TERM EXAM - MIDTERM Flashcards by Keannah Keim Insular

How do kidneys make use
of the secreted H+?

a. used to reclaim most of
filtered HCO3
b. Titrate renal buffers
c. generate new HCO3
d. all of the choices
e. except C

c. generate new HCO3

H+ fates:
1) Titrate with filtered HCO3-
2) Titrate with filtered
phosphate (or other filtered
buffers in 9tratable acid)
3) Titrate with NH3 (both
secreted and filtered)

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In a patient with 11B-HSD2 deficiency, they are expected to have the following findings

hypokalemia, hypertension
and abnormal Na retention

11B-HSD2 Deficiency =
Apparent Mineralocorticoid
Excess (AME) = Abnormal Na+
retention, Hypokalemia,
Hypertension

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The following is/are true
about a cystometrogram,
except:

a. it is a test used to record
the relationship between
bladder volume and
intravesical pressure
b. once the bladder is empty,
pressure is recorded while
filling it with ~50mL
increments of water
c. Procedure starts by
inserting a catheter through
the urethra and emptying
the bladder
d. No exception

b. once the bladder is empty,
pressure is recorded while
filling it with ~50mL
increments of water

Ratio:
A. Bladder tone is defined
by the relationship
between bladder
volume and internal
(intravesical) pressure.
The record of the
relationship between
volume and pressure is
a cystometrogram
B. FALSE. [One first senses
the urge for voluntary
bladder emptying at a
volume of ~150 mL]
C. One can measure the
volume-pressure
relationship by first
inserting a catheter
through the urethra and
emptying the bladder,
and then recording the
pressure while filling
the bladder with 50-mL
increments of water.

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long-term lack of potassium
can lead to several metabolic
disturbances such as the
following, except:

a. enhance secretion of
ammonium in the kidneys
b. high tendency to develop
metabolic alkalosis
c. inability to balance
potassium homeostasis
between the external and
internal environment
d. kidneys not being able to
form a concentrated urine
e. NOTA

c. inability to balance
potassium homeostasis
between the external and
internal environment

Ratio:
Chronic K+ depletion leads to several metabolic disturbances.
These include the following: (1) inability of the kidney to form a concentrated urine; (2) a tendency to develop metabolic alkalosis; and, closely related to this acid-base disturbance, (3) a striking enhancement of renal ammonium excretion (p792)
A. TRUE
B. TRUE
C. wala siya’y apil
D. TRUE

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which of the following
clinical examples in which
reduced ECV can lead to
inappropriate increase in AVP levels?
a. severe hemorrhagic shock
b. hypovolemic shock
a. congestive heart failure
b. all of the choices
c. NOTA

a. congestive heart failure

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entry of sodium in the first
half proximal tubule is thru:

a. apical membrane via NA2+ coupled electrogenic cotransporter
b. basolateral membrane via
Na-K exchanger 3 (NHE3)
c. basolateral membrane via
electrogenic Na/HCO3
cotransporter 1 (NBCe1)
a. all of the choice

a. all of the choice

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medullary trapping of K is
the result of steps happening in the nephron, such as the following,except:

a. passive secretion of K into
tDLH by juxtamedullary
nephrons
a. K reabsorption by tALH TAL
depositing k in medulla
b. reabsorption of K by MCD
c. K secretion in tDLH also
known as medullary K
recycling
d. NOTA

a. passive secretion of K into
tDLH by juxtamedullary
nephrons

Ratio
Medullary K+ Trapping is the
result of 3 steps:
1) secrete K+ passively into
tDLH — “MEDULLARY K+
RECYCLING”
2) K+ reabsorp9on by tALH and TAL — deposited in medullary interstitium 3) Reabsorption of K+ by MCD

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two separate but closely
interrelated control systems
regulate the volume and
osmolality of ECF. how will the body regulate extracellular osmolality:

a. monitoring and adjusting
the total body content of
NaCl
a. monitoring and adjus5ng
the total body water
content

a. monitoring and adjusting
the total body water
content

Ratio:
The body regulates extracellular
osmolality by adjusting total body
water content
chapter 40 page836

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these are the site of
reabsorption of calcium, except
a. proximal tubule
a. collecting duct
b. TAL
c. DCT

a. collecting duct

Ratio:
Kidney REABSORBS ~99% of the filtered load of CALCIUM principally at PROXIMAL
TUBULE (2/3 of calcium) and
the remainder at TAL and DCT
chapter 36 page 787

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a 6 year old female had
acute gastroenteritis with
severe dehydration and serum BUN was done. what is the expected result of serum BUN and physiologic mechanism?

