1.

Patients with renal artery stenosis may present with very high blood pressures due
to increased renin secretion. Which of the following structures in the kidney is
responsible for sensing inadequate perfusion and secreting renin?
A) Afferent arteriole
(B) Collecting duct
(C) Distal convoluted tubule
(D) Efferent arteriole
(E) Loop of Henle

2. Monitoring acid-base status is very important in individuals with kidney pathology.

Which of the following diuretics causes metabolic alkalosis?
(A) Acetazolamide and potassium-sparing diuretics
(B) Loop diuretics and acetazolamide
(C) Loop diuretics and potassium-sparing
diuretics
D) Loop diuretics and thiazides
(E) Thiazides and acetazolamide(F) Thiazides and potassium-sparing diuretics

3. A 25-year-old man comes to the emergency department with bloody sputum. A few
weeks later he progresses to renal failure with signifi cant hematuria and hypertension.
A renal biopsy shows linear immunofl uorescence. Which of the following types of
hypersensitivity reaction is this patient experiencing?
(A) Type I hypersensitivity
B) Type II hypersensitivity
(C) Type III hypersensitivity
(D) Type IV hypersensitivity

4.A 2-month-old infant is found to have a horseshoe kidney. Which structure prevents
this abnormal kidney from occupying its appropriate position?
(A) Aorta
(B) Celiac trunk
C) Inferior mesenteric artery
(D) Inferior vena cava
(E) Superior mesenteric artery
5.A 56-year-old woman who has been taking cefoxitin for treatment of Klebsiella
pneumonia is found to still have Klebsiella organisms in her blood 1 week after
beginning treatment. Another drug is added to the patient’s regimen. Two days later,
laboratory tests show:
Na+: 141 mEq/L
K+: 4.3 mEq/L
Cl–: 102 mEq/L
HCO3 –: 24 mEq/L
BUN: 65 mg/dL
Creatinine: 4.4 mEq/L

Which of the following medications was most likely added to this patient’s regimen?

(A) Azithromycin
(B) Aztreonam
(C) Clindamycin
(D) Piperacillin
E) Tobramycin

6. A 40-year-old woman presents to the emergency department after a 5-day course of

profuse vomiting. She has a history of rheumatoid arthritis, which is treated with
celecoxib. She complains of joint pain at present. Which of the reasons below
describes why celecoxib would be contraindicated in this patient at presentation?
(A) Because of its effects on platelet function
B) Because of its effects on the arterioles of the kidney
(C) Because of its effects on the gastrointestinal mucosa
(D) Because of its effects on the macula densa
(E) Because of its effects on the production of inflammatory cytokines

7. Mannitol, an osmotic diuretic, is sometimes used to lower intracranial pressure.

Where along the nephron is the primary site of action of mannitol?
(A) Collecting tubule
(B) Distal tubule
C) Loop of Henle
(D) Thick ascending limb of loop of Henle
8. A 53-year-old woman experiences hot fl ashes associated with menopause. She calls
her primary care physician to ask for advice about the risks and benefi ts of hormone
replacement therapy (HRT). Which of the following is a potential benefi t of HRT?
(A) Decreased risk of breast cancer
(B) Decreased risk of deep venous thrombosis
C) Decreased risk of hip fracture
(D) Decreased risk of myocardial infarction
(E) Decreased risk of stroke

9.During hernia surgeries, it is important to isolate important structures in the inguinal

canal so that they do not become damaged and cause a functional defi cit. Which of
the following structures lies inside the inguinal canal but outside of the spermatic
cord?
(A) Ductus deferens
B) Ilioinguinal nerve
(C) Pampiniform plexus
(D) Testicular artery
(E) Testicular lymphatic vessels

10.A woman who is 31 weeks’ pregnant comes to the emergency department with
symptoms of preeclampsia. The presence of which of the following signs would
change this initial diagnosis?
(A) Edema
(B) Hyperrefl exia
(C) Hypertension
(D) Proteinuria
E) Seizure

11.Which of the following is the function of the androgen-binding globulin?

