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apex Flashcards

1
Q

what is increased in the serum of the patient with renal osteodystrophy

A

2 p’s
phosphate and parathyroid

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2
Q

what is produced by the kidney

A

erythropoietin
renin

not antidiureitc hormone or angiotensin II

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3
Q

where is angiotensinogen produced

A

liver

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4
Q

where is angiotensin I produced

A

systemic circulation

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5
Q

what does a bun to creatine ratio of 30 suggest

A

inc bun/ cr ratio (> 10:1)
upper gi bleed
dehydration
inc protein intake
obstructive uropathy

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6
Q

creatine clearance

A

normal = 95-150
mild = 50-80
mod dysfxn= 10-25
severe dysxn <10

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7
Q

calculate gfr for a male

A

(140-age) x wt kg / (serum cr x72)

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8
Q

gfr calculation for a women

A

0.85 x ((140-age) x wt kg/ serum creatine x 72))

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9
Q

how does vasopressin increase gfr

A

constrict efferent

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10
Q

what tells concentrating ability of the kidney?

A

creatine clearance and fractional excretion of sodium

tubular fxn is measured by concentrating ability

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11
Q

what labs are liekly to be abnormal with ESRD

A

hgb and bleeding time

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12
Q

staging kidney dz

A

stage 1- inc cr 50% or uo < 0.5 ml/kg/hr for 6 hrs
stage 2- inc 100% or for 12 hrs
stage 3- inc 200% or for <0.3 for 24 hrs

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13
Q

what are causes of prerenal azotemia

A

chf, abd compartment syndrome, aortic artery clamping

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14
Q

intrarenal azotemia causes

A

acute tubular necrosis
vasculitis
intersitial nephritis
acute glomerulonephritis

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15
Q

best way for renal protect after major muscle trauma

A

mannitol

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16
Q

complications of sevo to pt with renal dysfunction

A

fluoride and compound A

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17
Q

what drugs cause hypokalemia (u waves)

A

bumetanide
metolazone

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18
Q

what diuretic worsens hyperkalemia

A

hydrochlorothiazide

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19
Q

what diuretic should be avoided in diabetic patient

A

hydrochlorothiazide- thiazide diuretics cause hyperglycemia

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20
Q

what diuretics cause ototoxicity

A

furosemide
ethacrynic acid

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21
Q

what kind of diureitc is indapimide

A

thiazide diuretic

inhibits na-cl transporter in distal tubule- dec reabsorption of na, cl, bicarb and water

