Man - ACID BALANCE and Shapiro hypertension

Question 1

Blood pH range compatible with life

Answer 1

6.8 - 7.8

Question 2

The normal physiological pH

Answer 2

7.35 - 7.45

Question 3

Primary change in metabolic acidosis/alkalosis

Answer 3

[HCO3-]

Question 4

Major change in respiratory acidosis/alkalosis _____

Answer 4

PCO2

Question 5

Normal [HCO3-]

Answer 5

23-25 mEQ/L

24

Question 6

Normal Pco2

Answer 6

35-45mmHg

40

Question 7

3 defense mechanism for pH maintenance

Answer 7

Extracellular and intracellular buffering

Adjustments in Pco2 by alterations in ventilatory rate

Adjustments in renal acid excretion

Question 8

Metabolic disorders are buffered primarily in the

Answer 8

Extracellular fluids

Question 9

What are other extracellullar buffers besides bicarb?

Answer 9

HPO4

Protein

Question 10

Inside the cells, H+ is titrated by ?

Answer 10

Phosphate and proteins

Question 11

Renal response to metabolic acidoses takes _____ to complete

Answer 11

Several days.

Question 12

The renal response to acidosis is ?

Answer 12

Increase secretion of hydrogen ions

Reabsorb the entire filtered load of bicarb

Increase production and excretion of NH4

Question 13

The renal response to alkalosis?

Answer 13

Decrease secretion of H ions

Decrease HCO3 reabsorption

Question 14

What kind of defense mechanisms are used in respiratory disorders?

Answer 14

ICF buffers

Renal NAE changes

Question 15

What kind of defense mechanisms are there in metabolic disorders?

Answer 15

ICF and ECF buffers

Ventilatory changes

NAE changes

Question 16

A graph that helps predict the different disorders in acid base balance and their compensation. Based on the blood pH and the amount of bicarb in solution

Answer 16

Davenport diagram

Question 17

Low plasma bicarbonate and pH

Due to addition of nonvolatile acid

The removal of a nonvolatile alkali

Or the failure of the kidneys to excrete sufficient net acid

Answer 17

Metabolic acidosis

Question 18

Unmeasured anions are

Answer 18

Proteins, phosphates, sulfates, etc.

Question 19

Unmeasured cations are

Answer 19

Calcium, magnesium, minerals, etc.

Question 20

A way of approximating the total concentration of anions other than Cl- and HCO3- in the plasma.

The sum of the “routinely measured” cations minus the sum of the ‘routinely measured’ anions in the blood

Answer 20

Anion gap

Question 21

Normal value for anion gap??

If K is not used to calculate?

Answer 21

16mEq/L

Less than or equal to 12 if K is not used

Question 22

Causes of metabolic acidosis with high anion gap ?

Answer 22

Diabetic ketoacidosis

Saolicylate poisoning

Lactic acidosis

Question 23

Metabolic acidosis with normal anion gap

Answer 23

Decreased bicarbonate is replaced by Cl-

Question 24

Metabolic acidosis with ____ anion gap has decreased bicarbonate replaced by ‘unmeasured anions’

Answer 24

High

Question 25

A high anion gap tells you that ?

Answer 25

An acid has been added!

Question 26

Characterized by increased plasma pH and [HCO3-] Can develop by the addition of nonvolatile alkali to the body (ingestion of antacids) Or The loss of nonvolatile acid (vomit)

Answer 26

Metabolic alkalosis

Question 27

Characterized by elevated pCO2 and reduced plasma pH Can develop by inadequate ventilation (brain centers suppressed) Or Impaired gas diffusion (pulmonary edema)

Answer 27

Respiratory acidosis

Question 28

What are the responses for respiratory acidosis?

Answer 28

Increased renal excretion of NH4 and acids, and increased reabsorption of bicarbonate Intracellular compartment buffering

Question 29

Characterized by reduced pCO2 and increased pH Can be caused by stimulation of the respiratory centers

Answer 29

Respiratory alkalosis

Question 30

Compensation for respiratory alkalosis?

Answer 30

Buffering ICF Renal compensation; decrease NH4 excretion, increase Bicarb excretion

Question 31

A second acid-base disturbance compounding the first acid-base disturbance

Answer 31

Combined simple

Question 32

Respiratory failure followed by renal failure is an example of ?

Answer 32

A combined simple Respiratory acidosis and renal failure

Question 33

People with hypertension are ___- times more likely to get CAD

Answer 33

3

Question 34

People w/ hypertension are ___ times more likely to develop CHF

Answer 34

6

Question 35

People with hypertension are ____ times more likely to develop stroke`

Answer 35

7

Question 36

The closest link between hypertension and another disease is with _____

Answer 36

Stroke

Question 37

Usual clue is hypokalemia Hypokalemia in face of ACE inhibitor is red flag Goal is to demostrate suppressed renin and non-suppressible aldosterone Try to stimulate renin with diuretic and suppress aldosterone with volume expansion

Answer 37

Evaluation for hyperaldosteronism

Question 38

Type of renovascular hypertension. Seen in : Young Female > male Familial history Responds well to correction UNCOMMON in people of african descent

Answer 38

Fibromuscular dysplasia

Question 39

Who should be evaluated for Secondary Hypertension?

Answer 39

Hypertension presenting “early” Hypertension w/o family history Severe or difficult to control hypertension

Question 40

Medical injury Evidence for acute vascular injury in context of hypertension Generally evidence for acute vascular injury is found on the retinal examination Actual number may not be all that high.

Answer 40

Malignant hypertension

Question 41

The vast majority of hypertension is ________

Answer 41

Essential (primary)

Question 42

The most common cause of secondary hypertension?

Answer 42

Sleep apnea (as high as 50% of secondary)

Question 43

___________ is necessary to produce sustained hypertension

Answer 43

Renal involvement

Question 44

Altered renal _______ necessary to maintain hypertension

Answer 44

Set point

Question 45

Risk factors for atherosclerosis:

Answer 45

Smoking Dyslipidemia (high LDL or low HDL) Age > 60 Male or postmenopausal female Family history

Question 46

JNC 7 recommendation for uncomplicated hypertension

Answer 46

Diuretics

Question 47

JNC 7 agent recommendations for hypertension w/ diabetes

Answer 47

ACE inhibitors or ARB if proteinuria present

Question 48

JNC 7 agent recommendations for hypertension w/ Myocardial infarction

Answer 48

Beta blocker

Question 49

JNC 7 agent recommendations for systolic heart failure

Answer 49

ACE inhibitors or ARB