Ms2 - Test 5 - Week 1

Front 1

What is normal plasma pH?

Back 1

7.35 - 7.45

Front 2

What is the MOST important Intracellular buffer for volatile acid (CO2)?

What amino acid specifically on this molecule?

Back 2

Hemoglobin

Histadine

Front 3

What is the best intracellular buffer for fixed acid (H+)?

What is the best extracellular buffer for fixed acid (H+)?

Back 3

Bone

HCO3/CO2 buffer pair

Front 4

True or False

The HCO3/CO2 system is effective in buffering BOTH volatile and fixed acid?

Back 4

False

Not volatile acid (CO2)!!!

Front 5

Under normal conditions what is the daily excreted amount of HCO3 in the urine?

Back 5

15-20 mEqs

Front 6

What is the major site of HCO3 reabsorption in the kidney?

What is the second most important and why?

Back 6

Poximal tubular cells

Type A intercalated cells in collecting ducts, not as important b/c does NOT have carbonic anhydrase in the lumen

Front 7

True or False

H+ secretion by type A cells occurs in parallel w/ K secretion by principal cells

Back 7

True

Front 8

What cell in the collecting ducts secrete HCO3 into the urine?

When would they be useful?

Back 8

Type B intercalated cells


Metabolic Alkalosis

Front 9

What is the minimum achievable urine pH?

Back 9

4.5

Front 10

How is most fixed acid (H+) excreted as?

Back 10

H2PO4

NH4

Front 11

What is the most prevalent tritable acid in tubular fluid?

Back 11

HPO4

Front 12

True or False

NH4 is NOT a tritable acid?

Back 12

True

Front 13

What is the most important mechanism the kidney has to regulate fixed acid secretion?

Back 13

Ammonium (NH4) Secretion

Front 14

Where does urinary NH4 come from?

Back 14

Proximal Convoluted Tubular cells doing glutamine metabolism

Front 15

What is the daily net secretion equation?

Back 15

NAE (mEq) = Urine mEq (NH4 + H2PO4 - HCO3) x Liters of urine/day

Front 16

What are the two major forms to have chloride loss?

What kind of acid base disturbance does this cause?

Back 16

Vomiting & Nasogastric suctioning

Metabolic Alkalosis & Hypokalemia

Front 17

What are the 4 fates of H+ secreted?

Back 17

Buffered by luminal HCO3 and reabsorbed

Buffered by luminal weak acids (HPO4) and excreted (H2PO4)

Buffered by luminal NH3 and excreted (NH4)

Excreted as free H+

Front 18

What are the 2 situations when proximal convoluted tubules (PCT) glutamine extraction and glutaminase activity increases?

Back 18

Acidosis

Hyperkalemia

Front 19

True or False

Hypokalemia causes more cleaving of glumatime = new bicarb to be made?

Back 19

True

Front 20

What percent of the the U.S. population is obese?

Back 20

35.7%

Front 21

What are the 4 components of a diet history?

Back 21

24-hr recall - ideal for pt's w/ DM

Usual intake - ideal for elderly and infants

Food frequency - ideal method to evaluate intake

Food journal - ideal for pt's trying to lose weight

Front 22

What number BMI is considered obese?

Back 22

30 and above

Front 23

How much should a normal person consume of sodium?

How much should an African American, over 51, HTN, CKD, or diabetic patient consume of sodium a day?

Back 23

1 tsp = 2,300 mg

1/2 tsp = 1,500 mg

Front 24

What kind of carbohydrates are better for diabetics?

Examples?

Back 24

Complex carbohydrates

Nuts, seeds, brown rice, whole wheat bread

Front 25

How much of each day's grain intake should be whole grains?

Back 25

50% or more

Front 26

How many grams of dietary fiber (whole grains) should one consume a day?

Back 26

30 grams/day! OT

Front 27

How many servings of meat are recommended each day?

How many servings of fish are recommended each week?

Back 27

2

2

Front 28

What kind of fat is the worst kind?

What kind of fats are associated with a lower incidence of CVD?

Back 28

Saturated fats - are solid at room temp.

Monounsaturated fats (olive oil, avocados)

Front 29

What kind of fats raise total and LDL cholesterol levels?

How much cholesterol should a person consume a day?

How much of saturated fats should one consume a day?

Back 29

Trans fat

<300 mg/day! OT

<10%

Front 30

What lifestyle modification can cause an increase in HDL?

Back 30

Exercise

Front 31

What is the major cause of IE in IVDU?

What is the most common cause of IE in prosthetic valves?

