Q_D_Electroly Dia_Par_Old
A previously healthy 55-year-old man undergoes elective right hemicolectomy for a stage I (T2N0M0) cancer of the cecum. His postoperative ileus is somewhat prolonged, and on the fifth postoperative day his nasogastric tube is still in place. Physical examination reveals diminished skin turgor, dry mucous membranes, and orthostatic hypotension. Pertinent laboratory values are as follows:Arterial blood gases: pH 7.56, PCO2 50 mm Hg, PO2 85 mm Hg.Serum electrolytes (mEq/L): Na+ 132, K+ 3.1, Cl- 80; HCO3- 42.Urine electrolytes (mEq/L): Na+ 2, K+ 5, Cl- 6What is the patient’s acid–base abnormality?
Metabolic alkalosis with respiratory compensation
Respiratory acidosis with metabolic compensation
Combined metabolic and respiratory alkalosis
Uncompensated metabolic alkalosis
Mixed respiratory acidosis and respiratory alkalosis
A mother brings her 9-month-old daughter to the pediatrician with complaints of a rash. The mother states that the infant had a high fever [temperature up to 40.0 C (104 F)] for 3 days prior to developing the rash, but is now afebrile. The mother also says that the infant has had a runny nose and a slight cough for the past 3 days. On examination, there is a fine macular rash on the infant's trunk and neck. The examination is otherwise within normal limits, and the infant is playful and smiling. Which of the following is the most likely diagnosis?
Roseola
Rubella
Varicella
Erythema infectiosum
Rubeola
A 71-year-old man develops dysphagia for both solids and liquids and weight loss of 60 lb over the past 6 months. He undergoes endoscopy, demonstrating a distal esophageal lesion, and biopsies are consistent with squamous cell carcinoma. He is scheduled for neoadjuvant chemoradiation followed by an esophagectomy. Preoperatively he is started on total parenteral nutrition, given his severe malnutrition reflected by an albumin of less than 1. Which of the following is most likely to be a concern initially in starting total parenteral nutrition in this patient?
Hypophosphatemia
Hypoglycemia
Hypochloremia
Hypermagnesemia
Hyperkalemia
A 72-year-old Caucasian man presents to your office complaining of severe fatigue. He says that five months ago he was able to climb four flights of stairs without shortness of breath, but now he has to rest after two. His appetite has decreased, but he denies any abdominal discomfort or black stool. Physical examination reveals firm, enlarged cervical and supraclavicular lymph nodes. A soft I/VI grade systolic murmur is heard along the left sternal border. Abdomen is soft and non-tender. His liver span is 10 cm and the spleen is palpated 4 cm below the left costal margin. His blood hemoglobin level is 7.5 mg/dl. Which of the following is the most likely cause of this patient's anemia?
Bone marrow infiltration
Folate deficiency
Red blood cell membrane defect
Glucose-6-phosphate dehydrogenase deficiency
Glucose-6-phosphate dehydrogenase deficiency
A 73-year-old man undergoes abdominal aortic aneurysm repair. The patient develops hypotension to 80/50 mm Hg for approximately 20 minutes during the procedure according to the anesthesia record. He received 4 units of packed red blood cells. Postoperatively, his blood pressure is 110/70 mm Hg, heart rate is 110, surgical wound is clean, and a Foley catheter is in place. Over the next 2 days his urine output slowly decreases. His creatinine on post-op day 3 is 3.5 mg/dL (baseline 1.2). His sodium is 140 mEq/L, K 4.6 mEq/L, and BUN 50 mg/dL. Hemoglobin and hematocrit are stable. Urinalysis shows occasional granular casts but otherwise is normal. Urine sodium is 50 mEq/L, urine osmolality is 290 mosmol/L, and urine creatinine is 35 mg/dL. The FENa (fractional excretion of sodium) based on these data is 3.5. What is the most likely cause of this patient’s acute renal failure?
Acute tubular necrosis
Acute interstitial nephritis
Contrast induced nephropathy
Acute glomerulonephritis
Prerenal azotemia
A 73-year-old woman with arthritis presents with confusion. Neurologic examination is nonfocal, and CT of the head is normal. Laboratory data include: Na: 140 mEq/L, K: 3.0 mEq/L, Cl: 107 mEq/L, HCO3: 12 mEq/L. Arterial blood gases: PO2 62, PCO2 24, pH 7.40. What is the acid-base disturbance?
