Renal Exam 2006

Front 1

1) Ingestion of 1 liter of pure water would result in which of the following conditions:
A. hyperosmotic dehydration
B. hypoosmotic dehydration
C. isoosmotic overhydration
D. hypoosmotic overhydration
E. hyperosmotic overhydration

Back 1

D. hypoosmotic overhydration

Front 2

2) The reabsorption of glucose and the secretion of PAH are similar in that:
A. both require a Na+ gradient established by a Na+ / K+ ATPase
B. both occur primarily within the distal convoluted tubule
C. the transport rates for both are always 50% of the filtered load
D. the excretion rates of both decrease with an increase in filtered load
E. both are examples of paracellular transport

Back 2

A. both require a Na+ gradient established by a Na+ / K+ ATPase

Front 3

3) Molecules which do not normally pass through the renal filter are:
A. negatively charged ions
B. positively charged ions
C. neutral amino acids
D. glucose
E. large proteins

Back 3

E. large proteins

Front 4

4) ADH secretion will be stimulated by which of the following:
A. drinking a liter of pure water
B. infusing an intravenous solution of isotonic NaCl
C. profuse sweating, followed by drinking pure water
D. profuse sweating, without drinking additional water
E. drinking a liter of isotonic solution

Back 4

D. profuse sweating, without drinking additional water

Front 5

5) A solution that is iso-osmotic compared to plasma is:
A. 300 mM urea
B. 75 mM NaCl and 200 mM urea
C. 150 mM glucose
D. 150 mM NaCl and 150 mM urea
E. 100 mM NaHCO3

Back 5

A. 300 mM urea

Front 6

6) Normally, all of the nutrients (glucose, amino acids) are reabsorbed in which tubular segment:
A. Bowman’s capsule
B. proximal tubule
C. thin loop of Henle
D. distal convoluted tubule
E. collecting duct

Back 6

B. proximal tubule

Front 7

7) The tubular segment that receives fluid from more than one nephron is the:
A. glomerulus
B. proximal tubule
C. collecting duct
D. distal convoluted tubule
E. thick ascending loop of Henle

Back 7

C. collecting duct

Front 8

8) An individual has a plasma [urea] of 15 mg/dL. If her GFR then decreases by 50%, what will
happen to her plasma [urea] ? (Assume that there are no changes in the rate at which she produces urea.)
A. plasma [urea] will initially rise, then return to the previous value of 15 mg/dL
B. rise to a new, higher value and remain at that value until GFR changes again
C. decrease to a new, lower value and remain at that value until GFR changes again
D. initially decrease, then return to the previous value of 15 mg/dL
E. remain the same (15 mg/dL)

Back 8

B. rise to a new, higher value and remain at that value until GFR changes again

Front 9

9) In describing the renal response to an acid load, “titratable acid” refers to acid that:
A. combines with filtered HCO3- to form carbonic acid
B. combines with plasma HCO3- to form carbonic acid
C. combines with filtered HPO4-2 to form H 2PO4-
D. is formed from glutamine
E. uses a Na+ / cotransporter

Back 9

C. combines with filtered HPO4-2 to form H 2PO4-

Front 10

10) A child has a prolonged illness, during which she lost 1 liter of fluid in diarrhea. This fluid had an osmolality of 200 mosm/L. What result would this fluid loss have on the child?
A. her plasma osmolality would be lower than normal
B. her ICF volume would be lower than normal
C. her ECF volume would be decreased by more than 1 liter
D. her ICF osmolality would be greater than her ECF osmolality
E. her ECF osmolality would be increased but her ICF osmolality would decrease

Back 10

B. her ICF volume would be lower than normal

Front 11

11) In the presence of ADH, which tubular segment will have fluid that is hyperosmotic?
A. proximal tubule
B. descending thin loop of Henle
C. thick ascending loop of Henle
D. distal convoluted tubule
E. collecting duct

Back 11

E. collecting duct & B. descending thin loop of Henle

Front 12

12) If an individual on a high protein diet has already exceeded the buffering capacity of the
phosphate buffers in the urine, the additional acid will be secreted primarily as:
A. free H+
B. ammonium
C. carbonic acid
D. glutamine
E. CO2

