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284 Cards in this Set
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immunosuppressants:
cyclosporine + tacrolimus (FK506) MOA |
inhibit secretion of IL2
cyclosporine via calcineurin tacrolimus via FK-binding protein |
|
immunosuppressants:
azationprine (6MP) and mycophenolate mofetil MOA |
interfere w/ purine metabolism, block lymphocyte production
|
|
immunosuppressants:
muromonab-CD3 (OKT3) and sirolimus (rapamycin) MOA |
block signal transduction from IL2 binding to t-cell
muromonab via CD3 binding sirolimus (rapamycin) via mTOR binding |
|
immunosuppressants:
daclizumab MOA |
directly binds to IL2 on t-cell
|
|
Bacteriostatic mnemonic
|
ECSTaTiC about bacteriostatics.
Erythromycin, Clindamycin, Sulfamethoxazole, Trimethoprim, Tetracycline, Chloramphenicol (all are protein synthesis blockers except TMP/SMX) |
|
Bactericidal mnemonic
|
Very Finely Proficienct At Cell Murder
Vanco, FQs, Penicillins, Aminoglycosides, Cilastatins, Metronidazole (all are membrane disrupters + FQ + AG) |
|
ampicillin spectrum mnemonic
|
ampicilln HELPS kill enterococci
g+ and hemophilus, e. coli, listeria, proteus, salmonella, enterococci |
|
what are the anti pseudomonal penicillins?
|
TCP - take care of pseudomonas
ticarcillin, carbenicillin, piperacillin give w/ clavulanic acid |
|
cephalosporins: mnemonic for 1st and 2nd generation
|
PEcK - proteus, ecoli, klebsiella
HEN PEcKS - PEcK + hemophilus, enterobacter aerogenes, neisseria, serratia |
|
3g cephalosporins - common treatments, and exceptions
|
ceftriaxone for meningitis, ceftazidime for pseudomonas,
cant do LAME: listeria, atypicals, MRSA and enterococci |
|
aztreonam
|
gets the TRIO of colorful g- rods
pseudomonas, klebsiella, serratia wannabe aminoglycoside, g- only, good for pts who are allergic to penicillins and have renal failure. |
|
imipenem/cilastatin, meropenem
|
g+cocci, g-rods, DOC for enterobacter
penicillin side effects + 50% of pts have seizures (lower in meropenem) |
|
Vanco side effects
|
does NOT have much toxicity
Nephrotoxic, ototoxic, thrombophlebitis (red man syndrome) |
|
30s vs 50s drugs, mnemonic
|
but AT 30, CCELL at 50
30S - AG, tetracyclines 50S - clindamycin, chloramphenicol, erythromycin, linezolid, lincomycin |
|
Which protein synthesis inhibitors block translocation?
|
Macrolides prevent Movement of ribosomes.
Clindamycin causes ribosome to Cling to mRNA. Lincomycin is just like erythromycin. |
|
Which protein synthesis inhibitors block peptide bond formation?
|
ChloramPhenicol blocks Peptide bond formation via Peptidyltransferase.
|
|
Which protein synthesis inhibitors block initiation?
|
Aminoglycosides - A is the first letter, blocks intitiation which is the first step.
LinezolIDE - looks like aminoglycoside, has similar mechanism |
|
Tetracycline mnemonic
|
TTC:
tRNA Tries but Cant bind to 30S |
|
Aminoglycosides mnemonic
|
Mean GNATS canNOT kill anerobes.
gentamicin, neomycin, amikacin, tobramycin, streptomycin nephrotoxicity, ototoxicity, teratogen |
|
Tetracycline mnemonic
|
VACUUM THe BedRoom
Vibrio, Acne, chlamydia, ureaplasma urealyticum, mycoplasma, Tularemia, H. pylori, borrelia burgdorferi, Rickettsiae. Doxy is okay for renal failure, do not give with divalent cations. |
|
Erythromycin
|
Neiss Chicks Like My Mack
Neisseria, Chlamydia, Legionella, Mycoplasma, g+s prolongs QT, increases GI motility, acute cholestatic hepatitis. inhibits cyp450 |
|
Chloramphenicol
|
Treats SHiN meningitis and rickettsia.
anemia, aplastic anemia, gray baby syndrome |
|
Clindamycin
|
anerobic infections above diaphragm (bacteriodes, clostridium) and staph osteomyelitis
causes pseudomembranous colitis, fever, diarrhea |
|
mtb tx
|
TB is RIPE for treatment
rifampin, inh, pyrazinamine, ethambutol |
|
mai tx
|
treat mai ARSE
same as mtb tx but replace INH with azithromycin, pyrazinamide with streptomycin rifampin, azithromycin, strepotmycin, ethambutol |
|
Rifampin uses
|
mtb (w INH), leprosy (w dapsone), prophylaxis for meningococcemia and h. influenzae b exposure.
