FINAL EXAM MO (Felicia) Flashcards
1
Q
EMG to the lateral rectus monitors what nerves?
A
Abducens (6)
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
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
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
5
Q
SSEP assesses the integrity of what part of the spinal cord?
A
posterior spinal cord
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
7
Q
Patient with increased ICP that suddenly rises to 30 mmHg will exhibit? SELECT 3
A
Irregular respiration
bradycardia
hypertension
8
Q
Which potential is MOST RESISTANT to anesthesia?
A
BAEP- Auditory
9
Q
- Where is the subarachnoid space on diagram?
A
look at a diagram for this one until an image is added lol
10
Q
Which nerve can be blocked to decrease pain from tourniquet inflation during IV regional anesthesia?
A
Intercostalbrachial nerve
11
Q
Aqueduct of sylvius supplies?
A
third and fourth ventricle
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)
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
14
Q
Which evoked potential is measured during pituitary surgery
A
Visual evoked potential
15
Q
What part of the brain controls the activity of interneurons in the substantia gelatinosa?
A
Periventricular and periaqueductal gray matter
16
Q
Gray Ramus contains what kind of fibers?
A
Postganglionic sympathetic fibers
17
Q
Patient has eyelid drooping, pupil fixed and dilated, not reactive to light. What nerve is damaged?
A
Oculomotor the third cranial nerve
18
Q
Name a drug combination that decreases cerebral blood flow?
A
Fentanyl- droperidol
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
20
Q
Which bone supports the pituitary gland
A
Sphenoid bone
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.
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
23
Q
Masseter muscle and temporalis muscle responses are monitored using which nerve?
A
Trigeminal CN V
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
25
In the case of venous air embolism, aspiration with a multi-orificed catheter is done by placing the tip ________ the SVC-atrial junction.
2 cm below
26
If a man is smiling and half of his face only is smiling then what nerve is injured?
Facial VII
27
Pain, afferent nerve fibers, dorsal horn ascend 1-3 seg ____ in before entering synapse dorsal horn?
Track of lissauer
28
Berry aneurysm picture, damage is where?
Anterior communicating artery
29
Picture of drop hand (wrist drop) what nerve is damaged?
radial nerve damage
30
Describe a baby with Erb-Duchenne palsy?
Excessive stretch of neck during delivery, damage to superior trunk of C5, C6. Can occur in falls, traumas. Pronated forearm, arm turned medially
31
Posterior spinal artery occlusion with loss of dorsal column tract, what sensations will you lose? Choose 2
Fine touch
| vibration
32
What two things could make Venous Air Embolism more likely to occur?
Lateral 15 degrees, head up
| use of PEEP
33
Regulation of Cerebral blood flow:
| Extrinsic mechanism, you have a what % increase for each mmHg PCO2?
2% increase for each mmHg PCO2
34
What nerve is monitored through the vocal cords in major tumor resections?
Vagus
35
Claw hand would be an injury to what nerve?
Ulnar nerve injury
36
Ape hand injury would be what nerve?
Median nerve injury
37
Warfarin is part of which pathway?
Extrinsic pathway
38
Vitamin k dependant factors are?
1972 (X IX, VII, II)
39
Pt is getting ready for heart surgery and is being heparinized. Pt ACT is not getting past 250, what do you do?
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.
40
Erythroblastosis fetalis is?
Mother is Rh- having a fetus who is Rh+
41
Pt on heparin starts bleeding. What do you give?
Protamine
42
Dipyridamole persantine increases what?
increases cAMP
43
How does Ticlopidine work?
inhibit ADP
44
Inhibition by NSAID lasts?
24-48 hours
45
How long does cox inhibition by aspirin last?
What lab will it prolong?
cox inhibition by aspirin lasts for about 8-12 days; life of PLT)
*prolongs bleeding time (BT)
46
Abciximab is what kind of drug?
GP iib/IIIa inhibitor
47
Reversal for coumadin?
vitamin K
48
What is the best test for platelet function?
Bleeding time
49
Deficiency of ____ causes Hemophilia B?
factor IX
| hemophilia A is IIX
50
Most common inherited coagulopathy is:
Von Willebrand's disease
51
Two tests used to check Warfarin levels?
PT and INR
52
Heparin is part of which pathway?
Intrinsic pathway
53
Treatment for vWD is?
dDAVP
54
Fibrin stabilizing factor?
XIII
55
After tissue injury Thromboplastin activates what factor?
factor VII
56
If a patient has priapism they most likely have what disease?
Sickle Cell Anemia
57
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:
Spleenomegaly
| spleen shrinks in Sickle cell
58
Reticulocytes are?
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)
59
Male Patient that has a High TIBC and low iron, what diagnostic study would be done next?
Occult stool and colonoscopy (rule out colon cancer; verified on review)
60
Patient complains of weakness and lightheadedness after menstruation, treatment would be?
Ferrous Sulfate
61
Pt living in a high altitude has polycythemia, what is the treatment?
no treatment needed
62
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?
Inadequate Vit. B12 absorption
63
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?
Hemophilia
| most likely A
64
Pregnant woman comes into the hospital. She is Rh(+), husband is Rh(-) and it’s there second child. What do you do.
Nothing, it is only an issues if the mom is Rh - and the child is Rh +
65
Patient with Polycythemia Vera has?
Increased blood viscosity
66
All of the following are chemical accelerators of clot formation except?
PG12
67
vWF is responsible for stabilizing?
VIII (8)
68
Patient receiving multiple blood infusions will be deficient in?
Platelets
69
If a clinical picture of a patient with DIC is described, what will that look like?
Bleeding from tubes, wounds, vascular access sites
Shock, ischemia, infection
Multiple organ failure
Increased PT, PTT, FDP, dimer.
Decreased Fibrinogen and platelets
70
Hemolytic Anemia due to mismatched blood transfusion would most likely lead to elevated blood levels off?
Free Bilirubin
71
What is the treatment of megaloblastic anemia?
Give B12 and Folic Acid
72
Anemia in a patient with chronic kidney disease or end stage renal failure, what is the treatment?
Erythropoietin
73
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?
D/C Heparin
74
Which factor activates prothrombin for conversion to thrombin?
Factor X
| Xa combines with V and converts prothrombin to thrombin
75
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?
Acute intermittent porphyria
76
Deficiency of factor ____ causes hemophilia A.
Factor VIII (Hemophilia A)
77
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?
Normal - platelets, PT
Increased - BT, PTT
she has vWD
78
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)
Platelets and PT - NORMAL
bleeding time and PTT- INCREASED
increased (von Willebrand’s disease)
79
Asprin inhibits?
Cycloxygenase 1
80
Is this statement true or false: Aspirin inhibits COX, leading to increased formation of thromboxane A2?
Not true, it would be decreased thromboxane A2.
81
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?
tPA
82
average life span of a RBC
4 months (120 days)
83
All of the following promote platelet aggregation EXCEPT:
| know what does and does not promote PLT aggregation
Prostacyclin (PG12) was the answer on exam.
PGI2 and NO decrease aggregation.
(Thromboxane A2 and ADP promote platelet aggregation.)
84
What is the major cause of diffuse bleeding after 25 pints of whole blood transfusion?
Thrombocytopenia (lack of plts)
85
The source of progesterone and estrogen in second trimester is
Placenta
86
The source of progesterone and estrogen in first trimester is:
Corpus luteum
87
How the reproductive hormones change in postmenopausal woman?
Estrogen decreases
| FSH, LH, and GnRH are increased
88
*What letter indicates HCG (graph)
highest and most sharp point on pregnancy graph
89
*What letter indicates LH (graph)
*highest peak - on the menstrual cycle days 12-14
90
*What letter indicates Progesterone?
on the menstrual cycle graph it looks like an upside down U
during pregnancy it is the middle line at the end.
91
Increase urinary excretion rate of VMA this would be diagnostic for what disorder?
Pheochromocytoma
92
Which set of labs indicates parathyroid adenoma?
Increased - PTH and Calcium
Low - Phosphorous
Primary Hyperthyrodism- Parathyroid adenoma-MCC
93
During normal menstrual cycle, LH surge predicts?
Ovulation
94
Guy has chronic diarrhea, lack of appetite, colicky abd pain…. Exam revels wheezing and bronchospasm, and flushing. Dx?
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
Deficiency of ___ causes decreased level of cortisol and androgen, increased aldosterone?
17 alpha hydroxylase deficiency
96
Incorrect statement about anesthetic management of pt with Grave’s disease?
Requires increased MAC
97
35 yr old DM 1 with difficulty managing morning hyperglycemia b/c of somogyi effect, what do you do?
Decrease evening dose of insulin
98
*During throidectomy of medullary carcinoma, pts BP suddenly rises. Assuming preexisting pheochromocytoma, what is the most probable dx?
MEN Type IIa or
Men type III
(MO accepted both answers)
99
Bipolar guy on lithium gets polyuria. Urine osm 90 and not responsive to nasal dDAVP, whats wrong?
Nephrogenic DI
100
What drug increases prolactin secretion?
Haloperidol
101
Source of ADH? choose two
posterior pituitary
hypothalamic supra optic nuclei (this is the actual correct answer but I think Mo accepted both)
102
Pt presents with HTN, buffalo hump, puffy face. Likely cause?
Prolonged steroid use
103
Rathke’s pouch develops into?
Anterior pituitary
104
Angiotension II acts on this to release aldosterone:
Zona glumerulosa
105
Most sensitive test for thyroid function?
TSH
106
Alcohol inhibits the release of ?
ADH
107
Pt with HTN leg cramps, hypokalemia, …. Nodule on adrenal cortex…
Conn's syndrome
108
Pt with head injury from skiing. Became polydipsic, serum osm 300’s, urine osmolarity 70s. Treated with dDavp and urine osmolarity increased.
Central DI
109
Man presented with changes in his appearance, hands and feet enlarged, hyperglycemic, mri revealed pituitary mass.
Acromegaly
110
Nitric oxide uses which messenger hormone?
cGMP hormone
111
Ambiguous genitalia… 9 month old? Baby picture. Testosterone levels are 4 x normal. Brother had similar problem
21 beta hydroxylase
112
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
Hypoparathyriodism (hypocalemic)
113
6 mos Pregnant , fatigued, TSH is elevated, T3 and t4 are low, what disorder is present?
Hypothyroid
114
Pregnant pt with high TBG, T3 and T4, normal TSH, treatment required?
no treatment required
115
Baby found to have elevated TSH. tx?
Levothyroxine
116
Milk production in breast is due to?
Prolactin
117
Milk ejection and let down reflex is due to?
oxytocin
118
Why does hypocalcemia cause musculare spasm and tetany?
Increases Na permeability across cell membrane
119
Man complains of frequent urination urgency. Rectal exam = BPH. Proscar is prescribed. Proscar is a?
5 alpha-reductase inhibitor
120
Destruction of posterior pituitary gland results in deficiency of?
ADH
| Oxytocin
121
Growth hormone comes from what source?
anterior pituitary
122
Lab values for cretinism?
High TSH
| low T3 and T4
123
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?
Conn's syndrome
124
What is the source of ADH?
Hypothalamic supra optic nuclei
125
What area of the kidney/nephron is known as countercurrent multiplier?
Loop of Henle (know where it is on a diagram)
126
In a diagram know which arrow represents secretion and which is reabsorption?
going out is reabsorption (into the blood stream).
| Coming into the kidney is secretion (from the blood stream)
127
Formula for Excretion?
Excretion = Filtration - Reabsorption + Secretion
128
What is used to measure GFR?
Creatinine clearance
129
Dilating efferent arterioles causes?
Decreased GFR
130
*Causes of hyperkalemia are?
Acidosis
tissue trauma
extreme exercise
131
Calcium gluconate is used for hyperkalemia for what reason?
Cardiac stabilization
132
Most important renal buffers? (2)
Phosphate and Ammonia
133
Anion gap, how do you calculate?
Na - (Cl + HCO3)
134
Patient who has been vomiting will have?
Metabolic alkalosis
135
After anesthesia the most possible acid base disorder would be?
Respiratory acidosis
136
Salicylate overdose acid base disorder?
```
Respiratory alkalosis
(also could have been high anion gap metabolic acidosis but that was not an answer)
```
137
Wife who urinates when husband squeezes her. What is the treatment? CHOOSE 2
Kegel's exercise
| a agonist
138
Treatment for incomplete emptying? CHOOSE 2
Cholinergic
Intermittent catheterization
139
Furosemide works where?
Thick ascending limb of loop of Henle
140
Which diuretic is an aldosterone antagoinist?
Spironolactone
141
*Which lab is used to determine pre renal from renal failure?
FEF na
142
All labs are indicative of renal failure except for?
a. Hyperkalemia
b. Hyperphosphatemia
c. Hypermagnesemia
d. Hypercalcemia
d. hypercalcemia (bc it would actually cause hypocalcemia due to hyperphos)
143
Most common cause of death with renal failure is?
Sepsis
144
How is cerebral blood flow autoregulated?
```
CBP constant btwn 60-160
increased CPP = vasoconstriction
decreased CPP = vasodilation
below 60 = ischemia
above 160 = hemorrhage
```
145
Acetazolamide works where?
Proximal tubule
146
Treatment for BPH?
a adrenergic blocker
147
How do you calculate renal clearance?
urine sodium X urine flow rate / plasma sodium = Renal clearance in ml/min
148
First line of defense? (talking about acid base buffering systems)
Buffer system (chemical buffer system)
149
What does diarrhea look like on a volume diagram?
ICF is normal
ECF is less
(the only change is a decrease in ECF)
150
What does DI look like on a volume diagram?
shifted to the left and a little low.
151
What would a volume diagram of infusion of isotonic solution look like?
ICF is normal
| ECF is increased
152
What would a volume diagram of SIADH look like?
Both ICF and ECF are increased
153
What would a volume diagram for Diabetes Insipidus look like?
Decreased ICF and ECF.
Top of graph increased as well.
(on exam it was the 5th diagram)
154
Five questions on ABG interpretation, so have that down. what does a perfectly normal ABG look like?
pH: 7.35-7.45
CO2: 35-45
HCO3: 22-26
155
High anion gap metabolic acidosis would be an anion gap over what?
What are the possible causes for the above?
greater than 12
```
MUDPILES:
Methanol
Uremia
DKA
Propylene glycol
Iron tab or INH
Lactic acidosis
Ethylene glycol
Salicylates/Sepsis
Starvation
```
156
What are some key features of SIADH? (what is your sodium, what is your urine osmolarity compared to serum osmolarity?)
overproduction of ADH
hyponatremia (<120)
urine osmolarity > serum osmolarity
Signs of brain swelling, lethargy, weakness, seizures, coma, death.
157
What are some key features of DI?
Hypernatremia
Colorless dilute urine osmolarity < 200
elevated plasma osmolarity > 300
158
What hormone is stimulated by EC vol. expansion?
ANP
159
Conversion of 25-OH (inactivated vit. D) to 1.25-OH (active) is performed where?
Kidneys
160
Labs/findings with Conn's syndrome?
```
Hypertension
Hypernatremia
Hypokalemia
Low plasma renin
Metabolic alkalosis
```
161
True or False, you will see increased urinary flow with SIADH?
False, the release of ADH would cause less urinary flow.
162
If a boy has precocious puberty or a girl has ambiguous genitalia what deficiency may that be?
21B-hydroxylasse deficiency (CAH)
163
What does sickle cell anemia look like under microscope?
You will see RBC's that are in the shape of a sickle.
164
What does megoloblastic anemia look like under the microscope?
abnormally large immature RBC production (less of them in the field of view, typically not as shallow in the middles)
165
What does microcytic Hypochromic cells look like?
"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
Describe Horner's syndrome?
```
loss of sympathetic tone and predominant parasympathetic tone.
Ptosis
Anhidrosis
Miosis
enopthalamos
increased temp.
flushing
nasal congestion
```
167
Where would you find the lamina on a vertebrae? (label on actual vertebrae, I am going to write it out for the answer lol)
away from the body, near the spinous process, connects spinous process to transverse process.
168
Describe falx cerebri?
fold that dips into the longitudinal fissure
169
Describe falx Cerebelli
ford that runs along the vermis of the cerebellum
170
Differentiate between cerebral steal and inverse steal?
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
Where do you place the electrode for tibial stimulation? (this is on someones head)
Right in the very middle of the head on top. (z)
172
30 y/o jumped into a pool and injured c3-c4. Neurological damage shows bilateral blindness. describe this injury?
Damage to optic nerve has occurred.
173
structure and function of BBB?
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
MOA of morphine in the substantia gelatinosa?
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
Be able to identify MC nerve on a Brachial plexus diagram.
typically MC nerve will be outside the sheath in the upper right corner.
176
Know on a cross section picture of the spinal cord where C fibers are?
