picu board card Flashcards
(522 cards)
<p>main effect of BK virus infection</p>
<p>renal failure</p>
<p>anacrotic limb signifies what</p>
<p>aortic valve opening and onset of LV ejection</p>
<p>hepatopulmonary syndrome</p>
<p>pathological dilation of pulm vessels causing increased intrapulmonary shunt, hypoxemia</p>
<p>carb overfeeding causes \_\_\_\_ RQ</p>
<p>higher</p>
<p>what happens in carbon monoxide poisoning pulse oximetry reading?</p>
<p>the oxygen saturation is overestimated because it interprets carboxyhemoglobin to be oxyhemoglobin, this also occurs in hemolysis</p>
V/Q =
((8.63 x R(CaO2-CmvO2))/PACO2
<p>hyperammonemia with acidosis, yes urine ketones</p>
<p>organic aciduria</p>
<p>low lipid solubility, high protein binding, decreased tissue binding produce a \_\_\_ volume of distribution</p>
<p>low</p>
<p>CaO2 = </p>
<p>1.36 (amount of oxygen in ml that a fully saturated Hb can carry) x Hb (g/dL) x %sat x 0.003 (solubility coefficient of oxygen in ml of oxygen per dL of blood)</p>
<p>it is difficult/easy to remove a drug with large Vd by dialysis</p>
<p>difficult</p>
<p>immunodeficiency of older kids, B cell defect, increased risk autoimmune disease</p>
<p>CVID</p>
<p>risk ratio is similar to odds ratio if events are \_\_</p>
<p>rare</p>
<p>do neonates have a larger or smaller relative volume of distriubtion</p>
<p>larger</p>
<p>this is in cryo</p>
<p>8, 13, vWF, fibrinogen; 1 unit increases fibrinogen by 50 mg/dL</p>
<p>what facilitates the interaction of actin and myosin</p>
<p>an increase in cytosolic calcium</p>
<p>which type of diuretic is likely to cause kidney stones, esp in premature infants</p>
<p>loop diuretics</p>
<p>EKG signs hypercalcemia</p>
<p>prolonged PR, short QT, wide QRS</p>
<p>normal pyruvate and elevated lactate to pyrvate ratio</p>
<p>mitochondrial disorder</p>
<p>x linked recessive failure of neutrophil oxidative burst, NADPH oxidase deficiency</p>
<p>CGD</p>
<p>Lasix and bumex quickly increase \_\_\_ leading to improvement in heart failure</p>
<p>venous capacitance</p>
<p>antidote for serotonin syndrome</p>
<p>cyproheptadine; antihistamine and serotonin antagonist</p>
<p>infection after liver transplant after 4 weeks</p>
<p>viral</p>
<p>when is risk ratio similar to odds ratio, when events are rare or when events are frequent</p>
<p>when events are rare</p>
<p>risk of catheter related infection is lowest for \_\_\_</p>
<p>subclavian, but highest risk mechanical complications</p>
PAO2 =
((Patm-PH20) x FiO2) - PaCO2/RQ
how does NO cause vasodilation
activation of guanylate cyclase to increase cAMP
effect of ATII and endothelin on afferent arteriole
constriction
DO2 (ml/min) =
CaO2 x CO x 10 dL/L
which muscles are most resistant to neuromuscular blockade in children/adults
larynx, diaphragm
high fever, diarrhea, severe encephalopathy, 50% mortality
hemorrhagic shock encephalopathy syndrome
administration of ___ is contraindicated in children with MCAD deficiency
MCT oil
is inhaled NO helpful in lung transplant dysfunction
yes
what is treatment for NMS
benzos and dopaminergic agents
v wave
atrium filling with blood again
dicrotic notch signifies what
reflected waves back from arteries when measured peripherally
flexed upper extremities posturing is called
decorticate, comes before decerebrate
hallmark of community acquired MRSA
profound neutropenia
hyperammonemia without acidosis is the hallmark of the ___
urea cycle defects
this MRI mode uses the brownian movement of water molecules to identify acute and subacute edema, ischemic areas will be ___ on this method
DWI, bright
altered systemic ____ synthesis leads to decreaesd pulm clearance of ROS leading to ARDS in liver failure
glutathione
risk of infection with PICC is __ than CVL
same, time to infection is longer however
in what zone of lung does PA catheter need to be for best measurement
in area least effected by alveolar pressure, zone 3
hereditary hemochromastosis has low levels of ___, a regular or iron homeostasis
hepcidin
in massive transfusion for every 5 units blood give
4 units plt and 1 unit FFP
this is the crunching sound during systole that suggests air or fluid abutting the heart signifying mediastinitis
hamman sign
neonatal airways are ___ than adults when normalized to BSA
larger
this disease has elevated pyruvate but normal lactate to pyruvate ratio, hypoglycemia
glycogen storage
this disease has decreased number of Ach receptors to not have an effective contraction
myasthenia gravis
on which MRI is CSF dark
T1
all alcohols are metabolized to ___
oxalic acids
TCA mechanisms
alpha 2 antagonists, block Na channels
biotin deficiency will result in a secondary deficiency in what enzyme
pyruvate carboxylase
type II HIT
antibody to plt factor 4, issue is thrombosis not bleeding; type I HIT self resolves
this is from reactivation of latent EBV after transplant leading to B cell hyperplasia/lymphoma
PTLD
TTP pentad
fever, AMS, microangiopathic hemolytic anemia, renal dysfunction, thrombocytopenia
EKG findings of propofol infusion syndrome
