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Year 3 > Clinical Chemistry > Flashcards

Clinical Chemistry Flashcards

1
Q

What are the causes of HYPERthyroidism?

A
  1. Autoimmune- Grave’s disease
  2. Thyroid nodules
  3. Chemical toxicity eg. Amiodarone
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2
Q

What are the clinical signs of HYPERthyroidism?

A

Increased metabolic rate: Diarrhoea, weight loss anxiety
Increased sympathetic drive: Sweating, tachycardia, tremor
Goitre
Thyroid acropachy
Exophthalmos
Lid retraction
Pretibial myxoedema

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3
Q

What is thyroid acropatchy?

A

Extreme mannifestation of hyperthyroidism
Clubbing
Painful finger and toe swelling
Periosteal bone reaction

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4
Q

What is pretibial myxoedema?

A

Oedematous swelling above the lateral malleoli
Due to hyaluronic acid deposition
Discoloured skin

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5
Q

What is exophthalmos

A

Anterior bulging of the eye out of the orbit

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6
Q

What are the treatments for HYPERTHYROIDISM?

A
  1. Thionamides eg. Carbimazole which inhibit thyroid peroxidase
  2. Radioactive iodine
  3. Thyroidectomy
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7
Q

What are the causes of HYPOTHYROIDISM?

A
  1. Autoimmune- Hashimoto’s
  2. Iodine deficiency
  3. Pituitary disease
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8
Q

What are the clinical signs of HYPOthyroidism?

A 
Weight gain
Dry skin and hair
Hoarse voice
Bradycardia
Constipation
Tiredness
Round puffy face
Depression
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9
Q

What are the treatments for HYPOthyroidism?

A
  1. Levothyroxine - aim for normal TSH, check after 4 weeks
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10
Q

Which hormones are produced by the anterior pituitary?

A 
Growth Hormone
Thyroid Stimulating Hormone
Prolactin
FSH and LH
ACTH
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11
Q

Which hormones are released by the posterior pituitary?

A

Oxytocin

ADH

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12
Q

What are the clinical features of a prolactinoma?

A

Galactorrhoea (spontaneous milk production)
Amenorrhoea
Loss of axillary/pubic hair

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13
Q

What causes a prolactinoma?

A

Pituitary adenoma

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14
Q

What is the treatment for a prolactinoma?

A

Dopamine agonists eg. Bromocriptine, Cabergoline
as dopamine inhibits prolactin synthesis
Rare side effects = manic symptoms

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15
Q

What are the clinical features of acromegaly?

A

Large hands/ feet
Wide nose
Sweating and headache
Cardiomyopathy, hypertension, diabetes

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16
Q

What are the treatments for acromegaly?

A
  1. Trans-sphenoidal surgery 1st line
  2. Somatostatin analogues eg. Lanreotide, Ocreotide which are growth hormone inhibiting hormone
  3. Pegvisomant if resistant
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17
Q

What is the role of ADH?

A

Acts on renal collecting ducts, reabsorption of water via aquaporins
Makes urine more concentrated

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18
Q

What happens in diabetes insipidus?

A

Too LITTLE ADH produced due to posterior pituitary damage
Large volume urine
Blood more concentrated
Causes hypernatraemia, thirst, polyuria

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19
Q

What is the treatment for diabetes insipidus?

A

Desmopressin (ADH analogue)

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20
Q

What happens in SIADH?

A

Too much ADH produced, causes low urine output and increased blood volume so hyponatraemia

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21
Q

What are the causes of SIADH?

A

Head injury
Malignancy- lung small cell, pancreas, prostate
Infection - Pneumonia, meningitis
Medication- Diuretics, AEDs, SSRIs

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22
Q

What are the treatments for SIADH?

A
  1. Volume restriction
  2. Vasopressin antagonists (Vaptans)
  3. Demeclocycline
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23
Q

What is Addison’s disease?

