MCQs

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1. Neurotransmitters categorized as inhibitory would E

are expected to
A) act independently of their receptor proteins.
B) close potassium channels.
C) open sodium channels.
D) close chloride channels.
E) hyperpolarize the membrane.

2. Which of the following would contain blood in a nor- A

mally functioning nephron?
A) vasa recta
B) Bowman¹s capsule
C) loop of Henle
D) proximal tubule
E) collecting duct

3. What substance is secreted by the proximal-tubule ammonia

cells and prevents the pH of urine from
becoming too acidic?
A) bicarbonate
B) salt
C) glucose
D) ammonia
E) NaOH

4. filtration occurs in the _________ glomerulus

5. The majority of reabsorption occurs in the proximal tubule

6. The bulk of secretion occurs in the proximal tubule

7.

8. The transfer of fluid from the glomerulus to Bowman¹s

capsule
A) results from active transport.
B) transfers large molecules as easily as small ones.
C) is very selective as to which sub-protein sized
molecules are transferred.
D) is mainly a consequence of blood pressure in the
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capillaries of the glomerulus
E) usually includes the transfer of red blood cells to
the Bowman¹s capsule.

9. Which structure passes urine to the renal pelvis? B

A) loop of Henle
B) collecting duct
C) Bowman¹s capsule
D) proximal tubule
E) glomerulus

10. Which structure descends deep into the renal medul- A

la only in juxtamedullary nephrons?
A) loop of Henle
B) collecting duct
C) Bowman¹s capsule
D) proximal convoluted tubule
E) glomerulus

11. Which of the following processes of osmoregulation D

by the kidney is the least selective?
A) salt pumping to control osmolarity
B) H+ pumping to control pH
C) reabsorption
D) filtration
E) secretion

12. Proper functioning of the human kidney requires con- C

siderable active transport of sodium in the kidney
tubules. If these active transport mechanisms were
to stop completely, how would urine production be
affected?
A) No urine would be produced.
B) A less-than-normal volume of hypoosmotic urine
would be produced.
C) A greater-than-normal volume of isoosmotic urine
would be produced.
D) A greater-than-normal volume of hyperosmotic
urine would be produced.

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E) A less-than-normal volume of isoosmotic urine
would be produced.

13. Which one of the following is extremely important for A

water conservation in mammals?
A) juxtamedullary nephrons
B) Bowman¹s capsule
C) urethra
D) podocytes
E) ureter

14. Processing of filtrate in the proximal and distal C

tubules accomplishes what important
function?
A) sorting plasma proteins according to size
B) converting toxic ammonia to less toxic urea
C) maintaining a constant pH in body fluids
D) regulating the speed of blood flow through the
nephron
E) reabsorbing urea to maintain osmotic balance

15. What is unique about transport epithelial cells in the C

ascending loop of Henle in humans?
A) They are the largest epithelial cells in the body.
B) They are not in contact with interstitial fluid.
C) Their membranes are impermeable to water.
D) 50% of their cell mass is comprised of smooth
endoplasmic reticulum.
E) They are not affected by high levels of nitrogenous
wastes.

16. What is the typical osmolarity of human blood? D

A) 30 mosm/L
B) 100 mosm/L
C) 200 mosm/L
D) 300 mosm/L
E) 500 mosm/L

17. Which one of the following, if present in a urine sam- D

ple, would likely be caused by trauma?
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A) amino acids
B) glucose
C) salts
D) erythrocytes
E) vitamins

18. Which structure increases the reabsorption of Na+ E

when stimulated by aldosterone?
A) loop of Henle
B) collecting duct
C) Bowman¹s capsule
D) proximal tubule
E) distal tubules

19. What would account for increased urine production C

as a result of drinking alcoholic
beverages?
A) increased aldosterone production
B) increased blood pressure
C) inhibition of antidiuretic hormone secretion (ADH)
D) increased reabsorption of water in the proximal
tubule
E) the osmoregulator cells of the brain increasing
their activity

20. In a laboratory experiment with three groups, one A

group of people drinks pure water, a
second group drinks an equal amount of beer, and a
third group drinks an equal amount of
concentrated salt solution all during the same time
period. Their urine production is monitored for sever-
al hours. At the end of the measurement period, which
group will have
produced the greatest volume of urine and which
group the least?
A) beer the most, salt solution the least
B) salt solution the most, water the least
C) water the most, beer the least
D) beer the most, water the least

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E) There will be no significant difference between
these groups.

21. Which of the following activities would initiate an B

osmoregulatory adjustment brought about primarily
through the renin-angiotensin-aldosterone system?
A) sleeping
B) spending several hours mowing the lawn on a hot
day
C) eating a bag of potato chips
D) eating a pizza with olives and pepperoni
E) drinking several glasses of water

22. How does ADH function at the cellular level? D

A) ADH stimulates the reabsorption of glucose
through channel proteins.
B) It triggers the synthesis of an enzyme that makes
the phospholipid bilayer more
permeable to water.
C) It causes membranes to include more phospho-
lipids that have unsaturated fatty acids.
D) It causes an increase in the number of aquaporins
in the apical membranes of collecting duct cells.
E) It decreases the speed at which filtrate flow
through the nephron leading to increased
reabsorption of water.

