1. Normal osmolality of serum
A. 260
B. 270
C. 280
D. 290
E. 300
2. What is the intracellular osmolality when the plasma osmolality is 280?
A. 270
B. 280
C. 290
3. Cells defend their
A. Size
B. Osmolality
4.Serum osmolality is contributed by. Select all that are correct.
A. Sodium
B. Potassium
C. Glucose
D. BUN
E. Creatinine
5. In hyperglycemic state glucose can freely enter cells to balance osmolality.
A. True
B. False
6. BUN cam freely enter cells, thus does not contribute to osmolar imbalance between ICF and ECF.
A. True
B. False
7. Which of the following is defended as a priority by the body?
A. Volume
B. Osmolality
8. What is the % volume loss that will trigger defensive actions by the body?
A. 0-2 %
B. 4-6%
C. 8-10%
9. What is the osmolality change that will trigger defensive actions by the body?
A. 2%
B. 4%
C. 6%
D. 8%
10. Sensors for volume loss are
A. baroreceptors in atrium
B. Juxtaglomerular apparatus
C. Both
D. Neither
10. Sensors for osmolality change
A. Osmoreeptors in thalamus
B. Thirst center in thalamus
C. Both
D. Neither
11. Hyperosmolality induced by urea will stimulate thirst center and osmolality receptors in thalamus
A. True
B. False
12. Stimulation of osmoreceptors results in
A. Secretion of angiotensin II
B. Secretion of ADH from posterior pituitary
C. Both
D. Neither
13 Angiotensin II is a potent stimulus for
A. Thirst
B. ADH release from posterior pituitary
C. Both
D. Neither
14. Stimulation of baroreceptors initiate. Select all that apply
A. Angiotensin II release
B. ADH release
C. Aldosterone release
D. All of the above
15. ADH primarily acts upon. Select all that apply
A. Glomerulus
B. Proximal tubule
C. Loop of Henle
D. Distal tubule
E. Collecting ducts
16. How much fluids (approximately) reach distal tubules in normal individuals
A. 3 liters
B. 6 liters
C. 9 liters
D. 18 liters
17. In normals the osmolality of urine at the distal tubule is
A. 50
B. 100
C. 200
D. 300
18. Sodium absorption from medullary thick ascending limb of loop of Henle in normals
A. 5%
B. 15%
C. 25%
D. 35%
19.In the total absence of ADH the urine volume will be
A. 3 liters
B.6 liters
C. 9 liters
D. 18 liters
19. Defenses for volume expansion are
A. Release of atriopeptin from cardiac atria
B. Oropharyngeal reflex to suppress thirst
C. Intrarenal Prostaglandin E2
D. All of the above
E. None of the above
20. In hypotonic disorders
A. Ratio of solutes to water is reduced
B. Serum osmolality is reduced
C. Serum sodium is reduced
D. All of the above
E. None of the above
21. When serum sodium is low , it means
A. Total body sodium is low
B. Total body sodium is normal
C. Total body sodium is increased
D. Any of the above
22. Example of low serum sodium with low total body sodium is
A. Nasogastric suction
B. Inappropriate ADH secretion
C. Congestive heart failure
23. Example of low serum sodium with normal total body sodium is
A. Nasogastric suction
B. Inappropriate ADH secretion
C. Congestive heart failure
24. Example of low serum sodium with increased total body sodium is
A. Nasogastric suction
B. Inappropriate ADH secretion
C. Congestive heart failure
25. Serum sodium is 130 with serum osmolality of 300 mOsm/kg. Most likely it is
A. Inappropriate ADH secretion
B. Diabetic ketoacidosis
C. Uremia
D. Ethanol intoxication
26. Serum sodium is 138 with serum osmolality of 300 mOsm/kg. Most likely it is
A. Inappropriate ADH secretion
B. Diabetic ketoacidosis
C. Uremia
27. Spurious hyponatremia can be seen in
A. Uremia
B. Excessive mannitol administration
C. Hyperlipemia
28. Serum sodium of 125 with serum osmolality of 270 mOsm/kg
A. Primary increase in water ingestion
B. Ability of kidney to maximally dilute is limited
C. Both
D. Neither
29. Decreased sodium delivery to distal nephron segments occurs in all of the following except
A. Congestive heart failure
B. Cirrhosis
C. Sepsis
D. Nephrotic syndrome
30. Decreased sodium delivery to distal nephron segments results in inability to create an osmotic gradient with interstitium.
A. True
B. False
31. With a normal diet, a normal individual can consume how much fluid without becoming hyponatremic
A. 5 liters
B. 10 liters
C. 15 liters
D. 20 liters
32. In inappropriate ADH secretion, select the best option
A. Hyponatremia
B. Volume expansion
C. Natriuresis
D. Hypouricemia
E. Normal or reduced BUN and creatinine
F. All of the above
33. In inappropriate ADH secretion, there is serum hyponatremia and is associated with
A. normal urinary sodium excretion
B. decreased urinary sodium excretion
C. increased urinary sodium excretion
34. In patients with inappropriate ADH secretion, there is volume expansion but it is not associated with edema.
A. True
B. False
35. In patients with congestive heart failure, the hyponatremia is due to
A. Non-osmotic, volume mediated ADH release
B. Reductions in the rate of sodium delivery to the diluting segment
C. Both
D. Neither
36. Acute hyponatremia is a medical emergency.
A. True
B. False
37. In patients with acute hyponatremia associated with volume contracted states, the treatment of choice is
A. 3-5% saline over 4-6 hours
B. Normal saline over 4-6 hours
C. Restrict water to 800 ml/day
38. The best way to treat chronic hyponatremia is by restriction of electrolyte free water to less than 1 L/day along with high dietary salt intake
A. True
B. False
39.. What are the alternative method of treating chronic hyponatremia, if you are unable to restrict fluids?
A Normal saline in combination with a loop diuretic
B. Lithium carbonate
C. Neither
D. Both