410 Quiz#2 Flashcards
1
Q
Components of BMP
A
- sodium, potassium, chloride, bicarbonate/CO2, BUN, creatinine and glucose
2
Q
Factors Affecting GFR
A
- Age: GFR decreases with age
- Gender: GFR is lower in female
- Race: higher GFR used to be accepted in black patients
3
Q
Gross Assessment of Urine
A
turbidity, Color, and smell
4
Q
Urine Dipstick
A
- specific gravity: urince concentration
- pH: reflects serum pH
- RBCs
- protein: proteinuria = hallmark of renal disease
- glucose: when blood glucose > 180mg/dL
- Ketones: not normally in urine; byproduct of fat metabolism, uncontrolled DM
- bilirubin: conjugated bilirubin, screens for liver or bile duct disease
5
Q
RBCs on urine Microscopy
A
- hematuria: >3RBCs per HPF
- gross color can be misleading
- transient vs persistent (persistent requires work-up)
- dysmorphia indicates glomerular disease
5
Q
RBCs on urine Microscopy
A
- hematuria: >3RBCs per HPF
- gross color can be misleading
- transient vs persistent (persistent requires work-up)
- dysmorphia indicates glomerular disease
6
Q
WBCs on urine microscopy
A
- Pyuria: >5 WBCs per HPF
- neutrophils: bacteria, renal TB, lithiasis
- Eosinophils: interstitial nephritis
7
Q
Epithelial Cells on Urine Microscopy
A
- shed from genitourinary tract
- excess of epithelial cells may indicate contamination
- renal disease/tubular disease: >15 epithelial cells per 10HPF
8
Q
Nitrates vs Nitrites
A
- Nitrate: normal constituent of urine; converts to nitrite in presence of certain bacteria
- Nitrites: abnormal, correlate well with possible infection; >10,000 bacteria count per mL
9
Q
Leukocyte Esterase
A
enzyme produced by neutrophils, signals pyuria
subject to contaminated specimen, read only after 30-60 secs
nonspecific: TB, tumors, viral, stones, foreign bodies
works with synovial fluid as well to test for septic joint
10
Q
Accuracy of hematuria, leukocytosis, and nitrites in urinalysis
A
- hematuria: very sensitive but not specific
- leukocytosis: very sensitive, not specific
- Nitries: not sensitive, very specific
11
Q
Myocardial Cells
A
- “working cells” of the heart, contractile ability
- connected by intercalated discs with gap junctions
- held to by desmosomes
12
Q
When Heart Cells are injured they release:
A
Troponin and CPK-MB
13
Q
Anterior Leads
A
V1-V4
14
Q
Lateral Leads
A
V5-V6, aVL, lead I
15
Q
Inferior Leads
A
aVF, lead II, and lead III
16
Q
Normal Intervals
A
PR: 0.12-0.20s
QRS: 0.06-0.11s
QT: 0.36-0.44s
17
Q
ECG paper
A
small square: 0.04 s in duration, and 0.1mV in amplitude
18
Q
P wave
A
- normal duration: 0.06-0.10s; Amplitude: 0.5-2.5mm
- if amplitude >2.5mm = RAE, P pulmonale
- if duration > 0.10s (2.5 boxes) = LAE, P mitrale
19
Q
A
Flutter Waves
- seen instead of normal P waves when the atria fire rapidly from one site at a rate of 250-350bpm “Saw tooth pattern”
20
Q
A
Fibrillatory Waves
seen instead of P waves when the atra fire rapidly from many sites at a rate of >350bpm
21
Q
Short QRS complexes (in amplitude)
A
obesity, hypothyroid patients, pericardial effusion
22
Q
1st degree AV heart block
A
when the PR interval is lengthened consistently due to a delay in impulse conduction through the AV node
23
Q
2nd degree AV heart block
A
- PR intervals get progressively longer until a QRS complex is skipped and the cycle repeats
24
3rd degree AV heart block
P wave is completely independent from QRS complex, so PR interval cannot be measured
25
Wandering atrial pacemaker
* pacemaker changes location from site to site producing a slightly irregular rhythm
26
Paroxysmal Tachycardia
Normal rate that suddenly accelerates to a rapid rate producing an irregularity in the rhythm
27
Hypertrophy vs. Enlargement
* _Hypertrophy_:
* thickening of the wall of the cardiac chamber due to increased pressure that the muscle is having to work against ( high BP, stenotic valve); *common in ventricles*
* _Enlargement (dilation)_:
* not the same as hypertrophy; often occurs due to stretching as a result of fluid overload; *common in the atria*
