Pt Gi and Renal Exam

PLE: GASTROINTESTINAL AND RENAL PHYSIOLOGY 1. Not true about movements in the gastrointestinal tract: a. Propulsive movement causes food to move forward along the tract at an appropriate rate for digestion and absorption b. Pyloric pump is the intense antral peristaltic contractuins during stomach emptying c. Mixing movement in the large intestine is called as haustration d. Segmentation is the mixing movement in the stomach e. None of these 2. The following statements correctly describe Bile, except: a. It is secreted by gallbladder b. It is relevant in fat digestion and absorption through emulsification of large fat particles c. Bile also serves as a means for excretion of waste products from blood, this includes bilirubin and cholesterol d. All of these e. None of these 3. The following statement/s correctly describe/s the stages of swallowing, except: I. During the pharyngeal stage, the food bolus is propelled from the mouth into the esophagus without involvement of airways II. The food is squeezed or rolled posteriorly into the pharynx by the pressure of the tongue this happen during the voluntary stage III. Esophageal stage is characterized by: closed trachea, opened esophagus, fast peristalsis in the pharynx

IV.

forces the bolus to move into upper esophagus During the esophageal stage, 2 peristaltic movement occurs, the primary and the secondary. The former is distention of esophagus and the latter is continuation of the movement which has occurred in the pharynx a. I,III b. II,IV c. III,IV d. II,III e. I,II

4. The vitamin that is essential for wound healing a. Vit A b. Vit B c. Vit C d. Vit D 5. Digestion of lactose results in: a. molecules of fructose b. molecules of glucose + 1 molecule of fructose c. molecules of glucose + 1 molecule of sucrose d. molecules of glucose e. molecules of glucose + 1 molecule of glucose 6. This vitamin is best absorbed in the ileum a. E b. K c. B12 d. C e. A 7. Stimulation of mass movements after ingestion of a normal meal is called a. Ileal break b. Gastrocolic Reflex c. Enterogastric reflex d. Gastrosphicteric Reflex e. Rectrosphincteric Reflex

8. True about the electrical activity of gastrointestinal smooth muscle: a. Oscillations of resting potentials of the GI Smooth Muscle not associated with muscle contraction is called as fast waves and it does not occur in the stomach b. The difference between the electrical activity of the GI smooth fibers and nerve fibers, in the former, action potential is the influx of large number of calcium ions and small number of sodium ions c. Spike potentials are true action potentials and they do occur when the RMP of smooth muscle becomes more positive than about -40mV d. All of these e. None of these 9. A common manifestation of Vit A deficiency is a. bleeding b. muscle cramps c. sensory deficits d. night blindness 10. The hallmark of Vit K deficiency is a. blindness b. hemmorhagic manifestation c. cheilosis d. cardiovascular dysfunction 11. Glucose is primarily absorbed by this transport process a. Secondary active transport b. Primary active transport c. Complex diffusion d. Simple diffusion e. Facilitated diffusion 12. The chemical substance that will activate trypsinogen into trypsin is a. Enterokinase b. Protein c. Cl- ion

d. Intestinal Lipase e. Hydrochloric Acid 13. Stomach emptying is promoted by the intense peristaltic contractions of a. Pyloric Antrum b. Pyloric Canal c. Distal body d. Fundus e. Proximal Body 14. Which of the following gives signals from the colon and small intestine to inhibit stomach motility and secretion a. Presence of any irritant on the gastric mucosa b. Degree of duodenal distention c. Degree of acidity of the duodenal chyme in the upper intestine d. Presence of protein breakdown or certain breakdown products in the chyme e. All of these 15. Which of the following meal will be emptied first? a. 300 cal semi solid high proteins b. 300 cal liquid high carbohydrates c. 300 cal liquid high protein d. 300 cal solid high protein e. 300 cal solid high carbohydrates 16. Normally, the movement of the contents of the gastrointestinal tract is slowest along this segment a. mouth b. large intestine c. esophagus d. small intestine e. stomach 17. Digestion of food involves the process of a. Hydrolysis b. Conjugation c. Condensation d. Mastication e. Decarboxylation

18. This structure regulates the flow of material into the colon a. Ileocecal sphincter b. Pyloric Sphincter c. Appendix d. Sigmoid Colon e. Anal Canal

24. The ascending loop of Henle is impermeable to a. Urea b. Water c. Albumin d. Sodium e. Chloride

19. The nutritional disorder is characterized by marasmus a. Protruding abdomen b. Diffuse pigmentation of the skin c. Pitting edema d. Emaciation and old face

25. Which of the following event will lead to diluted urine? a. There is high level of antidiuretic hormone when the tubular fluid leaves the collecting duct b. When the thick ascending loop of henle, distal convoluted tubule and collecting duct reabsorbs more solute than water c. Both A and B are correct d. Both A and B are correct

20. Bacterial activity in the colon is responsible for the formation of several necessary substances. Among them are the following, except: a. Vitamin C b. Vitamin K c. Vitamin B12 d. Riboflavin 21. True about the following statements: a. All solutes are impermeable to descending loop of Henle except the urea b. Thick ascending loop of Henle is permeable to water c. Thin descending loop of Henle is impermeable to water d. A and B e. B and C 22. Drooping/ Inferior displacement of kidney is termed as a. Bright’s disease b. Polypeptic Kidney disease c. Glomerulonephritis d. Nephroptosis 23. Secretion of H+ takes place in which of the following a. proximal convoluted tubules b. collecting duct c. distal convoluted tubule d. ascending limb of loop of henle

26. Which of the following does not correctly describe urinary incontinence? a. Stress incontinence is the most common type in young mid-aged female characterized by leakage of urine as a result of increase abdominal pressure caused by laughing, sneezing and coughing due to weak pelvic floor muscles b. Urge incontinence is most common in children, characterized by abrupt and intense urge to urinate followed by an involuntary loss of urine c. Overflow incontinence is characterized by dribbling out of small amount of urine caused by a blockage or weak urinary bladder muscle contraction d. Functional incontinence is described as loss of urine resulting from inability to get to a toilet due to neurological diseases, arthritis and Alzheimer’s disease

27. Which is the correct order of filtrate flow? a. LOH, Glomerular capsule, PCT, DCT, Collecting Duct b. Ascending limb of LOH, PCT, DCT, Collecting Duct c. Glomerular capsule, PCT, Loop of Henle, DCT, Collecting Duct d. Collecting Duct, DCT, PCT, Collecting Duct, Glomerular Capsule e. PCT, Glomerular Capsule, DCT, Collecting Duct, Loop of Henle 28. The normal amount of residual urine a. 50 cc b. 10-20 cc c. none d. 20-30 cc 29. The most dilute luminal fluid in the presence of anti-diuretic hormone is found in the a. proximal tubule b. proximal convoluted tubule c. thick ascending limb of loop of henle d. distal convoluted tubule e. thin ascending limb of loop of henle 30. Which of the following bladder functions can be voluntarily controlled? a. Relaxation of internal sphincter muscle b. Contraction of internal sphincter muscle c. Contraction of external sphincter muscle d. Generation of Micturition Reflex e. Intramural Ureters 31. True about hormonal regulation of GFR a. Angiotension II is a potent vasoconstrictor which reduces the renal blood flow therefore increasing the amount of GFR

b. Cells in the atria, specifically the atrial natriuretic peptide increases GFR by increasing the capillary surface area in the glomerulus c. Both A and B d. Neither A nor B 32. Which of the following stimuli trigger the release of Angiotensin II a. Low Blood Pressue b. Low Blood Volume c. Increase Plasma K+ d. Decreased level of plasma Ca2+ e. None of these 33. The proximal convoluted tubules reabsorb what percentage of filtered water? a. 25% b. 50% c. 65% d. 80% e. 99% 34. Concentration of the luminal fluid occurs at the a. proximal convoluted tubules b. collecting duct c. distal convoluted tubule d. dispersing tubule e. thick ascending limb of the loop of Henle 35. Normal glomerular filtration rate a. 110 ml/ min for both male and females b. 125 ml/min for both males and females c. 135 ml/min for males and 120 ml/min for females d. 115 ml/min for males and 100 ml/min for females e. 125 ml/min for males and 105 ml/min for females 36. The most important factor giving rise to a concentrated urine is the presence of the

a. b. c. d.

distal convoluted tubule proximal tubule anti-diuretic hormone well-developed zonula occludens at the collecting tubule e. non-reabsorbable solute in the lumen of the collecting tubule 37. The kidneys contribute to the acidbase regulation along with the lungs and body fluid buffers by excreting acids and by regulating the body fluid buffer stores. The kidneys are the only means of eliminating from the body certain types of acids, such as sulfuric acid and phosphoric acid generated by the metabolism of proteins. a. 1st statement is true, 2nd is false b. 1st statement is flase, 2nd is true c. Both statements are true d. Neither is true 38. Which of the following is/are not true about the function of kidneys? a. The kidneys secrete erythropoietin, which stimulates the production of RBCs b. One important stimulus for erythropoietin secretion by kidneys is hypoxia c. The kidneys normally account for half of the erythropoietin secreted into the circulation, the other half is performed by the liver and spleen d. In people with severe kidney disease or who have had their kidneys removed and have ben placed on hemodialysis, severe anemia develops as a result of decreased erythropoietin production e. None of these 39. Which of the following is true? a. Urinary excretion = Glomerular filtration + Tubular reabsorption – Tubular secretion

b. Urinary excretion = Glomerular filtration + Tubular reabsorption + Tubular secretion c. Urinary excretion = Glomerular filtration - Tubular reabsorption + Tubular secretion d. Urinary excretion = Glomerular filtration - Tubular reabsorption – Tubular secretion 40. True about micturition reflex a. Mediated by S1-S4 spinal segments b. When the urine exceeds 100-200 ml, stretch receptor will send signal to the higher center indicating that the person needs to micturate c. Both A and B are correct d. Both A and B are incorrect 41. The chemical substance that will activate pepsinogen into pepsin is enterokinase. The pancreatic amylases found in the small intestine breakdown carbohydrates a. 1st statement is true, 2nd is false b. 1st statement is false, 2nd is true c. Both are true d. Both are false 42. Of the total volume of water presented to GIT per 24 hours, the largest bulk is absorbed by the small intestine. Normally, the movement of the contents of the GIT is slowest along the large intestine. a. 1st statement is true, 2nd is false b. 1st statement is true, 2nd is false c. Both are true d. Both are false 43. True regarding the movement and propulsive activity in the GIT: a. Churning is termed as the propulsive activity in the stomach b. Segmentation is the movement of bolus inside the small intestine

c. Both are true d. Neither A nor B 44. Which of the following will be emptied last? a. 300 cal semi solid high proteins b. 300 cal liquid high carbohydrates c. 300 cal liquid high protein d. 300 cal solid high protein e. 300 cal solid high carbohydrates 45. The following stimulate enterogastric reflex, except: a. Duodenal enzyme activity b. None of these c. Duodenal irritation d. Duodenal distention e. All of these 46. The ability of the stomach to accommodate food and fluid without significant increase in pressure is known as: a. Repetitive Relaxation b. Perceptive Relaxation c. Retropulsion d. Tone e. Sleeving function 47. During defecation, an individual has voluntary control over motor activities of his/her: a. Internal anal sphincter b. External anal sphincter c. Sigmoid colon d. Rectum 48. Which of the following factors give signals to the colon and small intestine to inhibit stomach motility, except: a. Presence of any irritant in the gastric mucosa b. Degree of duodenal distention c. Degree of acidity of the duodenal chime in the upper intestine d. Presence of protein breakdown or certain breakdown products in the chime

