Florida International University

BIO PCB 4023

Chapter 19

1)Plasma can gain solutes and/or water from which of the following?

1. 1. gastrointestinal tract only
   2. renal tubules only
   3. bone only
   4. both the gastrointestinal tract and bone
   5. both the gastrointestinal tract and renal tubules
2. Fluid and electrolyte balance occur when
   1. the charges are neutral and happen to be in an aqueous solution.
   2. the amount of solute in the plasma is the same as the amount in the interstitial fluid.
   3. solutes and water enter and exit the plasma at the same rate.
   4. solutes and water enter the plasma at a greater rate than it exits.
   5. solutes and water exit the plasma at a greater rate than it enters.
3. A substance is in negative balance when
   1. it exits plasma at a greater rate than it enters plasma.
   2. it enters plasma at a greater rate than it exits plasma.
   3. it enters plasma at the same rate it exits plasma.
   4. its production by cells is increased.
   5. its usage by cells is decreased.
4. A substance is in positive balance when
   1. it enters plasma at the same rate it exits plasma.
   2. its production by cells is decreased.
   3. its usage by cells is increased.
   4. it enters plasma at a greater rate than it exits plasma.
   5. it exits plasma at a greater rate than it enters plasma.
5. The regulation of water and ion excretion occurs primarily within the
   1. proximal tubules only.
   2. late distal tubules only.
   3. collecting ducts only.
   4. both proximal tubules and late distal tubules.
   5. both collecting ducts and late distal tubules.
6. The regulation of sodium and water balance in the kidneys occurs primarily through the unique action of which cells in the distal tubules and collecting ducts?
   1. podocytes
   2. mesangial cells
   3. granular cells
   4. principal cells
   5. intercalated cells

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7. The regulation of acid-base balance in the kidneys occurs primarily through the unique action of which cells in the distal tubules and collecting ducts?
   1. principal cells
   2. mesangial cells
   3. intercalated cells
   4. podocytes
   5. granular cells
8. Which of the following is a source of water input?
   1. digestive tract only

8. 2. renal tubules only
   3. metabolism only
   4. both digestive tract and metabolism
   5. both the digestive tract and renal tubules
9. What regulates the rate of water loss?
   1. cardiovascular system
   2. lungs
   3. kidney
   4. skin
   5. digestive tract
10. What is the force that moves water out of the distal tubules and collecting ducts?
    1. the passive regulated movement through Na+/H2O transporter
    2. an osmotic gradient
    3. the active transport of water
    4. the passive unregulated movement along the paracellular pathway
    5. an alteration in temperature
11. A greater plasma volume than normal is called
    1. hypovolemia.
    2. fluid balance.
    3. normovolemia.
    4. equilibrium.
    5. hypervolemia.
12. If a person is normovolemic and consumes a large quantity of a hyperosmotic solution, it will
    1. cause cells to shrink due to a decrease in the osmolarity of extracellular fluid .
    2. cause cells to swell due to an increase in the osmolarity of extracellular fluid.
    3. have no effect on cell osmolarity and thereby cell size.
    4. cause cells to swell due to a decrease in the osmolarity of extracellular fluid.
    5. cause cells to shrink due to an increase in the osmolarity of extracellular fluid.

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13. Under which of the following conditions do cell volumes not change and the osmolarity in both extracellular and intracellular fluids remain the same?
    1. hypotonicity
    2. hypertonicity
    3. hypovolemia
    4. hypervolemia
    5. osmotic equilibrium
14. A student in your physiology lab is thirsty and decides to sneak a drink of deionized or distilled water. The student drinks a fairly large quantity of this water in a short period of time. What will happen to the

student's cells?

14. 1. Water is water, so it will not do anything to the student's cells.
    2. It will make the cells hypovolemic.
    3. It will cause the student's cells to swell.
    4. It is an isotonic solution, so water will enter and leave cells at the same rate.
    5. It will cause the student's cells to shrink.
15. Seawater has an osmolarity of around 1000 mOsm, mostly from dissolved sodium. Given what you know about the osmolarity in most of the cells in the body, why is it dangerous to drink seawater?
    1. In the cardiovascular system, the higher sodium levels would decrease the pressure in the arteries making it more difficult to get blood to the systemic capillaries.
    2. In membrane transport, the increased sodium concentration would slow down secondary active

transport of glucose into cells.

