PSA - Data Interpretation

Question 1

microcytic anaemia causes (3)

normocytic anaemia causes (4)

macrocytic anaemia causes (5)

Answer 1

micro
- Iron def
- Sideroblastic anaemia
- Thalassaemia

Norm
- acute bleed
- chronic disease
- haemolytic anaemia
- chronic renal failure

Macro
- B12 + folate
- Alcohol
- Liver disease (non-alcoholic)
- Hypothryroidism
- Haem disease beginning with ‘M’ - myeloproliferative, myelodysplastic, multiple myeloma

Question 2

Normal sodium levels?

Hyponatraemia - look at fluid status to narrow diff

Hyponatraemia causes
- hypovolaemia (3)
- euvolaemic (3)
- hypervolaemic (5)

Hypernatarmia causes (4D’s)

Answer 2

135-145mmol/L

Hyponatraemia
Hypo - Fluid loss, Addisons, Diuretics (any)
Euvo - SIADH, psych polydipsia, Hypothryoid
Hyper - HF, Renal Failure, Liver failure, Nutritional faliure (hypoalbuminaemia), Thyroid failure

Hyper
D - dehydration
D - drips (Too much IV saline)
D - Drugs - effervescent tablet preparations
D - Diabetes insip. (ADH not working- fluid loss is more so than sodium loss therefore concentration increases)

Question 3

Normal potassium levels?

Hypokalaemia causes DIRE

Hyperkalaemia causes DREAD

Answer 3

3.5 - 5.0 mmol/L

Hypo
D - Diuretic Loop or thiazide
I - Inadequate intake or loss (diarrhoe or vom)
R - Renal tubular acidosis
E - Endocrine (Cushing’s or Conn’s)

D - Drugs (ACEi or K+ sparing diuretics)
R - Renal failure
E - Endocrine (Addison’s)
A - Artefact in blood bottle (clotted sample)
D - DKA (insulin drops it when given)

Question 4

Raised Urea - what is your initial thought?

What should ALWAYS be your second thought?

Answer 4

Initially - AKI, Raised Cr too? Dehydrated

Next - Upper GI bleed because gastric acid has broken down Hb into urea.
- Normal Cr and not dehydrated
- Look at Hb!!!

Question 5

AKI causes

Pre-renal (4)

Renal
INTRINSIC

Post-renal (2)

Answer 5

Pre-renal (70%)
- hypovolaemia
- sepsis
- blood loss
- renal artery stenosis

Renal
I- Ischaemia - Tubular necrosis
N - nephrotoxic Abx - Gentamicin
Tablets - ACEi, NSAIDs
R - Radiological contrast
I - Injury - rhabdomyolysis
N - Negative bifringent crystals (gout)
S - syndromes (glomerulonephritis)
I - inflammation - vasculitis
C - Cholesterol emboli

Post-renal
- Renal stone
- BPH or Prostate cancer

Question 6

LFTs
Synthetic function look at? (2)

Hepatocyte injury look at (4)

Answer 6

Synthetic function
- Albumin
- PT or INR - Vit K clotting factors (1972- 2,7, 9 ,10)

ALT, AST, Bilirubin, ALP

Question 7

Causes of derranged LFTs

Prehepatic - Increase Bilirubin (2)

Hepatic - Increase Bilirubin, AST/ ALT (6)

Post- hepatic - Increase bili and ALP and GGT
In lumen:
-
- Drugs which cause cholestasis (5)

• -

Answer 7

Prehepatic
- Haemolysis
- Gilbet’s sydrome

Hepatic
- Fatty liver
- Hepatitis (virus, alcohol, drugs, autoimmune)
- Cirrhosis
- Malignancy
- Wilsons disease
- Heart failure (hepatic congestion)

Posthepatic
In lumen:
- Gallstone
- Drugs which cause cholestasis - Co-amoxiclav, Fluclox, nitrofarantoin, steroids, sulphonylureas

In wall
- tumour (cholangiocarcinoma)
- primary biliarly cirrhosis
- sclerosing cholangitis

External
- pancreatic or gastric cancer
-

Question 8

Reasons for INCREASE in ALP that is NOT due to liver cause

A
L - liver cause
K
P (2)
H
O
S

Answer 8

A- any fracture
L - liver function
K - K for kancer
P - Paget’s disease of bone AND Preg
H- Hyperparathyroidism
O - Osteomalacia
S - Surgery

Question 9

TFTs - changing levothyroxine dosages
Use TSH levels

TSH normal range =
what to do with levo depending on TSH
TSH too low =
Within range =
TSH too high =

Answer 9

TSH normal range = 0.5 - 5mIU/L

< 0.5 = decrease dose
0.5 - 5 = nil action
>5 = increase dose

Question 10

Hypothyroidism

1 - TFTs?
Cause (2)

2 - TFTs?
Cause (1)

Hyperthyroidism
1 - TFTs?
Cause (3)

2- - TFTs?
Cause (1)

Answer 10

Hypothyroidism

1 - TFTs? High TSH, Low T3T4
Cause - Hashimotos thyroiditis, drug induced

2 - TFTs? Low TSH, Low T3T4
Cause - Pituitary tumour

Hyperthyroidism
1 - TFTs? Low TSH, High T3T4
Cause - Grave’s, toxic multi-nodular goitre, drug induced

2- - TFTs? High TSH, Low TSH
Cause - Pituitary tumour

Question 11

Drug toxicity monitoring
common drugs to be aware of:
Phenytoin, Digoxin, theophylline, lithium, gentamicin, vanocmycin

adequate clinical response + low serum levels -

adequate clinical response + normal serum levels -

adequate clinical response + high serum levels -

evidence of toxicity -
APART from ….

Answer 11

adequate clinical response + low serum levels - increase by smallest increment

adequate clinical response + normal serum levels -Nil change

adequate clinical response + high serum levels -decrease by smallest increment

evidence of toxicity - can omit for a few days
APART from gentamicin (only need high serum levels, no signs of toxicity needed becuase its highly oto and nephrotixic)

Question 12

Signs of toxicity

Digoxin (4)

Lithium early - intermed - late (5)

Phenytoin (5)

Gentamicin (2)

Vancomycin (2)

Answer 12

Digoxin - confusion, nausea, visual halo, arrthymia

Lithium - tremor (early), tired (intermed), Arrythmia, seizure, coma, renal failure diabetes insipidus (late)

Phenytoin - Gum hypertrophy, ataxia, nystagmus, renal failure, diabetes insipidus

Gentamicin - oto and nephrotoxic

Vancomycin - oto and nephrotoxic