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double star Flashcards

1
Q

BETA LACTAMS

A

pencillins

cephalosporins

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2
Q

LEVOFLOXACIN (LEVAQUIN) – CLASS

A

fluroquinolone

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3
Q

CEFTRIAXONE (ROCEPHIN) – CLASS

A

cephalosporin

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4
Q

AZITHROMYCIN (ZITHROMAX) – CLASS

A

macrolide

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5
Q

CLARITHROMYCIN (BIAXIN) – CLASS

A

macrolide

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6
Q

ERYTHROMYCIN – CLASS

A

macrolide

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7
Q

CAP: mgmt for under 65 x4

A

MACROLIDE - 1 of the following:

  • azithromycin (Zithromax)
  • clarithromycin (Biaxin)
  • erythromycin

OR

TETRACYCLINE: doxy

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8
Q

CAP: mgmt 65+ or comorbs x4

A

FLUOROQUINOLONE

  • levofloxacin (Levaquin)
  • ciprofloxacin (Cipro)
  • moxifloxacin (Avelox)
  • gemifloxacin (Factive)
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9
Q

Pseudomonas pneumonia: inpt ICU mgmt (rx only)

A

antipneumococcal/antipseudomonal beta lactam

  • piperacillin-tazobactam (Zosyn)
  • cefepime (Maxipime)
  • meropenem (Merrem)

PLUS
- ciprofloxacin (Cipro)
//or//
- levofloxacin (Levaquin)

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10
Q

pneumonia: inpt ICU mgmt (rx only)

A

BETA LACTAM
- ceftriaxone (Rocephin)

PLUS
- fluroquinolone
//or//
- azithromycin (Zithromax): resistance likely, avoid

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11
Q

community acquired MRSA pneumonia: rx x2

A

vancomycin
//or//
linezolid

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12
Q

CA-MRSA cellulitis

A

choices:
Bactrim
Doxy/mino
Clindamycin

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13
Q

Group A Strep cellulitis

A

choices:
Bactrim + beta lactam (pcn, amoxicillin, Keflex)
Doxy/mino + beta lactam (same as above)
Clindamycin

! – same as CA-MRSA + BLs – !

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14
Q

cephalexin (Keflex): class + generation of that class

A

1st generation cephalosporin

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15
Q

most common causes of cellulitis: outpatient

A 
Strep pyogenes (group A) -- usually
Staph aureus (less common)
Strep etc. (B, C, G) - rare
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16
Q

most common causes of cellulitis: inpatient

A
  • gram negs: E Coli, Klebsiella, Pseudomonas, Enterobacter
  • S. aureus (MRSA? CA-MRSA? possibilities endless)
  • Strep
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17
Q

gram positive organisms

A 
bacillus
clostridium
enterococcus
listeria
staph
strep (strep pneumo is pneumococcus)
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18
Q

gram negative organisms

A 
E coli
Enterobacter
Haemophilus 
Pseudomonas aeruginosa
Moraxella
Neisseria
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19
Q

abx with gram neg coverage

A

Azithromycin (both)
Cephalosporins (both)
Penicillins (both)

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20
Q

abx with gram pos coverage

A 
Azithromycin (both)
Bactrim
Cephalosporins (both)
Clindamycin
Doxycycline
Linezolid
Minocycline
Penicillins (both)
Vanc
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21
Q

azotemia lab value

A

BUN 100+

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22
Q

syphilis treatment

A

Penicillin G

if allergic: doxycline or erythromycin

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23
Q

chlamydia treatment

A

azithromycin or doxycycline

co-treat with gonorrhea (ceftriaxone)

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24
Q

gonorrhea treatment

A

ceftriaxone

azithromycin (to cover chlamydia)

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25
Q

chancroid treatment

A

azithromycin
ceftriaxone
ciprofloxacin

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26
Q

1 underdiagnosed psych disorder

A

depression

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27
Q

which is the priority for patient who can’t make own decision: next of kin or advanced directive?

