Renal Physiology Mcq 1t632n
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RENAL PHYSIOLOGY MCQ You have 33 questions in this exam.
1. Concerning renal ontogeny: A. the pronephros is a transitory kidney present during the embryonic life of all vertebrates B. the mesonephros is a functional yet transitory kidney during intrauterine life of mammals C. a main morphological difference between the metanephros (permanent kidney) and the mesonephros, is the development of the loop of Henle D. A and C are correct E. all are correct
A. inulin is a good GFR marker because it is freely filtered in the glomeruli and it is not reabsorbed, or secreted, by the renal tubules B. inulin concentration in the proximal tubule's lumen increases progressively as water is reabsorbed in the segment of the nephron C. PAH (para-amino-hippuric acid)is a good marker of renal plasma flow because it is freely filtered and is rapidly secreted by the proximal tubule; as a result very little PAH reaches the renal vein D. A and C are correct E. all are correct
Show answer Correct Answer: E
Show answer Correct Answer: E
2. The main barrier precluding the free age of albumin across the glomerular capillary walls is formed by: A. the fenestrated glomerular endothelium B. anionic proteoglycan clusters within the glomerular basement membrane C. the filtration slits in between visceral epithelial cells (podocytes) D. none are correct E. all are correct
4. Concerning the functional histology of the kidney: A. the superficial nephrons have short loops of Henle; thus, they have a low capacity to reabsorb salt (salt losing nephrons) B. the deep nephrons have long loops of Henle; thus they have a high capacity to reabsorb salt and water C. in dehydration, the blood flow to deep nephrons tends to increase D. A and C are correct E. all are correct
Show answer Correct Answer: E
Show answer Correct Answer: B
3. Concerning the measurement of renal plasma flow (RPF) and glomerular filtration rate(GFR):
5. The following factor(s) tend(s) to INCREASE the rate of glomerular filtration (GFR): A. decreased albumin concentration in plasma B. vasodilation of the afferent (pre-glomerular) arteriole
C. vasoconstriction of the efferent (post-glomerular) arteriole D. A and C are correct E. all are correct
Correct Answer: D
Show answer Correct Answer: E
6. The following factor(s) tend(s) to INCREASE the rate of glomerular filtration (GFR): A. sympathetic stimulation (norepinephrine) of the afferent arteriole B. obstruction of the renal tubules, ureter or urethra C. vasodilation of the efferent arteriole D. none are correct E. all are correct
8. Concerning the function of the proximal tubule: A. most of the glomerular ultrafiltrate is reabsorbed in the proximal tubule in an iso-osmotic fashion. B. the concentration of PAH doesn't change much along the length of the proximal tubule C. under normal conditions, most of the filtered glucose and bicarbonate are reabsorbed in the proximal tubule D. A and C are correct E. all are correct
Show answer Correct Answer: D
Show answer Correct Answer: D
7. Concerning the function of the glomerular mesangial cells: A. mesangial cells can contract and cause some decrease in total glomerular filtration area B. mesangial cells play a major role in systemic angiotensin II production C. mesangial cells are phagocytic and play a role in the clearing of proteins and immune-deposits entrapped in the mesangium D. A and C are correct E. all are correct
Show answer
9. Concerning metabolic energy (at production) for renal transport: A. the main substrate for proximal tubule is glucose B. the cortical PO2 is about 10 mmHg C. the papillary tissues normally generate ATP via oxidative metabolism D. A and C are correct E. all are correct
Show answer Correct Answer: B
10. Concerning water reabsorption by the proximal
tubule: A. main driving forces for water reabsorption in the proximal tubule are solute uptake and oncotic pressure in peritubular capillaries B. a significant amount of water uptake in the proximal tubule is dependent on sodium uptake by the Na/H antiports present in their luminal membrane C. aquaporine-I (water channels) are abundantly present in the cellular membranes of proximal tubule cells D. A and C are correct E. all are correct
generally hypotonic with respect to plasma C. in the absence of ADH, urine is not concentrated along the length of the collecting duct D. A and C are correct E. all are correct
Show answer Correct Answer: E
Show answer Correct Answer: E
11. Concerning the THICK loop of Henle: A. the thick segment of the loop has a very powerful Na/K/2Cl pump that moves salt from the tubular lumen into the peritubular space B. water and urea move freely across the epithelium of the thick ascending segment of the loop C. following the istration of furosemide (lasix) large volumes of diluted urine are produced D. A and C are correct E. all are correct
13. Concerning the transport of urea in the different segments of the nephron: A. main tubular urea sound is the plasma via the glomerular ultrafiltrate B. the urea concentration in the lumen of the cortical collecting ducts increases as water is reabsorbed C. the thin loop of Henle and the medullary collecting duct are permeable to urea D. A and C are correct E. all are correct
Show answer Correct Answer: E
Show answer Correct Answer: D
12. Concerning urinary concentration: A. the thick loop of Henle generates most of the osmotic gradient needed for reabsorption of water in the collecting duct B. the tubular urine that reaches the collecting duct is
14. Concerning the macula densa: A. the macula densa senses the total amount of sodium chloride (sodium chloride concentration times volume) of tubular urine being delivered by the loop of Henle into the distal convoluted tubule B. if the delivery of sodium chloride is lower than normal the macula densa signals the afferent arteriole (pre-glomerular) to release renin C. renin release causes intravascular angiotensin formation and indirectly aldosterone release D. A and C are correct E. all are correct
Show answer Correct Answer: E
