Urinary and Electrolytes

Question 1

Example, Action and SE of loop diurectics

Answer 1

Furosemide
Inhibit Na/K/2Cl symporter in the tick ascending limb of the LoH
SE - hypokalaemic, hyponatramiea, low mg, met alkalosis, ototoxic, Hypovolaemia/ low BP, nausea

Question 2

Example, Action, SE and CI of thiazide diurectics

Answer 2

Bendroflumethazide
Inhibit NaCl co-transporter in DCT

SE: ↓K,Na,Mg, hyperglycaemia, ↑ urate, postural hypotension, ↑ calcium, impotence

CI - addisons, ↓K, ↑ calcium, gout

Question 3

Example, Action, SE and CI of K-Sparing Diuretics

Answer 3

Spironolactone - aldosterone antagonist
Amiloride - blocks DCT/CD luminal Na channel
 SE: ↑K, anti-androgenic (e.g. gynaecomastia, impotence, menstrual irregularities), ↓Na, lethargy, headache, confusion, hepatotoxic

Question 4

Example, Action, SE and CI of Osmotic Diuretics

Answer 4

mannitol - freely filtered and poorly reabsorbed
 Effect: ↓ brain volume and ↓ ICP
 SE: ↓Na, pulmonary oedema, n/v

Question 5

Causes of haematuria

Answer 5

HSP and PKD
Antibiotics - cipro/ cephalosporin
Embolism/ infarct
Malignancy - renal, bladder, prostate, BPH, ureter
AI - GN, TIN
Trauma - renal/extrarenal - stone/catheter
Urethritis/ prostitis
Renal stone
Infection - pyelonephritis, cystitis 
Anticoagulants - NSAIDs

Question 6

Causes of proteinuria

Answer 6

Common

• DM
• mimimal change
• amyloidosis
• SLE

Other
- HTN/ UTI/ Fever/ ATN/ TIN

Question 7

what is eGFR modified for

Answer 7

sex, age, race

Question 8

Causes of renal disease/ AKI

Answer 8

Pre-renal

• shock/ hypovolaemia
• renal vascular - RAS, NSAIDs, ACEi, thrombosis, hepatorenal syndrome

Renal

• GN
• ATN - ischaemia (shock) or nephrotoxins

Post-renal - SNIPIN

• Stone
• Neoplasm
• Inflammation (stricture)
• Prostatic hypertophy
• Infection - TB/ Sarcoid
• Neuro - post op/ neuropathy

Question 9

Presentation of renal failure

Answer 9

UP-NAKAD
- Uraemia
- Protein loss and Na retention
poly/oli/an- uria, polydipsia, SOB; oedema, HTN, ↑ JVP
- Acidosis
SOB -+/- kussmaul, confused
- hyperKalaemia - palpitations, chest pain, weakness
- Anaemia - SOB, lethagy, faint, tiniitus, pallor, ↑HTR, Flow murmur
- vitamin D deficiency - bone pain/ # +/- osteomalacia

Question 10

Symptoms and signs of uraemia

Answer 10

Symptoms 
Pruritus
n/v, anorexia, wt. loss 
Lethargy
Confusion
Restless legs
Metallic taste 
Paraesthesia: neuropathy 
Bleeding
Chest pain: serositis 
Hiccoughs

Signs
Pale, sallow skin
Striae
Pericardial or plueral rub Fits
Coma

Question 11

Presentation of UTI

Answer 11

Pyelonephritis
 Fever, rigors
 Loin pain and tenderness
 Vomiting
 Oliguria if ARF

Cystitis
 Frequency and urgency
 Polyuria
 Haematuria
 Dysuria
 Suprapubic tenderness
 Foul smelling urine

Prostatitis
 Flu-like symptoms
 Low backache
 Dysuria
 Tender swollen prostate on PR

Question 12

Risk Factors for UTIs

Answer 12

 Female
 Sex
 Pregnancy
 Menopause
 DM
 Abnormal tract: stone, obstruction, catheter,
malformation

