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42 Cards in this Set
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FE01 [Mar96] [Mar98] [Jul98] [Apr01] [Jul01] [Mar03] [Jul03] [Mar05] [Jul05]
Effects of hypokalaemia: A. Short PR interval B. Ventricular extrasystoles C. Elevated ST segments D. Long QRS interval E. Long QT interval F. Q waves |
FE01 [aefkl] Effects of hypokalaemia:
A. Short PR interval – No, it increases the PR interval (Ganong, p543) B. Ventricular extrasystoles - Correct C. Elevated ST segments – ST depression (Ganong p543) D. Long QRS interval – No effect on QRS duration E. Long QT interval – QT interval remains normal, however hidden U waves may make it look prolonged if mistaken for a T wave (Ganong p15) F. Q waves – could they mean U Waves? If so, this would be the correct answer |
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FE01b Jul98 version: Hypokalaemia:
A. Hyperpolarises membrane B. Peaked T waves C. Prolonged QT D. VEBs E. ST elevation |
ANSWER A
A. Hyperpolarises membrane – Yes, decreases RMP B. Peaked T waves – No, this occurs with hyperkalaemia C. Prolonged QT – Nil change D. VEBs – Yes, but (A) occurs first E. ST elevation – ST Depression (Ganong, p543) |
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Hypokalaemia:
A. Hyperpolarizes the membrane B. Shortens the QRS C. Shortens the PR interval D. Depresses the ST segment E. Prolongs the QT interval |
ANSWER A
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Alt version: Hypokalemia
A. ST segment changes (it did read “changes”) B. P wave flattening C. Shortened QT D. No Q wave |
Alt version: Hypokalemia
A. ST segment changes (it did read “changes”) – ST Depression B. P wave flattening – No C. Shortened QT – No change in QT interval D. No Q wave – No, no change |
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FE02 [Mar97] [Jul04] For two solutions separated by a semi-permeable membrane (Solution A: saline solution AND solution B: H2O): Which of the following statements is true?
A. A hydrostatic pressure applied to A will stop osmotic pressure (?) B. There will be bulk flow from A to B C. The fluid level in B will go up D. The NaCl concentration at A will remain the same E. Water will move from A to B by diffusion |
FE02 [c] For two solutions separated by a semi-permeable membrane (Solution A: saline solution AND
solution B: H2O): Which of the following statements is true? A. A hydrostatic pressure applied to A will stop osmotic pressure (?) – It won’t stop ‘osmotic pressure’ but it could oppose the osmotic pressure… B. There will be bulk flow from A to B C. The fluid level in B will go up – No, H2O will flow from B to A down its concentration gradient (ie. B will go down) D. ? |
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FE03 [Mar97] [Jul97] [Jul99] Rapid (?ingestion/?infusion) of 2 litres of normal saline causes:
A. Increased ECF, increased ICF, decreased [Na+] B. Increased ECF, unchanged ICF, increased [Na+] C. Unchanged ECF, increased ICF, increased [Na+] D. Increased ECF, unchanged ICF, unchanged [Na+] |
ANSWER B
as per Brandis "...the decrease in measured plasma Na+ due to the plasma solids effect is about the same as the increase in Na+ that occurs due to the Gibbs-Donnan effect...", with the result being that measured plasma Na+ is about the same as measured ISF Na+. Hence, the postulated reduction in plasma [Na+] that is present as a result of the plasma solids effect is negated, and we can effectively treat the system (for measurement purposes only) as though the two do not exist. Consequently, infusing a solution that contains 150mmol/L of NaCl into a compartment that contains 140mmol/L of NaCl will result in: Expansion of ECF No change in ICF (despite a measured osmolality of 300mOsmol/L, this is not true in-vivo) Increase in measured [Na+] |
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FE04 [d] [Jul98] [Jul00] Hyperkalaemia:
A. Causes a prolonged QT interval B. Prolongs the QRS duration C. Causes ST segment elevation D. Potentiates digoxin toxicity E. Causes loss of P wave |
ANSWER B
A. Causes a prolonged QT interval – No, it shortens the QT Interval (Brandis – Viva, p15) B. Prolongs the QRS duration – Yes, prolongation of QRS occurs (Ganong, p543) C. Causes ST segment elevation – No, tall tented T-Waves are an early sign D. Potentiates digoxin toxicity – No, hypokalaemia does E. Causes loss of P wave – Atrial activity decreases & P-waves flatten (not technically loss I guess) (Ganong, p543) & also Brandis p15 |