Back 12

B. ammonium

Front 13

13) The stimulus that initiates the tubuloglomerular reflex is the:
A. electrolyte content of tubular fluid flowing by macula densa cells
B. osmolality of plasma near hypothalamus neurons
C. amount of stretch of the smooth muscle cells in the renal artery
D. amount of stretch of the carotid sinus baroreceptors
E. amount of stretch of the myocardial cells of the atrium

Back 13

A. electrolyte content of tubular fluid flowing by macula densa cells

Front 14

14) A molecule of H+ lost from the body via the GI tract (as during vomiting):
A. can combine with HCO3
- in the body to form CO2 and H2O
B. is equivalent to adding one molecule of HCO3- to the body
C. is compensated for by renal secretion of one H+ molecule
D. is compensated for by renal reabsorption of one HCO3
- molecule
E. is buffered in plasma by the formation of CO2 and H2O

Back 14

B. is equivalent to adding one molecule of HCO3- to the body

Front 15

15) In the peritubular capillaries:
A. oncotic pressure is usually lower than the oncotic pressure in the glomerular
capillaries
B. hydrostatic pressure is unchanged if efferent arterioles vasoconstrict
C. filtration is favored near the efferent arteriole, but reabsorption is favored near the
venule
D. hydrostatic pressure is always lower than hydrostatic pressure in the glomerular
capillaries
E. filtration is favored except during extreme hypovolemic conditions

Back 15

D. hydrostatic pressure is always lower than hydrostatic pressure in the glomerular
capillaries

Front 16

16) The clearance of a substance that is reabsorbed by the tubular cells:
A. can exceed the RPF if the transporters become saturated
B. can never be greater than the GFR
C. does not change with increasing filtered load of the substance
D. has units of mg/min
E. is always equal to the filtered load of the substance

Back 16

B. can never be greater than the GFR

Front 17

17) An iso-osmotic increase in ECF will result from an increased rate of Na+ reabsorption in which tubular segment?
A. proximal tubule
B. distal convoluted tubule
C. thick ascending loop of Henle
D. thin descending loop of Henle
E. collecting duct in the absence of ADH

Back 17

A. proximal tubule

Front 18

18) Which of the following would increase the rate of Na+ excretion?
A. decreased GFR
B. increased secretion of aldosterone
C. increased level of sympathetic nerve activity
D. increased ECF volume
E. increased secretion of ADH

Back 18

D. increased ECF volume

Front 19

19) Multiplying the plasma concentration of a solute times the GFR always gives you the:
A. clearance of the solute
B. renal threshold for that solute
C. transport maximum for that solute
D. excreted load of that solute
E. filtered load of that solute

Back 19

E. filtered load of that solute

Front 20

20) The macula densa is located btwn what two regions?

Back 20

TALH and CCD

Front 21

21) What region that is always impermeable to
Na+, regardless of the hormones present?

Back 21

DTLH

Front 22

22) A man has the following values for Na+.
Dietary intake of Na+ 434 mmol/day
GFR 180 L/day
Plasma [Na+] 140 mmol/L
Assuming that he is in steady state balance for Na+ (his excretion rate = his intake rate), what fraction of Na+ is reabsorbed by the kidney?
A. 98.3 %
B. 99.6 %
C. 32.2 %
D. 100 %
E. 50 %

Back 22

A. 98.3 %

Front 23

23) A special dye is used to measure fluid volume. The properties of this dye are that:
• it is injected intravenously,
• it does not enter blood cells
• it does not escape from blood vessels.
The volume you can measure with this dye is:
A. plasma volume
B. ICF volume
C. blood volume
D. ICF + ISF volume
E. ECF volume

Back 23

A. plasma volume

Front 24

24) Using the same dye above, you inject 100 mg intravenously, wait a short time for complete
mixing, then withdraw a sample of fluid. The fluid concentration is 25 g/ml. The volume of this
fluid compartment is:
A. 40 L
B. 4 L
C. 25 L
D. 2.5 L
E. 10 L

Back 24

B. 4 L

Front 25

25) Blood in the efferent arteriole of the kidney will flow next and directly into the:
A. glomerular capillaries
B. peritubular capillaries
C. minor calyx
D. interlobular vein
E. interlobar vein

Back 25

B. peritubular capillaries

Front 26

26) The mechanism for bicarbonate reabsorption in the renal tubules requires all of the
following EXCEPT:
A. intracellular carbonic anhydrase
B. diffusion of CO2 from the lumen into the cell
C. apical membrane transporter for H+
D. apical membrane transporter for HCO3-
E. carbonic anhydrase on the apical cell membrane

