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Chapter 37: Structure and Function of the Renal and Urologic SystemsMULTIPLE CHOICE1.            The area of the kidneys that contains the glomeruli and portions of the tubules is called the:a.            Medulla               c.             Pyramidsb.            Cortex  d.            Columns                2.            What is the functional unit of the kidney called?a.            Glomerulus        c.             Collecting ductb.            Nephron              d.            Pyramid                3.            Which cells have phagocytic properties similar to monocytes and contract like smooth muscles cells, thereby influencing the glomerular filtration rate?a.            Principle cells     c.             Mesangial cellsb.            Podocin cells      d.            Intercalated cells                4.            The only surface inside the nephron where cells are covered with microvilli to increase the reabsorptive surface area is called the:a.            Proximal convoluted tubules      c.             Ascending loop of Henleb.            Distal tubules     d.            Descending loop of Henle                5.            What part of the kidney controls renal blood flow, glomerular filtration, and renin secretion?a.            Macula densa    c.             Juxtaglomerular apparatus (JGA)b.            Visceral epithelium         d.            Filtration slits                6.            Kidney stones in the upper part of the ureter would produce pain referred to which anatomical area?a.            Vulva or penis   c.             Thighsb.            Umbilicus            d.            Lower abdomen                7.            Innervation of the bladder and internal urethral sphincter is supplied by which nerves?a.            Peripheral nerves            c.             Sympathetic nervous systemb.            Parasympathetic fibers d.            Tenth thoracic nerve roots                8.            How much urine accumulates in the bladder before the mechanoreceptors sense bladder fullness?a.            75 to 100 ml        c.             250 to 300 mlb.            100 to 150 ml      d.            350 to 400 ml                9.            What is the trigone?a.            A smooth muscle that comprises the orifice of the ureterb.            The inner mucosal lining of the kidneysc.             A smooth triangular area between the openings of the two ureters and the urethrad.            One of the three divisions of the loop of Henle                10.          The glomerular filtration rate is directly related to which factor?a.            Perfusion pressure in the glomerular capillariesb.            Diffusion rate in the renal cortexc.             Diffusion rate in the renal medullad.            Glomerular active transport                11.          On average, what percent of cardiac output do the kidneys receive?a.            10% to 20%         c.             20% to 25%b.            15% to 20%         d.            30% to 35%                12.          What effects do exercise and body position have on renal blood flow?a.            Exercise and body position activate renal parasympathetic neurons and cause mild vasoconstriction.b.            They activate renal sympathetic neurons and cause mild vasoconstriction.c.             Both activate renal parasympathetic neurons and cause mild vasodilation.d.            They activate renal sympathetic neurons and cause mild vasodilation.                13.          Blood vessels of the kidneys are innervated by the:a.            Vagus nerve       c.             Somatic nervous systemb.            Sympathetic nervous system     d.            Parasympathetic nervous system                14.          When renin is released, it is capable of which action?a.            Inactivation of autoregulationb.            Direct activation of angiotensin IIc.             Direct release of antidiuretic hormone (ADH)d.            Formation of angiotensin I                15.          What effect do natriuretic peptides have during heart failure when the heart dilates?a.            Stimulates antidiuretic hormones.           c.             Stimulates renin and aldosterone.b.            Inhibits antidiuretic hormones.  d.            Inhibits renin and aldosterone.                16.          What is the direct action of atrial natriuretic hormone?a.            Sodium retention            c.             Water retentionb.            Sodium excretion            d.            Water excretion                17.          What term is used to identify the movement of fluids and solutes from the tubular lumen to the peritubular capillary plasma?a.            Tubular secretion             c.             Tubular reabsorptionb.            Ultrafiltration     d.            Tubular excretion                18.          How high does the plasma glucose have to be before the threshold for glucose is achieved?a.            126 mg/dl            c.             180 mg/dlb.            150 mg/dl            d.            200 mg/dl                19.          Which hormone is required for water to be reabsorbed in the distal tubule and collecting duct?a.            Antidiuretic hormone    c.             Cortisolb.            Aldosterone       d.            Adrenocorticotropin hormone                20.          Which glycoprotein protects against urolithiasis and is a ligand for lymphokines?a.            Uromodulin        c.             Urodilatinb.            Nephrin               d.            Cystatin                21.          What is the end-product of protein metabolism that is excreted in urine?a.            Glucose                c.             Bileb.            Ketones               d.            Urea                22.          What is the action of urodilatin?a.            Urodilatin causes vasoconstriction of afferent arterioles.b.            It causes vasodilation of the efferent arterioles.c.             Urodilatin inhibits antidiuretic hormone secretion.d.            It inhibits salt and water reabsorption.                23.          The concentration of the final urine is determined by antidiuretic hormone (ADH), which is secreted by which gland?a.            Posterior pituitary           c.             Parathyroidb.            Thyroid d.            Anterior pituitary                24.          Which statement is true regarding urodilatin?a.            Urodilatin inhibits sodium chloride and water reabsorption in the medullary part of the collecting duct.b.            It inhibits antidiuretic hormone (ADH) to prevent water reabsorption in the medullary part of the collecting duct.c.             Urodilatin is stimulated by a rise in blood pressure and an increase in extracellular volume.d.            It is stimulated by a fall in blood pressure and a decrease in extracellular volume.                25.          What substance stimulates renal hydroxylation in the process of producing vitamin D?a.            Erythropoietin   c.             Calcitoninb.            Thyroid hormone             d.            Parathyroid hormone                26.          Which hormone is synthesized and secreted by the kidneys?a.            Antidiuretic hormone    c.             Erythropoietinb.            Aldosterone       d.            Angiotensinogen                27.          What provides the best estimate of the functioning of renal tissue?a.            Glomerular filtration rateb.            Hourly urine outputc.             Serum blood urea nitrogen and creatinined.            The specific gravity of the solute concentration of the urine                28.          Which renal change is found in older adults?a.            Sharp decline in glomerular filtration rateb.            Sharp decline in renal blood flowc.             Decrease in the number of nephronsd.            Decrease in urine output                29.          Compared with a younger individual, how is the specific gravity of urine in older adults affected?a.            Specific gravity of urine in older adults is increased.b.            Specific gravity of urine in older adults is considered high normal.c.             Specific gravity of urine in older adults is considered low normal.d.            Specific gravity of urine in older adults is decreased.                30.          What process allows the kidney to respond to an increase in workload?a.            Glomerular filtrationb.            Secretion of 1,25-dihydroxyvitamin D3c.             Increased heart rated.            Compensatory hypertrophy                31.          Which process makes it possible for ureters to be transplanted successfully?a.            Compensatory hypertrophy       c.             Peristalsisb.            Erythropoietin secretion               d.            Collateral circulationChapter 38: Alterations of Renal and Urinary Tract FunctionMULTIPLE CHOICE                1.            How does progressive nephrons injury affect angiotensin II activity?a.            Angiotensin II activity is decreased.b.            It is elevated.c.             Angiotensin II activity is totally suppressed.d.            It is not affected.                2.            Which mineral accounts for the most common type of renal stone?a.            Magnesium-ammonium-phosphate       c.             Calcium oxalateb.            Uric acid               d.            Magnesium phosphate                3.            Regarding the formation of renal calculi, what function does pyrophosphate, potassium citrate, and magnesium perform?a.            They inhibit crystal growth.b.            Pyrophosphate, potassium citrate, and magnesium stimulate the supersaturation of salt.c.             They facilitate the precipitation of salts from a liquid to a solid state.d.            Pyrophosphate, potassium citrate, and magnesium enhance crystallization of salt crystals to form stones.                4.            Hypercalciuria is primarily attributable to which alteration?a.            Defective renal calcium reabsorptionb.            Intestinal hyperabsorption of dietary calciumc.             Bone demineralization caused by prolonged immobilizationd.            Hyperparathyroidism                5.            Detrusor hyperreflexia develops from neurologic disorders that originate where?a.            Spinal cord between C2 and S1  c.             Above the pontine micturition centerb.            Spinal cord between S2 and S4  d.            Below the cauda equina                6.            Considering the innervation of the circular muscles of the bladder neck, which classification of drug is used to treat bladder neck obstruction?a.            ?-Adrenergic blocking medications          c.             Parasympathomimetic medicationsb.            ?-Adrenergic blocking medications          d.            Anticholinesterase medications                7.            Renal cell carcinoma, classified as clear cell tumors, arises from epithelial cells in which structure?a.            Proximal tubule                c.             Nephronb.            Distal tubule       d.            Glomerulus                8.            Bladder cancer is associated with the gene mutation of which gene?a.            c-erbB2b.            Human epidermal growth factor receptor 2 (HER2)c.             TP53d.            myc                9.            What is the most common cause of uncomplicated urinary tract infections?a.            Staphylococcus c.             Proteusb.            Klebsiella             d.            Escherichia coli                10.          Which differentiating sign is required to make the diagnosis of pyelonephritis from that of cystitis?a.            Difficulty starting the stream of urineb.            Spasmodic pain that radiates to the groinc.             Increased glomerular filtration rated.            Urinalysis confirmation of white blood cell casts                11.          Considering host defense mechanisms, which element in the urine is bacteriostatic?a.            High pH (alkaline urine) c.             High glucoseb.            High urea             d.            High calcium                12.          Which clinical manifestations of a urinary tract infection may be demonstrated in an 85-year-old individual?a.            Confusion and poorly localized abdominal discomfortb.            Dysuria, frequency, and suprapubic painc.             Hematuria and flank paind.            Pyuria, urgency, and frequency                13.          Pyelonephritis is usually caused by which type of organism?a.            Bacteria                c.             Virusesb.            Fungi     d.            Parasites                14.          Which abnormal laboratory value is found in glomerular disorders?a.            Elevated creatinine concentration            c.             Elevated immunoglobulin A (IgA)b.            Low blood urea nitrogen (BUN) d.            Low serum complement                15.          Which glomerular lesion is characterized by thickening of the glomerular capillary wall with immune deposition of immunoglobulin G (IgG) and C3?a.            Proliferative       c.             Mesangialb.            Membranous    d.            Crescentic                16.          Goodpasture syndrome is an example of which of the following?a.            Antiglomerular basement membrane diseaseb.            Acute glomerulonephritisc.             Chronic glomerulonephritisd.            Immunoglobulin A (IgA) nephropathy                17.          A patient exhibits symptoms including hematuria with red blood cell casts and proteinuria exceeding 3 to 5 g/day, with albumin as the major protein. These data suggest the presence of which disorder?a.            Cystitis  c.             Glomerulonephritisb.            Chronic pyelonephritis  d.            Nephrotic syndrome                18.          Hypothyroidism, edema, hyperlipidemia, and lipiduria characterize which kidney disorder?a.            Nephrotic syndrome      c.             Chronic glomerulonephritisb.            Acute glomerulonephritis            d.            Pyelonephritis                19.          Which antibiotics are considered “major culprits” in causing nephrotoxic acute tubular necrosis (ATN)?a.            Penicillin and ampicillin  c.             Gentamicin and tobramycinb.            Vancomycin and bacitracin          d.            Cefazolin and cefepime                20.          Which urine characteristics are indicative of acute tubular necrosis (ATN) caused by intrinsic (intrarenal) failure?a.            Urine sodium >30 mEq/Lb.            Urine osmolality >500 mOsmc.             Fractional excretion of sodium (FENa) <1%d.            Urine sediment has no cells, some hyaline casts                21.          How are glucose and insulin used to treat hyperkalemia associated with acute renal failure?a.            