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22
Q

what is mannitol likely to cause

A

hypoNa
pulmonary edema

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23
Q

where is the portal v located

A

between splanchnic circulation and liver

basin of blood leaving spleen, intestine, stomach, gallbladder and pancreas

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24
Q

what supplies 25% of liver blood flow

A

hepatic a. also supplies 50% of oxygen

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25
how does propranolol reduce hepatic blood flow?
hepatic a. constriction
26
what part of liver is most susceptible to hypoxic injury
zone 3- near central vein- recieve the least amount of oxygen- most susceptible to hypoxic injury
27
most common cause of viral hepatitis
A
28
hepatitis msot likely to be transitted during a blood transfusion
b and c
29
most significant risks for halothane hepatitis
obesity and age > 40 femle; genetic predisposition; induction of cyp3e1 (alcohol, isoniazid, phenobarbital)
30
physiologic changes that accompany liver failure
restrictive pulm defect, thrombocytopenia failing liver cannot clear endogenous vasodilators (VIP, glucagon) - it decreases response to vasopressors
31
what is used in child pugh score
albumin, pt, bilirubin, ascites, encephalopathy
32
what happens with cirrhosis
cell death- healthy hepatic tissue is replaced by nodules and fibrotic tissue- reduces number of functional hepatocytes and sinusoids number of blood vessels in liver is reduced- inc hepatic vascular resistance- portal htn causes ascites, hepatomegaly, splenomegaly, peripheral edema, esophogeal varices
33
how do you tx hepatorenal syndrom
liver transplant
34
management for pt with bleeding esophogeal varices
TIPs, propranolol
35
alcohol withdrawl syndrome is tx with
BB (for tachycardia), benzo (sedation), a2 agonist (ans hyperactivity), alcohol disulfiram- used as a part of alochol abstinence program- not for acute withdrawl
36
what comes from adrenal cortex
alosterone-> sodium reabsorption
37
what comes from adrenal medulla
inc epi and NE-> systemic vasoconstriction
38
what comes from atrium
natriuresis
39
what comes from post pit gland
inc antidiuretic hormone- aquaporin synthesis and insertion in renal collecting ducts
40
what should be avoided in hyperthyroid
levothyroxine
41
when does glucosuria happen
>180 mg/dL
42
what is expected with acromegaly
-oversecretion of growth hormone after adolescence -large tongue (macroglossia) and epiglottis -subglottic narrowing along vocal cord enlargement -turbinate enlargement -OSA
43
etiologies of addisons
autoimmune (most common in US) adrenal tumor TB (most common worldwide) dm1 trauma hiv hitt
44
what should you avoid in someone with thyroid storm
amiodarone
45
what should you not give with hypercalcemia
LR- b/c it contains calcium
46
which of the following is true? 1. an excess causes muscle wasting 2. mineralcorticoid acitvity inc serum glucose 3. it engages w receptors on cell membrane 4. it inhibits insulin release
1 cortisol is a glucocorticoid- raises serum glucose through gluconeogenesis also has some mineralcorticoid proterties - leads to na retention , k secretion, h secretion (think aldosterone) it does not interact with membrane bound receptors- delayed onset of action
47
drug class of glipizide
sulfonylurea
48
drug class of pioglitazone
thiazoilidinedione
49
drug class of exenatide
glp 1 agonist
50
complications of conns syndrome
hypokalemia and htn
51
insulin in shortest to longest acting
humalog, humulin R, humulin N, lantus
52
what do you give if carcinoid syndrome becomes hotn
somatostatin (octeotide or lanreotide)- inhibits release of vasoactive substances from carcinoid tumors
53
graves disease has inc or dec T4/ TSH
graves= hyperthyroid inc free T4 dec TSH
54
s/s of graves disease
insomnia protein catabolism and wt loss expothalmos anxiety ht intolerance
55
steroid potency compared to cortisol: aldosterone, methylprednisone, fludrocortisone, decadron
aldosterone 0x methylprednisone 5x fludrocortisone 10x decadron 25x
56
what is the cause of endemic goiter
iodine deficiency
57
addisons disease symptoms
hyponatremia hyperpigmentation hyperk severe hypovolemia (na and cl wasting) shock like state from decreased co death within 3d- 2weeks decrease mineralcorticoid (aldosterone) production; decreases glucocorticoid (cortisol) production -surgery, sepsis, trauma poorly toelrated- can elad to death
58
what increases growth hormone secretion
stress, anxiety, surgery physiologic sleep hypoglycemia dec free fatty acid levels inc blood amino acid levels fasting dopamine alpha adrenergic agonists estrogen not corticosteroids or pregnancy
59
hyperthryoid anesthesia considerations
-even mild no elective procedures unless euthyroid -inc sensitivity to muscle relaxants -mac unchanged -higher risk of corneal abrasion -bb good -inc risk for pathologic fractures during positionign
60
cv changes accompanying a normal pregnancy include increased
HR, sv, plasma volume dbp decreases sbp unchanged
61
a pregnant mom has hx of mitral stenosis. when is greatest risk of hemodynamic compromise?
third stage of labor
62
what are the effects of progesterone?
decreased mac, decreased paco2, increased sensitivity to LA
63
side effects of beta agonist therapy for preterm labor
maternal hypokalemia, hyperglycemia, tachycardia
64
what LA is least likely to undergo fetal ion trappign
chloroprocaine
65
fetal bradycardia is a common complication of which block
paracervical
66
when is the best time to perform non obstetric surgery on pregant patient
2nd trimester
67
cardiovascular complications of chronic maternal cocaine abuse include all the following except
anemia
68
what is youngest pca for surgery
60 weeks
69
what are most reliable indicators of recovery in neonate
max insp force better than -25 flexion of knees to chest neonates will not follow commands
70
what is not an acute tx for postintubation laryngeal edema: -nebulized racemic epi -heliox -cool and humidified oxygen -decadron 0.5 mg/kg iv
-decadron
71
what congenital heart defects are associated with ventricular outflow obstruction?
tetralogy of fallot pulmonary stenosis with ASD
72
can you use nasopharyngeal airways with cleft lip/ palate
yes
73

Prodigy (4 decks)

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