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Pathology BB quizzes > Chemical pathology > Flashcards

Chemical pathology Flashcards

1
Q

what are the breakdown products of heroin?

A

6-MAM, morphine, 3-MAM

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2
Q

A man was put into custody after driving under the influence of drugs. On arrest he was reported as acting extremely aggressive and paranoid. He also claimed his heart was racing. One hour later he was found dead. What is the likely drug of abuse?

A

cocaine

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3
Q

WCC reference range?

A

4.0 - 11.0

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4
Q

PTH refrence range

A

10 - 60 ng/L, 1.05 - 6.83 pmol/L

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5
Q

corrected calcium ref range

A

2.05 - 2.60 mmol/L

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6
Q

Which drug is found in the most addict related deaths?

A

cocaine

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7
Q

What is a disadvantage of using saliva for forensic drug analysis?

A

small window of detection

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8
Q

which drug is not excreted into saliva?

A

THC

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9
Q

what are the serious adverse effects of theophylline?

A

tachyarrhythmia, seizures, diarrhoea

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10
Q

what are the features of digoxin toxicity?

A
  • arrhythmia
    • specifically ventricular ectopics, bigeminy/trigeminy or complete heart block
  • GI - anorexia, neusea, vomiting
  • confusion (esp elderly)
  • VISUAL - yellow vision​, blurred vision, photophobia
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11
Q

treatment for beta-blocker OD?

A

IV atropine for heart rate stabilisation

If still sick, IV glucagon

Glucagon - couteracts hyperglycaemia and activates Gs on heart, increasing cAMP behaving as positive inotrope

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12
Q

what toxins are not treated with activated charcoal?

A
  1. cyanide
  2. iron
  3. ethanol
  4. lithium
  5. acid base disturbance
  6. pesticides
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13
Q

what is the indication for activated charcoal?

what advice should be given to patients?

A

poisoning with a PO drug immediately after ingestion

given in a dose approx 10:1 w/w charcoal:drug, or 50g q4hr

will taste awful and poo will be black

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14
Q

what is the treatment for severe salicylate toxicity (with severe acid base disturbance)

A

haemodialysis

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15
Q

at what [glucose]serum does polyuria usually develop as a symptom?

A

> 10 mM

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16
Q

what are the situations in which HbA1c is a bad test of diabetic control?

A

IDA

haemaglobinopathy

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17
Q

what is the diagnostic criteria of diabetes by HbA1c?

A

value of > 48 mmol/mol (6.5%) on 2 occasions

sample NOT done by finger prick test

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18
Q

procedure of OGTT

A
  • overnight fast
  • 75 g glucose in 250 - 250 mL water (440 mL lucozade)
  • take blood at t = 0, 60 mins & 120 mins
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19
Q

diagnostic definition of diabetes

fasting and OGTT

A

fasting >= 7.0

120 mins OGTT >= 11.1

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20
Q

diagnostic definition impaired glucose tolerance

results from OGTT

A

120 mins OGTT = 7.8 - 11.0 mmol/L

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21
Q

diagnostic definition impaired fasting glucose

A

fasting = 6.1 - 6.9 mmol/L

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22
Q

a pregnant woman with 120 mins OGTT = 7.8 - 11.0 should be treated how?

A

as though she has GDM

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23
Q

which antibiotic should have peak and trough levels measured?

A

gentamicin

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24
Q

thiazide diuretics affet the renal clearance of which notoriously toxic medication?

A

lithium

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25
Q

which liver enzyme will be raised in MI?

A

AST

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26
Q

which blood test(s) varies with posture when taken?

A

albumin

renin

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27
Q

which blood test has the greatest variability with race?

A

CK

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28
Q

what hormonal disturbance can be caused by ecstasy?

A

SIADH and hyponatraemia

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29
Q

most common cause of addison’s disease worldwide?

A

tuberculosis

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30
Q

Na + = 115 mmol/L

K + = 6.3 mmol/L

Osm = 210 mmol/L

A

addison’s disease

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31
Q

a 2/12 old baby vomits profusely.

pH = 7.57, H+ = 26 nmol/L ( rr: 35-45 nmol/L), HCO3- = 50 mmol/L

what is the likely accompanying eletrolyte disturbance?

A

hypokalaemia

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32
Q

what are the principle differences between type 1 and 2 RTA?

