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INPATIENT PRACTIC APPROACH AKI > rapid labs interpretation > Flashcards

rapid labs interpretation Flashcards

1
Q

Anion gap causes

A 
GOLDMARK 
glycols 
oxoprolin
D lactate
L lactate 
methanol
asa
renal failure 
ketoacidosis; AKA;DKA;STARVATION
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2
Q

Tylenol and anion gap

A
  • can happen in therapeutical range in sick patients

- tylenol converted to pyroglutamic acid / send out 5 oxoprolin level/

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3
Q

difference between D-lactate and L-lactate

A

D lactate - fermentation in large bowel by bacterias e.g. short bowel syndrome
clinically post carbohydrate confusion

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4
Q

L lactic acidosis two types

A

type A - lack of oxygen - sepsis

type B - impaired krebs or electron transfer system

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5
Q

19 y/o runner coming with confusion and lactic acid 9

A

NSAIDS toxicity blocking metabolism of glucose - electron transferring system shifting glucose to lactic acid
eg using a lot of gel

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6
Q

hyperemesis gravidarum and lactic acidosis

A

lack of thiamin;

glucose unable to enter kreb’s cycle

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7
Q

alcoholism and lactic acidosis

A

lack of thiamin

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8
Q

diabetic with severe lactic acidosis

A

metformin block electron transferring system

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9
Q

HIV and lactic acidosis

A

AZT block electronic transfer system

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10
Q

cancer and lactic acidosis

A

cancer can metabolized to lactic acid glucose

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11
Q

house fire and down with lactic acidosis

A

cyanide toxicity - block electron chain

CO never found down

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12
Q

b12 deficiency

A

MMA elevation

homocystein elevation

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13
Q

folic acid elevation

A

homocysteine elevation only

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14
Q

pancytopenia with indirect hyperbilirubinemia
MCV 120
hypersegmental PMN
LDH up

A

b12 deficiency

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15
Q

81 y/o nondrinker MCV 120 ANEMIC

A 
ATROPHIC GASTRITIS 
TEST 
INTRINSTIC FACTOR AB
PARIETAL CELL AB 
GASTRIN
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16
Q

Which medication is causing B12 deficiency?

A

metformin

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17
Q

Which GI disease is associated with B12 deficiency

A

Crohn’s

terminal ileum absorption of b12

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18
Q

34 y/o rash, fatigue, low ferritin, low b12, low vitamin d 25OH

A

celiac disease

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19
Q

anemia ddx

A

blood lost anemia
bone marrow failure
hemolysis

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20
Q

low reticulocyte count –> bone marrow issue

ddx 5 groups

A 
b12 deficiency, b1, b6, folate, iron, malnutrition 
myelophthisis 
sideroblastic anemia 
erythropoetin low 
endocrinne
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21
Q

endocrine dx. causing bone marrow failure

A

hypogonadism
adrenal insufficiency
hypothyroidism

22
Q

sideroblastic anemia

  • findings on peripheral smear
  • findings on bone marrow aspirate
A

bone marrow ringed sideroblast / iron deposition/

peripheral smear pappenheimer bodies

23
Q

etiology of sideroblastic anemia

A
  • MDS
  • copper deficiency
  • alcohol
  • linezolid
24
Q

elderly with sideroblastic anemia

A

MDS

overload of Zn / lubricant for denture/ compete with Copper absorption

25
Q

primary bone marrow problem

A 
- myelophthisis 
infiltration of bone marrow by cancer - prostate, breast 
infection TB 
autoimmune 
peripheral smear LEUKOERYTHROBLASTIC - red cell with the nucleus
myelocytes 
TEARDROP RBC
bone marrow fibrosis
MDS pancytopenia or pure RBC aplasia
26
Q

hemolysis two types

A

congenital

acquired

27
Q

congenital hemolysis

A

hemoglobinopathies - SS, thalassemia
G6P deficiency
hereditary spherocytosis

28
Q

acquired hemolysis

A 
1. autoimmune hemolysis  
.2MAHA
3hypersplenism; liver damage 
4infection 
5PNH 
6copper excess
29
Q

acquired hemolytic anemia autoimmune hemolysis

A

warm AIHA
cold agglutinins
PCH paroxysmal cold hemoglobinuria
alloimmune - transfusions reactions

