Question 1

What is the function of the ureters?

Accepted Answer

Transport of urine from the kidneys to the bladder

Answer

Storage of urine

Answer

Production of urine

Answer

Filtration of blood

Answer

Removal of metabolic waste

Question 2

Which part of the urinary system stores urine before it is voided from the body?

Accepted Answer

Urinary bladder

Answer

Ureters

Answer

Renal pelvis

Answer

Urethra

Answer

Kidneys

Question 3

Which muscle is innervated by the subcostal nerve?

Accepted Answer

Quadratus lumborum

Answer

Rectus abdominis

Answer

Transversus abdominis

Answer

Psoas major

Answer

Iliacus

Question 4

Which structure passes through the esophageal hiatus of the diaphragm?

Accepted Answer

Esophagus

Answer

Thoracic duct

Answer

Sympathetic trunk

Answer

Inferior vena cava

Answer

Aorta

Question 5

What are the components of juxtaglomerular apparatus (JGA)?

Accepted Answer

freetext://1 Macula densa cell
2 Juxtaglomerular cell
3 Mesangial cell (intra and extra mesangial cell)
4 Glomerulus

Question 6

Which cells are the main function of JGA?

Accepted Answer

freetext://1. JG cells - modified smooth muscles cell secreting renin in response to falling blood pressure in afferent arteriole
2. Macula densa - chemoreceptors which secrete renin if solute concentration falls

Question 7

Please describe the specified epithelium of proximal convoluted tubule.

Accepted Answer

simple cuboidal epithelium:- brush border = microvill

Question 8

Please describe the specified epithelium of Bowman capsule.

Accepted Answer

Simple squamous epithelium

Question 9

Please describe the specified epithelium of thick part of Loop of Henle.

Accepted Answer

low cuboid epithelium

Question 10

Please describe the specified epithelium of thin part of Loop of Henle.

Accepted Answer

Simple squamous epithelium

Question 11

Please describe the specified epithelium of Distal convoluted tubule.

Accepted Answer

Simple cuboidal epithelium:- long mitochondria

Question 12

Please describe the specified epithelium of collecting tubule.

Accepted Answer

simple cuboidal epithelium

Question 13

Please describe the specified epithelium of Collecting duct.

Accepted Answer

simple cuboidal epithelium:- principle cell, intercalated cell(microvilli)

Question 14

Please describe types of nephron:

Accepted Answer

freetext://There are two types of nephrons
1. Cortical nephron
These are the nephrons present within the cortex. These are short and comprise about 80% of the total nephrons.
2. Juxtamedullary nephron
These have long loops of Henle and extend into the medulla. These are about 20%.

Question 15

What are functions of nephron

Accepted Answer

freetext://Functions of Nephron
The primary function of nephron is removing all waste products including the solid wastes, and other excess water from the blood, converting blood into the urine, reabsorption, secretion, and excretion of numerous substances.
As the blood passes through the glomerulus with high pressure, the small molecules are moved into the glomerular capsules and travel through a winding series of tubules.
The cell present in each tube absorbs different molecules excluding the glucose, water, and other beneficial molecules which are called as the ultrafiltrate.  As the ultrafiltrate molecules travel down the tubules they become more and more hypertonic, which results in more amount of water to be extracted from the ultrafiltrate before it exits the nephrons.
The blood surrounding the nephron travels back into the body through the renal blood vessels, which are free of toxins and other excess substances. The obtained ultrafiltrate is urine, which travels down via the collecting duct to the bladder, where it will be stored and released through the urethra.

Question 16

Describe structure of the fenestrated capillary of glomerulus.

Accepted Answer

freetext://1. Endothelial Cells
The glomerular capillary endothelium has many perforations called fenestrae, which are pores about 70nm in diameter. These pores actually do not restrict the movement of water and proteins or large molecules but instead prevent the filtration of blood cells (e.g. RBCs).
Surrounding the luminal surface of the endothelial cells is a glycocalyx consisting of negatively charged glycosaminoglycans. This functions to hinder the diffusion of negatively charged molecules by repelling them due to like charges.
2. Glomerular Basement Membrane
The basement membrane surrounds the capillary endothelium and is mostly made up of type IV collagen, heparan sulfate proteoglycans and laminin. In particular, heparan sulfate proteoglycans help restrict the movement of negatively charged molecules across the basement membrane.
3. The basement membrane consists of 3 layers:
- An inner thin layer (lamina rara interna)
- A thick layer (lamina densa)
- An outer dense layer (lamina rara externa)
These layers help to limit the filtration of intermediate and large sized solutes.
4. Epithelial Cells
Podocytes are specialized epithelial cells of Bowman’s capsule which form the visceral layer of the capsule.
Foot-like processes project from these podocytes and interdigitate to form filtration slits. These filtration slits are bridged by a thin diaphragm (the slit diaphragm) which has very small pores. The pores prevent large molecules, such as proteins, from crossing. Similar to the endothelial cell glycocalyx, negatively charged glycoproteins cover the podocytes, restricting filtration of large anions.

Question 17

Which of the following structure is the remnant of the allantois?