RBBB and ST elevations V1 to V3
person is awake but drowsy
alpha
symptoms of TRALI must appear within ___ hours of transfusion
6
do highly lipophilic oral meds absorb faster or slower
faster
this inhibits GABA release presynaptically
tetanus toxin
conditions where PAOP underestimates
LV non compliance, aortic regurg (mitral valve closes but retrograde flow continues and thus elevates LVEDP)
hyperammonenia with acidosis, no urine ketones
disorder of FA oxidation
anti inflammatory cytokines
IL-10, TGF-beta
how many half lives until steady state
4-5
this is a bath salt that causes seizures, hyperthermia, agitation, fever
mephedrone
higher gas flow at lower pressures is the ___ principle
bernoulli principele
K time long or shallow alpha angle in TEG
need plt, fibrinogen to help clot kinetics
side effect of cyclophosphamide
hemorrhagic cystitis
critical point of oxygen delivery
at this point tissues are supply dependent for oxygen delivery and consumption will fall with falling oxygen delivery
side effect of vincristine
peripheral neuropathy
location of phlebostatic axis
junction of 4th intercostal space and mid axillary line
this dopamine receptor is on renal tubules and mediates naturiesis
DA-1, also cause vasodilation postsynaptic
with decreasing GFR there is an ____ in Cr secretion
increase, thus further overestimating GFR
as the arterial pulse is transmitted distally the ___ peak increases, the ___ pressure decreases
systolic, diastolic
equation for renal plasma flow
RPF = (renal artery pressure-renal vein pressure)/RVR
pompes EKG
biventricular strain, short PR
this is the volume of plasma from which drug is removed over a period of time and equals k x Vd
clearance
combo of neutropenia, panc insufficiency, resp infection
schwachmann diamond
high spinal cord injury can cause autonomic ___
dysreflexia, episodes of hypertension
this metabolic disorder has cardiomyopathy, myopathy, myoglobinuria
fatty acid oxidation
plt adhesion is ____ in liver failure
increased
proximal RTA type II
decreased ability of proximal tubule to absorb bicarb, low urine pH
response of large pulm arteries to hypoxia
vasodilation
significant slowing on eeg
delta
this impairs release of Ach at NMJ
botulinum toxin
name of decreased and delayed arterial upstroke seen in aortic stenosis
pulsus parvus et tardus
infant chest wall has __ compliance, ___ elastance
increased, decreased
these are the most prevalent immune deficiences
antibody defects
the point where inhaled gas becomes 100% humidified in mechanical ventilated patients
isothermic saturation boundary
this medication inhibits acetylcholinesterase and improves muscle strength in MG in 1 min
edrophonium
most mineralocorticoid steroid
hydrocortisone
GFR plasma inulin formula
GFR x Pin = V x Uin
conditions where PAOP overestimates LVEDP
catheter in west zone 1 or 2, excessive positive mean airway pressure, mitral valve disease as only the high LA pressure is reflected not the actual LVEDP, increased PVR
whats the primary cytokine for macrophages
RANTES
infant lungs have ___ elastance
decreased
when focal vascular injury occurs due to the trauma the initial response is
vasoconstriction
anterior spinal cord is responsible for ...
pain, temperature
this elimination has constant amount eliminated per unit time
zero order
risk of clot in HIT persists for how long
weeks
fast component of nystagmus with warm water is away/toward the warm water
away
alkalinization of urine in TCA overdose does/does not effect excretion
does not, it increases the binding of free drug
milrinone half life is ___ in infants than children
longer
a wave
atrial contraction
in what phase of CPR does the RA pressure fall faster than aortic pressure allowing the coronaries to perfuse
decompression phase, need at least 15 mm Hg difference
what is the effect of hypothermia on cerebral blood flow
reduced, also decreases response to changes in CO2
triscupid valve stenosis, PS, PA, pulm htn, non complaint RV causes these waves
cannaon a waves
chemotaxis neutrophil failure, recurrent staph infection of lung, eczema, increased Ige
hyper IgE (job syndrome)
side effect of amyl nitrite, sodium nitrite
methemoglobinemia
gold standard for HIT
C-serotonin assay
works through cGMP to activate Ca sensitive K channels, K goes into cell and Ca is inhibited resulting in relaxation
NO
which way does oxyhemoglobin dissociation curve go with increased 2,3 DPG, acidosis, increased temp, decreased pH
to the right
risk of significant LV dysfunction is minimized in duchennes patients who have received ___
steroids
this receptor activates adenylate cyclase to increase cAMP, increase protein kinase, increased cytosolic Ca
beta 1
this is a deficiency of acid alpha glucosidase, a lysosomal hydrolase responsible for degradation of a small amount of glycogen
pompes
decreased respiratory system elastance ___ closing volume
increases; volume in infants is above FRC so there is atelectasis in quiet breathing
this is a reflex where an increase in atrial volume causes an increase in HR and contractility
