyperaldosteronism. Aldosterone causes increased Na+ reabsorption and increased K+ secretion”

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78
Q

Also known as the “cortical diluting segment” of the nephron
A. Thick Ascending Limb of the Loop of Henle
B. Thin Ascending Limb of the Loop of Henle
C. Early Distal Tubule
D. Late Distal Tubule

A

Answer: C. Early Distal Tubule.

Segment in the cortex which avidly reabsorbs most ions but is impermeable to H2O. (Guyton and Hall, 356)

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79
Q 
Thiazide diuretics (hydrochlorothiazide, chlorthalidone) act on which segment of the nephron?
A. Early Distal Tubule
B. Proximal Convoluted Tubule
C. Collecting Tubule
D. Descending Loop of Henle
A

Answer: A. Early Distal Tubule.

Guyton and Hall, page 428

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80
Q 
In acidosis, the kidneys do not excrete \_\_\_\_\_\_\_\_\_\_\_ into the urine but reabsorbs all the filtered \_\_\_\_\_\_ and produce new \_\_\_\_\_, which is added back to the extracellular fluid. This reduces the extracellular fluiod H+ concentration back to normal.
A. HCO3, H20, CO2
B. CO2, H20, HCO3
C. HCO3, HCO3, HCO3
D. HCO3, H20, HCO3
A

Answer: C. HCO3, HCO3, HCO3

Guyton and Hall, page 729

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81
Q

Which is true when Renal Treshold has been reached?
A. All nephrons are now working properly.
B. Some substance normally excreted (glucose) is reabsorbed.
C. All of the excess substance is excreted.
D. A minimal amount of glucose appears in the blood.

A

Answer: D. A minimal amount of glucose appears in the bloodRenal treshold means that at least 1 nephron has been saturated and cannot reabsorb anymore. Substances that are not supposed to be in the urine starts to appear.

82
Q

Which of the following is the most likely basis for renal treshold and Transport maximum?
A. There are only a limited amount of transporters available, limiting the amount of solutes (ex. Glucose) that can be transported
B. Active transport requires a gradient, which becomes saturated the higher the amount of solutes (ex. Glucose) to be filtered is present
C. There is only a finite amount that the macula densa can measure, exceeding it means that the solute (ex. Glucose) is not reabsorbed
D. Because the pressure is too high in the glomerulus that the solutes (ex. Glucose) penetrate the membranes.

A

Answer: A. There are only a limited amount of transporters available, limiting the amount of solutes (ex. Glucose) that can be transported.

83
Q 
The kidneys regulate extracellular fluid H+ concentration through three fundamental mechanisms except:
A. Secretion of H+
B. Reabsorption of filtered HCO3
C. Production of new HCO3
D. Reabsorption of H2O
A

Answer: D. Reabsorption of H2O does not regulate H+ concentration.

(Guyton and Hall, page 729)

84
Q 
Glucose would appear in the urine once it exceeds:
A. 200 mg/cL
B. 200 mg/dL
C. 300 mg/mL
D. 400 mg/L
A

Answer: B. 200 mg/dL

85
Q 
Hormone which decreases PO4 reabsorption, increase Ca reabsorption, and stimulate 1-alpha hydroxylase.
A. Aldosterone
B. Angiotensin II
C. PTH
D. ANP
A

Answer: C. PTH.

Guyton and Hall, page 364

86
Q

Acids are:

a. Proton donors
b. Electron donors
c. Proton acceptors
d. Electron acceptors

A

Answer: A. Proton donors

Acids: H30+ (proton donors), bases: OH- (proton acceptors)

87
Q

It is a substance that resist change in pH

a. Acid
b. Base
c. Buffer
d. Base

A

Answer: C. Buffer

Buffers are substances that resist change in pH because they can reversibly bind H+

88
Q

What is the normal plasma pH?

a. 6.4
b. 7.4
c. 5.4
d. 8.4

A

Answer: B. 7.4

Normal plasma level range is 7.35 - 7.45

89
Q

Which organ responds to metabolic acidosis/alkalosis?

a. Lungs
b. Liver
c. Kidneys
d. Stomach

A

Answer: A. Lungs

90
Q

In ___________, Increased H+ in the plasma will decrease RR causing ___________.

a. metabolic acidosis, metabolic alkalosis
b. metabolic acidosis, respiratory acidosis
c. metabolic alkalosis, metabolic acidosis
d. metabolic alkalosis, respiratory alkalosis

A

Answer: b. metabolic acidosis, respiratory acidosis

In metabolic acidosis, Increased H+ in the plasma will decrease RR causing respiratory acidosis.

91
Q

Henderson-Hasselbalch equation

a. pH = pKa + log HA/A
b. pKa = -log Ka
c. pH = pKa + log A/HA
d. pH = -log H+

A

Answer: C. pH = pKa + log A/HA

92
Q

What is the compensatory mechanism when there is respiratory acidosis?

a. Hyperventilation
b. Hypoventilation
c. Inc. H+ excretion and HCO3- reabsorption
d. Dec. H+ excretion and HCO3- reabsorption

A

Answer: C. Inc. H+ excretion and HCO3- reabsorption

Renal compensation is to increase H+ excretion and HCO3- reabsorption to make the environment more basic

93
Q

Which of the following statements is correct?
A. Reabsorption of bicarbonate in the kidneys is coupled with H+ excretion
B. Excretion of bicarbonate in the kidneys is coupled with H+ excretion
C. Reabsorption of bicarbonate in the kidneys is coupled with K+ reabsorption
D. Reabsorption of bicarbonate in the kidneys is coupled with Ca+ reabsorption

A

Answer: A. Reabsorption of bicarbonate in the kidneys is coupled with H+ excretion

Reabsorption of bicarbonate in the kidneys is coupled with H+ excretion thus maintaining pH at physiologic level.

