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WWW - Natures.Ir: More Free Usmle, Mccee, Mcqe and Amq Flashcards
WWW - Natures.Ir: More Free Usmle, Mccee, Mcqe and Amq Flashcards
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More Free USMLE , MCCEE ,MCQe and AMQ Flashcards
pH changes
how does it relate to K+ in ICF?
Digitalis, -blocker
succinylcholine
U wave
Renal failure
Pseuohyperkalemia
clinical findings?
Hyperkalemia
peaked T waves
ECG shows?
Chronic bronchitis due to
smoking
respiratory acidosis
anxiety
respiratory alkalosis =
Paco2 < 33mm Hg
pathogenesis?
what condition commonly
occurs in acute respiratory
alkalosis?
Tetany
Metabolic acidosis
HCO3- <22 mEq/L
pathogenesis?
AG metabolic acidosis
what replaces buffered HCO3?
what is the most common AG
metabolic acidosis?
examples?
anions of acid
Lactic acidosis
anaerobic glycolysis in shock
Metabolic alkalosis
serum HCO3- > 28mEq/L
serum HCO3- is > than _____?
Salicylate intoxication
common conditions?
normal pH,
exteme change in pH
a mixture of primary metabloic
acidosis and primary
respiratory alkalosis;
normal pH
Edema = ?
Transudate = ?
Pitting edema:
transudate; hydrostatic
pressure and/or oncotic
pressure
Exudate =
characteristics of fluid?
Pitting edema:
right-sided heart failure due to
?
Lymphedema
may occur when?
protein-rich and
cell-rich fluid
hydrostatic pressure;
cirrhosis due to oncotic
pressure
lymphatic obstruction after
modified radical mastectomy
and radiation
arterial thrombus
fibrin clot composed of platelets
Compostion ?
aspirin
femoral veins
Pulmonary infarction is
uncommon due to?
Systemic embolism
in left side of heart
majority originate where?
fat embolism
fracture of long bones
causes?
fat embolism
causes?
Amniotic fluid embolism
clinical findings?
Decompression sickness = ?
Pneumothorax, pulmonary
embolism, aseptic necrosis
Hypovolemic shock
blood loss
most often caused by?
Hypovolemic shock
pathophysiology (/)? :
CO (cardiac output),
LVEDP (Left ventricular enddiastolic pressure),
PVR (peripheral vascular
resistance),
MVO2 (mixed venous oxygen
content)
CO,
LVEDP,
PVR,
MVO2
Cardiogenic shock
acute myocardial infarction
most often cused by?
Cardiogenic shock
pathophysiology (/)? :
CO (cardiac output),
LVEDP (Left ventricular enddiastolic pressure),
PVR (peripheral vascular
resistance),
MVO2 (mixed venous oxygen
content)
CO,
LVEDP,
PVR,
MVO2
Septic shock
sepsis due to E. coli
most often caused by?
CO,
LVEDP,
PVR,
MVO2
Multiorgan dysfunction
Na+ , K+
TBNa+/TBW
TBNa+
signs of volume depletion
is a sign of?
TBna+
produces?
Weight of patient in hospital
TBNa+
Hypotonic disorders
what is always present?
gain in fluid:
ECF always
expands/contracts?
loss in fluid:
ECF always
expands/contracts?
Hypertonic loss =
TBNa+/ TBW ?
examples?
rapid correction of
hyponatremia with saline
TBNa+/ TBW
Hypertonic disorder = ?
hypernatremia or
hyperglycemia; ICG contraction
TBNa+/ TBW;
osmotic diuresis, sweating
TBNa+/ TBW
TBNa+/ TBW ?
conditions developed?
TBNa+/ TBW
TBNa+/ TBW ?
conditions developed?
Diabetic ketoacidosis =?
Proximal tubule
reabsorb Na+, reclaim HCO3does what?
EABV FF P0 > PH
EABV FF PH > PO
free water
generates?
Cl- binding site in (Na+)- (K+2)(Cl-) cotransporter:
inhibited by?
