TERM EXAM - MIDTERM Flashcards
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)
- 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
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.
- 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
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
- 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
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
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
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
- 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
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)
- 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.
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
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
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
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
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
