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Medicine: Data Interpretation > Clinical Chemistry > Flashcards

Clinical Chemistry Flashcards

1
Q

What does haemocrit level tell us?

A

The % of the whole blood that is made up of RBCs

E.g. Raised in dehydration

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2
Q

What may cause an increase in RBCs due to decreased oxygen supply to the kidneys (which produce EPO) ?

A
  • smoking
  • altitude
  • COPD
  • blood loss
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3
Q

What is ESR a marker of ?

A
  • inflammation
  • anaemia
  • cancer
  • the higher the ESR the worse the disease/inflammation
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4
Q

What blood markers are included in the inflammation triad?

A

CRP, ESR and plasma viscosity

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5
Q

ALP levels can indicate damage where ?

A

Biliary tree

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6
Q

ALT, AST, GGT give info from where in the liver ?

A

Inside the liver

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7
Q

What can be measured in the blood to give information about pre hepatic problems ?

A

Bilirubin

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8
Q

What does the ratio of indirect bilirubin:direct bilirubin tell us

A

Evaluate liver plumbing and performance

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9
Q

Reasons for low albumin?

A
  • nutritional problems
  • protein loss through renal disease
  • failure of protein synthesis due to loss of functioning liver tissue
  • inflammatory conditions (liver switches to maki diff proteins)
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10
Q

What do alanine aminotransferase (ALT) and aspartate aminotransferase (AST) indicate ?

A
  • indicate leakage from damaged cells due to inflammation or cell death
  • normally inside cells so raised levels indicates hepatocellular damage
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11
Q

Which is more specific to the liver AST or ALT ?

A

ALT

* AST also found in cardiac and skeletal muscle and RBCs

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12
Q

Which other measurement can help localise source of raised transferases ?

A
  • Creatinine kinase (CK), raised will confirm muscle damage
  • troponin will confirm myocardium damage

*liver more likely if both AST and ALT are raised

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13
Q

Which rises more in acute liver damage, ALT or AST ?

A

ALT

  • very high levels suggest drug toxicity or viral or autoimme hepatitis
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14
Q

Once cirrhosis is established in liver disease what is the AST:ALT ratio ?

A

AST>ALT

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15
Q

AST:ALT ratio >2 suggests what ?

A

Alcoholic liver disease

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16
Q

Raised GGT in patient with chronic liver disease is associated with what ?

A

Bile duct damage and fibrosis

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17
Q

Where does alkaline phosphatase (ALP) come from ?

A
  • Cells lining the bile ducts

- bone

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18
Q

Raised ALP and normal GGT suggests what ?

A

Bone disorders

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19
Q

What test is useful in distinguishing alcoholic and non alcoholic fatty liver disease ?

A

AST:ALT ratio

>2 = alcoholic

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20
Q

Causes for raised unconjugated bilirubin

A
  • increased bilirubin production (e.g. Haemolysis)

- decreased hepatic uptake or conjugation or both

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21
Q

Causes of conjugated hyperbilirubinaemia

A
  • liver disease
  • cholestatic drug reactions
  • immune cholestatic disease
  • biliary obstruction
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22
Q

Raised bilirubin with raised ALP and GGT higher than rise in aminotransferases suggests what ?

A
  • Biliary Obstruction
  • cholestatic disease
  • liver injury with cholestatic pattern (less common)
23
Q

Isolated rise in GGT suggests what ?

A
  • Alcohol abuse

- enzyme inducing drugs

24
Q

Varying degrees of ALP In those with ulcerative colitis suggests what ?

A

Primary sclerosing Cholangitis

25
Q

Raised ALP in middle aged women with history of pruritis and autoimmune disease is suspicious of what ?

A

Primary biliary cirrhosis

26
Q

Elevated GGT, MCV very high and very low folate suggests what ?

A

Excessive alcohol intake

27
Q

High GFR has what result on sodium loss ?

A

Increased sodium loss

28
Q

Causes of hypernatraemia

A
  • hyperaldosteronism
  • diarrhoea and vomiting,dehydration(fluid loss without replacement)
  • diabetes insipidus
  • iatrogenic e.g. Incorrect IV fluid replacement
29
Q

Presentation of hypernatraemia ?