Glucose has an osmotic effect, which attracts water and sodium, resulting in more dilute blood and a lower potassium concentration.b.            When insulin transports glucose into the cell, it also carries potassium with it.c.             Potassium attaches to receptors on the cell membrane of glucose and is carried into the cell.d.            Increasing insulin causes ketoacidosis, which causes potassium to move into the cell in exchange for hydrogen.                22.          Creatinine is primarily excreted by glomerular filtration after being constantly released from what type of tissue?a.            Nervous system               c.             Muscleb.            Kidneys                d.            Liver                23.          Which statement is false concerning the skeletal alterations caused by chronic renal failure when the glomerular filtration rate (GFR) declines to 25% of normal?a.            Parathyroid hormone is no longer effective in maintaining serum phosphate levels.b.            The parathyroid gland is no longer able to secrete sufficient parathyroid hormone.c.             The synthesis of 1,25-vitamin D3, which reduces intestinal absorption of calcium, is impaired.d.            The synthesis of 1,25-vitamin D3, which impairs the effectiveness of calcium and phosphate resorption from bone by parathyroid hormone, is impaired.                24.          Anemia of chronic renal failure can be successfully treated with which element?a.            Intrinsic factor   c.             Vitamin Db.            Vitamin B12        d.            Erythropoietin                25.          When the right kidney is obstructed, how will the glomeruli and tubules in the left kidney compensate?a.            Increase in number         c.             Develop collateral circulationb.            Increase in size d.            Increase speed of production                26.          What medical term is used to identify a functional urinary tract obstruction caused by an interruption of the nerve supply to the bladder?a.            Neurogenic bladder        c.             Necrotic bladderb.            Obstructed bladder        d.            Retrograde bladderChapter 39: Alterations of Renal and Urinary Tract Function in ChildrenMULTIPLE CHOICE                1.            The functional kidney is associated with which embryonic organ?a.            Metanephros    c.             Pronephrosb.            Mesonephros   d.            Endonephros                2.            When does urine formation and excretion begin?a.            At birth c.             By 6 months’ gestationb.            By 3 months’ gestation  d.            By 8 months’ gestation                3.            Compared with an adult, an infant has a greater content of extracellular fluid, as well as a greater rate of fluid exchange. What effect does this have on the fluid balance of a child compared with that of an adult?a.            Edema development is less of a problem.b.            Overhydration is not difficult to manage.c.             Daily fluid requirements are greater.d.            The control of dehydration is more difficult.                4.            What term is used to identify the condition that exists when the urethral meatus is located on the undersurface of the penis?a.            Hypospadias      c.             Hyperspadiasb.            Epispadias           d.            Chordee                5.            What initiates inflammation in acute poststreptococcal glomerulonephritis?a.            Lysosomal enzymesb.            Endotoxins from Streptococcusc.             Immune complexesd.            Immunoglobulin E (IgE)–mediated response                6.            Acute glomerulonephritis (AGN) may be accompanied by a positive throat or skin culture for which bacteria?a.            Staphylococcus aureus  c.             Pseudomonas aeruginosab.            Streptococcus   d.            Haemophilus                7.            What is the cause of smoky, brown-colored urine resulting from acute poststreptococcal glomerulonephritis?a.            Presence of red blood cells         c.             Slough from the collecting tubulesb.            Presence of urobilinogen             d.            Protein in the urine                8.            In immunoglobulin G (IgG) nephropathies such as glomerulonephritis, IgG is deposited in which location?a.            Juxtamedullary nephronsb.            Glomerulus basement membranesc.             Mesangium of the glomerular capillariesd.            Parietal epithelium                9.            What is the pathophysiologic process responsible for the autoimmune disorder of hemolytic-uremic syndrome (HUS)?a.            Immunoglobulin A (IgA) coats erythrocytes that are destroyed by the spleen, and remnants are excreted through the kidneys.b.            Verotoxin from Escherichia coli is absorbed from the intestines and damages erythrocytes and endothelial cells.c.             Endotoxins from E. coli block the erythropoietin produced by the