94
Q

Ingestion of Diuretics except Carbonic Anhydrase inhibitor causes

a. Respiratory Alkalosis
b. Metabolic Alkalosis
c. Respiratory Acidosis
d. Metabolic Acidosis

A

Answer: b. Metabolic Alkalosis

95
Q

Which of the following statements is correct?
A. Strong acids do not dissociate rapidly while weak acids dissociates rapidly
B. Strong acids dissociate rapidly while weak acids dissociates not rapidly
C. Strong acids and Weak acids does not dissociate rapidly.
D. Strong acids and Weak acids dissociate rapidly.

A

Answer: A. Strong acids do not dissociate rapidly while weak acids dissociates rapidly

96
Q 
Which of the hormones increases cell potassium uptake after a meal? 
A. Glucagon
B. Somatostatin
C. Insulin
D. Parathyroid hormone
A

Answer: C. Insulin

Insulin shifts K+ into cells and decreases extracellular K+ (Guyton and Hall, Renal Physiology III handout by Dr. Banzuela)

97
Q 
Which is characterized by excess aldosterone secretion?
A. Addison’s disease
B. Renal artery stenosis
C. Pheochromocytoma
D. Conn’s syndrome
A

Answer: D. Conn’s syndrome

Conn’s syndrome is caused by aldosterone hypersecretion by the adrenal glands.

98
Q 
Which is characterized by deficient aldosterone production? 
A. Addison’s disease
B. Renal artery stenosis
C. Pheochromocytoma
D. Conn’s syndrome
A

Answer: A. Addison’s disease

Patients with Addison’s disease have deficient aldosterone production that results into hyperkalemia from accumulation of potassium in the extracellular space and renal retention of potassium.

99
Q 
Which of the following inhibits K+ secretion?
A. Chronic acidosis
B. Acute acidosis
C. Chronic alkalosis
D. Acute alkalosis
A

Answer: B. Acute acidosis

Acute acidosis decreases potassium secretion; decreases the activity of sodium-potassium ATPase pump; decreases intracellular K+; decreases diffusion of K+ into the lumen

100
Q 
Which of the following decreases Ca++ excretion?
A. Increase blood pressure
B. Decrease plasma phosphate
C. Increase PTH
D. Metabolic alkalosis
A

Answer: C. Increase PTH

Increased levels of PTH, increases calcium reabsorption through the thick ascending loop of Henle and distal tubule, which reduces urinary excretion of calcium.

101
Q

Which of the following increases extracellular K+?
A. Increase extracellular fluid osmolarity
B. Alkalosis
C. Aldosterone
D. Insulin

A

Answer: A. Increase extracellular fluid osmolarity

Increased extracellular fluid osmolarity causes cell dehydration, which raises the intracellular potassium concentration and promotes diffusion of potassium from the cells to the extracellular fluid.

102
Q 
Secretion of K+ by the distal tubule will be decreased by\_\_\_\_\_\_\_\_.
A. Metabolic alkalosis
B. High K+ diet
C. Hyperaldosteronism
D. Spironolactone administration
A

Answer: D. Spironolactone administration

Distal K+ secretion is decreased by factors that decrease the driving force for passive diffusion of K+ across the luminal membrane. Because spironolactone is an aldosterone antagonist, it reduces K+ secretion. (Costanzo)

103
Q 
Which of the following causes a decrease in renal Ca++ clearance?
A. Hypoparathyroidism
B. Treatment with chlorothiazide
C. Treatment with furosemide
D. Extracellular fluid volume expansion
A

Answer: B. Treatment with chlorothiazide

Thiazide diuretics have a unique effect on the distal tubule; they increase Ca2+ reabsorption, thereby decreasing Ca2+ excretion and clearance. (Costanzo)

104
Q 
Which of the following causes hyperkalemia?
A. Exercise
B. Insulin injection
C. Decreased serum osmolarity
D. Treatment with b-agonists
A

Answer: A. Exercise

Exercise causes a shift of K+ from cells into blood. The result is hyperkalemia. (Guyton and Hall, Renal Physiology III handout by Dr. Banzuela)

105
Q

Which of the following is an action of parathyroid hormone on the renal tubule?
A. Stimulation of adenylate cyclase
B. Inhibition of distal tubule K+ secretion
C. Inhibition of distal tubule Ca++ reabsorption
D. Stimulation of proximal tubular phosphate reabsorption

A

Answer: A. Stimulation of adenylate cyclase

PTH acts on the renal tubule by stimulating adenyl cyclase and generating cAMP. (Costanzo)

106
Q

The following factors tend to INCREASE the rate of glomerular filtration (GFR) except:
A. decreased albumin concentration in plasma
B. vasodilation of the afferent arteriole
C. vasoconstriction of the efferent arteriole
D. vasodilation of the efferent arteriole

A

Answer: D. vasodilation of the efferent arteriole

107
Q

Select the correct order of renal blood circulation

a. Renal artery- segmental artery- intralobar artery-arcuate artery-afferent arteriole- glomerulus- arcuate vein-renal vein
b. Renal artery- interlobar artery- interlobular artery- afferent arteriole- glomerulus- intralobar vein-arcuate vein- renal vein
c. Renal artery- interlobar artery- interlobular artery- afferent arteriole- glomerulus- arcuate vein-renal vein
d. Renal artery- interlobar artery- afferent arteriole- glomerulus- intraarcuate vein

A

Answer: C. Renal blood circulation:
Renal artery-Segmental artery-interlobar artery-arcuate artery- interlobular artery- afferent arteriole- glomerulus- efferent arteriole- vasa recta- interlobular vein- arcuate vein- interlobar vein- renal vein (Guyton and Hall, Handout)

108
Q

Which of the following creates a hyperosmotic environment for the cell? (Internal environment of the cell is at 300mOsm/L)

a. Na ions = 300mOsm/L
b. Glucose = 1000mOsm/L
c. Urea = 50mOsm/L
d. Na = 1000mOsm/L

A

Answer: b. Glucose = 1000mOsm/L

High concentration of glucose or urea can make the cell environment hyperosmotic. Na ion only causes hypertonicity.