A

Primary adrenal insufficiency

Leads to decreased adrenalin, cortisol and aldosterone

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24
Q

What are the causes of HYPERnatraemia?

A 
Volume loss- diarrhoea, vomit, burns
Diabetes insipidus
Primary hyperaldosteronism (Conn's)
Iatrogenic- incorrect fluid replacement
Osmotic diuresis
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25
Q

How is hypernatraemia managed?

A
  1. Oral fluid
  2. Glucose 5% IV 1:6
  3. Saline 0.9% if volume depleted
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26
Q

What are the causes of hyponatraemia?

A

IF DEHYRDRATED:

  1. Loss via kidneys: Addison’s excess diuretics, renal failure, osmotic diuresis
  2. Loss elsewhere: diarrhoea, vomit, burns, fistulae, bowel obstruction, CF, trauma

IF NOT DEHYDRATED:

  1. Cardiac failure, renal failure, liver cirrhosis, nephrotic syndrome
  2. SIADH, volume overload, severe hypothyroidism
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27
Q

What is the treatment for hyponatraemia?

A

Correct sodium/ water loss:

  1. Fluid restrict if asymptomatic
  2. Saline 0.9% slowly
  3. Vaptans- vasopressor receptor antagonists- promote water loss without sodium loss
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28
Q

What is the risk if saline is given too quickly to correct Hyponatraemia?

A

Central Pontine Myelinolysis

Irreversible and often fatal pontine demyelination seen in rapid correction of low sodium.

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29
Q

What is normal plasma osmolality?

A

275-295mOsm/Kg

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30
Q

Which foods are high in potassium?

A 
Banana
Prune juice
Papaya
Raisins
Mango
Orange
Pear
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31
Q

After a potassium load, which hormones are released?

A 
Insulin
Aldosterone
Catecholamines (adrenalin, noradrenalin, dopamine)
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32
Q

How do insulin and catecholamines impact on potassium levels?

A

IF potassium INCREASES, insulin and catecholamines cause INCREASED uptake of potassium to cells (skeletal muscle, liver and adipose)

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33
Q

How does aldosterone impact on potassium levels?

A

It INCREASES the amount of potassium excreted renally

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34
Q

What are the potassium levels in metabolic ACIDOSIS?

A

HYPERkalaemic

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35
Q

What are the potassium levels in metabolic ALKALOSIS?

A

HYPOKalaemic

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36
Q

What ECG changes are seen in HYPERKalaemia?

A
  1. Tall tented T waves
  2. Wide QRS complex
  3. Flattened P wave
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37
Q

What are the concerning signs/ symptoms in HYPERkalaemia?

A

Fast irregular pulse
Palpitations
Chest pain
Light headedness

38
Q

What are the causes of HYPERkalaemia?

A

INCREASED POTASSIUM INTAKE: oral or IV therapy

REDUCED POTASSIUM EXCRETION: CKD, Addison’s, Tubular defects

ALTERED DISTRIBUTION: Metabolic acidosis
Rhabdomyolysis, crush injury, diabetes

DRUGS: ACEIS, ARBS, Spironalactone

39
Q

Which blood bottle should be collected first; yellow or purple?

A

Yellow

Then Purple

40
Q

How should HYPERkalaemia be treated?

A
  1. Cardioprotection: ECG monitor, Calcium gluconate
  2. Potassium removal: Furosemide, Ion exchange resins, dialysis
  3. Potassium redistribution: Insulin, glucose, salbutamol nebuliser, bicarbonate
41
Q

What are the consequences of Hyperkalaemia?

A 
Weakness
Paralysis
Nausea and vomit
Ileus
Arrhythmias
42
Q

What are the causes of HYPOKalaemia?

A
  1. GI LOSSES: Diarrhoea, Fistula, Pyloric stenosis
  2. RENAL LOSSES: Loop diuretics, Mineral corticoid excess eg. Cushings, Conn’s
  3. REDISTRIBUTION: Salbutamol, Metabolic Alkalosis
43
Q

What are the ECG changes in HYPOKalaemia?

