Blood Results QUIZ Flashcards
High K
Low Na
Addisons disease
Low Na
High urine Na
High urine osmolality
SIADH
Low glucose
Low K
Excess insulin injection
Raised WCC
Leucocytes and nitrites on urine dip
UTI
High potassium
High sodium
High creatinine
High urea
Renal failure
cANCA
crescents
casts
Wegeners granulomatosis
Low potassium High aldosterone Low renin Normal magnesium/calcium High bp
Conn’s syndrome
Low potassium High aldosterone High renin High calcium Low bp
Barrters syndrome (defect in Na+k+Cl- transporter in TALH)
Bart is hyper-active, but NO pressure
Low potassium High aldosterone High renin Low calcium Low magnesium Normal bp
Gitlemans syndrome (defect in Na+cl- symporter)
Little man - not much calcium/or magnesium
Low serum sodium
Low blood volume
Low urine sodium
Vomiting
Diarrhoea
Skin loss
Treat cause, replace volume
Low serum sodium
Low blood volume
High urine sodium
Adrenocortical deficiency
Renal failure
Diuretics
Cerebral salt wasting
Treat cause, replace volume
Low serum sodium
Normal blood volume
Low urine sodium
Acute water load
Psychogenic
Low serum sodium
Normal blood volume
High urine sodium
SIADH - also look at plasma/urine osmolality
Severe hypothyroidism
Addisons
NEEDS INVESTIGATIONS SIADH - fluid restrict
Low serum sodium
High blood volume
Low urine sodium
CCF
Cirrhosis
Nephrotic syndrome
Treat cause, diuretics
Low serum sodium
High blood volume
High urine sodium
Renal failure
Treat cause, diuretics
High serum sodium
Low blood volume
Diabetes insipidus
Iatrogenic
Hyperosmolar hyperglycaemic state
Treat cause
High serum sodium
Dilute urine
Water deprivation test - failure to concentrate urine
Diabetes Inspidus
Desmopressin
High PTH
High Calcium
Low phosphate
High ALP
PRIMARY HYPERPARATHYROIDISM
Parathyroid adenoma
High PTH
Low calcium
High phosphate
High ALP
SECONDARY HYPERPARATHYROIDISM
Hypocalcemia
Vit D deficiency (common in CKD)
High PTH
High Calcium
Normal phosphate
Normal ALP
TERTIARY HYPERPARATHYROIDISM
Secondary hyperparathyroidism for so long that the gland becomes autonomous
High calcium
Low PTH
Low phosphate
High ALP
MALIGNANT HYPERCALCEMIA
- paraneoplastic PTHrP secretion from squamous cell lung cancer
- bony mets
Low calcium
Low phosphate
Very low vit D
High PTH
Osteomalacia (rickets)
Huge ALT
Paracetamol overdose
AI hepatitis
Viral
(ALT is specific to liver, whereas AST is not)
AST:ALT ratio >2.5
Alcoholic hepatitis
High ALP
High GGT
High bilirubin
Cholestatic picture (gallstones, cholangitis, PBC, PSC, pancreatic cancer)
High ALP
Other LFTs normal
Pregnancy
Bone - osteomalacia, pagets, bone mets
Hyperparathyroidism
IBD
Very high GGT
Increased MCV
Alcohol ingestion
ALT/AST in 1000s
Acute hepatitis picture
ALT/AST in 100s
Chronic hepatitis picture
Unconjugated high bilirubin
Haemaolytic anaemia
Gilberts
Physiological neonatal jaundice
Conjugated high bilirubin
Liver disease
Cholestasis
Low albumin
Low protein
Advanced cirrhosis
Alcoholism
Chronic inflammation
Low albumin
Normal protein
Infection (acute phase reactant)
Low albumin
High protein
Multiple myeloma (paraprotein)
High INR
Liver disease Vit K deficiency Consumptive coagulopathy (DIC)
Raised IgM
