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Path - Nephro

Total questions: 103

Worksheet time: 56mins

Name
Class
Date
1.

The presence of protein in urine suggests dysfunction at which of the following sites within the nephron?

[Massey quiz]

a)

renal papilla

b)

loop of Henle

c)

glomerular membrane

d)

proximal convoluted tubule

2.

Which of the following is NOT part of the renal corpuscle?

[Massey quiz]

a)

glomerulus

b)

bowman capsule

c)

mesangial cells

d)

afferent arteriole

3.

The volume of fluid filtered from the renal glomerular capillaries into the Bowman capsule per unit of time is called [Massey quiz]

a)

tubular reabsorption

b)

tubular secretion

c)

glomerular filtration rate (GFR)

d)

creatinine clearance rate (CrCl)

4.

Which of the following would cause a DECREASE in GFR?

[Massey quiz]

a)

expansion of blood volume

b)

hypertension

c)

dehydration

d)

activation of RAAS

5.

Erythropoietin is secreted by ___________ when oxygen levels get too ____________.

[Massey quiz]

a)

the kidney; low

b)

bone marrow; low

c)

bone marrow; high

d)

the kidney; high

6.

Which of the following represents the outer most layer of the kidney that contains glomeruli?

[Massey quiz]

a)

capsule

b)

hilum

c)

cortex

d)

medulla

7.

Medial indentation where renal blood vessels, nerves, lymphatic vessels, and ureter enter and exit the kidney

a)

Hilum

b)

Cortex

c)

Medulla

8.

Forms the inner part of the kidney and consists of regions called the pyramids

a)

Hilum

b)

Cortex

c)

Medulla

9.

Renal pyramids

a)

Site of urine formation

b)

Provides structure and anchoring

c)

Consists of blood vessels

d)

Extend between pyramids (medullary extension of the cortex)

10.

Renal columns

a)

Site of urine formation

b)

Provides structure and anchoring

c)

Consists of blood vessels

d)

Extend between pyramids (medullary extension of the cortex)

11.

Synthesize nitric oxide (a vasodilator) and endothelin-1 (a vasoconstrictor) that help to regulate blood flow. __________ has many small openings called fenestrae.

a)

Filtration by the Endothelium

b)

Filtration by the Basement Membrane

c)

Filtration by the Visceral Epithelium

12.

Composed of a selectively permeable network of proteoglycans, secreted and maintained by epithelial cells.

a)

Filtration by the Endothelium

b)

Filtration by the Basement Membrane

c)

Filtration by the Visceral Epithelium

13.

Podocytes interlock with foot processes of adjacent podocytes, forming clefts (filtration slits)

a)

Filtration by the Endothelium

b)

Filtration by the Basement Membrane

c)

Filtration by the Visceral Epithelium

14.

____________ are negatively charged and therefore REPELL negatively charged (anionic) proteins. Therefore we do not have proteins in our urine!

a)

Proteoglycans

b)

Fenestrae

c)

Podocytes

15.

Does get filtered into primary urine

a)

Red blood cells

b)

Water

c)

Ions

d)

Amino acids

e)

Glucose

16.

is the volume of blood plasma that is cleared of creatinine per unit time and is a useful measure for approximating GFR

a)

tubular reabsorption

b)

tubular secretion

c)

creatinine clearance rate (CrCl)

17.

_______ pulls H2O from the interstitial compartments into the intravascular compartments (serum) → maintains blood pressure!

a)

Albumin

b)

Water

c)

Glucose

d)

Red blood cells

18.

Persons with low serum albumin levels retain fluid in their interstitial layers and experience ______ and ________

a)

edema

b)

hypotension

c)

hypertension

d)

weight loss

19.

Takes back important ions and molecules that were filtered into the urine and transport it back into the blood (glucose) ***

a)

Reabsorption

b)

Secretion

20.

Transports metabolic wastes and toxins from surrounding blood vessels into the nephron for excretion in the urine ***

a)

Reabsorption

b)

Secretion

21.

