lOMoARcPSD|24536077 Ch. 18 Test Bank - Gould's Ch. 18 Test Bank Pathophysiology (Sam Houston State University) Studocu is not sponsored or endorsed by any college or university Downloaded by cathy mio (cathy20090117@hotmail.com) lOMoARcPSD|24536077 Chapter 18: Urinary System Disorders Test Bank MULTIPLE CHOICE 1. Which of the following structures is most likely to be located in the renal medulla? a. Proximal convoluted tubule b. Glomerulus c. Loop of Henle d. ANS: C REF: 492-493 Afferent arteriole 2. Which of the following is NOT a function of the kidney? a. Regulation of body fluid concentrations b. Removal of nitrogenous and acidic wastes c. Activation of vitamin D d. ANS: D REF: 491 Production of albumin 3. Which of the following describes the correct flow of blood in the kidney? a. Afferent arteriole to the peritubular capillaries to the venule b. Efferent arteriole to the glomerular capillaries to the peritubular capillaries c. Peritubular capillaries to the glomerular capillaries to the venule d. ANS: D REF: 494 Afferent arteriole to the glomerular capillaries to the efferent arteriole 4. Which of the following describes the flow of filtrate in the kidney? a. The collecting duct to the distal convoluted tubule to the renal pelvis b. Bowmans capsule to the proximal convoluted tubule to the loop of Henle c. The loop of Henle to the collecting duct to Bowmans capsule d. ANS: B REF: 492 The distal convoluted tubule to the loop of Henle to the collecting duct 5. Which of the following describes the normal flow of urine? a. Collecting duct to the renal pelvis to the ureter to the bladder Downloaded by cathy mio (cathy20090117@hotmail.com) lOMoARcPSD|24536077 b. Renal pelvis to the urethra to the bladder to the ureter c. Ureter to the renal pelvis to the urethra to the bladder d. ANS: A REF: 496 Collecting duct to the ureter to the urethra 6. Which statement about the bladder is TRUE? a. The bladder wall lacks rugae. b. Three openings from the urinary bladder form the trigone. c. It contracts when stimulated by the sympathetic nervous system. d. ANS: B REF: 496 Continuous peristalsis in the bladder wall promotes urine flow. 7. Which of the following increases glomerular filtration rate? a. Increased plasma osmotic pressure b. Dilation of the efferent arteriole c. Increased hydrostatic pressure in the glomerular capillaries d. ANS: C REF: 495 Constriction of the afferent arteriole 8. By what process is water reabsorbed from the filtrate? a. Osmosis b. Active transport c. Cotransport d. ANS: A REF: 492 Capillary action 9. Which substance directly controls the reabsorption of water from the collecting ducts? a. Renin b. Aldosterone c. Angiotensin d. ANS: D REF: 492 Antidiuretic hormone 10. Under what circumstances do cells in the kidneys secrete renin? Downloaded by cathy mio (cathy20090117@hotmail.com) lOMoARcPSD|24536077 a. The urine pH decreases. b. Blood flow in the afferent arteriole decreases. c. Serum potassium levels are high. d. ANS: B REF: 495 Serum osmotic pressure increases. 11. Which of the following should be present in the filtrate in the proximal convoluted tubule? a. Plasma proteins b. Erythrocytes c. Sodium ions d. ANS: C REF: 492 Leukocytes 12. From the following, choose the substance likely to appear in the urine when the glomerulus is inflamed. a. Albumin b. Urea c. Sodium d. ANS: A REF: 497 Creatinine 13. Involuntary urination by a child after age 4 or 5, when bladder control is expected, is referred to as: a. enuresis. b. stress incontinence. c. micturition. d. ANS: A REF: 496 overflow incontinence. 14. When a respiratory infection with high fever is present in the body, how would the kidney tubules maintain normal pH of body fluids? a. Increase the flow of filtrate. b. Secrete more acids and reabsorb more bicarbonate ions. Downloaded by cathy mio (cathy20090117@hotmail.com) lOMoARcPSD|24536077 c. d. ANS: B REF: 502-503 Excrete a larger volume of more dilute urine. Retain more potassium ions in exchange for sodium ions. 15. When comparing normal kidney function with dialysis, which of the following mechanisms is not possible in dialysis? a. Diffusion b. Osmosis c. Ultrafiltration d. ANS: D REF: 500 Active transport 16. What is the cause of most cases of pyelonephritis? a. An ascending infection by E. coli b. Abnormal immune response, causing inflammation c. Dialysis or other invasive procedure d. ANS: A REF: 500 Severe pH imbalance of urine 17. Which disease is manifested by dysuria and pyuria? a. Nephrotic syndrome b. Cystitis c. Glomerulonephritis d. ANS: B REF: 502 Urolithiasis 18. Why may acute pyelonephritis and cystitis follow untreated prostatitis? a. Microbes spread through the circulation. b. Antibodies have not yet formed. c. There is no effective treatment. d. ANS: D REF: 502 There is a continuous mucosa along the involved structures. 