109
Q

Total body water of a 75kg person is 45L. what is the volume of the Interstitial fluid in his body?

a. 18L
b. 24L
c. 15L
d. 12L

A

Answer: a. 18L

40% of 45kg = 18L
Remember the 60-40-20 rule!

110
Q

Vial A contains 2 liters of water. Vial B contains a glucose solution with a concentration of 3000mOsm/L. What will happen to both of the solution if they will be placed adjacent to each other with only a semipermeable membrane in between?

a. Vial A’s content will go to B through passive diffusion
b. Vial B’s content will go to A through osmosis
c. Vial A’s content will go to B through facilitated diffusion
d. Vial A’s content will go to B through osmosis

A

Answer: d. Vial A’s content will go to B through osmosis

Osmosis is the movement of water from an area of low solute concentration to high through a semi permeable membrane. (Guyton and Hall)

111
Q

All are true pertaining to juxtamedullary nephrons except:

a. Contains interstitial cells that produces EPO
b. 25% of nephron in the kidney
c. Has a hairpin loop shape structure
d. Traverses the corticomedullary junction

A

Answer: A. Contains interstitial cells that produces EPO

112
Q

Alfonso’s right kidney contains 1 million nephrons. Since he has a lifestyle that is very detrimental or dangerous for his kidney, he starts to experience symptoms of kidney failure. At what approximate amount of nephrons is now damaged in his right kidney?

a. 750,000 nephrons
b. 690,000 nephrons
c. 800,000 nephrons
d. 850,000 nephrons

A

Answer: c. 800,000 nephrons

Symptoms BEGIN to appear once there 80% damage to the nephrons of a single kidney. (Guyton and Hall, Handouts)

113
Q

The blood pressure of a patient measured 40mmHg and a blood sodium level of 128mEq/L (NV= 134 to 146). Which structure on the kidney will sense the abrupt change in the said blood values?

a. JG cells
b. Distal Convoluted Tubule
c. Afferent Arteriole
d. Macula Densa

A

Answer: D. Macula Densa

Found in the walls of the DCT, they monitor the Na+ concentration. If it senses the low sodium level in the body and subsequently, low BP, it stimulates JG cells found in the walls of afferent arteriole to release Renin. (Guyton and Hall, Handouts)

114
Q

What is the amount of glucose reabsorbed in the collecting duct of the kidney?

a. 40%
b. 66%
c. 100%
d. No glucose is reabsorbed

A

Answer: D. No glucose is reabsorbed.

No glucose is reabsorbed in the collecting duct since it is completely (100%) reabsorbed in the Proximal Convoluted Tubule. (Guyton and Hall, Handouts)

115
Q

All of the following about the descending limb of loop of Henle is FALSE, except:

a. Permeable to Na+ and permeable to H20
b. Impermeable to H20 and permeable to Na+
c. Permeable to H20 and impermeable to Na+
d. Impermeable to Na+ and impermeable to H20

A

Answer: C. The DESCENDING limb is permeable to H20 and impermeable to solutes (Na+). The ASCENDING limb is permeable to Solutes and impermeable to water. (Guyton and Hall, Handout

116
Q

All of the following are functions of the segment of nephron first affected by acute tubular necrosis EXCEPT:

a. Contains SGLT, and most of the solute transporters
b. Contains Na, K2, Cl pump
c. Diluting segment
d. Cortical Diluting Segment

A

Answer: a. Contains SGLT, and most of the solute transporters

The proximal convoluted tubule contains the most of the solute transporters being the workhorse of the nephron. It also contains SGLT for transport of glucose. Na,K2,Cl pump is found on the Ascending limb of henle which also functions as the diluting segment. The cortical diluting segment is the Early part of the DCT. (Guyton and Hall, Handouts)

117
Q

What is the receptor opened by the ADH in the collecting duct?

a. Aquaporin III
b. Na, K2, Cl receptor
c. Aquaporin II
d. Aquaporin I

A

Answer: C. Aquaporin II

It is the receptor acted upon by the ADH in collecting duct. (Guyton and Hall, Handouts)

118
Q

Which of the following parts of nephron can you find the cells which secrete H+ and reabsorb K+?

a. Thick Ascending limb of Henle
b. Early Distal Convoluted Tubule
c. Thick Descending limb of Henle
d. Late Distal Convoluted Tubule

A

Answer: D. Late Distal Convoluted Tubule

This is where you can find the Intercalated cells which secrete H+ and Reabsorb K+. (Guyton and Hall, Handouts)

119
Q

Function of the counter-current mechanism?
A. Create urine with a different concentration than that of urine and conserve water
B. Induce dehydration
C. Decrease water reabsorption
D. Decrease plasma sodium

A

Answer: A. Create urine with a different concentration than that of urine and conserve water

120
Q 
What hormone helps create a concentrated urine?
A. Parathyroid Hormone
B. Thyroid hormone
C. Growth hormone
D. Anti Diuretic Hormone
A

Answer: D. ADH

In high levels of ADH, urine concentration is high while urine concentration is low in low levels of ADH

121
Q 
In the absence of which hormone is urine more dilute?
A. ADH
B. Growth hormone
C. Thyroid hormone
D. PTH
A

Answer: A. ADH

In high levels of ADH, urine concentration is high while urine concentration is low in low levels of ADH (Dr. Banzuela’s Renal Physiology Handouts)

122
Q 
Where is the counter current mechanism located?
A. Loop of henle
B. DCT
C. PCT
D. Bowman's capsule
A

Answer: A. Loop of Henle

Dr. Banzuela’s Renal Physiology Handouts

123
Q 
Which of the following is not true about the thick ascending tubule and its role in the counter current mechanism?
A. Secretes 25% NaCl
B. Resorbs 25% NaCl
C. Impermeable to water
D. Called the diluting segment
A

Answer: A. Secrete 25% NaCl

Dr. Banzuela’s Renal Physiology Handouts

124
Q

How do kidneys handle water and solvent excretion differently?
A. Solute excretion depends on the diet and metabolic waste and water excretion is based upon water intake
B. Water intake is based upon diet and metabolic waste and excretion is based upon water intake
C. Water intake is not essential component
D. The kidneys do not excrete water and waste products

