Myogenic autoregulation US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Myogenic autoregulation. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Myogenic autoregulation US Medical PG Question 1: A healthy 30-year-old female has a measured creatinine clearance of 100 mL/min. She has a filtration fraction (FF) of 25%. Serum analysis reveals a creatinine level of 0.9 mg/dL and an elevated hematocrit of 0.6. Which of the following is the best estimate of this patient’s renal blood flow?
- A. 1.2 L/min
- B. 600 mL/min
- C. 800 mL/min
- D. 400 mL/min
- E. 1.0 L/min (Correct Answer)
Myogenic autoregulation Explanation: ***1.0 L/min***
- The **renal plasma flow (RPF)** can be calculated by dividing the **creatinine clearance (which approximates GFR)** by the **filtration fraction (FF)**: RPF = GFR / FF = 100 mL/min / 0.25 = 400 mL/min.
- To find the **renal blood flow (RBF)**, we use the formula RBF = RPF / (1 - Hematocrit). Given RPF = 400 mL/min and Hematocrit = 0.6, RBF = 400 mL/min / (1 - 0.6) = 400 mL/min / 0.4 = 1000 mL/min, or **1.0 L/min**.
*1.2 L/min*
- This value would result if the hematocrit were lower (e.g., 0.5) or if the GFR or FF were different, leading to an incorrect RPF or RBF calculation.
- It does not align with the provided values when applying the standard physiological formulas relating GFR, FF, RPF, and hematocrit.
*600 mL/min*
- This value might be obtained if the hematocrit was significantly underestimated or if the RPF calculation was incorrect in determining the RBF.
- It arises from using an incorrect formula or misinterpreting the relationship between plasma flow and blood flow.
*800 mL/min*
- This result would occur if the calculation for RPF or the subsequent RBF was erroneous, possibly by using an incorrect denominator in the RBF formula.
- For example, if RPF was incorrectly assumed to be 320 mL/min and divided by 0.4 (1-Hematocrit).
*400 mL/min*
- This value represents the calculated **renal plasma flow (RPF)**, not the **renal blood flow (RBF)**.
- RBF is always higher than RPF because it includes both plasma and cellular components of blood.
Myogenic autoregulation US Medical PG Question 2: A woman with coronary artery disease is starting to go for a walk. As she begins, her heart rate accelerates from a resting pulse of 60 bpm until it reaches a rate of 120 bpm, at which point she begins to feel a tightening in her chest. She stops walking to rest and the tightening resolves. This has been happening to her consistently for the last 6 months. Which of the following is a true statement?
- A. This patient's chest pain is indicative of transmural ischemia
- B. Perfusion of the myocardium takes place equally throughout the cardiac cycle
- C. Increasing the heart rate increases the amount of time spent during each cardiac cycle
- D. Increasing the heart rate decreases the relative amount of time spent during diastole (Correct Answer)
- E. Perfusion of the myocardium takes place primarily during systole
Myogenic autoregulation Explanation: ***Increasing the heart rate decreases the relative amount of time spent during diastole***
- With increasing heart rate, the **duration of the cardiac cycle decreases**, but this reduction is disproportionately greater in **diastole (filling phase)** compared to systole (ejection phase), which becomes critical in patients with coronary artery disease as myocardial perfusion occurs during diastole.
- Reduced diastolic time means less time for **coronary artery filling** and **myocardial perfusion**, exacerbating ischemia in the presence of fixed coronary stenosis.
*This patient's chest pain is indicative of transmural ischemia*
- The patient's symptoms are consistent with **stable angina**, characterized by chest pain with exertion that resolves with rest, suggesting **subendocardial ischemia** rather than transmural.
- **Transmural ischemia** typically indicates a more severe, often prolonged, and extensive reduction in blood flow, such as in a **ST-elevation myocardial infarction (STEMI)**.
*Perfusion of the myocardium takes place equally throughout the cardiac cycle*
- Myocardial perfusion is **not equal throughout the cardiac cycle**; it primarily occurs during **diastole** when the heart muscle is relaxed and coronary arteries are less compressed.
- During **systole**, the contracting myocardium compresses the coronary arteries, restricting blood flow, especially to the **subendocardial layers**.
*Increasing the heart rate increases the amount of time spent during each cardiac cycle*
- **Increasing heart rate** by definition **decreases the total duration of each cardiac cycle** (e.g., if heart rate is 60 bpm, cycle duration is 1 second; if 120 bpm, cycle duration is 0.5 seconds).
- While both systole and diastole shorten, the **diastolic phase shortens more significantly**, which is problematic for myocardial perfusion.
