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  • Question 1 - A 54-year-old man is found collapsed in the street and is brought to...

    Correct

    • A 54-year-old man is found collapsed in the street and is brought to the A&E. The results from the blood tests reveal Calcium = 1.62mmol/l and Albumin = 33 g/l. The man is known to have a history of alcoholic liver disease. Which of the following is the best management regarding his calcium levels?

      Your Answer: 10ml of 10% calcium gluconate over 10 minutes

      Explanation:

      Acute, symptomatic hypocalcaemia is treated with 10ml of 10% calcium gluconate over 10 minutes.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      39.7
      Seconds

  • Question 2 - A 70-year-old male came to the OPD with complaints of nocturia, difficulty in...

    Incorrect

    • A 70-year-old male came to the OPD with complaints of nocturia, difficulty in initiating urination and continuous dribbling of urine afterwards. A transrectal US guided biopsy was performed and the diagnosis of BPH was made. His TURP was planned. Which of the following electrolyte imbalance is most likely to occur?

      Your Answer: Hyperkalaemia

      Correct Answer: Hyponatremia

      Explanation:

      In a TURP procedure, fluid is used to irrigate the bladder and to remove blood clots. IV fluids are also given to the patient post-operatively. These factors will lead to dilutional hyponatremia.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      23.5
      Seconds

  • Question 3 - A 32-year-old male presents to the emergency after being involved in a horrific...

    Correct

    • A 32-year-old male presents to the emergency after being involved in a horrific fire incident at home with 55% burns over is trunk, back and arms. He has an episode of 300ml of hematemesis which prompts endoscopy. Endoscopy reveals several ulcers in the stomach. How would you manage this patient?

      Your Answer: IV PPI

      Explanation:

      Curling’s ulcer is an acute gastric erosion resulting as a complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa. The medical management of patients with stress ulcers is more or less similar to the management of peptic ulcer disease in general. The medication targeting acid peptic disease includes proton pump inhibitors, antihistamines, and ulcer-healing drugs like sucralfate. Patients with overt GI bleeding from ulceration will require endoscopic evaluation and management of the stress ulcers. Endoscopic therapies may include epinephrine injection, electro-cauterization, or clipping of the bleeding vessels. Bleeding ulcers refractory to localized endoscopic treatment may need embolization of the culprit vessel or rarely surgical intervention as a last resort. Surgical interventions are commonly indicated for patients with refractory bleeding despite endoscopic or angiographic treatment or patients with unstable hemodynamics to undergo endoscopic or angiographic procedures. Surgeries are performed as an ultimate life-saving approach.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      50
      Seconds

  • Question 4 - A 54-year-old female patient presents with a one week history of bloody diarrhoea,...

    Incorrect

    • A 54-year-old female patient presents with a one week history of bloody diarrhoea, fever and abdominal pain. She has a history of rheumatoid arthritis which she controls with methotrexate. Her stool sample shows Campylobacter jejuni. What is the single most appropriate management?

      Your Answer: Fluids alone

      Correct Answer: Fluids + clarithromycin

      Explanation:

      This woman is receiving methotrexate, an immunosuppressant, to control her rheumatoid arthritis. In such immunocompromised patients, BNF suggests clarithromycin as first-line management.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      41.5
      Seconds

  • Question 5 - A 19-year-old lady with established anorexia nervosa is admitted with a BMI of...

    Correct

    • A 19-year-old lady with established anorexia nervosa is admitted with a BMI of 16. However, she gives the consent to be fed by a nasogastric tube. Which of the following electrolyte disturbances are you most likely to find?

      Your Answer: Hypophosphataemia

      Explanation:

      Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally). These shifts result from hormonal and metabolic changes and may cause serious clinical complications. The hallmark biochemical feature of refeeding syndrome is hypophosphatemia. However, the syndrome is complex and may also feature abnormal sodium and fluid balance; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalaemia; and hypomagnesaemia.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      27.1
      Seconds

  • Question 6 - A 69-year-old woman is admitted with confusion. She's known to have a history...

    Correct

    • A 69-year-old woman is admitted with confusion. She's known to have a history of multiple myeloma. Blood exam reveals the following: Na+ = 147 mmol/l, K+ = 4.7 mmol/l, Urea = 14.2 mmol/l, Creatinine = 102 μmol/l, Adjusted calcium = 3.9 mmol/l. What is the single most appropriate management?

