Critical Care, Fluid, Nutrition Absite Flashcards

Front 1

Normal Alveolar-Arterial gradient in non-ventilated patient = _-_ mmHg

Back 1

Normal Alveolar-Arterial gradient in non-ventilated patient = 10-15 mmHg

Normal A-a gradient is <10 mmHg, but can range from 5–20 mmHg.
For every decade a person has lived, their A-a gradient is expected to increase by 1 mmHg.
An abnormally increased A-a gradient suggests a defect in diffusion, V/Q (ventilation/perfusion ratio) defect, or right-to-left shunt.

Front 2

How is A-a gradient calculated?

Back 2

A-a gradient = PAO2 − PaO2
PAO2 = alveolar = calculated from alveolar gas equation
PaO2 = arterial = from ABG

Front 3

what ABG change should be anticipated in elderly pts?

Back 3

Decreased PO, unchanged PCO.
-Arterial PO falls by approximately 5 mm Hg per decade of life. This is due to ventilation perfusion mismatching associated with aging, which leads to increased shunt and dead space ventilation.

-ALso, ventilatory responses to hypoxia and hypercapnia fall by 50% and 40%, respectively, with aging. The exact mechanism is unknown but likely involves reduced chemoreceptor function.

Front 4

effect of ACE-inhibitor on potassium

Back 4

ACE-I increase K

Front 5

how do ACE inhibitors lower the glomerular pressure gradient?
-Can precipitate ARF in patients c/ _

Back 5

ACE-I lowers the glomerular pressure gradient by efferent arteriole vasodilation
-Can prescipite renal failure in patients c/ renal artery stenosis

Front 6

hypoxic pulm vasoconstriction is worsened by what acid/base status?

Back 6

Hypoxic pulmonary vasoconstriction is worsened by acidosis

Front 7

Activated protein C: what is is used for in pts c/ sepsis and multiorgan failure

Back 7

Activated protein C = Xigris
Inactivates the inhibitor of protein C -> FIBRINOLYSIS

Front 8

What is the best initial therapy for a patient with acute pancreatitis who develops a Na of 122 on the second day of hospital admission?

Back 8

FLUID RESTRICTION Pseudohyponatremia can occur in pancreatitis & hyperglycemia. For each increment of glucose over 100, add 2 to the Na value. Na deficit = .6 x kg weight x (140-Na)

Front 9

How does ADH work?

Back 9

ADH: -stimulated by intravascular hypovolemia, osmolality of ECF
-Stimulated peri-op by pain, anxiety, some narcotics => may be 5-50x highter post-op, then normalize w/in 3-5 days
-V1: vasocontriction of vascular sm muscle
-V2 (intrarenal) H20 reabsorption @ collecting ducts
-V3 (extrarenal): release of factor 8, vWF

Front 10

most sensitive test for adrenal insufficiency

Back 10

corticotrophin stim test most sensitive test for adrenal insufficiency

Front 11

how does aldosterone work?

Back 11

Aldosterone:
-Stimulated by Angiotensin 2, K
-Causes transcription of Na/K ATPase, Na/H ATPase -> reabsorb Na, secrete H and K in distal convoluted tubule ->
Water reabsorption

Front 12

For diagnosing ALI, an S/F ratio of _ corresponds with P/F ratio of _

Back 12

For diagnosing ALI, an S/F ratio of 235 corresponds with P/F ratio of 200

Front 13

normal inspiration is associated with greater ventilation of zone _ alveoli

Back 13

normal inspiration is associated with greater ventilation of zone 3 alveoli (dependent portion of lung)

Front 14

zone _ alveoli may contribute to physiological dead space of the respiratory system

Back 14

Physiologic dead space:
-Emphysematous lung
-lung involved in PE
-proximal 2/3 of subsegmental (+ eerything proximal)
-zone 1 alveoli

Front 15

__ type AA's: leucine, isoleucine, valine
-metabolized in __
-all essential

Back 15

Branched-chain AA's: leucine, isoleucine, valine
-metabolized in muscle
-all essential

Front 16

Angiotensin 2 is formed mostly in the _
Its role is to …….

Back 16

Angiotensin:
ACE converts Angiotensin 1 to Angiotensin 2 (highest concentration is in lung) ->
ALDOSTERONE RELEASE, vasocontstriction, increased HR and contractility

Front 17

How is anion gap calculated?
What are the anion gap acidoses

Back 17

Anion gap acidosis = MUDPILES:
Methanol
UREMIA
DKA
paraldehyde
LACTATE
ethylene glycol
salicylates
-Anion gap = Na - HCO - Cl. Normal gap <12

Front 18

For diagnosing ARDS, an S/F ratio of _ corresponds with P/F ratio of _

Back 18

For diagnosing ARDS, an S/F ratio of 315 corresponds with P/F ratio of 300

Front 19

What is the basic ventilation strategy for ARDS:

Back 19

Ventilation for ARDS:
-Pressure-control ventilation
-Permissive hypercapnea
-Correct pH c/ bicarb

Front 20

What conditionally essential amino acid is shunted into nitric oxide synthase during times of stress?

