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71 Cards in this Set
- Front
- Back
which artery should you use for arterial blood gas
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radial
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what 5 stats do you get from ABG
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blood pH: indication of acid base balance
O2 sat of Hb PaO2 PaCO2: related to ventilation concentration of bicarb |
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as pCO2 rises, what happens to pH
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goes down
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as bicarb rises, what happens to pH
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goes up
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normal pH of blood
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7.4
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an acute change in PaC02 will change the pH by....
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.08 in the opposite direction
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what does hypo and hyperventilation do to PaCO2
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hypo: increase CO2 (can't blow it off)
hyper: decrease CO2 (more blown off) |
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HH eq for acid-base balance
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pH = pKa + log (bicarb/0.03pCO2)
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Name 3 chemical triggers of respiration
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pO2, pH, pCO2
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which respiration trigger is most sensitive, but has the lowest trigger point
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pO2
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which respiration trigger is the least sensitive but has the highest trigger point
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pCO2
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5 physiologic causes of hypoxemia
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1. low FiO2 (normal lung)
2. Hypoventilation (normal lung) 3. diffusion limitations (abnormal lung) 4. shunt (abnormal lung) 5. V/Q imbalance (abnormal lung) |
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normal stimulus for breathing
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pCO2
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which physiologic causes of hypoxemia have high A-a gradient
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Abnormal lung: diffusion limitations, shunt, V/Q imbalance
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formula for A-a gradient
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A-a= FiO2*[(Patm-Ph2o)-PaCO2/.8]-PaO2
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anion gap formula
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Na-(Cl+HCO3)
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3 causes of high anion gaps
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1. Lactic acidosis
2. Uremia in renal failure 3. Ketoacidotic (diabetic, starvation, alcoholic) |
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well's criteria
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used to assess risk of PE
point-based system |
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light's criteria
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Pleural fluid is exudate if:
total protein>.5 LDH>.6 LDH>2/3 uppernomral limit of plasma LDH (200) |
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How many of lights criteria need to be met for pleural fluid to be considered exudate
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1
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what 2 tests should you order to determine if pleural fluid is exudate or transudate
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LDH and total protein
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3 causes of low glucose and low pH in pleural fluid
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cancer, infection, rheumatoid arthritis
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Indications for special pleural fluid tests: Adenosine deaminase
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Tb
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Indications for special pleural fluid tests: Hematocrit
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hemothorax
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MCC hemothorax
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trauma
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Indications for special pleural fluid tests: amylase
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booerhave's esophagus/pancreatitis
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Indications for special pleural fluid tests: triglycerides
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chylothorax
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cut off criteria for PPD testing
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5mm: HIV, intimate exposure, CXR w/ Tb changes, immunosuppressed
15mm: someone with no risk factors 10mm: everyone else |
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name the capacity: IRV+Vt
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IC
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name the capacity: ERV+RV
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FRC
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name the capacity: IRV+Vt+ERV
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Vital capacity
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name the capacity: IRV+Vt+ERV+RV
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total lung capacity
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volume expired in first second of expiration
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forced expiratory volume1 (FEV1)
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fastest a patietn can blow out their vital capacity
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forced vital capacity (FVC)
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normal FEV1/FVC
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>75%
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FEV1/FVC <75%
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obstructive disease
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3 MC obstructive diseases
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asthma
chronic bronchitis emphysema |
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how does restrictive lung disease appear on PFT
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reduced TLC
DICO reduced |
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def of chronic bronchitis
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productive cough for 3straight months in 2 consecutive years
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causes of pseudohematuria
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food: beets, rhubarb, blackberries, paprika
meds: analgesics, abx, laxatives, chemo menstrual bleed, hematospermia metabolic conditons--> myoglobin that's been filtered in urine |
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hematuria at the beginning of urination that becomes clear
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trauma in anterior urethra
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hematuria that is clear at first and then becomes bloody
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bladder or prostate
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where are these RBCs from: dymorphic RBC
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kidney
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where are these RBCs from: eumorphic
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bladder
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hematuria with no RBCs
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pseudohematuria: urine has myoglobin/hemoglobin
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urine with WBCs
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infection
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urine with RBC or WBC casts
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glomeruli cappilaries and tubules
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sensitive or specific: urine dipstick
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sensitive
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sensitive or specific: urine cytology
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specific
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which is the best test to look at kidneys: x-ray, US, IVP, CT
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US, CT
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what labs should you order for hematuria
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1st: dipstick and urinalysis
Then... CBC Chem7/Metabolic Panel urine culture urine cytology Coagulation studies |
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risks of bladder cancer
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smoking
occupation exposures (dyes, chemicals) dietary intake of preservaties chronic UTI schisto infections |
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how do u differentiate glomerular bleeding from epithelial bleeding
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glomerular bleeding: RBC/WBC casts in the urine + dysmorphic free RBCs
epithelial bleeding: no casts, eumorphic RBCs |
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DDx for glomerular hematuria in pt <50
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IgA nephropathy
Thin BM disease Hereditary nephritis (Alports) mild focal glomerulonephritis |
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DDx for glomerular hematuria in pt >50
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IgA nephropathy
Hereditary nephritis (Alports) mild focal glomerulonephritis |
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DDx for upper UTI in pt <50
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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 |
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DDx for upper UTI in pt >50
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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 |
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DDx for lower UTI in pt <50
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cystitis, prostatitis, urethritis
benign bladder/ureteral polyps/tumor bladder cancer prostate cancer urethral and meatal strictures schisto haemotobium |
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DDx for lower UTI in pt >50
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cystitis, prostatitis, urethritis
bladder cancer prostate cancer benign bladder/ureteral polyps/tumor |
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does inflammation of the PIP joints occur in osteoarthritis or rheumatoid arthritis?
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both
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is a bony swelling indicative of osteoarthritis or inflammatory arthritis?
spongy swelling? |
osteo
inflammatory |
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4 types of arthritis
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mechanical
inflammatory crystalline infectious |
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arthritis that worsens with use and improves with rest; Gelling phenomenon (brief stiffness that improves with movement)
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osteoarthritis
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a. negatively birefringment needle shapes intracellular crystals
b. positively weakly birefringment rhomboid |
a. gout
b. pseudogout |
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diagnostic test for infectious arthritis
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arthrocentesis: high WBC, fluid is cloudy or purulent (except Lyme disease)
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when is ANA positive
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1:160
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specific or sensitive: ANA test
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sensitive
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specific or sensitive for SLE: anti- dsDNA and anti-smith
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specific
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is Rheumatoid factor a good test for early detection of RA?
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No
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ulnar deviation
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rheumatoid arthritis
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winking owl sign on radiograph...what's your #1ddx
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metastatic cancer b/c mets love the pedicles and vertebral bodies
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