Accepted Answer

Urachal cyst

Answer

Urogenital sinus

Answer

Cloaca

Answer

Mesonephric duct

Answer

Urogenital ridge

Question 18

Incomplete division of the metanephric diverticulum (uteric bud) results in

Accepted Answer

Bifid ureter

Answer

Supernumerary kidney

Answer

Duplication of the ureter

Answer

Bifid kidney

Answer

Bifid ureter and supernumerary kidney

Question 19

ผู้ป่วยชายอายุ 25 ปี ปัสสาวะมากและดื่มน้ำมากมา 1เดือน ผลตรวจเลือดพบ osmolality 320 mOsm/kg, Na+ 150 mmol/L, K+ 4.0 mmol/L ตรวจปัสสาวะพบ sp.gr. 1.002, Glucose negative, protein negative ลักษณะดังกล่าวน่าจะเกิดจากสาเหตุใด

Accepted Answer

การดูดกลับ H2O ที่ collecting duct ลดลง

Answer

การกรอง Na+ ที่ glomerulus เพิ่มขึ้น

Answer

การดูดกลับ Na+ ที่ proximal convoluted tubule ลดลง

Answer

การดูดกลับ Na+ ที่ distal convoluted tubule ลดลง

Answer

การดูดกลับ H2O ที่ proximal convoluted tubule ลดลง

Question 20

A 52-year-old business man comes to hospital for health checkup. The laboratory analysis reveals plasma creatinine 1.0 mg/dl, urine creatinine 1.1 mg/ml and urine flow rate 60 ml/hour.

What is his creatinine clearance?

Accepted Answer

110 ml/min

Answer

115 ml/min

Answer

120 ml/min

Answer

125 ml/min

Answer

100 ml/min

Question 21

A 55-year-old woman presents with polyuria and dehydration. Laboratory results are fasting blood glucose 100 mg/dl, plasma osmolality 298 mOsm/kg, UA: glucose 3+ and urine osmolality 300 mOsm/kg.

Which part of nephron is abnormal?

Accepted Answer

Proximal tubule

Answer

Thin segment of Henle loop

Answer

Distal tubule

Answer

Collecting duct

Answer

Glomerulus

Question 22

Which of the following would cause an increase in water reabsorption in renal tubule?

Accepted Answer

Efferent arteriole constriction

Answer

Decreased Ang II production

Answer

Decreased sympathetic activity

Answer

Increased hydrostatic in peritubular capillary

Answer

Decreased plasma protein concentration

Question 23

ในคนปกติเมื่อได้รับโซเดียมเข้าสู่ร่างกายในปริมาณที่มาก แล้วเกิดภาวะ hypernatremia ร่างกายจะมีกลไกการควบคุมอย่างไร?

Accepted Answer

กระตุ้นการหลั่ง ADH

Answer

กระตุ้นการหลั่ง renin

Answer

กระตุ้นการหลั่ง aldosterone

Answer

กระตุ้นการหลั่ง angiotensin II

Answer

กระตุ้นการหลั่ง natriuretic peptide

Question 24

คนสุขภาพดีเมื่อได้รับอาหารที่มีโพแทสเซียม (K+ intake) มากเกินไป ทำให้ความเข้มข้นของโพแทสเซียมที่ของเหลวนอกเซลล์เพิ่มขึ้น ร่างกายจะมีกลไกในการรักษาสมดุลโพแทสเซียมอย่างไร?

Accepted Answer

กระตุ้นการหลั่ง Aldosterone และเพิ่ม K+ secretion

Answer

กระตุ้นการหลั่ง Aldosterone และลด K+ secretion

Answer

กระตุ้นการหลั่ง Aldosterone และลด K+ excretion

Answer

ยับยั้งการหลั่ง Aldosterone และลด K+ excretion

Answer

ยับยั้งการหลั่ง Aldosterone และลด K+ secretion

Question 25

26-year-old man faint while walk in the sunny day for a few hours which hormone is

most likely to increase?

Accepted Answer

Antidiuretic hormone

Answer

Renin

Answer

Atrial natriuretic peptide

Answer

Angiotensin

Answer

Epinephrine

Question 26

A 20-year-old female athlete feel thirsty after 25 km marathon competition. She has water deprivation and her plasma osmolarity is increased. What is the least likely response in this case?

Accepted Answer

Isotonic osmolarity of tubular fluid in proximal tubule

Answer

High concentration fluid in late distal tubular

Answer

Decrease urine production

Answer

Increase level of ADH

Answer

High concentration fluid in thick ascending limb

Question 27

สมชายถ่ายอุจจาระเหลว 6 ครั้ง ในเวลา 12 ชั่วโมง มาพบแพทย์ด้วยอาการอ่อนเพลีย ผลตรวจร่างกายพบว่าค่า pH ในเลือดเท่ากับ 7.30 ค่า PaCO2 ต่ำว่าปกติ และค่า HCO3- ต่ำกว่าปกติเช่นกัน ข้อใดวินิจฉัยภาวะความผิดปกติของสมดุลกรด-ด่างของสมชายได้ถูกต้อง

Accepted Answer

Metabolic acidosis with respiratory compensation

Answer

Metabolic acidosis

Answer

Metabolic alkalosis with respiratory compensation

Answer

Respiratory acidosis

Answer

Respiratory acidosis with renal compensation

Question 28

ผู้ป่วยชายไทย อายุ 45 ปี อาเจียนอย่างรุนแรง 8 ครั้ง ในเวลา 12 ชั่วโมง ผลตรวจร่างกายพบว่า ค่า pH ในเลือดเท่ากับ 7.50 ค่า PaCO2 สูงว่าปกติ และค่า HCO3- สูงกว่าปกติ ข้อใดคือกลไกการชดเชย(compensate) ต่อภาวะดังกล่าว

Accepted Answer

เพิ่ม renal HCO3- excretion

Answer

เพิ่มอัตราการหายใจ

Answer

เพิ่มการสร้าง HCO3-

Answer

เพิ่มการขับ H+ ในรูป Phosphate buffer

Answer

เพิ่มการขับ H+ ในรูป Ammonia buffer

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