Pulmonology+Haematology Questions, Renal + Reproductive Questions, Kidney Q's, Respiratory System
Decreased GFR
24-year-old man with a history of renal insufficiency is admitted to the hospital after taking a large amount of ibuprofen. His BUN is 150 mg/dL. This patient's high serum urea nitrogen was most likely caused by which of the following?
Decreased arterial partial CO2 tension
A 28-year-old male with claustrophobia (fear of closed spaces) is stuck in a malfunctioning elevator. He became severe anxiety, dizziness, weakness and blurred vision. Which of the following best explains this patient's symptoms?
ATP - gated
A 5-year-old Caucasian female with a history of pneumonia and weight loss has a high sweat chloride content. The dysfunctional transmembrane protein in this patient is of which of the following types?
ciliated cells
A 12-year-old boy playing soccer in a dusty football field in windy weather inhales many small particles in his terminal bronchioles. Which type of the cells is most important in clearing the particles?
5625 mL/min
A 125-lb, 40-year-old woman with a history of nasal polyps and aspirin sensitivity since childhood presents to the emergency department with status asthmaticus and hypercapnic respiratory failure. She requires immediate intubation and is placed on a mechanical ventilator on an FIO2 of 40%, a control rate of 15 breaths per minute, and a tidal volume of 500 mL. Which of the following is her approximate alveolar ventilation?
She can become pregnant but will likely require an oocyte donation
A 17-year-old girl is brought to the Mount Sinai Hospital in New York by her parents for failure to undergo menarche. She has 2 sisters, both of whom began menstruating before the age of 16. Physical examination shows a short and stocky girl with a thick neck, square chest, and widely spaced nipples. The physician refers the girl for karyotype analysis, which shows 45 XO. During a meeting with the girl and her parents to discuss the diagnosis, the parents express concern over their daughter's future chances to conceive. Which of the following is the most appropriate response?
Methacholine
A 20-year-old female complains of occasional nighttime dyspnea and wheezing. She has no history of allergies, but her older sister suffers from atopic dermatitis. Spirometry findings are normal in this patient. Which of the following is the best drug to use as a provocation test in this patient?
C02 content in the mixed venous blood
A 20-year-old male marathon runner runs ten miles. Which of the following is most likely to be increased at the end of this distance?
respiratory failure
A 22-year-old woman is brought to the emergency department with progressive weakness and confusion. She also complains of recent polyuria and polydipsia. She has lost weight over the last 3 weeks, and her urine has a strong fruity odor. Her blood pressure is 105/70 mm Hg and her pulse is 120 /min. Based on the laboratory findings, which of the occurring in this patient?
Complete central diabetes insipidus
A 23-year-old Caucasian female is hospitalized to the Texas Regional Hospital with excessive thirst and frequent urination. Her blood glucose level is 86 mg/dL. You proceed with the standard water deprivation test in this patient. The results of urine osmolality (mOsm/L) during 4 hours of dehydration are: Which of the following is most likely diagnosis in this patient?
Increased plasma FSH
A 23-year-old male is evaluated in the Mount Sinai Hospital for bilateral breast enlargement. He has a tall stature and little body hair. His testicles are small. Which of the following findings would you expect most on laboratory evaluation?
d
A 23-year-old male patient is at the Regional Hospital with a history of type 1 diabetes mellitus. He hospitalized with confusion and weakness. His symptoms started two days ago when he developed mild diarrhea. He has missed several doses of insulin because his appetite has been poor. His breath has a mildly fruity odor. Which of the following trends in urine chemistry would be most expected in this patient?
a
A 23-year-old male patient is brought to the Regional Urgent Clinic by his relative with aspirin intoxication. Which of the following is most likely in this patient?
Dead space
A 25 -years-old male volunteer participates in a clinical study. Which of the following best explains the difference between the minute ventilation and the alveolar ventilation?
alveolar ventilation
A 26-year-old man training for a marathon reaches a workload that exceeds his anaerobic threshold. If he continues running at or above this workload, which of the following will increase?
Diastolic arterial pressure
A 28-year-old athlete begins special training with high-intensity physical exercises. At the peak of the exercise, which of the following parameters is the same in the systemic and pulmonary circulations?
The measured PaO2 will be higher and the measured PaCO2 will be lower than the patient's actual blood gas values
A 28-year-old man is admitted to the emergency department with multiple fractures suffered in a car accident. Arterial blood gases are ordered while the patient is breathing room air. After the first-year resident obtains an arterial blood sample from the patient, the glass plunger slides back, drawing an air bubble into the syringe before it is handed to the blood gas technician for analysis. How does exposure to room air affect the measured values of PO2 and PCO2 in arterial blood?
