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Path - HANIN > Chem Path > Flashcards

Chem Path Flashcards

1
Q

How to work out Osmolarity?

A

2 (Na+ + K+) + Urea + Glucose

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2
Q

Normal range for serum osmolarity?

A

275 - 295 mmol/kg

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3
Q

Normal sodium range?

A

135- 145 mmol/L

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4
Q

Symptoms of hyponatraemia

A

less than 136 - nausea and vomiting
less than 130 - confusion
less than 125 - seizures and pulmonary oedema
less than 120 - coma/death

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5
Q

True hyponatraemia

A

Low osmolality

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6
Q

What is important to check when it comes to working out cause of true hyponatraemia?

A

Hydration status - are they hypervolemic, euvolemic or hypovalemic. Check urinary Na+ as well:

Hypervolemic - cardiac failure, cirrohosis, nephrotic syndrome. >20 - renal and less than 20 = non-renal

Euvolemic - SIADH, hypothyroidism, adrenal insufficiency

Hypovolemic - salt losing nephropathy, D+V, diuretics. > 20 = renal and less than 20 = non-renal

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7
Q

Major risk of rapidly correcting hyponatraemia?

A

Central pontine myelinolysis so to avoid increase Na+ by 1mmol/l

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8
Q

What is the urine osmolality like in SIADH?

A

Inapproriately high but patient is euvolemic. Increased renal secretion of Na+ (>20)

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9
Q

What are the causes of SIADH?

A
  • Drugs : opiates, SSRIs and carbamazepine
  • CNS : haemorrhage, abscess and meningoencephalitis
  • Lungs : TB, pneumonia, abscess
  • Cancer: Small cell lung cancer, pancreas, prostate and lymphoma (ectopic)
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10
Q

Risk of rapid correction of hypernatraemia?

A

Cerebral oedema

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11
Q

What types of hypernatraemia are there?

A

Hypovolemia - D + V, burns, excessive sweating, renal (loop diuretics or disease)
Euvolemia - diabetes
Hypervolemia - Conn’s syndrome, hypertonic saline (our fault)

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12
Q

Path of diabetes insipidus?

A

lack or no ADH

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13
Q

Symptoms + signs of diabetes insipidus?

A

polydipsia, polyuria, hypernatremia (thirst, lethargy, confusion), plasma osmolality > 2 (v.conc), urine dilute. Patient is euvolemic

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14
Q

Types of DI?

A

Cranial - makes no ADH (tumour, trauma, surgery)

Nephrogenic - doesnt respond to ADH (lithium, inhertied or chronic renal failure)

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15
Q

How to diagnose DI?

A

8hr fluid deprivation test

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16
Q

Diagnose - low plasma sodium, low plasma osmolality, normal/high urine osmolality, low urine sodium. Fluid status - hypovolemic

A

This patient could have D+V as they are losing the salt somewhere else. They could also have excessive sweating or severe burns leading to dehydration

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17
Q

Diagnose - low plasma sodium, low plasma osmolality, normal/high urine osmolality, low urine sodium. Fluid status - euvolemic

A

Patient most likely has SIADH

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18
Q

Diagnose - low plasma sodium, low plasma osmolality, normal/high urine osmolality, low urine sodium. Fluid status - hypervolemic/overloaded

A

Patient probably has either cardiac failure, cirrohosis, nephrotic syndrome

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19
Q

Diagnose - low plasma sodium, normal/high plasma osmolality.

A

Pseudohyponatraemia - caused by hyperlipidemia, hyperglycemia, multiple myeloma. Investigate further

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20
Q

Diagnose - low plasma sodium, normal/high plasma osmolality.

A

Pseudohyponatraemia - caused by hyperlipidemia, hyperglycemia, multiple myeloma. Investigate further

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21
Q

Results of fluid deprivation test?

A

Primary polydipsia - urine concentration goes back to normal
Cranial polydipsia - urine concentrates when desmopressin is given
Nephrogenic polydipsia - urine does not concentrate so urine osmolality is still low (?)

