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SUM '20 Final Exams Prep > FINAL EXAM MO (Felicia) > Flashcards

FINAL EXAM MO (Felicia) Flashcards

1
Q

EMG to the lateral rectus monitors what nerves?

A

Abducens (6)

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2
Q

*On a diagram, what area of the brain would be supplied by the anterior cerebral artery?

A

outer layer of the brain, Left/Top side. (blue on exam)

anterior meaning top

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3
Q

*On a diagram, what area of the brain is supplied by the posterior cerebral artery?

A

outer lower right side of the brain. (green on exam)

posterior- lower area

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4
Q 
Calculate CPP:
BP = 100/70
HR = 65
RAP = 10
ICP = 15
A

CPP = MAP - ICP

MAP is [(diastolic x 2 )plus systolic] / 3.

Thus 80-15 = 65 = CPP

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5
Q

SSEP assesses the integrity of what part of the spinal cord?

A

posterior spinal cord

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6
Q

Name structures pierced during lumbar puncture? (short answer)

A 
Skin
subcutaneous tissue
supraspinous ligament
interspinous ligament
ligamentum flavum
epidural space
dura mater
subdural space*
arachnoid mater
subarachnoid space
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7
Q

Patient with increased ICP that suddenly rises to 30 mmHg will exhibit? SELECT 3

A

Irregular respiration
bradycardia
hypertension

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8
Q

Which potential is MOST RESISTANT to anesthesia?

A

BAEP- Auditory

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9
Q
  • Where is the subarachnoid space on diagram?
A

look at a diagram for this one until an image is added lol

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10
Q

Which nerve can be blocked to decrease pain from tourniquet inflation during IV regional anesthesia?

A

Intercostalbrachial nerve

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11
Q

Aqueduct of sylvius supplies?

A

third and fourth ventricle

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12
Q

*Cerebral blood flow and partial pressure graph, know what each line represents.

A 
x = PaCO2 (line that starts low and ends at the top)
y = PaO2 (line that starts high and levels out in the middle)
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13
Q

*Tell me where on the hand (posterior and anterior) which nerves innervate what parts of the hand.

A

ulnar is pinky and half of ring finger of hand on both sides (blue)

Radial is typically green on diagram and median is yellow lol

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14
Q

Which evoked potential is measured during pituitary surgery

A

Visual evoked potential

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15
Q

What part of the brain controls the activity of interneurons in the substantia gelatinosa?

A

Periventricular and periaqueductal gray matter

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16
Q

Gray Ramus contains what kind of fibers?

A

Postganglionic sympathetic fibers

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17
Q

Patient has eyelid drooping, pupil fixed and dilated, not reactive to light. What nerve is damaged?

A

Oculomotor the third cranial nerve

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18
Q

Name a drug combination that decreases cerebral blood flow?

A

Fentanyl- droperidol

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19
Q

A 55-year-old is undergoing an intracranial tumor resection under GA. Preoperatively, the patient is alert & oriented and has no focal neurological deficit. Within what range should the PaCO2 be maintained during surgery?

A

25-30

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20
Q

Which bone supports the pituitary gland

A

Sphenoid bone

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21
Q

Ketamine, tell me if it has any change on CMR, CBF, CSF production, CSF re-absorption, CBV, or ICP?

A

Ketamine:

has little or no change to CMR or CSF production.

Increases CBF, CBV, ICP.

Decreases only CSF re-absorption.

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22
Q

If someone has head trauma and you are choosing an agent to treat them with, what would you want said agent to possess?

A

be able to decrease CMR, CBF, CBV, ICP

and increased re-absorbtion of CSF

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23
Q

Masseter muscle and temporalis muscle responses are monitored using which nerve?

A

Trigeminal CN V

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24
Q

In the case of venous air embolism, aspiration with a single-orificed catheter is done by placing the tip ________ the SVC-atrial junction.

A

3 cm above

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25
Q

In the case of venous air embolism, aspiration with a multi-orificed catheter is done by placing the tip ________ the SVC-atrial junction.

A

2 cm below

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26
Q

If a man is smiling and half of his face only is smiling then what nerve is injured?

A

Facial VII

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27
Q

Pain, afferent nerve fibers, dorsal horn ascend 1-3 seg ____ in before entering synapse dorsal horn?

