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CPR Exam 3 > Acid Base Review > Flashcards

Acid Base Review Flashcards

1
Q

Normal pH

A

7.35-7.44

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2
Q

normal bicarb

A

24

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3
Q

normal paco

A

40

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4
Q

normal anion gap

A

12

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5
Q

normal osmolar gap

A

10

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6
Q

What does GOLD MARK stand for?

A 
glycols 
5-oxoproline 
L lactate 
D lactate 
methanol 
aspirin 
renal failure 
ketoacidosis
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7
Q

Winter’s formula

A

1.5xBicarb +8 +/- 2

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8
Q

Anion gap formula

A

Na - (HCO3+Cl)

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9
Q

Osmolar gap fomula

A

measured - calculated osmolarity

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10
Q

Osmolarity equation

A

2*Na + glucose/18 + BUN/2.8

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11
Q

Delta-delta gap equation

A

delta gap: Calculated anion gap - normal anion gap

delta bicarb: 24 - delta gap

if the measured bicarb was greater than what we calculated here, then theres metabolic alkalosis as well

if the measured bicarb was less than what we calculated here, then there’s NAGMA as well

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12
Q

Diagnosis of osmolar gap mnemonic

A 
ME DIE 
methanol 
ethanol 
diethylene glycol 
isopropyl alcohol 
ethylene glycol
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13
Q

NAGMA diagnosis mnemonic

A 
DURHAMM 
diarrhea 
ureteral diversion 
renal tubular acidosis 
hyperalimentation 
acetazolamide 
addisons disease 
miscellaneous
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14
Q

What is the effect of acidosis and alkalosis on potassium levels?

A

acidosis - hyperkalemia

alkalosis - hypokalemia

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15
Q

What is the difference in presentation between glomerular and non glomerular hematuria?

A

glomerular will have RBC casts, new proteinuria, elevated serum creatinine

non glomerular: more likely to have visible blood clots

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16
Q

What is the first thing to consider in work-up of hematuria?

A

urine culture

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17
Q

What are the features of IgA nephropathy?

A

IgA deposits in mesangium
hematuria associated with a viral infection
1-2 days after infection present with dark urine

18
Q

What are the clinical features of Renal Cell Carcinoma

A

gross hematuria
flank pain
mass
fever and weight loss

19
Q

What is the next step for imaging of RCC?

A

CT or MRI

20
Q

When is PSA and DRE not recommended for screening of prostate cancer?

A

when the man is asymptomatic

21
Q

what increases a patient’s risk for prostate cancer?

A

primary degree relative

22
Q

If you suspect urinary tract stone disease, what is the primary concern?

A

concomitant infection (surgical concern)

23
Q

How do you diagnose urinary tract stone disease?

A

flank pain, frequent UTIs, nausea/vomiting, stone on imaging

24
Q

What are the considerations in transient urinary incontinence?

A 
DIAPPERS 
delirium 
infection 
atrophic vaginitis 
pharmaceuticals 
psychosocial/psychiatric 
excess urine 
stool impaction
25
Q

What are the common causes of fever?

A

infection
autoimmune disease
CNS disease (head trauma, mass lesion)
malignancy (lymphoma, leukemia, RCC, liver cancer)

26
Q

How do you calculate urine anion gap?

A

(urine Na + Urine K) - Urine Cl

27
Q

What does it mean if UAG is positive?

A

the distal nephron is unable to acidify the urine.

28
Q

What does it mean if UAG is negative?

A

distal nephron is able to acidify the urine

29
Q

What is the etiology of proximal RTA Type 2?

A

primary - idiopathic/heriditary

secondary - cystinosis in children and fanconi syndrome in adults

30
Q

What are the clinical manifestations of proximal RTA?

A 
NAGMA 
hypokalemia (mild compared to distal RTA type 1)
31
Q

How to diagnose proximal RTA?

A

urine pH can be high or low depending on serum bicarb. can have urine pH <5.5
UAG can be positive or negative

32
Q

What is the pathophysiology of Distal RTA type 1? 2 causes?

A

decreased secretion of H+ ions in distal nephron so distal RTA is unable to acidify the urine.

  • H/K ATPase and H ATPase
  • gradient defect - H flows back into tubular cell
33
Q

What is the etiology of Distal RTA type I?

A
  • primary - idiopathic or hereditary

- secondary - sjogrens syndrome, or glue sniffing

34
Q

What is the clinical manifestation of distal RTA type I?

A

nephrolithiasis or nephrocalcinosis

35
Q

How can you diagnose distal RTA type I? (4 things)

A
  • NAGMA
  • patients are unable to acidify their urine pH <5.5
  • hypokalemia (severe)
  • UAG is positive
36
Q

What is hyperkalemic RTA type 4?

A

distal nephron dysfunction from impaired renal excretion of H and K causing a NAGMA and hyperkalemia

37
Q

What are the two etiologies of RTA type 4?

A

deficiency of circulating aldosterone
- diabetes mellitis
-drugs such as NSAIDS, ACEI
aldosterone resistence in collecting ducts
- interstitial renal disease (sickle cell nephropathy, obstructive uropathy, lupus)
-drugs such as amiloride, triamterene, spironolactone

38
Q

What is the pathophysiology of hyperkalemic RTA type 4?

A

impaired Na reabsorption by principle cells leading to decrease in luminal negativity of CD, which impairs acidification as a result of decreased driving force of H secretion.

39
Q

What are the clinical manifestations of hyperkalemic RTA type 4? (theres 4)

A

asymptomatic
NAGMA
hyperkalemia
history of diabetes or CKD

40
Q

Diagnosis of hyperkalemic RTA type 4?

A

Variable urine pH, usually >5.5

UAG is positive

CPR Exam 3 (7 decks)

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