Data Interpretation

Question 1

Causes of a microcytic anaemia?

Answer 1

IDA
Thalassaemia
Sideroblastic anaemia

Question 2

Causes of normocytic anaemia ?

Answer 2

Anaemia of Chronic Disease
Acute blood loss
Haemolytic anaemia
Renal failure (chronic)

Question 3

Macrocytic anaemia cause?

Answer 3

• B12/folate deficiency
• Excess alcohol
• Liver disease (non-alcohol)
• Hypothyroidism
• Haematological disease beginning with M: myeloproliferative, myelodysplasia, multiple myeloma.

Question 4

Causes of high neutrophils (neutrophilia)

Answer 4

Bacterial infection
Tissue damage
Steroids

Question 5

Causes of low neutrophils?

Answer 5

Viral infection
Chemo and radiotherapy
Clozapine
Carbimazole (antithyroid)

Question 6

Causes of high lymphocytes (lymphocytosis)?

Answer 6

Viral infection
Lymphoma
Chronic Lymphocytic Leukaemia

Question 7

Causes of low platelets? Thrombocytopenia

Answer 7

Reduced production

• Infection (viral)
• Drugs (penicillamine (rheumatoid)
• Myelodysplasia, myelofibrosis, myeloma.

Increased destruction

• Heparin
• Hypersplenism
• DIC
• ITP
• HUS/TTP

Question 8

Causes of high platelets? Thrombocytosis

Answer 8

Reactive

• Bleeding
• Tissue damage
• INflammation, malignancy
• Post-splenectomy

Primary
- Myeloproliferative disorder

Question 9

Causes of a raised Urea?

Answer 9

Could indicate AKI
Upper GI bleed.

Therefore a patient with a raised urea and normal creatinine who is not dehydrated (look at haemoglobin for a GI bleed).

Question 10

Causes of an pre-renal AKI?

Answer 10

Prerenal - Urea rise >> creatine rise. eg urea 19 and creatinine 110.
Normal urea (3-7.5mmol/L)
Normal Creatinine (35-125)

Dehydration

Sepsis /Blood loss

Renal artery stenosis

Multiple urea by 10. If it exceeds creatinine then this suggests prerenal aetiology.

Question 11

Causes of a renal AKI?

Answer 11

Urea rise &laquo_space;creatinine rise, bladder or hydronephrosis not palpable (non-obstructive).

Due to ischaemia - due to prerenal AKI, causing acute tubular necrosis)

Nephrotoxic antibiotics - Gentamicin, vancomycin, tetracyclines.
Tablets (ACEi, NSAIDs)

Radiological contrast

Injury

Negatively birefringement crystals (gout)

Syndromes (glomerulonephridites)

Inflammation (Vasculitis)

Cholesterol emboli

Question 12

Causes of a postrenal AKI?

Answer 12

Urea rise &laquo_space;creatinine rise, bladder or hydronephrosis may be palpable depending on level of obstruction.

In lumen: stone or slough papilla.

In wall: Tumour, fibrosis,

External pressure: Benign prostatic hyperplasia, prostate cancer, lymphadenopathy, aneurysm.

Question 13

Hypovolaemic Hyponatraemia causes?

Answer 13

Low Na (<135mmol/L) + fluid status is hypovolaemic)

Fluid loss (especially diarrhoea/vomiting)
Diuretics
Addison’s disease

Question 14

Euvolaemic hyponatraemia causes?

Answer 14

SIADH
Psychogenic polydipsia
Hypothyroidism

SIADH = Small cell lung cancer, Infection, Abscess, Drugs (carbamazepine, antipsychotics) and Head injury.

Question 15

Hypervolaemic hyponatraemia causes?

Answer 15

Heart failure
Renal failure
Liver failure
Nutritional failure
Thyroid failure

Question 16

What are the LFT markers for: 1-Hepatocyte injury or cholestasis
2-Synthetic function

Answer 16

Hepatocyte injury or Cholestasis:

• Bilirubin
• ALT (alanine aminotransferase)
• ALP (alkaline phosphatase)
• Rarely measured= AST (aspartate aminotransferase).

Synthetic function:

• Albumin
• Vitamin K dependent clotting factors (II, VII,IX & X) which are measured via PT (prothrombin time) & INR (international normalized ratio)

Question 17

Bilirubin interpretation for jaundice:
1-Raised on its own
2-Rasied with AST/ALT
3-Rasied with ALP

Answer 17

1-Prehepatic Jaundice (hemolysis)
2-Intrahepatic Jaundice
3-post-hepatic/Obstructive Jaundice (BUT there are other causes of raised ALP)

Question 18

Common causes of a raised ALP?

Answer 18

ALKPPHOS

Any fracture
Liver damage
K(Cancer)
Paget's
Pregnancy
Hyperparathyroidism
Osteomalacia
Surgery

Question 19

Causes of pre-hepatic jaundice?

Answer 19

Cause: Haemolysis, Gilbert’s and Crigler-Najjar Syndrome

Question 20

Causes of Intrahepatic jaundice?

Answer 20

Cause:
Fatty liver
Hepatitis & Cirrhosis (due to
1) alcohol
2) Viruses (Hep A-E, CMV, EBV)
3) drugs (paracetamol, statins, rifampicin)

Malignancy

Metabolic: Wilson’s disease/haemochromatosis

Heart failure

Question 21

post-hepatic jaundice causes?

Answer 21

Bilirubin increased
ALP increased

In lumen: Stone (gallstone), drugs causing cholestasis (Flucloxacillin, co-amoxiclav, nitrofurantoin, steroids, sulphonylurea)

In wall: tumour (cholangiocarcinoma), PBC, PSC.
Extrinsic pressure: pancreatic or gastric cancer, lymph node.

Question 22

Causes of hyperkalaemia?

Answer 22

DREAD

• Drugs, Spironolactone, ACEi
• Renal failure
• Endocrine: Addisons
• Artefact (due to clotted sample)
• DKA (insulin to treat DKA potassium drops requiring regularly hourly monitoring.)

Question 23

Causes of hypokalaemia?

Answer 23

DIRE

• Drugs (loop and thiazide)
• Inadequate intake or intestinal loss
• Renal tubular acidosis
• Endocrine (Cushing’s and Conn’s syndrome) - excess aldosterone