A

next of kin - ask if they want to go with advanced directive

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28
Q

Top 4 Killers of adults

A

1: CAD
2: cancer
3: lower resp disease (asthma, COPD)
4: CVA

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29
Q

1 mortality in US blacks

A

CAD

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30
Q

1 mortality in US women

A

CAD

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31
Q

1 cancer mortality in women

A

lung

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32
Q

leading gyn cancer mortality in women

A

ovarian

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33
Q

leading cancer incidence in women

A

breast

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34
Q

top 2 cancer mortalities in men

A

lung

prostate

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35
Q

top 2 cancer mortalities in all US adults

A

lung

colorectal

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36
Q

TSH normal

A

0.4 - 5.0

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37
Q

FT4 normal

A

0.8 - 2.8

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38
Q

Tot T4 normal

A

4.5 - 11.5

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39
Q

T3 normal

A

80 - 230

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40
Q

urine Na normal

A

10 - 20

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41
Q

serum osm normal

A

285 - 295

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42
Q

MCV normal

A

80 - 100

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43
Q

MCH normal

A

26 - 34

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44
Q

MCHC normal

A

32 - 36

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45
Q

hct normals

A

M 40 - 54

F 37 - 47

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46
Q

TIBC normal

A

240 - 450

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47
Q

ferritin high in anemia

A

100+

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48
Q

fibrogen low in DIC

A

less than 170

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49
Q

FDP high in DIC

A

45+

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50
Q

PT normal + prolonged

A

11 - 14 sec

19 sec

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51
Q

PTT normal + prolonged

A

25 - 35 sec

42 sec

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52
Q

albumin normal

A

3.5 - 5

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53
Q

BPH normal

A

under 4.5

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54
Q

phosphorous normal

A

3.5 - 5

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55
Q

Ca (total x2)

A
  1. 5 - 10.5 mg/dL

2. 2 - 2.6 mmol/L

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56
Q

Ca (ionized x2)

A
  1. 5 - 5.5 mg/dL

1. 1 - 1.4 mmol/L

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57
Q

CO/CI in hypovolemic shock?

A

↓

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58
Q

CVP in hypovolemic shock?

A

↓

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59
Q

PCWP in hypovolemic shock?

A

↓

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60
Q

SVR in hypovolemic shock?

A

↑

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61
Q

SVO2 in hypovolemic shock?

A

↓

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62
Q

CO/CI in cardiogenic shock?

A

↓

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63
Q

CVP in cardiogenic shock?

A

↑

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64
Q

PCWP in cardiogenic shock?

A

↑

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65
Q

SVR in cardiogenic shock?

A

↑

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66
Q

SVO2 in cardiogenic shock?

A

↓

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67
Q

CO/CI in septic shock?

A

↑ then ↓

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68
Q

CVP in septic shock?

A

↓ then ↑

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69
Q

PCWP in septic shock?

A

↓ then ↑

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70
Q

SVR in septic shock?

A

↓

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71
Q

SVO2 in septic shock?

A

↓ then ↑

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72
Q

CO/CI in anaphylactic shock?

A

↓

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73
Q

CVP in anaphylactic shock?

A

↓

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74
Q

PCWP in anaphylactic shock?

A

↓

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75
Q

SVR in anaphylactic shock?

A

↓

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76
Q

SVO2 in anaphylactic shock?

A

↓

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77
Q

CO/CI in neurogenic shock?

A

↓

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78
Q

CVP in neurogenic shock?

A

↓

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79
Q

PCWP in neurogenic shock?

A

↓

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80
Q

SVR in neurogenic shock?

A

↓

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81
Q

SVO2 in neurogenic shock?

82
Q

CO/CI in obstructive shock?

83
Q

CVP in obstructive shock?

84
Q

PCWP in obstructive shock?

85
Q

SVR in obstructive shock?

86
Q

SVO2 in obstructive shock?

87
Q

what is the difference between PAP and PAWP?

A

pulmonary artery pressure is essentially the “blood pressure” in the pulm art

pulmonary artery wedge pressure is a measurement using a swan ganz catheter and the inflation of a balloon in the pulm art to measure the pressure in front of it - a proxy for left ventricular pressure (and therefore function)

88
Q

How soon should you order antibiotics in newly diagnosed septic shock?

A

Within 1 hour of diagnosis

89
Q

SVR is high for which shocks and low for which shocks?

A

high for cardiogenic, hypovolemic, and obstructive

low for the distributives (septic, anaphylactic, neurogenic)

90
Q

what are 5 potential causes of hypovolemic shock?

A

internal/external bleeding, burns, DKA/HHNK, severe dehydration

91
Q

hypovolemic shock: mgmt

A
  • fluid resuscitation - MAINSTAY! I mean, duh

- PRBCs when indicated by hgb/hct

92
Q

what is the mainstay of treatment for hypovolemic shock?

