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Quarter 3 > Clin Lab Med Exam II > Flashcards

Clin Lab Med Exam II Flashcards

1
Q

Epithelial cells

A

contaminated specimen

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2
Q

Oval fat bodies

A

Nephrotic syndrome

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3
Q

Hyaline cast

A

Normal, most common

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4
Q

RBC cast

A

Glomerulonephritis

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5
Q

WBC cast

A

Acute pyelonephritis

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6
Q

Renal tubule cast

A

Acute tubular necrosis

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7
Q

Specific gravity (UA)

A

Acute kidney failure

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8
Q

Glucose (UA)

A

Diabetes

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9
Q

Ketones (UA)

A

Acidosis (DKA)

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10
Q

Protein (UA)

A

Kidney dz

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11
Q

Moderately increase Albumin (UA)

A

Early Kidney dz

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12
Q

Bilirubin/ Urobilinogen (UA)

A

Liver dz
Hemolysis
Biliary obstruction

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13
Q

Uric acid crystals

A

Hyperuricemia

Gout

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14
Q

Struvite crystals

A

Alkaline urine

Infection by urease producing bacteria

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15
Q

Hypokalemia

Low K

A 
Causes:
Vomiting/gastric suction
Thiazide//loop diuretics
Alkalosis
Insulin
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16
Q

Kyperkalemia

A

Causes:
ACE-I, ARB
Aldosterone antagonist
K-sparing diuretics

Acidosis

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17
Q

Tx for Hyperkalemia

A

Insulin/Ca/Bicarb administration
Loop/Thiazide diuretics
Dialysis

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18
Q

Normal range of sodium

A

135-145

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19
Q

Solutes that determine ECF osmolality

A

Sodium
Glucose
Urea

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20
Q

Sx occur if osmolality is out of whack by this much

A

<265

>320

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21
Q

Substances that are active but not included in calculated osmolality (lead to Osmolol Gap)

A 
Mannitol
Other proteins
Ethanol
Methanol
Ethylene glycol (antifreeze)
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22
Q

Tonicity

A

ability of all solutes to make Osmotic Driving Force that causes water mov from one compartment ot another

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23
Q

Examples of solutes unable to cross from ECF to ICF that influence tonicity

A

Sodium
Glucose
Mannitol

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24
Q

What is a substance that crosses freely and therefore does NOT contribute to tonicity?

A

Urea

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25
Q

Major determinant of the size of ECF volume

A

(Na) Sodium

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26
Q

Increase Na in ECF

A

Hypervolemia

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27
Q

Serum [Na+]

A

refers to amt of water relative to sodium in ECF

not the total body Na+ amt

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28
Q

Abnormal Serum [Na+] means

A

disorder of water regulation

not necessarily a messed up sodium level

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29
Q

Abnormal ECF volume

A

marker of abnormal (Na) sodium control

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30
Q

Causes of Hypovolemia

A 
GI loss
Renal loss (diuretics, Diabetes Insipidus)
Skin loss (sweat, burn)
Intestinal obstruction, pancreatitis, Rhabdo
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31
Q

Hypovolemia sx

A 
Weakness 
Muscle cramps
Decreased BP
Postural hypotension
Increased pulse
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32
Q

Causes of HYPERvolemia

A 
Renal failure
Nephrotic synd
Primary Hyperaldosteronism
Cushing's synd
Liver dz
Heart failure
Pregnancy
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33
Q

3 main causes of HYPER volemia

A

Kidney failure
Liver failure
Heart dz

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34
Q

Signs of HYPERvolemia

A 
Edema
SOB
Orthopnea (PND)
JVD
Hepatojugular reflux
Crackles
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35
Q

Water retention influenced by:

A

Thirst

ADH

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36
Q

Salt retention influenced by:

A

RAAS
ANP
Catecholamines
Renal fx (GFR, BF)

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37
Q

Aldosterone actions

A

Increase Na absorption

Kicks K out of body

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38
Q

Severe Hyponatremia (sodium so low, in danger zone)

