Electrolytes/Biochemistry

Question 1

An elderly diabetic patient is found to have a serum sodium level of 122 and a blood glucose of 30.5. After correcting the glucose concentration with insulin, the serum sodium concentration should:

a) Decrease significantly unless the patient receives 3% saline.

b) Decrease transiently but return to 122 without specific treatment.

c) Remain essentially unchanged.

d) Increase to the normal range without specific therapy.

Answer 1

d) Increase to the normal range without specific therapy.

Question 2

The oxyhemoglobin dissociation curve is shifted to the left by:

a) Decreased blood pH.

b) Increased erythrocyte 2, 3-diphospho – glycerate concentration.

c) Increased body temperature.

d) Methemoglobinemia.

Answer 2

Methemoglobinemia.

Question 3

Harmful effects of significant alkalosis following trauma resuscitation or major surgery include all of the following, EXCEPT:

a) Decreased cerebral blood flow.

b) Hypercalcemia.

c) Hypokalemia.

d) Tissue hypoxia.

Answer 3

b) Hypercalcemia.

Question 4

In the acute-phase response to injury or infection, levels of which of the following serum proteins is decreased?
a) C-reactive protein

b) fibrinogen

c) ceruloplasmin

d) albumin

Answer 4

d) albumin

Question 5

Which of the following can cause spuriously elevated pulse oximeter readings?
a) methemoglobinemia

b) finger nail polish

c) hyperbilirubinemia

d) IV methylene blue

Answer 5

A

Question 6

Stimuli of the neuroendocrine response (3)

Answer 6

1. Hypoxia
2. Hypotension
3. Hypovolemia

Question 7

Where are the baroreceptors located? (3)

Answer 7

1. Atria
2. Aortic arch
3. Carotid bodies

Question 8

What are the effects of cortisol? (2)

Answer 8

1. Gluconeogenesis
2. Lipolysis

Question 9

What is the effect of RAS?

Answer 9

Increase in aldosterone, increases sodium and water

Question 10

What is the effect of vasopressin?

Answer 10

Increases water resorption in the distal renal tubules

Question 11

What is the effect of the neuroendocrine response on pancreas?

Answer 11

Decreased insulin leading to an increase hepatic gluconeogenesis

Question 12

In SIRS, what is the organ most sensitive to injury?

Answer 12

Lungs, leading to ARDS

Question 13

What is the most common cause of mortality in the ICU?

Answer 13

Multiorgan Dysfunction Syndrome

Question 14

In hypovolemic shock, what happens to HR, CVP, PCWP, CO, and SVR?

Answer 14

HR variable
CVP decreases
PCWP decreases
CO decreases
SVR increases

Question 15

In NEUROGENIC shock, what happens to HR, CVP, PCWP, CO, and SVR?

Answer 15

HR increases
CVP decreases
PCWP decreases
CO decreases
SVR decreases

Question 16

In CARDIOGENIC shock, what happens to HR, CVP, PCWP, CO, and SVR?

Answer 16

HR variable
CVP increases
PCWP increases
CO decreases
SVR increases

Question 17

What percent of blood loss is 750ml? What class of hemorrhagic shock is this?

Answer 17

<15%, Class I

Question 18

What percent of blood loss is 750m-1500ml? What class of hemorrhagic shock is this?

Answer 18

15-30%, Class II

Question 19

What percent of blood loss is 1500-2000ml? What class of hemorrhagic shock is this?

Answer 19

30-40%, Class III

Question 20

What percent of blood loss is > 2000ml? What class of hemorrhagic shock is this?

Answer 20

> 40%, Class IV

Question 21

At what class(es) of hemorrhagic shock where you see a BP drop?

Answer 21

Class III and Class IV

Question 22

What are the causes of neurogenic shock?

Answer 22

Spinal cord injury, regional anesthetic, autonomicle blockade

Question 23

How do you diagnose adrenal insufficiency?

Answer 23

1. Cortisol <15mg/dl
2. ACTH stimulation test

Question 24

What is the treatment for adrenal insufficiency?

Answer 24

Steroid

Question 25

What electrolytes are imbalanced after parathyroidectomy?

Answer 25

1. Hypocalcemia
2. Hypomagnasemia
3. Hyperkalemia
4. Hypophosphatemia

Question 26

What is the most common cause of electrolyte disturbance leading to an ileus

Answer 26

Hypokalemia

Question 27

What are the 3 signs and symptoms of central pontine myelinosis

Answer 27

Confusion
Spastic quadriplegia
Horizontal gaze paralysis

Question 28

What is defined as anuria?

Answer 28

<50cc urine output in 24 hours

Question 29

Oliguria

Answer 29

50 to 400cc urine output in 24 hours

Question 30

What are the indications for acute dialysis?

Answer 30

AEIOU
Acidosis
Electrolyte abnormalities
Intoxication
Overload - volume
Uremic complication