Question #: 2

Calculate the free-water clearance in a patient with the following laboratory data:
urine output: 1.5 L/24 hours

glomerular filtration rate: 125 ml/min

osmolarity of the urine: 150 mosmol/L
osmolarity of the plasma: 300 mosmol/L

Question #: 3
A man is chopping wood outside when he accidentally chops into his arm, causing it to bleed
profusely. A friend drives him to the hospital, 30 minutes away. Although pressure is applied to
the wound. There is continued blood loss. Upon arrival at the emergency department, he
appears lethargic and pale. Which of the following set of vital signs would most likely be seen in
this patient as he is being transported to the hospital?
 CHOICE Heart rate Total peripheral Renin Vasopressin
resistance

A decrease increase increase increase

B increase decrease increase increase

C increase increase decrease increase

D increase increase increase decrease

E increase increase increase increase

Question #: 4
An 11-year-old boy presents to his pediatrician with muscle cramps and fatigue that have
progressively worsened over the past year. His mom says that he has always had occasional
symptoms including abdominal pain, muscle weakness, and mild paresthesias: however, since
starting middle school these symptoms have started interfering with his daily activities . In
addition the boy complains that he has been needing to use the restroom a lot, which is
annoying since he has to ask for permission to leave class every time. Labs are obtained
showing hypokalemia, hypochloremia, metabolic alkalosis, hypomagnesemia, and
hypocalciuria. The most likely cause of this patient's symptoms involves a protein that binds
which of the following drugs?

A. Amiloride
B. Furosemide
C. Hydrochlorothiazide
D. Mannitol
E. Spironolactone

Q-5

A 5-year-old boy is brought to the clinic for recurrent bedwetting. The child has an intellectual
disability, thus, the mother is providing most of the history. She states that the child constantly
drinks fluids and has a difficult time making it to the bathroom as often as he needs. Therefore,
he sometimes wets himself during the day and at night. She has tried bedwetting alarms with no
success. Review of systems is negative, His past medical history is unremarkable except for
moderate growth retardation. His temperature is 99.5"F (37.5*C), blood pressure is 80/54
mmHg, pulse is 90/min, respirations are 20/min, and oxygen saturation is 99% on room air.
Routine laboratory tests and a 24 hour urine test are shown below.

Serum
Na+: 138 mEq/L
K+: 2.5 mEq/Ll
BUN: 9 mg/dL
Glucose: 98 mg/dL
Creatinine: 1.0 mg/dl
thyroid-stimulating hormone: 1.2 pu/ml
AST: 13 U/L
ULT: 10 U/L
PH: 7 49
Urine:
Epithelial cells: 5 cells
Glucose: Negative
WBC: 0/hpf
Bacterial: None
weapon Normal
Calcium: 370 mg/24h(Normal: 100-300 mg/24h)
What is the most likely explanation for this patient's findings ?

A. Defect of NaCl reabsorption at the distal collecting tube

B. Defect of Na+/K+/2Cl- cotransporter at the thick ascending loop of Henle
C. Generalized reabsorptive defect in the proximal collecting tube
D. Hereditary deficiency of 11B-hydroxysteroid dehydrogenase
E. Increased sodium reabsorption at the collecting tubules

Q-6

A 2-year old boy is brought to his primary care physician for persistent failure to thrive. He has
not been meeting normal motor developmental milestones. Further questioning reveals a
family history of congenital kidney disorders, although the parents do not know details Based on
clinical suspicion a panel of lab tests are ordered which reveal a sodium of 129 mg/dl.
(normal range 136-145), a potassium of 3.1 mp/dL (normal range 3.5- 5.0 ) , a bicarbonate of 32
mg/dL(normal range 22-28) and a pH of 7.5 (normal range 7.35- 7.45), Urinary calcium excretion is
also found to be increased. Which of the following drugs have the most similar mechanism of action
to the most likely diagnosis in this patient?

A. Furosemide

Question #: 7

A 78-year-old man presents with a 1-day history of increasing shortness of breath and difficulty
lying down to sleep. His past medical history is significant for hypertension, myocardial
infarction, and congestive heart failure. He denies chest pain and says
that he has not noticed any other recent changes to his health. A physical exam is notable for
inspiratory crackles on lung auscultation and 2+ pitting edema on the bilateral lower extremities.
His physician increases the dose of one of his medications.If this medication acts upon a
cotransporter that binds to both sodium and potassium, which of the sets of serum laboratory
abnormalities in Figure below would most likely be seen in this patient?