19. Pyelonephritis may be distinguished from cystitis by the presence in pyelonephritis of: Downloaded by cathy mio (cathy20090117@hotmail.com) lOMoARcPSD|24536077 a. microbes, leukocytes, and pus in the urine. b. painful micturition. c. urgency and frequency. d. ANS: D REF: 502 urinary casts and flank pain. 20. In a case of acute pyelonephritis, what is the cause of flank pain? a. Inflammation, causing ischemia in the tubules b. Inflammation, stretching the renal capsule c. Increasing glomerular permeability, creating an increased volume of filtrate in the kidney d. ANS: B REF: 502 Microbes irritating the tissues 21. Which pathophysiological process applies to acute post-streptococcal glomerulonephritis? a. Streptococcal infection affects both the glomerular and tubule functions Ischemic damage occurs in the tubules, causing obstruction and decreased glomerular filtration b. rate (GFR) c. Immune complexes deposit in glomerular tissue, causing inflammation d. Increased glomerular permeability for unknown reasons ANS: C REF: 502-503 22. What causes the dark urine associated with acute post-streptococcal glomerulonephritis? a. Blood and protein leaking through the capillary into the filtrate b. Proteinuria and microscopic hematuria from the inflammation c. Pyuria from inflammatory exudate d. ANS: A REF: 503 Bleeding from ulcerations in the kidneys 23. Renal disease frequently causes hypertension because: a. albuminuria increases vascular volume. b. congestion and ischemia stimulate release of renin. c. antidiuretic hormone (ADH) secretion is decreased. d. ANS: B REF: 503 damaged tubules absorb large amounts of filtrate. Downloaded by cathy mio (cathy20090117@hotmail.com) lOMoARcPSD|24536077 24. Urinary casts are present with acute post-streptococcal glomerulonephritis because: a. large numbers of microbes and leukocytes enter the filtrate. b. ruptured capillaries release debris into the tubules. c. normal reabsorption of cells and proteins cannot take place. d. ANS: D REF: 508 inflamed tubules compress red blood cells (RBCs) and protein into a typical mass. 25. Which disease would cause an increased ASO titer and elevated serum ASK? a. Nephrotic syndrome b. Acute post-streptococcal glomerulonephritis c. Pyelonephritis d. ANS: B REF: 503-504 Polycystic kidney 26. Why does metabolic acidosis develop with bilateral kidney disease? a. Tubule exchanges are impaired. b. GFR is increased. c. Serum urea is increased. d. ANS: A REF: 510 More bicarbonate ion is produced. 27. What is the first indicator in the arterial blood gases of acidosis caused by glomerulonephritis? a. Increased carbonic acid b. Increased bicarbonate ion c. A pH less than 7.35 d. ANS: D REF: 503 Decreased bicarbonate ion 28. What would be the long-term effects of chronic infection or inflammation of the kidneys? a. Dehydration and hypovolemia b. Gradual necrosis, fibrosis, and development of uremia c. Sudden anuria and azotemia Downloaded by cathy mio (cathy20090117@hotmail.com) lOMoARcPSD|24536077 d. ANS: B REF: 504 Severe back or flank pain 29. What factors contribute to headache, anorexia, and lethargy with kidney disease? 1. Increased blood pressure 2. Elevated serum urea 3. Anemia 4. Acidosis a. 1 only b. 2, 4 c. 1, 3, 4 d. ANS: D REF: 513 1, 2, 3, 4 30. What are the significant signs of nephrotic syndrome? a. Hyperlipidemia and lipiduria b. Pyuria and leucopenia c. Hypertension and heart failure d. ANS: A REF: 504 Gross hematuria and pyuria 31. Why does blood pressure often remain near normal in patients with nephrotic syndrome? a. Massive amounts of fluid are lost from the body with polyuria. b. Renin and aldosterone are no longer secreted. c. Tubules do not respond to ADH and aldosterone. d. ANS: D REF: 504 Hypovolemia results from fluid shift to the interstitial compartment. 