Pathophysiology of Body Fluids and Fluid Therapy

Question . 1. Diabetes insipidus may be due to all of the following except: a. Pituitary adenoma b. Renal epithelial ADH reception defect c. Hypokalemia d. Hypercalcemia e. Adrenal deficiency Question . 2. A 1-mo-old boy presents with severe failure to thrive, emesis, and a temperature of 41C. Serum electrolyte measurements reveal a sodium level of 185 mEq/L, and the urine specific gravity is 1001. The most likely diagnosis is: a. Adrenal insufficiency b. Salt poisoning c. Hypernatremic dehydration d. Malignant hyperthermia e. Nephrogenic diabetes insipidus Question . 3. A well-grown 6-mo-old presents with a tonic-clonic seizure lasting 30 min. The child is found to be hypothermic and remains lethargic. The diet history reveals that the mother is a participant in the WIC program. Because it is the end of the month, she has begun to dilute the remaining formula with water as there is not enough to last until she receives her next allotment of formula next week. The most likely diagnosis is: a. Hypocalcemia b. Hyponatremia c. Hypoglycemia d. Hypernatremia e. Hypokalemia Question . 4. Hyperkalemia may be associated with all of the following except: a. Succinylcholine use b. Burns c. Trauma d. Chemotherapy e. Metabolic alkalosis f. Digitalis toxicity g. Uremia Question . 5. A normal anion gap acidosis is most likely to be due to: a. Diabetes mellitus b. Renal tubular acidosis c. Nephrotic syndrome d. Uremia e. Shock Question . 6. A 10-mo-old infant presents with vomiting and diarrhea, tachycardia, normal blood pressure, dry mucous membranes, a capillary refill time of 2 sec, deep respirations, and irritability. The percent dehydration for this patient is: a. 0-3% b. 3-5% c. 6-9% d. 10-12% e. 12-15%

Question . 7. A serious complication of the treatment of hypernatremic dehydration is:

a. Cerebral thrombosis b. Cerebral edema c. Hyperchloremia d. Hypoglycemia e. None of the above Question . 8. The best method to reduce the potassium level during hyperkalemia, by reducing the body burden of potassium, is: a. Sodium bicarbonate infusion b. Glucose and insulin infusion c. Calcium infusion d. Albuterol aerosol e. Kayexalate enema Question . 9. The finding of marked metabolic alkalosis with acidic urine indicates: a. Marked sodium depletion b. Marked potassium depletion c. Hyperventilation d. Diabetes mellitus e. Laboratory error Question . 10. From the following list, choose the route(s) by which insensible water loss may occur. 1. Sweat 2. Fecal loss 3. Evaporative loss from skin 4. Respiratory water loss 5. Obligate water for urinary solute excretion a. 1 and 3 b. 1, 2, and 3 c. 3 only d. 3 and 4 e. 2 and 5 Question . 11. Which of the following drugs or agents may inhibit antidiuretic hormone release? a. Demerol b. Barbiturates c. Alcohol d. Nicotine e. Adrenergic drugs Question . 12. Hypernatremia may be induced by all of the following except: a. Hyperglycemia b. Adipsia c. Insufficient breast-feeding d. Gastroenteritis e. Nephrogenic diabetes insipidus Question . 13. The most common cause of nutritional hyponatremia is: a. Salt substitutes b. Low-salt diets c. The WIC syndrome d. Furosemide (Lasix) therapy e. Vegan diets

Question . 14. Manifestations of hyperkalemia include all of the following except:

a. Paresthesias b. Weakness c. Paralysis d. Wide QRS complex e. Tetany Question . 15. Potential causes of hyperkalemia include all of the following except: a. Succinylcholine b. Digitalis toxicity c. Acute renal failure d. Albuterol overdose e. Captopril overdose Question . 16. An increased anion gap occurs in all of the following except: a. Diabetic ketoacidosis b. Renal tubular acidosis c. Salicylate poisoning d. Methylmalonicacidemia e. Ethylene glycol poisoning Question . 17. A preterm infant born to a mother with severe preeclampsia is noted to be hypotonic and apneic in the delivery room. After resuscitation and stabilization, she remains hypotonic with decreased deep tendon reflexes in the arms and knees. The mother's treatment included hydralazine, magnesium sulfate, and indomethacin. The laboratory evaluation of this patient should include: 1. Serum calcium determination 2. Arterial blood gas analysis 3. Serum magnesium determination 4. CBC 5. Anion gap measurement a. 1 and 3 b. 2 only c. 1, 2, and 3 d. 2 and 4 e. 2, 3, and 5 Question . 18. The serum magnesium level for the patient in Question 17 is 6.5 mg/dL. From the following list, select the most appropriate next step(s) in treatment. 1. Continue mechanical ventilation 2. Infuse normal saline 3. Add calcium to the intravenous solution 4. Begin chelation therapy 5. Administer KCl a. 1, 2, and 3 b. 3 only c. 4 only d. 1 and 5 e. 2 and 4 Question . 19. Possible consequences of hypophosphatemia include all of the following except: a. Hypocalcemia b. Hemolysis c. Rhabdomyolysis d. Paresthesias e. Confusion