Combined metabolic acidosis and respiratory alkalosis
Hyperchloremic (normal anion gap) metabolic acidosis with appropriate respiratory compensation
High anion-gap metabolic acidosis with appropriate respiratory compensation
Respiratory alkalosis with appropriate metabolic compensation
No acid-base disorder
A 58-year-old man is admitted to the intensive care unit with an exacerbation of his chronic obstructive pulmonary disease (COPD) and respiratory failure. After several hours on noninvasive ventilation the patient develops worsening respiratory distress and requires endotracheal intubation. Which of the following is a contraindication to the use of succinylcholine for rapid-sequence intubation?
Hyperkalemia
COPD exacerbation
Hepatic failure
Hypokalemia
Hypercalcemia
A 65-year-old man undergoes a low anterior resection for rectal cancer. On the fifth day in hospital, his physical examination shows a temperature of 39°C (102°F), blood pressure of 150/90 mm Hg, pulse of 110 beats per minute and regular, and respiratory rate of 28 breaths per minute. A computed tomography (CT) scan of the abdomen reveals an abscess in the pelvis. Which of the following most accurately describes his present condition?
Sepsis
Severe sepsis
Severe septic shock
Systemic inflammatory response syndrome (SIRS)
Septic shock
A 65-year-old white female comes to the ER because of persistent vomiting and epigastric pain. She has been suffering from left knee osteoarthritis for the past 6 years, and has been taking ibuprofen for the past year. She also has a history of chronic obstructive pulmonary disease but is well controlled on her current medications. She quit smoking a few years ago. Her laboratory results are given below: ABG: pH 7.55, PCO2 46 mm Hg. Chemistry panel: Serum sodium 132 mEq/L, Serum potassium 3.0 mEq/L, Chloride 88 mEq/L, Bicarbonate 38 mEq/L, Serum creatinine 0.8 mg/dl. Which of the following would describe her primary acid-base status?
Metabolic alkalosis
Respiratory alkalosis
Metabolic acidosis
Respiratory acidosis
Normal profile
A 67-year-old woman comes to her physician because she is feeling tired, all the time. She thinks that it is due to multiple surgeries she had over the past several years. She had two caesarian sections at the age of 22 and 26. She also had a thyroid surgery for Graves’s disease, 30 years ago. 12 years ago she was diagnosed with colon cancer and had undergone left hemicolectomy. She denies smoking or alcohol use. Her vitals are Temperature 36.7°C (98.2°F); BP 138/86 mm Hg; PR 77/min; RR 12/min. She looks markedly pale and has weakness in all four extremities. There is some sensory loss in lower limbs. The test for occult blood was negative. Labs came back as: Sodium 144 mEq/L, Potassium 4.2 mEq/L, Bicarbonate 24mEq/L, Blood urea nitrogen 18mg/dl, Creatinine 1.0 mg/dl, Glucose 82 mg/dl, WBC 8,600/cmm, Hemoglobin 7.9, Hematocrit 25%, Platelets 176,000/cmm. The physician decides to further investigate anemia and order RBC indices and peripheral blood smear. The results are: MCV 120 fl, MCH 36 pg, MCHC 28%, Reticulocyte count 04%. Peripheral smear showed anisocytosis, poikilocytosis, 4+ macrocytes, polychromatophilia and basophilic stippling. A whole new bunch of tests are ordered and the following report is seen on the computer. Vitamin B12 106 pg/ml (N=210-911 pg/ml), Serum Folate 16.4 ng/ml (N=2.8-17.8 ng/ml), Serum Bilirubin 1.8 mg/dl, Serum LDH 2500 U/L. Gastric analysis demonstrated an absence of hydrochloric acid. What is the most probable cause of her anemia?
Pernicious anemia
Dietary B12 deficiency
Malabsorption syndrome
Hemicolectomy
Folate deficiency
A 56-year-old male comes to the emergency room because of increasing shortness of breath for the last 3 days. He had a cold recently, and since then his symptoms have been worse. He has a mild productive cough but denies fever or chills. He has a several year history of smoking and has been diagnosed with emphysema. He also has a history of diabetes, hypertension, hyperlipidemia, and hypothyroidism. He takes glipizide, metformin, lisinopril, furosemide, aspirin, atorvastatin and levothyroxine. Physical examination shows trace bilateral lower extremity edema and a diffuse decrease in breath sounds along with wheezing. Heart sounds are distant. His arterial blood gas shows the following: Blood pH 7.23, PaO2 88mm Hg, PaCO2 40 mm Hg, HCO3- 16mEq/L. Which of the following best describes the acid-base status of this patient?
. Mixed metabolic and respiratory acidosis
Respiratory acidosis
Metabolic acidosis
Normal acid-base balance
Mixed metabolic acidosis and respiratory alkalosis
A 56-year-old male presents in the emergency department with severe nausea, vomiting, polyuria, polydipsia, and constipation. His past medical history is significant for hypertension and type 2 diabetes mellitus. His home medications include metformin, atenolol, and hydrochlorothiazide. He has a 26-pack-year history of smoking. He drinks alcohol occasionally. He denies the use of recreational drugs. His father also has diabetes mellitus type 2. His blood pressure is 110/70 mmHg, pulse is 102/min, temperature is 36.7°C (98°F) and respirations are 16/min. His mucus membranes are dry. His lung examination reveals decreased breath sounds over the right base. The rest of the physical examination is unremarkable. The patient is subsequently admitted. Laboratory studies (obtained in the emergency department) are as follows: Serum calcium 14.8 mg/dl, Albumin 4.0 g/dl, PTH 9 pg/ml (normal 10-60 pg/ml), Serum creatinine 1.9 mg/dl, BUN 54 mg/dl, Blood glucose 180 mg/dl, 25-hydroxyvitamin D 30 ng/ml (normal 20 to 60 ng/ml), 1,25-dihydroxyvitamin D 30 pg/ml (normal 15 to 65 pg/ml). What is the most likely cause of this patient's hypercalcemia?
Hypercalcemia of malignancy
Sarcoidosis
Primary hyperparathyroidism
Hydrochlorothiazide-induced
Dehydration
A 56-year-old male with a history of type-2 diabetes presents for a routine office visit. His blood work from two months ago showed hyperkalemia, and at that time his physician discontinued lisinopril. His repeat blood work done today is shown below: Chemistry panel: Serum sodium 136 mEq/L, Serum potassium 5.6 mEq/L, Chloride 110 mEq/L,Bicarbonate 18 mEq/L, Blood urea nitrogen (BUN) 26 mg/dl, Serum creatinine 1.9 mg/dl. He currently takes glipizide, furosemide, nifedipine and aspirin. His blood pressure is 150/90 mmHg. Examination is unremarkable. Which of the following is the most likely cause of his low bicarbonate and elevated potassium?
Renal tubular acidosis
Chronic renal failure
Glipizide
Furosemide
Nifedipine
A 56-year-old white male comes to the office for a health maintenance visit. He feels healthy, and is "enjoying life as much as possible in a stressed environment." He smokes 2-3 packs of cigarettes daily and drinks socially. His temperature is 37°C (98.6°F), blood pressure is 160/94 mm Hg, pulse is 78/min, and respirations are 14/min. Physical examination reveals plethora of the face and moderate splenomegaly. Blood tests show the following: WBC 15,600/mm3, Hemoglobin 17 gm/dl, Hematocrit 52%, Platelets 550,000mm3, RBC count 7.5 million, Sodium 141 mEq/L, Potassium 3.6 mEq/L, Bicarbonate 22 mEq/L, Blood urea nitrogen 16 mg/dl, Creatinine 0.6 mg/dl, Glucose 95 mg/dl. The erythrocyte indices are all within normal range. What is the most probable diagnosis?
Polycythemia vera
Cushing syndrome
Idiopathic hypertension
Primary hyperaldosteronism
Congestive heart failure
A 6-day-old girl who was born at home is being evaluated for bruising and gastrointestinal bleeding. Laboratory findings include partial thromboplastin time and prothrombin time, greater than 2 minutes; serum bilirubin, 4.7 mg/dL; alanine aminotransferase, 18 mg/dL; platelet count, 330,000/mm3; and hemoglobin, 16.3 g/dL. Which of the following is the most likely cause of her bleeding?
Vitamin K deficiency
Liver disease
Factor VIII deficiency
Idiopathic thrombocytopenic purpura
Factor IX deficiency
A 60-year-old male is admitted to the hospital because of right lower lobe pneumonia. His medical history is significant for hypertension, diabetes mellitus, severe degenerative disease of the spine, and longstanding lower back pain. He is a chronic smoker with a 40-pack year smoking history. During his hospitalization, the laboratory report shows decreased serum calcium levels and increased phosphate levels. Further evaluation reveals increased serum intact parathyroid hormone levels. Which of the following medical conditions is most likely responsible for this patient's abnormal lab findings?
Renal failure
Primary hyperparathyroidism
Plasma cells in marrow
Thyroidectomy
Lung cancer
A 62-year-old woman is seen after a 3-day history of fever, abdominal pain, nausea, and anorexia. She has not urinated for 24 hours. She has a history of previous abdominal surgery for inflammatory bowel disease. Her blood pressure is 85/64 mm Hg, and her pulse is 136. Her response to this physiologic state includes which of the following?
Hyperkalemia
Increase in sodium and water excretion
Decrease in cortisol levels
Increase in renal perfusion
Hypoglycemia
A 53-year-old Caucasian female is admitted to the ER with hypotension. Her condition is considered very serious, and invasive hemodynamic monitoring is established. Blood pressure measured by intra-arterial method is 72/46 mmHg. Her heart rate is 120/min, regular. Pulmonary capillary wedge pressure (PCWP) estimated using Swan-Ganz catheter is 6 mmHg. Mixed venous oxygen concentration (MVo2) is 16 vol% (Normal = 15.5 vol%). Which of the following is the most likely cause of this patient's condition?
Volume depletion
Hemorrhagic shock
Cardiogenic shock
Neurogenic shock
Septic shock
A 55-year-old male comes to you with complaint of fatigue for the past month. He also complains of occasional heartburn. His past medical history is significant for hepatomegaly, secondary to fatty liver. He has been drinking 3-4 shots of alcohol per day for the past 30 years. He denies smoking. His physical examination reveals pallor of skin and mucous membranes, and mild hepatomegaly. His laboratory report shows: Hb 8.5 g/dl, WBC 8,000/cmm, MCV 110 fl, Platelets 150,000/cmm, Blood glucose 118 mg/dl, BUN 16 mg/dl, Serum creatinine 1.0 mg/dl. What is the most likely cause of anemia in this patient?
Folate deficiency
Anemia of chronic disease
Vitamin B- 12 deficiency
Chronic blood loss from peptic ulcer
Thiamine deficiency
A 56-year-old female is admitted with a diagnosis of chronic renal failure from systemic lupus erythematosus and non-steroidal anti-inflammatory drug use. She has a history of recurrent kidney stones. Laboratory studies show the following: Serum calcium 10.6 mg/dL, Serum albumin 3.9 g/L, PTH 140 pg/mL, Serum phosphorus 3.0 mg/dL. Her baseline serum creatinine level ranges from 1.6 to 1.8 mg/dL. Her bone mineral density is measured by DXA scan, revealing a T score of-2.5 at the lumbar spine, which is consistent with osteoporosis. What is the most likely cause of this patient's hypercalcemia?
. Primary hyperparathyroidism
Sarcoidosis
Hypercalcemia of malignancy
. Milk-alkali syndrome
Chronic renal failure
A 56-year-old male comes to the emergency room because of a 2-day history of fever, chills, shortness of breath and productive cough. He also threw up once in the emergency room. He has been smoking for several years and occasionally drinks alcohol. On admission, his BP was 90/60, but with one liter of normal saline it improved to 120/80 mm Hg. His temperature is 38.8°C (102°F). His arterial blood gas (ABG) analysis is as follows: Blood pH 7.53, PaO2 70 mmHg, PaCO2 30 mmHg, HCO3- 22 mEq/L. Which of the following best describes his primary acid-base status?
Respiratory alkalosis
Respiratory acidosis
Metabolic acidosis
Metabolic alkalosis
Normal acid base status
A 50-year-old female presents with a 3-year history of abdominal pain and diarrhea. She has not been evaluated by a physician. Recently, her symptoms have been progressively worsening. Endoscopy shows multiple ulcerations of the duodenum and prominent gastric folds. Secretin stimulation test shows increased gastrin secretion. Which of the following is most likely associated with this patient's condition?
Primary hyperparathyroidism
Pheochromocytoma
Medullary thyroid cancer
Marfanoid habitus
Neuromas
A 42-year-old male comes to the physician's office for evaluation of skin rash and hair loss. He has a long history of Crohn's disease and has had extensive small bowel resection resulting in short bowel syndrome. He is currently receiving total parenteral nutrition. When he does try to eat, he complains that the food does not taste good. His vital signs are stable. Examination shows alopecia and bullous, pustular lesions around the perioral and periorbital areas. Which of the following is the most likely cause of his current symptoms?
Zinc deficiency
Celiac disease
Vitamin A deficiency
Vitamin B 12 deficiency
Systemic lupus erythematosus
A 35-year-old man presents to the office with a two-week history of low-grade fever and progressive weakness. He has "a heart murmur detected a long time ago." He denies illicit drug use. Physical examination reveals splinter hemorrhages, small petechiae on the palatal mucosa, and an audible murmur. His ESR is 60/min. Urinalysis reveals microscopic hematuria and 1 +proteinuria. Which of the following valvular dysfun ctions is most likely to be detected?
Mitral regurgitation
Mitral stenosis
Pulmonic stenosis
Tricuspid regurgitation
Aortic regurgitation
A 35-year-old woman is involved in a motor vehicle crash, sustaining a severe pelvic fracture, with disruption of the pelvic ring. In the trauma resuscitation room, she is confused and tachypneic, with a blood pressure of 90 mmHg systolic and a heart rate of 130/min. Laboratory investigations include serum electrolyte analysis, revealing a sodium of 139, a chloride of 103, and a bicarbonate of 14 meq/L. This patient demonstrates which of the following?
Anion gap metabolic acidosis
Nonanion gap metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Normal serum electrolytes
A 36-year-old male is brought to the emergency department due to confusion, nausea and decreased arousal. He is unable to answer questions and no other history is available. His temperature is 36.7°×„C (98.2°F), respirations are 22/min and pulse is 86/min. His ABG and serum electrolyte levels are shown below: pH 7.21, PaO2 96 mmHg, PaCO2 28 mmHg, Serum sodium 140 mEq/L, Serum potassium 3.6 mEq/L, Chloride 90 mEq/L, Bicarbonate 12 mEq/L, Blood urea nitrogen (BUN) 30 mg/dl, Serum creatinine 1.2 mg/dl. What is the most likely primary acid-base disorder in this patient?
Anion gap metabolic acidosis
Non-anion gap metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis
A 31-year-old man is brought by helicopter to the trauma center after a motor vehicle accident in which he sustained massive lower extremity crush injury. The patient is alert and awake but in tremendous pain. His blood pressure is 140/80 mm Hg, and his pulse is 110/min. There is copious ongoing blood loss from the sites of injury. Urgent laboratory data will most likely show which of the following electrolyte abnormalities?
Hypernatremia
Hyperkalemia
Hypophosphatemia
Hypocalcemia
Hypoglycemia
A 35-year-old bank executive is brought to the emergency department after the sudden onset of a severe (10/10) headache, followed by a brief period of unconsciousness. His headache started while he was at a meeting and shortly thereafter, he vomited and lost consciousness. He regained consciousness soon afterwards, but was quite confused and irritable. His blood pressure is 160/100 mm Hg, pulse is 90/min, temperature is 37.2°C (99°F), and respirations are 16/min. The physical examination reveals a normal pupil size, no congestion or inflammation of the eye, and no focal neurological deficits. The ECG reveals nonspecific ST and T wave changes. The CT scan shows a subarachnoid hemorrhage. What is the most likely expected electrolyte abnormality with the patient's disease?
Hypokalemia
Hypercalcemia
. Hypernatremia
. Hyponatremia .
Hypokalemia .
A 42-year-old woman presents to the emergency department with multiple complaints. She reports that she had been feeling well until approximately one month ago, when she began to feel increasingly fatigued and weak. For the past two weeks, she has had anorexia, nausea, and abdominal pain. In the past three days, she has had two syncopal episodes. Her medical history is unremarkable and she takes no medications. She denies tobacco and drug use and drinks wine only occasionally. Physical exam reveals a temperature of 36.7°C (98°F), blood pressure of 86/52 mmHg, heart rate of 90/min, and respiratory rate of 18/min. Her cardiac exam is normal and her lungs are clear to auscultation bilaterally. You note hyperpigmentation of the skin in the palmar creases. Which of the following additional findings is most likely to be present in this patient?
Hypochloremia
Hyperkalemia
. Hypokalemia
. Hypernatremia .
Hypomagnesemia .
A 45-year-old male with Burkitt's lymphoma is being treated with combination chemotherapy and allopurinol. On the 3rd day of treatment, he is noted to have decreased urine output and increased levels of BUN and creatinine. The patient is started on vigorous hydration. EKG reveals prolonged QT intervals. The suspected diagnosis is tumor lysis syndrome. Complete metabolic profile is ordered. Which of the following sets of results are expected in this patient? (Calcium, Phosphate, Potassium, Uric Acid)
. Decreased, Increased, Increased, Increased
Decreased, Decreased, Increased, Increased
. Increased, Increased, Increased, Increased
Decreased, Increased, Decreased, Decreased
. Decreased, Decreased, Decreased, Decreased
A 45-year-old white male comes to the emergency room with "all sorts of things going wrong with him", for the last few months. He has a severe headache, chest and abdominal pain. He is sweating profusely. He has lost weight recently, has diarrhea and palpitations. He is feeling hot all the time. Vital signs reveal BP: 190/100mm of Hg; PR 124/min; RR 18/min; Temperature 37.7° C (99.8°F). On physical examination he has enlarged cervical lymph nodes. Examination of the thyroid reveals multiple thyroid nodules. FNA biopsy reveals thyroid C-cell hyperplasia. Which of the following can also be found on laboratory results?
Increased serum calcium
Decreased urine metanephrine
. Decreased serum alkaline phosphatase .
Decreased serum calcitonin .
Increased serum phosphorus .
A 45-year-old woman with chronic alcohol abuse admitted 3 days ago for nausea and severe diarrhea now complains of perioral and finger tingling. She was admitted for hydration after 1 week of severe watery diarrhea. She has been receiving intravenous hydration and dextrose but has not been able to take oral nutrition secondary to continued nausea. Her blood pressure is 130/74 mmHg, pulse is 68/min, and respiratory rate is 16/min. She is afebrile. Physical examination is significant for facial twitching on percussion of her facial nerve just anterior to the ear, as well as the induction of carpal spasm after the inflation of a blood pressure cuff on her arm. Which of the following is most likely to have caused these findings?
Hypomagnesemia
Hypophosphatemia
Azotemia
Hypouricemia
Hypernatremia
A 5-week-old infant presents with a 1-week history of progressive nonbilious emesis, associated with a 24-hour history of decreased urine output. The infant continues to be active and eager to feed. On examination, the infant has a sunken fontanels and decreased skin turgor. The abdomen is scaphoid, and with a test feed, there is a visible peristaltic wave in the epigastrium. Electrolytes and a urinalysis are evaluated. Which of the following laboratory findings are most likely to be seen in this patient?
. Na 130, K 3.0, Cl 80, CO2 36, urine pH 4.0
. Na 145, K 3.0, Cl 110, CO2 17, urine pH 8.0
. Na 140, K 5.2, Cl 100, CO2 16, urine pH 4.0
. Na 132, K 3.2, Cl 96, CO2 25, urine pH 7.0
. Na 135, K 4.0, Cl 104, CO2 23, urine pH 7.0
A 53-year-old man presents to the emergency department with severe epigastric abdominal pain. His temperature is 37.2°C, blood pressure 110/70 mm Hg, pulse 110/min, and respirations 20/min. Examination of the heart and lungs is normal, and his abdomen is tender in the epigastric region. His white count is 15,000/mL and amylase is 450 U/L (25–125 U/L). Which of the following laboratory abnormalities is also most likely to be present?
Hypoglycemia
. hypercholesterolemia
. hyperglycemia
. hypercalcemia .
hypercarbia .
A 60-year-old male who emigrated from Russia comes to you with complaints of dizziness, fatigue and weight loss. A review of systems reveals that the patient experiences daily fevers and cough. He does not use tobacco, alcohol or drugs. He does not take any medication. His blood pressure is 108/64 mmHg while standing. His respiratory rate is 14/min and is unlabored. Laboratory studies reveal the following: Chemistry panel: Serum sodium 130 mEq/L, Serum potassium 5.9 mEq/L, Chloride 102 mEq/L, Serum creatinine 0.8 mg/dL, Blood glucose 58 mg/dL. Complete blood count: Hemoglobin 10.0g/L, Platelets 430,000/mm3, Leukocyte count 4,500/mm3, NeutrophiIs 46%, Lymphocytes 45%, Eosinophils 9%. Chest x-ray shows a right upper lobe cavity. Which of the following acid-base disturbances is expected in this patient?
. Respiratory acidosis
Elevated anion gap metabolic acidosis .
Normal anion gap metabolic acidosis .
Metabolic alkalosis
. Respiratory alkalosis
A 60-year-old man comes to office with persistent complaints of malaise and easy fatigability, for the past 8 months. On examination, he appears pale. PR 93/min; BP 127/84mm Hg; Temperature 37°C (98.6°F); RR 16/min. Fecal occult blood test is negative. Further testing is ordered that include CBC, serum electrolytes and colonoscopy. The results are: WBC 7,600/mm3, Hemoglobin 8.8 gm/dl, Hematocrit 30%, RBC count 3.6 million, Platelets 211,000/mm3. RBC Indices were:MCV 65 fl, MCH 16.5 pg, MCHC 26%, Reticulocyte count 0.5%. Which one of the following is expected on iron studies in this patient? (Serum Iron, Ferritin, TIBC, Transferrin Saturation)
. Low,Low,High,Low
. Low,Low,Low,Low
Normal, Normal, Normal, Normal
. High,Normai,High,Normal to High
Low,High,Low,Lowto normal
A 65-year-old black female presents for an annual examination. Physical examination is unremarkable for her age. In completing the appropriate screening tests, you order a dual x-ray absorptiometry (DXA) to evaluate whether the patient has osteoporosis. DXA results reveal a T-score of -3.0 at the total hip and −2.7 at the spine, consistent with a diagnosis of osteoporosis. Since her Z-score is -2.0, you proceed with an initial evaluation of secondary osteoporosis. Laboratory evaluation reveals: Calcium: 9.7 mg/dL, Cr: 1.0 mg/dL, Bun: 19 mg/d, Glucose: 98 mg/dL, 25, OH vitamin D: 12 ng/mL (optimal > 25), WBC: 7700/μL, Hg: 12 g/dL, HCT: 38 g/dL, PLT: 255,000/μL. Based on the above information, additional laboratory would most likely reveal which of the following?
. Normal iPTH, normal ionized calcium, elevated alkaline phosphatase
. Elevated iPTH (intact parathormone), low ionized calcium, normal alkaline phosphatase
Elevated iPTH, normal ionized calcium, elevated alkaline phosphatase
. Elevated iPTH, low ionized calcium, normal alkaline phosphatase
. Normal iPTH, low ionized calcium, elevated alkaline phosphatase
A 68-year-old Caucasian male complains of right-sided leg pain over the last year. The pain is poorly controlled with over-the-counter pain medications. He also complains of frequent headaches. His past medical history is significant for hypertension and recent hearing loss. An X-ray of the skull shows areas of bone resorption and sclerosis. Which of the following are the most likely findings on laboratory work-up? (Serum calcium, serum phosphate, alkaline phosphatase, Urinary hydroxyproline)
. Normal Normal High High
Normal Normal Normal High
. Low High Normal Normal
. High Low High Normal
. High Normal Normal Normal
A 48-year-old white male complains of generalized bone pain after undergoing bowel surgery for inflammatory bowel disease. His pain is more severe at the lower spine, pelvis, and lower extremities. Examination shows tenderness over the lower spine, pelvis, and lower extremities. Proximal muscle weakness is noted. X-rays of the lumbar spine show decreased bone density with blurring of the spine. X-rays of the femoral neck show pseudofractures, bilaterally. Which of the following lab abnormalities is consistent with this patient's diagnosis?
. Low serum calcium, low serum phosphate, increased serum parathyroid hormone
. Low serum calcium, increased serum phosphate, low serum parathyroid hormone
. Increased serum calcium, low serum phosphate, increased serum parathyroid hormone
. Increased serum calcium, increased serum phosphate, low serum parathyroid hormone
. Normal serum calcium, normal serum phosphate, normal serum parathyroid hormone
An 87-year-old female is brought to the emergency department for evaluation of altered mental status. Her medical history is significant for multi-infarct dementia, hypertension, stroke, coronary artery disease, severe degenerative joint disease, chronic atrial fibrillation, constipation and urinary incontinence. Her medications include aspirin, acetaminophen, atenolol, nitroglycerin, multivitamins, pravastatin, docusate, senna, digoxin and glucosamine. She lives in a local nursing home, and the people who brought her to the ED deny any history of new symptoms. Her blood pressure is 110/70 mmHg, pulse is 98/min, respirations are 16/min and temperature is 36.1°C (97°F). Physical examination reveals dry mucus membranes and decreased skin turgor. There are no new focal neurologic deficits. Which of the following is most likely to be present in this patient?
Hyperkalemia
. Hypernatremia
. Hypocalcemia .
Hyponatremia .
Hypokalemia .
A recovering premature infant who weighs 950 g (2 lb, 1 oz) is fed breast milk to provide 120 cal/kg/d. Over the ensuing weeks, the baby is most apt to develop which of the following?
Hypocalcemia
Hyperphosphatemia
Vitamin D toxicity
Blood in the stool Hyperphosphatemia
Hypernatremia
A 13-year-old patient with sickle-cell anemia presents with respiratory distress; she has an infiltrate on chest radiograph. The laboratory workup of the patient reveals the following: hemoglobin 5 g/dL; hematocrit 16%; white blood cell count 30,000/μL; and arterial blood (room air) pH 7.1, PO2: 35 mm Hg, and PaCO2: 28 mm Hg. These values indicate which of the following?
Acidosis with compensatory hypoventilation
Long-term metabolic compensation for respiratory alkalosis
Primary respiratory alkalosis
Acidemia, metabolic acidosis, respiratory alkalosis, and hypoxia
Acidemia, metabolic acidosis, respiratory alkalosis, and hypoxia
A 20-year-old man presents with obtundation. Past medical history is unobtainable. Blood pressure is 120/70 mm Hg without orthostatic change, and he is well perfused peripherally. The neurological examination is nonfocal. His laboratory values are as follows: Na: 138 mEq/L, K: 4.2 mEq/L, HCO3: 5 mEq/L, Cl: 104 mEq/L, Creatinine: 1.0 mg/dL, BUN: 14 mg/dL, Ca: 10 mg/dL. Arterial blood gas on room air: PO2 96, PCO2 15, pH 7.02 Blood glucose: 90 mg/dL. Urinalysis: normal, without blood, protein, or crystals. Which of the following is the most likely acid-base disorder?
