Data interpretation Flashcards
Causes of hyponatraemia
Hypovolaemic: Addison’s (Low Aldosterone = Low Na and H2O reabsorption)
Euvolaemic: SIADH (Inc water retention, Urine high osmolality), H2O toxicity (Urine osmolality under 100 - v dilute)
Potassium (think intake, shift, loss)
Causes hypo
Causes hyper
Hypokalaemia
- Low intake (eating disorder, alcohol)
- Shift into cells (alkalosis, drug - salbutamol, refuting syndrome)
- Loss: GI (D&V), Renal (diuretics, hypomagneisa, hyperaldosteronism - Conn’s, Cushings)
Hyperkalaemia
- IV fluids (Hartmanns)
- Shift out of cells (acidosis, swapped for H+), Tissue damage
- Reduced loss: kidney disease, drugs (ACEi/ARB), Addisons
Measures of renal fucntion
Creatinine (beware in bodybuilders - Cr prod by muscle)
Urea (from protein)
eGFR (using creatinine/sex/age)
Bone profile
Osteoporosis Malacia Pagets mets Primary hyperparathyroidism
Ca, PO4, ALP
N,N,N L,L,H N,N,H H,H,H H,L,H
Causes of hypocalcaemia
Vit D def
Renal failure (low active Vit D)
Hypopara
Hypomagnesia
Causes of hypercalcemia
Primary Hyperparathyroid
Cancer (mets, myeloma)
Sarcoidosis (granuloma cAMP mediated Ca release)
Thiazide diuretics
Useful tests for hypocalcaemia
Vit D
U&E
Mg
PTH
Magnesium
- low
- link
Poor intake/alc/malabsorption
Shifts into cells (treat DKA, referring)
Loss (diarrhoea, diuretics)
Hypomagnesia and Hypokalaemia are linked
LFTs
- Eg
- Which are non-specific
- Raised in hepatocellular damage
- Billiary outflow block
AST, ALT, Bilirubin, GGT, ALP, Albumin
AST - muscle ALP - bone
AST+ALT
ALP+GGT
What is seen in failing liver?
Poor synthetic = low albumin, raised INR
Iron studies
TIBC (transferrin sats)
Serum Iron
High ferritin
Compensation for metabolic acidosis
Inc resp rate
Compensation for respiratory acidosis
Inc in bicarbonate
Compensation speeds
Resp compensation = quick
Metabolic compensation = days
Causes of:
- Resp acidosis
- Resp alkalosis
- Metabolic acidosis
- Metabolic alkalosis
Pneumonia, oedema, Pulmonary fibrosis, PE, COPD
Hyperventilation always
Calculate anion gap (normal = bicarb loss - diarrhoea or RTA, High excess acid - ketoacidoiss, lactic acidosis, renal failure)
Vomiting, hypercalcemia, hyperaldosteronism
Causes of resp failure
T1 things that block O2 = pulmonary oedema, pulmonary fibrosis, pneumonia, PE
T2 affect blow off = COPD, muscle weakness, resp centre depression
Enzymes as markers:
Amylase
Lipase
CK
LDH
Amylase: Pancreas and salivary glands
Raised - acute pancreatitis, pancreas Ca, salivary gland disease (mumps, tumour), DKA, morphine.
Lipase
More specific for pancreas
CK From damaged skeletal muscle Elevated in: - Muscle disease (rhabdo, dystrophy, polio, excercise) - Statins, antipsychotics
LDH
Elevated in haemolysis
Plama Proteins
- High
- Low
Acute phase proteins
M Protein
Albumin
- High: dehydration
- Low: malabsorption, liver fail, nephrotic, burns
CRP and ESR
- Liver prod in inflam/infect
- Raised ESR but normal CRP in SLE, Myeloma
M protein:
- Paraprotein seen in Myeloma
- Serum free light chains and urinary Bence Jones can be seen
Lipid profile
Total cholesterol
HDL
Triglycerides
Common causes of dyslipidaemia
High total cholesterol, high LDL
FH (hypercholesterol) Alcohol DM Hypothyroid Liver disease Obestiy
Troponin
- Time frame
- Causes
bHCG
Can be seen from 2h -> 7 days
MI, Congestive HF, PE, Sepsis, Myocarditis
(CK, ASR and Lactate dehydrogenase also high following MI)
Tumour markers
- Panc
- Ovarian
- Prostate
- Medullary thyroid
- Liver/Testicular (teratoma)
- Testes - Seminoma
Ca19-9
Ca-125, bHCG
PSA
Calcitonin
AFP
bHCG
Albumin Creatinine Ratio. What does this show if high?
Proteinuria
How to differentiate Pre-renal AKI from ATN
Pre-renal has Low urinary Na and urine concentrated (due to RAAS activation)
in ATN there is high urinary NA and dilute urine
Pleural Fluid analysis
- Unilateral Vs Bilateral
- When is pH low
- Causes of transudates
- Causes of exudates
Uni - exudate
Bi - Transudate
pH low in Empyema
Trans:Congestive HF, Liver fail, nephrotic, hypoalbuminaemia (nutritional)
Exudates: Pneumonia, PE, pancreatitis, infection, malignancy, TB, sarcoid
Peritoneal fluid
- Causes of transudates
- Causes of exudates
- High WCC?