a. increase urine flow —
increase water reabsorp9on
— increase urea
reabsorp9on — increase
serum UREA

b. decrease urine flow —
decrease water secre9on —
decrease urea reabsorp9on
— increase serum urea

c. decrease urine flow —
increase water reabsorp9on
— decrease urea secre9on
— increase serum urea

d. increase urine flow —
increase water reabsorp9on
— increase urea
reabsorp9on

c. decrease urine flow —
increase water reabsorption
— decrease urea secretion
— increase serum urea

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large organic molecules
such as proteins are not usually
found in
a. interstitial fluid
b. intracellular fluid
c. plasma

b. intracellular fluid

Ratio:
ECF are constantly mixing, so that the plasma and interstitial
fluids have about the same
composition except for proteins, which have a higher concentration in the plasma.
(ppt, 2020)

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which of the following is
correct:

a. MCD — countercurrent
multiplier, Loop of henle —
countercurrent exchanger,
loop-shaped vasa recta —
straight tube exchanger

B. loop of henle —
countercurrent multiplier;
loop-shaped vasa recta —
countercurrent exchanger,
MCD — straight tube
exchanger

B. loop of henle —
countercurrent multiplier;
loop-shaped vasa recta —
countercurrent exchanger,
MCD — straight tube
exchanger

Ratio:
Loop of henle acts as
COUNTERCURRENT
MULTIPLIER, loop-shaped vasa recta acts as COUNTERCURRENT EXCHANGER, the MCD acts as an unlooped or STRAIGHT-TUBE EXCHANGER.

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The following are TRUE of
the role of nephrons in acidbase
transport, except:

a. most nephron segments
secrete H+ to a varying
degree
b. nephron reclaims virtually
all the filtered bicarbonate
a. nephron generates new
HCO3 mostly in the
proximal tubule
b. nephrons 9trate secreted
NH3 which is responsible to
less than half of net acid
excre9on of new HCO3 in
healthy people

a. nephron generates new
HCO3 mostly in the
proximal tubule

Ratio:
NEPHRON RECLAIMS virtually all the FILTERED HCO3 in the PROXIMAL TUBULE (~80%), TAL (~10%), DISTAL NEPHRON
(~10%) NEPHRON REGENERATES NEW HCO3, mostly in the PROXIMAL TUBULE
chapter 39
page 825

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TRUE of sodium transport:

a. in transcellular pathway,
passive entry of Na in the
basolateral area thru
electrochemical gradient

a. in the trancellular pathway,
active extrusion of sodium
out of the cell across the
basolateral membrane

b. in paracellular pathway, the
net driving force is
NEGATIVE—favoring passive
Na reabsorp9on—only in
the S2 and S3 segment of
PT and in TAL

a. in the trancellular pathway,
active extrusion of sodium
out of the cell across the
basolateral membrane

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what is the most important
transporter of H+ from tubule cell to lumen (secretion)

a. ENaC
a. Na-H exchanger
b. H-K exchange pump
c. electrogenic H+ pump

a. Na-H exchanger

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Renal kallikrein is produced in which epithelial element of the nephron:

a. Connecting tubule CNT
a. initial collecting tubule ICT
b. cortical collecting tubule
CCT
c. proximal convoluted tubule PCT

a. Connecting tubule CNT

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which is an advantage of
colloids over crystalloids

a. cheaper
b. plasma volume expansion is
superior than crystalloids
c. no interference with
coagula9on
d. no risk for allergic reactions
e. all of the above

plasma volume expansion is
superior than crystalloids

Ratio:
A. disadvantage of colloids
B. TRUE
C. advantage of crystalloids
D. advantage of crystalloids

acute blood loss will lead to a cascade which includes?

a. release of prostaglandin
causing efferent arteriolar
dilation
b. release ANG II causing
afferent arteriolar
constriction
c. prevent GFR from falling by increasing filtration fraction
d. all of the choices
e. NOTA

c. prevent GFR from falling by increasing filtration fraction

Ratio:
RPF decreases so GFR falls, body compensates this by Increasing FF then if taas ang FF, sign sya nga naay problem

because urea comes from
protein breakdown, urea
delivery to the kidney, and
therefore the contribu9on of
urea to the medullary
hyperosmolality, is larger with protein-rich diets
a. true
b. false

a. true

Ratio:
Urea delivery to the kidney is larger with consumption of protein-rich diets (since urea comes from protein breakdown)

Which of the following
correctly describes the renal cortex:

a. granular inner region of the kidney
b. appears darker than the
renal medulla
a. granularity is due to the
presence of glomeruli tufts
of capillaries and tubules

a. granularity is due to the
presence of glomeruli tufts
of capillaries and tubules

Ratio:
Granularity of the cortex results from the presence of
GLOMERULI, microscopic TUFTS of CAPILLARIES.

