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141 Cards in this Set

  • Front
  • Back
Na resorption in exchange for K
extracell volume decrease
stimul. aldosterone
stimulate aldosterone secretion
high K, ACTH
from post pituitary increases water resorption
plasma osmolarity decreases
inhibit ADH
right and left atria volume receptors
inhibit adh secretion
meningeal coccemia
dic purpura
painless ulcer
pustules with central
early meningitis
pink maculopapular
finkelsteins test
dequervain tnosynovitis
repiratory acidosis
decr ph, inc co2 (not removed from lungs because gas exchange is impaired) net co2 not blown off during respir (COPD, pulm edema)
metabolic acidosis
dec ph, dec bicarbonate
over produc of acids or loss of base
produce metabolic acids
ketone product, DM, malnutrition, starvation
loss of base (met acidosis)
diarrhea, kidney disease
respiratory alkalosis
inc ph, dec co2
inceased co2 loss from lungs
hyperventilation, high altitudes
kidney retain H, increase bicarbonate excretion.
Metabolic Acidosis
inc ph, excess loss acid or uptake of alkaline substance.
body tries to retain co2
(dec breathing, kidney retain more H)
hodgekins acute lymphoma
reed sternberg cells
20 - 40 yos, and >50yos
non hodgkins lymphoma
50 yos, asymptomatic lymphadenopathy
(ALL) acute lymphoblastic leukemia
immature lymphoid stem cells replace bone marrow elements, prim children(2/3), fever,bone pain, purpura, easy bruising, lymphadenopathy, hepatosplen
(CLL) Chronic Lymphocytic leukemia
Mature appearing neoplastic lymphocytes, middle age M>F,
(AML) Acute myelogenous Leukemia
Myeloid (blast) cells replace bone marrow us resulting in hematopoietic insuff. SYN=acute nonlymphoblastic leuk
risk factors: prev ca drugs, radiation, chronic myelo dis
Chronic Myelogenous leukemia
abnormal prol of immature granulocytes, chronic phase then accelerated phase then terminal phase, +philadelphia chromosome is good
Crohns dz
entire gi tract possible, not continuous lesions, skip areas, abcesses
rubeola; incubation; prodrome; rash
regualr measles; 10-14 days incubation; 2-4day prodrom includes koplik spots 2d b4 rash; rash=erythomaculaopapular begins behind ears to forhead-neck-then down;turns copper brown then desquam
SIADH: ADH action
incr Na and H2O resorption in kidney, increases intravascular volume
SIADH outcome
low sodium, low serum osmolality, inc urine osmolality (concen urine- hold onto h2o) need to restrict fluid
free air under diaphram
perforated intestine
75% sigmoid, 25% cecum
small bowel obstruction
air fluid levels on KUB
air fluid level KUB
charcot triad
jaundice, fever, tenderness RUQ
epigastric pain, Lpleural effusion, jaundice, abd mass
post op fever 1-3 days
post op ileus
secondary to hypocalcemia
pulmonary embolism
loud s2, gallop rhythm, fleural friction rub
bfragilis intrabd
staph postop
blunted costophrenic angles
pleural effusion
clindamycin gives
c dificile, treat with vanco
subphrenic abscess
abnl chest, pleural effeusions
head injury hyponatremia
secondary to siadh
epidural hematoma
rupture middle meningeal artery (traumatic)
subdural hematoma
rupture bridging veins
liver mets
prostate ca
mets to lung, bone not liver
testicular cancer
25-35yos, mets to lung
delayed findings on xray
hip dislocation injures ___nerve
paget dz
path fractures
chronic renal dis metabolic acidosis
dec ph, increase respir
chronic renal disease
respiratory compenates for metabolic acidosis
increase respir, dec bicarbonate
(renal) hypocalcemia second to
(renal) magnesium, anemia, coagulopathy
hypermagnesium, normochromic, normocytic anemia, uremia/heparinzation
diabetes: hyperglycemia
stress, infection =ketoacid/hyperglyc
diabetes: Ketoacidosis
n/v, abd distention, polyuria, inc urine ketones (metab of fuel in abscence of glucose) can have normal glucose levels but can't access them: need insulin
diabetes: gastroparesis
inc risk of aspiration
hydrogen moves from high area (extracellular) to area of low concentr (intracellular)
Hydrogen ions mover from area of high concentration (intracellular) to one of low concentration (extracellular)
hypokalemia, hypochloremic metabolic acidosis
vomiting or prolonged gastric drainage
isotonic volume depletion (third space losses)
peritonitis, intestinal obst, extens soft tissue, inflamm, or trauma. Balanded salt solutions (lactated ringers) used to replace isotonic loss.
