Roddi urinary system

433. In the treatment of someone with progressive renal failure A. Protein should be excluded from the diet. B. Water intake should be restricted to about 0.5 litre/day. C. The diet should be potassium-free. D. Adequate dietary iron intake prevents anaemia. E. The calorific value of the diet should be gradually reduced.

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424. Dialysis fluid used in the treatment of renal failure should contain the normal plasma levels of A. Urea. B. Potassium. C. Osmolality. D. Plasma proteins. E. Hydrogen ions.

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412.The collecting ducts in the kidney A. Can actively transport water molecules into the urine. B. Are the site of most of renal water reabsorption. C. Are rendered impermeable to water by antidiuretic hormone (ADH). D. Pass through a region of exceptional hypertonicity. E. Determine to a large extent the final osmolality of urine.

FFFTT

415. In normal healthy people, urinary A. Specific gravity ranges from 1.010-1.020. B. Osmolality ranges from 200-400 mosmol/litre. C. Colour is due to small quantities of bile pigments. D. pH falls as dietary protein rises. E. Calcium excretion is increased by parathormone.

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395. Hydrostatic pressure in renal glomerular capillaries A. Is lower than pressure in efferent arterioles. B. Rises when afferent arterioles constrict. C. Is higher than in most capillaries at heart level. D. Falls by 10 per cent when arterial pressure falls by 10 per cent. E. Falls along the length of the capillary.

FFTFT

402. In the nephron, the osmolality of fluid in the A. Tip of the loop of Henle is less than that of plasma. B. Bowman's capsules is less than that in the distal tubules. C. Collecting duct rises when vasopressin is being secreted. D. Proximal convoluted tubule rises along its length. E. Medullary interstitium can exceed one osmole per litre.

FFTFT

413. Aldosterone A. Is a steroid hormone secreted by the adrenal medulla. B. Production ceases following removal of the kidneys and their juxtaglomerular cells. C. Production decreases in treatment with drugs which block angiotensin-converting enzyme. D. Secretion results in increased potassium reabsorption by the nephron. E. Secretion results in a fall in urinary PH

FFTFT

414. As fluid passes down the proximal convoluted tubule, there is a fall of more than 50 per cent in the A. Concentration of sulphate ions. B. Concentration of sodium ions. C. Concentrations of amino acids. D. Concentration of potassium ions. E. Rate of filtrate flow in the tubules.

FFTFT

407. Renal blood flow falls A. About 10 per cent when arterial pressure falls 10 per cent below normal. B. About 5 per cent when metabolic activity in the kidney falls by 5 per cent. C. During emotional stress. D. After moderate haemorrhage. E. Gradually from the inner medulla to the outer cortex per unit weight of tissue.

FFTTF

419. Secretion of renin A. Occurs in the stomach during infancy. B. Is stimulated by the hormone angiotensin I. C. Leads to raised levels of angiotensin II in the blood. D. Is stimulated by a fall in extracellular fluid volume. E. Inhibits ACTH secretion by the pituitary gland.

FFTTF

423. Treatment with an aldosterone antagonist causes a fall in A. Urine volume. B. Body potassium. C. Body sodium. D. Blood volume. E. Blood viscosity.

FFTTF

404. When a patient's mean arterial blood pressure falls by 50 per cent A. Renal blood flow falls by less than 10 per cent. B. Glomerular filtration falls by about 50 per cent. C. There is an increase in the circulating aldosterone level. D. Renal vasoconstriction occurs. E. Urinary output ceases.

FFTTT

427. Renal transplantation for chronic renal failure in adults should A. Be covered by immunosuppression even when the donor is the recipient's identical twin. B. Raise postoperative glomerular filtration rate to the 10-20 ml/minute level. C. Correct abnormal calcium metabolism. D. Correct anaemia. E. Abolish the need for further renal dialysis.

FFTTT

409. Voluntary micturition A. Depends on the integrity of a lumbar spinal reflex arc. B. Is not possible after sensory denervation of the bladder. C. Involves stimulation of the detrusor muscle in the bladder by autonomic sympathetic nerves. D. Is normally accompanied by some reflux of bladder contents into the ureters. E. Is inhibited during ejaculation.