A

Flat T wave/ T wave inversion
Prominent P waves and U waves
ST depression
Prolonger PR interval

44
Q

How is HYPOKalaemia treated?

A
  1. Oral potassium eg. Sando k

2. IV potassium

45
Q

What is the role of parathyroid hormone?

A

Increases serum calcium and Decreases serum phosphate
Increases osteoclast activity
Increases renal production of Vit D3

46
Q

What is the role of calcitonin?

A

Decreases serum calcium

47
Q

How does magnesium impact PTH?

A

Magnesium REDUCES the release of PTH

48
Q

Which protein does calcium bind in blood?

A

Albumin (40% of calcium is bound, rest is free)

49
Q

What are the signs/ symptoms of hypocalcaemia?

A 
SPASMODIC:
S- Spasms
P- Perioral paraesthesia
A- Anxious and irritable
S- Seizures
M- Muscle tone increased -> wheeze and colic
O- Orientation impaired
D- Dermatitis
I- Impetigo
C- Corner of mouth twitches Chvostek sign
50
Q

What are the causes of LOW calcium with HIGH phosphate?

A
  1. Hypoparathyroidism
  2. CKD
  3. Magnesium deficiency
  4. Pseudohypoparathyroidism
51
Q

What are the causes of LOW calcium with NORMAL/ LOW phosphate?

A
  1. Vitamin D deficiency
  2. Osteomalacia (adult version of rickets)
  3. Acute pancreatitis
  4. Respiratory alkalosis
  5. Over hydration
52
Q

What are the signs of Hypercalcaemia?

A

Bones, stones, moans, groans

Abdominal pain
Vomiting
Depression
Hypertension
Kidney stones
Weight loss
Ectopic calcification
53
Q

What are the commonest causes of hypercalcaemia?

A

Malignancy- bone mets, myeloma

Hyperparathyroidism

54
Q

What suggests that malignancy has caused a Hypercalcaemia?

A

Raised ALP
Low albumin, chloride and potassium
Raised phosphate
Alkalosis

55
Q

What suggests that hyperparathyroidism has caused a hypercalcaemia?

A

Raised PTH

56
Q

What are the less common causes of Hypercalcaemia?

A

Sarcoidosis
Vitamin D excess
Lithuim
Tertiary hyperparathyroidism

57
Q

How is HYPERCalcaemia treated?

A
  1. Correct dehydration 0.9% saline
  2. Bisphosphonates- inhibit osteoclasts eg. Zoledronate
  3. Calcitonin
58
Q

What is the triad that makes up nephrotic syndrome?

A
  1. Proteinuria
  2. Oedema
  3. Hypoalbuminaemia
59
Q

What is an insulinoma?

A

Benign tumour of pancreatic islet cells; presents with hypoglycaemia when fasting.

60
Q

What will the blood results be of a patient with an insulinoma?

A

Raised insulin levels when fasting
Glucose below 2.5
Raised C-Peptide

61
Q

What is a Phaeochromocytoma?

A

Adrenal medulla tumour, producing catcholamines

10% malignant, 10% familial, 10% bilateral

62
Q

How does a Phaeochromocytoma present?

A 
Sweating
Episodic headaches
Tachycardia
Pallor
Anxiety
Hypertension
63
Q

What is normal serum phosphate?

A

0.8- 1.5

64
Q

What are the causes of hypophosphataemia?

A

Vitamin D deficiency
Alcohol withdrawal
Refeeding syndrome
Primary hyperparathyroidism

65
Q

What is the most common cause of hyperphosphataemia?

A

CKD

66
Q

When should Conn’s (Primary Hyperaldosteronism) be expected?

A
  1. Hypertension WITH hypokalaemia
  2. Hypertension despite 3 ant hypertensives
  3. Hypetension in <40yrs female
67
Q

What is the most common cause of Cushing’s?

