[MCQ] Acidosis & Alkalosis- Part 3

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Acidosis & Alkalosis- Part 3

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Question 1

Which of the following is a metabolite of ethylene glycol ?

A	Lactic acid
B	Tricarboxylic acid
C	Oxalic acid
D	Hydrochloric acid

Question 1 Explanation:

Ethylene glycol (used in antifreeze) causes metabolic acidosis and damage to CNS, heart, lungs and kidneys. Its metabolites are oxalic acid, glycolic acid, and other organic acids

Question 2

Under most physiologic conditions, osmotic pressure of blood is generated by ?

A	Sodium
B	Urea
C	Glucose
D	All of the above

Question 3

The chemical name of ‘Fomepizole’ is ?

A	2-methylpyrazole
B	3-methylpyrazole
C	4-methylpyrazole
D	5-methylpyrazole

Question 4

‘Fomepizole’ is a ?

A	Aldehyde dehydrogenase inhibitor
B	Alcohol dehydrogenase inhibitor
C	Ketone dehydrogenase inhibitor
D	None of the above

Question 4 Explanation:

Fomepizole or 4-methylpyrazole is an alcohol dehydrogenase inhibitor. It is used to treat Alcoholinduced acidosis in a IV loading dose of 7 mg/kg

Question 5

Which of the following about methanol is false ?

A	Also called ‘wood alcohol’
B	Has high molecular weight
C	Metabolites include formaldehyde and formic acid
D	Intoxication cause severe optic nerve damage

Question 5 Explanation:

Methanol or wood alcohol causes metabolic acidosis. Its metabolites formaldehyde & formic acid cause optic nerve & CNS damage. It has a low molecular weight (32 Da)

Question 6

Acidosis is not present in which of the following ?

A	Ethylene glycol ingestion
B	Isopropyl alcohol ingestion
C	Methanol ingestion
D	Ketosis

Question 6 Explanation:

In Isopropyl alcohol ingestion, acidosis is not present because acetone is rapidly excreted.

Question 7

Which of the following about uremic acidosis is false ?

A	Reduced rate of NH4+ production and excretion
B	[HCO3-] levels rarely < 15 mmol/L
C	Anion gap (AG) rarely > 20 mmol/L
D	Anion gap (AG) rarely > 20 mmol/L

Question 7 Explanation:

Uremic acidosis is characterized by reduced rate of NH4+ production & excretion due to decreased renal mass. [HCO3–] rarely falls to <15 mmol/L and AG is rarely >20 mmol/L.

Question 8

‘Extrarenal cause’ of acidosis is suggested by ?

A	Negative urine anion gap (UAG)
B	‘Extrarenal cause’ of acidosis is suggested by ?
C	Zero urine anion gap
D	Any of the above

Question 9

Urine anion gap (UAG) is calculated by the formula ?

A	[Na+ + K+]u / [Cl-]u
B	[Na+ + K+]u x [Cl-]u
C	[Na+ + K+]u - [Cl-]u
D	[Na+ + K+]u + [Cl-]u

Question 9 Explanation:

Urinary NH4+ levels are estimated by urine anion gap (UAG) i.e. [Na+ + K+]u – [Cl–]u. When [Cl–]u > [Na+ + K+], the UAG is negative which indicates that urine ammonium level is appropriately increased, suggesting an extrarenal cause of the acidosis. When urine anion gap is positive, urine ammonium level is low, suggesting a renal cause of acidosis.

Question 10

Fanconi syndrome is characterized by ?

A	Glycosuria
B	Generalized aminoaciduria
C	Phosphaturia
D	All of the above

Question 10 Explanation:

Fanconi syndrome refers to glycosuria, generalized aminoaciduria, and phosphaturia due to generalized proximal tubular dysfunction (type 2 RTA).

Question 11

Typical findings in classic distal RTA (type 1 RTA) include ?

A	Hypokalemia
B	Low urinary NH4+ excretion
C	Urine pH > 5.5
D	All of the above

Question 12

The typical findings in classic distal RTA (type 1 RTA) include all except ?

A	Hyperkalemia
B	Hyperchloremic acidosis
C	Low urinary NH4+ excretion
D	High urine pH

Question 12 Explanation:

Typical findings of classic distal RTA (type 1 RTA) include hypokalemia, hyperchloremic acidosis, low urinary NH4+ excretion (positive UAG, low urine [NH4+]), and high urine pH (pH > 5.5).

Question 13

Mnemonic “MUDPILES” is to remember cause of ?

