Data interpretation

Question 1

What are the key info you gain from U+Es?

Answer 1

• Electrolyte levels
• Presence and type of kidney injury

Question 2

What are causes of hypernatraemia?

Answer 2

• Dehydration
• Drips
• Drugs
• Diabetes insipidus

Question 3

What are the causes of hypokalaemia?

Answer 3

DIRE
- Drugs (loop/thiazide diuretics)
- Inadequate intake/intestinal losses
- Renal tubular acidosis
- Endocrine (cushings/conns)

Question 4

What are the causes of hyperkalaemia?

Answer 4

DREAD
- Drugs (potassium sparing diuretics/ACE-In)
- Renal failure
- Endocrine (addisons)
- Artefact (clotted sample)
- DKA

Question 5

What drugs cause hypokalaemia?

Answer 5

• Loop diuretics
• Thiazide diuretics

Question 6

What drugs cause hyperkalaemia?

Answer 6

• ACE-In
• Potassium sparing diuretics

Question 7

What are the main causes of megaloblastic anaemia?

Answer 7

• B12/folate deficiency
• Excess alcohol
• Liver disease (inc non alcoholic)

Question 8

What causes high neutrophils?

Answer 8

• Bacterial infection
• Steriods

Question 9

What causes low neutrophils?

Answer 9

• Viral infection
• Clozapine
• Carbimazole (antithyroid)

Question 10

What drugs can cause SIADH?

Answer 10

• Carbamazepine
• Antipsychotics

Question 11

What drugs can cause intrinsic AKI?

Answer 11

• ACE-In
• NSAIDs
• Gentamicin
• Vancomycin
• Tetracyclines

Question 12

What does an isolated rise in bilirubin indicate?

Answer 12

Haemolysis

Question 13

What does an isolated rise in urea indicate?

Answer 13

Upper GI haemorrhage

Question 14

What is the target range for TSH in patients on levothyroxine for hypothyroidism?

Answer 14

• 0.5-5 mIU/L
• If <0.5 - decrease dose
• If >5 - increase dose

Question 15

What are the most likely CXR in the PSA?

Answer 15

• Pneumonia
• Pleural effusion

Question 16

How do you assess the quality of a CXR?

Answer 16

PRIM
- Projection
- Rotation
- Inspiration
- Markings

Question 17

What indicates adequate inspiration on a CXR?

Answer 17

If the 7th anterior (down sloping) rib transects the diaphragm

Question 18

What indicates effusion on CXR?

Answer 18

• Unilateral
• Solid

Question 19

What indicates pneumonia on CXR?

Answer 19

• Unilateral
• Fluffy

Question 20

What indicates oedema on CXR?

Answer 20

• Bilateral
• Fluffy

Question 21

What indicates fibrosis on CXR?

Answer 21

• Bilateral
• Honeycomb

Question 22

What are the different dose options (+ indications) for gentamicin?

Answer 22

• 5-7mg/kg OD (most people)
• Divided daily dosing (1mg/kg)
  
  • 12 hourly in renal failure
  • 8 hourly in infective endocarditis

Question 23

Why is gentamicin monitoring important?

Answer 23

Risk of ototoxicity and nephrotoxicity

Question 24

How do you manage a major bleed in a patient on warfarin?

Answer 24

• Stop warfarin
• 5-10 mg IV vitamin K
• Prothrombin complex

Question 25

How do you manage a minor bleed in a patient on warfarin?

Answer 25

• Stop warfarin
• 5-10 mg IV vitamin K

Question 26

How do you manage a patient on warfarin with an INR >8 (no bleeding)?

Answer 26

• Stop warfarin
• 5-10 mg PO vitamin K

Question 27

How do you manage a patient on warfarin with an INR 5-8 (no bleeding)?

Answer 27

• Stop warfarin for 2 days
• Then reduce dose

Question 28

When are blood transfusions indicated in iron deficiency anaemia?

Answer 28

• Severely symptomatic and cannot tolerate or wait for the effect of iron-replacement
• Hb <70g/L

Question 29

Can 5% dextrose (maintenance fluids) be given to diabetic patients

Answer 29

Yes - unless significantly hyperglycaemic