Guyton Review Renal Questions

27. A patient is referred for treatment of HTN. After testing you discover he has a very high level of plasma aldosterone, and your diagnosis is Conn's syndrome. What would you expect to find on lab work? Answers in order of plasma pH, plasma [K+], urine K+ excretion, urine Na excretion, and plasma [Renin] a. Increase, decrease, no change, no change, decrease b. Decrease, decrease, no change, no change, decrease c. Increase, decrease, increase, decrease, decrease d. Increase, increase, no change, decrease, increase

A

34. The GFR of a 26 year old man with glomerulonephritis decreases by 50% and remains at that level. For which substance would you expect to find the greatest increase in plasma concentration? a. Creatinine b. K+ c. Glucose d. Na+ e. Phosphate f. H+

A

14. In normal kidneys, which of the following is true of the osmolarity of renal tubular fluid that flows through the early distal tubule in the region of the macula dense? a. Usually isotonic compared with plasma b. Usually hypotonic compared with plasma c. Usually hypertonic compared with plasma d. Hypertonic, compared with plasma, in antidiuresis

B

65. A patient's urine is collected for 2 hours and the total volume is 600 mL. Her urine osmolarity is 150 mOsm/L and her plasma osmolarity is 300 mOsm/L. What is her "free water clearance"? a. +5.0 mL/min b. +2.5 mL/min c. 0.0 mL/min d. -2.5 mL/min e. -5.0 mL/min

B

109. What would tend to decrease GFR by more than 10% in a normal kidney? a. Decrease in renal arterial pressure from 100 to 85 mmHg b. 50% decrease in afferent arteriolar resistance c. 50% decrease in efferent arteriolar resistance d. 50% increase in the glomerular capillary filtration coefficient e. Decrease in plasma colloid osmotic pressure from 28 to 20 mmHg

C

15. Which of the following changes would be expected in a patient with diabetes insipidus due to a lack of ADH secretion? Answers in order of plasma osmolarity concentration, plasma sodium concentration, plasma renin, urine volume a. No change, no change, decrease, increase b. No change, no change, increase, increase c. Increase, increase, increase, increase d. Increase, increase, no change, no change e. Decrease, decrease, decrease, no change

C

16. A 26 year old woman recently decided to adopt a healthier diet and eat more fruits and vegetables. As a result, her K+ intake increased from 80 to 160 mmol/day. Which of the following conditions would you expect to find 2 weeks after she increased her K+ intake, compared with before the increase? Answers in order of K+ excretion rate, Na excretion rate, plasma [aldosterone], and plasma [K+] a. No change, no change, increase, large increase b. No change, decrease, increase, small increase c. 12x, no change, increase, small increase d. 12x, increase, decrease, large increase e. 12x, increase, no change, large increase

C

20. A patient with severe HTN (185/110 mmHg) is referred to you. A renal MRI shows a tumor in the kidney and lab findings include a very high plasma renin activity of 12 ng angiotensin 1/mL/h (normal = 1). The diagnosis if a renin secreting tumor. Which of the following changes would you expect to find in this patient? Answers in order of plasma [aldosterone], sodium excretion rate, plasma [K=], and renal blood flow a. No change, decrease, decrease, increase b. No change, no change, decrease, increase c. Increase, no change, decrease, decrease d. Increase, decrease, no change, decrease e. Increase, decrease, decrease, no change

C

29. Which change tends to increase GFR? a. Increased afferent arteriolar resistance b. Decreased efferent arteriolar resistance c. Increased glomerular capillary filtration coefficient d. Increased Bowman's capsule hydrostatic pressure e. Decreased glomerular capillary hydrostatic pressure

C

3. A 36 y/o woman reports headaches and frequent urination. Lab values reveal: Urine specific gravity = 1.003 Urine protein = negative Plasma sodium = 165 mmol/L Plasma potassium = 4.4 mmol/L Plasma creatinine = 1.4 mg/dL Blood pressure = 88/40 mmHg Heart rate 115 bpm What is the most likely cause of her elevated plasma sodium concentration a. Primary aldosteronism b. Diabetes mellitus c. Diabetes insipidus d. Simple dehydration due to insufficient water consumption e. Bartter's syndrome f. Liddle's syndrome

C

A person with normal body fluid volumes weighs 60 kg and has an ECFV of approximately 12.8 L, a blood volume of 4.3 L and a hematocrit of 0.4. 57% of his body weight is water. 80. What is the approximate intracellular fluid volume? a. 17.1 L b. 19.6 L c. 21.4 L d. 23.5 L e. 25.6 L

C

31. What is the net renal tubular reabsorption rate of K+ in the patient from question 5? a. 0.020 mmol/min b. 0.040 mmol/min c. 0.090 mmol/min d. 0.110 mmol/min e. 0.200 mmol/min f. K+ is not reabsorbed in this example

