Test 2: Electrolytes/renal/acid base

1 Which of the following can be associated with post-renal acute kidney injury (AKI)?
a) Interstitial nephritis
b) Acute blood loss
c) Heavy metal poisoning
d) Acute glomerulonephritis
e) Prostatic hypertrophy

2 Which of the following can be commonly associated with Fanconi’s syndrome?

a) Hyperkalaemia
b) Hyperuricaemia
c) Metabolic alkalosis
d) Hypermagnesaemia
e) Hypophosphataemia

3 With which of the following is chronic kidney disease stage 5 (CKD 5) usually
associated?
a) Hypouricaemia
b) Hypokalaemia
c) Hyperphosphataemia
d) Polycythaemia
e) Metabolic alkalosis

4 Which of the following are associated with renal calculi?

a) Hypocalcaemia
b) Hypophosphataemia
c) Hypouricaemia
d) Cystinuria
e) Hyponatraemia

5 The modification of diet in renal disease (MDRD) estimated glomerular filtration rate
(eGFR) equation usually can be applied appropriately in which of the following
circumstances?
a) Patient has a limb amputation
b) Patient is under 18 years of age
c) Patient is black African or Afro-Caribbean
d) Patient has a body mass index (BMI) of 61 kg/m2
e) Patient is acutely ill

6 Which of the following can cause a metabolic acidosis?

a) Hypokalaemia
b) Hyperventilation
c) Conn’s syndrome
d) Ethylene glycol ingestion
e) Severe asthma

Clinical Biochemistry and Metabolic Medicine, 8th edition © 2012 Martin A. Crook / CRC Press
7 Which of the following can cause a metabolic alkalosis?
a) Pyloric stenosis
b) Paracetamol overdose
c) Hyperkalaemia
d) Mechanical ventilation
e) Thiamine deficiency

8 Which of the following is associated with a hyperchloraemic acidosis?

a) Protracted vomiting
b) Obesity hypoventilation syndrome (pickwickian syndrome)
c) Acezatolamide usage
d) Respiratory stimulants
e) Massive rhabdomyolysis

9 Which of the following can cause a lactic acidosis?

a) Renal tubular acidosis
b) Metformin toxicity
c) Bilateral pneumothorax
d) Chloride-losing diarrhoea
e) Ureteric diversion

10 Which of the following can cause a respiratory (non-metabolic) acidosis?

a) Guillain–Barré syndrome
b) Severe hypomagnesaemia
c) Gastrointestinal fistula
d) Primary hyperparathyroidism
e) Hyperventilation

11 Which of the following can cause a respiratory (non-metabolic) alkalosis?

a) Aspirin (salicylate) overdose
b) Diabetic ketoacidosis
c) Alcohol excess
d) Chronic obstructive pulmonary disease (COPD)
e) Myasthenia gravis

12 Which of the following can be associated with a serum sodium concentration of

168 mmol/L (reference range 135–145) in a 3-year-old boy?
a) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
b) Salt-losing nephropathy
c) Hypotonic fluid infusion
d) Severe and prolonged diarrhoea and vomiting
e) Addison’s disease

13 Which of the following can be associated with pseudohyponatraemia?

a) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
b) Cranial diabetes insipidus
c) Severe hypertriglyceridaemia of greater than 20 mmol/L
d) Cushing’s syndrome
e) Nephrogenic diabetes insipidus

Clinical Biochemistry and Metabolic Medicine, 8th edition © 2012 Martin A. Crook / CRC Press
14 Which of the following can be associated with a serum sodium concentration of
111 mmol/L (reference range 135–145) in a 85-year-old woman being treated for
hypertension?
a) Conn’s syndrome
b) Accidental salt ingestion
c) Increased insensible loss of water due to hyperventilation
d) Failure to drink fluid
e) Chronic diuretic usage

15 Which of the following conditions could not readily explain a daily urine output of 4.2 L
in a 74-year-old man?
a) Psychogenic polydipsia
b) Severe obstructive prostatic hypertrophy
c) Nephrogenic diabetes insipidus
d) Cranial diabetes insipidus
e) Type 2 diabetes mellitus

16 What is the most likely cause of a plasma potassium concentration of 2.8 mmol/L
(reference range 3.5–5.0) in a 30-year-old man with hypertension?
a) Use of an angiotensin II receptor blocker
b) Blood sample in vitro haemolysis
c) Conn’s syndrome
d) Hyporeninaemic hypoaldosteronism
e) Metabolic acidosis

17 What is the most likely cause of a serum potassium concentration of 6.3 mmol/L
(reference range 3.5–5.0) in a 54-year-old man with hyponatraemia, generalized
weakness, postural hypotension and autoimmune hypothyroidism?
a) Bendroflumethiazide usage
b) Addison’s disease
c) Cushing’s syndrome
d) Bartter’s syndrome
e) Anorexia nervosa

18 Which of the following would not easily explain uncontrolled hypertension in a 42-year-
old man taking four antihypertensive drugs?
a) Phaeochromocytoma
b) Conn’s syndrome
c) Cushing’s syndrome
d) Bartter’s syndrome
e) Renal artery stenosis

Clinical Biochemistry and Metabolic Medicine, 8th edition © 2012 Martin A. Crook / CRC Press
1 Which of the following can be associated with post-renal acute kidney injury (AKI)?
Answer e). Acute blood loss may lead to pre-renal AKI, and interstitial nephritis, heavy
metal poisoning and acute glomerulonephritis may cause renal AKI. Obstruction of the
urinary tract is associated with post-renal AKI.

2 Which of the following can be commonly associated with Fanconi’s syndrome?

Answer e). Renal tubular loss of urate, phosphate, potassium and amino acids can result
in hypouricaemia, hypophosphataemia, hypokalaemia and possible amino acid
deficiencies.

3 With which of the following is chronic kidney disease stage 5 (CKD 5) usually
associated?
Answer c). In CKD 5, hyperuricaemia, hyperkalaemia, hyperphosphataemia, anaemia
and a metabolic acidosis may be seen.

4 Which of the following are associated with renal calculi?

Answer d). Hypercalcaemia and hyperuricaemia can be associated with calcium and
urate calculi respectively. Cystinuria is an autosomal recessive inborn error of metabolism
associated with renal calculi due to abnormal proximal renal tubule reabsorption of the
amino acid cystine.

5 The modification of diet in renal disease (MDRD) estimated glomerular filtration rate
(eGFR) equation usually can be applied appropriately in which of the following
circumstances?
Answer c). The MDRD eGFR equation has limitations and may not apply in children,
those with oedema and limb amputations, the grossly obese and acutely ill. A conversion
factor of 1.212 is applied if patient is black African or Afro-Caribbean.

6 Which of the following can cause a metabolic acidosis?

Answer d). Severe hypokalaemia and Conn’s syndrome (primary hyperaldosteronism)
are associated with a metabolic alkalosis, hyperventilation with a respiratory (non-
metabolic) alkalosis and severe asthma with a respiratory (non-metabolic) acidosis.

7 Which of the following can cause a metabolic alkalosis?

Answer a). Loss of ‘acid’ gastric contents as seen in prolonged vomiting can result in a
metabolic alkalosis, as can severe hypokalaemia. Mechanical ventilation can cause a
respiratory (non-metabolic) alkalosis, while thiamine deficiency can evoke a lactic
acidosis and thus a metabolic acidosis.

8 Which of the following is associated with a hyperchloraemic acidosis?

Answer c). Acezatolamide is a carbonic anhydrase inhibitor sometimes used in the
treatment of glaucoma, altitude sickness and ‘benign’ intracranial hypertension. Obesity
hypoventilation syndrome is associated with a respiratory (non-metabolic) acidosis and
respiratory stimulants can evoke a respiratory (non-metabolic) alkalosis. Massive
rhabdomyolysis can cause a metabolic acidosis, while protracted vomiting can cause a
metabolic alkalosis.

