Internal-Medicine

Questions: 44–62 165
On examination, his blood pressure is 100/50
mm Hg, pulse 100/min, and neck veins are not
visible. His urine sodium is 40 mEq/L and urine
osmolality is 330 mOsm/kg. (SELECT ONE)
54. A 65-year-old woman is admitted to the hospital
after a stroke resulting in left hemiparesis.
She has no trouble swallowing and is on a
full diet. One week later, on routine biochemistry,
her sodium is 128 mEq/L and osmolality
is 270 mOsm/kg. She has no symptoms
and is euvolemic on clinical examination.
Urine sodium is 40 mEq/L and urine osmolality
is 450 mOsm/kg. (SELECT ONE)
55. A 42-year-old man is on amitriptyline for
depression. Recently he has been feeling more
lethargic and unwell. His clinical examination
is normal. Serum sodium is 125 mEq/L and
osmolality is 260 mOsm/kg, and urine sodium
is 40 mEq/L and osmolality is 450 mOsm/kg.
(SELECT ONE)
56. A 32-year-old man is feeling unwell and
brought to the hospital. His serum sodium is
125 mEq/L. On examination, his blood pressure
is 110/70 mm Hg, pulse 110/min supine,
and sitting up causes him to feel light-headed
with a drop in his blood pressure. His urine
sodium is 5 mEq/L and urine osmolality is
800 mOsm/kg. (SELECT ONE)
57. A 57-year-old man is referred for assessment of
his low serum sodium of 125 mEq/L. On examination,
he has pitting edema and elevated neck
veins. His urine sodium is 10 mEq/L and urine
osmolality 350 mOsm/kg. (SELECT ONE)
58. A 63-year-old man is feeling unwell with symptoms
of increased thirst and voiding. He is not
taking any medications and there is no past
medical history. Physical examination is normal,
but his serum sodium is 130 mEq/L and serum
osmolality is 310 mOsm/kg. (SELECT ONE)
Questions 59 through 63
(A) lower gastrointestinal (GI) losses
(B) prior use of diuretics
(C)
(D)
(E)
(F)
(G)
RTA
current use of diuretics
malignant hypertension
primary hyperaldosteronism
glucocorticoid excess
For each patient with hypokalemia, select the most
likely diagnosis.
59. A 30-year-old woman is having symptoms of
muscle weakness and fatigue. On examination,
her blood pressure is 120/80 mm Hg,
pulse 80/min, JVP 4 cm, heart sounds normal,
and lungs clear. Her serum potassium level is
2.5 mEq/L, and bicarbonate 30 mEq/L. The
urine potassium is 10 mEq/L. (SELECT ONE)
60. A 55-year-old man is having symptoms of
muscle weakness and fatigue. He has poorly
controlled asthma and recently had an exacerbation.
On examination, his blood pressure is
160/90 mm Hg, pulse 80/min, JVP 4 cm, heart
sounds normal, and lungs clear. His serum
potassium level is 2.5 mEq/L and bicarbonate
30 mEq/L. The urine potassium is 40 mEq/L.
Plasma renin and aldosterone levels are low.
(SELECT ONE)
61. A 44-year-old woman is having symptoms of
muscle weakness and fatigue. On examination,
her blood pressure is 120/80 mm Hg, pulse
80/min, JVP 4 cm, heart sounds normal, and
lungs clear. Her serum potassium level is 2.5
mEq/L, bicarbonate 18 mEq/L, and anion gap
is normal. The urine potassium is 40 mEq/L.
(SELECT ONE)
62. A 30-year-old man is having symtoms of
muscle weakness, fatigue, and headaches. On
examination, his blood pressure is 180/100
mm Hg, pulse 80/min, JVP 4 cm, heart
sounds normal, and lungs clear. His serum
potassium level is 2.5 mEq/L and bicarbonate
30 mEq/L. The urine potassium is 40 mEq/L.
Plasma renin is low and aldosterone is high.
(SELECT ONE)