A

Answer: A.Solute excretion depends on the diet and metabolic waste and water excretion is based upon water intake

(Dr. Banzuela’s Renal Physiology Handouts)

125
Q 
What is the normal plasma osmolarity?
A. 100 mOsm/L
B. 300 mOsm/L
C. 500 mOsms/L
D. 700 mOsm/L
A

Answer: B. 300 mOsm/L

Dr. Banzuela’s Renal Physiology Handouts

126
Q 
What is the osmolarity of urine when the kidney neither adds nor subtracts urine volume?
A. Same as plasma
B. Higher than plasma
C. Lower than plasma
D. There is zero urine volume
A

Answer: A. Same as plasma

Dr. Banzuela’s Renal Physiology Handouts

127
Q

When ADH is low the following occur except:
A. Urine remains concentrated
B. Dilute urine is formed in the thick ascending limb
C. Cortical and medullary collecting ducts are impermeable to water
D. Urine remains dilute

A

Answer: A. Urine remains concentrated

When ADH levels are low, water reabsorption is low, urine volume is high and urine concentration is low. (Dr. Banzuela’s Renal Physiology Handouts)

128
Q

Which statement is false?
A. The urine is iso-osmolar at the end of the tDLH
B. Urine is hypo-osmolar at the end of the TAL
C. Urine is iso-osmolar at the end of the PT
D. Urine is hyper-osmolar at the end of the tDLH

A

Answer: A. The urine is iso-osmolar at the end of tDLH

Dr. Banzuela’s Renal Physiology Handouts

129
Q

Glomerular capillaries filter the following in order for urine formation to occur except?

a. water
b. fluid
c. plasma protein
d. interstitial fluid

A

Answer. C. plasma protein

Because the Bowman’s Space Oncotic Pressure = normal value which is 0 mmHg, no protein should be filtered. (Dr. Banzuela’s Renal Physiology Handouts)

130
Q

Marcelino asked you where micturition occurs. What will you answer?

a. urethra
b. urinary bladder
c. ureter
d. renal plexus

A

Answer: B. urinary bladder

Micturition is the process by which the urinary bladder empties when it becomes filled. (Guyton and Hall, page 307)

131
Q

In the equation: filtration rate- (reabsorption rate + secretion rate). What is being measured?

a. urinary excretion rate
b. urinary concentration rate
c. fluid excretion rate
d. urinary reabsorption rate

A

Answer: A. Urinary excretion rate

Dr. Banzuela’s Renal Physiology Handouts

132
Q

Which of the following is not excreted in the urine

a. glucose
b. sodium
c. chloride ions
d. waste product

A

Answer: A. Glucose

Glucose is completely reabsorbed thus, normally absent in the urine. (Guyton and Hall, page 576)

133
Q

Sasha said that the first step to urine formation is

a. glomerular excretion
b. glomerular filtration
c. glomerular inhibition
d. glomerular formation

A

Answer: B. Glomerular filtration

(Dr. Banzuela’s Renal Physiology Handouts

134
Q

The average GFR is:

a. 210L
b. 1.5L
c. 180L
d. 750ml

A

Answer: C. 180L

The normal GFR is 125mL/min or 180L/day. (Dr. Banzuela’s Renal Physiology Handouts)

135
Q

Which of the following cannot be filtered by the kidneys?

a. water
b. 20angstrom
c. 50 angstrom
d. positive substance

A

Answer: C. 50 Angstrom

Dr. Banzuela’s Renal Physiology Handouts

136
Q

What is the effect of afferent arteriolar dilation?

a. Positive GFR
b. Negative GFR
c. Zero GFR
d. No change

A

Answer: A. Positive GFR.

Dilation of afferent arteriole provides more blood volume to be filtered by the kidneys thus causing an increase in filtration. (Dr. Banzuela’s Renal Physiology Handouts)

137
Q

Stimulates Principal cells
A. Dec ECF K
B. Inc ECF Na
C. Dec ECF Na
D. Inc ECF K

A

Answer: D. Inc ECF K

Dr. Banzuela’s Renal Physiology Handouts

138
Q

Mode of action of acute acidosis
A. Dec H2O and Na reabsorption in PCT - inc tubular flow rate- inc K secretion
B. Inhibition of Na-K-ATPase pump- dec intracellular K -dec diffusion of K into the lumen
C. Inhibition of Na-K-ATPase pump- inc extracellular K - inc diffusion of K into the wall
D. Inc H2O and Na reabsorption in DCT- inc tubular flow rate - inc H secretion

A

Answer: B. Inhibition of NA-K-ATPase pump- dec intracellular K -dec diffusion of K into the lumen.

(Dr. Banzuela’s Renal Physiology Handouts)

139
Q

Factor that causes a shift of K into the cells
A. Addison’s disease
B. Diabetes mellitus
C. B-adregenic blockade
D. Aldosterone

A

Answer: D. Aldosterone

Aldosterone stimulates the principal cells and increase the permeability of the luminal membrane to potassium, causing a shift of potassium from the extracellular fluids into the cells. (Dr. Banzuela’s Renal Physiology Handouts)

140
Q

Calcium _______ in the kidneys is controlled by _________ and parallels that of sodium and water.
A. Reabsorption; Vit. D and PTH
B. Secretion; Vit. D and PTH
C. Reabsorption; Mg and K
D. Secretion; Mg and K

A

Answer: A. Reabsorption; Vit. D and PTH

Dr. Banzuela’s Renal Physiology Handouts

141
Q 
Which factor will increase the transport maximum of Phosphate
A. Banana
B. Salt
C. Milk
D. Fruits
A

Answer: C. Milk and meat

Dr. Banzuela’s Renal Physiology Handouts

142
Q

Where is Magnesium greatly excreted
A. PCT
B. LH
C. DCT
D. Collecting Duct

A

Answer: B. LH

There is 65% reabsorption in the Loop of Henle, while there is 25% reabsorption in the Proximal Convoluted Tubule. (Dr. Banzuela’s Renal Physiology Handouts)