D

74. If a person has a kidney transport maximum for glucose of 250 mg/min, a GFR of 100 mL/min, a plasma [glucose] of 150 mg/dL, a urine flow rate of 2 mL/min, and no detectable glucose in the urine, what would be the approximate rate of glucose reabsorption assuming normal kidneys? a. Glucose reabsorption cannot be estimated from this data b. 0 mg/min c. 50 mg/min d. 150 mg/min e. 350 mg/min

D

79. A patient reports that he is always thirsty and his breath has an acetone smell. You suspect that he has diabetes mellitus and that diagnosis is confirmed by a urine sample that test positive for glucose and a blood sample that shows a fasting blood glucose concentration of 400 mg/dL. Compared to normal, what changes would you expect to find in his urine? Answers in order of urine pH, NH4 excretion, urine volume, and renal HCO3 production a. Decrease, decrease, decrease, decrease b. Decrease, increase, decrease, decrease c. Increase, decrease, decrease, decrease d. Decrease, increase, increase, increase e. Increase, increase, increase, increase

D

84. The principle cells in the cortical collecting tubules a. Are the main site of action of the thiazide diuretics b. Have sodium-chloride-potassium co-transporter c. Are highly permeable to urea during antidiuresis d. Are an important site of action of amiloride e. Are the main site of action of furosemide

D

96. Which of the following would be the most likely cause of hypernatremia associated with a small volume of highly concentrated urine (osmolarity = 1400 mOsm/L) in a person with normal kidneys? a. Primary aldosteronism b. Diabetes mellitus c. Diabetes insipidus d. Dehydration due to insufficient water intake and heavy exercise e. Bartter's syndrome f. Liddle's syndrome

D

A 65 year old man had a heart attack and experiences cardiopulmonary arrest while being transport to the ED. These were his lab values: Plasma pH = 7.12 Plasma pCO2 = 60 mmHg Plasma [HCO3-] = 19 mEq/L 23. Which of the following options best describes his acid-base disorder? a. Respiratory acidosis with partial renal compensation b. Metabolic acidosis with partial respiratory compensation c. Mixed acidosis: combined metabolic and respiratory d. Mixed alkalosis: combined metabolic and respiratory

D

Lab results (use for #10 and 11) Urine flow rate = 1 mL/min Urine [insulin] = 100 mg/mL Plasma [insulin] = 2 mg/mL Urine [urea] = 50 mg/mL Plasma [urea] = 2.5 mg/mL 11. What is the net urea reabsorption rate? a. 0 mg/min b. 25 mg/min c. 50 mg/min d. 75 mg/min e. 100 mg/min

D

The following test results were obtained: urine flow rate = 2.0 mL/min, urine [inulin] = 60 mg/mL plasma [inulin] = 2 mg/mL, urine [K+] = 20 umol/mL, plasma [K+] = 4.0 umol/mL, urine osmolarity = 150 mOsm/L, and plasma osmolarity = 300 mOsm/L 102. What is the approximate GFR? a. 20 mL/min b. 25 mL/min c. 30 mL/min d. 60 mL/min e. 75 mL/min f. 150 mL/min

D

The following test results were obtained: urine flow rate = 2.0 mL/min, urine [inulin] = 60 mg/mL plasma [inulin] = 2 mg/mL, urine [K+] = 20 umol/mL, plasma [K+] = 4.0 umol/mL, urine osmolarity = 150 mOsm/L, and plasma osmolarity = 300 mOsm/L 103. What is the net potassium reabsorption rate? a. 0 umol/min b. 20 umol/min c. 60 umol/min d. 200 umol/min e. 240 umol/min f. 300 umol/min g. Potassium is not reabsorbed in this case

D

To evaluate kidney function in a 45 y/o woman with TIIDM, you ask her to collect urine for 24 hours. She collects 3600 mL. The lab returns the following results: plasma creatinine = 4 mg/dL, urine creatinine = 32 mg/dL, plasma potassium = 5 mmol/L, and urine potassium = 10 mmol/L. 88. What is the net renal tubular reabsorption rate of potassium in this patient? a. 1.050 mmol/min b. 0.100 mmol/min c. 0.037 mmol/min d. 0.075 mmol/min e. Potassium is not reabsorbed in this example

D

101. In a patient with very high levels of aldosterone and otherwise normal kidney function, approximately what percentage of the filtered load of sodium would be reabsorbed by the distal convoluted tubule and collecting duct? a. >66% b. 40-60% c. 20-40% d. 10-20% e. <10%

E

111. A 55 y/o overweight male patient reports frequent urination and his BP is 165/98 mmHg. Based on 24 creatinine clearance, you estimate his GFR to be 150 mL/min. His plasma glucose is 400 mg/100 mL. Assuming that his renal transport maximum for glucose is normal, what would be the approximate rate of urinary glucose excretion for this patient? a. 0 mg/min b. 100 mg/min c. 150 mg/min d. 225 mg/min e. 300 mg/min f. The information provided is inadequate to estimate glucose excretion rate

E

98. Which of the following has similar values for both intracellular and interstitial body fluids? a. [K+] b. Colloid osmotic pressure c. [Na+] d. [Cl-] e. Total osmolarity