|
|
mechanism of resistance: penicillin, cephalosporins
|
b-lactam cleavage, or altered PBP in MRSA or penicillin resistant S. pneumo
|
|
mechanism of resistance: aminoglycosides
|
modificaiton by acetylation, adenylation, phosphorylation
|
|
mechanism of resistance: vancomycin
|
D-ala --> D-lac
|
|
mechanism of resistance: chloramphenicol
|
acetylation
|
|
mechanism of resistance: macrolides
|
alteration of rRNA near its binding site in ribosome
|
|
mechanism of resistance: tetracyclines
|
decreased uptake, increased efflux out of cell
|
|
mechanism of resistance: sulfonamides
|
altered bacterial dihydropteroate synthetase, decreased uptake, increased PABA synthesis
|
|
mechanism of resistance: quinolones
|
altered gyrase, reduced uptake
|
|
amphotericin / nystatin
moa |
bind ergosterol, disrupting fungal membrane.
nystatin only topical, amphotericin is amphoterrible and doesnt cross bbb (give intrathecal) |
|
azoles
moa |
inhibit lanosterol -> ergosterol synthesis, inhibits hormone synthesis may cause gynecomastia, crosses BBB, inhibits cyp450
|
|
flucytosine moa
|
inhibits DNA synth by conversion to 5FU
|
|
caspofungin moa
|
inhibits cell wall synth by blocking b-glucan
cASPo for invasive ASPergillosis |
|
terbinafine
|
inhibits squalene epoxidase (blocks lanosterol), for dermatophytes
|
|
griseofulvin
|
blocks microtubule function, disrupts mitosis, deposits in keratin
for dermatophytes teratogenic, carcinogenic, headaches, induces CYP450 |
|
Amantadine
|
A man to dine takes off his coat. inhibits penetration / uncoating of virus (M2 protein), blocks influenza A, rubellA, may cause problems w/ cerebellA
lots of resistance to drug... |
|
Zanamivir, oseltamivir (tamiflu)
|
inhibits neuraminidates, decreasing release of progeny in influenza A and B
|
|
Ribavirin
|
inhibits imp dehydrogenase, less guanine nucleotide synthesis
used for chronic hep C w/ interferon a |
|
acyclovir
|
monophosphorylated active by viral thymidine kinase, triphosphorylated by cell enzymes, inhibits viral DNA polymerase by chain termination.
loss of thymidine kinase = resistance similar to gancicyclovir which works in CMV as well.... (more toxic) |
|
foscarnet
|
pyrophosphate analog doesnt need activation by viral kinase, for cmv in resistance cases.
nephrotoxicity looks like furosemide overdose - lose Ca K and Mg... |
|
HIV protease inhibitors
|
-navir
navir TEASE a proTEASE all have toxicity of GI intolerance, hyperglycemia, lipodystrophy, inhibit cyp450 indinavir has thrombocytopenia |
|
NRTI that causes hypersensitivity reactions?
|
abacavir
|
|
NRTIs
|
haveudined with my nuclear family?
VUDINE - NRTI zidovudine, didanosine, zalcitabine, stavudine, lamivudine, abacavir ALL cause lactic acidosis and bone marrow suppression |
|
NNRTIs
|
Nevirapine, Efavirenz, Delaviridine
Never Ever Deliver nucleosides. inhibit HIV reverse transcriptase Cause rash, neuropathy |
|
HIV drugs that cause pancreatitis and peripheral neuropathy
|
didanosine, zalcitabine, stavudine (nrtis)
|
|
safest RTI?
|
lamivudine
|
|
RTI used for pregnant women or occuational exposure?
|
ZDV, or AZT.
