(P2)Tp-Test 3

Front 1

kidney is endocrine organ that secretes?

Back 1

EPO, Renin, and Prostaglandins

Front 2

what are the Hypercellularity cells in glomerular diseases

Back 2

mesangium
endothelium
epithelium
leukocytes

Front 3

basement mebrane thickening components

Back 3

immune complexes
fibrin
amyloid

Front 4

clues of Nephrotic syndrome

Back 4

proteinuria-3.5 g/day
hypoalbuminemia in plasma
hyperlipidemia
gen. edema

Front 5

causes of membranous glomerulonephritis

Back 5

thickening of glom. capillary wall
IgG deposits on epithelial side

Front 6

clues of Nephritic syndrome

Back 6

****RBC' casts in urine***
HTN, edema
MODERATE proteinuria

Front 7

types of tubular injury

Back 7

ischemic/toxic
inflammation

Front 8

Acute Tubular Necrosis
what type of injury?
caused by?

Back 8

toxic injury to tubules
by radiocontrast dyes and myoglobin

Front 9

ischemia leads to

Back 9

dec GFR->oliguria

Front 10

ATN occurs in ho many phases?
describe each phase

Back 10

3 phases
initiation
-dec. urine output

maintenance
-inc. BUN, dec Urine out, HyperKalemia, metab acidosis

Recovery
-hypoK, restoration/normal

Front 11

etiology of pyelonephritis

Back 11

Gram - bacteria
PEEKS
proteus
Enterobacter
E. Coli
Klebsiella
S. faecalis

Front 12

mechs associated with ascending infections

Back 12

colonization
multiplaction in bladder
vesicoureteral reflux
intrarenal reflux

Front 13

acute pyleonephr. predisposing conditions

Back 13

U.T. obstructions
Preg
vesicoureteral reflux
Diabetes
Immuno deficency

Front 14

hallmarks of Acute Pyeloneph.

Back 14

-patchy interstital suppurative inflammation
-intratubular aggregates of neutrophils
-tubular necrosis
-discrete focal abscesses

Front 15

Aids to diagnosis acute pyleo

Back 15

CVA tenderness
fever/malaise
dysuria/freg/urgency
leukocyte casts

Front 16

characteristic of chronic obstructive pyleo

Back 16

throidization->loss of epithelial cells + dilation
corticomed. scarring

Front 17

tubular nephritis dueto drugs is what type of rxn?

what cells are involved

Back 17

hypersensitivity

-edema, lymphocytes, macrophages, basophils

Front 18

bruits are?

Back 18

abnormal sound produced by fluid

Front 19

most useful test fo inital evaluation?

Back 19

renal ultrasound

Front 20

most likely to cause acute renal failure

Back 20

decreased renal perfusion

Front 21

most likely indication for hemodiaysis

Back 21

volume overload

Front 22

most approp. tx?

Back 22

renal artery angioplasty

Front 23

azotemia definition

Back 23

increase in blood/ serum urea nitrogen

Front 24

prerenal azotemia

Back 24

hypoperfusion
ex. vomiting, shock, hemorrage
artery stenosis(bilateral)

Front 25

postrenal azotemia

Back 25

obstruction of urineflow
ex. BPH, inflam. congenital anomalies

Front 26

in prerenal azeotemia what happens to Na + H20

Back 26

Na + H2O is reabsorbed
the fraction excreted of Na
FEna is <1%

Front 27

Na range

Back 27

135-145mEd/L

Front 28

osmolality range

Back 28

275-290 mOsm/kg

Front 29

Osmolality equation

Back 29

Osmo= 2(Na) + (gluc.)/18 + (BUN)/2.8

Front 30

V2 site of action and effects?

Back 30

renal collecting tubules

increases water absorpt.

Front 31

causes of HypoNAtremia-Isovolemic

Back 31

Glucorticoid def.
hypothyroidism
reset osmostat
Excess ADH:-SIADH, cancer
CBMZ, TCA's, SSRI's, antineoplastics

Front 32

promptness of Na correction

Back 32

1.1-2 mEq/L/hr-symptomatic, severe acute or onset <48H

< or = .5-1 - chronic onset >2days or unkown

Front 33

conivaptan info

Back 33

vasopress receptor antag.
V1a, V2 receptors
hypoK

Front 34

tolvaptan info

Back 34

v2 receptors
hyperK

Front 35

What is Mg role in hypokalemia?

