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Baynes & Dominiczak: Medical Biochemistry, 2nd Edition

Test Bank

Chapter 23: Lung and Kidney: The Control of Acid-Base Balance


There may be more than one correct answer.

MULTIPLE CHOICE

1. The following factors determine plasma hydrogen ion concentration:


A. The concentration of plasma bicarbonate
B. The PO2
C. The PCO2
D. Urine volume
E. Plasma potassium concentration

ANS: A, C
The plasma concentration of bicarbonate is the key determinant of blood pH. It remains in
equilibrium with CO2, and therefore PCO2 also determines pH.

2. The "metabolic" component of the acid base balance is


A. pH
B. Plasma bicarbonate concentration
C. Hematocrit
D. CO2
E. Plasma urea

ANS: B
Because the plasma concentration of bicarbonate is determined by its renal reabsorption and
synthesis, it is, by convention, called the metabolic component of the acid-base balance. The
other component is the PCO2, which is called the respiratory component.

3. The following conditions can lead to metabolic acidosis:


A. Diarrhea
B. Vomiting
C. Diabetes mellitus
D. Diabetes insipidus
E. Potassium loss

ANS: A, C
Diarrhea causes metabolic acidosis through the loss of bicarbonate. The acidosis in diabetes
mellitus is caused by an excess production of ketoacids, acetoacetate, and hydroxybutyrate.

Copyright © 2006 Elsevier, Inc. All rights reserved.


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Test Bank
4. Metabolic alkalosis is characterized by
A. Low hydrogen ion concentration
B. High plasma concentration of potassium
C. High bicarbonate concentration
D. High ventilation rate as compensation
E. Dehydration

ANS: A, C
Metabolic alkalosis is, by definition, characterized by a low hydrogen ion concentration (i.e.,
high pH). This is caused by the high bicarbonate concentration. The compensatory response is
slowing the ventilation rate (i.e., slow, deep breaths).

5. Compensation in prolonged metabolic acidosis includes


A. Increased urine volume
B. Decrease in plasma potassium concentration
C. Increased ventilation rate
D. Increase in PCO2
E. Increased plasma osmolality

ANS: C
The respiratory compensation for metabolic acidosis is increasing the ventilation rate. The
typical pattern is fast, shallow breathing called Kussmaul breathing.

6. Bicarbonate is produced
A. By carbonic anhydrase in erythrocytes
B. In the liver
C. In the proximal kidney tubules
D. In the small intestine
E. In the duodenum

ANS: A, C
Bicarbonate is produced from the carbon dioxide and water by the enzyme carbonic anhydrase.
This reaction takes place in the erythrocytes and in the kidney.

7. Factors that determine gas exchange include


A. The state of hydration
B. Ventilation rate
C. Renal function
D. The degree of lung perfusion
E. The acid-base status

ANS: B, D
The gas exchange in the lungs is determined by the rate of ventilation and the rate of blood
perfusion. Disorders of each and combined disorders exist.

Copyright © 2006 Elsevier, Inc. All rights reserved.


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Test Bank

8. The following may lead to disorders of acid-base metabolism:


A. Chest deformity
B. Acute cardiac arrest
C. Osteoporosis
D. Asthma
E. Dyslipidemia

ANS: A, B, D
Chest deformity may lead to inadequate ventilation and respiratory acidosis. Acute cardiac arrest
is usually accompanied by severe metabolic acidosis due to the accumulation of lactate. Asthma
in the early stages usually leads to respiratory alkalosis due to hyperventilation; however, severe
asthma may be accompanied by respiratory failure and respiratory acidosis.

9. CO2 transport by the erythrocytes involves


A. Potassium entry into erythrocytes
B. Exchange of bicarbonate for chloride ion
C. Conversion of CO2 to bicarbonate
D. Change in osmolality within erythrocytes
E. Transport of gaseous CO2 in plasma

ANS: B, C, E
Carbon dioxide is transported in the erythrocytes predominantly as bicarbonate. Transport
involves the so-called chloride shift, when bicarbonate is exchanged for chloride anion. A small
amount of carbon dioxide is dissolved in plasma.

10. In mixed respiratory and metabolic acidosis,


A. Bicarbonate concentration is high
B. Potassium concentration is high
C. Respirations are rapid
D. Low bicarbonate levels combine with high PCO2
E. Hydrogen ion concentration is smaller than in a single disorder

ANS: B, D
In mixed respiratory and metabolic acidosis, the plasma potassium concentration is likely to be
high because acidosis releases hydrogen ions from cells. The low bicarbonate level (i.e.,
metabolic component) is low due to the existence of metabolic causes, such as diabetes. This is
accompanied by a high PCO2 value because of an independent respiratory cause, such as chronic
obstructive airways disease (COAD).

Copyright © 2006 Elsevier, Inc. All rights reserved.