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POS Fluids + Electrolytes > POS Fluids + Electrolytes > Flashcards

POS Fluids + Electrolytes Flashcards

1
Q

What is the unmeasured anion that contributes to a normal anion gap metabolic acidosis?

  1. Albumin
  2. Urea
  3. Lactate
  4. Chloride
A
  1. Albumin
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2
Q

Which ONE of the following is true regarding loop diuretics?

A. They decrease blood flow to the kidney
B. They inhibit the sodium-potassium-chloride co-transporter
C. They do not affect calcium
D. They decrease venous capacitance

A

B. They inhibit the sodium-potassium-chloride co-transporter

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3
Q

Earliest sign of hypermagnesemia:

A. Stupor
B. Loss of deep tendon reflexes
C. Hypotension

A

B. Loss of deep tendon reflexes

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4
Q

Not a complication of severe hypocalcemia:

A. Seizure in children
B. Painful muscle spasm
C. Perioral or fingertip tingling
D. Cardiac dysfunction with shortening of the ST segments

A

D. Cardiac dysfunction with shortening of the ST segments

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5
Q

PT s/p parathyroidectomy, develops perioral tingling, numbness, carpopedal spasm. ECG findings:

A. Prolonged QT
B. Peaked T
C. Torsade
D. U Waves

A

A. Prolonged QT

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6
Q

Signs of hypercalcemia except:

A. Proximal muscle weakness
B. Carpopedal spasm (hypocalcemia)
C. Coma

A

B. Carpopedal spasm (hypocalcemia)

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7
Q

Which abnormalities least likely to see with hypoadrenalism:

A. Diaphoresis
B. Hypotension
C. Hypoglycemia
D. HypoNa
E. HypoK

A

E. HypoK

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8
Q

In a patient with pulmonary failure and on TPN, which electrolyte distb most likely to result in difficulty with ventilator weaning secondary to resp muscle weakness:

A. HypoCa
B. HypoCl
C. HypoNa
D. HypoMg
E. HypoP04

A

E. HypoP04

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9
Q

Urine Na wasting despite reduced ECF occurs in all of the following excess:

A. Hyperglycemia
B. Polyuric phase of ATN
C. Post-obstructive diuresis
D. Cirhossis with ascites
E. Adrenal insufficiency

A

D. Cirhossis with ascites

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9
Q

Not a complication of massive blood transfusion:

A. Hypercalemia
B. Thrombocytosis
C. Met Acidosis
D. Hypocalcemia

A

A. Hypercalemia

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10
Q

Which form of HTN associated with low renin:

A. Renal artery stenosis
B. Primary hyperaldosteronism
C. CHF
D. Cirrhosis

A

B. Primary hyperaldosteronism

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11
Q

Lasix does all except:

A. Hyperuricemia
B. Metabolic Alkalosis (Not Met Acidosis - Another Q)
C. HyperCa (Causes hypoCa)
D. HypoK

A

C. HyperCa (Causes hypoCa)

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12
Q

All true about hyper-aldosteronism except:

A. Hypokalemia
B. Water Retention
C. Met Acidosis (Get met alk)
D. Hypertension

A

C. Met Acidosis (Get met alk)

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13
Q

Which of the following causes hypokalemia:

A. ACE, captopril
B. Cushings
C. Cyclosporine A
D. Hemolysis
E. Primary Hyperaldosteronism

A

E. Primary Hyperaldosteronism

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14
Q

Most reliable sign of hypoMG is:

A. Decreased DTR
B. Tremor
C. Decrease LOC

A

B. Tremor

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15
Q

Appropriate therapy for HyperCa include all except:

A. NA
B. Thiazide Diuretics
C. Calcitonin
D. Pamidronate
E. Steroids

A

B. Thiazide Diuretics

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16
Q

Woman known to have mets from CA, presents with signs of hypercalcemia. First step in management:

A. IV Fluids and lasic
B. Calicitonin
C. Bisphosphonates
D. Denosumab A

A
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17
Q

What was best proven for contrast-induced nephropathy?
A. NAC
B. Mannitol
C. Steroids
D. Benadryl

A
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18
Q

Hyponatremia will have which picture?

