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201 Cards in this Set
- Front
- Back
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What is a Chief Complaint?
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Why the patient is seeking medical attention (note. This may not be the most serious problem).
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What does a Physical exam Report?
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What the clinician can See, feel or hear during an exam.
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Name the HEENT organ system
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Head eyes ears nose throat
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What is the COR organ system?
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Coronary
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ABD Stands for what organ system?
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Abdominal
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What Organ system does GU notate?
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Genitourinary
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What organ system does EXT notate?
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Extremities
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of what nature is the information gathered by a physical exam?
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Objective
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Is treatment based on one exam?
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NEVER! but it is used as a component of the patients assessment
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Differentiate between subjective and objective information.
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Subjective information is something the patient tells you that you haven't physically measured or can't physically see (temp or rash on chest..."pain") While Objective information is measured heard or seen...hearing a murmur or dry cough...
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What does SOAP notate?
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SUBJECTIVE: listed subjective info OBJECTIVE: listed objective info ASSESSMENT: statement sumarizing patients perceived state of health PLAN: bulled points stating exact plan for patient including follow-up (very specific).
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What are the components of an Assessment?
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What is happening, known cause, acute/chronic, assessment of current therapy: optimal? Adherence? Additional monitoring?
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What are the benfits of lab tests?
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They either rule in or rule out potential symptoms and can be used to define the goal of therapy but NEVER CONFIRM A DISEASE STATE BASSED ON 1 LAB
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What 3 concepts should you keep in mind when evaluatin lab data?
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Is it "Normal", is there a cause for an abnormality, does it make sense based on pt symptoms?
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Why should one "Treat the patinet not the number" when looking at an abnormal lab?
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Because the patient might have their own "Normal", for example a diabetic coming in for a routine check-up could have a high Ser Glu but might have just eaten...
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A rule of thumb for abnormal labs is "If something doesn't look right, than_____"
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Test it again foo!
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What is Sensitivity?
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The ability of a lab to test positive. (aka...if creat levels change even 0.001mg/dL would the test pick up on that change?)
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What is Specificity?
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The ability of a lab test to be negative (rule out a certain diease).
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Differentiate between Sensitivity and Specificity.
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Sensitivity will detect the presence of change but won't tell you what is causing that change, Specificity will determine the cause of that change but levels of something might be elevated to a greater degree before a specific test picks up on it (aka, SCr lvls aern't elevated until 50% kidney dmg).
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Is Sensitivity or Specificity a better test for diagnoses?
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Specificity
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What 4 methods are used to obtain blood specimins?
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Venipuncture, Finger Sticks, Heel Sticks (infant), Arterial Lines
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Which of the 4 is most invasive? Venipuncture, Finger Sticks, Heel Sticks (infant), Arterial Lines?
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Arterial lines becasuse they go deeper :(
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*What are the advantages/disadvantages of and IV line?
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Advantages: allows multiple blood withdrawl with only 1 stick Disadvantages: May cause clotting when used to administer drugs, posibility of infection and limited lab tests can be performed.
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*What are the advantages/Disadvantages of a Centarl line?
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Advantages: dialysis and admin of Chemo, also low irritation. Disadvantages: semi-permenant, risk of infection, potential of thrombus
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What are the Chem-7?
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Na, Cl, BUN, GLU
K, CO2, Scr |
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What does LBC notate?
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Electrolytes, BUN and Createnine
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What are normal Sodium levels? What role does Sodium play and what excreetes it?
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Normal Sodium levels are 135-145mmol/L, sodium maintains blood volume (osmolality) and electric potential and is excreted by the kidneys
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When is someone considered hypernatremic?
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When Na>145mmol/L
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What is the most promenant cause of Hypernatremia?
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Water loss exceeding sodium loss (skewed H20 to Na ratio) caused prominently by burns and fever and has signs and symptoms of thirst, confusion and weakness.
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When is someone considered Hyponatremic?
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When Sodium <135mmol/L
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What is the most likely cause of Hyponatremia?
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Accumulation of water that is greater than dilution of Na. Caused by haert failure (low ability to pass fluid so high vol and same lvl of Na) or cirrhosis.
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What are the S/S of Hyponatremia?
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Confusion, edema and Seizures (Hyponatrema lowers the seizure threshold so it is of greatest concern)
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What are Normal Potassium Levels?
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3.4-4.8mmol/L
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What role does K+ play in the body?
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Contractility, excitability (Na/K pump) Acid base balance.
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Whate regulates K+ in the body?
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renal function, Insulin/Glucose & acid base balance
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A patient is admitted to you with a K+ lvl of 6.0, how would you interpret his K+ lvls?
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Hyperkalemic as they exceed 4.8.
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Hyperkalemia?
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Caused by renal disease/drug induced and symptomized by arrhythmnias/EKG abnormalities.
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What are the two major causes of Hypokalemia:
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Vomiting & Dirrhea
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If a patient is admited to your clinic with K+ level of 3.4 how would you interpret this?
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First find our the Norm for your clinic. If it is <3.5 than you patient is mildly hyopkalemic and could have muscle weakness, confusion or abnormal EKG
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Detail the Normal Chloride levels.
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100-108mmol/L
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What are normal CO2 levels?
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24-30mmol/L
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Explain the importance of CO2
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Key component of bicarb-buffer so it works to maintain the blood pH
elevation = resp. acidosis decrease = alkalosis (hyperventilation) |
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What are normal levels of BUN?
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8-25mg/dL
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What is BUN a measure of? What is it and when is it elevated or depressed?
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how well the kidneys are filtering things, it's the end product of protein metabolism and is elevated w/dehydration, high protein diet and depressed w/liver diesase (as it is produced in the liver).
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What are normal Scr levels?
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0.7-1.5mg/dL
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A patatient comes into your office, You look over her LBC and notice that her createnine levels are high, what conclusions can you draw?
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She either has kidney damage and isn't passing fluids as she should be or she isn't drinking enough water.
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What are normal glucose levels and what should be taken into account when interpreting them?
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Normal levels are 70-110mg/dL fasting and one should determine if the recorded Glu levels are used post-meal or fasting and if the patient is diabetic.
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What are the ranges for Hyper and Hypo glycemia?
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Hyperglycemia >126mg/dL
Hypoglycemia < 55mg/dL |
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Write the equation used to calculate calcium.
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(4g/dL-albumin) x 0.8 + measured lvl
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What are normal calcium levels for the body?
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8.5-10.5mg/dL
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What are common causes of Hypercalcemia?
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Vit-D defficiency (b/c need it to break down Ca), Hyperthyroidism...
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What are normal Mg levels? What is it's use?
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1.4-2meq/L, used to stabalize cardiac muscle.
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Hypermagnesia is caused by:
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renal failure and hyperparathyroidism.
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Hypomagnesemia is caused by:
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dirrhea
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What are normal PO4 levels?
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2.6-4.5mg/dL
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What role doe PO4 play and what is it regulated by?
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Role in energy metabolism, regulated by Calcium
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For what reason must pH be maintained within a very narrow range?
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for enzymatic and cellular functions that are greatly affected by changes in pH
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What are the 3 systems in place to maintain normal acid-base balance?
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Buffers (extracellular HCO3), lungs and kidneys
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What is the order of effect for the Body's systems that maintain acid-base balance?
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Buffers, lungs, Kidneys
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Explain why CO2 is considered an acid in the respiratory system?
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Because it removes bicarbonate which is an acid so CO2 is used as a clinical represnetation of how much acid is in the body.
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Acid is the byproduct of what?
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normal cellular metabolism of energy sources (glucose, fats & proteins).
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What are the 3 components of extracellular buffers?
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Bicarbonate/Carbonic acid, Phosphate, Proteins
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What is one problem with extracellular buffering?
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It can be overcome very easily with a insult of great enough severity.
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What chem-7 value is regulated by the lungs?
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pCO2
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CO2 excretion by the lungs is proportional to___.
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Tidal volume (how deep of a breath you are taking), Increased rate of respiration.
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What are the two mechanisms that the kidneys use to regulate H+ and HCO3?
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1: excrete H+ (acid) 2: they retain bicarbonate (HCO3)
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What 3 chem-10 measures are used to calculate HCO3?
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pH, pCO2, pO2
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What is the biological pH under normal conditions?
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7.4
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A pH under what is considered acidemia? alkalemia?
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< 7.35 or >7.45
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How much time does it take for extracellular buffers to respond to acid-base changes?
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immediately and maximally in 2 hrs
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How much time does it take for the kidneys to respond to an acid-base imbalance?
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24 hours and maximally in 3-5 days
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How much time does it take for the lungs to respond to a change in acid base balance?
