4.
3.
1.
2.
Secretion of K+ by the distal tubule will be decreased by a. b. c. d. e.
Metabolic alkalosis
A high K+ diet
Hyperaldosteronism
Spironolactone administration
Thiazide diuretic administration
The following blood gas picture is most consistent with: pH = 7.56; pCO
2
20mmHg; pO
2
= 100mmHg; bicarb = 25mmol/ 
= a. b. c. d. e.
Sepsis
Emphysema
Prolonged vomiting
Bicarbonate ingestion
2 week residence at high altitude
The principal buffer in interstitial fluid is
Regarding absorption of Na+ in the proximal tubule a. b. c. d. e. a. b. c. d. e.
Carbonic acid
Hb
Phosphate
Other proteins
Compounds containing histidine
The proximal tubule reabsorbs 80% of the filtered sodium load
Absorption of Na+ causes increasing hypertonicity in the tubule lumen
Absorption is powered by the Na+/H+ ATPase
Shares a common carrier with glucose
All of the above are true

5.
8.
7.
6.
Which of the following agents does not cause contraction of the mesangial cells in the glomerulus? a. b. c. d. e.
Angiotensin I
Noradrenaline
Histamine
Dopamine
Vasopressin
The lower pH limit of the urine is a. b. c. d. e.
ADH (vasopressin) secretion is increased by a. b. c. d. e.
1.0
3.5
4.5
6.0
7.0
Alcohol
Carbamazepine
 extracellular fluid volume
Angiotensin I
Lying supine
With respect to the counter current system a. b. c. d. e.
The Loops of Henle act as counter current exchangers
Solutes diffuse out of vessels conducting blood toward the cortex
Water diffuses out of ascending vessels
Water diffuses into the collecting ducts
Counter current exchange is passive and can operate even if counter current multiplication ceases
9. Which of the following is most permeable to water? a. b. c. d. e.
Thin ascending Loop of Henle
Distal convoluted tubule
Thin descending Loop of Henle
Cortical portion of collecting tubule
Thick ascending limp of Loop of Henle
10. pH 7.16; pCO
3.4mmol/ 
2
= 24mmHg; pO
2
= 100mmHg; bicarbonate = 6mmol/  ; K+ =
Which of the following is MOST likely to cause the above picture a. b. c. d. e.
Cyanide poisoning
Hyperventilation
Liquorice ingestion
Addison’s disease
Conn’s syndrome

11. Metabolic alkalosis can be caused by all of the following EXCEPT a. b. c. d. e.
Hyperaldosteronism
Hyperventilation
Hypokalaemia
Volume depletion
Vomiting
12. The consumption of oxygen by the kidney a. b. c. d. e.
Decreases as blood flow increases
Is regulated by erythropoietin
Remains constant as blood flow increases
Directly reflects the level of sodium transport
Is greatest in the medulla
13. If the plasma concentration of a freely filterable substance that is neither secreted nor reabsorbed is 0.12gmg/ml, its urine concentration is 25mg/ml, and urine formation 1.0ml/min – the GFR is a. b. c. d. e.
50ml/min
125ml/min
150ml/min
200ml/min
362ml/min
14. An increase in the concentration of plasma potassium causes an increase in a. b. c. d. e.
Release of renin
Secretion of aldosterone
Secretion of ADH
Release of natriuretic hormone
Production of Angiotensin II
15. GFR would be increased by a. b. c. d. e.
Constriction of the afferent arteriole
A decrease in afferent arteriolar pressure
Compression of the renal capsule
A decrease in the concentration of plasma protein
A decrease in renal blood flow
16. The greatest amount of hydrogen ion secreted by the proximal tubule is associated with a. b. c. d. e.
Excretion of potassium ion
Excretion of hydrogen ion
Reabsorption of calcium ion
Reabsorption of bicarbonate ion
Reabsorption of phosphate ion