1. 3. In the nervous system, the additional extracellular sodium concentration would slow down the normal flow of sodium ions used to generate action potentials.
   4. In the digestive system, the seawater would draw more water out of the bloodstream than would be absorbed, leading to severe dehydration.
   5. In the renal system, the osmolarity of the medulla of the kidney would become even more concentrated.

16. Which of the following is NOT a mechanism of dissipating heat during exercise?
    1. convection
    2. evaporation
    3. radiation
    4. secretion of ADH
    5. conduction
17. Which of the following conditions is NOT indicative of a decrease in plasma osmolarity?
    1. neural hyperexcitability
    2. headache
    3. nausea
    4. confusion
    5. seizure  3
18. Kidneys compensate for changes in plasma volume and osmolarity by adjusting the rate of water
    1. reabsorption only.
    2. secretion only.
    3. resorption only.
    4. reabsorption and secretion.
    5. secretion and resorption.
19. What solute is primarily responsible for producing the osmotic gradient that drives water reabsorption?
    1. phosphate B) sodium C) chloride D) potassium E) calcium
20. Which of the following accurately describes the thick ascending limb of the loop of Henle?
    1. impermeable to water and contains Na+/K+/Cl- cotransporters
    2. impermeable to water and does NOT contain Na+/K+/Cl- cotransporters
    3. permeable to water and contains Na+/K+/Cl- cotransporters
    4. permeable to water in the presence of specific hormones
    5. permeable to water and does NOT contain Na+/K+/Cl- cotransporters
21. The osmotic gradient in the medullary region of the kidneys is established and maintained by which of the following?
    1. Na+/K+/Cl- cotransporters in the ascending limb of the loop of Henle
    2. Na+/K+/Cl- cotransporters in the descending limb of the loop of Henle
    3. efflux of water from the ascending limb of the loop of Henle
    4. efflux of Na+ from the descending limb of the loop of Henle
    5. efflux of water from the descending limb of the loop of Henle
22. If nothing else is removed from the filtrate once it reaches the late distal tubules, the urine excreted would have which of the following properties?
    1. low osmolarity and large volume
    2. low osmolarity and low volume
    3. devoid of ions and large volume
    4. high osmolarity and large volume
    5. high osmolarity and low volume

23. What solute maintains the medullary interstitial fluid osmotic gradient?
    1. urea
    2. sodium ions
    3. water
    4. glucose
    5. potassium ions

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24. Which of the following correctly describes water movement across the epithelial cells lining the collecting duct?
    1. Water can permeate the basolateral membrane through aquaporin-2 and the apical membrane through aquaporin-3, but aquaporin-2 is only present in the presence of aldosterone.
    2. Water can permeate the apical membrane through aquaporin-2 and the basolateral membrane through aquaporin-3, but aquaporin-2 is only present in the presence of ADH.
    3. Water can permeate the phospholipid bilayer only in the presence of aldosterone.
    4. Water can permeate the lipid bilayer at all times.
    5. Water can permeate the phospholipid bilayer only in the presence of ADH.
25. A person must void what volume of urine per day? A) 0 mL B) 15 mL C) 120 mL D) 440 mL E) 1200 mL
26. In the early portion of the collecting duct (in cortical interstitial fluid), an increase in water permeability will result in a(n)
    1. movement of water into the duct.
    2. increase in filtrate volume.
    3. efflux of urea from the tubule.
    4. decrease in filtrate volume.
    5. transport of sodium out of the tubule.
27. From where is ADH released?
    1. posterior pituitary
    2. pancreas
    3. distal tubule
    4. anterior pituitary
    5. collecting duct
28. Antidiuretic hormone binds to receptors on   cells in the collecting ducts and distal tubules where it

             .

28. 1. intercalated : causes vesicles with aquaporin-3 to insert into the apical membrane
    2. granular : causes vesicles with aquaporin-2 to insert into the apical membrane
    3. principal : causes vesicle with aquaporin-3 to insert into the apical membrane
    4. intercalated : causes vesicles with aquaporin-2 to insert into the basolateral membrane
    5. principal : causes insertion of aquaporin-2 into the apical membrane
29. At high concentrations of antidiuretic hormone, the extent of water reabsorption in the collecting ducts is

             , causing urine output to       .

