Block 6 Renal Physiology Part 2
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Questions and Answers
- 1.
During acidosis, levels of phosphate in the plasma, and thus in the ultrafiltrate, increase to aid in the excretion of the acid load. What is a detrimental consequence of the increased H+ buffering by phosphate?
- A.
A. Bone fragility
- B.
B. Uncontrolled diabetes mellitus
- C.
C. Anemia
- D.
D. Metabolic alkalosis
- E.
E. Muscle hyperexcitability
Correct Answer
A. A. Bone fragilityExplanation
During acidosis, the body tries to buffer the excess H+ ions by increasing the levels of phosphate in the plasma and ultrafiltrate. However, this increased buffering by phosphate can lead to a detrimental consequence of bone fragility. This is because phosphate is an important component of bone mineralization, and when it is used to buffer H+ ions, it can lead to a loss of phosphate from the bones, weakening them and increasing the risk of fractures.Rate this question:
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- 2.
Aldosterone stimulates H+-ATPase on intercalated cells. What acid-base disorder is found in hyperaldosteronism?
- A.
A. Metabolic acidosis
- B.
B. Metabolic alkalosis
- C.
C. Respiratory acidosis
- D.
D. Respiratory alkalosis
- E.
E. None
Correct Answer
B. B. Metabolic alkalosisExplanation
Aldosterone stimulates the H+-ATPase on intercalated cells, which leads to increased secretion of hydrogen ions (H+) into the urine and reabsorption of bicarbonate ions (HCO3-) in the kidneys. This results in an excess of bicarbonate in the blood, leading to metabolic alkalosis. Therefore, the correct answer is b. Metabolic alkalosis.Rate this question:
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- 3.
Aspirin overdose leads to a mixed acid-base disorder because aspirin (salicylic acid) is an acid producing metabolic acidosis as well as a (an)
- A.
A. Stimulant of the respiratory center producing respiratory alkalosis.
- B.
B. Fever-inducer producing respiratory alkalosis.
- C.
C. Constrictor of alveolar smooth muscle producing respiratory acidosis
- D.
D. Inhibitor of HCO3- reabsorption producing metabolic acidosis
- E.
E. Inhibitor of NH3 synthesis producing metabolic alkalosis.
Correct Answer
A. A. Stimulant of the respiratory center producing respiratory alkalosis.Explanation
Aspirin overdose leads to a mixed acid-base disorder because it causes metabolic acidosis by producing excess acid. Additionally, aspirin acts as a stimulant of the respiratory center, leading to hyperventilation and respiratory alkalosis. This means that the body eliminates more carbon dioxide, which decreases the levels of carbonic acid in the blood and causes alkalosis. Therefore, option a is the correct answer.Rate this question:
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- 4.
A patient presents with an elevated arterial pH, elevated arterial Pco2 and arterial [HCO3-]. This is suggestive of ……
- A.
A. respiratory acidosis
- B.
B. respiratory alkalosis
- C.
C. metabolic acidosis
- D.
D. metabolic alkalosis
Correct Answer
D. D. metabolic alkalosisExplanation
An elevated arterial pH, elevated arterial Pco2, and elevated arterial [HCO3-] indicate a condition called metabolic alkalosis. In metabolic alkalosis, there is an excess of bicarbonate ions in the blood, leading to an increase in pH. The elevated arterial Pco2 suggests that the respiratory system is compensating for the alkalosis by retaining carbon dioxide. This helps to decrease the pH and bring it back towards normal.Rate this question:
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- 5.
Chronic diarrhea is likely to result in …….
- A.
A. respiratory acidosis
- B.
B. respiratory alkalosis
- C.
C. metabolic acidosis
- D.
D. metabolic alkalosis
Correct Answer
C. C. metabolic acidosisExplanation
Chronic diarrhea can lead to metabolic acidosis because the loss of fluids and electrolytes in the stool can disrupt the balance of acids and bases in the body. This can result in an accumulation of acid in the blood, leading to a decrease in pH and an acidic environment.Rate this question:
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- 6.
With anuria lasting 3-5 days, which one of the following will decrease in the ECF?
