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Clinical Medicine LAB - Professor Sample > GU #2 > Flashcards

GU #2 Flashcards

1
Q

Electrolyte Studies purpose?

A

To delineate fluid and electrolyte status

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2
Q

Electrolyte Studies useful in?

A

Hospitalized patients
Critical or unstable patients
Post-operative patients
Outpatients

**useful in hospitalized patients - cause we need to constantly monitor them
*
** dehydration
dialysis - potassium, phosphorus *

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3
Q

What does a BMP have?

A 
Glucose
Calcium
Sodium
Potassium
CO2
Chloride
Blood urea nitrogen (BUN)
Creatinine
Anion Gap
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4
Q

What are the CMP adds to a BMP?

A 
Albumin
Protein
ALP
AST
ALT
Total Bilirubin
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5
Q

Sodium is the major ______ in the _____cellular space

A

Major cation in the extracellular space

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6
Q

What is the major determinant of extracellular osmolality?

A

Na

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7
Q

Balancing sodium is a trade off between _________ intake and renal _________

A

dietary intake and renal excretion

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8
Q

what is the average daily intake of Na needed to maintain sodium balance in adults?

A

90-250 meQ/day

**contains the osmotic gradient, water follows sodium, controlled by kidneys and they are constant balancing dietary intakes and excretion of sodium, aldosterone - reabsorb sodium and ADH - reabsorb water ( 2 main players in regulating sodium concentration)*

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9
Q

Normal sodium level?

A

135-145 mEq/L

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10
Q

Sodium critical values?

A

<120

> 160

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11
Q

Sodium critical values: <120 sxs.?

A

weakness, fatigue, delirium, hyperreflexia

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12
Q

Sodium critical values: >160 sxs.?

A

confusion, hyperreflexia, seizures, coma

**you can go into a coma with low or high*

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13
Q

Sodium increased: increased NA intake causes?

A

Increased dietary intake

Hyperosmotic IV fluids -
can raise sodium levels so be careful

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14
Q

Sodium increased: Decreased Na loss causes?

A

Cushing syndrome
excess mineralocorticoids

hyperaldosteronism - increased aldosterone you are going to not longs so much sodium which will give you increased serum sodium levels

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15
Q

Sodium increased: Excessive free water loss?

A 
GI loss
Excessive sweating
Extensive burns
Diabetes insipidus
Osmotic diuresis

**losing water you get more conc. of particles *

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16
Q

Sodium decreased: Decreased Na intake causes?

A

Deficient intake

Hypotonic IV fluids

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17
Q

Sodium decreased: Increased Na loss causes?

A

Addison disease

Diarrhea/vomiting

NG suction

Diuretics

CRI

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18
Q

Sodium decreased: Increased free water causes?

A

Psychogenic polydipsia
drink to much water

Hyperglycemia
shift osmotic gradient where you have increased free water in the vasculature cause the glucose pulls it in

CHF

Ascites

SIADH - increased in ADH and pull water back into the vascular

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19
Q

Hypovolemic Hyponatremia: renal causes?

A

Primary adrenal insufficiency (aldosterone deficit)

Interstitial nephropathies

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20
Q

Hypovolemic Hyponatremia: Nonrenal causes?

A

GI loss - Vomiting, diarrhea, tube drainage

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21
Q

Hypovolemic Hyponatremia:

Insensible loss?

A

Sweating or burns in the absence of repletion

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22
Q

Euvolemic Hyponatremia is caused secondary by _____________________ from the pituitary gland

A

adrenal insufficiency

glucocorticoid deficiency

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23
Q

Euvolemic Hyponatremia is also caused by _____ which is most frequent

A

SIADH

** most frequent cause (steady subclinical hypervolemia)
they are subclinical euvoluemic *

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24
Q

Hypervolemic Hyponatremia causes?

A

CHF

Cirrhosis

Nephrotic syndrome - CHF liver disease fluid overload , retains water

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25
Q

Potassium in the major _____cellular cation

A

intracellular

** hemolysis can affect it
dietary is only was to get K in and no way to reabsorb it*

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26
Q

Potassium is most important in?

A

membrane electric potential

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27
Q

K is excreted by ?

A

kidenys

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28
Q

This is no ___________ by the kidneys with K.

A

no reabsorbtion

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29
Q

NL K range?

A

3.5-5.0 mEq/L

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30
Q

K critical values?

A

<2.5

> 6.5

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31
Q

K critical values: <2.5 sxs?

A

V fib/Torsades

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32
Q

K critical values: >6.5 sxs?

A

Myocardial irritibality

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33
Q

Potassium indications?