A

below 125

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39
Q

Most common electrolyte abnormality in hospitalized pts

A

Low sodium

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40
Q

Hyponatremia is assoc/ with

A

Pulmonary dz

CNS disorder

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41
Q

Signs of low sodium

A 
HA, dizzy
N/v
Lethargy
Weakness
Confusion
Severe: Hypoventilation, Resp arrest, Seizure, Coma, Death
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42
Q

Pseudohyponatremia

A

Falsely low serum sodium, <135 BUT osmolality is normal

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43
Q

Pseudohyponatremia (falsely low sodium) occurs with:

A

Hyperlipidemia

Hyperprotein

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44
Q

Redistributive or Hyperosmolar Hyponatremia

A

Osmotically active particles in the ECF are concentrating stuf out there and drawing water out of the cell as a result, diluting the Na concentration outside of the cell

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45
Q

Common cause of Redist/Hyperosmolar Hyponatremia (low sodium)

A

Hyperglycemia

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46
Q

Hyperglycemia is often seen with

A

Hyponatremia

type: Hyperosmolar/Redistributive

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47
Q

Hypervolemic Hyponatremia

A

too much volume

too little Na

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48
Q

Cause of Hypervolemic Hyponatremia

too much fluid, too little sodium

A

Liver, Heart, or Kidney failure

Tx: diuretics, dialysis, fluid restrict

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49
Q

Hypovolemic Hyponatremia

low volume, low sodium

A

Check Urine Na

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50
Q

If urine Na >20 in Hypovolemic Hyponatremia

A

Cerebral salt wasting
Renal tubular acidosis
Diuretics (thiazide)

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51
Q

If urine Na <20 in Hypovolemic Hyponatremia

A

Vomiting/diarrhea

Third space loss (burn, pancreatitis)

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52
Q

Tx of Hypovolemic Hyponatremia (low everything)

A

Replace with fluids

Tx underlying cause

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53
Q

Euvolemic Hyponatremia

A

SIADH
Psychogenic polydipsia
Hypothyroid
Adrenal insuff

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54
Q

Tx of Euvolemic Hyponatremia

A

Fluid restriction

Tx underling cause

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55
Q

SIADH

too much ADH
retaining water

A

TOO MUCH ADH activity
Keeps water in
but lets Na out

Serum diluted
Urine concentrated

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56
Q

Determine cause of SIADH

A

CT/MRI head (CNS disorder)
CXR (lung tumor/inf)
Review pt meds

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57
Q

SIADH dx criteria (5 things)

A
  1. diluted plasma <275
  2. concentrated urine >100
  3. elevated urine Na >20
  4. euvolemic
  5. normal cortisol and thyroid levels
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58
Q

Dx Hyponatremia, First look at

A

Serum: Na, osmolality

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59
Q

Dx Hyponatremia, 2nd look at

A

Urine Na and osmolality

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60
Q

Dx Hyponatremia, 3rd look at

A

TSH, Serum Cortisol

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61
Q

When to admit a pt to hospital for Hyponatremia?

A

If sodium is below 125 OR symptomatic

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62
Q

Common use for tx of Chronic Hyponatremia

A

“Vaptans” and

Demeclocycline

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63
Q

Correcting Low Sodium

A

4-6 in first 24 hours

definitely less than 8

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64
Q

How often to check sodium when you are correcting levels

A

every 2 hours

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65
Q

CPM- Central Pontine Myelinolysis

A

Aka osmotic demyelination synd

Focal demyelination in the pons
Irreversible!

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66
Q

Sx of CPM- Central Pontine Myelinolysis

A

Dysarthria, dysphagia, seizures, AMS, quadriparesis, hypotension
1-3 days after over-correction

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67
Q

Hypernatremia

A

too little water relative to salt

>145

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68
Q

Clinical features of Hypernatremia d/t

A

brain shrinkage

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69
Q

Clinical sx of Hypernatremia (if any, often asymptomatic)

A 
Thirst
AMS, weakness
Neuromusc irritability
Focal neuro deficits
Seizure/coma
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70
Q

Causes of Hypernatremia

A 
GI loss (elderly or infants w diarrhea)
Sweating, fever
Renal loss
Diuretics
Osmotic diuresis
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71
Q

Vast majority of Hypernatremia are d/t:

A

Water loss

GI, skin, renal

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72
Q

Body’s normal response to Hypernatremia

A

Thirst and fluid intake

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73
Q

Diabetes Insipidus

dilute urine
concentrated blood

A

Losing a bunch of dilute water
(collecting ducts are impermeable to water and cannot reabsorb it)
Concentrated serum Na

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74
Q

Causes of DI

A

Central: impaired secretion of ADH
tx: desmopressin

Nephrogenic: lack of kidney response to normal amts of ADH

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75
Q

SIADH

A

too much ADH!

