RT Summer Study Set (all 212, 120, 205, and 103 final)

metabolic processes continuously generate ……….. and ……… of blood must be kept in a narrow range for vital enzymes to function. Regulation is important or ………. will occur

1. [H+] hydrogen ions

2. [H+] hydrogen ions

3. acidosis

……… are effective ………… buffers as they combine to remove them from solution. They are vital to enzymes as changes in ……… can inactivate enzymes

1. proteins

2. [H+]

3. [H+]

……… = proton donor [H+]

acid

……… = proton acceptor

base

An increase in blood [H+] is termed ……….

acidemia

An increase in body fluid [H+] is termed ……….

acidosis

Acids and bases react in solution to form a …….. and ………

1. salt

2. water

a ………. acid ionizes almost 100% in solution and the reaction goes only one way

strong acid

a ………. acid does not ioniz 100% in solution and the reaction goes both ways

…….. is the dissociation constant and reflects the strength of an acid. (E.g. H2CO3 has a small ……… and HCl has a large ……..

1. KA

2. KA

3. KA

[H+] body fluids = ………. nmol/L or ………… mol/L

1. 40 nmol/L

2. 40 × 10^-9 mol/L

PH = -log [H+] (T/F?)

True

Why does H2O have an extremely small KA value?

Because of minimal dissociation

………….. represents the dissociation constant of H2O

Kw

what is the Kw of water at equilibrium?

10^-14 mol/L

10^-14 mol/L H2O = 10^-7 mol/L of H+ x 10^-7 mol/L of OH- (T/F?)

True

1 mol/L = ……. nmol/L

10^9

1 nmol/L = …….. mol/L

10^-9

what is the normal range of body PH?

PH = 7.35-7.45

The relationship between Ph and [H+] is …….. in the normal physiologic range of body fluids (7.35 - 7.45). In this range a 1 nmol/L change in [H+] produces a ……… change in PH

1. linear

2. 0.01

Outside of normal physiologic range, small changes in PH represent ………. changes in [H+] concentration

large

1. [H+] of 40 nmol/L = PH of 7.40

2. [H=] of 45 nmol/L = PH of …….

7.35

what are the 2 sources of [H+] in the body?

1. volatile acids

2. non-volatile acids

……… acids: acids that arise from equilibrium with a dissolved gas (e.g. H2CO3 which is in equilibrium with dissolved CO2)

volatile acids

……….. acids: aka fixed acids. These acids are not in equilibrium with dissolved gases

nonvolatile acids

There is massive CO2 production via aerobic metabolism:13,000 mEq/day but no change in body PH due to isohydric buffering (T/F?)

True

…………..: at tissue level, RBC’s Hb buffers H+ as rapidly as it is formed: H2O + CO2 → H2CO3 → HCO3ˉ + H+ thus, no pH change occurs

isohydric buffering

a ……….. reduces the magnitude of changes in PH when acid or base is added. It contains a mixture of ……. molecules and ……… anions

1. buffer

2. acid

3. conjugate base

What is the conjugate base of the acid H2CO3

HCO3

Why isn’t a solution of HCl and its conjugate base an effective buffer system?

because HCl completely dissociates in a solution

The ………. buffer is also known as the open buffer system and is composed of ……….. and ………..

1. bicarbonate buffer

2. H2CO3

3. HCO3

the ………… buffer is also known as the closed buffer system and is composed of ………….. and ……….., including ……….

1. non-bicarbonate

2. phosphate

3. proteins

4. Hb (hemoglobin)

what are the 2 body buffer systems

1, bicarbonate buffer (open buffer system)

2. non-bicarbonate buffer (closed buffer system)

Open and closed buffer systems are in equilibrium with the same [H+] (40 nmol/L) (T/F?)

True

the ……….. equation calculates PH of blood’s bicarbonate buffer system

H-H equation (Henderson-Hasselbalch)

H-H equation

PH = 6.1 + log [HCO3 / (PCO2 × 0.03)]

What is the blood’s pH if the ratio between [HCO3ˉ] and (PCO2 × 0.03) is

25:1?

7.49

The ……….. equation can be used to compute PH, HCO3, and PCO2 and is used in blood gas analyzers

H-H equation

Each buffer solution has it own unique PH range in which it most effectively resists PH changes (T/F?)

True

The bicarbonate buffer technically never ends as CO2 is constantly eliminated through ventilation and HCO3 is constantly produced (T/F?)

True

In the HCO3 titration curve, the resistance to PH change occurs at a PH of ………. It takes significantly more [H+] to change the PH from 6.5 to ………..