*Perfusion of the myocardium takes place primarily during systole*
- **Myocardial perfusion primarily occurs during diastole**, not systole, because the **intramyocardial pressure is lower** and the coronary arteries are less compressed, allowing for better blood flow.
- During **systole**, the high intramyocardial pressure, especially in the left ventricular wall, compresses the coronary vessels, significantly reducing blood flow to the myocardium.
Myogenic autoregulation US Medical PG Question 3: A 70-year-old female with chronic kidney failure secondary to diabetes asks her nephrologist to educate her about the techniques used to evaluate the degree of kidney failure progression. She learns about the concept of glomerular filtration rate (GFR) and learns that it can be estimated by measuring the levels of some substances. The clearance of which of the following substances is the most accurate estimate for GFR?
- A. Paraaminohippurate (PAH)
- B. Sodium
- C. Inulin (Correct Answer)
- D. Creatinine
- E. Glucose
Myogenic autoregulation Explanation: ***Inulin***
- **Inulin** is freely filtered by the glomeruli and is neither reabsorbed nor secreted by the renal tubules, making its clearance the **gold standard** for accurately measuring GFR.
- Due to its ideal physiological properties, inulin clearance perfectly reflects the rate at which plasma is filtered by the kidneys.
*Paraaminohippurate (PAH)*
- **PAH** is almost completely cleared from the blood by both glomerular filtration and **tubular secretion**, making its clearance an accurate measure of **renal plasma flow (RPF)**, not GFR.
- While important for assessing renal blood flow, it does not directly reflect the filtration capacity of the glomeruli.
*Sodium*
- **Sodium** is freely filtered at the glomerulus, but a significant portion (approximately **99%**) is **reabsorbed** by the renal tubules.
- Its clearance is highly variable and depends on various physiological factors, making it unsuitable for GFR estimation.
*Creatinine*
- **Creatinine** is freely filtered by the glomeruli and is also **modestly secreted** by the renal tubules, leading to an **overestimation of GFR** at lower kidney function levels.
- Despite being the most commonly used clinical marker due to its endogenous production, its tubular secretion makes it less accurate than inulin.
*Glucose*
- **Glucose** is freely filtered by the glomeruli but is almost **completely reabsorbed** by the renal tubules under normal physiological conditions.
- Its presence in urine (glycosuria) indicates a high plasma glucose level or tubular reabsorption defects, not a measure of GFR.
Myogenic autoregulation US Medical PG Question 4: Which factor most strongly influences coronary blood flow during exercise?
- A. Endothelin release
- B. Metabolic demand (Correct Answer)
- C. Myogenic response
- D. Neural regulation
- E. Baroreceptor reflex
Myogenic autoregulation Explanation: **Metabolic demand**
- During exercise, increased **myocardial activity** leads to a higher demand for oxygen and nutrients, prompting a significant increase in coronary blood flow.
- Local release of **metabolites** such as adenosine, nitric oxide, and hydrogen ions causes powerful vasodilation of coronary arteries, closely matching blood supply to demand.
*Endothelin release*
- **Endothelin** is a potent vasoconstrictor and plays a role in regulating vascular tone, but its primary influence is not the immediate or strongest factor dictating increased coronary flow during exercise.
- While it can modulate flow, metabolic changes are the dominant driver for the rapid and substantial increases needed during exertion.
*Myogenic response*
- The **myogenic response** is an intrinsic property of vascular smooth muscle cells to contract when stretched (due to increased pressure) and relax when pressure decreases, helping to maintain relatively constant blood flow.
- This mechanism primarily contributes to **autoregulation** and flow stability, but it does not account for the massive increase in flow required by the heart during exercise.
*Neural regulation*
- **Neural regulation**, primarily sympathetic stimulation, increases heart rate and contractility, which indirectly increases metabolic demand.
- However, direct neural effects on coronary arteries can be complex (both vasodilation and vasoconstriction depending on receptor type), and the overriding control during exercise is typically metabolic.
Myogenic autoregulation US Medical PG Question 5: A researcher is investigating the effects of a new antihypertensive medication on renal physiology. She gives a subject a dose of the new medication, and she then collects plasma and urine samples. She finds the following: Hematocrit: 40%; Serum creatinine: 0.0125 mg/mL; Urine creatinine: 1.25 mg/mL. Urinary output is 1 mL/min. Renal blood flow is 1 L/min. Based on the above information and approximating that the creatinine clearance is equal to the GFR, what answer best approximates filtration fraction in this case?
