PATHOPHYSIOLOGY URINARY

Which of the following structures is most likely to be located in the renal medulla?
A. Proximal convoluted tubule
B. Glomerulus
C. Loop of Henle
D. Afferent arteriole

Which of the following structures is most likely to be located in the renal medulla?
A. Proximal convoluted tubule
B. Glomerulus
C. Loop of Henle
D. Afferent arteriole

C. Loop of Henle

Which of the following is NOT a function of the kidney?
A. Regulation of body fluid concentrations
B. Removal of nitrogenous and acidic wastes
C. Activation of vitamin D
D. Production of albumin

D. Production of albumin

Which of the following describes the correct flow of blood in the kidney?
A. Afferent arteriole to the peritubular capillaries to the venule
B. Efferent arteriole to the glomerular capillaries to the peritubular capillaries
C. Peritubular capillaries to the glomerular capillaries to the venule
D. Afferent arteriole to the glomerular capillaries to the efferent arteriole

D. Afferent arteriole to the glomerular capillaries to the efferent arteriole

Which of the following describes the flow of filtrate in the kidney?
A. The collecting duct to the distal convoluted tubule to the renal pelvis
B. Bowman's capsule to the proximal convoluted tubule to the loop of Henle
C. The loop of Henle to the collecting duct to Bowman's capsule
D. The distal convoluted tubule to the loop of Henle to the collecting duct

B. Bowman's capsule to the proximal convoluted tubule to the loop of Henle

Which of the following describes the normal flow of urine?
A. Collecting duct to the renal pelvis to the ureter to the bladder
B. Renal pelvis to the urethra to the bladder to the ureter
C. Ureter to the renal pelvis to the urethra to the bladder
D. Collecting duct to the ureter to the urethra

A. Collecting duct to the renal pelvis to the ureter to the bladder

Which statement about the bladder is TRUE?
A. The bladder wall lacks rugae.
B. Three openings from the urinary bladder form the trigone.
C. It contracts when stimulated by the sympathetic nervous system.
D. Continuous peristalsis in the bladder wall promotes urine flow.

B. Three openings from the urinary bladder form the trigone.

Which of the following increases glomerular filtration rate?
A. Increased plasma osmotic pressure
B. Dilation of the efferent arteriole
C. Increased hydrostatic pressure in the glomerular capillaries
D. Constriction of the afferent arteriole

C. Increased hydrostatic pressure in the glomerular capillaries

By what process is water reabsorbed from the filtrate?
A. Osmosis
B. Active transport
C. Cotransport
D. Capillary action

B. Active transport

Which substance directly controls the reabsorption of water from the collecting ducts?
A. Renin
B. Aldosterone
C. Angiotensin
D. Antidiuretic hormone

D. Antidiuretic hormone

Under what circumstances do cells in the kidneys secrete renin?
A. The urine pH decreases.
B. Blood flow in the afferent arteriole decreases.
C. Serum potassium levels are high.
D. Serum osmotic pressure increases.

B. Blood flow in the afferent arteriole decreases.

Which of the following should be present in the filtrate in the proximal convoluted tubule?
A. Plasma proteins
B. Erythrocytes
C. Sodium ions
D. Leukocytes

C. Sodium ions

From the following, choose the substance likely to appear in the urine when the glomerulus is inflamed.
A. Albumin
B. Urea
C. Sodium
D. Creatinine

A. Albumin

Involuntary urination by a child after age 4 or 5, when bladder control is expected, is referred to as:
A. enuresis.
B. stress incontinence.
C. micturition.
D. overflow incontinence.

A. enuresis.

When a respiratory infection with high fever is present in the body, how would the kidney tubules maintain normal pH of body fluids?
A. Increase the flow of filtrate.
B. Secrete more acids and reabsorb more bicarbonate ions.
C. Excrete a larger volume of more dilute urine.
D. Retain more potassium ions in exchange for sodium ions.

B. Secrete more acids and reabsorb more bicarbonate ions.

When comparing normal kidney function with dialysis, which of the following mechanisms is not possible in dialysis?
A. Diffusion
B. Osmosis
C. Ultrafiltration
D. Active transport

D. Active transport

What is the cause of most cases of pyelonephritis?
A. An ascending infection by E. coli
B. Abnormal immune response, causing inflammation
C. Dialysis or other invasive procedure
D. Severe pH imbalance of urine

A. An ascending infection by E. coli

Which disease is manifested by dysuria and pyuria?
A. Nephrotic syndrome
B. Cystitis
C. Glomerulonephritis
D. Urolithiasis

B. Cystitis

Why may acute pyelonephritis and cystitis follow untreated prostatitis?
A. Microbes spread through the circulation.
B. Antibodies have not yet formed.
C. There is no effective treatment.
D. There is a continuous mucosa along the involved structures.

