FLUID AND ELECTROLYTE

1) Which of the following physiologic events take place when serum osmolality reaches
285mOsm/kg –
A) Aquaporin 4 water channels are inserted In the luminal membrane of collecting duct
B) Neurons in hypothalamus release ACTH
C) Urine osmolality decreases
D) Renal medullary osmotic gradient increases

Answer D) Harrisons 19th edition chapter 63

2) Which portion of glomerulus is responsible for bulk of sodium reabsorption

A) Collecting duct
B) Distal collecting tubule
C) Proximal tubule
D) Thick ascending limb of Henle

Answer C) Harriosns 19th edition chapter 63

3) A patient presents with recurrent vomiting .on examining he has dry mucous membranes ,
diminished skin turgor and orthostatic hypotension .A urine sample is obtained for testing ,
which of the following will be true –

A) Urine sodium>20 mM
B) Urine sodium <20 mM
C) Urine osmolality <300 mOsm/kg
D) Urine specific gravity <1.020

Answer B) Harriosns 19th edition chapter 63

4) A 63 year old woman presents with dehydration , diaarhea and on examination is mildly
tachycardic with dry mucous membranes . Serum sodium is 132 mEq/L, urine sodium is
undetectably low . To manage hyponatremia ,you will do what
A) Furosemide to allow free water loss
B) Thiazide to allow free water loss
C) IV hydration to reduce free ADH levels and allow free water diuresis
D) Tolvaptan therapy

Answer C) Harriosns 19th edition chapter 63

5) Which of the following is associated with hypovolemia with hyponatremia –

 A) Central diabetes insipidus
B) Cirrhosis
C) Dehydration
D) Psychogenic polydipsia

Answer D) Harriosns 19th edition chapter 63

6) Normal serum osmolality ranges between (mOsm/kg)

A) 280-295
B) 290-295
C) 275-290
D) 275-285

Answer A) Harriosns 18TH edition page 341

7) Which is true about total body water

A) Total body water in women is greater than men
B) Majority of body water is in the extracellular compartment
C) Extracellular fluid is divided into plasma and interstitial in the ratio of 1:3
D) Return of fluid into the intravascular compartment is via the venous return

Answer C) Harriosns 18TH edition page 341

8) Most appropriate fluid for normonatremic severely hypovolemic patients is

A) 0.9% normal saline
B) Ringer lactate
C) Dextrose normal saline
D) 5% dextrose

Answer A) Harriosns 18TH edition page 344

9) Urine sodium >20 mM with hypovolemia can be seen in all of the following except –
A) Diuretic excess
B) Ketonuria
C) Renal loss
D) Severe diarrhea

Answer D) Harriosns 18TH edition page 345

10) Which of the following is a cause of euvolemic hyponatremia –

A) SIADH
B) Hyperthyroididm
C) Chronic renal failure
D) Pancreatitis
Answer A) Harriosns 18TH edition page 345

11) Cerebral salt wasting is

A) Hyponatremia with inappropriate natriuresis
B) Hypervolemic hyponatremia
C) Poor response to NaCl therapy
D) Uncommon in patients with intracranial diseases

Answer A) Harriosns 18TH edition page 345

12) Most common cause of euvolemic hyponatremia is

A) SIADH
B) Stress
C) Hypothyroidism
D) Glucocorticoid deficiency

Answer A) Harriosns 18TH edition page 345

13) Hypervolemic hyponatremia is seen in

A) Nephrotic syndrome
B) Pancreatitis
C) Osmotic diuresis
D) Excess diuretic

Answer A) Harriosns 18TH edition page 345

14) Most common malignancy causing SIADH

A) Small cell CA lung

B) CA stomach
C) CA pancreas
D) Mesothelioma

Answer A) Harriosns 18TH edition page 346

15) Most common drugs causing SIADH

A) Carbamezapine
B) NSAIDS
C) MDMA/ecstasy
D) SSRI
Answer D) Harriosns 18TH edition page 346

16) Causes of acute hyponatremia include

A) MDMA ingestion
B) Renal failure
C) Cardiac failure
D) SIADH

Answer A) Harriosns 18TH edition page 347

17) ODS – osmotic demyelination syndrome is

A) Overly rapid correction of serum sodium resulting in demyelination in pons

B) Correction of > 5mM in 24 hours
C) Correction of > 15mM in 48 hours
D) Degenerative loss of oligodendrocytes

Answer A) Harriosns 18TH edition page 347

18) Insensible loss is nearly

A) 15ml/kg
B) 20ml/kg
C) 10ml/kg
D) 5ml/kg

Answer C) Harriosns 18TH edition page 348

19) Regarding potassium which of the following is true

A) Chief extracellular ion
B) 98% located chiefly in the epithelial cells
C) Nearly 90% excreted in urine , 10% in stools
D) Reabsorption in proximal tubule

Answer C) Harriosns 18TH edition page 351

20) Which of the following is associated with redistribution of potassium into the cells and causes
hypokalemia
A) Lack of insulin
B) Beta 2 adrenergic blockers
C) Metabolic acidosis
D) Thyrotoxic periodic paralysis

Answer D) Harriosns 18TH edition page 352

 21) All are causes of hypokalemia except
A) Magnesium deficiency
B) Hypothermia
C) Hyperthermia
D) Clay ingestion

Answer C) Harriosns 18TH edition page 352

22) Treatment of thyrotoxic periodic paralysis is

A) IV Potassium supplementation
B) Oral potassium supplementation
C) High dose propranolol
D) Antithyroid drugs

Answer C) Harriosns 18TH edition page 354

23) Mainstay of therapy for hypokalemia is

A) IV replacement of potassium
B) Oral KCl
C) Oral potassium phosphate
D) Oral potassium bicarbonate

Answer B) Harriosns 18TH edition page 354

24) Regarding hyperkalemia which is true

A) Common with metabolic acidosis
B) Uncommon in diabetic nephropathy
C) Leads to CNS manifestations commonly
D) Most common cause is redistribution

Answer A) Harriosns 18TH edition page 355 , 356

25) Treatment of hyperkalemia includes

A) Calcium gluconate in the absence of ECG changes
B) Urgent dialysis to cause intracellular potassium shift
C) Rapid reduction of plasma potassium by glucose and insulin
D) IV bicarbonate

Answer C) Harriosns 18TH edition page 359

E)