A

type 1 = failure to excrete H+ in DCT & CD

type 2 = failure to resorb HCO3- in PCT

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33
Q

what are the 3 principle characteristics of RTA?

A
  1. acidosis with HYPOkalaemia
  2. alkaline urine with positive anion gap
  3. nephrocalcinosis
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34
Q

which RTA is most common?

what are the aetiologies of both?

A

type 1 more common

  • type 1 = idiopathic, autoimmune (SLE), chronic pyelonephritis
  • type 2 = fanconi syndrome
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35
Q

what is delayed separation?

A

when you leave a vial of blood lying around too long and K+ leaks out from RBC and contaminates the result (falsely eleveated K+)

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36
Q

what disease results in

hypervolaemia with urinary Na+ > 20 mmol/L

A

chronic renal failure

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37
Q

what must you consider with:

normovolaemic and hyponatraemic

A

SIADH

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38
Q

high dose dex supression test

cortisol levels high and rest and supressed in response..

diagnosis?

A

cushing disease

ACTH secreting pit adenoma

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39
Q

a 52 y/o male presents with muscle cramps and headache

hypertensive and HYPOkalaemia

renin-aldosterone ratio = 0.02

diagnosis?

A

aldosterone-secreting adrenal adenoma

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40
Q

excess ACTH symptoms following bilateral adrenalectomy..

eponymous syndrome

A

nelson’s syndrome

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41
Q

what steroid is detectable in the urine of CAH patients ?

A

pregnanetriol

42
Q

what is the gold standard for measurement of GFR?

A

inulin

43
Q

A 65 yr old woman presents with a four week Hx of weight gain, tiredness, constipation and a puffy face. On Ix she is found to have a TSH level of 20mU/l and a free T4 level of 7pmol/l

A

primary hypothyroidism

44
Q

A 35 yr old woman presents with pain in her neck which radiates to her upper neck, jaw and throat. The pain is worse on swallowing. She has a Hx of an upper respiratory tract infection two weeks ago. On Ix she has a free T4 of 30pmol/l, free T3 of 11pmol/l and a TSH level of 0.1mU/l. On technetium scanning of the thyroid there is low iodine uptake.

A

de Quervain’s thyroiditis

(or subacute granulomatous; viral; painful)

45
Q

A 30 yr old woman presents with a Hx of weight loss, diarrhoea, tremor and a marked swelling at the front of her neck. On Ix she is found to have a TSH level of 0.05mU/l a free T4 level of 30pmol/l and a free T3 of 12pmol/l. On technetium scanning the thyroid shows increased iodine uptake.

A

Graves disease

46
Q

A 70 yr old lady is found to have a tumour of the thyroid gland. She is also found to have high levels of circulating calcitonin

A

medullary thyroid CA

47
Q

Neurotoxic product(s) of heme breakdown producing neurovisceral damage in certain porphyrias

A

5-ALA

aminolevulinic acid

48
Q

Product(s) of heme breakdown resulting in photosensitivity (i.e. cutaneous) damage in certain porphyrias

A

activated porphyrins and oxygen free radicals

49
Q

what is pseudo-hyponatraemia?

A

increased lipids and proteins in the serum means a lower sodium concentration is detected due to dilution

there is an apparent hyponatraemia without other deranged U&Es

50
Q

what is the numerical osmolality of plasma in SIADH?

A

plasma <270 mmol/L

51
Q

the urine osmolality is greater than plasma osmolality in which condition?

A

SIADH

52
Q

what is the best test for hypovolaemia?

A

Low urine Na (<20)

kidney notices hypovelaemia and retains salt and water to compensate

53
Q

what are the causes of hypovolaemic hyponatraemia?

A

diarrhoea, vomiting

diuretics

salt wasting nephropathy

54
Q

what are the causes of euvolaemic hyponatraemia?

A

hypotothyroidism

adrenal insufficiency

SIADH

55
Q

what are the causes of hypervolaemic hyponatraemia?

A

cardiac failure

renal failure

liver failure

56
Q

in what instance are fluids contraindicated in hyponatraemia?

what is the mechanism?

A

SIADH

high circulating ADH, give 0.9% saline. retain all the water, excrete the salt. overcome the protective natriuretic peptide effect and go into further hyponatraemia/fluid overload

57
Q

what is the treatment of SIADH?

