OS 206 E3 Samplex 2014 Flashcards Preview

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Flashcards in OS 206 E3 Samplex 2014 Deck (58)
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1

Which statement does not describe the perirenal
fascia?

A. It encloses the perirenal fat
B. It is also known as gerota's fascia
C. It anchors the kidney to its surrounding
structures and abdominal wall
D. It is the innermost of the 3 tissue layers
that surround the kidney

D

2

You noticed a urine-like fluid leaking from the
anterior abdominal wall of a child. You explain to
the mother that an abdominal structure, the
urachus, has persisted in her child. The leak can
be seen at the:

A. Hypogastrium
B. Mons Pubis in Female
C. Umbilicus
D. Inguinal Area
E. Ventral Aspect of Genitalia

C

3

During surgical removal of pathologic left kidney
its renal vein has to be ligated towards renal
hilum to avoid compromise venous drainage of
one of these abdominal viscerae.

A. Pancreas
B. Spleen
C. Ovary
D. Left colon
E. Loop of jejunum.

C

4

The stones in the urinary tract are usually composed of

A. uric acid
B. calcium oxalate
C. magnesium phosphate
D. cystine
E. mixture of calcium, magnesium and uric acid

B

5

Why does the urine from the bladder not backflow to the kidneys?

A. Presence of ureteral peristalsis
B. Presence of a valvelike fold when distended
and the oblique orientation of the ureter with
respect to the bladder.
C. Ureteropelvic junction sphincter action to
close and prevent backflow.
D. Viscoelastic nature of the bladder and ability
to maintain low pressure even in increasing
volume

C

6

What detects the concentration of Na+ and fluid
levels in the distal convulated tubules?

A. macula densa
B. efferent arteriole
C. distal loop of Henle
D. none of the above

A

7

True of efferent arteriole

a. receives blood from vasa recta
b. contains mechanoreceptors responsive to BP
c. branches to peritubular capillaries
d. reabsorbs interstitial solutes and water from LOH
e. AOTA

C

8

True of the glomerulus:

A. Podocytes' processes are the ultrafilter in the
glomerulus.
B. The capillary basement membrane
consists of 3 layers which are negatively
charged.
C. The parietal layer of the Bowman's capsule
forms the outer layer of the glomerulus.
D. Filtration in the glomerulus is drivenby
osmotic gradient.
E. AOTA

B

9

PCT:

A. Found at cortex and medulla
B. Reabsorbs using an osmotic gradient.
C. Generates osmotic gradient of the renal
interstitium
D. Distinguished from DCT by brush border
E. AOTA

D

10

What is the large space lined by transitional
epithelium which funnels urine to the ureter?

a. capsule
b. calyx
c. hilus
d. papillae
e. pelvis

E

11

True about LOH

a. has water-permeable descending loop
and water-impermeable ascending loop
b. acted upon by aldosterone and ADH
c. determine osmotic gradient...
d. removes all blood components from filtered
urine
e. AOTA

A

12

Fluids and solutes reabsorbed from the proximal
and distal convoluted tubules are returned to the
circulation via:

a. vasa recta
b. podocytes
c. peritubular capillaries
d. interlobular arteries
e. arcuate arteries

C

13

Which anatomical part is not seen in a noncontrast plain film?

A. stomach
B. Psoas
C. ureter.
D. Bladder.

C

14

In a normal adult, the kidney lies in which
vertebral bodies?

a. T11-L3
b. T9-T12
c. L3-L4
d. T10-L1

A

15

The outline of the renal shadows are visible on a
plain film of the abdomen because of:

A. The low density of perirenal fat
B. The uptake of contrast by the kidneys
C. The low soft tissue density of the psoas
D. The presence of surrounding bowel gas

A

16

Which is not within the renal sinus?

A. Medullary pyramid
B. Branches of renal artery
C. Tributaries of renal vein
D. Renal collecting system

A

Renal sinus is consisted of collecting system,
renal vessels (arteries and veins), lymphatics,
fats and fibrous tissue

17

Which is not a common finding on an intravenous
pyelogram in patients with hydronephrosis?

A. Flattening of normal concavity of the calyx
B. Reversal of the convexity of the renal pelvis
C. Atrophy of the renal pelvis
D. Enlarged calyces

C

Intravenous pyelogram of patients with
hydronephrosis will show dilation of the renal
pelvis and blunting/dilation of the calices.

18

Which of the following does not describe the
perirenal fascia?