Dilation of afferent arterioles
A 28-year-old woman presents to her physician's office with fatigue, malaise, and orthostatic dizziness. When asked what medications she is taking, she stated that she has been taking 800 mg ibuprofen four to six times a day for painful menstrual cramps. Serum creatinine was elevated to 2.1 mg/dL. Which of the following is most likely to produce an increase in GFR in patients with acute renal failure?
c
A 29-year-old female with no significant past medical history presents after motor vehicle accident with headache and altered mental status. Her vital signs are temperature 37.5°C (99.5°F), pulse is 72/min, respirations are 10/min and irregular, and blood pressure is 170/110 mm Hg. Emergent head CT without intravenous contrast demonstrates cerebral edema and punctate hemorrhages indicative of diffuse axonal injury. Neurosurgery is consulted and immediate measures to decrease intracranial pressure are initiated, including administration of mannitol. Diagrams A-E below show the relative osmolality and volume of the intracellular fluid (ICF) and extracellular fluid (ECF) compartments under normal conditions (solid black line) and after various disturbances in the two compartments (broken blue line). Which of the diagrams most likely represents changes in the patient's tissue fluid volumes and osmolalities during mannitol infusion?
exercise
A 30-year-old woman with tachycardia (increased heart rate) and raised cardiac output. Her arterial PaO2 and PaCO2 are normal. Which of the following responses match with her symptoms?
Juxtaglomerular cell tumor
A 32-year-old man hospitalized to the Central Texas Regional Hospital with muscle weakness and periodic headaches. His blood pressure is 200/120 mm Hg and his pulse is 90/min. His serum potassium level is 30 mEq/L. His plasma renin activity is high, as is his urinary aldosterone excretion. Which of the following is a potential cause of this patient's symptoms?
c
A 34-year-old male undergoes spirometry as a part of a pre-employment evaluation. At which point on the graph below is the total pulmonary vascular resistance lowest?
The PO2 of the alveolus will be equal to that in the inspired air
A 34-year-old woman presents in the emergency department with tachypnea and shortness of breath of acute onset. The history reveals that she has been taking oral contraceptives for 9 years. A lung scan demonstrates a perfusion defect in the left lower lobe. Which of the following occurs if the blood flow to alveolar units is totally obstructed by a pulmonary thromboembolism?
heroine overdose
A 35-year-old male hospitalized to the Central Texas Regional Hospital with the following arterial blood gas readings: pH 7.25pCO2 70 mmHg HCO3- 25 mEq/L Which of the following is most likely contributing to this patient's abnormal laboratory findings?
Poor alveolar perfusion
A 35-year-old woman is admitted to the intensive care unit because the acute-onset shortness of breath. Analyses of her expiratory gasses are following: Tracheal p02 140 mm Hg Alveolar p02 150 mm Hg Alveolar pC02 10 mm Hg
c
A 37-year-old man is repairing his car inside the garage with the running engine. After work in some hours, he lost consciousness. Which of the following combinations match in this patient?
Urea
A 40-year-old female patient is hospitalized in the Mount Sinai Regional Hospital with polyuria. She received a vasopressin injection. Her urinary output decreases significantly shortly afterward. Renal clearance of which of the following substances would be most significantly reduced from baseline after the injection.
metabolicalkalosis
A 40-year-old man with upper gastrointestinal bleeding is brought to the local emergency department by ambulance. The patient was found in front of a grocery store after customers called emergency services. He is unable to provide any history, but his medical records reveal that he has a history of alcoholism. After undergoing emergency evaluation and appropriate resuscitation, the patient's condition stabilizes . Gastric lavage fluid initially contained blood, but quickly cleared. Upper endoscopy shows a linear mucosal tear at the gastroesophageal junction. The etiology directly underlying this patient's bleeding is most likely associated with which of the following acid-base disturbances?
Calcium chelation by a substance in the transfused blood
A 43-year-old man is brought to your emergency department after being involved in a motor vehicle accident. He suffered abdominal trauma and bilateral femur fractures. His blood pressure is 90/50 mm Hg and pulse is 120 /min. During resuscitation, he receives several units of packed red blood cells. Once stabilized, he begins complaining of a tingling sensation in his toes and fingers. His serum calcium level is 7,2 mg/dl. Which of the following is the cause of this patient's current symptoms?
