HBY 531 MEDICAL PHYSIOLOGY

HBY 531 MEDICAL PHYSIOLOGY

Lecture Exam 2

2003

Section 1: Answer the following using:

a = becomes more positive

b = remains the same

c = becomes more negative

1. The maximum diastolic potential of a Purkinje fiber_____A____ if the external [K] is raised from 4mM to 10mM in the bathing solution

2. The maximum diastolic potential of a sinus node myocyte___C____ after a beta agonist is added to the bathing solution

Section 2: Answer the following using:

a = increases

b = remains unchanged, causes no change in

c = decreases

3. The interval between sinus node action potentials___A____ if acetylcholine is added to the bathing solution

4. The duration of the P wave of the EKG___B_____ if the conduction velocity of the Purkinje fibers is slowed.

5. The duration of the QRS complex___A_____ if the plasma [K] is reduced from 4mM to 0.5mM

6. The amplitude of contraction of a ventricular myocyte____A____ if a beta agonist is added to the bathing solution.

7. The duration of a sinus node action potential____C_____ when the vagus nerve is being stimulated.

8. As the end-diastolic volume is increased from 100 mL to 130 mL, stroke volume___A______

9. The velocity of contraction within the ventricle ____B______ during isovolumetric contraction.

10. As the mean arterial pressure is increased from 95 to 115 mmHg, end-systolic volume within the left ventricle ____A______.

11. Following selective stimulation of the sympathetic nerves to the heart, central venous pressure _____C________.

12. The pressure within the portal vein ____C_____ following an infusion of propranolol (a non-specific b blocker).

13. As a vein vasoconstricts (venoconstriction), the compliance of the vessel wall _____C____.

14. Local vascular resistance ____C______ following an increase in adenosine levels in the interstitial fluids surrounding vascular smooth muscle cells.

15. Local vascular resistance ____A______ following infusion of phenylephrine (an a1 agonist).

16. As a normal healthy person moves upright from a supine position, stroke volume _____C______.

17. The hydrostatic pressure within a systemic capillary _____A______ following a decrease in arteriolar vascular resistance.

18. The airways consist of a series of branching tubes which become progressively narrower and shorter as they penetrate deeper into the lung. This results in a(n)___A____ in total cross sectional area of the respiratory tract.

19. At low lung volumes, expiratory flow (as measured on an expiratory flow-volume curve)_____B_______with increasing expiratory effort.

20. The surface area available for diffusion is A during exercise due to increased blood flow.

21. The Bohr effect demonstrates that increased CO₂ (i.e., high PCO₂) shifts the O₂ dissociation curve to the right which C___ the O₂ content of the blood.

22. The Haldane effect demonstrates that decreased O₂ saturation (i.e., high PO₂) shifts the CO₂ dissociation curve to the left which A___ the CO₂ content of the blood.

Section 3: For each of the following, choose the single best response.

The figure shown above is a pressure-volume loop from a normal, healthy adult. Use this figure to answer questions 23 and 24.

23. The mitral valve closes: (A)

a. at point a

b. at point b

c. at point c

d. at point d

e. somewhere between points b and c

24. Which portion of the pressure volume loop correlates with the T wave of the EKG?(B)

a. the portion between points a and b

b. the portion between points b and c

c. the portion between points c and d

d. the portion between points d and a

e. point a

The figure shown above shows how pressure changes over time within the left ventricle (solid line), aorta (upper dotted line), and left atrium (lower dotted line) for a normal healthy adult. Use this figure to answer questions 25 and 26.

25. Which of the following intervals corresponds to isovolumetric contraction? (A)

a. the interval between points A and B

b. the interval between points B and C

c. the interval between points C and D

d. the interval between points D and E

e. the interval between points E and A

26. The mitral valve opens at point: (E)

a. A

b. B

c. C

d. D

e. E

The figure shown above compares the pressure volume loop of a normal healthy adult with that of a patient with a valve problem. Use this figure to answer questions 27 and 28.

27. With regard to the patient’s pressure volume loop, all of the following statements are true EXCEPT: (D)

a. the peak ventricular pressure in this patient is higher than normal

b. the ventricle in diastole of this patient is less compliant than normal

c. the end diastolic volume of this patient is greater than normal

d. the ejection fraction of this patient is greater than normal

e. there is an increase in the contractility of this patient’s ventricle compared to normal.

