1. What is the main function of the kidney?

Correct Answer: B. Excretion of metabolic waste products

Justification: While the kidneys perform multiple roles, their primary function
is to remove waste products from the blood and excrete them in the urine.

Reference: Guyton & Hall, 14th ed., Ch. 26.

2. What is the functional unit of the kidney?

Correct Answer: B. Nephron

Justification: The nephron is the microscopic structural and functional unit of

the kidney responsible for filtration, reabsorption, secretion, and excretion.

Reference: Guyton & Hall, Ch. 25.

3. Which part of the nephron is responsible for filtration?

Correct Answer: C. Glomerulus

Justification: Filtration occurs at the glomerulus where blood plasma is

filtered into Bowman’s capsule.

Reference: Guyton & Hall, Ch. 26.

4. Which of the following substances is actively secreted by the kidneys?

Correct Answer: C. Sodium

Justification: Sodium is actively reabsorbed and can be secreted based on

hormonal control. However, urea and creatinine are filtered and partially
reabsorbed; glucose is reabsorbed, not secreted.

Correction Note: Though the kidney secretes substances like PAH and H+,
sodium is more relevant for active transport.

Reference: Guyton & Hall, Ch. 27.

5. Which region of the kidney is responsible for concentrating urine?

Correct Answer: A. Medulla

Justification: The medulla contains the loop of Henle and collecting ducts, key
structures for concentrating urine using the countercurrent multiplier system.

Reference: Guyton & Hall, Ch. 28.

6. The glomerular filtration rate (GFR) is a measure of:

Correct Answer: B. The rate at which fluid is filtered from the blood into
tubules

Justification: GFR measures the amount of plasma ultrafiltrate formed per

minute by the kidneys.

Reference: Guyton & Hall, Ch. 26.

7. Which structure connects the kidney to the bladder?

Correct Answer: C. Ureter

Justification: The ureter is a muscular tube that carries urine from the renal
pelvis to the bladder.

Reference: Moore’s Clinically Oriented Anatomy, 7th ed.

8. Which part of the brain is primarily responsible for controlling micturition?

Correct Answer: B. Pons

Justification: The pontine micturition center coordinates the activities of the

bladder and urethral sphincters.

Reference: Ganong’s Review of Medical Physiology, Ch. 24.

9. What is the role of the vasa recta in the kidney?

Correct Answer: B. They deliver oxygen and nutrients to the renal tissue

Justification: Vasa recta maintain the osmotic gradient in the medulla while
supplying blood to deep nephron segments.

Reference: Guyton & Hall, Ch. 28.

10. The detrusor muscle is located in the:

Correct Answer: C. Bladder

Justification: The detrusor muscle is the smooth muscle layer of the bladder
wall responsible for contraction during urination.

Reference: Ganong’s, Ch. 24.

11. A patient presents with decreased urine output, swelling, and increased
blood pressure. Lab tests show elevated creatinine levels. What is most likely
affected in the kidneys?

Correct Answer: A. Glomerular filtration

Justification: Elevated creatinine and fluid retention are hallmark signs of

reduced glomerular filtration rate (GFR), indicating impaired kidney function.

Reference: Guyton & Hall, Ch. 30.

12. A patient with spinal cord injury above the sacral level experiences
involuntary bladder emptying without voluntary control. This is most likely
due to:

Correct Answer: B. Automatic bladder

Justification: Lesions above the sacral micturition center result in a

hyperreflexic (automatic) bladder that empties involuntarily.

Reference: Ganong’s Review, Ch. 24.

13. A 50-year-old male complains of frequent urination and incontinence. An

MRI shows damage to the brainstem. What part of the urinary system is most
affected?

Correct Answer: C. Brain’s ability to inhibit micturition

Justification: The brainstem (especially the pons) helps inhibit bladder

contractions. Damage causes loss of control, leading to urgency and
incontinence.

Reference: Ganong’s, Ch. 24.

14. A 65-year-old woman has difficulty urinating despite a full bladder. She
has no sensory input from the bladder. What condition is most likely?

Correct Answer: B. Atonic bladder

Justification: Atonic bladder occurs when sensory input is lost, usually due to
spinal cord injury or peripheral neuropathy. The bladder fills but cannot
contract properly.

Reference: Guyton & Hall, Ch. 26.

15. A patient presents with elevated blood pressure and increased fluid
retention. Urinalysis shows high levels of sodium retention. What kidney
process is most likely disrupted?

Correct Answer: C. Tubular reabsorption

Justification: Excessive sodium reabsorption increases fluid retention and

blood volume, contributing to hypertension.

Reference: Guyton & Hall, Ch. 28.

16. A 30-year-old male with kidney failure has reduced glomerular filtration
rate (GFR). What will this most directly affect?