1. 1. high : increase
   2. high : decrease
   3. low : increase
   4. low : decrease
   5. unaffected : remain unchanged

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30. What is the strongest stimulus for the release of antidiuretic hormone from the posterior pituitary?
    1. decrease in sodium content of the blood
    2. decrease in plasma osmolarity

30. 3. increase in plasma osmolarity
    4. increase in blood pressure
    5. decrease in blood pressure
31. In diabetes insipidus, blood levels of      are decreased causing an increase in  .
    1. aldosterone : potassium in the urine
    2. insulin : glucose in the urine
    3. ADH : urine volume
    4. aldosterone : sodium in the urine
    5. ADH : plasma volume
32. Which of the following diseases is associated with decreased responsiveness of the renal tubules to ADH?
    1. diabetes mellitus type 1
    2. diabetes mellitus type 2
    3. diabetic nephropathy
    4. nephrogenic diabetes insipidus
    5. central diabetes insipidus
33. In diabetes insipidus, why does polyuria occur?
    1. A lack of ADH decreases water reabsorption.
    2. Glucose transporters in the renal tubules become saturated.
    3. An increase in aldosterone increases water reabsorption.
    4. A lack of insulin decreases water permeability of the renal tubules.
    5. A lack of angiotensin II decreases thirst.
34. Which of the following conditions would be associated with hypernatremia?
    1. decreased plasma volume
    2. decreased plasma osmolarity
    3. hypotension
    4. increased plasma sodium
    5. increased plasma potassium
35. Which of the following statements on sodium movement in the renal tubules is TRUE?
    1. Sodium is actively secreted from the collecting duct.
    2. Sodium channels are located on the basolateral membrane of principal cells.
    3. Sodium reabsorption follows water reabsorption in all segments of the renal tubules.
    4. Sodium is actively transported across the basolateral membrane of both the proximal and distal tubule.
    5. Sodium is actively secreted from the proximal tubule.

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36. In the renal tubules, where is the Na+/K+ pump located?
    1. in the basolateral membrane of the proximal tubules
    2. in the apical membrane of the collecting ducts
    3. in both the apical and basolateral membranes of principal cells
    4. in the apical membrane of the descending limb of the loop of Henle
    5. in both the apical and basolateral membranes of intercalated cells
37. Which of the following best describes sodium movement in the proximal tubule?
    1. Sodium is transported across the apical membrane by the Na+/K+ pump and across the basolateral membrane by facilitated diffusion.
    2. Sodium is transported across the apical membrane by the Na+/K+ pump and across the basolateral membrane by diffusion through sodium channels.
    3. Sodium is transported across the basolateral membrane by the Na+/K+ pump and across the apical membrane by secondary active transport.
    4. Sodium is transported across the apical membrane by the Na+/K+ pump and across the basolateral

membrane by secondary active transport.

1. 5. Sodium is transported across the basolateral membrane by the Na+/K+ pump and across the apical membrane by diffusion through sodium channels.

38. Which of the following best describes sodium movement in the distal tubule?
    1. Sodium is transported across the basolateral membrane by the Na+/K+ pump and across the apical membrane by facilitated diffusion.
    2. Sodium is transported across the apical membrane by the Na+/K+ pump and across the basolateral membrane by diffusion through sodium channels.
    3. Sodium is transported across the apical membrane by the Na+/K+ pump and across the basolateral membrane by secondary active transport.
    4. Sodium is transported across the basolateral membrane by the Na+/K+ pump and across the apical membrane by diffusion through sodium channels.
    5. Sodium is transported across the apical membrane by the Na+/K+ pump and across the basolateral membrane by facilitated diffusion.

39. Aldosterone is released from the     in response to          .
    1. adrenal cortex : increases in plasma potassium
    2. pancreas : increases in plasma glucose
    3. posterior pituitary : increases in plasma osmolarity
    4. macula densa : increased flow of tubular fluid in the distal tubule
    5. adrenal medulla : decreases in plasma sodium
40. Which of the following is an effect of aldosterone on principal cells?
    1. decreased number of Na+/K+ pumps in the basolateral membrane
    2. increased number of open Na+/K+ channels in the basolateral membrane
    3. increased number of open Na+/K+ channels in the apical membrane
    4. increased number of Na+/K+ pumps in the apical membrane
    5. decreased number of open Na+/K+ channels in the basolateral membrane

