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Chem Path Flashcards

1
Q

Osmolarity=

A

2(Na + K) + Urea + Glucose

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2
Q

Osmolar gap=

A

Osmolality (measured) - Osmolarity (calculated)

Normal less than 2

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3
Q

Anion Gap=

A

(Na + K) - (Cl +HCO3)

Normal= 14-18

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4
Q

Normal range of Na

A

135-145

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5
Q

Hyponatraemia Sx

A

N+V
Confusion
Seizures
Coma

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6
Q

True Hyponatraemia

A

Low osmolality

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7
Q

Causes of True Hyponatraemia

A

Hypervolaemic - Organ failure (CCF, Cirrhosis, Neophrotic)
Euvolaemic - Endocrine (HoTy, Adrenal insuf., SIADH)
Hypovolaemic - Loss (D+V, Salt losing neph., Diuretics)

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8
Q

Differentiating causes of Hypovolaemic HoNa

A

Urinary Na >20= renal (diuretic, Addison’s, Salt losing neph.)
Urinary Na less than 20= non renal (D+V)

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9
Q

SIADH feats

A

True, euvolaemic HoNa w/ Urinary Na >20
Urine osm >100! (usually > serum osm)
No adrenal, renal or thyroid dysfunction

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10
Q

Hypernatraemia Sx

A

Thirst
Confusion
Seizures + ataxia
Coma

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11
Q

Hypernatraemia causes

A

Hypovolaemic
Euvolaemic
Hypervolaemic

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12
Q

Hypovolaemic HyperNa causes

A 
GI loss (D+V)
Skin loss (sweating, burns)
Renal loss (loop diuretics, osmotic diuresis, renal disease)
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13
Q

Euvolaemic HyperNa causes

A 
Resp loss (tachypnoea)
Skin loss (sweating, fever)
Renal loss (Diabetes insipidus)
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14
Q

Hypervolaemic HyperNa causes

A 
Mineralocorticoid excess (Conn's)
Hypertonic saline infusion
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15
Q

Diabetes insipidus

A

Polyuria, polydipsia + dilute urine (osm less than 2)

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16
Q

8 hour fluid deprivation test

A

Normal - Concentrate urine >600 osm/kg
Primary polydipsia - Concentrate urine >400-600
Cranial DI - Concentrate urine after desmopressin
Nephrogenic DI - No urine concentration

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17
Q

Potassium normal range

A

3.5-5

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18
Q

Hypokalaemia causes

A 
GI loss (vomiting)
Renal loss (hyperaldosteronism, excess cortisol, osmotic diuresis)
Redistribution into cells (insulin, alkalosis)
Rare (Tubular acidosis T1+2, Bartter's, Liddle's, Gitelman's)
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19
Q

Hyperkalaemia causes

A 
Excessive intake (oral, parenteral, blood transfusion)
Transcellular movement (acidosis, insulin shortage, tissue damage/catabolic state)
Decreased excretion (ARF, CRF, Sprionolactone, Addison's NSAIDs, ACEi)
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20
Q

Adult maintenance fluid requirement

A

25-30ml/kg/day

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21
Q

Paediatric maintenance fluid requirement

A

1st 10 kg: 100ml/kg/day
2nd 10kg: 50ml/kg/day
Each kg after: 20ml/kg/day

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22
Q

Normal serum osmolality

A

275-295

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23
Q

Causes of HoNa w/ normal osmolality

A

Spurious, Drip arm sample, PseudoHoNa (hyperlipidaemia/paraproteinaemia) - everything normal except Na + Hx of DM or metabolic synd.

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24
Q

TURP syndrome

A

Hyponatraemia from water absorbed through damaged prostate

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25
Q

Differentiating Causes of Hypervolaemic HoNa

A

Urinary Na >20= Renal (ARF, CRF)

Urinary Na less than 20= Non renal (CCF, Cirrhosis)

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26
Q

Central pontine myelinosis

A

Pseudobulbar palsy, Paraparesis, Locked in syndrome due to Correcting HoNa too quickly
Increase Na by no more than 12mmol/L in 1st 24h

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27
Q

SIADH causes

A

Malignancy (SCLC, pancreas, prostate, lymphoma)
CNS disorders (meningoenceph., haem, abscess)
Resp (TB, pneumonia, abscess)
Drugs (opiates, SSRIs, Carbamazepine)

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28
Q

Addison’s bloods

A

HypoNa, HyperK, HypoGly, Urine Na >20

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29
Q

Bartter syndrome

A

Autosomal recessive
HypoK, Alkalosis + HoTN
Hypercalciuria + Nephrocalcinosis

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30
Q

Short SynACTHen

A

Cortisol measured at 0, ACTH given at 30mins + Cortisol measured at 60 mins
Final Cortisol less than 550= production defect

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31
Q

Long SynACTHen

A

1mg ACTH given and measure cortisol at 24h
>900= Secondary (Pituitary problem)
NB Secondary also has HypoK NOT HyperK
less than 900= Primary

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32
Q

OGTT for Acromegaly

A

75mg Glucose should decrease GH to 2 = Acromegaly

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33
Q

Schmidst’s syndrome

A

AI polyendocrine syndrome

Addison’s, HoTy + T1DM

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34
Q

Kallman’s syndrome

A

Hypogonadotrophic Hypogonadism

Low LH + FSH + Anosmia

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35
Q

Renal Tubular Acidosis

A

HypoK w/ Acidosis
T1 - Distal tubule (HypoCa)
T2 - Proximal Tubule (Fanconi -> HyperPhos -> Ricketts)
T3 - Both
T4 - Defect in adrenals (HyperK - deficiency of Aldosterone)

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36
Q

Drugs that causes nephrogenic DI

A

Lithium, Demeclocycline (used to Tx SIADH!)

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37
Q

Causes of conn’s

A 
ABCD
Adrenal Adenoma
Bilateral nodular hyperplasia
Ca of adrenals
Defective gene (GRA)
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38
Q

Causes of Elevated anion gap Metabolic acidosis

A 
MUDPILES
Methanol
Uraemia
DKA
Propylene glycol
Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates
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39
Q

Causes of HoNa w/ high osmolality

A

Glucose, Mannitol, EtOH

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40
Q

Gilbert’s

A

Isolated unconj bili

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41
Q

Crigler-Najjar

A

Isolated unconj bili (more constant and severe than Gilbert’s)

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43
Q

Alcoholic liver disease LFTs

A 
High AST> High ALT (AST:ALT>1)
High GGT (chronic)
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43
Q

Hepatitis LFTs

A

High AST=High ALT

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43
Q

Cholestatic LFTs

A

High GGT + ALP then Increased AST, ALT + Bili (conj)

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44
Q

NAFLD LFTs

A

High AST + ALT (AST:ALT less than 1) + High GGT

45
Q

Paracetamol poisoning LFTs

A

V high (>1000) AST + ALT > increase in GGT + ALP

46
Q

Alcohol abuse LFTs

A

Isolated GGT increase

47
Q

Dubin Johnson LFTs

A

Isolated conj bili

48
Q

HCC LFTs

A

High AFP + any LFT picture (therefore unlikely to be answer unless AFP given!)

49
Q

ALP

A

High ALP w/ High GGT confirms liver cause

Also increases w/ bone disease (e.g. Paget’s) + Pregnancy

51
Q

Acute intermittent porphyria Ez Def

A

Autosomal Dominant

Porphobilinogen deaminase deficiency

52
Q

Acute Intermittent Porphyria Sx

A

Abdo pain, seizures, N+V, muscle weakness, peripheral neuropathy after stress e.g. alcohol or infection
No cutaneous Sx

53
Q

Porphyria Cutanea Tarda

A

Uroporphyrinogen decarboxylase deficiency

Sx: Vesicles on sun exposed sites

54
Q

X linked sideroblastic Anaemia (Type of Porphyria)