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22
Q

What is normal range of potassium?

A

3.5 - 5.5 mmol/l

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23
Q

Where is K+ reabsorbed in the nephron?

A

PCT and thick ascending limb

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24
Q

Which cells secrete K+ into the urine from the kidney?

A

Principle cells

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25
Q

What does aldosterone do?

A

Na+ reabsorption and K+ secretion

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26
Q

What drugs cause hypokalaemia?

A

Loop diuretics and thiazides diuretics

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27
Q

Which loses more K+? Vomiting or Diarrhoea

A

Vomiting - minimal but causes metabolic alkolosis which causes hypoK due to low H+. Diarrhoea causes more K_ loss so Diarrhoea (seen in laxative abuse)

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28
Q

Symptoms of hypokalaemia?

A

Skeletal muscle - cramps, weakness, flaccid paralysis
Smooth muscle - constipation
Cardiac - arrythmias, cardiac arrest (Damn dramatic)
Resp - resp depression

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29
Q

Causes of hypokalemia?

A

GI losses - V + D
Renal - loop + thiazides diuretics, hyperaldosterism, cushings
Metabolic alkalosis, insulin, beta-agonists.
Poor intake - fasting, anorexia nervosa
Renal tubular acidosis?

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30
Q

What do you see on an ECG in hyperkalaemia?

A

Peaked T-waves, short QT interval, ST segment depression

SEVERE - prolonged PR/absent P wave and widened QRS segment

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31
Q

Tx of hyperkalaemia?

A
  • Calcium, insulin, glucose, beta-adrengic agonists and sodium bicarbonate
  • Potassium wasting diuretics
  • Dialysis
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32
Q

Causes of hyperkalaemia?

A
  • Excessive intake: iatrogenic or oral.
  • Cellular: acidosis, insulin deficiency (prediagnosed diabetes), tissue damage (burns, rhabdomylosis)
  • Decreased excretion: K+ sparing diuretics, beta-blockers, ACE-I, addison’s acute and chronic renal failure
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33
Q

What is normal pH?

A

7.35 - 7.45

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34
Q

What is CO2 range?

A

4.7 - 6 kPa

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35
Q

What is bicarbonate range?

A

22 - 30 mmol/L

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36
Q

What is O2 range?

A

10-13 kPa

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37
Q

What does a high base excess suggest?

A

A high base excess (> +2mmol/L) indicates that there is a higher than normal amount of HCO3- in the blood, which may be due to a primary metabolic alkalosis or a compensated respiratory acidosis.

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38
Q

What does a low base excess suggest?

A

A low base excess (< -2mmol/L) indicates that there is a lower than normal amount of HCO3- in the blood, suggesting either a primary metabolic acidosis or a compensated respiratory alkalosis.

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39
Q

Anion gap?

A

(Na+ + K+) - (Cl- + HCO3-)

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40
Q

Normal range for anion gap?

A

14- 18 mmol/l

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41
Q

Mneumonic/causes of elevated anion gap?

A

MUDPILES:

Methanol/Metformin 
Uraemia 
Dka 
Paraldehyde 
Iron
Lactate 
Ethanol 
Salicylates
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42
Q

Causes of decreased anion gap?

A

A decreased anion gap indicates decreased acid excretion or loss of HCO3–−:

GI loss of HCO3— diarrhoea, ileostomy, proximal colostomy
Renal tubular acidosis (retaining H+)
Addison’s disease (retaining H+)

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43
Q

Liver Function tests - markers of liver cell damage

A 
ALT
AST 
ALK Phos
GGT
Bilirubin
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44
Q

Liver function tests - markers of synthetic function

A

Albumin
Clotting (INR)
Glucose

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45
Q

What would AST:ALT = 2:1 suggest?

A

Alcoholic liver disease

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46
Q

What would AST:ALT where AST is slightly higher than ALT suggest?

