ABG (Kane) Exam 2 Flashcards
Which of the following best describes the normal pH range of human blood?
a) 7.0 - 7.2
b) 7.35 - 7.45
c) 7.5 - 8.0
d) 6.5 - 7.0
Answer: b) 7.35 - 7.45
7.4 is what we will be using in class
Why is the pH of blood tightly regulated within a narrow range?
a) To maintain hormone levels
b) To ensure optimal function of enzymatic reactions.
c) To ensure optimal function of non-enzymatic reactions
d) To control the level of electroyltes coming in and out of our body
Answer: b) To ensure optimal function of enzymatic reactions.
An increase in H+ ions will lower the pH (making it more acidic), while an increase in OH- ions will raise the pH (making it more basic).
What effect does a change in the relative concentration of ions in water have on pH?
a) It only affects temperature, not pH.
b) It disassociates water into glucose molecules.
c) It alters the auto-ionization of water
d) It dissasociates water into only protons H+
Answer: c) It alters the auto-ionization of water into H+ or OH- ions, thus changing the pH.
Change in relative concentrations of F/E (Field Effect) changes waters ability to auto-ionize (dissasociate into H+ or OH- ions and alter pH)
In the context of acid-base balance, what significant observation did O’Shaughnessy make in 1831 regarding cholera patients?
a) They had elevated levels of calcium in their blood.
b) They had a loss of carbonate of soda.
c) They had a decrease in enzymatic activity.
d) They showed septic signs d/t increased carbonate soda levels
b) They experienced a loss of carbonate of soda.
Which of the following best describes the relationship between alkalemia and hydrogen ions (H+)?
a) Excess production of OH- ions in relation to H+ ions.
b) Excess production of H+ ions in relation to OH- ions
c) Balance between H+ and OH- ions.
d) None of the above
Answer: a) Excess production of OH- ions in relation to H+ ions.
Increased OH- ions and decreased H+ therefore increased pH
In which condition would you expect a higher concentration of H+ ions relative to OH- ions?
a) Alkalemia
b) Neutral pH
c) Acidemia
d) Alkalosis
Answer: c) Acidemia
What does the pH scale measure?
a) The concentration of hydroxyl ions (OH-) and hydrogen ions (H+).
b) The concentration of hydroxyl ions (OH-) in a solution.
c) The concentration of hydrogen ions (H+) in a solution.
d) The enzymatic level of electrolytes.
c) The concentration of hydrogen ions (H+) in a solution.
Why is pH often referred to as “the power of hydrogen”?
a) It measures the energy produced by hydrogen.
b) It represents the concentration of hydrogen ions in terms of logarithmic power.
c) It indicates the weight of hydrogen atoms in a solution in terms of logarithmic power.
d) It calculates the force exerted by hydrogen in a solution.
b) It represents the concentration of hydrogen ions in terms of logarithmic power.
How does the body manage the removal of CO2 to help stabilize pH levels?
a) It enters through lungs and leaves through the digestive system.
b) It enters and leaves through the lungs during respiration.
c) It enters the lungs and is stored in muscle tissues.
d) It enters through the lungs and leaves through the sweat glands.
b) Enters/leaves the lungs during respiration.
Which organ is primarily responsible for managing bicarbonate (HCO3-) levels in the body to maintain pH balance?
a) Liver
b) Pancreas
c) Kidneys
d) Intestines
C) Kidneys
In which part of the kidney is hydrogen ion (H+) reabsorption primarily regulated to help maintain pH stability? Select 2
a) Collecting Ducts
b) Proximal tubule
c) Loop of Henle
d) Distal tubule
e) Glomerulus
a) Collecting Ducts
d) Distal tubule
The Henderson-Hasselbalch equation is used to calculate pH. Which of the following correctly represents this equation?
