Chem Path Flashcards
Deficiency in a vegan woman
B12 and Iron and probably lots of other things
Intrinsic Factor deficiency causes…
B12 deficiency
Polyendocrinopathies (Schmidt’s Syndrome)
Addisons, T1DM, Hypothyroidism. Also associated with pernicious anaemia and coeliac disease so B12 deficiency again
Crohn’s Nutritional deficiency due to affected terminal ileum
B12
Coeliac Can Cause
Iron, calcium, folate and b12
Indian woman presents with tiredness with macrocytic anaemia. and is vegan
B12 deficiency
Patient with coeliac has glossitis and blood film shows macrocytic anaemia
B12 deficiency
Patient with dementia symptoms and dermatitis and diarrhoea
B3/Niacin causing Pellagra
6 year old boy with bowed legs
Rickets. Vit D deficiency
A patient with high PTH. You suspect osteomalacia
Vit D deficiency
What do you give in Wernicke’s encephalopathy
Thiamine (B1)
What deficiency causes Beri Beri?
Thiamine (B1)
What deficiency raises PTH levels?
Vitamin D
Only raised ALP. with bone pain
Paget’s
LFT’s for: Intrahepatic cholestasis abnormality
Raised ALP and bilirubin
LFT’s for Cirrhosis
Raised AST and ALT
LFT’s for Gilberts
Mildly raised unconjugated bilirubin, all else normal
LFT’s for Viral Hepatitis
ALT>AST
LFT’s for Paracetamol Overdose
Massively raised AST and ALT
LFT’s for Alcoholic Liver Disease
AST>ALT
LFT’s for Gallstones
Raised ALP and conjugated bilirubin
Haemachromatosis and what stain is used
Build up of iron in liver and dye used is Prussian blue stain
Rate limiting enzyme in haem synthesis
ALA Synthase
Deficiency leads to high urate levels and can cause Lesch Nyhan syndrom
HGPRT
What condition and enzyme deficiency can present as a salt wasting crisis
CAH and 21 hydroxylase deficiency
What can be used to diagnose Beta Thalassaemia trait?
HbA2 levels raised.
What enzyme is raised in mumps
Amylase
What do you see in a patient with T1DM’s kidneys
Renal sclerosis
Emphysema in a non-smoker
A1AT deficiecny
Normal Ca, Phosphate and PTH levels
Ca 2.2-2.6
Phosphate 0.8-1.4
PTH 0.8-8.5
Osteoporosis Bloods
Normal
Osteomalacia Bloods
Low Vitamin D Raised PTH Raised ALP Low/Normal calcium Low/Normal Phosphate
Breast Cancer with Mets Bone Bloods
Raised ALP Raised Calcium Low PTH Raised Phosphate Vit D can be anything
Paget’s Disease Bone Bloods
Raised ALP
Rest Normal
Primary Hyperparathyroidism Bone Bloods
Raised (or inappropriately normal) PTH Raised Calcium Low Phosphate Variable ALP Variable Vitamin D
Renal Bone Disease Bone Bloods
Low or Borderline Calcium Raised PTH Increased Phosphate ALP raised or normal Vitamin D normal Due to decreased 1 alpha hydroxylase
Hypoparathyroidism Bone Bloods
Low PTH Low Calcium Raised Phosphate Normal Vitamin D Normal ALP
What would the potassium be in a patient with untreated DKA be?
Raised Potassium
How to calculate osmolality
2(Na+K)+urea+glucose
How to calculate anion gap
Na+K-Cl-Bicarb
Impaired Glucose tolerance values
7.8-11.1
Patient with bloods: Raised glucose Raised Potassium Acidotic pH Low Bicarb
DKA
Patient with bloods Raised glucose Raised Na Raised osmolality Normal pH Normal Bicarb
HONK
What would bicarbonate levels be in pyloric stenosis?
Raised bicarbonate levels.
You get a hypochloraemic hypokalaemic metabolic alkalosis
Low Sodium, High potassium, low Mg
Addison’s
High sodium, low potassium, HTN
Conn’s
A 67-year-old woman presented with confusion 2 days after a cholecystectomy. She had experienced some pain postoperatively, largely relieved by analgesia. On examination, she was disoriented, her heart rate was 66 beats per minute and her blood pressure was 162/82 mmHg. She only had minor discomfort of the abdomen. The urine sodium was 90mmol/l (NR 20-200mmol/l depending on hydration of patient).
The figure below shows the colours you would see on the dipstick after it has been dipped in the urine, and it was yellow in colour, consistent with an SG of 1.030.
Investigations:
Haemoglobin 130 g/L (115-165)
MCV 92 fL (80-96)
white cell count and platelet count normal
serum sodium 120 mmol/L (137-144)
serum potassium 3.7 mmol/L (3.5-4.9)
serum urea 3 mmol/L (2.5-7.0)
serum creatinine 90 µmol/L (60-110)
serum albumin 36 g/L (37-49)
random plasma glucose 5 mmol/L
SIADH
High serum osmolality and high sodium. Low urine osmolality
DI
High serum osmolality High potassium
DKA
Impaired glucose tolerance test
Diabetes glucose tolerance
Fasting glucose diabetes
Impaired fasting glucose
7.8-11
>11
>7
6.1-6.9
High LH
High FSH
All else normal
Premature ovarian failure
Slightly raised prolactin
Rest normal
Non-functioning adenoma
Significantly raised prolacting
Prolactin secreting macroadenoma
Raised GH, others suppressed. How to daignose
Acromegaly, glucose tolerance test
Myxoedema
Raised TSH
Low T3, Low T4
Polyuria, polydipsia, hyponatraemia and high serum osmolality, high serum glucose
Diabnetes Mellitus, Pseudohyponatraemia
Polyuria, polydipsia, high serum osmolality, low urine osmolality
DI
Patient three days post OP, has low sodium, raised urine osmolality. Euvolaemic
SIADH
`Hypovolaemic hyponatraemia
D+V, Diuretics, Salt losing nephropathy
If urine sodium is low, then it’s likely to be non-kidney
Hypervolaemic hyponatraemia
Kidney, liver and heart failures
Euvolaemic hyponatraemia
Hypothyroidism, Adrenal Insufficiency, SIADH.
Low Sodium, High Potassium, HTN
Addison’s
Woman with thin skin, proximal myopathy, impaired fasting glucose. DM excluded already, what test to do and what diagnosis?
Dexamethasone suppression test
Cushing’s syndrome
Polyuria, polydypsia, low sodium on bloods, normal serum osmolality. What test to do next?
Blood glucose as it may be pseudohyponatraemia
Patient notices swollen big fingers and ring doesn’t fit anymore. What test to do next?
Oral glucose tolerance test
Acromegaly
Measure GH levels
Addison’s disease test
Short SynACTHen test
Best way to monitor blood glucose control over a period of 2-3 months
HbA1C
What hormone lowers calcium levels
calcitonin
Raised TSH, Raised T4, Low T3
TSH secreting tumour OR poor sensitivity to TSH (ie body doesn’t recognise T4 is present enough so TSH is high)