What is the most common cause of subacute infectious endocarditis?

Back 31

Staph. aureus

Staph. epi (Coag. negative staph)

Viridans Streptococci

Front 32

Streptococcus bovis = ?

Back 32

Colon cancer

Front 33

What is the most common cause of IE in general?

What is the second most common cause of IE in general?

Back 33

Staph. aureus

Strep. viridans

Front 34

What is the difference between Osler nodes and Janeway's lesions?

What dx do these findings point to?

Back 34

Osler nodes - are painful!!!
Janeway’s lesions - are hemorrhagic and non-painful

Endocarditis

Front 35

If a young person presents with heart fialure, chest pain, unexplained arrhythmia, and tachycardia out of proportion to fever, what is the dx?

What is the most likely causative agent?

Back 35

Myocarditis


Coxsackie B (an Enterovirus)

Front 36

Normally in a fever, for every degree above normal, your HR should go up by?

Back 36

10

Front 37

True or False

Corticosteroids may be indicated as an adjunct therapy for myocarditis

Back 37

False!

It is NEVER used for myocarditis, it may be used for TB induced pericarditis

Front 38

Nutmeg liver = ?

Back 38

Chronic Passive Congestion due to RHF

Front 39

What is the most common cause of a malignant liver tumor?

Where from?

Back 39

Metastasis

From GI, Breast, & Lung

Front 40

What is the most common primary hepatic malignancy?

What is the most common visceral malignant tumor worldwide?

Back 40

Hepatocellular carcinoma

Hepatocellular carcinoma in MALES

Front 41

What is the reference values for HCO3?

What is the reference values for CO2?

What is the reference value for the anion gap?

Back 41

22-28 mEq/L or mmol/L

33-45 mm Hg

12 +/- 4 mEq/L

Front 42

What is the rule of thumb for acute respiratory acidosis?

Back 42

HCO3 increases 1 mEq/L for each 10 mmHg increase in PaCO2

Front 43

What is the rule of thumb for chronic respiratory acidosis?

Back 43

HCO3 increases 3.5 mEq/L for each 10 mmHg increase in PaCO2

Front 44

What is the clinical manifestation of acute hypercapnia (increased CO2)?

What is the clinical manifestation of chronic hypercapnia?

Back 44

Anxiety, Confusion, Agitation


Drowsiness, Memory Loss, Somnolence

Front 45

What acid base disturbance presents with low SVR, warm flushed skin and increased cardiac output?

Resembling septic shock?

Back 45

Respiratory Acidosis

Front 46

What is the most common acid base disorder?

In what 2 conditions does this usually occur?

Back 46

Respiratory Alkalosis

Pregnancy & High Altitude

Front 47

What is the rule of thumb for acute respiratory alkalosis?

Back 47

Arterial HCO3 decreases by 2 mEq/L for each 10 mmHg decrease in PaCO2

Front 48

What is the rule of thumb for chronic respiratory alkalosis?

Back 48

Arterial HCO3 decreases by 5 mEq/L for each 10 mmHg decrease in PaCO2

Front 49

What acid base disorder presents with tetany, paresthesias, & carpopedal spasm (recurrent spasms of hand or feet)?

What is the cause of this?

Back 49

Respiratory Alkalosis

Due to decreased ionized Ca

Front 50

What is the initiating event for metabolic acidosis?

Back 50

A decrease in ECF HCO3

Front 51

What is the rule of thumb for metabolic acidosis?

Back 51

PaCo2 fall by 12 mmHg for each 10 mEq decrease in arterial HCO3 concentration

Front 52

True or False

A low plasma HCO3 concentration by itself does not establish the diagnosis of metabolic acidosis

Back 52

True

Front 53

What is the most characteristic clinical finding of metabolic acidosis?

Back 53

Hyperventilation - Kussmaul respiration

Front 54

True or False

The size of the anion gap INCREASES in hypoalbuminemia

Back 54

False, it decreases

Front 55

By how much does the anion gap decrease in hypoalbuminemia?

Back 55

Anion gap decreases ~2.5 mEq/L for each 1 g/dL decrease in plasma albumin

Front 56

What is the acid base disturbance found in someone with salicylate toxicity?

Back 56

Respiratory Alkalosis b/c of increased central respiration

Anion-gap metabolic acidosis

Front 57

What is the cause of a metabolic acid base disorder that presents with blindness and an increased anion gap?

Back 57

Methanol poisoning

Front 58

What is the only acid base disturbance that compensation can return blood pH back to normal?

Back 58

Chronic respiratory alkalosis

Front 59

What are the 7 common causes of anion gap metabolic acidosis?