A. Lethargy, seizures
B. Nausea, vomiting, abdominal cramps
C. Diarrhea, metabolic acidosis

A
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19
Q

Which of the following solutions contains NA 130?

A. RL
B. D51/2NS
C. NS
D. Hypertonic Saline

A
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20
Q

How much volume actually gets intravascular after 1L bolus of crystalloid? (replace 4:1)

A. 100
B. 250
C. 500
D. 800

A
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20
Q

6 week old with clear history of pyloric stenosis. What do you expect will be the lab values?

A. Na 130, K 2.5, C1 112, HCO 330
B. Na130, K3.0, C191, HCO3 29
C. Na135, K3.0, C187, HC03 20

A

might be missing another answer

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20
Q

Which of the following has highest total body water?

A. Man < 30 year old
B. Man > 70 year old
C. Woman < 30 year old
D. Woman > 70 year old

A
21
Q

An elderly diabetic man is admitted to hospital for treatment of an infected foot ulcer. He is found to have a serum sodium of 119 and a blood glucose level of 33. His hyponatremic state should be treated with?

A. Insulin infusion to reduce blood glucose level to normal
B. Normal saline 150 cc/h until the serum sodium returns to normal
C. 3% NaCl at 400 cc/h until the serum sodium returns to normal
D. 100 cc/day water restricted diet

A
22
Q

An 80 year old woman undergoes laparotomy and ileostomy because of an obstructing unresectable carcinoma of her colon. Post-operatively she does well. Because of excessive ileostomy output she is kept on clear fluids by mouth. She receives IV 2/3-1/3 of saline of 20 µmol/1 HCL/1 at 100 cc/h. On post-operative day four, her electrolytes are:

  • Na 122
  • K 4.8
  • HCO2 22
  • CR 140
  • Bun 2.5

Her hyponatremia should be treated with?

A. Change IV to normal saline 75 ccs/h and replace ileostomy losses with normal saline
B. Infuse 3% NACl 30 ccs/h
C. Make patient NPO and follow lytes carefully
D. Give lasix 20 mgs IV stat.

A
23
Q

A 58 year old woman undergoes total hysterectomy, bilateral salphingoophorectomy and omentectomy for ovarian carcinoma. Post-operatively she receives an intravenous of 2/3-1/3 of 20 mmol of KCL/1 at 100 ccs/h. On post operative day two, routine blood work records:

  • Hg 98 ( previously 125)
  • Na 127
  • K 6.3
  • Cl 115
  • Creatinine 75**

She has no history of diabetes or renal disease. The next step in her management should be?

A. Transfuse 2 unites packed red blood cells
B. Give 10 units regular insulin subcutaneously
C. Give oral sodium polystyrene solution (potassium exchange agent)
D. Repeat blood work

A
24
Q

A 58 year old man has chronid duodenal ulcer disease because of noncompliance with medications. Over the past two weeks he has had increasing nausea and vomiting with weight loss. In the Emergency room hea ppears dehydrated with a serum creatining of 170. All of the following metabolic abnormalities are expected, EXCEPT?

A. Elevated pH
B. Low serum sodium
C. Low Serum Chloride
D. Low Serum Potassium

A
25
Q

Initial fluid resuscitation of the above patient should consist of?

A. Ringers lactate solution
B. Normal saline with 20 mmol K Cl/l
C. Half-normal saline with 20 mmol K Cl/l
D. 3% hypertonic saline

A
26
Q

A 57 year old hypertensive man develops torsades de pointes arrhythmia four days after 4-vessel coronary artery bypass grafting for severe coronary artery disease associated with a recent anterior myocardial infarction. Which of the following electrolytes disturbances is likely contributing to the etiology os his arrhythmia?

A. Hyperkalemia
B. Hypermagnesium
C. Hypomagnesium
D. Hypocalcemia

A
27
Q

All of the following are involved in the control of aldosterone secretion, EXCEPT?