- A.
A. BUN (blood urea nitrogen)
- B.
B. Volume
- C.
C. [K+].
- D.
D. [HCO3-].
- E.
E. [HPO4-].
Correct Answer
E. E. [HPO4-].Explanation
During anuria, there is a complete absence of urine production, leading to the buildup of waste products and electrolytes in the extracellular fluid (ECF). Phosphate (HPO4-) is one of the electrolytes that can accumulate in the ECF due to the lack of excretion through urine. Therefore, with anuria lasting 3-5 days, the concentration of phosphate (HPO4-) in the ECF will likely increase.Rate this question:
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- 7.
A patient is most likely to have problems generating a concentrated but not a dilute urine with which one of these?
- A.
A. Glomerulonephritis
- B.
B. Renal calculi (“Kidney stones”)
- C.
C. Pyelonephritis
- D.
D. Nephrotic syndrome
- E.
E. ESRD
Correct Answer
C. C. PyelonepHritisExplanation
Pyelonephritis is an infection of the kidneys that can lead to inflammation and damage to the renal tubules. This can impair the kidneys' ability to concentrate urine, resulting in a dilute urine. However, it does not typically affect the ability to generate a concentrated urine. Therefore, the patient is most likely to have problems generating a concentrated but not a dilute urine with pyelonephritis.Rate this question:
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- 8.
A patient with chronic lung disease has an arterial PCO2 of 60mm Hg. To what value will the patient’s kidneys have to adjust the plasma bicarbonate concentration if the arterial pH value is to return to normal.
- A.
A. 19 mEq/L
- B.
B. 25 mEq/L
- C.
C. 28 mm Hg
- D.
D. 36 mm Hg
- E.
E. 53 mm Hg
Correct Answer
D. D. 36 mm Hg -
- 9.
Which of the following will increase as an adjustment in response to metabolic alkalosis?
- A.
A. Tidal volume
- B.
B. Respiration rate.
- C.
C. Alveolar ventilation
- D.
D. Urinary NH4+ excretion
- E.
E. Carbonic acid production.
Correct Answer
A. A. Tidal volumeExplanation
Tidal volume refers to the amount of air that is inhaled and exhaled during normal breathing. In the case of metabolic alkalosis, which is a condition characterized by an increase in blood pH, the body compensates by decreasing the respiratory rate and increasing the tidal volume. This adjustment helps to retain more carbon dioxide in the body, which can lower the blood pH and counteract the alkalosis. Therefore, an increase in tidal volume is a response to metabolic alkalosis.Rate this question:
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- 10.
A patient has the following electrolyte values. [Na+] 142 mEq/L [K+] 3.4 mEq/L [Cl-] 75 mEq/L [HCO3-] 9 mEq/L These values are consistent with
- A.
A. respiratory acidosis
- B.
B. metabolic acidosis
- C.
C. respiratory alkalosis
- D.
D. metabolic alkalosis
Correct Answer
B. B. metabolic acidosisExplanation
The given electrolyte values show a low level of bicarbonate (HCO3-), which is an indicator of metabolic acidosis. In metabolic acidosis, there is an excess of acid or a loss of bicarbonate, leading to a decrease in the pH of the blood. The low bicarbonate level in this patient's values supports the diagnosis of metabolic acidosis.Rate this question:
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- 11.
An individual produces 1 L urine per day. If his urine HCO3- concentration is 5 mEq/L, his urinary ammonium is 20 mEq/L, and his titratable acid is 10 mEq/L, then he is
- A.
A. reabsorbing all of his filtered HCO3-.
- B.
B. making 25 mEq of new HCO3- daily
- C.
C. making 35 mEq new HCO3- daily.
- D.
D. very alkalotic
Correct Answer
C. C. making 35 mEq new HCO3- daily.Explanation
Based on the given information, the individual is producing 1 L of urine per day. The urine HCO3- concentration is 5 mEq/L, urinary ammonium is 20 mEq/L, and titratable acid is 10 mEq/L. To determine the amount of new HCO3- being made daily, we subtract the urinary HCO3- concentration from the sum of urinary ammonium and titratable acid. Therefore, 20 mEq/L + 10 mEq/L - 5 mEq/L = 25 mEq/L. Since the individual is producing 1 L of urine per day, the amount of new HCO3- being made daily is 25 mEq/L * 1 L = 25 mEq. Thus, the correct answer is c. making 35 mEq new HCO3- daily.Rate this question:
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- 12.