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
Difference between supraspinal and spinal analgesia?
```
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
Most common cause of death if someone has Chronic renal failure is?
infection
179
The diuretic that inhibits sodium potassium chloride co transport is?
Loop diuretic (lasix)
180
Side effect of acetazolamide is? (think acid base disorder)
NORMAL anion gap metabolic acidosis
181
Urinary retention from GA treatment (2)
urinary catheterization and cholinergic drug
182
The most common type of urinary incontinent in the elderly is urge incontinent that is due to Hyperactive urinary bladder what is the treatment?
anticholinergic drugs
183
BPH treated with what type of drug?
alpha blocker
184
Tetany occurs in respiratory alkalosis due to what electrolyte?
calcium
185
ASA overdose causes what two acid base disorders?
Metabolic acidosis and Respiratory alkalosis
186
In the waiting room vomiting what acid base disorder will occur?
Metabolic alkalosis
187
Diarrhea scenario (if that is the only indicator) what acid base disorder will occur?
Metabolic acidosis
188
Most common Anesthesia related acid base situation is?
Respiratory acidosis (less breathing, but if they are being hyperventilated then Respiratory alkalosis)
189
You know that a blood gas is compensated if what level is normal?
pH
190
Pars recta is what part of the nephron?
straight portion of proximal conv. Tubule
191
In severe vomiting increased level of WHAT further increases the alkalotic state
Aldosterone
192
Which one of the following is not associated with chronic renal failure
hypercalcemia
193
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 thiazide diuretic
194
Side effect of a Acetazolamide is?
Normal anion gap metabolic acidosis
195
What is the treatment of urinary retention resulting from general anesthesia? (select 2)
Intermittent catheterization
Cholinergic drug
196
Thiazide diuretic site of action?
Distal Convoluted tubules (DCT)
197
The most common type of urinary incontinence in elderly his urge incontinence that is due to hyperactive urinary bladder. What is the treatment?
Anticholinergic drug
198
Urinary track outlet obstruction in benign Prostatic hypertrophy (BPH) can be treated with?
Alpha blocker
199
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)
Pelvic muscle (Kegel) exercises
Alpha agonist
200
Tetany occurs in respiratory alkalosis due to the decreased level of?
Calcium
201
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?
Chemical compensation through buffer system.
202
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)
Metabolic acidosis
respiratory alkalosis
203
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?
Metabolic acidosis
204
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)
Metabolic acidosis
respiratory alkalosis
205
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?
Metabolic acidosis
206
The best interpretation of this ABG (pH=7.24, pCO2=60, PO2=80, HCO3=26) is?
Acute respiratory acidosis (acute bc the bicarb has not changed yet)
207
The best interpretation of this ABG (pH=7.36, pCO2=60, PO2=80, HCO3=32) is?
Chronic respiratory acidosis with metabolic compensation
208
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?
Renal tubular acidosis
209
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.
Metabolic alkalosis
210
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?
Diarrhea
211
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?
Normal anion gap metabolic acidosis
212
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?
High anion gap metabolic acidosis
213
Which of the following are urinary buffers? (Select 2 answers)
Ammonia
| Phosphate
214
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
10ml/min
215
Which of the following tests distinguishes between prerenal from renal failure?
fractional excretion of filtered sodium (FEFNa)
216
Which one is the best test for assessment of renal function?
Creatinine clearance
217
Furosemide site of action is where?
loop of henle, specifically thick ascending loop
218
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?
3% saline at 30-40ml/hr
219
Calcium gluconate is the first line of treatment in case of hyperkalemia. This drug ______
Stabilizes cardiac cell membrane
220
Pars recta is______
Straight portion of proximal convoluted tubule
221
In severe vomiting , increase of _________further increases the alkalosis.
Aldosterone
222
All of the following causes hyperkalemia except?
Hyperventilation
223
All of the following stimulate ADH secretion except?
Decrease serum osmolarity
224
All of the following stimulate ADH secretion except?
Decrease serum osmolarity
225
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
40L/min
226
Ace inhibitors e.g. captopril dilate the efferent arteriol. This causes GFR to______
Decrease
227
_____ Is a major determinant of serum osmolarity
sodium
228
Vitamin ______ is activated in the kidney ?
D
229
67% of filtered sodium and potassium is absorbed in the..
Proximal convoluted tubules