Back 20

Arginine is considered a conditionally essential amino acid. Humans do not produce adequate amounts to meet metabolic needs following acute surgical illness. This relative deficiency is felt to result from the upregulation of arginase 1 which shunts arginine away from nitric oxide synthase and production of nitric oxide. Nitric oxide is the body's most potent endogenous vasodilator.

Front 21

The magnitude of a left-to-right shunt in the presence of an ASD is determined by...

Back 21

Difference in compliance b/w left and right atria
The blood will tend to fill the more compliant ventricle which will usually be the right, until chronic pulmonary hypertension yields right ventricular hypertrophy.

Front 22

what type of cells cause fever 2/2 atelectasis?
what cytokine?

Back 22

alveolar macrophages are activated by atelectasis, cause fever via IL-1

Front 23

___ macrophages =
source of fever in atelectasis

Back 23

alveolar macrophages =
source of fever in atelectasis

Front 24

Atrial natiuretic peptide:
-Released from atria when stretched
effect in the kidney is ... -> end effect ...

Back 24

Atrial natiuretic peptide:
-Released from atria when stretched
-Inhibits Na and water absorbtion -> natiuresis, diuresis

Front 25

what are the brain death criteria?

Back 25

Deep tendon reflexes and even local pain stimulation reflexes may be present when brain is dead.

Brain death criteria include:
Lack of brain stem reflexes (doll's eyes, cold caloric, corneal, gag, cough)
Lack of motor response to noxious stimuli
Lack of pupillary light reflexes
APNEA - no respiratory drive with pCO2 of 60 mm Hg

Front 26

Fluid leaves the capillary at the arterial end because _ type pressure exceeds _ type pressure.

Back 26

Fluid leaves the capillary at the arterial end because hydrostatic pressure exceeds oncotic pressure.

Front 27

symptoms of carcinoid syndrome are ameliorated by drug _

Back 27

symptoms of carcinoid syndrome are ameliorated by SOMATOSTATIN

Front 28

what is normal cardiac index?

Back 28

normal cardiac index = 2.5-4 L/min

Front 29

A postsurgical patient you are managing has a history of congestive heart failure. Despite fluid resuscitation, the patient remains hypotensive with an elevated SVR. Management considerations could include

Back 29

Post-op hypotension in patient with CHF - can try: B1 agonist, nitroprusside, phosphodiesterase inhibitor, IV fluids + afterload reduction

Front 30

_ deficiency =>
hyperglycemia (relative diabetes)
neuropathy

Back 30

Chromium deficiency =>
hyperglycemia (relative diabetes)
neuropathy

Front 31

Carbon monoxide poisoning:
-Carboxyhemoglobin is elevated if >10% in nonsmoker or >20% in smoker
-CO binds Hgb -> carboxyHgb -> falsely increases O2 sat on monitor
-Tx: 100% O2 displaces CO, hyperbaric O2 if severe

Back 31

Carbon monoxide poisoning:
-Carboxyhemoglobin is elevated if >10% in nonsmoker or >20% in smoker
-CO binds Hgb -> carboxyHgb -> falsely increases O2 sat on monitor
-Tx: 100% O2 displaces CO, hyperbaric O2 if severe

Front 32

_ deficiency:
anemia
neutropenia

Back 32

Copper deficiency:
anemia
neutropenia

Front 33

Cori cycle:
-glucose metabolized to _ -> metabolized to _ in the __

Back 33

Cori cycle:
-glucose metabolized to lacatate -> metabolized to glucose in liver

Front 34

Adrenal secretion of cortisol has negative feedback on what gland?

Back 34

Adrenal secretion of cortisol has negative feedback on the HYPOTHALAMUS

Front 35

#1 non-iatrogenic cause of Cushing's syndrome = _
-Diagnosed by ...
-Localized by...
-Treatment is ...

Back 35

PITUITARY ADENOMA = 80-80% of non-iatrogenic Cushing's syndrome
-Cortisol supressed by high- or low-dose Dex supression test.
-Usually MICROadenomas
-Need petrosal sampling to figure out which side. MRI also helps
-Vertical incisions to find adenoma
-Tx: most tumors removed c/ transsphenoidal approach.
-Unresectable or residual tumors treated c/ XRT

Front 36

CVP: 7 +/- 2

Back 36

CVP: 7 +/- 2

Front 37

enzyme which catalyzes the conversion of arachidonic acid to prostaglandins is

Back 37

cyclooxygenase catalyzes the conversion of arachidonic acid to prostaglandins is

Front 38

what is the role of IL-4 and IL-10?

Back 38

IL-4 and IL-10 are anti-inflammatory cytokines

Front 39

define dead space
-roughly _cc

Back 39

Dead space:
-ventilated, not perfused
-about 150 cc

Front 40

Dobutamine:
-5-15 ug/Kg/kin => beta 1 (mostly contractility)
->15 ug/Kg/min => beta 2 (vasodilation, increased HR)

Back 40

Dobutamine:
-5-15 ug/Kg/kin => beta 1 (mostly contractility)
->15 ug/Kg/min => beta 2 (vasodilation, increased HR)

Front 41

Dopamine:
-0-5 ug/Kg/min => dopamine R's (renal)
-6-10 ug/Kg/min => beta adrenergic (cardiac contractility)
->10 ug/Kg/min => alpha adrenergic (vasoconstiction, increased BP)

Back 41

Dopamine:
-0-5 ug/Kg/min => dopamine R's (renal)
-6-10 ug/Kg/min => beta adrenergic (cardiac contractility)
->10 ug/Kg/min => alpha adrenergic (vasoconstiction, increased BP)

Front 42

2 names for the molecule that acts via cGMP pathway to promote relaxation of vascular sm muscle

Back 42

EDRF = endothelium derived relaxing factor = NO
-made from ARGININE in endothelial cells-> activates guanylate cyclase (cGMP path) -> vascular sm muscle relaxation
-increased in sepsis
(endothelin => vascular sm muscle constriction)

Front 43

Metabolic disturbance 2/2 NG suction is _

Back 43

NG suction -> hypochloremic, hypokalemic, metabolic alkalosis c/ paradoxical aciduria
-Lose HCl, HCO3 in gastric suctioning ->
Kidney compensates for H2O loss by absorbing Na in exchange for K (-> hypokalemia)
-Kidney compensates for K loss by absorbing K in exchange for H (-> aciduria)
Tx: D5 1/2 NS + 20mEq KCl

Front 44

Metabolic disturbance 2/2 pyloric stenosis in child is _

Back 44

Vomiting -> hypochloremic, hypokalemic, metabolic alkalosis c/ paradoxical aciduria
-Lose HCl, HCO3 in gastric suctioning ->
Kidney compensates for H2O loss by absorbing Na in exchange for K (-> hypokalemia)
-Kidney compensates for K loss by absorbing K in exchange for H (-> aciduria)
Tx: D10 + 10 mEq KCl

Front 45

patient has following lung changes - what lung disease is it?

Back 45

EMPHYSEMA:
-increased minute ventilation
-increased airway resistance (2/2 destruction of these terminal bronchioles, early collapse of remaining bronchioles)
-Early (increased) closing volume (2/2 coalesced alveoli)
-Adverse length-tension relationship of diaphragm.

Front 46

Epinephrine
-Initial dose = 2 ug/min
-Low dose => beta 1 (cardiac contractility, rate), beta 2 (bronchial and vascular sm muscle relaxation), can decrease BP @ low doses
-High dose => alpha 1 (vascular sm muscle constriction), alpha 2 (venous sm muscle constriction), increases cardiac ectopic pacer activity, myocardial O2 demand

Back 46

Epinephrine
-Initial dose = 2 ug/min
-Low dose => beta 1 (cardiac contractility, rate), beta 2 (bronchial and vascular sm muscle relaxation), can decrease BP @ low doses
-High dose => alpha 1 (vascular sm muscle constriction), alpha 2 (venous sm muscle constriction), increases cardiac ectopic pacer activity, myocardial O2 demand

Front 47

_ chain and _ chain fatty acids go via portal system c/ AAs + carbs

Back 47

only medium and short chain fatty triglycerides go to portal system c/ AAs + carbs

Front 48

how is fat transported from bowel to central circulation?

Back 48

Fat digestion:
-micelles go to enterocytes -> chylomicrons go to lymphatics -> junction of L IJ + SCV

Front 49

_ chain fatty acids = preferred food for colon

Back 49

short chain fatty acids = preferred food for colon

Front 50

how are medium-chain fatty acids absorbed?

Back 50

MCT (6–12 carbons) are more rapidly hydrolyzed and have greater solubility than LCT. This allows absorption directly into the portal vein and require little or no pancreatic or bile salts for absorption

Front 51

LR is comprised of _

Back 51

LR is comprised of Na 130, Cl 109, K 4, Ca 2.7, HCO3 28 mEq/L

Front 52

NS is comprised of _

Back 52

NS is comprised of NaCl 154 mEq/L

Front 53

equation for maintenance fluid in a child

Back 53

Maintenance fluid:
40 mL/hr for 1st 10 Kg
20 mL/hr for 2nd 10 Kg
1 mL/Kg/hr for rest of body weight

Front 54

how is free water deficit calculated?

Back 54

free water deficit = body weight × 0.6 × (1 – 140/actual serum sodium)

Front 55

Glutamine:
-preferred food for _ bowel
-why are levels decreased in stress?

