RENAL PHYSIOLOGY:
1. Renal blood flow is dependent on:
A. Juxtaglomerular apparatus
B. [Na+] at macula densa
C. Afferent vasodilatation
D. Arterial pressure – CORRECT - if there is NO PRESSURE.
E. Efferent vasoconstriction
2.Which has the greatest renal clearance?
A. PAH - Yes, used to measure renal plasma flow
B. Glucose – No, 100% reabsorbed
C. Urea – No, 53% reabsorbed
D. Water
E. Inulin
3.The thick ascending limb of the Loop of Henle is:
A. Impermeable to Na+ - No, active transport… (Na-K-2Cl-ATPase)
B. Involved in active transport of K+ into the lumen – No, passive diffusion and actively pumped out
C. Involved in active transport of Cl- out of lumen – CORRECT (Na-K-2Cl-channel) – secondary active transport
D. Involved in active transport of Na+ into lumen
4.Water filtration by the kidney:
A. Is 180 l/hr – No, GFR is 180 L/Day
B. Is 125 ml/min – Correct
C. Up to 90% is reabsorbed – No, up to 99.7% reabsorbed (maximal ADH)
D. Most drugs have MW less than 600 and are freely filtered
5.Which ONE of the following is NOT involved in the regulation of glomerular filtration rate (GFR)?
A. Juxtaglomerular apparatus –
B. Arterial pressure – No, autoregulation maintains GFR (unless outside extremes) – BUT there is the
pressure diuresis concept. CORRECT
C. Efferent arteriolar tone
D. Na content in distal tubule
E. Afferent arteriolar tone
6. Significant tubular reabsorption occurs with:
A. Phosphate – CORRECT, proximal tubule Na/Pi co transporter
B. Creatinine
C. Urea
D. Sulphate
E. All of the above
7.The formula for GFR is:
A. GFR = Kf (HPG - HPB + OPG - OPB)
B. GFR = Kf (HPG - HPB - OPG + OPB) - Correct
C. GFR = Kf (HPG + HPB - OPG + OPB)
D. GFR = Kf (HPG + HPB - OPG - OPB)
E. GFR = Kf (HPG - HPB - OPG - OPB)
(Comment: HP is hydrostatic pressure, OP is oncotic pressure, G is glomerulus, B is Bowman’s capsule)
8. Resistance to renal blood flow is chiefly determined by:
A. Renal artery
B. Afferent & efferent arterioles – Correct
C. Interlobular & arcuate arteries
D. Peritubular capillaries
9. Kidneys produce:
A. Erythropoietin - CORRECT
B. ADH - No, supraoptic and paraventricular nuclei of the hypothalamus
C. Angiotensin II – No, produced in the liver
D. ANP - Atrium
E. Cholecalciferol – Made in the skin, 25-hydroxy in the liver, 1-hydroxy in the kidney
10. Renal nerve sympathetic stimulation
A. Causes increased sodium reabsorption from the PCT – CORRECT- directly affects tubular reabsorption as well as effect on RBF & GFR
B. Inhibits renin release
C. Increased GFR.
D. causes increased potasium reabsorption.
11. Glomerular filtration rate (GFR):
A. Is independent of the size of the capillary bed – No, it is dependant on capillary SA and permeability (Kf)
(GFR = Kf [PGC – (PT + πGC)]