A

fluid resuscitation duh

93
Q

what % of blood loss constitutes hypovolemic shock?

A

results from a loss of greater than 20% circulating blood volume

94
Q

what are 5 potential causes of cardiogenic shock?

A

MI (most common), dysrhythmia, pericardial tamponade, pulmonary edema, acute valvular regurg

95
Q

what is the most common cause of cardiogenic shock?

96
Q

cardiogenic shock: mgmt

A
  • initial, careful admin of IVF
  • vasopressor support
  • nitroglycerin IV PRN ischemia
97
Q

what is distributive shock?

A

3 types - all characterized by vasodilation, decreased intravascular volume, reduced peripheral vascular resistance, and loss of capillary integrity

septic, anaphylactic, neurogenic

98
Q

why does hypovolemia result in septic shock?

A

hypovolemia develops as a result of blood pooling in the microcirculation

99
Q

what is an important diagnostic to order for septic shock in addition to hemodynamic monitoring?

A

BLOOD CULTURES!!!

100
Q

septic shock: mgmt

A
  • crystalloid fluid resus (mainstay)
  • vasopressors
  • upon diagnosis of sepsis, abx WITHIN 1 HOUR !!
101
Q

what is the mainstay of treatment for septic shock?

A

crystalloid fluid resuscitation

102
Q

what is anaphylactic shock?

A

IgE mediated reaction that occurs shortly after exposure to an allergen

103
Q

anaphylactic shock: mgmt

A
  • maintain airway
  • diphenhydramine 25 - 75 mg IV or IM (depends on severity)
  • epinephrine 0.3 - 0.5 mg (1:1000 sol) SQ or IM for respiratory distress, stridor, wheezing, etc.
  • crystalloid IVF
  • IV glucocorticosteroids
  • consider H2 antagonist (ranitidine/Zantac)
  • inhaled beta agonist for bronchospasm
104
Q

what is the indication for epinephrine in anaphylactic shock management?

A

respiratory distress, stridor, wheezing, etc

105
Q

what is obstructive shock?

A

inadequate CO d/t impaired ventricular FILLING

causes ex: massive PE (most common), tension pneumothorax, cardiac tamponade, obstructive valve disease

106
Q

what are 4 causes of obstructive shock?

A

massive PE (most common), tension pneumothorax, cardiac tamponade, obstructive valve disease

107
Q

what is the most common cause of obstructive shock?

A

massive PE

108
Q

obstructive shock: mgmt

A
  • maintain BP while initiating tx of underlying cause

- fluid admin + vasopressors

109
Q

what are the 5 steps of managing a patient (from start to finish?)

A 
history
assessment
labs/diagnostics
diagnosis
treat
110
Q

2 rhabdo labs

A

↑ urine myoglobin

↑ serum creatine kinase

111
Q

lipid panel: normal

A 
-- less than --
CHOL: 200
TRIG: 150
LDL 100
\+
HDL: 40 - 60
112
Q

lipid panel: DM/CAD

A 
-- less than --
TRIG: 150
LDL 70
\+
HDL: 40+
113
Q

what is a major adverse effect of metoclopramide (Reglan)? what is metoclopramide’s class?

A

tardive dyskinesia

anti-emetic agent + prokinetic (upper GI)

114
Q

schistocyte

A

fragmented RBC bit
irregularly shaped, jagged, two pointed ends

often seen in hemolytic anemia

115
Q

sideroblastic anemia

A

bone marrow produces ringed sideroblasts instead of healthy RBCs - r/t defect incorporating Fe into hgb

sideroblasts usually turn into RBCs

116
Q

sideroblastic anemia: labs

A

↑ Fe

↓ TIBC

117
Q

AEIOU criteria for dialysis

A 
a cidemia
e lectrolyte imbalance
i ntoxication
o liguria
u remia
118
Q

which valve closures are S1?

A

tricuspid & mitral

119
Q

what is between S1 + S2?

A

systole; ventricles are squeezing

120
Q

which valve closures are S2?

A

pulmonic & aortic

121
Q

what is between S2 + S1?

A

diastole; ventricles are filling

122
Q

what is S3?

