The Urinary System

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1

Components of the urinary system include

  1. two kidneys
  2. two ureters
  3. one urinary bladder
  4. one urethra
  5. All of these are correct.

E

2

Which of the following is NOT a function of the kidneys?

  1. production and release of calcitriol and erythropoietin
  2. storage of urine
  3. regulation of blood composition and pH
  4. regulation of blood volume and pressure
  5. maintenance of blood osmolarity

B

3

Each of the following is a waste product normally secreted by the kidneys EXCEPT

  1. urea
  2. bilirubin
  3. glucose
  4. ammonia
  5. creatinine

C

4

The kidneys

  1. are retroperitoneal and are attached to the posterior abdominal wall.
  2. are partially protected by ribs 6-9.
  3. are surrounded by capsules of epithelial tissue.
  4. are protected from mechanical trauma by a thick layer of loose connective tissue.
  5. have concave lateral borders.

A

5

The layer of the kidney superficial to the renal pyramids but deep to the renal capsule is the

  1. renal pelvis
  2. renal pyramid
  3. renal medulla
  4. renal cortex
  5. renal papilla

D

6

Place the following structures in the order in which urine would normally pass through them.

1. renal sinus

2. papillary duct

3. renal pelvis

4. major calyx

5. minor calyx

  1. 2, 5, 4, 3 but never 1
  2. 2, 4, 5, 3 but never 1
  3. 2, 4, 5, 1 but never 3
  4. 1, 4, 5, 3 but never 2
  5. 3, 4, 5, 2 but never 1

A

7

The blood vessels that supply the kidneys are the

  1. suprarenal arteries.
  2. gonadal arteries.
  3. branches of the celiac artery.
  4. cystic arteries.
  5. renal arteries.

E

8

Renal nerves

  1. mostly arise from the vagus nerve.
  2. pass through the renal pelvis.
  3. are part of the parasympathetic division of the autonomic nervous system.
  4. are mostly vasomotor nerves.
  5. All of the above are correct.

D

9

Which of the following is true of nephrons?

  1. They are the functional units of the kidneys.
  2. Most of the nephrons are located entirely in the renal medulla.
  3. The proximal convoluted tubules allow the kidney to concentrate or dilute urine.
  4. The collecting ducts of several nephrons empty into a single collecting duct.
  5. There are about a billion nephrons in each kidney.

A

10

Components of the renal corpuscle include the

  1. glomerulus and renal capsule
  2. glomerulus and glomerular capsule
  3. glomerular capsule and proximal convoluted tubule
  4. proximal convoluted tubule and loop of Henle
  5. loop of Henle and distal convoluted tubule

B

11

Place the following in the order that a molecule of water would ordinarily pass through them.

1. collecting duct

2. descending loop of Henle

3. papillary duct

4. glomerulus

5. ascending loop of Henle

6. glomerular capsule

7. distal convoluted tubule

8. proximal convoluted tubule

  1. 6, 4, 8, 2, 5, 7, 1, 3
  2. 4, 6, 8, 5, 2, 7, 1, 3
  3. 4, 6, 8, 2, 5, 7, 1, 3
  4. 4, 6, 8, 2, 5, 7, 3, 1
  5. 4, 6, 8, 2, 7, 5, 1, 3

C

12

Which components of the nephrons are associated with the juxtaglomerular apparatus?

  1. afferent arteriole
  2. ascending loop of Henle
  3. collecting tubule
  4. A and B are correct.
  5. A, B and C are correct.

D

13

Which of the following is correct?

  1. Loss 10% of a person’s kidney function may not result in clinically observable effects.
  2. As a person grows, the number of nephrons in his or her kidney stays constant.
  3. If one kidney is removed, the other nephrons in the other kidney will hypertrophy.
  4. A and B are correct.
  5. A, B and C are correct.