bainbridge
complication of silver sulfadizene
leukopenia due to neutrophils going to the site
anion gap acidosis with normal lactate and high ketones
disorder of ketolysis or aminoacidopathy like MSUD
infection after liver transplant common in first 4 weeks
bacterial
GFR using bedside Schwartz equation
GFR = (0.41 x height in cm)/Cr
positive and negative predictive value are influenced by the ___ of disease in the population
frequency
coronary steal
when coronary blood flow redistributes from endocardial to epicardial muscle
PVR =
(MPAP-PAOP)/CO x 80
absent dolls eye reflex
eyes turn with head and never deviate back to midline
channels between alveoli that allow for collateral ventilation
pores of kohn (not present until 3-4 years of age)
which is better for variceal bleeding, octreotide or vasopressin
octreotide
this drug inhibits PDE III
milrinone
which has a higher sat in normal conditions, Smv or Scv
Smv because its in PA and avoids coronary sinus blood
normal lysis at 30 min in teg is ____
less than 5%
whats the primary cytokine for neutrophils
IL-8
eczema, thrombocytopenia, immunodeficiency
wiskott aldrich
if there is no difference between therapies but investigators conclude there is
type I error, alpha
Qs=
VO2/Cao-Cpa
response of peripheral chemoreceptors in carotid and aorta to hypoxemia less than 60 mm Hg
increase minute ventilation, increase sympathetic tone
which waves become more prominent in tricuspid regurg
c and v
drugs with poor tissues penetration have a small/large Vd
small
this equals 0.693/k
T1/2
Reynolds number =
(2vrp/n); less than 2000 is laminar, over 4000 is turbulent
which curve is linear for elimination, first order or zero order
first order
anion gap acidosis with normal lactate and low ketones
disorder of fatty acid oxidation
elevated BUN and elevated bili can __ free fraction of drug
increase
color of full thickness burn
white or black
the area of the LV pressure volume curve represents ___
stroke work
closing capacity
the volume at which small airway closure occurs during expiration
reverse Fick VO2 =
(CaO2 - CmvO2) x CO
anacrotic limb
initial sharp upstroke of arterial waveform
where is v/q ratio highest
apex of lung
most immunosuppressive steroid
decadron
this is the neurotransmitter at all sympathetic ganglia, the post gang neurotransmitter is ___
ach, norepi
antidote for calcium channel blocker overdose
calcium, then insulin
what distinguishes PA waveform from RV waveform
PA waveform has a higher diastolic pressure
what is the response of the coronaries to acidosis
vasodilate
BNP acts via ___
cGMP
which type of cardiac muscle gets more blood flow, endocardial or epicardial ?
endocardial at ratio of 1.25:1
HIV diagnosis greater than 18 months
HIV ab
another word for accuracy ie close to the truth
validity
in hypervolemic (zone III) conditions an increase in abdominal pressure with diaphragm descent caused a ___ in venous return
increase (non splanchnic blood flow is not inhibited), splanchnic flow increases
symp pregang neurotransmitter is ___, post gang is ___
ach, norepi
this is equal to (total amount of drug in the body)/(concentration in the plasma)
volume of distribution
TLR3 recognizes ____
dsDNA viruses
highly protein bound drugs are/are not readily filtered
are not
Qpul =
VO2/Cpv-Cpa
antidote for ethylene glycol
fomepizole to inhibit alcohol dehydrogenase; dialysis to remove the oxalic acid
when is intraaortic balloon pump inflated
during diastole
c wave
tricuspid valve displacement toward atrium during isovolumic contraction
this toxic overdose blocks Na-K ATPase in myocardium
TCAs
what accounts for over 50% liver transplants
biliary atresia with failed kasai
auto recessive impaired neutrophil phagocytosis, neuropathy, albinism
chediak higashi
antidote for methanol toxicity
folinic acid
if there is a difference but investigators conclude there is not
type II, beta
fetal Hb has ___ O2 affinity, _____ p50
higher, lower
distal RTA type I
decreased urine proton excretion, high urine pH
anion gap acidosis with high lactate and normal pyruvate(elevated lactate to pyruvate ratio)
mitochondrial disorder
lymphomatous transformation when infected with EBV, see lymphadenopathy, hepatic/BM failure
X linked lymphoproliferative disease
flail chest
chest collapses with inspirations
drug is eliminated as a fixed amount over time
zero order
this elimination kinetic has rate of elimination directly proportional to concentration of drug
first order
wall tension T = ; aka law of LaPlace
(P x r)/2w
this inhibits IL-2, is nephrotoxic
calcineurin inhibitors like cyclosporin
this is the best load independent measure of contractility because it measures contractility at different preloads and afterloads
end systolic pressure volume relationship ie slope of the curve
need to rule out this disorder in nonaccidental trauma
glutaric aciduria type I, tx is L carnitine, retinal hemorrhages not seen
FeNa
(UnaxPna)/(UcrxPcr)
___ and ____ stimulate gastric empyting
ghrelin and motilin
SIRS criteria must include ___ or ___