. Pure high anion-gap metabolic acidosis
. Respiratory acidosis
. Combined high anion-gap metabolic acidosis and respiratory alkalosis
. Pure normal anion-gap metabolic acidosis
. Combined high anion-gap metabolic acidosis and respiratory acidosis
A 20-year-old white male is found to have an elevated calcium level on routine pre-employment screening blood tests. He denies any polyuria, polydipsia or constipation. He has no significant past medical history and does not take any medication. He does not use tobacco, alcohol or drugs. His pulse rate is 82/min, blood pressure is 110/70 mmHg, temperature is 37.0°C (99°F) and respirations are 14/min. Complete physical examination is unremarkable. Laboratory studies show the following: Serum sodium 140 mEq/L, Serum potassium 4.0 mEq/L, Chloride 103 mEq/L, Bicarbonate 24 mEq/L, Blood urea nitrogen (BUN) 18 mg/dl, Serum creatinine 0.8 mg/dl, Calcium 11.2 mg/dl, Blood glucose 98 mg/dl, Serum PTH level 55 pg/ml (normal 10-65 pg/ml), Urine calcium/creatinine clearance ratio < 0.01. Which of the following conditions is most consistent with this patient's findings?
. Familial hypocalciuric hypercalcemia
. Vitamin D overproduction
. Multiple myeloma
. Sarcoidosis
. Primary hyperparathyroidism
A 23-year-old man presents to your office complaining of occasional headaches, muscle weakness and fatigue. He also describes periodic numbness of his extremities. The symptoms started 6 months ago and have gradually progressed. His past medical history is insignificant. He is not taking any medication. His blood pressure is 165/104 mmHg and heart rate is 80/min. His physical examination is within normal limits. Which of the following laboratory findings is the most specific for the patient's condition?
. High aldosterone/renin ratio
. High serum sodium level
. Low plasma renin activity
. Low serum potassium level
. Metabolic alkalosis
A 4-year-old child has mental retardation, shortness of stature, brachydactyly (especially of the fourth and fifth digits), and obesity with round facies and short neck. The child is followed by an ophthalmologist for subcapsular cataracts, and has previously been noted to have cutaneous and subcutaneous calcifications, as well as perivascular calcifications of the basal ganglia. This patient is most likely to have which of the following features?
. Elevated concentrations of parathyroid hormone
. Hypercalcemia
Hypophosphatemia
. Advanced height age
. Decreased bone density, particularly in the skull
A 42-year-old woman presents to the emergency department with multiple complaints. She reports that she had been feeling well until approximately one month ago, when she began to feel increasingly fatigued and weak. For the past two weeks, she has had anorexia, nausea, and abdominal pain. In the past three days, she has had two syncopal episodes. Her medical history is unremarkable and she takes no medications. She denies tobacco and drug use and drinks wine only occasionally. Physical exam reveals a temperature of 36.7°C (98°F), blood pressure of 86/52 mmHg, heart rate of 90/min, and respiratory rate of 18/min. Her cardiac exam is normal and her lungs are clear to auscultation bilaterally. You note hyperpigmentation of the skin in the palmar creases. Which of the following additional findings is most likely to be present in this patient?
Hypomagnesemia
Hypokalemia .
Hypernatremia .
Hyperkalemia .
Hypochloremia .
AmlodipineAmlodipineA 79 year-old-man known to have chronic congestive heart failure is readmitted with worsening heart failure. His furosemide (frusemide) dosage is increased to 200 mg/day to aid the relief of his symptoms. His other medications are bendrofluazide, ramipril and bisoprolol. Which of the following effects can be encountered?
Hyperuricaemia
Hyperkalaemia
Hypoalbuminaemia
Hypermagnesaemia
Hypercalciuria
A 55-year-old Caucasian male presents to your office for a routine check-up. His past medical history is significant for gout, hypertension, and hypercholesterolemia. His current medications include enalapril and pravastatin. He does not smoke or consume alcohol. His blood pressure is 156/94 mmHg and heart rate is 80/min. Physical examination reveals that the patient is moderately overweight (BMI = 27 kg/m2) with increased waist-to-hip ratio. You consider adding hydrochlorothiazide to the treatment regimen to improve the control of hypertension. Which of the following metabolic effects do you expect to emerge after this correction?
. Hyperkalemia
. Decreased LDL cholesterol
. Hyperglycemia
. Decreased plasma triglycerides .
Hypocalcemia
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