a) pH = 6.1 + log (HCO3-/0.03 x SvCO2)
b) pH = 7.4 + log (H2O/CO2)
c) pH = 6.1 + log (HCO3-/0.03 x PaCO2)
d) pH = 5.5 + log (HCO3-/0.03 x PaCO2))
c) pH = 6.1 + log (HCO3-/0.03 x PaCO2)
Henderson-Hasselbalch coined “acid-base” balance
Which property allows water to act as both an acid and a base?
a) Alcalescent nature
b) Amphoteric nature
c) Alkalescent nature
d) Amphiprotic nature
b) Amphoteric nature
How does HCL hydrochloric acid interact with water?
a) Water acts as an acid and donates a proton to HCl.
b) Water acts as a base and accepts a proton from HCl.
c) Water remains neutral and does not react with HCl.
d) Water acts as a base and donates a proton from HCL.
b) Water acts as a base and accepts a proton from HCl.
How does potassium hydroxide (KOH) interact with water?
a) Water acts as an acid and donates a proton to KOH.
b) Water acts as a base and accepts a proton from KOH.
c) Water remains neutral and does not react with KOH.
d) Water acts as a base and donates a proton from KOH.
a) Water acts as an acid and donates a proton to KOH.
Why is lactic acid (pKa 3.4) considered a strong acid in the context of its dissociation in water?
a) Because it has a high pKa value.
b) Because it completely dissociates in water.
c) Because it is less soluble in water.
d) Because it is a neutral molecule in water.
b) Because it completely dissociates in water
LA (pKa 3.4) completely dissociates in water.. therefore strong acid
Which of the following best describes carbonic acid (H2CO3) in water based on its pKa (6.4) value?
a) It is a strong acid because it completely dissociates in water.
b) It is a strong acid because it incompletely dissociates in water.
c) It is a weak acid because it completely dissociates in water.
d) It is a weak acid because it incompletely dissociates in water.
d) It is a weak acid because it incompletely dissociates.
Which principle ensures that the total positive charge in a solution must equal the total negative charge?
a) Mass Conservation
b) Dissociation Equilibria
c) Electrical Neutrality
d) Chemical Equilibrium
c) Electrical Neutrality
*The sum of all positive charges in a system must equal the sum of all negative charges.
For example: NaCl –> The number of Na+ ions is equal to the number of Cl- ions to maintain pH balance in biological systems
Which of the following describes the concept of dissociation equilibria?
a) The rate at which a large compound evaporates in a solution.
b) A larger complex to separates into its smaller parts
c) The rate at which a compound turns from a liquid into a solid.
d) When a large compound goes through a chemical reaction and does not change
b) b) A larger complex to separates into its smaller parts
Kane describe this as things breaking into pieces or chunks, not staying solid. The sum of cations are equal to anions
Example - Acids produce hydrogen ions due to dissociation. Consider the ionization of hydrochloric acid,
HCl → H+(aq) + Cl-(aq).
What does the principle of mass conservation state about chemical reactions?
a) The total mass of reactants must be greater than the total mass of products.
b) The total mass of reactants is equal to the total mass of products.
c) Mass can be created during the reaction process.
d) The total mass changes based on reaction conditions.
b) The total mass of reactants is equal to the total mass of products.
Kane says the AMOUNT matters not the size. You cannot lose substance or create a new substance
Science says: The total mass of substances before a chemical reaction is equal to the total mass of substances after the reaction, reflecting the law of conservation of mass.
What is a defining characteristic of strong ions in a solution?
a) They only partially dissociate in solution.
b) They completely dissociate in solution
c) They do not dissociate at all in solution.
d) They change their dissociation based on the temperature of the solution.
b) They completely dissociate into their constituent ions in solution.
Which of the following are considered the most abundant strong ions in the extracellular fluid (ECF)?
a) Potassium (K+) and Magnesium (Mg2+)
b) Sodium (Na+) and Chloride (Cl-)
c) Sulfate (SO42-) and Calcium (Ca2+)
d) Potassium (K+) and Calcium (Ca2+)
b) Sodium (Na+) and Chloride (Cl-)
Which statement is true about the Strong Ion Difference (SID) in the extracellular fluid (ECF)?
a) SID is always negative in the ECF.
b) SID is always positive in the ECF.
c) SID equals zero in the ECF.
d) SID fluctuates between positive and negative values in the ECF.
b) SID is always positive in the ECF.
