[MCQs] The Quizzes about Chronic Conditions – Part 3 (20 test)

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Chronic Conditions-3

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Question 1

You are evaluating a generally healthy 33-year-old man with low back The pain began yesterday, occurring suddenly while loading firewood in his truck. He reports that the pain radiates to his right leg. On examination, his range of motion is limited by pain. His lower extremity neurological examination is normal. When you lay the patient on his back and raise his fully extended leg by the heel, he reports pain below the knee at about 30° of elevation. What is the most likely diagnosis?

A	Back strain
B	An inflammatory condition
C	Disk herniation
D	Compression fracture
E	Neoplasm

Question 1 Explanation:

The test described in this question is called the straight leg raising test. The test is considered positive when the patient feels pain below the knee when the leg is raised 30°–60°. The positive test indicates nerve root irritation, likely due to a herniated disk. A back strain should not produce a positive straight leg raising test.254 Family Medicine A compression fracture may occur suddenly, but would be unlikely in an otherwise healthy young man. Neoplasms and inflammatory conditions would be less likely to occur suddenly

Question 2

A 41-year-old sedentary man presented to you 6 weeks ago with the acute onset of low back pain radiating to the left His neurological examination at the time was normal, but he did not respond to conserva- tive therapy. X-rays are normal. What is the most appropriate next step?

A	Flexion and extension radiographs
B	MRI
C	Electromyelography
D	Bone scan
E	A complete blood count and erythrocyte sedimentation rate

Question 2 Explanation:

MRI is indicated for people whose pain persists for more than 6 weeks despite normal radiographs and no response to conservative therapy. Flexion/extension films would not be helpful in identifying more concerning causes of pain. EMG is not indicated without neurological involvement. A bone scan and/or erythrocyte sedimentation rate should be considered in those with symptoms consistent with cancer or infection.

Question 3

A 35-year-old woman presents to you with low back It occurred suddenly when lifting her 6-year-old son yesterday. She has tried aceta- minophen without relief. On examination, her range of motion is limited by pain, and she has tenderness to palpation of the lumbar paraspinal muscles. Which of the following would be the best treatment option?

A	Bed rest for three to five days
B	Spinal traction
C	Nonsteroidal anti-inflammatory agents and return to normal activity
D	Opiate analgesia and limited activities
E	Oral corticosteroids

Question 3 Explanation:

It is recommended that patients with low back pain maintain usual activities, as dictated by pain. Neither prolonged bed rest nor traction has been shown to be effective in returning people to their usual activities sooner. NSAIDs are effective for short-term symptomatic pain relief. Muscle relaxants appear to be effective as well. Opioids may be indicated in pain relief for those who have failed NSAIDs, but are significantly sedating. Steroids can be considered in those who have failed NSAID therapy.

Question 4

Despite several months of conservative therapy including physical therapy, one of your 44-year-old male patients has had persistent low back Which of the following interventions has been shown to be effective in the short term?

A	An individualized exercise program
B	Antidepressants
C	Steroid injections
D	Traction
E	Acupuncture

Question 4 Explanation:

There is strong evidence that individualized exercise programs through physical therapy or an exercise trainer has beneficial effects and can allow most people to perform specific tasks required on a daily basis at home or at work. There is no evidence that antidepressants, steroid injections, traction, and acupuncture provide any additional benefit.

Question 5

You are evaluating a 31-year-old man complaining of left-sided neck and upper-back He reports worsening discomfort when he turns his head toward the left, with some paresthesias in his left upper extremity. On examination, when you rotate his head to the left and exert downward pressure on his head, it reproduces the pain and paresthesia. Which of the following is the most likely diagnosis?

A	Cervical strain
B	Cervical disk herniation
C	Toroticollis
D	Spondylosis
E	Osteoarthritis

Question 5 Explanation:

The provocative maneuver described in this question is called Spurling’s test. It is positive with nerve root irritation that may accompany a disk herniation. It would not be positive with cervical strain, spondylosis, or arthritis. Torticollis is a sudden onset of unilateral muscular pain, and would also not produce a positive Spurling’s test.

Question 6

A 60-year-old woman was the restrained driver in a motor vehicle accident Today, she presents to you for evaluation. She reports neck and upper back pain. On examination, she does not have bony ten- derness, but cannot rotate her head 45° to the right or left. Which of the following is the most appropriate next step in her evaluation?

