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Because ICF volume can only change if and when ECF osmolarity changes (because all substances enter and leave the body through the ECF compartment) an addition 10L of isotonic NaCl will cause what change in ICF volume? a. 5L increase b. No change c. 5L decrease d. 10L increase e. 2.5L increase 2. An addition of 10L of isotonic D5W will cause what change in ICF volume? a. Increase b. No change c. Decrease d. Cannot answer with information given 3. Why would a 2L infusion of isotonic NaCl to the ECF not affect ICF volume and osmolarity but a 2L infusion of isotonic D5W would affect both ICF volume and osmolarity if they are both isotonic? a. NaCl is much more permeable to cell membranes than Glucose b. Isotonic D5W is hypertonic to plasma c. Glucose is quickly taken up and metabolized by cells, essentially making isotonic D5W a hypotonic solution d. NaCl has higher permeability to cell membranes than Glucose e. Isotonic D5W has a higher affinity than isotonic NaCl 4. What hormone responds to changes in, and thus is largely responsible for controlling plasma osmolarity? a. Aldosterone b. Cortisol c. 11-DOC d. ADH e. Mineralocorticoids 5. If both plasma osmolarity increase and there is body volume depletion of 10-15%, ADH will choose to increase body volume no matter the affect of diluting the plasma/decreasing the osmolarity. In which of the following diseases can you refine your diagnosis to include Late-Stage versus Early-stage based on the severe hyponatremia caused by ADH’s preference in maintaining body volume over plasma osmolarity after a 10-15% body volume loss? a. Diabetes Insipidus Nephrogenic b. Conn’s (primary hyperaldosteronism) c. Cushing’s Disease d. SIADH e. Addison’s Disease
6. The concentration of impermeable particles (whether to cell membrane or capillary endothelium) determines the effective osmolarity of a particular compartment. Interstitial Fluid and Plasma are separated from each other via capillary endothelium, to which ALL natural substances dissolved in plasma – except proteins – are permeable. What determines the effective osmolarity between Interstitium and Plasma within the ECF? a. [Na+] plasma b. [Glucose] plasma c. [Ca++] plasma d. [proteins] plasma e. [K+] plasma 7. What substance represents most of the nonpermeant (osmolarity-causing) particles in the ECF? a. NaCl b. MgCl2 c. CaCl2 d. NaHCO3 e. H+ 8. Because NaCl exists in the body in its ionized form, Na+ and Cl- and it is responsible for most of the ECF’s osmolarity because its ions are the most highly concentrated of the ECF particles, how can you use a [Na+] in the ECF of 143 mOsm (mM) to find the osmolarity of the ECF? a. Add [Na+] in the Intracellular Compartment to 143 b. Multiply 143 by 2, since if Na+ = 143 in ECF, there must be an equivalent osmolarity produced by Cl- in the ECF c. Subtract the [Cl-] in the ECF from the [Na+] in the ECF d. Add the [K+] in the ECF to the [Na+] in the ECF e. Find Na+ in mEq/L in the ECF and add it to the NaCl in mEq/L in the ECF 9. Many diagnoses in renal physiology can only be determined or differentiated from other similar diagnoses by comparing serum osmolarity versus urine osmolarity. Match the appropriate diagnosis to its corresponding “states” of osmolarity. a. Equal directional change in [Na+] serum as [Na+] in urine b. [Na+] serum of 156 mEq/L and [Na+] urine of 50 mEq/L c. [Na+] serum of 120 mEq/L and [Na+] urine of 900 mEq/L d. [NaCl] serum of 150 mM and Dilute Urine e. [NaCl] serum of 300 mOsm/L and Concentrated Urine SIADH (C), DI (B), Primary Polydipsia (A), Cholera (chronic diarrhea) (C or E), Conn’s Syndrome (A) **Normal serum osmolarity is around 280-320 and normal urine osmolarity is 500-800 mOsm/L but range can be less than 50 – 1200 mOsm/L
10. Intravenous infusion of 1 liter of 3% saline would cause which of the following changes after osmotic equilibrium? D