|
|
enfivurtide
|
fusion inhibitor, binds viral gp41, inhibits fusion w/ cd4 cells. blocks entry and replication
for pts not responsive to HAART |
|
Antibiotics to avoid in pregnancy
|
SAFE Moms Take Really Good Care
Sulfonamides - kernicterus AG - oto FQ - cartilage Erythromycin - acute cholestatic hepatitis Metronidazole - mutagen Tetracyclines - bone / teeth problems Ribavirin - teratogen Griseofulvin - teratogen Chloramphenicol - gray baby |
|
paclitaxel
|
anti breast cancer, stabilizes microtubules, they get stuck in metaphase
|
|
colchicine
|
macrophages need microtubules for chemotaxis, colchicine blockes their chemitaxis = no inflammatory response
|
|
vincristine, vinblastine
|
anticancer, no polymerization of microtubules
|
|
chediak higashi
|
microtubule polymerization defect results in poor phagcytosis, recurrent pyogenic infections, partial albinism, peripheral neuropathy
|
|
cytokeratin
|
epithelial cells
|
|
vimentin
|
connective tissue
|
|
desmin
|
muscle
|
|
gfap
|
neuroglia
|
|
neurofilaments
|
neurons
|
|
collagen synthesis: which step is defective in:
Scurvy |
hydroxylation of pro and lys residues of preprocollagen in the ER. requires vitC
|
|
collagen synthesis: which step is defective in:
OI |
defect in glycosylation of pro-alpha-chain in the ER, prevents formation of procollagen, the triple helix form
|
|
collagen synthesis: which step is defective in:
ehlers danlos |
defect in cleavage of C-terminal end of procollagen, required for the formation of insoluble tropocollagen outside the fibroblast
|
|
collagen synthesis: which step is defective in:
Cu defiency |
required for lysyl oxidase to cross link tropocollagen into covalently linked lysin-hydroxylysine cross linkage, making collagen fibrils
|
|
collagen synthesis: which step is defective in:
Zn deficiency |
metalloproteinase / collagenases break down type 3 collagen and replace with type 1 collagen, this requires Zn (in healing of scars)
|
|
ADPKD
|
APKD1 gene is on chromosome 16. 16 letters in "polycystic kidney"
|
|
Familial adenomatous polyposis
|
APC gene is on chromosome 5, 5 letters in "polyp"
|
|
Huntington's disease
|
C's... Chorea, caudate atrophy, crazy, decreased acetylCholine and gaba, chromsome cuatro, CAG repeat, Cuarenta years old
|
|
Hereditary spherocytosis
|
AD, spectrin and ankyrin, increased MCHC
|
|
Familial hypercholesteremia IIa
|
AD, LDLR defect, MI at 19, chromosome 19
|
|
NF1
NF2 |
AD
NF1- von recklinghausen - chromosome 17, 17 letters NF2- type 2, chromosome 22, 2 acoustic neuromas |
|
Von Hippel Lindau
|
AD - VHL gene - 3 letters - chromsome 3. constant HIF hypoxia induced factor causes angiogenic growth factors
|
|
cystic fibrosis
|
AR - CFTR gene on chromosome 7, abnormal protein folding causes degradation of channel before reaching cell surface
|
|
X-linked recessive disorders mnemonic
|
Be Wise Fools GOLD Heeds Silly Hope
Bruton's agammaglobulinemia, Wiscott Aldrich, Fabrys, G6PD, Ocular albinism, Lesch Nyhan, Duchenne's MD (and beckers), Hunters Syndrome, Hemophilia A and B |
|
Fragile X
|
X-linked, FMR1 gene, familial mental retardation. CGG repeat
|
|
Trinucleotide repeats mnemonic
|
Try Hunting for My Fried Eggs (X)
Huntington - CAG MyoTonic dystrophy - CTG FraGile X - CGG Freidrichs - GAA - decrease in frataxin protein |
|
Down syndrome quad screen results
|
increased bHCG, (inhibin A)
decreased aFP, estriol |
|
Patau
|
13 fingaz, cleft Palate, holoProsencephaly, Polydactly, microPthalmia
|
|
Edwards
|
Election age 18, micrognathia, clenched hands head dz
|
|
Chromosomal inversions
|
Paracentric - does not involve centromere, does not go thru meiosis, "paralyzed" meiosis
Pericentric - involves centromere, goes thru meiosis may decrease fertility |
|
Cri du chat
|
chromosome 5 "cridu" 5 letters, microcephaly, mental retardation, high pitched crying mewin, epicanthal folds, cardiac defect
|
|
william syndrome
|
microdeletion of 7, 7 letters in william, elfin facies, hypercalcemia, verbal baller, extremely friendly, cardiac defect
|
|
22q11 deletion
|
CATCH 22
Cleft Palate, Abnormal Facies, Thymic aplasia, Cardiac Defect, Hypocalcemia (pth aplasia) 3rd and 4th pharyngeal pouch problems. Velocardiofacial syndrome - palate, facial, cardiac |
|
Water soluble vitamins mnemonic
|
The Rich Never Pan Pyrite Filled Creeks
B1 - Thiamine, B2 - Riboflavin, B3 - Niacin, B5 - Pantothenic acid, B6 - Pyridoxine, B9 - Folate, B12 - Cobalamin |
|
B1 deficiency - enzymes affected
|
pyruvate dh
akg dh bcaa dh transketolase |
|
B3 deficiency - causes of
|
derived from tryptophan, requires B6 for synthesis.
Hartnups syndrome, malignant carcinoid syndrome, INH treatment |
|
B6 deficiency - processes effected
|
transaminations, decarboxylations, glycogen phosphorylase, cystathionine synthesis, heme synthesis, niacin synthesis, gaba synth
def caused by INH and OCP tx |
|
B12 deficiency - enzymes affected
|
homocysteine + n-me-THF -> methionine + THF
methylmalonyl CoA -> Succinyl CoA |
|
biotin def - enzymes affected
|
pyruvate carboxylase - gng
acetyl coa carboxylase - fa synth propionyl coa carboxylase - ocfa oxidation |
|
vitamin c functions
|
keeps Fe reduced, more absorption
hydroxylation of por lys for collagen cofactor for dopamine b hydroxylase for DA->NE |
|
drugs w/ disulfiram like reaction
|
inhibit acetaldehyde dh.
metronidazole, procarbazine, sulfonylureas, cephalosporins |
|
mitochondrial reactions
|
fa oxidation, acetyl coa synthesis, TCA cycle, oxphos
|
|
cytoplasmic reactions
|
glycolysis, fa synth, hmp shunt, protein synth, steroid synth
|
|
reactions that occur in both cytoplasm and nucleus
|
HUGs take two.