      Your Answer: IV 0.9% saline

      Explanation:

      NICE guidelines on hypercalcemia recommend that maintaining good hydration equals drinking 3-4 L of fluid/day, provided there are no contraindications. A low calcium diet is not necessary because intestinal absorption of calcium is reduced. The patient should avoid any other drugs or vitamins that could worsen the hypercalcemia. Mobilization is encouraged and any symptoms of hypercalcemia should be reported.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      47.7
      Seconds

  • Question 7 - A 57-year-old male presented to the OPD with a complaint of yellow discoloration...

    Incorrect

    • A 57-year-old male presented to the OPD with a complaint of yellow discoloration of his skin. On examination, he was found to have digital clubbing, jaundice, an enlarged and nodular liver, as well as caput medusa. Clinical investigations revealed normal electrolyte levels but low albumin levels. Which of the following is the appropriate management of this patient's fluid intake?

      Your Answer: Oral fluids

      Correct Answer: Albumin infusion

      Explanation:

      This patient has an accumulation of fluid inside his body which, along with the lowered albumin level, tells us that the oncotic pressure of the blood is very low in this patient. Therefore, albumin infusion is the best option for him because albumin is the key human protein that contributes the most to the oncotic pressure.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      100.8
      Seconds

  • Question 8 - A 27-year-old male is admitted after drinking engine coolant in an apparent suicide...

    Incorrect

    • A 27-year-old male is admitted after drinking engine coolant in an apparent suicide attempt.

      Lab investigations reveal:
      pH 7.1 (7.36-7.44)
      pO2 15.3 kPa (11.3-12.6)
      pCO2 3.2 kPa (4.7-6.0)
      Standard bicarbonate 2.2 mmol/L (20-28)
      Serum calcium 1.82 mmol/L (2.2-2.6)

      After replacing calcium, which of the following is the most urgent treatment for this man?

      Your Answer: Haemodialysis

      Correct Answer: 8.4% bicarbonate infusion

      Explanation:

      Carbon monoxide has high affinity for haemoglobin and myoglobin resulting in a left-shift of the oxygen dissociation curve and tissue hypoxia. There are approximately 50 deaths per year from accidental carbon monoxide poisoning in the UK. In these circumstances, antidotal therapy to block alcohol dehydrogenase with ethanol or 4-MP alone is insufficient to treat the poisoning. Data suggest that a severe lactic acidosis needs initial correction and in this patient the most appropriate treatment would be IV fluids with bicarbonate to correct the metabolic acidosis. Haemodialysis may be required thereafter.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      94.2
      Seconds

  • Question 9 - A 48-year-old male with a history of bipolar disorder presents with acute...

    Incorrect

    • A 48-year-old male with a history of bipolar disorder presents with acute confusion. In-transit to hospital he had a generalized seizure which terminated spontaneously after around 30 seconds. On arrival to the emergency department, his GCS is 14/15 and he is noted to have a coarse tremor. Suspecting a diagnosis of lithium toxicity, intravenous access is obtained, a blood sample was drawn for investigations and a saline infusion is started. The blood investigations revealed:

      Lithium level: 4.2 mmol/l
      Na+: 136 mmol/l
      K+: 4.6 mmol/l
      Urea: 8.1 mmol/l
      Creatinine: 99 µmol/l
      Bicarbonate: 18 mmol/l

      What is the most appropriate management for the patient?

      Your Answer:

      Correct Answer: Arrange haemodialysis

      Explanation:

    • This question is part of the following fields:

      • Fluids & Electrolytes
      0
      Seconds

  • Question 10 - Choose the correct statement regarding hyponatremia: ...

    Incorrect

    • Choose the correct statement regarding hyponatremia:

      Your Answer:

      Correct Answer: Hyperlipidaemia may cause pseudohyponatraemia

      Explanation:

      The Hyperlipidaemia Effect: Pseudohyponatremia in Pancreatic Cancer; Patients who have disorders of cholestasis commonly present with volume depletion due to vomiting and poor oral intake, which, in turn, often leads to hypovolemic hyponatremia. It is less well known that disorders of cholestasis, including tumours of the hepatobiliary system, can be accompanied by hyperlipidaemia.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      0
      Seconds

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Fluids & Electrolytes (4/8) 50%
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