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FE04b [Mar02] [Feb07] ECG changes in hyperkalaemia include:
A. ST depression B. T wave inversion C. P wave flattening D. Sinus tachycardia E. ? |
ANSWER C
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FE05 [Mar98] [Apr01] [Jul04] Thoracic lymph contains:
A. Clotting factors B. Higher protein content than plasma C. Similar composition to ISF D. Rarely contains fat E. ? |
FE05 [ek] Thoracic lymph contains:
A. Clotting factors - Yes B. Higher protein content than plasma – This can’t be possible as it is derived from filtered plasma (thoracic duct 50g/l protein – large proportion from hepatic lymph (Brandis, p19-20) C. Similar composition to ISF – thoracic duct lymph contains more protein than usual ISF (from liver) D. Rarely contains fat – Contains fat (chylomicrons) from gut lymphatics after meals – important in fat absorption (90%) E. ? |
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FE06 [Mar98] [Jul98] [Mar99] [Feb04] Gibbs-Donnan effect leads to:
A. Non-diffusible ions between 2 sides will be equal B. Diffusible ions between 2 sides will be equal C. Equal concentrations of ions on both sides D. Equal passive diffusion E. Osmotic gradient F. Important in the measurement of plasma oncotic pressure |
FE06 [efg] Gibbs-Donnan effect leads to:
A. Non-diffusible ions between 2 sides will be equal – No! B. Diffusible ions between 2 sides will be equal – No! C. Equal concentrations of ions on both sides D. Equal passive diffusion E. Osmotic gradient – yes, which will in itself, upset the Gibbs-Donnan Effect if the membrane is permeable to the solvent |
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FE07 [Jul98] [Mar05] [Jul05]
With decreased osmolality and hypovolaemia, you would see: A. increased urine output B. Decreased ADH secretion C. Decreased aldosterone D. Increased permeability of collecting ducts to water E. Decreased renin |
ANSWER D
Decreased urine output due to increased ADH secretion. Osmoreceptors are very sensitive to a decrease in osmolality and the decreased osmolality will result in a decreased ADH secretion. However, the low pressure baroreceptors (volume receptors) in the right atrium and great veins though being less sensitive than the osmoreceptors respond far more powerfully. The peak [ADH] resulting from hypovolaemia is much higher than that produced by maximal response to osmoreceptor input. So the knowledge this question is testing is whether you know that hypovolaemia over-rides the inhibition from the hypo-osmolality. Volume is maintained at the expense of a decreased osmolality. But either way it is true that permeability of collecting duct to water is increased, therefore correct answer D. |
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FE08 [Mar99] [Jul00] [Apr01] [Jul04] Hartmann’s solution contains:
A. Potassium 2 mmol/l B. Calcium 3 mmol/l C. Magnesium 2 mmol/l D. Sodium 154 mmol/l E. Chloride ?131 ?154 mmol/l |
FE08 [gjk] Hartmann’s solution contains:
A. Potassium 2 mmol/l – No… 5 B. Calcium 3 mmol/l – No… 2 C. Magnesium 2 mmol/l – No… 0 D. Sodium 154 mmol/l – No… 129 E. Chloride ?131 ?154 mmol/l – No… 109 |
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FE08b [Apr01] [Mar05]
Hartmann’s solution contains no: A. Na+ B. Ca++ C. Mg++ D. Lactate E. Cl- |
ANSWER C
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FE09 [Mar99] [Feb00] [Jul00] The total osmotic pressure of plasma is:
A. 25 mmHg B. 285 mOsm/l (or ?308mOsm/l) C. 5900 mmHg D. 300 kPa E. None of the above |
FE09 [gij] The total osmotic pressure of plasma is:
A. 25 mmHg – this is roughly plasma ONCOTIC pressure (25-28mmHg) B. 285 mOsm/l (or ?308mOsm/l) – wrong units, we want pressure not osmoles C. 5900 mmHg – for 280mOsm/l would give 5409mmHg (? 720kPa) for total osmotic pressure D. 300 kPa - Nope E. None of the above - Correct |
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FE10 [Mar99] [Jul05] Normal saline:
A. Osmolality of 300-308 mOsm/l B. Has pH 7.35 to 7.45 C. ? |
FE10 [g] Normal saline:
A. Osmolality of 300-308 mOsm/l – Osmolality is 308mOsm/l B. Has pH 7.35 to 7.45 – No pH is 4.0-7.0 C. ? |
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FE11 [Mar99] [Mar03] [Jul03] Obligatory water loss from body:
A. 400 mls in faeces B. 300 mls from lung C. Loss from skin & respiratory tract 700ml D. ??Insensible water loss E. 500 mls in urine |