E

71. Long term administration of furosemide would do what? a. Inhibit the Na-Cl co-transporter in the renal distal tubules b. Inhibit the Na-Cl-K co-transporter in the renal tubules c. Tend to reduce renal concentrating ability d. Tend to cause hyperkalemia e. A and C f. B and C g. B, C, and D

F

Match the following patients to these results: pH-HCO3-pCO2-Na-Cl A 7.66 22 20 143 111 B 7.28 30 65 142 102 C 7.24 12 29 144 102 D 7.29 14 30 143 117 E 7.52 38 48 146 100 F 7.07 14 50 144 102 92. A patient with diabetic ketoacidosis and emphysema

F

107. Which change tends to increase urinary calcium excretion? a. Extracellular fluid volume expansion b. Increased plasma [PTH] c. Decreased blood pressure d. Increased plasma [phosphate] e. Metabolic alkalosis

A

12. If a patient has a creatinine clearance of 90 mL/min, a urine flow rate of 1 mL/min, a plasma [K+] of 4 mEq/L, and a urine [K+] of 60 mEq/L, what is the approximate rate of K+ excretion? a. 0.06 mEq/min b. 0.30 mEq/min c. 0.36 mEq/min d. 3.6 mEq/min e. 60 mEq/min

A

19. An 8 year old boy is brought to your office with extreme swelling of the abdomen. His parents indicate that he had a sore throat a month or so ago and that he has been swelling gup since that time. He appears to be edematous and when you check his urine, you find that large amounts of protein are being excreted. Your diagnosis is nephrotic syndrome subsequent to glomerulonephritis. Which of the following changes would you expect to find, compared to normal? Answers in order of thoracic lymph flow, interstitial fluid protein concentration, interstitial fluid hydrostatic pressure, and plasma renin concentration a. Increase, decrease, increase, increase b. Increase, decrease, increase, no change c. Increase, decrease, no change, increase d. Decrease, increase, no change, no change e. Decrease, decrease, decrease, decrease

A

38. If the average hydrostatic pressure in the glomerular capillaries is 50 mmHg, the hydrostatic pressure in the Bowman's space is 12 mmHg, the average colloid osmotic pressure in the glomerular capillaries is 30 mmHg, and there is no protein in the glomerular ultrafiltrate, what is the net pressure driving glomerular filtration a. 8 mmHg b. 32 mmHg c. 48 mmHg d. 60 mmHg e. 92 mmHg

A

61. Which change compared to normal would be expected to occur in a patient who severe renal disease has reduced the number of function nephrons to 25% of normal? a. Increased GFR of the surviving nephrons b. Decreased urinary creatinine excretion rate c. Decreased urine flow rate in the surviving nephrons d. Decreased urinary excretion of Na e. Increased urine concentrating ability

A

62. Which of the following would likely lead to hyponatremia? a. Excessive ADH secretion b. Restriction of fluid intake c. Excess aldosterone secretion d. Administration of 2L of 3% NaCl solution e. Administration of 2L of 0.9% NaCl solution

A

63. Assuming steady state conditions and that water and electrolyte intake remained constant, a 75% loss of nephrones and a 75% decrease in GFR due to chronic kidney disease would cause all of the following changes EXCEPT what? a. A large increase in plasma [sodium] b. An increase in plasma creatinine to four times normal c. An increase in average volume excreted per remaining nephron to four times normal d. A significant increase in plasma [phosphate] e. Reduced ability of the kidney to maximally concentrate the urine

A

67. In a person on a very low potassium diet, which part of the nephron would be expected to reabsorb the most potassium? a. Proximal tubule b. descending limb of the loop of Henle c. thick ascending loop of Henle d. Distal tubule e. collecting duct

A

68. Which part of the nephron normally reabsorbs the most water? a. Proximal tubule b. descending limb of the loop of Henle c. thick ascending loop of Henle d. Distal tubule e. collecting duct

A

85. A patient has a GFR of 100 mL/min, her urine flow rate is 2.0 mL/min, and her plasma [glucose] is 200 mg/100 mL. If the kidney transport maximum for glucose is 250 mg/min, what would be her approximate rate of glucose excretion? a. 0 b. 50 mg/min c. 100 mg/min d. 150 mg/min e. 200 mg/min f. 300 mg/min g. Glucose excretion rate cannot be estimated from this data

A

The following test results were obtained: urine flow rate = 2.0 mL/min, urine [inulin] = 60 mg/mL plasma [inulin] = 2 mg/mL, urine [K+] = 20 umol/mL, plasma [K+] = 4.0 umol/mL, urine osmolarity = 150 mOsm/L, and plasma osmolarity = 300 mOsm/L 104. What is the free water clearance rate? a. +1.0 mL/min b. +1.5 mL/min c. +2.0 mL/min d. -1.0 mL/min e. -1.5 mL/min f. -2.0 mL/min

A

105. Assume that you have a patient who needs fluid therapy and you decide to administer 2 L of 0.45% of NaCl solution via IV infusion. After osmotic equilibrium, which changes would you expect compared to normal? Answers in order of ICFV, intracellular osmolarity, ECFV, and extracellular osmolarity a. Increase, increase, increase, increase b. Increase, decrease, increase, decrease c. No change, increase, increase, increase d. Decrease, increase, increase, increase e. Decrease, decrease, decrease, decrease

B

2. Partial obstruction of a major vein draining a tissue would tend to __ lymph flow rate, __ interstitial fluid hydrostatic pressure, and __ interstitial fluid protein concentration in the tissue drained by that vein a. Increase, increase, increase b. Increase, increase, decrease c. Increase, decrease, decrease d. Decrease, decrease, decrease e. Decrease, increase, increase f. Decrease, increase, decrease

B

21. The clinical laboratory returned the following values for arterial blood taken from a patient: plasma pH = 7.28, plasma HCO3- = 32 mEq/L, and plasma pCO2 = 70 mmHg. What is the patients acid-base disorder? a. Acute respiratory acidosis without renal compensation b. Respiratory acidosis with partial renal compensation c. Acute metabolic acidosis without respiratory compensation d. Metabolic acidosis with partial respiratory compensation

B

25. What would cause the greatest degree of hyperkalemia? a. Increase in K+ intake from 60 to 180 mmol/day in a person with normal kidneys and a normal aldosterone system b. Chronic treatment with a diuretic that inhibits the action of aldosterone c. Decrease in Na intake from 200 to 100 mmol/day d. Chronic treatment with a diuretic that inhibits loop of Henle Na+ 2Cl- K+ co-transport

B

28. A patient with renal disease has a plasma creatinine of 2 mg/dL during an exam two months ago. You note his BP has increased about 30 mmHg since his last visit and lab tests indicate his plasma creatinine is now 4 mg/dL. Which of the following changes in lab work would you expect to see? Answers in order of Na excretion rate, creatinine excretion rate, creatinine clearance, and filtered load of creatinine a. No change, no change, decreased by 50%, decreased b. No change, no change, decreased by 50%, no change c. No change, no change, decreased by 75%, decrease d. Decrease, decrease, no change, no change e. Decrease, decrease, decrease by 50%, decrease

B

40. IV infusion of 1L of 0.45% NaCl solution (MW of NaCl = 58.5) would cause which of the following changes after osmotic equilibrium? Answers in order of ICFV, intracellular fluid osmolarity, ECFV, extracellular fluid osmolarity a. Increase, increase, increase, increase b. Decrease, decrease, increase, decrease c. No change, increase, increase, increase d. Decrease, increase, increase, increase e. Decrease, decrease, decrease, decrease

B

45. An adrenal tumor that causes excess aldosterone secretion would tend to __ plasma [K+], __ plasma pH, __ renin secretion, and __ blood pressure a. Decrease, decrease, decrease b. Decrease, increase, decrease, increase c. Decrease, decrease, decrease, increase d. Decrease, increase, increase, increase, e. Increase, increase, decrease, increase f. Increase, decrease, decrease, increase

B

54. A female patient has unexplained severe hypernatremia (plasma Na+ = 167 mmol/L) and reports frequent urination and large urine volumes. A urine specimen reveals that [Na+] = 15 mmol/L (very low) and the osmolarity is 155 mOsm/L (very low). Lab tests reveal the following: plasma renin activity = 3 ng angiotensin 1/mL/h (normal = 1.0), plasma ADH = 30 pg/mL (normal = 3) and plasma aldosterone = 20 ng/dL (normal = 6). Which of the following is the most likely reason for her hypernatremia? a. Simple dehydration due to decreased water intake b. Nephrogenic diabetes insipidus c. Central diabetes insipidus d. Syndrome of inappropriate ADH e. Primary aldosteronism f. Renin secreting tumor

B

59. Under conditions of normal renal function, what is true of the concentration of urea in tubular fluid at the end of the proximal tubule? a. It is higher than the concentration of urea in the tubular fluid at the top of the loop of Henle b. It is higher than the concentration of urea in the plasma c. It is higher than the concentration of urea in the final urine in antidiuresis d. It is lower than plasma urea concentration because of active urea reabsorption along the proximal tubule

B

75. Which diuretic inhibits Na-2Cl-K co-transport in the loop of Henle as its primary action? a. Thiazide diuretic b. Furosemide c. Carbonic anhydrase inhibitor d. Osmotic diuretic e. Amiloride f. Spironolactone

B

94. Which change would you expect to find in a patient who developed acute renal failure after ingesting poisonous mushrooms that caused renal tubular necrosis? a. Increased plasma [bicarbonate] b. Metabolic acidosis c. Decrease plasma [potassium] d. Decreased BUN e. Decreased hydrostatic pressure in Bowman's capsule