A	Metabolic acidosis
B	Metabolic alkalosis
C	Respiratory acidosis
D	Respiratory alkalosis

Question 13 Explanation:

Useful to memorize causes of anion gap metabolic acidemias. Letters in MUDPILES represent methanol, uremia, diabetic & alcoholic ketoacidosis, paraldehyde, isoniazid (INH), lactic acidemia, ethylene glycol toxicity, and salicylates. Paraldehyde can be replaced with propylene glycol

Question 14

Hyporeninemic hypoaldosteronism can be seen in ?

A	Diabetes mellitus
B	Diabetes mellitus
C	Renal insufficiency
D	All of the above

Question 14 Explanation:

Hyporeninemic hypoaldosteronism causes hyperchloremic metabolic acidosis, in older adults with diabetes mellitus or tubulointerstitial disease and renal insufficiency

Question 15

Metabolic alkalosis is manifested by all except ?

A	Elevated arterial pH
B	Increase in serum [HCO3-]
C	Hyperchloremia
D	Increase in PaCO2

Question 15 Explanation:

Metabolic alkalosis manifests as elevated arterial pH, increased serum [HCO3–] & increased PaCO2 due to compensatory alveolar hypoventilation. It is often accompanied by hypochloremia & hypokalemia

Question 16

The PaCO2 increases how much for each 10 mmol/L increase in [HCO3-] above normal ?

A	2 mm Hg
B	4 mm Hg
C	6 mm Hg
D	8 mm Hg

Question 17

Hypokalemia and alkalosis in a normotensive, nonedematous patient suggests ?

A	Magnesium deficiency
B	Vomiting
C	Diuretic ingestion
D	All of the above

Question 18

Hypokalemia and alkalosis in a normotensive, nonedematous patient suggests ?

A	Bartter’s syndrome
B	Gitelman’s syndrome
C	Exogenous alkali
D	All of the above

Question 18 Explanation:

Combination of hypokalemia & alkalosis in a normotensive, nonedematous patient can be due to Bartter’s or Gitelman’s syndrome, magnesium deficiency, vomiting, exogenous alkali, or diuretic ingestion

Question 19

Which of the following is true for urine in patients who are vomiting ?

A	Acidic urine, elevated [Na]u and [K]u, low [Cl]u
B	Alkaline urine, low [Na]u and [K]u, low [Cl]u
C	Acidic urine, low [Na]u and [K]u, low [Cl]u
D	Alkaline urine, elevated [Na]u and [K]u, low [Cl]u

Question 19 Explanation:

If urine is alkaline, with elevated [Na+] & [K+] but low [Cl–], diagnosis is either vomiting or alkali ingestion.

Question 20

Acid urine with low urinary Na+, K+, and Cl- suggest ?

A	Prior vomiting
B	Posthypercapnic state
C	Posthypercapnic state
D	Posthypercapnic state

Question 20 Explanation:

Posthypercapnic state

Question 21

Which of the following is false about Liddle’s syndrome ?

A	Increased activity of collecting duct sodium channel
B	Hypertension
C	Hypokalemic alkalosis
D	Elevated aldosterone levels

Question 21 Explanation:

Liddle’s syndrome results from increased activity of collecting duct Na+ channel (ENaC) manifests as hypertension due to volume expansion leading to hypokalemic alkalosis & normal aldosterone levels

Question 22

Presentation of metabolic alkalosis is similar to ?

A	Hypercalcemia
B	Hypocalcemia
C	Hyperkalemia
D	All of the above

Question 22 Explanation:

Changes in central and peripheral nervous system function with metabolic alkalosis are similar to those of hypocalcemia

Question 23

High urine chloride metabolic alkalemia includes ?

A	Bartter syndrome
B	Gitleman syndrome
C	Liddle’s syndrome
D	All of the above

Question 24

High urine chloride metabolic alkalemia with hypertension includes all except ?

A	Conn’s Syndrome
B	Cushing disease
C	Bartter’s syndrome
D	Liddle’s syndrome

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See all quizzes of Acidosis & Alkalosis at here:

Acidosis & Alkalosis- Part 1 |Acidosis & Alkalosis- Part 2| Acidosis & Alkalosis- Part 3| Acidosis & Alkalosis- Part 4

1.Which of the following is a metabolite of ethylene glycol ?
A. Lactic acid
B. Tricarboxylic acid
C. Oxalic acid
D. Hydrochloric acid

2. Under most physiologic conditions, osmotic pressure of blood is generated by ?
A. Sodium
B. Urea
C. Glucose
D. All of the above
3. The chemical name of ‘Fomepizole’ is ?
A. 2-methylpyrazole
B. 3-methylpyrazole