(A) Binding of inhibin
B) Binding of testosterone
(C) Conversion of testosterone into estrogen
(D) Inhibition of androgen secretion
(E) Testosterone transport

12.A 57-year-old man with erectile dysfunction has cavernosography prior to surgery.
Cavernosography demonstrates a leak from the dorsal vein to the saphenous vein.
Which of the following is the most likely cause of this patient’s impotence?
(A) Arterial insuffi ciency
(B) Hormonal impotence
(C) Psychogenic impotence
(D) Somatosensory defect
E) Venous outflow
13. A woman in her seventh month of pregnancy asks her obstetrician why her breasts
are enlarging. In which of the following locations is the hormone responsible for
breast milk production synthesized?
A) Adenohypophysis
(B) Corpus luteum
(C) Hypothalamus
(D) Placenta
(E) Syncytiotrophoblast

14. A 23-year-old woman comes to the physician with vaginal candidiasis and is
placed on an antifungal medication. Shortly thereafter, she experiences amenorrhea.
Which of the following antifungal drugs did this patient most likely use?
(A) Amphotericin B
(B) Fluconazole
(C) Flucytosine
(D) Itraconazole
E) Ketoconazole

15. A 25-year-old woman comes to her physician complaining of cyclic dysmenorrhea

and pain with intercourse. A sonogram reveals bilateral adnexal masses, and a
laparoscopy shows chocolate cysts. This patient at risk for developing which of the
following conditions?
(A) Carcinoma
B) Infertility
(C) Masculinization
(D) Obesity

16. A 27-year-old woman presents to her primary care physician with breast pain,
nonbloody nipple discharge, and multiple bilateral breast masses. She denies any
history of breast cancer in her family. Which of the following would most likely confi
rm that a breast mass is benign?
(A) Central necrosis
(B) Lymphocytic infi ltration
(C) Lymphatic involvement
(D) Overlying eczema
E) Sclerosis
17. A newborn with tachypnea and cyanosis (bluish color) is found to have a blood pH
of 7.1. A serum bicarbonate is measured as 12 mM, but the blood gas machine that
would determine the partial pressures of oxygen (PO2) and carbon dioxide (PCO2) is
broken. Recall the pKa of 6.1 for carbonic acid (reflecting the HCO3
−/CO2 equilibrium in blood) and the fact that the blood CO2 concentration is equal to
the PCO2 in mmHg (normal value = 40 mmHg) multiplied by 0.03. Which of the
following treatment strategies is indicated?
(a). Administer oxygen to improve tissue perfusion and decrease metabolic acidosis
b. Administer oxygen to decrease respiratory acidosis
c. Increase the respiratory rate to treat respiratory acidosis
d. Decrease the respiratory rate to treat respiratory acidosis
e. Administer medicines to decrease renal hydrogen ion excretion

18. The basic abnormality producing metabolic alkalosis is

(a). Decreased arterial hydrogen ion concentration with increased arterial bicarbonate
causing arterial pH to be greater than 7.4
b. Decreased respirations with increased arterial carbon dioxide and hydrogen ion
concentrations causing arterial pH to be less than 7.4
c. Increased arterial hydrogen ion concentration with decreased arterial bicarbonate
causing arterial pH to be less than 7.4
d. Increased arterial hydrogen ion concentration with decreased arterial bicarbonate
causing arterial pH to be greater than 7.4
e. Increased respirations with decreased arterial carbon dioxide and hydrogen ion
concentrations causing arterial pH to be greater than 7.4

19. An anxious 19-year-old female presents with perioral numbness and carpopedal
spasm. Laboratory examination reveals decreased PCO2 and decreased bicarbonate.
Which one of the listed conditions is most consistent with these findings?
a. Metabolic acidosis due to ketoacidosis
b. Metabolic acidosis due to renal tubular acidosis
c. Metabolic alkalosis due to thiazide diuretic
d. Respiratory acidosis due to hypoventilation
(e). Respiratory alkalosis due to hyperventilation

20. In utero bilateral renal agenesis is most likely to produce

a. Anencephaly
b. Gastroschisis
(c). Oligohydramnios
d. Polycythemia
e. Retrolental fibroplasia
21. An 8-month-old male infant presents with progressive renal and hepatic failure.
Despite intensive medical therapy, the infant dies. At the time of autopsy, the external
surfaces of his kidneys are found to be smooth, but cut section reveals numerous cysts
that are lined up in a row. What is the mode of inheritance of this renal abnormality?
a. Autosomal dominant
b. Autosomal recessive
c. X-linked dominant
d. X-linked recessive
e. Mitochondrial

