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135 Cards in this Set

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Plasma vol measured by..
Albumin
ECF vol measured by…
Inulin
Used to measure GFR…
Inulin or creatinine
Equation for RBF…
RBF= RPF/(1-hct), measure RPF using PAH
Equation for filtered load of substance in kidney…
Filtered load= GFR x plasma concentration
Free water clearance equation…
Ch20= total urine (V) –water occupied w/ solute (Cosm); Cosm= UosmxV/Posm
Relative free water clearance when using loop diuretics…
0, isotonic
Excretion rate of substance… how relate to clearance…
Ux*V… Clearance = excretion rate/Plasma concentration (note: same for drugs)
When does a patient start seeing glc on a pee dipstick…
When urine glc >160-200
What is missing in Hartnup dx… what does it lead to and why…
Deficiency in neutral AA transporter for Tryptophan in PCT. Get pellagra because Try  Niacin (used B6)
Role of PTH and where does it act in nephron…
Inhbits Na/P cotransport in PCT, induces Ca/Na exchange in DCT, incr 1,25OH vit D conversion in PCT
ATII role and where does it act in nephron…
Stimulates Aldosterone from adrenal gland, causes secretion of ADH from post pit, vasoConstricts, Constricts Efferent arteriole to preserve renal funxn in low vol state, incr PCT Na/H exchange (permits contrxn alkalosis)
Cl more secreted or reabsorbed in kidney… relative TF/P…
more secreted. TF/P ratio is about 1.3
Cause release of rennin from JG cells…
Decr BP in JG cells (afferent arteriole), decr Na delivery to MD cells (DCT), incr sympathetic tone (B1) to JG cells
Causes of non-anion gap metabo acidosis…
Diarrhea, glue sniffing, RTA, hyperchloremia (acetozolamide use, diabetes)
Type I RTA due to… causes…
Defect in CD ability to excrete H+, get hypokalemia and Ca containing stones. Assoc w/ autoimmune dx
Type II RTA due to… assoc…
Defect in PCT bicarb reabsorption. Assoc w/ hypokalemia and hypophosphatemic rickets
Type IV RTA due to… assoc
Hypoaldosteronism leading to hyperkalemia (cannot secrete it) and inhibition of ammonium secretion in PCT so cannot buffer urine (decr urine pH as well)
RBC casts seen in…
Glomerulonephritis, ischemia or malignant HTN
WBC casts seen in…
Tubulointersitial inflammation, acute pyelonephritis, transplant rjxn
Cause a hypertonic loss of fluid…
Loop diuretics, addisons, 21-hydroxilase deficiency
Causes a hypotonic gain of fluid…
Loss of protein (nephrotic syn, cirrhosis), Right sided heart failure
Complement level and acute poststrep glomerulonephritis…
Decr C3 level because ICs, subepithelial, activate alternative complement cascade
Most common cause of death in SLE…
Renal failure due to diffuse proliferative glomerulonephritis (DNAanti-DNA deposits and decr C4)
LM, EM, and IF findings in membranous glomerulonephritis…
LM-diffuse capillary and GBM thickening. EM-Spike & dome w/ subepithelial deposits. IF granular
Causes of membranous glomerulonephritis…
Captopril, gold, infxns: malaria, TB, HBV; solid tumors
Pathophysiology of membranous glomerulonephritis and how does that explain infxns…
Incr # of pores and incr pore size leading to subepithelial deposits, lose Ig’s so incr risk of infxn
Minimal change disease seen in… what is lost in the urine that is unique… MOA…
Kids and Hodgkins patients, often post viral infxn or immune stimulus. Albumin lost in the urine, not Igs, due to GBM polyanion loss
MOA of diabetic glomerulonephropathy…
NEG of GBM  incr permeability (microabluminuria), thickening. NEG of efferent arterioles incr GFR and leads to mesangial expansion
