Block 6 Renal Physiology Part 1
- 1.A patient with congestive heart failure has a higher than normal plasma creatinine concentration because of:
- A.
A. A reduced GFR
- B.
B. Increased creatinine secretion
- C.
C. A reduction in protein metabolism
- D.
D. An increase in blood volume
- E.
E. Increased cardiac output
- 2.Which of the following would NOT be observed in uncontrolled diabetes mellitus?
- A.
A. Dehydration
- B.
B. Positive glucose clearance
- C.
C. Osmotic dieresis
- D.
D. Hypokalemia
- E.
E. Hyperglycemia
- 3.The pK’s of 5 weak acids are listed below. Which would be the best physiological buffering system in the plasma?
- A.
A. Weak acid A: pK = 1.6
- B.
B. Weak acid B: pK = 3.5
- C.
C. Weak acid C: pK = 6.8
- D.
D. Weak acid D pK = 9.3
- E.
E. Weak acid E: pK = 10.5
- 4.Which of the following is a compensation method for respiratory acidosis?
- A.
A. Hypoventilation
- B.
B. Increased HCO3- excretion
- C.
C. Decreased intracellular buffering of H+ ions
- D.
D. Increased formation of ammonia through glutamine
- E.
E. Inhibition of ADH secretion
- 5.Which one of the following conditions produces metabolic acidosis?
- A.
A. Partial obstruction of the trachea
- B.
B. Severe vomiting
- C.
C. Inhibition of carbonic anhydrase
- D.
D. Living at high altitude (but not born there)
- E.
E. Excessive ingestion of antacids
- 6.pH [HCO3-] PCO2 a. 7.57 44 50 b. 7.20 8 20 c. 7.52 20 25 d. 7.32 40 80 e. 7.24 25 60 Which patient is suffering from an anxiety-induced panic attack?
- A.
A
- B.
B
- C.
C
- D.
D
- E.
E
- 7.pH [HCO3-] PCO2 a. 7.57 44 50 b. 7.20 8 20 c. 7.52 20 25 d. 7.32 40 80 e. 7.24 25 60 Which patient is in diabetic ketoacidosis?
- A.
A
- B.
B
- C.
C
- D.
D
- E.
E
- 8.pH [HCO3-] PCO2 a. 7.57 44 50 b. 7.20 8 20 c. 7.52 20 25 d. 7.32 40 80 e. 7.24 25 60 Which patient has chronic obstructive pulmonary disease?
- A.
A
- B.
B
- C.
C
- D.
D
- E.
E
- 9.pH [HCO3-] PCO2 a. 7.57 44 50 b. 7.20 8 20 c. 7.52 20 25 d. 7.32 40 80 e. 7.24 25 60 Which patient has suffered from pneumonia for several days?
- A.
A
- B.
B
- C.
C
- D.
D
- E.
E
- 10.In congestive heart failure, edema occurs as a direct result of:
- A.
A. Renal failure
- B.
B. Increased hydrostatic pressure in systemic capillaries
- C.
C. Decreased ADH
- D.
D. Increased plasma oncotic pressure
- E.
E. Increased urine output.
- 11.A patient suffering from metabolic acidosis will NOT exhibit
- A.
A. An increase in urinary titratable acid
- B.
B. An increase in urinary potassium excretion
- C.
C. An increase in the urinary ammonium concentration
- D.
D. A decrease in urinary bicarbonate excretion
- E.
E. A decrease in urinary pH.
- 12.A patient is severely dehydrated following prolonged diarrhea that lasted several days but was not associated with vomiting. However, malaise and nausea prevented the patient from taking much food and drink during this period. After 3 days of theis diarrhea, the blood values are: pHa = 7.34, [HCO3- = 12mM, PaCO2 = 20mmHg, [Na+] =138mM, [K+] = 4.8mM, [Cl-] = 114mM. The above patient has:
- A.
A. Uncompensated metabolic acidosis
- B.
B. Partially compensated metabolic acidosis
- C.
C. Uncompensated respiratory acidosis
- D.
D. Partially compensated respiratory acidosis
- E.
E. A significantly increased anion gap
- 13.A patient is severely dehydrated following prolonged diarrhea that lasted several days but was not associated with vomiting. However, malaise and nausea prevented the patient from taking much food and drink during this period. After 3 days of theis diarrhea, the blood values are: pHa = 7.34, [HCO3- = 12mM, PaCO2 = 20mmHg, [Na+] =138mM, [K+] = 4.8mM, [Cl-] = 114mM. In the above patient, which one of the following would you expect to be decreased?
- A.
A. Plasma [aldosterone]
- B.
B. Plasma [atrial natriuretic peptide]
- C.
C. Plasma [angiotensin II]
- D.
D. Plasma [ADH]
- E.
