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71 Cards in this Set

  • Front
  • Back
which artery should you use for arterial blood gas
radial
what 5 stats do you get from ABG
blood pH: indication of acid base balance
O2 sat of Hb
PaO2
PaCO2: related to ventilation
concentration of bicarb
as pCO2 rises, what happens to pH
goes down
as bicarb rises, what happens to pH
goes up
normal pH of blood
7.4
an acute change in PaC02 will change the pH by....
.08 in the opposite direction
what does hypo and hyperventilation do to PaCO2
hypo: increase CO2 (can't blow it off)
hyper: decrease CO2 (more blown off)
HH eq for acid-base balance
pH = pKa + log (bicarb/0.03pCO2)
Name 3 chemical triggers of respiration
pO2, pH, pCO2
which respiration trigger is most sensitive, but has the lowest trigger point
pO2
which respiration trigger is the least sensitive but has the highest trigger point
pCO2
5 physiologic causes of hypoxemia
1. low FiO2 (normal lung)
2. Hypoventilation (normal lung)
3. diffusion limitations (abnormal lung)
4. shunt (abnormal lung)
5. V/Q imbalance (abnormal lung)
normal stimulus for breathing
pCO2
which physiologic causes of hypoxemia have high A-a gradient
Abnormal lung: diffusion limitations, shunt, V/Q imbalance
formula for A-a gradient
A-a= FiO2*[(Patm-Ph2o)-PaCO2/.8]-PaO2
anion gap formula
Na-(Cl+HCO3)
3 causes of high anion gaps
1. Lactic acidosis
2. Uremia in renal failure
3. Ketoacidotic (diabetic, starvation, alcoholic)
well's criteria
used to assess risk of PE
point-based system
light's criteria
Pleural fluid is exudate if:
total protein>.5
LDH>.6
LDH>2/3 uppernomral limit of plasma LDH (200)
How many of lights criteria need to be met for pleural fluid to be considered exudate
1
what 2 tests should you order to determine if pleural fluid is exudate or transudate
LDH and total protein
3 causes of low glucose and low pH in pleural fluid
cancer, infection, rheumatoid arthritis
Indications for special pleural fluid tests: Adenosine deaminase
Tb
Indications for special pleural fluid tests: Hematocrit
hemothorax
MCC hemothorax
trauma
Indications for special pleural fluid tests: amylase
booerhave's esophagus/pancreatitis
Indications for special pleural fluid tests: triglycerides
chylothorax
cut off criteria for PPD testing
5mm: HIV, intimate exposure, CXR w/ Tb changes, immunosuppressed
15mm: someone with no risk factors
10mm: everyone else
name the capacity: IRV+Vt
IC
name the capacity: ERV+RV
FRC
name the capacity: IRV+Vt+ERV
Vital capacity
name the capacity: IRV+Vt+ERV+RV
total lung capacity
volume expired in first second of expiration
forced expiratory volume1 (FEV1)
fastest a patietn can blow out their vital capacity
forced vital capacity (FVC)
normal FEV1/FVC
>75%
FEV1/FVC <75%
obstructive disease
3 MC obstructive diseases
asthma
chronic bronchitis
emphysema
how does restrictive lung disease appear on PFT
reduced TLC
DICO reduced
def of chronic bronchitis
productive cough for 3straight months in 2 consecutive years
causes of pseudohematuria
food: beets, rhubarb, blackberries, paprika
meds: analgesics, abx, laxatives, chemo
menstrual bleed, hematospermia
metabolic conditons--> myoglobin that's been filtered in urine
hematuria at the beginning of urination that becomes clear
trauma in anterior urethra
hematuria that is clear at first and then becomes bloody
bladder or prostate
where are these RBCs from: dymorphic RBC
kidney
where are these RBCs from: eumorphic
bladder
hematuria with no RBCs
pseudohematuria: urine has myoglobin/hemoglobin
urine with WBCs
infection
urine with RBC or WBC casts
glomeruli cappilaries and tubules
sensitive or specific: urine dipstick
sensitive
sensitive or specific: urine cytology
specific
which is the best test to look at kidneys: x-ray, US, IVP, CT
US, CT
what labs should you order for hematuria
1st: dipstick and urinalysis
Then...
CBC
Chem7/Metabolic Panel
urine culture
urine cytology
Coagulation studies
risks of bladder cancer
smoking
occupation exposures (dyes, chemicals)
dietary intake of preservaties
chronic UTI
schisto infections
how do u differentiate glomerular bleeding from epithelial bleeding
glomerular bleeding: RBC/WBC casts in the urine + dysmorphic free RBCs

epithelial bleeding: no casts, eumorphic RBCs
DDx for glomerular hematuria in pt <50
IgA nephropathy
Thin BM disease
Hereditary nephritis (Alports)
mild focal glomerulonephritis
DDx for glomerular hematuria in pt >50
IgA nephropathy
Hereditary nephritis (Alports)
mild focal glomerulonephritis
DDx for upper UTI in pt <50
nephrolithiasis
pyelo
polycystic kidney disease
medullary sponge kidney
hypercalciuria, hyperuricouria
renal trauma
papillary necrosis
ureteral stricture and hydronephrosis
sickle cell trait or disease in blacks
renal infarction or AV malformation
renal TB
DDx for upper UTI in pt >50
Nephrolithiasis
renal-cell cancer
polycystic kidney disease
pyelo
renal-pelvis or ureteral transitional cell cancer
papillary necrosis
renal infarction
ureteral stricture and hydronephrosis
renal TB
DDx for lower UTI in pt <50
cystitis, prostatitis, urethritis
benign bladder/ureteral polyps/tumor
bladder cancer
prostate cancer
urethral and meatal strictures
schisto haemotobium
DDx for lower UTI in pt >50
cystitis, prostatitis, urethritis
bladder cancer
prostate cancer
benign bladder/ureteral polyps/tumor
does inflammation of the PIP joints occur in osteoarthritis or rheumatoid arthritis?
both
is a bony swelling indicative of osteoarthritis or inflammatory arthritis?
spongy swelling?
osteo
inflammatory
4 types of arthritis
mechanical
inflammatory
crystalline
infectious
arthritis that worsens with use and improves with rest; Gelling phenomenon (brief stiffness that improves with movement)
osteoarthritis
a. negatively birefringment needle shapes intracellular crystals
b. positively weakly birefringment rhomboid
a. gout
b. pseudogout
diagnostic test for infectious arthritis
arthrocentesis: high WBC, fluid is cloudy or purulent (except Lyme disease)
when is ANA positive
1:160
specific or sensitive: ANA test
sensitive
specific or sensitive for SLE: anti- dsDNA and anti-smith
specific
is Rheumatoid factor a good test for early detection of RA?
No
ulnar deviation
rheumatoid arthritis
winking owl sign on radiograph...what's your #1ddx
metastatic cancer b/c mets love the pedicles and vertebral bodies