FTFFT

397. The renal clearance of a substance A. Is inversely related to its urinary concentration, U. B. Is directly related to the rate of urine formation, V. C. Is directly related to its plasma concentration, P. D. Is expressed in units of volume per unit time. E. Must fall in the presence of metabolic poisons.

FTFTF

431. Cutting the sympathetic nerves to the bladder may cause A. Difficulty in emptying the bladder. B. Loss of tone in the internal sphincter of the bladder. C. Loss of tone in the external sphincter of the bladder. D. Loss of pain sensation in the bladder. E. Infertility in the male.

FTFTT

426. Emptying of the bladder may be less effective if A. The sympathetic nerves carrying afferent information from bladder to spinal cord are cut. B. The pelvic nerves are cut. C. Anticholinergic drugs are administered. D. Alpha-adrenergic receptor antagonists are administered. E. Beta-adrenergic receptor agonists are administered.

FTTFT

405. The cells of the distal convoluted tubule A. Reabsorb about 50 per cent of the water filtered by the glomeruli. B. Secrete hydrogen ions into the tubular lumen. C. Form NH4 ions. D. Reabsorb sodium in exchange for hydrogen or potassium ions. E. Determine the final composition of urine.

FTTTF

406. If, during an infusion of para-aminohippuric acid, peripheral venous plasma PAH level is 0.02 mg/ml (not above renal threshold), urinary PAH level is 16 mg/ml and urinary flow rate 1 ml/min, then the A. PAH level in renal venous blood must exceed 0.02 mg/ml. B. PAH level in renal arterial blood must be about 0.02 mg/ml. C. PAH level in glomerular filtrate must be about 0.02 mg/ml. D. Renal plasma flow is nearer 800 than 1000 ml/minute. E. Renal blood flow is nearer 1300 than 1500 ml/minute if the haematocrit is 0.40.

FTTTT

425. Long-standing obstruction of the urethra may cause A. Enlargement of the prostate gland. B. Hypertrophy of the bladder muscle. C. Dilation of the ureters. D. Reduction of the glomerular filtration rate. E. An increase in residual volume in the bladder.

FTTTT

421. Diabetes insipidus (deficiency of antidiuretic hormone) causes a fall in the A. Osmolality of the urine. B. Reabsorption of water from the proximal tubules. C. Extracellular but not intracellular fluid volume. D. Extracellular fluid osmolality. E. Intracellular fluid osmolality.

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432. Sudden (acute) renal failure differs from gradual (chronic) renal failure in that A. Potassium retention tends to be more severe. B. Blood urea levels tend to be higher. C. Depression of bone marrow activity is unlikely to occur. D. Metabolic acidosis is usually not a problem. E. Dietary protein restriction is unnecessary.

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398. In fluid in the distal part of the proximal convoluted tubule A. Urea concentration is higher than in Bowman's capsule. B. pH is less than 6 when the kidneys are excreting an acid urine. C. Glucose concentration is similar to that in plasma. D. Osmolality is about 25 per cent that of glomerular filtrate. E. Bicarbonate concentration is lower than in plasma.

TFFFT

400. As plasma glucose concentration rises above normal, glucose A. Filtration increases linearly. B. Transport maximum Tm increases linearly. C. Clearance increases linearly. D. Reabsorption increases and then levels off. E. Excretion increases and then decreases.

TFFTF

403. Transport maximum (Tm) - limited reabsorption of a substance implies that its A. Reabsorption is active. B. Reabsorption is critically related to tubular transit time. C. Reabsorption is complete below a certain threshold load. D. Renal clearance falls with its plasma concentration. E. Excretion rate is zero until its Tm value is reached.

TFTFT

420. In chronic renal failure A. Glomerular filtration rate may fall by 70 per cent before the condition gives rise to symptoms. B. The specific gravity of the urine tends to be elevated, e.g. about 1.030. C. Blood PCO2 tends to be low. D. Ionized calcium levels in the blood tend to be high. E. Anaemia is common.