A

Track of lissauer

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28
Q

Berry aneurysm picture, damage is where?

A

Anterior communicating artery

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29
Q

Picture of drop hand (wrist drop) what nerve is damaged?

A

radial nerve damage

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30
Q

Describe a baby with Erb-Duchenne palsy?

A

Excessive stretch of neck during delivery, damage to superior trunk of C5, C6. Can occur in falls, traumas. Pronated forearm, arm turned medially

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31
Q

Posterior spinal artery occlusion with loss of dorsal column tract, what sensations will you lose? Choose 2

A

Fine touch

vibration

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32
Q

What two things could make Venous Air Embolism more likely to occur?

A

Lateral 15 degrees, head up

use of PEEP

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33
Q

Regulation of Cerebral blood flow:

Extrinsic mechanism, you have a what % increase for each mmHg PCO2?

A

2% increase for each mmHg PCO2

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34
Q

What nerve is monitored through the vocal cords in major tumor resections?

A

Vagus

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35
Q

Claw hand would be an injury to what nerve?

A

Ulnar nerve injury

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36
Q

Ape hand injury would be what nerve?

A

Median nerve injury

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37
Q

Warfarin is part of which pathway?

A

Extrinsic pathway

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38
Q

Vitamin k dependant factors are?

A

1972 (X IX, VII, II)

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39
Q

Pt is getting ready for heart surgery and is being heparinized. Pt ACT is not getting past 250, what do you do?

A

Give FFP

If a patient is being heparinized for heart surgery you want their ACT 400-450, you will not proceed with surgery if below 400.

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40
Q

Erythroblastosis fetalis is?

A

Mother is Rh- having a fetus who is Rh+

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41
Q

Pt on heparin starts bleeding. What do you give?

A

Protamine

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42
Q

Dipyridamole persantine increases what?

A

increases cAMP

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43
Q

How does Ticlopidine work?

A

inhibit ADP

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44
Q

Inhibition by NSAID lasts?

A

24-48 hours

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45
Q

How long does cox inhibition by aspirin last?

What lab will it prolong?

A

cox inhibition by aspirin lasts for about 8-12 days; life of PLT)

*prolongs bleeding time (BT)

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46
Q

Abciximab is what kind of drug?

A

GP iib/IIIa inhibitor

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47
Q

Reversal for coumadin?

A

vitamin K

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48
Q

What is the best test for platelet function?

A

Bleeding time

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49
Q

Deficiency of ____ causes Hemophilia B?

A

factor IX

hemophilia A is IIX

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50
Q

Most common inherited coagulopathy is:

A

Von Willebrand’s disease

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51
Q

Two tests used to check Warfarin levels?

A

PT and INR

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52
Q

Heparin is part of which pathway?

A

Intrinsic pathway

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53
Q

Treatment for vWD is?

A

dDAVP

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54
Q

Fibrin stabilizing factor?

A

XIII

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55
Q

After tissue injury Thromboplastin activates what factor?

A

factor VII

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56
Q

If a patient has priapism they most likely have what disease?

A

Sickle Cell Anemia

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57
Q

A 20 year old African American male with sickle cell Anemia (ss homozygous) has had several episodes of painful crises. The LEAST likely physical finding in this patient is:

A

Spleenomegaly

spleen shrinks in Sickle cell

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58
Q

Reticulocytes are?

A

Immature RBCs thus if you have an over production then it would mean an anemia may have been or is present. The body produces more during times of anemia.

(I blv RBC was the answer on the test)

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59
Q

Male Patient that has a High TIBC and low iron, what diagnostic study would be done next?

A

Occult stool and colonoscopy (rule out colon cancer; verified on review)

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60
Q

Patient complains of weakness and lightheadedness after menstruation, treatment would be?

A

Ferrous Sulfate

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61
Q

Pt living in a high altitude has polycythemia, what is the treatment?

A

no treatment needed

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62
Q

64 year old male patient develops a macrocytic anemia after surgery to remove a large part of his stomach. Which of the following is the most likely cause of this patients problem?

A

Inadequate Vit. B12 absorption

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63
Q

Male Pt(baby) cannot stop bleeding after a heel stick. History of prolonged bleeding time after circumcision. Bruises on elbows, what disorder does he most likely have?

