Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Physiology 2 - Renal > Final Exam review > Flashcards

Final Exam review Flashcards

(120 cards)

Start Studying
1
Q

Safety factors that prevent edema include all except:
A.
Accumulation of interstitial proteins.
B.
Washdown of interstitial fluid proteins.
C.
Variable lymphatic drainage.
D.
Low interstitial compliance.

A

A.
Accumulation of interstitial proteins.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The kidneys normally receive about what percentage of cardiac output?
A.
14%
B.
21%
C.
29%
D.
10%

A

B.
21%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The functions of the kidney are many and varied. Which of the following is NOT a function of the kidney?
A.
Regulation of fluid volume and body fluid composition.
B.
Release of ADH.
C.
Excretion of metabolic waste and foreign chemicals.
D.
Secretion of certain hormones.

A

B. Release of ADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What percent of nephrons are juxtamedullary?
A.
They are 50-50 split with cortical nephrons.
B.
In humans, about 15% are juxtamedullary nephrons.
C.
In humans, there are no juxtamedullary nephrons.
D.
In humans, about 85% of the nephrons are extramedullary.

A

B.
In humans, about 15% are juxtamedullary nephrons.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hypoglycemia is more likely to occur in the diabetic surgical patient with which of the following diseases?
A.
Manic-depressive disorder treated with lithium
B.
Chronic obstructive lung disease treated with a terbutaline inhaler and aminophylline
C.
Rheumatoid arthritis requiring high-dosage prednisone
D.
Renal disease

A

D.
Renal disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The osmolarity of plasma is primarily due to:
A.
Potassium
B.
Magnesium
C.
Sodium
D.
Protein
E.
Calcium

A

C.
Sodium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hyponatremia due to cortisol and aldosterone deficiency, aldosterone deficiency causes sodium wasting, and cortisol deficiency results in the increased antidiuretic hormone. Which pathology is the most likely cause?
A.
Addison’s disease
B.
Diabetes insipidus
C.
Delirium or dementia
D.
Trauma with long bone fractures

A

A.
Addison’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Differences between intracellular and extracellular fluid composition include all of the following except:
A.
Sodium levels are higher in the extracellular fluid.
B.
Potassium levels are much higher in the intracellular fluid.
C.
Phosphate levels are greater in the extracellular fluid.
D.
The osmolarity of intracellular and extracellular fluids are similar.
E.
All the above are correct.

A

C.
Phosphate levels are greater in the extracellular fluid.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A serum sodium of 120mEq/liter is?
A.
Normal
B.
An indication of hyponatremia
C.
Due to hypertonic irrigating solutions
D.
An indication of hypernatremia

A

B.
An indication of hyponatremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

The major reabsorptive area of the nephron (where most reabsorption occurs) is:
a.
The proximal tubule
b.
The thick ascending limb of Henle’s loop
c.
The distal convoluted tubule
d.
The collecting ducts
e.
None of the above

A

a.
The proximal tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Because protein molecules are too large to be reabsorbed by normal mechanisms, a special mechanism called ________________ is used to save proteins.
a.
Symport
b.
Secondary active transport
c.
Pinocytosis
d.
Passive transport

A

c.
Pinocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Net filtration pressure favoring filtration into Bowman’s space is closest to:
a.
40 mm Hg
b.
20 mm Hg
c.
10 mm Hg
d.
60 mm Hg

A

c.
10 mm Hg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

All the following statements are true about the glomerular basement membrane except
a.
Large molecules easily pass through
b.
Maintains a strong negative charge
c.
Plasma protein filtration is prevented due to the strong negative electrical charge
d.
The membrane charge is due to glycoproteins

A

a.
Large molecules easily pass through

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Decreased glomerular filtration causes overabsorption of sodium ions (Na+) and chloride ions (Cl − ) in the ascending limb of the loop of Henle resulting in a reduction in the delivery of these ions in the ultrafiltrate to the ________________, which are specialized cells designed to detect small changes in osmolality.
a.
Macula densa
b.
Afferent arteriole
c.
Mesangial cells
d.
Vasa recta

A

a.
Macula densa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Active transport of Cl is a feature of:
a.
The descending limb of Henle’s loop
b.
The thick ascending limb of Henle’s loop
c.
The proximal tubule
d.
The distal tubule