Potassium Calcium Magnesium

A Normal
B
C
D
E Normal Normal

Question #: 8
An 8-year-old male with congestive heart failure recently had his medication regimen adjusted
to better control his hypertension. Three weeks later, laboratory analysis shows his serum
calcium and magnesium levels have both decreased, The diuretic used
in this patient acts predominantly on which nephron segment:

A. Proximal tubule
B. Descending loop of Henle
C. Thick ascending loop of Henle
D. Distal tubule
E. Cortical collecting duct

Question # : 9

A 9-year-old girl is being evaluated for suspected Bartter's syndrome, a renal disorder caused
by defective Cl- reabsorption by the Na+/K/2cl- cotransporter. In normal individuals , the
segment of the nephron that houses this transport is also characterized by which of the
following ?

A. Secretion of calcium
B. Impermeability to water
C. Site of action of ADH
D. Site of action of thiazide diuretics

Question #: 10
A 21-year-old male presents to the emergency department with generalized weakness and
fatigue. His past medical history is significant for hypertension refractory to several medications
but is otherwise unremarkable. He is afebrile, his pulse is 82/min,respirations are 18/min, and
blood pressure is 153/94mmHg.
Labs are as follows:
Sodium: 142 mEq/L
Potassium: 2.7 mEq/L
Bicarbonate: 36 mEq/L
Serum PH: 7.5
pCO2: 50 mmHg
Aldosterone decreased
Based on clinical suspicion, a genetic screen is performed, confirming an underlying syndrome
due to an autosomal dominant gain of function mutation. Which of the following medications can
be given to treat the most likely cause of this patient's symptoms?

A. Amiloride

Question #: 11
A 26-year-old female complains of frequent, large volume urination. This negatively affects her
sleep, as she has to frequently wake up at night to urinate. She also complains of increased
thirst. Her past medical history is significant for bipolar disorder that is treated with lithium for 3
years. Serum Osmolality is 425 mosm/kg and urine Osmolarity is 176 mosm/kg. Which of the
following best explains this patient's serum and urine osmolality ?

A Hypothalamic over-production of antidiuretic hormone (ADH)

B. Deacred production of ADH
C. ADH resistance in the renal collecting ducts
D. Increased aquaporin expression in the renal collecting ducts

Question #: 12
A 17-year-old boy with insulin-dependent diabetes is brought to the emergency department
unconscious with a fruity odor on his breath. Upon his admission, insulin is administered and
serum potassium levels are monitored closely. Potassium balance is essential for the normal
function of excitable tissues such as muscles and nerves. Which of the following clinical
situations could also put a patient at risk for hypokalemia?

A High-K+ diet
B Hypoaldosteronism
C. Metabolic acidosis
D. Overuse of amiloride
E. Overuse of hydrochlorothiazide
Question #: 13

A 56-year-old man with a 60 pack-year smoking history and normal fluid intake presents to his
physician with two months of fatigue and weakness accompanied by cough and mild dyspnea.
The patient's vital signs are normal, but a lower left lobe mass is noted on an X-ray of the chest.
Biopsy leads to the diagnosis of small cell carcinoma which is also secreting antidiuretic
hormone. Results of laboratory tests are shown below.

Plasma sodium: 125 mEg/L

Plasma potassium: 3.9 mEq/L
Plasma carbon dioxide: 24 mEq/L
Plasma osmolality: 253 mosm/L
Urine sodium: 48 mEg/L
Urine osmolality: 280 mOsm/L
The hormone most likely responsible for this patient's abnormal laboratory values has which of
the following direct effects?

A. Activation of V2 receptors results in the insertion of aquaporins into the renal collecting duct;
activation of V1 receptors leads to an increase in total peripheral resistance

Q - 14

A 67-year-old woman with osteoporosis is given a diuretic to treat her hypertension. This
particular diuretic has the adverse effect of limiting calcium excretion by the kidney. Referring to
the image, where along the nephron does this drug act ?