Heme synthesis, Urea Cycle, Gluconeogenesis |
|
rate limiting enzyme:
glycolysis |
PFK1
+ insulin, F26bp, AMP - citrate |
|
rate limiting enzyme:
gluconeogenesis |
F16BPase
+ glucagon - F26bp |
|
rate limiting enzyme:
TCA cycle |
isocitrate dehydrogenase
+ ADP, Ca - NADH |
|
rate limiting enzyme:
Glycogen synthesis |
glucokinase
+ insulin |
|
rate limiting enzyme:
Glycogenolysis |
glycogen phosphorylase
+ glucagon - insulin |
|
rate limiting enzyme:
HMP shunt |
G6P dehydrogenase
+ NADP+ |
|
rate limiting enzyme:
De novo purines |
glutamine PRPP amidotransferase
-AMP, GMP |
|
rate limiting enzyme:
de novo pyrimidines |
CPS2
+PRPP -UTP |
|
rate limiting enzyme:
urea cycle |
CPS1
+NAG |
|
rate limiting enzyme:
fatty acid synth |
Acetyl coa carboxylase
+citrate, acetylcoa |
|
rate limiting enzyme:
fa oxidation |
carnitine acyltransferase
-malonyl coa |
|
rate limiting enzyme:
ketogenesis |
hmg-coa synthase
|
|
rate limiting enzyme:
cholesterol synthesis |
hmg coa reductase
-cholesterol |
|
Heme synthesis
|
ALA synthase
|
|
Bile acid synthesis
|
7 alpha hydroxylase
|
|
4 places you use NADPH
|
1. respiratory burst
2. anabolic processes (fa+steroids) 3. glutathione reductase 4. CYP450 |
|
hexokinase vs glucokinase:
feedback inhibition |
only hexokinase has feedback inhibition by g6p
|
|
glucokinase deficiency
|
results in maturity onset dm or gestational dm because its rate limiting step toward insulin release from b cells
|
|
pyruvate kinase - regulation
|
+F16BP
-alanine, ATP |
|
pyruvate DH - regulation
|
- ATP, NADH, acetylcoa
|
|
arsenic poisoning
|
inhibits lipoic acid, needed in akgdh,pdh, leads to vomiting, rice water stools, garlic breath
|
|
PDC / akgDH cofactors mnemonic
|
Tender Loving Care For Nobody
Thiamine, Lipoic acid, CoA, FADH2, NADH |
|
PDC deficiency
|
backup of ala and pyr, lactic acidosis, can be acquired in alcholics 2/2 B1 deficiency
tx: give ketogenic aa, (lys, leu) |
|
akg DH and pdc - what regulates them?
|
both are inhibited by ATP, NADH, and their products (succinyl coa and acetyl coa)
|
|
oxphos - inhibitors of complex 1
|
amytol (barbiturate), rotenone (tick poison), mpp (metabolite of MPTP)
|
|
oxphos - inhibitors of complex 3
|
antimycin A
|
|
oxphos - inhibitors of complex 4
|
arsenic, CN-, CO, H2S, N3-
this step converts 1/2O2-> H2O |
|
oxphos - inhibitors of complex 5 (atp synthase)
|
oligomycin, macrolide causing lactic acidosis
|
|
oxphos - uncoupling agents
|
2,4DNP, aspirin, thermogenin
cause leaking membrane in mitochondria |
|
can odd chain fatty acids make glucose?
|
yes, they release propionyl coa, which becomes succinyl coa and enters TCA cycle, to OAA which goes into gluconeogenesis. even chains only make acetyl coa, which is before the block on isocitrateDH in the fasting state, so cannot make glucose.
|
|
respiratory burst
|
NADPH oxidase takes gives electron from NADPH to O2, SOD takes superoxide radical and makes hydrogen peroxide, myeloperoxidase takes h202 and makes HClO. bacteria dies.
|
|
neutralizing h2o2
|
catalase uses GSH to turn H2O2 into H2O, G6PD makes NADPH from G6P, which is used in GSH reductase to replenish GSH
|
|
infantile cataracts:
hurlers vs galactosemia vs fructose intolerance |
hurlers is 2 years after birth, galactosemia is 2 weeks after birth, fructose intolerance is 6 months after birth
|
|
what tissue-specific enzyme deficiency causes osomotic problems in diabetics?
|
sorbitol dehydrogenase, which converts sorbitol to fructose in normal tissue.