A

b.
The thick ascending limb of Henle’s loop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Glomerular filtration is also dependent on the following physiologic factors except:
a.
The pressure in the Bowman capsule
b.
The level of ADH present in the ultrafiltrate
c.
The colloid osmotic pressure of the plasma proteins
d.
The pressure inside the glomerular capillaries

A

b.
The level of ADH present in the ultrafiltrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which of the following statements about creatinine is/are true?
a.
Clearance can be used to estimate GFR.
b.
It is a byproduct of skeletal muscle metabolism.
c.
It is secreted in the proximal tubule to a limited extent.
d.
All the above
e.
None of the above

A

d.
All the above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Increased sodium delivery to the macula densa will:
a.
Increase water loss in collecting tubules.
b.
have no effect on GFR.
c.
increase GFR.
d.
decrease GFR.

A

d.
decrease GFR.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Filtration, which results from pressures forcing fluids and solutes through the glomerulus, is the first step in the formation of urine. The quantity of glomerular filtrate formed each minute in all nephrons is called the glomerular filtration rate (GFR). Normal GFR is approximately:
a.
5-6 L/min
b.
1.0-1.2 L/min
c.
125ml/min
d.
20-25% of cardiac output

A

c.
125ml/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Urea passively diffuses from medullar collecting duct during water deficits when?
A.
The macula densa releases ADH
B.
In the presence of ADH
C.
Blood glucose levels are high
D.
The cortical osmolarity is 300mOsmol/L

A

B.
In the presence of ADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Following this quiz, you go to the local pub drown your sorrows. After eating 2 bowls of the saltiest popcorn ever and drinking several cheap brews you are surprised that you have a strong urge to visit the restroom several times during your time there. Perplexed (because you didn’t study), you ask your wiser friend who explains why - despite a large sodium load - you still must urinate. The reason is:
A.
The alcohol has destroyed the hypertonic interstitium of the renal medulla.
B.
Alcohol has inhibited the release of ADH.
C.
Alcohol has inhibited the renin angiotensin pathway.
D.
Alcohol has inhibited angiotensin-converting enzyme.

A

B.
Alcohol has inhibited the release of ADH.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

For which situations below would you expect to see increased stimulation for the release of ADH? (Pick all that apply)
A.
Ethanol, alpha-adrenergic agonists, and atrial natriuretic peptide.
B.
Hypovolemia
C.
Hypernatremia
D.
Elevations in osmolarity

A

B.
Hypovolemia
C.
Hypernatremia
D.
Elevations in osmolarity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

The minimal obligatory urine volume of a normal 70 kg human is:
A.
50ml/day
B.
1200ml/day
C.
1L/day
D.
0.5L/day

A

D.
0.5L/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

________________ is a potent vasoconstrictor cleaved from angiotensin I primarily in the _______________ by the action of angiotensin-converting enzyme:
A.
Arginine Vasopressin, adrenal gland
B.
Cortisol, spleen
C.
Angiotensin II, primarily in the pulmonary endothelium
D.
Epinephrine, liver