A	Reassurance and nonsteroidal anti-inflammatory agents
B	Cervical spine x-rays
C	MRI
D	Bone scan
E	Dual energy X-ray absorptiometry (DEXA) scan

Question 6 Explanation:

The Canadian cervical spine rules help to identify which patients with neck pain require radiographic evaluation. If a patient is unable to rotate his/her neck 45° regardless of pain, x-rays are indicated. MRI, bone scan and DEXA scanning are not indicated in this situation.

Question 7

You are assessing a 59-year-old patient with an 80-pack-year history of smoking He stopped smoking 1 year ago. He reports a cough productive of white frothy sputum for the past 4 months. Reviewing his chart, you discover that he had a similar presentation last winter, with a cough that lasted more than 3 months. Given this information, what is his most likely diagnosis?

A	Asthma
B	Chronic bronchitis
C	Bronchiectasis
D	Emphysema
E	Recurrent pneumonia

Question 7 Explanation:

Chronic bronchitis is defined as a productive cough lasting 3 consecutive months over 2 consecutive years. Emphysema is generally not a clinical diagnosis, requiring evidence of terminal airway airspace enlargement due to alveoli destruction. Chronic bronchitis and emphysema are the clinical manifestations of COPD. Asthma is a result of airway hyperreactivity, and cannot be assumed given the above history. Bronchiectasis is a destruction of the bronchial walls leads to permanent dilation of the bronchi, with infection as the major cause. Clinical features include a persistent cough with purulent sputum production. Pneumonia would be unlikely given the clinical features described.

Question 8

You have been treating a 33-year-old woman for asthma for the last three She began with mild symptoms, but has become progressively more short of breath over the last year. She reports weight loss and signifi- cant dyspnea on exertion. She has never smoked, but her husband smokes in the home. Her maternal aunt was a smoker, and died of emphysema in her early 50s. Her chest x-ray reveals flattened diaphragms, a long, narrow heart cardiac silhouette, and increased retrosternal airspace on the lateral projection. Given this clinical picture and x-ray, what is the most likely consideration?

A	HIV with chronic lung infection
B	Congestive heart failure
C	Chronic bronchitis
D	Lung cancer due to passive exposure to cigarette smoking
E	Alpha 1-antitrypsin deficiency

Question 8 Explanation:

Alpha 1-antitrypsin deficiency is a rare genetic abnormality, accounting for less than 1% of the cases of COPD. It should be suspected in people who develop COPD before age 50, especially in nonsmokers, and in people with a family history. The x-ray would show typical emphysematous blebs, especially in the basilar areas. HIV, congestive heart failure and lung cancer are unlikely causes of the x-ray findings described. The patient does not meet the criteria for chronic bronchitis.

Question 9

You are caring for a 64-year-old former smoker who complains of increasing shortness of breath with exertion and sometimes at rest. You observe that he is somewhat “barrel-chested,” he breathes with pursed lips, and leans forward resting on his elbows when sitting in your On examination, he has decreased breath sounds and distant heart sounds. You are concerned about chronic obstructive pulmonary disease (COPD) and order office spirometry. Which measurement is most sensitive to diag- nose COPD?

A	Total lung capacity (TLC)
B	Forced vital capacity (FVC)
C	Forced expiratory volume in 1 second (FEV1)
D	Forced expiratory flow rate over the interval from 25% to 75% of the total FVC (FEF25–75%)
E	FEV1/FVC ratio

Question 9 Explanation:

The patient described in the question has risk factors and physical stigmata of COPD. Office spirometry is helpful to diagnose COPD and assess its severity. While all the answer choices are common measurements of airflow, the more sensitive measure to diagnose COPD is the FEV1/FVC ratio. It is considered normal if it is 70% or more of the predicted value based on the patient’s gender, age and height. The total lung capacity is not often used in the routine management of COPD, but may be important for restrictive disease.

Question 10

You have diagnosed a 59-year-old woman with In addi- tion to pulmonary rehabilitation and lifestyle changes, you would like to try medical therapy. What should be your first line therapy in this patient?

A	A short-acting beta-adrenergic agent (albuterol)
B	A long-acting beta-adrenergic agent (salmeterol)
C	An anticholinergic agent (ipratropium)
D	Theophylline
E	A corticosteroid

Question 10 Explanation:

A number of studies demonstrate that anticholinergic agents produce significantly greater bronchodilation, reduce mucous hypersecretion, have fewer side effects, and less tachycardia than beta-adrenergic agents. Therefore, they are considered the first line therapy for emphysema. The other medications may be used or added, if there is inadequate or suboptimal response.