schwann cells, lens, retina, kidneys have aldose reductase but no sorbitol dh, and are therefore sites of osmotic damage in DM |
|
Urea cycle mnemonic
|
Ordinarily Careless Crappers Are Also Frivolous About Urination
Ornithine, Carbamoyl phosphate, Citrulline, Aspartate, Arginosuccinate, Fumarate, Arginine, Urea Nitrogens in urea are from NH4 and Aspartate, and Carbon is from CO2. |
|
ammonia effect on metabolism
|
depletes akg, inhibiting TCA cycle. treat w/ benzoate or phenylbutyrate
|
|
ammonia intoxication
|
tremor, slurring, somnolence, vomiting, cerebral edema, blurred vision
|
|
CPS1 vs CPS2
|
CPS1 - urea cycle, in mitochondria, gets N from ammonia and aspartate
CPS2 - pyrimidine synthesis, cytosolic, N from glutamine |
|
Phe derivatives
|
tyrosine, dopa, dopamine, NE (vitc), epi(sam) , melanin, thyroxine
|
|
trp derivatives
|
niacin (b6), melatonin, serotonin (both BH4)
|
|
his derivatives
|
histamine (b6)
|
|
glycine derivatives
|
porphyrin, heme (both b6)
|
|
arg derivatives
|
NO, urea, creatine (sam)
|
|
glu derivatives
|
gaba (b6), glutathione
|
|
breakdown products
DA NE Epi |
DA - HVA
NE - VMA Epi - metanephrine |
|
PKU causes
|
deficiency in phe hydroxylase, tetrahydrobiopterin, dihydropterin reductase
|
|
albinism causes
|
tyrosinase deficiency, defective tyr transporters, lack of neural crest cell migration
|
|
homocystinuria causes
|
1. cystathionine synthase def (tx: dec met, inc cys, inc b12 and B9)
2. dec affinity of cystathionine synthase for B6 (tx:inc B6 in diet) 3. homocysteine methyltransferase deficiency (needs b12) retarded marfans w/ stroke, MI and bone problems all of them, inc cys, dec met |
|
MSUD
|
def in aketacid dh, decrease intake of I Love Vermont maple syrup
Ile, Leu, Val |
|
Niemann Pick vs Tay Sachs
|
NP has no HSM, but has foam cells. Tay SaX (hexosaminidase, GM2 ganglioside) has onion skin lysosomes. Both have cherry red spot and progressive neurodegeneration.
|
|
Fabrys enzyme, accumulated substrate, findings
|
XR - alpha galactosidase, ceramide trihexose, peripheral neuropathy, angiokeratomas, cardio / renal dz.
|
|
Krabbe's dz
|
galactocerebrosidase, galactocerebroside accum, optic atrophy, globoid histiocytic cells
|
|
Metachromic leukodystrophy
|
central and peripheral demyelination, arylsulfatase a def, cerebroside sulfate accumulates
|
|
Hurlers vs Hunters
|
X marks spot w/ hunters, hurlers has corneal clouding, hurLers enzyme is alpha L idurinase, hunters is iduronate sulfatase, both accum heparan sulfate and dermatan sulfate
|
|
carnitine deficiency
|
cant transport LCFA into mitochondria, toxic accumulation. weakness hypotonia, hypoketotic hypoglycemia
|
|
acyl-coa dehydrogenase deficiency
|
increased dicarboxylic acids, decreased glucose and ketones
|
|
ketone bodies
|
made in prolonged starvation or drunkness when depletion of OAA (from too much NADH or depletion) stalls krebs cycle, shunts glucose and FFA toward production of ketone bodies for muscle and brain. RBC (no mito) and liver cannot use ketone bodies.
|
|
zellweger syndrome
|
cannot break down vlcfa, phytanic acid accumulates, cant for myelin. hypotonia + seizures, hepatomegaly, retardation and death as child
|
|
apoproteins of:
VLDL |
B-100 - Binds to LDL receptor, mediates VLDL secretion
C-II - cofactor for LPL E - mediates Extra (remnant) uptake |
|
apoproteins of:
IDL |
B-100 - Binds to LDL receptor, mediates VLDL secretion
E - mediates Extra (remnant) uptake |
|
apoproteins of:
LDL |
B-100 - Binds to LDL receptor, mediates VLDL secretion
|
|
apoproteins of:
Chylomicrons |
B48 - mediates chylo secretion
A-IV - activates LCAT(?) C-II - cofactor for LPL E - mediates Extra (remnant) uptake |
|
apoproteins of:
HDL |
AI and AII - activate LCAT
|
|
familial dyslipidemias:
type 1 |
hyperchylomicronemia, elevated TG and chol due to LPL deficiency or altered ApoC2.
pancreatitis, HSM, eruptive xanthomas (no risk of atherosclerosis) |
|
familial dyslipidemias:
type 2a |
familial hypercholesteremia, increased LDL and cholesterol, AD, deficient LDLR, causes accelerated atherosclerosis, achiles xanthomas and corneal arcus
|
|
familial dyslipidemias:
type 3 |
liver cannot remove chylomicrons or VLDL remnants from blood due to def in E3 and E4, inc TG and cholesterol. (Looks like type 1)
|
|
familial dyslipidemias:
type 4 |
hypertriglyceridemia, increased VLDL and TG, hepatic overproduction of VLDL, causes pancreatitis
tx w/ fibrates, which increase PPARalpha, increasing LPL and tg lysis... |
|
bronchopulmonary segments - triad and diad
|
tertiary segmental bronchus, bronchial and pulmonary arteries at center
veins and lympatics at the borders. |
|
which is more common for aspiration, right or left mainstem bronchus?