A. Encloses perirenal fat.
B. Known as Gerota’s Fascia.
C. Anchors kidney to its surrounding structures
and abdominal wall.
D. Innermost of 3 three tissue layers that
surround kidney

D

There are 3 layers of supportive tissue
surrounding each kidney: (1) RENAL CAPSULE -
a transparent dense irregular connective tissue
covering the kidney surface, which protects the
kidneys from physical trauma and prevents
infections in surrounding regions from spreading
into the kidneys; (2)ADIPOSE CAPSULE - a
mass of adipose tissue outside the renal capsule
which helps hold the kidney in place against the
posterior abdominal wall and cushions the
kidneys against external blows; (3)
PERIRENAL/RENAL/GEROTA’S FASCIA - a
layer of dense irregular connective tissue outside
the adipose capsule (the outermost tissue layer)
that anchors the kidney to the abdominal wall.

19

Glomerular oncotic pressure is primarily contributed by

A. Plasma protein
B. Glucose
C. Sodium
D. Urea

A

Blood flowing into the glomerulus contains
plasma proteins and blood cells that displace the
water content of the blood. This creates, in effect,
a counter force called oncotic pressure, as water
outside the capillaries seeks to equalize with the
water inside the capillaries through osmosis.

20

What influences Kf?

A. Hydrostatic pressure of the glomerulus
B. Oncotic pressure of the glomerulus
C. Contraction of mesangial cells
D. NOTA

C

Kf or permeability characteristic of glomerulus
depends on: (1) surface area available for
filtration (increased SA, increased Kf, increased
GFR); (2) change in porosity of filtration
membrane such as when there is inflammation
(increased no. of holes, increased fluid mov’t,
increased GFR) and; (3) mesangial cell activity.
Mesangial cells provide support for the
glomerular capsule and alter capillary SA which
then affects Kf and GFR

21

Which of the following statements concering the
process of glomerular filtration is CORRECT?

A. Bowman’s capsule hydrostatic pressure
opposes filtration.
B. The glomerular filtration rate is limited by Tm
C. All of the plasma that enters the glomerulus is filtered.
D. It is generally affected by small fluctuations in blood pressure

A

Glomerular filtration is promoted by capillary
hydrostatic pressure and opposed by capsular
hydrostatic pressure and blood colloid osmotic
pressure.

22

Which of the following is involved in
autoregulation of GFR?

a. Automatic constriction of afferent arteriole when stretched.
b. Increased delivery of Na+ and Cl- to macula
densa causes vasoconstriction of afferent arteriole
c. Sympathetically induced vasoconstriction of afferent arteriole
d. Vasoactive substance released from renal
nerves cause afferent arteriole vasoconstriction

A

23

The substance mediating the changes in afferent
arteriolar diameter when there is increased
delivery of Na+ and Cl- to the macula densa is:

A. Renin
B. Angiotensin
C. Adenosine
D. Aldosterone

C

With increased uptake of Na, K, and Cl,
there is increased generation of adenosine;
adenosine activates adenosine1 receptors to
trigger an increase in cytosolic Ca++ in
mesangial cells, and then intensive coupling
between juxtaglomerular (renin-containing) cells
and mesangial cells occurs. Final result is
afferent arteriole constriction and renin inhibition.

24

A drug that inhibits Na+ reabsorption results to
lower __________ reabsorption.

A. Amino acid
B. H+
C. Creatinine
D. Organic acid or base

A

AAs are cotransported with sodium. Organic
acids and bases are secreted. Creatinine is not
reabsorbed. Hydrogen ion is secreted via an
antiport mechanism.

25

An important mechanism in reabsorbing amino
acids and organic molecules in the proximal
tubule is:

A. facilitated diffusion
B. endocytosis
C. secondary active transport
D. simple diffusion

C

Amino acids and organic molecules are
reabsorbed with sodium in a cotransport
mechanism. The transport is driven by the Na/K
ATPase pump in the basolateral surface.

26

95% of the molecules is reabsorbed in the
proximal tubule except:

A. bicarbonate
B. sodium
C. urea
D. water

C

Urea is only 50% reabsorbed in the PCT.

27

An example of a substance that is filtered and reabsorbed but not secreted is:

A. potassium
B. creatinine
C. glucose
D. phosphate

C

K+ and phosphate are substances that are
filtered, reabsorbed and secreted.
Creatinine is a substance that is filtered and
secreted.

28

Which of the following statements is true
regarding PCT reabsorption?

A. It replies on the osmotic gradient created
by the Na-K pump
B. It is dependent on ADH
C. It is independent of Na.
D. NOTA

A

29

Where are drugs and foreign substances such as
creatinine secreted?

A. Proximal tubule
B. Loop of Henle
C. Distal tubule
D. collecting duct

A

Most drugs and foreign substance are secreted
along the proximal convoluted tubule.