Question 11

A 64-year-old man with known chronic obstructive pulmonary dis- ease complains of increasing dyspnea despite therapy with ipratropium and a short-acting beta-adrenergic You are considering the addition of theophylline. Which of the following is true of this medication?

A	It does not enhance bronchodilation when added to ipratropium and beta- agonists
B	It should be considered in patients with cor pulmonale
C	The therapeutic range is wide, and the toxicity is low
D	Renal disease is a contraindication to the use of theophylline
E	Smoking slows the rate of metabolism

Question 11 Explanation:

Theophylline enhances bronchodilation when added to other medications, but also works by enhancing diaphragmatic function and stimulating the respiratory center. It also improves cardiac output, decreases pulmonary vascular resistance,256 Family Medicine and can improve the perfusion of ischemic cardiac muscle, therefore is of benefit for patients with cor pulmonale or cardiac disease. The therapeutic range is narrow, and is altered by many things making the risk of toxicity high. Toxicity is more likely in the setting of liver disease, and smoking speeds the rate of metabolism.

Question 12

You are seeing a patient in the office for the first She is a 68-year- old recently retired school teacher with diabetes and hypertension. She is overweight and does not exercise regularly. Which of the following is the best indicator of the presence of renal insufficiency in this patient?

A	Her body mass index
B	The presence of diabetes
C	The presence of hyptertension
D	Her calculated or estimated glomerular filtration rate
E	Her serum creatinine level

Question 12 Explanation:

Weight, diabetes, and hypertension, by themselves, do not indicate the presence or absence of renal insufficiency. However, most cases of chronic renal failure are caused by diabetes and hypertension (60%), so those should be recognized as significant risk factors. The serum creatinine level can be normal in elderly people with chronic renal insufficiency, because they generally have less muscle mass. Therefore, the best indicator of the presence of renal failure is the glomerular filtration rate.

Question 13

You are following a 45-year-old man with difficult to control dia- As such, you are monitoring his kidney function and are alert to changes suggesting the beginning of chronic renal insufficiency. Of the fol- lowing, which would occur first in the setting of chronic renal failure?

A	Hyperkalemia
B	Hyponatremia
C	Hyperphosphatemia
D	A fall in plasma bicarbonate level
E	Anemia

Question 13 Explanation:

The kidney’s role in concentrating and diluting urine is usually retained until the GFR falls below 30% of normal. Therefore, hyponatremia, hyperkalemia, hyperphosphatemia, and metabolic acidosis (due to a fall in plasma bicarbonate) generally occur in later stages of kidney disease. The kidney is the source of erythropoietin, and anemia generally appears when the GFR falls below 60 mL/minute.

Question 14

You are following a 56-year-old patient who has been diagnosed with hypertension and diabetes for 4 He does fairly well with diet and exercise, and has remained compliant with his medications. Laboratory evaluation demonstrates a normal serum creatinine, no microalbuminuria, but a glomerular filtration rate (GFR) of 70 mL/minute. According to the National Kidney Foundation staging guidelines, what stage of renal failure does this represent?

A	Stage 0 renal failure
B	Stage 1 renal failure
C	Stage 2 renal failure
D	Stage 3 renal failure
E	Stage 4 renal failure

Question 14 Explanation:

The National Kidney Foundation staging system is useful to clinicians as it helps guide appropriate testing and referral for patients with kidney failure. Stage 0 represents people at risk for renal failure, but with a GFR greater than 90 mL/minute. In these people, control of blood pressure and diabetes may forestall the progression to kidney failure. Stage 1 renal failure represents evidence of renal damage (either microalbuminuria or proteinuria), but with a GFR greater than 90 mL/minute. Stage 2 renal failure represents mildly reduced GFR (values between 60–90 mL/minute). In stage 3, the GFR is between 30–59 mL/minute. Stage 4 represents moderate to severe renal failure with GFR levels from 15 to 29 mL/minute, and stage 5 represents severe renal failure with GFR less than 15 mL/minute.

Question 15

You are seeing a newly diagnosed hypertensive patient in your As you are considering appropriate therapy for this patient you note that his mother had renal failure from hypertension and was on dialysis. Which of the following medications should you consider for blood pressure management?