a patch of specialized
tubule epithelial cells at the
transition between the TAL and distal tubule:

a. granular cells
b. juxtaglomerular cells
a. macula densa cells
b. epitheloid cells

macula densa cells

Ratio:
Macula densa = patch of
specialized tubule epithelial
cells that contacts its own
glomerulus. chapter 33 page
727

which of the following is a
ways or a factor of renin release by JGA:

a. decreased systemic blood
pressure
b. decreased NaCl concentration at macula densa
c. decreased renal perfusion
pressure
a. all of the choices
b. NOTA

a. all of the choices

Ratio:
decrease in ECV manifests itself to the JGA and thus stimulates renin release in THREE WAYS:
dec systemic bp, dec NaCl conc at macula densa, dec renal perfusion pressure

in the proximal tubule,
water reabsorption follows
______

a. follows sodium passively
and isosmotically
b. facilitated by high density
aquaporin 1 (AQP1) water
channels in the apical
membrane
c. facilitated by high density
aquaporin 1 (AQP1) water
channels in the basolateral
membrane
a. all of the above
b. nota

a. all of the above

Ratio:
- PARACELLULAR: passive, high water permeability
- TRANSCELLULAR: High
density of aquaporin 1
(AQP1) water channels in
apical and basolateral

the nerve reaching external
urethral sphincter is \_\_\_\_
a. pelvic nerve
a. pudendal nerve
b. hypogastric nerve
c. lumbar nerve

a. pudendal nerve

``` which of the following represents the greatest source of fluid loss from the body? a. urine a. sweat b. insensible fluid loss from the skin c. insensible fluid ```

a. urine

TRUE regarding handling of inulin by the kidney: ``` a. inulin clearance is dependent on urine flow b. inulin clearance is dependent on plasma inulin concentration c. rate of inulin excretion is inversely proportional to plasma inulin concentra9on a. diluting inulin in large amount of urine does not affect the total amount of inulin excreted b. all statements are FALSE ```

diluting inulin in large amount of urine does not affect the total amount of inulin excreted ``` Ratio 1. Rate of inulin excre9on is DIRECTLY PROPORTIONAL to the plasma inulin concentration. 2. Inulin clearance is INDEPENDENT of the plasma inulin concentration. 3. Inulin clearance is INDEPENDENT of urine flow. • Diluting this glomerular marker in a large amount of urine, or concentrating it in a small volume does not affect the total amount of inulin excreted. ```

splay in the glucose transport in the tubules occurs because of mismatch between ___ and ___ of glucose: a. secre9on; reabsorp9on b. filtra9on; secre9on c. filtra9on; reabsorp9on d. reabsorp9on; secre9on

c. filtra9on; reabsorp9on ``` Ratio: chap 36 page733 / figure 36-4 A a particular nephron’s filtered load of glucose may be mismatched to its capacity to reabsorb glucose ```

FALSE regarding glomerular filtration barrier: ``` a. larger molecules are increasingly restricted from passage a. cationic dextran is relatively restricted to pass through the barrier b. inulin freely passes through the barrier c. barrier has a net nega9ve charge ```

a. cationic dextran is relatively restricted to pass through the barrier Ratio: Anionic dextrans are restricted from filtration, whereas cationic dextrans pass more readily into the filtrate

How does TAL move NaCl from lumen out to interstitium: ``` a. it takes up Na and Cl through an apical NCC transporter b. lumen-negative transepithelial voltage drives Na from lumen to blood through the 9ght junctions a. it moves NaCl through combination of transcellular and paracellular pathways b. all of the choices c. NOTA ```

it moves NaCl through combination of transcellular and paracellular pathways Ratio: chapter 38 page 811 moves NaCl from lumen out to interstitium via TRANSCELLULAR and PARACELLULAR pathways

Examples of cases where K and Na excre9on are not inversely related include the following, except: ``` a. simultaneous elevation of both aldosterone and ANG II such as hypovolemia b. in “aldosterone escape” during chronic administration of mineralocorticoids or untreated primary hyperaldosteronism c. effect of glucocorticoids during “constant rate” perfusion of distal K secretory system d. in low- or high- flow Na loads that fails to increase K excre9on ```

d. in low- or high- flow Na loads that fails to increase K excre9on ``` Ratio: chapter 37 page 801 A and B = correct A. TRUE B. TRUE C. p801 [When one perfuses the distal K+- secretory system at a constant rate, glucocorPcoids have NO effect on K+ transport.] D. ??? ```

which of the following statement is true about countercurrent mutiplier: ``` a. it is about the repetitive reabsorption of NaCl by the TAL and continued inflow of new NaCl from the proximal tubule into the loop of henle b. the single effect is the result of active NaCl reabsorption in the tALH and passive reabsorption in TAL c. TAL can generate single effect as large as 500mOsm d. all of the choices e. NOTA ```

