Melissa Denker
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Undergraduate MBChB Year 2 Quiz on REPRO/NEPHRO BLOCK: Week 3 - Kidneys, created by Melissa Denker on 05/12/2015.

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Melissa Denker
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REPRO/NEPHRO BLOCK: Week 3 - Kidneys

Question 1 of 45

1

What proportion of body weight is extracellular or intracellular fluid?

Select one of the following:

  • Extracellular: 20%
    Intracellular: 40%

  • Extracellular: 40%
    Intracellular: 20%

  • Extracellular: 30%
    Intracellular: 30%

  • Extracellular: 10%
    Intracellular: 50%

  • Extracellular: 50%
    Intracellular: 10%

Explanation

Question 2 of 45

1

Which factors affect fluid movement between compartments across endothelium barriers?

These are found between intravascular and extravascular components (i.e. extracellular fluid).

Select one or more of the following:

  • Osmotic forces

  • Hydrostatic forces

  • Electrolyte concentrations

  • Availability of transport channels

Explanation

Question 3 of 45

1

What factors affect fluid movement between compartments across cell membranes?

These are found between extracellular and intracellular compartments.

Select one of the following:

  • Hydrostatic pressure

  • Osmotic pressure

  • Availability of transport proteins

  • Electrolyte concentrations

Explanation

Question 4 of 45

1

What happens to the body fluid compartments when only water is given to the patient?

Select one of the following:

  • Number of sodium particles: no change in all compartments
    Volume: increases slightly in all compartments
    Concentration: decreases slightly in all compartments

  • Number of sodium particles: increase in the intravascular and interstitial compartment, but NOT the intracellular compartment
    Volume: increases in the intravascular and interstitial compartments; decreases in the intracellular compartment
    Concentration: increases in the intracellular compartment; no change in the intravascular and interstitial compartment

  • Number of sodium particles: increases in the intravascular and interstitial compartment; no change in the intracellular compartment
    Volume: increases in intravascular/interstitial compartment; no change in the intracellular compartment
    Concentration: decreases slightly in all compartments

  • Number of sodium particles: increases in the intracellular compartment; no change in the intravascular and interstitial compartments
    Volume: increases in the intracellular compartment; no change in the intravascular and interstitial compartments
    Concentration: decreases slightly in all compartments

  • Number of sodium particles: increases in the intracellular compartment; no change in the intravascular and interstitial compartments
    Volume: increases in the intracellular compartment; no change in the intravascular and interstitial compartments
    Concentration: increases in the intracellular compartment; no change in the intravascular and interstitial compartments

Explanation

Question 5 of 45

1

What happens to the body fluid compartments when the patient is given only sodium?

Select one of the following:

  • Number of sodium particles: no change in all compartments
    Volume: increases slightly in all compartments
    Concentration: decreases slightly in all compartments

  • Number of sodium particles: increase in the intravascular and interstitial compartment, but NOT the intracellular compartment
    Volume: increases in the intravascular and interstitial compartments; decreases in the intracellular compartment

  • Number of sodium particles: increases in the intravascular and interstitial compartment; no change in the intracellular compartment
    Volume: increases in intravascular/interstitial compartment; no change in the intracellular compartment

  • Number of sodium particles: increases in the intracellular compartment; no change in the intravascular and interstitial compartments
    Volume: increases in the intracellular compartment; no change in the intravascular and interstitial compartments
    Concentration: decreases slightly in all compartments

Explanation

Question 6 of 45

1

What happens to the body fluid compartments when the patient is given sodium AND water, i.e. isotonic saline infusion?

Select one of the following:

  • Number of sodium particles: no change in all compartments
    Volume: increases slightly in all compartments
    Concentration: decreases slightly in all compartments

  • Number of sodium particles: increase in the intravascular and interstitial compartment, but NOT the intracellular compartment
    Volume: increases in the intravascular and interstitial compartments; decreases in the intracellular compartment

  • Number of sodium particles: increases in the intravascular and interstitial compartment; no change in the intracellular compartment
    Volume: increases in intravascular/interstitial compartment; no change in the intracellular compartment
    Concentration: no change in all compartments

Explanation

Question 7 of 45

1

What are the 3 features of the glomerular filtration barrier?

