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Clin Lab Med - Electrolytes / Pleural Fluid

Total questions: 81

Worksheet time: 43mins

Name
Class
Date
1.

A pleural effusion is an _______ accumulation of a significant volume of fluid in the pleural space.

a)

abnormal

b)

normal

2.

Milky white pleural fluid

a)

should be centrifuged

b)

signifies emphyema

c)

suggests a chylous effusion

d)

often from traumatic disruption of the thoracic duct

e)

hemorrhagic pleural effusion

3.

empyema

a)

abnormal accumulation of a significant volume of fluid in the pleural space

b)

infection of the pleural space

4.

occur in the setting of normal capillary integrity and suggest the absence of local pleural disease. 90% CHF

a)

Transudates

b)

Exudates

5.

form as a result of pleural disease associated with increased capillary permeability or reduced lymphatic drainage

a)

Transudates

b)

Exudates

6.

________ and ________are the most common causes of exudative effusion.

a)

Bacterial pneumonia

b)

cancer

c)

COPD

d)

asthma

7.

Transudative pleural effusions characteristically occur in the ________ of pleural disease.

a)

absence

b)

presence

8.

Pleural fluid analysis -- glucose


<30 mg/dL (0-10):

a)

Rheumatoid

b)

TB, malignancy, SLE

9.

Pleural fluid anaylsis -- glucose


30 - 50 mg/dL:

a)

Rheumatoid

b)

TB, malignancy, SLE

10.

Pleural fluid analysis -- pH ***


pH < 7.30

a)

ALWAYS means EXUDATE (empyema, rheumatoid, TB, malignancy, SLE)

b)

consistent with esophageal rupture --> coming from GI tract

c)

transudates

11.

Pleural fluid analysis -- pH ***


pH < 6.0

a)

ALWAYS means EXUDATE (empyema, rheumatoid, TB, malignancy, SLE)

b)

consistent with esophageal rupture --> coming from GI tract

c)

transudates

12.

Pleural fluid analysis -- pH ***


pH > 7.30

a)

ALWAYS means EXUDATE (empyema, rheumatoid, TB, malignancy, SLE)

b)

consistent with esophageal rupture --> coming from GI tract

c)

transudates

13.

Pleural fluid analysis -- pH ***


Collagen vascular disease is the only other cause for pH

a)

< 7.0

b)

> 7.0

14.

Total WBC count is almost _____ diagnostic.

a)

never

b)

always

15.

Pleural fluid analysis -- cell count WBC


WBC >10,000

a)

inflammation (mc with pneumonia, pulmonary infarct, pancreatitis, post cardiotomy)

b)

parapneumonic effusions, usually empyema

c)

Chronic exudates (malignancy / TB)

d)

Transudates

16.

Pleural fluid analysis -- cell count WBC


WBC >50,000

a)

inflammation (mc with pneumonia, pulmonary infarct, pancreatitis, post cardiotomy)

b)

parapneumonic effusions, usually empyema

c)

Chronic exudates (malignancy / TB)

d)

Transudates

17.

Pleural fluid analysis -- cell count WBC


WBC < 5,000

a)

inflammation (mc with pneumonia, pulmonary infarct, pancreatitis, post cardiotomy)

b)

parapneumonic effusions, usually empyema

c)

Chronic exudates (malignancy / TB)

d)

Transudates

18.

Pleural fluid analysis -- cell count WBC


WBC < 1,000

a)

inflammation (mc with pneumonia, pulmonary infarct, pancreatitis, post cardiotomy)

b)

parapneumonic effusions, usually empyema

c)

Chronic exudates (malignancy / TB)

d)

Transudates

19.

Pleural fluid analysis -- cell count RBC


_______ needed to give red tinged appearance

a)

5,000-6,000

b)

10,000-20,000

c)

100,000-200,000

d)

50,000-60,000

20.

Pleural fluid analysis -- cell count RBC

can be caused by:

a)

needle trauma

b)

age

c)

anemias

d)

emphyema

21.

Pleural Fluid analysis -- cell count RBC


grossly hemorrhagic and suggests malignancy, pulmonary infarct, or trauma (occasionally seen in CHF)

a)

> 100,000

b)

< 100,000

c)

> 5,000

d)

< 5,000

22.

Pleural fluid analysis -- cell count RBC

___________ suggests trauma, bleeding from vessel, bleeding disorder or malignancy

a)

venous Hematocrit ratio > 2

b)

venous Hematocrit ratio < 2

23.

_________ differentiates PMNs from mononuclear cells. Cannot differentiate lymphocytes from monocytes

a)

Wright stain

b)

Light stain

24.

Pleural fluid analysis -- smears

Mononuclear cells

>50%

a)

1/3 transudates and in chronic exudates (lymphoma, TB, viral/fungal infections, malignant, rheumatoid, uremia)

b)

seen in 2/3 cancer cases

c)

suggest TB, lymphoma, sarcoidosis, rheumatoid, chylo- also seen after CABG)

25.

