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19 The equilibrium constant for the hydrolysis of 2 C2O4 is best represented by which of the following 2 (A) K = [OH ][C2O4 ]/[HC2O4 ] + 2 (B) K = [H3O ][C2O4 ]/[HC2O4 ] 2 (C) K = [HC2O4 ][OH ]/[C2O4 ] 2 (D) K = [C2O4 ]/[HC2O4 ][OH ] + 2 (E) K = [C2O4 ]/[HC2O4 ][H3O ]

The answer is true The excess solute retains water, thus diluting tubular potassium and reducing the driving force for reabsorption The answer is false The high amounts of nonreabsorbed solute increase the sodium content of the luminal fluid, with water accompanying it This dilutes potassium This stimulates potassium secretion both by the dilution effect and by the high rate of sodium reabsorption The answer is high The increased aldosterone stimulates potassium secretion and, thereby, excretion Moreover, once enough sodium has been retained to increase GFR and to cause partial inhibition of proximal reabsorption, the increased delivery of fluid to the cortical collecting duct further enhances potassium secretion There is no potassium escape similar to the sodium escape from aldosterone The answer is relatively normal One may have answered high, assuming that the increased aldosterone would stimulate potassium secretion, as in Question 8 6 However, this effect is more than balanced by the fact that the patient has a decrease in flow of fluid into the cortical collecting duct (because of decreased GFR and increased proximal and loop reabsorption) Recall that potassium secretion is impaired when the amount of fluid flowing through the cortical collecting duct is reduced This explains why patients with the diseases of secondary hyperaldosteronism with edema do not lose large quantities of potassium, whereas those with primary hyperaldosteronism do The answer is D There is little control over potassium transport before the connecting tubule When excretion is high, the major process leading to high excretion is high secretion by the connecting tubule and cortical collecting duct The answer is B While insulin exerts many actions, its chief action in limiting the rise in plasma potassium due to a high-potassium meal is to stimulate tissue uptake, particularly by skeletal muscle

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Integrated Access Device (IAD) An IAD is a device that includes the functions of a media gateway as well as additional data network capability, with the purpose of coalescing voice/video and data connectivity to a site through a single uplink (communications facility) For example, an IAD may have an Ethernet interface to the site LAN and a T1/E1 interface to the site PBX, together with an IP interface as an uplink to a public VoIP/MPLS network that carries the voice and data Voice Terminals Voice terminals form the interface between the human user and the telecommunications infrastructure Traditional voice terminals for the PSTN/ISDN networks include analog phone, PBX, key system, VF modem, fax machines, and ISDN terminals In addition to being connected directly to an IAD or AG, the voice terminals may be connected to a VoIPoMPLS network via the following: A conventional PBX through an interworking device such as an H323 gateway; an IP PBX; a phone hub, which would be a device with multiple analog or digital phone interfaces on one side and an Ethernet on the other side; a single port adapter, which has a single phone port and an Ethernet port; a telephone adapter to another device on the network such as a PC; or an IPPhone (or SIP-Phone or H323 terminal), which is an end device with a native network interface Phone hubs, single port adapters, IP-Phones, and other devices may use external call agents H323 gateways, IP PBXs, and similar devices are combined call agent/media gateways VoIPoMPLS Media Gateway A VoIPoMPLS media gateway is an implemen-

9 1 9 2 The answer is true The answer is B If the urine has a pH greater than 74, clearly there is no titratable acid excreted Indeed, there is negative titratable acid excretion Ammonium does not contribute to titratable acid and may be ignored in the calculation of titratable acid None of them are acid loads Vomiting of stomach acid adds bicarbonate to the blood Fruit juice, when oxidized to CO2 and water, adds bicarbonate Sweetening it makes no difference because the metabolism of saccharides is acid-base neutral Lactate, when metabolized, adds bicarbonate The answer is false Filtered bicarbonate is not transported into the epithelial cells; rather, it is converted in the lumen to CO2 and water when it combines with secreted protons Bicarbonate is generated within

Which species, in the above equilibrium, behave as bases 2 I HPO4 II H2PO 4 III H2O (A) I only (B) I and II (C) II and III (D) I and III (E) III only 23 H2C3H2O4 + 2 H2O

9 3

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