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Pathology > Chemical pathology > Flashcards

Chemical pathology Flashcards

1
Q

Which LFT is most raised in alcoholic liver disease, and chronic alcohol use?

A

AST, GGT

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2
Q

Where in the liver is ALP produced?

A

Sinusoidal and canalicular membranes

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3
Q

In which conditions is AFP raised?

A

Hepatocellular carcinoma, pregnancy, testicular cancer

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4
Q

What is/isn’t detected in the urine of someone with obstructed jaundice?

A

Increased conjugated bilirubin, dark urine, absent urobilinogen

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5
Q

What is fasting bilirubin used to diagnose?

A

Gilberts syndrome

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6
Q

What is courvoisier’s sign?

A

in the presence of a painless palpable GB, jaundice is unlikely to be caused by gallstones.

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7
Q

What biochemical abnormality common presents with depression

A

Hypercalcaemia

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8
Q

What is a Pott’s fracture?

A

Ankle fracture involving the tibia and fibula

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9
Q

What are the effects of PTH?

A

efflux of ca from bone, decreased urine ca loss, enhanced intestinal ca absorption, increased phosphate urinary excretion, enhances 1a hydroxylase

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10
Q

How does hypercalcaemia cause polydipsia/polyuria?

A

Nephrogenic DI

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11
Q

What type of renal stones tend to form staghorns?

A

Struvite (magnesium ammonium phosphate)

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12
Q

Which is the commonest causative organism of renal stone infections?

A

Proteus

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13
Q

Which tumours are associated with MEN1 and MEN2?

A

MEN1: pituitary, pancreas, parathyroid
MEN2: parathyroid, thyroid, phaeo

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14
Q

When would you give pamidronate for hypercalcaemia?

A

Cancer patients for pain relief of bony mets

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15
Q

What is the most important immediate management of hypercalcaemia?

A

IV 0.9% saline

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16
Q

Which type of diuretics are avoided in hypercalcaemia and why?

A

Thiazides - increase Na/Ca anti porter, so more Ca is absorbed from lumen into cells.

17
Q

What bone changes are associated with hyperparathyroidism?

A

Osteitis fibrosa cystica (brown tumours), giant multinucleate cells

18
Q

Why does sarcoidosis cause hypercalcaemia?

A

Ectopic 1a hydroxylase production by macrophages

19
Q

Which organs produce ALP?

A

Liver, bone, intestines, placenta

20
Q

What is the most specific marker of acute pancreatitis?

A

Pancreatic lipase

21
Q

Causes of a raised serum amylase?

A

Acute pancreatitis, mumps parotitis, acute abdomen

22
Q

In relation to the onset of chest pain, when should troponin be measured?

A

6 and 12h after

23
Q

What are the other names for vitamin B1,2,3,6 and 12

A

Thiamine, riboflavin, niacin, pyridoxine, cobalamin

24
Q

What is the presenting triad of wernicke’s encephalopathy and what causes it?

A

ophthalmoplegia, ataxia, and confusion

B1 (thiamine) deficiency

25
Q

What are the 4 components contributing to daily energy expenditure?

A
  • Resting energy expenditure
  • Exercise
  • Thermogenesis
  • Facultative thermogenesis
26
Q

What are 2 medications for obesity and how do they work?

A

Orlistat- inhibit pancreatic lipase

GLP-1 agonist- e.g. exanetide. increase satiety

27
Q

How is ALP affected in osteomalacia and why?

A

Increased due to 2ry hyperparathyroidism

28
Q

Which enzyme is most raised in viral hepatitis?

A

ALT

29
Q

What happens to vitamin D levels in primary hyperparathyroidism and why?

A

Reduces, as 1a hydroxylase uses up vitamin D

30
Q

What are the main indications for dialysis?

A

“AEIOU”-“A”- intractable acidosis; “E”- electrolyte disarray ( K+, Na+, Ca++); “I” - intoxicants (methanol ethylene glycol, Li, ASA); “O”- intractable fluid overload; “U”- uremic symptoms (nausea, seizure, pericarditis, bleeding).


31
Q

How to manage hyperkalaemia?

A

calcium gluconate, 50ml 50% dextrose and insulin

32
Q

Marker of glucose control over last 3 weeks, and what does it represent?

A

fructosamine 
- fraction of total serum proteins that are glycated (mainly albumin)

33
Q

What are the 3 main causes of a metabolic acidosis?

A
  • H+ loss (i.e. vomiting)
  • Hypokalaemia
  • Ingestion of bicarbonate
34
Q

What are the 3 main causes of hypokalaemia?

A
  • intestinal loss (d&v, fistula)
  • renal loss (mineralocorticoid excess, diuretics, renal tubular disease)
  • redistribution (insulin, alkalosis)
35
Q

How does hypokalaemia cause alkalosis in terms of cells, and the kidneys?

A

Cells
1. H+ moves into cells (due to lack of K for exchange with Na)

Kidneys:

  1. H is exchanged with Na), and kidneys increases H+ secretion (in exchange for Na) –> acidic urine
  2. Generation of bicarbonate
36
Q

How does alkalosis cause hypokalaemia in terms of cells, and the kidneys?

A

K moves into cells (instead of H+), and kidneys increases K+ secretion

37
Q

What are the possible causes of cushing’s syndrome?

A

pituitary, ectopic ACTH, adrenal tumour, iatrogenic

38
Q

How does ectopic ACTH cause hypokalaemia

A

VERY high levels of cortisol can bind to aldosterone receptor

39
Q

Which type of thyroid cancer is associated with MEN2?

A

Medullary

Pathology (5 decks)

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