A

treat the underlying cause + EITHER

fluid restriction with IV hypertonic saline + frusemide

OR

Tolvaptans (V2 receptor antagonist)/demeclocycline

58
Q

what electrolyte abnormalities can cause a nephrogenic diabetes insipidus?

A

hypokalaemia and hypercalcaemia

59
Q

what is translocational hyponatraemia?

A

high glucose in the serum draws water out into the extracellular space which dilutes the sodium causing a translocational hyponatraemia

60
Q

management of hyperkalaemia?

A
  1. 10 ml 10% calcium gluconate
  2. 50 ml 50% dextrose & 10 U insulin
  3. Nebulised salbutamol
  4. Treat underlying cause
61
Q

causes in order of likelihood for hyperkalaemia

A

CKD

Drugs - ACE-I, ARB, sprionolactone

Endo - Addison’s, type IV RTA

Release from cells - rhabdomyolysis, systemic acidosis

62
Q

algorithm for hypokalaemia

A
  • GI loss.
  • Renal loss:
    • hyperaldosteronism (excess cortisol);
    • increased sodium delivery to DCT;
    • Osmotic diuresis.
  • Redistribution into the cells:
    • insulin; beta-agonist; alkalosis.
  • Rare - RTA I & II, hypomagnesaemia.
63
Q

muscle weakness

cardiac arrhythmia

polyuria and polydipsia

what is the abnormality?

A

hypokalaemia

remember: hypokalaemia and hypercalcaemia cause nephrogenic DI

64
Q

what is the treatment algorithm for hypokalaemia?

A

if 3.0-3.5

two SandoK tablets tds for 48 hours, then review

if <3.0

IV KCl in normal saline, max 10 mmol/hr.

65
Q

what are the osteolytic bone met primaries?

A

BLT with Kosher Pickle, Mustard & Mayo

breast, lung, lymphoma, thyroid, kidney, prostate, Multiple Myeloma

66
Q

what is the urgent management for hypercalcaemia?

A

FLUIDS

4 L in 24 hours 0.9% saline

or

frusemide & fluids if volume overloaded (must start calciuresis)

67
Q

after calciuresis, what is the next step in management of hypercalcaemia?

A

keep well hydrated

avoid thiazides

surgery (parathyroidectomy)

68
Q

what is the treatment for hypercalcaemia in malignancy?

A

fluids and IV pamidronate 30-60 mg

69
Q

on hand x-ray, what does radial aspect cystic changes suggest?

A

primary hyperparathyroidism

70
Q

what is a Looser’s zone?

A

feature of Vitamin D deficiency

71
Q

what is the pathogenesis of pseudohypoparathyroidism?

A

inherited resistance to PTH, TSH (mild) and LH
Very high PTH, low Ca++, high Phosphate, normal ALP
female - hypogonadotrophic hypogonadism

hypocalcaemia = carpopedal spasm, parasthesia etc.

Albright hereditary osteodystrophy = short, mental retardation, obese, strabismus, ocular opacities, subcut calcifications, short metacarpals/metatarsals

72
Q

elevated - ALP, PTH

decreased - Ca++, Phos, Vit D

diagnosis?

A

osteomalacia/rickets

73
Q

A 32 year old librarian presents to your clinic complaining of blurring of her vision and amenorrhoea. She has a BMI of 22 and is generally well but has noticed some white secretions from her breast over the past 3 months. What would be a first line investigation for this lady?

A

CT head

74
Q

what is given for a complete pituitary function test?

A

100 mcg GnRH, 200 mcg TRH, insulin (complicated dose)

75
Q

at what point is there increased cardiovascular risk with the following parameters:

LDL, HDL, cholesterol:HDL ratio

A

LDL > 4.1 mmol/L

HDL <0.9 mmol/L

Ratio >5

76
Q

at what point in there decreased cardiovascular risk with LDL and HDL levels?

A

LDL <3.4 mmol/L

HDL >1.2 mmol/L

77
Q

what is the best drug to decrease LDL?

A

statins

78
Q

which is the best drug to increase HDL?

A

niacin

79
Q

which are the best drugs to decrease TGs?

A

fibrates (gemfibrozil)

80
Q

what are the priorities in treating dyslipidaemia from the cardiovascular risk factor perspective?