D. There is a continuous mucosa along the involved structures.

Pyelonephritis may be distinguished from cystitis by the presence in pyelonephritis of:
A. microbes, leukocytes, and pus in the urine.
B. painful micturition.
C. urgency and frequency.
D. urinary casts and flank pain.

D. urinary casts and flank pain.

In a case of acute pyelonephritis, what is the cause of flank pain?
A. Inflammation, causing ischemia in the tubules
B. Inflammation, stretching the renal capsule
C. Increasing glomerular permeability, creating an increased volume of filtrate in the kidney
D. Microbes irritating the tissues

B. Inflammation, stretching the renal capsule

Which pathophysiological process applies to acute post-streptococcal glomerulonephritis?
A. Streptococcal infection affects both the glomerular and tubule functions
B. Ischemic damage occurs in the tubules, causing obstruction and decreased glomerular filtration rate (GFR)
C. Immune complexes deposit in glomerular tissue, causing inflammation
D. Increased glomerular permeability for unknown reasons

C. Immune complexes deposit in glomerular tissue, causing inflammation

What causes the dark urine associated with acute post-streptococcal glomerulonephritis?
A. Blood and protein leaking through the capillary into the filtrate
B. Proteinuria and microscopic hematuria from the inflammation
C. Pyuria from inflammatory exudate
D. Bleeding from ulcerations in the kidneys

B. Proteinuria and microscopic hematuria from the inflammation

Renal disease frequently causes hypertension because:
A. albuminuria increases vascular volume.
B. congestion and ischemia stimulate release of renin.
C. antidiuretic hormone (ADH) secretion is decreased.
D. damaged tubules absorb large amounts of filtrate.

B. congestion and ischemia stimulate release of renin.

Urinary casts are present with acute post-streptococcal glomerulonephritis because:
A. large numbers of microbes and leukocytes enter the filtrate.
B. ruptured capillaries release debris into the tubules.
C. normal reabsorption of cells and proteins cannot take place.
D. inflamed tubules compress red blood cells (RBCs) and protein into a typical mass.

D. inflamed tubules compress red blood cells (RBCs) and protein into a typical mass.

Which disease would cause an increased ASO titer and elevated serum ASK?
A. Nephrotic syndrome
B. Acute post-streptococcal glomerulonephritis
C. Pyelonephritis
D. Polycystic kidney

B. Acute post-streptococcal glomerulonephritis

Why does metabolic acidosis develop with bilateral kidney disease?
A. Tubule exchanges are impaired.
B. GFR is increased.
C. Serum urea is increased.
D. More bicarbonate ion is produced.

A. Tubule exchanges are impaired.

What is the first indicator in the arterial blood gases of acidosis caused by glomerulonephritis?
A. Increased carbonic acid
B. Increased bicarbonate ion
C. A pH less than 7.35
D. Decreased bicarbonate ion

D. Decreased bicarbonate ion

What would be the long-term effects of chronic infection or inflammation of the kidneys?
A. Dehydration and hypovolemia
B. Gradual necrosis, fibrosis, and development of uremia
C. Sudden anuria and azotemia
D. Severe back or flank pain

B. Gradual necrosis, fibrosis, and development of uremia

What factors contribute to headache, anorexia, and lethargy with kidney disease?
1. Increased blood pressure
2. Elevated serum urea
3. Anemia
4. Acidosis
A. 1 only
B. 2, 4
C. 1, 3, 4
D. 1, 2, 3, 4

D. 1, 2, 3, 4

What are the significant signs of nephrotic syndrome?
A. Hyperlipidemia and lipiduria
B. Pyuria and leucopenia
C. Hypertension and heart failure
D. Gross hematuria and pyuria

A. Hyperlipidemia and lipiduria

Why does blood pressure often remain near normal in patients with nephrotic syndrome?
A. Massive amounts of fluid are lost from the body with polyuria.
B. Renin and aldosterone are no longer secreted.
C. Tubules do not respond to ADH and aldosterone.
D. Hypovolemia results from fluid shift to the interstitial compartment.

D. Hypovolemia results from fluid shift to the interstitial compartment.

Common causes of urolithiasis include all of the following EXCEPT:
A. hypercalcemia.
B. hyperlipidemia.
C. inadequate fluid intake.
D. hyperuricemia.