A	An aldosterone antagonist
B	An angiotensin-converting enzyme (ACE) inhibitor
C	A beta-blocker
D	A calcium-channel blocker
E	A alpha1-blocker

Question 16

You are seeing a hypertensive patient in you He is well-controlled with hydrochlorozide, and is seeing you for a routine evaluation. His blood pressure at the visit is 118/76. Laboratory evaluation reveals a normal creati- nine and a GFR greater than 90 mL/minute, but he does have microalbumin- uria. Which of the following interventions is indicated in this patient?

A	Commend him on his excellent control and make no changes
B	Work to achieve better blood pressure control through diet and exercise
C	Increase his hydrochlorothiazide dose
D	Add an ACE inhibitor
E	Check a glycosolated hemoglobin level

Question 16 Explanation:

According to National Kidney Foundation guidelines, this patient has stage 1 renal failure. ACE inhibitors should be added to his regimen to prevent the evolution of microalbuminuria to full blown proteinuria. Improvements in diet and exercise are always appropriate, but should not take the place of the addition of an ACEI. Checking a glycosolated hemoglobin level would not be indicated as a screen for diabetes.

Question 17

You are following a patient with hypertension and diabetes in your Despite good blood pressure and glycemic control, his GFR has started to decrease. GFR measurement was 74 mL/minute 3 months ago. At this visit, GFR is 55 mL/minute. Creatinine is within normal limits, and his serum potassium is 5.2 mmol/L (normal is up to 5.1 mmol/L). The patient denies any changes in urination or other problems. Which of the following is most appropriate at this stage?

A	See the patient more frequently, at least monthly
B	Increase his ACE inhibitor
C	Add diuretic therapy
D	Refer to a nephrologist
E	Refer to a transplant surgeon

Question 17 Explanation:

The patient’s laboratory values and clinical picture is consistent with moderate renal failure (National Kidney Foundation stage 3). At this point, nephrology referral is indicated. Renal replacement therapy (transplant or dialysis) is indicated for severe renal insufficiency (GFR less than 15 mL/minute).

Question 18

You are seeing a 48-year-old man with known He has several physical signs of his illness, including spider angiomata, palmar erythema, Dupuytren’s contractures, gynecomastia, testicular atrophy, splenomegaly, and parotid gland enlargement. Which of his physical examination findings are more commonly seen in patients with nonalcoholic causes of cirrhosis?

A	Spider angiomata
B	Dupuytren’s contractures
C	Testicular atrophy
D	Splenomegaly
E	Parotid gland enlargement

Question 18 Explanation:

There are many physical manifestations of cirrhosis, and some can help determine the underlying cause of liver disease. Spider angiomata and palmar erythema are non-specific, and can be seen with many etiologies. Dupuytren’s contractures, testicular atrophy, and parotid gland enlargement are seen more commonly with alcoholic cirrhosis. Splenomegaly is common, especially in patients with cirrhosis from nonalcoholic etiologies.

Question 19

You are following a patient who is known to have primary biliary cir- You are following his liver function tests as indicators of disease sever- ity and progression. Which of the following tests, if rising, is the poorest prognostic sign?

A	Aspartate aminotransferase (AST)
B	ALT
C	Gamma-glutamyl transpeptidase (GGT)
D	Alkaline phosphatase
E	Bilirubin

Question 19 Explanation:

Liver tests are followed in patients with cirrhosis to assess severity and progress. While all of the tests above may be abnormal in patients with cirrhosis, bilirubin may be normal if the cirrhosis is well-compensated. Rising serum bilirubin may indicate a poor prognosis in patients with primary biliary cirrhosis.

Question 20

You are following a cirrhotic patient with On laboratory eval- uation, you note that he is hyponatremic. Which of the following is the most likely cause of his hyponatremia?

A	High levels of antidiuretic hormone secretion
B	Hepatic synthetic protein dysfunction causes osmotic losses of sodium
C	Shunting of blood away from the kidney to the liver
D	First pass excretion of sodium
E	Osmotic sodium shifts from the blood to the ascitic fluid

Question 20 Explanation:

Hyponatremia is common Hyponatremia is common in patients with cirrhosis and ascites and is related to the inability to excrete free water. This results from high levels of antidiuretic hormone secretion.

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II. Preview all questions below

1.You are evaluating a generally healthy 33-year-old man with low back The pain began yesterday, occurring suddenly while loading firewood in his truck. He reports that the pain radiates to his right leg. On examination, his range of motion is limited by pain. His lower extremity neurological examination is normal. When you lay the patient on his back and raise his fully extended leg by the heel, he reports pain below the knee at about 30° of elevation. What is the most likely diagnosis?