"Dirty" blood

a)

into renal artery

b)

out by renal vein

22.

"Clean" blood

a)

into renal artery

b)

out by renal vein

23.

The Renal Tubules

a)

Proximal convoluted tubule

b)

Loop of Henle

c)

Distal convoluted tubule

d)

Collecting duct

e)

Bowman capsule

24.

Reabsorption in the proximal tubule:

a)

Na, K+

b)

All most all glucose

c)

Bicarbonate, chloride

d)

Amino acids, phosphate, Ca2+

e)

Water

25.

where urine is concentrated ***

a)

Proximal convoluted tubule

b)

Loop of Henle

c)

Distal convoluted tubule

d)

Collecting duct

e)

Bowman capsule

26.

NaCl is actively pumped out of the ______________; impermeable to water

a)

Ascending thick limb

b)

Descending thin limb

27.

____________ is permeable to water → and because of that gradient, water is going to follow salt and that is one of the things that drives the concentration of urine

a)

Ascending limb

b)

Descending limb

28.

osmolality ________ as you go deeper in medulla

a)

increases

b)

decreases

29.

__________ is reabsorbed under the control of parathyroid hormone in the thick ascending limb ***

a)

Magnesium

b)

Calcium

c)

Sodium

d)

Potassium

30.

general path of urine ***

a)

glomerulus --> proximal convoluted tubule --> loop of Henle --> distal convoluted tubule --> collecting duct

b)

glomerulus --> distal convoluted tubule --> loop of Henle --> proximal convoluted tubule --> collecting duct

c)

collecting duct --> distal convoluted tubule --> loop of Henle --> proximal convoluted tubule --> glomerulus

d)

collecting duct --> proximal convoluted tubule --> loop of Henle --> distal convoluted tubule --> glomerulus

31.

Normally

a)

afferent arteriole diameter > efferent arteriole diameter

b)

efferent arteriole diameter > afferent arteriole diameter

32.

If you contract the afferent arteriole, there will be

a)

less of a pressure difference and reduced filtration pressure

b)

an increased in the pressure difference and increased filtration pressure

33.

If you contract the efferent arteriole, there will be

a)

less of a pressure difference and reduced filtration pressure

b)

an increased in the pressure difference and increased filtration pressure

34.

GFR will increase with

a)

Increased blood pressure

b)

Increased blood flow

c)

Increased hydrostatic pressure (stones)

d)

Dehydration

35.

GFR will decrease with:

a)

Increased blood pressure

b)

Increased blood flow

c)

Increased hydrostatic pressure (stones)

d)

Dehydration

36.

Macula densa

a)

Specialized epithelial cells located in the distal convoluted tubule

b)

Senses excessive Na+ and triggers vasoconstriction of afferent arteriole

c)

Derived from smooth muscle cells located in the walls of the afferent arteriole

d)

Synthesize, store and secrete the hormone renin

37.

Juxtaglomerular cells

a)

Specialized epithelial cells located in the distal convoluted tubule

b)

Senses excessive Na+ and triggers vasoconstriction of afferent arteriole

c)

Derived from smooth muscle cells located in the walls of the afferent arteriole

d)

Synthesize, store and secrete the hormone renin

38.

mediates the physiologic responses to low blood pressure

a)

Angiotension II

b)

Renin

c)

ADH

d)

Aldosterone

39.

elevated hydrostatic component due to cardiac congestion

a)

Heart Failure (HF)

b)

Nephrotic Syndrome

40.

fall of oncotic pressure due to protein loss in the urine

a)

Heart Failure (HF)

b)

Nephrotic Syndrome

41.

_______ activates RAAS → HYPERTENSION

a)

Angiotension II

b)

Renin

c)

ADH

d)

Aldosterone

42.

Kidneys activate RAAS due to

a)

decreased blood flow

b)

increased blood flow

43.

___________ is another stimulation for aldosterone secretion

a)

Hyperkalemia

b)

Hypokalemia

44.

Kidney is the site of the synthesis of

a)

Calcitriol

b)

PTH

45.

