PAEA GENERAL SURGERY EOR EXAM
LATEST STUDY KIT WITH EXAM
QUESTIONS WITH VERIFIED DETAILED
ANSWERS (GRADED A+)
what are the signs/symptoms of mild-severe hyponatremia?
Correct Answer mild- nausea/malaise
mod- HA/AMS
sev- herniation/coma
what tests do we run for hyponatremia? Correct Answer BMP
(what you ran first that showed you hyponatremia), then serum
osmolarity (to determine if it is iso/hypo/hypertonic hyponatremia),
urine Na
what is on the differential for isotonic hyponatremia? Correct
Answer (just a lab error)
1. hyperproteinemia
2. hyperlipidemia
what is on the differential for hypertonic hyponatremia? Correct
Answer 1. hyperglycemia
2. mannitol, sorbitol, glycerol, maltose in blood
3. radiocontrast agents (IV dye)
hypertonic hyponatremia can be pseudohyponatremia in diabetic
patients because? how is the false hyponatremia corrected for?
Correct Answer the lab's laser cannot correctly read the actual
amt of Na due to all the glucose being in the way
SO, you must correct for this with a calculation: if S(Na) is 121
and BS is 400 you add 2 to the Na level for ever 100 over 200...
so corrected Na level is 121 + 4 = 125
,(you do this so you don't overcorrect the Na and put them into
central pontine myelinolysis)
what is on the differential for hypotonic hyponatremia? Correct
Answer -hypovolemic: diuretics, dehydration, diarrhea, vomiting,
burns
-euvolemic: SIADH, hypothyroidism, adrenal insufficiency, water
intoxication
-hypervolemic: heart/liver failure, nephrotic syndrome
*figure out their volume status by PE (mucous membranes,
turgor, etc)
how do you treat hypo/eu/hypervolemic hyponatremia when it is
chronic/asymptomatic? Correct Answer hypovol- NS 0.9%
euvol- free water restriction
hypervol- loop diuretics or dialysis
for severe/symptomatic hyponatremia how much of an increase is
usually needed to reverse neuro manifestations? Correct Answer
4-6
for severe/symptomatic acute hyponatremia (ex. exercise
induced) what is the treatment? Correct Answer 100ml of 3%
hypertonic NaCl infused over 10 min
for severe/symptomatic non-acute hyponatremia (ex. overnight in
the hospital and AM blood work shows low Na + pt is having
symptoms) how is the sodium deficit calculated? and the infusion
rate of 3% saline? Correct Answer sodium deficit = TBW x
(desired Na - actual serum Na)
where TBW is 50% wt in W and 55% wt in M
,ex. 80kg.55(126-120)= 264mEq
infusion rate = Na deficit/0.513/24
ex. 264/0.513/24 = 21 ml/hr x 24 hrs
what medications can be used to treat severe non-acute
hyponatremia over infusion of 3% saline? what pt's are these
meds contraindicated in? what is a downside of using them over
infusing saline? Correct Answer vasopressin antagonists (aka
anti-ADH meds)
1. demeclocycline 300-600mg BID
2. tolvaptan 15mg QD
-ESRD pts bc can cause nephrotoxicity
-cannot control how fast they are metabolized by the body so
could cause too rapid of an inc in Na level
what are the s/sx's of hypernatremia? Correct Answer -change in
consciousness, irritability, dizziness, weakness, orthostatic
hypotension, dec skin turgor, dry mucous membranes
*basically think: you're dehydrated
how do you calculate the free water deficit to resuscitate
hypernatremia pts? Correct Answer 1. 2 x BW (kg) = amt of D5W
to run per hr
2. 2(Serum(Na)-140) = hours to run
ex. 2(50kg) = 100mL D5W/hr
2(150-140) = 20 hrs to run ^
-correcting hyponatremia at a rate of ≤____ prevents
demyelination
, -correcting hypernatremia at a rate of ≤____ prevents cerebral
edema Correct Answer ≤0.5 mEq/L/hr in BOTH
what is a good objective measure of fluid status? Correct Answer
urine output- should be ~0.5ml/kg/hr
how is % dehydration calculated? Correct Answer = (nml wt - ill
wt)/nml wt x 100
mild dehydration is ____% and the signs are? Correct Answer
3%
dry mucous membranes, inc thirst, slight dec urine output
mod dehydration is ____% and the signs are? Correct Answer
6%
dry mucous membranes, tachycardia, little to no urine output,
lethargy, sunken eyes, dec skin turgor
severe dehydration is ____% and the signs are? Correct Answer
9% or more
dry mucous membranes, tachycardia, thready pulse, tachypnea,
delayed cap refill, hypotension, mottled skin, cyanosis, coma, no
urine output
how is the volume deficit calculated? Correct Answer using the
degree of dehydration (3, 6, or 9%)
wt x 0.3/0.6/0.9 x 1L
how is the maintenance fluid requirement (that you replace over
24-48hrs) calculated? Correct Answer if replacing over 24 hrs:
(2500ml + volume deficit)/24 hrs = ___mL/hr
if replacing over 48 hrs: (2x2500ml + volume deficit)/48 hrs =
___mL/hr
LATEST STUDY KIT WITH EXAM
QUESTIONS WITH VERIFIED DETAILED
ANSWERS (GRADED A+)
what are the signs/symptoms of mild-severe hyponatremia?