15. Concerning angiotensin II: A. the exocrine renin-angiotensin-aldosterone system includes angiotensinogen production by the liver, renin secretion by the juxtaglomerular apparatus and angiotensin-converting enzyme present at the luminal surface of endothelial cells B. aldosterone, but not AII, stimulate thirst and salt appetite C. angiotensin II induces marked increases in sodium reabsorption by the loop of Henle and the collecting duct D. A and C are correct E. all are correct
17. Within eight hours following large intravenous aldosterone infusion the following is(are)clinically evident: A. unchanged sodium reabsorption by the collecting duct B. decreased potassium and hydrogen excretion in urine C. hypernatremia (high sodium in plasma), hypokalemia (low potassium in plasma) and alkalosis (low hydrogen ion activity in plasma) D. A and C are correct E. all are correct
Show answer Correct Answer: C
Show answer Correct Answer: A
16. Within an hour following intravenous angiotensin II infusion, the following is(are) clinically evident: A. increased sodium uptake in the proximal tubular epithelium B. systemic vasoconstriction C. increased plasma aldosterone D. A and C are correct E. all are correct
18. Concerning arterial blood pressure regulation: A. prostaglandins and dopamine and bradykinin are vasodilators B. ADH, angiotensin II and epinephrine are vasoconstrictors C. the vasodilator/vasoconstrictor ratio that regulates total peripheral resistance plus cardiac stroke volume and heart rate are determinants of blood pressure D. all are correct E. none are correct
Show answer Correct Answer: E
Show answer Correct Answer: E
Show answer 19. Concerning cell volume regulation: A. the Na/H and Cl/HCO3 antiports are involved in hypertonic cell volume regulation B. rapid efflux of cytoplasmic water is followed by volume regulatory KCL efflux C. KCL efflux is involved in hypotonic cell volume regulation D. A and C are correct E. all are correct
Show answer
Correct Answer: C
22. Atrial natriuretic peptide A. Increased H2O reabsorption B. Decreased sodium reabsorption C. AII formation D. Increased sodium reabsorption E. Decreased phosphate reabsorption
Correct Answer: D
Show answer Correct Answer: B 20. Intravenous istration of 1.5 liters of isotonic Ringer's solution to a healthy adult could cause: A. increased cardiac output and renal blood flow B. increased GFR C. increased atrial natriuretic peptide and decreased renin in plasma D. A and C are correct E. all are correct
23. ADH A. Increased H2O reabsorption B. Decreased sodium reabsorption C. AII formation D. Increased sodium reabsorption E. Decreased phosphate reabsorption
Show answer Correct Answer: E Show answer Correct Answer: A
21. Renin A. Increased H2O reabsorption B. Decreased sodium reabsorption C. AII formation D. Increased sodium reabsorption E. Decreased phosphate reabsorption
24. AII A. Increased H2O reabsorption B. Decreased sodium reabsorption C. AII formation D. Increased sodium reabsorption E. Decreased phosphate reabsorption
Show answer Correct Answer: D
25. PTH A. Increased H2O reabsorption B. Decreased sodium reabsorption C. AII formation D. Increased sodium reabsorption E. Decreased phosphate reabsorption
27. All of the following occur within one hour of eating a large acid load EXCEPT: A. the acid load is immediately buffered by intracellular proteins and phosphates as well as extracellular bicarbonate B. the lungs will begin eliminating CO2 generated as a result of the acid load C. the kidney will eliminate all the nonvolatile acids and regenerate bicarbonate to replace all the bicarbonate used in buffering D. hemoglobin will buffer some of the protons
Show answer Correct Answer: C
Show answer Correct Answer: E
26. Which one of the following is correct about nonvolatile acids. A. they are not essential to eliminate from the body B. we generate much greater amounts of nonvolatile than volatile acids C. they are fully buffered by bone D. they are products of intermediary metabolism and protein degradation E. they are eliminated by the lungs
Show answer Correct Answer: D
28. If the pH is 7.60 (H+ concentration = 25 nEq/L) and the pCO2 is 40 mmHg, what is the HCO3concentration (in mEq/liter). A. 10 B. 20 C. 30 D. 40
Show answer Correct Answer: D
29. A patient takes a drug overdose and becomes comatose. His blood pCO2 was 40 mmHg ten minutes ago, but you discover it is now 80 mmHg. Which one of the following statements about this patient is correct. A. the pH of his CSF is likely to fall more slowly than the pH of his blood B. the pH of his blood is likely to fall more slowly than the pH of his CSF C. the pH of the blood and CSF will not change because
he will rapidly eliminate bicarbonate in the urine in response to the rise in pCO2 D. the pH of the blood and CSF will change to a similar degree in this time period
Correct Answer: A
Show answer Correct Answer: B
32. Renal ammonium ion excretion is increased by aldosterone, elevated blood pCO2 and acidemia A. true B. false
Show answer 30. Which one of the following statements is true about the proximal tubule. A. the Na+/K+ ATPase drives sodium into the cell from the urine side of the tubule B. Na+/H+ exchange is largely the mechanism by which hydrogen ion secretion occurs C. bicarbonate reabsorption is independent of carbonic anhydrase activity D. the pH in the lumen of the proximal tubule can reach as low as about 5.0
Show answer Correct Answer: B
31. A patient ingests antifreeze and needs to eliminate the ingested acid. Renal elimination of the protons in this excess acid is primarily accomplished by which of the following mechanisms. A. increased urinary ammonium excretion B. increased urinary excretion of phosphates C. hyperventilation D. increased urinary free hydrogen ion concentration E. increased urinary sulfate excretion
Show answer
Correct Answer: A
33. Which one of the following statements is correct with regard to net collecting duct hydrogen ion secretion. A. it is decreased by increased renal production of ammonia B. it is increased by increased reabsorption of sodium through the apical sodium channel C. it is not affected by the presence or absence of titratable acids D. aldosterone does not modify collecting duct hydrogen ion secretion