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76
Q

Diabetes Insipidus

A

not enough ADH or impaired response to ADH!

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77
Q

Tx of Nephrogenic DI

we want to get rid of Na

A

when kidneys aren’t responding to normal amts of ADH

  • Thiazide diuretics (cause you to get rid of Na)
  • Amiloride
  • Chlorpropamide
  • NSAIDs
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78
Q

Tx of Hypernatremia

A

Stop water loss
Replace water deficit
Hospitalize (if severe)

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79
Q

Water deficit

A

Normal TBW- current TBW

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80
Q

3 parts to UA

A

Gross examination
Dipstick
Microscopic analysis

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81
Q

What can cause urine to be red or red-brown

A

Beets and Rhubarb

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82
Q

What can cause urine to be brown-black?

A

Biliary dz
Alkaptonuria
Malignant melanoma

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83
Q

Maple syrup urine dz and Phenylketonuria

A

Amino acid disorder

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84
Q

Normal pH for Urine

A

4.5-8.0

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85
Q

Urine is water containing dissolved:

A

Urea, Na, and Cl (some other stuff)

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86
Q

Normal Spec Gravity of Urine

A

1.003-1.035

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87
Q

Spec Grav reflects kidney’s ability to

A

Concentrate and dilute the urine

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88
Q

In kidney dz, Spec Grav may be fixed at

A

1.01

“Isothenuria”

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89
Q

Urine volume normal

A

500-2000

Olig: <500
Anuria: <100

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90
Q

False negatives for Glucose in urine

A

Absorbic acid

ASA

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91
Q

Ketones

A

product of incomplete fat metabolism, occur when carbs diminished

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92
Q

Ketones in urine

A

Acidosis

DKA, rapid weight loss, fasting, starvation, pregnant

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93
Q

Albumin

A

indication of Renal endothelial dysfx

Early sign of kidney dz

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94
Q

False positive Albuminuria test

A

Pyridium can cause false positive

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95
Q

Limit to Albuminuria test

A

Low levels: 30-300 usually not detectable with dipstick

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96
Q

Alb to Cr ratio used for screening for Kidney Damage in high risk pts

A

Diabetes
HTN
Cardiovascular dz

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97
Q

Persistently positive dipstick for protein should:

A

also have Albuminuria quantified

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98
Q

Blood in urine can mean 3 things:

A

RBC
Hemoglobin
Myoglobin

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99
Q

False negative to blood can be d/t

A

Ascorbic acid

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100
Q

High power field

A

WBC

RBC

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101
Q

Low power field

A

Casts

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102
Q

RBC

A

> 3 in urine is abnormal

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103
Q

If sediment is red

A

Hematuria (RBC)

104
Q

If supernatant is red, do a dipstick heme

A

if negative, red color is d/t something else

105
Q

If supernatant is red, do a dipstick heme

A

if positive, centrifuge again and determine color
Clear: myoglobin
Red: hemoglobin

106
Q

WBC
lobed nuclei
refractile cyto granules

A

> 5 is abnormal
10-20 suspicious
20 probably UTI

107
Q

Tubular and transitional epithelial cells

A

tubular degeneration if high numbers

108
Q

Oval fat bodies

A

“Maltese cross”

Nephrotic syndrome

109
Q

“Maltese cross”

A

seen by Polarized light microscopy

Nephrotic synd

110
Q

Where are casts formed?