Back strain
An inflammatory condition
Disk herniation
Compression fracture
Neoplasm

2. A 41-year-old sedentary man presented to you 6 weeks ago with the acute onset of low back pain radiating to the left His neurological examination at the time was normal, but he did not respond to conserva- tive therapy. X-rays are normal. What is the most appropriate next step?

Flexion and extension radiographs
MRI
Electromyelography
Bone scan
A complete blood count and erythrocyte sedimentation rate

3. A 35-year-old woman presents to you with low back It occurred suddenly when lifting her 6-year-old son yesterday. She has tried aceta- minophen without relief. On examination, her range of motion is limited by pain, and she has tenderness to palpation of the lumbar paraspinal muscles. Which of the following would be the best treatment option?

Bed rest for three to five days
Spinal traction
Nonsteroidal anti-inflammatory agents and return to normal activity
Opiate analgesia and limited activities
Oral corticosteroids

4. Despite several months of conservative therapy including physical therapy, one of your 44-year-old male patients has had persistent low back Which of the following interventions has been shown to be effective in the short term?

An individualized exercise program
Antidepressants
Steroid injections
Traction
Acupuncture

5. You are evaluating a 31-year-old man complaining of left-sided neck and upper-back He reports worsening discomfort when he turns his head toward the left, with some paresthesias in his left upper extremity. On examination, when you rotate his head to the left and exert downward pressure on his head, it reproduces the pain and paresthesia. Which of the following is the most likely diagnosis?

Cervical strain
Cervical disk herniation
Toroticollis
Spondylosis
Osteoarthritis

6. A 60-year-old woman was the restrained driver in a motor vehicle accident Today, she presents to you for evaluation. She reports neck and upper back pain. On examination, she does not have bony ten- derness, but cannot rotate her head 45° to the right or left. Which of the following is the most appropriate next step in her evaluation?

Reassurance and nonsteroidal anti-inflammatory agents
Cervical spine x-rays
MRI
Bone scan
Dual energy X-ray absorptiometry (DEXA) scan

7. You are assessing a 59-year-old patient with an 80-pack-year history of smoking He stopped smoking 1 year ago. He reports a cough productive of white frothy sputum for the past 4 months. Reviewing his chart, you discover that he had a similar presentation last winter, with a cough that lasted more than 3 months. Given this information, what is his most likely diagnosis?

Asthma
Chronic bronchitis
Bronchiectasis
Emphysema
Recurrent pneumonia

8. You have been treating a 33-year-old woman for asthma for the last three She began with mild symptoms, but has become progressively more short of breath over the last year. She reports weight loss and signifi- cant dyspnea on exertion. She has never smoked, but her husband smokes in the home. Her maternal aunt was a smoker, and died of emphysema in her early 50s. Her chest x-ray reveals flattened diaphragms, a long, narrow heart cardiac silhouette, and increased retrosternal airspace on the lateral projection. Given this clinical picture and x-ray, what is the most likely consideration?

HIV with chronic lung infection
Congestive heart failure
Chronic bronchitis
Lung cancer due to passive exposure to cigarette smoking
Alpha 1-antitrypsin deficiency

9. You are caring for a 64-year-old former smoker who complains of increasing shortness of breath with exertion and sometimes at rest. You observe that he is somewhat “barrel-chested,” he breathes with pursed lips, and leans forward resting on his elbows when sitting in your On examination, he has decreased breath sounds and distant heart sounds. You are concerned about chronic obstructive pulmonary disease (COPD) and order office spirometry. Which measurement is most sensitive to diag- nose COPD?

Total lung capacity (TLC)
Forced vital capacity (FVC)
Forced expiratory volume in 1 second (FEV₁)
Forced expiratory flow rate over the interval from 25% to 75% of the total FVC (FEF25–75%)
FEV₁/FVC ratio

10. You have diagnosed a 59-year-old woman with In addi- tion to pulmonary rehabilitation and lifestyle changes, you would like to try medical therapy. What should be your first line therapy in this patient?

A short-acting beta-adrenergic agent (albuterol)
A long-acting beta-adrenergic agent (salmeterol)
An anticholinergic agent (ipratropium)
Theophylline
A corticosteroid

11. A 64-year-old man with known chronic obstructive pulmonary dis- ease complains of increasing dyspnea despite therapy with ipratropium and a short-acting beta-adrenergic You are considering the addition of theophylline. Which of the following is true of this medication?