Back 55

Glutamine:
-preferred food for small bowel
-#1 AA in bloodstream => decreased levels in stress b/c glutamine goes to kidney to form ammonium, help acidosis (but sm bowel still the #1 consumer)
-decreases bacterial translocation, increases mucosal health c/ chemo or XRT to bowel
-delivered to sm bowel enterocytes by intestinal lumen or blood stream.

Front 56

In major illness, the major carrier of nitrogen from skeletal muscle breakdown is amino acid _

Back 56

In major illness, the major carrier of nitrogen from skeletal muscle breakdown = GLUTAMINE

Front 57

Goldman index = 9 factors for increased risk of periop cardiac complications.

Back 57

Goldman index by points:
11: uncompensated CHF (elevated CVP/JVD,S3 gallop)
10: MI in past 6 mo
7: >5 PVC/min any time pre-op
7: non-sinus rhythm or PACs on pre-op EKG
othes: age >70; intra-peritoneal/intra-thoracic/aortic surgery; emergency surgery; important aortic stenosis; poor general medical condition

Front 58

Hydralazine = alpha blocker

Back 58

Hydralazine = alpha blocker

Front 59

An 85 year old male with metastatic prostate cancer presents to the ER with mental status changes and an abnormal QT interval. What is the best initial therapy?

Back 59

SALINE INFUSION
Neoplasm is the most common cause of hypercalcemia in the hospitalized patient. The malignancy most commonly associated with hypercalcemia is breast cancer due to its high rate of bone metastasis. Prostate cancer is the second most common cause. Medical treatment of hypercalcemia should start with IV saline infusion followed by loop diuretics. Dialysis should be reserved for refractory hypercalcemia or life threatening episodes. Long term medical management of hypercalcemia can include use of lasix, mithramycin, calcitonin, &/or aldaronic acid.

Front 60

Tip of an IABP should be located at _

Back 60

Tip of an IABP should be 2 cm below the top of the aortic arch
-Higher than that => can occlude the arch vessels
-Lower than that => can occlude the mesenteric vessels

Front 61

IABP improves coronary blood flow by _

Back 61

IABP:
-Improves coronary blood flow, increasing SBP -> augments flow to coronaries, then decreases afterload by deflating during systole
(inflates on T wave, deflates on P wave)

Front 62

Contraindication to IABP = _

Back 62

Aortic regurgitation = contraindication to IABP
IABP improves coronary blood flow by INFLATING IN DIASTOLE TO AUGMENTING FLOW TO CORONARIES, then decreases afterload by deflating during systole
(inflates on T wave, deflates on P wave)

Front 63

intrinsic factor is produced by _ cells in the _ and _ of the stomach

Back 63

intrinsic factor is produced by PARIETAL cells in the FUNDUS and CORPUS of the stomach

Front 64

Isoproterenol
-Intial dose = 1-2 ug/min
-Beta 1 (myocardial contractiliy, rate), Beta 2 (bronchial and vascular sm muscle relaxation)
-Arrhythmogenic, increases metabolic demand of heart (rarely used), can decrease BP

Back 64

Isoproterenol
-Intial dose = 1-2 ug/min
-Beta 1 (myocardial contractiliy, rate), Beta 2 (bronchial and vascular sm muscle relaxation)
-Arrhythmogenic, increases metabolic demand of heart (rarely used), can decrease BP

Front 65

Kreb's cycle = ___ ATPs from 1 glucose (anaerobic glycolysis = _ ATP + _ lactate)

Back 65

Kreb's cycle = 38 ATP from 1 glucose
(anaerobic glycolysis = 2 ATP + 1 lactate)

Front 66

_ deficiency (essential fatty acids) =>
dermatitis
hair loss
vision change

Back 66

linoleic acid deficiency (essential fatty acids) =>
dermatitis
hair loss
vision change

Front 67

Long chain fatty acids enter the body via _, in the form of _ or _

Back 67

Long chain fatty acids enter the body via LYMPHATICS (terminal lacteals), in the form of LONG CHAIN FATTY ACIDS or CHYLOMICRONS

Front 68

how do loop diuretics work?

Back 68

Loop diuretics:
-inhibit active Na reabsorption @ thick ascending limb of Henle
-increase venous capacitance => may relieve pulm edema before significant natiuresis
-increase renal blood flow by stimulating vasodilatory prostaglandins
-reach intratubular site of action by active proximal tubular secretion (not by glomerular filtration)

Front 69

Medium + short-chain fatty acids enter the body via _

Back 69

Medium + short-chain fatty acids enter the body via PORTAL CIRCULATION
(along with carbs, protein)

Front 70

In metabolic acidosis, the renal regulation of body fluid pH depends primarily on secretion of _ ion in exchange for _ ion

Back 70

In metabolic acidosis, the renal regulation of body fluid pH depends primarily on SECRETION OF H+ in exchange for NA

Front 71

Methemoglobinemia:
-Nitrites (e.g. Hurricaine spray) bind Hgb ->
decreases O2 sat to 85%
-Tx: methylene blue

Back 71

Methemoglobinemia:
-Nitrites (e.g. Hurricaine spray) bind Hgb ->
decreases O2 sat to 85%
-Tx: methylene blue

Front 72

Metoclopramide stimulates release of _ by blocking _ receptors

Back 72

Metoclopramide stimulates release of ACETYL CHOLINE by blocking DOPAMINERGIC receptors

Front 73

How does low Mg cause hypo-Ca?