FE11 [g] Obligatory water loss from body: - minimal amount of fluid that has to be lost (equal to excretion of
urinary solute load, sweat, faecal, insensible losses) A. 400 mls in faeces – no approx 200ml B. 300 mls from lung – no, approx 400ml C. Loss from skin & lung – constitutes insensible loss (800ml), which is part of obligatory D. ??Insensible water loss – part of obligatory loss (same as option C) E: 500ml in Urine – Correct. This is the MINIMUM daily urine loss |
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Alt version: Normal amount of daily water loss in a 70kg man:
A. 300mls faeces B. 500mls from urine C. 700mls from lungs and skin (?insensible) D. ? E. None of the above "All figures seemed slightly off from standard text" |
Alt version: Normal amount of daily water loss in a 70kg man:
A. 300mls faeces - No, 100ml B. 500mls from urine – No, 1500ml C. 700mls from lungs and skin -Yes! D. ? E. None of the above "All figures seemed slightly off from standard text" |
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FE12 [Jul99] [Mar03] [Jul03] [Jul05]
Which ONE of the following statements about intravenous crystalloid solutions is TRUE? A. Rapid infusion of (?one litre) Hartmann's may cause lactic acidosis B. Hartmann's 300-308 mosm/kg C. 0.9% saline pH 7.35-7.45 D. N/saline osmol 300-308 mosm/kg E. 0.9% sodium chloride has a pH 6.5-7.5 F. One litre of Hartmann’s solution contains 150 mmol of Na+ |
FE12 [h] Which ONE of the following statements about intravenous crystalloid solutions is TRUE?
A. Rapid infusion of (?one litre) Hartmann's may cause lactic acidosis – No, it is only the anion, not the acid that is being added B. Hartmann's 300-308 mosm/kg – No, 274mOsm/l C. Hartmann's pH 7.35-7.45 – No pH 5.0-7.0 D. N/saline osmol 300-308 mosm/kg – States approx 308mOsm (probably the closest to correct) – when you do the sums 9g of NaCl in 1000ml of H20 equals about 154mmol of Na and 154mmol of Cl E. 0.9% sodium chloride has a pH 6.5-7.5 – No pH 4.0-7.0 (but when you run it through the gas analyser it has a pH of 6.8 F. ?One litre of Hartmann’s solution contains 150 mmol of Na+ - No, 129mmol Na |
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FE13 [Mar99] [Jul99] [Feb00] Water handling by the kidney (% reabsorption):
A. 93% B. 94% C. 99% D. 99.4% E. 99.9% |
FE13 [ghi] Water handling by the kidney (% reabsorption):
A. 93% B. 94% C. 99% D. 99.4% - Correct, see Table 38-5 (Ganong, p685) – but on p691 they say 99.7%! E. 99.9% Maximum would depend on minimal urine output for solute load (eg. At best 500ml/day) & GFR (normally 180L/day). Therefore, the water reabsorption would be 179.5/180 = 99.7% - option D is probably the safest bet |
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FE14 [Jul00] [Jul04] [Mar05] [Jul05] [Feb06]
The ion with lowest intracellular concentration is: A: Na+ B: HCO3- C: Ca++ D: Mg++ E: K+ |
FE14 [j] The ion with lowest intracellular concentration is:
A: Na+ B: HCO3 - C: Ca2+ - Correct (10-7 – see notes by Buntain, back of 2nd page) D: Mg2+ E: K+ |
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FE15 [Apr01] Total plasma osmolality can be calculated via:
A. Van Halen’s equation B. Starling equation C. P = nRT D. (multiplying 19.2mmHg/mOsm/L by body Osm) (it worked out in the exam!) E. None of the above |
FE15 [k] Total plasma osmolality can be calculated via:
A. Van Halen’s equation – Good one! No, even if it were the Van’t Hoff equation, it is used to calculate osmotic pressure B. Starling equation – for net fluid flux due to filtration C. P = nRT – the Van’t Hoff equation (see A) with a few bits missing ie c/W D. (multiplying 19.2mmHg/mOsm/L by body Osm) (it worked out in the exam!) – IMPOSSIBLE – LOOK AT THE UNITS… you’ll end up with pressure which sure isn’t osmolality E. None of the above – the most likely answer |
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FE16 [Apr01] Which of the following will increase plasma potassium concentration
A. Beta adrenergic receptor AGONIST B. Insulin C. Aldosterone D. Thiazides E. None of the above |
ANSWER E
FE16 [k] Which of the following will increase plasma potassium concentration A. Beta adrenergic receptor AGONIST – No, decreases potassium (Ganong, p699) B. Insulin – No, decreases potassium C. Aldosterone – No, reabsorption of Na at the expense of K and H D. Thiazides - decrease K E. None of the above - Correct |
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FE16b [Ju05]: Which will increase plasma [K+]?