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41. Which of the following is associated with actions of aldosterone on principal cells?
    1. increased sodium secretion
    2. decreased plasma osmolarity
    3. increased calcium reabsorption
    4. increased potassium secretion
    5. decreased blood pressure
42. Renin is released by         cells of the           .
    1. principal : afferent arteriole
    2. intercalated : afferent arteriole
    3. granular : afferent arteriole
    4. principal : distal tubule
    5. granular : distal tubule
43. What enzyme converts angiotensinogen into angiotensin I?
    1. renin
    2. mucin
    3. angiotensin converting enzyme (ACE)
    4. carbonic anhydrase
    5. atrial natriuretic peptide
44. What enzyme converts angiotensin I into angiotensin II?
    1. mucin
    2. angiotensin converting enzyme (ACE)
    3. renin

44. 4. carbonic anhydrase
    5. atrial natriuretic peptide
45. ACE inhibitors prevent angiotensin converting enzyme (ACE) from performing its role in the body. Which statement best describes why doctors prescribe ACE inhibitors?
    1. ACE inhibitors increase blood pressure by blocking the RASS pathway.
    2. ACE inhibitors slow down the heart rate by not allowing atrial natriuretic peptide (ANP) to be released from the heart, decreasing sodium production and, therefore, blood pressure.
    3. ACE inhibitors block the production of renin in the juxtaglomerular cells in the kidneys reducing fluid volume and, therefore, blood pressure.
    4. ACE inhibitors reduce blood pressure by blocking the conversion of angiotensin I to angiotensin II.
    5. ACE inhibitors block baroreceptors and reduce sympathetic activity to the cardiovascular system, thereby reducing blood pressure.

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46. Angiotensin II acts directly in the hypothalamus to stimulate what?
    1. a systemic increase in blood pressure
    2. an increase in body temperature
    3. the release of oxytocin
    4. the release of aldosterone
    5. an increase in thirst
47. Which of the following conditions triggers the release of renin?
    1. increased mean arterial pressure (MAP)
    2. high blood pressure
    3. increased sympathetic stimulation
    4. atrial stretching due to increased plasma volume
    5. low blood pressure
48. Angiotensinogen is synthesized by what organ?
    1. bone marrow
    2. adrenal gland
    3. kidney
    4. liver
    5. pituitary gland
49. What stimulates atrial natriuretic peptide release?
    1. changes in the concentration of sodium in the blood of the atrium
    2. distension of the atrial wall due to an increase in blood pressure
    3. changes in the concentration of potassium in the blood of the atrium
    4. distension of the atrial wall due to an increase in plasma volume
    5. renin
50. The primary function of atrial natriuretic peptide (ANP) is to
    1. decrease potassium secretion thereby increasing potassium reabsorption.
    2. increase sodium secretion thereby decreasing sodium reabsorption.
    3. increase the stretching capacity of the atria.
    4. increase potassium secretion thereby decreasing potassium reabsorption.
    5. decrease sodium secretion thereby increasing sodium reabsorption.
51. Atrial natriuretic peptide causes which of the following effects in principal cells?
    1. decreased number of open sodium channels in the apical membrane
    2. increase in glomerular filtration rate
    3. efferent arteriole dilation
    4. decreased activity of the Na+/K+ pump in the basolateral membrane
    5. afferent arteriole constriction

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52. The extent of potassium excretion is regulated primarily by the
    1. amount reabsorbed in the distal tubule.
    2. amount secreted into the proximal tubule.
    3. amount secreted into the distal tubule.
    4. amount reabsorbed into the proximal tubule.
    5. amount filtered by the basement membrane of the glomerular capillaries.
53. Hyperkalemia refers to an excess of what?
    1. potassium B) calcium C) chloride D) water E) sodium
54. Potassium secretion is regulated by
    1. parathyroid hormone (PTH).
    2. angiotensin I.
    3. aldosterone.
    4. atrial natriuretic peptide (ANP).
    5. renin.

55. Which of the following structures is NOT involved in the regulation of plasma calcium?
    1. skeletal muscle
    2. gastrointestinal tract
    3. kidneys
    4. skin
    5. bone
56. The bone can supply calcium to the plasma by what process?
    1. calcification
    2. reabsorption
    3. filtration
    4. resorption
    5. ossification
57. A decrease in plasma calcium will initiate an increase in the release of which of the following?
    1. parathyroid hormone only
    2. calcitonin only
    3. 1,25-dihydroxy vitamin D3 only
    4. both parathyroid hormone and calcitonin
    5. both parathyroid hormone and 1,25-dihydroxy vitamin D3

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58. Exposure of the skin to sunlight converts    to vitamin D3.
    1. calcitriol
    2. 25-OH D3
    3. calcium
    4. 7-dehydrocholesterol
    5. cholesterol
59. What form of osteoporosis would be localized to a specific bone?
    1. disuse osteoporosis
    2. primary osteoporosis
    3. secondary osteoporosis
    4. tertiary osteoporosis
    5. hyperosteoporosis
60. Which type of cell carries out bone formation?