- A. 10%
- B. 17% (Correct Answer)
- C. 33%
- D. 50%
- E. 25%
Myogenic autoregulation Explanation: ***17%***
- First, calculate **GFR** using the creatinine clearance formula: GFR = (Urine creatinine × Urinary output) / Serum creatinine = (1.25 mg/mL × 1 mL/min) / 0.0125 mg/mL = **100 mL/min**.
- Next, calculate **Renal Plasma Flow (RPF)** from Renal Blood Flow (RBF) and Hematocrit: RPF = RBF × (1 - Hematocrit) = 1000 mL/min × (1 - 0.40) = **600 mL/min**.
- Finally, calculate **Filtration Fraction (FF)** = GFR / RPF = 100 mL/min / 600 mL/min = 0.1667 = **16.7%, which approximates to 17%**.
- This is the correct answer based on the physiological calculations and represents a normal filtration fraction.
*10%*
- This would correspond to a filtration fraction of 0.10, which would require either a GFR of 60 mL/min (lower than calculated) or an RPF of 1000 mL/min (higher than calculated).
- This value is too low given the provided parameters and doesn't match the calculation from the given data.
*25%*
- This value would suggest FF = 0.25, requiring a GFR of 150 mL/min with the calculated RPF of 600 mL/min.
- This is higher than the calculated GFR of 100 mL/min and doesn't match the given creatinine values.
*33%*
- This would imply FF = 0.33, requiring a GFR of approximately 200 mL/min with RPF of 600 mL/min.
- This is significantly higher than the calculated GFR and would represent an abnormally elevated filtration fraction.
*50%*
- A filtration fraction of 50% is unphysiologically high and would indicate severe pathology.
- This would require a GFR of 300 mL/min with the calculated RPF, which is impossible given the provided creatinine clearance data.
Myogenic autoregulation US Medical PG Question 6: A 48-year-old woman comes to the physician for a follow-up examination. At her visit 1 month ago, her glomerular filtration rate (GFR) was 100 mL/min/1.73 m2 and her renal plasma flow (RPF) was 588 mL/min. Today, her RPF is 540 mL/min and her filtration fraction (FF) is 0.2. After her previous appointment, this patient was most likely started on a drug that has which of the following effects?
- A. Inhibition of the renal Na-K-Cl cotransporter
- B. Constriction of the afferent arteriole
- C. Relaxation of urinary smooth muscle
- D. Constriction of the efferent arteriole (Correct Answer)
- E. Inhibition of vasopressin
Myogenic autoregulation Explanation: ***Constriction of the efferent arteriole***
- The previous GFR was 100 mL/min and RPF was 588 mL/min. For the follow-up, RPF is 540 mL/min and FF is 0.2. The new GFR can be calculated as FF × RPF = 0.2 × 540 = **108 mL/min**.
- The patient shows **increased GFR** (100→108 mL/min) with **decreased RPF** (588→540 mL/min), resulting in an **increased filtration fraction**.
- Medications that **constrict the efferent arteriole**, such as **NSAIDs**, produce this pattern by blocking prostaglandin synthesis. Prostaglandins normally cause vasodilation (predominantly of the afferent arteriole). When blocked, there is relatively more **efferent arteriolar constriction**, which increases glomerular hydrostatic pressure, thereby **increasing GFR while reducing overall RPF**.
*Inhibition of the renal Na-K-Cl cotransporter*
- This effect describes **loop diuretics** (e.g., furosemide), which increase sodium excretion and water diuresis.
- Loop diuretics typically cause a **decrease in GFR** due to reduced fluid volume and lower filtration pressure, which contradicts the slight increase in GFR observed.
*Constriction of the afferent arteriole*
- **Afferent arteriole constriction** (e.g., by NSAIDs in high doses or norepinephrine) would decrease blood flow into the glomerulus, leading to a **decrease in both RPF and GFR**.
- While RPF decreased in this case, GFR actually increased, making this option incorrect.
*Relaxation of urinary smooth muscle*
- Relaxation of urinary smooth muscle is characteristic of drugs like **alpha-blockers** (e.g., tamsulosin) or antimuscarinics used for conditions like benign prostatic hyperplasia or overactive bladder.
- This effect primarily impacts urine flow out of the bladder and does **not directly affect GFR or RPF** in the way described.
*Inhibition of vasopressin*
- Vasopressin (ADH) inhibition leads to **increased water excretion** and is seen with drugs like **vasopressin receptor antagonists** (vaptans) or ethanol.
- While it affects fluid balance, it typically causes a **decrease in GFR** due to hypovolemia and has no direct mechanism to increase GFR with decreased RPF as observed.