Strong cations-strong anions
This keep pH balance
Which of the following ions contribute to the Strong Ion Difference (SID) in the ECF? Select 6
a) HCO3-
b) Ca2+
c) Na+
d) K+
e) NH4+
f) Cl-
g) Mg2+
i) PO43-
j) SO42-
b) Ca2+
c) Na+
d) K+
f) Cl-
g) Mg2+
j) SO42- (sulfate)
Chemistry ptsd anyone?
If a patient’s blood pH is measured to be 7.25, how is this classified?
a) Normal
b) Acidic (Acidosis)
c) Alkaline (Alkalosis)
d) Hypertonic
Answer: b) Acidic (Acidosis)
pH has decreased
Which of the following blood pH values indicates alkalosis?
a) 7.20
b) 7.35
c) 7.40
d) 7.50
d) 7.50
pH has increased
In a scenario where both PaCO2 and HCO3- levels are increased from their normal values, what can be inferred?
a) There is a mixed acid/base disorder.
b) There is a primary disorder with tertiary compensation.
c) There is a primary disorder with secondary compensation.
d) There is no significant disturbance.
c) There is a primary disorder with secondary compensation.
Which condition is suggested if PaCO2 is decreased and HCO3- is increased from normal?
a) Primary respiratory acidosis with metabolic compensation
b) Primary metabolic alkalosis with respiratory compensation
c) Mixed acid/base disorder
d) Primary respiratory alkalosis with metabolic compensation
c) Mixed acid/base disorder
Given the values: pH 7.33, PCO2 48, HCO3- 26
What type of acid-base disturbance is present?
a) Metabolic acidosis with respiratory compensation
b) Respiratory acidosis with metabolic compensation
c) Metabolic alkalosis with respiratory compensation
d) Respiratory alkalosis with metabolic compensation
Normal: pH 7.35-7.45, PCO2 35-45, HCO3 22-26
b) Respiratory acidosis with metabolic compensation
The high normal HCO3- (26 mEq/L) indicates metabolic compensation, as the kidneys retain bicarbonate to buffer the excess CO2.
ROME - Respiratory Opposite, Metabolic Equal
Given the values: pH 7.58, PCO2 35, HCO3- 29
What type of acid-base disturbance is present?
a) Metabolic acidosis with respiratory compensation
b) Respiratory acidosis with metabolic compensation
c) Metabolic alkalosis with respiratory compensation
d) Respiratory alkalosis with metabolic compensation
Normal: pH 7.35-7.45, PCO2 35-45, HCO3 22-26
c) Metabolic alkalosis with respiratory compensation
The **low normal **PCO2 (35 mm Hg) shows respiratory compensation, where the lungs are expelling CO2 to counteract the high bicarbonate levels.
Given values: pH 7.28, PCO2 46, HCO3- 18
What type of acid-base disturbance is present?
a) Mixed Respiratory/Metabolic Acidosis
b) Respiratory acidosis with metabolic compensation
c) Metabolic alkalosis with respiratory compensation
d) Respiratory alkalosis with metabolic compensation
Normal: pH 7.35-7.45, PCO2 35-45, HCO3 22-26
a) Mixed Respiratory/Metabolic Acidosis
The increased PCO2 (46 mm Hg) indicates that respiratory compensation has not fully occurred, but the body is retaining CO2 due to possible decreased respiratory function.
Given values: pH 7.48, PCO2 32, HCO3- 22
What type of acid-base disturbance is present?
a) Metabolic acidosis with respiratory compensation
b) Respiratory acidosis with metabolic compensation
c) Metabolic alkalosis with respiratory compensation
d) Respiratory alkalosis with metabolic compensation
Normal: pH 7.35-7.45, PCO2 35-45, HCO3 22-26
d) Respiratory alkalosis with metabolic compensation
The **low normal **HCO3- (22 mEq/L) indicates that metabolic compensation is in effect, where the kidneys are excreting bicarbonate to counteract the loss of CO2 from hyperventilation.