143
Q

Increased aldosterone levels increase
A. Na-K-ATPase pump
B. Na-K pump
C. Na-K-2Cl pump
D. Na-Cl pump

A

Answer: B. Na-K pump

An increase in aldosterone stimulates the principal cells and increases the Na-K pump and increases the permeability of the luminal membrane to potassium. (Dr. Banzuela’s Renal Physiology Handouts)

144
Q

Increased tubular flow rate occurs with
A. Eating tuyo
B. Eating cake
C. Drinking calamansi juice
D. Drinking soda

A

Answer: A. Eating tuyo

Increased tubular flow rate occurs in volume expansion, high sodium intake, use of diuretics. Tuyo is a type of food high in sodium. (Dr. Banzuela’s Renal Physiology Handouts)

145
Q

Which of the following will decrease Calcium excretion?
A. BP 140/80
B. ECF volume 40%
C. Metabolic acidosis
D. Metabolic alkalosis

A

Answer: C. Metabolic acidosis

Dr. Banzuela’s Renal Physiology Handouts

146
Q 
Antagonistic to Ca levels    
A. Sodium                  
B. Phosphate      
C. Potassium     
D. Magnesium
A

Answer: D. Magnesium

Dr. Banzuela’s Renal Physiology Handouts

147
Q

The basic requirement/s for forming a concentrated urine is/are:
A. a high level of ADH for reabsorption of water
B. hyperosmolarity of the renal medullary interstitial fluid
C. A only
D. Both a and b

A

Answer: D. Both A and B

Basic requirements in concentrating urine are: high level of ADH increase the permeability of tubules for reabsorption of water and high osmolarity of the renal medullary interstitial fluid that provides osmotic gradient necessary for water reabsorption to occur in the presence of high levels of ADH. (Dr. Banzuela’s Renal Physiology Handouts)

148
Q 
In the absence of ADH, there is a small amount of water absorbed in the late distal tubule that would result to\_\_\_\_\_\_. 
A. increase osmolarity 
B. decrease osmolarity 
C. decrease level of tubular fluid
D. Increase level of tubular fluid
A

Answer: B. Decrease osmolarity

Osmolarity decreases even further because of continued active reabsorption of ions from late distal tubules and cortical tubules. (Guyton and Hall, page 379)

149
Q

If urine osmolarity is greater than plasma osmolarity, what does it indicate?
A. Water clearance will be negative indicating water conservation
B. Water clearance will be positive indicating water conservation
C. Water clearance will be positive indicating water loss
D. Water clearance will be negative, no change in concentration

A

Answer: A. Water clearance will be negative indicating water conservation

(Guyton and Hall, page 380)

150
Q

The vasa recta as countercurrent exchanger does this important function
A. concentrate urine
B. increases solutes
C. minimize washout of solutes from the medullary interstitium
D. rapidly excrete solute in the cortex

A

Answer: C. Minimize washout of solutes from medullary interstitum

(Guyton and Hall, page 378)

151
Q 
What happens to the tubular fluid as it reaches the early distal tubule?
A. concentrated 
B. further diluted 
C. reabsorbed 
D. secreted
A

Answer: B. Further diluted

The early distal tubule further dilutes the tubular fluid because this segment is like the ascending loop of henle which is impermeable to water. (Guyton and Hall, page 376)

152
Q

Which of the following is true with regards to the production of hyperosmotic urine?
A. Urine Osmolarity is greater than plasma osmolarity
B. Urine Osmolarity is less than plasma osmolarity
C. Plasma Osmolarity is equal to urine Osmolarity
D. Urine osmolarity is not associated with plasma osmolarity

A

Answer: A. Urine osmolarity is greater than plasma osmolarity

(BRS, page 164)

153
Q

Which of the following is the correct statement regarding the ADH levels and the collecting duct?
A. ADH low - water reabsorption high - urine volume low - urince concentration high
B. ADH low - water reabsorption low - urine volume high - urine concentration high
C. ADH low - water reabsorption low - urine volume high - urine concentration low
D. ADH low - water reabsorption high - urine volume high - urine concentration high

A

Answer: C. ADH low - water reabsorption low - urine volume high - urine concentration low

(Dr. Banzuela’s Renal Physiology Handouts)

154
Q 
A 35 year old patient was brought to the ER with a complaint of polyuria. Upon taking the history, patient was found out to be taking Tetracycline. Desmopressin was administered intravenously. After 2 hours, urine output and urine osmolarity remain unchanged. What is most likely the diagnosis for this patient?
A. Central Diabetes Insipidus
B. SIADH
C. Nephrogenic Diabetes Insipidus
D. Addison's Disease
A

Answer: C. Nephrogenic Diabetes Insipidus

Nephrogenic DI can be distinguised from Central DI by the administration of Desmopressin. A lack of prompt decrease in urine volume and an increase in urine osmolarity within 2 hours after is suggestive of nephrogenic diabetes insipidus. (Guyton and Hall, page 381)

155
Q

In patients with SIADH, serum ADH is increased. What happens to water reabsorption, urine volume and urine concentration?
A. Water reabsorption- normal; urine volume- low; urine concentration- high
B. Water reabsorption- low; urine volume- high; urine concentration- normal
C. Water reabsorption- high; urine volume- high; urine concentration- high
D. Water reabsorption high; urine volume- low; urine concetration- high

A

Answer: D. Water reabsorption high; urine volume- low; urine concetration- high

In Syndrome of Inappropriate Anti-Diuretic Hormone Secretion, there is an increase in ADH levels which causes more aquaporins to be inserted resulting to an increase in water reabsorption, a decrease in urine volume and an increase in urine concentration. (Dr. Banzuela’s Renal Physiology Handout)

156
Q

A positive free water clearance will occur in the following, EXCEPT
A. drinks 3L of distilled water in 45 minutes
B. urine osmolarity of 100mOsm/L
C. excreting urine osmolarity of 1000mOsm/L
D. polyuric and unresponsive to ADH