abnormal temp or WBC count
to diagnose organophosphate toxicity measure this
RBC cholinesterase
clue that pt may develop malignant hyperthermia
sustained masseter muscle rigidity
myoglobin precipitates when it interacts with
tamm-horshall protein
the receptor activates adenylate cyclase to increase cAMP, increase protein kinase, decreased cytosolic Ca
beta 2
most common type of TEF
esophageal atresia plus distal fistula between esophagus and trachea getting air into stomach
this is a class III antiarrythmic that blocks K channels on the sarcolemma of cardiac myocytes
adenosine
sympathetic pregang neurons are located from ____ and release Ach
T1-L2, Ach
what is treatment for varicella exposure
varicella immune globulin up to 10 days after
term for the percentage of drug that reaches the systemic circulation after administration
bioavailability
in critical illness both protein synhesis and breakdown are increased but there is still net ___ protein balance
negative
phase 2 of myocardial depol
calcium enters cell via L type channels, triggers Ca release from SR via ryanodine receptors (ca induced ca release), Ca binds to Tn-C, allowing actin and myosin to interact
which factor during CPR correlates with return of spontaneous circulation
coronary perfusion
anion gap acidosis with high lactate and high pyruvate (ie normal lactate:pyruvate ratio) but hypoglycemia
glycogen storage I or disorder of gluconeogenesis
a wave
atrial contraction at the end of diastole
this receptor has adenylate cyclase inhibited pre synaptically to decrease cAMP and PKA and decrease norepi leading to vasodilation
alpha 2
time based billing codes are used for patients older than _
6 years
this is the neurotransmitter for parasymp
ach
pressures the define pulm htn
over 25 at rest, over 30 in exercise
which area has highest O2ER in body
coronary sinus (its about 0.6), so decreased ability to increase thus vulnerable to ischemia
this has low WBC count with low levels of T cell surface markers CD3, CD8, CD4 and gets infected with P jiroveccii
SCID
fast component of nystagmus with cold water is away/toward the ice water
toward
response of small pulm arteries to hypoxia
vasoconstriction
when Pra is less than 0 venous return is still limited by the collapse of ___
extrathoracic blood vessels
medication of choice for cocaine intoxication
benzos
this drug blocks Na channels
cocaine
cannon a waves are caused by what
atrial contraction against a closed tricuspid valve
high crit, excesssive FFP, severe acute rejection
risk factors for hepatic artery thrombosis
x linked, CD40L mutation, cryptosporidium diarrhea
hyper IgM
is higher number or lower number worse for abbreviated injury score
higher
excessive glycolysis and unchanged lactate to pyruvate ratio can cause an elevated lactate, which type of lactic acidosis is this
type B
these two treatments can be helpful in MMA
B12, carnitine
Th2 cells are pro or anti inflammatory?
anti
the BBB is permeable/impermeable to mannitol and 3%
impermeable
vasopressin V1 receptor leads to ___
vasoconstriction, via PLC
which spinal levels innervate the diaphragm
C3, C4, C5
____ inhibit gastric emptying
CCK, GLP-1, secretin
oxygen consumption equation
VO2 = DO2 x O2extraction
area of kidney most susceptible to ischemic damage
medulla; ie medullary thick ascending limb and S3 segment of proximal tubule
term for condunction velocity of heart
dromotropy
equation for flow using conservation of mass principle
Q = (amount of substance)/(average concentration of dye T1 to T2)
what does 10 mm Hg CO2 do to pH
decrease by 0.08
odds ratio is for ___ studies
case control
this inhibits release of GH, insulin, glucagon, and decreases portal venous blood flow
octreotide
risk of catheter related infection is highest for __
femoral, also highest risk DVT
first line for aspergillus
vori
elevated abdominal pressure increases chest wall ___
elastance
half life albumin
20
3 parts of ICP wave, P1, P2, P3
P1 is systolic pressure, P2 compliance, P3 venous pulsations
as p50 increases, O2 affinity ____
falls
what is the energy source of cardiac muscle
fatty acids
effect of hypercapnia on coronary blood flow
vasodilate
main side effect of mycophenolate
diarrhea
failure of t and b cell, adenosine deaminase deficiency, fungal/viral infections
SCID
which receptor does labetalol hit the most
B1 more than B2, alpha 1
what is respiratory quotient
ratio of amount of CO2 being produced to O2 being consumed
whats difference between neuronal NOS/endothelial NOS and iNOS
neuronal/endothelial NOS are Ca dependent and produce NO at low levels, iNOS is Ca independent and produces at high levels
ATII causes ____ greater than ____ constriction during times of reduced renal perfusion pressure
efferent greater than afferent
normal SVRi, PVRi
800-1600, 80-240
high thoracic or spinal cord injury can injure the ___
Sympathetic nervous system and cause spinal shock, baseline bronchoconstriction
this disease has elevated pyruvate but normal lactate to pyruvate ratio, normoglycemia