11. A patient is brought to your office and after lab testing, you are given the following results: Plasma osmolarity: 270 mosm/L Urine osmolarity: 1200 mosm/L Blood pressure: 100/56 mmHg Based on the fact that urine osmolarity is directly related to urine flow rate (thus diluting or concentrating the osmotic particles in urine) and your knowledge of how body volume affects blood pressure, which diagnosis would you choose? a. b. c. d. e. SIADH Primary Hyperaldosteronism Diabetes Insipidus Severe Diarrhea Diuretic Abuse (surreptitious use)
12. If a person has a kidney transport maximum for glucose of 350 mg/min, a glomerular filtration rate of 110 ml/min, a plasma glucose of 375 mg/dl, and a urine flow rate of 3.0 ml/min, what would be the approximate rate of glucose excretion, assuming normal kidneys? a. glucose excretion cannot be estimated from this data b. 0 mg/min c. 25 mg/min d. 60 mg/min e. 180 mg/min 13. You wish to evaluate kidney function in a 65 year old male and ask him to collect his urine over a 24 hours period. He returns to you 4320 ml of urine, collected over the preceding 24 hours. The clinical lab returns the following results from analysis of his urine and plasma samples: Plasma creatinine: 3.0 mg/dl Urine creatinine: 30 mg/dl
Plasma potassium: 5.0 mmol/L Urine potassium: 10 mmol/L What is his approximate glomerular filtration rate, assuming that he collected all of his urine in the 24 hour period? a. 3 ml/min b. 10 ml/min c. 30 ml/min d. 100 ml/min e. 125 ml/min 14. What is the renal reabsorption rate of potassium in the patient described in question #13? a. no potassium is being reabsorbed in this patient. b. 0.03 mEq/min c. 0.12 mEq/min d. 0.15 mEq/min e. 3.0 mEq/min f. 30 mEq/min 15. Which of the following changes would you expect to find as a result of a 50% increase in efferent arteriolar resistance? A B
For questions 16-18, choose the appropriate nephron site in the diagram.
16. In a dehydrated patient with otherwise normal kidneys, which part of the tubule would have the lowest tubular fluid osmolarity? C 17. In a patient with central diabetes insipidus, who is excreting 20 liters of urine a day, which part of the tubule would have the lowest tubular fluid osmolarity? E 18. In a person with normal kidneys on a normal potassium diet, which part of the nephron reabsorbs the most potassium? A 19. You are treating a 20 year old patient who was diagnosed with inappropriate ADH syndrome (excess ADH production). Which of the following would you expect to fine under steady-state conditions in this patient, compared with normal and assuming a normal diet and fluid intake. a. hyponatremia b. decreased plasma renin activity c. significantly decreased urine volume d. decreased ANP levels e. a and b f. a, b and c 20. The clinical laboratory returns the following arterial blood values for a patient: pH: 7.31 plasma HCO3-: 32 mmole/L plasma PCO2 65 mmHg What is the patient’s 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 e. not enough information is given to make an educated guess 21. In the patient described in question #20, which of the following laboratory values are you likely to find, compared to normal? C
22. The graph below illustrates the relationship between the plasma concentration of a hypothetical substance X and its reabsorption by the kidney. The GFR is 100 ml/min. The renal threshold for this substance is
a. 50 mg/dl b. 100 mg/dl c. 150 mg/dl d. 200 mg/dl e. 500 mg/dl 23. The Tmax for substance X is a. 100 mg/min b. 200 mg/min