A

ALA Synthase deficiency

55
Q

Congenital erythropoietic porphyria

A

Uroporhyrinogen synthase deficiency

56
Q

Hereditary coproporhyria

A

Copropophyrinogen oxidase deficiency

57
Q

Variegate porphyria

A

Protopophyrinogen oxidase deficiency

58
Q

Erythropoietic protoporphyria

A

Ferrochelatase deficiency

59
Q

Anterior pituitary hormones

A 
GH
TSH
ACTH
Prolactin
LH
FSH
60
Q

Posterior pituitary hormones

A

ADH (Vasopressin)

Oxytocin

61
Q

Ca causing Bone Mets

A

BLT w/ a Kosher Pickle (prostate)

62
Q

Dexamethasone Suppresion test

A

No suppression = Cushing’s syndrome (low ACTH- primary hypercortisolism) or Ectopic ACTH
Suppression after high dose= Cushing’s disease

63
Q

Tx of Phaeo

A

Short acting alpha blocker then
Long acting alpha blocker then
Beta blocker then
Surgery

64
Q

Phenytoin toxicity

A

HoTN, Heart block, Ventricular Arr., Ataxia, Nystagmus

65
Q

Digoxin toxicity

A

Arr., Prolonged PR, Bradycardia, Xanthopsia

66
Q

Lithium toxicity

A

D+V, Dysarthria + Coarse tremor

67
Q

Gentamicin toxicity

A

Tinnitus, Deafness, Nystagmus, RF

68
Q

Theophylline toxicity

A

N+D, taccy, Arr., Headache, Seizure

NB Toxicity precipitated by Erythromycin and Cipro

69
Q

Procainamide toxicity

A

Rash, Fever, Agranulocytosis + DI-SLE

70
Q

Methotrexate toxicity

A

Hepatotoxic, Ulcerative stomatitis, Leukopoenia, Pulmonary fibrosis

71
Q

Carbamazepine toxicity

A

Headaches, Ataxia, Abdo pain, SIADH + aplastic An.

72
Q

Cyclosporine toxicity

A

ARF

73
Q

Ca Normal range

A

2.2-2.6

74
Q

PTH actions

A
  1. Increase tubular Vit D 25(OH) -> Vit D 1,25(OH)2
  2. Mobilise Ca from bone (increase osteoclast activity)
  3. Increase renal Ca absorption + PO4 excretion
75
Q

Calcitriol actions (1,25 (OH)2 Vit D)

A

Increase Ca and PO4 absorption from gut

Bone remodelling

76
Q

Primary Hyperparathyroidism bloods

A

High Ca, Low PO4, High/N PTH, High/N ALP, N Vit D

77
Q

Renal osteodystrophy (2o HyperPTy) bloods

A

Low Ca, High PO4, High PTH, High ALP

78
Q

3o HyperPTy bloods

A

High Ca, Low PO4, High PTH, High/N ALP, N Vit D

NB Autonomous PTH secretion post renal transplant/dialysis

79
Q

Hypoparathyroidism bloods

A

Low Ca, High PO4, Low PTH, N/low ALP, N Vit D

80
Q

PseudoHoPTy bloods (Albright’s osteodystrophy)

A

Low Ca, High PO4, High PTH

Short stature + 4th+5th metacarpals, rounded facies

81
Q

PseudoPseudoHoTy

A

Feats of Pseudo (short stature, rounded facies)

Normal Bloods

82
Q

Sx of HyperCa

A 
Stones (renal)
Bones (pain)
Groans (Psych)
Moans (abdo pain)
Polyuria
Muscle weakness
83
Q

Sx of HypoCa

A 
Perioral parasthesiae
Carpopedal spasm
Trousseau's sign (BP cuff)
Chovstek's sign
Hypereflexia
Tetany
84
Q

Vitamin B1 (thiamine) deficiency

A

Sx: Wernicke’s (confusion, ataxia, ophthalmoplegia)
Wet beri beri
Test: RBC Transketolase

85
Q

Vitamin B2 (riboflavin deficiency)