pyruvate carboxylase or dehydrogenase deficiency
MA in TEG is what
plt concentration and function
tx of neonatal iron storage disease
antioxidant cocktail
aspirated sea water leads to ___
pulm edema
where does botulism work
presynaptically, stopping release of ach
haldane effect
deoxygenated blood has increased ability to carry CO2 and oxygenated blood has decreased ability to carry CO2 and H, so in lungs where oxygen is abundant CO2 is easily unloaded
this mab blocks CD25, IL-2
basilixumab
most common cause heptaic failure infants
metabolic disease
cephalic phase of gastric emptying is mediated by
histamine H2 receptor
gradient of CO2 between alveoli and large airways, another mechanism of ventilation in HFOV
molecular diffusion
severe rash, immunodeficiency state, lactic acidosis, hyperammonemia
biotinidase deficiency, tx with biotin
chemo drug that causes cerebellar syndrome, myelopathy
cytarabine
in TEG this has a short R time, high alpha angle, short K time, quick fibrinolysis
DIC
what part of the brain does the blood brain barrier not cover
choroid plexus
critical point of oxygen delivery in ARDS
tissues remain supply dependent at much higher levels of oxygen delivery
this receptor uses PLC to hydrolyze PIP2 to DAG and IP3 to promote increased intracellular Ca
alpha 1
main lipid component of sufactant is
phosphatidylcholine
___ is the membrane reflection coefficient, the resistance of the membrane to protein passage
sigma; 0 is no resistance , 1 is full resistance
this inotrope causes renal splanchnic vasodilation at low dose
dopamine
biggest viral infection risk in liver failure
CMV, EBV
risk factors for secondary infection/death in immunoparalysis
lymphocyte apoptosis, lymphopenia
RQ of carbs
1
the dinamap method of blood pressure underestimates the ___ pressure
diastolic
this degrades cAMP, cGMP and is inhibited by milrinone
PDE-3
O2 extraction ratio =
(CaO2 - CvO2)/CaO2
lack of nicotinamide adenine nucleotide disphosphate is what disorder
CGD
mechanism of organophosphates
acetylcholinesterase inhibitors
what happens to afferent arteriole with high sodium delivery to macula densa
constriction
this drug is a highly selective B1 blocker metabolized by RBC esterases
esmolol
venom of elapidea snakes effects what system
neuro with descending paralysis
bohr effect
increased CO2, H+ reduce affinity of Hb for O2
what is the effect of hypoxia and hypercarbia on cerebral blood flow
cerebral vasodilation
parasymp pregang and post gang are___
ach
these vasopressin receptors are on vascular smooth muscle and cause contraction as well as selective pulm and cerebral vasodilation
V1a
beta lactams, vanc, macrolides are time dependent or concentration dependent for killling
time dependent
this antibiotic inhibits adrenal synthesis of steroids
ketoconazole
anion gap acidosis with high lactate and high pyruvate (ie normal lactate:pyruvate ratio) but normal glucose
pyruvate dehydrogenase or pyruvate carboxylase deficiency
vasopressin V2 receptor leads to ___
water retnetion via cAMP
if PCO2 increases by 10, pH will fall by ___
0.08
how is n. meningitidis transmited
oral secretions
even numbers are ___ side on EEG
right
3 ml/kg prbc increases Hb by ____
1 g/dL
what neurotransmitter inhibits the conversion of tyrosine to dopa
norepi
sensitivity/1-specificity
positive likelihood ratio
another word for precision ie close to each other
reliability
carbon dioxide bound to hemoglobin ____ as oxygen hemoglobin saturation increases
decreases (easy to unload CO2 in high oxygen environment)
is higher number or lower number worse for revised trauma score
lower; if less than 11 refer to trauma center
90% of CO2 in the blood is in the form of ___
bicarbonate ion
hyperammonemia with acidosis
organic acidemia
infant seizing, no acidosis or ketones
non ketotic hyperglycinemia
cox proportional hazards model assumes hazards are ___ throughout the course
proportional; if not proportional use grays
second most common cause of unintentional death in children
submersion injury
gold standard to diagnosis MH
in vitro contracture test to expose muscle to halothane, caffeine or both
where is kidney medullary blood flow greatest, outer or inner medulla
outer
major criteria rheumatic fever
carditis with mitral then aortic, arthritis, chorea, erythema marginatum
edrophonium, neostigmine
anticholinesterases that potentiate effect of Ach; can be given in myasthenia gravis
VCO2 in HFOV =
f x Tv^2
effect of mannitol on cerebral blood vessels
it decreases blood viscosity, blood flows easier, vessels then constrict
patients with cochlear implant are at risk for
S. pneumo meningitis
these vasopressin receptors are in kidney and have antidiuretic effect
V2
X linked dominant disorder thats most common urea cycle defec
ornithin transcarbamylase deficiency
CNS changes in pompes
anterior horn cells of spinal cord and brainstem nuclei
1 tailed test can be used when only one direction of association is ___
clinically relevant
increased cGMP and cAMP cause pulm constriction or dilation?