Back 35

Mg is a cofactor for Na/K ATPase pump---if K is not increasing with supplement check Mg levels and tx Mg first

Front 36

K range

Back 36

3.5-5

Front 37

HyperK causes: drugs

Back 37

K-sparing diuretics, ACEI, NSAIDS, BB, Digoxin, heparin, TMP, succinylcholine

Front 38

Cl range

Back 38

95-106

Front 39

Co2 range

Back 39

22-28

Front 40

Anion gap(AG)

Back 40

AG= Na - (Cl + HCO3)

Front 41

Ca range

Back 41

8.6-10.2

Front 42

HypoCa causes

Back 42

vit. D. def.
hypoPARAthyroidism

Front 43

more causes for hypoCa

Back 43

renal failure, phenytoin, phenobarb, loops, steroids

Front 44

Tx of hyperCa

Back 44

>13
hydration + furosemide IV
Bisphosphates(Etidronate)
Glucocoticoids, calcitonin
hemodialysis if refractory

Front 45

what should you avoid in hyperCa?

Back 45

IV phosphates

Front 46

Drugs that cause hypoMg

Back 46

Loops, amino's, ampB
Cistplatin, cyclosporine, steroids

Front 47

causes of hyperMg

Back 47

Renal failure or excessive Mg intake (dumb)

Front 48

define CKD

Back 48

kidney damage
>3 months
with/without decr. GFR

Front 49

CKD classifications

Back 49

stage 1 >90
2 (60-89)
3 (30-59)
4 (15-29)
5 (<15) or dialysis

Front 50

susceptibility risk factors for CKD

Back 50

old age, low birth weight, dyslipidemia, socioecon.
race/ ethnicity (minorites more)

Front 51

initiation risk factors for CKD

Back 51

condt. or substances taht harm kidneys
DM, HTN, HIV, nephrotoxic drugs

Front 52

4 factors than contribute to CKD progression

Back 52

Hyperglycemia
Elevated BP
High Cholestrol
Smoking

Front 53

HTN is considered a _____ and ______

Back 53

Risk Factor
Consequence

Front 54

Goal BP for CKD + HTN

Back 54

130/80

Front 55

ACEI/ ARB work moreso on what?

Back 55

the efferent arteriole

Front 56

define UACR
values for proteinura
microalbuminuria

Back 56

units of albumin per g of creatinine in 24H
>300 mg/g
30-300mg/g

Front 57

what is a contraindication for ACEI and ARB in HTN + CKD

Back 57

Bilateral renal artery stenosis

Front 58

what is not removed by dialysis

Back 58

ARB's

Front 59

Avoid what kind of diuretics in CKD + HTN

Back 59

K-sparing -spironolactone, triamterene

thiazides may not work in CrCl <30ml

Front 60

BB good or bad in CKD?

Back 60

good except the water soluble ones

Front 61

when should metformin not be used

Back 61

Scr >1.5 (males)
>1.4(females)

Front 62

avoid what kinds of diabetes drugs in CKD

Back 62

glyburide, chlorpropamide

use shortacting ex glipizide

Front 63

statin tx ______ decrease proteinuria and slow rate of decline

Back 63

MAY

Front 64

Tx CKD with statins except when

Back 64

LDL <100
TG<150, TC <200, HDL >40

Front 65

most statins require renal adjustments, except?

Back 65

atorvastatin and pravastatin

Front 66

which fibrate is prefered for hypertriglyceridemia

Back 66

gemfibrozil

Front 67

CKD metabolic acidosis, what happens

Back 67

buildup of H+ and loss of bicarb (normal kidney its opposite)

Front 68

CKD metabolic acidosis tx

Back 68

sodium bicarb
sodium citrate
potassium citrate

Front 69

patients tend to have what in ROD

Back 69

High phosp->high parathyroid
low vitD-> high parathyroid

Front 70

phosphorus target in CKD ROD

Back 70

2.7-4.6

Front 71

how to decrease high phosphorus in CKD ROD?

Back 71

phosphate binders-Ca carbonate, Ca-acetate, Ca-citrate
Sevelamer(avoids adding Ca to serum levels)

phosph dietary restriction 800mg-1g/day

Front 72

in CKD ROD
Vit D targets what?

Back 72

25-hydroxyvitamin D> 30
the inactive form

Front 73

in stage 3 +4 CKD +ROD what kind of Ca should be given?

