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NephSAP Module 3 Fluid, Electrolytes, and Acid-Base Disturbaces Pre toets

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1. A young man is found to have hypertension and hypokalemia. A resident taking a careful history discovers that the patient is extremely fond of European licorice.

Which ONE of the following genetic defects produces a similar syndrome?

A. A mutation in the gene for the inwardly rectifying potassium channel ROMK
B. A mutation in the gene for the basolateral chloride channel CLC-Kb
C. A mutation in the gene for the NaCl co-transporter
D. A mutation in the gene for 11[H9252]-hydroxysteroid dehydrogenase
E. A chimeric gene with portions of the 11[H9252]- hydroxylase gene and the aldosterone synthase gene

2. A 45-yr-old previously healthy woman who weighs 50 kg undergoes surgery for a ruptured ovarian cyst. During surgery, she is given 2 L of lactated Ringer solution, and she is given 5% dextrose in 0.45% NaCl with 20 mEq/L KCl at 250 ml/h postoperatively. Forty-eight hours after surgery, she complains of headache and vomiting. BP is 140/80 mmHg. She is alert and oriented, and the general physical and neurologic examinations are unremarkable. Laboratory data reveal the following: Serum Na 115 mEq/L, plasma osmolality 241 mOsm/kg H2O, and urine osmolality 850 mOsm/kg H2O. The patient is not taking anything by mouth.

In addition to stopping the 5% dextrose in 0.45% NaCl infusion, which ONE of the following would be the MOST appropriate treatment?

A. 5% dextrose in 0.9% saline with 20 mEq KCl at 50 ml/h
B. 5% dextrose in 0.9% saline with 20 mEq KCl at 250 ml/h
C. 3% saline at 100 ml/h plus intravenous furosemide until serum sodium concentration is 132 mEq/L
D. 3% saline at 50 ml/h plus intravenous furosemide until the serum sodium is 120 mEq/L

3. A 40-yr-old man with ESRD that requires hemodialysis presents with proximal muscle weakness. The serum potassium is 8 mEq/L, and an electrocardiogram shows peaked T waves.

Which ONE of the following agents would lower his serum potassium concentration most quickly?

A. Calcium gluconate intravenously
B. Propranolol intravenously
C. Kayexalate in sorbitol orally
D. Sodium bicarbonate intravenously
E. Glucose and insulin intravenously

4. A homeless man is discovered unconscious in the park and is brought to the emergency department. He wreaks of alcohol, is unkempt, and is incoherent. Physical examination shows a BP of 90/50 mmHg, heart rate of 120 bpm, temperature of 39C, slight scleral icterus and dullness, and bronchial breath sounds over the right lower lung fields. Laboratory data reveal the following: Serum Na 131 mEq/L, K 2.9 mEq/L, Cl 70 mEq/L, CO2 21 mEq/L, blood urea nitrogen 34, creatinine 1.4 mg/dl, glucose 240 mg/dl, serum osmolality 320 mOsm/kg H2O, serum ketones weakly positive, pH 7.53, PaCO2 25 mmHg, PaO2 60 mmHg, and serum albumin 3.8 g/dl.

Which ONE of the following choices BEST describes his acid-base disturbance?

A. Metabolic acidosis
B. Respiratory alkalosis
C. Metabolic acidosis and respiratory alkalosis
D. Metabolic acidosis and metabolic alkalosis
E. Metabolic acidosis, metabolic alkalosis, and respiratory alkalosis

5. A 9-yr-old girl complains of profound weakness, dizziness, and polyuria. She is taking no medications and has no gastrointestinal complaints. Pertinent clinical finding is BP of 90/50 mmHg with orthostatic dizziness. Laboratory data reveal the following: Na 140 mEq/L, K 2.5 mEq/L, Cl 100 mEq/L, CO2 33 mEq/L, blood urea nitrogen 25 mg/dl, and creatinine 0.7 mg/dl. A 24-h urine collection reveals the following: Sodium 90 mEq, potassium 60 mEq, Cl 110 mEq, and calcium 280 mg. Plasma renin and aldosterone are elevated.

These findings are MOST suggestive of which ONE of the following?

A. Adrenal adenoma
B. Gitelman syndrome
C. Bartter syndrome
D. Licorice ingestion
E. Hemangiopericytoma