23. How do ADH and RAAS work together in maintaining B

osmoregulatory homeostasis?
A) ADH monitors osmolarity of the blood and RAAS
regulates blood volume.
B) ADH monitors appropriate osmolarity by reabsorp-
tion of water, and RAAS maintains
osmolarity by stimulating Na+ reabsorption.
C) ADH an RAAS work antagonistically; ADH stimu-
lates water reabsorption during
dehydration and RAAS removal of water when it is in
excess in body fluids.
D) Both stimulate the adrenal gland to secrete aldos-

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terone which increases both blood
volume and pressure.
E) Only when they are together in the receptor sites
of proximal tubule cells, will
reabsorption of essential nutrients back into the
blood take place.

24. Which of the following is not a normal response to B

increased blood osmolarity in humans?
A) increased permeability of the collecting duct to
water
B) production of more dilute urine
C) release of ADH by the pituitary gland
D) increased thirst
E) reduced urine production

25. The high osmolarity of the renal medulla is main- E

tained by all of the following except
A) diffusion of salt from the thin segment of the as-
cending limb of the loop of Henle.
B) active transport of salt from the upper region of the
ascending limb.
C) the spatial arrangement of juxtamedullary
nephrons.
D) diffusion of urea from the collecting duct.
E) diffusion of salt from the descending limb of the
loop of Henle.

26. Which process in the nephron is least selective? A

A) filtration
B) reabsorption
C) active transport
D) secretion
E) salt pumping by the loop of Henle

27. compare and contrast steroid and peptide hormones Steroid hormones
(i.e. aldosterone and vasopressin/ADH) affect the synthe-
sis of proteins,
whereas peptide
hormones affect
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the activity of pro-
teins already pre-
sent in the cell

28. If a person drinks a large amount of water in a short E

period of time, he or she may die from water toxicity.
ADH can help prevent water retention through inter-
action with target cells in the
A) anterior pituitary.
B) posterior pituitary.term-23
C) adrenal gland.
D) bladder.
E) kidney

29. When an individual is subject to short-term starva- B

tion, most available food is used to provide energy
(metabolism) rather than building blocks (growth and
repair). Which hormone would be particularly active
in times of food shortage?
A) epinephrine
B) glucagon
C) oxytocin
D) antidiuretic hormone
E) insulin

30. Blood samples taken from an individual who had E

been fasting for 24 hours would have which of the
following?
A) high levels of insulin
B) high levels of glucagon
C) low levels of insulin
D) low levels of glucagon
E) both B and C

31. What happens when beta cells of the pancreas re- B

lease insulin into the blood?
A) Blood glucose levels rise to a set point and stimu-
late glucagon release.
B) Body cells take up more glucose.
C) The liver breaks down glycogen to glucose.
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D) Alpha cells are stimulated to release glucose into
the blood.
E) Both B and D are correct.

32. Which of the following is secreted by the pancreas? B

A) ecdysone
B) glucagon
C) thyroxine
D) oxytocin
E) growth hormone

33. True or false? true

If glomerular filtration decreases, water excretion
tends to decrease as well.

34. True or false? true

Antidiuretic hormone increases water reabsorption
by increasing the permeability of the distal tubule and
collecting duct to water.

35. True or false? true

Osmolarity of the fluid in the descending limb of the
loop of Henle is greater than the osmolarity of the
fluid in the ascending limb of the loop of Henle at any
given level in the renal medulla.

36. which of the following regions of the nephron is im- D

permeable to water?
A) proximal tubule
B) collecting duct
C) distal tubule
D) ascending limb of the loop of Henle
E) descending limb

37. In comparison with the renal cortex, fluid in the prox-

imal tubule is _________________________.

38. True or false?

Urea diffuses from the collecting duct into the

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medullary interstitial fluid maintaining to the
medullary interstitial fluid osmotic gradient.

39. U4Q2-1 E
In a normally-hydrated person, about two thirds of fil-
tered water and Na+ is reabsorbed in the __________.
A) collecting duct
B) DCT
C) Loop of Henle
D) peritubular capillaries
E) proximal tubule

40. U4Q2-2 the concentration

What serves as the driving force that moves amino gradient for Na+
acids from the filtrate in the proximal tubule to the between the fil-
cytosol of proximal tubule epithelial cells? trate and cytosol

41. U4Q2-4 Which of these solutes is NOT transported B

across the proximal tubule epithelium to facilitate
osmotic movement of water from the proximal tubule
filtrate into the surrounding renal interstitial fluid
space?
A) amino acids
B) plasma proteins
C) HCO3-
D) Na+
E) glucose

42. U4Q2-5 vasopressin,

The collecting duct is permeable to water only aquaporins, apical
when the hormone _________ causes proteins called
__________ to be inserted into the ____________
membrane of tubular epithelial cells

43. U4Q2-6 A patient's blood sample shows that plasma D

osmolarity is 380 mOsm/L (normal = 300) and he is
forming a large volume of urine with an osmolarity of
80 mOsm/L (normal 600-900). Intranasal administra-
tion of antidiuretic hormone (ADH) causes no change
in his condition. What disease state does he have?
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A) osmotic diuresis
B) diabetes mellitus
C) central diabetes insipidus
D) nephrogenic diabetes insipidus

44. U4Q2-7 daily excreted

To calculate the "obligatory water loss," solute load; maxi-
you divide the _________________ by the mum urinary con-
___________________________. centration