Raised AMA
Primary biliary cirrhosis
Raised IgG
Raised ANA, Anti SM
Autoimmune hepatitis
Raised ANCA
Primary sclerosing cholangitis
Raised IgA
On a background of liver dysfunction
Alcoholic liver disease
Liver dysfunction
High TTG
Low ferritin
Coeliac disease
Hepatitis IgM
Acute infection
Hepatitis IgG
Chronic/past infection/vaccination
HbsAg
Anti-hbC
IgM
Acute infection
Hbe antigen
Highly infectious state
Anti Hb s antigen
Vaccination
Increased APTT
Deficiency of factor 8,9,11, 12 Antiphospholipid syndrome (doesn't correct on mixed study) Haemophilia A/B Von Willebrand disease Warfarin/vit K deficiency Liver disease DIC
Increased PT
Warfarin/vit K deficiency
Liver disease
DIC
High D dimer
PE/DVT
Aortic dissection
ACS
Very high D dimer Low platelets Low clotting factors High PT/APTT/INR High fibrin degradation products
DIC
FEV1>80% predicted
Normal
FEV1/FVC<70%
FEV1 50-80%
MILD obstructive lung disease
FEV1/FVC<70%
FEV1 30-50%
MODERATE obstructive lung disease
FEV1/FVC<70%
FEV1 <30%
SEVERE obstructive lung disease
TLCO decreasesd
KCO normal
Reduced alveolar volume (pneumonectomy)
Incomplete alveolar expansion (restrictive disorder)
TLCO decreased
KCO decreased
Pulomonary vascular bed abnormalities (PE, HTN) Alveolar destruction (emphysema, ILD)
TLCO decreased
KCO increased
Extra-pulmonary problem
Reduced TLC
Restrictive disease of the lung
Hamburger shape on flow volume curve
Problem with large airways
Church shape on flow volume loop
Problem with small airways
Haematuria?
ONNIT Obstruction Neoplasm Nephritic syndrome Inflammation Trauma
Most common cause is glomerular disease
Proteinuria?
Nephrotic syndrome
Fever, orthostatic, exercise
Glomerular disease
Myeloma (bence jones proteins)
Leucocytes + nitrites in urine?
UTI
Ketones in urine?
DKA, starvation
Glucose in urine?
DM
Cushings
Pregnancy
Renal tubular disease
White cell casts in urine?
Acute interstitial nephritis
Red cell casts in urine?
Glomerulonephritis
Eosinophils in urine?
Acute allergic interstitial nephritis
Epithelial cells in urine?
Acute tubular necrosis
Pleural fluid
High protein (>30)
Protein ratio >0.5
LDH ratio >0.6
Exudate (infection, inflammation, infarction, malignancy?
Pleural fluid
Low protein (<30)
Protein ratio <0.5
LDH ratio <0.6
Transudate (failure)
Pleural fluid
High protein (>30)
Low glucose
Empyema
Ascitic Fluid
SAAG >11g
(SAAG = serum album - ascitic albumin)
Portal hypertension
- portal vein thrombosis
- cirrhosis
- chronic hepatitis
- post-hepatic
Ascitic Fluid
SAAC <11g
Peritoneal disease - SBP, malignancy
Hypoalbuminaemia - nephrotic syndrome, malnutrition
Pancreatitis
Ascitic fluid
Neutrophils >0.25x10^9/L
Spontaneous Bacterial Peritonitis
High CK
Statins
Rhabdomyolysis
Polymyositis/dermatomyositis
High muscle mass
ABG High pH Low CO2 Normal bicarb High Oxygen
Respiratory alkalosis
eg. hyperventilation
ABG Normal pH High Co2 High bicarb Low oxygen
Fully compensated respiratory acidosis + type 2 respiratory failure
eg. chronic COPD
ABG Low pH High C02 High bicarb Very low Oxygen
Partially compensated respiratory acidosis + type 2 respiratory failure
eg. acute COPD exacerbation
Normal ABG
Asthma