A

Hemophilia

most likely A

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64
Q

Pregnant woman comes into the hospital. She is Rh(+), husband is Rh(-) and it’s there second child. What do you do.

A

Nothing, it is only an issues if the mom is Rh - and the child is Rh +

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65
Q

Patient with Polycythemia Vera has?

A

Increased blood viscosity

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66
Q

All of the following are chemical accelerators of clot formation except?

A

PG12

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67
Q

vWF is responsible for stabilizing?

A

VIII (8)

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68
Q

Patient receiving multiple blood infusions will be deficient in?

A

Platelets

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69
Q

If a clinical picture of a patient with DIC is described, what will that look like?

A

Bleeding from tubes, wounds, vascular access sites
Shock, ischemia, infection
Multiple organ failure

Increased PT, PTT, FDP, dimer.

Decreased Fibrinogen and platelets

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70
Q

Hemolytic Anemia due to mismatched blood transfusion would most likely lead to elevated blood levels off?

A

Free Bilirubin

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71
Q

What is the treatment of megaloblastic anemia?

A

Give B12 and Folic Acid

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72
Q

Anemia in a patient with chronic kidney disease or end stage renal failure, what is the treatment?

A

Erythropoietin

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73
Q

A 64 year old male is hospitalized with TIA and is evaluated for carotid disease. PE normal. CBC normal. The patient is started on heparin. A repeat cbc one week later show Hb of 14 g/dl. You should?

A

D/C Heparin

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74
Q

Which factor activates prothrombin for conversion to thrombin?

A

Factor X

Xa combines with V and converts prothrombin to thrombin

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75
Q

Patient presented with pain in abdomen, (I think it said pink tinged urine too?), accumulation of aminolevulinic acid (ALA) and uroporphyrins, what do they have?

A

Acute intermittent porphyria

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76
Q

Deficiency of factor ____ causes hemophilia A.

A

Factor VIII (Hemophilia A)

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77
Q

Female pt with heavy periods last 8-9 days and difficult to stop bleeding after cut. What is increased or decreased and what disorder does she have?

A

Normal - platelets, PT
Increased - BT, PTT

she has vWD

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78
Q

Female pt with heavy periods last 8-9 days and difficult to stop bleeding after cut. What is increased or decreased and what disorder does she have?
(PLT, PT, BT, PTT)

A

Platelets and PT - NORMAL
bleeding time and PTT- INCREASED
increased (von Willebrand’s disease)

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79
Q

Asprin inhibits?

A

Cycloxygenase 1

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80
Q

Is this statement true or false: Aspirin inhibits COX, leading to increased formation of thromboxane A2?

A

Not true, it would be decreased thromboxane A2.

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81
Q

66 yr old woman comes to ER 30 mins after the onset of chest pain that radiates to neck and left arm. She is diaphoretic and hypotensive; the serum troponin-I is elevated. Thrombolytic therapy is begun. Which of the following drugs is most likely to be administered?

A

tPA

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82
Q

average life span of a RBC

A

4 months (120 days)

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83
Q

All of the following promote platelet aggregation EXCEPT:

know what does and does not promote PLT aggregation

A

Prostacyclin (PG12) was the answer on exam.

PGI2 and NO decrease aggregation.

(Thromboxane A2 and ADP promote platelet aggregation.)

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84
Q

What is the major cause of diffuse bleeding after 25 pints of whole blood transfusion?

A

Thrombocytopenia (lack of plts)

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85
Q

The source of progesterone and estrogen in second trimester is

A

Placenta

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86
Q

The source of progesterone and estrogen in first trimester is:

A

Corpus luteum

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87
Q

How the reproductive hormones change in postmenopausal woman?

A

Estrogen decreases

FSH, LH, and GnRH are increased

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88
Q

*What letter indicates HCG (graph)

A

highest and most sharp point on pregnancy graph

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89
Q

*What letter indicates LH (graph)

A

*highest peak - on the menstrual cycle days 12-14

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90
Q

*What letter indicates Progesterone?

A

on the menstrual cycle graph it looks like an upside down U

during pregnancy it is the middle line at the end.

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91
Q

Increase urinary excretion rate of VMA this would be diagnostic for what disorder?