A. Hyperglycaemia B. Aldosterone C. Metabolic acidosis D. ? E. Carbonic anhydrase inhibitors |
ANSWER C
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FE17 [Apr01] Osmotic pressure in plasma is usually 1.6 mosmol/L more than ISF. This is because of
A Plasma Proteins B Plasma Oxygen Tension C Plasma creatinine D ? E ? |
FE17 [k] Osmotic pressure in plasma is usually 1.6 mosmol/L more than ISF. This is because of
A Plasma Proteins – yes… which would directly account for 0.9mOsm/L as well as the rest from the Gibbs- Donnan Effect & the ‘exluded volume’ effect B Plasma Oxygen Tension C Plasma creatinine D ? E ? Note: units are wrong in the question! |
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FE18 [Apr01] [Mar03] [Jul03] [Feb04] [Jul04] (Responses to ?increased osmolarity)
A. Thirst and ADH from stimulation of osmoreceptors in posterior hypothalamus B. Thirst via stimulation of SFO and OVLT via Angiotensin II in hypovolaemia C. Baroreceptors afferents to the Posterior Pituitary D. Increased ADH levels E. Aldosterone |
ANSWER D
A. Thirst and ADH from stimulation of osmoreceptors in posterior hypothalamus – Yes, but not in that order B. Thirst via stimulation of SFO and OVLT via Angiotensin II in hypovolaemia – This is correct, however if the question was asking about ‘responses to increased osmolarity’…. C. Baroreceptors afferents to the Posterior Pituitary – input to hypothalamus (both low pressure (volume) and high pressure baroreceptors) D. Increased ADH levels - Yes E. Aldosterone – only if significant hypovolaemia |
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July 04 version:
Thirst in hypovolaemia from: A. Stimulation of baroreceptors which stimulate posterior pituitary B. Angiotensin II stimulating SFO and OVLT C. increased ADH levels D. Aldosterone |
ANSWER B
Guyton & Hall referenced below, pg 325&326, identify a number of important factors in stimulating thirst: Increased osmolarity is probably the most important. Stmiulates thirst by intracellular dehydration of cells in the thirst centre Drop in blood volume, and blood pressure- as in haemorrhage, probably via baroreceptors. Note that the response exist independent of osmolarity changes Increases in ADH Dry mucous membranes |
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FE19 [Apr01] [Feb04] Sweat in patients acclimatised to hot weather (as compared to patients in a temperate climate) contains less Na+ because:
A. Takes longer for Na+ to be transported through sweat ducts B. Aldosterone effect causing a reduction in Na+ in sweat C. Increased intake of water causing a reduction in Na concentration D. ? |
Answer B
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FE20 [l] Magnesium is required for:
A. To Depolarise excitable cell membranes – reduces membrane excitability (Brandis, p17) B. Na+-K+ ATPase – Yes, an important cofactor for all enzymes that involve phosphate transfer among others C. Coagulation - No D. ? E. ? |
FE20 [l] Magnesium is required for:
A. To Depolarise excitable cell membranes – reduces membrane excitability (Brandis, p17) B. Na+-K+ ATPase – Yes, an important cofactor for all enzymes that involve phosphate transfer among others C. Coagulation - No D. ? E. ? |
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FE21 [Jul01] Intracellular ?osmolality is greater than interstitial ?osmolality because:
A. Proteins in plasma B. Cells producing intracellular proteins C. ? D. ? E. ? |
FE21 [l] Intracellular ?osmolality is greater than interstitial ?osmolality because:
A. Proteins in plasma B. Cells producing intracellular proteins – Correct (initially I thought they were the same under normal conditions but apparently they not quite…) C. ? D. ? E. ? |