E

14

The first step in urine production

  1. is called reabsorption.
  2. occurs as water and solutes move from the glomerulus to the glomerular capsule.
  3. moves water and solutes into the peritubular capillaries from the renal tubules.
  4. moves water and solutes from the renal tubules into the peritubular capillaries.
  5. is called secretion

B

15

The rate of urinary excretion of any solute is equal to

  1. its rate of glomerular filtration, plus its rate of secretion, minus its rate of reabsorption.
  2. its rate of glomerular filtration, minus its rate of secretion, minus its rate of reabsorption
  3. its rate of glomerular filtration, plus its rate of secretion, plus its rate of reabsorption
  4. its rate of glomerular filtration, plus its rate of secretion, times its rate of reabsorption
  5. its rate of glomerular filtration, times its rate of secretion, minus its rate of reabsorption

A

16

The filtration membrane consists of

  1. glomerular endothelial cells
  2. the basal lamina
  3. the slit membranes between the pedicels of podocytes
  4. A and B are correct.
  5. A, B and C are correct.

E

17

Each of the following can ordinarily cross the filtration membrane EXCEPT:

  1. small proteins
  2. water
  3. platelets
  4. ions
  5. monosaccharides

C

18

Why is the volume of fluid filtered by the renal corpuscle much larger than the volume exiting other capillaries of the body?

  1. A large surface area for exchange is presented by the glomerular capillaries.
  2. The filtration membrane is thick and impermeable.
  3. The blood pressure in the glomerular capillaries is low.
  4. Mesangial cells contract and increase surface area available for filtration.
  5. All of these are correct.

A

19

Which pressure opposes glomerular filtration?

  1. capsular hydrostatic pressure
  2. blood colloidal osmotic pressure
  3. glomerular blood hydrostatic pressure
  4. A and B are correct.
  5. A, B and C are correct.

D

20

An individual has a glomerular blood hydrostatic pressure of 60 mmHg, a capsular hydrostatic pressure of 18 mmHg, and a blood colloidal osmotic pressure of 32 mmHg. What is the individual’s net filtration pressure?

  1. 60 mmHg +18 mmHg + 32 mmHg = 110 mmHg
  2. 60 mmHg – 18 mmHg – 32 mmHg = 10 mmHg
  3. 60 mmHg + 18 mmHg – 32 mmHg = 46 mmHg
  4. 60 mmHg – 18 mmHg + 32 mmHg = 54 mmHg
  5. 60 mmHg x 18 mmHg /32 mmHg = 34mmHg

B

21

A patient has both systemic lupus erythematosus, which has damaged her liver, and insulin-dependent diabetes mellitus, which has damaged her kidneys. As the diseases have progressed, the edema she experiences has worsened. Why?

  1. Liver damage prevents her from making sufficient plasma proteins, thus lowering her BCOP.
  2. Kidney damage allows some of her plasma proteins to be excreted, thus lowering her BCOP.
  3. Kidney damage allows little fluid to accumulate in the Bowman’s capsule, lowering her CHP.
  4. A and B are correct.
  5. A, B and C are correct.

D

22

Each of the following is correct about glomerular filtration rate (GFR) EXCEPT:

  1. GFR is affected by the diameters of the afferent and efferent arterioles.
  2. GFR is dependent upon factors that determine net filtration pressure.
  3. GFR increases dramatically when the GBHP drops below 45 mmHg.
  4. GFR remains fairly constant at mean arterial pressures between 80-180 mmHg.
  5. An insufficient GFR may allow wastes to accumulate in the blood.

C

23

Mechanisms that control glomerular filtration include

  1. renal autoregulation
  2. neural control
  3. hormonal control
  4. A and B are correct.
  5. A, B and C are correct.

E

24

The myogenic mechanism of renal autoregulation

  1. depends completely on contraction of smooth muscle cells in the wall of efferent arterioles.
  2. requires minutes to respond to changes in blood pressure.
  3. controls the size of materials that cross the filtration membrane.
  4. normalizes renal blood flow and GFR in response to a change in blood pressure.
  5. requires the presence of nitric oxide.