isotonic volume loss signs
tackycardia, narrowed pulse pressure, hypotenstion, decre urine output, rising hematocrit, bun:Creat ration>20:1
isotonic loss (sources)
surgical GI (vomitng, ng suction, diarrhea, external drainage gi fistulas)
Third Space loss (burns, crush, fractures, peritonitis, pancreat, obstruc, pleural effusions, soft tissue infection.
to replace gi volume loss from vomitying or ng suctioning
NOT LR (inadeq chloride, conversion of lactate to bicarbonate does not correct hypochloremic, hypokalemic metabolic alkalosis. 1/2 NS w 20 meq KCL
rapid infusion glucose contianing soluitons
iatrogenic hyperglycemia induced osmotic diuresis and further fluid loss
volume excess
excess isotonic replacement, inapp admin of salt poor solutions to replace gi, 3ed space loss, or hypertonic solutions (mannitol, glucose)
causes of hyponatremia:dilution
axcess water, hypotonic fluid replac of isotonic gi or 2rd space loss, enhanced metabolic production of free water occ with surgical stress, caloric deprivation, overingestion h2o, SIADH,
Hyponatremia: excess renal loss
thiazide diruestics, metabolic alkalosis, ketoacidosis, adrenal insuff, salt wasting nephropathy
occurs in situ where people can't respond to thirst.
may also be hypomag, hypophosphorus; often GI factors (highest concen in colon or rectum) low voltage ekg, invet T, prominent U waves, prolonged PR int
usually multifact; exogenous loading, transfusions, dialysis pts(crush injuries, homolysis, rapid rewarming, drugs diuretics, nsaids, EKG: peaked T waves treat with glucose infusion
usually loss of gastric acidic contents, vomity or ng suction, renal losses also possible
acute pancreatitis, infl bowel disease (decre absorp/inc loss) soft tissue infections
1) dificient or absent PTH (hypomag) (2) ineffective -vit D dis, renal fail, pseudohypoparathyroid (3) overwhelmed (hyperphosphatemia)
hyperparathyroidism, malignancy (incl lymph/leuk), granulomatous dz(sarcoid, tuberc,fungal), excess diet,milk/alkalia synd, thiazides, immobiliz, thyrotoxicosis, adrenal insuff
acute respiratory acidosis
result of carbon dioxide retention because of hypoventilation: repirt depre,rib fract,abd dist, tumor, foreign body,
chronic respiratory acidosis
effects of respir acidosis
hypercapnia, hypoxia: if ph change is equal to magnitude of CO2 increase then it is respir acid, if less then its metabolic
rule 1
increase or dec of CO2 of 10mmHg gives reciprocal pH change of 0,08 units
rule 2
incre or decr of HC)3 of 10 mEq is reciprocal to 0.15 pH units
metabolic acidosis
GI or urine loss of HCO3. or increaded metabolic acid load= lactic acidemia second to cardiogenic, septic, hypovolemic low flow staes or ischemia of major tissue beds and ketoacidosis.
respiratory alkalosis
metabolic alkalosis
elevated HCO3 with elevated pH.
total body water calculation
60-50% total weight
sodium resorption in exchange for K, H. triggered by decrease in renal perfusion which secretes renin - angiotensin I -angiotensin II- stim aldosterone secretion. volume receptors right atrium also, increased serum potasium will stimulate aldost secretion
ADH secretion stimulated by
volume sensore atria (right senses decreased volume, Left senses increased volume)
intracranial osmoreceptors
plasma osmolality eq
2x na + (glucose/18) + (BUN/2.9)
hypmagnesium (often seen with refractory hypokalemia so check mag)
wound healing: substrate
PMN and macrophages predom 48 hrs. leukocytes deal w bacteria. Macrophages involved wound debridement.
Wound healing:proliferative phase
begin when would is covered by epithelium. 2nd stage. fibroblast produce collagen
wound healing: maturation phase
flattening pale supple scar formation.
granutlation tissue consists of:
fibroblasts, capillaries, bacteria (<10-5) and infl cells. mature collagen present in remodeling phse after wound closure (phase 2),
maturation phase=
no net collagen production;crosslinking occurs
a "clean wound" has
fewer than 100,000 organisms/g tissue.
inflammatory phase characterized by:
no collagen; macrophages and PMNs present
post op wound infection closure perforated appendix=
closure of wound on 5th day
strep contaminated wound?