60. 1. osteoclasts B) ossicles C) osteons D) osteoblasts E) osteocytes
61. Which type of cell carries out bone resorption?
    1. osteons B) ossicles C) osteoblasts D) osteocytes E) osteoclasts
62. Which statement best describes why estrogen may contribute to osteoporosis?
    1. A decrease in estrogen stimulates calcitonin secretion from the pituitary gland.
    2. A decrease in estrogen stimulates the production of interleukin-6 that then stimulates osteoclast activity.
    3. Estrogen is a steroid hormone that interferes with calcium resorption.
    4. A decrease in estrogen stimulates an increase in osteoblast activity due to the activation of 1,25-(OH2) D3.
    5. A decrease in estrogen causes a corresponding decrease in interleukin-6 that then lowers calcium levels.

63. The last step to synthesis of 1,25-dihydroxy vitamin D3 occurs in what organ?
    1. brain
    2. kidney
    3. gastrointestinal tract
    4. liver
    5. skin  11
64. What hormone decreases plasma calcium levels?
    1. calcitonin only
    2. 1,25-dihydroxy vitamin D3 only
    3. parathyroid hormone only
    4. both calcitonin and 1,25-dihydroxy vitamin D3
    5. both calcitonin and parathyroid hormone
65. The effects of antidiuretic hormone (ADH) are not restricted to regulating water movement; it also affects sodium reabsorption by
    1. decreasing the synthesis of sodium channels in principal cells.
    2. increasing the synthesis of sodium channels in intercalated cells.
    3. decreasing the synthesis of sodium channels in intercalated cells.
    4. increasing the synthesis of Na+/K+ pumps in principal cells.
    5. increasing the synthesis of sodium channels in principal cells.
66. Angiotensin II and atrial natriuretic peptide are able to alter the reabsorption of water through a similar pathway that involves altered
    1. integration of aquaporin-3 into the membrane.
    2. Na+/K+ pump activity in the intercalated cells.
    3. sodium channel expression on the apical membrane.
    4. Na+/K+ pump activity in the principal cells.
    5. release of antidiuretic hormone (ADH).
67. Which of the following is NOT a response to hemorrhage?
    1. increased angiotensin II production
    2. increased sympathetic activity
    3. increased epinephrine secretion
    4. increased ADH release
    5. decreased renin secretion
68. The hemorrhage-induced decrease in blood flow to the kidneys will
    1. increase the production of erythrocytes.
    2. increase the release of atrial natriuretic peptide.

68. 3. increase glomerular filtration rate.
    4. decrease the release of renin.
    5. increase the production of leukocytes.
69. The hydrogen ion concentration or pH of arterial blood is regulated by the combined actions of the                                                                                                                                                    

and             .

1. 1. kidneys : cardiovascular system
   2. lungs: buffer systems
   3. kidneys : lymphatic system
   4. kidneys : buffer systems
   5. lungs : kidneys

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70. The activity of the respiratory system can increase pH by
    1. a hyperventilation-induced decrease in PCO2.
    2. a hyperventilation-induced increase in PCO2.
    3. a hypoventilation-induced increase in PCO2.
    4. a hypoventilation-induced decrease in PCO2.
    5. increasing the amount of carbonic acid in the blood.
71. Which statement BEST distinguishes metabolic acidosis from respiratory acidosis?
    1. Metabolic acidosis occurs due to changes in blood glucose as opposed to changes in PO2 and PCO2.
    2. Metabolic acidosis occurs due to changes in PO2 as opposed to PCO2.
    3. Metabolic acidosis is a disturbance in blood pH caused by something other than an abnormal PCO2.
    4. Metabolic acidosis occurs due to changes in bicarbonate as opposed to PCO2.
    5. Metabolic acidosis is a disturbance in blood pH caused by exercise as opposed to hyper- or hypoventilation.

