Main Concepts

Question 0

What pH does thenlow volume state have?

Answer 0

Alkalotic (except diarrhea, RTA Type II and DKA) b/c Aldo dumps H+

Question 1

What electrolytes does the low volume state have?

Answer 1

HIGH total Na, LOW serum Na (dilutional affect), LOW Cl, LOW K

Question 2

What pH does vomiters have?

Answer 2

Alkalotic b/c you vomit out H+

Question 3

What pH does diarrhea have?

Answer 3

Acidosis b/c stool has bicarb

Question 4

What happened if pulse increased more than 10 on standing?

Answer 4

Hypovolemic shock

Question 5

What happened if pulse decreases to less than 5 on standing?

Answer 5

Autonomic dysfunction

Question 6

What are the symptoms of a low energy state?

Answer 6

CNS: mental retardation
CV: heart failure, pericardial effusion
Muscle: weakness, SOB, vasodilation, impotence, urinary retention, constipation

Rapidly dividing cells:

• skin: dry
• cuticles: brittle
• hair:alopecia
• bone marrow: suppressed
• vascular endothelium: breaks down
• lungs: infection, SOB
• kidney: PCT will feel the effect first
• GI: nausea, vomit, diarrhea
• bladder: oliguria
• sperm: decreased
• germ cells: predisposed to cancer
• breasts: atrophic
• endometrium: amenorrhea

Question 7

What are the most common signs of the low energy state?

Answer 7

Tachypnea and dyspnea

Question 8

What are the most common symptoms of the low energy state?

Answer 8

Weakness and SOB

Question 9

What are the most common infections of the low energy state?

Answer 9

UTI and respiratory infections

Question 10

What is the most common cause of death in the low energy state?

Answer 10

Heart failure

Question 12

Explain all restrictive lung diseases:

Answer 12

Restrictive: intersticial problem (non bacterial)

• small stiff lungs (low VC)
• trouble breathing in => FEV1/FVC : >0.8
• ABG: low pO2 => increases RR, low pCO2, high pH
• CXR: reticulo-nodular pattern, ground glass apperance
• Die of cor pulmonale
• Ex: NM diseases (breathing out is passive), drugs, autoimmune dz
• Tx: Pressure support on ventilator, ^ O2 ^RR, ^inspiratory time

Question 13

Explain all obstructive lung diseases:

Answer 13

Obstructive: airway problem (bacterial)

• Big mucus-filled lungs (^RV, ^Reid index = ^airway thickness/airway lumen)
• Trouble breathing out => FEV1/FVC: ^RR, v pH
• Die of bronchhiectasis
• Ex: COPD
• Tx: Manipulate rate on ventilator, ^RR, ^ expiratory time, ^O2 only if needed

Question 14

What symptoms does a “more likely to depolarize” state have?

Answer 14

Brain: psychosis, seizures, jitteriness
Skeletal Muscle: muscle spasm, tetany
SM: diarrhea, then constipation
Cardiac: tachycardia, arrhytmias

Question 15

What symptoms does a “less likely to depolarize” state have?

Answer 15

Brain: lethargy, mental status changes, depression
Skeletal Muscle: weakness, SOB
SM: constipation, then diarrhea
Cardiac: hypotension, bradycardia

Question 16

What is humoral immune response?

Answer 16

B cells and PMNs patrol the blood looking bacteria

Question 17

What is the cell-mediated immune response?

Answer 17

T cells and macrophages patrol the tissues looking for non-bacteria

Question 18

What are macrophages called in each area of the body?

Answer 18

Blood:Monocytes
Brain: microglia
Lung: T1 pneumocytes
Liver: Kupffer cells
Spleen: RES cells
Lymph: Dendritic cells
kidney: Mesangial cells
Payers patches: M cells
Skin: Langerhans
Bone: Osteoclasts

CT:
-Histiocytes
-Giant cells
Epitheloid cells

Question 19

What is the CBC for every vasculitis?

Answer 19

v RBC, v platelets, ^WBC, ^T cells, ^ MP and schistocytes, ^ESR

Question 20

What is the time course of the inflammatory response?

Answer 20

1 hr: swelling
day 1: PMNs show up
day 3: PMNs peak
day 4: MP/T cells show up
day 7: MP/T cells peak, fibroblast arrive
day 30: fibroblast peak
Month 3-6: Fibroblast leave

Question 21

What state does estrogen mimic?

Answer 21

The neuromuscular disease state (estrogen is a muscle relaxant)

Question 22

What does high GABA levels lead to?

Answer 22

Bradycardia, lethargy, constipation, impotence and memory loss