Correct Answer: A. The ability of the kidneys to filter waste from the blood

Justification: GFR directly reflects the kidneys’ capacity to clear waste

products like creatinine and urea.

Reference: Guyton & Hall, Ch. 26.

17. A patient with high levels of creatinine in the blood might have:

Correct Answer: A. Impaired renal filtration

Justification: Creatinine is filtered at the glomerulus and not reabsorbed. High

plasma levels imply reduced GFR.

Reference: Guyton & Hall, Ch. 30.

18. A 70-year-old male with chronic kidney disease has a reduced number of
nephrons. What is the most likely outcome of this condition?

Correct Answer: C. Decreased kidney function over time

Justification: Nephron loss reduces total GFR and limits the kidney’s capacity
to regulate fluid, electrolyte, and waste balance.

Reference: Guyton & Hall, Ch. 30.

19. A patient has frequent urination and a full bladder but cannot urinate.
This could be a sign of:

Correct Answer: C. Obstruction in the urinary tract

Justification: A full bladder with inability to void typically indicates an

obstructive uropathy such as a stone or enlarged prostate.

Reference: Ganong’s, Ch. 24.

20. A 40-year-old male is experiencing severe pain due to kidney stones.

Which process in the kidney is likely causing this pain?

Correct Answer: B. Ureteral peristalsis

Justification: Kidney stones cause pain (renal colic) as they obstruct and
stretch the ureter during peristaltic movement.

Reference: Guyton & Hall, Ch. 26.

21. Normal Glomerular Filtration Rate (GFR) in humans?

Answer: B. 125 mL/min

Justification: The average GFR in healthy adults is ~125 mL/min or ~180

L/day.

Reference: Guyton & Hall, Ch. 26

22. Factors affecting GFR?

Answer: D. All of the above

Justification: GFR depends on hydrostatic pressure, oncotic pressure, and

vascular resistance (afferent/efferent arterioles).

Reference: Guyton & Hall, Ch. 26

23. Total body water (TBW) in 70 kg male is approximately:

Answer: C. 60%

Justification: TBW ≈ 60% of body weight in males.

Reference: Guyton & Hall, Ch. 25

24. Largest portion of extracellular fluid (ECF)?

Answer: B. Interstitial fluid

Justification: Interstitial fluid makes up ~75% of ECF; plasma ~25%.

Reference: Guyton & Hall, Ch. 25

25. Intracellular fluid (ICF) percentage of TBW?

Answer: D. 66%

Justification: ICF is about 2/3 (~66%) of TBW.

Reference: Guyton & Hall, Ch. 25

26. Main contributor to osmolality of ECF?

Answer: B. Sodium

Justification: Sodium is the dominant cation in ECF, driving osmolality.

Reference: Ganong’s, Ch. 1

27. Kidneys’ role in regulating fluid composition?

Answer: D. All of the above

Justification: The kidneys regulate hydration, electrolyte balance, and excrete
waste.

Reference: Guyton & Hall, Ch. 25–28

28. Normal plasma osmolarity?

Answer: B. 280–300 mOsm/L

Justification: Normal osmolarity is tightly maintained within this range.

Reference: Guyton & Hall, Ch. 25

29. Primary function of osmosis?

Answer: B. To move water across a semipermeable membrane

Justification: Osmosis is the movement of water from low to high solute

concentration.

Reference: Ganong’s Physiology

30. Not a characteristic of transcellular fluid?

Answer: C. Makes up about 25% of total body water

Justification: Transcellular fluid is a small component, not 25%.

Reference: Guyton & Hall

31. Sodium 130 mEq/L, leg swelling—likely condition?

Answer: B. Hyponatremia

Justification: Sodium <135 mEq/L = hyponatremia; swelling indicates fluid

imbalance.

Reference: Harrison’s Internal Medicine

32. Diabetes insipidus, Na⁺ = 160 mEq/L?

Answer: B. Hypernatremia
Justification: Water loss without sodium loss raises Na⁺ = hypernatremia.

Reference: Guyton & Hall

33. Severe burns = ↑ water loss due to?

Answer: A. Denuded cornified layer of the skin

Justification: Damaged skin increases insensible water loss.

Reference: Ganong’s

34. Extreme dehydration after exercise—main cause?

Answer: C. Excessive sweating

Justification: Sweat loss leads to hypotonic fluid loss.

Reference: Guyton & Hall

35. Proteinuria with podocyte damage—condition?

Answer: A. Minimal change nephropathy

Justification: Podocyte injury is classic for minimal change disease.

Reference: Robbins Pathology

36. ↑ colloid osmotic pressure = ↓ GFR—cause?

Answer: A. Increased plasma protein concentration

Justification: High oncotic pressure opposes filtration.

