a patient has diabetes mellitus? Does the abscence of sugar rule out diabetes mellitus? Why are polyuria and glucosuria both hallmark signs of diabetes? …
;;1 You are rounding with your team, as a third year medical student
in the medicine wards The attending ask you where in the nephron is
most of the glomerular filtrate reabsorbed? A What would be the
consequence if one was to give a Na/K pump blocker that worked
specifically in this region of the nephron?
B Considering this region, how is the glucose filtration curve
obtained?
b From the filtration and excretion curve below, what determines the
glucose reabsorption curve?
c Based on this data, can you conclude that glucose reabsorption
involves active transport?
d Does finding glucose in the urine prove that a patient has diabetes
mellitus? Does the abscence of sugar rule out diabetes mellitus?
e Patients with Addisons disease often present with hyponatriemia and
hyperkalemia due to an inability to produce mineralocorticoids such as
aldosterone Why might a lack of aldosterone lead to hyperkalemia?
Do you think the hyperkalemia would get progressively more severe or
would the plasma K concentration reach a new steady state?
f Define ideal osmometer and
non-ideal osmometer How would you
describe the brain?
g a What possible effects does a change in blood volume have on the
body clinically?
b What about a change in interstitial fluid volume?
c What determines the colloid osmotic pressure in blood ie osmotic
pressure between interstitium and blood?
h Why is it important that skeletal muscle is an ideal osmometer?
i One of the first signs of diabetes mellitus is polyuria In addition
to noting polyuria, physicians used to taste the urine for sweetness
to test for diabetes in order to check for glucosuria Why are
polyuria and glucosuria both hallmark signs of diabetes?
j BUN Blood-Urea-Nitrogen plasma levels are a very important clinical
indicator of GFR for the physician to know what is going on in the
patient BUN levels, however, can be affected by things other than
glomerular filtration Name two other factors that need to be
considered when looking at BUN levels and how they change urea
absorption
k When a flight attendant was ordered to provide a urine sample for drug
testing, she became quite anxious and
was unable to void any urine
She tried drinking a large amount of spring water but still could not
urinate after several hours A couple of hours later she was brought
to the emergency room presenting with some neurological symptoms and
felt she was not herself In the ER she was confused and drowsy,
and as she nodded off, she had a convulsion Believing her report of
no drug use, you order STAT blood chemistries When they arrive back,
the plasma osmolality is 220 mOsm and the plasma [Na] is 110 mM
a Given her usual plasma osmolality is 280 mOsm, her plasma water is
3 kg, her extracellular water is 12 kg, and her totat body water is 28
kg, how many liters of water would she have to drink to explain the
low plasma osmolality?
b Assuming that all the cells in the body were perfect osmometers,
how much would her intracellular space have changed in response to
her drop in osmolality?
8 Despite a wide range of blood pressures the kidneys can maintain a
relatively constant RPF and GFR How?
What purely arteriolar changes would lead to the greatest GFR? What
are other factors
that determine GFR?
Source:state.nj.us