28. The particular valve problem experienced by this patient is most likely: (A)

a. aortic stenosis

b. aortic insufficiency (regurgitation)

c. mitral stenosis

d. mitral insufficiency (regurgitation)

29. Dobutamine is a specific b1 agonist. Following an infusion of dobutamine into the coronary circulation, all of the following would occur except (B)

a. intracellular cAMP levels would increase within cardiac myocytes

b. duration of systole would increase within cardiac myocytes

c. the size of the inward calcium current would increase

d. the pump rate of the Ca²⁺ ATPase on the sarcoplasmic reticulum (SR) would increase within cardiac myocytes

e. the contractility of the ventricle would increase

30. A patient has a heart rate of 65 beats/min, a pulmonary vein O₂ content of 0.19 mL O₂/mL of blood, a pulmonary artery O₂ content of 0.13 O₂/mL of blood, and an oxygen consumption of 285 mL O₂/minute. What is this patient’s stroke volume? (C)

a. 50.7 mL

b. 64.1 mL

c. 73.1 mL

d. 87.2 mL

e. The stroke volume cannot be determined from this information

31. An individual is injected with 10 mg of Evan’s blue. Following a suitable equilibration period, an arterial blood sample was obtained which contained Evan’s blue at a concentration of 2.5 mg/L. The hematocrit was found to be 0.42. Assume no urinary excretion of Evan’s blue. On the basis of this information, what is this person’s plasma volume? (B)

a. 2.0 L

b. 4.0 L

c. 4.5 L

d. 5.5 L

e. cannot be determined

32. With regard to the previous question, which of the following body fluid volumes can be computed on the basis of the given data? (E)

a. total body water

b. extracellular fluid volume

c. intracellular fluid volume

d. interstitial fluid volume

e. total blood volume

33. The velocity of blood flow is lowest within: (C)

a. arteries

b. arterioles

c. capillaries

d. venules

e. veins

34. The pressure within blood vessels is lowest within: (E)

a. arteries

b. arterioles

c. capillaries

d. venules

e. veins

35. For a person who has a resting cardiac output of 6 L/min and a total peripheral resistance of 18 mmHg^. min / L, what is their mean arterial pressure? (D)

a. 80 mmHg

b. 95 mmHg

c. 98 mmHg

d. 108 mmHg

e. Mean arterial pressure cannot be determined from this information

36. Which of the following conditions will result in a decrease in pulse pressure(C)

a. an increase in stroke volume

b. a decrease in arterial compliance

c. an increase in peripheral runoff due to arteriolar vasodilation

d. both a and c

e. both b and c

37. As a result of stimulation of sympathetic nerves to the vascular supply of an organ, all of the following decrease EXCEPT (Accept All)

a. blood flow through that organ

b. blood volume within that organ

c. interstitial fluid volume within that organ

d. capillary pressures within that organ

e. venous pressures within that organ

38. Following an infusion of exogenous norepinephrine, which of the following decreases? (D)

a. total peripheral resistance

b. systolic blood pressure

c. diastolic blood pressure

d. cardiac output

e. none of the above.

39. During exercise, which of the following decreases? (A)

a. total peripheral resistance

b. stroke volume

c. heart rate

d. cardiac output

e. none of the above

40. The conducting airways (E)

a. Do not participate in gas exchange because they contain no alveoli

b. Transport air between the environment and the gas exchange regions of the lung

c. Comprise the anatomical dead space in a healthy individual

d. Are the primary site of gas exchange

e. a, b, and c

41. Transpulmonary pressure is equal to (C)

a. Atmospheric pressure minus alveolar pressure

b. Alveolar pressure minus atmospheric pressure

c. Alveolar pressure minus intrapleural pressure

d. Intrapleural pressure minus atmospheric pressure

e. Intrapleural pressure minus alveolar pressure

42. At functional residual capacity (end expiration), (D)

a. The elastic recoil of both the lung and chest wall are directed inward

b. The elastic recoil of both the lung and chest wall are directed outward

c. The inward directed elastic recoil of the lung is less than that of the outward directed elastic recoil of the chest wall

d. The inward directed elastic recoil of the lung balances the outward directed elastic recoil of the chest wall

e. The inward directed elastic recoil of the lung is greater than that of the outward directed elastic recoil of the chest wall