45. Which of the following limits the volume of the oblig- C

atory water loss?
A) diameter of the loop of Henle
B) the osmolarity at the early portion of the distal
tubule
C) the maximal osmolarity of the medullary osmotic
gradient
D) the water permeability of the the collecting ducts
E) the water permeability of the distal tubule

46. U4Q2-9 A
Which section of the nephron is impermeable to wa-
ter under all physiological circumstances?
A) ascending loop of Henle
B) proximal tubule
C) medullary collecting duct
D) descending loop of Henle
E) distal convoluted tubule

47. U4Q2-10 B
Into what region of the nephron does urea secretion
typically occur?
A) proximal tubule
B) loop of Henle
C) medullary collecting duct
D) cortical collecting duct
E) distal convoluted tubule

48. U4Q2-12 E
When the mean arterial blood pressure falls below
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normal, which of these is part of the reflex response
that brings it back toward normal?
A) ‘ANP
B) “angiotensin II
C) ‘firing by parasympathetic nerves
D) “renin
E) ‘aldosterone

49. U4Q2-13 1. “osmolarity

What happens when excess H2O is ingested? 2. “firing osmore-
ceptors
3. “vasopressin
4. “H2O perme-
ability in collecting
ducts
5. “H2O reabsorp-
tion in collecting
ducts
6. ‘ H2O excretion

50. U4Q2-14 secretion; cortical

Changes in K+ excretion by the kidney are main- collecting duct
ly due to changes in K+ ________ occurring in the
_______________.

51. U4Q2-15 B
An increase in plasma [K+] directly causes an in-
crease in secretion of _____________.
A) renin
B) aldosterone
C) Na+
D) ADH
E) ANP

52. U4Q2-16 Severe sweating causes _______________ a decrease; an in-

in the extracellular fluid volume and ____________ in crease
body fluid osmolarity.

53. U4Q2-17 What are the two major regulators of ADH

secretion?
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osmoreceptors
and arterial
baroreceptors

54. U4Q2-18 Which of the following is NOT an example of D

a nonvolatile acid?
A) lactic acid
B) sulfuric acid
C) phosphoric acid
D) carbonic acid

55. Glutamine breaks down into what two products in NH4+ and HCO3-
tubular epithelial cells?

56. U4Q2-20 B
A patient has an arterial PCO2 of 30 mmHg and a plas-
ma pH of 6.9. Her condition could best be described
as _______________________.
A) metabolic alkalosis
B) metabolic acidosis
C) respiratory acidosis
D) respiratory alkalosis

57. U4Q1-4 1. Bowman's cap-

Rank these structures in the order they are passed sule
through by a molecule that is filtered from the blood 2. proximal tubule
by the kidney and then excreted without being reab- 3. loop of Henle
sorbed or secreted. 4. DCT
5. Collecting duct
6. renal papilla
7. Renal calyx
8. Renal pelvis
9. ureter
10. bladder
11. urethra

58. Rank these structures in the order a red blood cell 1. renal artery
would circulate through them. 2. afferent arteri-
ole
3. glomerular cap-
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illary
4. efferent arteri-
ole
5. peritubular cap-
illary
6. renal vein

59. rank structures in the order a molecule of albumin 1. renal artery

would circulate through kidney 2. afferent arteri-
ole
3. glomerular cap-
illaries
4. efferent arteri-
ole
5. peritubular cap-
illaries
6. renal vein

60. U4Q1-7 Which structures of kidney are only found in proximal tubule,
the renal cortex? JGA, renal cor-
puscle

61. U4Q1-8 Which equation correctly relates the basic E+R = F+S
renal processes for a substance that is neither pro-
duced or destroyed by the kidney?

62. U4Q1-9 Normally, about 20% of the Na+ flowing Half of the plasma
through glomerular capillaries is filtered, while only Ca2+ is bound to
about 10% of the Ca2+ is filtered. What accounts for plasma proteins.
this difference in filtration rate?

63. U4Q1-10 1. hydrostat-

What are the three main Starling's forces that normal- ic pressure in
ly determine the net filtration pressure in the renal 2.Bowman's cap-
corpuscle? sule
protein osmotic
pressure in the
plasma
3. hydrostat-
ic pressure in
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glomerular capil-
laries

64. In the absence of other changes, dilation of efferent a decrease in

arterioles causes glomerular cap-
illary hydrostatic
pressure and a de-
crease in GFR.

65. What increases GFR?

66. What decreases GFR?

67. average GFR 125 ml/min = 180

L/day

68. U4Q1-13 If a patient produces 2 ml of urine per 15.95

minute, has a plasma [Na+] of 145 mmol/L, and has
a GFR of 110 ml/min, what is her filtered load for Na+
(in mmol/min).

69. Average % of the amount filtered that is reabsorbed 100%

for the 3 substances: 99.1%?
44%
glucose
water
urea

70. U4Q1-15 glucosuria filtered load >

transport maxi-
mum

71. U4Q1-16 Which equation can be used to determine (V x Ui)/Pi

the glomerular filtration rate?
(Note: gl = glucose, i = inulin)

72. U4Q1-17 Describe the micturition reflex ‘ ara = detrusor

P
contraction

“sym = decreased
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internal urethral
sphincter relax-
ation

73. U4Q1-18 The human body is normally composed of 60

about _________ % water by weight.

74. U4Q1-19 exhalation and

"Insensible water loss" is caused by: skin evaporation.