Myogenic autoregulation US Medical PG Question 7: A 75-year-old woman is brought to a physician’s office by her son with complaints of diarrhea and vomiting for 1 day. Her stool is loose, watery, and yellow-colored, while her vomitus contains partially digested food particles. She denies having blood or mucus in her stools and vomitus. Since the onset of her symptoms, she has not had anything to eat and her son adds that she is unable to tolerate fluids. The past medical history is unremarkable and she does not take any medications regularly. The pulse is 115/min, the respiratory rate is 16/min, the blood pressure is 100/60 mm Hg, and the temperature is 37.0°C (98.6°F). The physical examination shows dry mucous membranes and slightly sunken eyes. The abdomen is soft and non-tender. Which of the following physiologic changes in glomerular filtration rate (GFR), renal plasma flow (RPF), and filtration fraction (FF) are expected?
- A. Decreased GFR, decreased RPF, decreased FF
- B. Decreased GFR, decreased RPF, no change in FF
- C. Increased GFR, increased RPF, increased FF
- D. Increased GFR, decreased RPF, increased FF
- E. Decreased GFR, decreased RPF, increased FF (Correct Answer)
Myogenic autoregulation Explanation: ***Decreased GFR, decreased RPF, increased FF***
- Due to **dehydration** from diarrhea and vomiting, there is a decrease in blood volume leading to decreased renal blood flow and **renal plasma flow (RPF)**.
- The body responds to hypovolemia by activating the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system, which cause **preferential efferent arteriolar constriction** (more than afferent constriction). This helps maintain glomerular hydrostatic pressure despite reduced renal perfusion.
- As a result, **GFR decreases** but proportionally **less than RPF decreases**, causing the **filtration fraction (FF = GFR/RPF) to increase**.
- In this patient with significant dehydration (tachycardia, hypotension, dry mucous membranes), both GFR and RPF are reduced, but FF is elevated due to compensatory mechanisms.
*Decreased GFR, decreased RPF, decreased FF*
- While GFR and RPF will decrease due to dehydration, the **filtration fraction is expected to increase**, not decrease.
- A decreased FF would imply GFR fell proportionally more than RPF, which contradicts the physiologic response where efferent arteriolar constriction helps preserve GFR relative to RPF.
*Decreased GFR, decreased RPF, no change in FF*
- With significant fluid loss and compensatory mechanisms (efferent arteriolar constriction via angiotensin II), a change in **filtration fraction** is expected.
- The body actively alters arteriolar tone to prioritize GFR maintenance, which directly increases FF.
*Increased GFR, increased RPF, increased FF*
- This pattern suggests **hypervolemia** or increased renal perfusion, which directly contradicts the patient's severe dehydration.
- Both GFR and RPF are expected to decrease in volume depletion, not increase.
*Increased GFR, decreased RPF, increased FF*
- An increase in GFR is physiologically impossible given the patient's severe volume depletion and reduced renal perfusion.
- While FF does increase in dehydration, this occurs in the context of **both GFR and RPF being decreased**, not with an increased GFR.
Myogenic autoregulation US Medical PG Question 8: A 9-year-old boy is brought to the physician's office by his mother because of facial swelling for the past 2 days. The mother says that her son has always been healthy and active but is becoming increasingly lethargic and now has a puffy face. Upon inquiry, the boy describes a foamy appearance of his urine, but denies having blood in the urine, urinary frequency at night, or pain during urination. He has no history of renal or urinary diseases. Physical examination is unremarkable, except for generalized swelling of the face and pitting edema on the lower limbs. Dipstick analysis reveals 4+ proteinuria. An abdominal ultrasound shows normal kidney size and morphology. A renal biopsy yields no findings under light and fluorescence microscopy; however, glomerular podocyte foot effacement is noted on electron microscopy. Which of the following changes in Starling forces occurs in this patient's condition?
- A. Decreased oncotic pressure in the Bowman's capsule
- B. Increased hydrostatic pressure in the Bowman's capsule
- C. Decreased hydrostatic pressure in the Bowman's capsule
- D. Decreased glomerular oncotic pressure (Correct Answer)
- E. Increased glomerular hydrostatic pressure
Myogenic autoregulation Explanation: ***Decreased glomerular oncotic pressure***
- The patient presents with **nephrotic syndrome**, characterized by severe proteinuria (4+ on dipstick), edema, and **minimal change disease** (podocyte foot effacement on electron microscopy without changes on light or fluorescence microscopy).