A

Viral liver disease

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47
Q

Normal range of ALP?

A

30 - 150 IU/L

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48
Q

Normal range of GGT

A

8 - 60 IU/L

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49
Q

When would GGT be raised?

A

Chronic alcohol use. It is used to confirm a hepatic cause of raised ALP. Also raised in bile duct disease and metastates

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50
Q

When would ALP be raised?

A

Bone disease
Pregnancy
Cholestasis

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51
Q

Normal range for AST?

A

3- 30

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52
Q

Normal range for ALT?

A

3 - 40

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53
Q

Normal range for bilirubin?

A

3- 17

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54
Q

Normal range for albumin

A

35 - 50

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55
Q

Comparing ALT and ALP?

A

A greater than 10-fold increase in ALT and a less than 3-fold increase in ALP suggests a predominantly hepatocellular injury
A less than 10-fold increase in ALT and a more than 3-fold increase in ALP suggests cholestasis
It is possible to have a mixed picture involving hepatocellular injury and cholestasis (e.g. ALT < 10-fold increase and ALP > 3-fold increase)

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56
Q

What if ALT > AST ?

A

ALT > AST is seen in chronic liver disease

AST > ALT is seen in cirrhosis and acute alcoholic hepatitis

57
Q

When can you not do the combined pituitary function test?

A

Ischaemic heart disease, epilepsy and untreated hypothyroidism (impairs GH and cortisol response?)

58
Q

How big is a microadenoma?

A

<10 mm (benign)

59
Q

How big is a macroadenoma?

A

> 10 mm (malignant)

60
Q

When would you have excess ADH (SIADH)?

A 
Ectopic production (SCLC) 
Drugs - SSRIs, carbamazepine, amtryliptine 
Brain - meningitis, traumatic brain injury
61
Q

Reference range for TSH?

A

0.33 - 4.5

62
Q

Reference range for free T4?

A

10.2 - 22.0

63
Q

Reference range for free T3?

A

3.2 - 6.5

64
Q

Types of hyperthyroidism

A

High Uptake - Grave’s disease, toxic nodular, toxic adenoma

Low uptake - Postpartum thyroiditis, viral thyroiditis

65
Q

Types of hypothyroidism

A 
Hashimotos 
Iodine deficiency 
Post-thyroidectomy 
Drug induced - Lithium, amiodarone 
Primary atrophic hypothyroidism
66
Q

Treatment of hyperthyroidism?

A

NSAIDs - viral thyroiditis
High uptake - carbimazole/propylthiouracil (risk of aplastic anaemia)
Surgery

67
Q

Treatment of hypothyroidism?

A

Thyroid replacement therapy

68
Q

Types of thyroid cancers

A

Most common —> least common

  • Papillary
  • Follicular
  • Medullary
  • Lymphoma (MALT)
  • Anaplastic
69
Q

Role of calcitonin?

A

Lowers Ca2+ levels by inhibiting osteoclasts and inhibiting renal tubular resorption of Ca2+

70
Q

Where is calcitonin produced?

A

Thyroid (parafollicular/ c-cells)

71
Q

How is addison’s diagnosed?

A

SynACTHen test

72
Q

Electrolyte imbalance seen in addison’s?

A

high K+ and low Na+ and low glucose

73
Q

Role of aldosterone in terms of H+?

A

Excretes H+ into urine and keeps HCO3-

74
Q

What is conn’s syndrome

A

Adrenal tumour secreting too much aldosterone

75
Q

What electrolyte imbalance would you see with conn’s?

A

V. high Na+ and v. low K+. Hypertension

76
Q

How to investigate conn’s?

A

Aldosterone:renin ratio

77
Q

How to investigate PHAEO

A

Plasma and 24 hr urinary VMA and catecholamines

78
Q

What would you see in phenytoin toxicity?

A

Ataxia and nystagmus

79
Q

What would you see in digoxin poisoning?