30
Q

hemolytic anemia MAHA

A

Micro or macro hemolytic anemia
prosthetic valve
AVM
TMA - MAHA and trombocytopenia

31
Q

infectious hemolytic anemia

A

babesiosis
malaria
bartonella
clostridium perfringens

32
Q

spur cell anemia

A

acquired hemolytic anemia with hypersplenism or liver damage

33
Q

excess of what is causing acquired hemolytic anemia

A

copper Willson

34
Q

leucoerythroblastic peripheral smear

A

myelephthisis eg prostate cancer

35
Q

warm AIHA

A
  • extravascular - spleen sequestration
  • COOMBs POSITIVE DAT+
  • Ig G
  • PNC
  • infection
  • spherocytes
36
Q

cold agglutinin disease

A
  • intravascular hemolysis / dark urine/
  • COMBs + DAT
  • infectious
  • malignancy
  • C3 could be mediated
  • IgM
  • false increased MCV
37
Q

G6PD deficiency

A

Heinz bodies - special staining

bite cells

38
Q

PNH

A

dx
check on RBC CD55, and CD59 flow cytometry
episodic intravascular hemolysis

39
Q

Which medication can cause a classic warm autoimmune hemolytic anemia?

A

PNC

40
Q

BITE CELLS PATHOGNOMIC

A

G6PD

41
Q

Why G6PD level can be normal?

A

Sick cells are hemolysed and only healthy ones are there.
Add on smear bite cells
add on special staining for Heinz bodies

42
Q

what are late findings in urine for intravascular hemolysis?

A

urine hemosiderin

43
Q

PNH

A

lack of CD55, CD59 causing complement induced intravascular hemolysis

44
Q

Treatment for PNH

A

C5 antibodies ECULIZUMAB

45
Q

Red kayak flowing through the tiny river. The current is strong. He does break down.Another kayak hit the sandy boulder and break down. Mud is clogging pieces of sand and water is clearer. Adam feels weak and sees Willendbrand putting more glue into the water. He calls an excavator which is far so he used dynamite Later Adam put a mash to avoid floating rocks to break his kayak.

A

MAHA - micronangiohemolytic anemia
MAH and thrombocytopenia eg TTP
ADAMSTS3 breaks down vW factor thus blocking clotting. Autoantibodies against Adam can be eliminated by adding more adam
- FFP
-steroids dynamite
-plasmapheresis mash
The only way to find out is to check how many Adams kayaks.

46
Q

Confused Adam kayaks and get burned by the sun.

A

Petechia and confusion -TTP.

47
Q

Adam is drunk from gin and tonic. He kayaks in tiny river. It turns to tomato color without sunscreen.
Is this really Adam? Plex is Adam girlfriend.
Adam start to poop like crazy. What is his issue??
Adam has sex with Plex. She got pregnant and she becomes tomato. Plex is swollen like a balloon.

A

Drug-induced TMA.
ADAMS AB. NEGAT.
Supportive care but start PLEX before you know.
HUS causes TTP
Complement mediated TMA - AKI - HD unless treated early.

48
Q

PORTOFINO DRIP
- PAIN - PHARMACY- PAIN KILLER
-DIARRHEA
-TIRED FROM FLIGHT
-LOST U TURN
-RED WINE - HANGOVER - WATER WITH SUGAR
- OLD HOUSE
Angie visited Portofino. She loves it. Her trip is spoiled by pains. She buys PAIN MEDICATIONS. She was just fine yesterday. She is weak and boyfriend is upset. Why do you have belly pain for years? She wants to be in bed only. She finally got to beach. Her skin is like bubble wrapper. She has to go to a doctor. Angie did you need to take U turn to come here.
Angie is poor and stay in old house from 1920s painted in pink.
Her pipi is red. OMG did I drink too much of Italian red wine?
Her pipi is red always. You can check it randomly
She wants her urine be while so she drinks water with sugar hoping to get stronger and have nice yellow pipi again.
She is surprise when pipi turn white after drinking pure red grape juice

A

AIP.
Acute intermittent porphyria. Weakness, neuropathic pain,
and hyponatremia.
Check random /spot/ urine Portobilinogen /porfobilinogen/. If oxidized urine is red.
D10/W infusion while waiting for hematin.

