Physicians may receive up to three credit hours in Category 1 for the Physician's Recognition Award of the American Medical Association by reading the material in this issue and successfully answering the questions in the quiz below. To obtain credits, follow these instructions.
1 . Read each off the articles carefully. Do not neglect the tables and other illustrative materials, as they have been selected to enhance your knowledge and understanding.
2. The following questions have been designed to provide a useful link between the articles in the issue and your everyday practice. Read each question, choose the correa answer, and record your answer on the CME Registration Form at the end of the quiz. Retain a copy of your answers so that they can be compared with the correct answers that will be sent to you later.
3. Type or print your full name and address and your Social Security number in the spaces provided on the CME Registration Form.
4. Send the completed form, with your check or money order for $25 made payable to the University of Missouri, 1 1 7 Old Alumni Ctr. DCO345.00 Columbia, MO 652 1 2.
5. Your answers will be graded, and you will be advised that you have passed (or failed). An answer sheet containing all correct answers will be mailed to you. Review the parts of the articles dealing with any questions you have missed, and read the supplemental material on this aspect of the subject listed in the references in this issue.
6. Be sure to mail the form on or before the deadline listed on the CME Registration Form so that credit can be awarded. (After that date, the quiz will close, and correct answers will appear in the journal.) Unanswered questions will be considered incorrect and so scored. A minimum score of 70 must be obtained in order for credits to be awarded.
The Office of Continuing Education, School of Medicine. University of Missouri-Columbia is accredited by the Accreditation Council for Continuing Medical Education (ACCME] to provide CME programs for physicians. This activity is designated for up to 3 hours of credit for the Physician's Recognition Award.
Fluids and Electrolytes
1 . The percentage of total body mass that extracellular fluid (plasma fluid and interstitial fluid) comprises is approximately:
2. Maintenance fluid volume for a 12-fcg child under normal conditions would be:
A. 600 mL
3. All off the following statements about fluid and electrolyte requirements are true except:
A. Insensible water losses are essentially electrolyte free.
B. The urinary tract is the major source of insensible water loss.
C. Normal kidneys can adjust the electrolyte composition of the urine under various abnormal conditions.
D. Extracellular volume depletion is primarily all saline depletion.
4. A child with diarrhea, weight loss, hypotension, oliguria, and a hematocrit of 55% likely has a volume depletion of about:
5. A 16-kg child with 15% volume depletion requires deficit correction of:
B. 500 mL of D61Jb NS.
C. 240OmL of D661A" NS.
6. The percentage of the Altered load of bicarbonate (HC03) that is reabsorbed in the proximal tubule approximates:
A. 35% to 45%.
B. 60% to 65%.
C. 70% to 75%.
D. 80% to 90%.
7. The most prominent feature of proximal renal tubular acidosis (RTA) is:
A. Failure to thrive
B. Muscle weakness.
C. Metabolic bone disease.
8. All of the following are major causes of distal (type 1 ) RTA except:
A. Nephrotic syndrome.
B. Sickle-cell anemia.
C. Autoimmune disorders.
D. Primary hyperparathyroidism.
9. A positive urinary anion gap is found in:
A. Proximal RTA.
B. Interstitial nephritis.
C. Hypocalcemia and Vitamin D de ciency.
10. Hypoparathyroidism should Ii suspected in a child with any or all ? the following electroyte disturbance except:
C. Decreased serum magnesium.
D. Absent or diminished parathyro hormone.
1 1 . You are asked to examine a year-old girl who has frequent dysurl and abdominal pain. Her urine cultui Is sterile, but you observe persistei microhematuria on several urinafyse blood urea nitrogen, creatinine, eta trofytes, calcium, and renal ultrasour are all normal. The test that will mo likely reveal the source of her hem turia is:
A. Intravenous pyelogram.
B. Calcium to creatinine ratio on a spj urine sample.
C. Platelet count.
D. Parathyroid hormone level.
1 2 . Initial therapy for a patient wh] normocalcemic hypercalciuria is:
A. Dietary salt restriction.
B. Strict reduction of dietary calcium far less than the recommended da allowance.
13. Hypomagnesemia may occur all of the following except:
A. Premature infants with apnea.
B. Malabsorption syndromes.
C. Infants with significant intrauterin growth retardation.
D. Children with chronic renal failure.
14. All off the following EKG c hang are associated with hyperkalemia cepr.
A. Narrow peaked T waves.
B. Shortened QT interval.
C. Wide QRS.
D. Elevated ST segment.
15. Of the following therapies f symptomatic hyperkalemia, the ?? that has the most rapid effect on stai lizing resting membrane potential is
A. Intravenous bicarbonate therapy.
B. Intravenous calcium therapy.
C. Intravenous glucose.
16. AJf off the following statement about potassium (K+) balance are tr except:
A. Potassium excretion occurs mairi through the gastrointestinal tract.
B. Aldosterone is necessary for both ? mal and augmented K+ secretion.
C. The ratio of the K+ concentration rJ tween the intracellular fluid and t extracellular fluid is the major deten nant of the resting electrical poten: across the ceil membrane.
D. Profound potassium depletion may cause muscle cramps, rhabdomyolsis, and myglobinuria.
17. All of the following are high food sources of potassium except:
1 8. All of the following statements about osmolality and the regulation of tonicity are true except:
A. Sodium is the major osmoticaliy active solute in extracellular fluid.
B. Tonicity rather than osmolality is the key most important physiologic parameter in assessment.
C. Regulation of tonicity of the extracellular fluid is maintained by osmoreceptors in the suprasellar region of the brain.
D. An increase of osmolality of only 1% leads to stimulation of thirst and antidiuretic hormone (ADH) release.
19. The syndrome of inappropriate secretion of ADH (SIADH):
A. Is characterized by volume depletion and an "inapropriate" volume stimulus to ADH despite hyptonicity.
B. Is best treated by administration of hypertonic saline.
C. Results in both increased total body sodium and increased total body water.
D. Is commonly seen with acute central nervous system or pulmonary infections.
20. Hypernatremic dehydration:
A. Results in urinary (Na) greater than 20 mEq/L.
B. May be seen in infants with diarrhea and high insensible water losses.
C. Should be treated with rapid hypotonic fluid administration to minimize the effects of brain cell shrinkage.
D. Is a common complication of exogenous ADH administration.
Answers to the October Quiz Infectious Diarrhea