A

C.
Angiotensin II, primarily in the pulmonary endothelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Osmoreceptors which help regulate ADH secretion are mainly found where? :A. Hypothalamus B. Aorta and carotid vessels C. Left ventricle D. Adrenal medulla
A. Hypothalamus
26
RAAS activation produces which result in the body? (Pick 3) A. Increases circulating fluid volume. B. Promotes H2O and Na+ retention. C. Increases GFR. D. Increases blood pressure.
A. Increases circulating fluid volume. B. Promotes H2O and Na+ retention. D. Increases blood pressure.
27
The renal medullary interstitial fluid is hyperosmolar compared to cortical interstitial fluid. Which factor contributes to this? A. Urea B. Active transport mechanisms C. ADH level D. All influence medullary osmolarity E. None of the above.
D. All influence medullary osmolarity
28
Which statement about the macula densa is FALSE? A. It is in the proximal tubule. B. Specialized cells detect sodium concentration of the fluid in the tubule. C. Decreased fluid flow and sodium delivery and the macula densa responds by increasing renin release to increase GFR. D. Elevated tubule sodium triggers contraction of the afferent arteriole, reducing glomerular filtration rate.
A. It is in the proximal tubule.
29
In which of the patients below would you expect to see decreased aldosterone secretion? A. A thirsty patient walking in the desert B. A patient with Conn's syndrome C. A patient with hyperkalemia D. A patient taking Lisinopril E. None of the above
D. A patient taking Lisinopril
29
Where is bicarb reabsorbed at?
Proximal tubule
30
Potential causes of metabolic alkalosis?
sodium depletion long term diuretic decreased aldosterone
31
Affects of acidosis
Decreased cardiac contractility, Rightward shift in oxy-hemoglobin dissociation curve, decreased responsiveness to catecholamines, K increases 0.6mEq/L for each 0.1 unit decrease in pH
32
The following 7.32, hco3 25, paco2 50
acidotic acute respiratory acidosis
33
Possible effective treatments for someone who has metabolic alkalosis
stop NG suction IV hydrochloric acid discontinue diuretics Spironolactone if increased mineralocorticoid activity Administer K
34
Name some body buffers
Bicarb Hemoglobin Intracellular proteins Phosphate Ammonia
35
Hydrogen ion pump exists in which tubule and is able to create a large hydrogen ion gradient
Distal tubule
36
Acidosis will have what effect on serum potassium
increases K 0.6 mEq/L for each 0.1 unit decrease in pH
37
Something that facilitates the hydration of carbon dioxide in plasma and erythrocytes. Carbonic acid which then spontaneously dissociates which spontaneously dissociates to hydrogen ion and bicarb. What do you need for this process.
Carbonic anhydrase
38
what do diuretics lead to?
Contraction alkalosis
39
What causes alkalosis?
The loss of acids through various things we do…like suctioning OG tubes, vomiting and diuretic administration.
40
Where in the tubule does carbonic anhydrase work?
The proximal tubule
41
Where is the majority of filtered bicarb reabsorbed?
80-90% of filtered bicarbonate is reabsorbed in the proximal tubule….with 10-20% reabsorbed in the distal tubule
42
Where is the sodium chloride symporter?
Distal convoluted tubule
43
How do most clinically used diuretics work?
By decreasing the rate of sodium reabsorption from the tubules which causes sodium output to increase (natriuresis) which then results in diuresis (water output)
44
What are osmotic diuretics
Mannitol/urea, glycerin, isosorbide, work in the *proximal tubule* by drawing fluid into the tubules For AKI, HTN, acute oliguria Causes increased intravascular volume which may cause pulmonary edema in CHF patients
45
What are loop diuretics?
Furosemide/bumetanide/ethacrynic acid… inhibit the Na-2Cl-K co-transporter in the *TAL* of Henle….the countercurrent multiplier gets disrupted and the interstitium cannot become hyperosmolar Causes metabolic alkalosis, decreased lithium clearance, decreased K, decrease Ca, hypovolemia
46
What is the most used diuretic?
Thiazides (HCTZ)
47
How do thiazide diuretics work?
Inhibit sodium chloride reabsorption in the early *distal tubule* by affecting the NaCl cotransport mechanism Cause Increased Ca, *hyperglycemia*, decreased K, and Hypochloremic metabolic alkalosis
48
What are carbonic anhydrase inhibitors?
Acetazola*mide*….Reduce reabsorption of Na+ in the proximal convoluted tubule by decreasing HCO3 and H2O reabsorption. Causes mild metabolic acidosis
49
What is mainly used to treat glaucoma?
Carbonic anhydrase inhibitors
50
What is the disadvantage of carbonic anhydrase inhibitors?