Acidosis can significantly impact the heart’s function. How does a pH of 7.2 specifically affect the heart?
A) Increased contractility due to acidosis
B) No effect on contractility
C) Impaired contractility due acidosis
D) Impaired contractility due to increased calcium availability
C) - Acidosis impairs the heart’s contractility
How does acidosis affect arterial blood pressure?
A) It increases arterial blood pressure
B) It decreases arterial blood pressure
C) It stabilizes arterial blood pressure
D) It has no direct effect on arterial blood pressure.
B - Acidosis decreases arterial blood pressure primarily through vasodilation and reduced myocardial contractility, leading to lower cardiac output.
Acidosis makes the cardiovascular system more sensitive to re-entry dysrhythmias. Which factor contributes most to this increased sensitivity?
A) Enhanced conduction velocity in myocardial tissue
B) Decreased repolarization period of myocardial cells
C) Increased repolarization period of myocardial cells
D) Uniform repolarization of cardiac cells
B - Acidosis alters ion channel function. It delays or decreases repolarization and conduction in the myocardium, increasing sensitivity to re-entry dysrhythmias.
Kane - more sensitive to cyclic arrythmias, never have that repolarization, no break/rest, continuosly depolarize, more susceptible to Vtach
Acidosis affects the threshold for ventricular fibrillation (v-fib). Which statement best describes this effect?
A) Increases the threshold for v-fib
B) Decreases the threshold for v-fib
C) Does not alter the threshold for v-fib
D) Only affects atrial fibrillation threshold, not v-fib
B - Acidosis decreases the threshold for ventricular fibrillation, making it easier for the heart to enter this life-threatening rhythm.
Regarding the impact of acidosis on the responsiveness to catecholamines, which statement is accurate for a pH of 7.1?
A) Increased responsiveness to catecholamines
B) No change in responsiveness to catecholamines
C) Decreased responsiveness to catecholamines
D) Enhanced catecholamine release but decreased receptor sensitivity
C) - Acidosis decreases the responsiveness to catecholamines, which are critical for stimulating heart rate and contractility.
Kane - If the pt is in vtach or vfib and we are trying to give vaso/epi, these drugs are a whole lot less responsive
Acidosis can lead to various levels of altered consciousness. Which of the following best describes obtundation?
A) Complete unresponsiveness with no arousal to stimuli
B) Slight confusion with full alertness
C) Decreased alertness with diminished response to stimuli
D) Full alertness but with significant motor impairment
C - Obtundation is characterized by decreased alertness and a diminished response to stimuli, which can occur with acidosis
How does severe acidosis affect consciousness?
A) Enhances mental clarity and alertness
B) Causes mild confusion and disorientation
C) Can lead to coma
D) Leads to hyperactivity and increased motor function
C - Severe acidosis can lead to coma, a state of profound unresponsiveness due to significant depression of central nervous system activity.
Kane -First obtundation and then coma, its a continuation per Kane
How does the body initially respond to acidosis to compensate and maintain normal pH levels?
A) Decreased respiratory rate to retain CO2 levels in the blood
B) Hyperventilation to increase minute ventilation and decrease CO2 levels
C) Hypoventilation to increase minute ventilation and decrease CO2 levels
D) No change in respiratory rate as the body uses renal compensation
B - The body responds to acidosis by hyperventilating to increase minute ventilation and blow off CO2, thereby reducing the acid load and increasing pH.
Acidosis often leads to a sensation of difficulty breathing. What term best describes this symptom?
A) Eupnea
B) Dyspnea
C) Apnea
D) Bradypnea
B) Dyspnea is the term that describes the sensation of difficulty or labored breathing commonly experienced during acidosis.
In acidosis, why might respiratory muscle fatigue become a significant clinical concern?
