A high blood level of which substance causes hepatic coma?
Bilirubin
Calcium
Ammonia
Sodium
The Correct Answer is C
Choice A reason: While elevated bilirubin levels can indicate liver dysfunction and lead to jaundice, they are not the primary cause of hepatic coma. Bilirubin is a byproduct of red blood cell breakdown and its accumulation can cause yellowing of the skin and eyes.
Choice B reason: Calcium levels, whether high or low, can affect neuromuscular function and cardiac health, but they are not directly associated with causing hepatic coma. Hypercalcemia or hypocalcemia can present with various symptoms, but not typically with hepatic coma.
Choice C reason: Elevated ammonia levels are directly associated with hepatic coma. In patients with severe liver dysfunction, the liver cannot efficiently convert ammonia (a byproduct of protein metabolism) into urea for excretion. The accumulation of ammonia in the blood can cross the blood-brain barrier and lead to encephalopathy, resulting in confusion, altered mental status, and potentially hepatic coma.
Choice D reason: Sodium levels can affect neurological function, particularly with conditions like hypernatremia or hyponatremia. However, these imbalances are not the primary cause of hepatic coma. The direct link to hepatic coma is through elevated ammonia levels.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: 0.45% sodium chloride is a hypotonic solution, which is not ideal for rapidly replacing fluid volume in patients with low blood pressure due to severe diarrhea. Hypotonic solutions can cause fluid to move into cells rather than staying in the vascular space, potentially worsening hypotension.
Choice B reason: 0.9% sodium chloride, also known as normal saline, is an isotonic solution. It is the best choice for rapidly replacing fluid volume in patients with low blood pressure. Isotonic solutions stay in the vascular space and help restore circulating blood volume and blood pressure without causing fluid shifts that can lead to cellular edema or dehydration.
Choice C reason: 5% dextrose in 0.9% sodium chloride is a hypertonic solution, which might not be the most appropriate for initial rapid fluid resuscitation. Hypertonic solutions can draw fluid into the vascular space from the interstitial and intracellular spaces, potentially leading to rapid changes in fluid balance and electrolyte shifts.
Choice D reason: 5% dextrose in 0.45% sodium chloride is also a hypertonic solution but with a hypotonic component (0.45% sodium chloride). This combination is not typically used for rapid fluid resuscitation because it can cause fluid shifts that are less predictable and may complicate the patient's electrolyte balance and hydration status.
Correct Answer is B
Explanation
Choice A reason: Upper GI bleeding is not a direct cause of right heart failure (cor pulmonale). While severe GI bleeding can lead to other complications such as anemia or shock, it does not typically result in cor pulmonale.
Choice B reason: Chronic obstructive pulmonary disease (COPD) is a primary cause of cor pulmonale. COPD leads to chronic hypoxia, which increases pressure in the pulmonary arteries (pulmonary hypertension). The right ventricle of the heart must work harder to pump blood through these high-pressure arteries, eventually leading to right heart failure.
Choice C reason: Liver failure can lead to various systemic complications such as fluid imbalance and electrolyte disturbances, but it is not a direct cause of right heart failure (cor pulmonale). Cor pulmonale is specifically related to pulmonary conditions that increase right ventricular workload.
Choice D reason: Renal failure, while serious and capable of causing cardiovascular complications due to fluid overload and hypertension, is not typically linked to the development of cor pulmonale. The primary cause of cor pulmonale is chronic lung disease like COPD, which directly affects the pulmonary vasculature.
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