e. Secretion degree of the osmolality of the chime 49. The normal amount of residual volume of urine is 50 cc. The normal bladder capacity is about 400-600 ml. a. 1st statement is true, 2nd statement is false b. 1st statement is false, 2nd statement is true c. Both are true d. Both are false 50. The most diluted luminal fluid in the presence of ADH is found in the: a. Proximal tubule b. Distal convoluted tubule c. Proximal convoluted tubule d. Thin ascending limb of loop of Henle e. Thick ascending limb of loop of Henle 51. The early distal convoluted tubules reabsorb what percentage of filtered water? a. 5 % b. 15 % c. 65 % d. 80 % e. 99 % 52. Concentration of the luminal fluid occurs at the: a. Proximal convoluted tubule b. Collecting Duct c. Distal Convoluted Tubule d. Dispersing Tubule e. Thick ascending limb of loop of Henle 53. Secretion of H* takes place in which of the following: a. Proximal convoluted tubules b. Collecting duct c. Distal convoluted tubule d. Ascending limb of loop of henle

54. GFR is greatest at the: a. Proximal third b. Middle and distal third c. Distal third d. Middle third 55. Area that has the most concentrated urine a. Proximal tubule b. Thick descending segment of the loop of Henle c. Thin descending segment of loop of Henle d. Distal tubule 56. Area that has the most diluted urine a. Proximal tubule b. Thick descending segment of the loop of Henle c. Thin descending segment of loop of Henle d. Distal tubule 57. The indented medial side of the kidney where the renal artery and vein, lymphatics, nerve supply and ureter passes through going to the renal bladder a. Renal Calyx b. Renal Hilum c. Renal Medulla d. Renal Pelvis 58. Which of the cells in the glomerulus does form the mechanical barrier to filtration? a. Basement membrane b. Endothelial c. Podocytes d. Mesangeal Cells e. All of these f. None of these 59. This segment of the nephron which is permeable to water is the: a. Proximal tubule b. Thin descending loop of Henle c. Thin ascending limb of loop of Henle

d. Distal convoluted tubule 66. Filtration of small substances in the blood takes place in which of the following structures? a. Loop of Henle b. Bowman’s Capsule c. Glomerulus d. Proximal Convoluted Tubules 67. In order for a particular ion to be excreted in the urine, what process/s should take place? a. Tubular secretion b. Tubular filtration c. Tubular reabsorption d. All of these 68. Filtered glucose and amino acids are reabsorbed in which of the following structures? a. Loop of Henle b. Proximal Convoluted Tubule c. Distal Convoluted Tubule d. Glomerulus 69. The osmotic gradient in the medullary interstitium is maintained because: I. The vasa recta is only to water and not to solutes II. The oncotic concentration in the vasa recta decreases from the cortex to the medulla III. The rate of fluid is slower than the tubules IV. The flow of fluid in the ascending extremities of the vasa recta is perpendicular but along the same direction V. The direction of fluid in descending and ascending limb of vasa recta is parallel and counter to each other. a. I,III b. II, IV c. III, V d. II,V e. V only

70. The kidneys are paired, bean-shaped structures located outside the peritoneal cavity and at the level of: a. T8-T10 b. T12-L2 c. L1-L2 d. L2-L3 80. Belching (Eructation) a. Is the involuntary/ voluntary release of gas from stomach or esophagus b. It occurs most frequently after meals when gastric distention results in transient lower esophageal sphincter (LES) relaxation c. Is a normal reflex and does not itself denote gastrointestinal dysfunction d. AOTA e. NOTA 81. Flatus a. Is derived from 2 sources: swallowed air and bacterial fermentation of undigested carbohydrate b. Swallowed air may contribute up to 500 ml of flatus per day (primarily nitrogen) c. Bacterial fermentation of undigested carbohydrates leads to the additional production of gas, particularly H2, CO2, and Methane. d. AOTA e. NOTA 82. The following factors will inhibit ADH secretion a. Increase blood volume b. Increase plasma osmolality c. Increase serum sodium d. Decrease plasma concentration e. Stress 83. Which of the following factors will stimulate the enterogastric reflex? a. Duodenal enzyme activity b. All of these c. Duodenal irritation d. Duodenal distention e. None of these