A

Distal tubule or Collecting duct

111
Q

Red cell casts

A

Glomerulonephritis

112
Q

White cell casts

A

Pyelonephritis

113
Q

Renal tubular casts

A

Acute tubular NECROSIS

114
Q

Cystine crystals

“sisteine chapel genetically caused stones”

A

rare Genetic cause of kidney stones

115
Q

Struvite

A

Urease producing bacterial infection

116
Q

Calcium oxylate

A

kidney stones

117
Q

crystals that cause Kidney stones

A

Cystine (rare genetic)

Calcium oxylate

118
Q

Regulation of Renal K excretion occurs in

A

Distal nephron

119
Q

Too much K

Hyperkalemia

A

Serum level >5

120
Q

Causes of too much K

Hyperkalemia

A

Pseudo
Inadequate kidney excretion
Redistribution
Excess administration

121
Q

Aldosterone leads to low K levels

A

so anything that antagonises Aldosterone will —> too much K (Hyperkalemia)

122
Q

Causes of Hyperkalemia (too much K)

A

Aldosterone antagonist
K sparing diuretic
ACE-I/ ARB

Adrenal insuff (Addison’s dz)
Congenital Adrenal Hyperplasia
Renal tubular dysfx

123
Q

When to clinical features of Hyperkalemia generally appear?

A

7 or greater
“It’s
A F A C T”

124
Q

A F A C T

A

Arrhythmia

Flaccid paralysis
Asc muscle weak
Conduction abn
T waves (tall and peaked)

125
Q

Tx for Too much K

Hyperkalemia

A 
ER/ICU if >6.5
Correct levels (rapid or slow)
126
Q

Rapid correction of Hyperkalemia

A

IV Calcium Chloride

Maneuver to shift K from ECF to ICF

127
Q

Birmingham lecture

treat for too much K

A

Sodium bicarb IV

D50W + Insulin IV

128
Q

Slow correction of Hyperkalemia

A

Loop or thiazide diuretic

Hemodialysis

129
Q

Med cause of too much K

A

ACE-I and ARBs
K-sparing diuretic
Aldo Antag

130
Q

Tx of Hyperkalemia

A

Thiazide or Loop diuretic

131
Q

Not enough K

Hypokalemia

132
Q

When does low K become dangerous?

133
Q

Causes of Not enough K

Hypokalemia

A

Inadequate intake
GI tract loss
Kidney loss
Redistribution

134
Q

When does a person usually suffer from Hypokalemia d/t inadequate intake?

A

If they are already on Thiazide or Loop diuretic which enhances K excretion

135
Q

Common cause for K los

A

GI loss

Upper GI: vomiting, NG suction (this causes Alkalosis which promotes Renal K loss, further worsening the problem)

136
Q

Too much Aldosterone function can lead to

A

Low K
Hypokalemia

(i.e. Hyperaldosteronism and Cushing’s syndrome)

137
Q

Redistribution causes of Low K

A

Alkalosis
Insulin administration
B-adrenergic agonists

138
Q

Hypokalemia sx

139
Q

U CRAMP with low K

A

U waves

Cramp
Rhabdo and Resp failure
Anorexia, n/v
Musc weakness
Paralysis
140
Q

Having a hard time correcting low K?

A

check Mg level

141
Q

Rapid correction of Low K

A

Cardiac monitor
IV Potassium Cl
(check K every 2-4 hrs)

142
Q

Slow correction of Low K

143
Q

Causes of Hypokalemia

A

vomiting/gastric suction
Thiazide/loop
Alkalosis
Insulin

144
Q

Alkalosis causes

145
Q

KOH dissolves host cells and bacteria, sparing:

A

Fungi and elastin

146
Q

Tzank Prep

A

Herpes Virus
Giemsa or Wright stain

Giant multinucleated cells

147
Q

What is more commonly used to diagnose HSV than Tzanck smear?

A

Immunofluorescencse

148
Q

India Ink

A

Cyrptococci

large capsules that exclude the ink

149
Q

Dark field microscopy

A

thin bacteria

T. pallidum (Syphilis)

150
Q

Diagnosing Syphilis (T. pallidum) We use dark field microscopy bc Syphilis is

A

cannot be cultured
gram (-) but too thin for staining
Dark stain reveals spirochetes

151
Q

Extra testing for Syphilis (other than dark field)

A

Veneral Dz Research Lab (VDRL):

  • CSF test
  • Fluorescent Trep Antibody Absorption FTA-ABS

ALSO
Rapid Plasma Reagin (RPR)
-serum

152
Q

Extra testing for Syphilis

A

VDRL (venereal)

