Test interpretation Flashcards
ABPI
- > 1.2: may indicate calcified, stiff arteries. This may be seen with advanced age or PAD
- 1.0 - 1.2: normal
- 0.9 - 1.0: acceptable
- < 0.9: likely PAD. Values < 0.5 indicate severe disease which should be referred urgently
Impaired glucose tolerance
fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l
DM Glucose results
If the patient is symptomatic:
•fasting glucose greater than or equal to 7.0 mmol/l
•random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)
in asymptomatic people need on 2 occasions
Hba1c
- a HbA1c of greater than or equal to 48 mmol/mol (6.5%) is diagnostic of diabetes mellitus
- a HbAlc value of less than 48 mmol/mol (6.5%) does not exclude diabetes (i.e. it is not as sensitive as fasting samples for detecting diabetes)
- in patients without symptoms, the test must be repeated to confirm the diagnosis
- it should be remembered that misleading HbA1c results can be caused by increased red cell turnover
Impaired fasting glucose
fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l
Cushings syndrome
- overnight dexamethasone suppression test (most sensitive)
- 24 hr urinary free cortisol
Hypokalaemic metabolic alkalosis
PTH function
Encourages increased absorption Ca2+ from gut and release calcium bones. Decreases phosphate
Pseudohypoparathyroidism
High PTH but low calcium and high phospate.
E.g. gland working fine but the tissue is not responding to the PTH
Primary Hypoparathyroidiam
Low PTH, Low calcium and high phosphate
PTH not being produced by gland
Lights criteria
Exudaitive if:
- Effusion protein/serum protein ratio greater than 0.5
- Effusion lactate dehydrogenase (LDH)/serum LDH ratio greater than 0.6
- Effusion LDH level greater than two-thirds the upper limit of the laboratory’s reference range of serum LDH
Target Hba1c in patients with gliclazide
53mmol/mol as these drugs can cause hypoglycaemia
GH deficiency in children - Sx
Obesity
Anorexia biochemistry results
Most things low e.g. potassium
Raised G’s and C’s - growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
COPD breathless/ exacerbations despite salbutamol
FEV1 dependant management
FEV1 > 50%
•long-acting beta2-agonist (LABA), for example salmeterol, or:
•long-acting muscarinic antagonist (LAMA), for example tiotropium
FEV1 < 50%
•LABA + inhaled corticosteroid (ICS) in a combination inhaler, or:
•LAMA
ECg in hypokalaemia
The ECG findings are: •prominent U-waves, best seen in precordial leads •T waves have a 'sine wave' appearance •prolonged QTc > 600ms •borderline PR interval
Sick Euthyroid expected results
low total and free T4 and T3, with a normal or low TSH.
When to BNP
History sounds like heart failure and no previous MI
Prev MI - Echo
Low fibrinogen - which blood product to give
Cryoprecipitate
Secondary Hyperparathyroism
Due to low to calcium
e.g. renal failure –> low Ca2+, high phosphate therefore increased PTH produced to try and counter
or loop diuretic overuse
Primary hyperparathyroidism
High PTH, High Calcium,low phosphate
Loop diuretic overuse
Hypokalaemia, hyponatraemia, hypocalcaemia (therefore increased PTH - secondary hyperparathyroidism)
Increased serum ACE levels
Sarcoidosis
Fractional exhaled nitric oxide (FeNO
Adult new diagnosis of Asthma
Levels of NO typically correlate with levels of inflammation.
conjugated bilirubin percentage
> 50% direct bilrubin of total = conjugated
Causes paraproteinaemia
Multiple Myeloma
Waldestroms macroglobuminaemia
Primary amyloidosis
Hodgkins Lympoma characteristic cell
Reed Sternberg cells
When to transfuse platelets
Discuss with haematology when below 50
Definitely if: plts below 10
Haemorrhage (DIC)
Before invasive procedures e.g. LP and biopsy toget count above 50
Myeloma Diagnosis Criteria
High index suspicion in bone/back pain not improving - do ESR and serum electrophoresis
1) Momoclonal band on electrophoresis
2) increased plasma callson BM biopsy
3) End organ damage - high Ca,Renal damage, anaemia
4) Bone lesions on skeletal survey
Myeloma test findings
Normocytic normorchromic aneamia Blood film - rouleaux formation RBC IgG paraproteineamia on electrophroesis Urinary bence jones proteins punched out lesions on x ray
causes of LAD on ECG
LVH
Inferior MI
left anterior hemiblock
WPW - some types
Causes of RAD on ECG
PE
RVH
Anterolateral MI
WPW - sometypes
Bifasicular block
RBBB and LAD
Trifasicular block
Pronlonged PR
RBBB and LAD
Congenital Adrenal hyperplasia
Increased plasma 17-hydroxyprogesterone levels
Increased plasma 21-deoxycortisol levels
Increased urinary adrenocorticosteroid metabolites
Issues biosynthesising cortisol therefore increase in ATCH production and inc Adrenal androgens –> Virilisation females
HOCM
S4
‘jerky’ or sudden carotid upstroke
ejection systolic murmur/crescendo–decrescendo systolic murmur exacerbated by Valsalva manoeuvres . ECG LVH .
Echocardiography is usually diagnostic, typically showing asymmetrical left ventricular hypertrophy with greater septal thickening compared to the posterior wall.
Dehydration
inc urea, albumin and PCV
Dec urine output and skin turgor
Abnormal kidney function - low GFR
inc urea, Creatinine, K+, H+, Urate, phosphate and oilguria
AKI and CKD (if also anaemic and inc PTH)
Abnormal kidney function - Tubular dysfunction
Dec K+, urate phosphate.
Normal urea and creatinine
Acidotic
Recovery from AKI, Hypercalcaemia, hyperuricaemia, myeloma, pyelo ,hypokalaemia, Wilsons
Thiazide and Loop diuretics
Hypokalaemia, hyponatraemia,
Inc Bicarb and Inc Urea
Hepatocellular disease
↑ bili, ↑↑AST, ↑ALP (slightly), ↑ clotting
Dec Albumin
Cholestasis
↑bili, ↑↑ gamma GT, ↑↑ALP ↑ AST
Excess alcohol
↑Gamma GT and ↑MCV
Also hepatocellular disease picture
MI
↑Trop, CK AST and LDH
Addisons
↑K+, ↑ Urea and hyponatraemia
Cushings
↑bicarb and Na+, hypokalaemia
Conns
Hypokalaemia, HTN, ↑bicarb
Diabetes insipidus
↑Na+, ↑plasma osmolarity, and low urine osmolarity
SIADH
Low Na+, with high urine osmolarity and ↑urine sodium (>20)