43. Surfactant (D)

a. Enhances the structural interdependence of alveoli

b. Has no effect on maintaining stability of alveolar volumes of different sizes

c. Decreases surface tension independent of lung volume (surface area)

d. Has a greater ability to reduce surface tension at smaller lung volumes (smaller alveolar surface area) than at larger lung volumes (larger alveolar surface area)

e. Ensures relatively even distribution of the ventilation throughout the lung

44. Which of the following lung volumes cannot be measured with a simple spirometer?(D)

a. Tidal volume

b. Inspiratory reserve volume

c. Expiratory reserve volume

d. Residual volume

e. FEV₁

45. Which of the following factors may reduce the FEV₁in a patient with chronic obstructive pulmonary disease (COPD)? (B)

a. Restricted expansion of the lung

b. Excessive secretions in the airways

c. Increased radial traction on the airways

d. Increased elastic recoil in the lung

e. All of the above factors may contribute to reduced FEV₁

46. Which patient has the highest alveolar ventilation? (D)

a. Tidal volume = 1000ml; Frequency = 9 breaths/min; Dead space volume = 250 ml

b. Tidal volume = 650ml; Frequency = 15 breaths/min; Dead space volume = 200 ml

c. Tidal volume = 500ml; Frequency = 18 breaths/min; Dead space volume = 125 ml

d. Alveolar ventilation is the same in all cases

e. Measuring the response to bronchodilator drugs

47. On top of Pikes Peak (4300 meters above sea level), the barometric pressure is approximately 440 mmHg. The partial pressure of O₂ is about: (C)

a. 0.44 mmHg

b. 44 mmHg

c. 92 mmHg

d. 160 mmHg

e. 440 mmHg

48. A normal person, seated upright, begins to inspire from functional residual capacity (FRC). The inspired gas is labeled with xenon 133. Most of this radioactive gas will probably be found in (C)

a. The conducting airways (i.e., anatomical dead space)

b. In the alveoli in the upper portions of the lung

c. In the alveoli in the lower portion of the lung

d. Uniformly distributed to all alveoli

49. Which of the following is not true regarding the pulmonary circulation as compared to the systemic circulation ©

a. Pulmonary arterial vessels have thinner walls and greater internal diameters than corresponding branches of the systemic vessels

b. Pulmonary arterial vessels have lower intravasclar pressures than those found in systemic arteries

c. Pulmonary arterial vessels have the same vascular smooth muscle response to hypoxia

d. The pulmonary circulation has the same blood flow per minute

e. c and d

50. Which of the following situations would be expected to lead to an increase in the amount of lung under zone 1 conditions? (E)

a. Changing from the standing to supine position

b. Positive pressure ventilation with positive end-expiratory pressure

c. Blood loss secondary to trauma

d. A reduction in pulmonary venous pressure

e. b and c

51. Which of the following circumstances might be expected to contribute to the formation of pulmonary edema? (E)

a. An accumulation of fluid in the perivascular and peribronchial interstitial tissues

b. Occlusion of the lymphatic drainage of an area of the lung

c. Destruction of portions of the pulmonary capillary endothelium by toxins

d. A reduction in the concentration of plasma proteins

e. All of the above factors may contribute to the formation of pulmonary edema

52. On top of Pikes Peak (4300 meters above sea level), hemoglobin saturation with O₂ is reduced to 82%. The oxygen carrying capacity of blood in a person with 15 g Hb/100 ml of blood is approximately: (B)

a. 12.3 ml O₂/100 ml blood

b. 16.48 ml O₂/100 ml blood

c. 19.58 ml O₂/100 ml blood

d. 20.1 ml O₂/100 ml blood

e. 82.0 ml O₂/100 ml blood

53. CO₂is carried in the blood mostly (E)

a. Dissolved

b. As carbamino compounds with plasma proteins

c. As carbamino Hb

d. As bicarbonate ions in red blood cells

e. As bicarbonate ions in the plasma

54. A comatose patient is admitted from the emergency room with the following arterial blood gas values: PO₂ 46 mmHg, PCO₂ 80 mmHg, and pH 7.10. The most likely cause of this hypoxemia is (A)

a. A sedative-hypnotic drug overdose

b. Severe pulmonary fibrosis

c. An acute exacerbation of COPD

d. Carbon monoxide poisoning

e. Congenital right-to-left shunt

55. The apex, compared with the base, of the upright lung (C)

a. Has smaller alveoli

b. Has higher compliance

c. Has a high ventilation-perfusion ratio

d. Has a low PO₂

e. Has a high PCO₂

56. A patient was admitted to the hospital with an acute exacerbation of COPD. When given 100% O₂, his arterial PCO₂ increased from 50 to 80 mmHg. The most likely causative factor was (C)

a. Increased in airway resistance

b. Hypoxic pulmonary vasoconstriction in poorly ventilated areas of the lung

c. Depression of ventilation

d. Depression of cardiac output

e. Reduced levels of 2,3-DPG in the blood

57. Which of the following characteristics are unique to juxtamedullary nephrons? (B)

a. outer medullary thin descending limbs.

b. efferent arterioles that perfuse medullary vasa recta.

c. the presence of a juxtaglomerular apparatus.

d. glomeruli that are located in the medulla near the cortex.