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minutes and maximally in 4-24 hours
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What is the body's pCO2 level under normal conditions?
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40
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what is the body's HCO3- level under normal conditions?
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24
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Describe the purpose of the anion gap.
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The anion gap is used to help categorize and evaulate potential causes of METABOLIC ACIDOSIS
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How do you calculate anion gap and what are normal ranges?
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Anion gap = Na+ - (Cl + HCO3)
Normal range is 8-12 |
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Anion gap is a ratio of what to what?
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Cations (+)-chgs to Anions (-) chgs
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If there is a primary metabolic alteration what chem-10 value is of concern?
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HCO3
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In primary respiratory alterations what is the Chem-10 value of concern?
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pCO2 concentrations
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True/False: The body NEVER overcompensates and NEVER completely compensates to normal pH
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TRUE!
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What would these levels indicate: pH 7.2, pCO2: 60, HCO3: 22
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Acute respiratory acidosis (acute because the bicarb hasn't repsonded yet to compensate).
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What are the causes of respiratory acidosis?
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Pulmonary edema, severe pneumonia, smoke inhalation, respiratory depression due to narc OD' and Emphysema
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How would pulmonary edema lead to an acid-base disorder?
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It covers the alveoli reducing their ability to exchange gas and created respiratory acidosis.
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How would severe pneumonia lead to acid-base disorders?
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It covers the alveoli in mucous reducing the SA avaliable for gas excahnge
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What are the signs and symptoms of respiratory alkalosis?
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Confusion, tetany, syncope (fainting)
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the "brown bag" is used to treat what?
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Respiratory alkalosis
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What are the signs and symptoms of metabolic acidosis?
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Kussmaul breathing, hyperkalemia and ventricular arrhythmia
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What does MUDPILES notate?
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causes of Metabolic acidosis: Methanol, Uremia, DKA, Propylene glycol, INH, Lactic Acidosis, Ethylene glycol, Salicylate
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What are potential causes of Metabolic acidosis?
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Organic Acids, Toxins, renal failure, hypoxia, dirrhea and GI loss.
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What are the two types of Metabolic acidosis? Differentiate between the two
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Gap: decrease in HCO3 concentration and treated by addressing the underlying cause: restore circulating volume or plasma O2 (lactic acid acidosis) insulin if keto...
Non-gap: Bicarb losses in ECF b/c of renal failure or diarrhea & treated W/bicarb if pH <7.1 |
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State the causes as well as Signs/Symptoms of Metabolic Alkalosis.
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Cause: net loss of H+ from the ECF, net addition of bicarbm, loss of Cl-rich/Bicarb poor fluid.
S/S: Chyene-Stokes breathing: rapid & shallow rspns, Hyopkalemia, cramping & seizures |
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What is CBC indicative of?
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CBC is indicative of a patients overall health.
etiology effectivenss of therapies differential diagnosis |
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What four things do CBC evaluate?
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RBC count
Hemoglobin Hematocirt RBC indicies |
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Bone marrow is the source of what?
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RBC and WBC production
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Reticulocytes are mature or immature? what % composition of the blood are they?
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Immature, 0.5-2.5%
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What are normal RBC counts?
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4.1 - 5.3 million
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Describe how Erythropoiesis works?
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O2 levels drop stimulating EPO release which causes Reticulocyte release from bone marrow. Reticulocytes mature and cary O2 which turns off EPO stimulation
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What can bilirubin be used to determine?
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if cells are being broken down at a normal rate
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What is hematocrit (Hct) a measure of and list the levels for men/women.
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Measure of the Volume occupies by RBC's (in a %)
female: 36-46 male: 37-49 Prob = dehydration causes low blood vol |
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Hemoglobin (Hgb) measures what?
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O2 carying capacity (product of wight)
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What is the relationship between Hct and Hgb?
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Hgb is 3x more than Hct.
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What role does transferrin play?
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It transports iron through the plasma
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When would a lab value for ferritin be useful?
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When determining if you have iron defficiency anemia (reflects Fe stores in the spleen and marrow
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hemosiderin?
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A measure of the level of Fe (storage) in the liver.
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TIBC is useful in determing what?
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the total amount of iron that can bind to transferrin...
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List the 4 types of RBC indicies.
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MCV
Microcytic Normocytic Macrocytic |
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What is MCV?
