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Reviewed by Daniel Mercer on 24 June 2019

Tubular processing and electrolyte balance

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Question 1

Why does tubular secretion occur?

A
If there is too much solute being filtered, it is also secreted
B
If there are substances that cannot cross the filtration barrier
C
It does not
D
If there is too much substance being reabsorbed
Question 2

A patient presents with glycosuria and proteinuria, which portion of the nephron is most likely to be affected?

A
Distal convoluted tubule
B
Proximal convoluted tubule
C
Collecting duct
D
Loop of Henle
Question 2 Explanation: 
The PCT absorbs 100% of the glucose and protein
Question 3

Why do people get glycosuria?

A
Glucose transporters on the proximal convoluted tubule have a maximum rate at which they can uptake glucose (transport maximum - tm), so when glucose concentration exceeds tm, glucose is lost in the urine.
B
Because they develop an acute episode of diabetes
C
Feedback from high levels of blood glucose decrease the number of glucose transporters on the PCT
D
The body already has more glucose than it needs, so it is then eliminated in urine
Question 4

What is the body’s main way of eliminating excess sodium to maintain homeostasis?

A
By down-regulating sodium transporters in the nephron
B
By causing diuresis, as water normally follows sodium down its concentration gradient
C
By sequestering sodium in cells
D
By converting it into sodium bicarbonate
Question 5

A patient presents with palpitations, fatigue and on routine ECG peaked T waves are observed.   A medication is prescribed for the immediate decrement of serum potassium, that is normally given in the management of T2DM. Which of the following best fits this prescription?

A
Propranolol
B
Selective COX2 inhibitor
C
Conformational change to activate GLUT4
D
Blocks sodium voltage gated channels
Question 6

Which of the following is not a way in which the body regulates potassium concentration?

A
Aldosterone release
B
Increasing tubular flow rate
C
Insulin release
D
Release of renin from the kidney
Question 7

Your patient presents to you smelling of pear drop, has an increased rate of breathing and tachycardia. You take their bloods and find that they have hypokaleamia. How can this be explained?

A
Both protons and potassium ions are cations. The increased concentration of cations in the ECF prevents potassium from being uptaken by the cells.
B
The acidic environment increases cation concentration in the extracellular fluid, drawing potassium out of the cell by diffusion to correct the cell membrane potential
C
The patient is in an acidotic state. The protons in the filtrate of the kidney displace sodium at the sodium and potassium ATPase which increases its activity. This drives more potassium out of cells into the filtrate, decreasing its concentration in the ECF
D
The increased acidity of the blood denatures the potassium channels specifically (as these are more susceptible to denaturation) thus preventing the uptake of potassium into the cell.
Question 8

Which of the following is not a cause of hypokalaemia?

A
Reduced potassium intake from diet
B
Diarrhoea
C
Furosemide
D
Increased salt intake
Question 9

A patient presents to your GP practice complaining of muscle weakness and anxiety. You check their pulse and find that they have an arrhythmia.  In which condition are these symptoms more likely to occur?

A
Hypokalaemia
B
Hyperkalemia
C
Both hyper and hypokalaemia
D
Hypernatreamia
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