B

99. Which of the following is true of the tubular fluid that passes through the lumen of the early distal tubule in the region of the macula densa? a. Usually isotonic b. Usually hypotonic c. Usually hypertonic d. Hypertonic in antidiuresis e. Hypertonic when the filtration rate of its own nephron decreases to 50% below normal

B

Assume the following initial conditions: ICFV = 40% of body weight before fluid administration, ECFV = 20% of body weight before fluids, molecular weight of NaCl = 58.5 g/mol and no excretion of water or electrolytes. 36. What is the approximate ECFV in this patient after administration of the NaCl solution and osmotic equilibrium? a. 15.1 L b. 17.2 L c. 19.1 L d. 19.8 L e. 21.2 L

B

Lab results (use for #10 and 11) Urine flow rate = 1 mL/min Urine [insulin] = 100 mg/mL Plasma [insulin] = 2 mg/mL Urine [urea] = 50 mg/mL Plasma [urea] = 2.5 mg/mL 10. What is the GFR? a. 25 mL/min b. 50 mL/min c. 100 mL/min d. 125 mL/min e. None of the above

B

To evaluate kidney function in a 45 y/o woman with TIIDM, you ask her to collect urine for 24 hours. She collects 3600 mL. The lab returns the following results: plasma creatinine = 4 mg/dL, urine creatinine = 32 mg/dL, plasma potassium = 5 mmol/L, and urine potassium = 10 mmol/L. 87. What is this patient's approximate GFR? a. 10 b. 20 mL/min c. 30 mL/min d. 40 mL/min e. 80 mL/min

B

1. Which of the following solutions, when infused intravenously, would result in an increase in extracellular fluid volume, a decrease in intracellular fluid volume, and an increase in total body water after osmotic equilibrium? a. 1L of 0.9% NaCl solution b. 1L of 0.45% NaCl solution c. 1L of 3% NaCl solution d. 1L of 5% dextrose solution e. 1L of pure water

C

106. If the renal clearance of substance X is 300 mL/min and the glomerular filtration rate is 100 mL/min, it is most likely that substance X is a. Filtered freely but not secreted or reabsorbed b. Bound to plasma proteins c. Secreted d. Reabsorbed e. Bound to tubular proteins f. Clearance of a substance cannot be greater than the GFR

C

108. Which change would you expect to find in a patient consuming a high sodium diet (200 mEq/day) compared to a normal sodium diet (100 mEq/day)? a. Increased plasma [aldosterone] b. Increased urinary potassium excretion c. Decreased plasma renin activity d. Decreased plasma ANP e. An increase in plasma [sodium] of at least 5 mmol/L

C

33. A patient that has the following lab values Arterial pH = 7.13 Plasma HCO3- = 15 mEq/L Plasma [Cl-] = 118 mEq/L Arterial pCO2 = 28 mmHg Plasma [Na+] = 141 mEq/L What is the most likely cause of his acidosis? a. Salicyclic acid poisoning b. Diabetes mellitus c. Diarrhea d. Emphysema

C

37. Which changes would you expect to find after administering a vasodilator drug that caused a 50% decrease in afferent arteriolar resistance and no change in arterial pressure? a. Decreased RBF, decreased GFR, decreased peritubular capillary hydrostatic pressure b. Decreased RBF, decreased GFR, increased peritubular capillary hydrostatic pressure c. Increased RBF, increased GFR, increased peritubular capillary hydrostatic pressure d. Increased RBF, increased GFR, no change in peritubular capillary hydrostatic pressure e. Increased RBF, Increased GFR, decreased peritubular capillary hydrostatic pressure

C

42. If a distal tubule fluid creatinine concentration is 5 mg/100 mL and plasma creatinine concentration is 1.0 mg/100 mL what is the approximate percentage of the water filtered by the glomerular capillaries that remains in the distal tubule? a. 5% b. 10% c. 20% d. 50% e. 80% f. 95%

C

43. Which change tends to increase peritubular capillary fluid reabsorption? a. Increased blood pressure b. Decreased filtration fraction c. Increased efferent arteriolar resistance d. Decreased angiotensin II e. Increased renal blood flow

C

44. A 32 y/o man reports frequent urination. He is overweight (280 lbs = 127 kg), 5 feet 10 inches (178 cm) tall. After measuring the 24 hour creatinine clearance, you estimate his GFR to be 150 mL/min. His plasma glucose level is 300 mg/dL. Assuming that his renal transport maximum for glucose is normal, what would be his approximate rate of urinary glucose excretion? a. 0 mg/min b. 100 mg/min c. 150 mg/min d. 225 mg/min e. 300 mg/min f. Information is inadequate to estimate

C

56. Juvenile (type I) diabetes mellitus is often diagnosed because of polyuria and polydipsia that occur because of which of the following? a. Increased delivery of glucose to the collecting duct interferes with the action of ADH b. Increased glomerular filtration of glucose increases Na+ reabsorption via the Na-glucose transporter c. When the filtered load of glucose exceeds the renal threshold, a rising glucose concentration in the proximal tubule decreases the osmotic driving forces for water reabsorption d. High plasma glucose concentration decreases thirst e. High plasma glucose concentration stimulates ADH release from the posterior pituitary

