1. Plasma and urine osmolality values in a patient are 295 and 100 mOsm/L, respe

Question

1.      Plasma and urine osmolality values in a patient are 295 and 100 mOsm/L, respectively. The urinary excretion of aquaporin-2 is very low but increases substantially in response to exogenous administration of antidiuretic hormone (ADH). The most likely diagnosis for this patient is which of the following?

A.    Central diabetes insipidus

B.     Nephrogenic diabetes insipidus

C.     Syndrome of inappropriate ADH secretion, hypothalamic

D.    Syndrome of inappropriate ADH secretion by an ectopic tumor

2.      Which of the following would be expected in a patient with nephrogenic diabetes insipidus?

Increased synthesis of ADH in the paraventricular nucleus

Decreased renin secretion

Decreased drinking

Decreased plasma osmolality

3. A patient has the syndrome of inappropriate ADH secretion due to carcinoma of the lung. This patient also drinks greater than normal amounts of water. You would expect

A.    Increased ADH secretion from the pituitary gland

B.     A large decrease in plasma osmolality

C.     Increased renin secretion

D.    An inappropriately low urine osmolality relative to plasma osmolality

4. Vasopressin/desmopressin can be administered in which of the following ways?

A. INTANASALLY

B. INTRAMUSCULARLY

C. SUBCUTANEOUSLY

D. ALL OF THE ABOVE

5. MAGNOCELLULAR NEURONS INCLUDE WHICH OF THE FOLLOWING?

a. pvn

b. son

c. hypothalamic cell bodies

d. both a and b

e. all of the above

6. ANF

a. increases plasma sodium levels

b. decreases plasma sodium levels

c. in synthesized in the kidney

d. is lipid soluble

e. both b and d

7. Which of the following is a secondary secretagogue for the release of aldosterone ?

a. angiotensinogen

b. atrial natriuretic peptide

c. angiotensin

d. none of the above

8. The thirst center is located in

a. hypothalamus

b. posterior pituitary gland

c. medulla

d. basal ganglion

9. In response to hemorrhage,

a, renin levels increase

b. renin levels decrease

c. aldosterone levels decrease

d. none of the above

10. Whish of the following is a stimulus for the release of ADH ?

a. stress

b. hypervolemia

c. hypoosmolarity

d. hypertension

11. A G protein has how many subunits ?

a. 1

b. 2

c. 3

d. 4

12. Which of the following might be an indication of dehydration in the elderly?

a. alterations in LOC

b. impaired glucose metabolism

c. increased falls

d. both a and c

Explanation / Answer

1) The urine and plasma osmolarity is 295 mOsm and 100 mOsm respectively. Any condition which has an urinary osmolarity of less than 200 mOsm is considered as diabetes insipidus. Diabetes insipidus is of two types: central and nephrogenic. Central diabetes insipidus is due to inadequate secretion of ADH from pituitary and nephrogenic diabetes insipidus is due to absence of receptors for ADH in kidneys. Here, the urinary excretion of aquaporin-2 increased after administration of vasopressin (ADH). This shows the response of collecting duct to vasopressin. Therefore, the patient is suffering from central diabetes insipidus (option A).

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