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MBChB Yr 3 OSCES > Biochemistry > Flashcards

Biochemistry Flashcards

1
Q

Is T3 or T4 a better marker of thyroid function?

A

T4

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2
Q

What % of T4 is free (fT4)?

A

Roughly 1% of the total T4, with the rest being bound to thyroid binding globulin

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3
Q

What is the half life of T4?

A

1 week

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4
Q

List 10 clinical features of hypothyroidism?

A
  1. Lethargy
  2. Increased weight
  3. Cold intolerance
  4. Memory impairment
  5. Menorrhagia
  6. Bradycardia
  7. Depression
  8. Dry skin
  9. Hair loss
  10. Constipation
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5
Q

List 6 clinical features of Grave’s disease?

A
  1. Exophthalmos/Proptosis
  2. Pretibial myxoedema
  3. Other autoimmune conditions
  4. Thyroid bruits
  5. Diffuse symmetrical goitre
  6. Chemosis
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6
Q

List 14 clinical features of hyperthyroidism?

A
  1. Tachycardia
  2. Palpitations (AF)
  3. Hyperactivity
  4. Decreased weight and appetite
  5. Muscle weakness & wasting
  6. Palmar erythema
  7. Goitre
  8. Hyperreflexia
  9. Fine tremor
  10. Onycholysis
  11. Diarrhoea
  12. Sweating
  13. Oligomenorrhea/Amenorrhoea
  14. Heat intolerance
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7
Q

Describe the biochemistry results of primary hypothyroidism?

A
  • Raised TSH (due to no -ve feedback)
  • Low T4 (due to thyroid’s inability to produce enough)
  • Normal T4 & raised TSH suggests subclinical hypothyroidism (most commonly caused by underlying autoimmune disease)
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8
Q

List 7 causes of primary hypothyroidism?

A
  1. Autoimmune thyroiditis (50%)
  2. Iodine deficiency or excess
  3. Thyroidectomy
  4. Therapy with radioactive iodine
  5. External radiotherapy
  6. Drugs
  7. Thyroid agenesis/dysgenesis
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9
Q

Describe the biochemistry result of secondary hypothyroidism?

A
  • Normal/low TSH (due to a lack of production)

- Low T4 (due to no +ve feedback from TSH)

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10
Q

List 4 causes of secondary hypothyroidism?

A
  1. Pituitary Adenoma- most common
  2. Surgery or radiotherapy which damages the pituitary tissue
  3. Hypothalamic/suprasellar tumour
  4. History of hypothalamic surgery or radiation
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11
Q

Describe the biochemistry results of primary hyperthyroidism?

A
  • Raised T3/T4 (due to excessive production)

- Low TSH (due to -ve feedback on pituitary/hypothalamus)

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12
Q

List 5 causes of primary hyperthyroidism?

A
  1. Graves’ disease (75% of all cases)
  2. Toxic multinodular goitre
  3. Toxic adenoma
  4. Iodine-induced (rare)
  5. Trophoblastic tumour (very rare)
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13
Q

Describe the biochemistry results of secondary hyperthyroidism?

A
  • Raised T3/T4 (due to excess production driven by a raised TSH level)
  • Raised TSH (due to excess production)
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14
Q

List 3 causes of secondary hyperthyroidism?

A
  1. TSH-secreting tumour
  2. Chorionic-gonadotropin secreting tumours (hCG secreting)
  3. Thyroid hormone resistance (usually euthyroid)- TSH is resistant to T3/T4 -ve feedback
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15
Q

What 4 blood tests assess the liver’s synthetic function?

A
  1. Bilirubin
  2. Albumin
  3. Prothrombin Time (PT)
  4. Serum glucose
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16
Q

What are 4 causes of an isolated rise in ALP?

A
  1. Bony metastases / primary bone tumours (e.g. sarcoma)
  2. Vitamin D deficiency
  3. Recent bone fractures
  4. Renal osteodystrophy
17
Q

What are 2 causes of isolated jaundice/rise in bilirubin?

A
  1. Gilbert’s syndrome (most common cause)

2. Haemolysis

18
Q

What 5 blood tests would you do to confirm haemolysis?

A
  1. Blood film
  2. Full blood count
  3. Reticulocyte count
  4. Haptoglobin
  5. LDH levels to confirm
19
Q

What is the cause of jaundice if you have normal stools & urine?

A

Pre-hepatic jaundice

20
Q

What is the cause of jaundice if you have dark urine & normal stools?

A

Hepatic jaundice

21
Q

What is the cause of jaundice if you have dark urine & pale stools?

A

Post-hepatic jaundice (obstructive)

22
Q

List 3 causes of unconjugated hyperbilirubinaemia?

A
  1. Haemolysis (haemolytic anaemia)
  2. Impaired hepatic uptake (drugs, congestive cardiac failure)
  3. Impaired conjugation (Gilbert’s syndrome)
23
Q

List 2 causes of conjugated hyperbilirubinaemia?

A
  1. Hepatocellular injury

2. Cholestasis

24
Q

List 3 causes of a decreased albumin?

A
  1. Liver disease (e.g. cirrhosis)
  2. Inflammation –> acute phase response which temporarily decreases the liver’s production of albumin
  3. Excessive loss due to protein-losing enteropathies/nephrotic syndrome
25
Q

What is the likely cause of ALT > AST?

A

Chronic liver disease

26
Q

What is the likely cause of AST > ALT?

A

Cirrhosis & acute alcoholic hepatitis

27
Q

What is the cause of this LFT derangement?:

  • ALT increased
  • ALP normal or slightly increased
  • GGT normal or slightly increased
  • Bilirubin slighty/very increased
A

Acute hepatocellular damage

28
Q

What is the cause of this LFT derangement?:

  • ALT normal or slightly increased
  • ALP normal or slightly increased
  • GGT normal or slightly increased
  • Bilirubin normal or slightly increased
A

Chronic hepatocellular damage

29
Q

What is the cause of this LFT derangement?:

  • ALT normal or slightly increased
  • ALP increased
  • GGT increased
  • Bilirubin increased
A

Cholestasis

30
Q

List 3 common causes of acute hepatocellular damage?

A
  1. Poisoning (paracetamol overdose)
  2. Infection (Hepatitis A and B)
  3. Liver ischaemia
31
Q

List 4 common causes of chronic hepatocellular damage?

A
  1. Alcoholic fatty liver disease
  2. Non-alcoholic fatty liver disease
  3. Chronic infection (Hepatitis B or C)
  4. Primary biliary cirrhosis
32
Q

List 3 uncommon causes of chronic hepatocellular damage?

A
  1. Alpha-1 antitrypsin deficiency
  2. Wilson’s disease
  3. Haemochromatosis

MBChB Yr 3 OSCES (5 decks)

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