72. A person walks into the emergency room with rapid and shallow breathing and a feeling of

light-headedness. A blood test shows high levels of bicarbonate ions and a pH of 7.34. What could explain these symptoms?

72. 1. respiratory alkalosis with renal compensation
    2. acidosis with no compensation
    3. metabolic acidosis with respiratory compensation
    4. respiratory acidosis with renal compensation
    5. metabolic alkalosis with respiratory compensation
73. During hyperventilation, why do some people detect a tingling sensation in their hands and feet?
    1. an increase in carbon dioxide in blood
    2. hyperexcitability of afferent neurons
    3. a decrease in carbon dioxide in blood
    4. a decrease in blood flow to the distal extremities
    5. widespread release of catecholamines
74. Which of the following is NOT a metabolic disturbance that can result in a metabolic acidosis?
    1. high-fat diet
    2. high-protein diet
    3. excessive vomiting
    4. severe diarrhea
    5. heavy exercise

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75. What is the most rapid defense against changes in blood pH?
    1. respiratory compensation
    2. renal compensation
    3. cardiac compensation

75. 4. hepatic compensation
    5. buffering of hydrogen ions
76. How does severe diarrhea cause a metabolic acidosis?
    1. production of hydrogen ions
    2. production of bicarbonate
    3. loss of hydrogen ions
    4. loss of phosphate
    5. loss of bicarbonate
77. How does severe vomiting cause a metabolic alkalosis?
    1. production of bicarbonate
    2. loss of hydrogen ions
    3. loss of phosphate
    4. loss of bicarbonate
    5. production of hydrogen ions
78. How might a high-protein diet cause metabolic acidosis?
    1. direct production of hydrogen ions
    2. production of phosphoric acid and sulfuric acid
    3. loss of phosphate
    4. loss of hydrogen ions
    5. loss of bicarbonate
79. How might heavy exercise cause metabolic acidosis?
    1. loss of phosphate
    2. direct production of hydrogen ions
    3. loss of bicarbonate
    4. loss of hydrogen ions
    5. production of lactic acid
80. How might a high-fat diet cause metabolic acidosis?
    1. direct production of hydrogen ions
    2. breakdown of fat into fatty acids
    3. loss of bicarbonate
    4. loss of phosphate
    5. loss of hydrogen ions

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81. Which of the following ions acts as a buffer to minimize changes in intracellular pH?
    1. sodium B) potassium C) chloride D) phosphate E) bicarbonate
82. The role of a buffer is to
    1. reduce the reabsorption of hydrogen ions in the kidneys.
    2. limit the change in pH with changing hydrogen ion concentrations.
    3. enhance the ability of an increase in hydrogen ions to increase pH.
    4. reduce the secretion of bicarbonate ions in the kidneys.
    5. reduce the secretion of hydrogen ions in the kidneys.
83. What is the secondary defense against changes in pH that requires minutes to be activated?
    1. buffering of hydrogen ions
    2. renal compensation
    3. hepatic compensation
    4. respiratory compensation
    5. cardiac compensation

84. Respiratory compensation for changes in pH is originated by
    1. directly affecting the activity of the diaphragm.
    2. baroreceptors.
    3. central chemoreceptors.
    4. proprioceptors.
    5. peripheral chemoreceptors.
85. When an increase in hydrogen ions remains after one hour, this will lead to a(n)
    1. increase in hydrogen ion secretion from the kidneys.
    2. increase in bicarbonate secretion in the kidneys.
    3. failure of the kidneys to filter any more hydrogen ions.
    4. decrease in bicarbonate reabsorption in the kidneys.
    5. increased hydrogen reabsorption in the kidneys.
86. The most important buffer system in the extracellular fluid is
    1. carboxyl groups.
    2. monoprotonated phosphates.
    3. bicarbonate.
    4. chloride.
    5. amino acids.
87. If hydrogen ions are added to a solution, the pH will
    1. increase. B) decrease. C) remain the same.

