Excretory System MCQ for RRB & SSC and other Competitive exams
71
What is the significance of 24-hour urine collection?
✓ Answer:
B
To accurately quantify substances excreted over a full day - used to measure proteinuria, creatinine clearance, electrolytes, and hormones
24-Hour Urine Collection is used to accurately measure the total daily excretion of substances, providing more reliable data than spot urine samples. Common 24-hour urine tests: 24-hour urine protein (nephrotic syndrome >3.5 g/day, nephritic syndrome <3.5 g/day), Creatinine clearance (estimates GFR - especially when eGFR equations are unreliable), 24-hour urine calcium (hypercalciuria - kidney stone risk), 24-hour urine oxalate (hyperoxaluria - stone risk), Urine cortisol (Cushing's syndrome - elevated), Catecholamines/VMA (phaeochromocytoma - adrenal tumour), and Urine uric acid (gout assessment). Collection method: Discard first morning void, collect ALL urine for 24 hours, include final morning void next day. Store refrigerated.
72
What are the three layers of the glomerular filtration barrier?
✓ Answer:
B
Fenestrated capillary endothelium, glomerular basement membrane, and podocyte filtration slits
The Glomerular Filtration Barrier has three layers that determine what passes into the filtrate: 1) Fenestrated Capillary Endothelium - Large pores (70-100 nm), allows passage of water, small solutes, and proteins, blocks blood cells. 2) Glomerular Basement Membrane (GBM) - composed of type IV collagen and heparan sulphate (negatively charged), main barrier to proteins, blocks albumin (also negatively charged - charge barrier). 3) Podocyte Filtration Slits - Podocytes have foot processes (pedicels) with filtration slit diaphragms (nephrin protein) - final size barrier. Damage to any layer causes proteinuria. Minimal Change Disease: Podocyte foot process effacement (fusion) causes massive proteinuria (nephrotic syndrome).
73
What is hydronephrosis?
✓ Answer:
B
Distension and dilation of the renal pelvis and calyces due to obstruction of urine outflow
Hydronephrosis is the dilation (swelling) of the renal pelvis and calyces due to obstruction of urine outflow, causing urine to back up into the kidney. Causes: Kidney stones (most common - obstruct ureter), Ureteric stricture (narrowing), Benign Prostatic Hyperplasia (BPH) - bladder outlet obstruction, Tumours (bladder, prostate, cervical cancer), Congenital (PUJ - pelviureteric junction obstruction - most common in children), and Pregnancy (physiological hydronephrosis - right side due to uterus compression). Symptoms: flank pain, haematuria, recurrent UTIs. Diagnosis: Ultrasound. Treatment: relieve obstruction - nephrostomy, ureteric stent, surgery. Untreated causes progressive kidney damage.
74
What is the role of the kidney in glucose homeostasis?
✓ Answer:
B
The kidney reabsorbs all filtered glucose (normally), participates in gluconeogenesis, and can produce/release glucose during prolonged fasting
The kidney's roles in glucose homeostasis: 1) Glucose reabsorption - All ~180 g/day of filtered glucose is reabsorbed in the PCT via SGLT2 (90%) and SGLT1 (10%) - none normally in urine. 2) Gluconeogenesis - The kidney (like the liver) can synthesise glucose from amino acids, lactate, and glycerol - contributes ~20-25% of endogenous glucose production, especially during prolonged fasting. 3) Glucose consumption - The medulla uses glucose; cortex preferentially uses fatty acids. SGLT2 inhibitors (gliflozins - empagliflozin, dapagliflozin): Block SGLT2 - glucosuria - lower blood glucose - used in T2 diabetes. Also have cardioprotective and nephroprotective effects independent of glucose lowering.
75
What is the significance of the renal artery and renal vein?
✓ Answer:
B
The renal artery supplies oxygenated blood to the kidney; the renal vein drains deoxygenated blood - the kidney receives the highest blood flow per gram of any organ (~25% of cardiac output)
Renal Artery: Branches from the abdominal aorta at L1-L2 level - supplies oxygenated blood to the kidney. Renal Vein: Drains into the inferior vena cava (IVC) - left renal vein is longer (crosses aorta). The kidneys receive ~1200 mL of blood per minute - approximately 20-25% of resting cardiac output (~5 L/min). This high blood flow ensures efficient filtration. Blood flow path: Renal artery > Interlobar arteries > Arcuate arteries > Interlobular arteries > Afferent arteriole > Glomerulus > Efferent arteriole > Peritubular capillaries / Vasa recta > Venous system.