C

57. Which of the following would cause the most serious hypokalemia? a. A decrease in K intake from 150 mEq/day to 60 mEq/day b. An increase in Na intake from 100 to 200 mEq/day c. Excessive aldosterone secretion plus high Na intake d. Excessive aldosterone secretion plus low Na intake e. A patient with addison's disease f. Treatment with a B-adrenergic blocker g. Treatment with spironolactone

C

60. You begin treating a hypertensive patient with a powerful loop diuretic. Which changes would you expect to find compared to pre-treatment values when the patient returns for follow up 2 weeks later? Answers in order of urine Na excretion, ECFV, blood pressure, and plasma [K+] a. Increase, decrease, decrease, decrease b. Increase, decrease, no change, no change c. No change, decrease, decrease, decrease d. No change, decrease, no change, no change e. Increase, no change, decrease, increase

C

69. In a normally functioning kidney, which part of the tubule has the lowest permeability to water during antidiuresis? a. Proximal tubule b. descending limb of the loop of Henle c. thick ascending loop of Henle d. Distal tubule e. collecting duct

C

8. Which of the following tends to decrease potassium secretion by the cortical collecting tubule? a. Increase plasma potassium concentration b. A diuretic that decreases proximal tubule sodium resorption c. A diuretic that inhibits the action of aldosterone d. Acute alkalosis e. High sodium intake

C

83. Which nephron segment is the primary site of magnesium reabsorption under normal conditions? a. Proximal tubule b. Descending limb of the loop of Henle c. Ascending limb of the loop of Henle d. Distal convoluted tubule e. Collecting ducts

C

86. Which changes would you expect to find in a newly diagnosed 10 y/o patient with type I diabetes and uncontrolled hyperglycemia Answers in order of thirst, urine volume, glomerular filtration rate, and afferent arteriolar resistance a. Increase, decrease, increase, decrease b. Increase, increase, decrease, increase c. Increase, increase, increase, decrease d. Decrease, increase, increase, increase e. Decrease, decrease, decrease, decrease

C

9. Because the usual rate of phosphate filtration exceeds the transport maximum for phosphate reabsorption, which statement is true? a. All the phosphate that is filtered is reabsorbed b. More phosphate is reabsorbed than is filtered c. Phosphate in the tubules can contribute significantly to titratable acid in the urine d. The "threshold" for phosphate is usually not exceeded e. PTH must be secreted for phosphate reabsorption to occur

C

95. The type A intercalated cells in the collecting tubules... a. Are highly permeable to urea during antidiuresis b. Secrete K+ c. Secrete H+ d. Are the main site of action of furosemide e. Are the main site of action of thiazide diuretics

C

97. The most serious hypokalemia would occur in which condition? a. Decrease in potassium intake from 150 to 60 mEq/day b. Increase in sodium intake from 100 to 200 mEq/day c. Fourfold increase in aldosterone secretion plus high sodium intake d. Fourfold increase in aldosterone secretion plus low sodium intake e. Addison's disease

C

A 65 year old man had a heart attack and experiences cardiopulmonary arrest while being transport to the ED. These were his lab values: Plasma pH = 7.12 Plasma pCO2 = 60 mmHg Plasma [HCO3-] = 19 mEq/L 24. In this patient which of the following lab results would be expected? a. Increased renal excretion of HCO3- b. Decreased urinary titratable acid c. Increased urine pH d. Increased renal excretion of NH4+

C

A person with normal body fluid volumes weighs 60 kg and has an ECFV of approximately 12.8 L, a blood volume of 4.3 L and a hematocrit of 0.4. 57% of his body weight is water. 81. What is the approximate plasma volume? a. 2.0 L b. 2.3 L c. 2.6 L d. 3.0 L e. 3.3 L

C

A person with normal body fluid volumes weighs 60 kg and has an ECFV of approximately 12.8 L, a blood volume of 4.3 L and a hematocrit of 0.4. 57% of his body weight is water. 82. What is the approximate interstitial fluid volume? a. 6.4 L b. 8.4 L c. 10.2 L d. 11.3 L e. 12.0 L

C

Assume the following initial conditions: ICFV = 40% of body weight before fluid administration, ECFV = 20% of body weight before fluids, molecular weight of NaCl = 58.5 g/mol and no excretion of water or electrolytes. 35. A male patient appears to be dehydrated and after obtaining a plasma sample, you find hyponatremia with a plasma [Na+] of 130 mmol/L and plasma osmolarity of 260 mOsm/L. You decide to administer 2L of 3% NaCl. His body weight was 60 kg before fluid is administered. What is his approximate plasma osmolarity after administration of the NaCl solution and after osmotic equilibrium? a. 273 mOsm/L b. 286 mOsm/L c. 300 mOsm/L d. 310 mOsm/L e. 326 mOsm/L

C

100. In a person with normal kidneys and normal lungs who has chronic metabolic acidosis, you would expect to find all of the following EXCEPT: a. Increased renal excretion of NH4Cl b. Decreased urine pH c. Decreased urine HCO3 excretion d. Increased plasma [HCO3] e. Decreased plasma pCO2

D

110. Acute metabolic acidosis tends to __ intracellular [K+] and __ K+ secretion by the cortical collecting tubules a. Increase, increase b. Increase, decrease c. Decrease, increase d. Decrease, decrease e. Cause no change in, increase f. Cause no change in, cause no change in

D

17. When the dietary intake of K+ increase, body K+ balance is maintained by an increase in K+ excretion primarily by which of the following? a. Decreased glomerular filtration of K+ b. Decreased reabsorption of K+ by the proximal tubule c. Decreased reabsorption of K+ by the thick ascending limb of the Loop of Henle d. Increased K+ secretion by the late distal and collecting tubules e. Shift of K+ into the intracellular compartment

D

22. The following lab values were obtained from a 58 year old man: Urine volume = 4320 mL over 24 hours Plasma creatinine = 3mg/100mL Urine creatinine = 50 mg/100mL Plasma K+ = 4.0 mmol/L Urine K+ = 30 mmol/L What is his approximate GFR, assuming that he collected all of his urine in the 24 hour period? a. 20 mL/min b. 30 mL/min c. 40 mL/min d. 50 mL/min e. 60 mL/min f. 80 mL/min g. 100 mL/min

D

26. Which of the following changes would be expected in a patient with Liddle's syndrome (excessive activity of amiloride-sensitive sodium channel in the collecting tubule)? Answers in order of plasma renin concentration, blood pressure, sodium excretion concentration, and plasma aldosterone a. No change, increase, decrease, no change b. Increase, increase, no change, increase c. Increase, increase, decrease, decrease d. Decrease, increase, no change, decrease e. Decrease, increase, decrease, decrease f. Decrease, decrease, increase, increase

D

30. Which of the following changes would you expect to find 3 weeks after a patient ingested a toxin that caused sustained impairment of proximal tubular NaCl reabsorption? Answers in order of GFR, afferent arteriolar resistance, sodium excretion a. No change, no change, increase b. No change, no change, increase (maybe meant to be decrease?) c. Decrease, increase, increase d. Decrease, increase, no change e. Increase, decrease, no change

D

32. The maximum clearance rate possible for a substance that is totally cleared from the plasma is equal to which of the following? a. GFR b. Filtered load of that substance c. Urinary excretion rate of that substance d. Renal plasma flow e. Filtration fraction

D

39. In a patient with chronic uncontrolled diabetes mellitus, which set of conditions would you expect to find? Answers in order of titratable acid excretion, NH+ excretion, HCO3- excretion, and plasma pCO2 a. No change, increased, decreased, no change b. Decreased, increased, no change, decreased c. Increased, increased, no change, decreased d. Increased, increase, decrease, decrease e. Decrease, decrease, decrease, decrease f. No change, increase, decrease, no change

D

4. After receiving a kidney transplant, a patient has severe HTN (170/110 mmHg). A renal arteriogram indicates severe renal artery stenosis in his single remaining kidney, with a reduction in glomerular filtration rate (GFR) to 25% of normal. Which of the following changes, compared to normal, would be expected in this patient assuming steady-state conditions? a. Large increase in plasma sodium concentration b. Reduction in urinary sodium excretion to 25% of normal c. Reduction in urinary creatinine excretion to 25% of normal d. Increase in serum creatinine to about four times normal e. Normal renal blood flow in the stenotic kidney due to autoregulation

D

53. Furosemide (Lasix) is a diuretic that also produces natriuresis. Which of the following is an undesirable side effect of furosemide due to its site of action on the renal tubule? a. Edema b. Hyperkalemia c. Hypercalcemia d. Decreased ability to concentrate the urine e. Heart failure

D

55. Which change would you expect to find in a dehydrated person deprived of water for 24 hours? a. Decreased plasma renin activity b. Decreased plasma ADH concentration c. Increased plasma ANP concentration d. Increased water permeability of the collecting duct

D

58. A 26 y/o woman reports that she has had a severe migraine and has taken six times more than the recommended dose of aspiring for the past 3 days to relieve her headaches. Her plasma pH is 7.24. Which of the following would you expect to find? Answers in order as plasma HCO3- concentration, plasma pCO2, urine HCO3- concentration, urine NH4+ excretion, and plasma anion gap a. Increase, decrease, increase, increase, increase b. Increase, increase, increase, decrease, increase c. Decrease, decrease, decrease, decrease, decrease d. Decrease, decrease, decrease, increase, increase e. Decrease, decrease, decrease, increase, decrease f. Decrease, no change, decrease, decrease, no change