28
Clinical conditions associated with r atrial enlargement
pulmonic stenosis; tricuspid stenosis; tricuspid regurgitation
29
**RAE criteria**
R atrial enlargement: **amplitude \>2.5mm**
* if P is biphasic, the initial component is taller than the terminal component
* **leads II and V1 to diagnose atrial enlargement**
30
**LAE criteria**
Left Atrial Enlargement: duration \>0.10 sec (2.5 boxes)
* other criteria: terminal portion of P wave in V1 is negative, duration of \>0.04 s and depth of \>1mm
31
Right Ventricular Hypertrophy Criteria
less common, usually d/t pulmonary HTN or pulmonic stenosis, reverse R wave progression
**criteria: RAD, R wave \> S wave in V1** +/- S wave\>R wave in V6
32
Left Ventricular Hypertrophy Criteria
* common causes: HTN and valvular disease, precordial leads more sensitive and helpful in diagnosing LVH
* _Criteria (need ⅔)_: **sum of the deepest S in V1/V2 + tallest R in V5/V5 \> 35mm (Sokolov's rule); R in lead I + S in lead III \> 25mm; R in AVL \>11mm;**
33
Incomplete BBB
RR configuration (or “rabbit ears”) with normal QRS
34
RBBB criteria
* _Criteria_: **prolonged QRS,** M shaped RR' (rabbit ears), **wide _S wave_ in lead I and V6**
* seen in Coronary artery disease, and pulmonary embolism
35
LBBB Criteria
* _Criteria_: **prolonged QRS, wide _R wave_ in** ***lead I and V6***
36
Left Anterior Hemiblock
**left axis deviation**
normal QRS, tall R waves in lead I and deep S waves in aVF
37
Pre-Excitation Syndromes
* **Wolf-parkinson-white Syndrome**
* accessory pathway: _bundle of kent_
* **PR interval \<0.12 seconds**, wide QRS complex, _Delta Wave_
* **Lown-Ganong-Levine** **Syndrome**
* accessory pathway: _James Fibers_
* **PR interval \<0.12seconds**, normal QRS complex, _absence of delta wave_
38
Dissolvable Sutures
Vicryl, Dexon, Chromatic, PDS
Very dextrous Chris places dissolvable sutures
sizes, 2.0, 3.0, 4.0 (bigger # → smaller suture)
39
Non-Dissolvable Sutures
skin closure, drain anchors, internal suturing (sometime), vascular surgery (leave-in)
**nylon, ethilon, silk, prolene**
never eliminating stable Paul
size: 3.0, 4.0, 5.0
40
Needle Types
* cutting: skin
* non-cutting: tissue, bowel, vascular, skin
41
Removal Times of Sutures
* **face/neck: 3-5 days**
* scalp & arms: 7-10 days
* **trunk/legs/hands/feet: 10-14 days**
* Palms & soles: 14-21 days
42
Numbing the Wound
* _Lidocaine 1% with epi_: used on scalp & trunk, lasts longer, controls bleeding
* _Lidocaine 1% without epi:_ penis, fingers, toes and nose
* _Lidocaine_: can be used locally at wound or as a digital block on toes and fingers (use small 25g needle)
43
Post-Suturing Wound Care
* _toes/fingers_: keep covered for 48-72 hours
* _face/scalp_: keep covered for 24-48 hours
* _most wounds_: keep covered for 18 hours
44
how late is too late for sutures?
face: 24-48 hours
everywhere else: 18 hours?
45
When to contact specialist for suturing?
nerve injury, arterial injury, any exposed bone, facial lacerations in children
46
Rouleaux formation
stacked RBCs in a linear distribution
47
Howell-Jolly Bodies
fragments of nucleus left over in RBCs
usually cleaned out by the spleen
48
Acanthocytes aka Spur Cells
irregular projections
caused by changes in lipid metabolism that affect the RBC membrane
49
Echinocytes aka Burr Cells
small blunt projections, **uniformly** spaced over the red cells, cells still have central pallor
caused by: **liver disease, uremia**
50
Schistocytes
helmet or egg shaped fragments
caused by **hemolytic anemia**
→indicates destruction of RBCs
51
MCH
mean corpuscular hgb
average hgb per RBC
52
MCHC
mean corpuscular hgb concentration
**REDNESS**
normochromic, hypochromic, hyperchromic
53
Fishbone for CBC
54
Procalcitonin
high serum procalcitonin can indicate a systemic bacterial infection and sepsis
55
STEMI or Injury Pattern
2 contiguous leads have 1.5-2mm ST elevation
56
NSTEMI or Ischemia (No Injury)
2 contiguous leads have 1+mm ST depression
57
unstable angina
chest pain at rest