c. 300 mg/min d. 400 mg/min e. there not enough information given to calculate the Tmax value 24. Sodium reabsorption from the distal tubule will be increased if there is an increase in a. plasma potassium concentration b. plasma volume c. mean arterial pressure d. urine flow rate e. plasma osmolarity 25. If 600 ml of water is ingested rapidly, plasma volume will increase by approximately a. 400 ml b. 200 ml c. 100 ml d. 50 ml e. 25 ml 26. The daily production of hydrogen ions from CO2 is primarily buffered by a. extracellular bicarbonate b. red blood cell bicarbonate c. red blood cell hemoglobin d. plasma proteins e. plasma phosphates 27.The secretion of H+ in the proximal tubule is primarily associated with a. excretion of potassium ion b. excretion of hydrogen ion c. reabsorption of calcium ion d. reabsorption of bicarbonate ion e. reabsorption of phosphate ion 28. If a substance appears in the renal artery but not in the renal vein, a. its clearance is equal to the glomerular filtration rate b. it must be reabsorbed by the kidney c. its urinary concentration must be higher than its plasma concentration d. its clearance is equal to the renal plasma flow e. it must be filtered by the kidney
29. A freely filterable substance that is neither reabsorbed nor secreted has a renal artery concentration of 12 mg/ml and a renal vein concentration of 9 mg/ml. Calculate the filtration fraction. a. 0.15 b. 0.25 c. 0.75 d. 1.00 e. not enough information given to make this calculation 30. Renal correction of hyperkalemia will result in a. alkalosis b. acidosis c. increased secretion of HCO3d. decrease secretion of H+ e. increased excretion of Na+ 31. Which of the following is most likely to cause an increase in the glomerular filtration rate? a. contraction of mesangial cells b. blockage of the ureter c. release of renin from the juxtaglomerular apparatus d. dilation of the afferent arterioles e. volume depletion 32. Hypoxemia (arterial PO2 = 55 mmHg) has all the following effects EXCEPT a. it stimulates carotid body chemoreceptors b. it stimulates central chemoreceptors c. it stimulates aortic chemoreceptors d. it causes a reflex increase in ventilation e. it causes an increase in blood flow to the zone 1 of the lung 33. A spirometer can be used to measure directly a. functional residual capacity b. inspiratory capacity c. residual volume d. total lung capacity e. none of the above 34. A man breathing room air at sea level has a PACO2 of 48 mmHg. His alveolar oxygen tension (PAO2) is:
a. 150 mmHg b. 110 mmHg c. 100 mmHg d. 90 mmHg e. 60 mmHg Questions 35 and 36 The diagram below illustrates the change in intrapleural pressure during a single breath.
35. At which point on the diagram is inspiratory airflow the greatest? a. A b. B c. C d. D e. E 36. At which point on the diagram is lung volume the greatest? a. A b. B c. C d. D e. E Questions 37 and 38 Use the pulmonary values below to answer the following questions Tidal volume = 500 ml Respiratory rate = 15/min
Expired PCO2 = 40 mmHg Alveolar PCO2 = 50 mmHg 37. The patient’s physiological dead space is a. 80 ml b. 90 ml c. 100 ml d. 110 ml e. 120 ml 38. At the end of a quiet inspiration, intra-alveolar pressure is normally a. –40 cmH2O b. –4 cmH2O c. 0 cmH2O d. 14 cmH2O e. 140 cmH2O 39. During the effort-independent portion of a forced vital capacity (FVC) maneuver, the expiratory flow rate a. varies as a function of the interpleural pressure b. is limited by compression of the airways c. depends on the alveolar pressure d. is maximal for that individual e. is constant f. two of the above are true 40. Which indicators’ volumes of distribution would you need in order to measure volume of intracellular fluid? a. Both Antipyrine and 125I-Albumin b. Tritiated Water (T2O) plus 125I-Albumin c. Inulin d. Inulin and 125I-Albumin e. Tritiated Water and Inulin 41. Both Psychogenic Polydipsia (water intoxication) and SIADH are examples of “hypotonic expansion.” What is one lab value that would be especially important in helping us determine which diagnosis to give a patient in this condition? a. Body osmolarity/Na+ b. Weight c. Blood Pressure d. Hyponatremia e. Urine flow rate