Back 73

D2 or D3 (oral or IV)

Front 74

when should calcitriol be given

Back 74

ONLY in stage 5 with PTH>300

Front 75

IF 25-hydroxyvitamin D is <30 ng/ml give what?

Back 75

D2 or D3

Front 76

If 25-hydroxyvitamin D is normal but PTH >300 give what?

Back 76

calcitriol(stage 5)

Front 77

make sure when looking at Ca in CKD ROD to do what?

Back 77

adjust for low albumin

Front 78

what is cincalcet

Back 78

calcium mimetic
doesn't increase Ca, so can be used when Vit D can not due to hyperCa

Front 79

avoid what in hyperKalemia

Back 79

K+ sparing diuretics

Front 80

Tx for hyperKalemia

Back 80

glucose + insulin, B agonists(albuterol)
kayexalate
dialysis

Front 81

what is kayexalate?

Back 81

exchange resisn
sodium polystyrene

Front 82

what should values of serium ferritin be in anemia for: stage 4 and periotenal hemodialysis

Back 82

stage 4- >100

hemodialysis- >200

Front 83

T or F
Hypertensive urgency and emergency differs in BP values

Back 83

False-noting to do with BP

differs in target organ damage

Front 84

Hypertensive urgency

Back 84

no ACUTE (new) damage
usually pt's with undiagnosed HTN

Front 85

HTN urgency management

Back 85

reduce BP over 24-48H slowly-ORAL meds

CONFIRM followup w/i 7 days

Front 86

HTN urgency meds

Back 86

captopril, labetalol, clonidine

Front 87

what should not be used in HTN urgency?

Back 87

immediate-release nifedipine-causes uncontrolled drop in BP

Front 88

HTN emergency

Back 88

target organ damage with severe HTN

Front 89

signs of HTN encephalopathy

Back 89

cerebral edema, microhemorrhage
confusion, lethargy

Front 90

signs of Aortic Dissection

Back 90

splitting of innter wall of aorta

tearing chest pain radiating to the back

Front 91

goal for aortic dissection is?

Back 91

to reduce contract., BP, and HR

Front 92

What to use in pre-eclampsia and NOT to use

Back 92

use-labetalol, hydralazine, nicardipine

NOT-ACEI

Front 93

GOAL in HTN emergency

Back 93

reduce MAP up to 25% within mins to 1 H

if stable reduce BP to 160/100 over next 2-6H

imm. goal is NOT to return to normal

Front 94

Mean Arterial Pressure (MAP) equation

Back 94

DBP +( (SBP -DBP)/3 )

Front 95

how to find the HTN emergency goal BP?

Back 95

use MAP then multiple by 75%

Front 96

Nitroprusside

Back 96

arterial + venous dilator

NOT for HTN eneceph.
risk of thiocynate and cyanide accumm

Front 97

nitroprusside
no liver =
no kidney =

Back 97

cyanide toxicity

thiocynate toxicity

CHTR

Front 98

Nicardipine S.E.

Back 98

tachycardia, HA, N/V
Avoid in ischemia, acute HF

Front 99

Fenoldopam use?
S.E.?

Back 99

increases renal blood flow/ flow of urine

Tachycardia, HA, Nausea
DOC-severe HTN w/ impared renal function

Front 100

Nitroglycerin

Back 100

venodilator
FOR- coronary Heart Disease and M.Ischemia

tolerance may dev.
NOT good for HTN emerg.

Front 101

Enalaprilat

Back 101

ACEI
use-CHF
unpredictable response
CONTRAIND.-Pregnancy

Front 102

Hydralazine

Back 102

arterial vasodilation
causes angina-avoid in ACS

only really Eclampsia

Front 103

Labetalol

Back 103

alpha and beta Blocker
S.E. dizziness brochoconstric. H. Block

Front 104

Esmolol

Back 104

B.B.-use in aoric dissection + perioperative HTN
S.E.- H. Block, N.V.

Front 105

Phentolamine

Back 105

used for catecholamine-induced HTN crisis- cocaine overdose

switch to phenoxybenzamine once BP is controlled

Front 106

most cardio arrest due to?

Back 106

myocardial infarction
pulmonary embolism

Front 107

ACLS is?
most important is?

Back 107

extension of BLS
high quality CPR
defibbrillation

Front 108

which cardiac arrest is abnormal rhythms

which is shockable?