Type I MPGN MOA and assoc…
Caused by immune-complex (IC) deposits subendothelially and mesangial ingrowth leading to GBM regrowth ontop (tram-track). Assoc w/ HBV and HCV
Type II MPGN MOA and assoc…
Dense deposits and low C3 factor
Ca oxalate kidney stones can be due to and MOA of each of the causes… what else could theoretically cause…
Vit C tablets (citrate chelates Ca) or ethylene glycol (oxalate) abuse. Ethlene glycol can cause anion-gap MAcidosis
Uric acid stones seen in…
Gout, Leukemia, myeloproliferative dx such as MM
Cystinuria and when do kidney stones form… how treat…
Due to decr cysteine reabsorption in PCT (also decr Ornithine, Lysine, Arg) forming cystine (2 cys molecules held together by disulfide) kidney stones if urine is acidic. Tx by alkalinizing urine (actazolamide)
Paraneoplastic syndromes of RCC…
EPO, ACTH, PTHrP, Prolactin
WT1 (wilms tumor) is what kind of a gene…
Tumor suppressor
RFs for transitional cell carcinoma…
Phenacetin Smoking (just like RCC) Aniline dyes (textiles) Cyclophosphamide
MOA of drug induced interstitial nephritis… drugs…
Drugs bind protein and illicit immune response (hypersensitivity), act as haptens. Diuretics, sulfonamides, NSAIDs, penicillin derives, rifampin
Diffuse cortical necrosis… assoc…
Acute infaction of cortices of both kidneys due to vasospasm and DIC. Assoc w/ obstetric catastrophies (abrupto placenta) and septic schock
Causes of ATN…
Renal ischemia from shock or sepsis; myoglobinuria due to crush injury, fibrates, statins; toxins such as aminoglycosides or CT contrast
Lab values for ATN (Uosm, Una, FeNa, BUN/Cr)…
Uosm <350, Una >20, FeNa >2%, BUN/Cr <15
Chronic pyelonephritis findings…
Eosinophilic casts, Ushaped cortical scars, blunted calyx
Consequences of renal failure…
Na retension, hyperK, uremia, metabo acidosis, anemia from decr EPO prodxn, renal osteodystrophy (decr vit D)
MOA of Fanconis… causes…
Decr PCT absorption of glc, AA, P (Rickets), uric acid (stones), bicarb (RTA II), and electrolytes (Mg, Ca). Caused by Wilsons, glycogen storage dxs, cisplatin, expired tetracycline
Assoc of ADPKD…
Polycystic liver dx, berry aneurysms, MV prolapse
Dialysis cysts found where…
Cortex and medulla
Abdominal US shows small kidney and it has concentrating defects. There is fibrosis and many cysts, what is dx…
Medullary cystic kidney dx
Low serum Cl causes…
Secondary metabo alkalosis, hypoK, hypovolemia, incr aldosterone
High serum Cl causes…
Secondary non-anion gap acidosis
High serum Mg causes…
Decr DTRs, cardiopulm arrest, delirium
Uses of mannitol and SEs…
Shock, drug OD, decr ICP. SEs: pulm edema, dehydration; contraindicated in anuria and CHF
Uses and SEs of acetazolamide…
Glaucoma, urinary alkalinization, altitude sickness (causes blood to become acidic  incr ventilation and O2). SEs: hyperchloremic metabo acidosis, neuropathy, NH3 toxicity, sulfa allergy
Use of furosemide and SEs…
Use: Edematous states- CHF, cirrhosis, nephrotic syn, pulm edema; HTN, hyperCa. SEs: otoxicity, hypoK, Dehyration, sulfa Allergy, interstitial nephritis, Gout
Ethacrynic acid MOA… use and special cases… SEs…
Phenoxyacetic acid derivative that blocks Na-K-Cl transporter in loop of henle. Used for patients w/ sulfa allergy or gout. SEs: ototoxicity, hypoK, dehyrdration, interstitial nephritis (all same as Furosemide except sulfa and gout)
HCTZ use… SEs…
HTN, CHF, hypercalciuria, nephrogenic DI. SEs: Hypokalemic metabo acidosis and hypoNa; hyperglycemia, hyperlipidemia, hyperuricemia, hyperCa. Sulfa allergy
MOA of triamterene and amiloride…
Block ENaC (Na channels) in cortical collecting tubule and spare the K loss