Back 26

D. apical membrane transporter for HCO3-

Front 27

27) A woman has a Tm for glucose of 350 mg/min. This means that:
A. her plasma glucose concentration cannot exceed 350 mg/liter
B. her urine glucose concentration cannot exceed 350 mg/liter
C. if her glucose filtered load exceeds 350 mg/min she will excrete glucose
D. the clearance of glucose is 350 ml/min
E. the difference between the GFR and the urine excretion rate is 350 mg/min

Back 27

C. if her glucose filtered load exceeds 350 mg/min she will excrete glucose

Front 28

28) Aldosterone directly stimulates:

A. water reabsorption in proximal tubule cells
B. Na+ reabsorption in collecting duct cells
C. Na+ secretion in collecting duct cells
D. both water and Na+ reabsorption by thin loop of Henle cells
E. Na+ reabsorption in all renal tubule cells

Back 28

B. Na+ reabsorption in collecting duct cells

Front 29

31) Na+ reabsorption in which tubular segment has the greatest effect on the development of the
hyperosmotic medullary interstitial gradient?

A. proximal tubule
B. distal convoluted tubule
C. Collecting duct
D. ascending thin loop of Henle
E. thick ascending loop of Henle

Back 29

E. thick ascending loop of Henle

Front 30

32) The tubular segment which has a relatively long length in juxtamedullary nephrons, and a
short length in cortical nephrons, is the:

A. proximal tubule
B. distal convoluted tubule
C. loop of Henle
D. connecting tubule
E. Bowman’s capsule

Back 30

C. loop of Henle

Front 31

33) An individual has the following measures:
GFR = 100 ml/min
RPF = 600 ml/min
Clearance of X = 150 ml/min
Assuming that X is freely filtered, it is most likely that X is:

A. neither reabsorbed nor secreted
B. partly, but not entirely, secreted
C. partly, but not entirely reabsorbed
D. entirely reabsorbed
E. entirely secreted

Back 31

B. partly, but not entirely, secreted

Front 32

34) Which of the following is a correct comparison of body fluid compartments?

A. plasma volume is greater than ISF volume
B. ICF volume is greater than ISF volume
C. ECF volume is greater than ICF volume
D. ISF volume is greater than ECF volume
E. plasma volume is greater than blood volume

Back 32

B. ICF volume is greater than ISF volume

Front 33

35) Mr. Smith’s patient chart provides the following information:
pH Arterial CO2 Arterial [HCO3-]
7.1 70 mm Hg 36 mM
Your tentative diagnosis is:

A. uncompensated respiratory acidosis
B. respiratory acidosis with renal compensation
C. metabolic acidosis with renal compensation
D. uncompensated metabolic acidosis
E. metabolic acidosis with respiratory compensation

Back 33

B. respiratory acidosis with renal compensation

Front 34

36) Severe blood loss (hemorrhage) would result in an increase in all EXCEPT which of the
following:

A. ANP
B. renin
C. angiotensin II
D. aldosterone
E. ADH (vasopressin)

Back 34

A. ANP

Front 35

37) Given the following blood and urine values for inulin:
Plasma [inulin] Urine [inulin] Urine flow rate
85 mg/dL 4500 mg/dl 2.3 ml/min
What is the clearance of inulin?

A. 104 ml/min
B. 43 ml/min
C. 122 ml/min
D. 199 ml/min
E. 170 ml/min

Back 35

C. 122 ml/min

Front 36

38) The clearance of creatinine is a good estimate of the:

A. renal plasma flow
B. renal blood flow
C. GFR
D. clearance of urea
E. clearance of glucose

Back 36

C. GFR

Front 37

39) The cells that secrete renin are the:

A. macula densa cells
B. podocytes
C. juxtaglomerular cells
D. mesangial cells
E. capillary endothelium

Back 37

C. juxtaglomerular cells

Front 38

40) The primary effect of a drug is to vasodilate the afferent arterioles. This will increase GFR
due to the:

A. increased hydrostatic pressure in the glomerular capillary
B. reduced renal plasma flow
C. decreased hydrostatic pressure in the glomerular capillary
D. alteration in plasma oncotic pressure
E. increased hydrostatic pressure within Bowman’s space

Back 38

A. increased hydrostatic pressure in the glomerular capillary