17. All of the following comparisons between the distal nephron and the proximal tubule are correct EXCEPT a. b. c. d.
The distal nephron is less permeable to hydrogen ion than is the proximal tubule
The distal nephron is more responsive to aldosterone than is the proximal tubule
The distal nephron has a more negative intraluminal potential than does the proximal tubule
The distal nephron secretes more potassium than does the proximal tubule e. The distal nephron secretes more hydrogen ion than does the proximal tubule
18. Urinary volume is increased by all of the following EXCEPT a. b. c. d. e.
Sympathetic stimulation
Diabetes insipidus
Diabetes mellitus
Increased renal arterial pressure
Infusion of mannitol
19. Which one of the following statements about aldosterone is correct? a. b. c. d. e.
20. The ability of the kidney to excrete a concentrated urine will increase if a. b. c. d. e.
It produces its effect by activating cAMP
It produces its effects by increasing membrane permeability to potassium
It causes an increased reabsorption of hydrogen ion
It has its main effect on the proximal tubule
It is secreted in response to an increase in BP
The permeability of the proximal tubule to water decreases
The rate of blood flow through the medulla decreases
The rate of flow through the Loop of Henle increases
The activity of the Na-K pump in the Loop of Henle decreases
The permeability of the collecting duct to water decreases
21. Which of the following returns closest to normal during chronic respiratory acidosis a. b. c. d. e.
Alveolar ventilation
Arterial PCO
2
Arterial PO
2
Plasma concentration of bicarbonate
Arterial concentration of hydrogen ion

22. Renal correction of hyperkalaemia will result in a. b. c. d. e.
Alkalosis
Increased secretion of HCO
3
-
Acidosis
Increased secretion of H+
Increased excretion of Na +
23. In controlling the synthesis and secretion of aldosterone – which of the following factors is LEAST important a. b. c. d. e.
Renin
Angiotensin II
Concentration of plasma Na
ACTH
Concentration of plasma K +
+
24. Ammonia is an effective and important urinary buffer for which of the following reasons a. b. c. d. e.
Its production in the kidney
The walls of the renal tubules are impermeable to NH
The walls of the renal tubules are impermeable to NH
Its acid base reaction has a low pKa
None of the above
25. pH 7.67, PO
2
120mmHg on O a blood gas is indicative of
2

; PCO
during chronic alkalosis
2
3
4
+
60mmHg and bicarbonate 36mmol/l on a. b. c. d. e.
Respiratory alkalosis
Mixed metabolic and respiratory alkalosis
Metabolic acidosis
Respiratory acidosis
Metabolic alkalosis
26. The TMg for women (transport maximum for glucose) in the kidney is about a. b. c. d. e.
75mg/min
100mg/min
150mg/min
300mg/min
500mg/min
27. A loss of function mutates in the gene of which of the following proteins is associated with nephrogenic diabetes insipidus a. b. c. d. e.
Aquaporin -1
Aquaporin -2
Aquaporin -3
Aquaporin -4
Aquaporin -5

28. Dehydration increases the plasma concentration of all of the following
EXCEPT a. b. c. d. e.
Vasopressin
Angiotensin II
Aldosterone
Noradrenaline
Atrial natriuretic peptide
29. Calculate the anion gap from these results –
Na + 142; K + 3.5mmol/l; glucose 6mm0l/l; chloride 110mm0l/l; bicarbonate =
10mmol/l; urea = 7.0mmol/l a. b. c. d. e.
10
15
17
22
29
30. Regarding water excretion a. b. c. d. e.
At least 87% of filtered water in kidney is reabsorbed
Urine concentration ca get as high as 1400mosm/kg
About 5% of filtered water is removed in the distal tubule
Aquaporin -1 plays a major role in water conservation, although it is unaffected by vasopressin
All of the above are correct

1. C
5.
6.
7.
8.
2.
3.
4.
9. C
10. A
11. B
E
A
E
B
B
D
C
12. D
13. D
14. B
15. D
16. D
17. E
18. A
19. B
20. B
21. E
22. C
23. D
24. C
25. E
26. D
27. B
28. E
29. D
30. E