A

Routine evaluation

Monitor patients on diuretics

K-sparing = Sprinolatcton - monitor to make sure K is not getting to high

Monitor with patients with poor kidney function

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34
Q

K interfering factors?

A

Hemolysis of blood during a venipuncture ( increase falsely)

Alkalotic states lower potassium

Acidotic states increase potassium (DKA)

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35
Q

K increased?

A

Excessive dietary intake

Renal failure

Addison disease
low levels of aldosterone

Potassium sparing diuretics

Crush injury to tissues

Transfusion of hemolyzed blood

Acidosis

Dehydration - falsely increase K cause lower free water

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36
Q

K decreased?

A

Deficient intake

Burns

GI disorders - not absorbing it

Diuretics

Alkalosis

Insulin administration - drive
K into the cells

Ascites

Renal artery stenosis

**hyperkalemia tx is also insulin to drive K & glucose into the cell and out of the serum and lowering serum concentrations *

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37
Q

Calcium function?

A

Membrane and cell function

Contractility of cardiac and skeletal muscle

Clotting activation

Neural transmission

**has a lot to do with skeletal muscle contractility , decreased albumin you might have a decreased calcium as well *

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38
Q

Calcium exists as?

A

1/2 exists in free (ionized form)

1/2 exists in protein bound form (mostly with albumin)

** measure of Ca gives you both - free and protein bound *

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39
Q

Calcium NL range?

A

9-10.5 mg/dL

**10.8 is important - investigate it more ( not so much sensitive with Na), - .3 over is significant, over 10.5 investigate it by looking at PTH hormone or just retest*

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40
Q

Calcium critical values?

A

<6

> 13

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41
Q

Ca critical values: <6 sxs?

A

tetany/convulsions

low calcium - tapping on the face, and you get a reflex

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42
Q

Ca critical values: >13 sxs?

A

arrythmias/coma

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43
Q

Ca indications?

A

Evaluate parathyroid function

Evaluate calcium metabolism

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44
Q

Ca is indicated to monitor patients with what ?

A

Renal failure

Renal transplant

Hyperparathyroidism

Malignancies

After large volume blood transfusions

**important to monitor in renal patients hypo and hyper be carful *

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45
Q

Ca increased causes?

A

Hyperparathyroidism

Mets to bone

Paget disease of bone

Vit D intoxication

Addison disease

Prolonged immobilization

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46
Q

Increased Ca symtpoms?

A

stones ( kidney stones made up calcium oxylate, cholesterol as well)

bones ( they get broken bones causing losing Ca from bone cause it is increased in the serum)

abd groans(vague abd pain)

psychic moans ( changes in behavior and depression)

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47
Q

Ca decreased causes?

A

Hypoparathyroidism

Renal failure - cA is just spilling out

Hyperphosphatemia

Rickets

Vit D deficiency

Osteomalacia

Malabsorption

Pancreatitis

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48
Q

Ca decreased symptoms?

A

Chvostek, tap on facial nerve and they get spasm

Trousseau - when you put BP cuff on then it cause tetany of hand

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49
Q

Calcium and phosphorus relations?

A

higher the P then the lower the Ca ( inversely proportions)

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50
Q

NL urine sodium?

A

> 20 mEq/L

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51
Q

What causes urine sodium >20 mEq/L?

A

Dehydration

Adrenocortical insufficiency

Diuretic therapy

SIADH - retaining free water

Diabetic ketoacidosis

Chronic renal failure - spill sodium cause we cannot reasrobe it

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52
Q

what causes urine sodium <20 mEq/L?

A

CHF

Malabsorption

Diarrhea - losing Na from the
bowel

Cushing disease

Aldosteronism - low urine sodiums

Inadequate intake

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53
Q

Urine osmolality increased?

A

SIADH - conc. urine and through free water rout

Ectopic source of ADH (carcinoma)

Shock

Cirrhosis

CHF

54
Q

Urine osmolality decreased?

A

Diabetes insipidus

Excess fluid intake

Renal tubular necrosis

Severe pyelonephritis

55
Q

Chloride function is a major _____cellular anion?

A

extracellular

56
Q

Cl function?

A

Osmotic gradient

Not meaningful by itself but combined with other tests gives an indication of acid-base balance

Maintain electrical neutrality with NA+

Follows NA+ loss and accompanies NA+ excess

**lets important electrolytes we look at it is not meaning ful by itself , just know it follows Na - high Na = high Cl and low = low, if you increase Na will cause increase in Cl *

57
Q

NL Cl range?

A

98-106 mEq/L

58
Q

Cl critical values?

A

<80

> 115

59
Q

Cl indications?

A

Routine electrolyte studies

Acid-base balance

60
Q

Cl interfering factors?