Chronic blood loss
A 45-year-old male comes to the local physician for a routine examination. He has the following arterial blood results: PaO Normal % saturation (SaO) Normal Oxygen content Low Which of the following best explains his results?
A 2-fold increase in plasma creatinine concentration
A 45-year-old man returns to the physician for routine renal function tests. He has a history of glomerulonephritis. One year ago, his baseline creatinine clearance was 100 mL/min. Today, his creatinine clearance is 50 mL/min. Assuming that there has been no change in his diet, which of the following physiologic changes are most likely to have occurred in this patient in the year since his initial creatinine clearance studies?
Fractional Na+ excretion = 0.5%
A 45-year-old woman is admitted to the hospital because of chest pain and markedly elevated cardiac enzymes. Over the course of her hospitalization, her blood pressure decreases to 85/45mm Hg and pulse increases to 124/min. Her capillary refill is delayed and her extremities are cool. Her jugular venous pressure is 12 mm Hg. Her urine output decreases. Urine analysis reveals yellow-colored urine, negative for bilirubin, blood, and protein. Urine microscopy reveals minimal red cells and white cells and the absence of brown granular casts. A diagnosis is made. Which of the following best supports this diagnosis?
Hepatic parenchymal cells
A 45-year-old woman with a history of menorrhagia comes to the physician for lab analysis of hemoglobin. She is diagnosed with iron deficiency anemia and started on oral ferrous sulfate. After 5 months of therapy, her laboratory values have improved. Which of the following cell types exerts master control over the other cells involved in iron metabolism?
PTH increases, calcitriol decreases
A 46-year-old male with polycystic renal disease presents with complaints of persistent bone pain. Upper extremity x-rays reveal resorption of the cortical bone of the ulnas bilaterally. Which of the following patterns of abnormalities is most likely responsible?
higher-than-normal flow of hypotonic urine
A 46-year-old man presents to his physician with a 12-week history of frontal headaches. CT of the brain shows a mass in the posterior pituitary, and the posterior pituitary "bright spot" is absent on MRI. The patient also complains of increased thirst and waking up frequently during the night. Which of the following best describes his urine?
Low-density lipoprotein
A 48-year-old Caucasian man is brought to the physician because of persistent lower extremity edema. He says he has difficulty with ambulation. His pulse is 86/min and blood pressure is 100/64 mmHg. Cardiac and pulmonary examinations are noncontributory. Both lower extremities show pedal edema that tracks superiorly to the level of the knee. The left leg is slightly more swollen and erythematous with a positive Homans sign. Urinalysis reveals +2 blood, +4 proteinuria, and is negative for nitrites and leukocyte esterase. Circulating phospholipase A2 receptor antibodies are identified. Microscopy reveals few red blood cells. Renal biopsy reveals glomerular inflammation and thickened basement membranes. Electron microscopy reveals the presence of subepithelial immune complex deposits. Which of the following substances is most likely to be elevated in this patient's plasma?
Receptor aggregation
A 48-year-old European female hospitalized because of severe right leg cellulitis. In the ER she received a dose of cefazolin. Few minutes after starting the infusion, she complains of shortness of breath, diffuse itching, and dizziness. Her blood pressure is 65/30 mm Hg and heart rate is 145 /min. Her examination shows a diffuse early hematous skin rash and bilateral wheezing is heard on lung auscultation. This patient's symptoms are mediated by antigen-specific Ig E antibodies attached to high-affinity receptors on the surface of mast cells. What is the specific mechanism vasoactive substance released by the mast cells?
Tryptase
A 48-year-old European female hospitalized because of severe right leg cellulitis. In the ER she received a dose of cefazolin. Few minutes after starting the infusion, she complains of shortness of breath, diffuse itching, and dizziness. Her blood pressure is 65/30 mm Hg and heart rate is 145 /min. Her examination shows a diffuse early hematous skin rash and bilateral wheezing is heard on lung auscultation. Which of the following is most likely to be elevated in this patient's serum?
Ventilation / perfusion mismatch
A 48-year-old female is involved in a motor vehicle accident and suffers a right femoral shaft fracture. After the hospitalization, her leg was operated on immediately. In four hospital days she becomes agitated and tachypneic, and complains of chest pain. Her arterial blood sample shows a Pa02 of 60 mm Hg. Which of the following is the mechanism of hypoxemia in this patient?
b
A 48-year-old male is brought to your clinic with sudden dyspnea. His BMI is 31 kg/m2. He smokes one pack a day and drinks alcohol occasionally. His past medical history is insignificant except for mild swelling of the right calf over the past week. Which of the following arterial blood gas values is most likely to be observed?