dilation via inhibiting Ca mobilization from SR
defect in CD18, lack of beta 2 integrins occurs in what disorder
leukocyte adhesion deficiency
this interacts with guanylate cyclase to increase cGMP to reduce cytosolic Ca
NO
tx for metHb
methylene blue to stimulate NADPH reductase
this is associated with reduced stroke in sickle cell
regular exchange transfusion
this is a 5-HT2a agonist that is a hallucinogen that causes increased CK, fever, death
N-BOME
formula for resistance
R = (8nl)/(pie r^4)
hypertonia, seizures, coma, no lactate, no ammonia, urine ppt with DNPH
MSUD
dose of vasopressin for hemodynamic effects
0.0003 to 0.002 mcg/kg/min
x descent
decline in atrial pressure during systole
anion gap acidosis with high lactate and abnormal organic acids
organic acidemia like MMA, Prop acidemia, isovaleric
immunoparalysis
reduction of HLA-DR expression on circulating monocytes and decreased ability to make TNF-alpha for five or more days
this type of RTA is lack of urinary acidifcation despite acidosis
type I (distal) RTA
linear regression is for ___ outcomes
continuous
RBBB and ST elevation in anterior leads
brugada syndrome
which factors mediate hypoxic vasodilation in brain
NO, adenosine, K channels
expiratory lung volume is the volume at which ___ begins
inspiration
tx for the ESCAPE organisms
aminoglycoside/quinolone
decreased arterial oxygen content causes ___ (inc or dec_ autoregulated coronary flow
increaesd
MAP =
diastolic pressure + 1/3 (pulse pressure) and CO x SVR
transient htn with dexmed is via ____
peripheral alpha 1 stimulation
Cardiac index =
CO/BSA
hyperammonemia without acidosis
urea cycle defect
SVR =
(MAP-CVP)/CO x 80
mechanism of cocaine
inhibits reuptake of norep, dopamine presynaptically
how does prostacycline cause vasodilation
increasing cAMP, activating K channels, increasing NO production
a 10 meq/L change in base excess means
0.15 unit change in pH
y descent
opening of tricuspid valve, emptying into ventricle
color of superficial partial thickness burn
pink
person is awake on eeg
beta wave |
this type of herniation leads to contralateral leg paralysis
subfalcine herniation
where are glomeruli located
renal cortex which gets 90% of blood flow
2,3 DPG production is increased by
hypoxemia, thus shifting curve to R making oxygen more available
Qp/Qs =
(Cao-Cra)/(Cpv-Cpa)
for each increase in bicarb by 10, pH increases by
0.15
which factor during CPR predicts cerebral blood flow
systolic blood pressure
VO2 indirect calorimetry
Vi(FiO2) - Ve(FeCO2); can be fraught with error if there are leaks
these changes will cause an increase in slope of the venous return curve without changes Pms
decrease in SVR, anemia because resistance is decreased
in hypovolemic (zone II) conditions an increase in abdominal pressure with diaphragm descent caused a ____ in venous return
decrease (non splanchnic blood flow is inhibited); splanchnic flow increases
what infection is associated with strep TSS
varicella
TLR4 recognizes ____
LPS
AA increased in MSUD
leucine, isoleucine, valine
aminoglycosides, flagyl, fluoroquinolones are time dependent/concentration dependent for killing
concentration dependent
what inhibits interaction of actin and myosin during relaxation
TnI and tropomyosin, until Ca rises causing conf change in TnI and tropomyosin to facilitate actin and myosin cross bridging
chelate lead if level is over ___
45
electrolyte effect of cisplatin
low mg
lesions of eye and optic nerve will show bilateral/unilateral lack of constriction when shone at effected eye
bilateral
sinopuulm infections with encapsulated bacteria, increased malignancy risk, low T and low Ab levels
ataxia teleangiectasia
when is fasciotomy indicated in compartment syndrome
when pressures are over 40
central cord syndrome
loss of pain and temp in cape like distribution, possible bowel and bladder
this drug blocks Na-K ATPase in sarcolemma leading to increased Ca intracellularly
digoxin
v wave
blood returning to LA/RA
half life transferrin
8
this med is anti CD20
rituximab
area of liver that participates in drug metabolism that is most vulnerable to hypoxic ischemic injury and drug toxicity
zone 3
pH goal in GI bleed
over 6
in uncal herniation is symp or parasymp innervation to ipsilateral pupil effected
parasymp
EKG signs hypocalcemia
prolonged QT
cardiac transplant leads to loss of ___ input of heart
vagal input
mechanism of class IV antiarrythmic
block Ca channels
risks of cerebral edema DKA
young, 1st episode, lower CO2, high BUN, got bicarb, got insulin bolus
equation for filtration fraction
FF = GFR/RPF
hyperammonemia without acidosis, orotic acid not elevated, citrulline not elevated
THAN
equation for venous return
(Pms-Pra)/Rv; Rv is resistance to venous return
ptosis/miosis/anhidrosis (horners) seen in high or low cerical injury
high
this replaces gent in renal insufficiency
aztreonam
alpha receptors on coronaries cause __
vasoconstriction, beta cause vasodilation
large v waves seen in
tricuspid regurg, ebsteins
drug is eliminated as a fixed percentage over time
first order
spinal cord injury with ischemia to anterior spinal artery can occur after ____ repair
coarct
aspirated fresh water leads to ___
atelectasis
parkland formula
4 ml x % burned x weight (kg)
prolonged R time in TEG
need clotting factors like FFP
how is CO determined with PA catheter
thermodilution, inversely related to AUC
FRC is the volume at which lung recoil inward is balanced by chest recoil ___
outward
this may be helpful in propionic acidemia
biotin
this drug inhibits PDE-5 which normally degrades cGMP
sildenafil
whats mechanism of glucocorticoid anti-inflammatory response
inhibition of NF-kB
which steroid has the highest antiinflammatory effects
dexamethasone first, solumedrol medium, hydrocortisone lowest, mineralocorticoid effects are the reverse
extended upper extremities posturing is called
decerebrate, comes after decorticate
this type of metabolic seizure d/o has spike and burst suppression pattern on EEG
pyridoxine dependent seizures
these provide the pacemaker activity of the gut
cells of cajal
pro inflammatory innate cytokines
Il-1B, TNF alpha
antidote for beta blocker overdose
glucagon; activates cAMP
most common bacteria causing pericarditis
S. aureus
what atrial wave becomes more prominent during a fib
c wave
this controls quality of saliva, this controls amount
symp, parsymp
AV valve regurg causes a large ___ wave
v
infection that occurs with C1, C2, C3, C4 defect
encapsulated organisms
logistic regression is for __ outcomes
dichotomous (yes/no)
th1 cell are pro or anti inflammatory
pro
order of CVP waveform waves
acxvy
normal values of O2ER
0.2 to 0.3
wall stress =
(pressure x radius)/wall thickness
can you administer ABO incompatible plt?
