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Clinical Medicine-3


What are the 3 mechanisms that all work together in concert to minimize any changes in blood ph? 1.Ec and Ic buffering. 2. Adjustment in blood pCO2 by alteration in the ventilation rate of the lungs. 3.Adjustment in renal acid excretion. ...*also restoration of the blood pH to its normal value requires correction of the underlying process.
What is a buffer? A buffer prevents any change in the PH when H is removed.
What is a major and minor extracellular buffer and its pK? Bicarb is major pk-6.1 phoshphate is minor pk 6.8
What are some intracellular buffers? proteins like hgb, deoxyhgb, organic phosphates liek amp, adp, atp
What are 3 primary systems in the body that regulate the H in body fluids? 1. Chemical acid/base buffer systems of body fluids by combining w/SA/B to convert to weak. 2. 2nd line is respiratory center acts in few minutes to eliminate CO2. 3. Kidneys acts in hours to days . this is the most powerful which includes bbs, pbs, abs
What are some ways to gain H? generation of h ions from co2 in tissue capillaries. loss of bicarb in urine, diarrhea, production of non-volatile acids from metabolism of protein and organic sourcdes.
What is the Henderson Haseelbach equation? To calculate pH in a solution of a WA/WB. Its used to determine which buffer can be used in a solution at a specific pH.
The phosphate buffer is a minor buffer but the most important ________ urinary buffer
What are the 3 fundamental processes that regulate the H in ECF? 1.Reabsorption of filtered HCO3. 2. Production of new HCO3 3. Secretion of H in tubular lumen.
What is the anion gap? Refers to concentration of unmeasured anions in the body. ie. proteins. po4.so4.organic acids
Metabolic acidosis associated with increased AG and Normal Cl MUDPILES methanol, uremia, diabetic ketoacidosis, paraldehyde,phenformin, iron tablets or inh, lactic acidosis, ethylene glycol, salicylates
metabolic acidosis associated with normal AG but Increased CL CARD carbonic anhydrase inhibitors,addisons disease, renal tubular acidosis, diarrhea
80% of UTIs are caused by E. Coli
UTI associated with renal calculi Klebsiella, Proteus, Pseudomonas
UTI associated with young females Staph. Saprophyticus
UTI associated with instrumentation St. Aureus, enterococcus
What should you see on an EKG for a hyperkalemic patient? and which arrhythmia are you concerned about? 1.Peaked T waves, widened QRS 2.V.Fib
EKG for hypokalemia Flat T waves and U waves
Pulmonary hemorrhage and glomerulonephritis are features in most patients with this disease Good Pasture Syndrome
Good Pasture Syndrome appears in what two extremes? young men early 20's and men/women in their 60-70's
What are some clinical symptoms of GPS in the young? Disease in young age is explosive with hemoptysis and sudden fall in Hb, fever, dyspnea and hematuria.
What is the most common GN worldwide with male predominance? IgA nephropathy/Berger's disease
What are the two presentations of Berger's? 1. Recurrent episodes of macroscopic hematuria during or immediatley following an URI in children (Henoch-Schonlein purpura) 2.Asymptomatic microscopic hematuria often in adults
Treatment for Berger's There is no agreement on optimal treatment. Studies suggest that use of ACE inhibitors in patient w/IgA nephropathy w/proteinuria or declining renal function. Tonsillectomy, steroid thereapy have been suggested in small studies.
What is the hallmark of nephrotic syndrome? Peripheral edema
Name the 4 most common types of nephrotic syndromes 1. Minimal change disease 2. Membranous Nephropathy 3. Membranoproliferative GN 4. Focal Glomerulosclerosis
How do you treat proteinuria? Proteinuria is treated with ACE inhibitors.
Treatment for MPGN Primary MPGN in children can be treated with steroids. If proteinuria is present ACE inhibitors are helpful. Secondary MPGN treat the underlying cause.
Most common GN seen in children w/male predominance Minimal Change GN
Treatment for children with Minimal Change GN Although 30% have spontaneous remission, all children are treated w/steroids i.e. prednisone
Most common cause of nephrotic syndrome in adults Membranous GN
Most common cause of chronic renal failure in the USA Diabetic Nephropathy
Kimmelstiel-Wilson nodular lesions is pathognomonic Diabetic Nephropathy
A previously healthy, 3-year-old female patient presents with abdominal distension and left, upper quadrant prominence. On PE the mass is firm, smooth, nontender, and does not cross the midline. The patient is hypertensive. UA:microscopic hematuria. Nephroblastoma aka Wilm's Tumor
A 64-year-old man has painless hematuria. HX:similar episode 1 year ago and antibiotics resovled the bleeding. He has dec. flow and nocturia x2/night. He has smoked a pack of cigarettes QD x45yrs. PE: enlargement of the prostate. UA: 10-15RBC 5-10WBC Bladder cancer
Painless hematuria is suggestive of _____ bladder cancer
A 65-year-old white man in normal health. He describes nocturia 1/night and a 3-hr daytime voiding interval. He denies any incontinence, hematuria, dysuria, freq, urgency.no gI complaints. PE: smooth and symmetrical prostate, with approx vol of 40 mL. Prostate cancer
A 35-year-old man presents with nonspecific testicular discomfort and the feeling of a mass in the testis.a 2 cm by 1 cm smooth, painless mass is palpated in the right testis. The mass does not transilluminate with light. There is no lymphadenopathy. Testicular carcinoma.