Pulmonary fibrosis
A 48-year-old patient presents at your clinic because of dyspnea. The curve below (in black) represents the pressure/volume relationship in this patient's lung tissue. The blue curve represents a normal pressure/volume relationship. The patient most likely suffers from which of the following conditions?
Pulmonary hypertension
A 49-year-old male comes to the hospital because sleepiness and lack of energy. His wife mentions that he snores loudly and sometimes stops breathing while sleeping. This patient has a risk to develop which of the following?
P 02-Pa02 difference
A 49-year-old man living on the coast suffers from chronic mild dyspnea. He lives a sedentary lifestyle and has smoked a half pack of cigarettes per day for 10 years. His arterial blood gas analysis shows a PaO2 of 65 mm Hg and a PaC02 30 mm Hg. Which of the following is most likely increased in this patient?
d
A 52-year-old chronic alcoholic with history of recurrent pancreatitis is brought to the emergency department by emergency medical services who found him passed out outside a bar. Initial vital signs are temperature 37.6°C (99.7°F), pulse is 106/min, respirations are 12/min, and blood pressure is 130/72 mm Hg. On exam, the patient is alert, but not oriented. He complains of abdominal pain and thirst. Mucus membranes are dry and epigastric pain is elicited on palpation. During examination, the patient vomits non-bloody, non-bilious contents and complains of worsening abdominal pain. Diagrams A-E below show the relative osmolality and volume of the intracellular fluid (ICF) and extracellular fluid (ECF) compartments under normal conditions (solid black line) and after various disturbances in the two compartments (broken blue line). Relative to a healthy individual, which of the following most likely represents ICF and ECF volume and osmolality in the patient above?
Prostaglandins
A 52-year-old male is diagnosed with hepatic cirrhosis due to prolonged heavy alcohol consumption. He develops massive ascites and lower extremity edema that responds well to furosemide therapy. However, a week later the patient receives high-dose ibuprofen for joint pains and soon develops worsening abdominal distention. Blunting of the diuretic response in this patient is due to interruption of which of the following substances?
Sodium
A 52-year-old man presents to his internist for a 6-month checkup following diuretic therapy and recommended diet changes for his essential hypertension. His blood pressure is 145/95 mm Hg and serum aldosterone levels are increased. Aldosterone secretion is increased when there is a decrease in the plasma concentration of which of the following?
Heroin overdose
A 53-year-old man brought to the emergency department with the following arterial blood gas readings: pH 7,25 pC02 70 mm Hg HCO - 25 mEq/L The patient most likely suffers from which of the following conditions?
intracellular volume
A 54-year-old man with small cell lung cancer presents with lethargy, confusion, and muscle cramps. Blood work shows an increase in plasma levels of antidiuretic hormone (ADH). In patients with the syndrome of inappropriate antidiuretic hormone (SIADH), which of the following will increase?
Phagocytosis
A 55-year-old male has been working as a coal miner during the last 20 years, where he was exposing to industrial dust. What is the primary pulmonary defense mechanism of the respiratory tract of deposited small (less than 2 µm) particles?
Thick ascending loop of Henle, apical surface
A 56-year-old man with a history of congestive heart failure comes to the physician because of shortness of breath. Physical examination shows bilateral lower extremity edema. Crackles over both lung fields are heard on auscultation of the chest. The patient says that he has been eating salty foods and has not been compliant with all his medications. A drug that inhibits the Na+-K+-2Cl- cotransporter is administered. Which among the following renal epithelial surfaces is a primary site of action for such a drug?
3.5 L
A 56-year-old woman comes to the physician because of shortness of breath. She has smoked 2 packs of cigarettes daily for 37 years. Pulmonary function tests show the following pulmonary volumes and capacities using simple spirometry and helium washout techniques . Which is the residual volume of this patient?