Diuretic drugs causing academia…
Acetazolamide and K sparring (induces hyperkalemic state)
SEs of ACEIs…
ACE n GRI: Angioedema (decr bradykinin block), Cough, Eating difficulties- taste change, Gestation- renal dmge, Rash, Incr rennin, hyperK
Respiratory zone… conducting zone…
Respiratory: resp bronchioles, alveolar ducts/sacs. Conducting zone is everything else
Cartilage rings present where in resp system…
Trachea and bronchi
Pseudostratified ciliated columnar cells extend to the…
Respiratory bronchioles
Goblet cells extend to the…
Terminal bronchioles
Morphology of Clara cells… funxn…
Nonciliated, columnar cells w/ granules. Secrete component of phosphatidylcholine, degrade toxins, act as reserve cells
Visceral sensation above the vocal cords done by what nerve specifically…
Internal brac of superior laryngeal nerve
Visceral sensation below the vocal cords done by what nerve specifically…
Recurrent laryngeal nerve
Located in the center of the bronchopulmonary segments…
2 arteries, one to exchange gas (pulmonary) and one to feed parynchema (bronchial)
Pulmonary artery to bronchus relationship…
Right artery is Anterior to bronchus and Left artery is Superior to bronchus
During exercise, muscles used for expiration… muscles used for expiration in quiet breathing…
Exercise: Rectus abs, obliques, transverses abdominus, internal intercostals. During quiet breathing, no muscles, it’s passive
During exercise, muscles used for inspiration…
Scalenes, SCM, External intercostals
RV approximately what vol of air… FRC approximately what vol of air…
RV:1.2L FRC:2.2L
TV usually what vol of air…
0.5 L
VC equals sum of what volumes…
IRV + TV + ERV
Largest contributor of functional (not anatomical) dead space…
Apex of lung (air but not as much blood)
Equation for calculating dead space volume…
Vd = Vt (1- (PeCO2/PaCO2))
At FRC, what is airway pressure… intrapleural pressure…
Airway=0 (none coming in, none going out) but intrapleural pressure is -5.
Things that favor T form of Hb over R form…
Increased levels of: Cl, H+, CO2, 2,3BPG, Temperature
Methemoglobin… tx…
Oxidized Fe (Fe3+) that doesn’t bind O2 as well but has HIGHER affinity for CN. Tx by giving methylene blue
How tx CN poisoning…
Give nitrites to induce metHb, which will bind CN. Then give Thiosulfate to bind CN and be excreted renally. Can give Methylene blue to take Fe3+  Fe2+
Sigmoidal shape of O2 binding curve due to… how different from Mg curve…
Positive coorperativity (4 bindings sites for O2 and incr affinity w/ more binding). Mg has a plateau curve (1 binding site)
Relative O2 dissociatin curve for fetal Hb…
Shifted left (higher affinity)
Equation for diffusion of gas in lungs…
Vgas = A/Thickness x difference in partial pressures
Definition of pulm htn… morphological findings…
Pulm artery pressure >25 or >35 during exercise. Get atherosclerosis (turbulence), medial hypertrophy, intimal fibrosis of pulm arteries
Primary pulm HTN causd by… normal funxn of altered product…
INACTIVATING mutation in BMPR2 gene which usually inhibits vascular smooth muscle proliferation
Causes of pulm HTN…
COPD, mitral stenosis (pressure), LR heart shunt (incr vol and pressure), systermic scerlosis (medial hypertrophy), recurrent thromboemboli (decr cross-area), sleep apnea or high altitude (hypoxic vasoconstrxn)
Equation for pulm vasc resistance…
(Ppulm artery – Ppulm v.)/ CO… equivalent to R = P/Q since Q is flow or CO
Equation of O2 content of blood… when does O2 content decrease…
O2 content = (O2 binding capacity x % saturation) + dissolved O2. O2 content falls as Hb falls (note: but O2 sat and PaO2 do NOT)