A

kentucky (slushy in a big balloon)
blood passively enters ventricle and sloshes because the vent is overflowing already OR it is a dilated/non-compliant wall
- think: hypovolemia, CHF, pregnancy

123
Q

what is S4?

A

tennessee (z squeeze/ kick ball into wall)
atrial KICK into extra THICK wall like a soccer ball
- think: MI, LVH

124
Q

which shocks have ↑ PAWP?

A

cardiogenic ONLY

125
Q

which shocks have ↓ SVR/SVRI?

A

distributive shocks: sepsis, anaphylaxis, neurogenic

126
Q

in which 2 hemodynamic parameters are all shocks (except septic) ↓?

A

CO/CI & SVO2

septic is:
CO/CI - ↑ then ↓
SVO2 - ↓ then ↑

127
Q

CO/CI in septic shock?

A

↑ then ↓

128
Q

SVO2 in septic shock?

A

↓ then ↑

129
Q

BPH: diagnostics to order

A

UA: r/o infection
PSA: 4+ abn
transrectal US: if palpable nodule or elevated PSA

130
Q

Your BPH patient’s labs came back with elevated PSA. What is your next order?

A

transrectal US

131
Q

While performing a digital rectal exam your palpate a nodule on your patient’s prostate. What is your next order?

A

transrectal US

132
Q

BPH: mgmt

A
  • observe + refer to urologist as needed
  • alpha blockers: terazosin, tamsulosin, prazocin (relax bladder/prostate muscles)
  • 5-alpha-reductase inhibitors: finasteride (shrink prostate)
  • surgery: TURP, if significant sx persist
133
Q

Hep A lab markers

A

active: anti-HAV, IgM
recovered: anti-HAV, IgG

NO CHRONIC!

134
Q

Hep B lab markers

A

active: anti-HBc, HbeAg, HbsAg, IgM
chronic: anti-HBc, anti-HbeAg, HbsAg, IgM, IgG
recovered: anti-HBc, anti-HbsAg

135
Q

Hep C lab markers

A

acute: anti-HCV, HCV RNA
chronic: anti-HCV

136
Q

What test do you order to differentiate acute from chronic Hep C?

A

PCR (prior exposure vs current viremia)

137
Q

cardiogenic & obstructive shock: PAWP

A

cardiogenic: ↑ - LV can’t squeeze
obstructive: ↓ - LV isn’t filled d/t obstruction of blood

138
Q

cardiac tamponade can cause what kind of shock?

A

cardiogenic & obstructive

139
Q

pulmonary edema can cause what kind of shock?

A

cardiogenic

140
Q

pulmonary embolus can cause what kind of shock?

A

obstructive

141
Q

cluster headache

A

middle-aged men
very painful, severe, unilateral, perirbita
at night - wakes from sleep
ipsilateral: rhinorrhea, eye redness, nasal congestion

142
Q

which headache do you treat with sumatriptan or ergotamine?

143
Q

tension headache

A

most common type of headache
vise-like, tight, generalized
no focal neuro sx

144
Q

which headache do you treat with OTC?

145
Q

migraine headache

A

classic (aura) vs common (no aura)
r/t dilation + excess pulsation of EXTERNAL CAROTID ARTERY; unilateral, dull or throbbing, focal neuro sx
follow trigeminal pathway

146
Q

which headache do you treat prophylactically with elavil (Amitriptyline), divalproex (Depakote), verapamil (Calan)?

147
Q

complications of enteral vs parenteral nutritional support

A

enteral: problems with the solution
- aspiration, d/v, GIB, hyperNa, dehydration, clog, etc

parenteral: problems with the delivery
- pneuo/hemo -thorax, art laceration, catheter sepsis/thrombosis, etc

148
Q

what does urine Na tell you?

A

distinguishes renal from non-renal causes
20+ = think salt wasting (kidney problem)
-10 = think renal Na retention to compensate for extrarenal fluid loss

149
Q

what is isotonic hyponatremia?

A

PSEUDO hyponatremia… lab artifact

usually occurs w hld or hyperproteinemia

150
Q

describe the entire hypovolemia thought process.
what lab value do you expect indicating hyponatremia?
what two diagnostics do you assess next and how do you assess them?