A

Answer: C. excreting urine osmolarity of 1000mOsm/L

If positive, excess water is excreted. If negative, excess solutes are excreted. (Dr. Banzuela’s Renal Physiology Handout)

157
Q 
Pia Matter knows that the kidneys serve many homeostatic functions except:
A. Regulation of Arterial Pressure
B. Regulation of acid base balance
C. Secretion and metabolism of hormones
D. Glycogenesis
A

Answer: D Glycogenesis

Kidneys have an important role in gluconeogenesis not glycogenesis. (Guyton and Hall, page 576)

158
Q

Paul Lee asked his best friend Bro Li about renal physiology. His friend said that kidneys control the acid base balance by excreting acidic or basic urine. Which of the following statements is true?
A. Excreting basic urine reduces the amount of acid in extracellular fluid, whereas excreting basic urine removes base from the extracellular fluid.
B. Excreting acidic urine reduces the amount of acid in extracellular fluid, whereas excreting basic urine removes base from the extracellular fluid.
C. Excreting acidic urine reduces the amount of acid in extracellular fluid, whereas excreting acidic urine removes base from the extracellular fluid.
D. Excreting acidic urine reduces the amount of acid in extracellular fluid, whereas excreting basic urine removes acid from the extracellular fluid.

A

Answer: B. Excreting acidic urine reduces the amount of acid in extracellular fluid, whereas excreting basic urine removes base from the extracellular fluid.

(Guyton and Hall, page 729)

159
Q

What is the effect on transport of Angiotensin II?
A. Increased NaCl and Decreased H2O reabsorption
B. Decreased NaCl and Increased H2O reabsorption
C. Increased NaCl and H2O reabsorption
D. Decreased NaCl and H2O reabsorption

A

Answer: C. Increased NaCl and H20 reabsorption.

Berne and Levy

160
Q 
Where does isosmotic reabsorption of solute and water occur? 
A. Collecting Ducts 
B. Distal Convoluted Tubule 
C. Loop of Henle 
D. Proximal Convoluted Tubule
A

Answer: D Proximal Convoluted Tubule

161
Q 
Which of the following causes a potassium shift out of the cells? 
A. Hyposmolarity 
B. Beta 2 Adrenergic Agonists 
C. Beta 2 Adrenergic Antagonists 
D. Alpha Adrenergic Antagonists
A

Answer: C. Beta 2 Adrenergic Antagonists

162
Q 
Which hormone activates Urea Transporter 1 for the facilitated diffusion of urea? 
A. Anti-Diuretic Hormone 
B. Angiotensin II 
C. A7Aldosterone 
D. Dopamine
A

Answer: A. Anti-diuretic Hormone

163
Q

Furosemide is drug used to treat high blood pressure (hypertension). What is its mechanism of action?
A. Inhibition of active reabsorption of sodium chloride at the thick descending limb of the loop of Henle
B. Inhibition of active reabsorption of sodium chloride at the distal convoluted tubule
C. Inhibition of action of Aldosterone by binding its receptor in principal cells of the collecting duct
D. Alteration of the diffusion of water relative to sodium, reducing sodium reabsorption

A

Answer: A. Inhibition of active reabsorption of sodium chloride at the thick descending limb of the loop of Henle

Furosemide is an example of a loop diuretic that acts by blocking the Na-K-2Cl co-transport thereby raising the secretion of sodium, chloride, potassium, as well as other electrolytes. (Guyton and Hall, page 397-398)

164
Q 
Secretion of potassium by the distal tubule will be decreased by which of the following?
A. Hyperaldosteronism 
B. High potassium diet 
C. Spironolactone administration 
D. Metabolic Alkalosis
A

Answer: C. Spironolactone administration

Spironolactone is a mineralocorticoid receptor antagonist that compete with aldosterone for receptor binding sites in the cortical collecting tubule and can therefore decrease the reabsorption of sodium and secretion of potassium in the tubular segment. It also causes a movement of potassium from the cells to the extra-cellular fluid. Spirinolactone is therefore a potassium-sparing diuretic. (Guyton and Hall, page 399)

165
Q 
Active transport of substances from the blood into the nephron is called 
A. Tubular Reabsorption 
B. Tubular Secretion 
C. Tubular Excretion 
D. Tubular Filtration
A

Answer: A. Tubular Reabsorption

166
Q 
It is the movement of substances from the filtrate back to the peritubular capillaries capillaries 
A. Backflow 
B. Plasma Clearance 
C. Tubular Reabsorption
D. Filtration Fraction
A

Answer: C. Tubular reabsorption

167
Q

During tubular Reabsorption in the proximal convoluted tubule of the nephron, most solutes are moved across the apical membrane by ____________ and across the basal membrane by ____________.
A. Cotransport, cotransport
B. Cotransport, facilitated diffusion
C. Facilitated diffusion, facilitated diffusion
D. Facilitated diffusion, contransport

A

Answer: B. Cotransport, facilitated diffusion

168
Q 
"The permeability of the collecting ducts and and distal convoluted tubule is controlled by which of the following? 
A. Aldosterone 
B. Sodium ions 
C. Anti-Diuretic Hormone 
D. Atrial Natriuretic Factor "
A

Answer: C. Anti diuretic hormone

ADH influences the permeability of collecting ducts and Distal convoluted tubule by increasing water reabsorption. (Guyton and Hall)

169
Q 
Defining abnormal characteristic trait in DM
A. ketonuria 
B. oliguria 
C. polyuia 
D. euphoria
A

Answer: C. Polyuria

In diabetic patients 3Ps are presenting symptoms Polyuria, Polydipsia, and Polyphagia. An increase in the level of glucose in the proximal tubule where it is reabsorbed and consequently attracts more water due to a higher solute concentration. (Guyton and Hall)

170
Q 
Inulin undergoes what process of filtration? 
A. filtration only
B. filtration, partial reabsorption, 
C. filtration, complete reabsorption 
D. filtration secretion
A

Answer: A. Filtration only

Inulin is undergoes only filtration because its clearance is equal to GFR.

