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Evie Pathology > Chemical Pathology > Flashcards

Chemical Pathology Flashcards

1
Q

Three main causes of hypernatraemia

A

1 hypovalaemia - GI loss/diuretics

2 euvolaemia - respiratory losses

3 hypervolaemia - mineralocorticoid excess

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2
Q

Urine concentrates after 8h deprivation test indicates

A

Primary polydipsia

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3
Q

Urine doesn’t concentrate over 8h deprivation test but does with the administration of desmopressin

A

Cranial diabetes insipidus

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4
Q

Urine fails to concentrate after 8hour deprivation test and desmopressin administration

A

Nephrogenic diabetes insipidus

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5
Q

Causes of nephrogenic diabetes insipidus

A

ADH insensitivity due to - lithium/inherited/chronic renal failure

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6
Q

What is hypokalaemia and what are four causes?

A

<3.5mmol/l

1 GI loss

2 redistributative - insulin

3 renal loss - excess cortisol/osmotic diuresis

4 rarely - tubular acidosis/hypomagnesia

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7
Q

Where is potassium normally predominately found

A

Intracellularly

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8
Q

What is hyperkalaemia and what are three causes?

A

> 5.5mmol/l

1 excessive intake

2 movement out of cells - acidosis/decreased insulin/catabolic state

3 decreased excretion - acute renal failure/CRF/Addisons/NSAIDs/ACEi/spironolactone

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9
Q

What are five causes of decreased K excretion which lead to hyperkalaemia?

A 
ACEi
Spironolactone
Acute renal failure
Chronic renal failure
NSAIDs
Addisons
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10
Q

What is the rule linking pH to serum potassium?

A

For every 0.1 decrease in pH there is a 0.7 increase in K

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11
Q

Normal range for pH

A

7.35-7.45

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12
Q

Normal range for Co2

A

4.7-6

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13
Q

Normal range for bicarbonate

A

22-30

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14
Q

Normal range for O2

A

10-13

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15
Q

What are the steps you follow when looking at a blood gas (4)

A

1 pH
2 Does the CO2 fit with the pH
3 Does the bicarbonate fit with the pH
4 Any compensation>

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16
Q

How is the anion gap calculated and what is it normally?

A

(Na+k)-(Cl+Hco3)

Usually 14-18

17
Q

Name four causes of a raised anion gap

A

1 ketoacidosis
2 uraemia
3 lactic acidosis
4 toxins

18
Q

What causes the osmolar gap to be raised above 10?

A

An abnormal solute - ethylene glycol/ethanol/methanol/mannitol

19
Q

Name the three measures of liver synthetic function

A

Glucose
INR
Albumin

20
Q

Name the three causes of a raised alkaline phosphatase

A

Cholestasis
Pregnancy
Bone disease

21
Q

What does a raised AST and ALT mean?

A

Hepatocyte death ie viral/alcohol

22
Q

What does a raised gamma GT mean?

A

Chronic alcohol use, bile duct disease and metastases

Used to confirm hepatic source of raised ALP

23
Q

Inheritance of acute intermittent porphyria

A

Autosomal dominant

24
Q

What enzyme is deficient in acute intermittent porphyria

A

HMB synthase deficiency

25
Q

Fifth year medical student with abdominal pain, nausea and vomiting and muscle weakness. Their urine is noticed to be a port wine urine.

A

Acute intermittent porphyria

26
Q

What are some of the precipitating factors for acute intermittent porphyria

A

ALA synthase inducers - steroids/ethanol/barbiturates
Stress
Decreased caloric intake

27
Q

What type of symptoms does acute intermittent porphyria cause

A

Neuro-visceral

28
Q

Photosensitivity and burning itching oedema after sun exposure

A

Erythropoietin protoporphyria

29
Q

Enzyme deficiency in porphyria cutanea tarda

A

Uroporphyrinogen decarboxylase deficiency

30
Q

Vesicles and superficial scars from them on sun exposed sites

A

Porphyria cutanea tarda

31
Q

Increased urinary uroporphyrins, coproporphyrins and ferritin

A

Porphyria cutanea tarda

32
Q

Patient with light sensitivity and red urine

A

Congenital erythropoietic porphyria

33
Q

What is the aim of the combined pituitary function test, contra-indications and side effects

A

Used to assess all components of the anterior pituitary

Avoid in ischaemic heart disease/epilepsy/untreated hypothyroid

Side effects - sweating, palpitations, LOC. transient metallic taste with the injection of TRH

34
Q

What does the combined pituitary function test consist of?

A

Insulin tolerance test - cortisol and GH
Thyroptrophin Releasing Hormone test - TSH
Conadotrophin releasing hormone test - LH and FSH

35
Q

What is the expected response to an insulin tolerance test

A

Cortisol increase from >170 to >500

GH increase >6mcg/l

36
Q

What is the expected response to the thyrotrophin releasing hormone test?

A

TSH increase >5 and the 30 minutes value greater than the 60 minute value.

37
Q

What does a 60min value of TSH greater than the 30min value in the TRH test mean?

A

Primary hypothalamic disease

38
Q

What does an exaggerated response to the TRH test mean?

A

Hypothyroid

39
Q

What is a normal response to the GRH test?

A

Peak at 30 or 60 mins

LH >10 and FSH >2

Evie Pathology (5 decks)

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