49
Q

Andy Loeffler turns green and get chest pain. He felt strong till he get diarrhea and skin is like sandpaper. He travelled to Asia for a trip. Forgot water and drink from a stream.

A 
Loeffler eosinophilic endocarditis 
cough
dyspnea
rash 
eosinophilia
50
Q

ANDY GOES TO LAOS AFTER GOT HIS NEW KIDNEY.

Andy goes to 1.Laos. He eat fat dinner and 2 chest hurts him. Next day on a beach his pale skin became 3 black and he feels3 dizzy. He is 4sweating in the night and can not 5swallow his breakfast. He lost a lot of weight. He did drink a a 6water from farm. Andy had 6kidney transplant so finally can travel.
He has 7lumpy neck and developed diarrhea with blood.
Andy get anxious and can not breath and forgot his 8inhaler. He put his earphones on and relax with classical music - 8Strauss. Then he goes to pray to a 8churg. Oh my Got I can not even 8walk and can not breath. Finally he 3black out and woke up in hospital. He is fat and chest hurts and goes to cath lab. Then he is even greener. He looked like 9marble statue. His urine is like coca cola.
9He screams Fuck it I do have a lot of allergies and can not breath
- skin dark on the sun
- stomach in the evening after fat foot
-bad luck got cold and is sweaty and wheezy
-neck is lumpy skin is sweaty
-classic music
-sudden involuntary fuck

A

Eosinophilia ddx

  • cancer - lymphoma, gi
  • parasites - strongyloides check ABs if diarrhea and transplant
  • tissue damage esophigitis
  • CHURG- STRAUS disease, eosinophilia, granulomatous process lung, dyspnea, dark urine
  • adrenal insuficiency - dark skin and hypotension
  • Allergic bronchopulmonary Asperg-ilosis / asperger /
51
Q

ALKATRAS YELLOW SKINNY, COUGHING PRISONER ESCAPED.

Alkatras fecal waste with a lot of urine has thick mash. Prisoners can not escape. If he goes through will be yellow. He found out huge wall blocking outlet. Later he sees part of the wall is pressing the narrow passage. He was sick and doctor recently gave him pill.
There is a low of shit on the ground with some stones on the ground. Finally exist has a huge boulder.
Yellow strips on his prisoner uniform are now whole yellow. He was in prison and lost weight. His cell was cold and he is coughing. He send encrypted massage as part of his histo- ry to a friend.
He is tired and itchy. He has lump in his neck hurting him despite of pills. He is yellow but catacomb looking straight.
He has belly pain and is yellow like a lemon and catacomb looks lumpy.

A

CHOLESTASIS

  • sludge
  • stone
  • tumor - head of pancreas
  • tumor of the ampulla
  • sarcoid
  • TB
  • CHF right side
  • crypto
  • histo
  • AMOX
  • PSC primary sclerosing cholangitis - jaundice, abdominal pain, funny shaped duct, MRCP pearl shaped
  • PBC primary biliary cirrhosis MRCP neg, biopsy

-

52
Q

Fat movie star living hedonystic lifestyle sitting with his Budd on a chair.

Yellow fat movie star. He loves party with a lot of girls and drinks. Flying high is fun. He tries to go to mountain and drink orange healing water after big night out. I need to loose weight. Legs are like a balloon. Maybe my pains in the belly will help. He drinks hard and heart is skipping. His joints hurting him since being a yongster.

A
  • alcohol
  • hp B
  • hp C
  • NASH
  • hemochromatosis
  • amiodarone
  • MTX
  • RUQ pain Budd Chiary
  • PSC
  • PBC

INPATIENT PRACTIC APPROACH AKI (6 decks)

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