Show answer Correct Answer: B
Questions Major Exam #5 -- Renal Physiology (24 Questions) 1. For those substances that are actively reabsorbed, the maximal amount that can be transported per unit time by the kidney tubules: A. depends on the maximum rate at which the transport mechanism itself operates
B. is directly related to the plasma concentration of the substance C. is termed the tubular transport maximum D. is dependent upon tubular load E. A and C are correct. 2. If the clearance of Substance X is greater than the clearance of inulin, it is most likely that Substance X is: A. bound to tubular proteins B. bound to plasma proteins C. secreted D. reabsorbed E. neither secreted nor reabsorbed 3. Co-transport of glucose: A. is equivalent to a uniport for glucose B. will not be affected if the Na+/K+ pump is blocked C. cannot move glucose against its concentration gradient D. is equivalent to an antiproton E. depends on the interaction of Na+ with the glucose carrier 4. The plasma concentration at which a particular substance begins to appear in the urine is the: A. transport maximum (Tm) B. fractional excretion C. filtered load D. renal threshold E. titration point 5. The volume of plasma needed each minute to supply a substance at the rate at which it is excreted in the urine is known as the: A. diffusion constant of the substance B. clearance of the substance C. extraction ratio of the substance D. tubular mass of the substance E. filtration rate of the substance 6. Renin is produced and secreted from granules located in the: A. macula densa B. mesangial cells C. intercalated cells D. afferent arteriole E. interstitial cells
7. About 4 to 6 days after you place a normal person on a low-sodium diet, which of the following will be observed? A. plasma renin and aldosterone are below normal B. plasma renin and aldosterone are above normal C. plasma sodium concentration is below normal D. plasma sodium concentration is normal E. B and D are correct. 8. A 100 kg man has a plasma osmolarity of 300 mOsM (milliosmolar). After he drinks 2 liters of water (and before any fluid losses) his steady-state plasma osmolarity would be approximately: A. 270 mOsM B. 280 mOsM C. 290 mOsM D. 300 mOsM E. 321 mOsM 9. The normal human glomerular filtration rate (GFR) is approximately (in mL/min): A. 25 B. 50 C. 125 D. 300 E. 500 10. Which of the following statements is/are correct? A. Filtration fraction equals glomerular filtration rate divided by renal plasma flow. B. Tubular maximum secretion has a finite upper limit, though it exhibits a phenomenon analogous to the threshold phenomenon for reabsorption. C. Clearance ratio equals renal clearance of one substance divided by the clearance of another substance. D. Effective renal plasma flow is the volume of plasma flow supplied to juxtamedullary nephrons. E. A, B, and C are correct. 11. The renal "countercurrent" mechanism is dependent upon the anatomic relationship between: A. the distal tubule and the macula denza B. the loop of Henle and the macula denza C. the loop of Henle and the vasa recta
D. the glomerulus and the afferent and efferent arterioles E. the glomerulus and the proximal tubule 12. If renal perfusion pressure does not change, which of the following changes in afferent and efferent arteriolar resistance would result in an increase in renal blood flow but no change in filtration fraction?
A B C D E
A. isotonic B. hypotonic or isotonic, but never hypertonic C. hypotonic D. hypertonic E. hypertonic or isotonic, but never hypotonic 16. Which of the following might you expect to find associated with chronic renal failure? A. elevated packed cell volume (hematocrit) B. abnormally low plasma creatinine concentration Afferent arteriolar Efferent arteriolar resistance C. decreased bone density resistance D. lower than normal PTH (parathyroid hormone) unchanged decreased concentration decreased unchanged E. None of the above is correct. 17. The vasa recta: increased unchanged A. are the straight portions of the proximal decreased decreased tubules, found just proximal to the loops of Henle increased increased B. extend from the efferent arterioles of the 13. An increase in the osmolality of the superficial cortical nephrons extracellular fluid will: C. are the microvilli found on the cells of the A. stimulate the volume and osmoreceptors, and macula densa stimulate ADH secretion D. comprise the capillary network found in the B. stimulate the volume and osmoreceptors, and medulla of the kidney inhibit ADH secretion E. are the small straight segments of afferent C. inhibit the volume and osmoreceptors, and arterioles found directly next to the macula densa stimulate ADH secretion 18. The loops of Henle of the outer cortical D. inhibit the volume and osmoreceptors, and nephrons: inhibit ADH secretion A. are functionally unimportant in the renal E. cause no change in ADH secretion conservation of sodium and water 14. Polyuria (diuresis) occurs in a diabetic patient B. do not contribute to the medullary osmotic who has a GFR = 120 mL/min and a blood sugar = gradient 350 mg/dL. This is indicative of: C. do not participate in the urinary diluting A. losses of water and sodium which could be mechanism prevented by istration of antidiuretic D. do not play any important role in overall renal hormone (ADH) and an aldosterone-like function and are simply unimportant vestiges of mineralocorticoid evolutionary development B. diuresis due to reduced active transport of E. A and C are correct. sodium out of the tubule because of diminished 19. Ammonia produced by the kidneys comes + + activity of the Na /K ATPase mainly from: C. a cellular and extracellular over-hydration due A. glutamine to water retention, caused by the glucose B. glycine D. an osmotic diuresis due to glucosuria, in which C. leucine water loss will exceed "salt" loss D. alanine E. B and D are correct. E. B and D are correct. 15. The tonicity of the urine as it enters the renal 20. Glomerular filtration produces an ultrafiltrate collecting duct is: of plasma:
