39.1 Secretion of K+ in the late distal tubule and collecting ducts of kidney depends on:
A. Intracellular K+ content
B. Unabsorbed Na+ load presented to the distal segment
C. Aldosterone level
D. All of the above
39.2 Diuretics acting on the ascending limb of loop of
Henle are the most efficacious in promoting salt and
water excretion because:
A. Maximum percentage of salt and water is reabsorbed in this segment
B. Reabsorptive capacity of the segments distal to it is limited
C. This segment is highly permeable to both salt and water
D. This segment is responsible for creating corticomedullary osmotic gradient
39.3 Select the diuretic which is orally active, efficacious
in acidosis as well as alkalosis, causes diuresis even
in renal failure and has additional carbonic anhydrase
inhibitory action:
A. Mannitol
B. Benzthiazide
C. Indapamide
D. Furosemide
39.4 Furosemide acts by inhibiting the following in the renal tubular cell:
A. Na+-K+-2Cl– cotransporter
B. Na+-Cl– symporter
C. Na+-H+ antiporter
D. Na+ K+ ATPase
39.5 The following diuretic abolishes the corticomedullary
osmotic gradient in the kidney:
A. Acetazolamide
B. Furosemide
C. Hydrochlorothiazide
D. Spironolactone
39.6 Intravenous furosemide promptly mitigates dyspnoea
in acute left ventricular failure by:
A. Producing bronchodilatation
B. Causing rapid diuresis and reducing circulating blood volume
C. Increasing venous capacitance and reducing cardiac preload.
D. Stimulating left ventricular contractility
39.7 Parenteral furosemide is an alternative diuretic to
mannitol in the following condition:
A. Pulmonary edema
B. Cirrhotic edema
C. Cerebral edema
D. Cardiac edema
39.8 Thiazide diuretics and furosemide have directionally
opposite effect on the net renal excretion of the
following substance:
A. Uric acid
B. Calcium
C. Magnesium
D. Bicarbonate
39.9 Select the diuretic which is similar in efficacy and
pattern of electrolyte excretion to furosemide, but is
40 times more potent dose to dose:
A. Piretanide
B. Bumetanide
C. Xipamide
D. Metolazone
39.10 Though ethacrynic acid is also a high ceiling diuretic,
it is practically not used because:
A. It is more ototoxic
B. It causes diarrhoea and gut bleeding
C. Its response increases steeply over a narrow dose range
D. All of the above
39.11 The Na+-Cl– symport in the early distal convoluted
tubule of the kidney is inhibited by:
A. Thiazides
B. Metolazone
C. Xipamide
D. All of the above
39.12 The following diuretic reduces positive free water
clearance but does not affect negative free water
clearance:
A. Hydroflumethiazide
B. Furosemide
C. Ethacrynic acid
D. Mannitol
39.13 Choose the correct statement about thiazide diuretics:
A. They act in the proximal convoluted tubule
B. They are uricosuric
C. They augment corticomedullary osmotic gradient
D. They induce diuresis in acidosis as well as alkalosis
39.14 Thiazide diuretics enhance K+ elimination in urine primarily by:
A. Inhibiting proximal tubular K+ reabsorption
B. Inhibiting Na+ K+-2Cl– cotransport in the ascending limb of loop of Henle
C. Increasing the availability of Na+ in the distal
tubular fluid to exchange with interstitial K+
D. Potentiating the action of aldosterone
39.15 The primary site of action of thiazide diuretics is:
A. Proximal tubule
B. Ascending limb of loop of Henle
C. Cortical diluting segment
D. Collecting ducts
39.16 The most important reason for the thiazides being
only moderately efficacious diuretics is:
A. About 9/10th of glomerular filtrate is
reabsorbed proximal to their site of action
B. Compensatory increase in reabsorption at
sites not affected by these drugs
C. They decrease glomerular filtration
D. They have relatively flat dose response curve
39.17 Individual drugs of thiazide and related class of
diuretics differ markedly from each other in the
following respect?
A. Diuretic efficacy
B. Diuretic potency
C. Side effects
D. Propensity to cause hyperkalemia
39.18 Combined tablets of thiazide or high ceiling diuretics
with potassium chloride are not recommended
because:
A. Potassium absorbed while diuresis is occurring is largely excreted out
B. Potassium administered concurrently diminishes the diuretic action
C. Potassium chloride in tablet formulation is likely to cause gut ulceration
D. Both ‘A’ and ‘C’ are correct
39.19 Intravenous saline infusion is the treatment of choice
for the following complication(s) of vigorous furosemide
therapy:
A. Dilutional hyponatremia
B. Acute saline depletion
C. Hypokalemia
D. All of the above
39.20 Long-term thiazide therapy can cause hyperglycaemia by:
A. Reducing insulin release
B. Interfering with glucose utilization in tissues
C. Increasing sympathetic activity
D. Increasing corticosteroid secretion
39.21 In addition to counteracting potassium loss, triamterene
also opposes the following consequence of
thiazide/furosemide therapy:
A. Hyperuricaemia
B. Rise in plasma LDL-cholesterol
C. Magnesium loss
D. Both ‘A’ and ‘C’ are correct
39.22 A patient of congestive heart failure was being treated
with furosemide and digoxin. He developed urinary
tract infection. Which of the following antimicrobials
should be avoided:
A. Ampicillin
B. Gentamicin
C. Norfloxacin
D. Cotrimoxazole
39.23 Nonsteroidal antiinflammatory drugs reduce the
diuretic action of furosemide by:
A. Preventing prostaglandin mediated intrarenal haemodynamic actions
B. Blocking the action in ascending limb of loop of Henle.
C. Enhancing salt and water reabsorption in distal tubule
D. Increasing aldosterone secretion
39.24 The most appropriate measure to overcome diminished
responsiveness to furosemide after its longterm
use is:
A. Switching over to parenteral administration of furosemide
B. Addition of a thiazide diuretic
C. Addition of acetazolamide
D. Potassium supplementation
39.25 At equinatriuretic doses which diuretic causes the maximum K+ loss:
A. Furosemide
B. Hydrochlorothiazide
C. Acetazolamide
D. Amiloride
39.26 Which of the following has a ‘self limiting diuretic’
(action of the drug itself causing changes which limit
further diuresis) action:
A. Indapamide
B. Spironolactone
C. Xipamide
D. Acetazolamide
39.27 The following is not itself an efficacious diuretic,
and is used only as an adjuvant/corrective to other
diuretics:
A. Acetazolamide
B. Metolazone
C. Spironolactone
D. Indapamide
39.28 Spironolactone can be usefully combined with the
following diuretics except:
A. Furosemide
B. Amiloride
C. Hydrochlorothiazide
D. Chlorthalidone
39.29 The current therapeutic indication of acetazolamide is:
A. Congestive heart failure
B. Renal insufficiency
C. Cirrhosis of liver
D. Glaucoma
39.30 A patient of liver cirrhosis with ascitis was treated
with hydrochlorothiazide 50 mg twice daily. He
responded initially, but over a couple of months the
diuretic action gradually diminished and ascitis again
appeared. Select the measure to reinduce diuresis:
A. Increase hydrochlorothiazide dose to 100 mg
twice daily
B. Add acetazolamide 250 mg twice daily
C. Add spironolactone 50 mg thrice daily
D. Substitute hydrochlorothiazide by spironolactone
50 mg 6 hourly
39.31 Aldosterone increases Na+ reabsorption and K+
excretion in the renal collecting duct cells by:
A. Inducing synthesis of Na+K+ATPase
B. Inducing synthesis of amiloride sensitive Na+ channels
C. Translocating Na+ channels from cytosolic site to luminal membrane
D. All of the above
39.32 Select the diuretic that can cause gynaecomastia,
hirsutism and menstrual disturbance as a side effect
on long-term use:
A. Amiloride
B. Spironolactone
C. Metolazone
D. Acetazolamide
39.33 Amiloride inhibits K+ excretion in the distal tubules
and collecting ducts by blocking:
A. Electrogenic K+ channels
B. Electrogenic Na+ channels
C. Nonelectrogenic Na+-Cl– symport
D. H+K+ATPase
39.34 Which of the following is a potassium retaining diuretic:
A. Triamterene
B. Trimethoprim
C. Tizanidine
D. Trimetazidine
39.35 Triamterene differs from spironolactone in that:
A. It has greater natriuretic action
B. Its K+ retaining action is not dependent on presence of aldosterone
C. It acts from the luminal membrane side of the distal tubular cells
D. Both ‘B’ and ‘C’ are correct
39.36 Choose the correct statement about amiloride:
A. It antagonises the action of aldosterone
B. It can be used to treat lithium induced diabetes insipidus
C. It increases calcium loss in urine
D. It is dose to dose less potent than triamterene
39.37 Amiloride has the following effect on urinary cation excretion:
A. Decreases both K+ and H+ ion excretion
B. Decreases K+ excretion but increases H+ ion excretion
C. Increases K+ but decreases Na+ excretion
D. Decreases both Na+ and K+ excretion
39.38 Use of potassium sparing diuretics in patients receiving
the following drug needs close monitoring:
A. Furosemide
B. Hydrochlorothiazide
C. Captopril
D. Verapamil
39.39 The following diuretic acts on the luminal membrane
of distal tubule and collecting ducts to inhibit
electrogenic Na+ reabsorption so that K+ excretion is
diminished and bicarbonate excretion is enhanced:
A. Xipamide
B. Isosorbide
C. Triamterene
D. Spironolactone
39.40 Choose the correct statement about osmotic diuretics:
A. They are large molecular weight substances which form colloidal solution
B. Their primary site of action is collecting ducts in the kidney
C. They increase water excretion without increasing salt excretion
D. They can lower intraocular pressure
39.41 The following is true of mannitol except:
A. It inhibits solute reabsorption in the thick ascending limb of loop of Henle
B. It is contraindicated in patients with increased intracranial tension
C. It is contraindicated in acute left ventricular failure
D. It is not used to treat cardiac or hepatic or renal edema
Ans:
39.1D 39.2 B 39.3D 39.4 A 39.5 B 39.6 C 39.7 C 39.8 B 39.9 B 39.10D 39.11D 39.12 A 39.13D 39.14 C 39.15 C 39.16 A 39.17 B 39.18D 39.19 B 39.20 A 39.21 C 39.22 B 39.23 A 39.24 B 39.25 C 39.26D 39.27 C 39.28 B 39.29D 39.30 C 39.31D 39.32 B 39.33 B 39.34 A 39.35D 39.36 B 39.37 A 39.38 C 39.39 C 39.40 D 39.41 B
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