Deck 25: The Body Fluid Compartments: Extracellular and Intracellular Fluids; Edema

Question 1

You need to evaluate kidney function in a 55-year?-old obese man with type 2 diabetes; you ask him to collect his urine over a 24-hour period. He collects 4,320 mL of urine. The clinical laboratory returns the following results from analysis of his urine and plasma samples: Plasma creatinine = 3.0 mg/100 mL
Urine creatinine = 40 mg/100 mL
Plasma potassium = 5.0 mmol/L
Urine potassium = 20 mmol/L
What is his approximate GFR, assuming that he collected all of his urine in the 24-hour period?

A)10 mL/min
B)20 mL/min
C)30 mL/min
D)40 mL/min
E)80 mL/min

Answer 1

D

Question 2

A 22-year-old female patient complaining of headaches presents to your office. An examination reveals that her blood pressure is 180/118 mm Hg, and laboratory tests give the following results: Plasma renin activity = 14.5 (normal = 1.0)
Plasma Na+ = 142 mmol/L
Plasma K+ = 2.9 mmol/L
Magnetic resonance imaging of the kidneys suggests that she has a renin-secreting tumor in her left kidney. Compared with normal, which one of the following sets of conditions would you expect?

Answer 2

B

Question 3

You begin treatment of a hypertensive patient with a large dose of a powerful diuretic (Lasix) that inhibits tubular reabsorption of NaCl by the loop of Henle. He returns to your office for a follow-up examination 2 weeks later. Compared with the patient's status before treatment, which one of the following sets of conditions would you expect to find?

Answer 3

C

Question 4

Following Questions :The diagrams represent various states of abnormal hydration. In each diagram, the normal state (solid lines) is superimposed on the abnormal state (dashed lines) to illustrate the shifts in the volumes (width of rectangles) and total osmolarities (height of rectangles) of the extracellular fluid and intracellular fluid compartments.
A 22-year-old man runs a 10 km race on a 90 °F day. If he loses 3 liters of sweat and also drinks 3 liters of water during the race, which of the following changes would you expect, compared with normal, after absorption of the water?

Question 5

What is the net renal tubular reabsorption rate of potassium in the patient described in question 8?

A)0.280 mmol/min
B)0.140 mmol/min
C)0.060 mmol/min
D)0.030 mmol/min
E)Potassium is not reabsorbed in this example

Question 6

Which of the following would cause the greatest degree of hypokalemia?

A)Long-term treatment with a diuretic such as spironolactone that inhibits the action of aldosterone
B)Long-term treatment with a diuretic such as amiloride that inhibits sodium reabsorption in the late collecting ducts
C)Long-term treatment with a diuretic such as furosemide that inhibits loop of Henle Na+-2Cl- K+ co-transport
D)An increase in sodium intake from 150 to 300 mmol/day
E)A reduction in potassium intake from 160 to 80 mmol/day in a person with normal kidneys and normal aldosterone system

Question 7

A 60-year-old female patient appears to be dehydrated, with a hematocrit of 0.55 (55%) and a plasma protein concentration of 8.8 g percent (normal, ~7.0). After obtaining a plasma sample, you find that she has hyponatremia, with a plasma sodium concentration of 110 mmol/L and a plasma osmolarity of 240 mOsm/L. You decide to administer 2.0 L of 3% sodium chloride. Her body weight was 80 kg before giving the fluid. Assume the following: Intracellular fluid volume = 40% of body weight before fluid administration
Extracellular fluid volume = 20% of body weight before fluid administration
Molecular weight of NaCl = 58.5 g/mol
No excretion of water or electrolytes
Calculate her approximate plasma osmolarity after administration of the NaCl solution and after osmotic equilibrium.

A)240 mOsm/L
B)251 mOsm/L
C)265 mOsm/L
D)271 mOsm/L
E)286 mOsm/L

Question 8

Following Questions : Choose the appropriate nephron site in the diagram for each question.

-In a person on a very low ( $20 \mathrm { mmol } /$ day $)$ potassium diet, which part of the nephron would be expected to reabsorb the most polassium?

Question 9

You are monitoring a patient in your nephrology clinic whose serum creatinine concentration has risen from 1.0 to 4.0 mg/dL over a period of 5 years. Which of the following additional changes, compared with normal, would you expect to find in this patient? Assume steady-state conditions and that he has maintained the same diet.