A

Excess steroid use (Cushing’s syndrome)

68
Q

What is the second most common cause of Cushing’s?

A

Pituitary adenoma (Cushing’s disease)

69
Q

How does Addison’s affect Na, K, glucose levels?

A

Low sodium
High potassium
Low glucose

70
Q

What are the causes of hypoyglycaemia in diabetics?

A
  1. Insulin use
  2. Sulfonylureas (Glicazide)
  3. Missed meal, excess insulin dose, increased activity
71
Q

What are the causes of hypoyglycaemia in non diabetics?

A 
EXPLAIN:
Ex- Exogenous drugs: ACEIs, B Blockers, Alcohol, Aspirin overdose
P- Pituitary insufficiency
L- Liver failure
A- Addisons
I- Insulinoma
N- Neoplasms
72
Q

What is Whipple’s Triad (Hypoglycaemia)?

A
  1. Low blood glucose
  2. Symptoms and signs of hypogylcaemia
  3. Symptoms relieved when blood glucose rises
73
Q

Which CAUSES of hypoglycaemia will have low insulin, and raised ketones?

A

Alcohol
Addison’s
Pituitary insufficiency

74
Q

Which CAUSE of hypoglycaemia will have raised insulin and C peptide on fasting?

A

Insulinoma

75
Q

What is the treatment for hypogylcaemia?

A

If conscious- orange juice
If conscious but uncooperative- glucogel on gums
If unconscious- IV glucose, IM glucagon

Long acting carbohydrate once recovered

76
Q

What are the 2 main types of hyperglycaemia and which patients do they affect?

A
  1. Diabetic ketoacidosis- Mainly type 1

2. Hyperglycaemic hyperosmolar state- Type 2

77
Q

What 3 criteria are present to diagnose DKA?

A
  1. Hyperglycaemia
  2. High ketones (blood/urine)
  3. Acidosis
78
Q

What are the symptoms of DKA?

A

Drowsiness
Vomitting
Dehydration

79
Q

What is the treatment for DKA?

A
  1. Fluids
  2. Insulin

Keep checking VBG (pH, Bicarbonate, potassium)

80
Q

How does Hyperglycaemic Hyperosmolar state differ to DKA?

A

HHS:

  1. Glucose >30
  2. no acidosis
  3. no excess ketones
  4. Type 2 diabetics
  5. less sudden onset
81
Q

What is the WHO criteria for diagnosing diabetes with regards to HbA1c?

A

> 48mmol.L

6.5%

82
Q

How does type 1 diabetes usually present?

A

Polyuria
Polydispia
Weight loss
Ketosis

83
Q

How does Type 2 diabetes usually present?

A

Often asymptomatic

Complications such as MI

84
Q

What is metabolic syndrome?

A

Obesity plus 2 of:

  1. Hypertension
  2. Raised triglycerides
  3. Reduced HDL cholesterol
  4. Diabetes/ high glucose
85
Q

Which diabetic drug is a Biguanide?

A

Metformin

86
Q

What are the side effects of Metformin?

A

Nausea
Diarrhoea
Abdominal pain

NOT HYPOGLYCAEMIA

87
Q

Which diabetic drug is associated with weight gain?

A

Glicazide (sulfonylurea)

88
Q

Which diabetic drugs are associated with hypoglycaemia?

A

Glicazide (sulfonylurea)

Glitazone

89
Q

Which diabetic drug is associated with raised LFTs?

A

Glitazone

90
Q

What are the most common causes of hyperkalaemia?

A

CKD

Metabolic acidosis

91
Q

What blood results are needed to diagnose Diabetes mellitus?

A
  1. HbA1c >48mmol/l
  2. Fasting glucose >7mmol/L
  3. Random blood glucose >11mmol/l
92
Q

What can trigger diabetic ketoacidosis?

A

Infection
Stress
Pancreatitis
Non compliance with insulin

Year 3 (22 decks)

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