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Mean corpuscular volume, the Hct of one blood cell
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What are the values for microcytic MCV?
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<78 fl
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What are the values for normocytic MCV?
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78-100 fl
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What are the values for Macrocytic MCV?
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>100 fl
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Changes in Red blood cell distribution width (RDW) occur at two times, what are they? When would they return to normal?
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They are when you get sick and then when you get better and it takes 120 days for the RDW to return to normal as that is the life of a RBC.
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What would be the benefit of noticing a change in RDW?
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It would either tell you that your patient is getting better or more likely be a key diagnositc component of diagnosing anemia.
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Epoetin Alfa stimulates what?
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Erythropoiesis
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When would one get a transfusion?
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Old age, Acute problem, more "emergency" situations
DOES NOT ADDRESS THE CAUSE OF ANEMIA! |
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List the normal WBC levels.
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4,500 to 11,000
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CSF carries out the synthesis of what two types of WBC's?
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Granulocytes and Monocytes
(G-CSF and GM-CSF) |
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What percent of the WBC's are composed on neutrophils?
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45-75%
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Bands (immature) lewcocytes compose what percentage of the WBC's?
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0-5%
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What WBC's are the #1 killer of bacteria (phagocytose it!)
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Neutrophils
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Esoniophils compose what percent of the blood, What do they do and when are they elevated?
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0-8%, they Phagocytose larger molecules (non-bacterial) and are elevated in allergic diseases.
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Basophils compose what percent of the WBC's? What do they react with and what happens? What receptors are on their membranes?
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0-3%. They react with antigens causing release of histamine (can cause hypersensitivity rxns). IgE receptors.
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When would Basophils be elevated?
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Durring an immune risponse.
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What percent of the WBC's do lymphocytes compse?
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16-46%
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What percentage of lymphocytes do T Cells compose? what type of immunty are they involved in? lifespan?
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80-90%, cell mediated immunity, months to years
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What percentage of lymphocytes do B-cells compose? lifespan? Type of immunity?
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10-20%, days, Humoral immunity.
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lymphocytes are more involved in response to what type of foerign material?
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Viral (neutrophils respond to bacterial)
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What would one have to request to see in order to get a t-cell level?
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A "CD" or cluster of differentiation.
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What percentage of the WBC's are Monocytes? What is the role of Monocytes?
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4-11%
Hematopoiesis and part of the RES Can become macrophages |
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G-CSF and GM-CSF are pharmacologic agents to elicit what change in WBC's?
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They are used to increase the WBC count
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What is the range of platelets in the body under normal physiological conditions?
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150,000-350,000
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What percentage of platelets are in the bloodstream? Lifespan? Regulated and controlled by what?
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2/3's
8-11 days Megakaryocyte colony stimulating factor. |
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Interleukins perform what action?
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Increase the platelet levels
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Define anemia.
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A decrease in circulating Hb
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Anemia itself is not a disease; it is a sign of disease True or False.
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True!
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List causes of Anemia
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Impaired Erythropoiesis
Blood loss Abnormal Destruction Mixed Idiopathic |
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Elaborate on Impared Erythropoiesis (cause of anemia)
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Due to Nutritional deficiencies
Chronic diseases drug induced Inherited |
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What are the 3 classifications of anemia?
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Pathophysiology
-Underlying diease causing the anemia Etiology: - Cause of anemia Morphology: - What it looks like (indicated by MCV) |
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Microcytic anemia is also Hypochromic meaning what?
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It has a different color (morphologically)
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What are two possible causes of Microcytic anemia?
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Iron deficiency anemia
Anemia due to chronic disease |
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What diagnostic tests can be used to determine if anemias are microcytic?
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Serum ferritin, serum iron, TIBC, RDW, Transferrin receptor
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What are the 3 causes of Normocytic anemia?
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Hemorrhage, Hemolytic Anemia, Anemia of Chronic disease
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What two diagnostic tools are used to determine if an anemia is Normocytic?
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Reticulocyte count, Antiglobulin
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What are the two possible causes of Macrocytic Anemia?
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Vit-B12 or folic acid deficiency and Marrow toxicity
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What diagnostic tests would be helpful in determining if you have Macrocytic anemia?
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Vitamin levels, Schilling's test, S. Methylmalonate, S. Homocysteine
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True or false, Most patients with anemia have multiple symptoms?
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False! Most patients with anemias are asymptomatic.
