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47 Cards in this Set
- Front
- Back
What do physicians look for in infant lung maturity?
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Type 2 pneumocytes make the surfactant phospholipids, lecithin and sphingomyelin.
CO2 will be retained, causing respiratory acidosis |
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Both glomerular and tubular function develop over the first year of life (T/F)
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False. First 2 years of life.
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What is the first thing you should suspect when hyperkalemia is present?
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poor capillary puncture technique.
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What is the enzyme that conjugates bilirubin?
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UDP glucagonal transferase
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What is neonatal jaundice?
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The developing liver is unable to conjugate bilirubin because of lack of enzyme, resulting in “neonatal jaundice.”
Bilirubin result will show increased total bilirubin, most of which is indirect or unconjugated bilirubin |
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What pathological condition needs to be considered in neonatal physiologic jaundice?
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A pathological condition must be considered: Crigler-Najjar disease, a genetic disease in which the enzyme that conjugates bilirubin, UDP-glucuronoyltransferase, is not produced
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What genetic enzyme deficiency can result in the decreased synthesis of aldosterone and cortisol?
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steroid 21-hydroxylase
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Until what age do liver metabolizedrugs more slowly than adults?
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2 years old
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What increased lab results do geriatric patients exhibit?
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GGT
LD AST Lipids ALP (women) CK BUN pCO2Fasting glucose Potassium TSH Uric acid |
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What decreased lab results do geriatric patients exhibit?
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Albumin
pO2 Bilirubin T3 Total protein Growth hormone Creatinine clearance |
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What lab values do not change in geriatric patients?
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Chloride
Free T4 Sodium Insulin pH |
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All aspects of Therapeutic Drug Monitoring may be affected in geriatric patients: absorption, distribution, metabolism and excretion. (T/F)
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True
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What is the most significant of the changes in TDM in geriatric patients?
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elimination.
Renal mass and renal blood flow diminish. GFR decreases. Drugs may easily be overdosed and become toxic. |
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What are good nutrition markers in geriatric patients?
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protein - few days
albumin - weeks weight loss |
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What is CSF?
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CSF is the liquid that occupies the spaces of the CNS and surrounds all facets of brain and spinal cord
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What is the volume of CSF in adults?
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150 mL
Constantly produced and reabsorbed at the rate of 500 mL/day Formation is the result of ultrafiltration of plasma and active secretion by the epithelial membranes |
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What is the glucose ref range in CSF?
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40 – 70 mg/dL (~ 70 -80 % of serum glucose level)
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What is the protein ref range in CSF?
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0.02 to 0.04 g/dL (~ 0.5% of plasma level)
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What is the sodium ref range in CSF?
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Almost same as plasma (Osmolality ~ 280 mOsm/Kg)
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How are CSF specimens collected?
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Lumbar puncture
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What things are we interested in CSF as far as biochemical analysis?
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Glucose (decrease is significant)
increased lactate and normal to decreased glucose suggests bacterial infection Protein - CSF electrophoresis Increased prealbumin (compared to serum) IgG-Albumin ratio is used in diagnosis of MS |
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What are serous fluids?
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The pleural, peritoneal and pericardial cavities are all lined by two membranes.
The parietal membrane lines the cavity wall The visceral membrane covers the organs within the cavity. The fluid between the membranes which provides lubrication as the surface move against each other is called serous fluid |
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Where is pleural fluid?
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surrounds lungs
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Where is peritoneal fluid?
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surround the intestines
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Where is pericardial fluid?
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Surrounds the heart
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How are serous fluids formed?
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Serous fluids are formed as ultrafiltrates of plasma with no additional material contributed by the membrane cells.
Normally, only a small amount of serous fluid is present, because production and reabsorption take place at a constant rate. The spaces are subject to hydrostatic and colloidal (oncotic) pressures from the capillaries serving the cavities and capillary permeability. |
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What is effusion?
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Disruption of the mechanisms of serous fluid formation and reabsorption causes an increase in fluid between the membranes.
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What are some causes of effusion?
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increased hydrostatic pressure (CHF), decrease oncotic pressure (hypoproteinemia), increased capillary permeability (inflammation and infection) and lymphatic obstruction (tumor)
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What is a transudate?
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Serous effusion that form as a result of a systemic disorder that disrupts the balance in the regulation of fluid filtration and reabsorption between the serous membranes
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What is an exudate?
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serous effusion produced by conditions that directly involve the membranes of the particular cavity including infections and malignancies.
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What are examples of sample preparation?
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Centrifugation
Cytocentrigugation Direct smear Cell block: prepared in Histology Abundant fluid (greater than 100 ML) is usually collected; therefore ,suitable specimens are available for each section of the laboratory EDTA tube is used for cell counts and differential. The remaining fluid can be heparinized for chemical, serologic, microbial and cytologic analysis |
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Is pleural fluid transudative or exudative in origin?
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Pleural effusion may be of either transudative or Exudative in origin
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What ar ethe most common chemical tests performed on pleural fluid?
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are glucose, pH, and amylase
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What lab results are indicative that a pleural fluid is an exudate?
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pleural fluid:
cholesterol >60 mg/dL or pleural fluid:serum cholesterol ratio >0.3 and fluid:serum bilirubin ratio of >0.6 |
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What is a clear, pale yellow pleural fluid indicative of?
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Normal and transudate
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What is a turbid, white pleural fluid indicative of?
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presence of WBCs and indicates bacterial infection, tuberculosis, or an immunologic disorder such as RA.
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Bloody pleural fluid?
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This signify a hemothorax (traumatic injury) and hemorrhagic effusion. To differentiate between the two is by comparing HCT of fluid to HCT of blood.
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Milky pleural fluid?
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Chylous material from thoracic duct leakage and Pseudochylous material from chronic inflammation.
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What is the accumulation of fluid in the peritoneal cavity?
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ascites
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What causes ascitic transudates?
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Hepatic disorder such as cirrhosis
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What causes exudative fluids?
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Bacterial infection (peritonitis) often as a result of intestinal perforation or a ruptured appendix and malignancy
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How can you detect transudates of hepatic origin?
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The serum-ascites albumin gradient of 1.1 or greater is recommended over the fluid to serum total protein and LD ratio
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Gross exam for peritoneal fluid
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bloody: ruptured spleen or liver
cloudy: appendicitis, pancreatitis greenish: bile stained, perforated gallbladder, ulcer or cholecystitis pseudochylous: greenish milky, cellular debris or cholesterol crystals Peritoneal lavage - is a particularly sensitive test for the detection of intra-abdominal bleeding in blunt trauma cases, and results of the RBC count are used to aid in determining the need for surgery. |
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How does normal and transudate pericardial fluid appear?
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clear and pale yellow
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Tell me about pericardial effusions
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Pericardial effusions are primarily the result of changes in the permeability of the membranes due to infection (pericarditis), malignancy, trauma, or metabolic disorders, such as uremia.
The presence of an effusion is suspected when cardaic compression is noted during the physician’s examination |
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Gross exam of pericardial fluid.
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Gross exam
Exudates only Effusion result of infection, malignancy or metabolic damage clear- metabolic disorders turbid - infection and malignancy milky - lymphatic system damage blood streaked - membrane damage grossly bloody – cardiac puncture |
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What is the calculation to determine transudates from exudates?
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Total Protein (TP) and Lactic Dehydrogenase (LD) ratios.
TP Ratio = TP (Fluid) / TP (Serum). LD Ratio = LD (Fluid) / LD (Serum). TP <0.5 and LD <0.6 is Transudate. TP >0.5 and LD >0.6 is Exudate. |