Radial traction on airway walls
A 58-year-old man is hospitalized because of progressive ·shortness of breath that has been occurring slowly over the last 8 months. Physical examination of the patient shows bilateral crackles on pulmonary auscultation and drumstick shaped fingers. Pulmonary function testing reveals a decreased forced vital capacity, a supranormal FEV/FVC ratio, and increased expiratory flow rates. This patient's increased expiratory flow rates are best explained by an increase in which of the following?
tissue plasminogen activator (tPA)
A 62-year-old male was brought to the emergency department of the regional hospital because of severe chest pain, sweating and nausea. His examination showed ST elevation in leads II, III and aVF. Medical management of acute myocardial infarction was initiated. After initial treatment the pain decreased in intensity, but a reperfusion complex ventricular arrhythmia emerged. Which of the drugs was a result of rapid reperfusion in this patient?
Direct factor Xa inhibitor
A 62-year-old man comes to the medical clinic because of pain in the left leg. He has just returned from a trip to Europe. He has smoked one and half pack of cigarettes daily during last 20 years. Physical examination reveals 4 mm pitting edema of the left leg up to the knee. Peripheral pulse is normal. He begins the therapy that prolongs activated partial thromboplastin time (aPTI), prothrombin time (PT) and no effect on thrombin time (TT). Which of the following remedies is most likely to have been given to this patient?
7.0 L
A 62-year-old man comes to the physician for a routine examination. He has smoked 2 packs of cigarettes daily for 25 years. Physical examination shows no abnormalities and results of pulmonary function tests using simple spirometry and helium washout techniques are shown. Which is the most likely total lung capacity of this patient?
carotid bodies
A 63-year-old heavy smoker presents at the clinic because of chronic cough, lower extremity edema, and his physical examination reveals significant cyanosis and expiratory wheezes in the lungs. After being given supplemental oxygen through a nasal cannula, the patient's respiratory rate decreases and he becomes confused. This decline is the result of decreased stimulation of which of the following?
osteodystrophy
A 64-year-old overweight woman comes to her nephrologist for a regular follow-up appointment. Her medical problems include diabetes mellitus for 20 years and end-stage renal disease (ESRD). She has been on hemodialysis for the past 5 years, takes daily insulin, and has made lifestyle modifications. She reports that her blood sugars have been well controlled recently. Her other medical problems include hypertension and dyslipidemia, which are controlled with medication. This patient with ESRD is at greatest risk for which of the following metabolic derangements?
a
A 65-year-old man is brought to the emergency department because of diarrhea and vomiting for the last 24 hours. The patient lives at home with his son, and his son states that his father has been unable to take in much fluid since his symptoms began. On examination, his mucous membranes are dry and his blood pressure is 90/60 mm Hg. Which of the following changes in renal plasma flow (RPF), glomerular filtration rate(GFR), and filtration fraction(FF) are most likely to be present in this patient?
Mixed acidosis
A 66-year-old man is brought to the emergency department unconscious after being found lying on the floor in his kitchen. Cardiopulmonary resuscitation is begun. Laboratory analysis of an arterial blood sample obtained upon admission shows: (picture) Which of the following types of acid-base abnormality is most likely present in this patient?
Decreased cerebral vascular resistance
A 67-year-old female with chronic obstructive pulmonary disease (COPD) is hospitalized because shortness of breath, fever, yellow sputum and lower extremity edema. Physical examination shows cyanosis of the fingers and bilateral lung wheezes. Which of the following findings is most likely in this patient?
Decreased lung compliance
A 68-year-old male with a myocardial infarction presents at the emergency department because of shortness of breath and cough. Physical examination reveals crackles at the lung bases bilaterally and an S3 on cardiac auscultation. His oxygen saturation is low. Which of the following mechanism of the development the patient's dyspnea?
Relative erythrocytosis
A 68-year-old woman hospitalized because dyspnea and generalized fatigue. She has been hospitalized 5 times during the last 2 years for heart failure exacerbations. Also she has the medical problems include essential hypertension for 23 years, myocardial infarction at the age of 62, and hypercholesterolemia. Physical examination shows tachycardia distended neck veins, bilateral crackles on lung auscultation, a third heart sound on cardiac auscultation, and pedal edema. On the third day of hospitalization, her hematocrit level increases to 52%, up from 42% on admission. An arterial blood gas analysis shows an arterial partial pressure (PaO) - 70 mm Hg. She has normal red blood cell mass. Which of the following most likely explains the patient's polycythemia?
Decreased diffusing capacity of the lung
A 68-year-old woman with pulmonary fibrosis presents with a complaint of increasing dyspnea while performing activities of daily living. She is referred for pulmonary function testing to assess the progression of her disease. Which of the following laboratory values is consistent with her diagnosis?