Back 73

Low Mg inhibits PTH =>
replace Mg if difficulty correcting Ca

Front 74

Milrinone
-Phosphodiesterase inhibitor => increases cAMP
-Increases Ca flux -> cardiac contractility
-Also causes vascular smooth muscle relaxation, vasodilation

Back 74

Milrinone
-Phosphodiesterase inhibitor => increases cAMP
-Increases Ca flux -> cardiac contractility
-Also causes vascular smooth muscle relaxation, vasodilation

Front 75

Erythromycin binds the _ receptor, located in 3 locations…

Back 75

Erythromycin binds the MOTILIN receptor
Located in 3 locations: stomach, duodenum, colon

Front 76

how is Na level corrected in hyperglycemia?

Back 76

Hyperglycemia:
for every 100 glucose over 100, add 2 to Na

Front 77

How is Na deficit calculated?

Back 77

Na deficit:
- 0.6 (wt in Kg) (140-Na).
replace max of 1 mEq/hr to avoid CPM

Front 78

What vitamin deficiency?
red swollen skin lesions, cheilosis, mouth angular scars and stomatitis, and dementia.

Back 78

Niacin deficiency includes: red swollen skin lesions, cheilosis, mouth angular scars and stomatitis, and dementia.

Front 79

Nipride: arterial and venous dilator
-CN toxicity @ doses >_ ug/Kg/min x _ hrs => check _ levels, signs of metabolic acidosis
-Tx for CN toxicity = _ -> sodium nitrate

Back 79

Nipride: arterial and venous dilator
-CN toxicity @ doses >3 ug/Kg/min x 72 hrs => check thiocyanate levels, signs of metabolic acidosis
-Tx for CN toxicity = amyl nitrite -> sodium nitrate

Front 80

Nitroglycerine:
-Predominantly venodilation
-Modest effect on coronaries
-Decreases _-> decreases myocardial wall tension

Back 80

Nitroglycerine:
-Predominantly venodilation
-Modest effect on coronaries
-Decreases preload -> decreases myocardial wall tension

Front 81

the 2 main harms of nitroprusside are ...

Back 81

Nitroprusside can cause:
-Thiocyanate toxicity -> hypoxia
-Coronary steal (arteries in CAD already mazimally dilated, so additional arteriolar dilation steals perfusion away)

Front 82

Nitric oxide:
-Precursor is _
-Acts on enzyme _ -> increases _ -> end effect _

Back 82

Nitric oxide:
-Precursor is arginine
-Acts on guanylate cyclase -> increases cGMP -> vasodilation

Front 83

Norepinephrine:
-Initial dose = _ ug/min
-Low dose => _ R's (contractility)
-High dose => _ R's (vascular sm muscle constriction), _ R's (venous sm muscle constriction)
-Potent splanchnic vasoconstrictor

Back 83

Norepinephrine:
-Initial dose = 4 ug/min
-Low dose => beta 1 (contractility)
-High dose => alpha 1 (vascular sm muscle constriction), alpha 2 (venous sm muscle constriction)
-Potent splanchnic vasoconstrictor

Front 84

Basal caloric expenditure is ~___
Roughly how many g protein/Kg/day?

Back 84

Basal caloric expenditure:
-25 Kcal/Kg/day (~1g protein/Kg/day needed)

Front 85

Typical O2 in coronary sinus is _%

Back 85

Typical O2 in coronary sinus is 30%
(heart consumes a lot of O2)

Front 86

O2 dissociation curve:
Normal p50 @ which 50% of O2 R's are saturated = _
L-shifted by 3 things…

Back 86

O2 dissociation curve: normal p50 = 27 mmHg
L shift = oxygen more bound to Hgb:
-Low CO2
-Low temp
-High pH

Front 87

O2 dissociation curve:
Normal p50 @ which 50% of O2 R's are saturated = _
R-shifted by 4 things…

Back 87

O2 dissociation curve: normal p50 = 27 mmHg
R shift = oxygen less bound to Hgb:
-High CO2
-Low pH
-2-3 DPG
-ATP

Front 88

oliguria = <__ mL urine in 24 hrs

Back 88

oliguria: <600 mL UOP/24 hrs (<25 mL/hr)

Oliguric acute renal failure => get a FENA.
-FeNa > 3% => ATN.
-Urine osmolality >400, Urine spec grav >1.02, Urine Na <20 => prerenal azotemia.

Front 89

what is the formula for O2 consumption?