|
right, its wider and more vertical then the left
|
|
pulm artery association w/ mainstem bronchi
|
RALS - Right anterior, left superior.
|
|
aspirate a peanut, upright vs supine...
|
upright - lower portion of right inferior lobe
supine - superior portion of right inferior lobe |
|
crossing of diaphragm - esophagus, aorta, ivc
|
I(vc) 8, 10 eggs (vagus too), aat 12 (azygous and thoracic duct too)
|
|
diaphragm pain referral
|
c345 sends it to shoulder
|
|
inspiratory muscles during exercise
|
inSpiratory - external intercostals, Scalenes, Steromastoids
inspire w/ externals |
|
expiratory muscles during exercise
|
for muscles of abdominal wall and internal intercostals.
expire w/ internals |
|
why is kallikrein in lungs?
|
activates BK, activates plasmin, kills clots
|
|
what makes hemoglobin go from R to T?
|
increased Cl-, H+, CO2, 2,3BPG, temperature
|
|
right shift hb curve mnemonic
|
CADETs face right
CO2, Acid/Altitude, DPG, Exercise, Temperature |
|
what is diffusion limited?
|
O2 in emphysema, fibrosis, CO. Gas does not equilibrate by the time it blood reaches end of capillary. exercise kind of makes O2 diffusion limited.
|
|
Pulm HTN genetic cause
|
inactivation of BMPR2 (TGF beta related gene normally inhibits vasc smooth muscle proliferation)
|
|
Pulm Vasc resistance eq.
|
PVR = (Ppulm art - P L atrium) / CO
|
|
alveolar gas equation
and A-a gradient |
PAO2 = 150 - PAco2 / 0.8
A-a gradient = PAO2-PaO2 = 10-15mmHg increased in hypoxemia, shunting, V/Q mismatch, fibrosis (diffusion block) |
|
what causes hypoxemia w/ normal A-a gradient?
|
high altitude and hypoventilation
|
|
what causes hypoxemia w/ high A-a gradient?
|
V/Q mismatch, shunting R->L, diffusion block
|
|
zones of lung:
PA>Pa>Pv |
zone 1, apex
V/Q = 3 dead space |
|
zones of lung:
Pa>PA>Pv |
zone 2, middle
V/Q b/w .6 and 3 |
|
zones of lung:
Pa>Pv>PA |
zone 3, base
V/Q = .6 shunt |
|
do you give 100% O2 to pt w/ shunt or dead space?
|
100% O2 helps physiologic dead space (blood flow obstruction)
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do you give O2 if there is a shunt?
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you shunt give O2 to pt w/ a shunt (airway obstruction, pulmonary edema, pneumonia)
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terbafine mnemonic
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that black chick squalene is more than fine, she's terba-fine
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changes in PaO2 and PaCO2 during exercise
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no changes in PaO2 and PaCO2, but PvCO2 increases..
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prevention of DVT
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heparin
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chronic bronichitis or emphysema...
early onset cyanosis or early onset dyspnea? |
CB = early onset cyanosis due to shunting, you shant give O2 for shunt
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extrapulmonary restrictive lung dz's
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poor muscular effort - myasthenia gravis and polio
poor structural apparatus - scoliosis, obesity |
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interstitial lung dz's
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characterized by poor diffusion capacity - ARDS, NRDS, pneumoconiosis, sarcoidosis, IPF, goodpastures, wegeners, histiocytosis x, drugs
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drugs causing pulm fibrosis
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bleo, busulfan, amiodarone
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asbestosis, coal miners or silicosis?
increased TB risk |
silicosis impairs mphage phagolysosomes - eggshell calcification in hilar lymph nodes
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physical finding:
lung hyperresonance? |
tension pneumothorax
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physical finding:
increased fremitus |
lobar pneumonia
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physical finding:
tracheal deviation toward lesion |
bronchial obstruction
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physical finding:
tracheal deviation away from lesion |
tension pneumothorax
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physical finding:
decreased everything |
pleural effusion -
decreased breath sounds + dullness to percussion + decreased fremitus, no deviation of trachea |
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lung cancer - mets vs primary?
presents w/ cough |
primary
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lung cancer - mets vs primary?