1. 6.1

2. 5.5

In the HCO3 titration curve, ……… is the point where the slope is the steepest and the buffer is the strongest and it occurs at a PH of ………

1. PK

2. 6.1

Why is the bicarbonate open buffer system much more effective than the non-bicarbonate closed system?

CO2 is continuously removed through ventilation and equilibrium is never reached, therefore unlimited buffering capacity as long as ventilation removes CO2. The closed system reaches equilibrium and the buffering action stops.

Why is the patient’s ability to increase ventilation critical to the effectiveness of the the bicarbonate buffer system?

The ability to increase ventilation and expel more CO2 causes a left shift that increases HCO3 needed for buffering (open system) resulting in a constant PH

The bicarbonate buffer system cannot buffer volatile acids (T/F?)

True

What is the most important and most abundant nonbicarbonate closed buffer system component?

hemoglobin

The nonbicarbonate buffer system can buffer both fixed and volatile acids (T/F?)

True

Kidneys physically remove [H+] from the body through urine (T/F?)

True

The kidneys have much less acid excretion than the lungs by <……… mEq/day

<100 mEq/day than lungs

The kidneys reabsorb and eliminate HCO3 (T/F?)

True

Normal PaCO2 range?

35 to 45 mmHg

Normal HCO3 range?

22 to 26 mEq/L

PH is determined by the ratio of ………. and not the absolute values. As long as the ratio is …….., the PH is normal at 7.40 Lungs control the ……….. and kidney controls the …………

1. HCO3:CO2

2. 20:1

3. CO2

4. HCO3

The H-H equation can be written as PH = kidney control of HCO3/lung control of PCO2 (T/F?)

True

Alkalemia occurs at a PH of …………..

> 7.45

Acidemia occurs at a PH of ………..

< 7.35

Hyperventilation occurs at a PaCO2 of ………..

< 35 mmHg

Hypoventilation occurs at a PaCO2 of ………….

> 45 mmHg

A ……….. acidosis occurs when hypoventilation is present and the PaCO2 level rises

respiratory acidosis

a ……….. alkalosis occurs when hyperventilation is present and the PaCO2 level falls

respiratory alkalosis

a …………… acidosis occurs when fixed acids accumulate or loss of base. And both drop HCO3 levels while PaCO2 levels stay relatively neutral

metabolic acidosis

a ………….. alkalosis occurs when there is loss of [H+] or gain of ………

1. metabolic alkalosis

2. [HCO3]

(CO2 or HCO3 Decrease/Increase?)

Respiratory alkalosis: ……….

Metabolic alkalosis: …………

Respiratory acidosis: …………

Metabolic acidosis: ……….

1. decreased PCO2

2. increased HCO3

3. increased PCO2

4. decreased HCO3

The hydration reaction, in the presence of normal nonbicarbonate buffers produces:

1. HCO3 increase by 1 mEq/L = …….. mmHg increase in CO2 above 40 mmHg

2. HCO3 decrease by 1 mEq/L = …….. mmHg increase in CO2 above 40 mmHg

1. 10 mmHg

2. 5 mmHg

Because pH is a logarithmic scale, it is

anticipated that a change of one pH unit will

result in what change in [H+]?

A. Twofold change

B. Fivefold change

C. Tenfold change

D. Twentyfold change

C. Tenfold change

Functional anatomy of the kidneys:

1. condition the …….. returning it to circulation after removing …… and toxic substances

2. maintains ……… of the body fluid environment

3. controls ……… volume and composition

1. blood plasma

2. waste

3. homeostasis

4. body fluid

(basically 1. clean blood and 2. maintain body fluid)

Anatomy of the kidney:

1. paired, ……..-shaped retroperitoneal organs

2. ……… and medulla

3. ……… pelvis

4. ………. to bladder

1. bean shaped

2. cortex

3. renal pelvis

4. ureter

1. The outer region of the kidney is the ……… and the inner region is the ………..

2. The kidneys are located (anterior or posterior?)

1. cortex

2. medulla

3. posterior

the ……… is the functional unit of the kidney and there are …… to ……. million per kidney

1. nephron

2. 0.4 to 1.2 million

The ……… of the kidney’s function is to eliminated unwanted substances and return remainder to circulation

nephron

The nephron of the kidney eliminates a much greater volume than it reabsorbs (T/F?)

False

It reabsorbs a much greater volume than it eliminates

The nephron rids the body of the following:

1. ………..: amino acid (protein) byproduct

2. …………: from muscle cell breakdown

3. ………….: nucleic acids (DNA, RNA)

4. …………..: from hemoglobin breakdown

1. urea

2. creatinine

3. uric acids

4. bilirubin

The ………. is located at the beginning of the proximal tubule within the renal cortex. It is a hollow sphere that forms a double walled pouch. It contains the glomerulus.