Back 89

O2 consumption = CO x (arterial O2 content - venous O2 content)
-normal 5:1 ration of O2 delivery: consumption. Consumption is supply-independent until low level of delivery is reached

Front 90

what is the formula for O2 delivery?

Back 90

O2 delivery = CO x O2 content = CO x (Hgb x 1.34 x O2 sat + pO2 x 0.003)

Front 91

_ = limiting factor for oxygen transport in the alveolus

Back 91

Oxygen transport is perfusion limited in that once hemoglobin is fully saturated, continued exposure to the alveolus as a result of increase in transit time results in no further net uptake by hemoglobin

Although carbon dioxide is substantially more diffusible through the alveolar-capillary barrier than oxygen, a higher initial diffusion gradient exists for oxygen, which by combining with hemoglobin is able to maintain this gradient advantage such that approximately equivalent amounts of oxygen and carbon dioxide are eventually exchanged. Chemical binding with hemoglobin takes oxygen out of solution such that its partial pressure is reduced and the gradient for diffusion is increased.

Front 92

what is the typical concentration of Na, K, HCO3 in pancreatic secretions?

Back 92

Pancreatic secretions:
Na 140
K 5
HCO3 100

Front 93

PCWP: 11 +/- 4

Back 93

PCWP: 11 +/- 4

Front 94

what number is used to monitor dynamic compliance of lungs?

Back 94

PEAK pressure = measure of dynamic compliance

Front 95

Phenylephrine:
-Alpha 1 => vasoconstriction

Back 95

Phenylephrine:
-Alpha 1 => vasoconstriction

Front 96

_ deficiency:
weakness (resp)
encephalopathy (needed for ATP)

Back 96

Phosphate deficiency:
weakness (resp)
encephalopathy (needed for ATP)

Front 97

Potassium concentration in body fluids:
-Saliva
-Gastric
-Pancreas/duodenum

Back 97

Potassium concentration in body fluids:
-Saliva 20 mEq
-Gastric 10 mEq
-Pancreas/duodenum 5 mEq

Front 98

Alkalosis causes hypokalemia by _

Back 98

Alkalosis causes hypokalemia by driving K into cells and into urine (exchanged for H+)

Front 99

which part of the bowel has highest concentration of potassium in its secretions?

Back 99

COLON has highest K concentration in its secretions

Front 100

Pre-renal azotemia:
FeNa <_%
Urine Na < _
BUN/Cr >_
Urine osmolality >_ mOsm

Back 100

Pre-renal azotemia:
FeNa <1%
Urine Na <20
BUN/Cr >20
Urine osmolality >500 mOsm

Front 101

lab findings with prerenal azotemia (vs. ATN)

Back 101

oliguric acute renal failure => get a FENA.
-FeNa > 3% => ATN.
-Urine osmolality >400, Urine spec grav >1.02, Urine Na <20 => prerenal azotemia.

Front 102

normal pulm capillary wedge pressure = _ +/- _

Back 102

normal PCWP = 11 +/- 4

Front 103

what is the effect of high PEEP on wedge pressure?

Back 103

excessive PEEP artificially raises wedge pressure

Front 104

optimal site of placement of PA catheter = zone _

Back 104

optimal site of placement of PA catheter = zone 3
-avoids the effects of pulmonary pressures on wedge pressures

Front 105

When placing a Swan-Ganz catheter, what is the relative distance from the internal jugular vein to the pulmonary artery?

Back 105

The distance from the right internal jugular vein to the pulmonary artery is 40cm. This can easily be remembered by the rule of 5s: 40cm from the Right IJ to the PA 45cm from the Right SC to the PA 50cm from the Left IJ to the PA 55cm from the left SC to the PA

Front 106

Swan distance to wedge in L subclavian = _ cm

Back 106

Swan distance to wedge:
R SCV 45 cm
R IJ 50 cm
L SCV 55 cm
L IJ 60 cm

Front 107

Pulmonary vascular resistance is measured by _

Back 107

Pulmonary vascular resistance is measured only by SWAN-GANZ CATHETER

Front 108

normal PA pressure

Back 108

PA pressure: 20-30/6-15

Front 109

normal cardiac output = _ to _ L/min

Back 109

Cardiac output: 4-8 L/min

Front 110

normal cardiac index is...

Back 110

Cardiac index: 2.5-4 L/min

Front 111

How is PVR calaculated?

Back 111

PVR = [(PA pressure - wedge)/CO] x 80

Front 112

Pre-renal failure:
FeNa__
Urine Na __
BUN/Cr__
Urine osmolality __

Back 112

Pre-renal failure:
FeNa< 1%
Urine Na< 20
BUN/Cr >20
Urine osmolality >500 mOsm

Front 113

Aldosterone:
-Stimulated by Angiotensin 2
-Causes transcription of Na/K ATPase, Na/H ATPase -> reabsorb Na, secrete H and K in distal convoluted tubule ->
Water reabsorbtion

Back 113

Aldosterone:
-Stimulated by Angiotensin 2
-Causes transcription of Na/K ATPase, Na/H ATPase -> reabsorb Na, secrete H and K in distal convoluted tubule ->
Water reabsorbtion

Front 114

why are elderly people have impaired ability to concentrate urine?

