P21a Likely 9

1. What would be the long-term effects of chronic infection or inflammation of the kidneys?

A. dehydration and hypovolemia

B. gradual necrosis, fibrosis, and development of uremia

C. sudden anuria and azotemia

D. severe back or flank pain

2. Which of the following describes the flow of filtrate in the kidney?

A. the collecting duct to the distal convoluted tubule to the renal pelvis

B. Bowman’s capsule to the proximal convoluted tubule to the loop of Henle

C. the loop of Henle to the collecting duct to Bowman’s capsule

D. the distal convoluted tubule to the loop of Henle to the collecting duct

3. Which statement about the bladder is TRUE?

A. The bladder wall lacks rugae.

B. Three openings from the urinary bladder form the trigone.

C. It contracts when stimulated by the sympathetic nervous system.

D. Continuous peristalsis in the bladder wall promotes urine flow.

4. Which of the following should be present in the filtrate in the proximal convoluted tubule?

A. plasma proteins

B. erythrocytes

C. sodium and potassium ions

D. leukocytes

5. Which of the following describes the normal flow of urine?

A. collecting duct to the renal pelvis to the ureter to the bladder

B. renal pelvis to the urethra to the bladder to the ureter

C. ureter to the renal pelvis to the urethra to the bladder

D. collecting duct to the ureter to the urethra

6. What is the cause of most cases of pyelonephritis?

A. an ascending infection by E. coli

B. abnormal immune response, causing inflammation

C. dialysis or other invasive procedure

D. virulent bacteria in the blood

7. Which of the following structures is most likely to be located in the renal medulla?

A. proximal convoluted tubule

B. glomerulus

C. loop of Henle

D. afferent arteriole

8. Which of the following is NOT a function of the kidney?

A. regulation of body fluid concentrations

B. removal of nitrogenous and acidic wastes

C. activation of vitamin D

D. production of albumin

9. Normally, which of the following is reabsorbed completely from the filtrate?

A. glucose

B. sodium

C. water

D. urea

10. Which disease is manifested by dysuria and pyuria?

A. nephrotic syndrome

B. cystitis

C. glomerulonephritis

D. urolithiasis

11. Which substance directly controls the reabsorption of water from the collecting ducts?

A. renin

B. aldosterone

C. angiotensin

D. antidiuretic hormone

12. Which disease would cause an increased ASO titer and elevated serum ASK?

A. nephrotic syndrome

B. acute poststreptococcal glomerulonephritis

C. pyelonephritis

D. polycystic kidney

13. Which of the following describes the correct flow of blood in the kidney?

A. afferent arteriole to the peritubular capillaries to the venule

B. efferent arteriole to the glomerular capillaries to the peritubular capillaries

C. peritubular capillaries to the glomerular capillaries to the venule

D. afferent arteriole to the glomerular capillaries to the efferent arteriole

14. Which of the following increases glomerular filtration rate?

A. increased plasma osmotic pressure

B. dilation of the efferent arteriole

C. increased hydrostatic pressure in the glomerular capillaries

D. constriction of the afferent arteriole

15. Under what circumstances do cells in the kidneys secrete renin?

A. The urine pH decreases.

B. Blood flow in the afferent arteriole decreases.

C. Serum potassium levels are high.

D. Serum osmotic pressure increases.

16. In a case of acute pyelonephritis, what is the cause of flank pain?

A. inflammation, causing ischemia in the tubules

B. inflammation, stretching the renal capsule

C. increasing glomerular permeability, creating an increased volume of filtrate in the kidney

D. microbes irritating the tissues

17. When a respiratory infection with high fever is present in the body, how would the kidney tubules maintain normal pH of body fluids?