B. hyperlipidemia.

Which of the following results from obstruction of the left ureter by a renal calculus?
A. Mild flank pain on the affected side
B. Hydronephrosis in both kidneys
C. Immediate cessation of urine production
D. An attack of renal colic

D. An attack of renal colic

What does hydronephrosis lead to?
A. Ischemia and necrosis in the compressed area
B. Multiple hemorrhages in the kidney
C. Severe colicky pain radiating into the groin
D. Increased GFR

A. Ischemia and necrosis in the compressed area

Which of the following is a predisposing factor to bladder cancer?
A. Prostatic cancer
B. Hormonal abnormalities
C. Exposure to chemicals and cigarette smoke
D. Presence of embryonic tissue

C. Exposure to chemicals and cigarette smoke

What is the common initial sign of adenocarcinoma of the kidney?
A. Gross hematuria
B. Microscopic hematuria
C. Sharp flank pain
D. Oliguria

B. Microscopic hematuria

Which of the following does NOT usually result from nephrosclerosis?
A. Secondary hypertension
B. Chronic renal failure
C. Acute renal failure
D. Increased renin and aldosterone secretions

C. Acute renal failure

Which of the following relates to polycystic kidney disease?
A. It affects only one of the kidneys.
B. It results in gradual degeneration and chronic renal failure.
C. The kidneys are displaced and the ureters are twisted.
D. The prognosis is good because there is adequate reserve for normal life.

B. It results in gradual degeneration and chronic renal failure.

Which of the following is related to Wilms' tumor?
A. Direct exposure to carcinogens
B. Hormonal imbalance
C. Repeated infections
D. A genetic defect

D. A genetic defect

With severe kidney disease, either hypokalemia or hyperkalemia may occur and cause:
A. cardiac arrhythmias.
B. encephalopathy.
C. hypervolemia.
D. skeletal muscle twitch or spasm.

A. cardiac arrhythmias.

Which of the following indicates the early stage of acute renal failure?
A. Polyuria with urine of fixed and low specific gravity
B. Hypotension and increased urine output
C. Development of decompensated acidosis
D. Very low GFR and increased serum urea

D. Very low GFR and increased serum urea

What is/are a cause(s) of acute tubule necrosis and acute renal failure?
A. Prolonged circulatory shock
B. Sudden significant exposure to nephrotoxins
C. Crush injuries or burns
D. All of the above

D. All of the above

Which of the following would likely cause chronic renal failure?
A. Cystitis with pyelonephritis in the right kidney
B. Circulatory shock
C. Diabetes
D. Obstruction of a ureter by a renal calculus

C. Diabetes

What causes polyuria during the stage of renal insufficiency?
A. Loss of tubule function
B. Increased blood pressure
C. Decreased aldosterone secretion
D. Increased GFR

A. Loss of tubule function

What is the primary reason for hypocalcemia developing during end-stage renal failure or uremia?
A. Decreased parathyroid hormone secretion
B. Insufficient calcium in the diet
C. Excessive excretion of calcium ions in the urine
D. A deficit of activated vitamin D and hyperphosphatemia

D. A deficit of activated vitamin D and hyperphosphatemia

Cystitis is more common in females because:
A. the mucosa in the urinary tract is continuous.
B. the urethra is short, wide, and adjacent to areas with resident flora.
C. the pH of urine is more acidic in females.
D. females have a higher incidence of congenital anomalies.

B. the urethra is short, wide, and adjacent to areas with resident flora.

Which of the following indicate a decreased GFR?
A. Increased serum urea and decreased serum bicarbonate
B. Urine with low specific gravity and dark color
C. Albuminuria and hematuria
D. Hyponatremia and hypokalemia

A. Increased serum urea and decreased serum bicarbonate

Which of the following is NOT likely to lead to hydronephrosis?
A. Renal calculi
B. Pyelonephritis
C. Nephrosclerosis
D. Benign prostatic hypertrophy

C. Nephrosclerosis

Which of the following congenital defects is a common cause of cystitis in young children?
A. Polycystic kidney
B. Horseshoe kidney
C. Hypoplasia of the kidney
D. Vesicoureteral reflux

D. Vesicoureteral reflux

Which factor contributes to severe anemia in individuals with chronic renal failure?
A. Increased erythropoietin secretion
B. Limited protein intake
C. Compensatory increase in bone marrow activity
D. Inability to absorb vitamin B12 and iron

B. Limited protein intake

When acidosis becomes decompensated in renal failure, a key indicator is:
A. increased PCO2.
B. increased bicarbonate ion.
C. serum pH dropping below 7.35.
D. serum buffer ratio of 20 bicarbonate ions to 1 carbonic acid.