D

25

The tubuloglomerular mechanism of renal autoregulation

  1. acts more quickly than the myogenic mechanism.
  2. depends upon feedback from the macula densa to the glomerulus.
  3. is based on the response of cells in the macula densa to levels of Ca+2 and HCO3 -.
  4. uses ADH to adjust the diameter of the afferent arteriole.
  5. adjusts GFR more effectively in response to low blood pressure than to high blood pressure.

B

26

Methamphetamine mimics the effects of the sympathetic nervous system. How would a high dose of this substance probably affect the kidneys?

  1. The afferent arterioles will probably constrict.
  2. Blood flow into the glomerular capillaries will probably decrease.
  3. The GFR will probably decrease.
  4. Urine output will probably decrease.
  5. All of these are correct.

E

27

Which of the following combinations would be expected to increase GFR?

  1. increased angiotensin II and ANP levels
  2. decreased angiotensin II and ANP levels
  3. decreased angiotensin II levels with increased ANP levels
  4. increased angiotensin II levels with decreased ANP levels
  5. only increased angiotensin II levels

C

28

Tubular reabsorption

  1. returns 99% of the water filtered from the glomerulus to the blood.
  2. occurs mostly in the distal convoluted tubule.
  3. eliminates wastes from the body.
  4. usually helps control blood pH by removing H+ from the filtrate.
  5. All of the above are correct.

A

29

Each of the following substances is ordinarily secreted from the blood and tubular cells into tubular fluid EXCEPT:

  1. K+
  2. glucose
  3. penicillin
  4. creatinine
  5. NH4 +

B

30

The proximal convoluted tubule (PCT)

  1. uses Na+ symporters to reabsorb glucose and amino acids.
  2. uses Na+ antiporters to eliminate water soluble vitamins.
  3. uses Na+/H+ antiporters to reabsorb H+ and eliminate Na+.
  4. secretes 80-90% of the HCO3 - generated by tubular cells.
  5. reabsorbs NH3 and ammonia.

A

31

The loop of Henle

  1. contains fluid identical in composition to the glomerular filtrate.
  2. is permeable to water along its entire length.
  3. reabsorbs Na+, K+, Ca2+, HCO3 - and Cl-.
  4. reabsorbs water only in its ascending limb.
  5. All of these are correct.

C

32

The distal convoluted tubule (DCT)

  1. secretes Na+ and Cl-.
  2. is the major site where parathyroid hormone (PTH) stimulates reabsorption of Ca2+.
  3. are impermeable to water.
  4. receives tubular fluid directly from the Bowman’s capsule.
  5. secrete HCO3 - and reabsorb H+.

B

33

The collecting ducts

  1. receive only 5-10% of the water and solutes that initially filtered out of the glomerulus.
  2. contains principal and intercalated cells.
  3. has little influence on blood K+ concentration.
  4. A and B are correct.
  5. A, B and C are correct.

D

34

Which of the listed hormones directly impacts water reabsorption but not Na+ reabsorption?

  1. aldosterone
  2. ADH
  3. angiotensin II
  4. atrial natriuretic peptide
  5. A and D are correct.

B

35

The most important hormonal regulators of electrolyte reabsorption and secretion are

  1. aldosterone and angiotensin I.
  2. aldosterone and ADH.
  3. aldosterone and angiotensin II.
  4. aldosterone and ANP.
  5. ADH and angiotensin II.

C

36

Which of the following is a likely consequence if patient suffering from renal damage cannot release sufficient quantities of renin?

  1. The patient will not be able to activate enough angiotensin II.
  2. The patient will not be able to release enough aldosterone.
  3. The patient may have difficulty maintaining Na+, K+, and pH balance.
  4. The patient may have difficulty maintaining blood volume and, therefore, blood pressure.
  5. All of these are correct.

E

37

The hormone with the most important role in regulating Na+ and K+ balance is

  1. aldosterone
  2. ADH
  3. PTH
  4. androgen
  5. A and D are correct.

A

38

A very busy nurse working at the end of his third 12 hour shift in a row made two bad mistakes with the same patient. First, he forgot to double-check the label on I.V. solution he was hanging to make sure it matched the order for the patient. Then he forgot to check the setting on the I.V. pump. The patient received a liter of hypertonic fluid in less than 15 minutes instead of receiving the same volume of the ordered isotonic fluid in 2 hours. How will the patient’s body attempt to compensate for the nurse’s mistakes?

  1. The patient will secrete more ADH so that more water can be reabsorbed from the filtrate.
  2. The patient will secrete more ANP so that more Na+ and water can be secreted into the urine.
  3. The patient will secrete more aldosterone so that more Na+ and water can be reabsorbed.
  4. A and B are correct.
  5. A, B and C are correct.

B

39

Why does the osmolarity of tubular fluid decrease as it passes through the ascending loop of Henle, distal convoluted tubule and collecting duct?

  1. The ascending loop of Henle (LOH) is permeable to water but not to solutes.
  2. The distal convoluted tubule (DCT) is much more permeable to water than to solutes.
  3. If ADH levels are low, the collecting ducts reabsorb large quantities of water.
  4. If ADH levels are low, the collecting ducts reabsorb large quantities of solute.
  5. The LOH and DCT reabsorb solutes and dilute the fluid entering the collecting ducts.

E

40

Factors that create the osmotic gradient that enables ADH to cause formation of concentrated urine include

  1. differences in solute permeability and reabsorption in different parts of the long LOHs.
  2. differences in water permeability and reabsorption in different parts of the long LOHs.
  3. differences in solute and water permeability and reabsorption in the collecting duct.
  4. countercurrent flow in the LOHs.
  5. All of these are correct.

E

41

As tubular fluid flows up the ascending loop of Henle,

  1. its concentration remains unchanged.
  2. its concentration increases.
  3. its concentration decreases.
  4. its concentration decreases only if ADH is present.
  5. its concentration decreases only if aldosterone is present.

C

42

Normal constituents of urine include all of the following EXCEPT:

  1. urea
  2. protein
  3. creatinine
  4. water
  5. urobilinogen

B

43

Which of the following tests is most beneficial in evaluating kidney function?

  1. blood urea nitrogen (BUN)
  2. plasma creatinine level
  3. renal plasma clearance
  4. urinalysis
  5. A and D are most beneficial.

C

44

Which of the following statements about the ureters is NOT correct?

  1. transport urine from the kidney to the urinary bladder.
  2. are separated from the urinary bladder by an anatomical valve.
  3. are lined with a mucous membrane, have a middle muscular layer and an outer serosa.
  4. rely on a combination of gravity, hydrostatic pressure and gravity to move urine.
  5. enter the urinary bladder on its posterior.

B

45

The urinary bladder

  1. in males is directly posterior to the rectum.
  2. in females is posterior to the vagina and superior to the uterus.
  3. wall contains the detrusor muscle, which consists of three layers of smooth muscle tissue..
  4. has an internal sphincter composed of skeletal muscle, which is under voluntary control.
  5. has an external sphincter composed of smooth muscle, which is under involuntary control.

C

46

Micturition, which is also called urination or voiding,

  1. is a cranial reflex.
  2. involves contraction of the detrusor muscle and relaxation of the internal urethral sphincter.
  3. stimulates motor neurons that cause the external urethral sphincter to contract.
  4. is a reflex that cannot be voluntarily controlled.
  5. All of these are correct.

B

47

The urethra

  1. serves both reproductive and urinary system functions in males.
  2. has an opening between the clitoris and the vagina orifice in females.
  3. drains urine from the body.
  4. A and B are correct.
  5. A, B and C are correct.

E

48

Which body parts excrete heat, CO2, and water?

  1. GI tract
  2. sweat glands
  3. lungs
  4. A and B are correct.
  5. A, B and C are correct.

E

49

Which pair of kidneys remains functional after birth?

  1. pronephros
  2. mesonephros
  3. metanephros
  4. A and B are correct.
  5. A, B and C are correct.

C

50

Age related changes in the urinary system include all of the following EXCEPT:

  1. decreased blood supply to the kidneys
  2. decreased renal function
  3. decreased urinary bladder capacity
  4. increased risk of urinary tract infections
  5. increased kidney size

E