75. For a person to remain in homeostasis, the daily in- feces, sweat, urine
take of NaCl must equal the sum of the NaCl in which
three output sources? (Select all three.)

76. ______________ activates the cAMP second messen- C

ger system in principal cells of the distal tubules and
collecting ducts.
A) Aldosterone
B) Angiotensin II
C) ADH
D) ANP
E) renin

77. _______________ increases water reabsorption by C

inserting aquaporin-2 proteins into the apical mem-
brane of collecting duct cells.
A) Aldosterone
B) Angiotensin II
C) ADH
D) ANP
E) renin

78. Which of the following stimulates aldosterone re- B

lease?
A) Aldosterone
B) Angiotensin II
C) ADH
D) ANP
E) renin

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79. Which of the following acts on the hypothalamus to B
induce thirst?
A) Aldosterone
B) Angiotensin II
C) ADH
D) ANP
E) renin

80. ____________ release is stimulated by high levels of A

potassium.
A) Aldosterone
B) Angiotensin II
C) ADH
D) ANP
E) renin

81. The final activation step of ____________ occurs in

the kidneys.

82. _________ is activated from a precursor in the blood B

by two proteolytic cleavages.
A) Aldosterone
B) Angiotensin II
C) ADH
D) ANP
E) renin

83. What increases excretion of Na+? ‘ FR

G
“Na+ reabsorption
in cortical collect-
ing duct
‘Aldosterone
‘ANP

84. Most Na+ reabsorption is driven by the Na+/K+ pump proximal tubule
located in this region. basolateral mem-
brane
B) cells in basolateral membrane
C) intercalated cells apical membrane
D) proximal tubule apical membrane
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E) proximal tubule basolateral membrane
F) intercalated cells basolateral membrane
G) principal cells apical membrane.

85. Aquaporin-3 is located on this membrane in the ab- cells in basolateral

sence of ADH. membrane

86. where are the receptors for aldosterone located? in nucleus

87. Receptors for ADH are located in _________________ basolateral mem-

brane of collecting
duct cells.

88. Potassium channels located in the ___________ are

necessary for its reabsorption

89. where are the potassium channels located? apical membrane

90. describe how K+ is reabsorbed in the proximal tubule diffuses through

leaky tight junc-
tions in proximal
tubular epithelial
cells, just like urea

91. where is CA located? proximal tubule

basolateral mem-
brane

92. Potassium is exchanged for hydrogen across this intercalated cells

membrane. apical membrane

93. where are sodium-glucose transporters (SGLTs) lo- proximal tubule

cated? apical membrane

94. ADH increases the insertion of aquaporin-2 in collecting duct

____________ cells apical mem-
brane

95. Aldosterone increases the number of potassium

channels in ______________
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collecting duct
cells apical mem-
brane

96. hypervolemia increase in plas-

ma volume

97. Blood pH = 7.3, [HCO3-] is low, PCO2 is low B

A) respiratory alkalosis with renal compensation

B) metabolic acidosis with respiratory compensation
C) respiratory acidosis with renal compensation
D) metabolic alkalosis with respiratory compensation

98. Blood pH = 7.3, [HCO3-] is high, PCO2 is high. C

A) respiratory alkalosis with renal compensation

B) metabolic acidosis with respiratory compensation
C) respiratory acidosis with renal compensation
D) metabolic alkalosis with respiratory compensation

99. Blood pH = 7.5, [HCO3-] is high, PCO2 is high. D

A) respiratory alkalosis with renal compensation

B) metabolic acidosis with respiratory compensation
C) respiratory acidosis with renal compensation
D) metabolic alkalosis with respiratory compensation

100. Blood pH = 7.5, [HCO3-] is low, PCO2 is low. A

A) respiratory alkalosis with renal compensation

B) metabolic acidosis with respiratory compensation
C) respiratory acidosis with renal compensation
D) metabolic alkalosis with respiratory compensation

101. An increase in the concentration of plasma potassi- B

um causes increase in:
a) release of renin
b) secretion of aldosterone
c) secretion of ADH
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d) release of natriuretic hormone
e) production of angiotensin II .

102. Amino acids are almost completely reabsorbed from A

the glomerular filtrate via active transport in the:
a) proximal tubule
b) loop of Henle
c) distal tubule
d) collecting duct
e) renal pelvis

103. Glomerular filtration rate would be increased by: D

a) constriction of the afferent arteriole
b) a decrease in afferent arteriolar pressure
c) compression of the renal capsule
d) a decrease in the concentration of plasma protein
e) a decrease in renal blood flow

104. The greatest amount of hydrogen ion secreted by the D

proximal tubule is associated with:
a) excretion of potassium ion
b) excretion of hydrogen ion
c) reabsorption of calcium ion
d) reabsorption of bicarbonate ion
e) reabsorption of phosphate ion

105. In controlling the synthesis and secretion of aldos- E

terone , which of the following factors is least impor-
tant ?
a) renin
b) angiotensin II
c) concentration of plasma Na+
d) concentration of plasma K+
e) adrenocorticotropic hormone ( ACTH )

106. Renal correction of acute hyperkalemia will result in B

:
a) alkalosis
b) acidosis
c) increased secretion of HCO3-
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d) increased secretion of H+
e) increased secretion of Na+

107. Most of the glucose that is filtered through the A

glomerulus undergoes reabsorption in the :
a) proximal tubule
b) descending limp of the loop of Henle
c) ascending limb of the loop of Henle
d) distal tubule
e) collecting duct

108. Ammonia is an affective important urinary buffer for C

which of the following reasons :
a) its production in the kidney decrease during
chronic acidosis
b) the walls of the renal tubules are impermeable to
NH3
c) the walls of the renal tubules are impermeable to
NH4+
d) its acid base reaction has a low pKa
e) none of the above .