Back 114

Renal response to ADH is diminished in elderly pts causing a reduced ability to concentrate urine.

Front 115

Kidney receives _% of cardiac output

Back 115

Kidney receives 25% of cardiac output
-But does not require a lot of O2 expenditure to clear solutes, so oxygen tension in renal vein is relatively high, ~80%

Front 116

what are the 2 triggers for renin release?
what does renin do?

Back 116

Renin:
-Decreased pressure at JGA and/or increased Na concentration at macula densa ->
Renin released ->
converts angiotensinogen to angiotensin I

Front 117

Renin:
-Relased in response to 2 things…
Converts _ to _

Back 117

Renin:
-Decreased pressure at JGA and/or increased Na concentration at macula densa ->
Renin released ->
converts angiotensinogen to angiotensin

Front 118

how is respiratory quotient calculated?

Back 118

respiratory quotient = CO2 produced/O2 consumed
-0.7 => fat used
-1.0 => carb used
->1 => overfeeding

Front 119

What is respiratory quotient?
-0.7 => _ used
-1.0 => _ used

Back 119

Respiratory quotient = CO2 produced/O2 consumed
-0.7 => fat used
-1.0 => carb used

Front 120

what vitamin deficiency causes magenta tongue?

Back 120

Riboflavin deficiency causes magenta tongue?

Front 121

how is serum osmolality calculated?

Back 121

normal serum osmolarity = 275-299 mOsm/Kg H20
osmolality = 2 × Na (mEq/L) + glucose (mg%)/18 + BUN (mg%)/2.8

Front 122

what is normal serum osmolarity?

Back 122

normal serum osmolarity = 275-299 mOsm/Kg H20
osmolality = 2 × Na (mEq/L) + glucose (mg%)/18 + BUN (mg%)/2.8

Front 123

Cytokine induced hypotension is primarily stimulated by induction of enzyme _ mediated through the proinflammatory cytokines _ and _.

Back 123

Cytokine induced hypotension is primarily stimulated by induction of nitric oxide synthetase mediated through the proinflammatory cytokines TNF-α and IL-1.
-IL-1 also induces fever
-TNF-alpha also promoted WBC adhesion to endothelium

Front 124

A 23-year-old woman with malabsorption due to short gut syndrome has been receiving total parenteral nutrition in her home for one year. She now has hair loss, dry skin, and a reddish skin rash. These symptoms are evidence of a deficiency of

Back 124

essential fatty acids

Front 125

how are short-chain fatty acids provided to the colonocytes?

Back 125

Oligosaccharides which cannot be broken down and absorbed are fermented by bacteria in the colon providing end products of short-chain fatty acids (primarily butyrate and propionate) which are the primary oxidative fuel of the colonocyte.

Front 126

A 52-year-old male patient with lung cancer is admitted with the following laboratories: Serum sodium: 127 mEq/L. Serum potassium: 4 mEq/L. Serum uric acid: 3 mg/dL. Serum osmolality: 256 mOsm/kg. Urine osmolality: 340 mOsm/kg. Urine sodium: 55 mEq/L. On examination, he is normovolemic.
How should his fluid be managed?

Back 126

SIADH: 2/2 high ADH
-low UOP, low Na, low serum osmolarity (normal 275-299 mOsm/Kg)
-Tx: fluid restriction, then vasopressin R antagonist (diuresis) for goal Na >120 and improved neuro sx.
-Don't give NS if pt has normal volume status (may worsen condition) Can give 3% if treatment fails

Front 127

The major oncotic force of the interstitium is _

Back 127

The major oncotic force of the interstitium is hyaluronate, a proteoglycan, not albumin

Front 128

Starvation:
Brain begins using _ from fatty acids
(normally brain and RBCs are dependent on _)
-Late starvation: liver depleted of alanine => gluconeogenesis shifts to kidney

Back 128

Starvation:
Brain begins using ketones from fatty acids
(normally brain and RBCs are dependent on glutamine)
-Late starvation: _ depleted of alanine => gluconeogenesis shifts to the _

Front 129

Steroid hormones bind a receptor located at the cell, then affect transcription by _

Back 129

Steroid hormones bind a receptor in the CYTOPLASM -> enter nucleus as STEROID-RECEPTOR COMPLEX

Front 130

SvO2:
Nornal range = _-_
Decreased by 2 mechanisms …

Back 130

SvO2 = Mixed venous O2 saturation. Normal = 65-75% Decreased by:
-Decreased O2 delivery: MI, cardiac tamponade, low Hgb, low O2 sat
-Increased O2 consumption: malignant hyperthermia

Front 131

SvO2:
Nornal range = _-_
Increased by 2 mechanisms …

Back 131

SvO2 = Mixed venous O2 saturation Normal = 65-75% Increased by:
- Shunting of blood: sepsis, cirrhosis, L->R cardiac shunt
-Decreased O2 extraction: CN toxicity, hyperbaric O2, hypothermia, paralysis, coma, sedation

Front 132

normal SvO2 is ..