Select one or more of the following:

  • Specialised capillary endothelium

  • Collagen based glomerular basement membrane

  • Podocytes

  • Membrane channels for specific substances

  • Active transporters for specific substances

Explanation

Question 8 of 45

1

What is the normal GFR?

Select one of the following:

  • 100 ml/min

  • 60 ml/min

  • 90 ml/min

  • 30 ml/min

  • 120 ml/min

Explanation

Question 9 of 45

1

Which part of the nephron contains tight junctions between cells?

Select one of the following:

  • PCT

  • Thin descending loop of Henle

  • Thick ascending loop of Henle

  • DCT

  • Glomerulus

Explanation

Question 10 of 45

1

How much of the Na/Cl is absorbed in the PCT?

Select one of the following:

  • 50%

  • 60%

  • 70%

  • 80%

Explanation

Question 11 of 45

1

What is the most accurate description of the process of tubular secretion?

Select one of the following:

  • Secretion of substances made in the tubular cells to aid reabsorption purposes (similar to Gi system)

  • Secretion of substances from the blood capillaries through tubular cells to the filtrate for excretion

  • Secretion of substances made in the tubular cells for excretion of waste

Explanation

Question 12 of 45

1

Fill the blank spaces to complete the text.

Describe ADH action.
1. ADH binds to ( receptors) on the basolateral side of collecting duct cells
2. This causes a in the receptor, leading to the alpha subunit activating adenine cyclase
3. This stimulates production
4. This stimulates production
5. This causes expression of in the cell membrane, allowing more

Explanation

Question 13 of 45

1

What are the 3 effects of ADH?

Select one or more of the following:

  • Stimulates thirst

  • Vasodilation

  • Increased expression of aquaporins

  • Decreased expression of aquaporins

  • Vasoconstriction

  • Inhibits thirst

Explanation

Question 14 of 45

1

Fill the blank spaces to complete the text.

What membrane transporters are found in the collecting duct?
1. (function: of Na+)
2. (function: of K+)
3. (function: of H+)

Explanation

Question 15 of 45

1

What is the function of the macula densa?

Select one or more of the following:

  • Senses tubular flow

  • Secretes adenosine

  • Secretes renin

Explanation

Question 16 of 45

1

Fill the blank spaces to complete the text.

Change in kidney function in reduced tubular flow due to decreased blood flow:
1. Sensed by the
2. produce
3. Renin stimulates the renin-angiotensin system: results in the production
4. causes of the efferent arteriole
---This pressure in the glomerulus
---This hyperfiltration and thus tubular flow
5. also stimulates secretion
---This increases sodium retention via

Explanation

Question 17 of 45

1

Fill the blank spaces to complete the text.

Change in kidney function in increased tubular flow due to increased blood flow:
1. Sensed by the
2. Macula densa produces
3. causes
4. This blood flow to the kidney

Explanation

Question 18 of 45

1

Fill the blank spaces to complete the text.

Describe renal excretion of drugs via glomerular filtration protein binding.
1. Some drugs can enter the tubules via , e.g. if they are:
---
--- to plasma proteins
2. These drugs can then be in the urine
---NOTE: this cannot happen to large drugs (e.g. ) or those bound to plasma proteins

Explanation

Question 19 of 45

1

Fill the blank spaces to complete the text.

Describe renal excretion of drugs via tubular secretion independent of protein binding.
1. of drugs into the tubule from the
2. There are 2 routes of tubular secretion:
---
------Carry (i.e. alkaline), e.g.
--------->
--------->
--------->
---
------Carry , e.g.
---------> (loop diuretic)
--------->
---------> (NSAID)
3. Drugs are excreted in the urine very rapidly after secretion into the tubules
4. To prolong therapeutic effect:
---Agents can be prescribed to tubular reabsorption

Explanation

Question 20 of 45

1

Fill the blank spaces to complete the text.