yes, plasma washed out
units of VO2
ml O2/min
definition of increased PVR in woods units
over 3
in malrotation the dudoenal-jejunal junction is to the ___ of the spine, 4th portion of duod doesnt cross midline
right
sensory innervation above vocal cords is ___ , below is ____
superior laryngeal, recurrent laryngeal
downregulation of HLA-DR less than 30% or less than 8000 molecules per cell with decreased TNF alpha production is definition of ____
immunoparalyzed monocyte
whats the difference between CIM and CIP
CIM has stretch reflexes and intact proprioception, vibration, sensation
c wave
bowing of AV valves from ventricular contraction
tx for children with multiple carboxylase deficiency
biotin
posterior spinal cord is responsible for...
proprioception, vibratory sensation
hydrostatic forces favor fluid flow OUT/IN to the interstium
IN
slowing wave on eeg
theta
gastric phase of emptying mediated by
gastrin on parietal cells of stomach antrum
imipenem has strong association with ____
seizures
how are beta lactam excreted
renal, except PCN/CTX
tx for C. albicans
fluconazole
this enzyme breaks down cAMP which decreases cytosolic Ca and decreases muscle contraction
PDE III
urine sodium is ___ in hepatorenal
low
drugs of choice for tetanus
benzos, tetanus immuno glob, PCN
when does GFR reach adult levels
age 2
this percentange of total airway resistance is found between the nose and larynx
40-50%
necrotizing arteritis seen post coaractectomy
mesenteric arteritis |
lower MAC means weaker/stronger anesthetic?>
stronger
saturation in metHb
will be 85% because it absorbs light equally at 660 and 940 (pulsatile blood and reference tissue)
units of CaO2
ml O2 per dL of blood
this is most common type of ASD
ostium secundum
brief upstroke followed by two systolic peaks seen in aortic regurg and hypertrophic cardiomyopathy
pulsus bisfiriens
energy reverses/does not reverse metablic stress response
does not
ammonia scavengers to treat urea cycle defects
sodium benzoate, sodium phenylacetate
AA needed for gluconeogenesis
ala, glutamine
which has more CNS depression, more muscle rigidity, and is the only one that has bradykinesia, serotonin syndrome or NMS
NMS
infection with MAC defect
n men
anion gap metabolic acidosis from ketones, no hypoglycemia
disorder of ketolysis
brown sequard syndrome
loss of voluntary motor function and proprioception on ipsilateral side, loss of pain, temp, tactile sense on contralateral side
anesthetic agents with low blood gas partition coefficient (less soluble in blood) have faster/slower induction rates
faster
when focal vascular injury occurs from infection the initial response is
vasodilation
TLR2 recognizes ____
peptidoglycan of bacteria/viruses
half life prealbumin
2
this drug can uncouple hypoxic vasoconstriction leading to increased pulmonary shunting
nipride
high protein binding means low/high Vd
low
neonates have fewer ___ fibers in diaphragm (slow contracting, long sustaining fibers)
type I fibers
adenosine 1 receptors cause afferent ___ and adenosine 2 receptors cause efferent___
constriction, dilation
pro inflammatory Th cells
Th1
respiratory alkalosis leads to ___ ionized calcium
low
when cardiac output is decreased there is an increase in which west zone condition?
