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Guyton & Hall: Textbook of Medical Physiology, 11th Edition

UNIT V: The Body Fluids and Kidneys


1. Patients who develop metabolic acidosis (e.g., diabetics) can show the following
changes in pulmonary ventilation as mediated by the peripheral and central
a. Increase, decrease, increase
b. Decrease, further decrease, increase
c. Increase and hold steady
d. Decrease and hold steady

The initial increase in ventilation-increased H+ concentration results from stimulation of
peripheral chemoreceptors (carotid only in humans) but the resulting hyperventilation
decreases the arterial PCO2. This, in turn, inhibits the peripheral and central
chemoreceptors. In time, the cerebrospinal fluid pH is compensated, removing the
opposing drive to increased ventilation and ventilation increases due to stimulation of the
carotid body by increased H+ concentration.

2. An infant is admitted to the emergency room after accidentally ingesting acetic acid.
Which of the following defense mechanisms occurs first?
a. Renal compensation by means of hydrogen ion secretion
b. Respiratory compensation by hyperventilation to lower PCO2
c. Chemical compensation through buffer systems
d. Endocrine compensation by activation of renin

The chemical buffer system is the first and fastest line of defense against a change in
hydrogen ion concentration, acting within seconds. Respiratory compensation is the
second line of defense, acting within minutes. Renal compensation is the third line of
defense, acting within hours to days. Endocrine compensation does not occur.

Copyright 2006 by Elsevier, Inc.

Additional Test Bank 2

3. Acid-base imbalance (e.g., diabetic ketoacidosis) is normally compensated by

chemical buffering. Which of the following buffer systems is considered most
a. Bicarbonate buffer system
b. Phosphate buffer system
c. Protein buffer system
d. Sulfate buffer system

The bicarbonate buffer system, even though its pK (6.1) is not close to physiological pH
(7.4), is considered the most important because both of its components (HCO3 and CO2)
are regulated, respectively, by the kidneys and lungs.

4. An elderly patient with emphysema is admitted to the emergency room after suddenly
developing severe shortness of breath on exertion. Arterial blood gas analysis showed
the following values: PaO2 of 50, PaCO2 of 80, pH of 7.2, and HCO3 of 34. The
patient's acid base status is best described as
a. Chronic metabolic alkalosis with respiratory overcompensation
b. Chronic, compensated respiratory acidosis with acute respiratory acidosis
c. Chronic metabolic acidosis with partial respiratory compensation
d. Acute respiratory alkalosis with renal tubule acidosis

The low pH defines acidosis. The elevated PCO2 value indicates a respiratory problem
leading to hypercapnia and respiratory acidosis. The elevated HCO3 value indicates that
renal compensation had occurred. The most likely scenario is acute respiratory
insufficiency leading to acute respiratory acidosis.

5. A baby in the waiting room of the pediatric clinic suddenly begins vomiting. Which
of the following most likely describes the initial change in her acid-base status?
a. Metabolic acidosis
b. Respiratory acidosis
c. Respiratory alkalosis
d. Metabolic alkalosis

Vomiting of gastric contents alone would eliminate hydrochloric acid secreted by
stomach mucosa. This would result in loss of acid from the extracellular fluid and
development of metabolic alkalosis. This type of alkalosis is common in neonates who
have pyloric obstruction.

Copyright 2006 by Elsevier, Inc.