Kidney is the site of action of

a)

Calcitrol

b)

PTH

46.

A persistent or recurrent infection of one or both kidneys is called:

[Massey quiz]

a)

acute pyelonephritis

b)

vesicoureteral reflux

c)

recurrent nephrolithiasi

d)

chronic pyelonephritis

47.

Increasing fluid intake to generate 2.5 L of urine per day is recommended for the prevnetion of:

[Massey quiz]

a)

neurogenic bladder

b)

nephrolithiasis

c)

tumors

d)

hydroureter

48.

Chronic dehydration and gout increase the risk of this type of nephrolithiasis?

[Massey quiz]

a)

struvite

b)

uric acid

c)

xanthine

d)

calcium oxalate

49.

are large and fill the minor and major calyces.

a)

Staghorn calculi

b)

Nonstaghorn calculi

50.

are of variable size and are located in the calyces, in the renal pelvis, or at various sites along the ureter.

a)

Staghorn calculi

b)

Nonstaghorn calculi

51.

Kidney stones inhibiting substances:

a)

Potassium citrate

b)

Uromodulin

c)

Pyrophosphate

d)

Magnesium

e)

Calcium

52.

Women and multiple UTIs increases the risk of _______ stones

a)

struvite

b)

uric acid

c)

xanthine

d)

calcium oxalate

53.

most common kidney stone formed

a)

struvite

b)

uric acid

c)

xanthine

d)

calcium oxalate

54.

most common renal neoplasm

a)

renal cell carcinoma

b)

transitional cell carcinoma

55.

Renal tumor classic triad

a)

Hematuria

b)

Dull and aching flank pain

c)

Palpable flank mass

d)

Weight loss and fatigue

e)

Intermittent fever

56.

infection of one or both upper urinary tracts (ureter, renal pelvis, and kidney interstitium)

a)

acute pyelonephritis

b)

vesicoureteral reflux

c)

recurrent nephrolithias

d)

chronic pyelonephritis

57.

characterized by inflammation and fibrosis of the interstitial tissue between nephrons.

a)

acute pyelonephritis

b)

vesicoureteral reflux

c)

recurrent nephrolithias

d)

chronic pyelonephritis

58.

Upper Urinary Tract Obstruction most serious complications

a)

hydronephrosis

b)

hydroureter

c)

ureterohydronephrosis

d)

infection (caused by the accumulation of urine behind the obstruction)

59.

Kidney stones are caused by

a)

supersaturation of the urine with precipitation of stone-forming substances

b)

changes in urine pH

c)

urinary tract infection

60.

Compensatory hypertrophy and hyperfunction of the opposite kidney compensate for loss of function of the kidney with _______

a)

obstructive disease

b)

renal tumor

c)

pyelonephritis

61.

Post streptococcal glomerulonephritis is an example of which type of glomerular injury?

[Massey quiz]

a)

soluble immune-complex glomerulonephritis

b)

cell-mediated immunity

c)

antiglomerular basement membrane glomerulonephritis

d)

alternative complement pathway

62.

Which of the following is TRUE about nephritic syndrome?

[Massey quiz]

a)

characterized by hematuria and RBC casts in the urine

b)

it is never associated with long term kidney dysfunction

c)

proteinuria is worse than what is seen in nephrotic syndrome

d)

it is not associated with glomerulonephritis

63.

Which of the following does NOT result from damage and loss of glomerular filtration membrane?

[Massey quiz]

a)

hematuria

b)

excretion of glucose

c)

loss of immunoglobulins

d)

hypoalbuminemia

64.

seen in Goodpasture syndrome (type II hypersensitivity reaction)

a)

soluble immune-complex glomerulonephritis

b)

cell-mediated immunity

c)

antiglomerular basement membrane glomerulonephritis

d)

alternative complement pathway

65.

often seen in rapidly progressive glomerulonephritis

a)

soluble immune-complex glomerulonephritis

b)

cell-mediated immunity

c)

antiglomerular basement membrane glomerulonephritis

d)

alternative complement pathway

66.