D

64. Which statement is true? a. Urea reabsorption in the medullary collecting tubule is less than in the distal convoluted tubule during antidiuresis b. Urea concentration in the interstitial fluid of the renal cortex is greater than in the interstitial fluid of the renal medulla during antidiuresis c. The thick ascending limb of the loop of Henle reabsorbs more urea than the inner medullary collecting tubule during antidiuresis d. Urea reabsorption in the proximal tubule is greater than in the cortical collecting tubule

D

70. Which substances are best suited to measure interstitial fluid volume? a. Inulin and heavy water b. Inulin and 22Na c. Heavy water and 125I-albumin d. Inulin and 125I-albumin e. 51Cr RBCs and 125I-albumin

D

72. A patient with normal lungs who has uncontrolled type I diabetes and a plasma [glucose] of 400 mg/100 mL (normal ~100/100) would be expected to have which set of blood values? Answers in order of pH, HCO3, pCO2, Na, Cl a. 7.66, 22, 20, 143, 111 b. 7.52, 38, 48, 146, 100 c. 7.29, 14, 30, 143, 117 d. 7.25, 12, 28, 142, 102 e. 7.07, 14, 50, 144, 102

D

77. If the ratio of tubular fluid to plasma [inulin] in the proximal tubule is 3.0, 4.0 in the distal tubule, and 100 in the very distal collecting duct, if inulin is not reabsorbed, what is the approximate percentage of the filtered water that has been reabsorbed prior to the distal convoluted tubule? a. 25% b. 33% c. 66% d. 75% e. 99% f. 100%

D

Match the following patients to these results: pH-HCO3-pCO2-Na-Cl A 7.66 22 20 143 111 B 7.28 30 65 142 102 C 7.24 12 29 144 102 D 7.29 14 30 143 117 E 7.52 38 48 146 100 F 7.07 14 50 144 102 89. A patient with severe diarrhea

D

Match the following patients to these results: pH-HCO3-pCO2-Na-Cl A 7.66 22 20 143 111 B 7.28 30 65 142 102 C 7.24 12 29 144 102 D 7.29 14 30 143 117 E 7.52 38 48 146 100 F 7.07 14 50 144 102 91. A patient with proximal renal tubular acidosis

D

Match the following patients to these results: pH-HCO3-pCO2-Na-Cl A 7.66 22 20 143 111 B 7.28 30 65 142 102 C 7.24 12 29 144 102 D 7.29 14 30 143 117 E 7.52 38 48 146 100 F 7.07 14 50 144 102 93. A patient treated chronically with a carbonic anhydrase inhibitor

D

13. Given the following measurements, calculate the filtration fraction: Glomerular capillary hydrostatic pressure (PG)= 70 mmHg Bowman's space hydrostatic pressure (PB) = 20 mmHg Colloid osmotic pressure in the glomerular capillaries (πG) = 35 mmHg Glomerular capillary filtration coefficient (Kf) = 10 mL/min/mmHg Renal plasma flow = 428 mL/min a. 0.16 b. 0.20 c. 0.25 d. 0.30 e. 0.35 f. 0.40

E

18. Which of the following would cause the greatest decrease in GFR in a person with otherwise normal kidneys? a. Decrease in renal arterial pressure from 100 to 80 mmHg in a normal kidney b. 50% increase in glomerular capillary filtration coefficient c. 50% increase in proximal tubular sodium reabsorption d. 50% decrease in afferent arteriolar resistance e. 50% decrease in efferent arteriolar resistance f. 5 mmHg decrease in Bowman's capsule pressure

E

66. In a patient with severe central diabetes insipidus caused by a lack of ADH secretion, which part of the tubule would have the lowest tubular fluid osmolarity? a. Proximal tubule b. descending limb of the loop of Henle c. thick ascending loop of Henle d. Distal tubule e. collecting duct

E

73. Which of the following would be expected to cause a decrease in extracellular [K+] (hypokalemia) at least in part by stimulating K+ intake into the cells? a. a-adrenergic blockage b. Insulin deficiency c. Strenuous exercise d. Aldosterone deficiency (Addison's disease) e. Metabolic alkalosis

E

76. A selective decrease in efferent arteriolar resistance would __ glomerular hydrostatic pressure, __ GFR, and __ renal blood flow. a. Increase, increase, increase b. Increase, decrease, increase c. Increase, decrease, decrease d. Decrease, increase, decrease e. Decrease, decrease, increase f. Decrease, increase, increase

E

78. A patient with renal tubular acidosis would be expected to have which set of blood values? Answers in order of pH, HCO3, pCO2, Na, and Cl a. 7.66, 22, 20, 143, 111 b. 7.52, 38, 48, 146, 100 c. 7.07, 14, 50, 144, 102 d. 7.25, 12, 28, 142, 102 e. 7.29, 14, 30, 143, 117

E

Match the following patients to these results: pH-HCO3-pCO2-Na-Cl A 7.66 22 20 143 111 B 7.28 30 65 142 102 C 7.24 12 29 144 102 D 7.29 14 30 143 117 E 7.52 38 48 146 100 F 7.07 14 50 144 102 90. A patient with primary aldosteronism

E