A

Pheochromocytoma

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92
Q

Which set of labs indicates parathyroid adenoma?

A

Increased - PTH and Calcium
Low - Phosphorous

Primary Hyperthyrodism- Parathyroid adenoma-MCC

93
Q

During normal menstrual cycle, LH surge predicts?

A

Ovulation

94
Q

Guy has chronic diarrhea, lack of appetite, colicky abd pain…. Exam revels wheezing and bronchospasm, and flushing. Dx?

A

He has increased level of 5-hydroxyindolacetic acid (5-HIAA) in his urine.

The answer on the exam was increased 5-HIAA in urine

95
Q

Deficiency of ___ causes decreased level of cortisol and androgen, increased aldosterone?

A

17 alpha hydroxylase deficiency

96
Q

Incorrect statement about anesthetic management of pt with Grave’s disease?

A

Requires increased MAC

97
Q

35 yr old DM 1 with difficulty managing morning hyperglycemia b/c of somogyi effect, what do you do?

A

Decrease evening dose of insulin

98
Q

*During throidectomy of medullary carcinoma, pts BP suddenly rises. Assuming preexisting pheochromocytoma, what is the most probable dx?

A

MEN Type IIa or
Men type III
(MO accepted both answers)

99
Q

Bipolar guy on lithium gets polyuria. Urine osm 90 and not responsive to nasal dDAVP, whats wrong?

A

Nephrogenic DI

100
Q

What drug increases prolactin secretion?

A

Haloperidol

101
Q

Source of ADH? choose two

A

posterior pituitary

hypothalamic supra optic nuclei (this is the actual correct answer but I think Mo accepted both)

102
Q

Pt presents with HTN, buffalo hump, puffy face. Likely cause?

A

Prolonged steroid use

103
Q

Rathke’s pouch develops into?

A

Anterior pituitary

104
Q

Angiotension II acts on this to release aldosterone:

A

Zona glumerulosa

105
Q

Most sensitive test for thyroid function?

A

TSH

106
Q

Alcohol inhibits the release of ?

A

ADH

107
Q

Pt with HTN leg cramps, hypokalemia, …. Nodule on adrenal cortex…

A

Conn’s syndrome

108
Q

Pt with head injury from skiing. Became polydipsic, serum osm 300’s, urine osmolarity 70s. Treated with dDavp and urine osmolarity increased.

A

Central DI

109
Q

Man presented with changes in his appearance, hands and feet enlarged, hyperglycemic, mri revealed pituitary mass.

A

Acromegaly

110
Q

Nitric oxide uses which messenger hormone?

A

cGMP hormone

111
Q

Ambiguous genitalia… 9 month old? Baby picture. Testosterone levels are 4 x normal. Brother had similar problem

A

21 beta hydroxylase

112
Q

Pt had a seizure. Had thyroid surgery a year ago. CC fatigue, circumoral and foot numbness, hand fascculation, calf cramps. When her bp was check a wrist spasm was seen

A

Hypoparathyriodism (hypocalemic)

113
Q

6 mos Pregnant , fatigued, TSH is elevated, T3 and t4 are low, what disorder is present?

A

Hypothyroid

114
Q

Pregnant pt with high TBG, T3 and T4, normal TSH, treatment required?

A

no treatment required

115
Q

Baby found to have elevated TSH. tx?

A

Levothyroxine

116
Q

Milk production in breast is due to?

A

Prolactin

117
Q

Milk ejection and let down reflex is due to?

A

oxytocin

118
Q

Why does hypocalcemia cause musculare spasm and tetany?

A

Increases Na permeability across cell membrane

119
Q

Man complains of frequent urination urgency. Rectal exam = BPH. Proscar is prescribed. Proscar is a?

A

5 alpha-reductase inhibitor

120
Q

Destruction of posterior pituitary gland results in deficiency of?

A

ADH

Oxytocin

121
Q

Growth hormone comes from what source?

A

anterior pituitary

122
Q

Lab values for cretinism?

A

High TSH

low T3 and T4

123
Q

42 year old female is discovered to have hypertension on a routine physical exam, weakness and leg cramps, BP 165/110 labs show low serum potassium. High serum something…low plasma renin. Ct scan shows 1.7cm nodular mass on left adrenal cortex, what is going on?