Back 108

ventricular fibrillation

pulseless ventricular tachycardia

VF AND VT

Front 109

if shockable what are steps?

Back 109

CPR->Shock->
CPR->Shock->
CPR, epi->Shock->
CPR, amiodarone or lido

Front 110

vasopressin can...

Back 110

replace 1st or 2nd dose of epi

Front 111

what is the only proven therapy to increase survival to hospital discharge?

Back 111

defibrillation

Front 112

ideal time to defib?

Back 112

0-4mins is ideal-75%survival

Front 113

T or F
Vasopressin has NO increase in neurologically intact surivial

Back 113

true

Front 114

antiarrhytmics increase what and what not?

Back 114

increase short term survival to hospital admission, but not to hospital discharge

Front 115

what part of epi is associated with its efficacy

Back 115

a-1 vasocontric.
and increases coronary and cerebral perfussion

b-less desirable

Front 116

epi can be admined how?
and is used in?

Back 116

IV or IO(into bone)

VF, pulseless VT, PEA, asystole

Front 117

vasopressin is used for?

Back 117

VF, Pulseless VT, PEA, asystole

1 dose is enough to cover entire code (alt for epi)

Front 118

amiodarone class and used for?

Back 118

class 3
VF, pulseless VT (450mg) unrespons. to CPR, epi and defib

if pt has pulse, this CANNOT be used

Front 119

Lidocaine class

Back 119

class iB
same use as amiodarone

Front 120

Atropine

Back 120

indicated for PEA and asystole but removed from 2010 guidelnes

Front 121

what is reserved for Tosades de pointes

Back 121

magnesium sulfate

Front 122

Endotracheal admin

Back 122

less predictable, delayed

2-2.5 times normal dose

Front 123

when to use hypothermia?

Back 123

when pt is unresponsive ROSC

Front 124

doc for rapid analgesia

Back 124

fentanyl

Front 125

doc for hemodynamic stability

Back 125

morphine

Front 126

doc for hemodynamic instab.

drugs for renal impairment

Back 126

fentanyl
hydromorphone

Front 127

morphine A.E.

Back 127

active metab-watch in renal

long halflife 4 h

Front 128

fentanyl

Back 128

no active metab/histamine
good for renal impair/hemo instab

Front 129

hydromorphone

Back 129

lacks active metab
good for renal imp/ hemo instab

Front 130

meperidine

Back 130

NOT rec for critical care
active metab-normeperidine
-delirium, siezures

Front 131

pure antag of opoid

Back 131

naloxone-reversal of analgesia

induce opoid withdrawls

Front 132

ketorlac

Back 132

adjunct therapy
>5days = G.I. bleeding

Front 133

Ramsay scale-what is score for sleep states

Back 133

5 + 6
scores range from 1-6
(1 most agitated, 6 no response)

Front 134

RASS scale-goal is?

Back 134

0-alert and calm
ranges from +4 to -5

Front 135

100 and 0 on ekg mean?

Back 135

100-completely awake
0-absence of brain activity

Front 136

Benzo's bind ?

Back 136

GABA and enhance activity

Front 137

Midazolam

Back 137

-USE- acute for rapid sedation, SHORT term use- unpredicatble after 2 days
accum in-renal, fat, low albumin

Front 138

lorazepam

Back 138

longer t1/2
no active metab
-lactic acidosis, acute tubular necrosis
FOR LONGTERM sedation

Front 139

flumazenil

Back 139

benzo reverser
comp. binding to GABA
S.E.-acute withdrawls

Front 140

Propofol

Back 140

IV sedative-hypnotic-NO analgesic prop.

requires mech ventillation

Front 141

propofol S.E.

Back 141

conttraind. in soybean allergy

causes hypertriglyceridemia
asecptic techn. required

Front 142

Propofol monitoring

Back 142

level of sedation
BP, caloric component
Triglyc., hang time for bottles

Front 143

Dexmedetomidine

Back 143

sedative
NO resp. depress.
max of 24hours-dependence

Front 144

sedation holidays

Back 144

interrupt pts sedation meds until pt shows pain

if unable to toler. restart at 50% of pre-holiday dose

Front 145

when is a sedation holiday not indicated?