109. The amount of potassium excreted by the kidney will D

decreases if :
a)distal tubular flow increases
b)circulating aldosterone level increase
c) dietary intake of potassium increase
d)Na+ reabsorption by the distal nephron decreases
e) the excretion of organic ions increase .

110. In the presence of ADH, The distal nephron is least C

permeable to :
a) water .
b) ammonia .
c) urea .
d) sodium .
e) carbon dioxide.

111. Which of the following substances will be more con- B

centrated at the end of the proximal tubule than at the
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beginning of the proximal tubule?
a) glucose .
b) creatinine .
c) sodium .
d) bicarbonate .

112. When a person is dehydrated, hypotonic fluid will be C

found in the:
a) glomerular filtrate
b) proximal tubule
c) loop of Henle
d) distal convoluted tubule
e) collecting duct

113. Which one of the following statements about aldos- B

terone is correct?
a) it produces its effect by activating C-AMP .
b) it produces its effect by increasing membrane per-
meability to potassium
c) it causes an increased reabsorption of hydrogen
ion.
d) it has its main effect on the proximal tubule .
e) it is secreted in response to an increase in blood
pressure .

114. The effect of antidiuretic hormone ( ADH ) on the A

kidney is to:
a) increase the permeability of the distal nephron to
water.
b) increase the excretion of Na+
c) increase the excretion of water
d) increase the diameter of the renal artery .

115. In the distal tubules, sodium reabsorption is in- D

creased directly by increased:
a) sympathetic nerve stimulation of the kidney .
b) atrial natriuretic hormone secretion .
c) antidiuretic hormone secretion .
d) aldosterone secretion
e) angiotensin secretion .
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116. The ability of the kidney to excrete a concentrated B

urine will increase if:
a) the permeability of the proximal tubule to water
decreases .
b) the rate of blood flow through the medulla decreas-
es
c) the rate of flow through the loop of Henle increases
d) the activity of the Na-K pump in the loop of Henle
decreases
e) the permeability of the collecting duct to water
decreases

117. The glomerular filtration rate will increase if : D

a) circulating blood volume increase .
b) the afferent arteriolar resistance increases .
c) the efferent arteriolar resistance decreases .
d) the plasma protein concentration decreases .

118. The volume of plasma needed each minute to supply B

a substance at the rate at which it is excreted in the
urine is known as the :
a) diffusion constant of the substance
b) clearance of the substance
c) extraction ratio of the substance
d) tubular mass of the substance
e) filtration rate of the substance

119. An increase in the osmolarity of the extracellular D

compartment will:
a) stimulate the volume and osmoreceptors , and in-
hibit ADH secretion
b) inhibit the volume and osmoreceptors , and stimu-
late ADH secretion .
c) inhibit the volume and osmoreceptors , and inhibit
ADH secretion
d) stimulate the volume and osmoreceptors , and
stimulate ADH secretion.
e) cause no change in ADH secretion

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120. 20) Select the correct answer about proximal tubules: B
a) K+ is secreted in exchange with the Na+ which is
reabsorbed under the effect of aldosterone
b) glucose, amino acids & proteins are completely
reabsorbed
c) only 10% of the filtered water is reabsorbed
d) parathormone increase phosphate reabsorption .

121. The primary renal site for the secretion of organic A

ions e.g urate, creatinine is:
a) proximal tubule
b) loop of Henle
c) distal tubule
d) collecting duct .

122. Reabsorption of Na+: A

a) takes place in association with CL- & HCO3 -
b) occurs only in PT
c) is under control of parathormone hormone
d) is a passive process .

123. K+ excretion is markedly influenced by: A

a) aldosterone
b) amount of Na+ delivered to tubules
c) rate of tubular secretion of H+
d) all of the above .

124. More hydrogen is secreted in : C

a) alkalosis
b) administration of diamox
c) hypokalemia
d) hyperventilation.

125. Major determinants of plasma osmolarity include all B

the following except:
a) sodium
b) hemoglobin
c) chloride
d) albumin
e) glucose
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126. The hypothalamus will affect the release of ADH in E

response to all the following stimuli except :
a) dehydration
b) severe hemorrhage
c) decreased blood osmolarity
d) pain , anxiety , or surgical stress
e) nicotine

127. H+ secretion in the distal nephron is enhanced by all C

the following except:
a) an increase in the level of plasma aldosterone
b) an increase in the tubular luminal concentration of
poorly reabsorbable anions
c) hyperkalemia
d) metabolic acidosis
e) respiratory acidosis

128. Urinary volume is increased by all the following ex- C

cept :
a) diabetes insipidus
b) diabetes mellitus
c) sympathetic stimulation
d) increased renal arterial pressure
e) infusion of mannitol

129. Significant buffers for hydrogen ions generated in C

the body from anaerobic metabolism include all the
following except:
a) extracellular bicarbonate
b) plasma proteins
c) plasma lactate
d) inorganic phosphate
e) intracellular proteins

130. Extracellular bicarbonate ions serve as an effective D

buffer for all the following except :
a) sulfuric acid
b) phosphate acid
c) lactic acid
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d) carbonic acid
e) ß- hydroxybutyric acid

131. All the following statements are true of the H+ A

secreted into the lumen of the distal nephron except:
a)can combine with NH4+
b) can combine with HCO3
c) can combine with HPO
d) can remains as free H
e) is secreted by an H+-ATPase pump

132. The glomerular filtration barrier is composed of all B

the following except :
a) fenestrated capillary endothelium .
b) macula densa .
c) basement membrane .
d) podocytes .
e) mesangial cells .