A. in which the concentration of electrolytes is equal to plasma B. in which the concentration of protein is equal to plasma C. containing only those substances which must be eliminated in the urine D. A and B are correct. E. B and C are correct. 21. Which of the following is NOT a function of the kidneys? A. regulation of extracellular volume B. regulation of plasma glucose concentration C. regulation of arterial blood pressure D. excretion of the end products of protein metabolism E. excretion of foreign chemicals (e.g. pharmaceuticals, food additives, etc.) 22. Which of the following does NOT contribute to titratable acid when found in the urine? A. H2PO4B. lactic acid C. beta-hydroxybutyric acid D. acetoacetic acid E. NH4+ 23. Which of the following is NOT a function of the kidneys? A. regulation of extracellular osmolality B. regulation of acid-base balance C. excretion of end-products of muscle metabolism D. activation of antidiuretic hormone E. activation of vitamin D 24. Which of the following does NOT contribute to the formation of maximally concentrated urine? A. active NaCl transport in the proximal convoluted tubule B. active NaCl transport in the thick ascending limb of the loop of Henle C. impermeability of the thick ascending limb of the loop of Henle to water D. high water permeability of the collecting duct due to presence of ADH E. presence of urea in the inner medullary interstitium Answer Key
1-E 2-C 3-E 4-D 5-B 6-D 7-E 9-C
8-C 10 - E
11 - C 12 - B 13 - A 14 - D 15 - B 16 - C 17 - D 18 - B 19 - A 20 - A 21 - B 22 - E 23 - D 24 - A 1. The term "renal autoregulation" refers in part to the fact that A. the kidney does not require blood flow to sustain its active transport B. the kidney contains baroreceptors (pressure receptors) that contribute to the regulation of cardiac output C. renal blood flow is relatively constant over a wide range of systemic arterial pressures D. renal blood flow is not affected by activation of the sympathetic nerves that innervate the kidney E. a combination of both C and D above 2. The nerves that innervate the kidney are essential for regulating which of the following? A. Na-K-ATPase active transport pump rate B. renal autoregulation of blood flow C. urine volume and tonicity (osmolality)
D. all of the above E. none of the above 3. Which of the following would be expected to cause renal inulin (or creatinine) clearance to increase? A. dilation of the afferent arteriole B. dilation of the efferent arteriole C. constriction of the afferent arteriole D. constriction of the efferent arteriole E. both A and D above 4. Kidney inflammation may result in the appearance of albumin (a plasma protein) in the urine because A. more albumin enters the proximal tubule in the glomerular filtrate B. reabsorption of albumin from the proximal tubule is inhibited C. secretion of albumin into the distal tubule and collecting ducts is increased D. increased peritubular blood flow makes more albumin available for diffusion into the tubule E. reduced active transport of sodium ion reduces cotransport of other substances, including albumin 5. As blood es along the glomerular capillaries from the afferent to efferent arteriole, the net filtration pressure (DP - Dp) A. increases B. decreases C. first decreases, reaches a minimum about half way along the capillary, then increases D. first increases, reaches a maximum about half way along the capillary, then decreases E. remains constant 6. Sodium is actively reabsorbed from the renal tubule in which of the following nephron segments? A. proximal tubule B. distal tubule C. thick ascending limb of the loop of Henle D. all of the above E. none of the above 7. The rate of water reabsorption from the proximal tubule is determined primarily by the A. rate of dissolved particle (solute) reabsorption from the proximal tubule
B. concentration of ADH (antidiuretic hormone) in the blood C. osmotic pressure developed by plasma proteins in the proximal tubule D. active transport of water molecules by the proximal tubule cells E. ive filtration due to the high hydrostatic pressure in the proximal tubule 8. Urea has a higher concentration in the fluid that leaves the proximal tubule (and enters the loop of Henle) than in blood plasma because A. urea is synthesized by proximal tubule cells B. urea is secreted into the proximal tubule C. urea is reabsorbed from the proximal tubule but at a lesser rate that water is reabsorbed D. urea diffuses back into the proximal tubule because of the high urea concentration in the renal medulla E. urea is actively transported into Bowman's capsule from the glomerular capillaries 9. In the proximal tubule, penicillin is A. actively secreted into the tubule B. actively reabsorbed from the tubule C. ively reabsorbed from the tubule D. metabolized by the tubule cells E. neither secreted nor reabsorbed nor metabolized 10. At which sites would the concentration of creatinine be expected to be highest? (Note: assume the person is normally hydrated.) A. glomerular filtrate B. end of the proximal tubule C. end of the loop of Henle D. urine E. the concentration would be the same in all of the above, since creatinine is neither secreted or reabsorbed 11. Suppose a person loses the function of half his nephrons because of renal degenerative disease. Assuming the person survives and reaches a new steady state and that body urea production remains normal, which of the following would be expected to decrease below normal? A. plasma urea concentration B. renal urea excretion C. renal urea clearance
D. urine urea concentration E. all of the above 12. The following values are measured for potassium ion in a human subject. Plasma K+ 5 meq/liter Urine K+ 50 meq/liter Renal creatinine clearance 80 ml/min Urine formation rate 1.5 ml/minute This patient's potassium clearance is closest to which of the following? A. 5 ml/minute B. 7.5 ml/minute C. 15 ml/minute D. 50 ml/minute E. 75 ml/minute 13. Assuming the subject in the preceding question is a normal adult, we can conclude that most likely potassium is A. filtered but not secreted or reabsorbed B. secreted but not filtered or reabsorbed C. reabsorbed but not secreted or filtered D. filtered and secreted E. filtered and reabsorbed
