AcidoBasic STD

A 3-week-old boy presents to the physician's office with a 1-week history of forceful, projectile vomiting. He has been vomiting after almost every feeding. The vomitus contains mostly undigested formula and is non-bilious. On examination, his oral mucosa is dry, his anterior fontanel appears to be depressed, and his capillary refill is 3-4 seconds. An abdominal examination reveals an olive-sized mass in the epigastrium. Which of the following electrolyte findings will most likely be seen?

A 36-year-old male is brought to the emergency department due to confusion, nausea and decreased arousal. He is unable to file:///D:/DES_Entry_2016MCQs/3C_USMLE/C-2Diagnosis/C-2Diagnos... 122 of 316 12/19/2016 2:59 PManswer questions and no other history is available. His temperature is 36.7ׄ°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?

A 56-year-old male comes to the emergency room because of a 2-day history of fever, chills, shortness of breath and productive file:///D:/DES_Entry_2016MCQs/3C_USMLE/C-2Diagnosis/C-2Diagnos... 192 of 316 12/19/2016 2:59 PMcough. 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?

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?

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?

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?

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?

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?

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?

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?

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?