It does not enhance bronchodilation when added to ipratropium and beta- agonists
It should be considered in patients with cor pulmonale
The therapeutic range is wide, and the toxicity is low
Renal disease is a contraindication to the use of theophylline
Smoking slows the rate of metabolism

12. You are seeing a patient in the office for the first She is a 68-year- old recently retired school teacher with diabetes and hypertension. She is overweight and does not exercise regularly. Which of the following is the best indicator of the presence of renal insufficiency in this patient?

Her body mass index
The presence of diabetes
The presence of hyptertension
Her calculated or estimated glomerular filtration rate
Her serum creatinine level

13. You are following a 45-year-old man with difficult to control dia- As such, you are monitoring his kidney function and are alert to changes suggesting the beginning of chronic renal insufficiency. Of the fol- lowing, which would occur first in the setting of chronic renal failure?

Hyperkalemia
Hyponatremia
Hyperphosphatemia
A fall in plasma bicarbonate level
Anemia

14. You are following a 56-year-old patient who has been diagnosed with hypertension and diabetes for 4 He does fairly well with diet and exercise, and has remained compliant with his medications. Laboratory evaluation demonstrates a normal serum creatinine, no microalbuminuria, but a glomerular filtration rate (GFR) of 70 mL/minute. According to the National Kidney Foundation staging guidelines, what stage of renal failure does this represent?

Stage 0 renal failure
Stage 1 renal failure
Stage 2 renal failure
Stage 3 renal failure
Stage 4 renal failure

15. You are seeing a newly diagnosed hypertensive patient in your As you are considering appropriate therapy for this patient you note that his mother had renal failure from hypertension and was on dialysis. Which of the following medications should you consider for blood pressure management?

An aldosterone antagonist
An angiotensin-converting enzyme (ACE) inhibitor
A beta-blocker
A calcium-channel blocker
A alpha₁-blocker

16. You are seeing a hypertensive patient in you He is well-controlled with hydrochlorozide, and is seeing you for a routine evaluation. His blood pressure at the visit is 118/76. Laboratory evaluation reveals a normal creati- nine and a GFR greater than 90 mL/minute, but he does have microalbumin- uria. Which of the following interventions is indicated in this patient?

Commend him on his excellent control and make no changes
Work to achieve better blood pressure control through diet and exercise
Increase his hydrochlorothiazide dose
Add an ACE inhibitor
Check a glycosolated hemoglobin level

17. You are following a patient with hypertension and diabetes in your Despite good blood pressure and glycemic control, his GFR has started to decrease. GFR measurement was 74 mL/minute 3 months ago. At this visit, GFR is 55 mL/minute. Creatinine is within normal limits, and his serum potassium is 5.2 mmol/L (normal is up to 5.1 mmol/L). The patient denies any changes in urination or other problems. Which of the following is most appropriate at this stage?

See the patient more frequently, at least monthly
Increase his ACE inhibitor
Add diuretic therapy
Refer to a nephrologist
Refer to a transplant surgeon

18. You are seeing a 48-year-old man with known He has several physical signs of his illness, including spider angiomata, palmar erythema, Dupuytren’s contractures, gynecomastia, testicular atrophy, splenomegaly, and parotid gland enlargement. Which of his physical examination findings are more commonly seen in patients with nonalcoholic causes of cirrhosis?

Spider angiomata
Dupuytren’s contractures
Testicular atrophy
Splenomegaly
Parotid gland enlargement

19. You are following a patient who is known to have primary biliary cir- You are following his liver function tests as indicators of disease sever- ity and progression. Which of the following tests, if rising, is the poorest prognostic sign?

Aspartate aminotransferase (AST)
ALT
Gamma-glutamyl transpeptidase (GGT)
Alkaline phosphatase
Bilirubin

20. You are following a cirrhotic patient with On laboratory eval- uation, you note that he is hyponatremic. Which of the following is the most likely cause of his hyponatremia?

High levels of antidiuretic hormone secretion
Hepatic synthetic protein dysfunction causes osmotic losses of sodium
Shunting of blood away from the kidney to the liver
First pass excretion of sodium
Osmotic sodium shifts from the blood to the ascitic fluid

[MCQs] The Quizzes about Chronic Conditions – Part 3 (20 test)

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Chronic Conditions-3

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