22. What is the most likely cause of the combination of generalized edema,
hypoalbuminemia, hypercholesterolemia, marked proteinuria, and fatty casts and oval
fat bodies in the urine?
a. Nephritic syndrome
(b). Nephrotic syndrome
c. Acute renal failure
d. Renal tubular defect
e. Urinary tract infection

23. Immune complexes located within the glomerular basement membrane would
most likely be found in a patient with
a. Acute glomerulonephritis (GN)
b. Membranous GN
c. Type I membranoproliferative glomerulonephritis (MPGN)
(d). Type II MPGN
e. IgA nephropathy

24. Rapidly progressive glomerulonephritis is characterized histologically by

(a). Crescents in the glomeruli
b. Fibrinoid necrosis of the afferent arterioles
c. Fibromuscular hyperplasia of the renal artery
d. Neutrophils in the interstitium
e. Splitting of the basement membrane by mesangial cells

25. A linear pattern of immunoglobulin deposition along the glomerular basement

membrane that can be demonstrated by immunofluorescence is typical of
a. Lupus nephritis
b. Diabetic glomerulopathy
(c). Goodpasture’s syndrome
d. Goldblatt’s kidney
e. Renal vein thrombosis
26. A characteristic histologic feature of class IV lupus nephritis is
a. “Holly leaf ” mesangial deposits
b. “Spike and dome” appearance of the basement membrane
c. “String of popcorn” immunofluorescence pattern
d. “Tram-track” splitting of the basement membrane
(e). “Wire-loop” appearance of the glomerular capillaries

27. Histologic sections of a kidney reveal patchy necrosis of epithelial cells of both the
proximal and distal tubules with flattening of the epithelial cells, rupture of the
basement membrane (tubulorrhexis), and marked interstitial edema. Acute
inflammatory cells are not seen. What is the best diagnosis?
a. Acute pyelonephritis
(b). Acute tubular necrosis
c. Chronic glomerulonephritis
d. Chronic pyelonephritis
e. Diffuse cortical necrosis

28. The combination of severe acute flank pain and microscopic hematuria is
suggestive of
a. Cholelithiasis
b. Choledocholithiasis
c. Kidney tumor
d. Urinary bladder tumor
(e). Urolithiasis

29. All of the following about hypospadias incorrect except :

a. Testes due to failure of the normal descent of the intraabdominal testes
b. Urethral opening on the dorsal surface of the penis due to faulty positioning of the
genital tubercle
c. Urethral opening on the inferior surface of the penis due to failure of fusion of the
paramesonephric (Müllerian) ducts
d. Urethral opening on the superior surface of the penis due to failure of downgrowth
of mesoderm over the anterior bladder
(e). Urethral opening on the ventral surface of the penis due to failure of the urethral
folds to close
30. A 32-year-old male presents with scrotal enlargement. Physical examination,
including scrotal transillumination, reveals the presence of a testicular cyst containing
clear fluid. This abnormality most likely results from fluid accumulating within the
a. Ampulla of the ductus deferens
b. Appendix testis
c. Epididymis
d. Seminal vesicles
(e). Tunica vaginalis

31. Which of the following testicular tumors is most radiosensitive?

(a). Seminoma
b. Embryonal carcinoma
c. Choriocarcinoma
d. Yolk sac tumor
e. Immature teratoma

32. A 67-year-old male is found on rectal examination to have a single, hard, irregular
nodule within his prostate. A biopsy of this lesion reveals the presence of small glands
lined by a single layer of cells with enlarged, prominent nucleoli. From what portion
of the prostate did this lesion most likely originate?
a. Anterior zone
b. Central zone
(c). Peripheral zone
d. Periurethral glands
e. Transition zone

33. A newborn female is being worked up clinically for several congenital

abnormalities. During this workup, it is discovered that normal development of the
vagina and uterus in this female infant has not occurred. Failure of the uterus to
develop (agenesis) is directly related to the failure of what embryonic structure to
develop?
a. Urogenital ridge
b. Mesonephric duct
(c). Paramesonephric duct
d. Metanephric duct
e. Epoophoron
34. Multiple small mucinous cysts of the endocervix that result from blockage of
endocervical glands by overlying squamous metaplastic epithelium are called
a. Bartholin’s cysts
b. Chocolate cysts
c. Follicular cysts
d. Gartner’s duct cysts
(e). Nabothian cysts