A
  1. ELECTROLYTES: hyponatremia is serum Na less than 135
  2. OSMOLALITY: hypo-, iso-, hyper- tonic?
    2a. if HYPERtonic, treat.
    2b. if ISOtonic, treat.
    2c. if HYPOtonic, continue to 3.
  3. FLUID STATUS: hyper- or hypo- volemic?
    3a. if HYPERvolemic, treat.
    3b. if HYPOvolemic: fluid loss! Go to 4.
  4. UNa, given fluid loss.
    4a. 20+, salt wasting (extrarenal forced waste: meds)
    4b. -10, salt-retaining (extrarenal fluid loss: kidneys compensating)
151
Q

3 causes: hypovolemic hypotonic hyponatremia + urine Na under 10

A

FLUID LOSS: kidneys retain Na to compensate

  1. dehydration
  2. diarrhea
  3. vomiting
152
Q

C diff infection is associated with which electrolyte imbalance?

A

hypovolemic hypotonic hyponatremia + urine Na under 10

mega diarrhea = fluid loss = kidneys retain Na in an attempt to compensate

153
Q

3 causes: hypovolemic hypotonic hyponatremia + urine Na 20+

A

SALT WASTING: what is making kidneys chuck the Na?

  1. diuretics
  2. ACE inhibitors
  3. mineralocorticoid deficiency
154
Q

what is the most common electrolyte abnormality?

A

hyponatremia, and most likely –

hypervolemic hypotonic hyponatremia: fluid volume excess states like CHF, edema, liver failure, kidney failure.

155
Q

4 causes of hypervolemic hypotonic hyponatremia

A

DISEASE PROCESSES LEADING TO FLUID RETENTION.

  1. edematous state
  2. CHF
  3. liver disease
  4. advanced renal failure
156
Q

typical cause of hypertonic hyponatremia

A

Something else that is NOT sodium is causing HIGH SERUM OSMOLALITY.

ex: hyperglycemia – typically HHNK

157
Q

hypernatremia is usually due to what?

A

excess water loss (dehydration)

158
Q

what three states can you have with hypernatremia, and what is the management of each?

A

hypervolemic hypernatremia: free water, loop diuretics, maybe HD
- loop diuretics will get rid of Na and water so replace with free water; HD will help if kidneys can’t get rid of Na for some reason

euvolemic hypernatremia: free water
- will reduce Na concentration back to normal

hypovolemic hypernatremia: NS then ½ NS
- patient is extremely dehydrated which is causing the extreme Na concentration. replace fluid while keeping Na up.

159
Q

hyponatremia: mgmt

A

TREAT UNDERLYING PROBLEM

  • symptomatic: NS + loop diuretic
  • CNS symptoms: 3% NS + loop diuretic
160
Q

you have a symptomatic hyponatremic patient - what are 2 mgmt strategies?

A

other symptoms: NS + loop diuretic

CNS symptoms: 3% NS + loop

161
Q

respiratory acidosis vs respiratory alkalosis: patient presentation

A

respiratory acidosis: this patient looks dead

respiratory alkalosis: this patient is in distress

162
Q

what is the hallmark sign of metabolic acidosis?

A

low serum HCO3

163
Q

your patient has metabolic acidosis - what is your next step? what does doing this this tell you?

A

calculate anion gap with
[Na + K] - [HCO3 + Cl]

normal anion gap is 12 +/- 5
if anion gap is increased, the metabolic acidosis is more acute

164
Q

metabolic acidosis: MUD PILES + what it tells you?

A 
M ethanol 
U remia 
D KA / AKA **
P ropylene glycol 
I ron / INH 
L actic acidosis **
E thylene glycol 
S alicylates

mnemonic for causes of metabolic acidosis with increased anion gap

165
Q

Indications and contraindications for sodium bicarb use in the treatment of metabolic acidosis?

A

contraindications: no bicarb if DKA or hypoxia
indications: give if severe hyperkalemia

166
Q

what kind of acid/base abnormality would you expect for C Diff?

A

metabolic acidosis, because you are blowing base out your rear end

167
Q

what kind of acid/base abnormality would you expect with hyperemesis gravidarum?

A

metabolic alkalosis, because you are up-chucking acid

168
Q

why would you see hyperkalemia in metabolic acidosis?