A

Arrythmias, heart block, confusion and seeing yellow

80
Q

What would you see in lithium toxicity?

A

Tremor, seziures, renal failure, arrhythmia

81
Q

What would you see in gentamicin toxicity?

A

Tinnitus, deafness, nystagmus, renal failure

82
Q

Calcium range?

A

2.2-2.6 mmol/l

83
Q

Hormones involved in calcium metabolism

A

PTH (increases Ca2+) and calcitriol (1,25 (OH)2D) - increases Ca2+ too

84
Q

Tell me about PTH

A

Increases Ca2+
Gets rid of phosphate
Increased tubular 1alpha hydroxylation of Vit D 25 (OH) D
Kidney tings

85
Q

How does Calcitriol work?

A

increases both Ca2+ and phosphate absorption from the gut

86
Q

Main cause of primary hyperparathyroidism?

A

increase in PTH due to parathyroid adenoma (80%)

87
Q

What else would you see in primary hyperparathyroidism?

A

High Ca2+, low phosphate, normal/high alk phosphate, vit D - normal

88
Q

Main cause of secondary hyperparathyroidism?

A

Renal osteodystrophy

89
Q

What else would you see in secondary hyperparathyroidism?

A

low Ca2+, high phosphate, high PTH, alk phosph high,

90
Q

Main cause of tertiary hyperparathyroidism?

A

Post renal transplant

91
Q

Cause of hypoparathyroidism?

A

Primary - DiGeorge Syndrome

Secondary - Post-thyroid surgery

92
Q

What do you check in a patient with hypercalcaemia (next step)?

A

Albumin:

High - if high urea as well = dehydration

Low/Normal - check the phosphate. High phosphate - check the ALP.

93
Q

Causes of hypercalcaemia

A

Dehydration (high albumin)
ALP (high) - bone metastasis, thyrotoxicosis, sarcodosis
ALP (normal) - too much vit D, myeloma, milk alkali syndrome

94
Q

Symptoms of hypercalcaemia

A

Moans, bones, groans, stones and pyschiatric overtones

95
Q

Treatment of hypercalcaemia

A

Correct dehyration, bisphonates and treat underlying cause

96
Q

Causes of hypocalcaemia

A 
Parathyroid - autoimmune destruction, diGeorge (22) or surgical removal 
Renal - poor reabsorption due to renal failure 
Vit D deficiency 
Burns and rhambdomylsis 
Pancreatitis 
Magnesium deficiency 
Resp alkalosis 
Osteomalacia
97
Q

Symptoms of hypocalcaemia

A

Trousseaus and Chvostek sign, perioral tingling, seizures

98
Q

Treatment of hypocalcaemia

A
  • mild : give calcium
  • renal cause - ALFACALCIDOL
  • severe: IV calcium gluconate
99
Q

Which kind of kidney stone is likely to form in alkaline urine?

A

Calcium phosphate

100
Q

Which kind of kidney stone is likely to form in acidic urine?

A

Calcium oxalate

101
Q

Staghorn kidney stone?

A

Seen in infection related kidney stone (struvite)

102
Q

Risk factors for kidney stone

A

Dehydration
UTI
Diet high in purines or oxlate rich foods
Abnormal urine pH (renal tubular acidosis, red meat), Anatomical abnormalities

103
Q

Management of kidney stones

A
  • Keep hydrated
  • Reduce oxlate intake (spinach, beer, rhubarb)
  • Thiazides
  • Citrate (alkalises urine)
104
Q

Types of kidney stones

A 
Calcium oxlate 
Calcium phophate 
Struvite (staghorn)
Uric acid 
Cysteine 
Xanthine
105
Q

Which kidney stone is not radioopaque (most are - hint)

A

Cysteine and Xanthine

106
Q

How would you investigate a patient with suspected kidney stones?