Back 145

if pt is receiving paralytics

Front 146

sedation selection
acute->
intermittent->
continuous->

Back 146

acute->midazolam
inter->lorazepam
contin.->propofol(72H)
->midazolam( 48H)
->Lorazepam(long)

Front 147

assesment for delirium

Back 147

CAM-ICU
delierium is 1 + 2 + (3 or 4)

Front 148

Haloperidol

Back 148

delirium
A.E.-QT prolong torsades de pointes

Front 149

NMBA gen info

Back 149

last resort in ICU
no sedative, analgesic
daily holidays good

1-2 twiches is goal (train of four)

Front 150

depol. agents

Back 150

acetycholine
depol membrane-sustains depol blocks neuromuscular transmission

Front 151

non-depol agents

Back 151

comp inhibits ACH receptor
blocks depol.

Front 152

Succinylcholine

Back 152

depol NMBA
facilitate endotracheal intubation

Front 153

succinycholine A.E.

Back 153

muscle fascic
hyperK
Arrythm
Bradycardia
hypotension
inc. intracranial pressure
malignant hyperthermia

Front 154

Pancuronium

Back 154

non-depol
active metab
incr. cardiac output, HTN, tachycardia

Front 155

Atracurium

Back 155

nondepol
hypotension
no Renal/hepatic adjustment

Front 156

Cisatracurium

Back 156

isomer of atracurium(3x more potent)
non-depol
less histamine rel.
non renal/hepatic adjust

Front 157

Vecuronium

Back 157

analog of pancuronium
non-depol
no vagolytic prop-used in cardiovasc. problems
metab is 50%-avoid in renal

Front 158

Rocuronium

Back 158

non-depol
metab 5%-less significant in renal failure

Front 159

NMBA complications

Back 159

prolonged recovery
myopathy
aspiration/hypostatic pneomia
skin breakdown
venous thrombosis (DVT

Front 160

NMBA agent selection
normal hepatic + renal function->
liver/renal impairment->
CV disease OR hem instab

Back 160

normal-Pancuronium

impairment-atracurium
cisatracurium

Cv-> vecoronium
rocuronium

Front 161

anemia is a _____ and not a _____

Back 161

Anemia is an objective sign of a disease, not a diagnosis

Front 162

anemia is most prevelant in

Back 162

children, women, African Americans, elderly and low income persons

Front 163

macrocytic anemias

Back 163

Megaloblastic:
pernicious,
B12 deficiency,
folic acid deficiency

Front 164

normocytic anemias

Back 164

Hemolytic Anemia, Anemia of Chronic Disease

Front 165

microcytic anemias

Back 165

Iron Deficiency Anemia (IDA), Sickle Cell, Thalassemia`

Front 166

Rough estimate of O2 carrying capacity of blood

Back 166

hemoglobin

Front 167

MCV

Back 167

Mean Corpuscular Volume (MCV)

Average volume (size) of RBC

Front 168

falsely elevated MCV

elevated MCV

decreased MCV

Back 168

reticulocytosis

folate deficency

IDA

Front 169

MCH

Back 169

mean corpusal Hemoglobin
% volume of Hgb in RBC

Front 170

MCHC

Back 170

Mean Corpuscular Hemoglobin Concentration (MCHC)
Weight of Hgb/volume of RBC
Independent of cell size

Front 171

serum iron

Back 171

Concentration of iron bound to transferrin

Front 172

decreased serum iron

Back 172

IDA and Anemia of Chronic Disease (ACD)

Front 173

serum ferritin

Back 173

Concentration of ferritin in serum is proportional to total iron stores

Best indicator of iron deficiency or overload

Front 174

Tsat%

Back 174

TSat% = (serum iron/TIBC) x 100

usually 20-50% saturated with iron

≤15% in IDA

Front 175

Total Iron-Binding Capacity (TIBC)

Back 175

 Measures iron-binding capacity of serum transferrin
 More reliable than serum iron
o Low serum iron + high TIBC = IDA

o Low serum iron + low TIBC = ACD

Front 176

B12 levels may be low due to?

Back 176

folate deficiency, pregnancy & oral contraceptive pill (OCP)

Front 177

IDA

Back 177

Hgb < 12 g/dL male; Hgb < 10g/dL female
o Low serum iron
o serum ferritin < 12 ng/dL
o TIBC > 400 mcg/dL
o Reticulocyte count low to normal

Front 178

Low serum iron + high TIBC =

Back 178

IDA

Front 179

Low serum iron + LOW TIBC

Back 179

ACD

Front 180

Decreased serum folic acid levels means?

Back 180

folate acid def
or Vit B12 def