Pleural fluid analysis -- smears

Mononuclear cells

85-90%

a)

1/3 transudates and in chronic exudates (lymphoma, TB, viral/fungal infections, malignant, rheumatoid, uremia)

b)

seen in 2/3 cancer cases

c)

suggest TB, lymphoma, sarcoidosis, rheumatoid, chylo- also seen after CABG)

26.

Pleural fluid analysis -- smears

PMNs predominate in _____________________ (pneumonia, pulmonary infarct, pancreatitis, subphrenic abscess)

a)

early inflammatory effusions

b)

late inflammatory effusions

27.

LDH -- Light's Criteria ***

Only need 1 of 3 to be considered ______

a)

EXUDATIVE

b)

TRANSUDATIVE

28.

Light's criteria ***

a)

Pleural fluid LDH / serum LDH > 0.6

b)

Pleural fluid protein / serum protein > 0.5

c)

pleural fluid LDH > 2/3 upper limit of normal serum LDH

d)

Pleural fluid protein / serum protein > 0.6

e)

Pleural fluid LDH / serum LDH > 0.5

29.

For pt. w/ high suspicion for transudate, but meets Light’s criteria ***

a)

order serum albumin

b)

Pleural albumin <1.2 mg/dL to confirm if exudative

c)

order serum glucose

d)

Pleural albumin <30 mg/dL to confirm if exudative

30.

Hyponatremia is a problem of

a)

water balance

b)

sodium balance

31.

Hyponatremia classifications: ***

Hypovolemic

a)

dry

b)

not overloaded, not dehydrated

c)

fluid overload; wet

32.

Hyponatremia classifications: ***

Euvolemic

a)

dry

b)

not overloaded, not dehydrated

c)

fluid overload; wet

33.

Hyponatremia classifications: ***

Hypervolemic

a)

dry

b)

not overloaded, not dehydrated

c)

fluid overload; wet

34.

History of hepatic cirrhosis, congestive heart failure, or nephrotic syndrome ***

a)

Hypervolemic

b)

Euvolemic

c)

Hypovolemia

35.

PE findings: JVD, crackles, peripheral edema, ascites ***

a)

Hypervolemic

b)

Euvolemic

c)

Hypovolemia

36.

SIADH ***

a)

Hypervolemic

b)

Euvolemic

c)

Hypovolemia

37.

Excess fluid losses ***

a)

Hypervolemic

b)

Euvolemic

c)

Hypovolemia

38.

Severe Hyponatremia

a)

125-135meq/L

b)

120-125meq/L

c)

<120meq/L

d)

<120meq/L w/ Seizures

e)

>145 mEq/L

39.

Life-threatening hyponatremia

a)

125-135meq/L

b)

120-125meq/L

c)

<120meq/L

d)

<120meq/L w/ Seizures

e)

>145 mEq/L

40.

An increase in serum sodium of 4-6 mEq/L (do NOT go above 9) in 24 hours is generally sufficient ***

a)

Hypervolemia tx

b)

Euvolemic tx

c)

Hypovolemia tx

41.

Slow, cautious correction of serum sodium in these patients is important ***

a)

Hyponatremia

b)

Hypernatremia

c)

Hypokalemia

d)

Hyperkalemia

42.

Pseudohyponatremia = In certain cases, the plasma sodium concentration will be falsely reduced since the specimen contains less plasma water.

Can be seen in ***

a)

hyperglycemia

b)

hyperlipidemia

c)

hyperproteinemia

43.

suspect in any patient with hyponatremia, hypoosmolality and urine osmolality >100 mosmol/kg

a)

SIADH

b)

Diabetes Insipidus

44.

Causes of SIADH

a)

Adrenal insufficiency

b)

Hypothyroidism

c)

Any CNS disorder that increases ICP

d)

Tumor (Small Cell Lung CA)

e)

Mono

45.

Causes of SIADH

a)

Drugs

b)

Major Surgery

c)

Pulmonary

d)

Dermatologic infection

e)

Mono

46.

Iatragenic dz most of the time

a)

Hyponatremia

b)

Hypernatremia

c)

Hypokalemia

d)

Hyperkalemia

47.

Most common cause is inadequate access to water. (I.e. intubated, sedated, restrained patient).

a)

Hyponatremia

b)

Hypernatremia

c)

Hypokalemia

d)

Hyperkalemia

48.

Low URINE Na and polyuria ***

a)

SIADH

b)

Diabetes Insipidus

49.

This impairs water excretion but sodium continues to be excreted normally (hypotonic hyponatremia)

a)

SIADH

b)

Diabetes Insipidus

50.

Neurogenic DI

a)

deficient section of ADH from post pituitary

b)

kidneys unresponsive to nl vasopressin levels

51.

Nephrogenic DI

a)

deficient section of ADH from post pituitary

b)

kidneys unresponsive to nl vasopressin levels

52.

■If the patient has dilute urine with hypernatremia there is increased renal loss. (kidneys cannot preserve water)

■Usually pts will have polyuria (12L /day) and polydipsia

a)

SIADH

b)

Diabetes Insipidus

53.

