Fluid and Electrolytes
This electrolyte imbalance may result in peaked T waves and U waves.
Hyperkalemia
How would you define an acidotic pH?
pH <7.35
List at least 4 functions of the kidney.
Regulation of blood pressure (RAAS system)
Regulation of acid-base balance
Activation of Vitamin D
Erythropoietin production
Removal of waste
Regulation of electrolyte concentration (serum)
This component of the ventilation process involves increasing pressure and passive recoil.
Exhalation
True or false: All arteries contain oxygenated blood.
False: the pulmonary artery contains DE-oxygenated blood.
What is the name for the initial site of impact in traumatic brain injury?
Coup
What is the functional unit of the liver? List 3 roles/functions of this unit.
Hepatocytes
- Synthesis of clotting factors, proteins, hormones
- Synthesis of bilirubin
- Breakdown of ammonia
- Storage of fat soluble vitamins
- Filtration of medications and toxins, first pass metabolism
These clinical findings/signs are associated with hypocalcemia.
Trousseau's sign, Chvostek's sign
This buffer system is the last to kick in, but the strongest.
Renal buffer
Bonus: how does it work? secrete HCO3, Reabsorb HCO3, Excrete H+
What abnormal urinalysis findings would you expect in a patient with nephritic syndrome?
This is the site of gas exchange within the respiratory system.
Alveolus/Alveoli
Which of the following conditions will involve an elevated troponin?
- Stable Angina, Unstable Angina, Non-ST Elevation MI, ST-Elevation MI
Non-ST Elevation MI, ST-Elevation MI
BONUS: WHY do these clinical features occur?
Hypotension, Bradycardia
What laboratory tests are specific to the pancreas?
Bonus: List 2-3 lab values you'd expect in pancreatitis.
Amylase, Lipase
- WBC >16,000
- Elevated amylase and lipase
- Hypocalcemia
- Hypomagnesemia
What type of IV fluid is typically used for fluid resuscitation?
Bonus: list 2 specific examples of this fluid.
Isotonic fluid
- 0.9% NaCl
- Lactated Ringers
How would the respiratory buffer work to counteract an acidosis?
What is the cause of peripheral edema in a patient with nephrotic syndrome?
Albuminuria, change in oncotic pressure.
What is the underlying pathophysiology of acute respiratory distress syndrome (ARDS)?
Fluid fills the alveoli impairing diffusion, leads to hypoxia --> typically caused by critical illness
decreased ejection fraction due to thin, floppy myocardium. SQUEEZE problem.
This neuromuscular disorder occurs because of autoimmune destruction of the myelin sheath in the peripheral nervous system after a viral infection.
This inflammatory bowel disease is limited to the colon, carries a lower risk of bowel perforation, and a higher risk of colon cancer.
Ulcerative Colitis
What sodium derangement and volume status would you expect in a patient with DI?
HypERnatremia
HypOvolemia
List 2 causes each of metabolic acidosis and respiratory acidosis.
Metabolic acidosis: diarrhea, dehydration
Respiratory acidosis: opioid overdose, COPD, obstruction
List one potential cause for each type of acute kidney injury: Prerenal, Intrarenal, Postrenal.
Prerenal: dehydration, hemorrhage, arrhythmia
Intrarenal: nephrotoxic medications (vancomycin), nephritic/nephrotic syndromes
Postrenal: obstruction (BPH), tumor
This is an autosomal recessive disorder which causes both airway obstruction related to thick mucous production AND pancreatic insufficiency.
Cystic fibrosis
List the 3 mechanisms by which the RAAS system INCREASES blood pressure.
Is this helpful or unhelpful in heart failure and why?
- SNS stimulation (HR, contractility)
- ADH --> reabsorption of water at the CD
- Aldosterone --> reabsorption of Na, water follows sodium
Ultimately unhelpful, increases volume status, worsens heart failure
List 3 late signs of increased ICP.
1. Fixed and dilated pupil (cranial nerve 3 palsy)
2. Decreased level of consciousness
3. Cushing's triad
4. Posturing
List 1: the #1 risk factor for peptic ulcer disease
OR
2: 2 risks associated with gastric ulcer perforation.
1. H. Pylori
2. Bleeding, peritonitis
BONUS: Define peritonitis. What are the major causes
List 2-3 pathophysiologic causes of peripheral edema.
- Increased hydrostatic pressure
- Decreased oncotic pressure
- Increased vascular permeability
- Lymph vessel obstruction
What is the acid/base derangement?
pH 7.48, PaCO2 30, HCO3 21, PaO2 98
Respiratory alkalosis with partial compensation
List 3 lab values each which you'd expect to increase and 3 which you'd expect to decrease in chronic renal failure.
Increase: BUN/Cr, H+ (metabolic acidosis), Na, K+, Cl, Mag, PO4
Decrease: EPO, Calcium, Vitamin D, RBC, GFR
BONUS: At what GFR value do we decrease our medication dosing?
List one each: Ventilation, Perfusion, Diffusion problem
Ventilation: Asthma, obstruction
Perfusion: Pulmonary Embolus
Diffusion: Emphysema, ARDS
List the 4 steps of the development of atherosclerosis and 3 conditions in which you may see atherosclerosis.
Chronic endothelial injury, fatty streak, fibrous plaque, complicated lesion.
1. Coronary artery disease
2. Peripheral vascular disease
3. Ischemic stroke
A patient with a traumatic brain injury has a sudden decrease in their level of consciousness. Their HR is 48, BP 180/120, and their RR is 6. What is the name of this clinical phenomenon? What is the underlying pathophysiology?
List 3 clinical features of patients with cirrhosis and the underlying pathophysiology of these clinical features.
2. Jaundice - build up of bilirubin
3. Altered mental status - build up of ammonia
4. Bruising and bleeding - decreased production of clotting factors
5. Muscle wasting - decreased protein synthesis
6. Gynecomastia - decreased hormone synthesis