Chem Path Flashcards
Serum amylase is elevated in what condition?
Acute pancratitis
What is a physiological explanation for a raised creatine kinase?
Afro-Caribbean origin
What is a pathological cause of elevated creatine kinase levels?
Duchenne Muscular Dystrophy
MI
Statin related myopathy
Rhabdomyolysis
Which of the following have greater than five times the upper limit of normal raised ALP? Tumours Pagets Fractures Osteomalacia Osteomyelitis
Pagets
Osteomalacia
Which of the following have greater than five times the upper limit of normal raised ALP? Cholestasis Hepatitis Cirrhosis Infiltrative disease
Cholestasis
Cirrhosis
How long does it take for Creatine Kinase levels to return to baseline following an MI?
2-3 days
How long does it take for Troponin levels to return to baseline following an MI?
Greater than 3 days
What is the other name for von Gierke’s disease?
Glycogen Storage Disease type 1
What is the enzyme deficiency in Glycogen Storage Disease type 1?
glucose-6-phosphatase
Peroxisomal disorders affect the metabolism of what substance?
Very long chain fatty acids
How might a neonate with a peroxisomal disorder present?
Severe hypotonia
mixed hyperbilirubinaemia
Dysmorphic signs
How might an infant with a peroxisomal disorder present?
retinopathy –> blindness
Hepatic dysfunction
Large fontanelle
What is C-peptide an indirect measure of?
Secreted insulin
What test do you perform when investigating diabetes insipidus?
Fluid deprivation test followed by desmopressin administration
What would you expect to happen with urine osmolarity after a fluid deprivation test and subsequent administration of desmopressin in each of the following conditions:
- Polydipsia
- Nephrogenic DI
- Cranial DI
Polydipsia: FD (high osmolarity), Des (high osmolarity)
Nephrogenic DI: FD (low osmolarity), Des (low osmolarity)
Cranial DI: FD (low osmolarity), Des (high osmolarity)
How can the causes of Acute Kidney Injury be classified?
Pre-renal (poor perfusion)
Intrinsic (damage to kidney itself, e.g. glomerulus, tubules, interstitium)
Post-renal (urinary obstruction)
How many stages of Chronic Kidney Disease are there and what is each corresponding GFR?
- greater than 90 ml/min
- 60-89
- 30-59
- 15-29
- Less than 15
What is THE MOST common cause of chronic kidney disease?
Diabetes
Where can tumours be located in MEN-1?
Parathyroid (hyperplasia/adenoma)
Pancreas
Pituitary (prolactinoma)
Where can tumours arise in MEN-2a?
Thyroid (medullary carcinoma)
Adrenal (phaeochromocytoma)
Parathyroid (hyperplasia)
What is the most common form of thyroid cancer?
Papillary
Which type of thyroid cancer do you keep your eye out for that produces calcitonin?
Medullary
From what cell type do medullary thyroid cancers arise?
parafollicular cells
What action does the following hypothalamic hormone have on the pituitary hormones?
- GHRH
GH release
What action does the following hypothalamic hormone have on the pituitary hormones?
- GnRH
LH and FSH release
What action does the following hypothalamic hormone have on the pituitary hormones?
- TRH
TSH and Prolactin release
What action does the following hypothalamic hormone have on the pituitary hormones?
- Dopamine
Prolactin inhibition
What action does the following hypothalamic hormone have on the pituitary hormones?
- CRH
ACTH release
When performing a combined pitutary function test, what do you administer and why?
Insulin - observing rise in GH and cortisol in response to hypoglycaemia
GnRH - observe LH and FSH
TRH - observe rises in TSH and prolactin
What size are pituitary microadenomas?
less than 1cm
What size are pituitary macroadenomas?
Greater than 1cm
What hormones are produced from the anterior pituitary?
ADH
Oxytocin
What are the main physiological effects of oxytocin?
Expulsion of breast milk
Increase uterine contractions
What is TURP syndrome?
Complication of Transurethral Resection of the Prostate
Absorption of irrigation fluids in operation through the venous sinuses of prostate –> hyponatraemia as well as other symptoms
What is the normal range for serum osmolality?
275-296 mmol per kg
What is the risk of correcting a hyponatraemia too quickly and what are the symptoms?
Central Pontine Myelinolysis - depends on area of brain but generally paralysis, dysphagia, dysarthria
Potential causes of hypovolaemic hyponatraemia with raised urinary sodium above 20mmol/l?
Diuretics
Addison’s
Salt-losing nephropathies
(remember raised urinary sodium is telling you it’s renal rather than non-renal)
Potential causes of hypovolaemic hyponatraemia with low urinary sodium below 20mmol/l?
Vomiting
Diarrhoea
Excess sweating
Third space losses (ascites, burns)
Low urinary sodium is telling you it’s non-renal.
Potential causes of a euvolaemic hyponatraemia?
SIADH
Primary polydipsia
Hypothyroidism
Potential causes of a hypervolaemic hyponatraemia with raised urinary sodium greater than 20mmol/l
Renal failure
Potential causes of a hypervolaemic hyponatraemia with low urinary sodium less than 20mmol/l
Cardiac failure
Cirrhosis
Inappropriate IV fluid
Elevated blood urea nitrogen
Elevated creatinine
Low urine output
AKI
Haematuria Proteinuria Hypertension Azotemia (raised nitrogen blood components) Blurred vision Oliguria
Nephritic Syndrome
Thin glomerular basement membrane with podocytes that have pores large enough to allow blood and protein into the urine
Nephritic Syndrome
Proteinuria
Hypoalbuminaemia
Oedema
Nephrotic syndrome
Treatment of nephrotic syndrome?
Supportive
Nutrition - proteins
Diuretics to clear oedema
Corticosteroids for kidney damage
Muddy brown casts
epithelial cells found in urine
Acute tubular necrosis