It causes acidosis through bicarbonate loss in the urine.
51
What are aldosterone antagonists?
spironolactone (Aldactone), potassium-sparing, Decreases reabsorption of Na+ and decreases K+ secretion by competing for aldosterone (inhibits aldosterone) binding sites in the distal segment of the distal tubule.*
52
How are Na+ Channel blockers used for diuresis?
amiloride and triamterene….Decrease activity of Na/K ATPase in the collecting tubules and thereby decrease Na+ reabsorption
53
What is the #1 cause of renal failure?
DIABETES, 2nd leading cause is hypertension
54
What is the muscle relaxant of choice for renal patients?
Cis-atracurium as it is degraded by Hoffman elimination
55
Succinylcholine is safe in patients with K<____ mEq/L, will transiently increase K+ by almost ____ mEq/L
Safe with K < 5, will increase K by 0.5-1
56
What muscle relaxant should you avoid?
Pancuronium
57
What is the best analgesic because it doesn't have any active metabolites?
Fentanyl
58
How does ANP work?
Decrease renin release, thereby decreasing circulating levels of angiotensin II and aldosterone. Promotes natriuresis and diuresis.
59
What is counter-regulatory to the RAAS system?
Natriuretic peptides
60
What are the actions of ANP
Inhibits renin release, increased GFR/vasodilation to promote diuresis, inhibits aldosterone secretion, inhibits ADH release, Acts directly on the collecting duct to decrease NaCl reabsorption
61
Where does ANP directly act to decrease NaCL reabsorption
The collecting duct
62
What is NOT in dialyzing fluid?
Phosphate, urea, urate, sulfate, or creatinine
63
What is High in dialyzing fluid?
Bicarb and glucose
64
What is low in dialysis fluid?
K, Na, Cl
65
Where does chloride transportation occur?
Active Na and Cl transport in the TAL increases the osmolality of the interstitial space
66
Where are the macula densa cells?
The TAL and distal tubule
67
What do the macula densa do
They are epithelial cells in the high cortical TAL and distal convoluted tubule that detect sodium concentration of the fluid in the tubule.
68
In response to elevated sodium, the macula densa trigger _____ of the afferent arteriole, reducing flow of blood to the glomerulus and the glomerular filtration rate.
Constriction
69
What cannot cross Bowman’s capsule?
Cells and proteins more than 60 to 70 kDa cannot cross.
70
What does the basement membrane block?
Negatively charged proteins are thus repelled and are unable to pass through it. Molecules greater than 50-100 angstroms will not pass through
71
What are the two major determinants of filtration pressure?
Glomerular capillary pressure (PGC) and glomerular oncotic pressure (pgc).
72
Renal blood flow is around ____% of cardiac output
20%
73
What are the two major regulatory functions performed by the juxtaglomerular apparatus?
The high distal tubular [NaCl]-induced *afferent arteriolar vasoconstriction* the low tubular [NaCl]-induced *renin release*
74
What does a decrease in sodium chloride concentration initiate in the macula densa/JG?
1) It increases renin release from the juxtaglomerular cells of the afferent and efferent arterioles, which are the major storage sites for renin, and, 2) It decreases resistance to blood flow in the afferent arterioles, which raises glomerular hydrostatic pressure and helps return GFR toward normal.
75
When renin is released in response to decreased NA, it ____ the efferent arteriole, thus increasing GFR.
Constricts
76
Renin ___ the efferent arteriole in response to decreased NA to the JG apparatus.
Constricts
77
ANP ____ the afferent arteriole and also does what to the efferent?
vasodilates the afferent Constricts the efferent
78
What would you see in a preop uremic patient?
*Increased bleeding risk*, Anorexia, nausea, vomiting, pruritus, anemia, fatigue, coagulopathy, edema, pericarditis, acidosis, high nitrogenous wate products (urea, uric acid, creatine), increase in K, anemia, a compensatory increase in C.O
79
When are buffers the most efficient?
When pH = pKa
80
What does the the Henderson–Hasselbalch equation describe?
The relationship between pH, PaCO2, and serum bicarbonate.
81
The solubility coefficient for CO2 is what?
0.03 mmol/mm Hg
82
What is by far the most powerful of the acid-base regulatory systems?
Kidneys
83
What are the buffers for acidosis?
Brain/arterial receptors, increased RR, decrease co2, decrease H2CO3 (carbonic acid), increase PH
84
What are the buffers for alkalosis
Decreased RR, increase co2, increase H2CO3, decrease PH
85
The _____ _____ _____ is the most powerful extracellular buffer in the body.
Bicarbonate buffer system