35. The most common primary sites for the origin of Paget’s disease are the nipple and
the
a. Anal canal
b. Liver
c. Nasopharynx
d. Penis
(e). Vulva

36. Vaginal adenosis is most likely to precede the development of

a. Condyloma acuminatum
b. Cervical carcinoma
(c). Clear cell carcinoma
d. Carcinoma of the endometrium
e. Squamous carcinoma of the vagina

37. Prolonged unopposed estrogen stimulation in an adult female increases the risk of
development of endometrial hyperplasia and subsequent carcinoma. What is the most
likely histologic appearance of this endometrial carcinoma?
(a). Adenocarcinoma
b. Clear cell carcinoma
c. Small cell carcinoma
d. Squamous cell carcinoma
e. Transitional cell carcinoma

38. The most important factor related to the prognosis of breast cancer is
a. The presence of activated oncogenes
b. The histologic type and grade
c. The size of the tumor
(d). The status of axillary lymph nodes
e. The presence of estrogen receptors
1. Which is a common finding in acute glomerulonephritis?
a. Pulmonary congestion due to volume expansion
b. Hypovolemia due to tubular dysfunction
c. Uniformly progresses to chronic renal failure if untreated
d. Urine showing leukocytes and eosinophils

2. Which finding is fairly specific for chronic renal failure?

a. Anemia

b. Hyaline casts

c. Broad casts in urinalysis

d. Proteinuria

e. Hypocalcemia

3. Nephrotic syndrome is associated with

a. Excessive renal salt and water loss
b. Hyperlipidemia due to lipoprotein excess
c. Bleeding due to loss of clotting factors
d. Hypothyroidism due to loss of thyroid-binding globulin

240. A patient with chronic renal failure will be expected to have which of the following findings due to the
mechanisms described?
a. Hypercalcemic due to elevated PTH hormone

b. Prolonged bleeding due to decreased synthesis of clotting factors

c. Anemia due to increased red cell destruction

d. Hypermagnesemia due to decreased renal excretion

4. A high fractional excretion of sodium is typically found in

a. Heart failure
b. Urinary tract obstruction
c. Acute tubular necrosis
d. Acute glomerulonephritis
e. Hepatorenal syndrome

5. Which of the following nephron segment is correctly paired with its function?
a. Distal tubule and bicarbonate reclamation
b. Loop of Henle and potassium regulation
c. Proximal tubule and urinary concentration
d. Collecting tubule and water regulation

6. Which of the following statements is true in the management of acute renal failure?
a. Metabolic acidosis is fully corrected with bicarbonate

b. Hyperphosphatemia is primarily managed with dialysis

c. Low-dose dopamine is used to shorten the duration of renal failure

d. Hypervolemia is managed with high-dose loop diuretics

e. Hyponatremia is corrected by administration of sodium salts

7. Which of the following describes bone abnormalities in patients with chronic renal failure?
a. Osteitis fibrosis cystica is a result of oversuppression of PTH

b. Adynamic bone disease is associated with myopathy

c. Osteomalacia is due to excessive accumulation of magnesium

d. Hyperparathyroidism responds well to 1,25 dihydroxyvitamin D

e. Amyloidosis is similar in etiology to patients who are not on dialysis

8. Which of the following measures has not been shown to retard progression of renal failure?
a. Aggressive BP control
b. Decrease in protein intake
c. ACE inhibitors above other antihypertensives
d. Erythropoietin for anemia

9. In patients with chronic renal failure, which of the following adaptations are normal?
a. Fractional excretion of sodium increases due to suppression of aldosterone

b. Metabolic acidosis due to loss of bicarbonate in the urine

c. Increased potassium loss through extrarenal mechanisms

d. Decreased fractional excretion of water due to ADH resistance

10. Leukocytes and white cell casts in the urine are typically seen in
a. Radiocontrast nephropathy

b. Methicillin-induced renal insufficiency

c. Aminoglycoside nephrotoxicity

d. Rhabdomyolysis

11. Which may cause acute renal failure in patients with nephrotic syndrome?
a. Dietary protein restriction
b. ACE inhibitors
c. Lipid-lowering agents
d. Loop diuretics