TFTFT

428. Drugs which interfere with active transport of sodium in the proximal tubule tend to increase A. Urine production. B. Plasma osmolality. C. Chloride excretion. D. Interstitial fluid volume. E. Plasma specific gravity.

TFTFT

411. The renal clearance of A. Inulin provides an estimate of glomerular filtration rate. B. Chloride increases after an injection of aldosterone. C. PAH falls when the PAH load exceeds the Tm for PAH. D. Urea is lower than that of inulin. E. Inulin is independent of its plasma concentration.

TFTTT

401. A substance is being secreted by the renal tubules if its A. Clearance rate is greater than 250 ml/minute. B. Concentration is higher in arterial than in renal venous blood. C. Excretion rate is increased by tubular enzyme poisons. D. Concentration rises along the proximal convoluted tubule. E. Concentration in urine is greater than in plasma.

TTFFF

416. Aldosterone secretion tends to raise the volume of A. Plasma. B. Interstitial fluid. C. Intracellular fluid. D. Urine. E. Cerebrospinal fluid. 417. The renal clearance of

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408. Urea A. And glucose have similar molar concentrations in normal blood. B. Concentration rises in tubular fluid as the glomerular filtrate passes down the nephron. C. Is actively secreted by the renal tubular cells into the tubular fluid. D. Concentration in blood may rise ten-fold after a high protein meal. E. Causes a diuresis when its blood concentration is increased.

TTFFT

417. The renal clearance of A. Bicarbonate is similar to that of glucose. B. PAH is nearer 600 than 1200 ml/minute in the average adult. C. Creatinine provides an estimate of renal plasma flow. D. Phosphate is decreased by parathormone. E. Protein is normally zero.

TTFFT

422. The cystometrogram shows A. A plot of bladder pressure on the ordinate axis against bladder volume on the abscissa. B. Little rise in pressure with rise in volume at low bladder volumes. C. A steep rise in pressure when volume rises above 100 ml. D. That females generate higher pressures during micturition than males. E. That patients with chronic urinary tract obstruction can generate higher than normal micturition pressures.

TTFFT

430. A patient with chronic renal failure usually has an increased A. Blood urea. B. Blood uric acid. C. Creatinine clearance. D. Acid-base disturbance when he or she vomits. E. Acid-base problem on a high protein diet.

TTFFT

396. Tubular reabsorption of a filtered substance is likely to be active rather than passive if its A. Concentration in the tubular fluid is lower than in peritubular capillary blood. B. Excretion is increased by cooling the kidney. C. Renal clearance is lower than that of inulin. D. Renal clearance rises at high plasma levels. E. Urinary excretion rate:plasma concentration ratio is the same as for glucose.

TTFTT

410. The proximal convoluted tubules A. Reabsorb most of the sodium ions in glomerular filtrate. B. Reabsorb most of the chloride ions in glomerular filtrate. C. Reabsorb most of the potassium ions in glomerular filtrate. D. Contain juxtaglomerular cells which secrete rennin. E. Contain the main target cells for antidiuretic hormone.

TTTFF

429. A drug which inhibits carbonic anhydrase decreases A. Bicarbonate formation and reabsorption in the kidney. B. Plasma bicarbonate levels. C. Blood pH. D. Urinary loss of potassium ions. E. Urinary volume and pH.

TTTFF

434. A long-standing increase in arterial PCO2 (respiratory acidosis) leads to an increase in A. Renal bicarbonate formation. B. Urinary ammonium salts. C. Plasma potassium concentration. D. The ratio of monohydrogen to dihydrogen phosphate in urine. E. Urinary bicarbonate excretion.

TTTFF

399. Renal tubules normally reabsorb A. More water every hour than the entire plasma volume. B. All filtered HCO3 in respiratory acidosis. C. All filtered amino acids. D. All filtered plasma proteins. E. More K than Cl.

TTTTF

418. Potassium A. Is actively secreted in the distal convoluted tubule. B. Is reabsorbed in the proximal convoluted tubule. C. Deficiency favours hydrogen ion secretion in the distal tubule. D. Excretion is determined largely by potassium intake. E. Blood levels tend to rise in patients with acute renal failure taking a normal diet.

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