Chapter·PhysiologyAcid-base balance

Titratable acid excretionDownloads

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1

A 72-year-old female is brought to the emergency department after being found unresponsive in her garage with an open bottle of unmarked fluid. She is confused and is unable to answer questions on arrival. Her medical history is significant for Alzheimer disease, but her family says she has no medical comorbidities. Serum analysis of this patient's blood shows a pH of 7.28 with a high anion gap. The electrolyte that is most likely significantly decreased in this patient follows which of the following concentration curves across the proximal tubule of the kidney?

ACurve C

BCurve E

CCurve B

DCurve A

ECurve D

2

On cardiology service rounds, your team sees a patient admitted with an acute congestive heart failure exacerbation. In congestive heart failure, decreased cardiac function leads to decreased renal perfusion, which eventually leads to excess volume retention. To test your knowledge of physiology, your attending asks you which segment of the nephron is responsible for the majority of water absorption. Which of the following is a correct pairing of the segment of the nephron that reabsorbs the majority of all filtered water with the means by which that segment absorbs water?

ADistal convoluted tubule via passive diffusion following ion reabsorption

BDistal convoluted tubule via aquaporin channels

CThick ascending loop of Henle via passive diffusion following ion reabsorption

DProximal convoluted tubule via passive diffusion following ion reabsorption

ECollecting duct via aquaporin channels

3

A 45-year-old woman presents with severe, acute-onset colicky abdominal pain and nausea. She also describes bone pain, constipation, headache, decreased vision, and menstrual irregularity. Past medical history is significant for surgical removal of an insulinoma one year ago. Two months ago, she was prescribed fluoxetine for depression but hasn’t found it very helpful. Family history is significant for a rare genetic syndrome. Non-contrast CT, CBC, CMP, and urinalysis are ordered in the diagnostic work-up. Urine sediment is significant for the findings shown in the picture. Which of the following will also be a likely significant finding in the diagnostic workup?

ADecreased urine pH

BHypokalemia and non-anion gap acidosis

CDiagnosis confirmed with cyanide-nitroprusside test

DElevated hemoglobin on CBC with significantly low levels of EPO

EImaging demonstrates staghorn calculi

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