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88. If hydrogen ions are taken out of a solution, the pH will
    1. increase. B) decrease. C) remain the same.
89. Which of the following is an effect of the transporters in the proximal tubules?
    1. reabsorption of bicarbonate
    2. secretion of urea
    3. reabsorption of hydrogen
    4. secretion of sodium
    5. secretion of potassium
90. In the basolateral membrane of proximal tubular cells, bicarbonate is moved out of the cells by
    1. K+/HCO3- countertransporters only.
    2. HCO3-/Cl- countertransporters only.
    3. Na+/HCO3- cotransporters only.
    4. both K+/HCO3- and HCO3-/Cl- countertransporters.
    5. both HCO3-/Cl- countertransporters and Na+/HCO3- cotransporters.
91. In the proximal tubule, hydrogen ions are transported into the filtrate by
    1. Na+/H+countertransporters only.
    2. H+ primary active transporters only.
    3. H+/Cl- cotransporters only.
    4. both Na+/H+ countertransporters and H+ primary active transporters.
    5. both Na+/H+ countertransporters and H+/Cl- cotransporters.
92. Bicarbonate crosses the apical membrane of the proximal tubule by
    1. Na+/HCO3- cotransporters.
    2. conversion to carbon dioxide.
    3. HCO3-/Cl- countertransporters.
    4. HCO3- active transporters.
    5. Na+/HCO3- countertransporters.

93. Under severe acidic conditions, the proximal tubules can convert        into bicarbonate.
    1. glutamine
    2. lysine
    3. carbon monoxide
    4. glycine
    5. glutamate  16
94. In order to compensate for a hyperventilation, the
    1. kidneys decrease the reabsorption of bicarbonate.
    2. kidneys increase the reabsorption of hydrogen ions.
    3. lungs increase ventilation rate.
    4. kidneys increase the secretion of hydrogen ions.
    5. kidneys increase the conversion of glutamine to bicarbonate.
95. A patient is exhibiting several signs of acid-base imbalance. Blood tests reveal that blood pH is 7.3, and bicarbonate and carbon dioxide levels in blood are both low. What is the state of this patient?
    1. metabolic alkalosis with respiratory compensation
    2. respiratory acidosis with renal compensation
    3. respiratory alkalosis with renal compensation
    4. metabolic acidosis with respiratory compensation
    5. Blood pH is normal.
96. A patient is exhibiting several signs of acid-base imbalance. Blood tests reveal that blood pH is 7.5, and bicarbonate and carbon dioxide levels in blood are both low. What is the state of this patient?
    1. metabolic acidosis with respiratory compensation
    2. metabolic alkalosis with respiratory compensation
    3. respiratory alkalosis with renal compensation
    4. respiratory acidosis with renal compensation
    5. Blood pH is normal.
97. What hormone activates the cAMP second messenger system in principal cells of the distal tubules and collecting ducts?
    1. ADH
    2. aldosterone
    3. angiotensin II
    4. atrial natriuretic peptide
    5. parathyroid hormone
98. What hormone increases water reabsorption by inserting aquaporin-2 proteins into the apical membrane of principal cells?
    1. ADH
    2. aldosterone
    3. angiotensin II
    4. atrial natriuretic peptide
    5. parathyroid hormone

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99. What hormone stimulates the release of aldosterone?
    1. ADH
    2. aldosterone
    3. angiotensin II
    4. atrial natriuretic peptide
    5. parathyroid hormone
100. Release of what hormone is stimulated by high levels of potassium?

1. ADH
2. aldosterone
3. angiotensin II
4. atrial natriuretic peptide
5. parathyroid hormone

101. What hormone decreases calcium levels in blood?

1. aldosterone
2. angiotensin II
3. calcitonin
4. parathyroid hormone
5. ADH

102. What hormone increases calcium resorption from bone?

1. ADH
2. aldosterone
3. angiotensin II
4. atrial natriuretic peptide
5. parathyroid hormone

103. What hormone increases excretion of sodium?

1. ADH
2. aldosterone
3. angiotensin II
4. atrial natriuretic peptide
5. parathyroid hormone

104. Most sodium reabsorption is driven by the Na+/K+ pump located in what region?

1. principal cells apical membrane
2. principal cells basolateral membrane
3. proximal tubule apical membrane
4. intercalated cells basolateral membrane
5. proximal tubule basolateral membrane

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105. Aquaporin-3 is located on what membrane in the absence of ADH?