A
  • thirst, polydipsia, polyuria
  • CNS dysfunction: lethargy, weakness, confusion, Irritability, seizure
  • dehydration + hypovolaemia: dry mouth, abnormal skin turgor, tachycardia etc
30
Q

Symptoms of hyponatraemia

A

Mild: anorexia, headache, vom, lethargy
Mod: personality change, muscle cramps, weakness, confusion. Ataxia
Severe: drowsiness

31
Q

Causes of hyponatraemia ?

A
  • SIADH
  • diuretics
  • renal failure
  • vom/diarrhoea
  • sweat, burns
32
Q

Causes of hyperkalaemia ?

A
  • renal: AKI, CKD,
  • Mineralocorticoid deficiency
  • rhabdomyolysis
  • drugs
  • DKA
33
Q

Drugs that can cause hyperkalaemia ?

A
  • ciclosporin
  • tacrolimus
  • pentamidine
  • ketoconaole
  • NSAIDS
  • Spironolactone
34
Q

Signs of hyperkalaemia

A
  • muscle weakness and flaccid paralysis
  • depressed/absent tendon reflexes
  • tall tented t waves, small p waves and wide QRS on ECG
  • arrhythmias, palpitations, fast irregular pulse, chest pain
35
Q

Interpret ABG:

  • pH: 7.05
  • CO2: 2.0kPa
  • HCO3: 8.0 mmol/L
A

Metabolic acidosis:

There is an acidosis as pH

36
Q

Causes of metabolic acidosis ?

A
  • lactic acid
  • urate (renal failure)
  • ketones
  • Addison’s
  • diarrhoea
  • drugs
37
Q

Causes of metabolic alkalosis ?.

A
  • vomiting
  • burns
  • ingestion if base
  • potassium depletion e.g. Spironolactone
38
Q

Causes of respiratory acidosis ?

A
  • type 2 resp failure e.g. COPD
39
Q

Causes of resp alkalosis

A
  • hyperventilation
  • mild/mod asthma
  • PE
  • drugs
  • stroke
40
Q

Signs and symptoms of hypokalaemia

A
  • muscle weakness
  • hypotonia
  • hyporeflexia
  • cramps
  • tetany
  • small/inverted t waves, prominent u wave , long PR, depressed ST
41
Q

Causes of hypokalaemia

A
  • diuretics
  • vomiting and diarrhoea
  • alkalosis
  • Cushing’s
  • Conns syndrome
42
Q

Overall affect of PTH on calcium and phosphate ?

A

Increase calcium and decrease phosphate

43
Q

How does PTH control calcium and phosphate levels ?

A
  • Secretion of PTH triggered by low serum levels of ionised calcium
  • PTH causes increased osteoclast activity, releasing Ca and PO from bones
  • causes increased Ca and decreased PO reabsorption in kidney
  • increasing renal production of D3
44
Q

Where is vitamin D turned in to its active form?

A

Kidney

1,25-dihydroxy vit D aka calcitriol

45
Q

What stimulates calcitriol production ?

A
  • Low calcium and phosphate

- PTH

46
Q

What are the actions of calcitriol?

A
  • increased calcium and phosphate absorption from gut
  • inhibits PTH release
  • enhanced bone turnover
  • increased calcium and phosphate reabsorption from kidneys
47
Q

What is cholecalciferol?

A

D3 from animal source

48
Q

What is ergocalciferol?

A

D2 from vegetables

49
Q

What is calcitonin ?

A

Made in C cells of thyroid- causes decreased calcium and phosphate
- marker for recurrence/metastasis in medullary carcinoma of thyroid

50
Q

How might magnesium cause hypocalcaemia

A

Low levels of magnesium prevent the release of PTH (which increases levels of calcium)

51
Q

Symptoms of hypercalcaemia

A

bones, stones, groans, psychic moans, sitting on the throne

  • bone pain
  • renal calculi
  • abdo pain, nausea and vomiting
  • depression, anxiety, insomnia
  • polyuria, constipation
52
Q

Signs and symptoms of hypocalcaemia?

A
  • cramps
  • perioral numbness
  • carpopedal spasm (trousseaus sign)
  • tetany
  • chvosteks sign
53
Q

What does the mean cell volume (MCV) tell us?

A

What size are the RBCs e.g. Macrocytic?

Medicine: Data Interpretation (6 decks)

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