What is this?

 -↑pCO2 (CNS depression,     mechanical injury to  lungs/chest wall)

AND this?

 ↑Bicarb (Conditions that decrease K+

-Respiratory Acidosis

-Metabolic Alkalosis 

What is hypercapnia?

-What are some CNS signs of MODERATE hypercapnia?

-What are some CNS signs of SEVERE hypercapnia?

-Too much CO₂

-Increased cranial pressure, headache, confusion, cobativeness, hallucinations, transient psychosis, myoclonic jerks, flapping tremor, 

-(manifestations of pseudotumor cerebri) STUPOR, COMA, CONSTRICTED PUPILS, DEPRESSED TR's, EXTENSOR PLANTAR response, seizers, papiledema

What are some CV signs of SEVERE hypercapnia?

-Mild Signs?

-Cor pulmonale (increased bulk of RV muscle), depressed CO, arrhythmias, prerenal azoternia, PERIPHERAL EDEMA

-warm/flushed skin, BOUNDING PULSE, diaphoresis (profuse sweating)

Signs/Symp of Resp ALKALOSIS?

 CNS?

CV?

 -Cerebreal vasoconstriction, reduction of intracranial pressure, lightheadedness, confusion, INCREASED DTRs, Generalized SEIZURES

-Chest oppresion, angina pectoris, ischemic EKG changes, Normal to decreased BP, Arrhythmias, PERIPHERAL VASOCONSTRICTION

Numbness, paresthesia of extremities, circumoral numbness, larygngeal spasms, TETANY manifestations, Trousseau's SIGN, Chvostek's sign.

If there is a Chronic Metabolic Resp ALKALOSIS...what is it that we can do?

-What is the cut-off point (pH value) for Acute cases where we take measures toreduce HCO-₃levels?

-What else must be occuring?

-Not much, manage teh underlying causative disorder but no specific meassures are indicated.

- Anything >7.55

-Hemodynamic instability, altered mental status, or cardiac arrhythimias

What are some Resp Signs/ SYmptoms of Metabolic Acidosis?

 -CV?

-Metabolic?

-HYPERVENTILATION, dyspnea, decreased strength of resp muscles

- Increased symp dis charge, sensization to reentrant arrhythmias, Reductions in CO (impairment of cardiac contractility)

-Increased metabolic demands, INSULIN resistence, inhibition of anaerobic glycolysis, reduction in ATP Syn

CNS signs/symp of METABOLIC ACIDOSIS:

-Skeletal?

-impaired metabolism, inhibtion of CELL VOLUME REGULATION, COMA, Progressive obtundation

-Osteomalacia and FRACTURES

-Assessment of ____  ____  ____ is useful in approaching the differential diagnosis of unexplained metabolic acidosis. 

-What are teh 2 types of Lactic acidosis

- How do we treat inadequate tissue oxygenation lactic acidosis?

-plasma anion gap

-Impaired Tissue Oxygenation/ Preserved tissue Oxygenation

-If no circulatory failure...simply use oxygen-rich mixture and ventilator support, if Circ failure occurs you will need to replenish volumes and use pre and afterload REDUCING agents, also maybe a mycocardial stimulant

What kind of INSULIN deficiencies/resistences must exist to enter diabetic ketoacidosis?

-What happens to potassium plasma levels as we reach acidotic states?

 -SEVERE INSULIN deficiencies

-They Go DOWN

What are CNS signs/symp of Metabolic ALKALOSIS

-CV?

-Resp?

-headache, lethargy, stupor, delirium, tetany, seizures, potentiation of HEPATIC ENCEPHLOPATHY

-Supreventricular and VENTRICULAR ARs, potentiation of digitalis toxicity,

positive inotropic ventricular effect.  

-Hypoventilation with attendant hypercapnia and hypooxemia

S and S of Metabolic Alkalosis

-Neuromuscular?

-Renal?

-THe renal effects of this are mostly do to the depletion of what ion?