30

The renal threshold for glucose is the

A. maximum concentration of glucose the
glomerulus can filter
B. minimum concentration of glucose the
glomerulus can filter
C. plasma concentration of glucose above
which will appear in the urine
D. plasma concentration of glucose below
which will appear in the urine

C

By definition, the renal threshold for glucose is
the plasma concentration of which any
concentration of glucose above the said threshold
will appear in the urine.

31

Reabsorption of NA and Cl in the DCT and CD is
directly affected by

A. angiotensin II
B. ADH
C. aldostesrone
D. ANP

C

ANP causes the kidneys to excrete more water
through excretion of Na. ADH increases the
permeability of water along the apical membrane
of the collecting ducts by activating aquaporin-2
channels. The presence of Angiotensin II will
cause the release of aldosterone. It is
aldosterone which can cause Na and Cl
reabsorption in the DCT and CD of the kidneys.

32

Which of the following will increase ADH stimulation?

A. intake of 10 bottles of beer
B. intake of food rich in salt
C. intake of 2 liters of water before ultrasound
D. NOTA

B

33

Which of the following is true?

A. ADH1 affects intercalated cells of the
proximal tubule.
B. ADH attached to the apical membrane
receptors leads to CAMP activation, leading
to the formation of water channels
C. Aquaporin-2 water channels insert into
the apical membrane of the collecting
duct, which render the segment water
permeable
D. AOTA

C

ADH, once secreted by the posterior pituitary,
enters the bloodstream and gets transported to
the kidneys, where it increases the permeability
of the distal tubules, cortical collecting tubules
and medullary collecting ducts to water. ADH
binds with specific receptors, with increases the
formation of CAMP and protein kinases. These,
in turn, causes Aquaporin-2 to move towards the
luminal side of the cell membranes, fusing with it
to form water channels that facilitate rapid
movement of water through diffusion. Answer is
C, since ADH only affects the distal tubules and
collecting ducts and it requires both CAMP and
protein kinases to stimulate movement of
Aquaporin-2 water channels

34

Decrease in ECF volume comes with an increase in the following except:

A. aldosterone
B. ADH
C. sympathetic
D. ANP

D

A rise in ECF volume inhibits vasopressin (or
ADH) and aldosterone secretion, and a decline in
ECF volume produces an increase in the
secretion of these hormones. In addition,
expansion of the ECF volume increases the
secretion of ANP and BNP by the heart, and this
causes natriuresis and diuresis

35

Release of renin by granular cells of JGA is
stimulated by:

A. increased ECF volume
B. increased sympathetic activity
C. increased stretch of afferent arteriole
D. increased NA and Cl sensed by macula densa

B

Renin secretion is stimulated by 1) perfusion
pressure 2) sympathetic activity 3) NaCl delivery
to macula densa.

36

An increase in potassium intake is expected to
increase potassium secretion in this segment of
nephron:

A. proximal straight tubule
B. proximal convoluted tubule
C. Thick ascending limb of Henle's loop
D. collecting tubule

C

Sixty-five percent of filtered potassium is
reabsorbed in the proximal tubule. Another 25-
30% is reabsorbed in the thick ascending part of
the Loop of Henle, (cotransported with Na and
Cl). “With high potassium intakes, the required
extra excretion of potassium is achieved almost
entirely by increasing the secretion of potassium
into the distal and collecting tubules.

37

In the collecting tubule,

A. Entry of K+ into the cell across the
basolateral membrane occurs via Na+-K+ ATPase.
B. Secretion of K+ into tubular lumen in intercalated cells.
C. K+ movement across apical membrane is via Na+-K+ antiport.
D. Secretion of K+ occurs against an electrochemical gradient.

A

38

Magnesium is involved in many biochemical
processes in the body. What are the sites of Mg2+
reabsorption?

A. PT & Thick Ascending Limb
B. Thick & Thin Loop
C. CD & PT
D. PCT & DT

A

39

Which of the following is NOT a necessary
component of the countercurrent mechanism?

A. Straight segment of the proximal tubule
B. Loop of Henle
C. Vasa recta
D. Collecting tubule

A

40

Characteristics of the renal medullary interstitium:

A. Osmolarity is highest at the junction of the cortex and medulla
B. Medullary osmolarity is contributed to by both NaCl & urea
C. Decreased medullary blood flow decreases
medullary osmolarity
D. All of the above

B

41

Bartter’s syndrome is a set of autosomal
recessive genetic disorders characterized by
metabolic alkalosis and hyperaldosteronism.
Which of the following transport mechanisms is
affected in this disorder?

