[MCQ] Hyperkalemia

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1.Hyperkalemia is defined as a plasma K+ concentration of ?
A. > 4.5 mmol/L
B. > 5.0 mmol/L
C. > 5.5 mmol/L
D. > 6.0 mmol/L

2.  Pseudohyperkalemia can result from ?
A. Prolonged use of tourniquet
B. Hemolysis
C. Marked leukocytosis
D. All of the above
3.  Pseudohyperkalemia can result from ?
A. Intravascular hemolysis
B. Tumor lysis syndrome
C. Rhabdomyolysis
D. All of the above

4.  Which of the following regarding hyperkalemic periodic paralysis is false ?
A. Autosomal dominant disorder
B. Episodic weakness / paralysis precipitated by exercise
C. Due to mutation in gene for skeletal muscle Na+ channel
D. None of the above

5.  Hyporeninemic hypoaldosteronism is seen in ?
A. Mild renal insufficiency
B. Diabetic nephropathy
C. Chronic tubulointerstitial disease
D. All of the above

6.  Patients at increased risk of ACE inhibitor induced hyperkalemia include all except ?
A. Diabetes mellitus
B. Decreased effective circulating arterial volume
C. Unilateral renal artery stenosis
D. Concurrent use of NSAIDs

7.  Heparin can lead to severe hyperkalemia in patients with ?
A. Diabetes mellitus
B. Those receiving potasium sparing diuretics
C. Those receiving ACE inhibitors
D. All of the above

8. Pseudohypoaldosteronism is characterized by all except ?
A. High renin & aldosterone levels
B. End-organ resistance to aldosterone
C. Renal sodium wasting
D. Hypertension
9. Pseudohypoaldosteronism is characterized by all except ?
A. Hyperkalemia
B. Metabolic alkalosis
C. Renal sodium wasting
D. Hypotension

10.  Which of the following is a competitive mineralocorticoid antagonist ?
A. Spironolactone
B. Amiloride
C. Triamterene
D. All of the above

11. Which of the following blocks the apical sodium channel of principal cell ?
A. Amiloride
B. Trimethoprim
C. Pentamidine
D. All of the above

12. Nephropathy associated with impaired potassium excretion include ?
A. Drug-induced interstitial nephritis
B. Lupus nephritis
C. Sickle cell disease
D. All of the above

13.  Gordon’s syndrome includes all except ?
A. Hyperkalemia
B. Metabolic acidosis
C. Normal GFR
D. High renin

14.  The earliest ECG change in hyperkalemia is ?
A. Increased T-wave amplitude
B. Prolonged PR interval
C. Prolonged QRS duration
D. Loss of P waves
15.  Sine wave pattern seen in severe hyperkalemia is due to merging of ?
A. P + QRS
B. QRS + T
C. P + QRS + T
D. Any of the above

16.  Severity of hyperkalemia is determined by ?
A. Symptoms
B. Plasma K+ concentration
C. ECG abnormalities
D. All of the above

17.  The appropriate renal response to hyperkalemia is to excrete how much of K+ daily ?
A. At least 50 mmol
B. At least 100 mmol
C. At least 200 mmol
D. At least 300 mmol

18.  Potentially fatal hyperkalemia occurs when plasma potassium concentration exceeds ?
A. 5.5 mmol/L
B. 6.5 mmol/L
C. 7.5 mmol/L
D. 8.5 mmol/L

19.  In severe hyperkalemia, 10 mL of 10% calcium gluconate should be infused over ?
A. Half to 1 minute
B. 1 to 2 minutes
C. 2 to 3 minutes
D. 5 to 10 minutes

20. Which of the following is used for lowering potassium levels in severe hyperkalemia ?
A. Insulin-glucose infusion
B. Alkali therapy with IV NaHCO3
C. 2 adrenergic agonists
D. All of the above
21. Which of the following reduce plasma K+ levels by shifting K+ into cells ?
A. Glucose – insulin therapy
B. Alkali therapy with IV NaHCO3
C. Beta2-adrenergic agonists
D. All of the above

22. Which of the following is false regarding sodium polystyrene sulfonate ?
A. Anion-exchange resin
B. One gram binds 1 mmol of K+ & releases 2-3 mmol of Na+
C. Usual dose is 25-50 gram orally
D. Can be administered as retention enema

23. The most rapid & effective way of lowering plasma potassium concentration is ?
A. Insulin-glucose infusion
B. Calcium gluconate infusion
C. Peritoneal dialysis
D. Hemodialysis

24.  Which of the following parameter is not required in calculating TTKG ?
A. Serum Osmolality
B. Urine Osmolality
C. pH
D. Serum K

25.  Formula for calculating Transtubular Potassium Gradient (TTKG) is ?
A. (PPotassium x UPotassium) / (POsm x UOsm)
B. (POsm x PPotassium) / (UPotassium x UOsm)
C. (POsm x UPotassium) / (PPotassium x UOsm)
D. (PPotassium x UOsm) / (POsm x UPotassium)

26.  TTKG in a normal person on a normal diet is ?
A. 2 – 4
B. 4 – 6
C. 6 – 7
D. 8 – 9

27.  Which of the following statements is false ?
A. Hypokalemia should result in a TTKG < 2
B. Hyperkalemia should result in a TTKG>10
C. Hypokalemia not resulting in a TTKG<2 suggests renal loss as cause
D. Hyperkalemia not resulting in a TTKG>10 suggests type I
renal tubular acidosis