A

Conn’s syndrome

124
Q

What is the source of ADH?

A

Hypothalamic supra optic nuclei

125
Q

What area of the kidney/nephron is known as countercurrent multiplier?

A

Loop of Henle (know where it is on a diagram)

126
Q

In a diagram know which arrow represents secretion and which is reabsorption?

A

going out is reabsorption (into the blood stream).

Coming into the kidney is secretion (from the blood stream)

127
Q

Formula for Excretion?

A

Excretion = Filtration - Reabsorption + Secretion

128
Q

What is used to measure GFR?

A

Creatinine clearance

129
Q

Dilating efferent arterioles causes?

A

Decreased GFR

130
Q

*Causes of hyperkalemia are?

A

Acidosis
tissue trauma
extreme exercise

131
Q

Calcium gluconate is used for hyperkalemia for what reason?

A

Cardiac stabilization

132
Q

Most important renal buffers? (2)

A

Phosphate and Ammonia

133
Q

Anion gap, how do you calculate?

A

Na - (Cl + HCO3)

134
Q

Patient who has been vomiting will have?

A

Metabolic alkalosis

135
Q

After anesthesia the most possible acid base disorder would be?

A

Respiratory acidosis

136
Q

Salicylate overdose acid base disorder?

A 
Respiratory alkalosis
(also could have been high anion gap metabolic acidosis but that was not an answer)
137
Q

Wife who urinates when husband squeezes her. What is the treatment? CHOOSE 2

A

Kegel’s exercise

a agonist

138
Q

Treatment for incomplete emptying? CHOOSE 2

A

Cholinergic

Intermittent catheterization

139
Q

Furosemide works where?

A

Thick ascending limb of loop of Henle

140
Q

Which diuretic is an aldosterone antagoinist?

A

Spironolactone

141
Q

*Which lab is used to determine pre renal from renal failure?

A

FEF na

142
Q

All labs are indicative of renal failure except for?

a. Hyperkalemia
b. Hyperphosphatemia
c. Hypermagnesemia
d. Hypercalcemia

A

d. hypercalcemia (bc it would actually cause hypocalcemia due to hyperphos)

143
Q

Most common cause of death with renal failure is?

A

Sepsis

144
Q

How is cerebral blood flow autoregulated?

A 
CBP constant btwn 60-160
increased CPP = vasoconstriction
decreased CPP = vasodilation
below 60 = ischemia
above 160 = hemorrhage
145
Q

Acetazolamide works where?

A

Proximal tubule

146
Q

Treatment for BPH?

A

a adrenergic blocker

147
Q

How do you calculate renal clearance?

A

urine sodium X urine flow rate / plasma sodium = Renal clearance in ml/min

148
Q

First line of defense? (talking about acid base buffering systems)

A

Buffer system (chemical buffer system)

149
Q

What does diarrhea look like on a volume diagram?

A

ICF is normal
ECF is less

(the only change is a decrease in ECF)

150
Q

What does DI look like on a volume diagram?

A

shifted to the left and a little low.

151
Q

What would a volume diagram of infusion of isotonic solution look like?

A

ICF is normal

ECF is increased

152
Q

What would a volume diagram of SIADH look like?

A

Both ICF and ECF are increased

153
Q

What would a volume diagram for Diabetes Insipidus look like?

A

Decreased ICF and ECF.
Top of graph increased as well.

(on exam it was the 5th diagram)

154
Q

Five questions on ABG interpretation, so have that down. what does a perfectly normal ABG look like?

A

pH: 7.35-7.45
CO2: 35-45
HCO3: 22-26

155
Q

High anion gap metabolic acidosis would be an anion gap over what?
What are the possible causes for the above?

A

greater than 12

MUDPILES:
Methanol
Uremia
DKA
Propylene glycol
Iron tab or INH
Lactic acidosis
Ethylene glycol
Salicylates/Sepsis
Starvation
156
Q

What are some key features of SIADH? (what is your sodium, what is your urine osmolarity compared to serum osmolarity?)

A

overproduction of ADH

hyponatremia (<120)

urine osmolarity > serum osmolarity

Signs of brain swelling, lethargy, weakness, seizures, coma, death.

157
Q

What are some key features of DI?