Urine osmolality <250 mOsm/kg, despite hypernatremia

a)

SIADH

b)

Diabetes Insipidus

54.

Non-reabsorbed solute such as glucose, mannitol or urea increases the output of urine

a)

Diabetes Insipidus

b)

Osmotic Diuresis

55.

Hpokalemia: caused by 3 different mechanisms -->

a)

Pulmonary insufficiency

b)

Cellular shift

c)

Renal Loss

d)

Extrarenal loss

56.

Diuretic use is the most common cause

a)

Hyponatremia

b)

Hypernatremia

c)

Hypokalemia

d)

Hyperkalemia

57.

Severe hypokalemia

a)

Less than 4.0

b)

Less than 3.0

c)

Greater than 4.0

d)

Greater than 3.0

58.

Hypokalemia tx

a)

Replace Potassium!!

b)

Oral preferred method

c)

IV preferred method

d)

Diuretics

59.

Hypokalemia: NEVER PUSH IV POTASSIUM ***

a)

True

b)

False

60.

Make sure to also order Mg

a)

Hyponatremia

b)

Hypernatremia

c)

Hypokalemia

d)

Hyperkalemia

61.

__________ precipitates digoxin toxicity by potentiating the effects of cardiac glycosides on myocardial conduction

a)

Hyponatremia

b)

Hypernatremia

c)

Hypokalemia

d)

Hyperkalemia

62.

Hemolysis is usually the cause of

a)

pseudo hyponatremia

b)

pseudo hypernatremia

c)

pseudo hypokalemia

d)

pseudo hyperkalemia

63.

Severe hyperkalemia

a)

5.5-6.0 meq/L

b)

>7.0 meq/L

c)

<7.0 meq/L

64.

EKG

■Changes seen in approximately 50% of patients

■Peaked T waves ® Widen QRS ® Junctional

a)

Hyponatremia

b)

Hypernatremia

c)

Hypokalemia

d)

Hyperkalemia

65.

Hyperkalemia tx: EMERGENT

a)

IV Calcium

b)

IV Glucose/Insulin

c)

IV Sodium Bicarbonate

d)

IV Potassium

66.

■50-60% in ICU patients

■30-80% in alcoholics

a)

Hypomagnesemia

b)

Hypermagnesia

c)

Hypercalcemia

d)

Hypocalcemia

67.

Magnesium goal for anyone w heart related issues

a)

1 mEq/L

b)

1.5 mEq/L

c)

2 mEq/L

d)

3 mEq/L

68.

Hypermagnesemia

Magnesium concentration ______ is panic level

a)

< 2 mg/dl

b)

> 2 mg/dl

c)

> 5 mg/dl

d)

< 3

69.

“Stones, bones, abdominal moans, and psychic groans “ ***

a)

Hypomagnesemia

b)

Hypermagnesia

c)

Hypercalcemia

d)

Hypocalcemia

70.

■Malignancy and primary hyperparathyroidism cause 90% of cases

■Medications next most common cause

a)

Hypomagnesemia

b)

Hypermagnesia

c)

Hypercalcemia

d)

Hypocalcemia

71.

Volume Expansion #1 therapy. NS is choice.

(Emergent tx)

a)

Hypomagnesemia

b)

Hypermagnesia

c)

Hypercalcemia

d)

Hypocalcemia

72.

50% of circulating calcium is protein bound ***

a)

True

b)

False

73.

Chovstek sign and/or Trousseau sign can indicate:

a)

Hypomagnesemia

b)

Hypermagnesia

c)

Hypercalcemia

d)

Hypocalcemia

74.

facial twitch elicited by tapping jaw with a reflex hammer

a)

Chovstek sign

b)

Trousseau sign

75.

carpal spasm after three minutes of inflation of a pressure cuff of 20mmhg above patients systolic pressure. Very Specific.

a)

Chovstek sign

b)

Trousseau sign

76.

Movement disorders (such as Chorea and Dystonias) can indicate:

a)

Hypomagnesemia

b)

Hypermagnesia

c)

Hypercalcemia

d)

Hypocalcemia

77.

Severe hypophosphatemia

a)

1.0 - 2.5 mg/dL

b)

< 1 mg/dl

c)

> 1 mg/dl

78.

MC secondary to CKD

a)

Hypercalcemia

b)

Hypocalcemia

c)

Hypophosphatemia

d)

Hyperphosphatemia

79.

treated with dietary phosphorous restriction and oral phosphate binders

a)

Hyperphosphatemia

b)

Hypophosphatemia

80.

Tx: replete orally or IV (Na or KPhos)

a)

Hyperphosphatemia

b)

Hypophosphatemia

81.

Severe _________ may lead to rhabdomyolysis, parathesia, encephalopathy; diaphragmatic paralysis

a)

Hypercalcemia

b)

Hypocalcemia

c)

Hypophosphatemia

d)

Hyperphosphatemia

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