A. Angiotensin
B. Cortisol
C. Serum Potassium
D. Serum Sodium

A
28
Q

An 86 year old hypertensive man has left calf intermittent claudication after walking two blocks. His physician ordered an arteriogram. The patient’s creatinine is 240. Which of the following statements concerning contrast-induced nephropathy is TRUE?

A. Pre-procedure hydration with IV normal saline is contra-indicated because of the risk of congestive heart failure.

B. Pre-procedure hydration with IV sodium bicarbonate is more effective at preventing contrast-induced nephropathy than IV hydration with normal saline.

C. An increase in serum creatinine of 25% is expected and generally not clinically signifcant after contrast arteriography.

D. The risk of renal failure from intra-arterial contrast is too high in this patient and alternative imaging should be considered.

A
29
Q

Hypernatremia is sometimes seen in surgical patients. Which of the following does NOT contribute to the development of hypernatremia?

  1. Excessive Sweating
  2. Hyperlipidemia
  3. Lithium Treatment
  4. Glycosuria
A
30
Q

A 63 year old woman with known metastatic breast cancer to bones and liver, returns to see her surgical oncologist complaining of fatigueability, muscle weakness, anorexia, and nausea. The most likely cause of these symptoms is?

  1. Depression related to her metastatic cancer
  2. Hypercalemia secondary to bony metases
  3. Hypokalemia secondary to her chemotherapy
  4. Metabolic alkalosis secondary to her chemotherapy.
A
31
Q

All of the following may be acute complications of crush injury and rhabdomyolysis, EXCEPT?

  1. Hypercalcemia
  2. Hyperkalemia
  3. Acidosis
  4. Hypophosphatemia
A
32
Q

The amount of sodium (Na+) in 1 liter of Normal (0.9%) Saline is:

  1. 130 mmol
  2. 134 mmol
  3. 140 mmol
  4. 154 mmol
A
33
Q

Patient 84, delerious, lap for SBO, NA 111, CI 84, glucose 12.1, why is the likely cause of this derangement?

A. Uncontrolled hyperglycemia
B. Losses of Na from vomiting
C. SIADH
D. Excess water intake

A

B. Losses of Na from vomiting

34
Q

Man post embolectomy/fasciotomy of his leg, started on heparin post op. Urine output 20cc/h red tinged, what should you do?

A. Protamine
B. Stop Heparin
C. Mannitol + bicarbonate infusion
D. Lasix

A

C. Mannitol + bicarbonate infusion

35
Q

A 79 year old lady underwent a coronary artery bypass surgery six hours ago. She accidentally removed on her endotracheal tube and complains of sternal pain. You ask the nurse to give her Hydromorphone 0.5mg s/c. Later on, the nurse come to you because the patient is asleep and does nto breathe while stimualted. She shows you the patient’ blood gas. Which result corresponds the best to the patients condition?

A. pH =7.36, pCO2 = 41, HCO3 = 22, paO2=81
B. pH= 7.48, pCO2 = 25, HCO3= 30, paO2= 100
C. pH= 7.32, pCO2 = 25, HCO3= 35, paO2= 65
D. pH= 7.21, pCO2 = 85, HCO3 =24, paO2= 60

A

Answer: D = Acute hypercapneic respiratory insufficiency with acute respiratory acidosis.

D. pH= 7.21, pCO2 = 85, HCO3 =24, paO2= 60

36
Q

A 75 year old man is recovery from surgery following a hip fracture. Gases are drawn by the RT

Ph 7.33
HCO3 23 mEg/L
PaCO2 46 mmHg

What is the acid/base abnormality?

A. Metabolic acidosis without compensation
B. Respiratory acidosis without compensation
C. Respiratory Acidosis with metabolic compensation
D. Metabolic alkalosis with respiratory compensation

A

B. Respiratory acidosis without compensation

37
Q

All of the following are potentially appropriate treatments for hyperkalemia EXCEPT:

A. Calcium chloride infusion
B. Glucose + Insulin infusion
C. Hemodialysis
D. IV sodium bicarbonate
E. Spironolactone

A

E. Spironolactone

38
Q

Which of the following is a potential clinical manifestation of hypercalcemia:

