Kidney and Acid-base Balance

(1) Concerning the proximal convoluted tubules.

a) it is only related to solutes reabsorption .
b) the fluid leaving it is iso-osmotic with plasma .
c) water reabsorption is under ADH control.
d) potassium secretion occurs mainly in this segment.

(2) With regards to the peritubular capillaries .

a) its net reabsorbing force is about 10 mmHg .
b) are not reabsorbing vessels, but are filtering vessels .
c) its permeability coefficient is small.
d) it possesses a low colloidal osmotic pressure .

(3) The following findings are found in metabolic acidosis EXCEPT:

a) decreased respiratory rate .
b) decreased excretion of NaHCO3 .
c) increased excretion of NH4Cl in urine .
d) increased excretion of titratable acid in urine .

(4) A semi-comatosed 15-yaer old girl is brought to emergency room with

hyperventilation, rapid pulse and dry skin. Blood sample was sent to the
laboratory. The following data were obtained:
pH = 7.16
[Na+] = 142 mEq/L.
[K+] = 4.5mEq/L
[HCO3-] = 13 mEq/L
PCO2 = 28 mmHg
The most likely diagnosis is:
a) metabolic alkalosis .
b) respiratory alkalosis .
c) metabolic acidosis .
d) respiratory acidosis .

(5) A 40-year anxious woman is examined in the emergency room, after which the
following arterial blood sample data are obtained:
[Na+] = 140 mEq/L [K+] = 4.5 mEq/L
[HCO3-] = 19 mEq/L PCO2 = 20 mmHg
PO2 = 100 mmHg pH = 7.7
The most likely diagnosis is:
a) respiratory alkalosis .
b) metabolic alkalosis .
c) hypoxia .
d) metabolic acidosis with respiratory compensation .
(6) A 20-year old lady with diabetes mellitus was admitted to Kasr-Aini hospital. She
was hyperpenic and dehydrated. Urine analysis showed glucosuria and
Ketonuria .Blood report showed :
[HCO3-] = 20 mmol / L P CO2 = 34 mmHg pH = 7.38
The most likely diagnosis is:
a) metabolic acidosis with partial renal compensation .
b) respiratory acidosis with complete renal correction .
c) metabolic acidosis with complete respiratory compensation .
d) respiratory alkalosis with partial renal compensation .

(7) The following arterial blood data are obtained from a 50-year old man patient:
[H+] = 50mEq/L PO2 = 100 mmHg
PCO2 = 30 mmHg
Given these findings, what is the expected arterial bicarbonate concentration for this
patient?
a) 12 mEq/L.
b) 14.5 mEq/L.
c) 24 mEq / L .
d) 16 mEq/L.

(8) A 5-year old boy is brought to emergency room. His mother reported that her son
was in good health until 3 hours beforehand when his mental state began to
deteriorate. They found an empty bottle of aspirin beside his bed. Laboratory
examination revealed the following arterial data:
PCO2 =10 mmHg [HCO3-] = 13mmol/L [H+] = 18mmol/L
These data are most suggestive of:
a) respiratory alkalosis with partial renal compensation .
b) metabolic alkalosis with partial respiratory compensation .
c) respiratory acidosis with partial renal compensation .
d) metabolic acidosis with partial respiratory compensation.

(9) Which of the following conditions is most likely to cause acidosis?

a) severe persistent vomiting .
b) severe diarrhea .
c) excessive sweating .
d) frequent drinking of sodium bicarbonate .

(10) Extracellular HCO3- is an effective buffer for the following acids EXCEPT:
a) lactic acid .
b) carbonic acid .
c) phosphoric acid .
d) -hydroxybutyric acid.

(11) The following data are obtained from an arterial blood sample of hospitalized
patient:
PH = 7.55 PCO2= 25 mmHg [HCO3-] = 22.2 mEq / L
This patient has:
a) metabolic acidosis .
 b) respiratory alkalosis .
c) respiratory acidosis .
d) metabolic alkalosis .

(12) A 60-year old male, heavy cigarette smoker presents with chronic coughing and
dyspnea, come to emergency room in semicomatosed state Initial laboratory data
include:
Serum pH = 7.32 P CO2 = 70 mmHg PO2 = 35 mmHg.
From the above findings ,the most likely diagnosis is :
a) respiratory acidosis .
b) respiratory alkalosis .
c) metabolic acidosis .
d) metabolic alkalosis .