Clinical Biochemistry and Metabolic Medicine, 8th edition © 2012 Martin A. Crook / CRC Press
9 Which of the following can cause a lactic acidosis?
Answer b). Metformin in the presence of severe impaired renal function, acute cardiac
failure and fluid restriction can cause a lactic acidosis. Renal tubular acidosis and ureteric
diversion are associated with a hyperchloraemic acidosis, while a bilateral pneumothorax
can cause a respiratory (non-metabolic) acidosis and chloride-losing diarrhoea can cause
a metabolic alkalosis.

10 Which of the following can cause a respiratory (non-metabolic) acidosis?

Answer a). Guillain–Barré syndrome causes reduced respiratory muscle function and
hypoventilation. Severe hypomagnesaemia is associated with a metabolic alkalosis,
gastrointestinal fistula with a hyperchloraemic acidosis, primary hyperparathyroidism
with a renal tubular acidosis/hyperchloraemic acidosis, and hyperventilation with a
respiratory (non-metabolic) alkalosis.

11 Which of the following can cause a respiratory (non-metabolic) alkalosis?

Answer a). Salicylate overdose can result in impaired cellular respiration by uncoupling
oxidative phosphorylation and by stimulating the respiratory centre in the medulla; a
respiratory (non-metabolic) alkalosis can result, particularly in children. Alcohol excess
can result in ketosis and, like diabetic ketoacidosis, a metabolic acidosis. Both COPD and
myasthenia gravis can cause a respiratory (non-metabolic) acidosis.

12 Which of the following can be associated with a serum sodium concentration of

168 mmol/L (reference range 135–145) in a 3-year-old boy?
Answer d). Prolonged vomiting and diarrhoea can result in a water deficit that is greater
than the sodium deficit and thus evoke hypernatraemia. The other conditions listed above
are associated with hyponatraemia.

13 Which of the following can be associated with pseudohyponatraemia?

Answer c). Pseudohyponatraemia is a condition in which a very raised serum protein or
lipid concentration decreases the percentage of serum water and therefore the
concentration of sodium ions by direct electrode measurement. SIADH is associated with
dilutional hyponatraemia. The other conditions listed above are associated with
hypernatraemia.

14 Which of the following can be associated with a serum sodium concentration of

111 mmol/L (reference range 135–145) in a 85-year-old woman being treated for
hypertension?
Answer e). Chronic diuretic usage can cause urinary sodium depletion and
hyponatraemia. The other conditions listed above can be associated with hypernatraemia.

15 Which of the following conditions could not readily explain a daily urine output of 4.2 L
in a 74-year-old man?
Answer b). Severe prostatic hypertrophy can cause post-renal acute kidney injury and
urinary obstruction, and thus possible oliguria or anuria. The other conditions listed above
are associated with polyuria (usually greater than 3 L urine a day).

Clinical Biochemistry and Metabolic Medicine, 8th edition © 2012 Martin A. Crook / CRC Press
16 What is the most likely cause of a plasma potassium concentration of 2.8 mmol/L
(reference range 3.5–5.0) in a 30-year-old man with hypertension?
Answer c). Conn’s syndrome or primary hyperaldosteronism should be suspected in a
young patient with hypokalaemia and hypertension. The other clinical conditions listed
above are associated with hyperkalaemia.

17 What is the most likely cause of a serum potassium concentration of 6.3 mmol/L
(reference range 3.5–5.0) in a 54-year-old man with hyponatraemia, generalized
weakness, postural hypotension and autoimmune hypothyroidism?
Answer b). Addison’s disease should be suspected in a patient with hyponatraemia and
the other symptoms described, particularly if there is coexisting autoimmune endocrine
disease. The other conditions listed above are associated with hypokalaemia.

18 Which of the following would not easily explain uncontrolled hypertension in a 42-year-
old man taking four antihypertensive drugs?
Answer d). Bartter’s syndrome is associated with hypokalaemia and metabolic alkalosis,
and usually patients are normotensive.

Clinical Biochemistry and Metabolic Medicine, 8th edition © 2012 Martin A. Crook / CRC Press