zone I where PA>Pa>Pv
what causes decreased vital capacity in duchennes
kyphoscoliosis
half life RBP
12 hours
diving reflex
apnea causes decreased HR and increased SVR to maintain perfusion and reducing oxygen consumption
sickle Hb has____ O2 affinity, ____ p50
lower, higher
afferent limb of gag reflex is CN _, afferent is CN _
9,10
hyperammonemia without acidosis, orotic acid not elevated, citrulline elevated
CPS or NAGS deficiency
drug is eliminated slower as levels rise
michaelis mentin or capacity limited elimination
tx for htn in PIGN
fluid restriction and diurects because htn is from Na and H2o overload
which factor mediates hypercapneic vasodilation in brain
NO
name and order of atrial waves
a,c,v
color of deep partial thickness burn
white
this drug is a calcium channel blocker that prevents Ca movement from SR to cytosol to produce arteriolar vasodilation
nicardipine
greatest infectious risk in blood transfusion
gram negative bacteria
thyroid studies in sick euthyroid
normal T4, low T3, normal TSH
which has a lower sat at baseline, SVC or IVC
SVC due to cerebral extraction
hyperammonemia without acidosis, orotic acid elevated
OTC deficiency
neuroleptics cause NMS via blockade of what receptor
D2
this occurs in 25% of patients with HIV and has clubbing, HSM, diffuse reticulonodular pattern on CXR
lymphocytic interstitial pneumonitis
this is the antidote for Fe toxicity
deferoxamine, turns urine red
neonatal myocardium is dependent on Ca from ___
extracellular source, NOT SR
__ causes airway irritation, ___ causes hypotension/arrhythmias, ___ causes renal injury/hepatic injury (inhalational anesthetics)
iso, halo, sevo
lesions of eye and optic nerve will show bilateral/unilateral constriction when shone at unaffected eye
bilateral
whats the only agent that can be used to anticoagulated if there is HIT
argatroban (direct thrombin inhibitor)
mechanism of class I antiarrythmic
block Na channels
the recurrent laryngeal nerve innervates the entire larynx except the ___
cricothyroid muscle
random cortisol during stress less than ___ is consistent with adrenal insufficiency
18
does atropine reverse nicotinc or muscarinic effects
muscarininc
whats better for hyperammonemia, CRRT or HD
CRRT
antidote to calcineurin inhibitor toxicity
aminophylline (dilates afferent arteriole to counteract tacro constricting it)
diagnosis test for CGD
cytochrome c reductase or nitroblue tetrazolium test
which occurs faster, serotonin syndrome or NMS
serotonin
a 2 sided hypothesis states that an association exists but does not specify the ___ of the association
direction
organophosphates bind irreversibly with ___
acetylcholinesterase |
what is 1 cm H20 in mm Hg
1.36 mm Hg
lesions above ___ can cause spinal shock due to loss of sympathetic outflow
T6
Mean airway pressure =
((TixPIP) + (TexPEEP)/(Ti+Te)
calculated osmolarity
(na x 2) + (glucose/18) + (BUN/2.8)
which part of lung has more negative pressure during both spontaneous respiration and PPV?
the apex of the lung
early post op htn in coarct is ___, late is ____
systolic, diastolic
pro inflammatory adaptive cytokines
IL-2, IFN gamma
this metabolic disease has smell of sweaty feet
isovaleric aciduria
low serum Mg causes impairment of ___ leading to K leak out of cells and low K
Na-K ATPase
intestinal phase of empyting mediated by
somatostatin, CCK which decrease parietal cell secetion of acid, secretin, GLP-1
this drug stimulates guanylate cyclase to increase cGMP, protein kinase to decrease Ca influx and cause vasodilation
NO
this is a plateau wave that indicates cerebral non compliance
lundberg a waves
this starts process of DIC
tissue factor and extrinsic pathway
the flow of gas from alveoli with long time constants to those with short time constants at the end of exhalation; in inspiration it goes from short time constants to long
pendelluft movement
case control study is good for a ___ outcome
rare
hypoglycemia, lactic acidosis, hepatomegaly, ketones in urine, normal ammonia
glycogen storage disease type I
tx for PTLD
reduce immunosuppresion
this is a severe congenital neutropenia with infections with S aureus, psuedomonas
kostmann syndrome
this is the best Cu chelator for wilsons disease
Zn
failure to make B cells, mutation in tyrosine kinase, recurrent sinopulm infections
x linked agammaglobulinemia
which increases faster from apex to base of lung, ventilation or perfusion
perfusion
this binds cytochrome oxidase and interferes with electron transport
CO
whats byproduct of conversion of arginine to citrulline
NO
which is more common in liver transplant, portal vein clot or hepatic artery clot
hepatic artery clot
these vasopressin receptors cause ACTH release
V1b
most common infectious cause hepatic failure children
hep A
greatest risk of infection in plt transfusion
gram positive bacteria
which type of TSS is more likely to have positive blood culture and has higher mortality
strep TSS
antidote to organophosphate poisoning
pralidoxime which causes reactivation of acetylcholinesterase, can also give atropine
this is essential for oxidation of fatty acids and disposes of toxic acyl-coa compounds
carnitine
initial therapy for stroke in sickle cell
exchange transfusion
tx of tyrosinemia type I
NTBC
HIV diagnosis less than 18 months
2 positive PCRs
this type of herniation leads to loss of upward gaze and pinpoint minimally reactive pupils from loss of sympathetic input
upward tentorial hernation
this is high amplitude and irregular waves and spikes on EKG
hypsarrythmia, seen in infantile spasm
risk of type I error
p value
what does a 2/3 change in base excess do to pH
change by 0.01 (so a pH change of 0.03 would have a base excess change of 2)
effect of sympathetic nervous system on insulin/glucagon
inhibits insulin release, stimulates glucagon