A

Serum: Cr, bicarbonate, Ca, phosphate, urate, PTH
Stone analysis
Spot urine : pH, MCS, amino acids, albumin
24 hour urine
XRAY

107
Q

When would serum amylase be high? (x10)

A

Acute pancreatitis

108
Q

Different types of CK

A

CK-MM : skeletal muscle

CK-MB : cardiac muscle

109
Q

When would you see high CK

A 
Normal in black people 
MI 
Duchenne muscular dystrophy 
Statin related myopathy 
Rhambdomyolysis
110
Q

When do you measure Troponin?

A

6 and 12 hours post chest pain

111
Q

Diagnostic criteria for MI

A 
Typical rise and gradual fall of troponin 
Rapid rise and fall of CK-MB 
With: 
- Ischaemia
- Pathological Q waves 
- Coronary artery intervation 
- Pathological exam and history findings
112
Q

What happens when you don’t have enough vit A? (SERUM)

A

Colour blindness

113
Q

What happens when you have too much vit A? (SERUM)

A

Exfoliation
Hepatitis
Tetragenic

114
Q

What happens when you don’t have enough vit D? (SERUM)

A

Rickets

Osteomalacia

115
Q

When happens when you have too much vit D? (SERUM)

A

Hypercalcaemia

116
Q

What happens when you don’t have enough Vit E?

A

Anaemia

Neuropathy

117
Q

What happens when you don’t have enough Vit K?

A

Shit clotting (haemorrhagic disease of the newborn)

118
Q

What happens when you have enough Thiamin (B1)?

A

Beri-Beri
Neuropathy
Wernicke’s syndrome

119
Q

How do you test for thiamine deficiency?

A

RBC transketolase

120
Q

What happens when you don’t have enough Riboflavin (B2)?

A

Glossitis

121
Q

What happens when you dont have enough Pyridoxine (B6)?

A

Dermatitis/Anaemia

122
Q

What happens when you have too much pyridoxine (B6)?

A

Neuropathy

123
Q

What happens when you dont have enough Vit b12

A

Pernicious anaemia

124
Q

What happens when you dont have enough folate?

A

Neuro congential defects

Megaloblastic anaemia

125
Q

What happens when you dont have enough Niacin (B3)

A

Pellagra - 3Ds: diarrhoea, dermatitis and dementia

126
Q

Diagnositic criteria for diabetes mellitus

A

Fasting glucose > 7
Oral glucose tolerance test > 11.1
Random glucose >11.1

127
Q

Diagnostic criteria for impaired glucose tolerance

A

Random/oral glucose tolerance test > 7.8 but less than 11.1

128
Q

Hyperinsulinaemia hypoglycaemia

A

Insulin excess, sulphonyurea excess, insulinoma

129
Q

Hypoinsulinaemia hypoglycaemia (+ve ketones_

A

Alcoholic binge with no food, addison’s disease, pituitary insufficiency, liver failure, anorexia nervosa, fasting, strenuous excerise, critical illness

130
Q

Hypoglycaemia in the neonate

A

Worry if there are no ketone bodies (inherited metabolic disorder)
If ketones present - premature, IUGR etc

131
Q

Hypernatraemia

A

risk of intraventricular haemorrhage. Give sodium bicarbonate when treating acidosis

132
Q

Hyponatraemia

A

think congenital adrenal hyperplasia. Give caffeine when treating apnoea

133
Q

Common problems with low birth weight

A 
Respiratory distress syndrome 
Retinopathy of prematurity 
Intraventricular haemorrhage 
PDA 
NEC
134
Q

When does a kid reach maturity of their GFR?

A

Two years

135
Q

Why do you babies have issues concentrating their urine

A

short loop of henle and distal collecting duct

136
Q

why do babies lose salt easily?

A

distal tubule is not that sensitive to aldosterone

137
Q

Which one is always pathological? Unconjugated/Conjugated

A

Conjugated is always pathological

138
Q

When do you start worry about jaundice?

A

Jaundice in the first 24 hrs of life
More than 14 days in term
More than 21 days in term

Path - HANIN (5 decks)

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