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PSA > Data Interpretation > Flashcards

Data Interpretation Flashcards

1
Q

Give some causes of microcytic anaemia

A

Iron Deficiency Anaemia
Thalassaemia
Sideroblastic anaemia

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2
Q

Give some causes of normocytic anaemia

A

Anaemia of chronic disease
Acute blood loss
Haemolytic anaemia
Renal failure

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3
Q

Give some causes of macrocytic anaemia

A 
B12/folate deficiency (megaloblastic)
Excess alcohol
Liver disease
Hypothyroidism
Myeloproliferative and myelodysplastic disorders
Multiple myeloma
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4
Q

What can cause hypernatraemia?

A

D’s

Dehydration
Drips (IV saline)
Drugs - effervescent tablets or IV with high sodium
Diabetes insipidus

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5
Q

What can cause hyponatraemia?

A

Hypovolaemic - fluid loss (D&V), Addisons, diuretics

Euvolaemic - SIADH, psychogenic polydipsia, hypothyroid

Hypervolaemic - Heart failure, renal failure, liver failure, nutritional failure, thyroid failure (hypo)

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6
Q

What can cause neutrophilia (high neutrophils)?

A

Bacterial Infection
Tissue damage - inflammation, infarction, malignancy
Steroids

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7
Q

What can cause neutropenia?

A

Viral infection
Chemo/radio
Clozapine
Carbimazole

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8
Q

What can cause lymphocytosis (high)?

A

Viral infection
Lymphoma
Chronic Lymphocytic Leukaemia

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9
Q

What causes thrombocytopenia?

A 
Low production:
- Infection
- Drugs - penicillamine
- Myelodysplasia, myelofibrosis, myeloma
Destruction:
- Heparin
- Hypersplenism
- DIC
- ITP
- Haemolytic uraemic syndrome/TTP
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10
Q

What causes thrombocytosis?

A

Reactive:

  • Bleeding
  • Tissue damage - infection, inflammation, malignancy
  • Post-splenectomy

Primary
- Myeloproliferative disorders

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11
Q

What causes hypokalaemia?

A 
DIRE:
Drugs - loop and thiazide diuretics
Inadequate intake/intestinal loss
Renal tubular acidosis
Endocrine - cushings/conn's
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12
Q

What causes hyperkalaemia?

A 
DREAD:
Drugs - potassium sparing diuretics and ACE inhibitors
Renal failure
Endocrine - addisons
Artefact
DKA
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13
Q

What can a raised urea indicate?

A

Kidney Injury

Upper GI bleed - raised urea with normal creatinine in pt. who isn’t dehydrated –> check Hb, if low, likely upper GI bleed

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14
Q

What can cause pre-renal AKI?

A

Dehydration - sepsis, blood loss etc.

Renal artery stenosis

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15
Q

How does a pre-renal AKI appear biochemically?

A

Urea rise > creatinine rise

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16
Q

What can cause an intrinsic/renal AKI?

A 
INTRINSIC:
Ischaemia - causes acute tubular necrosis
Nephrotoxic abx - gentamicin, vancomycin and tetracyclines
Tablets - ACE inhibitors/NSAID's
Radiological contrast
Injury - rhabdomyolysis
Negative birefringent crystals - gout
Syndromes - glomerulonephritis
Inflammation - vasculitis
Cholesterol emboli
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17
Q

How does a Renal AKI appear biochemically?

A

Urea rise < Creatinine rise

Bladder/hydronephrosis not palpable

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18
Q

What can cause a post renal AKI?

A

In Lumen - stone, sloughed papilla

Wall - tumour (RCC), fibrosis

External pressure - BPH, prostate cancer, lymphadenopathy, aneurysm

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19
Q

How does a post-renal AKI appear biochemically?

A

Urea rise < creatinine rise

Bladder/hydronephrosis may be palpable

20
Q

Which blood results would you use to assess for hepatocyte injury or cholestasis?

A

Look at:

  • Bilirubin
  • ALT (and AST less commonly)
  • Alk Phos
21
Q

Which blood results would you use to assess the synthetic function of the liver?