171
Q

If Substance A is excreted in the urine, which of the following cannot occur?

a. Filtration and secretion
b. Filtration and complete reabsorption
c. Filtration only
d. Filtration and partial reabsorption

A

Answer: b. Filtration and complete reabsorption

Substance A is completely reabsorbed in the blood, making it absent in the urine. (Guyton and Hall, page 311)

172
Q

Constriction of afferent arteriole will result in a/an __________.

a. decrease in filtration fraction
b. increase in filtration fraction
c. increase in renal plasma flow
d. decrease in glomerular filtration rate

A

Answer: d. decrease in glomerular filtration rate

Constriction of afferent arteriole will decrease blood flow and consequently the filtration rate. No change in the filtration fraction. (Berne and Levy, page 574)

173
Q

Which of the following will most likely be filtered freely from the blood?

a. Albumin
b. Myoglobin
c. Glucose
d. Bicarbonate ion

A

Answer: c. Glucose

Filterability of solutes are determined by their size and electrical charge. Smaller and positively charged substances are more likely to be filtered from the blood. (Berne and Levy, page 569)

174
Q

Adamantium is a very small substance that can be used clinically to estimate the GFR. Which of the following best explains its significance in estimating GFR?

a. Adamantium is freely filtered and not reabsorbed nor secreted during urine formation.
b. Adamantium is completely reabsorbed in the renal tubules.
c. Adamantium is very small and is positively charged.
d. Adamantium is secreted in the renal tubules.

A

Answer: a. Adamantium is freely filtered and not reabsorbed nor secreted during urine formation.

Urinary excretion = Glomerular filtration - Tubular reabsorption + Tubular secretion
The rate at which Adamantium is excreted in the urine is equal to the filtration rate of the substance by the kidneys because no reabsorption nor secretion occured. (Guyton and Hall, pages 323 and 340)

175
Q

If Vibranium has a clearance rate less than the GFR, it must have been _________.

a. partially reabsorbed from the renal tubules
b. filtered, but not reabsorbed nor secreted
c. secreted by the renal tubules
d. incompletely filtered by the glomerulus

A

Answer: a. partially reabsorbed by the renal tubules

The rate of excretion of a substance (clearance) is less than the filtered load because some of the substances have been reabsorbed to the blood, decreasing its amount in urine. (Guyton and Hall, pages 342-343)

176
Q

Which of the following is not an effect of tubular secretion?

a. Elimination of undesirable substances or end products that have been reabsorbed by passive processes
b. Disposal of Drug X that is tightly bound to plasma proteins
c. Regulation of of blood pH
d. Decreased urine concentration

A

Answer: d. Decrease urine concentration

In addition to not reabsorbing substances from the filtrate, tubular secretion helps in clearing the plasma of these unwanted substance. Blood pH is regulated by secretion of hydrogen ions. (Marieb, et al, page 972)

177
Q

In tubuloglomerular feedback, which substance aids in the maintenance of a constant GFR?

a. Aldosterone
b. Adenosine
c. Arginine
d. Albumin

A

Answer: b. Adenosine

Adenosine autoregulates GFR when blood pressure is high, decreasing GFR back to normal. When blood pressure is low, Angiotensin II and Nitric Oxide increases GFR back to normal. (Guyton and Hall, page 320)

178
Q

These cells sense changes in sodium concentration in the distal tubules.

a. Macula densa
b. Juxtaglomerular cells
c. Mesangial cells
d. Lacis cells

A

Answer: a. Macula densa

They are located in the walls of the distal tubules, Macula densa monitors Na+ concentration and, consequently, blood pressure (Guyton and Hall, page 320)

179
Q

What would you expect the normal clearance value for amino acids to be?

a. 100%
b. 50%
c. 0%
d. Cannot be determined

A

Answer: c. 0%

Amino acids are valuable as nutrients and as the building blocks for protein synthesis, so it would not be good to lose them in the urine. Also, amino acids are filtered but are also reabsorbed completely and therefore will not be present in the urine. (Guyton and Hall, page 311; Renal Physiology Handout)

180
Q

What makes the filtration barrier impermeable to plasma proteins like albumin?

a. Fenestrae in the capillary endothelium are smaller than albumin.
b. Proteoglycans in the basement membrane are negatively charged.
c. Foot-like processes called podocytes have a high affinity to albumin so they bind with it and sweep it back to the capillary.
d. There are no transporters for these proteins are present in the barrier.

A

Answer: b. Proteoglycans in the basement membrane are negatively-charged.

Fenestrations in the capillary membrane are relatively large, but the electrostatic repulsion exerted by negative charges throughout the filtration barrier restricts albumin filtration. (Guyton and Hall, pages 312-313)

181
Q

What is the unit for osmolality?

a. milliosmoles per kilogram of water
b. milliosmoles per liter of water
c. osmoles per deciliter of water
d. osmoles per gram of water

A

Answer: a. Osmoles per kilogram of water

182
Q

If a cell is placed in a solution and it swell, what is the type of the solution?

a. Isotonic
b. Hypotonic
c. Hypertonic
d. osmosis

A

Answer: B. Hypotonic

In a hypotonic solution, the solute concentration is higher inside the cell compared to that of the solution. Water moves from a solution of low solute concentration to high solute concentration (osmosis). The cell swells as a result of water going into the cell. (Renal Physiology Handout by Dr. Banzuela)

183
Q

This structure has large spaces with Type IV collagen, lainin, argin, perlecan and fibronectin

a. podocytes
b. capillary endothelium
c. basement membrane
d. mesangial cells

A

Answer: C. basement membrane

The basement membrane is part of the renal corpuscle that has large spaces with Type IV Collages=n, Laini, Agrin, Perlecan and Fibronectin. It is also the main charged barrier (Renal Physiology Handout by Dr. Banzuela)