An individual looses lung function in a traumatic accident resulting in chronic respiratory acidosis. Over time, which one of the following would be most expected to return to a normal value?
- A.
A. Arterial pH.
- B.
B. PaCO2
- C.
C. PaO2
- D.
D. Plasma [HCO3-]
- E.
E. Alveolar ventilation.
Correct Answer
A. A. Arterial pH.Explanation
In chronic respiratory acidosis, there is an accumulation of carbon dioxide in the blood due to impaired lung function. This leads to a decrease in arterial pH, resulting in acidosis. Over time, with proper treatment and management of the underlying condition, the lungs may regain some function, allowing for better elimination of carbon dioxide. As a result, the arterial pH would be expected to return to a normal value.Rate this question:
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- 13.
An individual has an abdominal tumor that puts pressure on the left renal artery, causing it to be partially occluded. Which of the following would you expect to not be increased as a result of this tumor?
- A.
A. arterial diastolic pressure
- B.
B. total peripheral resistance
- C.
C. heart rate.
- D.
D. plasma aldosterone levels
- E.
E. plasma renin levels.
Correct Answer
C. C. heart rate.Explanation
The tumor is putting pressure on the left renal artery, causing it to be partially occluded. This would result in a decrease in blood flow to the left kidney. The decrease in blood flow to the kidney would activate the renin-angiotensin-aldosterone system, leading to an increase in plasma renin levels and subsequently an increase in plasma aldosterone levels. Increased aldosterone levels would cause sodium and water retention, leading to an increase in total peripheral resistance. However, the tumor's effect on the left renal artery would not directly affect heart rate.Rate this question:
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- 14.
The following figure relates arterial pH to arterial PCO2. Use this figure to answer the following two questions. Point representing metabolic acidosis?
- A.
A
- B.
B
- C.
C
- D.
D
- E.
E
Correct Answer
C. CExplanation
Based on the figure, point C represents metabolic acidosis. This is because point C is located in the lower left quadrant of the graph, indicating a low arterial pH and a high arterial PCO2. In metabolic acidosis, there is an excess accumulation of acid or a loss of bicarbonate, resulting in a decrease in pH and an increase in PCO2. Therefore, point C aligns with the characteristics of metabolic acidosis.Rate this question:
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- 15.
The following figure relates arterial pH to arterial PCO2. Use this figure to answer the following two questions. Point representing acute respiratory acidosis?
- A.
A
- B.
B
- C.
C
- D.
D
- E.
E
Correct Answer
D. DExplanation
Based on the given figure, point D represents acute respiratory acidosis. This can be inferred because point D falls below the normal range of arterial pH and above the normal range of arterial PCO2. Acute respiratory acidosis occurs when there is an increase in arterial PCO2, leading to a decrease in arterial pH. Therefore, point D represents a condition of elevated arterial PCO2 and decreased arterial pH, indicating acute respiratory acidosis.Rate this question:
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- 16.
Point representing a mixed disturbance of respiratory acidosis and metabolic acidosis?
- A.
A
- B.
B
- C.
C
- D.
D
- E.
E
Correct Answer
C. C -
- 17.
Which one of the following conditions produces metabolic acidosis?
- A.
A. Severe vomiting
- B.
B. High altitude
- C.
C. Acetazolamide treatment
- D.
D. Tracheal obstruction
- E.
E. Excessive ingestion of antacids
Correct Answer
C. C. Acetazolamide treatmentExplanation
Acetazolamide is a medication that is commonly used to treat glaucoma and altitude sickness. It works by inhibiting the enzyme carbonic anhydrase, which plays a role in the production of bicarbonate ions. By inhibiting this enzyme, acetazolamide reduces the production of bicarbonate ions, leading to a decrease in the blood pH and the development of metabolic acidosis. Severe vomiting can also lead to metabolic acidosis by causing a loss of bicarbonate ions through the stomach. High altitude and tracheal obstruction do not directly cause metabolic acidosis. Excessive ingestion of antacids can actually lead to metabolic alkalosis, not acidosis.Rate this question:
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- 18.