133. Where is the macula densa located? D

A) proximal tubule
B) ascending loop of Henle
C) descending loop of Henle
D) distal convoluted tubule

134. The amount of H+ excreted as titratable acid bound B

to phosphate would be increased by all the following
except :
a) an increase in the amount of phosphate filtered at
the glomerulus .
b) an increase in the pH of the urine .
c) an increase in the dietary intake of phosphate
d) an increase in the level of plasma parathyroid hor-
mone ( PTH )
e) a decrease in the renal tubular maximum (Tm) for
phosphate reabsorption .

135. Carbonic anhydrase plays an important role in all the D

following except:
a) the renal handing of HCO3- within the cells of the
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proximal tubule .
b) the renal handling of HCO3- within the lumen of
proximal tubule .
c) the renal handling of HCO3- within the cells of the
tubules of the distal nephron
d) the renal handling of HCO3 - within the lumen of
the tubules of the distal nephron
e) gastric secretion of HCl by parietal cells.

136. 36) About the proximal convoluted tubules , all are D

true except :
a) reabsorb most of Na+ ions in glomerular filtrate
b) reabsorb most of Cl- ions in glomerular filtrate
c) reabsorb most of K+ ions in glomerular filtrate
d) contains JGCs which secrete renin

137. where are the JG cells located? in walls of afferent

arterioles

138. About urea , all are true except: B

a) concentration rises in tubular fluid as the glomeru-
lar filtrate passes down the nephron.
b) is actively secreted by the renal tubular cells
c) concentration in the blood rises slightly after a high
protein diet
d) causes osmotic diuresis when its blood concentra-
tion is increased .

139. 1. For those substances that are actively reabsorbed, E

the maximal amount that can be transported per unit
time by the kidney tubules:
A. depends on the maximum rate at which the trans-
port mechanism itself operates
B. is directly related to the plasma concentration of
the substance
C. is termed the tubular transport maximum
D. is dependent upon tubular load
E. A and C are correct.

140. C
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2. If the clearance of Substance X is greater than the
clearance of inulin, it is most likely that Substance X
is:
A. bound to tubular proteins
B. bound to plasma proteins
C. secreted
D. reabsorbed
E. neither secreted nor reabsorbed

141. 3. Co-transport of glucose: E

A. is equivalent to a uniport for glucose
B. will not be affected if the Na+/K+ pump is blocked
C. cannot move glucose against its concentration
gradient
D. is equivalent to an antiproton
E. depends on the interaction of Na+ with the glucose
carrier

142. 4. The plasma concentration at which a particular D

substance begins to appear in the urine is the:
A. transport maximum (Tm)
B. fractional excretion
C. filtered load
D. renal threshold
E. titration point

143. 5. The volume of plasma needed each minute to sup- B

ply a substance at the rate at which it is excreted in
the urine is known as the:
A. diffusion constant of the substance
B. clearance of the substance
C. extraction ratio of the substance
D. tubular mass of the substance
E. filtration rate of the substance

144. 6. Renin is produced and secreted from JG cells lo- D

cated in the:
A. macula densa
B. mesangial cells
C. intercalated cells
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D. afferent arteriole
E. interstitial cells

145. 7. About 4 to 6 days after you place a normal person E

on a low-sodium diet, which of the following will be
observed?
A. plasma renin and aldosterone are below normal
B. plasma renin and aldosterone are above normal
C. plasma sodium concentration is below normal
D. plasma sodium concentration is normal
E. B and D are correct.

146. 8. A 100 kg man has a plasma osmolarity of 300 C

mOsM (milliosmolar). After he drinks 2 liters of water
(and before any fluid losses) his steady-state plasma
osmolarity would be approximately:
A. 270 mOsM
B. 280 mOsM
C. 290 mOsM
D. 300 mOsM
E. 321 mOsM

147. 9. The normal human glomerular filtration rate (GFR) C

is approximately (in mL/min):
A. 25
B. 50
C. 125
D. 300
E. 500

148. 10. Which of the following statements is/are correct? E

A. Filtration fraction equals GFR divided by renal
plasma flow.
B. Tubular maximum secretion has a finite upper limit,
though it exhibits a phenomenon analogous to the
threshold phenomenon for reabsorption.
C. Clearance ratio equals renal clearance of one
substance divided by the clearance of another sub-
stance.
D. Effective RPF is the volume of plasma flow sup-
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plied to juxtamedullary nephrons.
E. A, B, and C are correct.