A scarring lesion that involves some but not all glomeruli (focal) and some but not all of the glomerular capillaries (segmental).

a)

Focal segmental glomerulosclerosis

b)

Membranous nephropathy (glomerulonephritis)

c)

Rapidly progressive (Crescentic) glomerulonephritis (RPGN)

d)

Post infectious glomerulonephritis

e)

Mesangial proliferative glomerulonephritis

67.

Involves proliferation of messangial cells and formation of crescents related to the deposition of complement (C3 component) and inflammatory injury.

a)

Focal segmental glomerulosclerosis

b)

Rapidly progressive (Crescentic) glomerulonephritis (RPGN)

c)

Post infectious glomerulonephritis

d)

Mesangial proliferative glomerulonephritis

e)

Membranoproliferative glomerulonephritis

68.

Subepithelial deposition of circulating antibodies or antibodies formed in situ to antigens located on glomerular podocytes.

a)

Focal segmental glomerulosclerosis

b)

Membranous nephropathy (glomerulonephritis)

c)

Rapidly progressive (Crescentic) glomerulonephritis (RPGN)

d)

Post infectious glomerulonephritis

e)

Mesangial proliferative glomerulonephritis

69.

Antiglomerular basement membrane (anti-GBM) antibody disease (Goodpasture syndrome). Development of antibody to the glomerular basement membrane. Results inflammation

a)

Focal segmental glomerulosclerosis

b)

Membranous nephropathy (glomerulonephritis)

c)

Rapidly progressive (Crescentic) glomerulonephritis (RPGN)

d)

Post infectious glomerulonephritis

e)

Mesangial proliferative glomerulonephritis

70.

Immune complex glomerulonephritis. Immune complex deposition of systemic disease. Ex) post infectious GN in which there is cross-reactivity between an antigen of the infecting organism and a host antigen.

a)

Focal segmental glomerulosclerosis

b)

Membranous nephropathy (glomerulonephritis)

c)

Rapidly progressive (Crescentic) glomerulonephritis (RPGN)

d)

Post infectious glomerulonephritis

e)

Mesangial proliferative glomerulonephritis

71.

Involves deposits of immune complex in the mesangium with mesangial cell proliferation

a)

Focal segmental glomerulosclerosis

b)

Membranous nephropathy (glomerulonephritis)

c)

Rapidly progressive (Crescentic) glomerulonephritis (RPGN)

d)

Post infectious glomerulonephritis

e)

Mesangial proliferative glomerulonephritis

72.

Glomerular bleeding provides prolonged contact with the acidic urine and transforms hemoglobin to methemoglobin, which has a brownish color and no blood clots.

a)

Cola colored urine

b)

Nephritic syndrome

c)

Nephrotic syndrome

73.

Occurs when filtration of proteins exceeds tubular reabsorption

a)

Nephrotic syndrome

b)

Nephritic syndrome

74.

Hematuria and RBC casts in the urine

a)

Nephrotic syndrome

b)

Nephritic syndrome

75.

Primary causes of nephrotic syndrome ***

a)

membranous glomerulonephritis

b)

focal segmental glomerulosclerosis

c)

infection-related glomerulonephritis

d)

rapidly progressive crescentic glomerulonephritis

76.

The excretion of 3.5 g or more of protein in the urine per day

a)

Nephrotic syndrome

b)

Nephritic syndrome

77.

Nephritic syndrome occurs with

a)

membranous glomerulonephritis

b)

focal segmental glomerulosclerosis

c)

infection-related glomerulonephritis

d)

rapidly progressive crescentic glomerulonephritis

78.

Nephrotoxic drugs and dehydration can cause which type of AKI?

[Massey quiz]

a)

Pre-renal

b)

Intra-renal

c)

Post-renal

79.

Oliguria occurs in AKI.

[Massey quiz]

a)

True

b)

False

80.

Osteomalacia in adults with CKD results from which metabolic/hormone alteration?