ABG Low pH High C02 Normal bicarb Low oxygen
Respiratory acidosis + type 2 resp failreu, no compensation
eg. life threatening asthma, opiate overdose
ABG
Everything normal
Low 0xygen
Isolated type 1 resp failure
eg. pulmonary fibrosis
ABG High pH Low CO2 Normal bicarb Low oxygen
Respiratory alkalosis + type 1 reps failure
eg. pulmonary embolism
Anaemia Anti dsDNA Anti-Sm Homogenous ANA Low C3/C4 Raised ESR but normal CRP
(+Bchrom)
SLE
B chrom - drug induced
LE cell on biopsy
SLE
Raised ESR, CRP
Normocytic anaemia
Raised neutrophila/thrombo
Giant cell arteritis
Anti-Scl 70, RNA polymerase III
Diffuse systemic sclerosis
Anti-centromere
Limited systemic sclerosis
Anti-Ro/La
Low complement
High ESR
Sjorgens syndrome
Hep B virology
ANCA negative
Polyarteritis nodosa
Normal calcium
Normal phosphate
High ALP
Paget’s disease of the bone
Isolated rise in platelets
Essential thrombocythemia
(JAK2 myeloproliferative disorder)
Give aspirin and hydroxycarbamide
Isolated fall in platelets
ITP
Phil chromosome t(9:22)
Increased myeloid cells and myeloblasts
Chronic Myeloid Leukemia
Give imatinib (tyrosine kinase inhibitor)
All cell lines increased
Low epo
JAK2 mutation
Polycythemia vera
Give aspirin and hydroxycarbamide
Low FBC
Lots of monoclonal antibodies
Blood film rouleax
JAK2 mutation
Multiple myeloma
Give chemo and bisphosphonates
Pancytopenia OR pancythemia
Tear drop poikilocytes
Nucleated RBCs
Myelofibrosis
JAK2
High ALP/GGT
Low FBC
High MCV
High reticulocyte
Hereditary spherocytosis
- haemolytic anaemia with cholescystitis
Do splenectomy
Macrocytic anaemia
Pancytopenia
B12/folate deficiency
High APTT that corrects
Haemophilia A, B
Recombinant factor, rest, desmopressin
High APTT that corrects
Reduced ristocetin cofactor activity
Gp61 assay
Often nothing on bloods
vWF disease
High ESR
Low hb
Norma bloods otherwise
EBV positive
Generalised lymphadenopathy
Lymphoma
Pancytopenia
BONE MARROW FAILURE
Anaemia Pancytopenia Lots of blast cells Auer rods Trisomy 21
Acute myeloid leukemia
Anaemia
Pancytopenia
Lots of blast cells
LP shows blasts in CNS
Acute lymphocytic leukemia
Anaemia
High lymphocyte count
CLL
Anaemia
High WCC
CML
Normocytic anaemia
Normal platelets
Increased ferritin
Reduced total iron binding capacity
Anaemia of chronic disease
Grossly elevated APTT
No correction with mixed study
Acquired Haemophilia (often there is an occult malignancy so do tumour markers)
Do anti-TTG test
Fracture Low ca Low vit D Low phosphate High PTH High ALP
Osteomalacia (adults)
Rickets (kids)
Low FBC
High MCV
Low magnesium
Alcoholism
Elevated LDLc
Elevated total cholesterol
Low/normal TGs
Tendon xanthoma
Corneal arcus
Heterozygous familial hypercholesterolaemia
Elevated LDLc
Elevated total cholesterol
Low/normal TGs
Cutaneous xanthoma
Aortic stenosis
Homozygous familial hypercholesterolaemia
Elevated TG
Normal ApoB
Low HDLc
Eruptive xanthomas
Familial hypertriglyceridaemia
Elevated ApoB Elevated total cholesterol Elevated LDLc Elevated TG Low HDLc
Xanthelasma
Familial combined hyperlipidaemia
Low ApoB (pathopneumonic)
Elevated total cholesterol
Elevated TG
Presence of remnants of VLDL
Striate palmar xanthomas
Remnant (type 3) hyperlipidemia