Review Examination - Clinical Tree

Chapter 1

1.
A healthy individual weighs 50 kg. What is the volume of this individual’s extracellular fluid compartment?
- a.
  2.5 L
- b.
  7.5 L
- c.
  10.0 L
- d.
  20.0 L
- e.
  30.0 L
2.
A healthy individual loses body water from the following routes over a 24-hour period.
- Feces: 150 mL
- Expired air: 200 mL
- Perspiration: 150 mL
During this same 24-hour period, urine output is 2.5 L. How much water must this individual drink to stay in water balance?
- a.
  1.0 L
- b.
  1.5 L
- c.
  2.0 L
- d.
  2.5 L
- e.
  3.0 L
3.
An otherwise healthy woman develops diarrhea while on vacation in Mexico. Fecal water loss is 3 L/day. She drinks five 1-L bottles of water during this same period. If she also loses 1.5 L of water with respiration and perspiration, what is her estimated urine output over a 24-hour period?
- a.
  0.5 L
- b.
  1.0 L
- c.
  1.5 L
- d.
  2.0 L
- e.
  2.5 L
4.
After a rigorous practice session, on a hot afternoon, a high school football player tells the coach he feels “lightheaded” and then collapses. He is taken to the emergency department at a local hospital. Blood is drawn, and the osmolality of his plasma is 305 mOsm/kg H ₂ O (normal reference range = 275 to 295 mOsm/kg H ₂ O). If it could be measured, what would be the osmolality of his intracellular fluid? H int : Assume his plasma osmolality at the start of the practice session was 290 mOsm/kg H ₂ O).
- a.
  285 mOsm/kg H ₂ O
- b.
  290 mOsm/kg H ₂ O
- c.
  300 mOsm/kg H ₂ O
- d.
  305 mOsm/kg H ₂ O
- e.
  310 mOSm/kg H ₂ O
5.
A blood sample is taken from an individual whose blood osmolality is 295 mOsm/kg H ₂ O. Red blood cells from this sample are then placed in the following solutions.

	Osmolality (mOsm/kg H ₂ O)	σ of Solute
a. NaCl	300	1
b. Fructose	300	0.5
c. Urea	300	0
d. CaCl ₂	100	1
e. KCl	150	1

The red blood cells in which of these solutions will swell to the greatest degree?

Chapter 2

1.
Which of the following structures is a barrier to the filtration of proteins across the glomerulus?
- a.
  Capillary endothelial cells
- b.
  Basement membrane
- c.
  Lacis cells
- d.
  Parietal epithelial cells
- e.
  Mesangial cells
2.
The macula densa is part of which of the following structures in the kidney?
- a.
  Extraglomerular matrix
- b.
  Vasa recta
- c.
  Afferent arteriole
- d.
  Juxtamedullary nephron
- e.
  Juxtaglomerular apparatus
3.
The efferent arteriole of some juxtamedullary nephrons enters the renal medulla and becomes which of the following vessels?
- a.
  Interlobular artery
- b.
  Arcuate artery
- c.
  Vasa recta
- d.
  Glomerular capillary
- e.
  Interlobar artery
4.
The function of the vasa recta is to do which of the following?
- a.
  Concentrate the urine
- b.
  Exclude proteins from Bowman’s space
- c.
  Secrete renin
- d.
  Regulate tubuloglomerular feedback
- e.
  Deliver oxygen and nutrients to the renal medulla
5.
Podocin is mutated in what renal disease?
- a.
  Nephrotic syndrome
- b.
  Alport’s disease
- c.
  Polycystic kidney disease
- d.
  Nephrogenic diabetes insipidus
- e.
  SIADH
6.
What is the order of blood flow through the renal vasculature?
- a.
  Renal artery–interlobular artery–arcuate artery–interlobar artery–afferent arteriole
- b.
  Renal artery–interlobar artery–arcuate artery–interlobular artery–afferent arteriole
- c.
  Afferent arteriole–glomerular capillaries–peritubular capillary–efferent arteriole
- d.
  Renal artery–interlobar artery–arcuate artery–interlobular artery–peritubular capillary
- e.
  Renal artery–interlobar artery–arcuate artery–interlobular artery–vasa recta
7.
The renal corpuscle consists of which of the following?
- a.
  Afferent arteriole and glomerular capillaries
- b.
  Afferent arteriole, glomerular capillaries, and efferent arteriole
- c.
  Glomerular capillaries and Bowman’s capsule
- d.
  Macula densa and the juxtaglomerular apparatus
- e.
  Glomerular capillaries and mesangial cells
8.
Mutations in PKD1 cause polycystic kidney disease. Polycystin has what function?
- a.
  It transports potassium.
- b.
  It transports calcium.
- c.
  It transports water.
- d.
  It is an adhesion molecule.
- e.
  It transports sodium.
9.
The nephrotic syndrome:
- a.
  Is characterized by a decrease in the permeability of the glomerular capillaries to proteins
- b.
  Is characterized by a change in podocyte structure, including a thickening of foot processes
- c.
  Is characterized by a decrease in extracellular volume depletion
- d.
  Is characterized by an increase in the permeability of the glomerular capillaries to proteins
- e.
  Is caused by a decrease in renal blood flow
10.
Mesangial cells:
- a.
  Are specialized cells in the afferent arteriole
- b.
  Secrete antiinflammatory cytokines
- c.
  Secrete renin
- d.
  Are located in the renal medulla
- e.
  Have phagocytic activity