Sympathetic nerve activity
A 69-year-old man presents with symptoms of thirst and dizziness, and physical evidence of orthostatic hypotension and tachycardia, decreased skin turgor, dry mucous membranes, reduced axillary sweating, and reduced jugular venous pressure. He was recently placed on an angiotensin-converting enzyme (ACE) inhibitor for his hypertension. Urinalysis reveals a reduction in the fractional excretion of sodium and the presence of acellular hyaline casts. The internist suspects acute renal failure of prerenal origin associated with increased renin secretion by the kidney. A stimulus for increasing renal renin secretion is an increase in which of the following?
c
A 75-year-old woman with a history of atherosclerosis has recent onset of hypertension that is resistant to multidrug therapy. Renal angiogram shows narrowing of the renal artery lumen bilaterally. Arterial pressure distal to the stenoses has decreased by 25 mm Hg. Laboratory tests show a creatinine clearance of 74 mL/min/1.73 m2. Which of the following sets of values is most likely to be seen in this woman compared to the normal range in healthy individuals?
Protein excretion is increased by sympathetic stimulation of the kidney.
A 76-year-old man presents at the emergency department with headache, vomiting, shortness of breath, insomnia, and confusion. He is found to be oliguric with an increased BUN and creatinine. Urine-specific gravity is low and there is proteinuria. Which of the following statements concerning the normal renal handling of proteins is correct?
Hypothermia
A collection of tan fat-containing tissue is found around the kidneys and adrenal glands of a newborn during surgery. Surgical removal of the tissue would most likely contribute to:
d
A healthy 29-year-old man travels to Peruvian Andes (15000 feet above sea level). After 8 days, he has his blood drawn by the physician. Which of the following is the most likely blood analysis of the traveller?
E-D
A healthy 30-year-old woman is referred for a life insurance physical exam. History reveals that she has never smoked and vesicular breath sounds are heard at the periphery of the lung with auscultation. In the patient's spirometry tracing below, the expiratory reserve volume (ERV) equals which of the following?
a
A healthy 32-year-old male who has been consuming a high potassium diet for the past two weeks is found to have a urine potassium concentration that is higher than his plasma potassium concentration. Which of the following best describes the percentage of the filtered potassium load remaining in the tubular fluid as it flows along the nephron in this patient?
pulmonary edema
A hospitalized patient has tachypnea and significantly labored respirations requiring mechanical ventilation. Based on the pressure-volume curve of the lungs shown as Curve Z in the figure below, which of the following is the most likely diagnosis for the patient?
Increasing surface area of the membrane
A new dialysis technique is developed to clear circulating autoantibodies from plasma. The technique is based on using a special semipermeable membrane. Which of the following is most likely to increase the rate of dialysis?
The smaller sphere will collapse
A physiologist in the lab prepares a respiratory model for teaching his students. In his model, two spheres with elastic properties similar to alveoli are connected as shown below with a clamp positioned between them preventing airflow. The surface tension in the two elastic spheres is identical. What will happen when the clamp is opened?
60 mL/min X
A previously well 12-year-old boy is brought to the emergency department with vomiting and severe abdominal cramps after a prolonged period of exercise. Elevated levels of serum creatinine and blood urea nitrogen (BUN) suggest acute renal failure. Following treatment and recovery, his serum uric acid concentration (0.6mg/dL) remains consistently below normal. To determine if his low serum uric acid level is related to renal dysfunction, uric acid clearance studies are conducted and the following data are obtained: Urine flow rate = 1 mL/min Urine [uric acid] = 36 mg/dL Which of the following is the patient's uric acid clearance?
e
A research physiologist group makes an experimental renal project. An animal's ureteral diameter is reduced by 50% experimentally. Which of the following is most likely to be find from this intervention?
1000 mL/min
A research physiologist group makes measuring kidney function of 33-year- old man. The following measurements were taken from him: Assuming a hematocrit of 50% and a urine flow of 1 ml/min, which of the following is the best estimate of this patient's renal blood flow?
Residual volume (RV)/ total lung capacity (TLC) ratio
A research physiologist group makes measuring pulmonary function of 30-year-old man. He undergoes testing for workup of dyspnea. Patient's pulmonary volume curve (red line) is shown on the slide below in comparison with a normal individual (blue line).