Loop diuretic
may produce which conditions?
hyponatremia, hypokalemia,
metabolic alkalosis
Thiazide diuretic
possible complications?
hyponatremia, hypokalemia,
metabolic alkalosis,
hypercalcemia
Spironolactone = ?
Addison's disease
clinical findings?
Primary aldosteronism
possible complications?
hyponatremia, hyperkalemia,
metabolic acidosis
hyponatremia, hyperkalemia,
metabolic acidosis
Primary aldosteronism
lowplasma renin type
what type of hypertension?
Primary aldosteronism
absence of pitting edema
clinical findings?
Bartter's syndrome
are patients hypertensive or
normotensive?
Bratter's syndrome
normotensive
clinical findings?
hypokalemia, metabolic
alkalosis; aldosterone and
PRA
SIADH (syndrome of
inappropriate ADH)
Treatment of SIADH?
restrict water
-CH2O = ?
concentration; presence of
ADH
oCH2O = ?
hypernatremia, polyuria;
concentration disorder
Extra: Na, Cl
Intra: K, Phosphorus
Serum Na ~ TBNa/TBW
What is the
nonpharmacological treatment
of pitting edema?
Pharmacological?
pH = HCO3 / PCO2.
7.35-7.45
fix
fix
edema
exudates - non pitting
transudates - pitting
Blocking lymphatics - non
pitting, protein rich fluid
VHY***
What causes transudates
(protien/cellular poor fluid),
concepts and specific
examples?
VHY
Patient had an MI and
produced a Myocardial
infaction and ended up w/ fluid
in his lungs, is it an exudate or
a transudate?
VHY
This patient got a B-sting and
his face swelled up, what type
of edema is this and how was it
caused?
VHY
Patient has cirrhois of the liver
and has pitting edema and
ascites what is the mechanism
of the fluid accumulations?
lymphangiosarcoma
VHY***
Fluid in our bodies is in two
compartments, ICF and ECF,
how do they compare?
Na+
TBNa/TBW?
VHY
What are the signs of dec.
TBNa+?
SIGNS:
pitting edema from an excess
of Na in the interstitial space.
(due to low protein content fluid
obeys the law of gravity and
moves to the most dependent
place (e.g. ankles if you are
standing)
Starling forces alterations.
IMPORTANT CONCEPT
What must be present to
produce pitting edema and
body effusions?
TONICITIES VHY*****
What does it mean when there
is an isotonic loss of fluid?
what happens to the ECF?
When might you see this?
If a person is infused w/ to
much normal saline,what is this
There is no osmotic gradient to
called?
shift fluid from ICF to ECF and
POsm is normal
How does this effect the ECF
and ICF
pitting edema may result
VHY***
WHat happens to serum Na in
an isotonic loss or gain of
fluids?
it is normal
hyponatremia
NUT SHELL***
IN hypotonic disoders what is
always present?
VHY***
A patient w/ Small cell
carcinoma develops mental
status changes, has normal
skin turgor but has increased
ECF and ICF, dx and explain
the problem?
SIADH
note - oral sulfonureas can also
cause this
right-sided heart failure,
cirrhosis, and nephrotic
syndrome
Pitting edema
Hypernatremia or
hyperglycemia; ICF contraction
(fluid moves into the ECF)
GLUCOSE
instead of a IX or X nerve
response there is a
catecholamine release...this
cause the venous system to
constrict (inc. return of blood to
the heart)
VHY***
BIG INVOLVED QUESTION
(best to write this one out)
When there is a dec. in arterial
blood volume (i.e a dec. in
stroke volume or cardiac
output) you underfill the arch
vessels, how does the body
respond.
Juxtaglomerular apparatus on
the afferent arteriole
VHY***
What type of fluid does the
kidney reabsorb back into the
ECF when there is a decrease
in Cardiac output from any
cause, why?
VHY**
How does the body respond if
the ateriole blood volume or
stroke volume is increased?
Opposite as when it is
decreased. there is a
parasympathetic nerve
response and ... kidneys will
have increased hydrostatic
pressure and...
remember Atrial naturietc
peptide is released when the
heart is stretched and causes
Na to be released...
