Examkin

Question

Difficulty: MediumGeneral Internal Medicine

Match the following clinical scenarios with their most likely primary acid-base disturbance.

  • A 22-year-old man with polyuria, abdominal pain, Kussmaul respirations, and a blood glucose of 450450 mg/dL.High anion gap metabolic acidosis
  • A 68-year-old man with a severe exacerbation of chronic obstructive pulmonary disease and worsening somnolence.Primary respiratory acidosis
  • A 45-year-old woman with intractable vomiting for 33 days due to a suspected gastric outlet obstruction.Hypochloremic metabolic alkalosis
  • A 30-year-old woman with acute shortness of breath, perioral numbness, and carpopedal spasm following a stressful event.Primary respiratory alkalosis

Answer

The clinical scenarios correctly match their corresponding primary acid-base disturbances based on their distinct pathophysiological mechanisms (e.g., ketoacid accumulation, hypoventilation, gastric acid loss, and hyperventilation).
Each matching pair correctly identifies the cardinal acid-base disturbance associated with the patient's acute pathology. Diabetic ketoacidosis generates unmeasured anions (metabolic acidosis). Hypoventilation in COPD retains CO2CO_2 (respiratory acidosis). Gastric acid loss from vomiting removes HClHCl (metabolic alkalosis). Hyperventilation from a panic attack expires excess CO2CO_2 (respiratory alkalosis).

Step-by-Step Solution

1
Identify the underlying mechanism of acid-base disruption in each clinical vignette.
Diabetic ketoacidosis produces ketoacids, severe COPD impairs ventilation, vomiting depletes gastric acid, and panic attacks cause hyperventilation.
Determining the primary physiological insult is required to identify the initial acid-base disorder.

Key Concept

Pathophysiology and identification of primary acid-base disorders
Rate this question

Topics

General Internal Medicine

More questions from this topic