B. Depends only on the hydrostatic and osmotic pressure differences across the capillary
C. Is determined by the same forces governing filtration across all other capillaries - Correct
D. Depends only on the permeability of the capillary
E. Requires active transport – No, passive
12. Increase in GFR occurs with
A. Increased sympathetic stimulation
B. Decreased renal blood flow
C. Hypoproteinaemia – Correct (Starling’s Forces) but would be offset by TGF with time
D. Ureteric obstruction
E. None of the above
13. Regarding urea:
A. Urea is formed from ornithine – No, from Arginine to Ornithine & Urea
B. 10% is reabsorbed by kidney
c. 60% is reabsorbed by kidney. CORRECT
D. all is excreted in urine.
14. The clearance (or 'renal regulation') of which ONE of the following is NOT regulated by a hormone:
A. Sodium – Yes, aldosterone
B. Potassium – Yes, aldosterone
C. Calcium – Yes, PTH
D. Phosphate – Yes, PTH
E. Sulphate – ANSWER IS WRONG but CORRECT.
15. Biggest contribution to urine concentration by:
A. Na+ absorption in thick ascending limb - CORRECT
B. Passive diffusion of urea in collecting ducts
C. Chloride absorption in distal convoluted tubule
D. K+ reabsorption in thick ascending limb.
16. Water excretion by the kidney is due to:
A. solvent drag
B. Active transport into the lumen
C. Passive secretion in the collecting tubules
D. bulk flow and filtration - CORRECT
17. Angiotensin II causes:
A. Increases proximal tubular reabsorption of Na & H2O & increases secretion of K
B. Increases late distal and collecting tubular reabsorption of Na & H2O &
increases secretion of K+ -CORRECT
C. Decreases distal tubular reabsorption of Na & H2O
D. Increases excretion of Na & H2O
18. Secretion of K+ by distal tubule will decrease by:
A. metabolic alkalosis
B. thiazide diuretics administration
C. spironolactone administration - CORRECT
D. a high K+ diet.
19. To maintain normal H+ balance, total daily excretion of H+ shoul equal the daily
A. fixed acid producation plus fixed acid ingestion - CORRECT
B. HCO-3 excretion
C. HCO-3 filtered load
D. filtered load of H+
20. At plasma concentration of glucose higher than occur at transport maximum, the
a. clearance of glucose is zero
b. excretion rate of glucose equals the filtration rate of glucose.
c. reabsorption rate of glucose equals the filtration rate of glucose - CORRECT
d. excretion rate of glucose increases with increasing plasma glucose concentrations.
21. which of the following would produce an increase in the reabsorption of iso-osmotic fluid in proximal tubule?
a. increased filtration fraction - CORRECT
b. extracellular fluid (ECF) volume expansion
c. decreased peritubular capillary hydrostatic pressure.
d. increased peritubular capillary hydrostatic pressure.
22. which of the following substances or combination of substances could be used to measure interstitial fluid volume?
a. mannitol
b. D2O
c. evans blue
d. inulin and radioactive albumin - CORRECT.
23. which of the following would cause an increase in both glomerular filtration rate( GFR) and renal plasma flow (RPF)?
a. dilation of afferent arteriole - CORRECT.
b. dilation of efferent arteriole
c. constriction of afferent arteriole
d. constriction of efferent arteriole
24. which of the following changes would you expect to find in patient consuming a hig-sodium diet (200mEq/day) compared with same patient on a normal sodium diet (100mEq/day), assuming a normal steady state condition?
a. increased plasma renin activity
b. decreased plasma renin activity -CORRECT
c.increased urinary potassium excretion
d. increased plasma sodium concentration of at least 5mmol/L
25. which of the following changes tends to increase urinary Ca+2 excretion?
a. extracellular fluid volume expansion - CORRECT
b. intracellular fluid volume expansion
c. increased plasma parathyroid hormone concentration
d. increased plasma phosphate concentration.
26. which of the following statement is true.
a. ADH decreases urea permeability in the medullary collecting tubules
b. osmolarity of fluid in early distal tubule would be less than 300mOsm/L in a dehydrated person with normal kidneys and increased ADH levels - CORRECT.
c. ADH increases water reabsorption from descending loop of henle.
d. water reabsorptions is less than that from ascending loop of henle.
27. A healthy 25 years old man runs a 10 Km race on hot day and become very dehydrated. Assuming that his antidiuretic hormone levels are very high, in which part of renal tubule is the most water reabsorbed.
a. proximal tubule - CORRECT
b.distal tubule
c. cortical collecting duct
d. medullary collecting duct
28. which of the following changes would you expect to find in a dehydrated person deprived of water for 24 hours?
a. increased water permeability of collecting duct - CORRECT
b. increased water permeability in ascending loop of henle
c. decreased plasma renin activity
d. decreased plasma antidiuretic hormone concentration.
29. In acidosis, most of the hydrogen ions secreted by the proximal tubule are associated with which of the following processes?
a. reabsorption of potassium ion
b. reabsorption of bicarbonate ion - CORRECT
c. reabsorption of phosphate ion
d. excretion of Hydrogen ion.
30. A 46 years old women complains of severe polyuria and polydipsia. her urine contains no glucose and her urine is hyposmotic. which one of the following is the most likely diagnosis?
a. diabetes mellitus
b. diabetes insipidus - CORRECT
c. primary aldosteronism
d. syndrome of inappropriate antidiuretic hormone.