42. A 70kg patient has a hematocrit of 50 and a plasma volume of 3.5 liters. What is his total blood volume? a. 5.5 liters b. 6 liters c. 7 liters d. 7.5 liters e. 3 liters 43. For a patient with hypertension as a clinical finding, we automatically can eliminate which of the following diagnoses? a. SIADH b. Psychogenic Polydipsia (water intox) c. Conn’s Syndrome d. 11 B OH deficiency e. Diabetes Insipidus 44. For a patient with serum [Na]+ of 143 mEq/L as a clinical finding, we start the diagnostic process by eliminating all of the following except: a. Late Addison’s b. Severe sweating with no fluid replacement c. SIADH d. Infusion of 2% saline e. Effective Diuretic Use 45. Why do patients with severe diarrhea often present with serum hypokalemia (normal serum K+ is 3.5-5.0 mOsm/L)? a. Because there is a net secretion of K+ in the colon b. Because more H+ is excreted through diarrhea, an acidic substance c. Because less H+ is secreted due to high aldosterone levels d. Diarrhea blocks the reabsorption of K+ e. Chronic diarrhea increases ADH levels 46. Secondary active transport uses the energy provided by entrance or exit of another molecule through the same transport protein down its concentration gradient to move a second molecule or substance up or against its concentration gradient. What pump in the proximal tubule of the kidney is responsible for maintaining the Na+ gradient responsible for the co-transport of Na+ and Glucose into the proximal tubule cell? a. Na+/K+/2Cl- basolateral membrane b. H+/K+ ATPase luminal membrane c. Na+/K+ ATPase luminal membrane d. Na+/K+ ATPase basolateral membrane e. Paracellular movement of Na+ and Glucose 47. Factors affecting the rate of diffusion of a substance between two compartments separated by a membrane can include all of the following except:
a. b. c. d.
Underactive Na+/K+ pump Capillary Recruitment Alveolar Fibrosis Diffusion of CO2 will decrease in proportion to diffusion of O2 as PaCO2 and PaO2 decrease proportionately e. Charge disruption on the Glomerular Capillary Basement Membrane 48. The net force acting on an ion across a membrane is the sum of the force(s) resulting from: a. Both the concentration difference across the membrane and the electrical difference across the membrane b. Only the concentration difference across the membrane c. Only the electrical difference across the membrane d. The number of membrane Voltage-gated channels e. The number of membrane Ligand-gated channels 49. Match the a D5 - .45% saline with its appropriate osmolarity and tonicity: a. Hyperosmotic and Isotonic b. Hyperosmotic and Hypotonic c. Hyposmotic and Hypotonic d. Isosmotic and Hypertonic e. Isosmotic and Hypotonic 50. Why are there more cations in the plasma than in the interstitium? a. Because most interstitial proteins are negatively charged b. Because most plasma proteins are positively charged c. Because most interstitial and plasma proteins are neutral d. Because most plasma proteins are negatively charged e. Because most interstitial proteins are positively charged 51. Why does protein-mediated transport (any membrane transport requiring a protein – i.e. not simple diffusion) have a v-max, or Tm (transport maximum)? a. Because increasing surface area is limited b. Because decreasing membrane thickness is difficult c. Because protein transporters can become saturated d. Because protein-mediated transport decreases pressure differences e. Because simple diffusion only relies on solubility 52. The Na+/K+ pump, which is primary active transport and thus uses ATP to drive ions against their natural gradients, pumps Na+ and K+ in what quantity and direction? a. Pumps 1 Na+ out for 2 K+ in b. Pumps 3 Na+ in for 2 K+ out c. Pumps 2 Na+ out for 2 K+ in d. Pumps 3 Na+ out for 2 K+ in e. Pumps 2 Na+ in for 2 K+ out