- In nephrotic syndrome, large amounts of plasma proteins, particularly **albumin**, are lost in the urine, leading to **hypoalbuminemia** and a significant decrease in the **oncotic pressure of the plasma** (and thus the glomerular capillaries).
*Decreased oncotic pressure in the Bowman's capsule*
- The Bowman's capsule normally has a **very low oncotic pressure** due to the almost complete absence of proteins in the filtrate.
- While theoretically a massive increase in protein filtration could increase it, the primary Starling force affected by protein loss in nephrotic syndrome is the **plasma oncotic pressure**.
*Increased hydrostatic pressure in the Bowman's capsule*
- This condition is not typically associated with nephrotic syndrome and would rather **impair filtration**.
- Increased hydrostatic pressure in the Bowman's capsule is usually seen in conditions causing **urinary tract obstruction**, which is not present here.
*Decreased hydrostatic pressure in the Bowman's capsule*
- This would tend to **increase glomerular filtration rate** by favoring filtration, which is not the primary physiological change driving edema in nephrotic syndrome.
- There is no clinical indication for such a change in this patient's presentation.
*Increased glomerular hydrostatic pressure*
- While sometimes seen in specific glomerular diseases, this is not the primary or defining Starling force change in nephrotic syndrome leading to systemic edema.
- Increased glomerular hydrostatic pressure would tend to **increase filtration**, potentially worsening proteinuria, but the fundamental issue in nephrotic syndrome is the **loss of oncotic pressure due to protein leakage**.
Myogenic autoregulation US Medical PG Question 9: A 73-year-old male is brought in by ambulance after he was found to be lethargic and confused. He has not been routinely seeing a physician and is unable to recall how he came to be in the hospital. His temperature is 99°F (37°C), blood pressure is 150/95 mmHg, pulse is 75/min, and respirations are 18/min. His past medical history is significant for poorly controlled diabetes and longstanding hypertension, and he says that he has not been taking his medications recently. Labs are obtained and shown below:
Serum:
Na+: 142 mEq/L
Cl-: 105 mEq/L
K+: 5 mEq/L
HCO3-: 16 mEq/L
Urea nitrogen: 51 mg/dL
Glucose: 224 mg/dL
Creatinine: 2.6 mg/dL
Which of the following changes would most likely improve the abnormal parameter that is responsible for this patient's symptoms?
- A. Increased Bowman's space hydrostatic pressure
- B. Decreased filtration coefficient
- C. Increased Bowman's space oncotic pressure
- D. Decreased glomerular capillary hydrostatic pressure
- E. Increased glomerular capillary hydrostatic pressure (Correct Answer)
Myogenic autoregulation Explanation: ***Increased glomerular capillary hydrostatic pressure***
- This patient presents with **acute kidney injury (AKI)** evidenced by **elevated creatinine (2.6 mg/dL)** and **BUN (51 mg/dL)**, causing uremic symptoms of **lethargy and confusion**
- The "abnormal parameter" is the **reduced GFR** causing azotemia and uremia
- To improve AKI and restore adequate filtration, **GFR must be increased**
- **Increasing glomerular capillary hydrostatic pressure** increases the net filtration pressure: **NFP = (PGC - PBS) - (πGC - πBS)**, where PGC is the primary driving force for filtration
- In prerenal AKI (likely in this patient with poor medication compliance for hypertension), restoring adequate renal perfusion pressure is the therapeutic goal
- While chronic hyperfiltration can contribute to long-term diabetic/hypertensive nephropathy, the **acute management priority** is restoring adequate GFR to clear uremic toxins
*Decreased glomerular capillary hydrostatic pressure*
- This would **decrease the net filtration pressure**, thereby **reducing GFR**
- Lower GFR would worsen azotemia and uremic symptoms
- This is the opposite of what's needed to improve acute kidney injury
*Increased Bowman's space hydrostatic pressure*
- This **opposes filtration** by increasing back-pressure against the glomerular capillaries
- Would **decrease GFR** and worsen the AKI
- Occurs pathologically in urinary tract obstruction
*Decreased filtration coefficient*
- The filtration coefficient (Kf) represents the permeability and surface area of the glomerular capillaries
- **Decreasing Kf reduces GFR**, worsening kidney function
- This represents glomerular damage, not a therapeutic intervention
*Increased Bowman's space oncotic pressure*
- This would theoretically **increase net filtration pressure** and GFR
- However, this is **physiologically implausible** as Bowman's space normally contains minimal protein (filtrate is protein-free)
- Significant protein in Bowman's space indicates severe glomerular damage with proteinuria, not a mechanism to improve function
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