50 Analytical Multiple Choice Questions on Acid Base Balance with Explanation- Part 1





1. Which of the following is the primary buffer system in the extracellular fluid (ECF)?

a) Phosphate buffer system
b) Hemoglobin buffer system
c) Bicarbonate buffer system
d) Protein buffer system

Answer: c) Bicarbonate buffer system

Explanation: The bicarbonate buffer system is the most important buffer in the extracellular fluid. It involves the equilibrium between carbonic acid (H₂CO₃) and bicarbonate (HCO₃⁻), which helps maintain pH within a narrow range. This system is crucial for neutralizing excess acids and bases.


2. During metabolic acidosis, which compensatory mechanisms are most likely to occur?

a) Increased renal excretion of bicarbonate
b) Decreased respiratory rate
c) Hyperventilation
d) Increased secretion of hydrogen ions in the kidney

Answer: c) Hyperventilation

Explanation: In metabolic acidosis, there is an excess of acid or a loss of bicarbonate. The body compensates by increasing the respiratory rate (hyperventilation) to expel CO₂, which helps reduce the hydrogen ion concentration and partially correct the acidosis.


3. A patient has a blood pH of 7.50, PCO₂ of 32 mmHg, and HCO₃⁻ of 24 mEq/L. Which of the following is the most likely diagnosis?

a) Metabolic acidosis
b) Respiratory alkalosis
c) Metabolic alkalosis
d) Respiratory acidosis

Answer: b) Respiratory alkalosis

Explanation: A blood pH of 7.50 indicates alkalosis. The low PCO₂ (32 mmHg) suggests that the alkalosis is due to a respiratory cause, as hyperventilation leads to excessive loss of CO₂, reducing the carbonic acid in the blood.


4. Which of the following conditions is most likely to cause a metabolic alkalosis?

a) Severe diarrhea
b) Chronic obstructive pulmonary disease (COPD)
c) Prolonged vomiting
d) Diabetic ketoacidosis

Answer: c) Prolonged vomiting

Explanation: Prolonged vomiting leads to a significant loss of gastric acid (HCl), resulting in a reduction of hydrogen ions in the body and causing metabolic alkalosis. The body compensates by retaining bicarbonate to maintain the acid-base balance.


5. In a case of compensated respiratory acidosis, which of the following laboratory findings is expected?

a) Normal pH, elevated PCO₂, elevated HCO₃⁻
b) Low pH, low PCO₂, elevated HCO₃⁻
c) High pH, low PCO₂, low HCO₃⁻
d) Normal pH, low PCO₂, low HCO₃⁻

Answer: a) Normal pH, elevated PCO₂, elevated HCO₃⁻

Explanation: In compensated respiratory acidosis, the kidneys retain bicarbonate to neutralize the excess hydrogen ions due to high PCO₂. This compensatory mechanism normalizes the pH, even though PCO₂ remains elevated.


6. Which of the following is the fastest mechanism for regulating blood pH?

a) Renal regulation of bicarbonate
b) Respiratory regulation of carbon dioxide
c) Buffer systems in the blood
d) Secretion of hydrogen ions by the kidneys

Answer: c) Buffer systems in the blood

Explanation: Buffer systems act immediately to resist changes in pH by neutralizing excess acids or bases. The bicarbonate buffer system is particularly effective in the blood. Respiratory and renal mechanisms act more slowly.


7. An arterial blood gas (ABG) shows pH 7.25, PCO₂ 60 mmHg, and HCO₃⁻ 26 mEq/L. Which of the following is the most likely condition?

a) Metabolic acidosis with compensation
b) Respiratory acidosis without compensation
c) Metabolic alkalosis with compensation
d) Respiratory acidosis with compensation

Answer: b) Respiratory acidosis without compensation

Explanation: A pH of 7.25 indicates acidosis. The elevated PCO₂ (60 mmHg) suggests a respiratory cause. Since bicarbonate (HCO₃⁻) is within normal limits (26 mEq/L), it indicates that the kidneys have not yet compensated by retaining bicarbonate.


8. What is the primary renal response to respiratory alkalosis?

a) Increased excretion of hydrogen ions
b) Increased reabsorption of bicarbonate
c) Increased excretion of bicarbonate
d) Decreased excretion of ammonium

Answer: c) Increased excretion of bicarbonate

Explanation: In response to respiratory alkalosis, the kidneys excrete more bicarbonate to lower the blood pH toward normal. This helps to counteract the alkalosis caused by a decrease in carbon dioxide levels.


9. Which of the following would most likely lead to a decrease in plasma bicarbonate concentration?

a) Respiratory acidosis
b) Diarrhea
c) Ingestion of excess antacids
d) Hyperventilation

Answer: b) Diarrhea

Explanation: Diarrhea causes the loss of bicarbonate from the intestines, leading to a decrease in plasma bicarbonate concentration, which can result in metabolic acidosis.


10. A patient's ABG results show pH 7.38, PCO₂ 48 mmHg, and HCO₃⁻ 28 mEq/L. What is the most appropriate interpretation of these findings?

a) Uncompensated respiratory acidosis
b) Compensated respiratory acidosis
c) Uncompensated metabolic acidosis
d) Compensated metabolic alkalosis

Answer: b) Compensated respiratory acidosis

Explanation: The pH of 7.38 is within the normal range but on the lower side, indicating slight acidosis. The elevated PCO₂ (48 mmHg) suggests a respiratory cause, and the elevated HCO₃⁻ (28 mEq/L) indicates that the kidneys have compensated by retaining bicarbonate to normalize the pH.

50 Analytical Multiple Choice Questions on Acid Base Balance with Explanation- Part 1

50 Analytical Multiple Choice Questions on Acid Base Balance with Explanation- Part 2 

50 Analytical Multiple Choice Questions on Acid Base Balance with Explanation- Part 3

50 Analytical Multiple Choice Questions on Acid Base Balance with Explanation- Part 4 

50 Analytical Multiple Choice Questions on Acid Base Balance with Explanation- Part 5 


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