[Massey quiz]

a)

renin hypersecretion

b)

decreased biocarbonate reabsorption

c)

elevated parathyroid hormone

d)

decreased immunoglobulins

e)

decreased erythropoeitin

81.

Kidney stones in the ureter would cause which type of AKI?

[Massey quiz]

a)

pre-renal

b)

intra-renal

c)

post-renal

82.

AKI involves other body systems, but CKD does not.

[Massey quiz]

a)

True

b)

False

83.

Acute kidney injury is characterized by __________ whereas chronic kidney disease is characterized by _________.

[Massey quiz]

a)

cell death; nephron death

b)

nephron death; cell death

84.

Renal insufficiency is defined as a decline in renal function to approximately 25% of normal or a GFR of _________ ml/min with mildly elevated serum creatinine and urea.

[Massey quiz]

a)

60-75

b)

50-60

c)

25-30

d)

5-10

85.

Which of the following is NOT true about azotemia?

[Massey quiz]

a)

It is characterized by elevated BUN:creatine ratio.

b)

It is an early manifestion of AKI.

c)

It commonly requires supportive dialysis.

d)

There are near normal creatine levels.

86.

a decline in renal function to about 25% of normal or a GFR of 25 to 30 mL/minute. Levels of serum creatinine and urea are mildly elevated.

a)

Renal Insufficiency

b)

Acute Kidney Injury

c)

Renal failure

d)

End-Stage Kidney Disease (ESKD)

87.

ranges from minimal or subtle changes in renal function to complete renal failure requiring renal replacement therapy. (preferred to the term acute renal failure to reflect the diverse nature the syndrome)

a)

Renal Insufficiency

b)

Acute Kidney Injury

c)

Renal failure

d)

End-Stage Kidney Disease (ESKD)

88.

refers to significant loss of renal function.

a)

Renal Insufficiency

b)

Acute Kidney Injury

c)

Renal failure

d)

End-Stage Kidney Disease (ESKD)

89.

when less than 10% of renal function remains

a)

Renal Insufficiency

b)

Acute Kidney Injury

c)

Renal failure

d)

End-Stage Kidney Disease (ESKD)

90.

history of blood volume depletion or other causes of poor kidney perfusion

a)

Prerenal causes

b)

Intrinsic causes

c)

Postrenal causes

91.

exposure to nephrotoxins and infection

a)

Prerenal causes

b)

Intrinsic causes

c)

Postrenal causes

92.

associated with obstructive uropathies

a)

Prerenal causes

b)

Intrinsic causes

c)

Postrenal causes

93.

tubular function is maintained and salt, water, and urea are reabsorbed.

a)

Prerenal AKI

b)

ATN

94.

reabsorption and urinary concentration abilities are compromised.

a)

Prerenal AKI

b)

ATN

95.

found in the blood; produced by the liver as a waste product of the digestion of protein

a)

BUN

b)

Serum Creatinine

96.

A chemical waste molecule generated from muscle metabolism

a)

BUN

b)

Serum Creatinine

97.

Clinical term describing patient’s signs and symptoms when symptomatic end-stage renal failure is present

a)

Azotemia

b)

Uremia

98.

After kidney insult: Patients first develop ________ (elevated BUN without tubular necrosis)—direct consequence of GFR

a)

Azotemia

b)

Uremia

99.

Renal Azotemia

a)

Elevated ratio BUN: serum creatinine

b)

Near normal serum creatinine

c)

BUN: serum creatinine ratio returns to normal

d)

Progressively elevated serum creatinine

100.

Tubular Necrosis

a)

Elevated ratio BUN: serum creatinine

b)

Near normal serum creatinine

c)

BUN: serum creatinine ratio returns to normal

d)

Progressively elevated serum creatinine

101.

FENa+ = less than 1% (*unless diuretics)

a)

Simple prerenal azotemia

b)

ATN

102.

FENa+ = greater than 1% (kidney cannot retain Na+ efficiently)

a)

Simple prerenal azotemia

b)

ATN

103.

Both azotemia and uremia indicate an accumulation of nitrogenous waste products in the blood

a)

True

b)

False

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