58. Which of the following are characteristics of the glomerular capillary wall? (C)

a. it consists of 2 distinct layers: a basement membrane and a layer of epithelial cells called podocytes.

b. its permselectivity properties with respect plasma proteins are determined primarily by the fenestrations in the capillary endothelium.

c. it is freely permeable to uncharged solutes with MW less than approximately 5 kD.

d. large anionic solutes are more permeable than cationic solutes of the same effective molecular radius.

59. Which of the following statements about glomerular filtration is not correct?(C)

a. glomerular capillary hydrostatic pressure is normally about 50 mmHg.

b. net ultrafiltration pressure is greatest at the beginning of the glomerular capillaries.

c. glomerular plasma oncotic pressure is equal in magnitude to the hydrostatic pressure in Bowman's space.

d. the ultrafiltration coefficient, K_f, can be altered by some vasoactive hormones.

60. Which of the following statements about autoregulation of RBF and GFR is not correct? (B)

a. autoregulation is mediated, in part, by a myogenic reflex intrinsic to vascular smooth muscle.

b. an important autoregulatory mechanism is that the pressure in Bowman's space will rise sharply whenever GFR increases, thereby reducing GFR and RBF.

c. tubuloglomerular feedback contributes to renal autoregulation by increasing afferent arteriolar resistance when GFR increases and the flow of tubular fluid through Henle's loop rises.

d. renal autoregulation does not prevent changes in RBF in response to vasoactive hormones.

61. Which of the following factors will not influence net proximal tubular sodium and water reabsorption? (C)

a. angiotensin II

b. the hydrostatic pressure within the peritubular capillaries

c. anti-diuretic hormone

d. the fraction of renal plasma flow filtered in the glomerular capillaries

62. Which of the following statements about reabsorption in the second half of the proximal tubule is not correct? (B)

a. The transport of sodium and chloride into the cells involves the cycling of organic bases across the apical membrane.

b. There is no passive diffusion of ions through the tight junctions.

c. The chloride ion concentration in this segment is higher than in arterial plasma, owing to the preferential reabsorption of bicarbonate in the first part of the proximal tubule.

d. The osmolarity of the tubular fluid remains essentially the same as that of arterial plasma because of the high water permeability of this segment.

63. Which of the following is the most important apical membrane transport process that

moves sodium into TAL cells cells from the tubular fluid? (C)

a. active sodium transport by Na,K-ATPase

b. thiazide-inhibitable Na,Cl symport

c. furosemide-inhibitable Na,K,2Cl symport

d. passive diffusion of sodium through sodium channels

64. Which of the following mechanisms is not significantly involved in sodium

reabsorption in the principle cells in the late distal tubules and collecting ducts? (B)

a. passive sodium diffusion through apical membrane sodium channels

b. passive sodium diffusion through the tight junctions

c. active extrusion of sodium from the cell via Na,K-ATPase located in the basolateral membrane

d. the electrical potential difference across the apical membrane

65. Which of the following will result in a decrease in effective circulating volume. (A)

a. extravasation of plasma protein in a person with normal kidney function

b.ingestion of 2 liters of pure water.

c. ingestion of 300 mmoles of sodium chloride.

d.ingestion of all of the above will result in an increase in extracellular fluid volume.

66. Which of the following statements about renal medullary countercurrent multiplication is not true? (C)

a. The high concentrations of sodium and chloride in the medullary interstitium results from the reabsorption of theses ions by the cells of the ascending limb of Henle's loop.

b. Countercurrent multiplication does not occur in the vasa recta.

c. Urea is passively secreted into the tubular fluid along the entire length of the ascending limb of Henle's loop.

d. When ADH levels are low, the low osmolarity of the excreted urine is the result of the transport processes in the ascending limb of Henle's loop.