A

Sx: Stomatitis, oily skin rashes, anaemia
Test: RBC Glutathione

86
Q

Vitamin B3 (niacin) deficiency

A

Sx: Pellagra, Casal’s necklace rash , Stomatitis, dementia, diarrhoea

87
Q

Vitamin B5 (Pantothenic acid) deficiency

A

Sx: Chronic parasthesiae

88
Q

Vitamin B7 (Biotin) deficiency

A

Sx: infertility and poor hair growth

89
Q

Vitamin B9 (folate) deficiency

A

Sx: Megaloblastic anaemia
Test: Normal MMA

90
Q

Vitamin B12 (Cobalamin) deficiency

A

Sx: Megaloblastic anaemia, glossitis, Peripheral neuropathy
Test: Raised MMA

91
Q

Vitamin A (Retinol) deficiency

A

Sx: Dry skin, hair + cornea, Bitot’s spots on conjunctiva, night blindness

92
Q

Vitamin B6 (Pyridoxine) deficiency

A

Sx: Sideroblastic anaemia + seborrhoeic dermatitis
Test: RBC AST
Commonly due to Isoniazid

93
Q

Vitamin C (Ascorbic acid) deficiency

A

Sx: Bleeding in gums, skin and joints + bone weakness

94
Q

Vitamin E (tocopherol) deficiency

A

Sx: Haemolytic anaemia + spinocerebellar neuropathy (ataxia + areflexia)

95
Q

PKU

A

Phenylalanine hydroxylase deficiency

Sx: Fair haired, developmental delay between 6-12 months + musty smell

96
Q

Homocysteinuria

A

Cystathionine synthetase deficiency
Sx: V fair skin + brittle hair, developmental delay + LD
Tx: Pyridoxine + low methionine diet

97
Q

Galactosaemia

A

Gal-1-PUT deficiency

Sx: after milk ingestion - poor feed, vomiting, jaundice (conj) + hepatomegaly, hypoglycaemia + sepsis

98
Q

SCAD

A

Sx: FTT, hypotonia, metabolic acidosis, hyperglycaemia

99
Q

Von Gierke’s

A

GSD T1
Hypoglycaemia in infancy
Hepatomegaly +/- splenomegaly

100
Q

Pompe

A

GSD - lysosomal alpha glucosidase deficiency

101
Q

Cori’s

A

GSD - Amylo 1,6 glucosidase deficiency

102
Q

McArdle’s

A

GSD - Phosphorylase deficiency

103
Q

Maple syrup urine disease

A

Impaired metabolism of leucine, isoleucine + valine causes encephalopathy
Sx: Lethargy, poor feeding, hypotonia
Sweet odour + Sweaty feet

104
Q

Fabry’s disease

A

LSD - alpha galactosidase deficiency
Sx: developmental delay and dysmorphia
“Cherry red spot”

105
Q

Peroxisomal disorders

A

Disordered beta oxidation of VLCFA
Sx: Seizures, dysmorphic, severe hypotonia + jaundice
Retinopathy + large fontanelle

106
Q

Gout exacerbating factors

A 
Aspirin (other NSAIDs Tx)
Chemotherapy
Alcohol
Psoriasis
Thiazides
107
Q

Glasgow pancreatitis score

A 
PANCREAS
PaO2 less than 9
Age >55
Neutrophilia WCC>15
Calcium less than 2
Renal failure urea>16
Ezs - LDH >600 or AST >200
Albumin less than 32
Sugar >10
108
Q

Barth Mitochondrial disorder

A

Presents at birth w/ Cardiomyopathy, Neutropoenia, Myopathy

109
Q

MELAS Mitochondrial disorder

A

Presents age 5-15 w/
Mitochondrial Encephalopathy
Lactic acidosis
Stroke-like episodes

110
Q

Kearns Sayre Mitochondrial disorder

A 
Presents age 12-30 w/
CPEO
Retinopathy
Deafness
Ataxia
111
Q

Diabetes Dx

A 
One test + Sx or 2 tests:
Fasting glucose >7
OGTT >11.1
Random glucose >11.1
HbA1c >48 (6.5%)
112
Q

Impaired glucose tolerance Dx

A

Fasting glucose 6.1-6.9

Random glucose or OGTT 7.8-11.1

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