32. Common causes of urolithiasis include all of the following EXCEPT: a. hypercalcemia. b. hyperlipidemia. c. inadequate fluid intake. d. hyperuricemia. Downloaded by cathy mio (cathy20090117@hotmail.com) lOMoARcPSD|24536077 ANS: B REF: 506 33. Which of the following results from obstruction of the left ureter by a renal calculus? a. Mild flank pain on the affected side b. Hydronephrosis in both kidneys c. Immediate cessation of urine production d. ANS: D REF: 506 An attack of renal colic 34. What does hydronephrosis lead to? a. Ischemia and necrosis in the compressed area b. Multiple hemorrhages in the kidney c. Severe colicky pain radiating into the groin d. ANS: A REF: 507 Increased GFR 35. Which of the following is a predisposing factor to bladder cancer? a. Prostatic cancer b. Hormonal abnormalities c. Exposure to chemicals and cigarette smoke d. ANS: C REF: 508 Presence of embryonic tissue 36. What is the common initial sign of adenocarcinoma of the kidney? a. Gross hematuria b. Microscopic hematuria c. Sharp flank pain d. ANS: B REF: 507 Oliguria 37. Which of the following does NOT usually result from nephrosclerosis? a. Secondary hypertension b. Chronic renal failure c. Acute renal failure Downloaded by cathy mio (cathy20090117@hotmail.com) lOMoARcPSD|24536077 d. ANS: C REF: 508 Increased renin and aldosterone secretions 38. Which of the following relates to polycystic kidney disease? a. It affects only one of the kidneys. b. It results in gradual degeneration and chronic renal failure. c. The kidneys are displaced and the ureters are twisted. d. ANS: B REF: 510 The prognosis is good because there is adequate reserve for normal life. 39. Which of the following is related to Wilms tumor? a. Direct exposure to carcinogens b. Hormonal imbalance c. Repeated infections d. ANS: D REF: 509 A genetic defect 40. With severe kidney disease, either hypokalemia or hyperkalemia may occur and cause: a. cardiac arrhythmias. b. encephalopathy. c. hypervolemia. d. ANS: A REF: 513 skeletal muscle twitch or spasm. 41. Which of the following indicates the early stage of acute renal failure? a. Polyuria with urine of fixed and low specific gravity b. Hypotension and increased urine output c. Development of decompensated acidosis d. ANS: D REF: 510 Very low GFR and increased serum urea 42. What is/are a cause(s) of acute tubule necrosis and acute renal failure? a. Prolonged circulatory shock b. Sudden significant exposure to nephrotoxins Downloaded by cathy mio (cathy20090117@hotmail.com) lOMoARcPSD|24536077 c. d. ANS: D REF: 510 Crush injuries or burns All of the above 43. Which of the following would likely cause chronic renal failure? a. Cystitis with pyelonephritis in the right kidney b. Circulatory shock c. Diabetes d. ANS: C REF: 510 Obstruction of a ureter by a renal calculus 44. What causes polyuria during the stage of renal insufficiency? a. Loss of tubule function b. Increased blood pressure c. Decreased aldosterone secretion d. ANS: A REF: 510 Increased GFR 45. What is the primary reason for hypocalcemia developing during end-stage renal failure or uremia? a. Decreased parathyroid hormone secretion b. Insufficient calcium in the diet c. Excessive excretion of calcium ions in the urine d. ANS: D REF: 513 A deficit of activated vitamin D and hyperphosphatemia 46. Cystitis is more common in females because: a. the mucosa in the urinary tract is continuous. b. the urethra is short, wide, and adjacent to areas with resident flora. c. the pH of urine is more acidic in females. d. ANS: B REF: 500 females have a higher incidence of congenital anomalies. 47. Which of the following indicate a decreased GFR? Downloaded by cathy mio (cathy20090117@hotmail.com) lOMoARcPSD|24536077 a. Increased serum urea and decreased serum bicarbonate b. Urine with low specific gravity and dark color c. Albuminuria and hematuria d. ANS: A REF: 497 Hyponatremia and hypokalemia 48. Which of the following is NOT likely to lead to hydronephrosis? a. Renal calculi b. Pyelonephritis c. Nephrosclerosis d. ANS:CREF:502 | 506 | 507 | 515 Benign prostatic hypertrophy 49. Which of the following congenital defects is a common cause of cystitis in young children? a. Polycystic kidney b. Horseshoe kidney c. Hypoplasia of the kidney d. ANS: D REF: 500 Vesicoureteral reflux 50. Which factor contributes to severe anemia in individuals with chronic renal failure? a. Increased erythropoietin secretion b. Limited protein intake c. Compensatory increase in bone marrow activity d. ANS: B REF: 513 Inability to absorb vitamin B12 and iron 51. When acidosis becomes decompensated in renal failure, a key indicator is: a. increased PCO2. b. increased bicarbonate ion. c. serum pH dropping below 7.35. d. ANS: C REF: 513 serum buffer ratio of 20 bicarbonate ions to 1 carbonic acid. 52. What is the primary action of the diuretic furosemide? Downloaded by cathy mio (cathy20090117@hotmail.com) lOMoARcPSD|24536077 a. Decreased reabsorption of sodium and water b. Decreased reabsorption of H+ in the tubules c. Increased secretion of antidiuretic hormone d. ANS: A REF: 498 Inhibition of renin 53. Which of the following causes acute renal failure? a. Polycystic kidney disease b. Pyelonephritis in the right kidney c. Nephrosclerosis d. ANS: D REF: 510 Bilateral acute glomerulonephritis 54. Which of the following is a significant indicator of renal insufficiency? a. Urine with pH of 5 b. Increased serum urea and creatinine c. Urine with high specific gravity d. ANS: B REF: 510 Decreased blood pressure 55. Uremic signs of renal failure include all of the following EXCEPT: a. encephalopathy. b. high blood pressure. c. osteodystrophy. d. ANS: B REF: 513 azotemia and acidosis. 56. Choose the basic cause of osteodystrophy associated with chronic renal failure. a. Development of hypercalcemia b. Deficit of parathyroid hormone c. Failure of the kidney to activate vitamin D d. ANS: C REF: 513 Excessive loss of phosphate ion 57. Agenesis is often not diagnosed because: Downloaded by cathy mio (cathy20090117@hotmail.com) lOMoARcPSD|24536077 a. the kidney is displaced from its normal position. b. it is a genetic defect and asymptomatic until mid-life. c. the two functioning kidneys are fused together. d. ANS: D REF: 509 it is usually asymptomatic as one kidney provides adequate function. 58. The normal pH of urine is: a. 7.35-7.45. b. 4.5- 8.0. c. 1.5-7.5. d. ANS: B REF: 596-597 1.0-7.0. 59. Wilms tumor is: a. a malignant tumor in the bladder. b. an encapsulated mass in one kidney. c. not considered to have a genetic origin. d. ANS: B REF: 509 manifested in adulthood. 60. Reduced urine output resulting from inflammation and necrosis of the tubules is called: a. oliguria. b. anuria. c. pyuria. d. ANS: A REF: 510 polyuria. 61. The micturition reflex is initiated by: a. sympathetic nerves in the sacral spinal cord. b. relaxation of the internal sphincter of the bladder. c. increased pressure distending the bladder. d. ANS: C REF: 496 contraction of the bladder. 62. Which of the following results from decreased blood flow into the kidneys? Downloaded by cathy mio (cathy20090117@hotmail.com) lOMoARcPSD|24536077 a. Decreasing blood pressure b. Dilation of the afferent arterioles c. Decreased aldosterone secretion d. ANS: D REF: 496 Increased angiotensin and systemic vasoconstriction 63. In acute post-streptococcal glomerulonephritis, the glomerular inflammation results from: a. toxins produced by the bacteria. b. a type III hypersensitivity reaction. c. an ascending infection from the bladder. d. ANS: B REF: 502 spread of infection from the tubules. 64. In acute post-streptococcal glomerulonephritis, the inflammation causes: a. increased permeability of the glomerular capillaries. b. glomerular congestion and decreased GFR. c. decreased blood pressure and edema. d. ANS: D REF: 503 A and B 65. Circulatory shock causes: a. decreased GFR and increased renin secretion. b. increased ADH and decreased aldosterone secretion. c. immediate tubule necrosis and obstruction. d. sympathetic nervous system (SNS) stimulation and vasodilation of afferent and efferent arteriole ANS: A REF: 510 66. Autoregulation in the kidneys refers to: a. control of blood flow by the SNS. b. the secretion of renin and activation of angiotensin. c. local minor reflex adjustments in the arterioles to maintain normal blood flow. d. ANS: C REF: 495 the control of systemic blood pressure by the kidneys. 67. The reabsorption of water and electrolytes by the kidneys is directly controlled by: Downloaded by cathy mio (cathy20090117@hotmail.com) lOMoARcPSD|24536077 1. atrial natriuretic hormone. 2. antidiuretic hormone. 3. angiotensin. 4. the levels of bicarbonate ion. a. 2 only b. 3 only c. 1, 2 d. ANS: C REF: 492 2, 4 68. Uncontrolled essential hypertension may cause chronic renal failure because of: a. predisposition to recurrent urinary tract infections. b. damage to afferent arterioles and renal ischemia. c. failure of tubules to respond to hormonal controls. d. ANS: B REF: 508 glomerular congestion causes damaged capillaries. 69. Urine with a low specific gravity is usually related to: a. an infection of the gallbladder. b. renal failure due to tubule damage. c. lack of sufficient fluid intake. d. ANS: B REF: 510 | 512 presence of numerous renal calculi. 70. Excess urea and other nitrogen wastes in the blood is referred to as: a. dysuria. b. azotemia. c. bacteremia. d. ANS: B REF: 513 hematuria. Downloaded by cathy mio (cathy20090117@hotmail.com)