Describe reabsorption dependent manipulability of drugs in the kidney.
1. After entering the tubules (either through or ), drugs are either:
--- in the urine
--- into the blood
2. Drugs are into the bloodstream together with

Explanation

Question 21 of 45

1

Which of these drugs are excreted by the kidneys without first being metabolised, i.e. are largely unchanged?

Select one or more of the following:

  • Aminoglycosides

  • Atenolol

  • Bendroflumethiazide

  • Frusemide

  • Penicillin

  • Heparin

  • Thyroxine

  • Indomethacin

  • Aspirin

  • Analgesics

Explanation

Question 22 of 45

1

Fill the blank spaces to complete the text.

How can you measure creatinine clearance, used as a measure of kidney function?
1. (via 24 hour urine collection)
2.
3.
4.
5. (which take into account factors which change creatinine clearance, e.g. age, sex)

Explanation

Question 23 of 45

1

Fill the blank spaces to complete the text.

How do the kidneys excrete drugs?
1.
2. independent of protein binding
3.

Explanation

Question 24 of 45

1

Fill the blank spaces to complete the text.

What are the effects of impaired kidney function on drug metabolism/clearance?
1. Altered pharmacokinetics:
---
---
---
---
2. Altered drug effects
---
---
3. Worsening of existing renal impairment
---
---
---
4.
5.

Explanation

Question 25 of 45

1

Fill the blank spaces to complete the text.

What are the 5 main effects of impaired renal function on drug metabolism?
1.
2.
3.
4.
5.

Explanation

Question 26 of 45

1

Fill the blank spaces to complete the text.

Which factors affect the effects of renal impairment on drug metabolism?
1.
2.
3.

Explanation

Question 27 of 45

1

Fill the blank spaces to complete the text.

What are the different types of nephrotoxicity?
1. /
2.
3.
4.

Explanation

Question 28 of 45

1

Fill the blank spaces to complete the text.

How do ACE inhibitors cause nephrotoxicity?
1. Normally, if the sensed volume is reduced, causes of the to maintain glomerular filtration pressure and GFR
2. prevent the action of
3. Therefore there is no vasoconstriction of the efferent arteriole
4. Therefore, glomerular filtration pressure and GFR
---This causes kidney function impairment, i.e. nephrotoxicity

Explanation

Question 29 of 45

1

Fill the blank spaces to complete the text.

How do NSAIDs cause nephrotoxicity?
1. Normally, in reduced sensed volume, cause of in the nephron (while angiotensin II causes vasoconstriction of efferent arterioles) to maintain GFR
2. NSAIDs the action of prostaglandins
3. Therefore, there is of afferent arterioles
4. Therefore, glomerular filtration pressure and GFR
---This causes kidney function impairment, i.e. nephrotoxicity

Explanation

Question 30 of 45

1

Fill the blank spaces to complete the text.

How does gentamicin cause nephrotoxicity?
1. are needed for antibacterial activity, but this creates
2. cause , which affect the
3. Development of kidney failure depends on:
---
---
---
---

Explanation

Question 31 of 45

1

In what condition would you always AVOID giving ACE inhibitors and NSAIDs?

Select one of the following:

  • Renal impairment with reduced blood flow to the kidneys

  • Renal impairment with severe haematuria

  • Renal impairment with severe proteinuria

  • Chronic renal failure

Explanation

Question 32 of 45

1

What are hydrostatic forces, and where are they greatest?

Select one of the following:

  • Pressure in blood vessels created by the heartbeat
    Function: allows transport of fluid OUT of capillaries
    Largest in: arteries

  • Gradient in blood vessels created by solute concentrations
    Function: allows transport of fluid OUT of capillaries
    Largest in: arteries

  • Pressure in blood vessels created by the heartbeat
    Function: allows transport of fluid INTO capillaries
    Largest in: arteries

  • Pressure in blood vessels created by the heartbeat
    Function: allows transport of fluid OUT of capillaries
    Largest in: veins

  • Gradient in blood vessels created by solute concentrations
    Function: allows transport of fluid INTO capillaries
    Largest in: veins

Explanation

Question 33 of 45

1

Fill the blank spaces to complete the text.