Back 132

SvO2: 70 +/- 5

Front 133

normal SVR is...

Back 133

SVR: 800-1400

Front 134

normal SVR index is ...

Back 134

SVR index: 1500-2400

Front 135

what are the two main processes by which intubated pts get pneumotx?

Back 135

Tension pneumotx 2/2:
- trauma to pharynx or piriform sinus during intubation
-Peak pressures >50 cm H20 x 12 hrs (43% of pts c/ PIP >70 cm H2O)

Front 136

Total body water:
-% for infants, men, and women
-if TBW is 60%, then _% cellular, _% intestinal, _% plasma

Back 136

Total body water:
-Infant 80%
-Men 60%
-Women 50%
-Substract 10% if obese

If TBW is 60%, then 40% cellular, 15% intestinal, 5% plasma

Front 137

How do you compute a 24-hour UUN?

Back 137

-6.25 g of protein contains 1g nitrogen
-N balance = (Protein/6.25) - (24 hr urine N + 4g)

Front 138

Vasopressin:
-V1 R's: vascular sm muscle constriction
-V2 R's intrarenal: water reabsorbtion @ collecting ducts
-V2 R's extrarenal: release of factor VIII, vWF

Back 138

Vasopressin:
-V1 R's: vascular sm muscle constriction
-V2 R's intrarenal: water reabsorbtion @ collecting ducts
-V2 R's extrarenal: release of factor VIII, vWF

Front 139

Increasing PEEP can decrease a pt's UOP by mechanism …

Back 139

PEEP can prevent blood from traversing pulm capillaries ->
decreased preload ->
decreased cardiac output

Front 140

Lung dead space:
-~150cc in normal adults
-Everything proximal to resp bronchioloes, i.e. airway that is ventilated but not perfused
-Incrased by excessive PEEP (which collapses alveolar capillaries), PE, ARDS, pulm HTN

Back 140

Lung dead space:
-~150cc in normal adults
-Everything proximal to resp bronchioloes, i.e. airway that is ventilated but not perfused
-Incrased by excessive PEEP (which collapses alveolar capillaries), PE, ARDS, pulm HTN

Front 141

Vital capacity = max amount of air exhaled after max inhalation

Back 141

Vital capacity = max amount of air exhaled after max inhalation

Front 142

Residual volume is ~_% of total lung volume

Back 142

Residual volume = air left in lung after maximal exhalation
~20% of total lung volume

Front 143

Functional residual capacity = volume of air left in lungs after normal exhalation = residual volume + expiratory reserve volume

Back 143

Functional residual capacity = volume of air left in lungs after normal exhalation = residual volume + expiratory reserve volume

Front 144

How does atelectasis cause fever?

Back 144

Atelectasis:
Alveolar macrophages activated -> release IL-2 -> acts on hypothalamus to cause fever

Front 145

Pre-renal failure:
FeNa< 1%
Urine Na< 20
BUN/Cr >20
Urine osmolality >500 mOsm

Back 145

Pre-renal failure:
FeNa< 1%
Urine Na< 20
BUN/Cr >20
Urine osmolality >500 mOsm

Front 146

Rapid shallow breathing index = most sensitive parameter for predicting successful extubation
= RR/Tidal Volume

Back 146

Rapid shallow breathing index = most sensitive parameter for predicting successful extubation
= RR/Tidal Volume

Front 147

Vit _ deficiency =>
can decrease vit C stores

Back 147

Vit A deficinecy =>
can decrease vit C stores

Front 148

what are the steps of Vit D metabolism?

Back 148

Vitamin D:
-made in skin -> 25-OH in liver -> 1-OH in kidney-> active
-Increases Ca binding protein to increase intestinal absorbtion of Ca

Front 149

what vitamin deficiency should be suspected in a patient with bile drain AND broad-spec abx?

Back 149

Vitamin K being a fat-soluble vitamin is likely to be malabsorbed with bile diversion. Bile is required for adequate fat and fat-soluble vitamins. Approximately 50% of the vitamin K in the human comes from bacterial production in the colon. The broad spectrum antibiotic rapidly destroys a significant portion of the anaerobic bacteria in the colon. They are the primary vitamin K producers.

Front 150

what vitamin deficiency causes taste atrophy

Back 150

Zinc deficiency causes taste atrophy

Front 151

_ deficiency =>
perioral rash
hair loss
poor healing
change in taste

Back 151

Zinc deficiency =>
perioral rash
hair loss
poor healing
change in taste