An underlying diffusion impairment coupled with a decrease in pulmonary capillary transit time during exercise
An insulation worker presents with a chief complaint of dyspnea on exertion. Pulmonary function test is consistent with a restrictive impairment. His arterial PO2 is normal at rest but hypoxemic during exercise stress testing. Which of the following is the most likely explanation for the decline in the patient's PaO2 during exercise compared with rest?
c
Diagrams A-E show the relative osmolarity (y-axis) and volume (x-axis) of the intracellular and extracellular fluid compartments during normal conditions (solid lines) and following various disturbances in the body fluids (shaded area). Which of the following diagrams best depicts an individual who runs a marathon on a hot summer day and replaces all volume lost in sweat by drinking distilled water (assume that there has been no renal compensation)?
Hypoventilation
In Clayton regional hospital presents a 38-year-old male at the emergency room because of severe dyspnea. He has a PO2 of 62 mmHg by arterial blood gas analysis and you estimate his alveolar oxygen partial pressure (PA02) to be 71 mmHg. Which of the following findings is most likely in this patient?
carbonic anhydrase
In Mount Sinai hospital in New York group of physiologist started a research project related to hematology. It has been determined in healthy volunteers that the chloride content of erythrocytes is much lower in arterial blood than in venous blood. The mechanism of action which of the enzyme is responsible for this difference?
c
In Mount Sinai hospital in New York group of physiologists started a research project related to respiratory physiology. A small number of participants were included in study. The study is conducted to measure airflow resistance along the bronchial tree. Which of the following curves is most likely to be observed of the airway resistance pattern in normal lungs?
Bowman's space
In The Mount Sinai Hospital in New York group of physiologists started renal research. A 26 years-old volunteer is given a slow intravenous infusion of a para-aminohippurate (PAH) solution. In which of the following nephron segments is the PAH concentration lowest?
Glucose
In The Mount Sinai Hospital in New York group of physiologists started renal research. Renal clearance of substance X is studied in experimental settings. At a constant glomerular filtration rate, the following readings are observed on the substance X titration curve. Based on this data, the renal handling of substance X appears to be most similar to the renal handling of which of the following?
d
In The Mount Sinai Regional Hospital group of physiologists started renal research. A 42-year-old female is being evaluated for polyuria. Doctors plan to run several tests to assess the water-conserving function of her kidneys. Which of the following areas of the nephron shown on the slide is normally impermeable to water?
Hydrogen ion secretion from the intercalated cells of the collecting tubules
In The Mount Sinai Regional Hospital group of physiologists started renal research. A new agent has been shown to block aldosterone's interaction with its receptors. Which of the following is most likely to be decreased by the activity of this new drug?
d
In The Mount Sinai Regional Hospital group of physiologists started renal research. An experimental substance is infused intravenously at a constant rate into a healthy volunteer. The substance is known to selectively constrict the efferent arteriole in renal glomeruli. The rate of infusion is closely controlled during the experiment to allow for only mild constriction of the efferent arteriole. Which of the following changes in glomerular filtration rate (GFR) and filtration fraction (FF) is most likely to occur during the infusion of this substance?
Carrier transport is saturated
In The Mount Sinai Regional Hospital group of physiologists started renal research. It is estimated that for paraaminohippuric acid (PAH), the extraction ratio (arterial plasma PAH minus venous plasma PAH divided by arterial plasma PAH) is near 90% at arterial plasma concentrations lower than 20 mg/dl. Once the plasma concentration of PAH is increased above this level, the extraction ratio decreases progressively. Which of the following best explains the observed decrease in the PAH extraction ratio?
20%
In The Mount Sinai Regional Hospital group of physiologists started renal research. The analyses were taken from a healthy 25-year-old volunteer. Which of the following is the best estimate of the filtration fraction in this patient, assuming a urine flow of 1,0 ml/min?
Medullary segment of the collecting duct
In The Mount Sinai Regional Hospital group of physiologists started renal research. They are examining a 42-year-old man, who traveled alone and has no access to water for 36 hours. His urine osmolarity is 1100 mOsm/L. Which is primarily explained by the action of vasopressin on the:
proximal tubule
In The Mount Sinai Regional Hospital group of physiologists started renal research. They are examining a 42-year-old man, who traveled alone with deficiency of food and water. His urine osmolarity is 1100 mOsm/L. The fluid filtered by the glomerulus is primarily reabsorbed by which portion of the nephron?
constriction of efferent arteriole
In The New York Central Hospital group of physiologists started renal research. They are studying effects of various manipulations on kidney blood flow and glomerular filtration. Which of the following is most likely to both decrease renal plasma flow and increase the filtration fraction?
