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PathY5 > Clinical Chemistry CPC > Flashcards

Clinical Chemistry CPC Flashcards

1
Q

What is an alternative treatment to antidepressants?

A

CBT

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2
Q

What is St John’s Wort?

A

(Hypericum perforatum)
o Thought to be quite similar to paroxetine (an antidepressant)
o The St. John’s wort was moderately effective

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3
Q

What mood is hypercalcaemia associated with?

A

Depression/ tiredness

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4
Q

What is hypocalcaemia associated with?

A

irritability and fits

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5
Q

What are the heart affects of potassium?

A

o In hypokalaemia, your myocardium becomes more irritable -> leads to arrhythmias
o As potassium rises, myocardium becomes more stable, however, the ultimate stable rhythm = asystole

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6
Q

What are 3 important types of Fractures?

A

o Smith’s fracture = posterior displacement of the radius (i.e. radius towards the BACK of the hand)
Falling on a flexed wrist
Treated with manipulation under anaesthesia (MUA) and plaster

o Colle’s fracture = anterior displacement of the radius (i.e. radius towards the PALM of the hand)
Falling on an extended wrist

o Pott’s fracture = ankle fracture involving both tibia and fibula

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7
Q

Does Glomerulonephritis present with pain?

A

No

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8
Q

What are the differentials of abnormal urine dip?

A

Renal stones -> tear urothelium -> macroscopic haematuria

Glomerulonephritis -> microscopic haematuria (not overt)

DKA -> acidosis, ketonuria

Acute rheumatic fever -> proteinuria (or normal)

Subacute bacterial endocarditis -> microemboli, microscopic haematuria, splenomegaly

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9
Q

How do you investigate abdo pain with haematuria?

A

Plain abdominal XR -> calcified stones (can be confused with gallstones but better for renal colic)

USS abdomen -> nephrocalcinosis

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10
Q

How do you find out the cause for someones renal stones?

A
  1. Cancer (commonest in hospital)
  2. Primary HPT (commonest in community)
  3. Sarcoidosis

o N.B. do plasma calcium before PTH because you need the calcium level to interpret any PTH level
o [Ca2+] = 2.82 (2.20-2.60)
o PTH = 3.0 (1.1-6.8 pM)
o As PTH is normal -> primary HPT most likely

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11
Q

How do PTH and calcium behave in sarcoidosis, cancer and primary hyperparathyroidism?

A
  1. Sarcoid -> PTH suppression/low (as produces lots of calcium which suppresses PTH)
  2. Cancer -> PTH high (endogenous production) -> from PTHrP or invading bone cancer
  3. 1st HPT -> PTH normal/high (despite hypercalcaemia)
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12
Q

If PTH is not suppressed despite hypercalcaemia what is going on?

A

Endogenous PTH production

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13
Q

How often is the cause of hypercalcaemia with high PTH an adenoma?

A

85%

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14
Q

What are the actions of PTH?

A

Kidneys:
• Activate 1-alpha hydroxylase -> vitamin D activation ->
o Absorb calcium from gut
o Absorb phosphate from gut

  • Directly resorb calcium
  • Directly excrete phosphate

Bone:
• Activate osteoclasts

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15
Q

What are the features of hypercalcaemia?

A

o Moans, bones, groans and stones
 Many can be asymptomatic
 Calcium stones are radio-opaque, but urate stones are radio-lucent
o Polydipsia/polyuria (nephrogenic DI)  calcium acts like glucose to carry water with it via osmosis

o Band keratopathy (calcium deposition across the front of the eye)
 This is a feature of CHRONIC hypercalcaemia (so it cannot be hypercalcaemia of malignancy)

o	Complications:
	Renal stones			
	Peptic ulcer disease
	Pancreatitis			
	Skeletal changes
	Osteitis fibrosa cystica (i.e. pepper-pot skull)
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16
Q

What are the risk factors for renal calcium stones?

A 
FHx		
Dehydration
Hypercalciuria 
Hypercalcaemia
HPT		
Recurrent UTI
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17
Q

How would renal calcium stones present?

A

 Pain
 Haematuria
 Recurrent infections (Proteus mirabilis)
 Renal failure

18
Q

What is the investigations for renal stones?