RPR (rapid plasma)

153
Q

Latex agglutination

A

CSF for Meningococcal

also serum, saliva, urine

154
Q

Latex agglutination

A

detects pathogen specific antibodies/antigens

155
Q

ELISA

Enzyme Linked Immunoassay

A

Detects antibodies in serum
(used for many body fluids)
May need to repeat testing bc it takes up to 2 wks for some immune responses to kick in

156
Q

IFA

Indirect Immunofluorescence Assay

A

Detects antibodies

Primary test for ANA

157
Q

NAAT/PCR

A

Detects small quantities of bacterial/viral DNA or RNA

faster than ELISA

158
Q

AFD Acid Fast Bacilli stain

A

Tuberculosis
rapid and cheap
(mycobacterial culture is most sensitive and spec)

159
Q

Only types of sterile C&S

A

CSF, pleural, pericardial, peritoneal, or synovial fluids

160
Q

MIC Minimum Inhibitory Concentration

A

Lowest conc of Abx to inhibit the growth of an organism- achieved through microdilution

161
Q

Intermediate results on Antimicrobial sensitivity mean

A

Organism is inhibited by MAXIMAL recommended Abx dose

162
Q

Blood culture results

A

Prelim: 24 hours

Identification of org: 48-72 hours

163
Q

When should blood cultures be repeated within 48 hrs of starting Abx?

A 
Staph Aureus bacteremia
Endocarditis
Infection site w/limited penetration
Persistent leukocytosis
Prosthetic vascular grafts
Pacemaker
Resistant pathogens
Unknown source of original bacteremia
164
Q

Bacteremia

A

infection specifically in the blood

165
Q

Thoracocentesis

A

Aspirate fluid from PLEURAL space

166
Q

Paracentesis

A

Aspirate fluid from ABDOMINAL cavity

167
Q

Transudative effusion

A

Intact vascular wall

d/t Pressure differences

168
Q

Transudative effusion usually d/t

A

CHF
Liver cirrhosis
Nephrotic synd

169
Q

Is further testing usually needed for fluid from Transudative effusions?

170
Q

Exudative effusion

A

D/t inflammation and Vascular wall DAMAGE

171
Q

Common causes of Exudative effusion

A

Infection
CA
Inflammatory disorder (RA, Lupus)
Trauma

172
Q

Does fluid from exudative effusion usually require further testing?

173
Q

Normal values for Pleural fluid (around lungs) AND Peritoneal fluid (around abdomen)

A

50 mL
Clear, serous, light yellow
NO RBC
WBC <300

174
Q

Parapneumonic effusion (exudative) most common causes

A

Bacterial PNA
Lung abscess
Bronchiectasis

175
Q

Second most common cause of Parapneumonic effusion (exudative)

A

Lung CA
Breast CA
Lymphoma

176
Q

Hemothorax (exudative) effusion

A

RBCs in pleural space
>100,000

Main causes: trauma, CA, PE

177
Q

PE can cause either

A

transudative or exudative effusion

178
Q

Chylous effusion (exudative)

A

Lymphatic duct disruption or impairment
Cloudy, milky
+Triglycerides and lipids

179
Q

Causes of Chylous effusion (exudative)

A

Trauma

CA to induce lymphoma

180
Q

CXR before Thoracocentesis

A

PA, lateral, lateral decubitus
Ensure fluid is accessible by needle
Check for fluidy (lays out when person lies down)

181
Q

Parapneumonic effusion should be sampled if it meets any of the following

A

Layers out >25 mm
Loculated
Assoc w thickened parietal pleura on CT
Clearly delineated by US

182
Q

Contra for Thoracocentesis

A

Significant thrombocytopenia

183
Q

Rules for Thoracocentesis

A

Do not remove >1L

Do not perform bilaterally

184
Q

Pleural fluid- Transudative features

A

Protein ratio <0.5
LDH <0.6

Others: WBC <300, glucose levels equal, ph 7.4-7.4

185
Q

Pleural fluid- Exudative features

A

Protein ratio >0.5
LDH ratio >0.6

Others: WBC >500, Glucose serum, pH lower

186
Q

Pleural fluid analysis

A

Gross app, cell count, gram stain, protein, glucose, amylase, cytology, CEA carcinoembryonic, cultures, AFB

187
Q

Why would pleural fluid have a pH of <7.3?

