Investigations

Question 1

What does a solitary raised bilirubin generally mean?

Answer 1

Pre-hepatic jaundice - generally haemolysis or Gilbert’s / Crigler-Najjar

Question 2

What are the common causes of a raised alk phos?

Answer 2

ALK PHOS

Any fracture
Liver damage (posthepatic)
Kcancer
Paget's disease of the bone and Pregnancy
Hyperparathyrodism
Osteomalacia
Surgery

Question 3

What does raised bilirubin and AST/ALT mean?

Answer 3

Intrahepatic

Fatty liver
Hepatitis and cirrhosis (due to drugs (paracetamol overdose, statins, rifampicin, alcohol, viruses (hep A-E, CMV and EBV), autoimmune (primary biliary cirrhosis, primary schlerosing cholangitis and autoimmune hepatitis)
Malignancy
Wilson’s or haemochromatosis
Heart failure (causing hepatic congestion)

Question 4

What does raised bilirubin and ALP mean?

Answer 4

Posthepatic (obstructive)
In lumen: stone (gallstone), drugs causing cholestasis (flucloxacillin, co-amoxiclav, nitrofurantoin, steroids, and sulfonylureas)
In wall: tumour (cholangiocarcinoma), primary biliary cirrhosis, schlerosing cholangitis
Extrinsic presure: pancreatic or gastric cancer, lymph node

Question 5

What is the TSH target range?

Answer 5

0.5 - 5

Question 6

CXR - what is the sign of a triangle behind the heart?

Answer 6

Sail sign - indicative of left lower lobe collapse

Question 7

CXR what does a widened mediastinum indicate?

Answer 7

Right upper lobe collapse (with tracheal deviation) or aortic dissection

Question 8

ABG remember to check inspired oxygen concentration! A patient may be within normal range for PaO2 but not for the amount of oxygen they are on

Question 9

Calculate normal PaO2 by taking 10 fom the FiO2

Question 10

What type of respiratory failure is this? Low O2

Answer 10

Type 1 - caused by anything that damages heart or lungs, causing SOB

Question 11

What type of respiratory failure is this? High CO2

Answer 11

Type 2 - caused by COPD and less commonly neuromuscular failure and restrictive chest wall abnormalities

Question 12

Cause if only CO2 is abnormal on ABG?

Answer 12

Respiratory

Question 13

Cause if only HCO3 is abnormal on ABG?

Answer 13

Metabolic

Question 14

Cause if both CO2 and HCO3 are increased or decreased on an ABG?

Answer 14

Compensation. Fully compensated if PH is normal

Question 15

What does it mean if CO2 and HCO3 on an ABG are abnormal in opposite directions?

Answer 15

Co-existant metabolic and respiratory disease

Question 16

What causes respiratory alkalosis?

Answer 16

Fast breathing - due to disease or anxiety

Question 17

What causes respiratory acidosis?

Answer 17

COPD, neuromuscular wall abnormalities

Question 18

What causes metabolic alkalosis?

Answer 18

Vomiting, diuretics, Conn’s syndrome

Question 19

What causes metabolic acidosis?

Answer 19

Lactic acidosis (metformin), DKA, renal failure, ethanol intoxication

Question 20

How many small squares of the QRS for bundle branch block?

Answer 20

> 3

Question 21

What would indicate hyperkalaemia on ECG?

Answer 21

T waves more than 2/3 of the QRS height throughout

Question 22

What drugs have a narrow therapeutic index and need monitoring?

Answer 22

Phenytoin, digoxin, gentamicin, vancomycin, lithium, theophylline.