Reference: Guyton & Hall

37. Hypertension with ↓ GFR—most likely cause?

Answer: B. Thickening of the glomerular basement membrane

Justification: Seen in chronic hypertension and diabetic nephropathy.

Reference: Robbins
38. Isotonic fluid infusion causes:

Answer: C. No effect on intracellular fluid volume

Justification: Isotonic fluids expand ECF, not ICF.

Reference: Guyton & Hall

39. Swollen legs in heart disease—cause?

Answer: B. Heart failure-induced edema

Justification: CHF increases venous pressure → edema.

Reference: Guyton & Hall

40. Nephrotic syndrome with low proteins—edema cause?

Answer: B. Decreased plasma proteins

Justification: Low oncotic pressure causes fluid leakage.

Reference: Robbins Pathology

41. Which does NOT affect GFR directly?

Answer: D. Plasma glucose concentration

Justification: GFR is pressure-dependent, not glucose-dependent.

Reference: Guyton & Hall

42. Role of macula densa?

Answer: D. Detects sodium chloride concentration and adjusts GFR

Justification: Part of the tubuloglomerular feedback.

Reference: Guyton & Hall

43. Angiotensin II effect on GFR?

Answer: B. Constricts efferent arterioles

Justification: Helps maintain GFR during low BP.

Reference: Guyton & Hall

44. Chronic hyponatremia correction—most important?

Answer: B. Slow correction to avoid osmotic demyelination

Justification: Rapid correction can cause brain injury (central pontine

myelinolysis).

Reference: Harrison’s Internal Medicine

45. Kidney failure + edema—elevated pressure?

Answer: D. Bowman’s capsule hydrostatic pressure

Justification: Obstruction raises this pressure, lowering GFR.

Reference: Guyton & Hall

46. Function of proximal tubule?

Answer: B. Reabsorption of water and solutes

Justification: ~65% of filtrate is reabsorbed here.

Reference: Guyton & Hall

47. Substance secreted by proximal tubule?

Answer: C. Para-aminohippuric acid (PAH)

Justification: PAH is used to measure renal plasma flow; actively secreted.

Reference: Guyton & Hall

48. Function of Loop of Henle?

Answer: B. Reabsorption of sodium, potassium, and chloride

Justification: Key for countercurrent multiplier mechanism.

Reference: Guyton & Hall

49. Water reabsorption via osmosis occurs in:

Answer: A. Proximal tubule

Justification: Passive osmosis follows solute reabsorption.

Reference: Guyton & Hall

50. Sodium-potassium ATPase function?

Answer: D. Transport sodium out of the cells

Justification: 3 Na⁺ out, 2 K⁺ in using ATP.

Reference: Guyton & Hall

51. Hormone for water reabsorption?

Answer: C. Antidiuretic hormone (ADH)

Justification: ADH increases aquaporin channels in collecting duct.

Reference: Ganong’s

52. Term for max reabsorption rate?

Answer: C. Transport maximum (Tmax)

Justification: Tmax is when all carriers are saturated.

Reference: Guyton & Hall

53. GFR = 120, glucose = 300 mg/dL – what happens?

Answer: B. Some glucose will be excreted in the urine

Justification: Tmax is ~200–250 mg/dL; excess glucose spills into urine.

Reference: Guyton & Hall

54. High ANP levels in heart failure – effect on reabsorption?

Answer: B. Decreased sodium and water reabsorption

Justification: ANP promotes natriuresis and diuresis.

Reference: Ganong’s

55. ↓ Renal arterial pressure – effect on reabsorption?

Answer: A. Increased sodium reabsorption

Justification: RAAS system is activated, promoting Na⁺ retention.

Reference: Guyton & Hall

56. ↑ Plasma creatinine suggests:

Answer: C. The GFR is decreased

Justification: Creatinine inversely reflects GFR.

Reference: Guyton & Hall

57. Diabetes + glucosuria – why?

Answer: B. Some glucose would appear in the urine

Justification: High plasma glucose exceeds Tmax.

Reference: Guyton & Hall

58. Hyperaldosteronism effect?

Answer: A. Increased sodium and water reabsorption

Justification: Aldosterone increases ENaC activity.

Reference: Guyton & Hall

59. High ADH in dehydration – effect?

Answer: C. Decreased urine output

Justification: ADH increases water reabsorption.

Reference: Ganong’s

60. Loop diuretic effect?

Answer: A. Decreased sodium reabsorption in the thick ascending loop of

Henle

Justification: Furosemide blocks Na⁺-K⁺-2Cl⁻ transporter.

Reference: Guyton & Hall

61. Inhibition of Na⁺-K⁺ pump causes:

Answer: B. Decreased sodium reabsorption

Justification: Na⁺-K⁺ ATPase is essential for Na⁺ transport.

Reference: Guyton & Hall

62. High plasma urea – renal effect?

Answer: B. Urea reabsorption will increase

Justification: Urea diffuses passively with water reabsorption.