A

infection
esoph rupture
CA

188
Q

Why would amylase be elevated in pleural fluid?

A

pancreatitis
esoph rupture
CA

189
Q

Eisonophilia in pleural fluid

A

Parasite
CA
TB

190
Q

Causes of Ascites

A

Liver cirrhosis
Alc Hepatitis
Acute Liver failure

191
Q

Gold standard for dx Peritoneal Effusion

192
Q

Abdominal paracentesis indication

A

New onset Ascites
with or without:
Fever, abd tender, AMS, hypotension, periph leukocytosis, worsening kidney fx, trauma, severe cirrhosis

193
Q

Abdominal paracentesis contra

A

Coag abnormalities
Small amt fluid
Previous abd surgery
Massive ileus w bowel/distension

194
Q

Peritoneal fluid- Transudative features

A

Albumin gradient >1.1

195
Q

Peritoneal fluid- Exudative features

A

Albumin gradient <1.1

196
Q

LDH ratio >0.6 regarding Peritoneal fluid

A

Bowel perforation
CA
Infection

197
Q

Amylase elev with peritoneal fluid

A

Pancreatic
Bowel perforation
CA
Esoph rupture

198
Q

Ammonia with peritoneal fluid

A

Ruptured or strangulated bowel

199
Q

Bilirubin in peritoneal fluid

A

Bowel or biliary perforation

200
Q

Urea/Cr

A

Possible bladder rupture

trauma

201
Q

Spontaneous bacterial peritonitis SBP

IMP to recognize and tx d/t high Mortality

A

Pts with Hepatic cirrhosis and Ascites

Sx: ACUTE ONSET fever, chills, abd pain, rebound tender

Labs: exudative effusion

202
Q

Pericardial normal values

A

<50 mL
Clear, straw colored
NO RBC OR WBC

203
Q

Overall diagnostic approach for Pericardial effusion

A

CBC, CMP, Trop, Thyroid fx, ANA/ESR/CRP, EKC, CXR, US, MRI or CT

Pericardiocentesis only if necessary

204
Q

When to do pericardiocentesis

A

Pericardial effusion with TAMPONADE

If fluid needed for dx and may change tx

205
Q

Contra to pericardiocentesis

A

Coagulopathy

Uncooperative pt

206
Q

CSF located b/w

A

Pia and Arachnoid mater

in the Subarachnoid space

207
Q

Lumbar puncture indications categories

A

Infection
CA
Multiple Sclerosis
Cerebral/Subarachnoid Hemorrhage

208
Q

Subcategories of infection indications for LP

A

Meningitis
Encephalitis
Abscess
Neurosyphilis

209
Q

Contraindications to LP

A

Increased intracranial pressure
Vertebral degenerative joint dz
Infection near LP site
Pts on anticoags

210
Q

IDSA guidelines to do CT before LP!!!!

A

P A N I C S

Papilledema
AMS
Neuro def 
Immunocomp
CNS dz hx
Seizure within past week
211
Q

Try to draw two separate blood cultures immediately if CNS infection is concern

A

before starting Abx if possible

212
Q

CSF normal values

A 
Clear
Pressure <20
RBC and WBC 0-5
Protein 15-45
Glucose 50-75
LDH <40
213
Q

Xanthochromia (yellow) CSF

A

Bilirubin

indicating lysis of RBC

214
Q

Decreased pressure (hypovolemia)