ANS - E

Question #: 15
A 52-year-old postmenopausal woman sees her physician because she is worried about
osteoporosis. Her physician decides that he should investigate calcium reabsorption in the thick
ascending limb of the loop of Henle.Which of the following interventions would most effectively
increase her calcium reabsorption in the thick ascending loop of Henle?

A. Administration of exogenous parathyroid hormone

B. Discontinuation of her loop diuretic

Question #: 16
A newborn with hypercalciuria and hypokalemia alkalosis is diagnosed with neonatal Bartter’s
syndrome, a rare inherited dysfunction of the thick ascending limb of the nephron. Which
diuretic may mimic these symptoms by blocking a cotransporter found in this part of the
nephron?

A. Furosemide

Question #: 17

Which of the following signs would you NOT expect to find in a patient with Bartter's syndrome?

A. Secondary hyperaldosteronism.
B. Hypomagnesemia
C. Metabolic alkalosis
D. Hypocalciuria
E. Hypokalemia

Question #: 18

Which of the following medications would be contraindicated in patients with Bariter syndrome?

A ACE inhibitors
B Amiloride
C. Indomethacin
D. Spironolactone
E. Furosemide

Question #: 19

Which event would be most likely to cause increased capillary filtration and risk of development
of edema?

B. Dehydration or a potent arter

C. Intravenous infusion of plasma
D. Large doses of a diuretic
E. Reduced albumin synthesis caused by liver failure

Question #: 20
A patient with advanced liver failure is likely to experience increased filtration as a direct effect
of a decrease of which factor?

A. Capillary blood flow

B. Capillary hydrostatic pressure
C. Interstitial fluid hydrostatic pressure
D. Plasma colloid oncotic pressure
E Tissue colloid oncotic pressure
F Velocity of blood flow.

Question 21

In an experiment with an isolated skeletal muscle perfused with lactated Ringers containing
albumin, the following measurements were made:

Capillary hydrostatic pressure = 30 mm Hg

Tissue hydrostatic pressure = 5 mm Hg
Oncotic pressure in capillaries = 20 mm Hg
Oncotic pressure in tissue = 5 mm Hg
Net rate of filtration = 20 mL/min
What is the value of the filtration coefficient in mL/min/mm Hg?

A 0.5
B. 1.0
C. 1.5
D. 2.0

Question #: 22
Which force makes the greatest contribution to the forces that favor filtration of fluids from
capillaries into interstitial fluid in a person with normal circulatory function?

A. Capillary hydrostatic pressure

B. Interstitial fluid hydrostatic pressure

Question #: 23

The data below was obtained from the lungs of a patient with a restrictive lung disease:
Capillary hydrostatic pressure = 7mm Hg
Interstitial hydrostatic pressure (average over the respiratory cycle) = —10 mm Hg
Plasma colloid oncotic pressure = 28 mm Hg
Interstitial colloid oncotic pressure = 20 mm H
Kf, filtration coefficient = 1 mL/min/mm Hg
In this patient's lungs, what is the net rate of filtration or reabsorption of fluid in mL/min?

A. Filtration = 1.0 mL/min

B. Filtration = 5.0 mL/min
C. Filtration = 9.0 mL/min
D. Filtration = 11.0 mL/min
E. Reabsorption = 1.0 mL/min
F. Reabsorption = 5.0 mL/min
G. Reabsorption = 9.0 mL/min
H. Reabsorption = 11.0 mL/min

Question #: 24

Calculate the renal filtered load of sodium:

Glomerular filtration rate: 100 ml/min
urine flow rate: 2.4 ml/min
plasma concentration of sodium : 0.12 mEg/ml

Question #: 25

A 75 year-old woman is treated for urinary infection with an antibiotic. She weighs 320 pounds.
The antibiotic is completely eliminated in urine. Its dosage must be adjusted by 1% for every 1%
change from the normal GFR which is 100 mL/min for a woman of her age and weight. Two
weeks ago, the patient underwent a creatinine clearance test, in which the serum creatinine was
5 mg/dL and urine creatinine was 50 mg/dL. One liter of urine was collected within 200 minutes.
What is the most appropriate antibiotic dosage (in % of normal) for this patient?