A) Because the muscles adapt and become less efficient at sustaining increased ventilation
B) Because long-term hyperventilation leads to overexertion and muscle weakness
C) Because the kidneys can no longer compensate for the acid-base imbalance
D) Because CO2 levels become too low to maintain normal respiratory function
B - In acidosis, respiratory muscle fatigue becomes a significant concern because long-term hyperventilation can lead to overexertion and subsequent muscle weakness.
Which of the following is a consequence of acidosis related to metabolism?
a) Hypokalemia
b) Hypocalcemia
c) Hypercalcemia
d) Hyperkalemia
d) Hyperkalemia
Acidosis can lead to __________ resistance, affecting glucose metabolism.
a) Leptin
b) Glucagon
c) Insulin
d) Somatostatin
c) Insulin
Acidosis results in the inhibition of __________ glycolysis.
a) Aerobic
b) Anaerobic
c) Both aerobic and anaerobic
d) Neither aerobic nor anaerobic
b) Anaerobic
How is Respiratory Acidosis defined? “An acute decrease in alveolar ventilation results in __________.”
a) Increased PaCO2
b) Decreased PaCO2
c) Decreased HCO3-
d) Increased HCO3-
a) Increased PaCO2
Aka “resp failure”
Respiratory acidosis is characterized by a pH level of __________.
a) > 7.45
b) < 7.35
c) 7.35-7.45
d) Exactly 7.40
b) < 7.35
Which of the following is NOT a cause of respiratory acidosis?
a) Drug-induced ventilatory depression
b) Upper airway obstruction
c) Status asthmaticus
d) Hyperventilation
d) Hyperventilation
Which acid-base imbalance is seen the most or is caused by providers the most?
A) Respiratory Alkalosis
B) Metabolic Alkalosis
C) Respiratory Acidosis
D) Respiratory Alkalosis
C) Respiratory Acidosis
Which cause of respiratory acidosis is seen more often and considered Central ventilation control?
A) Status asthmaticus
B) Malignant hyperthermia
C) Disorder of neuromuscular function
D) Drug-induced ventilatory depression
D) Drug-induced ventilatory depression
Kane - we give prop/fent/versed, depresses the system and causes slow/shallow breathing
Treatment might be reversals like narcan, romazicon, time
What is a cause of respiratory acidosis that Kane emphasized that was categorized as “our fault”. Select 5
A) Opioid excess
B) Pneumonia
C) Restriction of ventilation (rib fracture,flail chest)
D) Inadequate NMBD reversal
E) Permissive hypercapnia
F) CO2 insufflation
E) Upper airway obstruction
H) Drug-induced ventilatory depression
*A) Opioid excess
*D) Inadequate NMBD reversal - didn’t give enough neostigmine and robinal, or atropine and neostigmine
E) Permissive hypercapnia (we didn’t set our ventilator right and we allowed them to get elevated PaCO2)
*F) CO2 insufflation (Abdomen is insufflated with CO2 and absorbs in the blood)
H) Drug-induced ventilatory depression (we gave too much drugs)
*starred ones she emphasized at the bottom of the slide
What is an example of Peripheral Ventilatory Control in regards to causing respiratory acidosis?
A) Neuromuscular Disorders
B) Myasthenia Gravis
C) Multiple Sclerosis
D) V/Q mismatch
E) Pneumothorax
F) High Spinal/epidural
G) Flail chest/ Rib fx
H) Hemothorax
I) All of the above
ALL OF THEM
Kane- specifically said MG, MS, “those immune like functions” and Neuromuscular Disorders
What is considered a V/Q mismatch that causes Respiratory Acidosis?
A) Pneumonia
B) Pleural Effusion
C) Retained secretions
E) Pulmonary Edema
F) Atelectasis
G) Abdominal Splinting
H) All of the above
ALL OF THEM
What does Peripheral Problems cause that can create Respiratory Acidosis?