53. All of the following substances or substance groups/pairs exhibit primary active transport except: a. Na+/K+ b. Na+/K+/Clc. Ca++ d. H+ 54. All of the following affect membrane permeability except: a. Molecular weight b. Surface area of membrane c. Lipid Solubility (solubility through lipid-rich, hydrophobic membrane) d. Membrane Thickness e. Number of protein channels f. Concentration difference 55. All of the following directly affect net rate of diffusion except: a. Membrane Permeability b. Concentration Difference c. Molecular Weight d. Electrical Difference e. Pressure Difference 56. Calculate the approximate osmotic pressure of a solution containing 200 mM of urea + 120 mEq/L of NaCl, given the following information: Reflection coefficient (sigma) of urea = .5; sigma NaCl = (1 if completely impermeable and 0 if completely permeable…you decide) RT = 19.3 And Osmotic Pressure, or pi, = sigma*i*RT*m a. 6500 mm Hg b. 4000 mm Hg c. 6000 mm Hg d. 8500 mm Hg e. 7000 mm Hg 57. Ohm’s law states that the current (“I,” rate of substance flow/exchange) running in a circuit (set of capillaries) is directly proportional to the applied voltage (“E,” net force of electrical and chemical difference across membrane) and inversely proportional to the resistance (“R,” arteriolar or capillary tone). I=E/R. Because of this, we can assume all of the following will decrease the Rate of Blood Flow through a given “circuit” except: a. Increasing the afferent arteriole tone/resistance alone b. Decreasing the efferent arteriole tone/resistance alone c. Activation of stretch receptors in smooth muscle (GI, for example) d. Vagal inhibition of the parotid gland e. Adenosine’s action on cardiac blood flow
Answers: 1. 2. 3. 4. 5. 6. 7. 8. b c c d e d a b – this answer and method is very useful in determining diagnoses in renal physiology because many diagnoses can be diffentiated based on body osmolarity versus urine osmolarity and you’re typically given only the [Na+] to figure this out 9. -SIADH – c (this is a distinguishing factor of SIADH – dilute serum osmolarity and concentrated urine based strictly on amount of fluid in each…lots of body water diluting the concentration of particles causing effective osmolarity and little loss of water in the urine, thus making each particle in the water effectively more osmotic/more concentrated) -DI (nephrogenic or neurogenic) – b; DI will present will diluted urine and concentrated serum -Primary Polydipsia – a; Patient will have a dilute serum and dilute urine -Cholera (severe diarrhea) – either c or e; choice depends on what the osmolarity of the fluid you’re replacing the lost fluid is. If fluid replacement is just water, because water is hypotonic to serum and patient is losing isotonic fluid (diarrhea), water replacement (and high ADH levels if volume loss 10-15%) will create a hypotonic/hyponatremic serum and patient will have a concentrated urine due strictly to the fact that not as much urine will be produced to conserve water. Chosing e means that patient’s fluid loss is being replaced in an equal amount with isotonic saline (there will be some dilution of serum due to high ADH levels and some concentration of urine for the same reasons…e would work mainly after an equilibrium has been reached again both in volume and osmolarity). -Conn’s Syndrome – a; with a functioning ADH system patient will return to Na+/osmotic balance after a transient net Na+ retention/increase in osmolarity 10. d 11. d 12. d 13. c 14. c 15. b 16. c 17. e 18. a 19. f 20. b 21. c 22. d
23. c 24. a 25. d 26. c 27. d 28. d 29. b 30. a 31. d 32. b 33. b 34. d 35. b 36. c 37. c 38. c 39. b 40. e 41. e 42. c 43. e – anything that results in a net gain in fluid will present with hypertension; DI is the only one with a net loss in fluid 44. e 45. a 46. d 47. d 48. a 49. b 50. d 51. c 52. d 53. b 54. f 55. c, it indirectly affects net rate of diffusion by directly affecting membrane permeability 56. a 57. c
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