Reference: Guyton & Hall

63. Kidney stone blocks proximal tubule – sodium reabsorption?

Answer: A. Sodium reabsorption will decrease

Justification: Obstruction prevents normal flow and reabsorption.

Reference: Ganong’s

64. ↑ GFR – tubule response?

Answer: C. Increase tubular reabsorption

Justification: Tubuloglomerular feedback enhances reabsorption.

Reference: Guyton & Hall

65. Normal arterial blood pH?

Answer: B. 7.35–7.45

Justification: Normal physiological range.

Reference: Guyton & Hall

66. Strong acid?

Answer: C. HCl

Justification: HCl fully dissociates in solution.

Reference: Biochemistry texts

67. Not part of bicarbonate buffer system?

Answer: C. NaCl

Justification: It doesn’t act as a buffer.

Reference: Guyton & Hall

68. ↑ HCO₃⁻ causes:

Answer: B. pH increases

Justification: Bicarbonate is a base; more base = higher pH.

Reference: Guyton & Hall

69. Respiratory system’s role in acid-base balance?

Answer: B. To eliminate CO₂

Justification: CO₂ is in equilibrium with carbonic acid.

Reference: Guyton & Hall

70. Most important intracellular buffer?

Answer: C. Protein buffer system

Justification: Proteins (e.g., hemoglobin) buffer H⁺ inside cells.

Reference: Guyton & Hall

71. Kidney excretes what for acid-base balance?

Answer: B. Non-volatile acids

Justification: Fixed acids must be excreted by kidneys.

Reference: Guyton & Hall

72. ↑ PCO₂ in ECF causes:

Answer: C. Respiratory acidosis

Justification: CO₂ retention lowers pH.

Reference: Guyton & Hall

73. Kidney acid-base regulation method?

Answer: A. Secretion of H⁺

Justification: Excreting H⁺ helps maintain pH.

Reference: Guyton & Hall

74. pH 7.3, PCO₂ 50 mmHg, HCO₃⁻ 22 = ?

Answer: A. Respiratory acidosis

Justification: High CO₂ with slightly low bicarb = primary respiratory.

Reference: ABG interpretation charts

75. pH 7.5, PCO₂ 30 mmHg, HCO₃⁻ 25 = ?

Answer: B. Respiratory alkalosis

Justification: High pH and low CO₂.

Reference: ABG interpretation

76. Metabolic acidosis compensation?

Answer: D. Increase in renal H⁺ secretion

Justification: Kidneys excrete H⁺ and regenerate HCO₃⁻.

Reference: Guyton & Hall

77. CKD + pH 7.25, low HCO₃⁻ = ?

Answer: C. Renal failure

Justification: Kidneys can’t excrete acid or reabsorb HCO₃⁻.

Reference: Guyton & Hall

78. Vomiting + ↑ pH, ↑ HCO₃⁻ = ?

Answer: C. Metabolic alkalosis

Justification: Loss of HCl leads to alkalosis.

Reference: Guyton & Hall

79. What determines gas diffusion?

Answer: B. Concentration gradient

Justification: Gases move from high to low pressure.

Reference: Guyton & Hall

80. Gas more soluble than O₂?

Answer: B. Carbon dioxide

Justification: CO₂ is ~20x more soluble than O₂.

Reference: Guyton & Hall

81. Vapor pressure of water at 37°C?

Answer: A. 47 mm Hg

Justification: Standard physiological value.

Reference: Guyton & Hall

83. Diffusion coefficient depends on:

Answer: A. Solubility and molecular weight

Justification: Fick’s Law includes these variables.

Reference: Guyton & Hall

84. Respiratory membrane surface area?

Answer: C. 70 m²

Justification: Surface area for gas exchange.

Reference: Guyton & Hall

85. Basic respiratory rhythm controlled by:

Answer: B. Medulla oblongata

Justification: DRG and VRG are in medulla.

Reference: Guyton & Hall

86. Controls rate & depth of breathing?

Answer: A. Dorsal respiratory group

Justification: DRG is responsible for inspiration rhythm.

Reference: Guyton & Hall

87. Dorsal respiratory group controls:

Answer: B. Inspiration

Justification: DRG initiates inspiration.

Reference: Guyton & Hall

88. Apneusis pattern?

Answer: B. Prolonged inspiratory gasps

Justification: Caused by damage to pneumotaxic center.

Reference: Ganong’s

89. % of O₂ carried by hemoglobin?

Answer: C. 97%

Justification: Most O₂ is bound to Hb, minimal is dissolved.

Reference: Guyton & Hall

90. Common form of CO₂ in blood?

Answer: C. As bicarbonate

Justification: ~70% of CO₂ is transported as HCO₃⁻.

Reference: Guyton & Hall