Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine > Acid Base Disorder,Hemodialysis , Renal Transplant > Flashcards

Acid Base Disorder,Hemodialysis , Renal Transplant Flashcards

1
Q

Most efficient buffer

A

Bicarbonate buffer system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Extracellular buffer are

A

Bicarbonate buffer system

Phosphate buffer system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

If pka levels are close to blood pH it means

A

pka means ph at which molecules can exist as both associated and dissociated form. So if pka is close to 7.4 pH blood it means it will exist in ionic form also to act as buffer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Intracellular buffer most important

A

Protein -Hb

Phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does lungs act as buffer

A

Lungs exhale or retain CO2 in response to extracellular pH

In metabolic acidosis more CO2 is exhaled from lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Non volatile Acids produced in kidney per day?

A

80meq of non volatile Acids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Total H+ excreted per day

A

4320 + 80 = 4400meq
4320 HCO3 filtered per day at glomerulus for which 4320 H+ excreted
80 meq non volatile acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Net acid excretion is?

A

80mEQ ie Ammonium and titrable acid (phosphate/creatinine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Urinary buffer are

A

Ammonia buffer

Phosphate buffer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Site of injury in RTA TYPE 1

A

Damage to Na-H exchanger in proximal tubule

Leading to inability to excrete H into lumen and excess conc in blood.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Acidifying machinery of kidney

A

Cortical collecting duct alpha intercalated cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

RTA type II

A

Damage to distal CD H+ATPase pump
Leading to inability to excrete H+ and increased levels in blood
Metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Importance of ammonia in acid base regulation

A

Ammonia synthesis and excretion is most important way kidney eliminates non volatile acids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where is ammonia formed

A

In proximal tubule by catabolism of glutamime to glutamate to alpha ketoglutarate
2 ammonium ion are generated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In response to increased acid load ammonia excretion increases
How does ammonium ion reach urine

A

NH3- at ThA L through NaK2Cl-it passes into interstitium and collecting duct and by combining with H+ excreted in form of NH4+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are volatile and non volatile acids in body

A

Volatile excreted as CO2 from lungs
Formed by metabolism of carb fat protein

Non volatile formed by metabolism of phospholipid nucleic acid
Sulfuric acid phosphoric acid
Excreted by kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Henderson hasselbach equation

Important determinant of H+

A

pH=pka +log [H+] /[HCO3-]

Bicarbonate
pCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

First line defense in acid base regulation

A

Chemical buffer
Then respiratory buffer 2nd
Then renal 3rd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Anion Gap is

A

Unmeasured cations and anions = 8-12meq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Measured anion and cation in body are

A

Na+

Cl and HCO3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Corrected anion gap is

A

Anion gap +2.5(4.5 - S.albumin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Effect of Met acidosis on heart cns

A

Heart - decrease myocardial contractility
Sympathetic overactivity

CNS
Lethargy disorientation stupor coma
Hyperventilation
Hyper kalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

HAGMA

Causes

A 
Ketoacidosis DM ALCOHOL STARVATION
Uremic acidosis
Salicylate 
Methanol /ethylene glycol 
Lactic acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

NAGMA normal anion gap Metabolic acidosis is also k a

A

Hyperchloremic metabolic acidosis because loss of HCO3 - leads to increase levels of chloride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Nagma is caused by

A

Renal tubular acidosis
Diarrhea
Small bowel tumor
Anion exchange resin

26
Q

Effect of metabolic alkalosis

A

Heart arrhythmia
Brain cerebral insufficiency
Hypo calcemia kalemia magnesemia

27
Q

Classification of metabolic alkalosis

A

Chloride responsive

Chloride unresponsive

28
Q

Urinary chloride are less than 15meq/L is it chloride responsive or unresponsive

A

Responsive because chloride is lost from other route not urine

29
Q

Chloride responsive example

A 
Vomiting
Nasogastric suction 
Long term diuretic 
Cystic fibrosis
Post hypercapnia 
Pyloric stenosis
30
Q

Site of access for hemodialysis

A

AV graft (PTFE)
central venous catheter- emergency use
Arteriovenous fistula most preferred

31
Q

Rule of 6 in AV fistula

A 
Fistula less than 6mm deep from skin 
Minimum 6mm diameter
Blood flow rate more than 600ml/min 
6cm long segment for canulation 
Mature in 6weeks
32
Q