149. 11. The renal "countercurrent" mechanism is depen- C

dent upon the anatomic relationship between:
A. the distal tubule and the macula densa
B. the loop of Henle and the macula densa
C. the loop of Henle and the vasa recta
D. the glomerulus and the afferent and efferent arte-
rioles
E. the glomerulus and the proximal tubule

150. 12. If renal per-

fusion pressure
does not change,
which of the fol-
lowing changes in
afferent and effer-
ent arteriolar re-
sistance would re-
sult in an increase
in renal blood flow
but no change in
filtration fraction?
Answer = B

151. 13. An increase in the osmolality of the extracellular A

fluid will:
A. stimulate the volume and osmoreceptors, and
stimulate ADH secretion
B. stimulate the volume and osmoreceptors, and in-
hibit ADH secretion
C. inhibit the volume and osmoreceptors, and stimu-
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late ADH secretion
D. inhibit the volume and osmoreceptors, and inhibit
ADH secretion
E. cause no change in ADH secretion

152. 14. Polyuria (diuresis) occurs in a diabetic patient D

who has a GFR = 120 mL/min and a blood sugar = 350
mg/dL. This is indicative of:
A. losses of water and sodium which could be pre-
vented by administration of antidiuretic hormone
(ADH) and an aldosterone-like mineralocorticoid
B. diuresis due to reduced active transport of sodium
out of the tubule because of diminished activity of the
Na+/K+ ATPase
C. a cellular and extracellular over-hydration due to
water retention, caused by the glucose
D. an osmotic diuresis due to glucosuria, in which
water loss will exceed "salt" loss
E. B and D are correct.

153. 15. The tonicity of the urine as it enters the renal B

collecting duct is:
A. isotonic
B. hypotonic or isotonic, but never hypertonic
C. hypotonic
D. hypertonic
E. hypertonic or isotonic, but never hypotonic

154. 16. Which of the following might you expect to find C

associated with chronic renal failure?
A. elevated packed cell volume (hematocrit)
B. abnormally low plasma creatinine concentration
C. decreased bone density
D. lower than normal PTH (parathyroid hormone) con-
centration
E. None of the above is correct.

155. Why is a decrease in bone density associated with

chronic renal failure?

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156. 17. The vasa recta: D
A. are the straight portions of the proximal tubules,
found just proximal to the loops of Henle
B. extend from the efferent arterioles of the superfi-
cial cortical nephrons
C. are the microvilli found on the cells of the macula
densa
D. comprise the capillary network found in the medul-
la of the kidney
E. are the small straight segments of afferent arteri-
oles found directly next to the macula densa

157. 18. The loops of Henle of the outer cortical nephrons: B

A. are functionally unimportant in the renal conserva-
tion of sodium and water
B. do not contribute to the medullary osmotic gradi-
ent
C. do not participate in the urinary diluting mecha-
nism
D. do not play an important role in overall renal func-
tion and are simply unimportant vestiges of evolu-
tionary development
E. A and C are correct.

158. 19. Ammonia produced by the kidneys comes mainly A

from:
A. glutamine
B. glycine
C. leucine
D. alanine
E. B and D are correct.

159. 20. Glomerular filtration produces an ultrafiltrate of A

plasma:
A. in which the concentration of electrolytes is equal
to plasma
B. in which the concentration of protein is equal to
plasma
C. containing only those substances which must be

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eliminated in the urine
D. A and B are correct.
E. B and C are correct.

160. 21. Which of the following is NOT a function of the B

kidneys?
A. regulation of extracellular volume
B. regulation of plasma glucose concentration
C. regulation of arterial blood pressure
D. excretion of the end products of protein metabo-
lism
E. excretion of foreign chemicals (e.g. pharmaceuti-
cals, food additives, etc.)

161. Which organ regulates plasma glucose concentra- pancreas en-

tion? docrine function

162. 22. Which of the following does NOT contribute to E

titratable acid when found in the urine?
A. H2PO4-
B. lactic acid
C. beta-hydroxybutyric acid
D. acetoacetic acid
E. NH4+

163. 23. Which of the following is NOT a function of the D

kidneys?
A. regulation of extracellular osmolality
B. regulation of acid-base balance
C. excretion of end-products of muscle metabolism
D. activation of antidiuretic hormone
E. activation of vitamin D

164. 24. Which of the following does NOT contribute to the A

formation of maximally concentrated urine?
A. active NaCl transport in the proximal convoluted
tubule
B. active NaCl transport in the thick ascending limb
of the loop of Henle
C. impermeability of the thick ascending limb of the
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loop of Henle to water
D. high water permeability of the collecting duct due
to the presence of ADH
E. presence of urea in the inner medullary interstitium

165. What would be the effects of a blockage of renin “ ngiotensin

A
production in JG cells? “Aldosterone
“Na+ transport via
distal tubule and
collecting ducts
‘urine production

166. For the following molecules or hormones, know

where they are produced, what causes their release
or conversion, and what they do to their target tis-
sues:

angiotensinogen (liver)
angiotensin
aldosterone
ADH
insulin
glucagon
epinephrine

167. Recovery of Na+ from filtrate that enters Bowman's

Capsule is an important function of the kidneys. De-
scribe the mechanisms for sodium reabsorption in
the distal tubules and collecting ducts and the hor-
monal mechanisms involved in its regulation

1. What are the .3 locations where Na+ is reabsorbed?

proximal tubule, ascending limb, cortical collecting
duct

2. What drives the gradient for movement of Na+ out

of filtrate?
active transport of Na+ out of cell into peritubular
space via basolateral Na+/K+ pumps

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168. Which of the following maintains the sodium gradient
for the movement of Na+ from filtrate into tubular
epithelial cells?