A

dehyrdation
shock
nasal fracture w dural tear

215
Q

Increased ICP

A

infection
intra-cranial bleed
tumor
hydrocephalus

216
Q

Neutrophilia in CSF

A

Bacterial/TB meningitis
Abscess
Subarach bleed
Tumor

217
Q

Macrophage in CSF

A

Fungal/ TB meningitis
Subarach bleed
Brain INFARCTION

218
Q

Lymphocytosis in CSF

A

VIRAL, SYPHILIS, Fungal, or TB meningitis
Multiple Sclerosis
Guillian Barre synd

219
Q

Multiple Sclerosis and Guillian Barre Syn

A

Lymphocytes in CSF

220
Q

Eisonophilia in CSF

A

Parasitic meningitis

Allergic rxn

221
Q

Xanthochromia usually present with

A

Subarachnoid hemorrhage

but beware it takes 2-4 hours to occur

222
Q

Oligoclonal gamma globulin bands in CSF

A

Multiple Sclerosis

223
Q

Lymphocytes in CSF and

Ologiclonal gamma

A

Multiple Sclerosis

224
Q

What to order with CSF analysis

A

everything with others PLUS:
Lactic acid
VDRL

225
Q

Is Lactic Acid elevated in viral meningitis?

A

NO

only in bacterial/fungal

226
Q

Glutamine in CSF

A

Hepatic failure

227
Q

CRP C-reactive protein

A

bacterial meningitis

228
Q

Syphilis test

A

VDRL or FTA-ABS

229
Q

Toxoplasmosis eval for CSF

A

Geimsa/Wright stain

also used for herpes

230
Q

CSF Tubes

A

1: Chemistry- Protein and glucose
2: Microbio- Gram stain, Acid fast stain, C&S, PCR
3. Heme- Cell count and diff
4. Hold

231
Q

Intracellular ions

A

K
phosphate and organic ions
protein

232
Q

Extracellular iions

A

Mainly Na

Cl also

233
Q

Types of IVF

A

Crystalloids
Colloids
Blood

234
Q

Types of Crystalloids (most commonly used)

A

Isotonic (often- dehydration and hypovolemia)
Hypertonic (emergency)
Hypotonic (maintenance)
Dextrose (sugar)

235
Q

What is used for IV boluses in dehydration and hypovolemia?

A

CRYSTALLOIDS
NS (0.9%)
Lactated Ringer
Plasmalyte

236
Q

Life threatening hyponatremia

A

CRYSTALLOID
Hypertonic 3% NS
life threat low Na with water excess

Caution: CPM

237
Q

Maintenance fluids

A

CRYSTALLOIDS
Hypotonic
NOT good for replacing volume deficits like dehydration or hypovolemia

238
Q

Hypoglycemia

A

CRYSTALLOIDS

D5W/Dextrose

239
Q

Colloids

A

more likely to expand Vascular compartment

Used when crystalloids fail to sustain plasma volume d/t low osmotic pressure

240
Q

Colloids use (not often)

A

Pt with burn or peritonitis can’t hold onto the Crystalloid fluid given

241
Q

DexTRAN and Hetastarch

Colloids, not often used

A

Operation room

242
Q

Types of COLLOIDS

A

Albumin
DexTRAN
Hetastarch

243
Q

Albumin (a Colloid)

A

Liver dz
Peritonitis
Burn
“third spacing”

244
Q

PRBCs

A

used WITH Crystalloids to expand intravascular volume

245
Q

What fluids can you bolus?

A

NS, LR, Plasma lyte, PRBCs

Hypovolemia (dehydration or acute blood loss)

246
Q

What incriments do we bolus?

A

250mL,500mL, 1L

247
Q

Maintenance IVD

A

maintain water and electrolyte balance in someone who isn’t eating/drinking normally

248
Q

What is generally used for Maintenance fluid?

A

D5/0.5 NS with 20 meq KCl

249
Q

Maintenance IVF

A

“Kg method” for Normal adult patients

1500 for basically everybody, then once past 20kg, add 20 ml/kg/day

250
Q

Children require less sodium than adults

A

Use 0.25 instead of 0.5 NS

251
Q

NEVER BOLUS

A

K-containing IVF

252
Q

Parkland formula

A

Burn patients
How much total fl to give them?
% burns x weight x 4 mL

8 hours: give 1/2 total amt
8 hours: 1/4
8 hours: 1/4

253
Q

Parenteral means

A

not into mouth

into blood in this case

254
Q

When to consider TPN for adults vs children with anticipated or current inadequate energy intake by mouth

A

adults 7-10 days

children 3-7 days

255
Q

Diuretics cause you to

256
Q

ACE-I

ARBs cause you to

A

retain K

too much K

Quarter 3 (17 decks)

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