First choice for AV fistula in HD

A

Radiocephalic in non dormant arm

Brescia cimino fistula

33
Q

Minimum vein and artery diameter

A

Vein 2.5 mm

Artery 2mm

34
Q

Sign of mature fistula

A

Large vein
Strong bruit
6cm straight segment
Prominent thrill

35
Q

Site for stenosis in
Forearm av fistula
Upper arm av fistula
Prosthetic graft

A

Arterial inflow
Venous outflow
Venous outflow

36
Q

Blood and dialysate flow in counter current mechanism in hemodialysis
What are individual flow rate

A

Blood - 250-400 ml/minute

Dialysate 500-800ml/min

37
Q

Two main process to filter across dialyser

A

Diffusion

Ultrafiltration

38
Q

Two main property of dialyser

A

Flux - amt of fluid removed when transmembrane pressure is 1mm Hg
High flux = large pore size

Efficiency-amt of solute removed per min when dialysate and blood flow at infinity

39
Q

What are middle molecules

A

Molecules of size more than pore size cannot be removed with normal flux membrane
Abeta2 microglobulin- dialysis ass amyloidosis
Vitamin B12, FGF23

40
Q

Preparation of dialysate ratio of water acid base

A

Acid: water:base 1:34:1.83

41
Q

If RO water is not used in hemodialysis what are the side effects

A

Dialysis dementia

Low bone turnover ds

42
Q

What is dialysis disequilibrium syndrome

A

Water from blood moves into cell by reverse urea effect leading to raised ict and cerebral edema

43
Q

What are the 2 type of dialyser reaction

A

Type A serious reaction due to ethylene oxide

Type B after 30 min due to activation of alternate complement pathway

44
Q

Hypotension during dialysis occurs due to

How to manage

A

Low blood volume due to fluid removal
Lack of vasoconstriction due to acetate buffer or warm dialysate
Cardiac factor

Mgt trendelenburg position
200ml NS
STOP ultrafiltration

45
Q

Dose of heparin during dialysis

A

1000 unit stat

Followed by 750 Unit every hr for next 3 hrs

46
Q

Most important factor for renal transplant

A

HLA compatibility

47
Q

Contraindications for renal transplant

A 
Active malignancy
Uncontrolled psychosis
Active drug dependence
Shortenes life expectancy
Positive T cell CDC crossmatch
48
Q

HLA matching is based on

A

HLA A, DR, B
3/6 - HAPLOMATCH (PARENTS)
6/6 - FULL MATCH (TWIN)

49
Q

Wait time for transplant in previous malignancy

A

Usually 2 yrs
In basal cell carcinoma no wait time
Melanoma more than 2 yrs

50
Q

What CT doppler or coronary angiography finding is contraindication to transplant

A

Calcification in iliac vessel doppler

Coronary angiography

51
Q

Ideal pt for transplant

A

CTID

CGN

52
Q

Three types of donor can be

A

Live related donor
Live unrelated donor
Cadaveric donor

53
Q

What are high and low risk transplant

A 
High risk 0-2/6
 require induction and immunosuppression 
Low risk 4-6/6
6/6 no induction 
4/6  5/6 single. Dose induction
54
Q

Induction agent used in transplant

High and low risk

A

Rabbit anti thymocyte globulin 3 doses in high risk

55
Q

Drug used for maintenance of transplant

A

Steroids calcineurin inhibitors mycophenolate mefetil

56
Q

Changes in antibody mediated graft rejection

A

20% of rejection are antibodies mediated
Peritubular capillaritis
80% cell mediated
Interstitial inflammation, tubulitis, vascular change intimal arteritis

57
Q

Infection in one month of transplant can be

A

Mostly nosocomial
Viral - HSV
fungal - Candida
Clostridium difficile

58
Q

Infection occurring in 1-6 months after transplant

And more than 6 months

A

Opportunistic infection
CMV

More than 6 month BK Polyoma virus

59
Q

BK Polyoma virus infection after transplant occurs due to

Urine microscopy findings

A

Reactivation of virus following immunosuppression

Urine microscopy shows decoy cells

60
Q

Most dangerous cmv infection can be due to

A

Donor positive and recipient negative (80% symptomatic)

61
Q

CMV prophylaxis drug of choice

A

Valganciclovir 900mg daily for 100 days

Medicine (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions