1. After retiring at the age of 67, Aquaman complains that his superpowers are waning and
that he now feels fatigued more often than not. His BP is 168/99 mmHg. His doctor
runs some routine tests which reveal an albumin excretion of 3g/24 hr. With the
following information, calculate his GFR (rounded to the nearest full unit value): Plasma
[creatinine] is 0.833 millimoles/L, urine [creatinine] is 8300 micromoles/L and urine flow
rate is 1.7 ml/min.
a)
b)
c)
d)
e)
2.
When he was healthy, Aquaman’s glomerular filtration barrier restricted the passage of
molecules based upon size and charge as well as the surface area available for
filtration. If this barrier were to become more negatively charged which of the
following would be TRUE:
a)
b)
c)
d)
e)
3.
Small molecules such as sodium would no longer go through the barrier
water would no longer go through the barrier
the barrier’s ability to restrict the passage of albumin would not change
albumin would pass through the barrier with more difficulty
albumin would pass through the barrier more easily
A renal biopsy performed on Aquaman reveals (by microscopy) immune complex
deposits in the glomeruli. This is consistent with which one of the following:
a)
b)
c)
d)
e)
4.
16.9 ml/min
17.1 ml/min
16938.8 mL/min
1.69 L/min
insufficient information to permit the calculation
Membranous nephropathy
Prostatic enlargement
Focal and segmental glomerulosclerosis
Diabetic nephropathy
Renal artery stenosis
In CKD, there are how many stages?:
a)
1
b)
c)
d)
e)
5.
In CKD, the last stage of disease progression is characterized by:
a)
b)
c)
d)
e)
6.
Slight decrease in GFR
Normal or increased GFR
decrease in GFR to below 15ml/min
A sudden drop in GFR
A sudden increase in blood pressure
Which of the following is a cause of (intrinsic) renal acute kidney injury (AKI)
a)
b)
c)
d)
e)
7.
2
4
5
6
Low blood pressure
Prostate cancer
Diabetes
Bleeding ulcer
Renal artery stenosis
The kidneys, along with hypothalamic antidiuretic hormone production, function to help
maintain sodium and water balance. Which of the following would best describe the
situation wherein water is retained along with sodium, which is retained due to
hyperaldosteronism, such that total ECF increases:
a)
b)
c)
d)
e)
Isovolemic hypernatremia
Hypovolemic hyponatremia
Hypovolemic hypernatremia
Hypervolemic hyponatrema
Hypervolemic hypernatremia
8.
Antidiuretic hormone activates which ONE of the following:
a)
Epithelial sodium channels (ENac)
b)
ROMK channels (Renal outer medullary channels)
c)
NaKCC transporters
d)
V2 receptors
e)
NaH (Sodium Hydrogen exchanger)
9.
Hydronephrosis can occur in which ONE of the following conditions:
a)
b)
c)
d)
e)
Vesicouretheral reflux
Renal artery stenosis
Diabetic nephropathy
Hyperkalemia
Mercury poisoning
10.
In late diabetic kidney disease GFR typically changes how:
a)
No change
b)
Decreases
c)
Increases
d)
Drops suddenly to zero
e)
Cannot be accurately measured
11.
Which one of the following is FALSE regarding GFR?:
a)
Rate at which plasma moves through the glomerular capillaries
b)
Units are in mmol/min
c)
Females have a lower GFR than males
d)
Children reach adult proportions by 2 years of age
e)
Cystatin C is a valid marker of GFR
12.
Which ONE of the following is a cause of hypercalcemia:
a)
Hyperparathyroidism
b)
Hypoparathyroidism
c)
Vitamin D deficiency
d)
Hyperphosphatemia
e)
Acute pancreatitis
13.
In diabetes insipidus which ONE of the following would not be expected to occur:
a)
Defects in AQP2 water channels
b)
Defects in V2 receptors
c)
Decreases in Vasopressin (ADH) levels
d)
increased urine output
e)
decreased thirst
14. Relying upon serum (plasma) creatinine alone to estimate GFR in cases of acute kidney
injury is inaccurate because:
a)
b)
c)
d)
e)
15.
creatinine is no longer freely filtered by the glomerulus
creatinine is secreted by the nephron
plasma creatinine levels have not had time to reach a steady state
muscle secretes more creatinine following acute kidney injury
all of the above are true
Which of the following is not used to assess GFR:
a)
b)
c)
d)
e)
Serum creatinine
Serum sodium
Cystatin C
Inulin
The MDRD formula
Fast forward to the year 2024, “The Wasp” is diagnosed with diabetes. Twenty years later
(2044) she has continued to exercise little, eats fast food regularly and has gained 33 pounds.
She complains that she now feels fatigued more often than not. Her latest blood test and
physical examination reveals that she has a plasma [K+] of 6.9 mM, pH is 7.18, pCO 2 is 33 mm
Hg and plasma [HCO3-] is 15 mM. An ECG reveals peaked T waves.
16.
Describe The Wasp’s acid base status:
a)
b)
c)
d)
e)
17.
primary respiratory acidosis with compensatory metabolic acidosis
primary metabolic acidosis with primary respiratory acidosis
primary metabolic acidosis with an underlying respiratory acidosis
primary metabolic acidosis with compensatory respiratory alkalosis
primary respiratory acidosis with compensatory metabolic alkalosis
The most likely cause of the plasma [HCO3-] of 15 mM in “The Wasp” is:
a)
b)
c)
d)
e)
18.
With respect to compensatory changes which one of the following is false:
a)
b)
c)
d)
e)
19.
An increase in pH (alkalosis) increases lung ventilation (respiratory rate)
Respiratory compensation in response to pH changes is immediate
A decrease in pH (acidosis) stimulates ventilation to drop pCO2
A decrease in pH (acidosis) stimulates HCO3- production
An increase in pH (alkalosis) decreases renal HCO3- production
If “The Wasp” had emphysema and her pCO2 had been measured at 40 mmHg (along
with a pH of 7.21 and HCO3- of 15 mM you could conclude that:
a)
b)
c)
d)
e)
20.
a reduction in GFR
increased systemic fixed acid production
decreased renal HCO3- production
hyperventilation
increased intestinal HCO3- losses
The lungs have failed to respond to the altered pH
The kidneys have not had enough time to compensate for the altered pH
There is an excess gain of bicarbonate from the intestine/diet
The lungs have increased their respiration rate
Too little information to suggest anything
One of the most recent advances for treating diabetes is the use of SGLT2 inhibitors.
The reason this class of drugs is effective is outlined in which one of the following
statements?:
a)
b)
c)
d)
e)
They increase the epithelial Na channel activity in the collecting duct
They increase glucose uptake by the intestine
They directly improve insulin secretion by the pancreas
They inhibit sodium uptake by the collecting duct
They inhibit glucose uptake by the proximal tubule