184
Q

These cells are found in the walls of distal convoluted tubules

a. mesangial cells
b. macula densa
c. Juxtaglomerular cells
d. podocytes

A

Answer: B. macula densa

The macula densa are found in the walls of the Distal Convoluted Tubule. Their function is to monitor Na concentration in DCT (and consequently blood pressure) (Renal Physiology Handout by Dr. Banzuela)

185
Q

This is the flow of water from a solution of low solute concentration to high solute concentration across a semi-permeable membrane.

a. Isotonic
b. Hypertonic
c. Hypotonic
d. Osmosis

A

Answer: D. Osmosis

Osmosis is defined as the flow of water from a solution of low solute concentration to a solution of high solute concentration across a semi-permeable membrane. (Renal Physiology Handout by Dr. Banzuela)

186
Q

These are found in-between capillaries. They are contractile, mediate filtration and take-up immune complexes

a. mesangial cells
b. macula densa
c. JG cells
d. Podocytes

A

Answer: A. mesangial cells

Mesangial cells are modified smoooth muscle, phagocytose cellular debris and are involved in glomerular diseases (Renal Physiology Handout by Dr. Banzuela)

187
Q

Diane is a consultant in St. Bede’s Hospital. Which of her patients would likely present a urinary volume less than normal?

a. Diabetes mellitus
b. Diabetes insipidus
c. Sympathetic stimulation
d. Increased renal arterial pressure

A

Answer: C. Sympathetic stimulation

There is a constriction in renal arteries that result to a decrease in renal blood flow thus GFR and Urine output also decreases.

188
Q

Which of the following structures has a unique feature whose purpose is to increase the surface area for re-absorption?

a. proximal convoluted tubule
b. loop of Henle
c. distal tubule
d. collecting duct

A

Answer: a. proximal convoluted tubule

Considered as the “workhorse” of the nephron, It is where reabsorption of 66% of Na, K and H2O occurs. Glucose and amino acids are completely reabsorbed in the PCT. The proximal convoluted tubule contains “brush borders” which increase the surface area for re-absorption.

189
Q

Which of the following statements best describes acid-base balance?

a. Acidosis increases K+ secretion
b. During alkalosis, the blood contains more H+
c. Alkalosis increases K+ secretion
d. During acidosis, blood contains too little H+

A

Answer: C. Alkalosis increases K+ secretion

190
Q 
Active transport of substances from the blood into the nephron is called 
A. Tubular Reabsorption 
B. Tubular Secretion 
C. Tubular Excretion 
D. Tubular Filtration
A

Answer: A. Tubular Reabsorption

191
Q

One of your classmates decided to breathe on a brown paper bag for fun. If your classmate continued to breathe on the brown paper bag for an extended period of time, it can result to which of the following acid-base abnormalities?

a. respiratory acidosis
b. respiratory alkalosis
c. metabolic acidosis
d. metabolic alkalosis

A

Answer: a. respiratory acidosis

Breathing on a brown bag will result to the patient inhaling the CO2 that he is exhaling. Increased amounts of CO2 will result in an increase in PCO2 and increase in H+ levels leading to a decrease in pH levels and an acidic environment, resulting to respiratory acidosis.

192
Q

Also known as the “cortical diluting segment” of the nephron
A. Thick Ascending Limb of the Loop of Henle
B. Thin Ascending Limb of the Loop of Henle
C. Early Distal Tubule
D. Late Distal Tubule

A

Answer: C. Early Distal Tubule.

Segment in the cortex which avidly reabsorbs most ions but is impermeable to H2O. (Guyton and Hall, 356)

193
Q

The expected compensation to the respiratory acidosis is to:
a. increase H+ excretion, increase in HCO3 reabsorption
b, decrease H+ excretion, decrease in HCO3 reabsorption
c. hyperventilation
d. hypoventilation

A

Answer: A. increase H+ excretion, increase in HCO3 reabsorption

When the acid-base abnormality is of respiratory origin, the compensatory mechanism is done by the renal system which rules out hyperventilation and hypoventilation. An increase in H+ excretion and increase in HCO3 reabsorption are done in order to make the environment more alkaline.

194
Q

Which of the following, if present in the urine, does not indicate a problem with the ability of the kidneys to filtrate solutes?

a. Inulin
b. Creatinine
c. Glucose
d. PAH

A

Answer:
D. PAH

PAH, along with other organic acids and bases have a high clearance and undergo filtration and secretion but they are never reabsorbed and are normally found in the urine.

195
Q

If your friend has been complaining of vomiting for three days, what type of acid-base imbalance should you anticipate?

a. respiratory acidosis
b. respiratory alkalosis
c. metabolic acidosis
d. metabolic alkalosis

A

Answer: D. metabolic alkalosis

Vomiting of gastric contents causes a loss of the HCl secreted by the stomach mucosa, resulting to a loss of acid from the extracellular fluid and development of metabolic alkalosis (Guyton and Hall, page 393).

196
Q

If your friend has been complaining of diarrhea, what type of acid-base imbalance should you anticipate?

a. respiratory acidosis
b. respiratory alkalosis
c. metabolic acidosis
d. metabolic alkalosis

A

Answer: c. metabolic acidosis

197
Q

This is the flow of water from a solution of low solute concentration to high solute concentration across a semi-permeable membrane.

a. Isotonic
b. Hypertonic
c. Hypotonic
d. Osmosis

A

Answer: D. Osmosis

198
Q

These cells are found in the walls of distal convoluted tubules

a. mesangial cells
b. macula densa
c. Juxtaglomerular cells
d. podocytes

A

Answer: B. Macula densa

199
Q 
Where does isosmotic reabsorption of solute and water occur? 
A. Collecting Ducts 
B. Distal Convoluted Tubule 
C. Loop of Henle 
D. Proximal Convoluted Tubule
A

Answer: D. Proximal Convoluted Tubule

200
Q

Sasha said that the first step to urine formation is

a. glomerular excretion
b. glomerular filtration
c. glomerular inhibition
d. glomerular formation

A

Answer: b. glomerular filtration

Renal Physiology (1 decks)

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