Question on ECCN 3
1. A 55-year-old male presents to the emergency department with confusion, deep rapid
breathing (Kussmaul respirations), and a history of diabetes mellitus. His arterial blood
gas (ABG) results are as follows:
pH: 7.25
PaCO₂: 28 mmHg
HCO₃⁻: 12 mEq/L
What is the most likely cause of this patient's acid-base imbalance?
A) partially compensated Respiratory acidosis
B) uncompensated Metabolic alkalosis
C) fully compensated Metabolic acidosis
D) partially compensated Metabolic acidosis
2. A 65-year-old male with chronic obstructive pulmonary disease (COPD) and sepsis is
brought to the ER in respiratory distress. His ABG results are:
pH: 7.15
PaCO₂: 60 mmHg
HCO₃⁻: 16 mEq/L
What is the most likely acid-base disorder?
A) Respiratory acidosis with metabolic compensation
B) Metabolic acidosis with respiratory compensation
C) Mixed metabolic and respiratory acidosis
D) Mixed metabolic alkalosis and respiratory acidosis
3. A 60-year-old patient with chronic kidney disease and sepsis presents with confusion.
ABG:
pH: 7.20
PCO₂: 30 mmHg
HCO₃⁻: 12 mEq/L
Anion Gap (AG): 25
Which acid-base disorders are present?
A) High anion gap metabolic acidosis with respiratory alkalosis
B) High anion gap metabolic acidosis with respiratory acidosis
C) High anion gap partially compensated Metabolic acidosis
D) Normal anion gap uncompensated metabolic acidosis
4. A 45-year-old with COPD and vomiting presents with confusion. ABG:
pH: 7.52
PCO₂: 65 mmHg
HCO₃⁻: 44 mEq/L
What is the most likely diagnosis?
A) Acute respiratory acidosis
B) Metabolic alkalosis with respiratory compensation(partially compensated Metabolic alkalosis)
C) Mixed metabolic alkalosis and respiratory acidosis
D) Normal acid-base balance
5. Which of the following electrolytes must be closely monitored and often restricted in
patients undergoing hemodialysis?
A) Sodium
B) Potassium
C) Calcium
D) Magnesium
6. A 70-year-old female with ESRD misses her scheduled hemodialysis session and
presents with generalized weakness and palpitations. An ECG shows peaked T waves.
What is the most appropriate initial treatment?
A) Intravenous calcium gluconate
B) Sodium polystyrene sulfonate
C) Emergency dialysis
D) Intravenous insulin and glucose
7. During a hemodialysis session, a patient develops headache, nausea, and confusion.
Which of the following interventions is most appropriate?
A) Increase the dialysis flow rate
B) Administer antiemetics
C) Slow or stop dialysis
D) Provide analgesics
8. A 58-year-old female undergoing peritoneal dialysis presents to the emergency
department with a 2-day history of abdominal pain and cloudy peritoneal effluent. She
reports mild nausea but denies fever or chills. On examination, her abdomen is
diffusely tender without guarding or rebound tenderness. Laboratory analysis of the
peritoneal fluid reveals a white blood cell count of 1500 cells/μL with 80% neutrophils.
What is the most likely diagnosis?
A) Peritonitis
B) Catheter blockage
C) Hemoperitoneum
D) Electrolyte imbalance
9. A 55-year-old male presents to the emergency department with severe vomiting and
diarrhea for two days. Laboratory results reveal elevated blood urea nitrogen (BUN)
and creatinine levels. Which type of acute kidney injury (AKI) is most likely in this
patient?
A) Prerenal AKI
B) Intrinsic AKI
C) Postrenal AKI
D) Chronic kidney disease
10. A 45-year-old male with no significant medical history presents with sudden onset of
flank pain and hematuria. Imaging reveals hydronephrosis due to a ureteral stone.
What type of acute kidney injury is this patient at risk for?
A) Prerenal AKI
B) Intrinsic AKI
C) Postrenal AKI
D) Chronic kidney disease
11. A 60-year-old male with a history of diabetes and hypertension presents with decreased
urine output and confusion. Laboratory results show a BUN of 80 mg/dL and creatinine
of 4.5 mg/dL. Which of the following findings would most strongly suggest a diagnosis
of intrinsic renal failure?
A) Fractional excretion of sodium (FENa) <1%
B) Presence of muddy brown casts in urine sediment
C) Urine specific gravity >1.020
D) BUN to creatinine ratio >20:1
12. A 24-year-old pregnant woman at 20 weeks gestation presents with dysuria, urinary
urgency, and suprapubic pain. Urinalysis reveals pyuria and bacteriuria. Which of the
following is the most appropriate initial management?
A) Initiate nitrofurantoin therapy and provide symptomatic analgesia
B) Prescribe ciprofloxacin and schedule a follow-up in one week
C) Obtain urine cultures and initiate broad-spectrum intravenous antibiotics
D) Advise increased fluid intake and monitor symptoms
13. A 4+5-year-old male presents to the emergency department with complaints of swelling
in his legs, decreased urine output, and fatigue over the past week. His blood pressure is
160/95 mmHg, and physical examination reveals periorbital and pedal edema.
Laboratory results show elevated serum creatinine and blood urea nitrogen (BUN)
levels. Urinalysis indicates proteinuria and hematuria. A kidney biopsy confirms acute
glomerulonephritis. What is the most appropriate initial management for this patient?
A) Initiate high-dose corticosteroid therapy
B) Start angiotensin-converting enzyme (ACE) inhibitors
C) Administer diuretics and sodium/fluid restriction
D) Schedule urgent dialysis