Hyperventilation produces
- A.
A. Respiratory alkalosis and is a compensation for respiratory acidosis
- B.
B. Respiratory alkalosis and is a compensation for metabolic acidosis
- C.
C. Respiratory alkalosis and is a compensation for metabolic alkalosis
- D.
D. Respiratory acidosis and is a compensation for respiratory alkalosis
- E.
E. Respiratory acidosis and is a compensation for metabolic alkalosis
Correct Answer
B. B. Respiratory alkalosis and is a compensation for metabolic acidosisExplanation
Hyperventilation is the act of breathing rapidly and deeply, leading to excessive elimination of carbon dioxide from the body. This causes a decrease in the concentration of carbon dioxide in the blood, which leads to respiratory alkalosis. Respiratory alkalosis is a condition characterized by a higher pH level in the blood. It is considered a compensation for metabolic acidosis, which is a condition characterized by a lower pH level in the blood due to an excess of acid or a loss of bicarbonate. Therefore, option b is the correct answer.Rate this question:
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- 19.
Which of the following is a compensation for respiratory acidosis?
- A.
A. Hypoventilation
- B.
B. Increased formation of ammonia from glutamine
- C.
C. Increased HCO3- excretion
- D.
D. Inhibition of ADH
- E.
E. Decreased intracellular buffering of H+ ions
Correct Answer
B. B. Increased formation of ammonia from glutamineExplanation
Increased formation of ammonia from glutamine is a compensation for respiratory acidosis because it helps to increase the excretion of hydrogen ions (H+) in the urine. When the body is in respiratory acidosis, there is an excess of carbon dioxide (CO2) in the blood, leading to an increase in the production of carbonic acid (H2CO3) and hydrogen ions. The increased formation of ammonia from glutamine helps to buffer these excess hydrogen ions by combining with them to form ammonium ions (NH4+), which can be excreted in the urine, thereby reducing the acidosis.Rate this question:
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- 20.
pH [HCO3-] PCO2 a. 7.56 48 55 b. 7.15 4 10 c . 7.52 20 25 d. 7.35 44 85 e. 7.18 28 70 Which patient is suffering from an anxiety-induced panic attack?
- A.
A
- B.
B
- C.
C
- D.
D
- E.
E
Correct Answer
C. CExplanation
The patient suffering from an anxiety-induced panic attack would have a decreased pH, decreased [HCO3-], and an increased PCO2. Among the given options, option c is the only one that matches these criteria. The pH is 7.52 (decreased), the [HCO3-] is 20 (decreased), and the PCO2 is 25 (increased). Therefore, the patient in option c is likely suffering from an anxiety-induced panic attack.Rate this question:
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- 21.
pH [HCO3-] PCO2 a. 7.56 48 55 b. 7.15 4 10 c . 7.52 20 25 d. 7.35 44 85 e. 7.18 28 70 Which patient suffers from chronic obstruction of the airways?
- A.
A
- B.
B
- C.
C
- D.
D
- E.
E
Correct Answer
D. DExplanation
The patient with a pH of 7.35, [HCO3-] of 44, and PCO2 of 85 is suffering from chronic obstruction of the airways. This can be determined by looking at the PCO2 value, which is elevated, indicating that the patient is retaining carbon dioxide due to impaired ventilation. This is a characteristic finding in patients with chronic obstructive pulmonary disease (COPD), a condition that causes obstruction of the airways and leads to impaired gas exchange.Rate this question:
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- 22.
pH [HCO3-] PCO2 a. 7.56 48 55 b. 7.15 4 10 c . 7.52 20 25 d. 7.35 44 85 e. 7.18 28 70 Which patient suffers from anorexia?
- A.
A
- B.
B
- C.
C
- D.
D
- E.