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What are the 4 most common causes of anemia?
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Nutritional deficienceies
Iron vitamin B-12 Folate |
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What populations are at risk for developing anemias?
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Children
Teens Women Pregnant women Alcoholics HIV patients The elderly |
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Children, teens and women are most likely to develop what type of anemia?
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Iron
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Alcoholics, HIV patients and the elderly are most likely to contract which types of anemia?
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Iron, folate and Vit-B12
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List the causes of Iron deficiency anemia
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Iron Loss, (blood loss/NSAIDS)
Increased demand for iron, (growth Poor Intake, Diet, Alcohol |
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What 5 symptoms are experienced in all types of anemia?
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Fatigue
Pallor Dizziness Palpitations Dyspnea |
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Why would you look at the "History and Physical" information when determining what type of anemia is present?
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To determine a possible cause (diet, lifestyle, medications) and symptoms, although ANEMIAS ARE USUALLY ASYMPTOMATIC!
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If and patient came to you known to have iron deficiency anemia what would his Hgb, MCV, Serum Fe, TIBC, Serum Ferritin and RDW look like?
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Hgb would be decreased (because by definition anemia is loss of Hb),
MCv would be decreased (due to loss of Fe) Serum Iron would decrease (poor diagnostic tool) TIBC would increase Serum Ferritin would decrease (b/c this is storage form of iron) RDW would increase |
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What is the goal of therapy in treating iron deficiency anemia?
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to correct the underlying cause (supply iron supplement in most cases)
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What is the USA recommended dose of Fe for adults & pregnant women?
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18mg, 27mg
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What is the therapeutic dose for iron?
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200mg elemental iron/day (in 2/3 doses)
65mg per tab |
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Iron is best absorbed in what form?
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Ferrous (Fe2+)
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Why is calcium (tums) bad if your taking iron supplements?
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because it decreases what is already low absorption
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Where is iron absorbed most efficiently?
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In the duodenum (pH2)
Wester diet ferric (Fe3+) is ionized to Fe2+ here and then absorbed. |
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What percent of Feosol- ferrous sulfate (elemental iron) is absorbed?
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20%
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What percent of Fergon ferrous gluconate (elemental iron) is absorbed?
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12%
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What percent of Carbonyl iron (elemental iron) is absorbed?
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100%
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What percent of Miferex Polysaccharide-iron complex (elemental iron) is absorbed?
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100%
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Where is immediate release oral iron absorbed?
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Stomach, because of lower pH
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Where is sustained or delayed release oral iron absorbed?
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Small intestine (because it's less acidic so absorption is slower...)
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What are good dosage strategies when treated iron deficiency anemia?
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Initiate at a low dose and work up (so you can poop),
Goal: to get to 200mg elemental iron daily (65mg TID) |
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How long is the duration of iron deficiency treatment?
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2-3 weeks because it takes time to be absorbed and then stored (this means symptoms can las for 2-3 weeks as well)
Could continue 3-6 months AFTER anemia replenished iron stores |
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What is a proper maintenance dose of iron to prevent reoccurring Fe anemia.
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18mg/day or 27 if pregnant
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What are the 5 adverse effects you can get while taking iron supplements? which 3 are most prominent?
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Most Common: 10-46% incidence
Nausea Abdominal Pain Constipation Less common: Black Stools Stained teeth (if liq dosage form) |
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What are some key points to discuss when counseling a patient who is taking iron supplements?
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Take on an empty stomach or with orange juice, DO NOT TAKE WITH MILK/TEA, Start at low does and gradually increase it, interaction with calcium, leading cause of infant poisoning (SO keep it out of reach)
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In the events of iron overload what therapy would you recommend?
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Chelaton therapy
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To determine the efficacy of iron supplement therapy you should monitor lab values, what would lab values that indicate improvement of condition be?
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Increase in Hb,
Increase in MCV, Decrease in TIBC, Increase in RDW, |
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What Hb levels put an individual at consideration for a blood transfusion?
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<8g/Dl and if elderly 8-11g/Dl
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Parenteral Iron is an alternative to Oral iron. What are it's indications and the three most common formulations?
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Oral therapy intolerance
No possibility of transfusions Hemodialysis Sodium Ferric Gluconate Iron Sucrose Iron Dextran if not related to Renal dysfuction. |
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What is of concern when administering Iron Dextran?
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It has a black box warning for anaphylactic-type reactions.