Cyanosis results when deoxygenated Hb at what level…
>5g/dL of Deoxygenated Hb
O2 binding capacity usually around what value…
20.1mLO2/dL
In what situation would arterial PO2 decr… why…
Chronic lung dx because physiological shunt decr O2 extraction ratio
Alveolar gas equation…
PAO2 = PIO2 – (PACO2/R), usually can be estimated w/ PAO2= 150 –PACO2/0.8
Causes of hypoxemia (decr PaO2) w/ incr A-a gradient…
V/Q mismatch, Diffusion limitation, RL shunt
Hyoxemia w/o A-a gradient…
High altitude, hypoventilation
Causes of hypoxia…
Decr CO, hypoxema, Anemia, CN, CO
V/Q of apex of lung approx… by this way…
V/Q = 3, lots of ventilation but not as much perfusion because high alveolar pressure compresses capillaries. In other lobes of lung the Pa is > then P aveoli
V/Q approaches zero when… how can you tell this is the case…
Airway obstrxn. 100% O2 will not improve PO2
V/Q approaches infinity when… how can you tell this is the case…
Blood flow obstrxn (physiological dead space-PE). 100% O2 improves O2
In lungs, how is CO2 release from the RBC favored…
Oxygenation of Hb dissociates H+ which shifts carbonic anhydrase equation to form CO2 and CO2 is released from RBC (haldane)
In peripheral tissues, how is O2 unloading from RBC favored…
H+ produced from tissues shifts oxygen dissoc curve to right, causing O2 unloading. Secondary mechanism: CO2 produced by tissues binds to Hb amino terminus favoring T form  O2 unloading
Mechanism of 2,3BPG release at high altitude…
Incr ventilation causes metabo alkalosis  induces PFK to make more 1,3BPG which is converted to 2,3BPG right shift
Characteristics of body’s response to high altitude…
Incr ventilation, incr EPO, incr 2,3BPG, incr mitochondria, incr renal excretion of bicarb acidosis and right shift, chronic pulm vasoconstrxn
Change in gas partial pressures during exercise…
No change in PaCO2 nor PaO2 but venous CO2 does elevate
Reason why COPD has incr RV…
Airways close prematurely at high lung volumes
Examples of V/Q mismatch…
Pulmonary embolus, CoPD
Reid index… indicative of CoPD/chronic bronchitis…
Gland depth/total thickness of bronchial wall. >50% means COPD/chronic bronchitis
Definition of chronic bronchitis…
Productive cough for >3 consecutive months in > or = 2years
Area of bronchial tree injured in chronic bronchitis… findings…
Small airways, esp terminal bronchioles. Wheezing, early onset cyanosis (shunting) and late onset dyspnea (blue bloater)
Area of respiratory tree that collapses in emphysema… difference between panacinar and centriacinar emphysema…
Terminal bronchiole collapses. Pancacinar emphysema occurs when entire repiratory unit is distended while in centriacinar emphysema only the respiratory bronchiole is distended
Pathology of asthma…
Bronchial hyperresponsiveness, smooth mscle hypertrophy and Curshmann Spirals (shed epithelium from mucous plugs, due to MBP)
Pathology of bronchiectasis… assoc…
Chronic necrotizing infxn of bronchi leading to permanently dilated airways, purulent sputum, infxns, hemopytysis. Assoc w/ bronchial obstrxn, CF, Kartageners. Can develop aspergillosis
Causes of interstitial lung dx causing a restrictive lung dx pattern…
ARDS, nARDS, Pneumoconiosis, Sarcoidosis, Idiopathic pulm fibrosis, Goodpastures syn, Wegener’s granulomatosis, Eosinophilic granuoloma, Drugs: Bleo, Amio, Busulfan
Coal miner’s pneumoconiosis…
Affects upper lobes, can cause Caplan syndrome w/ Rheumatoid nodules in lung; can cause cor pulmonale
MOA of silicosis… connection to TB…