E
Correct Answer
A. AExplanation
Based on the given information, the patient with a pH of 7.56, [HCO3-] of 48, and PCO2 of 55 is experiencing respiratory alkalosis. This is indicated by the high pH and PCO2 levels. Anorexia is not directly related to the acid-base balance in the body, so it cannot be determined solely based on the given information. Therefore, the correct answer cannot be determined.Rate this question:
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- 23.
pH [HCO3-] PCO2 a. 7.56 48 55 b. 7.15 4 10 c . 7.52 20 25 d. 7.35 44 85 e. 7.18 28 70 Which patient compensated for metabolic acidosis by hyperventilating?
- A.
A
- B.
B
- C.
C
- D.
D
- E.
E
Correct Answer
B. BExplanation
The patient with the values of pH 7.15, [HCO3-] 4, and PCO2 10 has a low pH and low bicarbonate levels, indicating metabolic acidosis. In response to this acidosis, the patient compensates by hyperventilating, resulting in a low PCO2 value. This is consistent with respiratory compensation, where the body tries to decrease the PCO2 levels by increasing ventilation. Therefore, the correct answer is b.Rate this question:
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- 24.
A patient suffering from nephrosis will exhibit edema
- A.
When their liver can no longer make up for the urinary protein loss.
- B.
Because of the increased plasma volume and resulting increased capillary pressure.
- C.
Because of the increased interstitial fluid colloid osmotic pressure
- D.
Because the capillary permeability is increased.
- E.
Because of the associated hypertension
Correct Answer
B. Because of the increased plasma volume and resulting increased capillary pressure.Explanation
Nephrosis is a condition characterized by excessive urinary protein loss. When the liver is unable to compensate for this loss, the plasma volume increases. This increased plasma volume leads to increased capillary pressure, which in turn causes fluid to leak out of the capillaries and into the surrounding tissues, resulting in edema. Therefore, the correct answer is "because of the increased plasma volume and resulting increased capillary pressure."Rate this question:
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- 25.
Which one of the following plasma values will decrease in a patient with renal shutdown?
- A.
A. Na+
- B.
B. pH
- C.
C. Creatinine
- D.
D. Phosphate
- E.
E. Volume
Correct Answer
B. B. pHExplanation
In a patient with renal shutdown, the kidneys are unable to effectively remove waste products and maintain the balance of electrolytes and acid-base levels in the body. As a result, there is a buildup of acidic waste products in the blood, leading to a decrease in pH.Rate this question:
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- 26.
Kidney failure is often associated with bone loss. Which one of the following does NOT play a role in such bone loss?
- A.
A. Impaired conversion of 25-(OH) vitamin D3 to 1,25-(diOH) vitamin D3.
- B.
B. Impaired intestinal calcium absorption.
- C.
C. Impaired calcium reabsorption in the thick ascending limb and early distal tubule
- D.
D. Increased plasma phosphate concentration.
- E.
E. Metabolic alkalosis
Correct Answer
E. E. Metabolic alkalosisExplanation
Metabolic alkalosis is not associated with bone loss in kidney failure. Kidney failure can lead to impaired conversion of vitamin D, impaired intestinal calcium absorption, impaired calcium reabsorption, and increased plasma phosphate concentration, all of which contribute to bone loss. However, metabolic alkalosis does not directly contribute to bone loss in this context.Rate this question:
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- 27.
Which one of the following is believed to play a role as an intrarenal vasoconstrictor?
- A.
A. NO
- B.
B. PGE2
- C.
C. PGI2
- D.
D. Endothelin
- E.
E. ANP
Correct Answer
D. D. EndothelinExplanation
Endothelin is believed to play a role as an intrarenal vasoconstrictor. Endothelin is a potent vasoconstrictor that is produced by endothelial cells and acts on smooth muscle cells in blood vessels. It plays a role in regulating blood flow and blood pressure within the kidneys. The vasoconstrictive effects of endothelin can reduce blood flow to the kidneys, potentially leading to decreased kidney function. Therefore, endothelin is considered to be an important factor in the regulation of renal blood flow and renal function.Rate this question:
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.JPG "Point representing a mixed disturbance of respiratory acidosis and metabolic acidosis?")
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