Correct Answer mild- nausea/malaise
mod- HA/AMS
sev- herniation/coma
what tests do we run for hyponatremia? Correct Answer BMP
(what you ran first that showed you hyponatremia), then serum
osmolarity (to determine if it is iso/hypo/hypertonic hyponatremia),
urine Na
what is on the differential for isotonic hyponatremia? Correct
Answer (just a lab error)
1. hyperproteinemia
2. hyperlipidemia
what is on the differential for hypertonic hyponatremia? Correct
Answer 1. hyperglycemia
2. mannitol, sorbitol, glycerol, maltose in blood
3. radiocontrast agents (IV dye)
hypertonic hyponatremia can be pseudohyponatremia in diabetic
patients because? how is the false hyponatremia corrected for?
Correct Answer the lab's laser cannot correctly read the actual
amt of Na due to all the glucose being in the way
SO, you must correct for this with a calculation: if S(Na) is 121
and BS is 400 you add 2 to the Na level for ever 100 over 200...
so corrected Na level is 121 + 4 = 125
,(you do this so you don't overcorrect the Na and put them into
central pontine myelinolysis)
what is on the differential for hypotonic hyponatremia? Correct
Answer -hypovolemic: diuretics, dehydration, diarrhea, vomiting,
burns
-euvolemic: SIADH, hypothyroidism, adrenal insufficiency, water
intoxication
-hypervolemic: heart/liver failure, nephrotic syndrome
*figure out their volume status by PE (mucous membranes,
turgor, etc)
how do you treat hypo/eu/hypervolemic hyponatremia when it is
chronic/asymptomatic? Correct Answer hypovol- NS 0.9%
euvol- free water restriction
hypervol- loop diuretics or dialysis
for severe/symptomatic hyponatremia how much of an increase is
usually needed to reverse neuro manifestations? Correct Answer
4-6
for severe/symptomatic acute hyponatremia (ex. exercise
induced) what is the treatment? Correct Answer 100ml of 3%
hypertonic NaCl infused over 10 min
for severe/symptomatic non-acute hyponatremia (ex. overnight in
the hospital and AM blood work shows low Na + pt is having
symptoms) how is the sodium deficit calculated? and the infusion
rate of 3% saline? Correct Answer sodium deficit = TBW x
(desired Na - actual serum Na)
where TBW is 50% wt in W and 55% wt in M
,ex. 80kg.55(126-120)= 264mEq
infusion rate = Na deficit/0.513/24
ex. 264/0.513/24 = 21 ml/hr x 24 hrs
what medications can be used to treat severe non-acute
hyponatremia over infusion of 3% saline? what pt's are these
meds contraindicated in? what is a downside of using them over
infusing saline? Correct Answer vasopressin antagonists (aka
anti-ADH meds)
1. demeclocycline 300-600mg BID
2. tolvaptan 15mg QD
-ESRD pts bc can cause nephrotoxicity
-cannot control how fast they are metabolized by the body so
could cause too rapid of an inc in Na level
what are the s/sx's of hypernatremia? Correct Answer -change in
consciousness, irritability, dizziness, weakness, orthostatic
hypotension, dec skin turgor, dry mucous membranes
*basically think: you're dehydrated
how do you calculate the free water deficit to resuscitate
hypernatremia pts? Correct Answer 1. 2 x BW (kg) = amt of D5W
to run per hr
2. 2(Serum(Na)-140) = hours to run
ex. 2(50kg) = 100mL D5W/hr
2(150-140) = 20 hrs to run ^
-correcting hyponatremia at a rate of ≤____ prevents
demyelination
, -correcting hypernatremia at a rate of ≤____ prevents cerebral
edema Correct Answer ≤0.5 mEq/L/hr in BOTH
what is a good objective measure of fluid status? Correct Answer
urine output- should be ~0.5ml/kg/hr
how is % dehydration calculated? Correct Answer = (nml wt - ill
wt)/nml wt x 100
mild dehydration is ____% and the signs are? Correct Answer
3%
dry mucous membranes, inc thirst, slight dec urine output
mod dehydration is ____% and the signs are? Correct Answer
6%
dry mucous membranes, tachycardia, little to no urine output,
lethargy, sunken eyes, dec skin turgor
severe dehydration is ____% and the signs are? Correct Answer
9% or more
dry mucous membranes, tachycardia, thready pulse, tachypnea,
delayed cap refill, hypotension, mottled skin, cyanosis, coma, no
urine output
how is the volume deficit calculated? Correct Answer using the
degree of dehydration (3, 6, or 9%)
wt x 0.3/0.6/0.9 x 1L
how is the maintenance fluid requirement (that you replace over
24-48hrs) calculated? Correct Answer if replacing over 24 hrs:
(2500ml + volume deficit)/24 hrs = ___mL/hr
if replacing over 48 hrs: (2x2500ml + volume deficit)/48 hrs =
___mL/hr