A

 CT-KUB
 Stone analysis
 Urine and serum biochemistry

19
Q

What is the management of renal stones?

A 
	Most stones will pass -> painkillers:
•	PR diclofenac is very good
	Lithotripsy 
	Cystoscopy
	Lithotomy
20
Q

How do you prevent renal stones?

A

 Drink more water
 Treat hypercalciuria (e.g. thiazides)
• Not in parathyroid adenoma -> hypercalcaemia (reduces calcinuria but increases serum Ca)
 Treat hypercalcaemia

21
Q

What is the management of hypercalcaemia?

A

IV 0.9% saline
IV frusemide
IV pamidronate 30-60mg (better if cancer)

22
Q

How do you give fluid in hypercalcaemia?

A
  • 4-hourly or 6-hourly bags of 1L 0.9% NaCl

* 1st bag of 1L given over 1 hour (if severely dehydrated)

23
Q

Why do you give frusemide?

A

prevent pulmonary oedema and aid calciuresis

24
Q

How do you give pamidronate?

A

IV pamidronate (bisphosphonate), 30-60mg
• Not given in all circumstances
• Do not take effect for around a week and is not given in all circumstances
• Hold off to begin with as you can’t measure serum calcium and phosphate if given
o Do NOT hold off if hypercalcaemia due to cancer

25
Q

What is the non urgent treatment of hypercalcaemia?

A

Well hydrated

Avoid thiazides (reduce hypercalciuria but increase plasma calcium)

Surgery (parathyroidectomy)

  • Technetium Sesta MIBI and USS performed -> shows hyperactive parathyroid
  • If both tests concordant -> whole neck does NOT need to be opened
  • If tests not concordant -> surgeon needs to view all four glands and take out the largest one
26
Q

What may the hand X ray be like in HPT?

A

o Often be normal

o Later stages may show cystic changes in the radial aspect

27
Q

What is the histology of HPT?

A

o Brown tumours = multinucleate giant cells
 Activated osteoclasts in the bone
o Brown tumours = long-standing undiagnosed HPT
o I.E. Histology of the bone shows…
 Brown tumours
 Multinucleate giant cells

28
Q

if high calcium and PTH normal, go for the parathyroids

A

if high calcium and PTH normal, go for the parathyroids

29
Q
  • 45yo, Afrocaribean man, SOB
  • Most helpful investigation -> CXR -> bilateral hilar lymphadenopathy
  • Histology of biopsy -> non-caseating granulomas

Diagnosis?

A

Sarcoidosis

30
Q

What is the biochemistry in sarcoidosis?

A
  • FBC -> [Ca2+] 2.82 (2.20-2.60)

* PTH suppressed to undetectable levels -> sarcoidosis picture

31
Q

What is the treatment of sarcoidosis?

A

Steroids

32
Q

What is the mechanism of hypercalcaemia in sarcoidosis?

A

‘Seasonal hyercalcaemia’

o Macrophages in the lungs express 1-alpha hydroxylase -> activate vitamin D
o Vitamin D leads to excessive calcium
o Patients more likely to become hypercalcaemic in summer months because of increased exposure to sunlight

33
Q

MEN 1 or 2 can present with hypercalcaemia

A

MEN 1 or 2 can present with hypercalcaemia

34
Q

What do potassium abnormalities do to the heart?

A

Hypokalaemia- VF

Hyperkalaemia- Asystole

35
Q

Can PTH be normal in primary hyperparathyroidism?

A

Yes- inappropriately not suppressed

36
Q

What is the rate limiting step in Vit D production?

A

1 alpha hydroxylase

37
Q

What will the hand x ray of 1HPT show?

A

Radial aspect cystic changes

38
Q

What are the symptoms of hypercalcaemia (HPT)?

A

Bones (fractures)
Stones (kidney)
Groans (psych)
Moans (abdo pain, pancreatitis)

39
Q

What are looser’s zones linked to?

A

Vit D deficiency

40
Q

How do giant cells get formed?

A

Failure of cell division adding nuclei to a single huge cell- can happen in many AI

41
Q

What is the rate limiting step of Vitamin D production?

A

1 alpha hydroxylation

PathY5 (98 decks)

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