A)Decreased filtered load of creatinine
B)Decreased renal sodium excretion
C)Decreased maximal urine concentrating ability
D)Alkalosis
E)Increased renal blood flow

Question 10

Which of the following substances would be filtered most readily by the glomerular capillaries?

A)Neutral dextran with a molecular weight of 25,000
B)Polycationic dextran with a molecular weight of 25,000
C)Polyanionic dextran with a molecular weight of 25,000
D)Albumin in plasma
E)Red blood cells

Question 11

A 55-year-old woman reports recent rapid weight gain and marked fluid retention. Her lab values reveal a plasma protein concentration of 3.3 g percent (normal = 7.0) and her blood pressure is 110/70 mm Hg. She has 4+ protein in her urine. Which of the following changes would you expect to find compared with normal?

Question 12

Which of the following changes would tend to reduce glomerular filtration rate?

A)Decreased afferent arteriolar resistance
B)Increased glomerular capillary filtration coefficient
C)Increased proximal tubular sodium reabsorption
D)Decreased efferent arteriolar resistance
E)Increased collecting tubule sodium reabsorption

Question 13

Which of the following changes would you expect to find after administration of a vasodilator that selectively reduced afferent arteriolar resistance?

Question 14

If the tubular fluid/plasma creatinine concentration ratio in the collecting duct is 100, what is the approximate percentage of the filtered water that remains at that point?

A)0%
B)1%
C)10%
D)50%
E)100%

Question 15

Which of the following changes would you expect to find in a newly diagnosed 12-year-old patient with type 1 diabetes and uncontrolled hyperglycemia (plasma glucose = 400 mg/dL)?

Question 16

Following Questions :The diagrams represent various states of abnormal hydration. In each diagram, the normal state (solid lines) is superimposed on the abnormal state (dashed lines) to illustrate the shifts in the volumes (width of rectangles) and total osmolarities (height of rectangles) of the extracellular fluid and intracellular fluid compartments.
Which of the diagrams represents the changes (after osmotic equilibrium) in extracellular and intracellular fluid volumes and osmolarities after infusion of a 2% solution of glucose (molecular weight of glucose = 180 g/mol)?

A)A
B)B
C)C
D)D

Question 17

Compared with normal conditions, which one of the following sets of changes would you expect to find in a patient with acute proximal tubular necrosis and marked reduction of proximal tubular sodium chloride reabsorption?

Question 18

Following Questions :The diagrams represent various states of abnormal hydration. In each diagram, the normal state (solid lines) is superimposed on the abnormal state (dashed lines) to illustrate the shifts in the volumes (width of rectangles) and total osmolarities (height of rectangles) of the extracellular fluid and intracellular fluid compartments.
Which of the diagrams would represent the changes (after osmotic equilibrium) in extracellular and intracellular fluid volumes and osmolarities after infusion of 3.0% sodium chloride (molecular weight of dextrose = 58.5 g/mol)?

A)A
B)B
C)C
D)D

Question 19

Following Questions : Choose the appropriate nephron site in the diagram for each question.
In a patient with severe "central" diabetes insipidus caused by lack of antidiuretic hormone secretion, which part of the tubule would have the lowest tubular fluid osmolarity?

Question 20

Which part of the nephron normally reabsorbs the most urea?

Question 21

Assuming steady-state conditions and that water and electrolyte intake remained constant, a 75% loss of nephrons due to chronic kidney disease would cause all of the following except:

A)A large increase in plasma sodium concentration
B)An increased in plasma creatinine to four times normal
C)An increase in average volume excreted per remaining nephron to four times normal
D)A significant increase in plasma phosphate concentration
E)Reduced ability of the kidney to maximally concentrate the urine

Question 22

A patient has the following laboratory values: - Arterial $\mathrm { pH } = 7.55$
- Plasma $\mathrm { HCO } _ { 3 } { } ^ { - } = 40 \mathrm { mEq } / \mathrm { L }$
- Plasma chloride concentration $= 101 \mathrm { mE } \mathrm { q } / \mathrm { L }$
- Arterial $\mathrm { pCO } _ { 2 } = 48 \mathrm {~mm} \mathrm { Hg }$
- Plasma sodium $= 150 \mathrm { mEq } / \mathrm { L }$ What is the most likely cause for his abnormal acid-base status?

