1

ACID-BASE MULTIPLE CHOICE QUESTIONS FOR 5

TH
YEAR
STUDENTS
MONASH UNIVERSITY

Provided it is allowed to continue for sufficient amount of time, compensatory response will
return pH to normal values within
a. 3 - 7 hours.
b. 6 24 hours.
c. 24 72 hours.
d. Youre joking! This will never happen!

The normal value for venous pH is
a. 7.4 7.5.
b. 7.2 7.3.
c. 7.3 7.4.
d. 7.2 7.4.

TRUE or FALSE. Only in the setting of normal anion gap metabolic acidosis respiratory
compensation will bring pH back to normal.

TRUE or FALSE. If arterial access is not available in the patient, VBG values can be used to
guide clinical decisions and treatment.

Respiratory compensation in the setting of high anion gap metabolic acidosis
a. begins within 6 12 hours of the onset of the process.
b. begins within about 30 minutes.
c. begins within 1 2 hours of the onset of the process.
d. is a late feature and never brings pH back to normal.

The difference between normal pH on ABG and VBG is
a. 0.06.
b. 0.06 0.07.
c. 0.03 0.05.
d. 0.02.

2

Respiratory compensation in the setting of metabolic alkalosis
a. is similar in efficiency to respiratory compensation in the setting of metabolic acidosis.
b. is stronger than respiratory compensation in metabolic acidosis.
c. is a process of limited efficiency.
d. may take 2 4 hours to develop fully.

The normal [HCO3
-
] on VBG is
a. 20 24mmol/L.
b. 19 - 22mmol/L.
c. 22 - 28mmol/L.
d. 26 - 30mmol/L.

In acute respiratory acidosis HCO3
-
a. increases.
b. decreases.
c. is of little value.
d. stays unchanged.

HCO
3
-
changes by 4mmol/L for every 10mmHg in pCO
2
change in
a. acute respiratory acidosis.
b. acute metabolic acidosis.
c. chronic respiratory acidosis.
d. chronic metabolic acidosis.

In chronic respiratory acidosis HCO3
-

a. changes more than in acute respiratory acidosis.
b. does not change due to development of renal adaptation.
c. does not change due to development respiratory adaptation.
d. changes less than in acute respiratory acidosis.

The rule of 15 is used to determine compensation in
a. respiratory acidosis.
b. metabolic acidosis.
c. respiratory alkalosis.
d. metabolic alkalosis.
3

Complete the sentence. In chronic respiratory alkalosis, HCO3 by for every decrease in
pCO2.

Complete the sentence. In acute respiratory acidosis HCO3 by for every increase in pCO2.

Anion gap is calculated as a
a. difference between anions in plasma.
b. difference between anions and pH.
c. difference between anions and cations.
d. difference between cations and cations.

KULT stands for
a. Potassium (K), Urea, Lactate, fever (T).
b. Lactate, Ketones, Uraemia, ingestions (Toxins).
c. Lactose, potassium (K), Uraemia, Toxins.
d. Ive had enough.

Acidosis in DKA
a. can be remedied by bicarbonate.
b. should not be remedied by bicarbonate.
c. can be treated by bicarbonate only after initial SC insulin administration.
d. usually of spurious nature.

The next morning following successful treatment of your first patient with DKA, as you
proudly walk in on the ward, you colleagues tell you that the patient has developed
hyperchloraemic metabolic acidosis. Your thoughts are.
a. This is probably due to biphasic nature of DKA.
b. Chillax as this is likely due to overresuscitation with NaCl (NS).
c. Give the patient furosemide to promote diuresis.
d. Increase dose of insulin to address the electrolyte abnormalities.

What is included in the measurement of anion gap?
a. Na
+
, K
+
, HCO3
-
, Cl
-

b. Na
+
, Cl
-

c. Na
+
, K
+
, HCO3
-
, Cl
-
, PO4
-

d. Na
+
, HCO3
-
, Cl
-
, PO4
-

4

TRUE or FALSE. Only arterial pH, [HCO3
-
] and pCO2 can be used to guide decisions in the
management of DKA.

5

The educators CHEAT SHEET
The correct answers to MCQ are given in bold.

Provided it is allowed to continue for sufficient amount of time, compensatory response will
return pH to normal values within
a. 3 - 7 hours.
b. 6 24 hours.
c. 24 72 hours.
d. Youre joking! This will never happen!
Compensatory process will NEVER return pH back to normal, provided there are no other concurrent
acid base disorders present (i.e. double or triple A-B disorder present) that together can lead to falsely
normal appearing pH.

The normal value for venous pH is
a. 7.4 7.5.
b. 7.2 7.3.
c. 7.3 7.4.
d. 7.2 7.4.
The normal value for venous pH is 7.3 7.4 (0.03 0.05 less than arterial pH)

TRUE or FALSE. Only in the setting of normal anion gap metabolic acidosis respiratory
compensation will bring pH back to normal.
FALSE.
Compensatory process will NEVER return pH back to normal, provided there are no other concurrent
acid base disorders present (i.e. double or triple A-B disorder present).

If arterial access is not available in the patient, VBG values can be used to guide clinical
decisions and treatment.
TRUE.
VBG can be used for decision making at the bedside if ABG is not available.

6

Respiratory compensation in the setting of high anion gap metabolic acidosis
a. begins within 6 12 hours of the onset of the process.
b. begins within about 30 minutes.
c. begins within 1 2 hours of the onset of the process.
d. is a late feature and never brings pH back to normal.
Respiratory compensation, regardless of the type of acidosis, develops in parallel with acidosis, however
it never brings pH back to normal.