86
What type of cells are especially important in eliminating hydrogen ions while reabsorbing bicarbonate in acidosis?
Type A intercalated cells
87
What cells have functions opposite to those of type A cells and secrete bicarbonate into the tubular lumen while reabsorbing hydrogen ions in alkalosis?
Type B intercalated discs
88
what are the three primary systems that regulate the H+ concentration in the body fluids to prevent acidosis or alkalosis?
1) Chemical acid base buffer systems 2) respiratory center 3) Kidneys (Most important)
89
What causes metabolic alkalosis?
Na Depletion: more Na absorbed in proximal tubule, contraction alkalosis with long term diuretic use Increased aldosterone (mineralcorticoid): increases Na reabsorption and H secretion in distal tubule
90
What causes an elevated anion gap in metabolic acidosis?
Three diseases (uremia, ketoacidosis, lactic acidosis) Toxins (methanol, ethylene glycol, salicylates, paraldehyde) Due to decreased excretion of non-volatile acids
91
What conditions of metabolic acidosis have a normal anion gap?
Anything with HCO3 loss: Renal tubular acidosis Diarrhea Carbonic anhydrase inhibition Ureteral diversions Early renal failure Hydronephrosis HCl administration Saline administration
92
What is considered a high anion gap?
>13mEq/L
93
When is Sugammadex not indicated?
Severe renal insufficiency/failure Peds ICU patients
94
How is the Sugammadex complex mainly excreted?
Excreted by the kidneys mainly Forms a stable complex with Roc that is then eliminated by the kidneys. In ESRD this complex remains in circulation for days
95
What is the key factor in causation of perioperative renal failure
Hypovolemia
96
When is gout most common?
When diet is rich in protein, fat, and alcohol
97
Signs and symptoms of uremic syndrome?
Anorexia Nausea Vomiting Pruritus Anemia Fatigue Coagulopathy Acidosis Increase in K, Phos, Phenols Increased CO
98
Rate of movement of a solute across a membrane in dialysis depends on these three things
Concentration gradient of solute Permeability of surface area of membrane Length of time they remain in contact
99
Four components of the JGA
Smooth muscle in afferent Smooth muscle in efferent Extraglomerular mesangial Macula densa in DISTAL TUBULE
100
Conn's syndrome
Aldosterone secreting tumor that causes HTN, hypernatremia, hypokalemia
101
2 functions of the vasa recta
Remove reabsorbed fluid from the interstitium Minimize solute uptake from the medulla (maintain hypertonicity)
101
Osmolality is defined as: Answers:A. Gram molecular weight per liter of solution B. Number of particles per 22.14 liters C. Osmoles per liter of solution D. Osmoles per kilogram of solution
D. Osmoles per kilogram of solution
102
The proximal tubule does bulk reabsorption of what 2 things?
Solutes and H2O
103
The descending loop of Henle is highly permeable to what and utilizes what mechanism?
Utilizes the countercurrent mechanism and is highly permeable to H2O
104
The Ascending loop of Henle uses what mechanism and is not permeable to what?
Uses the countercurrent mechanism and is NOT permeable to H2O
105
The distal convoluted tubule is the location for what important part of the kidney and fine tunes the concentration of what?
Location of JGA Fine tunes solute concentration
106
The collecting duct regulates the final concentration of what and has what three things working in that area?
Final concentration of urine ADH, aldosterone, ANP work here
107
What can be used to treat glaucoma, high altitude sickness and central sleep apnea
Carbonic anhydrase inhibitors
108
What medications are bad to use in combination with potassium sparing diuretics?
NSAIDs, Beta blockers, ace inhibitors
109
What labs assess GFR
BUN Serum Cr CrCl
110
What labs assess tubular function?
FxNa Osmolality Gravity Concentration
111
True or false: BUN goes through both filtration and reabsorption?
True
112
True or false: CrCl goes only through filtration?
True
113
What can excessive administration of 0.9% NaCl cause?
Hyperchloremic metabolic acidosis
114
What do alpha 1 agnonists cause in the kidneys?
Decreased renal blood flow
115
Which is constricted with vasopressin: afferent or efferent arterioles?
Efferent arterioles
116
How can you decrease K via ventilation?
Hyperventilate Decreases K by 0.5mEq/L
117
When is dialysis indicated?
Severe metabolic acidosis volume overload hyperkalemia symptomatic uremia overdose with a drug that can be cleared
118
What narcotics should not be given with renal disease?
Morphine Meperidine

Physiology 2 - Renal (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions