Data interpretation Flashcards
What blood result would be concerning in a patient on Clozapine?
neutropenia
Give 4 causes of hypernatremia
Dehydration
Drips (too much IV saline)
Drugs
Diabetes insipidus
3 causes of microcytic anaemia
Iron deficiency anaemia
Thalassaemia
Sideroblastic anaemia
3 causes of normocytic anaemia
Anaemia of chronic disease
Acute blood loss
Haemolytic anaemia
Renal failure (chronic)
3 causes of macrocytic anaemia
B12/ folate deficiency
Excess alcohol
Liver disease
Hypothyroidism
Multiple myeloma, myeloproliferative/myelodysplastic disease
What is the normal range for sodium?
135-145 mmol/L
What is the normal range for potassium?
3.5-5 mmol/L
What are some causes of high neutrophils (neutrophilia)?
Bacterial infection
tissue damage (inflammation, infarct, malignancy)
Steroids
What are some causes of low neutrophils (neutropenia)?
Viral infection
Chemo/radiotherapy
Clozapine
Carbimazole
What are some causes of high lymphocytes (lymphocytosis)?
Viral infection
Lymphoma
Chronic lymphocytic leukaemia
What are some causes of low platelets (thrombocytopenia)?
Reduced production:
- infection
- Drugs (penicillamine)
- myelodysplasia, myelofibrosis, myeloma
Increased destruction:
- heparin
- hypersplenism
- DIC
- ITP
- haemolytic uraemic syndrome/ thrombotic thrombocytopenic purpura
What are some causes of high platelets (thrombocytosis)?
- bleeding
- tissue damage
- post splenectomy
- myeloproliferative disorders
What are some causes of hyponatraemia?
Hypovolaemic
- fluid loss (D+ V)
- Addison’s disease
- Diuretics
Euvolemic:
- SIADH
- psychogenic polydipsia
- hypothyroidism
Hypervolemic
- Heart failure
- Renal failure
- Liver failure
- Nutritional failure
What are some causes of Hypokalaemia? (DIRE)
- Drugs (loop and thiazide diuretics)
- Inadequate intake or intestinal loss (D+V)
- Renal tubular acidosis
- Endocrine (Cushing’s and Conn’s)
What are some causes of Hyperkalaemia? (DREAD)
- Drugs (loop and thiazide)
- Renal failure
- Endocrine (Addison’s)
- Artefact
- DKA
Raised urea with a normal creatinine in a patient who is not dehydrated may indicate what?
Upper GI bleed
What is the biochemical disturbance in prerenal AKI?
Urea rise> creatinine rise
What are some causes of prerenal AKI?
Dehydration
Renal artery stenosis
Shock
What is the biochemical disturbance in intrinsic renal AKI?
Urea rise<creatinine rise
What are some intrinsic causes of AKI? (INTRINSIC)
- Ischaemia (due to prerenal AKI causing acute tubular necrosis)
- Nephrotoxic antibiotics
- Tablets (ACEi, NSAIDs)
- Radiological contrast
- Injury (rhabdomyolysis)
- Negatively birefringent crystals (gout)
- Syndromes (glomerulonephridites)
- Inflammation (vasculitis)
- Cholesterol emboli
What is the biochemical disturbance in postrenal AKI (obstructive)
Urea rise< creatinine rise (bladder or hydronephrosis may be palpable depending on level of obstruction)
What are postrenal causes of AKI?
In lumen: stone or sloughed papilla
In wall: tumour
External pressure: BPH, prostate cancer, lymphadenopathy, aneurysm
What are some common causes of a raised alk phos?
- Any fracture
- Liver damage
- K (cancer)
- Paget’s disease of the bone/Pregnancy
- Hyperparathyroidism
- Osteomalacia
- Surgery
What are some prehepatic causes of a raised bilirubin?
Haemolysis
Gilbert’s and Crigler-Najjar
What are some causes of a raised bilirubin and AST/ALT
fatty liver
hepatitis
cirrhosis
Malignancy
metabolic (Wilsons/haemochromatosis)
Heart failure (causing hepatic congestion)
what are some causes of a raised bilirubin and ALP?
Gallstone
drugs causing cholestasis
tumour
primary biliary cirrhosis
sclerosing cholangitis
pancreatic or gastric cancer
What drugs can cause cholestasis?
Flucloxacillin
Co-amoxiclav
Nitrofurantoin
Steroids
Sulphonylurea’s
How should you adjust levothyroxine dose based of TSH?
<0.5 = decrease dose
0.5-5 = no action
>5 = increase dose
What would TFT’s be in primary hypothyroidism?
T4 = low
TSH = high
What are some causes of primary hypothyroidism?
Hashimoto’s thyroiditis
Drug induced
What would TFT’s be in secondary hypothyroidism?
T4 = low
TSH = low
What is a cause of secondary hypothyroidism?
pituitary tumour or damage
What would TFT’s be in primary hyperthyroidism?
T4 = high
TSH = low
What are some causes of primary hyperthyroidism?
Grave’s disease
toxic nodular goitre
Drug induced
What would TFT’s be in secondary hyperthyroidism?
T4 = high
TSH = high
What is the main cause of secondary hyperthyroidism?
pituitary tumour
How do you assess the quality of a chest x-ray film? (PRIM)
- Projection
- Rotation
- Inspiration
- Markings
What on a blood gas indicates a respiratory problem
PaCO2 abnormality
What on a blood gas indicates a metabolic problem
HCO3 abnormality
What on a blood gas is the difference between T1 and 2 respiratory failure
type 2 has a high PCO2
What does 1st degree heart block look like on an ECG
PR interval constant but >1 large square
What does 2nd degree heart block look like in ECG?
- increasing PR interval then missing QRS then increasing again
- 2/3 p waves for every QRS
What does 3rd degree heart block look like on ECG?
no relationship between p and QRS
What does atrial fibrillation look like on ECG
- no P waves
- Irregular QRS
What does Left BBB look like on ECG?
V1 = W
V6 = M
What on ECG indicated Bundle branch block?
QRS width >3 small squares
What does Right BBB look like on ECG?
V1 = M
V6 = W
How do you calculate if someone has left ventricular hypertrophy?
add largest deflection of QRS in V1 to that in V6, if above 3.5 large squares then LVH
How do you know if a patient on oxygen is hypoxic from an ABG?
take away 10 from oxygen requirement, PaO2 should be this of higher
Name 2 causes of elevated ST segment
- Infarction
- pericarditis
Name 2 causes of depressed ST segment
- Ischaemia or infarction
- digoxin
What does T waves >2/3rds height of QRS indicate?
hyperkalaemia
In what leads is T wave inversion normal
aVR and I
What can T wave inversion indicate?
old infarction/LVH
Features of Digoxin toxicity
confusion
Nausea
visual halos
arrhythmias
Features of late lithium toxicity
arrhythmias
seizures
coma
renal failure
diabetes insipidus
Features of Phenytoin toxicity
Gum hypertrophy
Ataxia
Nystagmus
Peripheral neuropathy
Teratogenicity
Features of Gentamycin and vancomycin toxicity
Ototoxicity and nephrotoxicity
What action should you take if INR is increased and there is minor bleeding
Omit warfarin and give 1-5mg IV vitamin K