31. In a patient who has become dehydrated, body water should be replaced by intravenous infusion of.
a. distilled water
b. hyperoncotic albumin
c. 10% glucose solution
d. 5% glucose solution - CORRECT.
32. In a patient with a plasma PH of 7.10 the [HCO-3] / [H2CO3] ratio in plasma is?
a. 20
b. 10 - CORRECT
c. 2
d. 1
33. Increasing alvealor ventilation increases the blood PH because:
a. it activates neural mechanism that removes acid from the blood
b. it makes hemoglobin a stronger acid
c. it increases the PO2 of blood
d. it decreases the PCO2 of alveoli. - CORRECT
34. which of the following is the principal buffer in interstitial fluid?
a. hemoglobin
b. carbonic acid - CORRECT
c. H2PO4
d. protein buffer
35.Dehydration increases the plasma concentration of all of the following hormones EXCEPT:
a. atrial natriuretic peptide - CORRECT
b. angiotension II
c. aldosteron
d. vasopressin
36. In a resting adult, the kidney receives 1.2 to 1.3 liter of blood each minute, or just 25% of cardiac output. A high protein diet increases blood flow by rising:
a. oncotic pressure
b. osmotic pull of plasma
c. glomerular capillary pressure - CORRECT
d. mean arterial pressure.
37. The mesangial cells are especially located between the glomerular capillaries, these being contractile in nature; increasing glomerular filtration rate when inhibited by ANP hormone that results in pressure diuresis by causing in the tubules the following effect:
a. hypotension
b. increased GFR
c. Aldosteron escape - CORRECT
d. no ADH effect
38. The GFR in an average sized man is approximately 125ml/min or 180 lit/day . At this rate of filtration, kidney filters in one day, amount of fluid equal to following except:
a. renal fraction – CORRECT
b. 4 times the total body water
c. 15 times the total ECF volume
d. 60 times the plasma volume
40.which of the following ion is both reabsorbed and secreted across the tubular epithelium.
a. NA+
b. K+ - CORRECT
c. Cl-
d. HCO-3
41. Diuretic, an agent that increases urinary output. The diuretics like FUROSEMIDE, ETHACRYNIC ACID causes a marked diuresis by inhibiting one of the following carrier protein in the renal tubules:
a. NA+ - Glucose cotransporter
b. NA+ - H+ exchanger
c. NA+ - 2Cl- - K+ - CORRECT.
d. ENac
42. The limiting PH of urine in collecting ducts can stop even active secretion of H+ hence it is prevented by the following buffers EXCEPT one:
a. HCO-3
B. HPO4-2
C. NH3
D. protein buffer - CORRECT
43. Osmolarity of fluid in proximal tubule is:
a. less than osmolarity of plasma
b. greater than osmolarity of plasma
c. 1200 mOsm/ L
d. 300 mOsm/ L - CORRECT
44. purpose of counter current exchanged is to
a. decrease renal blood flow
b. maintain medullary fluid osmolarity - CORRECT.
c. forms dilute or concentrated urine
d. reabsorbs sodium
45. Renal buffer formed by kidney it self is
a ammonium buffer - CORRECT
b. phosphate buffer
c. bicarbonate buffer
d. protein buffer
46. composition of glomerular filtrate is
a. same is plasma
b. plasma minus the plasma proteins - CORRECT
c. like intracellular fluid
d. like trasncellular fluid
47.many patient with renal disease retain excessive amount of sodium and become edematous and hypertensive because of following except one:
a. pyelonephritis - CORRECT
b. glomerulonephritis
c. heart - failure
d. nephrotic syndrome
48.which of the following conditions increases renin secretion from kidney:
a. increase ANP
B. Increase GFR
c. increased mean atrial pressure
d. sympathetic stimulation - CORRECT.
49. Potassium sparing diuretics inhibits sodium reabsorption in which of the following:
a. proximal tubule
b. thick ascending limb of loop of henle
c. distal convulated tubule
d. cortical collecting duct. - CORRECT.
50. tubuloglomerular balance is a process that causes increased reabsorption of salt and water when GFR increases. The process is related by increase in:
a. peritubular capillary oncotic pressure - CORRECT
b. proximal tubular flow
c. distal tubular flow
d. peritubular capillary hydrostatic pressure
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