169. The sodium gradient provides gradient necessary for

the movement ions, like bicarbonate and water into
the cell.

170. Where are the receptors for aldosterone located? in the cytosol of
cells in the dis-
tal tubules and col-
lecting ducts.

171. The release of aldosterone is stimulated by: angiotensin II

172. SODIUM REABSORPTION The JG cells with-

in the afferent ar-
terioles respond
to a decrease
in pressure and
a decrease in
Na+ or Cl- within
the distal tubules
(through macula
densa) by increas-
ing the secretion
of renin.

Renin is an
enzyme that
converts
angiotensinogen
(secreted by liver)
into Angiotensin I

ACE is an enzyme
that converts an-
giotensin I into an-
giotensin II, pre-
sent in capillary
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endothelium.

Aldosterone binds
to its receptor
which causes an
increase in the
open state of Na+
channels in apical
membrane as well
as an increase in
their synthesis.

ANP secretion re-

lease is stimulated
by an increase in
atrial stretch (due
to increase in atri-
al pressure).

What are the ways

Na+ reabsorption
is facilitated?
(1) aldosterone
---> An increase in
number of active
Na+/K+ pumps
in the basolater-
al membrane and
sodium channels
in apical mem-
brane increase
movement of Na+
out of filtrate.

(2) vasoconstric-
tion of AA that
is initated by An-
giotensin II, which
“GFR and allows
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more time for Na+
reabsorption.

(3) ANP has op-

posite effect of
aldosterone. In-
duces a decrease
in Na+ reabsorp-
tion by “ EA re-
sistance through
dilation and de-
creasing the num-
ber of open
Na+ channels in
apical membrane
(“ Na+ reabsorp-
tion). ‘ANP = “renin
and “aldosterone.

173. RENAL HANDLING OF POTASSIUM K+ is reabsorbed

and secreted.

1. describe K+ re-
absorption
moves into tubu-
lar epithelial cells
via basolateral
Na+/K+ pumps
(move K+ into
cell).

‘ intracellular K+
= ‘K+ movement
through basolater-
al K+ channels
into peritubular flu-
id.

NET MOVEMENT
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OF K+ = outward
into peritubular flu-
id
NET MOVEMENT
OF K+ = in-
ward into distal
tubule and collect-
ing ducts

174. Na+/K+ pumps on the basolateral membrane of each

cell in distal tubule and collecting ducts create a gra-
dient for the outward movement of K+ across apical
membrane and into filtrate through K+ channels.

175. Which hormone regulates the expression of Na+/K+ aldosterone

pumps?

176. Factors that increase K+ secretion “pressure in

AA and cardiac
baroreceptor = “
renin

177. What are the net effects of renin on K+ secretion? ‘ aldosterone => ‘
K+ secretion

178. describe the hormonal regulation of the long-term 1. Which hor-

control of blood pressure. mones are re-
sponsible for the
long-term regula-
tion of BP?
Angiotensin II, al-
dosterone, ANP,
ADH, and EPO

2. The regulation
of which two hor-
mones are interre-
lated?
angiotensin II and
aldosterone
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3.

179. Describe the pathway to aldosterone release (1) Renin is re-

leased from JG
cells in response
to 3 different in-
puts (“EA pres-
sure, “filtrate Na+
and Cl- in dis-
tal tubule, and an
‘ in renal sympa-
thetic activity orig-
inated by activa-
tion of baroreflex)

(2) Which regions

does aldosterone
exert its effects?
late distal tubule
and collecting
ducts.

180. How does Angiotensin II affect blood pressure? (1) vasoconstric-

tive properties
(2) altering thirst at
hypothalamus
(3) stimulates
ADH release

181. What stimulates ADH release? Ÿosmolarity within

hypothalamus
release of ADH
modified by ‘An-
giotensin II and
“ANP

182. How does ADH affect blood pressure? alters the reab-
sorption of wa-
ter which occurs
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through the inser-
tion of AQP2 into
membrane of cells
within the collect-
ing ducts.

increases number
of Na+-channels
in apical mem-
brane.

EPO is stimulat-
ed by a decrease
in blood flow to
the kidneys, which
induces hypoxia
within kidneys (i.e.
medullary cells
are always on
verge of hypoxia)

since RBCs make

up ~45% vol-
ume of blood, any
change in pro-
duction will affect
blood volume.

183. What are the effects of ANP? ‘ a+ reabsorption

N
“release of ADH

184. How does ANP decrease GFR? “ gc via dilation of

P
AA and constric-
tion of EA

185. unlike water and Na+, whose plasma concentrations

are regulated by varying the extent of their reabsorp-
tion, K+ is regulated by varying the extent of its se-
cretion.

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186. The balance of acid and base within the blood plays 1. What is the
an important role in a number of bodily functions. typical blood pH
How do changes in the pH of the blood affect bodily range?
functions? 7.35-7.45

2. how does acido-

sis affect the ex-
citability of neu-
rons?
decreases ex-
citability

3. how does al-

kalosis affect the
excitability of neu-
rons?
increases ex-
citability

4. How does aci-

dosis affect K+ lev-
els?
results in K+ re-
tention

5. How does alka-

losis affect K+ lev-
els?

6. How does aci-

dosis affect sym-
pathetic activity?
cardiac arrhyth-
mias and vasodi-
lation of blood ves-
sels.

187. How is acid-base balance regulated?

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