3. Data interpretation Flashcards by cole roberts

What are the causes of microcytic anaemia?

Microcytic: TAILS
Thalassaemia, Anaemia of chronic disease, Iron-deficiency, Lead poisoning, Sideroblastic)

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What are the causes of normocytic anaemia?

Normocytic: Anaemia of chronic disease, acute blood loss, haemolytic, renal failure

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What are the causes of macrocytic anaemia?

Macrocytic: B12/folate, alcohol, hypothyroidism, myelo- conditions

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What are the causes of high neutrophils?

Bacterial infection
Tissue damage (inflammation, infarct, malignancy)
Steroids

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What are the causes of low neutrophils?

Viral infection
Clozapine
Carbimazole
Chemo/radiotherapy

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What are the causes of high lymphocytes?

Viral infection
Lymphoma
CLL

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What are the causes of high platelets?

Reactive: Bleeding, tissue damage
Primary: Myeloproliferative disorders

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What are the causes of low platelets

Reduced production: Drugs (penicillamine), infection, myelo issues
Increased destruction: Heparin, DIC/ITP/TTP/HUS/TTP

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What are the causes of hypovolaemic hyponatraemia?

Fluid loss (inc D+V)
Diuretics
Addison’s Disease

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Causes of euvolaemic hyponatraemia?

SIADH
Psychogenic polydipsia
Hypothyroidism

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Causes of hypervolaemic hyponatraemia?

Heart failure
Renal failure
+ liver/nutritional/thyroid failure

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What are the causes of SIADH?

SCLC
Infections
Abscess
Drugs (antipsychotics, carbamazepine)
Head injury

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Causes of hypokalaemia?

DIRE
Drugs (loop and thiazide)
Intestinal loss (D+V)
RTA
Endocrine (Cushings and Conns)

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Causes of hyperkalaemia?

DREAD
Drugs (ACEIs, K+-sparing)
Renal failure
Endocrine (Addison’s)
Artefact (clotted sample)
DKA (can go hypo once insulin given)

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How can you distinguish between pre, intra and post renal AKI?

Prerenal: rise urea > creatinine
Intra: rise creat > urea
Post: rise creat > urea + palpable bladder/hydronephrosis

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Causes of pre-renal AKI

Dehydration (inc RAS)

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Causes of intrinsic AKI

INTRINSIC
Ischaemia
Nephrotoxics
Radiological contrast
Injury (rhabdomyolysis)
Negative crystals (gout)
Syndromes (glomerulonephritis)
Inflammation
Cholesterol emboli

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Causes of post-renal AKI?

Obstructions in lumen, wall or externally

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How can severe pre-renal AKI be differentiated from intrinsic/post?

If urea x 10 > creat = severe pre-renal

How can AKI and UGI bleed be differentiated?

UGI bleed will have low Hb

What are the common nephrotoxics?

Renal drugs
NSAIDs
Antibiotics: gent, vanc, tetracylcines

How do you assess hepatic function

Albumin, PT, bilirubin and gluocse

How can pre, intra and post-hepatic jaundice be determined from LFTs

Raised bilirubin for all with
Pre: insignificant rises in both ALT and ALP
Intra: ALT rises > 10x and ALP rises < 3x
Post: ALT rises < 10x and ALP rises >3x

How can LFTs distinguish between pathological and drug induced intrahepatic jaundice?

ALT associated with liver disease
AST associated with alcohol

Causes of pre-hepatic jaundice?

Haemolysis

Causes of intrahepatic jaundice

Damage within the liver (hepatitis, cirrhosis, malignancy)

Causes of post-hepatic jaundice

Obstruction in lumen, wall or surrounding

Distinguish between primary and secondary a) hypothyroidism b) hyperthyroidism

a) Low T4 with raised / low TSH b) High T4 with low / raised TSH

What causes primary and secondary hypothyroidism?

1: Hashimoto's, drug induced 2: Pituitary pathology

What causes primary and secondary hyperthyroidism?

1: Graves, toxic nodular goitre, drugs 2: Pituitary tumour

What TSH dictates an increase or decrease in levothyroxine

decrease < 0.5-5.5 < increase

How is CXR quality assessed>

PRIM Projection: AP heart size > PA Rotation: Distance between clavicles Inspiration: Is the 7th anterior rib visible? Markings: additional things the radiographer has seen

Outline the ABCDE approach for CXR interpretation

Airway: trachea, carina, bronchi, hilar Breathing: Lungs and pleura Cardiac: Heart size and borders Diaphragm: inc costophrenic angles Everything else: bones, soft tissues, tubes, pacemakers etc

How does a normal airway look on CXR?

Trachea central/slightly right Bronchi division visible, right bronchus stockier than left

What problems can be seen with airways on CXR?

Tracheal deviation: Pushed away (cancer, effusion), towards (tension pneumothorax) Hilar enlargement: Unilateral (malignancy), bilateral (sarcoidosis)

How do you assess the lung fields?

Check upper middle and lower zones have lung markings throughout Pleura should be non visible (thickening suggests mesothelioma, reduced extension suggests pneumothorax

How do you assess the heart on CXR

<50% thoracic width on PA, if not then consider congestive, structural or effusion

How do you assess the diaphragm on CXR?

Should be indistinguishable from liver If separated, free gas could be present so urgent senior review (likely perforation) Blunted costophrenic angles mean fluid or consolidation

What are the features of pulmonary oedema?

Alveolar oedema B-lines Cardiomegaly Diversion to upper zones (vessels bigger here) Effusions

How can you differentiate between oedema and pneumonia?

ABCDE and bilateral for oedema, unilateral (usually) for pneumonia

How do you account for Pa02 for someone on O2 therapy?

% O2 -10 = normal kPa (if on 50% then kPa should be 40)

How can you distinguish between T1 and T2 resp failure?

T1: low/Normal PaCO2 (fast/shallow breathing so blowing off CO2) T2: High PaCO2 (slow breathing: blue bloaters, NM failure)

Outline how PaCO2, HCO3- and pH are interpreted for acid-base status

Raised PaCO2: resp Raised HCO3: metabolic Both up/down + normal pH: compensation

Causes of Resp acidosis Metabolic acidosis Resp alkalosis Metabolic alkalosis

Resp acidosis: T2RF Metabolic acidosis: Lactic acidosis, DKA, renal failure Resp alkalosis: rapid breathing, anxiety Metabolic alkalosis: vomiting, diruretics, Conn's Syndrome

How do you manage a paracetamol overdose

Acute: Check normogram after 4hrs + administer NAC if above/fluids if below line Staggered: NAC

What is INR? What does it indicate?

Patient PT/population PT Higher means longer clotting time .'. bleed risk

Treat the following INRs for patients on warfarin <6 6-8 >8 Major bleed (low BP, confined space eg brain, eye)

<6: reduce dose 6-8: Omit 2 days then reduce >8: Omit + give 1-5mg oral vitamin K Major: omit + 5-10 vit K IV + PT complex