(13) The following blood data are collected from 50-year old man:
[H+] = 49 mEq/L PCO2 = 30mmHg PO2 =95 mmHg
This patient's pH would be expected to be:
a) 4.23 .
b) 7.31 .
c) 8.24 .
d) 6.17.

(14) Persistent vomiting leads to a complicated disorder of acid-base balance because

there is loss both H + and K from the body:
a) the loss of H results in a non-respiratory (metabolic alkalosis).
b) the plasma HCO3- concentration will be lower than normal.
c) respiration will be stimulated .
d) an acid urine will be produced .

(15) Regarding acidification of urine by the renal tubule:

a) K+ is normally reabsorbed from the tubular fluid in exchange for H+ secretion
b) the H + reacts with NaH2PO4 in the tubular fluid to give Na2HPO4 .
c) H+ is secreted into tubular fluid by P cells lining the distal tubule and collecting duct.
d) most of H + secreted in tubular fluid in cases of acidosis is in the form of ammonium
salts .

(16) A patient arrives at emergency room with low arterial blood pressure. Arterial
blood sample showed:
pH =7.67 [HCO3-] = 54 mmol/L P CO2 = 46 mmHg
Which of the following responses would be expected to occur in this patient?
a) decreased K secretion by the distal tubules .
b) hyperventilation .
c) exchange of extracellular K+ for intracellular H+.
d) increased ratio of NaH2PO4 to Na2HPO4 in urine .

(17) Which of the following is a cause of metabolic alkalosis?

a) salicylate poisoning .
b) chronic renal failure .
 c) diarrhea .
d) hyperaldosteronism .

(18) A former developed severe diarrhea for 6 hours was admitted to emergency room.
An arterial blood sample showed the following values:
pH = 7.25 PCO2 = 24 mmHg [HCO3-] - 12mEq/L
The correct diagnosis for this patient regarding acid-base status is:
a) metabolic acidosis .
b) metabolic alkalosis .
c) respiratory alkalosis .
d) normal acid-base status .

(19) Reabsorption of filtered HCO3-:

a) can occur normally in the presence of carbonic anhydrase inhibitor
b) is inhibited by a decrease in arterial P CO2 .
c) acidifies tubular fluid to pH 4.6 .
d) represents 60 % of the filtered load when plasma concentration is 25 mEq / L .

(20) H+ is secreted:
a) by the thin descending limb of loop of Henle .
b) by the P-cells in the collecting duct.
c) by the intercalated cells of the collecting duct.
d) in response to ADH .

(21) In metabolic acidosis ,the primary abnormality is :

a) CO2 excess.
b) bicarbonate deficiency.
c) bicarbonate excess .
d) Na+ deficiency.

(22) Which of the following cause hyperkalemia ?

a) alkalosis .
b) insulin injection .
c) exercise .
d) treatment with -agonist.

(23) Which of the following substances has the highest plasma clearance?
a) Na+.
b) inulin .
c) glucose .
d) para-amino hippuric acid.

(24) Which of the following would cause an increase in both renal blood flow and
glomerular filtration rate?
a) hyperproteinemia .
b) dilation of the afferent arteriole .
c) dilation of the efferent arteriole .
d) stone in the ureter .
(25) At plasma para amino hippuric acid concentration below transport maximum
a) reabsorption is not saturated .
b) clearance equals inulin clearance .
c) concentration in renal vein is close to zero .
d) secretion rate equals excretion rate .
(26) Which of the following statements about renin is true?
a) it is secreted by the macula densa cells .
b) its secretion is stimulated by an increase in arterial blood pressure .
c) its secretion leads to expansion of ECF volume .
d) it converts angiotensin I to angiotensin II .

(27) The juxtaglomerular apparatus :

a) is located in the juxtamedullary nephron only .
b) contains macula densa cells that act as baroreceptors stimulated by drop of ABP.
c) contains juxtaglomerular cells that secrete renin .
d) plays an important role in creating high osmolarity of the medullary interstitium.

(28) Normally, most of the H is excreted by the kidney in the form of:
a) HCO3- .
b) phosphate ion .
c) NH4+ .
d) titratable acid .

(29) The following changes are likely to be observed in hyperaldosteronism, EXCEPT :

a) hyperkalemia .
b) metabolic alkalosis .
c) decreased hematocrite .
d) increased ECF volume .

(30) In the nephron, the osmolality of fluid in the:

a) proximal convoluted tubule rises along its length .
b) tip of the loop of Henle is less than that of plasma .
c) collecting duct rises when ADH is being secreted .
d) medullary interstitium is about 300 mosmol / liter .