A
  • Albumin

- Vitamin K dependent clotting factors - PT/INR

22
Q

What can cause a raised alkaline phosphatase?

A
  • Fractures
  • Post-hepatic liver damage
  • Cancer
  • Paget’s disease of bone
  • Pregnancy
  • Hyperparathyroidism
  • Osteomalacia
  • Surgery
23
Q

What causes pre-hepatic liver function derangement?

A

Haemolysis

Gilbert’s and Crigler-Najjar syndrome

24
Q

What causes hepatic liver function derangement?

A 
Fatty liver
Hepatitis
Cirrhosis
Malignancy
Metabolic - Wilson's/Haemochromatosis
Heart Failure
25
Q

What causes post hepatic LFT derangement?

A

Lumen - gallstone, drugs causing cholestasis
Wall - tumour (cholangiocarcinoma), PBC, PSC
Extrinsic - pancreatic/gastric cancer, lymph node

26
Q

What drugs cause cholestasis?

A 
Flucloxacillin
Co-amoxiclav
Nitrofurantoin
Steroids
Sulphonylureas
27
Q

What are the signs of pulmonary oedema seen on X-ray?

A 
Alveolar oedema (bat wings)
Kerly B Lines
Cardiomegaly
Enlarged blood vessels in upper zone
Pleural effusions
28
Q

Which drugs commonly require monitoring?

A 
Digoxin
Theophylline
Lithium
Phenytoin
Gentamicin
29
Q

What is typically done when drug’s are monitored?

A

Assess clinical state

Measure serum drug level

30
Q

What are the features of digoxin toxicity?

A

Confusion
Nausea
Visual halos
Arrhythmia

31
Q

What are the features of lithium toxicity?

A

Early - tremor
Intermediate - tiredness
Late - arrhythmia, seizure, coma, renal failure, diabetes insidious

32
Q

What are the features of phenytoin toxicity?

A 
Gum hypertrophy
Ataxia
Nystagmus
Peripheral neuropathy
Teratogenicity
33
Q

What are the features of gentamicin and vancomycin toxicity?

A

Ototoxicity

Nephrotoxicity

34
Q

What is the dose range of gentamicin normally and in infective endocarditis?

A

Peak (1h post dose) :
IE - 3/5mg/L
Others - 5-10mg/L

Trough (just before next dose):
IE - <1mg/L
Others - <2mg/L

35
Q

What are the three treatments recommended for drug toxicities (generic)?

A

1 Stop drug
2 Supportive measures - IV fluids
3 Give antidote if available

36
Q

What factors help you determine the gentamicin dose?

A

Patient weight and renal function

37
Q

What is the typical dose for gentamicin?

A

5-7mg/kg OD

38
Q

What is the typical dose for gentamicin in pt. with renal failure or infective endocarditis? (severe creatinine clearance <20mL/min)

A

Divided daily dosing 1mg/kg

  • every 12 hr in renal failure
  • every 8 hr in infective endocarditis
39
Q

What does gentamicin monitoring entail?

A
  • Measure levels at particular times - 6-14hr after infusion

- Use nomogram to determine level and adjust dosing accordingly

40
Q

How is a gentamicin dose adjusted?

A

You change the frequency of the dose rather than the dose itself - need to reach therapeutic level

41
Q

What is the management for a paracetamol overdose?

A

N-Acetyl Cysteine if over the line on nomogram

Supportive measures

42
Q

How is a warfarin OD managed in a major bleed?

A
  • Stop Warfarin
  • 5-10mg IV Vit K
  • Prothrombin complex (beriplex)
43
Q

How is a warfarin OD managed if there is no bleed?

A

INR <6 - Reduce warfarin dose
INR 6-8 - Omit warfarin for 2 days then reduce dose
INR >8 - Omit warfarin and give 1-5mg oral vit K

44
Q

How is a warfarin OD managed if there is minor bleeding?

A

INR>5 IV Vit K 1-3mg and omit warfarin

45
Q

How is warfarin monitored?

A

Monitor INR

Target 2.5 normally

Target 3.5 if:

  • Recurrent thromboemboli
  • Metal replacement heart valve

PSA (7 decks)

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