C. 4-methylpyrazole
D. 5-methylpyrazole
4. ‘Fomepizole’ is a ?
A. Aldehyde dehydrogenase inhibitor
B. Alcohol dehydrogenase inhibitor
C. Ketone dehydrogenase inhibitor
D. None of the above

5. Which of the following about methanol is false ?
A. Also called ‘wood alcohol’
B. Has high molecular weight
C. Metabolites include formaldehyde and formic acid
D. Intoxication cause severe optic nerve damage

6. Acidosis is not present in which of the following ?
A. Ethylene glycol ingestion
B. Isopropyl alcohol ingestion
C. Methanol ingestion
D. Ketosis

7. Which of the following about uremic acidosis is false ?
A. Reduced rate of NH4+ production and excretion
B. [HCO3–] levels rarely < 15 mmol/L
C. Anion gap (AG) rarely > 20 mmol/L
D. None of the above

8. ‘Extrarenal cause’ of acidosis is suggested by ?
A. Negative urine anion gap (UAG)
B. Positive urine anion gap
C. Zero urine anion gap
D. Any of the above
9. Urine anion gap (UAG) is calculated by the formula ?
A. [Na+ + K+]u / [Cl–]u
B. [Na+ + K+]u x [Cl–]u
C. [Na+ + K+]u – [Cl–]u
D. [Na+ + K+]u + [Cl–]u

10. Fanconi syndrome is characterized by ?
A. Glycosuria
B. Generalized aminoaciduria
C. Phosphaturia
D. All of the above

11. Typical findings in classic distal RTA (type 1 RTA) include ?
A. Hypokalemia
B. Low urinary NH4+ excretion
C. Urine pH > 5.5
D. All of the above
12. The typical findings in classic distal RTA (type 1 RTA) include all except ?
A. Hyperkalemia
B. Hyperchloremic acidosis
C. Low urinary NH4+ excretion
D. High urine pH

13. Mnemonic “MUDPILES” is to remember cause of ?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis

14. Hyporeninemic hypoaldosteronism can be seen in ?
A. Diabetes mellitus
B. Tubulointerstitial disease
C. Renal insufficiency
D. All of the above

15. Metabolic alkalosis is manifested by all except ?
A. Elevated arterial pH
B. Increase in serum [HCO3–]
C. Hyperchloremia
D. Increase in PaCO2

16. The PaCO2 increases how much for each 10 mmol/L increase in [HCO3–] above normal ?

A. 2 mm Hg
B. 4 mm Hg
C. 6 mm Hg
D. 8 mm Hg
17. Hypokalemia and alkalosis in a normotensive, nonedematous patient suggests ?
A. Magnesium deficiency
B. Vomiting
C. Diuretic ingestion
D. All of the above
18. Hypokalemia and alkalosis in a normotensive, nonedematous patient suggests ?
A. Bartter’s syndrome
B. Gitelman’s syndrome
C. Exogenous alkali
D. All of the above

19. Which of the following is true for urine in patients who are vomiting ?
A. Acidic urine, elevated [Na]u and [K]u, low [Cl]u
B. Alkaline urine, low [Na]u and [K]u, low [Cl]u
C. Acidic urine, low [Na]u and [K]u, low [Cl]u
D. Alkaline urine, elevated [Na]u and [K]u, low [Cl]u

20. Acid urine with low urinary Na+, K+, and Cl– suggest ?
A. Prior vomiting
B. Posthypercapnic state
C. Prior diuretic ingestion
D. All of the above

21. Which of the following is false about Liddle’s syndrome ?
A. Increased activity of collecting duct sodium channel
B. Hypertension
C. Hypokalemic alkalosis
D. Elevated aldosterone levels

22. Presentation of metabolic alkalosis is similar to ?
A. Hypercalcemia
B. Hypocalcemia
C. Hyperkalemia

D. All of the above

23. High urine chloride metabolic alkalemia includes ?
A. Bartter syndrome
B. Gitleman syndrome
C. Liddle’s syndrome
D. All of the above
24. High urine chloride metabolic alkalemia with hypertension includes all except ?
A. Conn’s Syndrome
B. Cushing disease
C. Bartter’s syndrome
D. Liddle’s syndrome

Acidosis & Alkalosis

[MCQ] Acidosis & Alkalosis- Part 3

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Acidosis & Alkalosis- Part 3

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[MCQ] Acidosis & Alkalosis- Part 4

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