A. Na+-K+-2Cl- cotransporter
B. Apical K+ channel in the thick ascending limb
of Henle’s loop
C. Basolateral Cl- channel in the thick ascending limb of Henle’s loop
D. Any of the above

D

42

PTH increases plasma Ca2+ concentration by:

A. Increase bone resorption
B. Increase renal Ca2+ absorption
C. Stimulate 1,25-dihidroxy vitamin D3
production
D. All of the above

D

43

Calcium reabsorption in the nephron is

A. by both paracellular and transcellular routes
in the proximal tubule
B. exclusively transcellular in the distal tubule
C. Both of the above
D. Neither of the above

C

44

Salicylic acid is a lipid soluble, weak acid that
undergoes nonionic diffusion. Which of the
following interventions would enhance urinary
excretion of this compound?

A. acidifying the urine
B. alkalinizing the urine
C. giving a drug which inhibits organic anion
secretion in the tubule lumen
D. any of the above

B

45

Which of the following 50 year-old persons will
have the highest percent body water?

A. Female athlete
B. Female, obese
C. Male, sedentary living
D. Male weight lifter

D

Hi muscle = Hi water, Hi fat = Low water

46

A 30-year old average male weighing 80kg would
have a total body water of?

A. 36L
B. 40L
C. 44L
D. 48L

D

The total body water is 60% of the total body
weight.

47

What is the major/main anion of the ECF?

A. Bicarbonate
B. Chloride
C. Protein
D. Phosphate

B

48

How many mmoles of sodium does 1 gram of
sodium chloride (NaCl) have?

A. 10
B. 17
C. 35
D. 43

B

Na = 23 g/mol, Cl = 35.5 g/mol --> NaCl = 58.5 g/mol  --> 1g NaCl = 17.094 mmol Na

49

How many meq are in 1 gram of Na?

A. 10
B. 17
C. 35
D. 43

D

50

Which of the following estimates comes closest to
the gold standard for assessing GFR?

a) serum creatinine
b) reciprocal serum creatinine
c) Cockroft Gault equation
d) MDRD

D

Answer A can be different for the same GFR
according to muscle mass, for one (b) is only
useful when there is more than 50% loss of renal
function (d) is more accurate than (c) because it
takes into account serum creatinine, age, race and gender

51

Which of the following is most useful for
monitoring sudden kidney collapse?

a) serum creatinine
b) plotting the reciprocal serum creatinine serially
c) Cockroft Gault equation
d) MDRD

B

only (b) gives kidney function over time

52

For a substance to be used as a marker for
GFR, it must be

a) bound to protein
b) freely filterable
c) synthesized by the kidneys
d) secreted by the tubules

B

Any substance that meets the following criteria will
serve as an appropriate marker for the
measurement of GFR. The substance must:
1) be freely filtered across the glomerulus into the
Bowman's Space
2) not reabsorbed/secreted by the nephron
3) not be metabolized or produced by the kidneys
4) not alter GFR

53

Which is an abnormal finding in urinalysis?

a. specific gravity of 1.020
b. protein
c. amorphous crystal
d. pH 6.0

B

54

A urine of pH 6.0 is normal and expected in the
following situations except

a. After a meal
b. Vegetarian diet
c. In the morning
d. Drinking bicarbonate medication to dissolve
uric acid stones

C

The initial/very first urine in the morning is
normally very acidic due to its concentration. .it
can reach pH levels of as low as 4.5

55

In normal voiding

a. pelvic nerve stimulates sphincter
b. hypogastric nerve stimulates bladder neck
c. pudendal nerve
d. pelvic nerve stimulates detrusor firing

B

56

Contraction of the trigonal muscles prevents this
event during normal voiding?

A. detrusor firing
B. stimulation of bladder neck
C. retrograde ejaculation
D. backflow of urine from bladder to
ureter

D

The ureteral orifices are found at the angle of the
trigone. Its contraction closes the orifices
preventing backflow.

57

Which of the following events is the first to occur
during voiding?

a. relaxation of external urethral sphincter
b. contraction of detrusor muscle
c. opening of bladder neck
d. relaxation of pelvic flow

C

The following is the correct sequence of events that occur during voiding:
1) inhibitory cortical impulses stop.
2) hypogastric nerve is inhibited and bladder neck opens.
3) pelvic nerve is stimulated.
4) trigone contracts and bladder neck opens further.
5) pudendal nerve is inhibited.
6) external sphincter and pelvic floor relax.
7) detrusor contracts and voiding begins.

58

Bladder compliance is essential in filling because

a) it allows a slight increase in bladder pressure
as bladder volume increases, in preparation
for voiding.
b) it maintains low bladder pressure even as
bladder volume increases.
c) it allows sustained and complete emptying of
the bladder during voiding phase.
d) it prevents backflow of urine from the bladder
to the ureters.

B

Normal filling requires the detrusor
muscle to be compliant. It must be able to relax
and accommodate, and allow the bladder to
reach its normal capacity without an increase in
bladder pressure.