A)Abnormal lung function (e.g., pneumonia)
B)Excessive aldosterone secretion
C)Impaired renal tubular HCO3^- reabsorption
D)Chronic renal failure
E)Diarrhea

Question 23

Evaluation of kidney function in a 46-year-old obese man with type 2 diabetes reveals the following: Urine volume = 5760 mL of urine, collected over the preceding 24 hours
Plasma creatinine = 3 mg/100 mL
Urine creatinine = 30 mg/100 mL
Plasma potassium = 4.0 mmol/L
Urine potassium = 20 mmol/L
What is his approximate glomerular filtration rate, assuming that he collected all of his urine in the 24-hour period?

A)10 mL/min
B)20 mL/min
C)30 mL/min
D)40 mL/min
E)80 mL/min

Question 24

A 70 kg patient needs fluid therapy. You decide to administer 2.0 liters of 5% glucose solution (isoosmotic) by intravenous infusion. After osmotic equilibrium and metabolism of the glucose, which of the following changes would you expect?

Question 25

Which set of changes would you expect to find after a selective decrease in efferent arteriolar resistance?

Question 26

Following Questions :Match each of the patients in questions 29 and 30 with the correct set of blood values in the table. The same values may be used for more than one patient. $$\begin{array} { l l l l l l } & \mathrm { pH } & \begin{array} { l } \mathrm { HCO } _ { 3 } ^ { - } \\( \mathrm { mmol } / \mathrm { L } )\end{array} & \begin{array} { l } \mathrm { pCO } _ { 2 } \\( \mathrm { mmHg } )\end{array} & \begin{array} { l } \mathrm { Na } ^ { + } \\( \mathrm { mmol } / \mathrm { L } )\end{array} & \begin{array} { l } \mathrm { Cl } ^ { - } \\( \mathrm { mmol } / \mathrm { L } )\end{array} \\\text { A. } & 7.07 & 14 & 50 & 144 & 102 \\\text { B. } & 7.29 & 14 & 30 & 143 & 117 \\\text { C. } & 7.25 & 12 & 28 & 142 & 102 \\\text { D. } & 7.52 & 38 & 48 & 146 & 100 \\\text { E. } & 7.66 & 22 & 20 & 143 & 111\end{array}$$

-Which patient has renal tubular acidosis?

Question 27

In the patient described in question 31, which of the following laboratory values are you likely to find compared with normal?

Question 28

The clinical laboratory returns the following arterial blood values for a patient: pH = 7.2
plasma HCO3 = 29 mmol/L
plasma pCO₂ = 75 mm Hg
What is this patient's acid-base disorder?

A)Acute respiratory acidosis without renal compensation
B)Respiratory acidosis with partial renal compensation
C)Acute metabolic acidosis without respiratory compensation
D)Metabolic acidosis with partial respiratory compensation

Question 29

Following Questions :Match each of the patients in questions 29 and 30 with the correct set of blood values in the table. The same values may be used for more than one patient. $$\begin{array} { l l l l l l } & \mathrm { pH } & \begin{array} { l } \mathrm { HCO } _ { 3 } ^ { - } \\( \mathrm { mmol } / \mathrm { L } )\end{array} & \begin{array} { l } \mathrm { pCO } _ { 2 } \\( \mathrm { mmHg } )\end{array} & \begin{array} { l } \mathrm { Na } ^ { + } \\( \mathrm { mmol } / \mathrm { L } )\end{array} & \begin{array} { l } \mathrm { Cl } ^ { - } \\( \mathrm { mmol } / \mathrm { L } )\end{array} \\\text { A. } & 7.07 & 14 & 50 & 144 & 102 \\\text { B. } & 7.29 & 14 & 30 & 143 & 117 \\\text { C. } & 7.25 & 12 & 28 & 142 & 102 \\\text { D. } & 7.52 & 38 & 48 & 146 & 100 \\\text { E. } & 7.66 & 22 & 20 & 143 & 111\end{array}$$

-Which patient has an aspirin overdose and emphysema?

Question 30

Which of the diagrams would represent the changes (after osmotic equilibrium) in a patient with inappropriate excess antidiuretic hormone secretion?

A)A
B)B
C)C
D)D
E)E

Question 31

Which of the following would tend to cause hyperkalemia by shifting potassium from the intracellular fluid into the extracellular fluid?

A)Aldosterone excess
B)Acidosis
C)Beta-adrenergic stimulation
D)Increased insulin
E)Decreased extracellular fluid osmolarity

Question 32

Which of the following statements is correct?