A

Hypernatremia

Colorless dilute urine osmolarity < 200

elevated plasma osmolarity > 300

158
Q

What hormone is stimulated by EC vol. expansion?

A

ANP

159
Q

Conversion of 25-OH (inactivated vit. D) to 1.25-OH (active) is performed where?

A

Kidneys

160
Q

Labs/findings with Conn’s syndrome?

A 
Hypertension
Hypernatremia
Hypokalemia
Low plasma renin
Metabolic alkalosis
161
Q

True or False, you will see increased urinary flow with SIADH?

A

False, the release of ADH would cause less urinary flow.

162
Q

If a boy has precocious puberty or a girl has ambiguous genitalia what deficiency may that be?

A

21B-hydroxylasse deficiency (CAH)

163
Q

What does sickle cell anemia look like under microscope?

A

You will see RBC’s that are in the shape of a sickle.

164
Q

What does megoloblastic anemia look like under the microscope?

A

abnormally large immature RBC production (less of them in the field of view, typically not as shallow in the middles)

165
Q

What does microcytic Hypochromic cells look like?

A

“hypochromic” this will look like a lot of RBC but are very pale in color and shallow looking. These red blood cells have less hemoglobin than normal.

166
Q

Describe Horner’s syndrome?

A 
loss of sympathetic tone and predominant parasympathetic tone. 
Ptosis
Anhidrosis
Miosis
enopthalamos
increased temp.
flushing
nasal congestion
167
Q

Where would you find the lamina on a vertebrae? (label on actual vertebrae, I am going to write it out for the answer lol)

A

away from the body, near the spinous process, connects spinous process to transverse process.

168
Q

Describe falx cerebri?

A

fold that dips into the longitudinal fissure

169
Q

Describe falx Cerebelli

A

ford that runs along the vermis of the cerebellum

170
Q

Differentiate between cerebral steal and inverse steal?

A

Cerebral steal is when through vasodilators or hypoventilation blood flow to non-ischemic brain increases and flow to ischemic brain decreases.

Inverse steal is when a patient with an ischemic region is hyperventilated and blood vessels in the non-ischemic brain constrict and blood is diverted to ischemic brain.

171
Q

Where do you place the electrode for tibial stimulation? (this is on someones head)

A

Right in the very middle of the head on top. (z)

172
Q

30 y/o jumped into a pool and injured c3-c4. Neurological damage shows bilateral blindness. describe this injury?

A

Damage to optic nerve has occurred.

173
Q

structure and function of BBB?

A

Non polar/lipid soluble substances cross more readily (via diffusion) than polar/water soluble ones, BUT water moves freely across BBB.

Functions to maintain a constant environment for neurons and protect the brain from toxins.

Prevents the escape of NT from their functional sites in the CNS into the general circulation.

174
Q

MOA of morphine in the substantia gelatinosa?

A

Morphine acts on opioid receptors in the substantia gelatinosa to decrease calcium entry and increase potassium out flux in order to inhibit the release of substance P and then the transmission of pain is reduced.

175
Q

Be able to identify MC nerve on a Brachial plexus diagram.

A

typically MC nerve will be outside the sheath in the upper right corner.

176
Q

Know on a cross section picture of the spinal cord where C fibers are?

A

C fibers were denoted with an X on the previous exam. They are the slow-chronic pain fibers, they lie under the A delta fibers in the tact of L.

177
Q

Difference between supraspinal and spinal analgesia?

A 
Spinal analgesia (relief of pain without loss of consciousness ) - Mainly mu-2 receptors.
Occurs when transmission of pain through SG is suppressed after epidural or spinal administration.

Supraspinal analgesia opioids act on limbic system, hypothalmus, and thalmus. Mediated by Mu-1 dominantly.
“I feel pain but I don’t care”

178
Q

Most common cause of death if someone has Chronic renal failure is?

A

infection

179
Q

The diuretic that inhibits sodium potassium chloride co transport is?

A

Loop diuretic (lasix)

180
Q

Side effect of acetazolamide is? (think acid base disorder)

A

NORMAL anion gap metabolic acidosis

181
Q

Urinary retention from GA treatment (2)

A

urinary catheterization and cholinergic drug

182
Q

The most common type of urinary incontinent in the elderly is urge incontinent that is due to Hyperactive urinary bladder what is the treatment?