A

Excessive infusions of saline

61
Q

Cl interfering factors: increased?

A

Acetozolamide

NSAIDs

62
Q

Cl interfering factors: decreased?

A

Bicarbonates

Steroids

Loop diuretics

63
Q

Cl increased?

A

Dehydration

Excessive saline IV

Metabolic acidosis

64
Q

Cl decreased?

A

Vomiting

NG suction

Burns

65
Q

CO2 functions?

A

Indirect measurement of the
HCO3 anion

Second in importance to the chloride anion

Used as a “rough guide” for acid-base imbalance

**different than pCO2 but it does give you idea if someone is acidotic or alkaloid ( give idea of what the bicarb might be)*

66
Q

CO2 NL range?

A

23-30 mEq/L

67
Q

CO2 critical values?

A

<6

68
Q

CO2 indications?

A

Evaluate pH status in a patient with possible acid-base imbalance

Do NOT confuse with PCO2

**poor mans blood gas *

69
Q

CO2 increased?

A

Alkalosis

Severe vomiting

NG suction

COPD

70
Q

CO2 decreased?

A

Acidosis

Chronic diarrhea

Renal failure

DKA

Starvation

Shock

71
Q

Anion Gap functions?

A

Difference between the cations and anions in the extracellular space

72
Q

Anion Gap formula?

A

(NA + K ) – (Chloride + HCO3)

73
Q

AG increased?

A

Lactic acidosis

DKA

Alcoholic ketoacidosis

Starvation

Renal failure

GI loss of HCO3

more acidotic states

**more acidotic state = more anion gap *

** number give you a rough indication o how bad the acid base balance disturbance might be *

74
Q

AG decreased?

A

Chronic vomiting

GI suction

Lithium toxicity

Hypoproteinemia

more alkaloid states

75
Q

BUN function?

A

Indirect and rough measurement of kidney function

**good indication on how well the kidney are working *

76
Q

BUN elevated levels?

A

Elevated levels = azotemia

Can be prerenal, renal, or postrenal ( after kidneys)

77
Q

what are the kidney function tests?

A

BUN + creatinine

** like ast, alt and alk pos are for liver function*

78
Q

BUN NL range?

A

10-20 mg/dL

79
Q

BUN critical value?

A

> 100

80
Q

BUN interfering factors?

A

High/low protein diets

GI bleeding

Overhydration or dehydration

81
Q

BUN increased: prerenal?

A

Hypovolemia - dont have excess free water

Shock

Dehydration

CHF - increase BUN

82
Q

BUN increased: renal?

A

Renal disease - cant excrete the BUN

Nephrotoxic drugs

83
Q

BUN increased: postrenal?

A

Ureteral obstruction

Bladder outlet obstruction - its going through the kidney but cant be excretes , maybe uretheeral obstruction

84
Q

BUN decreased?

A

Liver disease - cause it is not even being made

85
Q

Creatinine function?

A

Catabolic product of creatine phosphate used in skeletal muscle contraction

Not effected much by the liver

**extremely sensitive indicator for kidney function it is only affected by the kidney so elevated C it is definitely in the kidney not pre or post *

86
Q

Cr is excreted ________ by the kidneys

A

entirely

87
Q

Cr NL range?

A

0.5 – 1.2 mg/dL

**0.6 or 0.4 dont have to worry about it cause some healthy people will have lower levels *

88
Q

Cr critical values?

A

> 4

serious renal impairment

89
Q

Cr increased causes?

A

All diseases affecting renal function

Rhabdomyolysis - cause C is a end product of creatinine kinase

90
Q

Cr decreased causes?

A

Decreased muscle mass

**not worried about this as much *

91
Q

Creatinine Clearance (CC) function?

A

Used to measure the glomerular filtration rate (GFR) of the kidney (how well are we clearing the C, how well are our kidney working)

92
Q

CC requires?

A

Requires a 24 hour urine collection and a serum creatinine level

93
Q

CC is a function of what ?

A

CC= UV/P

CC is a function of urinary volume over serum creatinine ( serum C in the plasma)

94
Q

Estimated GFR equation?

A

GFR = 186 x (Pcr) -1.154 x (age) -0.203 x (0.742 if female) x (1.210 if AA)

95
Q

__ usually have a different GFR than anyone else?

A

African American

96
Q

Why do we need to know GFR?

A

medications , renal or hepatic alt dosed

a 99 yo who need keflex if she has cellulitis then the dose is probably going to be lower cause of the lower GFR and pharmacokinetics of the 90 yer old

97
Q

CC increased causes?

A

Exercise

High cardiac output

pregnancy

98
Q

CC decreased causes?

A

Decreased blood flow to the kidney

Shock

Dehydration

Impaired kidney function

99
Q

Phosphate NL range?

A

3.0-4.5

100
Q

Phosphate critical value?

A

<1 mg/dL

101
Q

Phosphate indications?

A

assists in studies re: calcium and parathyroid tests

**inversely proportions to Ca

looking at inorganic phosphate *

102
Q

Phosphate function?

A

“inorganic phosphate”

Intracellular storage of energy-organic

Electrical and acid-base homeostasis

Inverse relationship between CA and Phosphate

increases with everything that decreases calcium

103
Q

Phosphate increase causes?

A

Hypoparathyroidism

Renal failure - cA is just spilling out

Hyperphosphatemia

Rickets

Vit D deficiency

Osteomalacia

Malabsorption

Pancreatitis

104
Q

Phosphate decrease causes?

A

Hyperparathyroidism

Mets to bone

Paget disease of bone

Vit D intoxication

Addison disease

Prolonged immobilization

105
Q

Mg Nl range?

A

1.3-2.1 mEq/L

106
Q

Mg critical values?

A

<0.5

> 3

107
Q

Mg function?

A

Found mostly intracellularly

Critical to metabolic processes

Increases the intestinal absorption of Calcium

** important in cardiac patients and it can be squed by hemolysis *

**it follows glucose , aldosterone increase Mg excretion and decrease serum Mg when hemolysis increased Mg serum *

108
Q

Mg interfering factors?

A

hemolysis

109
Q

Mg increased causes?

A

Renal insufficiency - cause Mg is excreted by kidneys

Addison disease - decrease in aldosterone will then increase Mg levels

110
Q

Mg decreased causes?

A

Malabsorption

Malnutrition

Alcoholism - cause malnutrition ass. with ETOH

Diabetic acidosis

Hypoparathyroidism

111
Q

Anti-glomerular basement membrane Ab are used to detect the presence of circulating __ towards __________________________ .

A

Used to detect the presence of circulating Ab towards kidneys glomerular BM

112
Q

Ab are used to ________ tx?

A

monitor

113
Q

When are Anti-glomerular BM Ab present?

A

Present in autoimmune-induced nephritis (Goodpasture syndrome)

114
Q

Goodpasture syndrome triad?

A

Antibodies

Pulmonary hemorrhage

Glomerulonephritis = kidney failure and then they need dialysis

115
Q

Ab for kidneys?

A

Anti-glomerular basement membrane Ab

Antispermatozoal Ab

116
Q

Antispermatozoal Ab is a screening test for ?

A

infertility

117
Q

Antispermatozoal Ab function?

A

Tests for Ab against sperm which can be an autoimmune cause of infertility

118
Q

Antispermatozoal Ab can be found in?

A

serum

sperm

cervical mucous

119
Q

PSA indictions?

A

Used as a screening exam for prostate CA

Used to monitor treatment of prostate CA - while in remission

120
Q

PSA NL range?

A

0-2.5 ng/mL

121
Q

PSA is a __________ found in __________ _____

A

Glycoprotein found in prostatic lumen

122
Q

PSA ________ usually prevent high levels from reaching the blood stream, example?

A

Barriers

i.e. glandular tissue

123
Q

PSA barriers can be breached with?

A

cancers

infections

hypertrophy - allows more leakage of PSA into the serum

124
Q

___ is more sensitive and specific than other prostate tumor markers.

A

PSA

125
Q

____ of men with prostate CA have PSA of >4 ng/mL

A

80%

**4-10 is like a PSA grey zone and over 10 they have CA and under 4 they dont and in between maybe they have BPH*

126
Q

PSA velocity ?

A

Shows how fast the PSA is rising per year

**velocity is more accurate than total PSA *

**compare the PSA from 1 year versus another year ( 2 one yeas then 2.8 the next year - may want to look into it even though they are still below 4 - maybe a prostate exam or Bx.)*

**highly metabolic tissue are more prone to developing CA - like prostate and breast than any other tissues *
120 yo we will all have P and B CA

127
Q

PSA velocity __________ per year is associated with higher risk of dying from prostate CA

A

> 0.35 ng/mL

128
Q

Age adjusted PSA

A

Table 2-39 (Mosby’s)

<50 = <2.4 ng/mL

129
Q

Free versus attached PSA(bound to protein)?

A

Benign conditions are associated with more free PSA

130
Q

PSA considerations?

A

PSA should be drawn before DRE. DRE may minimally elevate PSA

Ejaculation within 24 hours of serum testing will raise PSA.

Finsteride (Proscar) may decrease levels of PSA
it shrinks the prostate

Clinical Medicine LAB - Professor Sample (36 decks)

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