Trans: cirrhosis (portal HTN, Congestive HF, hypoalb, nephrotic
Ex: Male, pancreatitis
SBP
Abnormalities seen in Para OD
Elevated liver enzymes (AST/ALT)
Elevated Prothombin time (impaired synthesis)
Impaired Kidneys (high Urea, Cr)
High anion gap acidosis
Para OD Tx
N-acetylcysteine
May cause anaphylaxis
Salicylate OD
- Pres
- Ix
- Tx
Stim resp centre
Resp alkalosis + metabolic acidosis (salicylic acid)
ABG
Sodium bicarbonate
TCA OD
- Ix
- Tx
ECG: Broad QRS, Tall R
Sodium bicarb for arrhythmia Benzo for seizures
Surgical Sieve
VITAMIN DIC
Vascular Inflammatory Trauma Autoimmune Metabolic Infection Neoplastic
Degenerative
Idiopathic
Congenital
Causes of high prolactin
Physiological: preg
Pituitary tumour
Antipsychotics/antiemetics (D2 block)
Hypothyroidsim
PCOS
Conns Signs
HTN
HypoK
HyperNa
RBC: Microcytic
IDA, sideroblastic, thalassaemia (rhymes with anaemia), chronic disease
RBC: Macrocytic
B12, folate, alcohol, reticulocytosis, aplastic anaemia, myeloproliferative disorders
Normocytic anemia causes
Blood loss, marrow infiltration, chronic disease, haemolytic
Evidence of Haemolysis
High LDH, high bilirubin, low haptoglobin, high reticulocytes, anaemia
Causes of Neutrophilia
Neutropeni
Bacterial infection, Malignancy
Chemo/Radio, Felty’s
Causes of pancytopenia
Aplastic anaemia, BM infiltration, hypersplenism, Sepsis, SLE
Auer rods in blood assoc
CML, ALL
Coal tests
PT (1972 - VitK/Liver),
INR (Comparison of PT between labs),
APTT (Intrinsic = factors except VII)
Target INR = 2.5 for all, recurrent DVT/Mechanical valve - 3.5
PT, APTT, Fibrinogen
Warfarin
Heparin
Haemophilia
Liver disease
DIC
PT, APTT, Fibrinogen
Warfarin - HNN Heparin - NHN Haemophilia - NHN Liver disease - HHN (synthetic of all factors) DIC - HHL
Churg strauss small vessel vasculitis antibodies
pANCA
MPO
Wegners antibodies
cANCA
Proteinase 3
Genetic disease E.g’s
- AD
- AR
- XR
- AD: ADPKD, huntingtons, Marfans, NF, tuberous sclerosis (tumours in vital organs)
- AR: CF (CFTR), Haemochromatosis (HFE), Wilsons, Thalassaemia
- XR: Duchenne/Becker Muscular dystrophy, Haemophilia A/B, G6PDD
Coombs test
Antibodies against RBC
CXR:
- White
- Black
- Grey
Bone
Gas
Soft tissue
AXR: Indication
Obstruction to bowel
Renal calculi
CT head indication
Decreased GCS
Suspected skull fracture (CSF leak)
Focal neurology
Seizure
When is Contrast CI
Renal impairment
Predisposing factors to pneumothorax
Asthma
COPD
CF
Pulmonary Fibrosis
Lines and dots on CXR (Reticulonodular shadowing)
Pulmonary fibrosis
Upper lobe fibrosis causes:
ESCHART
EAA Sarcoid Coal Histiocytosis Ank Spond Radiation TB
Lower lobe fibrosis:
RASCO
RA Asbestosis Sclerodera Sryptogenic Other: drug (amiodarone
Unilateral pleural effusion
Exudates
Malig, PE, Pneumonia, RA
Pulmonary oedema causes
HF Acute MI ARDS Renal failure Aggressive fluids
Bat Wing cause on CXR
Perihilar consolidation e.g. in acute pulmonary oedema due to HF
HF CXR (ABCDE
Alveolar oedema
Kerley B line/ Batwing
Cardiomegaly
Distension of venous system
Effusion
What is bright on diffusion weight MRI
Stroke (diffusion restriction)
CXR Mitral valve disease
Prominent L atrial appendage
LA enlargement
Cardiomegaly
CXR bronchial Ca
Pulmonary mets Effusion Consolidation/pneumonia Lung collapse Boney mets HIlar LN
Caveatting lung lesion DDx
TB Pneumonia Squam cell ca Abscess Vascular (Wegner's - cANCA) Rheumatoid nodule
Hetrogenous ring enhancing cerebral mass
Glioma
- astrocytoma
- glioblastoma multiforme
Ischaemic bowel AXR
Free pass in abdo, gas in bowel wall
Perforation AXR
Gas in peritoneal space (always pathological
What is P-mitrale and when is it seen
Mitral stenosis
Bifid P-wave
Normal length QRS
0.12-0.3 (3-5 small sq)
FEV1 in obstructive Vs Restrictive
Obs: under 0.7
Restrict: over 0.8
Urinalysis:
Bilirubin Blood Glucose Ketones Leukocytes Nitrites pH Protein Specific gravity Urobilinogen
Bilirubin: liver disease Blood: Glomerular damage, menstruation (contamination) Glucose: DM Leukocytes: UTI Nitrites: UTI pH: RTA Protein: Glomerular damage, Bence Jones Urobilinogen: Liver disease, haemolysis
LP
- bacterial
- viral
- SAH
Bacterial:
- high protein and WCC
- Low glucose
- Turbid
Viral
- normal protein,
- leukocytosis
- Glucose low/normal
- Clear
Xanthochromia
QRisk3
Risk MI/Stroke in next 10 years
- Age
- Ethnic group
- Postcode
- Other Hx (smoking, RA, Angina etc)
FRAX
Fracture risk
When to secure airway according to GCS
under 8
Causes of postural hypotension
Idiopathic Dehydration Drug (diuretics/vasodilation) Autonomic neuropathy (DM) MS
SIADH Na, Serum Osmolality, urine osmolality,
Low serum Na
Low serum osmolality
High urine osmolality
Low sodium in urine + AKI =
Prerenal cause