What are the 3 factors which affect the extracellular fluid volume/composition?

1.
2.
3.

Explanation

Question 34 of 45

1

Fill the blank spaces to complete the text.

What are the features of the tubular epithelium in the proximal convoluted tubule?

1.
2.
3.

Explanation

Question 35 of 45

1

Fill the blank spaces to complete the text.

What are the features of the tubular epithelium in the thin descending loop of Henle?

1.
2.

Explanation

Question 36 of 45

1

Fill the blank spaces to complete the text.

What are the features of the tubular epithelium in the thick ascending limb of the loop of Henle?

1.
2. ()

Explanation

Question 37 of 45

1

Fill the blank spaces to complete the text.

What are the features of the tubular epithelium in the collecting duct?

1.
2. ()

Explanation

Question 38 of 45

1

Which part of the nephron is completely impermeable to water?

Select one of the following:

  • PCT

  • Thin descending loop of Henle

  • Thick ascending loop of Henle

  • DCT

  • Collecting duct

Explanation

Question 39 of 45

1

What stimulates ADH secretion?

Select one or more of the following:

  • Increased serum osmolality

  • Decreased volume

  • Increased volume

  • Decreased filtrate osmolality

  • Increased filtrate osmolality

  • High H+ levels in the collecting duct

Explanation

Question 40 of 45

1

Which structure is responsible for sensing decreased volume, and consequently stimulating ADH production?

Select one of the following:

  • Juxtaglomerular cells

  • Macula densa

  • Osmoreceptors in the hypothalamus

  • Baroreceptors in the glomerulus

  • Intercalated cells in the collecting duct

Explanation

Question 41 of 45

1

Which structure is responsible for sensing increased serum osmolality, and consequently stimulating ADH production?

Select one of the following:

  • Osmoreceptors in the hypothalamus

  • Juxtaglomerular cells

  • Macula densa

  • Glomerulus

  • Intercalated cells in the collecting duct

Explanation

Question 42 of 45

1

Fill the blank spaces to complete the text.

Describe the counter-current exchange multiplier.

1. and are transported out of the (via )
a. The is impermeable to water, so this stays in the lumen
b. This creates a concentration of electrolytes in the and

2. The around the loop of Henle flow in the direction to the nephron, so the high concentration of electrolytes is moved to surround the

3. The creates a around the
a. This allows for the reabsorption of large amounts of from the descending loop

4. This also creates a filtrate in the descending loop, which then moves on to the ascending loop – this increases reabsorption of electrolytes along the concentration gradient in the ascending loop

Explanation

Question 43 of 45

1

Fill the blank spaces to complete the text.

Describe the renin-angiotensin-aldosterone system (RAAS).

1. is secreted by the in the kidney, stimulated by:
a. Increased
b. Decreased
c.
d. levels in the DCT (sensed by the )

2. stimulates conversion of into

3. is converted to by

4. Effects of :
a. (via AII/AT1 receptors)
b. Stimulates in the nephron
c. Stimulates secretion from the adrenal cortex
d. Stimulates secretion from the posterior pituitary gland
e. Stimulates in the brain
f. Enhances adrenergic innervation
g. Stimulates cardiac and vascular hypertrophy

Explanation

Question 44 of 45

1

Fill the blank spaces to complete the text.

How does aldosterone increase sodium and fluid retention?

1. (via preformed vesicles)
2.
3.

Explanation

Question 45 of 45

1

Fill the blank spaces to complete the text.

What is the juxtaglomerular apparatus made of?

1. (in the DCT)
2. (around the afferent arteriole)
3. (in the glomerulus)

Explanation

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