A
  1. decrease LDL by >30% (statins & ezetemibe)
  2. decrease TG (fibrates, niacin > statins)
  3. increase HDL (niacin)
81
Q

what is a specific therapy for familial hypercholesterolaemia (type II)?

how does it work?

A

lomitapide - MTP inhibitor

stops liver from producing VLDL

must be added to low-fat diet and highest possible dose statin

82
Q

what is the difference in the loop of henle between infants and adults?

A

infants - shorter loop of henle

impaired concentrating capacity, so maximum urine osmolality 700 mOsm

83
Q

which 3 drugs can cause aplastic anaemia?

A

terrible 3C’s:

carbimazole, carbamazepine, chloramphenicol

84
Q

what is the difference between cerebral salt wasting and SIADH?

A

Cerebral salt wasting (CSW) syndrome occurs after head injury or neurosurgical procedures where a natriuretic substance produced in the brain leads to sodium and chloride loss in the kidneys, reducing intravascular volume and leading to water retention. There is therefore a baroreceptor-mediated stimulus to vasopressin production.

It resembles SIADH in that both are hyponatraemic disorders seen after head injury with high urinary sodium, urinary osmalility and vasopressin levels. The
difference is the primary event in CSW is high renal sodium chloride loss, not high vasopressin release.

85
Q

what is carbohydrate-deficient transferrin?

A

transferrin is usually a glycoprotein in circulation

alcohol abuse leads to reduced carbohydrate moieties bound to the protein, which can be measured

It is a 70% sensitive, 95% specific test for alcohol abuse

86
Q

what does rasburicase do? when do you use it?

A

recombinant urate oxidase

use in the setting of chemotherapy to prevent hyperuricaemia in tumour lysis syndrome

87
Q

what does probenecid do?

A

increases renal excretion of uric acid (uricosuric agent)

mechanism - blocks oraganic acid transporter (OAT) in nephron, inhibiting uric acid resorbtion from lumen

use to prevent cidofovir nephropathy

88
Q

which diuertic class increases the chance for gout?

A

thiazides

89
Q

what is the biochemical picture in osteroporosis?

A

none

unless acute #, then raised ALP

90
Q

neonate: born with cataracts, poor feeding, lethargy, conjugated
hyperbilirubinaemia with hepatomegaly and reducing sugars

A

galactosaemia/carbohydrate metabolism disorders

91
Q

failure to thrive in the first few months, bloody stool, lethargy and jaundice. A distinctive cabbagelike odour is characteristic. On examination there is hepatomegaly with signs of liver failure and subsequent survival for less than 12 months if untreated

urinary succinylacetone is positive

A

tyrosinaemia

92
Q

test for PKU?

A

blood Phenylalanine

93
Q

immune reactive trypsin tests for what disease?

A

cystic fibrosis

94
Q

a common cause of cot death in infants screened for on newborn screening? what is the mechanism?

A

MCAD deficiency

put baby down to sleep for long night and cannot break down fats it has been storing so dies from hypoglycaemia during overnight fast

95
Q

early lens dislocation, thromboembolism and mental retardation…

suggests what inherited disorder of metabolism

A

homocysteinuria

96
Q

hyperammonaemia and respiratory alkalosis…

what group of disorders should you think of?

A

FIRST think of poisoning and drug toxicity…

then urea cycle disorder

97
Q

hyperammonaemia with metabolic acidosis (not lactate)…

what group of disorders should you consider?

A

organic aciduria

also lethargy, truncal hypotonia with limb hypertonia, myoclonic jerks
unusual odour

98
Q

hypoketotic hypoglycaemia…

what sort of disorders should you consider?

A

mitochondrial fatty acid oxidation disorders

also… hepatomegaly and cardiomyopathy

99
Q

what are the lab tests for fatty acid oxidation disorders?

A

blood ketones - low

urine organic acids

blood spot acylcarnitine profile

100
Q

what are children with carbohydrate metabolism disorders at most risk for?

A

E. coli septicaemia

101
Q

what are the investigations in mitochondrial disorders?

A

lactate - eleveated after periods of fasting

CSF - lactate, pyruvate, protein

CK

muscle biopsy for ragged red fibres

mitochondrial DNA

Pathology BB quizzes (5 decks)

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