A. Paresthesias
B. Painful muscle spasms
C. Seizures
D. Kidney stones
E. Prolonged QT Interval

A

D. Kidney stones

39
Q

The most likely cause of renal wasting of potassium leading to hypokalemia in the postoperative patient is:

A. Proteinuria
B. Hyperatremia
C. Hyperphosphatemia
D. Hypomagnesemia

A

D. Hypomagnesemia

40
Q

Name the cause of normal anion gap metabolic acidosis:

  1. DKA
  2. Hypovolemic shock
  3. High output enterocutaneous fistula
  4. Ethanol
A
  1. High output enterocutaneous fistula
41
Q

Trousseau’s sign and prolonged QT in ECG:
1. HypoCA
2. HypoMg
3. HypoK

A
  1. HypoCA
42
Q

Old patient with crush injury to the legs, now K of 7.3, starting to have loss p wave, slurred QRS. Appropriate treatment:

  1. IV calcium chloride infusion
  2. Loop diuretique
  3. Insulin and glucose
  4. Dialysis
A
  1. IV calcium chloride infusion
43
Q

Hypona causes which of the following:

A. Inc U/O
B. Loss of DTR
C. Tachy
D. Hypotension

A

B. Loss of DTR

44
Q

A 60 year old woman with chronic renal failure and undergoing hemodialysis 2-3/wk develops tumoral calcinosis. Her parathyroid hormone is marked elevated while her ionized calcium is normal. Her most likely diagnosis is:

A. Primary hyperparathyroidism
B. Secondary hyperparathyroidism
C. Tertiary hyperparathyroidism

A

B. Secondary hyperparathyroidism

45
Q

22kg child needing maintenance fluid. What is the rate?

A. 52 ml/h
B. 62 ml/h
C. 72 ml/h
D. 82 ml/h

A

B. 62 ml/h

46
Q

What is recommended as an IV fluid bolus in child who weighs 15kgs?

A. 75 cc (5cc/kg)
B. 150 cc (10cc/kg)
C. 300 cc (20cc/kg)
D. 450 cc (30cc/kg)

A

C. 300 cc (20cc/kg)

47
Q

55 female with breast cancer, comes into the emergency complaining of bony pain for a few days, additionally now she has nausea, vomiting and abdominal pain. EKG shows increased QT interval, T-wave flattened, PR interval prolonged. What is the most important electrolyte to asses?

A. Calcium
B. Potassium
C. Sodium
D. Magnesium

A

A. Calcium

48
Q

Female patient with breast cancer, has multiple bony metastases, has severe hypercalcemia, what is your next best step in management?

A. Administer IV fluids and then furosemide
B. Calcitonin
C. Bisphosphonate

A

A. Administer IV fluids and then furosemide

49
Q

Regarding SIADH, which is true?

A. Hyponatraemia, with normal volume status and increase in urine sodium and urine osmolality
B. Associated with head trauma and salt wasting and a history of brain surgery
C.Hypernatremia is present
D. You find urinary salt wasting and a history of brain surgery

A

A. Hyponatraemia, with normal volume status and increase in urine sodium and urine osmolality

50
Q

Kid with vomiting. What would be the electrolyte abnormality?

A. Hypokalemic, hypochloremic metabolic alkalosis
B. Hyerkalemic, hypochloremic metabolic alkalosis
C. Hypokalemic, hypochloremic metabolic acidosis

A

A. Hypokalemic, hypochloremic metabolic alkalosis

51
Q

What are the main determinants of exchange between ECF and ICF?

A. Sodium concentration
B. Proteins
C. Concentration of diffusible ions
D. Concentration of non-diffusible ions

A

A. Sodium concentration

52
Q

Which is a treatment involved in hyperkalemia to protect the heart?

A. Ca gluconate
B. Kayexalate
C. Dialysis
D. Insulin

A

A. Ca gluconate

53
Q

Cancer patient with high calcium. What is the most likely reason?

A. Thyrotoxicosis
B. Tumor lysis syndrome
C. Rhabdomyolysis

A

A. Thyrotoxicosis

B + C cause hypocalcemia

POS Fluids + Electrolytes (5 decks)

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