No racial predilections are obserbed except_____ _____ which is more common in African American population. lead nephropathy
Compensatory vasoconstriction may transiently maintain blood pressure but unreplaced losses of over 15% of intravascular volume can lead to ____ and ____ 1.hypotension 2. tissue hypoxia
Some common causes of hypovolemia loss of plasma:burns, 3-spacing:ascites,bowel obstruction, hemorrhage, hemothorax
symptoms of hypovolemia cool/mottled extremities, oliguria, thirst, tachycardia, bowel ischemia, decreased jvp, altered mental status
what is orthostatic hypotension lying to standing-systolic blood pressure drops >10-20mmHg and or an increase in pulse of more than 15BPM
What crystals form in acidic urine? Uric acid and Ca oxalate stones form in acidic urine.
What crystals form in alkaline urine? Calcium carbonate and Ca/Mg phosphate stones form in alkaline urine.
What type of urine (alkaline/acidic) does a UTI usually produce? alkaline
What medication can interfere with the leukocyte esterase component of a dipstick? Vitamin C and phenazopyridine
Nitrite on the dipstick reacts with which gram of bacteria? Gram negative
Renal threshold for glucose 180
Most common electrolyte disturbance in hospitalized patients HYPONATREMIA
Pontine Myelinolysis Its a consequence of a rapid rise in serum tonicity following treatment with severe hyponatraemia who have made intracellular adaptations to the prevailing hypotonicity. Hyponatremia should be corrected at no more than 12 mmol/L of na/D to prevent
On PE the patient has dry mucus membranes and hypereflexia. What electrolye imbalance might exist? Hypernatremia
S/S for hypocalcemia Tetany-Chvostek's sign (tap TMJ-face twitches) or Trousseus sign-muscle cramps, seizures, cardiac dysrhythmia-prolonged QT
Causes of hyperphosphatemia Hypoparathyroidism, renal failure (esp.ESRD on dialysis) decreased Ca, acidosis
Causes of hypophosphatemia Hyperparathyroidism, inc.Ca, ETOH, alkalosis---it causes multiple organ dysfunction, acutely neurological changes, confusion, coma, cardiac-hypotension, rhabdomyolysis, hypoxia;chronic--dec.mentation, muscle weakness, arthralgias
Common cause of acute renal failure in the elderly Dehydration
Most common physiological cause of proteinuria pregnancy
Clinical findings for hypernatremia CNS DYSFUNCTION, orthostatic hypotension, oliguria, hyperthermia, delirium, coma
What is the most common electrolyte disturbance seen daily in the ER? Hypokalemia, often secondary to diuretic therapy, commonly coexist with other electrolyte imbalances particularly Mg, and may not respond to therapy until these other abnormalities are corrected
S/S of hypokalemia generalized weakness, paralytic ileus, rhabdomylolysis, cardiac arrhythmia
What cardiac arrhythmias are associated with hypokalemia V Tach, Torsades de Pointes
3 Causes of Hyperkalemia 1. decreased renal excretion 2.drugs which interfere with RAAS 3.Digoxin toxicity
EKG findings for Hypocalcemia Prolongation of QT interval, Torsades
Milk is one of many treatment methods for ..... hypophosphatemia
Hypomagnesemia occurs in ___people and occurs with ___ occurs in 2/3 ICU patients, occurs with hypokalemia, hypocalcemia, metabolic acidosis
#1 cause of ARF Acute tubular necrosis-after toxi of ischemic renal injuries caused by shock, surgery or rhabdomyolysis
Strangulated hernia obstructed hernia in whih the blood supply is compromised. unless relieved, gangrene and perforation of the affected segment of bowel ensues. a strangulated hernia can have omentum or other viscera in the sac.
incarcerated hernia term is used to refer to different types or stages including irreducible hernia, obstructed or strangulated hernias. this term lacks precision and so should not be used to describe a complicated hernia.
What diagnostic test do you order for testicular torsion DOPPLER ULTRASOUND!!!!
Eosinophillic casts can be seen pyelonephritis
Created by: pastudygroup