1. intercalated cells basolateral membrane
2. proximal tubule basolateral membrane
3. principal cells basolateral membrane
4. proximal tubule apical membrane
5. principal cells apical membrane

106. Receptors for ADH are located where?

1. principal cells basolateral membrane
2. principal cells apical membrane
3. intercalated cells basolateral membrane
4. proximal tubule basolateral membrane
5. proximal tubule apical membrane

107. Potassium channels located where are necessary for its reabsorption?

1. proximal tubule basolateral membrane
2. principal cells basolateral membrane
3. proximal tubule apical membrane
4. intercalated cells basolateral membrane
5. principal cells apical membrane

108. Potassium channels located where are necessary for its secretion?

1. intercalated cells basolateral membrane
2. proximal tubule apical membrane
3. proximal tubule basolateral membrane
4. principal cells basolateral membrane
5. principal cells apical membrane

109. Carbonic anhydrase is located where?

1. proximal tubule apical membrane
2. principal cells apical membrane
3. intercalated cells basolateral membrane
4. principal cells basolateral membrane
5. proximal tubule basolateral membrane

110. Sodium-glucose cotransporters are located where?

1. principal cells apical membrane
2. proximal tubule basolateral membrane
3. principal cells basolateral membrane
4. proximal tubule apical membrane
5. intercalated cells basolateral membrane

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111. ADH increases the insertion of aquaporin-2 where?

1. intercalated cells basolateral membrane
2. proximal tubule basolateral membrane
3. principal cells basolateral membrane
4. principal cells apical membrane
5. proximal tubule apical membrane

112. Aldosterone increases the number of potassium channels where?

1. principal cells apical membrane
2. intercalated cells basolateral membrane
3. proximal tubule basolateral membrane
4. proximal tubule apical membrane
5. principal cells basolateral membrane

113. What would the following blood values indicate? Blood pH = 7.3, [HCO3-] is low, PCO2 is low.

1. metabolic alkalosis with respiratory compensation
2. respiratory acidosis with renal compensation
3. respiratory alkalosis with renal compensation
4. metabolic acidosis only
5. metabolic acidosis with respiratory compensation

114. What would the following blood values indicate? Blood pH = 7.3, [HCO3-] is high, PCO2 is high.

1. respiratory alkalosis with renal compensation
2. respiratory acidosis with renal compensation
3. metabolic acidosis only
4. metabolic alkalosis with respiratory compensation
5. metabolic acidosis with respiratory compensation

115. What would the following blood values indicate? Blood pH = 7.5, [HCO3-] is high, PCO2 is high.

1. respiratory alkalosis with renal compensation
2. metabolic alkalosis with respiratory compensation
3. metabolic acidosis with respiratory compensation
4. respiratory acidosis with renal compensation
5. metabolic acidosis only

116. The recovery of water from the filtrate that enters Bowman's capsule is an important function of the kidneys.

Describe the mechanisms whereby water is reabsorbed in each segment of the renal tubules. Include the cellular mechanisms that allow antidiuretic hormone (ADH) to modulate reabsorption and that regulate the release of ADH.

117. The recovery of sodium from the filtrate that enters Bowman's capsule is an important function of the kidneys. Describe the mechanisms for sodium reabsorption in the distal tubules and collecting ducts and the

hormonal mechanisms involved in its regulation.

118. The recovery of potassium from the filtrate that enters Bowman's capsule is an important function of the kidneys. Describe the mechanisms whereby potassium is secreted and/or reabsorbed in each segment of the kidney tubules.
119. The maintenance of plasma calcium has important implications. Describe the mechanisms whereby plasma calcium concentrations are regulated by hormones.
120. Hormonal regulation plays an important role in the long-term control of blood pressure. Identify the hormones outlined in this chapter that play a role in the long-term regulation of blood pressure, how those hormones are regulated, and the mechanisms they use to affect blood pressure.
121. The balance of acid and base within the blood plays an important role in a number of bodily functions. How do changes in the pH of the blood affect bodily functions?
122. Acid-base balance is regulated by a number of systems. Describe the sources of respiratory acidosis and alkalosis as well as metabolic acidosis and alkalosis.
123. Changes in acid-base balance are continuously occurring. The body must adjust to those changes through three mechanisms that differ in their ability to affect pH and in their time courses. Describe the three mechanisms that respond to changes in blood pH and their temporal course.
124. Renal compensation is the final mechanism for the reversal of pH change within the body. Describe the mechanisms that underlie renal compensation, including the proteins involved in hydrogen and bicarbonate transport within the proximal and distal tubules. Include mechanisms for synthesis of new bicarbonate.
125. Diagnosis of the source of an acid-base disturbance is important for determining the cause of the change in pH. Identify the characteristics of the acid-base disturbances and how the body would respond to those

changes.