12. Hyponatremia with a low urine sodium is associated with

a. SIADH
b. congestive heart failure
c. recent thiazide use
d. hypothyroidism

13. Which disease presents with predominantly tubulointerstitial involvement?

a. Systemic lupus erythematosus

b. Sjِgren’s syndrome

c. Rheumatoid arthritis

d. Essential mixed cryoglobulinemia

14. A patient on long-term lithium comes into your office complaining of polyuria; you would expect his serum
sodium to be
a. Elevated because he has central diabetes insipidus
b. Elevated because he has nephrogenic diabetes insipidus
c. Nearly normal because he is drinking increased amounts of water
d. Low because he is suffering from psychogenic polydipsia

15. Concerning the association between potassium and bicarbonate abnormalities, which of the following is
true?
a. The regulation of potassium excretion occurs largely in the loop of Henle, and this is why loop diuretics cause
hypokalemia
b. Metabolic alkalosis is associated with volume depletion caused by diuretics

c. Hypokalemia generally results in the increased production of aldosterone

d. Volume depletion inhibits reabsorption of bicarbonate in the proximal tubule

16. A middle-aged patient with an elevated serum creatinine, hypertension, and mild anemia comes to you for
evaluation. Urine dipstick shows trace protein without red cells or cellular casts. A 24-h urine collection reveals
5 g of protein. The most likely etiology is
a. Focal segmental sclerosis

b. Hypertensive nephrosclerosis

c. Amyloidosis

d. Multiple myeloma

17. Which of the following organs is not a major estrogen-dependent tissue in women?
a. Brain
b. Thyroid
c. Hypothalamus
d. Pituitary
e. Ovaries

18. Which of the following organs does not require androgens for proper growth in males?
a. Brain

b. Prostate

c. Epididymis

d. Vas deferens

e. Long bones

19. A 22-year-old woman marathon runner comes into the office complaining of amenorrhea for 8 months.
There has been no weight change, and the serum pregnancy test is negative. She has never been pregnant.
Menarche was at 13 years of age, and she had monthly menses until 8 months ago. Physical exam shows a
women who is 66 inches tall, 90 pounds, and is otherwise fully normal. Why does she have amenorrhea?
a. Hypothyroidism

b. Prolactinoma

c. Early menopause

d. Resistance to LH and FSH

e. Excessive exercise
20. A young couple, both in their 20s, have been trying for 2 years to have a baby. The male comes into the
office and on workup has oligospermia, high LH, high FSH, and a normal karyotype. How do you treat him?
a. Do nothing
b. Testosterone injections
c. Check the partner for causes of infertility
d. Infertility counseling

21. A 28-year-old woman presents to the office with 2 days of abdominal pain and a positive pregnancy test.
Her last menstrual period was 9 weeks ago. She reports no dysuria. She reports a history of two episodes of
pelvic inflammatory disease. Which of these is the most likely cause of the abdominal pain?
a. Endometriosis

b. Urinary tract infection

c. Ectopic pregnancy

d. Placental abruption

e. Premenstrual syndrome

22. A 38-year-old woman comes into the office with complaints of amenorrhea for 6 months, with increased
cold intolerance, loss of energy, and hair loss. Her menses were normal until this episode started, and she
has also gained 22 pounds over these 6 months. Her pregnancy test is negative. Which test would you now
order?
a. FSH and LH
b. Estrogen levels
c. Testosterone level
d. TSH
e. Cortisol level

23. A 29-year-old woman comes into the office after three spontaneous abortions (unplanned). All three
occurred at approximately 6 weeks’ gestational age. Her physical exam is normal. Which of these may be the
cause?
a. Ovary
b. Thyroid gland
c. Adrenal gland
d. Pituitary gland

24. Which of these medications treats benign prostatic hyperplasia by 5-reductase inhibition?
a. Leuprolide

b. Nafarelin

c. Flutamide

d. Megesterol

e. Finasteride

25. How does pregnancy increase the risk of diabetes mellitus?

a. Causing weight gain

b. Insulin resistance

c. Placental production of human chorionic somatomammotropin

d. Increase of maternal glucocorticoids

26. Which of these hormones blocks milk production during pregnancy?
a. Progesterone
b. Prolactin
c. Chorionic somatomammotropin
d. Thyroxine
e. Insulin

27. A 40-year-old female presents with amenorrhea and hirsutism. Which hormone is in excess in this woman
with polycystic ovary syndrome?
a. Estrogen
b. Progesterone
c. FSH
d. Androgens