A)Urea reabsorption in the inner medullary collecting tubule is less than in the distal convoluted tubule during antidiuresis.
B)Urea concentration in the interstitial fluid of the renal cortex is greater than in the interstitial fluid of the renal medulla during antidiuresis
C)The thick ascending limb of Henle's loop reabsorbs more urea than the inner medullary collecting tubule during antidiuresis.
D)A chronic low protein diet tends to increase urine-concentrating ability.
E)The inner medullary collecting duct is more permeable to urea than is the cortical collecting tubule.

Question 33

Which of the diagrams represents the changes (after osmotic equilibrium) in extracellular and intracellular fluid volumes and osmolarities after infusion of a 2% solution of glucose (molecular weight of glucose = 180 g/mol)?

A)A
B)B
C)C
D)D

Question 34

Which set of changes, compared with normal, would you expect to find in a patient with diabetes insipidus due to lack of antidiuretic hormone secretion and who has free access to plenty of water to drink?

Question 35

Which of the following is true regarding intercalated cells in the collecting tubules? A. They secrete $\mathrm { K } ^ { + }$
B. They secrete $\mathrm { H } ^ { + }$
C. They reabsorb $\mathrm { HCO } _ { 3 } -$
D. They are highly permeable to urea during antidiuresis
E. A and $\mathrm { B }$
F. B and C
G. B, C, and D

Question 36

A 57-year-old woman has progressive proteinuria. Her lab work shows a plasma protein concentration of 3.8 g percent (normal = 7.0) and 4+ protein in the urine. Which of the following changes would you expect to find compared with normal?

Question 37

A 26-year-old woman reports that she has a severe migraine and has taken six times more than the recommended dose of aspirin for the past 3 days to relieve her headaches. Her plasma pH is 7.24. Which of the following would you expect to find compared with normal?

Question 38

Which of the following changes would you expect to find in a patient with Liddle's syndrome under steady-state conditions, assuming that intake of electrolytes remained constant?

Question 39

In a patient with chronic excess aldosterone secretion (i.e., primary aldosteronism), you would expect to find which one of the following sets of conditions (compared with normal) under steady-state conditions, assuming that intake of electrolytes remained constant?

Question 40

Long-term administration of furosemide would:
A. Inhibit the $\mathrm { Na } ^ { + } - \mathrm { Cl } ^ { - }$ co-transporter in the renal distal tubules
B. Inhibit the $\mathrm { Na } ^ { + } - \mathrm { Cl } ^ { - } - \mathrm { K } ^ { + }$ co-transporter in the renal tubules
C. Tend to reduce renal concentrating ab ility
D. Tend to cause hyperkalemia
E. A and C
F. B and C
G. B, C, and D

Question 41

Match each of the patients in Following Questions : with the correct set of blood values in the table below (the same values may be used for more than one patient).
A patient with uncontrolled type 2 diabetes and a plasma glucose concentration of 400 mg/100 ml (normal, ~100 mg/100 ml), and with normal lungs.

Question 42

Match each of the patients in Following Questions : with the correct set of blood values in the table below (the same values may be used for more than one patient).
Which of the following changes, compared with normal, would you expect to find in a patient with metabolic acidosis caused by uncontrolled diabetes mellitus?

Question 43

Match each of the patients in Following Questions : with the correct set of blood values in the table below (the same values may be used for more than one patient).
A patient treated chronically with a carbonic anhydrase inhibitor.

Question 44

Match each of the patients in Following Questions : with the correct set of blood values in the table below (the same values may be used for more than one patient).
A diabetic patient with ketoacidosis and severe emphysema.

Question 45

Match each of the patients in Following Questions : with the correct set of blood values in the table below (the same values may be used for more than one patient).
Renal tubular acidosis is associated with____ plasma pH, renal HCO3- excretion, and renal NH4+ excretion.
a. Increased, increased, increased
b. Decreased, decreased, decreased
c. Decreased, increased, decreased
d. Decreased, decreased, increased
e. Decreased, increased, increased

Question 46

A healthy 24-year-old woman runs a 10k race on a hot day and becomes very dehydrated. Assuming that her antidiuretic hormone levels are very high, in which part of the renal tubule is the most water reabsorbed?

A)Proximal tubule
B)Loop of Henle
C)Distal tubule
D)Cortical collecting tubule
E)Medullary collecting duct