Pathophysiology
What electrolyte imbalance is commonly seen in renal failure?
You may see an array of electrolyte disturbances, but hyperkalemia is one of the most common ones.
What is the antidote for benzodiazepines? What are risks in using it and should it be used in individuals who use benzos chronically?
Flumazenil or Romazicon. Risks include seizures and cardiac arrhythmias (primarily seizures). Avoid in individuals who use benzodiazepines chronically.
What is the name of the positioning often noted in individuals who are progressively short of breath (Hint: it is common in idividuals with COPD).
Tripoding
pH: 7.15, pCO2 25 mmHg, pO2 84 mmHg, HCO3 10 mEq/L, BE -10
Partially compensated metabolic acidosis
Insertion of a small, flexible, and temporary tube to drain fluid within the pleural cavity (this tube is not left in).
Thoracentesis
What is the primary reaction that leads to Type 1 Diabetes?
Autoimmunity
What drug class does losartan belong to?
Angiotensin Receptor Blocker (ARB)
What lung sound is associated with fluid overload?
Crackles
pH 7.17, pCO2 70 mmHg, pO2 50 mmHg, HCO3 31 mEq/L, BE +6
partially compensated respiratory acidosis
Colonoscopy
Explain the Frank-Starling law.
It is the observation that ventricular output increases as preload (end-diastolic pressure) increases.
Name two side effects of loop diuretics.
Electrolyte disturbances such as: hyponatremia, hypokalemia, hypochloremia, and hypomagnesemia. Metabolic alkalosis, prerenal azotemia, dehydration, hypertriglyceridemia, hypercholesterolemia, hyperuricemia, gout, restlessness, headache, dizziness, vertigo, postural hypotension, and syncope. Skin photosensitivity, interstitial nephritis, tinnitus, ototoxicity, deafness, and in patients with renal failure who receive high doses, myalgias, and muscle soreness are also possible.
What does a positive Murphy's sign suggest?
Cholecystitis
pH 7.40, pCO2 60 mmHg, pO2 70 mmHg, HCO3 30 mEq/L, BE +6
Fully compensated respiratory acidosis
Surgical removal of the gallbladder.
Cholecystectomy
What pathophysiological process causes emphysema?
Lung injury in emphysema is a result of inflammatory and destructive processes in response to inhalants such as cigarette smoke. These pathways are activated and repair pathways are downregulated. There is eventually alveolar septal cell apoptosis and destruction of the extracellular matrix.
Why must vancomycin levels be monitored?
To optimize dosing to prevent bacterial resistance (antibiotic stewardship) and to prevent drug toxicity (nephrotoxic).
Describe the characteristics of arterial versus venous ulcers.
Arterial ulcers: most commonly located at the points farthest from the heart (toes, forefoot) and classically have well-defined margins, a pale or necrotic wound bed, and minimal to no exudate. PAD often consists of thin shiny epidermis, dry scaly skin, hair loss, and nail thickening. There is often cold feet and abnormal or absent pulses.
Venous ulcers: typically with edema and hyperpigmentation (hemosiderosis), with or without varicosities and telangiectasia.
pH 7.52, pCO2 15 mmHg, pO2 68 mmHg, HCO3 21 mEq/L, BE 0
Respiratory alkalosis without compensation
Procedure used to measure pressures within the heart.
Right heart catheterization
Describe the difference between compensated and decompensated shock.
Compensated shock is the initial stage of shock where the body is able to compensate for the decreased tissue perfusion despite a loss of intravascular volume or cardiac dysfunction. The blood pressure is often normal or sometimes high due to catecholamine release (stress response). HR is often high, RR may be high, etc. You often see an elevated lactic acid and you may see some acidosis and poor capillary refill. In decompensated shock, the body is no longer able to compensate and there is hypotension and organ dysfunction. The capillary refill is poor. The patient may be altered, cool, clammy, have low urine output, or cardiac dysrhythmias.
Explain how ACE inhibitors help in heart failure.
The angiotensin-converting enzyme (ACE) is involved in the renin-angiotensin-aldosterone system (RAAS) and stimulates the conversion of angiotensin I to angiotensin II. ACE is found in the lung capillaries and the endothelium of the kidneys. ACE inhibitors are competitive inhibitors of ACE, which prevent the conversion of angiotensin I to angiotensin II. Angiotensin II acts as a potent vasoconstrictor that, when inhibited, can reduce blood pressure by dilating vessels and decreasing aldosterone secretion. (Aldosterone induces sodium reabsorption and, in turn, water reabsorption through internal mineralocorticoid receptor activity). This decreases sodium reabsorption and subsequent water reabsorption decreasing stress and stretch on the heart.
What assessment finding suggest increased intracranial pressure?
Cushing's Triad: bradycardia, irregular respiration, and widened pulse pressure.
pH 7.51, pCO2 40 mmHg, pO2 85 mmHg, HCO3 31 mEq/L, BE +11
Treatment that uses high-frequency sound waves to destroy kidney stones.
Lithrotripsy