28. Which of these is the best therapy for preeclampsia?

a. Antihypertensive medication

b. Antiseizure medication

c. Intravenous fluids

d. Delivery of the baby

e. Anticoagulation

29. A 15-year-old male comes into the office complaining about a lack of pubic hair growth. He also informs
you that his voice has not yet deepened, and he has no interest in sexual activity. He is an only child. Blood
drawn reveals a very high testosterone level. What is the problem?
a. Low FSH and LH
b. High FSH and LH
c. Androgen insensitivity
d. Hyperthyroidism
e. XXY karyotype

30. A 52-year-old female presents to the office with a complaint of hot flashes. You suspect menopause.
Which of the findings below would confirm your diagnosis?
a. Normal androgen level
b. Normal or low estrogen level
c. Normal prolactin level
d. High FSH and LH
e. High androgen level

31. Which of the following organs does ovarian estrogen production have a stimulatory effect on?
a. Ovary

b. Brain

c. Hypothalamus

d. Pituitary

e. Vagina

32. Which of the following hormones is produced by both the ovary and uterus?
a. Inhibin
b. Activin
c. Follistatin
d. Relaxin
e. Enkephalin
33. Which of the following hormones is produced both by the theca and the kidney?
a. Inhibin
b. Relaxin
c. Renin
d. Epidermal growth factor-like
e. Transforming growth factor-

34. A 31-year-old male presents to the office due to infertility. On history, it is revealed that he has
Kartagener’s syndrome. Why is he infertile?
a. Oligospermia

b. Asthenospermia

c. Absence of the vas deferens

d. Epididymal obstruction

e. Undescended testes

35. A 74-year-old male presents to the office with trouble urinating for 1 week. The force of the urinary stream
is reduced, but there is no difficulty starting the stream. There is no pain. What is the problem?
a. Decreased detrusor contractility
b. Detrusor instability
c. Detrusor failure
d. Acute urinary obstruction
e. Chronic urinary obstruction

36. A 65-year-old male presents to the office with benign prostatic hypertrophy and new onset hypertension.
Which one medication could you give this patient to handle both diagnoses?
a. Nafarelin
b. Flutamide
c. Finasteride
d. Megesterol
e. Prazosin

37. A 28-year-old woman presents complaining of infertility. She had a healthy child 3 years ago and has
been trying to get pregnant with the child’s father for the last 18 months. She does not have dysmenorrhea.
Her menses occur regularly, but these show significantly less flow compared with before her pregnancy. She
recalls having a curettage performed to remove placental remnants. What is the diagnosis?
a. Ovarian failure

b. Hypothyroidism

c. Asherman’s syndrome

d. Endometriosis

e. Prolactinoma
38. A 28-year-old previously healthy female, with no medical history is now 28 weeks pregnant. She
complains of trouble seeing, polyuria, polyphagia, and polydipsia. What is her diagnosis?
a. Gestational diabetes mellitus

b. Deep venous thrombosis

c. Urinary tract infection

d. Preeclampsia

39. In which ovarian compartment is Müllerian-inhibiting substance produced?

a. Granulosa
b. Theca
c. Follicular fluid
d. Follicles
e. Corpus luteum

40. In which ovarian compartment is plasminogen activator produced?

a. Granulosa
b. Theca
c. Follicular fluid
d. Follicles
e. Corpus luteum

41. In which ovarian compartment is transforming growth factor-produced?

a. Granulosa

b. Theca

c. Follicular fluid

d. Follicles

e. Corpus luteum

42. In which ovarian compartment is basic fibroblast growth factor produced?

a. Granulosa

b. Theca

c. Follicular fluid

d. Follicles

e. Corpus luteum

43. During the course of an evaluation for thyroid function, your patient, a 33-year-old man who is infertile, is
found to have very low levels of luteinizing hormone. The likely site of his infertility is
a. Pretesticular

b. Testicular

c. Posttesticular

d. Idiopathic
44. A 27-year-old man who suffers seizures controlled with phenytoin comes to your office because his
neurologist discovered that the patient has a low FSH level. The patient is infertile. The likely site of his
infertility is
a. Pretesticular
b. Testicular
c. Posttesticular
d. Idiopathic

45. A urologist refers a 20-year-old man because of hypospadias and infertility. He has been sexually active
since his early teens. Recently, he married and, despite many attempts, his wife has been unable to become
pregnant. The likely site of his infertility is
a. Pretesticular

b. Testicular

c. Posttesticular

d. Idiopathic

46. The consumption of oxygen by the kidney

a. Decreases as blood flow increases
b. Is regulated by erythropoietin
c. Remains constant as blood flow increases
d. Directly reflects the level of sodium transport
e. Is greatest in the medulla

47. The anion gap will increase with an increase in the plasma concentration of
a. Sodium

b. Potassium

c. Chloride

d. Bicarbonate

e. Lactate

48. Sodium reabsorption from the distal tubule will be increased if there is an increase in
a. Plasma potassium concentration
b. Plasma volume
c. Mean arterial pressure
d. Urine flow rate
e. Plasma osmolality

49. ADH will be released from the posterior pituitary when there is a decrease in
a. Plasma Na
concentration
b. Plasma volume
c. Plasma Kconcentration
d. Plasma pH
e. Plasma Ca2concentration
50. If 600 mL of water is ingested rapidly, plasma volume will increase by approximately
a. 400 mL

b. 200 mL

c. 100 mL

d. 50 mL

e. 25 mL

51. Renin secretion by the kidney is increased by

a. Increasing mean blood pressure
b. Increasing glomerular filtration rate
c. Increasing sympathetic nerve activity
d. Increasing angiotensin II synthesis
e. Increasing atrial natriuretic hormone secretion

52. Nais reabsorbed from the basolateral surface of the renal epithelial cells by
a. Na/H exchange
b. Na-glucose cotransport
c. Na-K pump d. Facilitate
d diffusion
e. Solvent drag

53. Which of the following is most likely to cause an increase in the glomerular filtration rate?
a. Contraction of mesangial cells
b. Blockage of the ureter
c. Release of renin from the juxtaglomerular apparatus
d. Dilation of the afferent arterioles
e. Volume depletion

54. The daily production of hydrogen ion from CO2 is primarily buffered by

a. Extracellular bicarbonate
b. Red blood cell bicarbonate
c. Red blood cell hemoglobin
d. Plasma proteins
e. Plasma phosphate

55. Glomerular filtration rate would be decreased by

a. Constriction of the efferent arteriole
b. An increase in afferent arteriolar pressure
c. Compression of the renal capsule
d. A decrease in the concentration of plasma protein
e. An increase in renal blood flow

56. The secretion of H in the proximal tubule is primarily associated with

a. Excretion of potassium ion
b. Excretion of hydrogen ion
c. Reabsorption of calcium ion
d. Reabsorption of bicarbonate ion
e. Reabsorption of phosphate ion

57. If a substance appears in the renal artery but not in the renal vein,
a. Its clearance is equal to the glomerular filtration rate
b. It must be reabsorbed by the kidney
c. Its urinary concentration must be higher than its plasma concentration
d. Its clearance is equal to the renal plasma flow
e. It must be filtered by the kidney
58. Destruction of the supraoptic nuclei of the brain will produce which of the following changes in urinary
volume and concentration? (Assume that fluid intake equals fluid loss.)
a. An increased urinary volume and a very dilute urine
b. An increased urinary volume and concentrated urine
c. A normal urinary volume and concentration
d. Decreased urinary volume and a very dilute urine
e. Decreased urinary volume and a concentrated urine

59. Which one of the following returns closest to normal during chronic respiratory acidosis?
a. Alveolar ventilation b. Arterial P CO2
c. Arterial PO2
d. Plasma concentration of bicarbonate
e. Arterial concentration of hydrogen ion

60. The pH of the tubular fluid in the distal nephron can be lower than that in the proximal tubule because
a. A greater sodium gradient can be established across the wall of the distal nephron than across the wall of the proximal
tubule
b. More buffer is present in the tubular fluid of the distal nephron than in the proximal tubule
c. More hydrogen ion is secreted into the distal nephron than into the proximal tubule
d. The brush border of the distal nephron contains more carbonic anhydrase than that of the proximal tubule
e. The tight junctions of the distal nephron are less leaky to solute than those of the proximal tubule

61. Which of the following statements about renin is true?

a. It is secreted by cells of the proximal tubule

b. Its secretion leads to loss of sodium and water from plasma

c. Its secretion is stimulated by increased mean renal arterial pressure

d. It converts angiotensinogen to angiotensin I e. It converts angiotensin I to angiotensin II