C. serum pH dropping below 7.35.

What is the primary action of the diuretic furosemide?
A. Decreased reabsorption of sodium and water
B. Decreased reabsorption of H+ in the tubules
C. Increased secretion of antidiuretic hormone
D. Inhibition of renin

A. Decreased reabsorption of sodium and water

Which of the following causes acute renal failure?
A. Polycystic kidney disease
B. Pyelonephritis in the right kidney
C. Nephrosclerosis
D. Bilateral acute glomerulonephritis

D. Bilateral acute glomerulonephritis

Which of the following is a significant indicator of renal insufficiency?
A. Urine with pH of 5
B. Increased serum urea and creatinine
C. Urine with high specific gravity
D. Decreased blood pressure

B. Increased serum urea and creatinine

Uremic signs of renal failure include all of the following EXCEPT:
A. encephalopathy.
B. high blood pressure.
C. osteodystrophy.
D. azotemia and acidosis.

B. high blood pressure.

Choose the basic cause of osteodystrophy associated with chronic renal failure.
A. Development of hypercalcemia
B. Deficit of parathyroid hormone
C. Failure of the kidney to activate vitamin D
D. Excessive loss of phosphate ion

C. Failure of the kidney to activate vitamin D

Agenesis is often not diagnosed because:
A. the kidney is displaced from its normal position.
B. it is a genetic defect and asymptomatic until mid-life.
C. the two functioning kidneys are fused together.
D. it is usually asymptomatic as one kidney provides adequate function.

D. it is usually asymptomatic as one kidney provides adequate function.

The normal pH of urine is:
A. 7.35-7.45.
B. 4.5- 8.0.
C. 1.5-7.5.
D. 1.0-7.0.

B. 4.5- 8.0.

Wilms' tumor is:
A. a malignant tumor in the bladder.
B. an encapsulated mass in one kidney.
C. not considered to have a genetic origin.
D. manifested in adulthood.

B. an encapsulated mass in one kidney.

Reduced urine output resulting from inflammation and necrosis of the tubules is called:
A. oliguria.
B. anuria.
C. pyuria.
D. polyuria.

A. oliguria.

The micturition reflex is initiated by:
A. sympathetic nerves in the sacral spinal cord.
B. relaxation of the internal sphincter of the bladder.
C. increased pressure distending the bladder.
D. contraction of the bladder.

C. increased pressure distending the bladder

Which of the following results from decreased blood flow into the kidneys?
A. Decreasing blood pressure
B. Dilation of the afferent arterioles
C. Decreased aldosterone secretion
D. Increased angiotensin and systemic vasoconstriction

D. Increased angiotensin and systemic vasoconstriction

In acute post-streptococcal glomerulonephritis, the glomerular inflammation results from:
A. toxins produced by the bacteria.
B. a type III hypersensitivity reaction.
C. an ascending infection from the bladder.
D. spread of infection from the tubules.

B. a type III hypersensitivity reaction.

In acute post-streptococcal glomerulonephritis, the inflammation causes:
A. increased permeability of the glomerular capillaries.
B. glomerular congestion and decreased GFR.
C. decreased blood pressure and edema.
D. A and B

D. A and B

Circulatory shock causes:
A. decreased GFR and increased renin secretion.
B. increased ADH and decreased aldosterone secretion.
C. immediate tubule necrosis and obstruction.
D. sympathetic nervous system (SNS) stimulation and vasodilation of afferent and efferent arterioles.

A. decreased GFR and increased renin secretion.

Autoregulation in the kidneys refers to:
A. control of blood flow by the SNS.
B. the secretion of renin and activation of angiotensin.
C. local minor reflex adjustments in the arterioles to maintain normal blood flow.
D. the control of systemic blood pressure by the kidneys.

C. local minor reflex adjustments in the arterioles to maintain normal blood flow.

The reabsorption of water and electrolytes by the kidneys is directly controlled by:
1. atrial natriuretic hormone.
2. antidiuretic hormone.
3. angiotensin.
4. the levels of bicarbonate ion.
A. 2 only
B. 3 only
C. 1, 2
D. 2, 4

C. 1, 2

Uncontrolled essential hypertension may cause chronic renal failure because of:
A. predisposition to recurrent urinary tract infections.
B. damage to afferent arterioles and renal ischemia.
C. failure of tubules to respond to hormonal controls.
D. glomerular congestion causes damaged capillaries.

B. damage to afferent arterioles and renal ischemia

Urine with a low specific gravity is usually related to:
A. an infection of the gallbladder.
B. renal failure due to tubule damage.
C. lack of sufficient fluid intake.
D. presence of numerous renal calculi.

B. renal failure due to tubule damage.

Excess urea and other nitrogen wastes in the blood is referred to as:
A. dysuria.
B. azotemia.
C. bacteremia.
D. hematuria.

B. azotemia.