67. Which of the following will significantly increase urine flow in a person with high plasma ADH levels? (C)

a. a rise in plasma osmolarity

b. a rise in plasma aldosterone levels

c. a 5-fold increase in urinary solute excretion

d. none of the above will increase urine flow under these circumstances

68. Which of the following changes would not occur following inhibition of angiotensin converting enzyme? (A)

a. renin secretion will fall

b. aldosterone levels in plasma will fall

c. proximal tubular sodium reabsorption will decrease

d. peripheral resistance will decrease

69. Which of the following events would not occur as a result of doubling sodium chloride intake in a healthy person with free access to water? (D)

a. 10% rise in plasma sodium concentration

b. an immediate rise in renal sodium excretion to maintain body sodium balance

c. a fall in cardiac ANP secretion

d. neither a, b, nor c, would occur.

70. The renal handling of a new drug is studied by giving the drug and one hour later measuring GFR, urine flow, and the plasma and urine concentrations of the drug. The measurements yielded the following values: urine flow, 3 ml/min; GFR, 100 ml/min; plasma and urine concentrations drug concentrations of 0.1 and 5.0 mg/ml. respectively. What can you conclude about tubular transport of the drug from this data, assuming that the drug is freely filtered and not metabolized by the kidney? (C)

a. There is net reabsorption with a Tm of 5 mg/min.

b. There is net secretion with a Tm of 5 mg/min.

c. There is net secretion of the drug at a rate of 5 mg/min.

d. The data are insufficient to determine anything about tubular transport.

71. A person is infused with PAH and, after equilibration, P_PAH is 0.02 mg/ml. At this time, urine flow is 2 ml/min and U_PAH is 4 mg/ml. What is renal plasma flow? (E)

a. 200 ml/min

b. 300 ml/min

c. 500 ml/min

d. 1000 ml/min

e. none of the above are correct.

72. In response to the i.v. infusion of NaOH, which of the following would not occur?(B)

a. Plasma bicarbonate concentration would rise

b. Renal ammonia production would increase.

c. Arterial P_CO2 would rise as a result of decreased alveolar ventilation.

d. Renal bicarbonate excretion will increase.

73. Which of the following mechanisms is not significantly involved in the secretion of hydrogen ions (protons) in the intercalated cells in the late distal tubules and collecting ducts? (D)

a. intracellular generation of protons by carbonic anhydrase

b. active secretion of protons by a proton-ATPase located on the apical membrane

c. release of bicarbonate ions into the blood flowing through peritubular capillaries or vasa recta

d. all of the above mechanisms are involved

74. A person has a plasma pH of 7.22, plasma bicarbonate concentration of 10 mM, and arterial P_CO2 of 25 mmHg. How would you describe the acid base status of this person?(D)

a. respiratory alkalosis

b. respiratory acidosis

c. metabolic alkalosis

d. metabolic acidosis

75. A person has a urine flow of 1.5 liters/day, and urinary concentrations of ammonium, titratable acid, and bicarbonate of 25, 15, and 0 mM. What is the net rate of renal acid excretion? (A)

a. 60 mmoles/day

b. 25 mmoles/day

c. 50 mmoles/day

d. none of the above are within 1 mmole/day of the correct answer.

Section 4: This section contains 4 different cases that refer to cardiovascular, respiratory, and renal physiology. Each case is followed by several questions. For each of the following, choose the single best response.

Case 1: A patient presents complains of difficulty breathing, blood tinged sputum, chest pains, and fatigue and weakness that become severe upon mild exercise. The patient’s heart rate is increased, as is their respiratory rate. Their skin is pale, cold and clammy. Your tentative diagnosis is congestive heart failure.

76. Assuming that compensatory mechanisms have taken place, you would expect central venous pressure (CVP) in this patient to be: (A)

a. higher than the CVP of a normal person

b. the same as the CVP of a normal person

c. lower than the CVP of a normal person

77. One of the compensatory mechanisms that occurs in this patient involves hypervolemia. With regard to the pressure volume loop of this patient, hypervolemia would be expected to produce: (C)

a. a decrease in stroke volume

b. a decrease in ejection fraction

c. an increase in end diastolic volume

d. a reduction in end diastolic pressure:

e. none of the above

78. One of the compensatory mechanisms that occurs in this patient involves ventricular hypertrophy. With regard to the pressure volume loop of this patient, ventricular hypertrophy would be expected to result in: (E)

a. an increase in filling pressures

b. a decrease in ejection fraction

c. a decrease in stroke volume

d. a decrease in wall stress

e. all of the above

Case 2: A patient presents following a severe (1.5 L) hemorrhage. When seen in the emergency department, he is confused, with pale, clammy skin. His pulse is weak and rapid (120 beats/minute). His blood pressure while in a supine position is 95/65 mmHg.