A

anticholinergic drugs

183
Q

BPH treated with what type of drug?

A

alpha blocker

184
Q

Tetany occurs in respiratory alkalosis due to what electrolyte?

A

calcium

185
Q

ASA overdose causes what two acid base disorders?

A

Metabolic acidosis and Respiratory alkalosis

186
Q

In the waiting room vomiting what acid base disorder will occur?

A

Metabolic alkalosis

187
Q

Diarrhea scenario (if that is the only indicator) what acid base disorder will occur?

A

Metabolic acidosis

188
Q

Most common Anesthesia related acid base situation is?

A

Respiratory acidosis (less breathing, but if they are being hyperventilated then Respiratory alkalosis)

189
Q

You know that a blood gas is compensated if what level is normal?

A

pH

190
Q

Pars recta is what part of the nephron?

A

straight portion of proximal conv. Tubule

191
Q

In severe vomiting increased level of WHAT further increases the alkalotic state

A

Aldosterone

192
Q

Which one of the following is not associated with chronic renal failure

A

hypercalcemia

193
Q

A patient with multiple myeloma is hospitalized after 2 days of polyurea polydipsia and increasing confusion. Lab shows serum osmolarity of 310 mOsm/L and elevated serum calcium of 18 mg/dl. After making initial diagnosis treatment is started to decrease serum calcium. Unfortunately, a wrong drug is administered in error that produces further increase in the patient serum calcium. That drug is_________

A

A thiazide diuretic

194
Q

Side effect of a Acetazolamide is?

A

Normal anion gap metabolic acidosis

195
Q

What is the treatment of urinary retention resulting from general anesthesia? (select 2)

A

Intermittent catheterization

Cholinergic drug

196
Q

Thiazide diuretic site of action?

A

Distal Convoluted tubules (DCT)

197
Q

The most common type of urinary incontinence in elderly his urge incontinence that is due to hyperactive urinary bladder. What is the treatment?

A

Anticholinergic drug

198
Q

Urinary track outlet obstruction in benign Prostatic hypertrophy (BPH) can be treated with?

A

Alpha blocker

199
Q

A 36-year-old emotionally distressed woman complains of loss of urine, every time her husband squeezes her around his arms while hugging. She also avoids laughing out loud as it also results in same embarrassing accident. What is the treatment? (Select 2 answers)

A

Pelvic muscle (Kegel) exercises

Alpha agonist

200
Q

Tetany occurs in respiratory alkalosis due to the decreased level of?

A

Calcium

201
Q

A 3-year-old boy is admitted to the ER after accidentally ingested acetic acid which of the following is the first line of defense?

A

Chemical compensation through buffer system.

202
Q

A patient with a history of frequent and severe migraine headaches arrives at your office complaining of stomach pain and rapid breathing. She informs you that she has had a severe migraine for the past two days and has taken 6 times more than recommended dose of aspirin to relieve her headache for the past two days. Which of the following would you expect? (Select 2 answers)

A

Metabolic acidosis

respiratory alkalosis

203
Q

A woman returns from a trip to China with “travelers’ diarrhea”. She has weakness, weight loss, orthostatic hypotension, increased pulse rate, increased breathing rate, pale skin. PH 7.25 PCO2 34 HCO3 10.2. What is the diagnosis?

A

Metabolic acidosis

204
Q

A patient with a history of frequent and severe migraine headaches arrives at your office complaining of stomach pain and rapid breathing. She informs you that she has had a severe migraine for the past two days and has taken 6 times more than recommended dose of aspirin to relieve her headache for the past two days. Which of the following would you expect? (Select 2 answers)

A

Metabolic acidosis

respiratory alkalosis

205
Q

A woman returns from a trip to China with “travelers’ diarrhea”. She has weakness, weight loss, orthostatic hypotension, increased pulse rate, increased breathing rate, pale skin. PH 7.25 PCO2 34 HCO3 10.2. What is the diagnosis?

A

Metabolic acidosis

206
Q

The best interpretation of this ABG (pH=7.24, pCO2=60, PO2=80, HCO3=26) is?

A

Acute respiratory acidosis (acute bc the bicarb has not changed yet)

207
Q

The best interpretation of this ABG (pH=7.36, pCO2=60, PO2=80, HCO3=32) is?

