Chapter 3 - Data Interpretation Flashcards
3 causes of microcytic anaemia?
Iron deficiency anaemia
Thalassaemia
Sideroblastic anaemia
4 causes of normocytic anaemia?
Anaemia of chronic disease + acute blood loss
Haemolytic anaemia
Renal failure (chronic)
5 causes of macrocytic anaemia?
B12/folate deficiency + excess alcohol + liver disease
Hypothyroidism
Haem disease beginning with ‘M’ - myeloproliferative, myelodysplastic, multiple myeloma
3 causes of high neutrophils?
Bacterial infection
Tissue damage (inflam/infarct/malig)
Steroids
4 causes of low neutrophils?
Viral infection + clozapine + carbimazole
Chemo/radiotherapy
3 causes of high lymphocytes?
Viral infection
Lymphoma, CLL
3 causes of reduced production-related low platelets?
Drugs (e.g. penicillamine) + infection + haem ‘M’s
5 causes of increased destruction low platelets?
HEPARIN
Hypersplenism, DIC, ITP, HUS/TTP
Causes of high platelets?
Reactive = bleeding, tissue damage, postsplenectomy
Primary = myeloproliferative disorders
3 causes of hypovolaemic hyponatraemia?
Fluid loss (D+V) + diuretics (any)
Addison’s
3 causes of euvolaemic hyponatraemia?
SIADH, psychogenic polydipsia, hypothyroidism
5 causes of hypervolaemic hyponatraemia?
Heart + renal failure
Liver failure/nutritional failure (both = hypoalbuminaemia), thyroid failure
Causes of SIADH?
SIADH
- Small cell lung tumour
- Infection
- Abscess
- Drugs
- Head injury
Drugs that cause SIADH?
Carbamazepine + antipsychotics
Causes of hypernatraemia?
All D’s
- dehydration
- drips (excess IV saline)
- drugs
- diabetes insipidus
Causes of hypokalaemia + mnemonic?
DIRE
- Drugs (loop + thiazide diuretics)
- Inadequate intake/Intestinal loss (D+V)
- Renal tubular acidosis
- Endocrine Excess (Cushing’s, Conn’s)
Causes of hyperkalaemia + mnemonic?
DREAD
- Drugs (K-sparing diuretics, ACEi’s/ARBs)
- Renal failure
- Endocrine (Addison’s)
- Artefact (clotted sample)
- DKA
Method to distinguish between pre-renal, renal, and post-renal causes of AKI?
Pre-renal - urea rise»_space; creatinine rise
Renal - creatinine rise»_space; urea rise with no palpable bladder/kidney
Post-renal - creatinine rise»_space; urea rise with palpable bladder/kidney (hydronephrosis)
Causes of pre-renal AKI?
Dehydration/shock (hypovolaemia)
Renal artery stenosis (triggered by NSAIDs/ACEi’s/ARBs)
Causes of renal AKI?
INTRINSIC
- Ischaemia (secondary to pre-renal)
- Nephrotoxic antibiotics
- Tablets (ACEi’s, NSAIDs)
- Radiological contrast
- Negatively birefringent crystals (gout)
- Syndromes (glomerulonephritides)
- Inflammation (vasculitis)
- Cholesterol emboli
Nephrotoxic antibiotics?
Gentamicin, vancomycin, tetracyclines
Causes of post-renal AKI?
In lumen = stone, sloughed papilla
In wall = tumour (renal cell, transitional cell), fibrosis
External pressure = BPH, prostate cancer, lymphadenopathy, aneurysm
Non-liver causes of raised ALP?
ALKPHOS
- any fracture
- liver damage (post-hepatic)
- Kancer (lol)
- Paget’s & Pregnancy
- HyperPTH
- Osteomalacia
- Surgery
How to distinguish between pre-hepatic, intrahepatic, and post-hepatic liver damage?
Pre-hepatic = only bilirubin rise
Intrahepatic = bilirubin + transaminases rise
Posthepatic = bilirubin + ALP rise (cholestatic/obstructive picture)
Causes of prehepatic LFT derangement/jaundice?
Haemolysis
Gilbert’s/Crigler-Najjar syndromes
Causes of intrahepatic LFT derangement/jaundice?
Hepatitis + cirrhosis + fatty liver
Malignancy
Metabolic (Wilson’s, haemochromatosis)
Heart failure causing hepatic congestion
Causes of posthepatic LFT derangement/jaundice?
In lumen = stone (gallstone), drugs causing cholestasis
In wall = tumour (cholangiocarcinoma), PBC/PSC
Extrinsic pressure = pancreatic/gastric cancer, lymphadenopathy
Drugs that cause hepatitis/cirrhosis?
Paracetamol overdose
Statins
Rifampicin
Drugs that cause cholestasis?
Flucloxacillin + Co-amoxiclav
Nitrofurantoin
Steroids
Sulphonylureas
Method for changing dose of levothyroxine?
Use TSH level
If <0.5 = decrease dose
If 0.5-5 = keep same dose
If >5.5 = increase dose
Always increase/decrease by smallest increment provided unless grossly hypo/hyperthyroid
6 drugs with a narrow therapeutic index?
Digoxin
Theophylline
Lithium
Phenytoin
Gentamicin + Vancomycin
3 treatments for drug toxicity?
Omit drug (+/- alternative if required)
Supportive measures e.g. IV fluids
Give antidote (if available)
Confusion, nausea, visual halos, arrhythmia - toxicity of which drug?
Digoxin
Early = coarse tremor, intermediate = tiredness, late = arrhythmias, seizures, coma, renal failure, diabetes insipidus - toxicity of which drug?
Lithium (fine tremor in chronic use)
Gum hypertrophy, ataxia, nystagmus, peripheral neuropathy, teratogenicity - toxicity of which drug?
Phenytoin
Gentamicin and vancomycin cause which toxicities?
Ototoxicity + nephrotoxicity
2 main dosing regimens for gentamicin?
Most patients = high-dose regimen = 5-7mg/kg OD IV
Renal failure = divided daily dosing = 1mg/kg 12hrly (renal failure) or 8hrly (endocarditis)
When should gentamicin be measured for monitoring?
6-14 hours after the last dose (says on the nomogram anyway)
Brand name of prothrombin complex concentrate?
Beriplex
Substance name of vitamin K?
Phytomenadione