62. Most of the glucose that is filtered through the glomerulus undergoes reabsorption in the
a. Proximal tubule

b. Descending limb of the loop of Henle

c. Ascending limb of the loop of Henle

d. Distal tubule

e. Collecting duct

63. Which of the following structural features distinguishes the epithelial cells of the proximal tubule from
those of the distal tubule?
a. The distal tubule has a thicker basement membrane

b. The proximal tubule has a thicker basement membrane

c. The proximal tubule has a more extensive brush border

d. The proximal tubule forms the juxtaglomerular apparatus

e. The distal tubule has fewer tight intercellular junctions

64. A man drinks 2 L of water to replenish the fluids lost by sweating during a period of exercise. Compared
with the situation prior to the period of sweating,
a. His intracellular fluid will be hypertonic

b. His extracellular fluid will be hypertonic

c. His intracellular fluid volume will be greater

d. His extracellular fluid volume will be greater

e. His intracellular and extracellular fluid volumes will be unchanged

65. Which one of the following statements about ammonia (NH3) is correct?

a. It is impermeable to the epithelial cells of the proximal tubule

b. It is classified as a titratable acid
c. It is produced by epithelial cells in the distal nephron
d. It reduces the concentration of bicarbonate in the plasma
e. Its synthesis is increased in respiratory acidosis

66. The amount of potassium excreted by the kidney will decrease if

a. Distal tubular flow increases
b. Circulating aldosterone levels increase
c. Dietary intake of potassium increases
d. Nareabsorption by the distal nephron decreases
e. The excretion of organic ions decreases

67. Which of the following substances will be more concentrated at the end of the proximal tubule than at the
beginning of the proximal tubule?
a. Glucose
b. Creatinine
c. Sodium
d. Bicarbonate
e. Phosphate

68. When a person is dehydrated, hypotonic fluid will be found in the

a. Glomerular filtrate
b. Proximal tubule
c. Loop of Henle
d. Cortical collecting tubule
e. Distal collecting duct

69. Which one of the following statements about aldosterone is correct?

a. It produces its effect by activating cAMP
b. It produces its effect by increasing distal tubular permeability to sodium
c. It causes an increased reabsorption of hydrogen ion
d. It has its main effect on the proximal tubule
e. It is secreted in response to an increase in blood pressure

70. The effect of antidiuretic hormone (ADH) on the kidney is to

a. Increase the permeability of the distal nephron to water
b. Increase the glomerular filtration rate
c. Increase the excretion of Na
d. Increase the excretion of water
e. Increase the diameter of the renal artery

71. Hypokalemia can result from

a. Metabolic acidosis
b. Diarrhea
c. Adrenal insufficiency
d. Hypovolemia
e. Hyperosmotic extracellular fluid

72. The ability of the kidney to excrete a concentrated urine will increase if
a. The reabsorption of Na
by the proximal tubule decreases
b. The flow of filtrate through the loop of Henle increases
c. The glomerular capillary pressure increases
d. The activity of the Na-K pump in the loop of Henle decreases
e. The permeability of the collecting duct to water increases
73. The glomerular filtration rate will increase if
a. Sympathetic nerve activity to the kidney increases
b. The afferent arteriolar resistance increases
c. The efferent arteriolar resistance decreases
d. The plasma protein concentration decreases
e. Urine flow through the urethra is blocked

74. Metabolic alkalosis will be observed in a patient with

a. Hyperaldosteronism
b. Hyperventilation
c. Persistent diarrhea
d. Renal failure
e. Diabetes

75. An increase in the concentration of NaCl in the intraluminal fluid with the ascending limb of the loop of
Henle causes the macula densa to release
a. ADH
b. Aldosterone
c. Adenosine
d. Renin
e. Angiotensinogen

76. Metabolic acidosis is caused by

a. Hypoaldosteronism
b. Hyperventilation
c. Hypokalemia
d. Hypovolemia
e. Hypercalcemia

77. Aldosterone secretion is increased when there is an increase in the plasma concentration of
a. ACTH
b. Chloride
c. Sodium
d. Hydrogen
e. Potassium

78. In which one of the following situations is urinary flow less than normal?
a. Diabetes insipidus
b. Diabetes mellitus
c. Sympathetic stimulation
d. Increased renal arterial pressure
e. Infusion of mannitol

79. Most of the volatile acid entering the blood is buffered by

a. Bicarbonate
b. Plasma proteins
c. Hemoglobin
d. Phosphates
e. Lactate