Physician CME Questions (Regular Issue)
11. Which one of the following statements concerning crystalloid solutions is correct?
A. Crystalloids are restricted to the intravascular space.
B. The distribution of crystalloid solutions is determined by their sodium concentration.
C. When a crystalloid solution containing isotonic concentrations of sodium is infused, one-fourth of the volume will pass into the interstitial space.
D. Crystalloid solutions containing dextrose always must be used.
12. Which one of the following statements concerning lactated Ringer’s solution is correct?
A. Ringer’s lactate solution does not influence serum osmolality.
B. Ringer’s lactate solution is retained in the intravascular space to a greater extent than normal saline.
C. Ringer’s lactate solution has a more physiologic concentration of chloride.
D. Ringer’s lactate solution should be avoided in children because they cannot metabolize the infused lactate.
13. Which one of the following statements concerning hypertonic saline solutions is correct?
A. The effects of hypertonic saline are confined to volume expansion.
B. The intravascular persistence of hypertonic saline can be extended by mixing it with a colloid.
C. Hypertonic saline solutions do not enter the interstitial space.
D. The infusion of hypertonic saline solution will not increase plasma sodium concentration.
14. Human albumin infusions are frequently used in the volume resuscitation of patients in shock. Which one of the following statements concerning albumin is correct?
A. Infusion of albumin solutions has no influence on the patient’s acid-base balance.
B. Anaphylactoid reactions to albumin are higher than the synthetic colloids.
C. Serious adverse events in patients receiving albumin are common.
D. Albumin may possess direct anti-inflammatory properties independent of its antioxidant effects.
15. Which one of the following statements concerning colloid solutions is correct?
A. Fresh frozen plasma is recommended for routine fluid resuscitation.
B. Compared to crystalloids, colloids have greater intravascular persistence.
C. Gelatin solutions have the lowest incidence of anaphylactoid reactions.
D. A wide variety of hydroxyethyl starch solutions are available for use in the United States.
16. Which of the following statements concerning oxygen-carrying resuscitation fluids is correct?
A. The critical hemoglobin level can only be defined for specific situations and disease states.
B. Red-cell substitutes will be useful even when long-term oxygen-carrying capacity is needed.
C. Perfluorocarbons do not require supplemental oxygen to be effective.
D. When the hemoglobin concentration falls below 10 g/dL, transfusion of blood is required.
17. Review of the recent literature supports which one of the following statements?
A. Albumin should be abandoned as a resuscitation fluid.
B. Human albumin has an excellent long-term safety record.
C. Ringer’s lactate is the ideal resuscitation fluid.
D. Dextrose containing solutions can be safely used as resuscitation fluids.
18. A 1-year-old presents with fever and a heart rate of 187 beats/min. The capillary refill is prolonged. The initial fluid bolus should be:
A. 20 cc/kg D5W.
B. 20 cc/kg D5 .45NS.
C. 20 cc/kg .9NS.
D. 20 cc/kg whole blood.
19. Following agressive resuscitation of a child with meningococcemia (120 cc/kg of .9NS) the patient develops a worsening metabolic acidosis and base deficit. The heart rate is normal, perfusion is normal, and urine output is 1 cc/kg/h. The most likely explanation is:
A. tissue hypoperfusion.
B. hyperchloremic acidosis.
C. hypovolemia.
D. lactic acidosis.
20. The most important aspect of correction of metabolic acidosis is:
A. treatment of the underlying problem.
B. withholding bicarbonate administration for a patient with normal anion gap and a normal sodium concentration.
C. administering 2 mEq/kg of bicarbonate to patients with lactic acidosis.
D. administering 2-4 mEq/kg of bicarbonate with the first fluid bolus for any patient with evidence of hypoperfusion.
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