Question 13

UTI - causative organisms

Answer 13

 E. coli
 Staphylococcus saprophyticus
 Proteus (alkaline urine → struvite renal stones)
 Klebsiella

Question 14

Management of UTIs

Answer 14

Drink plenty, urinate often

Cystitis
 Trimethoprim/ Nitrofurantoin for 3d (F) and 7d (M)

Pyelonephritis
 Cefotaxime 1g IV BD for 10d

Prostatitis
 Ciproflxacin 4 weeks

Question 15

Causes of glomerulonephritis

Answer 15

 Idiopathic
 Immune: SLE, Goodpastures, vasculitis
 Infection: HBV, HCV, Strep, HIV
 Drugs: penicillamine, gold
 Amyloid

Question 16

Complications of renal biopsy and when you should stop meds before

Answer 16

• mild back pain
• visible haematuria
• bleeding
• need for transfusion
• have bed rest 4h

Stop aspirin 1 week and INR <1.2, LMWH stop 24h before

Question 17

Features of IgA nephropathy and Mx

Answer 17

 Young male  
- episodic macroscopic haematuria occurring a few days after URTI.
 Rapid recovery between attacks
 ↑IgA
 Can occasionally → nephritic syndrome

Biopsy - IgA deposition in mesangium

Mx: Steroids or cyclophosphamide if ↓renal function

Question 18

Features of thin BM disease

Answer 18

AD
 Persistent, asymptomatic microscopic haematuria
 V. small risk of ESRF

Question 19

Features of Alport’s syndrome

Answer 19

 Haematuria, proteinuria → progressive renal failure
 Sensorineural deafness
 Lens dislocation and cataracts
 Retinal “flecks”
 Females: haematuria only

Question 20

Nephritic v Nephrotic syndrome

Answer 20

Nephritic
 Haematuria (macro / micro) + red cell casts
 Proteinuria → oedema (esp. periorbital)
 Hypertension
 Oliguria and progressive renal impairment

Nephrotic
 Proteinuria: PCR >3.5g/24h
 Hypoalbuminaemia: <35g/L (Muehrcke’s nails)
 Oedema: periorbital, genital, ascites, peripheral
- Often intravascularly depleted = ↓ JVP (cf. CCF)

Question 21

Features and Rx of post-streptococcal GN

Answer 21

Young child develops malaise and nephritic syndrome  -  smoky urine 1-2wks after sore throat or skin infection.
 ↑ASOT (anti-strep Ab titre)
 ↓C3
 ↑ anti-DNAase
Biopsy: IgG and C3 deposition
Rx: Supportive

Question 22

Features of RPGN/ Cresenteric

Answer 22

Type 1: Anti-GBM (Goodpasture’s) 
 Ab to NC domain of collagen 4
 Haematuria and haemoptysis
 CXR shows infiltrates
 Rx: Plasmapheresis and immunosuppression

Type 2: Immune Complex Deposition – 45%
e.g SLE

Type 3: Pauci Immune – 50%
cANCA: Wegener’s
pANCA: microscopic polyangiitis, Churg-Strauss

Question 23

Complications of nephrotic syndrome

Answer 23

Infection: ↓ Ig, ↓ complement activity
VTE: up to 40%
Hyperlipidaemia: ↑ cholesterol and triglycerides

Question 24

Causes of nephrotic syndrome

Answer 24

• Systemic - DM, SLE, amyloidosis

1) Minimal change GN - children
 Assoc. URTI
 Biopsy: normal light micro, fusion of podocytes on EM
 Rx: steroids

2) Membranous Nephropathy
 20-30% of adult
 Assoc: Ca: lung, colon, breast; AI: SLE, thyroid disease; HBV; Penicillamine, gold
 Biopsy: subepithelial immune complex deposits
 Rx: immunosuppression if GFR ↓
 40% spontaneous remission

3) FSGS
 Idiopathic or Secondary e.g. HIV
 Biopsy: focal scarring, IgM deposition
 Rx: steroids or cyclophosphamide/ciclosporin
 Prog: 30-50% → ESRF 