A

your body is acidotic, meaning too much H
hydrogen/potassium pumps move extra H into the cell in exchange for a K
if the pump is moving lots of H into cells, then they are spewing out K

169
Q

ipecac: indications + contraindications

A

indications: at home ingestions
contraindications: detergent and corrosives

170
Q

gastric lavage: indications

A

only for ingestions greater than 30 minutes ago

171
Q

activated charcoal: dosage

A

1g/kg to a max of 50g - in water

can repeat q4 hours

172
Q

hypokalemia: causes

A

GI loss, diuretics and excess renal loss, alkalosis

173
Q

hypokalemia: s/s

A

muscular cramps/weakness, fatigue

if severe (less than 2.5): flaccid paralysis, tetany, rhabdomyolysis

174
Q

hypokalemia: EKG findings

A

decreased wave amplitude
U waves, broad T waves
dysrhythmias: PVC, v tach, v fib

175
Q

hyperkalemia: causes

A

excess intake, renal failure, drugs (NSAIDs), hypoaldosteronism

176
Q

hypoaldosteronism is associated with which electrolyte imbalance?

A

hyperkalemia - there is not enough aldosterone in the body to keep Na in, so all of the Na is going out in the urine. this means K is being kept instead, and it is really piling up in the serum.

177
Q

aldosterone function

A

conservation of Na

178
Q

hyperkalemia: s/s

A

weakness, flaccid paralysis

abdominal distension, diarrhea

179
Q

hyperkalemia: EKG

A

most patients won’t have changes, but peaked T waves are classic

180
Q

hyperkalemia: treatment

A

exchange resins: Kayexalate

181
Q

hypocalcemia: causes

A 
hypoPTH
hypomag
pancreatitis
renal failure
severe trauma
multiple blood transfusions
182
Q

pancreatitis is associated with what electrolyte imbalance?

A

hypocalcemia

183
Q

hypocalcemia: s/s

A

calcium calms - not enough calcium = spastic.

chvostek’s (cheek!)
trousseau’s sign (twitch!)
increased DTRs

184
Q

hypocalcemia: EKG findings

A

prolonged QT interval

185
Q

hypocalcemia: mgmt

A
  • look at blood pH, check for alkalosis
  • acute: IV calcium gluconate
  • chronic: oral supplements, Vit D, etc
186
Q

hypercalcemia: causes

A

hyperPTH, hyperthyroidism
prolonged immobilization
vitamin D intoxication

187
Q

hypercalcemia: s/s

A

calcium calms - too much calcium = sluggy.
fatigue, weakness, depresison, n/v, constipation

severe: coma and death (12+ = emergency)

188
Q

what level of Ca is considered a medical emergency?

189
Q

why hypocalcemia with alkalosis?

A

H and Ca compete for albumin binding site
alkalosis = not much H, therefore albumin binds the shit out of Ca

less Ca available

190
Q

4 Ps of spinal cord injuries

A

paralysis
pain
paresthesia
position

191
Q

spinal cord injury: C4 and above results in?

A

quadriplegia

192
Q

spinal cord injury: @ T1 - T2 results in?

A

paraplegia - can control upper extremities but not trunk

193
Q

cervical spine contains nerves that control what parts of the body?

A

arm through hand

194
Q

what parkinson’s meds increase available dopamine?

A

carbidopa-levidopa (Sinemet)
amantadine (Symmetryl)
pramipexole (Mirapex)
ropinirole (Requip)

195
Q

what anticholinergics are helpful in parkinson’s symptom alleviation?

A

benztropine (Cogentin)

trihexyphenydyle (Artane)

196
Q

what is the most common cause of dementia?

A

alzheimer’s

197
Q

alzheimer’s vs parkinson’s deficiencies

A

alzheimer’s: ACh deficiency

parkinson’s: dopamine deficiency

198
Q

Left (dominant) CVA symptoms

A

R hemiparesis

  • aphasia
  • dysarthria
  • difficulty reading/writing

think: LANGUAGE

199
Q

right (non-dominant) CVA symptoms

A

L hemiparesis
R visual field change
spatial disorientation

think: PERCEPTION

200
Q

vertebrobasilar TIA: symptoms

A

inadequate vertebral artery flow

  • vertigo/dizzy
  • ataxia/weakness
  • visual field deficit
  • confusion

think: DISORIENTATION + PERCEPTION

201
Q

carotid TIA: symptoms

A

carotid stenosis

  • aphasia
  • dysarthria
  • altered LOC
  • weak/numb

think: CLOUDY + MOTOR

202
Q

what is important to remember about SIADH and osmolarity?

A

urine osmolarity is up but serum osmolarity is down.

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