1. Concerning renal ontogeny: A. the pronephros is a transitory kidney present during the embryonic life of all vertebrates B. the mesonephros is a functional yet transitory kidney during intrauterine life of mammals C. a main morphological difference between the metanephros (permanent kidney) and the mesonephros, is the development of the loop of Henle D. A and C are correct E. all are correct
A. inulin is a good GFR marker because it is freely filtered in the glomeruli and it is not reabsorbed, or secreted, by the renal tubules B. inulin concentration in the proximal tubule's lumen increases progressively as water is reabsorbed in the segment of the nephron C. PAH (para-amino-hippuric acid)is a good marker of renal plasma flow because it is freely filtered and is rapidly secreted by the proximal tubule; as a result very little PAH reaches the renal vein D. A and C are correct E. all are correct
Show answer Correct Answer: E
Show answer Correct Answer: E
2. The main barrier precluding the free age of albumin across the glomerular capillary walls is formed by: A. the fenestrated glomerular endothelium B. anionic proteoglycan clusters within the glomerular basement membrane C. the filtration slits in between visceral epithelial cells (podocytes) D. none are correct E. all are correct
4. Concerning the functional histology of the kidney: A. the superficial nephrons have short loops of Henle; thus, they have a low capacity to reabsorb salt (salt losing nephrons) B. the deep nephrons have long loops of Henle; thus they have a high capacity to reabsorb salt and water C. in dehydration, the blood flow to deep nephrons tends to increase D. A and C are correct E. all are correct
Show answer Correct Answer: E
Show answer Correct Answer: B
3. Concerning the measurement of renal plasma flow (RPF) and glomerular filtration rate(GFR):
5. The following factor(s) tend(s) to INCREASE the rate of glomerular filtration (GFR): A. decreased albumin concentration in plasma B. vasodilation of the afferent (pre-glomerular) arteriole
C. vasoconstriction of the efferent (post-glomerular) arteriole D. A and C are correct E. all are correct
Correct Answer: D
Show answer Correct Answer: E
6. The following factor(s) tend(s) to INCREASE the rate of glomerular filtration (GFR): A. sympathetic stimulation (norepinephrine) of the afferent arteriole B. obstruction of the renal tubules, ureter or urethra C. vasodilation of the efferent arteriole D. none are correct E. all are correct
8. Concerning the function of the proximal tubule: A. most of the glomerular ultrafiltrate is reabsorbed in the proximal tubule in an iso-osmotic fashion. B. the concentration of PAH doesn't change much along the length of the proximal tubule C. under normal conditions, most of the filtered glucose and bicarbonate are reabsorbed in the proximal tubule D. A and C are correct E. all are correct
Show answer Correct Answer: D
Show answer Correct Answer: D
7. Concerning the function of the glomerular mesangial cells: A. mesangial cells can contract and cause some decrease in total glomerular filtration area B. mesangial cells play a major role in systemic angiotensin II production C. mesangial cells are phagocytic and play a role in the clearing of proteins and immune-deposits entrapped in the mesangium D. A and C are correct E. all are correct
Show answer
9. Concerning metabolic energy (at production) for renal transport: A. the main substrate for proximal tubule is glucose B. the cortical PO2 is about 10 mmHg C. the papillary tissues normally generate ATP via oxidative metabolism D. A and C are correct E. all are correct
Show answer Correct Answer: B
10. Concerning water reabsorption by the proximal
tubule: A. main driving forces for water reabsorption in the proximal tubule are solute uptake and oncotic pressure in peritubular capillaries B. a significant amount of water uptake in the proximal tubule is dependent on sodium uptake by the Na/H antiports present in their luminal membrane C. aquaporine-I (water channels) are abundantly present in the cellular membranes of proximal tubule cells D. A and C are correct E. all are correct
generally hypotonic with respect to plasma C. in the absence of ADH, urine is not concentrated along the length of the collecting duct D. A and C are correct E. all are correct
Show answer Correct Answer: E
Show answer Correct Answer: E
11. Concerning the THICK loop of Henle: A. the thick segment of the loop has a very powerful Na/K/2Cl pump that moves salt from the tubular lumen into the peritubular space B. water and urea move freely across the epithelium of the thick ascending segment of the loop C. following the istration of furosemide (lasix) large volumes of diluted urine are produced D. A and C are correct E. all are correct
13. Concerning the transport of urea in the different segments of the nephron: A. main tubular urea sound is the plasma via the glomerular ultrafiltrate B. the urea concentration in the lumen of the cortical collecting ducts increases as water is reabsorbed C. the thin loop of Henle and the medullary collecting duct are permeable to urea D. A and C are correct E. all are correct
Show answer Correct Answer: E
Show answer Correct Answer: D
12. Concerning urinary concentration: A. the thick loop of Henle generates most of the osmotic gradient needed for reabsorption of water in the collecting duct B. the tubular urine that reaches the collecting duct is
14. Concerning the macula densa: A. the macula densa senses the total amount of sodium chloride (sodium chloride concentration times volume) of tubular urine being delivered by the loop of Henle into the distal convoluted tubule B. if the delivery of sodium chloride is lower than normal the macula densa signals the afferent arteriole (pre-glomerular) to release renin C. renin release causes intravascular angiotensin formation and indirectly aldosterone release D. A and C are correct E. all are correct
Show answer Correct Answer: E