Chapter 3

1.
According to the tubuloglomerular feedback theory, an increase in tubular fluid NaCl concentration near the macula densa will result in which of the following?
- a.
  A decrease in the glomerular filtration rate of the same nephron
- b.
  An increase in renal blood flow to the glomerulus of the same nephron
- c.
  Activation of the renal sympathetic nerves
- d.
  An increase in proximal tubule solute and water reabsorption
- e.
  An increase in renin secretion
2.
Which of the following structures is a barrier to the filtration of proteins across the glomerulus?
- a.
  Capillary endothelial cells
- b.
  Podocyte slit diaphragm
- c.
  Lacis cells
- d.
  Parietal epithelial cells
- e.
  Mesangial cells
3.
Starling forces determine fluid movement across glomerular capillaries. What would cause an increase in the GFR?
- a.
  A decrease in K _f
- b.
  An increase in P _BS
- c.
  A decrease in π _GC
- d.
  A decrease in P _GC
- e.
  A decrease in πBS
4.
A 56-year-old man was admitted to the hospital with a myocardial infarction. At admission his serum creatinine was 1.2 mg/dL and his creatinine clearance was 100 mL/min. Over the next 3 days he had several periods of hypotension, and his serum creatinine increased to 3.6 mg/dL. Assuming that he is in steady-state balance for creatinine (i.e., amount excreted = amounted produced), what is his predicted creatinine clearance?
- a.
  10 mL/min
- b.
  33 mL/min
- c.
  50 mL/min
- d.
  66 mL/min
- e.
  100 mL/min
5.
Which of the following statements regarding the GFR is true?
- a.
  Plasma oncotic pressure is constant along the length of the glomerular capillary.
- b.
  Net filtration pressure decreases from the afferent to the efferent end of the capillary.
- c.
  Net filtration pressure increases from the afferent to the efferent end of the capillary.
- d.
  Filtration occurs at the afferent end and reabsorption at the efferent end of the capillary.
- e.
  Plasma oncotic pressure decreases along the length of the glomerular capillary.
6.
Which of the following responses to a fall in arterial pressure accounts for the ability of the kidneys to autoregulate GFR?
- a.
  Decreased resistance of the efferent arteriole
- b.
  Increased delivery of fluid to the end of the proximal tubule
- c.
  Increase resistance of the afferent arteriole
- d.
  Increased [NaCl] in tubular fluid at the macula densa
- e.
  Decreased in resistance of the afferent arteriole
7.
GFR will decrease in which of the following conditions?
- a.
  Dilation of the afferent arteriole
- b.
  Decrease in renal nerve activity
- c.
  Decrease in plasma oncotic pressure
- d.
  Increase in hydrostatic pressure in Bowman’s space
- e.
  Increase in renal blood flow
8.
A healthy 25-year-old woman donates a kidney to her identical twin, who has chronic renal failure. Her serum [creatinine] before removal of the kidney is 1.0 mg/dL. After donating her kidney, her serum [creatinine] increases to 2.0 mg/dL. One month later her serum [creatinine] has decreased to 1.5 mg/dL. Which of the following accounts for the fact that her serum [creatinine] fell from 2.0 to 1.5 mg/dL?
- a.
  Decreased production of creatinine by skeletal muscle
- b.
  Enhanced secretion of creatinine by the proximal tubule
- c.
  Increase in the GFR of each of the remaining nephrons
- d.
  Expansion of her ECF volume
9.
The woman described in question 8 has not modified her diet since removal of her kidney. What is the change in renal handling of Na ⁺ now that she has only one kidney?

Urinary Na ⁺ Excretion/24 h	Fractional Excretion of Na ⁺
a. No change	No change
b. No change	↑
c. ↑	↑
d. ↓	↓
e. ↓	↑

10.
A substance (Y) is found in the plasma at a concentration of 2 mg/dL. A 24-hour urine collection is done to determine the renal clearance of Y. The following data are obtained:
- Urine volume: 1.44 L
- Urine [Y]: 500 mg/L
What is the clearance of Y?
- a.
  5 mL/min
- b.
  25 mL/min
- c.
  36 mL/min
- d.
  100 mL/min
- e.
  250 mL/min
11.
Starling forces are measured across a capillary wall, and the following values are obtained:
- Capillary hydrostatic pressure: 30 mm Hg
- Capillary oncotic pressure: 25 mm Hg
- Interstitial hydrostatic pressure: 0 mm Hg
- Interstitial oncotic pressure: 15 mm Hg
If the reflection coefficient for protein across this capillary wall is 0.5, what is the pressure and direction of fluid flow across the capillary wall?

Net Pressure	Direction of Fluid Flow
a. 5 mm Hg	Into capillary
b. 10 mm Hg	Out of capillary
c. 15 mm Hg	Out of capillary
d. 20 mm Hg	Out of capillary
e. 25 mm Hg	Out of capillary

12.
Urine albumin is measured to evaluate:
- a.
  Acid-base status
- b.
  Renal disease
- c.
  Renal blood flow
- d.
  GFR
- e.
  The concentrating ability of the kidneys

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Chapter 1

Chapter 2

Chapter 3

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