79. You would expect central venous pressure (CVP) in this patient to be: (C)

a. higher than the CVP of a normal person

b. the same as the CVP of a normal person

c. lower than the CVP of a normal person

80. With regard to compensatory mechanisms, all of the following would be expected to be increased except: (D)

sympathetic nerve activity
plasma epinephrine levels
plasma angiotensin II levels
plasma atrial naturietic peptide (ANP) levels
plasma anti-diuretic hormone (ADH) levels

Case 3:

History: A 43 year old overweight male is referred to the clinic because his wife “couldn’t stand my snoring anymore.” The patient expresses no specific complaint himself and does not think anything is wrong with him. His wife relates that she is worried because he has been involved in two “fender benders” in the past few months, and he often falls asleep while watching television. Upon further questioning, she relates that he has gained a “lot of weight” lately and that at times he stops breathing while asleep and then restarts breathing with a very large snort. The patient and his wife deny all other symptoms.

The patient’s past medical and surgical histories, family history, and social history are noncontributory. He is on no medication.

Physical Examination:

1. The physical examination reveals an obese male with no respiratory distress.

2 His temperature is 37 ^oC.

3. His blood pressure is 170/98, heart rate 116 beats/min, and respiratory rate 14 breaths/min.

4. The head and neck examination reveals an over-abundance of redundant tissue and a small opening in the hypopharynx.

5. His cardiac rate and rhythm are regular; he has no murmur.

6. His lungs are clear.

7. His chest x-ray, electrocardiogram, and laboratory test results are within normal limits.

Case Discussion:

81. Which of the following factors most likely leads to the apneic episodes in this patient? (B)

a. Increased hypoxic drive during sleep

b. Loss of tone of upper airway muscles (e.g., genioglossus muscle)

c. Loss of tone of the intercostal muscles

d. Chronic sleep deprivation

e. Snoring

82. During the apneic episodes, alveolar PCO₂ A .

a. increases

b. remains unchanged

c. decreases

83. During the apneic episodes, oxyhemoglobin saturation C .

a. increases

b. remains unchanged

c. decreases

84. During the apneic episodes, the patient exhibits profound increases in respiratory efforts. This results in (A)

a. Intrapleural pressure progressively becoming more negative

b. A balance between the inward directed elastic recoil of the lung and the outward directed elastic recoil of the chest wall

c. Increased dynamic compression of the airways

d. Stimulation of arterial chemoreceptors

e. Pulmonary and systemic hypertension

85. The apneic episodes result in stimulation of the following: (A)

a. Arterial and central chemoreceptors

b. Arterial baroreceptors

c. Pulmonary irritant receptors

d. J receptors (Pulmonary C-fibers)

e. Muscle spindles of the gamma-efferent system

Case 4:

A patient presents with BP of 185/110 mmHg, and some mild peripheral edema. Diagnostics show no evidence of significant cardiovascular disease. Blood and urine chemistries are normal, except that plasma creatinine concentration is 4.2 mg/dl (normal 1.4), and elevated levels of blood urea nitrogen. Urinary protein excretion is 8-fold higher than normal.

86. Based on these data, and assuming that normal GFR is 100 ml/min, which of the following is the best estimate of GFR in the patient. (B)

a. 50-60 mL/min

b. 25-40 mL/min

c. 10-15 mL/min

d. less than 10 ml/min

87. Based on these findings, how would you characterize this patient? (C)

a. Hypertensive with chronic renal insufficiency

b. Hypertensive with azotemia

c. Hypertensive with uremia

d. Hypertensive with end-stage renal disease

88. Which of the following statements would not apply to this patient? (B)

a. It is unclear, with only these data, if the hypertension is essential or secondary.

b. It is likely that the hypertension is insensitive to dietary sodium intake.

c. It is likely that effective circulating volume and extracellular fluid volume are both expanded.

Effective control of the hypertension is essential in preventing further loss of renal function.

SPECIAL NOTES:

1. Question 22: should read (i.e., low PO2), not (i.e., high PO2)

2. Question 31: Assume that the urinary excretion of Evan’s blue is zero.

3. Question 87: Hard copy of the exam had responses c and d merged into c. It was announded that response d should be “Hypertensive with end-stage renal disease”. This is fixed above.