presents w/ dyspnea |
mets
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lung cancer complications mnemonic
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SPHERE of complications
SVC syndrome, pancoast tumor, hemoptysis, endocrine (paraneoplastics), recurrent laryngeal n., effusions (pericardial or pleural) |
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lung CA,
central w/ cavitation |
sq cell ca
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lung CA,
PTHrP |
sq cell ca
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lung CA,
MCC in nonsmokers |
adenoca, MCC in females, both bronchial and bronchioalveolar due to Clara cells - type 2 pneumocytes
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lung CA,
SIADH / ACTH / eaton lambert |
small cell, small blue neuroendocrine cells
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lung CA,
psammoma bodies |
mesothelioma
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lung CA,
pleomorphic giant cells |
large cell carcinoma, pleomorphic giant cells w/ leukocyte fragments in cytoplasm
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H1 antagonist toxicity
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sedation, antimuscarinic, anti alpha adrenergic (H1, M3 and alpha1 are all Gq)
H1 blockers are really Gq blockers... |
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theophylline mechanism
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inhibits PDE, increases cAMP like Beta2 agonist
blocks adenosine (Gi) |
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ZilEuton vs zafirlukast / montelukast
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ZilEuton blocks leukotriene Enzyme, lukasts block receptor
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bosentan - whats it used for, and mechanism?
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pulm htn, comp antagonizes endothelin-1, a vasoconstrictor
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macula densa: when does it release adenosine?
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increased NaCl levels release adenosine -> afferent constriction, decrease GFR
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body water - 60-40-20 rule
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60% of body weight is TBW, 40% is ICF, 20% is ECF (1/4 plasma, 3/4 interstitial)
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when does PAH clearance rate approximate RPF and GFR?
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RPF at low concentrations, GFR at high concentrations because carriers get saturated.
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filtered load equation
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FL = GFR x Plasma concentration
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increased plasma protein concentration. effect on FF?
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NC to RPF, decrease GFR, therefore decrease FF
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free water clearance
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Ch2o =V - Cosm
Cosm = (Uosm / Posm) * V Ch20 = V(1-Uosm/Posm) |
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excretion rate
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Excretion rate = Ux*V
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PTH effect on proximal tubule
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inhibits Na+/PO4 cotransport, increases phosphate excretion
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PTH effect in distal tubule
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Increases Na+ / Ca+ exchange, increase Ca+ reabsorption
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AT2 effect on proximal tubule
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Increases Na+/H+ exchange, leading to contraction alkalosis (BP down, aldosterone up, Na H exchange up, bicarb up
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carbonic anhydrase proximal tubule mechanism
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releases H+ into tubule, making HCO3 into H2O and CO2, which diffuses back into cell. Then it makes it back into bicarb and pumps it out into blood.
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what determines metabolic rate of kidney?
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GFR, because main metabolic function of kidney is NaK pump, so increase GFR = increased NaK pump work...
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Which substances concentrations increase in proximal tubule (TF/P)?
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PAH > Cr > Inulin > Urea > Cl- > K+ Na+ (1:1)
secreted except (K Na) |
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Which substances concentrations decrease in proximal tubule (TF/P)?
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Glucose < amino acids < bicarb
all are reabsorbed |
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ANP renal effects
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released from atria 2/2 inc volume, relaxes vascular smooth muscle by cGMP, increasing GFR and blocking renin / aldosterone effects
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renin vs ANP
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renin inc GFR, inc Na reabsorption
ANP inc GFR, dec Na reabsorption |
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JG cells
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modified smooth muscle of afferent arterioles, defect stretch, make store and secrete renin to decrease GFR (save sodium), raise bp
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3 stimuli for JG cells renin release
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1. dec BP
2. dec Na + delivery to macula densa 3. inc sympathetic tone (beta1) |
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hyper / hypoosmolarity:
effect on potassium? |
HYPERosmolarity causes HYPERkalemia, and vice versa
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winter's formula
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figure out respiratory compensation to metabolic acidosis:
Pco2 = 1.5bicarb+8 Pco2 should increase .7mmHg per 1mEg/L bicarb |
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winters formula:
pCO2 > bicarb |
metabolic acidosis also has primary respiratory acidosis
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winters formula:
bicarb > pCO2 |
metabolic acidosis also has primary respiratory alkalosis
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anion gap metabolic acidosis mnemonic
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MUDPILES - methanol, uremia, dka, paraldehyde / phenformin. iron / inh, lactic acidosis, etylene glycol, salicylates
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non-anion gap metabolic acidosis
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Dont Sniff Chloroform Rags
diarrhea, sniffing glue, chloremia, renal tubular acidosis |
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metabolic alkalosis
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peeing, vomiting, burping and aldosterone
diuretics, vomiting, antacids, hyperaldosterone |
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hypokalemic acidosis
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RTA 1 (distal) and 2 (proximal).
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RTA 1 vs RTA 2
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1. distal, cant excrete H+, alkaline urine, more Ca stones
2. proximal, cant absorb HCO3. hypophosphatemia rickets both have low K+ high H+ |
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RTA 4
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HYPERkalemic, 2/2 hypoaldosteronism, low urine pH due to less buffering capacity. Cong. adrenal hyperplasia
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Renal tubular acidosis
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hyperchloremic, non anion gap metabolic acidosis
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Renal tubular acidosis
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hyperchloremic, non anion gap metabolic acidosis
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Renal tubular acidosis
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hyperchloremic, non anion gap metabolic acidosis
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Renal tubular acidosis
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hyperchloremic, non anion gap metabolic acidosis
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nephritic syndrome - tetrad mnemonic
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lucas HAPOpuro has glomerolonephritis.