A. Increase the flow of filtrate.

B. Secrete more acids and reabsorb more bicarbonate ions.

C. Excrete a larger volume of more dilute urine.

D. Retain more potassium ions in exchange for sodium ions.

18. From the following, choose the substance likely to appear in the urine when the glomerulus is inflamed.

A. albumin

B. urea

C. sodium

D. creatinine

19. What factors contribute to headache, anorexia, and lethargy with kidney disease? 1. increased blood pressure 2. elevated serum urea 3. anemia 4. acidosis

A. 1 only

B. 2, 4

C. 1, 3, 4

D. 1, 2, 3, 4

20. What does hydronephrosis lead to?

A. ischemia and fibrosis in the compressed area

B. multiple hemorrhages in the kidney

C. severe colicky pain radiating into the groin

D. increased GFR

21. Common causes of urolithiasis include all of the following EXCEPT:

A. hypercalcemia

B. hyperlipidemia

C. inadequate fluid intake

D. hyperuricemia

22. Renal disease frequently causes hypertension because:

A. albuminuria increases vascular volume

B. congestion and ischemia stimulates release of renin

C. ADH secretion is decreased

D. damaged tubules absorb large amounts of filtrate

23. When comparing normal kidney function with dialysis, which of the following mechanisms is not possible in dialysis?

A. diffusion

B. osmosis

C. ultrafiltration

D. active transport

24. Pyelonephritis may be distinguished from cystitis by the presence in pyelonephritis of:

A. microbes, leukocytes, and pus in the urine

B. painful micturition

C. urgency and frequency

D. urinary casts and flank pain

25. What are the significant signs of nephrotic syndrome?

A. hyperlipidemia and lipiduria

B. pyuria and leucopenia

C. hypertension and heart failure

D. gross hematuria and pyuria

26. Why does blood pressure often remain near normal in patients with nephrotic syndrome?

A. Massive amounts of fluid are lost from the body with polyuria.

B. Renin and aldosterone are no longer secreted.

C. Tubules do not respond to ADH and aldosterone.

D. Hypoproteinemia results in significant fluid shift to the interstitial compartment.

27. Why does metabolic acidosis develop with bilateral kidney disease?

A. Tubule exchanges are impaired.

B. GFR is increased.

C. Serum urea is increased.

D. More bicarbonate ion is produced.

28. Which of the following functions would be impaired when tubular epithelial cells have been damaged?

A. adjusting the specific gravity of the urine

B. reabsorbing the plasma proteins

C. secreting renin

D. exchanging sodium ions for bicarbonate ions

29. Why may acute pyelonephritis and cystitis follow untreated prostatitis?

A. Microbes spread through the circulation.

B. Antibodies have not yet formed.

C. There is no effective treatment.

D. There is a continuous mucosa along these structures.

30. What causes the dark urine associated with acute poststreptococcal glomerulonephritis?

A. increased glomerular permeability resulting in gross hematuria

B. proteinuria and microscopic hematuria from the inflammation

C. pyuria from inflammatory exudate

D. bleeding from ulcerations in the kidneys

31. Urinary casts are present with acute poststreptococcal glomerulonephritis because of:

A. large numbers of microbes and leukocytes enter the filtrate

B. ruptured capillaries release debris into the tubules

C. normal reabsorption of cells and proteins cannot take place

D. inflamed tubules mold RBCs and protein into a typical mass

32. Which of the following results from obstruction of the left ureter by a renal calculus?

A. mild flank pain on the affected side

B. hydronephrosis in both kidneys

C. immediate cessation of urine production

D. an attack of renal colic

33. Which pathophysiologic process applies to acute poststreptococcal glomerulonephritis?

A. streptococcal infection affects both the glomerular and tubule functions

B. ischemic damage occurs in the tubules, causing obstruction and decreased GFR

C. immune complexes deposit in glomerular tissue, causing inflammation

D. increased glomerular permeability for unknown reasons

34. What is the first indicator in the arterial blood gases of acidosis caused by kidney disease?

A. increased carbonic acid

B. increased bicarbonate ion

C. pH less than 7.35

D. decreased bicarbonate ion