(31) Which of the following substances has the lowest plasma clearance ?
a) urea .
b) glucose .
c) para amino hippuric acid .
d) inulin .

(32) Regarding Na+ reabsorption

a) Na+ reabsorption across proximal tubular cells is active and transcellular.
b) Na+ transport across the apical membrane provides energy for cotransport of H+
c) is increased by ADH .
d) can be blocked by lasix in the distal tubule .
(33) Appearance of proteins in urine in appreciable amounts:
a) is directly related to plasma protein concentration .
b) is greater following damage to the glomerular membrane .
c) is increased by sympathetic stimulation .
d) may be due to decreased reabsorption by the proximal tubule .

(34) Patient with renal insufficiency develops very high plasma concentration of urea
because:
a) the glomerular filtration rate is decreased .
b) synthesis of urea by the renal tubule is increased .
c) secretion of urea by distal tubule is decreased .
d) reabsorption of urea by the loop of Henle is increased .

(35) A comatosed patient is noted to be hyperventilating. His arterial blood pH is 7.

This situation could have resulted from:
a) repeated vomiting .
b) prolonged diarrhea .
c) sudden ascent to high altitude .
d) antacid overdose .

(36) Which of the following would cause an increase in GFR ?

a) constriction of the afferent arteriole .
b) constriction of the efferent arteriole .
c) increased plasma protein concentration .
d) constriction of the ureter .

(37) Use the values given to answer the question that follows:
Glomerular hydrostatic presence = 47 mmHg.
Bowman's capsule hydrostatic pressure = 10 mmHg.
At what value of glomerular capillary oncotic pressure, would glomerular filtration
stop?
a) 57 mmHg .
b) 37 mmHg.
c) 10 mmHg. .
d) 30 mmHg.

(38) Concerning the renal tubules:

a) the ascending limb of the loop of Henle is freely permeable to water.
b) at the tip of the loop of Henle in the renal medullary papillae, the osmolality of the tubular
fluid is several times that of the glomerular filtrate.
c) in the presence of, ADH the fluid in the collecting duct is hypo-osmotic with respect to
plasma.
d) the permeability of the cortical collecting duct to urea is under the control of ADH.

(39) Juxtamedullary nephrons:

a) make up more than 40% of the nephrons.
b) have their glomeruli in the renal medulla.
c) play an important role in creating hyperosmolarity of the renal medullary interstition.
 d) are associated with afferent arterioles which only divide to form peritubular capillary
network.

(40) Regarding permeability of the glomerular membrane, all of the following is true,
EXCEPT:
a) it is inversely proportional to the diameter of the penetrating molecules.
b) to albumin is more than expected because albumin carries negative charges.
c) to cationic molecules is greater than the permeability to neutral ones having the same
diameter.
d) is influenced by charges lining the capillary endothelium.
(41) Regarding glucose reabsorption:
a) it occurs by the process of secondary active transport.
b) the renal threshold is 300 mg/dL.
c) most of the glucose that is filtered through the glomerulus undergoes reabsorption by the
proximal tubules and loop of Henle.
d) it is controlled by insulin.
(42) Glomerular filtration rate:
a) is the volume of fluid filtered by all the glomeruli of one kidney/min.
b) is greatly decreased by lowering the mean arterial blood pressure to 90 mmHg..
c) is decreased when the efferent arterioles constrict.
d) is decreased as the number of functioning glomeruli decreases.
(43) Regarding water diuresis, the following is true, EXCEPT:
a) is produced by drinking large amount of a hypotonic fluid..
b) produces urine of somolality far less than osmolality of plasma..

c) results from decreased water reabsorption by the proximal tubules and loop of Henle.
d) is independent of hyperosmolar concentration of medullary interstitium..

(44) The juxtamedullary nephrons:

a) constitute about 30% of nephrons in the human kidney.
b) have vasa recta that acts as a counter-current multiplier system..
c) are responsible for creating the hyperosmolarity of the medullary interstitium..
d) have proximal convoluted tubules, which extend into the renal medulla..
(45) Renal blood flow::
a) is about 630 mL/minute..
b) can be measured by use of creatinine clearance..
c) remains fairly constant over a mean arterial pressure between 80-200 mmHg.
d) auto-regulation depends on intact sympathetic supply..
(46) In the distal convoluted tubule:
a) 60% of NaCl in the glomerular filtrate is reabsorbed.
b) the tubular fluid is made hypertonic relative to plasma.
c) aldosterone increase K+ ion reabsorption.
 d) water reabsorption is under control of ADH..
(47) Vaso-pressen (ADH):
a) secretion is increased if the osmotic pressure of plasma decreases.
b) help reabsorption of 65% of the filtered water in the proximal convoluted tubule..
c) increases water reabsorption in the medullary portion of the collecting duct.
d) administration stops diuresis occurring in diabetes mellitus.
(48) The tubulo-glomerular feed back:
a) adjust GFR by constriction or dilatation of the afferent arteriole.
b) is affected by angiotensin II released from the macula densa.
c) is the increase in solute reabsorption by an increase of GFR.
d) is dependent on intact sympathetic innervation..
(49) Glomerular filteration:
a) increases with an increase in hydrostatic pressure in Bowman's capsule.
b) of protein anions increases in cases of glomerulo-nephritis.

c) increases with contraction of mesangial cells.

d) is diffusion-limited rather than flow-limited.
(50) All the following statements about proximal convoluted tubule are true, EXCEPT:
a) it reabsorbs most of the Na+ in tubular fluid .
b) it reabsorbs most of K+ in tubular fluid .
c) it contain juxtaglomerular cells which secrete renin .
d) it reabsorborbs most of HCO3- in tubular fluid.
(51) Renal clearance of:
a) inulin provides an estimate of GFR .
b) urea is higher than that of inulin .
c) PAH falls when PAH load exceeds Tm for PAH .
d) Of glucose is 180 ml / min .
(52) The collecting ducts in the kidney :
a) are the site of most water reabsorption .
b) can actively transport water molecules into the interstitium .
c) pass through a region of hyperosmolality which is equal althrough .
d) determine to a large extent the final osmolality of urine .
(53) The renal clearance of:
a) creatinine provides measurement of renal plasma flow .
b) bicarbonate is similar to that of glucose .
c) PAH is about 1200 ml/ min .
d) phosphate is decreased by parathormone .
(54) In normal healthy subjects , urine :
a) osmolality ranges from 300-400 m osmol/L .
b) specific gravity ranges from 1003-1060 .
 c) phosphate content is increased by parathormone .
d) pH rises after protein-rich meal.
(55) Potassium :
a) is reabsorbed only in the proximal convoluted tubule actively .
b) is secreted in the distal convoluted tubule .
c) excess in plasma favours hydrogen ion secretion in the distal tubule
d) blood levels are increased in alkalosis .
(56) Secretion of renin :
a) is stimulated by the hormone angiotensin I.
b) is stimulated by a fall in ECF volume .

c) inhibits ACTH secretion by the pituitary gland .

d) is stimulated by aldosterone .
(57) Diabetes insipidus causes a fall in :
a) reabsorption of water from the proximal tubule .
b) extracellular but not intracellular volume .
c) extracellular fluid osmolality .
d) osmolality of the urine .
(58) Treatment with aldosterone antagonist causes a fall in :
a) urine volume .
b) body Na+ .
c) body K+.
d) blood viscosity.
(59) A drug which inhibits carbonic anhydrase decreases :
a) blood pH.
b) urinary loss of K+.
c) urinary volume and pH.
d) bicarbonate secretion by the renal tubule .
(60) Micturition may be inhibited if:
a) the sympathetic nerves carrying afferent information from bladder to spinal cord are cut.
b) the pelvic nerves are cut.
c) parasympathomimetic drug like prostigmine is administered .
d) adrenergic antagonist is administered .
(61) Cutting the sympathetic nerve to the urinary bladder cause all the following,
EXCEPT:
a) loss of tone in the internal uretheral sphincter .
b) loss of tone in the external uretheral sphincter .
c) loss of pain sensation from the bladder .
d) infertility in the male .
(62) Calculate the renal plasma flow of a patient given the data below: effective renal
plasma flow = 585 ml/min
measured hematocrit = 45%
renal extraction of PAH = 0.90
(i.e., 90% of PAH is removed from the plasma by the kidney in a
single passage)
a) 1064 ml/min
b) 961 ml/min
c) 1066 ml/min
d) 650 ml/min
(63) Given the following data, Calculate the GFR of this patient:
 Plasma creatinine 0.8 mg/100 ml.
 Plasma urea 15.0 mg/100 ml
 24 hr urine volume 1,600 ml (=1.1 ml/min)
 Urine concentration of urea 130 mg/100 ml
 Urine concentration of creatinine 72 mg/100 ml.
a) 181 mL/min
b) 125 mL/min
c) 100 mL/min
d) 130 mL/min
e) 154 mL/min
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