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19 Cards in this Set

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What equation is used to calculate the anion gap? Describe what PCO2 and what HCO3- you would find in an anion gap metabolic acidosis.
Anion gap=Na-Cl-HCO3-
PCO2<40 mmHg
Decreased HCO3
Decreased pH
A patient of yours was diagnosed with diabetes mellitus 30 years ago and comes to you today for a general wellness exam. What would you pay particular attention to on your physical exam of this patient (ie. chronic manifestations of diabetes)?
Retinopathy, glaucoma, neuropathy, renal failure, HTN, Kimmelstiel Wilson nodules, gangrene, cerebral vascular disease
What are the endocrine functions of the kidney?
Erythropoietin: released in response to hypoxia from endothelial cells of peritubular capillaries
1,25 OH2 Vitamin D: PT cells convert to active form. PTH stim these cells
Renin: secreted by JG cells in response to decreased renal arterial pressure and increased renal sympathetic discharge
Prostaglandins: paracrine secretion to vasodilate the affterent arterioles to increase GFR
What is the appearance of asbestos fibers in the lung? What cancers are associated with asbestosis?
Associated with shipbuilding, roofing, plumbing
Results in "ivory white" calcified pleural plaques
Increased incidence of bronchogenic carcinoma and mesothelioma
Asbestos bodies are golden brown fusiform rods resembling dumbbells located inside macrophages
What is the structure of HbH? What disease results in HbH production? What is the structure of Hb Barts? What disease results in Hb Barts production?
HbH=3 deletions in alpha thalassemia. Beta 4.
HbBarts=4 deletions in alpha thalassemia. Gamma 4. Incompatible with life.
Which types of cancer are associated with the following chromosomal translocations?
9;22 Philadelphia chromosome, CML
8;14 Burkitt's lymphoma, cmyc activation
14;18 Follicular lymphoma, bcl-2 activation
15;17 AML (M3)
11;22 Ewings sarcoma
11;14 Mantle cell lymphoma
What are the causes of normocytic, normochromic anemia?
Hemolytic: hereditary spherocytosis, 6GPD, sickle cell anemia, pyruvate kinase deficiency, HbC, PNH, autoimmune, microangiopathic, infections, mechanical destruction
Non-hemolytic: aplastic anemia, anemia of chronic disease, kidney disease
The most common cause of osteomyelitis in all patients is Staph. aureus. What organism would you also suspect in a sickle cell patient with osteomyelitis? What about a drug addict with osteomyelitis?
Sickle cell diseases: salmonella
Drug addict: pseudomonas
What is Charcot’s triad?
Jaundice, fever, RUQ pain
Positive Murphy's sign: inspiratory arrest on deep palpation
Why is diphenhydramine (Benadryl) a poor medication choice in the elderly and those with BPH?
Diphenhydramine is a first generation H blocker
Tox: sedation, antimuscarinic (contra in elderly with glaucoma?), anti-alpha adrenergic (Contra in BPH)
Which antifungal may cause arrythmias?
Amphotericin B
Mech: binds ergosterol and forms membrane pores
Uses: wide spectrum
Tox: fever, chills, hypotension, arrythmias, nephortoxic, anemia, IV phlebitis
Which antifungal may cause liver dysfunction?
Mech: inhibit ergosterol synthesis
Uses: systemic mycoses
Tox: hormone synth inhibition (gynecomastia), liver dys (inhibits P450), fever, chills
Which antifungal interferes with microtubule function?
Uses: oral tx of superficial infections, good for dermatophytes
Tox: teratogen, carcinogen, confusion, headaches, increases P450 and warfarin metabolis
Which antifungal inhibits steroid synthesis in fungi and in humans?
Mech: inhibits cell wall synthesis by inhibiting synthesis of beta glucan.
Use: invasive aspergillosis
Tx: GI upset, flushing
Which antifungal is an oral treatment for superficial fungal infections?
Which antifungal is an oral treatment for superficial fungal infections?
Mech: binds ergosterol and disrupts fungal membranes
Swish and swallow for oral candidiasis, topical for diaper rash or vaginal candidiasis
How can you determine whether hypoglycemia is caused by an endogenous abnormality (such as an insulinoma) or by exogenous insulin uptake?
Serum C peptide is not present if someone is taking exogenous insulin.
What are some of the problems encountered with menopause?
Hot flashes
Amenorrhea, atrophy of the vagina
Vaginal dryness
Coronary artery disease
What is the general mechanism of action of the steroid/thyroid hormones? Which hormones are considered steroid hormones?
Lipophilic and insoluble in plasma so carried by binding globulins. Must be transcribed so protein synthesis delays onset of action.
Progesterone, estrogen, testosterone, cortisol, aldosterone, thyroxine and T3
Describe how heart failure, liver failure, infections and toxins, and lymphatic blockage would affect the Starling forces of fluid movement through capillaries.
They all cause edema
Heart failure increases capillary pressure
Nephrotic syndrome and liver failure decrease the plasma protein conten
Toxins and infections increase capillary permeability
Lymphatic blockage increases intersitital fluid colloid osmotic pressure