Data Interpretation

Question 1

Causes of anaemia…

Answer 1

Microcytic:

• Iron deficiency
• Thalassaemia

Normocytic:

• Anaemia of chronic disease
• Acute blood loss
• Haemolytic anaemia (accquired and hereditary)

Macrocytic:

• B12/folate deficiency
• Alcoholism
• Liver disease

Question 2

Causes of thrombocytopaenia (low platelets)…

Answer 2

Reduced production: Viral infection, drugs, myelodysplasia

Increased destruction: Heparin, DIC, ITP, HUS m

Question 3

Causes of thrombocytosis (high platelets)…

Answer 3

Reactive: bleeding, tissue damage
Primary: myeloproliferative disorders

Question 4

Causes of neutrophilia…

Answer 4

Bacterial infection
Tissue damage
Steroids

Question 5

Causes of neutropaenia…

Answer 5

Viral infection
Chemo/ radiotherapy
Clozapine
Carbimazole

Question 6

Causes of lymphocytosis…

Answer 6

Viral infection
Lymphoma
CLL

Question 7

Causes of hyponatraemia…

Answer 7

Hypovolaemic:

• Fluid loss (diarrhoea,/vomiting)
• All diuretics
• Addison’s

Euvolaemic:

• SIADH
• Psyhogenic polydipsia
• Hypothyroidism

Hypervolaemic:

• Heart failure
• Renal failure
• Liver failure (hypoalbuminaemia)

Question 8

Causes of SIADH…

Answer 8

Small cell lung cancer 
Infection 
Abscesses 
Drugs e.g. carbamezapine, antipsychotics 
Head injury

Question 9

Causes of hypernatraemia…

Answer 9

Ds:

• Dehydration
• Drips (IV saline)
• Drugs (tablets with high Na content)
• Diabetes Insipidus

Question 10

Causes of hypokalaemia…

Answer 10

DIRE:

• Drugs (loop and thiazide diuretics)
• Inadequate intake/ intestinal loss (vomiting/ diarrhoea)
• Renal tubular acidosis
• Endocrine - Cushings/Conns

Question 11

Causes of hyperkalaemia…

Answer 11

DEAD:

• Drugs (K sparing diuretics, ACEi, heparins)
• Endocrine - Addisons
• Artefact - clotted sample
• Dehydration/ DKA

Question 12

Causes of AKI..

Answer 12

Pre-renal: (UREA RISE»CREATININE RISE)

• Reduced perfusion due to low volume (dehydration /shock)
• ACEi/ NSAIDs - affecting RAAS

Renal: (UREA RISE< CREATININE RISE)

• Nephrotoxic drugs
• Glomerulonephropathies

Post-renal: (UREA RISE < CREATININE RISE)

• Tumours
• Strictures
• Stones

Question 13

Causes of raised ALP…

Answer 13

ALKPHOS: 
Any fracture
Liver failure 
K - cancer (bone mets) 
Paget's disease/ pregnancy 
Hyperparathyroidism 
Osteomalacia 
Surgery

Question 14

Causes of jaundice…

Answer 14

Pre hepatic: HIGH BILIRUBIN

• Haemolysis
• Gilbert’s

Intrahepatic: HIGH BILIRUBIN + HIGH AST/ALT

• Hepatitis
• Cirrhosis
• Malignancy
• Metabolic

Post -hepatic: HIGH BILIRUBIN + HIGH ALP

• Gallstones
• Cholestasis - induced by drugs (fluclox, co-amox, nitrofurantoin)
• Tumour
• Pancreatic/ gastric Ca

Question 15

Causes of hyperthyroidism…

Answer 15

Primary hyperthyroidism (HIGH T4 CAUSING LOW TSH)

• Grave’s disease
• Toxic nodular goitre

Secondary hyperthyroidism (HIGH TSH CAUSING HIGH T4) :
- Pituitary tumour

Question 16

Causes of hypothyroidism…

Answer 16

Primary hypothyroidism (LOW T4 CAUSING HIGH TSH) :
- Hashimoto’s thyroiditis
- Drug induced hypothyroidism
Secondary hypothyroidism (LOW TSH CAUSING LOW T4):
- Pituitary tumour/ damage

Question 17

What should be done if gentamicin levels are considered too high?

Answer 17

Drug dose should not be changed.

Instead, give the same dose but decrease frequency by 12h i.e. 24hrly dose changed to 36hrly dose

Question 18

When should gentamicin levels be checked?

Answer 18

6-14 hours after the last gentamicin infusion started.

Question 19

What is normal INR, and INR target for warfarin patients?

Answer 19

Normal INR = 1
Target INR for warfarin patients = 2.5
Metal heart valve replacements = 3.5

Question 20

What is the management for a warfarin patient who has a major bleed?

Answer 20

• Stop warfarin
• Give 5-10mg IV Vit K
• Give IV Prothrombin complex (Beriplex)

Question 21

Actions to take with varying INR ranges…

Answer 21

INR <6 = Reduce warfarin dose
INR 6-8 = Omit warfarin dose for 2d, then reduce dose
INR >8 = Omit warfarin, then give 1-5mg oral Vit K