15. Concerning angiotensin II: A. the exocrine renin-angiotensin-aldosterone system includes angiotensinogen production by the liver, renin secretion by the juxtaglomerular apparatus and angiotensin-converting enzyme present at the luminal surface of endothelial cells B. aldosterone, but not AII, stimulate thirst and salt appetite C. angiotensin II induces marked increases in sodium reabsorption by the loop of Henle and the collecting duct D. A and C are correct E. all are correct
17. Within eight hours following large intravenous aldosterone infusion the following is(are)clinically evident: A. unchanged sodium reabsorption by the collecting duct B. decreased potassium and hydrogen excretion in urine C. hypernatremia (high sodium in plasma), hypokalemia (low potassium in plasma) and alkalosis (low hydrogen ion activity in plasma) D. A and C are correct E. all are correct
Show answer Correct Answer: C
Show answer Correct Answer: A
16. Within an hour following intravenous angiotensin II infusion, the following is(are) clinically evident: A. increased sodium uptake in the proximal tubular epithelium B. systemic vasoconstriction C. increased plasma aldosterone D. A and C are correct E. all are correct
18. Concerning arterial blood pressure regulation: A. prostaglandins and dopamine and bradykinin are vasodilators B. ADH, angiotensin II and epinephrine are vasoconstrictors C. the vasodilator/vasoconstrictor ratio that regulates total peripheral resistance plus cardiac stroke volume and heart rate are determinants of blood pressure D. all are correct E. none are correct
Show answer Correct Answer: E
Show answer Correct Answer: E
Show answer 19. Concerning cell volume regulation: A. the Na/H and Cl/HCO3 antiports are involved in hypertonic cell volume regulation B. rapid efflux of cytoplasmic water is followed by volume regulatory KCL efflux C. KCL efflux is involved in hypotonic cell volume regulation D. A and C are correct E. all are correct
Show answer
Correct Answer: C
22. Atrial natriuretic peptide A. Increased H2O reabsorption B. Decreased sodium reabsorption C. AII formation D. Increased sodium reabsorption E. Decreased phosphate reabsorption
Correct Answer: D
Show answer Correct Answer: B 20. Intravenous istration of 1.5 liters of isotonic Ringer's solution to a healthy adult could cause: A. increased cardiac output and renal blood flow B. increased GFR C. increased atrial natriuretic peptide and decreased renin in plasma D. A and C are correct E. all are correct
23. ADH A. Increased H2O reabsorption B. Decreased sodium reabsorption C. AII formation D. Increased sodium reabsorption E. Decreased phosphate reabsorption
Show answer Correct Answer: E Show answer Correct Answer: A
21. Renin A. Increased H2O reabsorption B. Decreased sodium reabsorption C. AII formation D. Increased sodium reabsorption E. Decreased phosphate reabsorption
24. AII A. Increased H2O reabsorption B. Decreased sodium reabsorption C. AII formation D. Increased sodium reabsorption E. Decreased phosphate reabsorption
Show answer Correct Answer: D
25. PTH A. Increased H2O reabsorption B. Decreased sodium reabsorption C. AII formation D. Increased sodium reabsorption E. Decreased phosphate reabsorption
27. All of the following occur within one hour of eating a large acid load EXCEPT: A. the acid load is immediately buffered by intracellular proteins and phosphates as well as extracellular bicarbonate B. the lungs will begin eliminating CO2 generated as a result of the acid load C. the kidney will eliminate all the nonvolatile acids and regenerate bicarbonate to replace all the bicarbonate used in buffering D. hemoglobin will buffer some of the protons
Show answer Correct Answer: C
Show answer Correct Answer: E
26. Which one of the following is correct about nonvolatile acids. A. they are not essential to eliminate from the body B. we generate much greater amounts of nonvolatile than volatile acids C. they are fully buffered by bone D. they are products of intermediary metabolism and protein degradation E. they are eliminated by the lungs
Show answer Correct Answer: D
28. If the pH is 7.60 (H+ concentration = 25 nEq/L) and the pCO2 is 40 mmHg, what is the HCO3concentration (in mEq/liter). A. 10 B. 20 C. 30 D. 40
Show answer Correct Answer: D
29. A patient takes a drug overdose and becomes comatose. His blood pCO2 was 40 mmHg ten minutes ago, but you discover it is now 80 mmHg. Which one of the following statements about this patient is correct. A. the pH of his CSF is likely to fall more slowly than the pH of his blood B. the pH of his blood is likely to fall more slowly than the pH of his CSF C. the pH of the blood and CSF will not change because
he will rapidly eliminate bicarbonate in the urine in response to the rise in pCO2 D. the pH of the blood and CSF will change to a similar degree in this time period
Correct Answer: A
Show answer Correct Answer: B
32. Renal ammonium ion excretion is increased by aldosterone, elevated blood pCO2 and acidemia A. true B. false
Show answer 30. Which one of the following statements is true about the proximal tubule. A. the Na+/K+ ATPase drives sodium into the cell from the urine side of the tubule B. Na+/H+ exchange is largely the mechanism by which hydrogen ion secretion occurs C. bicarbonate reabsorption is independent of carbonic anhydrase activity D. the pH in the lumen of the proximal tubule can reach as low as about 5.0
Show answer Correct Answer: B
31. A patient ingests antifreeze and needs to eliminate the ingested acid. Renal elimination of the protons in this excess acid is primarily accomplished by which of the following mechanisms. A. increased urinary ammonium excretion B. increased urinary excretion of phosphates C. hyperventilation D. increased urinary free hydrogen ion concentration E. increased urinary sulfate excretion
Show answer
Correct Answer: A
33. Which one of the following statements is correct with regard to net collecting duct hydrogen ion secretion. A. it is decreased by increased renal production of ammonia B. it is increased by increased reabsorption of sodium through the apical sodium channel C. it is not affected by the presence or absence of titratable acids D. aldosterone does not modify collecting duct hydrogen ion secretion
Show answer Correct Answer: B