A

Chronic respiratory acidosis with metabolic compensation

208
Q

A patient has the following laboratory values arterial pH=7.25, Plasma HCO3=13mEq/L plasma chloride conc =118 mEq/L, Arterial PCO2=30mmhg, Plasma Na+ conc =141mEq/L. What is the most likely cause of his condition?

A

Renal tubular acidosis

209
Q

A 68-year-old female is found at home hypotensive BP equals 85 over 55 and confused. labs Na= 130, K= 2.6, HCO3=50, chloride =70, creatinine=1.7, BUN =40, calcium =10, PO2 =62, PCO2 =47, PH =7.63.

A

Metabolic alkalosis

210
Q

A70 year old male is found lethargic at home with a blood pressure of 98/60 and a temperature of 98F. Labs Na=138, K=2.8, HCO3=10, Cl=117, Cr=1.0, BUN=20, Ca=10, PO2=80, PCO2=25 and pH=7.29. Urine pH=4.5. What is the most likely cause of the patient’s disorders?

A

Diarrhea

211
Q

A70 year old male is found lethargic at home with a blood pressure of 98/60 and a temperature of 98F. Labs Na=138, K=2.8, HCO3=10, Cl=117, Cr=1.0, BUN=20, Ca=10, PO2=80, PCO2=25 and pH=7.29. Urine pH=4.5. What is the acid base disorder?

A

Normal anion gap metabolic acidosis

212
Q

A 30-year-old male is brought to the ER from prison, where he works in the paint shop. He has no past medical history. CT scan of the head is normal. Urine toxicology is negative. Ethanol and acetaminophen are not detectable. Labs Na=138, K=4.2, HCO3=5, Cl=104, Cr=1.0, BUN=14, Ca=10, PO2=96, PCO2=20 and pH=7.02. Blood glucose=90. Urine analysis is normal without blood, protein or crystals. Physical examination: BP=100/60 with no orthostatic change. Neurological exam: barely arousable, no focal abnormalities, responds to deep pain. What is the acid base disorder?

A

High anion gap metabolic acidosis

213
Q

Which of the following are urinary buffers? (Select 2 answers)

A

Ammonia

Phosphate

214
Q

What is the clearance of a substance when its concentration in the plasma is 20mg/dL, its concentration in the urine is 100mg/dL, and the urine flow is 2ml/min

A

10ml/min

215
Q

Which of the following tests distinguishes between prerenal from renal failure?

A

fractional excretion of filtered sodium (FEFNa)

216
Q

Which one is the best test for assessment of renal function?

A

Creatinine clearance

217
Q

Furosemide site of action is where?

A

loop of henle, specifically thick ascending loop

218
Q

A patient with serum sodium of 110mEq/L suffers grand Mal seizures. CT scan of the head and lumbar puncture are normal. What is the immediate treatment of hyponatremia?

A

3% saline at 30-40ml/hr

219
Q

Calcium gluconate is the first line of treatment in case of hyperkalemia. This drug ______

A

Stabilizes cardiac cell membrane

220
Q

Pars recta is______

A

Straight portion of proximal convoluted tubule

221
Q

In severe vomiting , increase of _________further increases the alkalosis.

A

Aldosterone

222
Q

All of the following causes hyperkalemia except?

A

Hyperventilation

223
Q

All of the following stimulate ADH secretion except?

A

Decrease serum osmolarity

224
Q

All of the following stimulate ADH secretion except?

A

Decrease serum osmolarity

225
Q

You wish to evaluate kidney function in 55-year-old, obese man with type 2 diabetes, and you ask him to collect his urine over 24 hour. He returns to you 4320 ml of urine. Labs: Plasma creatinine=3.0mg/100mL Urine creatinine=40mg/dL, plasma K+= 5.0, Urine K+=20. What is his approximate GFR

A

40L/min

226
Q

Ace inhibitors e.g. captopril dilate the efferent arteriol. This causes GFR to______

A

Decrease

227
Q

_____ Is a major determinant of serum osmolarity

A

sodium

228
Q

Vitamin ______ is activated in the kidney ?

A

D

229
Q

67% of filtered sodium and potassium is absorbed in the..

A

Proximal convoluted tubules

SUM '20 Final Exams Prep (7 decks)

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