76
What is Starling's hypothesis as applied to the glomerulus?
✓ Answer:
B
Filtration across the glomerular capillary is governed by the balance of hydrostatic and oncotic (colloid osmotic) pressures
Starling's Forces govern fluid movement across any capillary, including the glomerulus. Forces favouring filtration (OUT of capillary): Glomerular hydrostatic pressure (GHP) = ~55 mmHg and Bowman's capsule oncotic pressure (negligible, ~0). Forces opposing filtration (INTO capillary): Blood colloid osmotic pressure (BCOP) = ~30 mmHg (due to plasma proteins) and Bowman's capsule hydrostatic pressure (CHP) = ~15 mmHg. Net Filtration Pressure = 55 - 30 - 15 = +10 mmHg. This net positive pressure drives continuous filtration. Hypoalbuminaemia (low plasma proteins) > reduced BCOP > increased filtration > oedema. Shock > reduced GHP > reduced GFR > oliguria.
77
What is urethritis and how does it differ from cystitis?
✓ Answer:
B
Urethritis is inflammation of the urethra (often STI-related); cystitis is inflammation of the bladder (often E. coli UTI)
Urethritis vs Cystitis: Urethritis = inflammation of the urethra. Often caused by STIs (sexually transmitted infections): Neisseria gonorrhoeae (gonococcal urethritis) and Chlamydia trachomatis (non-gonococcal urethritis - NGU - most common STI cause). Symptoms: urethral discharge, dysuria, urethral itching. Treatment: ceftriaxone + azithromycin/doxycycline. Cystitis = inflammation of the bladder. Usually caused by E. coli. Symptoms: frequency, urgency, dysuria, suprapubic pain, no discharge. Treatment: trimethoprim, nitrofurantoin. Key distinguishing feature: urethral discharge = urethritis (STI). No discharge + suprapubic pain + frequency = cystitis.
78
What is the condition called when the kidneys produce too much urine?
✓ Answer:
C
Polyuria
Polyuria is the production of abnormally large volumes of urine - generally defined as >2.5 litres per day (some sources say >3 L/day). Causes: Diabetes Mellitus (osmotic diuresis due to glucose in filtrate/glucosuria draws water with it), Diabetes Insipidus (ADH deficiency or resistance - 10-20 L/day of very dilute urine), Polydipsia (primary/psychogenic - excess water intake - dilute urine), Chronic Kidney Disease (loss of concentrating ability - polyuria early in CKD), Hypercalcaemia/Hypokalaemia (reduce tubular concentrating ability), and Diuretics (medications that increase urine output). Always accompanied by polydipsia (increased thirst) as the body attempts to compensate for fluid loss.
79
What is the medical significance of urinalysis (urine analysis)?
✓ Answer:
B
It is a simple diagnostic test that can detect kidney disease, diabetes, infection, liver disease, and other systemic conditions from urine samples
Urinalysis (UA) is one of the most valuable, inexpensive diagnostic tests. Components: Physical (colour, clarity, odour, specific gravity), Chemical Dipstick (pH, protein, glucose, ketones, blood, bilirubin, urobilinogen, nitrites, leucocyte esterase), and Microscopic (RBCs, WBCs, casts, crystals, bacteria). Key diagnostic clues: Glucose = diabetes mellitus, Protein = kidney disease/pre-eclampsia, Blood = stones/infection/cancer/glomerulonephritis, Nitrites + leucocytes = UTI, Ketones = starvation/DKA, Bilirubin = liver disease/bile duct obstruction, RBC casts = glomerulonephritis (pathognomonic), and WBC casts = pyelonephritis/interstitial nephritis.
80
What is the medical term for blood in urine that is visible to the naked eye?
✓ Answer:
B
Gross (macroscopic) haematuria
Gross (Macroscopic) Haematuria is visible blood in the urine - the urine appears red, pink, or brown to the naked eye. Even 1 mL of blood per litre of urine is enough to cause visible colour change. Important causes by age: Children (UTI, glomerulonephritis, Wilms' tumour), Young adults (UTI, kidney stones, trauma, IgA nephropathy), Middle-aged adults (kidney stones, UTI, renal cell carcinoma), and Elderly - Bladder cancer (most important - painless haematuria in elderly = cancer until proven otherwise), prostate cancer, UTI, renal cell carcinoma. Painless gross haematuria in an adult >50 years = bladder cancer until proven otherwise - requires urgent cystoscopy.