HTN, azotemia, proteinuria, oliguria (and hematuria) |
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glomerulonephritis after URI
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either PSGN (lumpy bumpy subepithelial immune complexes, granular IF, IgG+C3) or Berger's dz (IgA+C3 in mesangium)
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diffuse proliferative GN
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MCC of death in SLE, (MPGN also)
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rapidly progressive GN
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goodpastures (anti BM IgG), wegeners (c-anca), or microscopic polyarteritis (p-anca)
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membranous GN
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MC adult nephrotic, in SLE, tumors, drugs
spike and dome, (subepithelial IgG+C3) |
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Focal segmental GS
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IVDA and HIV, poor prognosis
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Membranoproliferative GN type 1
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subendothelial IC, tram track (HBV associated)
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Membranoproliferative GN type 2
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subendothelial IC, dense deposits (C3 nephritic factor)
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Membranous GN - things that cause it
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Drugs - penicillamine
Infections - HBV HCV Systemic dz - SLE, DM Cancer - lung / colon |
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which renal stones do you treat by acidifying urine?
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Ca and Struvite (MAP magnesium ammonium phosphate), the radiopaque ones
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which renal stones do you treat by alkalinizing urine?
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uric acid and cystine stones, the radiolucent ones
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WAGR syndrome
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Wilms tumor, Aniridia, Genital malformations, Retardation
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Transitional cell CA causes
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PSAC problems
phenacetin, smoking (shistosoma), aniline dyes, cyclophosphamide |
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diffuse cortical necrosis
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acute infarction of both cortices of kidneys, post pregnancy DIC or vasospasm
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drug induced interstitial nephritis vs ATN
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DIIN is allergies to sulfa drugs, ATN is direct toxicity of AG, myoglobin, toxins (epithelial detachment muddy casts)
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renal papillary necrosis causes
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santa cruz pd
sickle cell, chronic pyelonephritis, phenacetin, DM |
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ARF:
Urine osmol >500, Urine Na <10, FeNa<1%, BUN/Cr>20 |
prerenal azotemia
no renal failure, perfusion problem, normal osmol, Na, low GFR raises BUN/Cr |
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ARF:
Urine osmol <350, Urine Na >20, FeNa>2%, BUN/Cr<15 |
renal azotemia - 2/2 ATN, ischemia, toxins - patchy necrosis, fluid backflow - granular casts - impaired BUN reabsorption
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ARF:
Urine osmol <350, Urine Na >40, FeNa>4%, BUN/Cr>15 |
postrenal azotemia - stones, bph, neoplasia, congenital - only if bilateral
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ARFs
BUN / Cr < 15 |
renal / ATN
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ARFs
Uosm > 500, FeNa<1% |
prerenal
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ARFs
Uosm < 350, FeNa>2% |
w/ renal tubular cell casts = renal
w/o casts = postrenal |
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Fanconi's causes
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wilsons, cisplatin, expired tetracycline
dec prox tubule reabsorption of everything. looks like DI |
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Electrolyte imbalances:
disorientation, stupor, coma |
hypo Na
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Electrolyte imbalances:
hypokalemia, hypovolemia, increased aldosterone |
hypo Cl-, secondary to metabolic alkalosis
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Electrolyte imbalances:
U wave on ECG, flattened T waves, arrythmias, paralysis, weakness |
hypo K+
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Electrolyte imbalances:
Tetany, NM irritability |
hypo Ca+2
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Electrolyte imbalances:
NM irritability, arrhymias |
hypo Mg+2
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Electrolyte imbalances:
bone loss, osteomalacia |
hypo PO4
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Electrolyte imbalances:
irritability, delirium, coma |
hyper Na
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Electrolyte imbalances:
accompanies anion gap acidosis |
hyper Cl
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Electrolyte imbalances:
peaked T waves, wide QRS, arrhythmias |
hyper K
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Electrolyte imbalances:
delirium, renal stones, abdominal pain |
hyper Ca
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Electrolyte imbalances:
delirium, decreased deep tendon reflexes, cardiopulmonary arrest |
hyper Mg
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Electrolyte imbalances:
renal stones, metastatic calicification |
hyper PO4
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diuretics causing gout mnemonic
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Fuckin Elbow Hurts
furosemide, ethacrynic acid, HCTZ |
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loops side effects mnemonic
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OH DANG!
Ototoxic, hypokalemia, dehydration, allergy (sulfa), nephritis, gout |
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HCTZ mnemonic
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hyperGLUC
glycose, lipidemia, uricemia, calicemia |
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K sparing diuretics mnemonic
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the potassium STAys
spironolactone, triamterene, amiloride |
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ACEi mnemonic
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CAPTOPRIL
cough, angioedema, proteinuria, taste changes, hypOtension, pregnancy problems, rash, increased renin, lower AT2 |