Back 59

KUSMALE: Ketoacidosis, Uremia, Salicylate, Methanol, Acetaminophen, Lactic acidosis, Ethylene glycol

Front 60

What are the 2 bacteria you would suspect if a patient presented with intense vomiting 1-6 hours after ingestion of food?

Back 60

Staph. aureus

Bacillus cereus

Front 61

Eating a raw hamburger + blood diarrhea = ?

Back 61

EHEC - Enterohemorrhagic E. coli

Front 62

Excessive vomiting + cruise ship = ?

Back 62

Norovirus

Front 63

What pathogen is most likely to cause illness in the U.S.?

What pathogen is most likely to cause death in the U.S.?

Back 63

Norovirus

Salmonella

Front 64

What infective organism causes loose/watery stools and lactose intolerance?

Back 64

Giardia lamblia

Front 65

What bacteria is associated with stools w/ blood and pus?

Back 65

Shigella

Front 66

What are the 3 first specific evidences that point to an intrahepatic process?

Back 66

Onset of dark urine

Light clay colored stool

Scleral Icterus

Front 67

What is the most specific marker for hepatic cell necrosis?

Back 67

ALT

Front 68

If both ALP and GGT are elevated, which one of these markers is most specific and sensitive for the liver?

Back 68

GGT

Front 69

The presence of what liver marker, would most likely indicate a chronic condition?

Back 69

Albumin

Front 70

What are the 3 prothrombin time factors that are synthesized by the liver?

What factor would be most useful to determine acute liver problems?

Back 70

II, VII, X

VII - b/c of short half life

Front 71

What is the enzyme responsible for turning UCB -> CB?

Where does this occur?

Back 71

UDP-gluconyltransferase

In mircrosomes of hepatocytes

Front 72

What is the cause of striking elevations of ALP with little or no increase in billirubin till late in dz?

Back 72

Interlobular & larger intrahepatic duct obstruction - cancer or granuloma

Front 73

What are 3 common causes of unconjugated hyperbilirubinemia?

Back 73

Newborn

Hemolytic anemia

Gilbert's syndrome

Front 74

True or False

Increased ALP tells whether cholestasis is due to intrahepatic or extrahepatic obstruction?

Back 74

False

It only tells you that cholestasis is more likely than necrosis

Front 75

In what condition will the AST/ALT ratio be >2 (b/c the AST is greater than the ALT)?

In what condition will it be <1?

Back 75

Acute alcoholic hepatitis


Acute viral hepatitis

Front 76

To detect acute decrease in hepatocyte function, what lab marker should you see increased?

Back 76

Prothrombin time

Front 77

Marked large increases in the AST & ALT indicates?

Back 77

Acute Viral hepatitis

Even though the AST/ALT ratio is <1

Front 78

ALP predominance over ALT and AST accompanied by normal bilirubin points to?

Back 78

Focal intrahepatic disease =

Tumor, lymphoma, granuloma

Front 79

If the ALP is elevated, who marker should you look at to prove that the rise is due to the liver?

Back 79

GGT

Front 80

In a patient with hemolysis or Gilbert’s or newborn, what should you expect their total bilirubin level to be?

Back 80

< 6 mg/dL

if you have high direct billirubin as the cause then it is > 25 mg/dL

Front 81

What are the 3 lab values that help determine the severity of liver dz?

Back 81

Total bilirubin is >15 mg/dL

PT is elevated (in acute dz)

Low Albumin (in chronic dz)

Front 82

What two hepatitis causing viruses are most likely to lead to the development of hepatocellular carcinoma?

Back 82

HBV

HCV

Front 83

What is the most useful marker for viral replication in Hepatitis B?

Back 83

HBcAg

Front 84

What virus is responsible for 95% of transfusion-associated hepatitis?

What virus is most likely to lead to chronic hepatitis?

Back 84

HCV


HCV

Front 85

True or False

A HBV & HDV co-infection is WORSE than a HBV & HDV superinfection

Back 85

False

The superinfection has a worse prognosis

Front 86

What is the pathologic cause of microvesicular steatosis in the liver (less common but more severe than macrovesicular)?

What drug causes this?

Back 86

Deficient Beta-oxidation of fatty acids


Aspirin

Front 87

If you have steatosis in the liver that is characterized by the presence of multiple small droplets of TG within the hepatocyte, which DO NOT displace the nucleus, what is the dz?

How does this cause death?


What is the cause?

Back 87

Microvesicular steatosis

Loss of cell energy -> hyperammonemia b/c loss of ureagenesis

Aspirin use

Front 88

What is the normal delta gap range?