contraindication to closure
clean contaminated wound example=
common duct explor, elective colon resection, gastrectomy
contaminated wound=
spill during elective gi surgery, perforated gi ulcer
dirty wound example
drainage of intraabdominal abscess, resection of infarcted intestine
antibiotic choice strep/staph
cellulitis, breast abscess, synthetic vascular garft, hip/heart/valve prosthesis
staph, strep enterococcus (prosthesis)
biliary tract, peritonitis
e coli, klebsiells enterococcus: aztreonam, clindamycin
hosp aquire pneum(pseudomonas, serratia, enterobacte)
cipro, amikacin
catheter ass bacteremia:
staph, enterobact
uti(post cath)
pseudomonas, serratia, enterobac
breast abscess
localized pain, aspiration helpful to confirm but req I/D
Perirectal abscess
drain under general anesthesia. anaerobes/aerobes
Gas gangrene
teatanus, surgical debridement without primary closure. penic not useful without aggressive debrid. metronidazol/clindamycin ok altern
staph, points at sulcus of nail border
deep infect pulp space of terminal phalanx, tx = drainage
may req drainage/opening the sheath to prevent necrosis of tendon
deep space comp of hand thenar: midpalmar; hypothenar
thenar; prominence, thumb in abduction; midpalmar; loss of normal concavity hypothenar; swelling painful movemnt
foot infections
radiographs, bone scans can show extent of
biliary tract infections
conseq of obstruction, e coli, klebsiella, enterococci. drainage best. acute cholecystitis - empyema (undrained infection) w systemic sepsis,- gangrene and perforation
ascending cholangitis
infection proximal to common duct obstruction, fever, leukocy, jaundice
acute peritonitis bacteria in peritoneal cavity after mechanical perforation; OR primary without perforation alcoholics w ascities
acute pain, fever, leuk, free air beneath diaphragm
perfor gi ulcers
precipitous, free air in upright chestxray. chemilcal or bacterial in first 12 hrs,gr neg bact antibiotic
gram negative antibiotic coverage
anaerobic: clinda, metro
aerobic; aminogly,p ceph, aztreonam cip, tmp,ap pen
Both: cefoxitin, cefotetan.cefm etc
colonic perforation (carcinoma or diverticular)
most virulent cause of peritonitis. left colon perfs usually require diversion of fecal
pulmonary infection (atelectasis,)
fever within first 48 hrs gr + or -
pulmonary infection (postoperative pneumonitis)
ass with respirator. wean asap is preventative, gram - (pseudo, serratia) w syst antibiotics. culture by endotracheal sampling
pulmonary infection (aspiration)
risk= obeste, gastric distension, altered mental status. bronchoscopy diagnosic, clean up airway of particulate matter. antibiotics dep on culture
post op UTI
catheter related often pseudomonas, serratia, other gram -. candida, enterococci. don't assume fever uti, often have pos bact urine culture w catheter use, wo pos blood culture don't treat?
post op UTI
catheter related often pseudomonas, serratia, other gram -. candida, enterococci. don't assume fever uti, often have pos bact urine culture w catheter use, wo pos blood culture don't treat?
post op intraabdominal infections: most are abscesses
abd tenderness, pain,fever leukocytosis rather than xray etc most imp indicators of the need for reoperation
Post op intraabdominal: diagnosis
ctscan. use contrast to help dist abscesses, fluid collec from structures. no contrast with sdynamic ileus. ascites makes results dificult. Drainage is treatment, localized percutaneous or operative.
Pleural Empyema: thoracotomy or chest tube placement, occ spontaneously with pulmonic process
effusion on xr, lateral chest film ct r us for posterior loculated cavity. dx confirmed by thoracentesis. tx dep on gram stain/cultures. antibiotic failure is us inadwquate drainage- rib resection/marsupialization
post of foriegn body infection
remove or replace all iv,centeral lines within 72 hours. susp with pos blood cultures for staph aureus or ep. 14 days antibiotics to prevent endocarditis
prophyylactic anti use in:
clean procedwith foriegn body implantation, clean contaminate cases, contaminated cases
short operative time
lessens wound infection; related to "break" in sterile field
most common nosocomial infection is
paronychia vs felon
paronychia inf margin nail may extend beneath nail. felon is soft pulp of digit, both ID, felon rearely goes extends to synovial spaces
most common cause of early postop fever
infect pulmonary tract; atelectasis, cxr
post op fever, leukocytosis, bacteremia: atelectasis, thrombophlebitis;impetigo;furuncle
supperative thrombophlebitis, atelectasis usually doesn't cause prolonged leukocytosis or bacteremia
suppurative thrombophlebitis, intravascular device associated bacteremia
req removal of device and debridement of infected tissue. May not even need antibiotics
class I hemorrhage
<15% blood loss (blood donation)
urine output normal (>30ml/hr)
Treatment is LR
Class II hemorrhage
15%-30% blood loss (750-1500ml)
tachycardia, HR>100, bp wnl
Pluse presure (syst-diast) is decreaded (sys unchanged but diast increases 2 to catecholamine vasoconstriction) tachypnea, rr= 20-30 br/min, UO 20-30 ml/hr, mild anxiety=fear hostility, capillary refil >2 sec
Class III hemorrhage
30-40% blood loss (1500-2000), hr >120bbp, bp is decr, pp decree, tachpnes rr=30-40, UO 5- 15ml/hr very ansious and confused.Tx= LR with transfusion