Inulin
In The New York Central Hospital group of physiologists study renal tubular transport proteins. A substance is identified that specifically and completely inhibits glucose transport in the proximal renal tubules . In a healthy volunteer receiving this substance, glucose clearance will best approximate the clearance of which of the following?
aromatase
In The New York Central Hospital, a genetically female infant born to a 21- year-old female demonstrates ambiguous genitalia and a normal -sized uterus. Blood pressure is normal, but serum testosterone and androstenedione levels are increased. The mother experienced increased facial hair growth and some voice deepening during pregnancy. Which of the following is most likely deficient in the newborn?
a
In the Physiology Lab pulmonary ventilation (V) and blood flow (Q) are measured in a healthy volunteer. Which of the following curves is most likely to be found? (The x-axis denotes the base and apex of the lung.)
c
In the Central Regional Hospital group of physiologists started renal research. develop a technique that permits sampling of tubular urine in experimental animals. Which of the following sampling sites contains the most concentrated urine in the absence of ADH?
Work of breathing
Physiologists are investigating the influences of autonomic nervous system on respiratory characteristics. Bronchi are richly innervated by the autonomic nervous system. Which of the following parameters would increase as a result of vagal stimulation?
10 mm Hg
Picture
4.0 L
Picture
5.25 L/min
Picture
Contraction of the intercostal muscles during inspiration causes the diaphragm to be drawn upward and the abdominal wall to be drawn inward
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Diameter of pulmonary arterial vessels
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Hematocrit
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Mixed venous PO2
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b
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c
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e
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functional residual capacity
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residual volume
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e
Renal physiologists at a national endocrinology research institute are studying how hydration status affects the mechanisms of urine concentration and dilution in humans. To do this, they developed a technique in experimental animals that permits sampling of tubular fluid in different parts of the nephron. A urine sample with an osmolarity of 110 mOsm/L is obtained from a healthy animal after 12 hours of water deprivation. Assuming the physiology of this animal mirrors human physiology, which of the following sites was most likely sampled?
Urea, bicarbonate
Scientists in the Regional Hospital are attempting to study the specifics of kidney function in humans. They begin by studying the concentrations of various compounds along the length of the proximal tubules in human kidneys. They are able to measure the concentrations of several substances over the length of a proximal tubule. Tubular fluid/plasma ultrafiltrate concentration ratios for several substances they were able to measure are shown on the slide below. Which of the following substances are most likely to produce curves 2 and 4, respectively?
Progesterone
The group of pathophysiologists started their research project. The blood LH level is measured daily in a 27-year-old volunteer woman over a one- month period. The blood levels of other hormones are measured at time points A and B. Which of the following hormones would have the highest B/A blood concentration ratio?
Medullary segment of the collecting duct
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25 mg/min
The group of physiologists started their research project. Substance A is freely filtered in the glomeruli and reabsorbed in the renal tubules. A healthy volunteer receiving substance A has the following findings: What is the expected excretion rate for substance A in this volunteer?
Venous admixture
The blood oxygen tension curve for healthy individual is ·shown below. Which of the following most likely explains the change in tension indicated by the arrow?
Hypokalemia, hypochloremia, and metabolic alkalosis
The friends of a 26-year-old man plan a bachelor's party for him in Las Vegas. After a round of golf, the group heads to the pool. They order several rounds of drinks over the next 4 hours and also order lunch poolside. Most of the group orders hamburgers and French fries, but the groom-to-be is watching his weight and opts for a club sandwich and a side of coleslaw. Later that night, they go for dinner and to the casinos, where they imbibe some more. Early the next morning, the groom to be becomes ill. He thinks it is just a hangover, but presents to the emergency department 36 hours later with persistent vomiting and orthostatic hypotension. Which of the following metabolic abnormalities are most likely present in this patient?
1000 mL/min
The graph below demonstrates the relationship between renal blood flow and glomerular filtration rate in a healthy individual. Assuming a hematocrit of 50% and a urine flow of ml/mm, which of the following is the best estimate of this patient's renal blood flow?
- 5 cm H2O
The lung and chest wall compliance curves for a healthy individual are shown on the slide below: Which of the following is the best estimate of the intrapleural pressure at the point on the graph marked by the red dot?
Lungs
The pattern of findings graphed below would be matched with which organ?
Creatinine
The table shows the relative concentrations of inulin and an unknown substance measured in the renal tubule fluid of an experimental animal's juxtamedullary nephron. Substance X (Sub X) is most likely to be which of the following?
