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35 Cards in this Set

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Squamous epithelial cells in urine
Normal?
Appearance
Normal
Pale with big cytoplasm
Non-squamous epithelial cells in urine?
Normal? Source?
Normal
From bladder
WBC in urine?
normal?
normal if 1-2/hpf, if >3/hpf abnormal
Eosinophils in urine
Normal?
Not normal
RBC
Normal? Source?
Not normal if >5
Can come from anywere along urinary tract
Determine location based on presence of casts
Hyaline casts in urine
Form from what?
Presence of albumin
Granular casts in urine?
Seen when?
Plasma proteins embedded in Tamm-horsfall proteins
Seen in heavy proteinuria, not dz specific
How to ID granular casts?
stain with anti-albumin AB
Dysmorphic RBC in urine
Seen in bleeding from glomerulus --> RBC cast
Where do casts come from?
Casts must come from kidney, regular RBC can come from anywhere!
For casts, blood collects after passing through glomerulus, and casts form in DCT
Where do WBC casts come from? When are they seen
Kidney
Commonly seen in interstitial dz (pyelonephritis)
When are tubular epithelial casts seen?
Acute renal failure, secondary to ATN
Calcium oxalate crystal appearance?
Clinical presentation
Envelope shaped kidney stones
Unilateral flank pain
(Can be normal in low #)
Triple phosphate crystals appearancE? Clinical presentation?
Coffin shaped
Seen in pts with chronic UTI w/ alkaline urine
(Urea secreting organisms make the urine more alkaline)
Uric acid crystal appearance? Treatment?
Lemon drop shaped
Precipitates in acidic urine
Treat with alkaline to dissolve crystals
Cause of cystine crystals?
Seen in hereditary cystine defect
Tubules can't resorb cystine
Pulmonary causes for respiratory acidosis
Asthma
COPD
Pneumonia
Pulmonary edema
PE
Non-pulmonary causes for respiratory acidosis
Decreased central drive (drugs, stroke, sleep apnea)
Decreased neural linkage
Muscle weakness
Thoracic cage dysfunction
Acute phase of compensation for respiratory acidosis
Make H2Co3 (from high PCO2) whcih can't be buffered with HCO3-, so use intracellular buffering mech
CO2 diffuses into cell and combines with H20 and dissociates into HCO3- and H+. Proton is buffered intracellularly by Hb via histadine side group
For each increase in 10 mmHg PCO2, serum HCO3- increases 1 mEq/L
What is the chronic phase of compensation for respiratory acidosis
HCO3- production by kidneys and increased H+ excretion
How long does it take for acute phase compensation to start working for resp acidosis? Chronic phase?
Minutes to hours
Hours to days
What are the pulmonary causes for respiratory alkalosis?
Pneumonia
Pulmonary edema/CHF
Interstitial dz
Asthma
What are hte non-pulmonary causes for respiratory alkalosis
Sepsis
Liver dz
CNS d/o
Salycilate intoxication
Pregnancy
High altitude
What is the compensation for respiratory alkalosis?
Decreased HCO3 from H release from IC buffers
Incresaed cellular lactate production
HCO3-/Cl- exchange at RBC
Causes of metabolic alkalosis?
H+ loss (vomiting, NG suction)
Renal loss (mineralocorticoid excess)
H+ movement into cells (hypokalemia)
HCO3- retention (from giving NaHCO3)
Contraction alkalosis/diuretics
What are the 2 phases of metabolic alkalosis?
The part that initiates the alkalosis
The part that maintains the alkalosis
What causes the maintaining of metabolic alkalosis
Decreased filtration (renal failure)
Increased HCO3- resorpption (volume depletion, hypokalemia, aldosterone excess, Cl- deficit)
How do you correct metabolic alkalosis?
Eliminate source of excess HCO3- resorption or H+ loss
Replete volume (isotonic saline)
How do patients compensate for metabolic alkalosis
Hypoventilation, can only do this until pCO2 = 60. Won't breathe any slower than that! At this point, hypoxemic drive takes over
How do you assess a patient in metabolic alkalosis?
Use urine Cl to determine if pt is volume depleted or not
Cl is better than Na b/c sometimes patient may excrete increased Na so it becomes unreliable (although this is not the norm)
If urine Cl <10 = volume depletion
Urine Cl NOT RELIABLE IN PATIENTS TAKING DIURETICS!!!
What is the normal value of anion gap?
10
What are causes of non-anion gap metabolic acidosis?
SEvere diarrhea (GI loss of HCO3)
RTA
Carbonic anhydrase inhibition
NH4Cl intake
Ureterosigmoidoscopy
Causes of anion gap metabolic acidosis
Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde
Iron, isoniazid (INH)
Lactic acid
Ethanol, ethylene glycol
Salicylates
Why does giving HCO3 to a pt in metabolic acidosis not work?
You can alter the pH with HCO3, but you are not treating the underlying cause of the acid-base d/o
This won't help the arrhythmias, CNS disturbances, etc
What are the most common causes for non-anion gap metabolic acidosis?
GI loss of HCO3-
RTA