Questions Major Exam #5 -- Renal Physiology (24 Questions) 1. For those substances that are actively reabsorbed, the maximal amount that can be transported per unit time by the kidney tubules: A. depends on the maximum rate at which the transport mechanism itself operates
B. is directly related to the plasma concentration of the substance C. is termed the tubular transport maximum D. is dependent upon tubular load E. A and C are correct. 2. If the clearance of Substance X is greater than the clearance of inulin, it is most likely that Substance X is: A. bound to tubular proteins B. bound to plasma proteins C. secreted D. reabsorbed E. neither secreted nor reabsorbed 3. Co-transport of glucose: A. is equivalent to a uniport for glucose B. will not be affected if the Na+/K+ pump is blocked C. cannot move glucose against its concentration gradient D. is equivalent to an antiproton E. depends on the interaction of Na+ with the glucose carrier 4. The plasma concentration at which a particular substance begins to appear in the urine is the: A. transport maximum (Tm) B. fractional excretion C. filtered load D. renal threshold E. titration point 5. The volume of plasma needed each minute to supply a substance at the rate at which it is excreted in the urine is known as the: A. diffusion constant of the substance B. clearance of the substance C. extraction ratio of the substance D. tubular mass of the substance E. filtration rate of the substance 6. Renin is produced and secreted from granules located in the: A. macula densa B. mesangial cells C. intercalated cells D. afferent arteriole E. interstitial cells
7. About 4 to 6 days after you place a normal person on a low-sodium diet, which of the following will be observed? A. plasma renin and aldosterone are below normal B. plasma renin and aldosterone are above normal C. plasma sodium concentration is below normal D. plasma sodium concentration is normal E. B and D are correct. 8. A 100 kg man has a plasma osmolarity of 300 mOsM (milliosmolar). After he drinks 2 liters of water (and before any fluid losses) his steady-state plasma osmolarity would be approximately: A. 270 mOsM B. 280 mOsM C. 290 mOsM D. 300 mOsM E. 321 mOsM 9. The normal human glomerular filtration rate (GFR) is approximately (in mL/min): A. 25 B. 50 C. 125 D. 300 E. 500 10. Which of the following statements is/are correct? A. Filtration fraction equals glomerular filtration rate divided by renal plasma flow. B. Tubular maximum secretion has a finite upper limit, though it exhibits a phenomenon analogous to the threshold phenomenon for reabsorption. C. Clearance ratio equals renal clearance of one substance divided by the clearance of another substance. D. Effective renal plasma flow is the volume of plasma flow supplied to juxtamedullary nephrons. E. A, B, and C are correct. 11. The renal "countercurrent" mechanism is dependent upon the anatomic relationship between: A. the distal tubule and the macula denza B. the loop of Henle and the macula denza C. the loop of Henle and the vasa recta
D. the glomerulus and the afferent and efferent arterioles E. the glomerulus and the proximal tubule 12. If renal perfusion pressure does not change, which of the following changes in afferent and efferent arteriolar resistance would result in an increase in renal blood flow but no change in filtration fraction?
A B C D E
A. isotonic B. hypotonic or isotonic, but never hypertonic C. hypotonic D. hypertonic E. hypertonic or isotonic, but never hypotonic 16. Which of the following might you expect to find associated with chronic renal failure? A. elevated packed cell volume (hematocrit) B. abnormally low plasma creatinine concentration Afferent arteriolar Efferent arteriolar resistance C. decreased bone density resistance D. lower than normal PTH (parathyroid hormone) unchanged decreased concentration decreased unchanged E. None of the above is correct. 17. The vasa recta: increased unchanged A. are the straight portions of the proximal decreased decreased tubules, found just proximal to the loops of Henle increased increased B. extend from the efferent arterioles of the 13. An increase in the osmolality of the superficial cortical nephrons extracellular fluid will: C. are the microvilli found on the cells of the A. stimulate the volume and osmoreceptors, and macula densa stimulate ADH secretion D. comprise the capillary network found in the B. stimulate the volume and osmoreceptors, and medulla of the kidney inhibit ADH secretion E. are the small straight segments of afferent C. inhibit the volume and osmoreceptors, and arterioles found directly next to the macula densa stimulate ADH secretion 18. The loops of Henle of the outer cortical D. inhibit the volume and osmoreceptors, and nephrons: inhibit ADH secretion A. are functionally unimportant in the renal E. cause no change in ADH secretion conservation of sodium and water 14. Polyuria (diuresis) occurs in a diabetic patient B. do not contribute to the medullary osmotic who has a GFR = 120 mL/min and a blood sugar = gradient 350 mg/dL. This is indicative of: C. do not participate in the urinary diluting A. losses of water and sodium which could be mechanism prevented by istration of antidiuretic D. do not play any important role in overall renal hormone (ADH) and an aldosterone-like function and are simply unimportant vestiges of mineralocorticoid evolutionary development B. diuresis due to reduced active transport of E. A and C are correct. sodium out of the tubule because of diminished 19. Ammonia produced by the kidneys comes + + activity of the Na /K ATPase mainly from: C. a cellular and extracellular over-hydration due A. glutamine to water retention, caused by the glucose B. glycine D. an osmotic diuresis due to glucosuria, in which C. leucine water loss will exceed "salt" loss D. alanine E. B and D are correct. E. B and D are correct. 15. The tonicity of the urine as it enters the renal 20. Glomerular filtration produces an ultrafiltrate collecting duct is: of plasma:
A. in which the concentration of electrolytes is equal to plasma B. in which the concentration of protein is equal to plasma C. containing only those substances which must be eliminated in the urine D. A and B are correct. E. B and C are correct. 21. Which of the following is NOT a function of the kidneys? A. regulation of extracellular volume B. regulation of plasma glucose concentration C. regulation of arterial blood pressure D. excretion of the end products of protein metabolism E. excretion of foreign chemicals (e.g. pharmaceuticals, food additives, etc.) 22. Which of the following does NOT contribute to titratable acid when found in the urine? A. H2PO4B. lactic acid C. beta-hydroxybutyric acid D. acetoacetic acid E. NH4+ 23. Which of the following is NOT a function of the kidneys? A. regulation of extracellular osmolality B. regulation of acid-base balance C. excretion of end-products of muscle metabolism D. activation of antidiuretic hormone E. activation of vitamin D 24. Which of the following does NOT contribute to the formation of maximally concentrated urine? A. active NaCl transport in the proximal convoluted tubule B. active NaCl transport in the thick ascending limb of the loop of Henle C. impermeability of the thick ascending limb of the loop of Henle to water D. high water permeability of the collecting duct due to presence of ADH E. presence of urea in the inner medullary interstitium Answer Key
1-E 2-C 3-E 4-D 5-B 6-D 7-E 9-C
8-C 10 - E
11 - C 12 - B 13 - A 14 - D 15 - B 16 - C 17 - D 18 - B 19 - A 20 - A 21 - B 22 - E 23 - D 24 - A 1. The term "renal autoregulation" refers in part to the fact that A. the kidney does not require blood flow to sustain its active transport B. the kidney contains baroreceptors (pressure receptors) that contribute to the regulation of cardiac output C. renal blood flow is relatively constant over a wide range of systemic arterial pressures D. renal blood flow is not affected by activation of the sympathetic nerves that innervate the kidney E. a combination of both C and D above 2. The nerves that innervate the kidney are essential for regulating which of the following? A. Na-K-ATPase active transport pump rate B. renal autoregulation of blood flow C. urine volume and tonicity (osmolality)
D. all of the above E. none of the above 3. Which of the following would be expected to cause renal inulin (or creatinine) clearance to increase? A. dilation of the afferent arteriole B. dilation of the efferent arteriole C. constriction of the afferent arteriole D. constriction of the efferent arteriole E. both A and D above 4. Kidney inflammation may result in the appearance of albumin (a plasma protein) in the urine because A. more albumin enters the proximal tubule in the glomerular filtrate B. reabsorption of albumin from the proximal tubule is inhibited C. secretion of albumin into the distal tubule and collecting ducts is increased D. increased peritubular blood flow makes more albumin available for diffusion into the tubule E. reduced active transport of sodium ion reduces cotransport of other substances, including albumin 5. As blood es along the glomerular capillaries from the afferent to efferent arteriole, the net filtration pressure (DP - Dp) A. increases B. decreases C. first decreases, reaches a minimum about half way along the capillary, then increases D. first increases, reaches a maximum about half way along the capillary, then decreases E. remains constant 6. Sodium is actively reabsorbed from the renal tubule in which of the following nephron segments? A. proximal tubule B. distal tubule C. thick ascending limb of the loop of Henle D. all of the above E. none of the above 7. The rate of water reabsorption from the proximal tubule is determined primarily by the A. rate of dissolved particle (solute) reabsorption from the proximal tubule
B. concentration of ADH (antidiuretic hormone) in the blood C. osmotic pressure developed by plasma proteins in the proximal tubule D. active transport of water molecules by the proximal tubule cells E. ive filtration due to the high hydrostatic pressure in the proximal tubule 8. Urea has a higher concentration in the fluid that leaves the proximal tubule (and enters the loop of Henle) than in blood plasma because A. urea is synthesized by proximal tubule cells B. urea is secreted into the proximal tubule C. urea is reabsorbed from the proximal tubule but at a lesser rate that water is reabsorbed D. urea diffuses back into the proximal tubule because of the high urea concentration in the renal medulla E. urea is actively transported into Bowman's capsule from the glomerular capillaries 9. In the proximal tubule, penicillin is A. actively secreted into the tubule B. actively reabsorbed from the tubule C. ively reabsorbed from the tubule D. metabolized by the tubule cells E. neither secreted nor reabsorbed nor metabolized 10. At which sites would the concentration of creatinine be expected to be highest? (Note: assume the person is normally hydrated.) A. glomerular filtrate B. end of the proximal tubule C. end of the loop of Henle D. urine E. the concentration would be the same in all of the above, since creatinine is neither secreted or reabsorbed 11. Suppose a person loses the function of half his nephrons because of renal degenerative disease. Assuming the person survives and reaches a new steady state and that body urea production remains normal, which of the following would be expected to decrease below normal? A. plasma urea concentration B. renal urea excretion C. renal urea clearance
D. urine urea concentration E. all of the above 12. The following values are measured for potassium ion in a human subject. Plasma K+ 5 meq/liter Urine K+ 50 meq/liter Renal creatinine clearance 80 ml/min Urine formation rate 1.5 ml/minute This patient's potassium clearance is closest to which of the following? A. 5 ml/minute B. 7.5 ml/minute C. 15 ml/minute D. 50 ml/minute E. 75 ml/minute 13. Assuming the subject in the preceding question is a normal adult, we can conclude that most likely potassium is A. filtered but not secreted or reabsorbed B. secreted but not filtered or reabsorbed C. reabsorbed but not secreted or filtered D. filtered and secreted E. filtered and reabsorbed
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