-Chovostek's Sign, Trousseau's Sign, WEAKNESS

-Polyuria, polydipsia, urinary concentration defect, cortical and medullary RENAL CYSTS

-POTASSIUM

What are teh metabolic effects of METABOLIC ALKALOSIS?

-What does Metabolic alkalosis do to GFR?

-What does it do to Cl levels?

-HYPOKALEMIA, hypocalcemia, hypomagnesemia, hypophosphatemia and INCREASED ORGANIC ACID AND AMMONIA PRODUCTION

-Usually decreases it

-Decreases them (may need to administer NaCL and KCl)

What is this scenario: pH decreased, PCO2 normal, HCO3 decreased

-What are teh 4 things this could be indicative of?

-Metbolic acidosis

-Renal failure, DKA, Starvation, ASA, Methanol, Ethylene glycol

-pH increased, PCO2 normal, HCO3 Increased

-What could this be due to (3 things)

-Metabolic Alkalosis

-Vomitting, gastric suction, MASSIVE blood transfusion

-pH decreased, pCO2 increased, HCO3 normal

-what 3 things could cause this?

-Resp Acidosis

-Pneumonia, pneumothorax, CNS depression

-pH increased, pCO2 decreased, HCO3 normal

-Name 6 things that can cause this?

-Resp ALKALOSIS (too much CO₂blown off during HYPERVENTILATION)

-Infection, CVA, trauma, hypoxia, CHF, ASA

-Splits complex carbohydrates (starch) at the internal
    α -1,4 linkage

-Pronounced levels of this enzyme occur at what concentration ?

-What can be causing this (3 things)?

-Amylase (exocrinic secretion from PANCREAS)

-5x

-1) Acute Pancreatitis (rises for 2-6 hrs and remains high for 2-4 days) 2) Pancreatic pseudocyst 3) Morphine admnistration (makes spinchter of Oddi CONTRACT and release AMYLASE)

- What are these indicative of?

Pancreatic carcinoma
Mumps
Parotiditis
Perforated peptic ulcer
 

Moderate Elevation of AMYLASE (3-5X)

-  _____ assay more sensitive and specific than amylase for acute pancreatitis

-Aside from pancreatitis..what else might this enzyme be elevated in?

-Lipase

-DKA, Alcholhism, Small bowel obstruction, acute and chronic renal failure, pancreatic pseudocyst, perforation of peptic ulcer

What is the link between the CNS and the endocrine System?

-T/F...Hypothalmus is involved in Emotions?

-Who regulates food and water intake?

-The hypothalamus

-True

-Hypothalmus (and sleep cycles)...also involved in motor function, homeostasis, and autonomic functions.

Name the 6 hypothalmic hormones:

Corticotropin-releasing factor (CRF)

 Dopamine (prolactin-inhibiting hormone, DA)

Gonadotropin-releasing hormone (GnRH)

Growth Hormone Releasing hormone (GRF)

Somatostatin  (SS)

Thyrotropin releasing hormone (TRH)

What hormone am I?

-with vasopressin, stimulates ant pit to secrete ACTH

-Inhibits secretion of prolactin from ant pit.

-stimulates ant pituitary to secrete LH and FSH

-CRH (Corticotropin-releasing hormone)

- DA (Dopamine)

-Gonadotropin-releasing hormone (GnRH)

What hormone am I?

-stimulates ant pit to secrete growth hormone

-Inhibits secretion of growth hormone from ant. pit

-stimulates ant pit to secrete TSH

-GHRF (Growth hormone releasing hormone)

-SS (Somatostatin)

-TRH (Thyrotropin-releasing factor)

After puberty, hyposecretion of GnRH may result from what 2 things?

Besides the hypothalmus, where else is CRH released?
 

- intense physical training  and anorexia nervosa

-is also synthesized by the placenta and seems to determine the duration of pregnancy

What am I? 

 Stimulates
Gluconeogenesis, Stored energy molecular breakdown, Sympathetic responses to stressors, gastric acid secretions
Reduces
Inflammation and immune function
 

Cortisol

-T/F...Somatostatin is a single polypeptide made up of 41 aas?