84. The most important substance regulating blood pressure that is produced by the kidney is: a. Vasopressin b. Renin c. Atrial Natriuretic hormone d. Prostaglandin e. Progesterone 85. The glomerulus and Bowman’s capsule is collectively referred to as the: a. juxtaglemorular apparatus b. renal corpuscle c. macula densa d. mesangium 86. As blood passes along the glomerular capillaries from the afferent to efferent arteriole, the net filtration pressure: a. increases b. decreases c. first decreases, reaches a minimum about half way along the capillary, then increases d. first increases, reaches a maximum about half way along the capillary, then decreases 87. Drinking vodka (a beverage with a high ethanol content, for those of you unfamiliar with this substance) would be expected to cause excretion of a a. large volume of concentrated urine b. small volume of concentrated urine c. large volume of diluted urine d. small volume of dilute urine 88. The function of urea is to eliminate what by product of metabolism? a. a creatinine b. lactic acid c. Nitrogen d. Co2

89. What portion of the kidney does the loop of Henle of the juxtaglomerular nephron “dip” into? a. cortex b. renal pyramid c. Medulla d. minor calyx 90. The fluid in the bowman’s space is similar to plasma EXCEPT that it does not contain a significant amount of— a. sodium b. Hydrogen c. Albumin d. Glucose 91. If you took a drug that inhibited the sodium reabsorption in the proximal tubule, you will: a. have an increased urine output b. have a decreased urine output c. have a decreased tubular fluid osmolality d. have an increased peritubular capillary osmolality 92. Increasing the length of which of the nephron segments below will increases the ability of the kidney to conserve water and concentrate the solutes excreted in the urine? a. proximal tubule b. Loop of Henle c. Distal Tubule d. Collecting Duct 93. At which sites would the concentration of creatinine be expected to be highest? (Note: assume the person is normally hydrated) a. glomerular filtrate b. end of proximal tubule c. end of loop of Henle d. urine 94. Stimulation of the osmoreceptors in the hypothalamus would be expected to cause all of the following

to increase EXCEPT: a. ADH release from the pituitary b. water reabsorption from the renal collecting duct c. rate of urine formation d. urine osmolality 95. The macula densa communicates with what structure to respond to low blood pressure and eventually release renin? a. Juxtaglomerular cells b. Goormatigh cells c. Lacis cells d. principal cells 96. The rate of water reabsorption from the proximal tubule is determined primarily by a. rate of dissolved particle (solute) reabsorption from the proximal tubule b. concentration of ADH (antidiuretic hormone) in the blood c. osmotic pressure developed by plasma proteins in the proximal tubule d. active transport of water molecules by the proximal tubule cells 97. As fluid passes along a juxtamedullary nephron, where is its osmolality (total concentration of dissolved particles) lowest? (Note: assume a normal concentration of circulating ADH) a. Bowman’s capsule (glomerular filtrate) b. fluid leaving the proximal tubule and entering the loop of Henle c. fluid leaving the descending thin limb & entering the ascending thin limb of the loop of Henle d. fluid leaving the thick ascending segment of the loop of Henle and entering the distal tubule 98. Urea has a higher concentration in the fluid that leaves the proximal tubule (and enters the loop of Henle) than in blood plasma because:

a. urea is synthesized by proximal tubule cells b. urea is secreted into the proximal tubule c. urea is reabsorbed from the proximal tubule but at a lesser rate that water is reabsorbed d. urea diffuses back into the proximal tubule because of the high urea concentration in the renal medulla 99. An increase secretion of renin would be expected to have what effect on sodium excretion and potassium excretion in urine? A. increase in Na+ excretion and increase K+ excretion B. increase in Na+ excretion and decrease K+ excretion C. decrease in Na+ excretion and increase K+ excretion D. decrease in Na+ excretion and decrease K+ excretion 100. In the concept of renal clearance, the maximum clearance rate for a substance that is totally cleared from the plasma is equal to which of the following parameters? a. glomerular filtration rate b. filtered load of a substance c. filtration fraction d. renal plasma flow “Therefore I tell you, whatever you ask in prayer, believe that you have received it, and it will be yours. Mark 11:24