Macros respond to silica & release fibrogenic factors leading to fibrosis. Affects upper lobes and get egg shell calcifications of hilar lymphs. Silica may also disrupt phagolysosomes and impair macros funxning w/ TB
MOA of ARDS…
Diffuse alveolar damage from PMNs and coagulation cascade causing incr alveolar capillary permeability  leakage of protein rich fluid making hyaline membranes. PMNs can damage type II pneumos also
Breath sounds, resonance, fremitus, and tracheal deviation in obstruxn of a bronchi…
Absent or decr breath sounds, decr resonance, decr fremitus, and tracheal deviation toward side of lesion (being pushed by normal lung)
Breath sounds, resonance, fremitus, and tracheal deviation in pleural effusion…
Decr breath sounds over effusion, dullness, decr fremitus, no trach deviation
Breath sounds, resonance, fremitus, and tracheal deviation in lobar pneumonia…
Maybe bronchial breath sounds, dullness, INCR fremitus, no trach deviation
Breath sounds, resonance, fremitus, and tracheal deviation in tension pneumothorax…
Decr breath sounds, hyperresonant, absent fremitus, tracheal deviation away from lesion (affected lung cavity filling w/ air)
Complications of lung CA…
SVC syndrome, Pancoast, Horners, Endocrine neoplasias, Recurrent laryngeal probs, Effusions
Characteristics and histo findings of squamous cell CA…
Central arising from bronchus, cavitates, linked to smoking, PTHrP release. On histo has Kertin pearls and intercellular bridges
Characteristics and histo findings of bronchial adenoCA…
Peripheral tumor developing in sites of prior inflammation. Clara cells become type II pneumos and CXR has multiple densities
Characteristics and histo findings of bronchioloalveolar adenoCA…
Mucin producing cells. Not linked to smoking and grows along airways. Can result in osteoarthropathy (clubbing, periositis). Clara cells become type II pneumos and there are multiple densities on chest.
Characteristics and histo findings of large cell CA of lung…
Peripheral tumor that is anaplastic and undifferentiated. Removed surgically and is less responsive to chemo (unlike small cell). Histo shows pleomorphic giant cells w/ leukocyte frags in cytoplasm
Sites where lung CA metastasizes most…
Adrenals, brain(seizure), bone (fracture), liver
Most common organisms causing lobar pneumonia…
S Pneumonia, Klebsiella (alcoholics)
Most common cause of broncopneumonia…
S aureus, Hflu, Klebsiella, S pyogenes
Most common causes of atypical pneumonia…
RSV, adenovirus, Mycoplasma, Legionella, Chlamydia
Causes of transudate pleural effusion…
CHF, nephrotic syn, hepatic cirrhosis (decr protein)
Causes of exudates pleural effusion…
Malignancy, pneumonia, collagen vascular dx, trauma
1st generation H1 blockers used for allergeies and what are SEs…
Diphenhydramine, dimenhydrinate, chlorpheniramine, hydroxazine promethazine. Can also be used for motion sickness. SEs: sedation, antimuscarinic, anti-alpha (post dizziness)
2nd generation H1 blockers used for allergies and SEs…
Loratadine, fexofenadine, desloratadine, cetirizine. Less sedating then 1st gen because decr entry into CNS
Use and MOA of isoproterenol and SE…
Isoproterenol is nonspecific beta blocker used for asthma. SE-tachycardia
SE of salmeterol…
Tremor and arrhythmia
MOA of theophylline… SEs…
Blocks phosphodiesterases thus incr cAMP levels causing bronchodilation. SEs: cardiotoxicity and neurotoxicity (the O is CardiO and NeurOtoxic) and blocks action of adenosine. Metabolized by p450
Tx of theophylline OD..
Beta blockers or benzos
MOA of steroids in tx of chronic asthma…
Inactivate NF-kB thus decr cytokines