-What does it act to inhibit?

-where else is it secreted?

-False, Somatostatin is a mixture of two peptides, one of 14 amino acids, the other of 28.

-TSH and GH from ant pit

-pancrease..it inhibits lots o' hormones here too.  

-Dopamine is a derivative of the amino acid ______.

-what does it inhibit?

-Who releases growth hormone?

-What is secreted by ant. pit?

-tyrosine

-Prolactin

-Pituitary

-FLAT PEG (FSH, LH, ACTH, TSH, Prolactin, ENDORPHINS, GH)

Who releases Aldosterone?

-acts to increase reabsorption of what?

- adrenal cortex

-Na (water retention)

Which condition is this? Cortisol HIGH, ACTH LOW

-Which kind of Hypothyroidism is this?

caused by LOW TSH

-Cushing's (do a DEX suppression test to simulate a negative feedback event....if ACTH is still high there is likely an ADRENAL ADENOMA

-Secondary Hypothyroidism

Which monitored med am I:

-Tonic clonic epilepsy, focal seizures, staticus epilepticus

-Tonic clonic seizure, psychomotor seizure, focal seizure
 

-Dilantin

-Phenobarbital

 - has antiinflammatory, immunomodulatory, and bronchoprotective effects that potentially contribute to its efficacy as a prophylactic anti-asthma drug

-Theophylline

-Digoxin

What do we need to cut down on when using Lithium?

-What drug should we avoid completely?

-Iodine salts, they enhance the hypothyroid effects of lithium

-MOA inhibitors should generally be avoided due to use reports of fatal malignant hyperpyrexia when combined with lithium

Salicylate

-When do we officially have Alcohol posoining?

-Woman absorb alcohol much slower than men?
 

-200mg/dL in the blood

-False, they absorb it faster

-Cortisol: Counteracts insulin by promoting _____ from amino acids, glycogen deposition in the liver, increases blood glucose, decreases peripheral utilization of glucose, stimulates lipolysis, and keogenesis

-characterized by fatigue, loss of muscle mass because of excess conversion of amino acids into glucose and redistribution of body fat (Moon face)
 

-gluconeogenisis

-Cushing's Syndrome (too much Cortisol)

-ACTH

-Addison's Dz (cortisol as well)

-What does Cortisol do to potassium levels?

-What specific immune cells does Cortisol inhibit?

-Induces potassium loss with the conservation of sodium

-T-cells (cell-mediated immunity)

-What does ACTH do to Cholesterol?

-Increases the transport of cholesterol into the mitochondra and activates hydolysis
 

AFP

All of these can be marked with?

Hepatocellular carcinoma

Testicular tumors

Ovarian tumors

 

CA15-3

CA-125

CA 19-9

 -is a glycoprotein produced during fetal development.  Not present in adults.
-Increased in colorectal (70%), gastointestinal (50%), lung (45%), pancreatic (55%), and breast carcinomas (40%). 
-Useful in monitoring surgical resection and metastatic disease
 

CEA (Carcinoembryonic antigen)

Human chorionic gonadotropin (β-HCG)

- Beta-HCG as a TUMOR MARKER

PSA

Methanol

Isopropanol

Ethylene Glycol (Antifreeze)

-Used against aerobic gram-negative bacteria
-Bind to 30S ribosomal subunit of bacterial mRNA – inhibiting protein synthesis
Very polar so are poorly absorbed from GI tract
Typically administered IV
 

Aminoglycosides

ER Drug Screen:

 -Narcotics, sedatives, antipsychotics, alcohol, tricyclics, benzodiazepines

-Theophylline, tricyclics, isoniazid, stimulants, camphor, carbon monoxide, hypoglycemic agents, alcohol withdrawl

- Anticholinergics, stimulants, withdrawl

-They will be in a  COMA

-They will be having a SEIZURE

-Psychosis or Altered Mental State

Drug Screening for (when they have what):

-Narcotics sedatives, benzodiazepines

-Tricyclics, quinidine, antichloinergics, beta blockers, digoxin, lithium antipsychotics, organophosphates

-Respiratory Distress

-Arrhythmias

-Hypotension

Drug Screening for (when they have what): 

-Antiepileptics, barbiturates, alcohol, lithium
 

-ATAXIA

What is teh fatal percent level of carbon monoxide?