A) Slow shallow breathing
B) Rapid shallow breathing
C) Airway problem
D) Rapid quick breathing
B) Rapid shallow breathing
What is NOT an example of an Obstructed breathing/airway problem that causes Respiratory Acidosis?
A) Supraglottic
B) Subglottic
C) Glottic
D) Infraglottic
E) Bronchospasm
D) Infraglottic
KANE LOVES THIS CHART <3
In acute hypercarbia, a rise in PaCO2 of 10 mmHg results in an increase in plasma HCO3- by __________.
a) 1 mmol/L or meq/L
b) 2 mmol/L or meq/L
c) 3 mmol/L or meq/L
d) 4 mmol/L or meq/L
a) 1 mmol/L or meq/L
10:1
Metabolic acidosis is associated with:
a) Decreased ionized calcium
b) Leftward shift of the oxyhemoglobin dissociation curve
c) Increased ionized calcium
d) Decreased production of acid
c) Increased ionized calcium
Assoc with
-alterations in transcellular ion pumps -Na/K pumps
-↑ ionized calcium
-Rightward shift of oxyhgb dissociation curve
In the decision tree, what parameters are checked to classify the type of lactic acidosis?
a) HR, CVP, CO
b) SvO2, CVP, and SV
c) SaO2, CVP, and SV
d) HCO3-, chloride, and anion gap
b) SvO2(mixed venous), CVP, and SV
How is the CO and the heart doing once you have checked the Lactic acid and pH?
If SvO2 < 70%, CVP < 5, and SV < 0.7 mL/kg, which type of lactic acidosis is considered?
a) Type A
b) Type B
c) Type C
d) Type D
a) Type A
Kane said to remember the oxyhemoglobin dissociation curve with high anion gap. Decreased SvO2 –> Increased CO2 –> right shift into acidosis
If SvO2 > 70%, CVP > 5, and SV > 0.7 mL/kg, which type of lactic acidosis is considered?
a) Type A
b) Type B
c) Type C
d) Type D
b) Type B
In Type A lactic acidosis, what is the next step if hemoglobin is low?
a) Check CRP/WCC
b) Look for bleeding source
c) Consider poisoning
d) Perform echocardiography
b) Look for bleeding source
hemorrhagic shock - consider GI/ retro-peritoneum, intra-abdomina
In Type A lactic acidosis, if hemoglobin is normal and CRP/WCC is high, what is the likely diagnosis?
a) Hemorrhagic shock
b) Cardiogenic shock
c) Septic shock
d) Metabolic shock
c) Septic shock
Consider chest, UTI, intra-abdominal or IV site
In Type B lactic acidosis, what should be considered if there is a possibility of poisoning? Select 4
a) Infection
b) Dehydration
c) Sodium nitroprusside
d) Electrolyte imbalance
e) Carbon monoxide
f) Cyanide
g) Metformin
c) Sodium nitroprusside
e) Carbon monoxide
f) Cyanide
g) Metformin
If lactic acidosis is NOT caused by poisioning, consider Endogenous or Exogenous epinephrine and check for liver failure of mitochondrial failure (late stage sepsis)
In Type B lactic acidosis, if not caused by poisioning, regional hypoperfusion is suspected and all pulses are NOT intact in peripheral perfusion, what should be considered next?
a) Poisoning
b) Liver failure
c) Renal failure
d) Arterial thrombosis
d) Arterial thrombosis
Consider Angiography and revascularization
In Type B if not caused by poisoning, regional hypoperfusion is suspected, pulses are intact, and bowel or splanchnic ischemia is considered, what is the next step? Select 3
a) Start broad-spectrum antibiotics
b) Image abdomen
c) Initiate dialysis
d) Laparotomy
e) Administer high-dose steroids
f) Bowel resection
b) Image abdomen
d) laparotomy
f) bowel resection
Are you tired of this chart yet?
In respiratory alkalosis, the pH level is:
a) < 7.35
b) 7.35-7.45
c) > 7.45
d) Unchanged
c) > 7.45
Kane - classic anxious, panic patient, person breathing in a paper bag on tv