The difference between normal pH on ABG and VBG is
a. 0.06.
b. 0.06 0.07.
c. 0.03 0.05.
d. 0.02.
The difference between pH on ABG and VBD is 0.03 0.05 with pH on VBG being normally lower (i.e. if
normal pH on ABG is 7.35 7.45, then normal pH on VBG is 7.3 7.4).

Respiratory compensation in the setting of metabolic alkalosis
a. is similar in efficiency to respiratory compensation in the setting of metabolic acidosis.
b. is stronger than respiratory compensation in metabolic acidosis.
c. is a process of limited efficiency.
d. may take 2 4 hours to develop fully.
The respiratory compensation for metabolic alkalosis leads to compensatory respiratory acidosis (this
would mean the patient had to breathe less). This is the least effective compensatory process in A-B
disorders.

The normal [HCO3
-
] on VBG is
a. 20 24mmol/L.
b. 19 - 22mmol/L.
c. 22 - 28mmol/L.
d. 26 - 30mmol/L.
The normal values for arterial and venous HCO3
-
are identical, i.e. 22-28mmol/L.




7

In acute respiratory acidosis HCO3
-
a. increases.
b. decreases.
c. is of little value.
d. stays unchanged.
In respiratory acidosis HCO3
-
increases to compensate for elevation in pCO2.

HCO3
-
changes by 4mmol/L for every 10mmHg in pCO2 change in
a. acute respiratory acidosis.
b. acute metabolic acidosis.
c. chronic respiratory acidosis.
d. chronic metabolic acidosis.
HCO3
-
increases by 4mmol/L for every 10mmHg change in CO2 in chronic respiratory acidosis.

In chronic respiratory acidosis HCO3
-

a. changes more than in acute respiratory acidosis.
b. does not change due to development of renal adaptation.
c. does not change due to development of respiratory adaptation.
d. changes less than in acute respiratory acidosis.
In chronic respiratory acidosis the change in HCO3
-
is greater than that in acute respiratory acidosis.

The rule of 15 is used to determine compensation in
a. respiratory acidosis.
b. metabolic acidosis.
c. respiratory alkalosis.
d. metabolic alkalosis.
The rule of 15 allows to predict what value CO2 should be if respiratory compensation were appropriate
in metabolic acidosis. It states that expected pCO2 in metabolic acidosis should be HCO3
-
+ 15 (+/-2). For
example: if, in metabolic acidosis, pCO2 = 26 and HCO3
-
= 5mmol/L, then, using the rule of 15, 5 + 15 =
20 +/-2 = 18-22, the value of expected pCO2 is 18-22. If the actual number is higher (as is in this
example), then the patient is either failing to compensate (i.e. tiring) or a second disorder is present.

Complete the sentence. In chronic respiratory alkalosis, HCO3 by for every decrease in
pCO2.
In chronic respiratory alkalosis, HCO3
-
DECREASES by 5mmol/L for every 10mmHg decrease in pCO2.

8

Complete the sentence. In acute respiratory acidosis HCO3 by for every increase in pCO2.
In acute respiratory acidosis HCO3 INCREASES by 1mmo/L for every 10mmHg increase in pCO2.

Anion gap is calculated as a
a. difference between anions in plasma.
b. difference between anions and pH.
c. difference between anions and cations.
d. difference between cations and anions.
Anion gap is calculated as difference between CATIONS and ANIONS.

KULT stands for
a. Potassium (K), Urea, Lactate, fever (T).
b. Lactate, Ketones, Uraemia, ingestions (Toxins).
c. Lactose, potassium (K), Uraemia, Toxins.
d. Ive had enough.
KULT is a practical memory device helping to memorise the most common causes of metabolic acidosis:
Ketoacidosis (DKA), Uraemia (renal failure), Lactic acidosis, Toxins (ingestions, poisonings).

Acidosis in DKA
a. can be remedied by bicarbonate.
b. should not be remedied by bicarbonate.
c. can be treated by bicarbonate only after initial SC insulin administration.
d. usually of spurious nature.
Bicarbonate is inappropriate to use in the management of DKA as in the setting of the metabolic
acidosis administration of bicarbonate can lead to significant worsening of acidosis.







9

The next morning following successful treatment of your first patient with DKA, as you
proudly walk in on the ward you colleagues tell you that the patient has developed
hyperchloraemic metabolic acidosis. Your thoughts are.
a. This is probably due to biphasic nature of DKA.
b. Chillax as this is likely due to overresuscitation with NaCl (NS).
c. Give the patient furosemide to promote diuresis.
d. Increase the dose of insulin to address the electrolyte abnormalities.
This acidosis is most likely due to inappropriate use of 0.9% NaCl (NS). As NS is an acidic solution (pH
6.9) and contains large amount of Cl
-
(154mmol/L), excessive (i.e. inappropriate) use of NS in
resuscitation of acidaemic patient will lead to development of hyperchloraemic acidosis. It usually
corrects itself and no treatment is required.

What is included in the measurement of anion gap?
a. Na
+
, K
+
, HCO3
-
, Cl
-

b. Na
+
, Cl
-

c. Na
+
, K
+
, HCO3
-
, Cl
-
, PO4
-

d. Na
+
, HCO3
-
, Cl
-
, PO4
-

Anion gap is the difference between cations (i.e. positively charged ions) and anions (i.e. negatively
charged ions). Anion gap is usually calculated as (Na
+
+ K
+
) - (Cl
-
+ HCO3
-
).

TRUE or FALSE. Only arterial pH, [HCO3
-
] and pCO2 can be used to guide decisions in the
management of DKA.
FALSE. Venous pH, [HCO3
-
] and pCO2 can be safely used to guide decisions in the management of DKA as
they show good correlation with arterial values.