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FE22 [Mar02] [Jul02] [Mar03] [Jul03] Sweating in strenuous exercise. Sweat contains Na+:
A. Less than plasma B. Equal to plasma C. More than plasma D. ? E. ? |
FE22 [mno] Sweating in strenuous exercise. Sweat contains Na+:
A. Less than plasma – Correct – between 30-65 mOsm/L B. Equal to plasma C. More than plasma D. ? E. ? |
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FE23 [Mar03] [Jul03] [Feb04] [Jul05]
Acute onset (4 hours) diabetes insipidus in an otherwise healthy person produces these biochemical changes ("these numbers may not be exact"): A. Na+ 130, K+ 3.0, Osm 260 B. Na+ 130, K+ 4.0, Osm 300 C. Na+ 150, K+ 3.0, Osm 260 D. Na+ 150, K+ 3.5, Osm 320 E. Na+ 160, K+ 3.0, Osm 320 |
ANSWER E
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FE24 [Mar03] [Jul03] Colligative properties:
A. Increase BP, decrease freezing point, decrease SVP B. Other combinations: increase/ decrease…boiling point/FP/SVP C. ? |
ANSWER A
FE24 Colligative properties: A. Increase BP, decrease freezing point, decrease SVP - Correct B. Other combinations: increase/ decrease…boiling point/FP/SVP C. ? Colligative properties of a solution depend on the number of solute particles, but not their chemical properties Freezing Point Depression Boiling Point Elevation Vapour Pressure Depression – reduction of the solvent molecules ability to leave the solution (it gets weird when the solute is volatile…) |
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FE25 [Mar03] [Jul03] Inorganic ion necessary in Na-K ATPase
A. Br B. Li C. Mg+2 D. PO4 E. SO4-2 |
ANSWER C
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FE26 [Jul04] A patient is given an infusion of 100 mL of 8.4% sodium bicarbonate solution. This represents an osmotic load of:
A. 42 mosmol B 84 mosmol C 100 mosmol D 168 mosmol E 200 mosmo |
ANSWER E
Normal dose of 8,4%= 1ml/kg = 1mmol/kg and this = 2mosmol/kg, thus 100x2. |
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FE27 [Mar05]
Regarding the ECF concentrations of K+ and H+: A. K+ rise causes pH rise B. They move in the same direction C. ? D. Hypokalaemia inhibits renal H+ excretion E. ? |
ANSWER B
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FE28 [Jul05] Hyperkalemia caused by:
A. Metabolic acidosis B. Aldosterone excess C. ? D. ? |
ANSWER A
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FE29 [Feb06] Diffusion across semipermeable membrane:
A. is inversely proportional to thickness B. is proportional to molecular weight C. ? D. ? |
ANSWER A
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FE30 [Jul07] [Feb08] Infusion of 40ml/kg of 0.9% saline solution will cause:
A. Hypochloraemic metabolic acidosis. B. Hypochloraemic metabolic alkalosis. C. Hyperchloraemic metabolic acidosis. D. Hyperchloraemic metabolic alkalosis. E. No acid base disturbance. |
ANSWER C
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FE31 [Jul07] Lymph flow:
A. greatest when skeletal muscle contracting B. when interstitial pressure 1-2mmHg above atmospheric C. approx. 1000ml per hour via thoracic duct D. ? E. ? |
ANSWER A
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FE32 [Jul07] Post-thoracotomy the drain is leaking fluid with protein, fat, lymphocytes etc. What could be the cause?
A. Bleeding B. Thoracic duct injury C. sympathectomy D. Pleural fluid E. ?? "something like CHF or pulmonary oedema" |
ANSWER B
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FE33 [Feb08] Hyponatraemia is usually due to:
A. Excess lipids B. Excess glucose C. Free water deficit D. Excess protein E. Free water excess |
ANSWER E
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Can04-19 What percentage of body weight is made up by plasma volume
A. 5% B. 7% C. 10% D. 15% E. 35% |
ANSWER A
45ml/kg =4.5% |