Bowman’s capsule

The ………. is a dense tuft of capillaries that is in contact with the inner capsule wall

Glomerular capillaries contain thousands of ………. making it highly permeable to plasma components

fenestrations/pores

Blood enters the glomerulus via the ……….. arteriole and leaves via the ……….. arterioles

1. afferent arteriole

2. efferent arteriole

bowman’s capsule + glomerulus = …………..

renal corpuscle

…………….:

• Drains the filtrate from the Bowman’s capsule
• Located upstream from the Loop of Henle.
• Convoluted meaning a curved, twisted path.
• The terminal end is near the medullary boarder but
otherwise located in cortex

proximal convoluted tube

………….:

• Straight descending limb
• Sharp hairpin turn
• Ascending limb
• Most of the ascending and descending loop located in ……..

1. loop of Henle

2. medulla

…………:

• These convoluted tubes are located beyond or distal to the Loop of
Henle
• Located in the renal cortex

distal convoluted tube

……….. of kidney:

• Extend deep in medulla

collecting duct

The renal vasculature receives ………..% of cardiac output

20%

What are the 2 capillary beds of the renal vasculature?

1. glomerular capillaries

2. peritubular capillaries

………. capillaries = high pressure bed due to increased resistance of efferent arteriole

• ………….. Vessels

1. glomerular capillaries

2. filtration vessels

…………… capillaries = low pressure bed (distal to efferent arteriole) that surrounds proximal and distal tubules

• ……….. Vessels

1. peritubular capillaries

2. absorption vessels

………. are branches of peritubular capillaries that surround the
Loop of Henle

vasa recta

the juxtaglomerular apparatus contains ………… and …………… cells

1. macula densa

2. juxtaglomerular cells

………….:

densely packed distal tubular cells adjacent to the arterioles

macula densa

………….: make up the smooth muscle cuffs.

◦ Cuffs of smooth muscle that control vessel

diameter.

◦ Located near the glomerular entry and

exit points.

juxtaglomerular cells

………….: secretes renin when blood pressure is low

juxtaglomerular apparatus

………. - involves the transfer of soluble components, such as water and waste, from the glomerular blood into the Bowman’s capsule.

filtration

………… - involves the absorption of molecules, ions, and water that are necessary for the body to maintain homeostasis from the glomerular filtrate back into the blood

Reabsorption

………… -is the transfer of water, ions, creatinine, toxins, and urea. the components of urine – into the collecting ducts.

Excretion

…………… –the movement of primarily electrolytes from the peritubular capillaries into the tubular filtrate.

secretion

Filtration occurs because of the pressure gradients between ……….. capillary blood and …………filtrate. It is a gradient between ……….. and hydrostatic pressures. A normal net filtration of ………. mmHg produces a GFR (glomerular filtration rate of …….. mL/min:

1. ………. L/day of filtrate

2. …….% of filtrate is reabsorbed into the blood

3. ……….. L/day urine output

1. glomerular

2. capsular

3. osmotic

4. 10 mmHg

5. 125 mL/min

6. 180L/day

7. 99%

8. 1.5L/day

Describe the process of movement of blood from afferent arteriole to collecting duct in order

1. afferent arteriole

2. bowman’s capsule and glomerulus (renal corpuscule)

3. efferent arteriole

4. proximal convoluted tube

5. loop of Henle

6. distal convoluted tube

7. collecting duct

forces that tend to move fluid out of the glomerulus:

glomerular ……… pressure

capsular ……….. pressure

1. glomerular hydrostatic pressure

2. capsular osmotic pressure

forces that tend to move fluid into the glomerulus:

glomerular ……….. pressure

capsular ……….. pressure

1. glomerular osmotic pressure

2. capsular hydrostatic pressure

Effective filtration pressure of glomerulus = forces that tend to move fluid …… glomerulus - forces that tend to move fluid ……… glomerulus

forces that tend to move fluid OUT of the glomerulus - forces that tend to move fluid INTO the glomerulus

Glomerulus filtration pressure:

1. Blood hydrostatic pressure (BHP) = ………. mmHg out

2. Colloid osmotic pressure (COD) = …………. mmHg …..

3. Capsular pressure (CP) = ………… mmHg in

Net filtration pressure (NFP) = ………. mmHg …….

1. 60 mmHg

2. -32 mmHg IN

3. -18 mmHg

4. 10 mmHg OUT