CONTRAST THIS W?
VOLUME DEPLETION
QUESTION
VHY***
How do you tell total body Na?
VHY***
What is the nonpharmcaological treatment of
any of the edema states
(cirrhotic liver and heart
failure)?
What can cause hypovolemic
shock?
Pathophys-Dec. CO and
LVEDP from dec. blood flow,
inc. PVR (From
vasoconstriction by
catecholamines...)
Cold clammy skinvasoconstriction of the arteries
Rapid weak pulse is from
compensatory response to dec.
CO.
Treat w/ .9% saline (normal
saline)
VHY**
What is the main thing
controlling resistance in your
blood vessels
VHY**
SUMMARY:
Compare the CO, PVR and
LVEDP of: hypovolemic,
cardiogenic and endotoxic
(septic) shock
Peripheral resistance
arteriolies.
Hypovolemic shock - CO dec.,
PVR inc., LVEDP dec.
Cardiogenic shock - CO dec.,
PVR inc., and LVEDP inc.
Septic shock - CO inc.
(initially), PVR dec., LVEDP
dec.
Diastolic BP drops
multiorgan dysfunction
acute tubular necrosis (ATN) coagulation necrosis of the
proximal tubule cells and cells
in the thick ascending limb
These people will die if not
fixed quick.
medullary oblongota
Respiratory acidosis
PaCO2>45mmHg
PaCO2<33mmHg
Light-headed, confusion and
signs of tetany (thumb
What are the clinical findings of
adduction into the palm
respiratory alkalosis?
(carpopedal spasm), perioral
twithcing when the facial nerve
is tapped (chvostek sign) and
perioral tingling/numbness)
increase the number of
negative charges on albumin
(more COO- gourps on acidic
Why do you get signs of tetany
A.A.)...calcium is displaced
w/ respiratory alkalosis?
from teh ionized fraction and is
bound to albumin, causing dec.
in the ionized calcium levels
and you get signs of tetany
Respiratory Alkalosis
Pregnancy - estrogen and
progestin stimulate respiratory
What kind of pH disturbance
rate and you have A-V fistuals
can occur during pregnancy
in the lungs so you clear more
and stress?
CO2 per-breath (from spider
angiomas froming)
VHY****
How does salicylate (aspirin)
intoxication effect you blood
gases?
Respiratory alkalosis
(salicylates overstimulate the
respiratory system) and
Metabolic acidosis (durg is an
acid) so the pH is normal
pH is normal
this means they have a mixed
disorder
CNS respiratory center trauma or barbituates
Upper airway -acute epiglotitis
and croup (parainfluenza virus)
trachea is swollen
1. crash cart (cart w/ stuff for
ACLS/ALS)
2. acute epiglotitis
3. lateral X-ray and see the
thumb print sign
4. Hemophilus influenzae
vaccination has caused this to
decrease dramatically
1. Croup
2. X-ray -see the staple sign
3. Parainfluenza virus
damaged the brachial plexus
effecting the muslces of
respiration specifically the
phrenic and it causes the
diaphram to be elevated.
Respiratory acidosis will result
Guillain-Barre
Respirtory acidosis from
parlysis of the muslces of
respiration (if you don't move
out the CO2 it dec. your pH)
Obstructive - problem getting
air out not in so respiratory
acidosis
Restrictive lung diseases respiratory alkalosis
tx is a hyperbaric oxygen
regulataes neuromuscular
excitability and muscle
contraction
regulation of insulin secretion
(hypokalemia inhibits insulin
secretion while hyperkalemia
stimulates insulin secretion)
1. aldosterone - inc. secretion
of H+ and K+
2. Arterial pH - alkalosis causes
H+ to move out of the cells in
exchange for K+...the reverse
is true as well
K+<3.5meq/L
Loop and thiazide diuretics
3.Muslce weakness from
changes in the
intracellular/extracellular
membrane potential
2.U-waves on ECG
Renal failure
Ventricular arrhythmias (severe
hyperkalemia causes the heart
to stop in diastole)
long bones