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35 Cards in this Set
- Front
- Back
Squamous epithelial cells in urine
Normal? Appearance |
Normal
Pale with big cytoplasm |
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Non-squamous epithelial cells in urine?
Normal? Source? |
Normal
From bladder |
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WBC in urine?
normal? |
normal if 1-2/hpf, if >3/hpf abnormal
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Eosinophils in urine
Normal? |
Not normal
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RBC
Normal? Source? |
Not normal if >5
Can come from anywere along urinary tract Determine location based on presence of casts |
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Hyaline casts in urine
Form from what? |
Presence of albumin
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Granular casts in urine?
Seen when? |
Plasma proteins embedded in Tamm-horsfall proteins
Seen in heavy proteinuria, not dz specific |
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How to ID granular casts?
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stain with anti-albumin AB
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Dysmorphic RBC in urine
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Seen in bleeding from glomerulus --> RBC cast
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Where do casts come from?
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Casts must come from kidney, regular RBC can come from anywhere!
For casts, blood collects after passing through glomerulus, and casts form in DCT |
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Where do WBC casts come from? When are they seen
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Kidney
Commonly seen in interstitial dz (pyelonephritis) |
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When are tubular epithelial casts seen?
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Acute renal failure, secondary to ATN
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Calcium oxalate crystal appearance?
Clinical presentation |
Envelope shaped kidney stones
Unilateral flank pain (Can be normal in low #) |
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Triple phosphate crystals appearancE? Clinical presentation?
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Coffin shaped
Seen in pts with chronic UTI w/ alkaline urine (Urea secreting organisms make the urine more alkaline) |
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Uric acid crystal appearance? Treatment?
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Lemon drop shaped
Precipitates in acidic urine Treat with alkaline to dissolve crystals |
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Cause of cystine crystals?
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Seen in hereditary cystine defect
Tubules can't resorb cystine |
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Pulmonary causes for respiratory acidosis
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Asthma
COPD Pneumonia Pulmonary edema PE |
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Non-pulmonary causes for respiratory acidosis
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Decreased central drive (drugs, stroke, sleep apnea)
Decreased neural linkage Muscle weakness Thoracic cage dysfunction |
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Acute phase of compensation for respiratory acidosis
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Make H2Co3 (from high PCO2) whcih can't be buffered with HCO3-, so use intracellular buffering mech
CO2 diffuses into cell and combines with H20 and dissociates into HCO3- and H+. Proton is buffered intracellularly by Hb via histadine side group For each increase in 10 mmHg PCO2, serum HCO3- increases 1 mEq/L |
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What is the chronic phase of compensation for respiratory acidosis
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HCO3- production by kidneys and increased H+ excretion
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How long does it take for acute phase compensation to start working for resp acidosis? Chronic phase?
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Minutes to hours
Hours to days |
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What are the pulmonary causes for respiratory alkalosis?
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Pneumonia
Pulmonary edema/CHF Interstitial dz Asthma |
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What are hte non-pulmonary causes for respiratory alkalosis
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Sepsis
Liver dz CNS d/o Salycilate intoxication Pregnancy High altitude |
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What is the compensation for respiratory alkalosis?
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Decreased HCO3 from H release from IC buffers
Incresaed cellular lactate production HCO3-/Cl- exchange at RBC |
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Causes of metabolic alkalosis?
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H+ loss (vomiting, NG suction)
Renal loss (mineralocorticoid excess) H+ movement into cells (hypokalemia) HCO3- retention (from giving NaHCO3) Contraction alkalosis/diuretics |
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What are the 2 phases of metabolic alkalosis?
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The part that initiates the alkalosis
The part that maintains the alkalosis |
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What causes the maintaining of metabolic alkalosis
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Decreased filtration (renal failure)
Increased HCO3- resorpption (volume depletion, hypokalemia, aldosterone excess, Cl- deficit) |
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How do you correct metabolic alkalosis?
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Eliminate source of excess HCO3- resorption or H+ loss
Replete volume (isotonic saline) |
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How do patients compensate for metabolic alkalosis
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Hypoventilation, can only do this until pCO2 = 60. Won't breathe any slower than that! At this point, hypoxemic drive takes over
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How do you assess a patient in metabolic alkalosis?
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Use urine Cl to determine if pt is volume depleted or not
Cl is better than Na b/c sometimes patient may excrete increased Na so it becomes unreliable (although this is not the norm) If urine Cl <10 = volume depletion Urine Cl NOT RELIABLE IN PATIENTS TAKING DIURETICS!!! |
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What is the normal value of anion gap?
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10
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What are causes of non-anion gap metabolic acidosis?
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SEvere diarrhea (GI loss of HCO3)
RTA Carbonic anhydrase inhibition NH4Cl intake Ureterosigmoidoscopy |
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Causes of anion gap metabolic acidosis
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Methanol
Uremia Diabetic ketoacidosis Paraldehyde Iron, isoniazid (INH) Lactic acid Ethanol, ethylene glycol Salicylates |
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Why does giving HCO3 to a pt in metabolic acidosis not work?
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You can alter the pH with HCO3, but you are not treating the underlying cause of the acid-base d/o
This won't help the arrhythmias, CNS disturbances, etc |
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What are the most common causes for non-anion gap metabolic acidosis?
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GI loss of HCO3-
RTA |