E. Hematocrit
- 14.A patient is severely dehydrated following prolonged diarrhea that lasted several days but was not associated with vomiting. However, malaise and nausea prevented the patient from taking much food and drink during this period. After 3 days of theis diarrhea, the blood values are: pHa = 7.34, [HCO3- = 12mM, PaCO2 = 20mmHg, [Na+] =138mM, [K+] = 4.8mM, [Cl-] = 114mM. In the above patient, comparing the relative changes in the volume of various compartments, which statement is correct?
- A.
A. The ICF volume decreases more than the ECF volume.
- B.
B. The packed rbc volume decreases more than the plasma volume.
- C.
C. The ISF volume decreases more than the plasma volume
- D.
D. The volume of all compartments decrease to an equal degree
- E.
E. The plasma volume decreases more than any other volume decreases
- 15.Assuming the same capacity, the buffer that is most effective in the body is the one with a pK of:
- A.
A. 6.1
- B.
B. 6.4
- C.
C. 6.7
- D.
D. 6.9
- E.
E. 7.2
- 16.Acidosis will result from:
- A.
A. Hyperaldosteronism
- B.
B. Renal failure
- C.
C. Intravenous infusion of Ringer-lactate solution
- D.
D. Hypokalemia
- E.
E. Consumption of a large volume of fruit juice.
- 17.pHa PaCO2, mmHg, plasma [HCO3-], mEq/L A. 7.20 73 28 B. 7.55 44 40 C. 7.33 44 45 D. 7.65 25 28 E. 7.45 20 14 Chronic (partially compensated) respiratory alkalosis.
- A.
A
- B.
B
- C.
C
- D.
D
- E.
E
- 18.pHa PaCO2, mmHg, plasma [HCO3-], mEq/L A. 7.20 73 28 B. 7.55 44 40 C. 7.33 44 45 D. 7.65 25 28 E. 7.45 20 14 Acute respiratory acidosis
- A.
A
- B.
B
- C.
C
- D.
D
- E.
E
- 19.pHa PaCO2, mmHg, plasma [HCO3-], mEq/L A. 7.20 73 28 B. 7.55 44 40 C. 7.33 44 45 D. 7.65 25 28 E. 7.45 20 14 Mixed disturbance
- A.
A
- B.
B
- C.
C
- D.
D
- E.
E
- 20.pHa PaCO2, mmHg, plasma [HCO3-], mEq/L A. 7.20 73 28 B. 7.55 44 40 C. 7.33 44 45 D. 7.65 25 28 E. 7.45 20 14 Acute metabolic alkalosis
- A.
A
- B.
B
- C.
C
- D.
D
- E.
E
- 21.Respiratory compensation for metabolic alkalosis takes 12-24hrs to be fully effective because:
- A.
A. CO2 takes that long to be produced metabolically.
- B.
B. The central chemoreceptors require this time to adapt to the hypercapnia produced by attempts to hypoventilate
- C.
C. It takes 24hrs to increase the CSF pH.
- D.
D. Peripheral chemoreceptors only effectively respond to a decrease in plasma pH.
- 22.As blood flows through metabolizing tissues the pH decreases. The pH decrease is less than would be predicted from the amount of carbonic acid being generated, primarily because of the buffering by:
- A.
A. Intracellular proteins
- B.
B. Plasma phosphate
- C.
C. Plasma proteins
- D.
D. Hemoglobin
- E.
E. HCO3-/H2CO3 buffer pair
- 23.Which one of the following statements does NOT correctly describe ammonium handling by the kidneys?
- A.
Ammonium enters the medullary interstitum by diffusion trapping
- B.
The major sources of urinary ammonium is from proximal tubular glutamine metabolism.
- C.
Ammonium enters the proximal tubule lumen in exchange for sodium.
- D.
Glutamine metabolism is stimulated by acidosis and hypokalemia
- E.
Ammonia contributes to the countercurrent multiplication mechanisms resulting in medullary interstitial hyperosmolarity.
- 24.A patient is suffering from diabetic ketoacidosis (and has not been treated with insulin as yet). Which of the following responses would be observed in this patient?
- A.
A. Hypoventilation
- B.
B. Increased buffering of H+ by plasma proteins
- C.
C. Increased utilization of glucose by skeletal muscle.
- D.
D. Decreased urinary phosphate buffering
- E.
E. Decreased bicarbonate reabsorption
- 25.Patients with congestive heart failure often develop hypokalemia (low plasma [K+]). One mechanism that leads to the development of hypokalemia is:
- A.
A. Decreased tubular fluid flow
- B.
B. ANP-induced K+ reabsorption in the proximal tubule
- C.
C. Lack of insulin
- D.
D. Aldosterone-induced K+ secretion by principal cells
- E.
E. Destruction of cardiac tissue.
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