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Iron dextran is administered via the "Z-track" technique, what is this?
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Slide skin sideways, inject, release the skin and remove the needle...used to keep the drug in the muscle!
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What are the 4 potential causes of a folic acid deficiency?
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Indaquate intake (most common)
Increased need (pregnant...) Impaired Metabolism (enzyme deficnecy) Malabsorption (intestinal changes) |
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What is one problem with dietary sources of folic acid?
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Cooking can destroy up to 50% of folic acid.
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How is folic acid metabolized by the body?
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Hydrolyzed in the intestine,
Activated by enzymes to tetrahydrofolic acid, B12 cofactor allows conversion to homocystic methionine needed for AA's and DNA. |
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What 3 symptoms are specific to folic acid deficiency anemia?
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Diarrhea, Weight loss, Glossitis.
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What are the laboratory values recorded with Folic acid deficiency anemia? RBC, Hb, MCV, reticulocytes, Ser-folate, Ser-homocystine
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low RBC,
Low Hb, High MCV, Low Reticulocytes, Low Serum Folate, High Serum Homocystine |
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For the management of folic acid anemia what is an allowed OTC dose and what is supplied therapeutically?
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400micro-grams/adult
800micro-grams/pregnant 1g therapeutic (this could mask a B12 deficiency which is MUY MAL!) |
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Folic acid is water soluble and well absorbed so what side effects would you expect
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None! Resolution of the symptoms should occur in 2-4 weeks!
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What are the possible causes of Vitamin B12 deficiency?
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Malabsorbtion (most prominent), Impaired Transport |
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Over what length of time would it take to develop Vit B12 (megaloblastic) deficiency?
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It would take years and symptoms would be present before there are any hemotological changes!
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Vitamin B12 is stored where?
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In the Liver
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Vitamin B12 is absorbed in food, what strips it off of food and what binds it so that it can be absorbed on a molecular level?
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Gastric acids tear B12 off of food and then Intrinsic factor binds to it so it can be absorbed by the cells.
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What are two functions of Vitamin B12?
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Cofactor to the transformation of homocystine to methionine which activates folic acid synth that is required for DNA synth
to enzymatically transform methylmalonate |
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What 4 symptoms are specific to Vitamine B12 deficiency anemia?
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Depression,
Peripheral Neuropathy, Sore tongue or mouth, Strange feeling/tingling extremities |
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What lab values are associated with a Vitamin B12 defficiency? RBC, Hgb, MCV, Reticulocytes, Ser-homocystine, Ser-Methylmalonate, Ser-B12
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low RBC,
Low Hgb, High MCV, Low Reticulocytes, High Serum HOmocystine High serum methylmalonate, Low Serum B12 |
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What must be determined if one has a vitamin B12 deficiency?
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the functionality of "Intrinsic factor" because if the patient has antibodies to it than oral B12 wont be absorbed.
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To manage Vitamin B12 deficiency what dose of suplement would you reccomend?
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2.4micro grams
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What are the three possible ways of administering Vitamin B12 supplements?
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Oral (1000micro-grams/day),
Nasal (only if loaded with an IM), IM/Deep SC (100micro/G's ) |
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How long would it take to treat a vitamin B12 deficiency?
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if pernicious than life-long,
If not than until underlying problem is resolved. |
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Vitamin B12 has an interaction with alcohol, how would you advise the patient of this interaction?
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Ask them to "Limit" alcohol, if you say not to drink it than they will probably binge drink and skip taking their med's
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What combination products exist for the treatment of B12 deficiency anemia?
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Niferex forte (300mg polysaccharide iron, 75micro of B12, 3mg Folic acid)
Chromagen (66mg iron, 10micro B12, 250 Vitamin C, desicated stomach substance: 100mg): use this if patient has problems with intrinsic factor! |
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What is the normal bound level of transferrin?
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30-50%
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Signs/Symptoms of Hyperglycemia?
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Polyphagia, Polydipsia, Polyuria
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50% of calcium is protein bound so if albumin is low than what needs to be corrected?
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Calcium levels!
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What does HAMFRS stand for?
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History of present illness,
Allergy history, Medical history, Family History, Review of systems, Social history |
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MOLDI TAR is an acronym for what?
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Social history:
Marital Status, Occupation, Living exposure, Diet, Insurance Tobaco, ALcohol, Recreational drug use |