``` a. it is about the repetitive reabsorption of NaCl by the TAL and continued inflow of new NaCl from the proximal tubule into the loop of henle ```

how will the kidneys increase sodium ion excretion: a. kidneys will increase sodium ion excretion in response to an increase in extracellular fluid volume ``` a. kidneys will increase sodium ion excretion in response to an increase in extracellular sodium ion concentration ``` ``` b. kidneys will increase sodium ion excre9on in response to both an increase in extracellular fluid volume and increase in extracellular sodium ion concentration ``` c. kidneys excre9on of sodium ions is independent to both extracellular fluid volume and extracellular sodium ion concentration

a. kidneys will increase sodium ion excretion in response to an increase in extracellular fluid volume Ratio: kidneys increase Na+ excre9on in response to an increase in ECF volume, not to an increase in extracellular Na+ concentra9on chapter 40 page 837

Reasons for higher rate of filtration in the glomerulus: a. higher capillary permeability because it is a discontinuous capillary b. greater starling forces with higher glomerular capillary hydrostatic pressure c. both statements are CORRECT d. both statements are WRONG

b. greater starling forces with higher glomerular capillary hydrostatic pressure ``` Ratio: A. fenestrated ang glomerulus B. Hydrostatic pressure in the glomerulus is 2x higher than in the capillaries ```

in which nephron segment is not critically dependent in dietary K in the handling of K: a. PCT a. DCT b. CNT c. ICT d. MCD

a. PCT

why does in high plasma PAH there will low urinary excretion of PAH: ``` a. kidneys cant remove the PAH in the blood in a single pass through the kidney b. kidneys especially the glomerulus can filter the PAH from the blood in a single pass through the kidney c. tubules cant secrete the PAH d. NOTA ```

a. kidneys cant remove the PAH in the blood in a single pass through the kidney Ratio: ppt: Peritubular capillaries can no longer secrete PAH to the renal tubules. Some PAH goes to vasa recta and reabsorbed At high plasma PAH levels, the kidneys can no longer fully remove PAH from the blood in a single pass through the kidney, and therefore it is no longer appropriate to use PAH secretion to estimate renal plasma flow. (p781)

what is the main source of urinary ammonium, NH3, which is used as acceptors of luminal H+? a. from glomerular filtration b. via apical Na-H exchanger, NHE3 a. diffusion into the lumen from proximal tubule cell b. from generated HCO3

a. diffusion into the lumen from proximal tubule cell ``` Ratio: Urinary NH3 – derived from diffusion into the lumen from PT cell chapter 39 page 825 ```

mr. trump, 30 year old male, had depression due to loss of his girlfriend. He took 20 tablets of acetyl salicylic acid. He was seen by his roommate 6 hours after the intake with lethargy and episodes of seizures. what can be done in manipula9ng the urine pH of MR. suave? a. make the urine more basic b. acidify the urine c. increase urine flow d. decrease urine flow

a. make the urine more basic

the principal cells is mainly responsible for K secre9on because of the following key elements, except: ``` a. favorable electrochemical driving force for K exit across the apical membrane b. relatively high apical K permeability due to ROMK channel c. active K uptake due to Na-K pump at the basolateral membrane a. active K movement from cell to lumen via apical KCC b. nota ```

a. active K movement from cell to lumen via apical KCC ``` Ratio: Three key elements of PRINCIPAL CELLS: 1. Na-K pump for ac9ve K uptake at basolateral membrane 2. Rela9vely high apical K permeability due to the ROMK channel 3. Favorable electrochemical driving force for K exit across apical membrane chapter 37 page 799 ```

which among the following conditions will lead to hypokalemia: a. alkalosis b. thiazide diuretics c. hypomagnesemia d. all of the choices

d. all of the choices

which among the following conditions will lead to hypokalemia: a. alkalosis b. thiazide diuretics c. hypomagnesemia d. all of the choices

d. all of the choices

the following nephron segments will increase its osmo9c water permeability in the presence of ADH except: a. CNT b. ICT c. CCT d. OMCD e. IMCD

a. CNT Ratio: AVP dramatically increases the water permeabilities of the collecting tubules (ICT and CCT) and ducts (OMCD and IMCD) by causing AQP2 water channels to insert into the apical membrane

Which part of the Kidney is sensitive to decreased Na and Cl level in the blood: ``` a. juxtaglomerular cells in afferent arteriole b. juxtaglomerular cells in the efferent arteriole a. macula densa in the proximal convoluted tubule b. macula densa in the distal convoluted tubule ```

macula densa in the | proximal convoluted tubule