-What will their blood look like (good clue)?

-How do their symptoms evolve?

-40% and over

-CHERRY RED!!!!!

-Symptoms progress from headache, lethargy, unconsciousness, respiratory faliure to death
Venous blood is cherry red in color
 

Symptoms of overdose by drug class

-CNS depression, slowed respiratory rate, abnormal body temperature, pinpoint pupils, deep tendon reflexes usually decreased

-CNS depression, ataxia, decreased body temperature, deep tendon reflexes decreased, metabolic acidosis with alcohols and ethylene glycol
 

-Narcotics

-Alcohol

Symptoms of overdose by drug class

-CNS and respiratory depression, deep tendon reflexes intact

-Anticholinergic syndrome, hypotension, coma, seizures, widened QRS and QT, ventricular arrhythmias
 

-Benzodiazepines

-Antidepressents (tricyclins)

Symptoms of overdose by drug class

-Delirium, increased pulse, increased temperature, flushed skin, warm, dry (no sweat), decreased bowel sounds, urinary retention, blurred vision, arrhythmias, prolonged QT

 -Anticholinergics (ex. atropine, scopolamine, antihistamines, mushrooms)

-STIMULANTS

Symptoms of overdose by drug class

-Anticholinergic syndrome, decreased blood pressure and temperature, pinned pupils, rigidity, dystonia, seizures

-Abdominal pain, respiratory alkalosis converting to metabolic acidosis, shock, diaphoresis, hypoglycemia
 

 -Phenothiazines

-Salicylates
 

-Abdominal pain, GI bleeding, hypotension, hypovolemia, acidosis, renal failure, cardiovascular collapse
 

Mycoplasma

-Beta-lactamase positive organisms can resist both PCN (beta-lactams)?

-What conveys resistence in MRSA and PCN-resistent Strept Pneum. species?  

-True (and cephalosporins (wiki))

-Lack of receptor usually targetted by Methicillin or PCN

Protozoans

Endotoxins are an integral part of what type of bacteria?

 -Nonphotosynthetic mass of branching interlacing filaments (hyphae) known as Mycelium
Forms
Mold
Yeast
 

-GNB (moderaltely toxic...exotoxins are more TOXIC)

-Clostridium tetani

Clostridium:

-Gram positive spore forming rods – obligate anaerobe

 -Gram positive spore forming anaerobic rods

-Gram positive rod (bacillus) “Chinese letters”
Causes diphtheria
Toxin is very potent
 

-C. botulinum

-C. perfringes

-C. diptheriae

Bacteriodes fragilis

 Inclusion Bodies:

o    large, abnormal lymphocytes that may contain more than one nucleus. These cells are found in Hodgkin lymphoma (mediastinal mass, cervical & supraclavicular (painless) lymphadenopathy
o    Middle aged women (MC)
 

-Reed Steinberg

Low MCV (>80) indicates?

-High MCV(100<)

-Microcytic anemia (iron deficiency)

-Macrocytic (megoblastic) B12 deficiency

-Auer Rods

BASOPHILIC STIPPLING

Dohle Bodies

Howell-Jolly Bodies

Cabot Rings

Pappenheimer Bodies

-are small round inclusions within red blood cells composed of denatured hemoglobin.^[1]

SEEN IN:    Unstable hemoglobinopathies, red cell enzymopathies, thalassemia, hemolytic anemia (that are named after the inclusion here)

Heinz Bodies

-epitrochlear node enlargement (common, but lymph nodes closest to actual wound are actually enlarged), but with tenderness & cellulitis

-Cat scratch Fever (Bartonella henselae) (Rod GN)