Back 88

0 +/- 6

Front 89

What alkalosis normally due to the anion gap?

Why?

Back 89

Increases AG by 2-4

B/c increased albumin negativity displaces Cl anions in plasma

Front 90

In what condition would you get non anion gap metabolic acidosis?

Back 90

When HCl is added to plasma, b/c it displaces HCO3 and increases plasma Cl

Front 91

True or False

Hyperkalemia decreases H secretion by type A intercalated cell

Back 91

True

Front 92

What is the normal urine anion gap equation?

Back 92

UAG = urine Na + K - Cl

Front 93

True or False

UAG is most useful for the determining the cause of an anion gap metabolic acidosis?

Back 93

False

it is least useful for that!

Front 94

Renal tubular acidosis is characterized by what kind of acid-base disorder?

Back 94

Non anion-gap metabolic acidosis

Front 95

In RTA 1, what would you expect the urine pH to be?

Back 95

> 5.5

It is the highest here than in any other RTA

Front 96

What is an acquired method of getting type 2 RTA?

Back 96

Ingesting outdated tetracycline

Front 97

True or False

Type 1 & 2 RTA both have an increased risk of Ca kidney stones?

Back 97

False

NOT Type 2 RTA

Front 98

What is the diagnostic lab value for type 2 RTA?

Back 98

Fractional excretion of HCO3 > 20%

Front 99

What is the mechanism by which bile duct cells are destroyed in primary biliary cirrhosis?

What antibody in the serum would clue you in on this dz?

Back 99

Autoimmune T cells


Anti-mitochondrial antibodies

Front 100

What hepatic disease has constrictions that are multifocal -> “beaded appearance” on cholangiography?

Back 100

Primary sclerosing cholangitis

Front 101

True or False

Wilson's disease is due to too much absorption of copper

Back 101

False

It is due to impaired excretion of copper

Front 102

Having a brown ring in the limbus of the cornea is indicative of what dz?

Where specifically does the copper deposit?

Back 102

Wilson's dz


Descemet's membrane

Front 103

What is the best test to diagnose wilson's dz?

Back 103

Serum ceruloplasmin BELOW 20 mg/dL

Front 104

What are the 4 most common causes of cirrhosis?

Back 104

Alcohol abuse

Chronic hepatitis (HCV)

Biliary disease

Iron overload (hemochromatosis)

Front 105

What is the major source of most of the extracellular matrix proteins that accumulate during cirrhosis?

Back 105

Stellate cell

Front 106

What are 3 common manifestations of alcohol withdrawel?

Back 106

Hallucinations

Convulsions

Delirium tremens

Front 107

What are the 3 pathologic conditions that alcohol can have on the liver?

Back 107

Fatty liver

Alcoholic hepatitis

Cirrhosis

Front 108

What drug is the most appropriate for a patient with Zollinger-Ellison syndrome, resulting from a gastrinoma?

Back 108

Omeprazole

Front 109

What is the best antimicrobial used for the tx of H. pylori?

Back 109

Clarithromycin

Front 110

Pink macular rash on trunk + fever = ?

Back 110

Salmonella typhi

Front 111

What hepatitis B surface marker indicates active viral replication?

What hepatitis surface marker indicates hepatitis B infection?

Back 111

HBeAg = high transmissibility


HBsAg

Front 112

What kind of viral hepatitis is most dangerous for pregnant women?

Back 112

Hepatitis E

Front 113

True or False

Both Hep A & Hep E are transmitted by the fecal oral route and both are naked POSITIVE ssRNA viruses

Back 113

True, both are naked and positive

Hep A is a picornavirus
Hep E is a Hepevirus

Front 114

True or False

Hep C is a flavivirus, thus it is an enveloped NEGATIVE ssRNA virus

Back 114

False

Hep C is an enveloped POSITIVE ssRNA virus

All positive strand RNA viruses are icosohedral
All negative strand RNA viruses are helical

Front 115

What does Hep. D virus require for replication?

What kind of polymerase does Hep. D require?

Back 115

HbsAg

DNA dependent-RNA polymerase

Front 116

What organ does hypertriglyceridemia mostly affect?

Back 116

Pancreas

Front 117

What is the cause of Type 2 RTA?

Back 117

Decreased HCO3 reabsorption by PCT

Front 118

What is the cause of Type1 RTA?

Back 118

Decreased H+ excretion by Type A cells

Front 119

What is the cause of Type IV RTA?

Back 119

Hyporeninemic hypoaldosteronism