4) Membranoproliferative GN
 Rare → nephrotic (60%) or nephritic (30%) syndrome
 Asooc. HBV, HCV, endocarditis
 Prog: 50% → ESRF

Question 25

Mx of Nephrotic syndrome

Answer 25

``` Monitor U+E, BP , fluid balance, wt.  Treat underlying cause  Symptomatic / Complication Rx:  Oedema: salt and fluid restrict + frusemide  Proteinuria: ACEi / ARA ↓ proteinuria  ↑ Lipids: Statin  VTE: LMWH (as ↑ CF)  Rx HTN  pneumococcal and varicella vaccines ```

Question 26

Definition of AKI

Answer 26

Significant decline in renal function over hrs or days manifesting as an abrupt and sustained ↑ in Se U and Cr

Question 27

Presentation of AKI

Answer 27

```  Acidosis  Hyperkalaemia  Fluid overload  Oedema, inc. pulmonary  ↑BP(or↓)  S3 gallop  ↑ JVP ```

Question 28

Examples of nephrotoxins

Answer 28

- ACEI - Aminoglycosides, Vancomycin, Aciclovir, Sulphonamides, Tetracyclines - NSAIDs - Lithium, - Hb - Bilirubin - Ig in Myeloma - Contrast - Ciclosporin and Tacrolimus - Urate

Question 29

Things to observe in clinical assessment of suspected kidney disease

Answer 29

1. Acute or chronic?  Hx of comorbidity: DM, HTN  Long duration of symptoms  Previously abnormal bloods ``` 2. Volume depleted?  Postural hypotension  ↓ JVP  ↑ pulse  Poor skin turgor, dry mucus membranes ``` ``` 3. GU tract obstruction?  Suprapubic discomfort  Palpable bladder  Enlarged prostate  Catheter  Complete anuria (rare in ARF) ``` 4. Rare cause?  proteinuria ± haematuria  Vasculitis: rash, arthralgia, nosebleed

Question 30

Stages of AKI

Answer 30

``` Stage 1 - ↑Cr x1.5 ↓GFR >25% <0.5ml/kg/h x 6h Stage 2 - ↑Cr x 2 ↓GFR >50% <0.5ml/kg/h x 12h Stage 3 - ↑Cr x 3 ↓GFR >75% <0.3ml/kg/h x 24h, or anuria x12h ```

Question 31

Management of AKI

Answer 31

General  Identify and Rx pre-renal or post-renal causes  Urgent US  Rx exacerbating factors: e.g. sepsis  Give PPIs  Stop nephrotoxins: NSAIDs, ACEi, gent, vanc  Stop metformin if Cr > 150mM ``` Monitor  Catheterise and monitor UO  Consider CVP  Fluid balance  Wt. ``` Treat hyperkalaemia, pulmonary oedema and bleeding (FFP. transfuse)

Question 32

Indications for Acute Dialysis

Answer 32

AEIOU A"- acidosis; "E"- electrolyte disarray ( K+, Na+, Ca++); "I" - intoxicants (methanol ethylene glycol, Li, ASA); "O"- intractable fluid overload; "U"- uremic symptoms (nausea, seizure, pericarditis, bleeding)

Question 33

Pathogenesis and clinical presentation of Rhabdomyolysis

Answer 33

 Skeletal muscle breakdown → release of K+, PO4, urate, Myoglobin, CK  ↑K and AKI  Muscle pain, swelling  Red/brown urine  AKI occurs 10-12h later

Question 34

Causes of Rhabdomyolysis

Answer 34

 Ischaemia: embolism, surgery  Trauma: immobilisation, crush, burns, seizures, compartment syndrome  Toxins: statins, fibrates, ecstasy, neuroleptics

Question 35

Ix and Rx of rhabdomyolysis

Answer 35

Ix  Dipstick: +ve Hb, -ve RBCs  Blood: ↑CK, ↑K, ↑PO4, ↑urat ``` Rx  Rx hyperkalaemia  IV rehydration: 300ml/h  CVP monitoring if oliguric  IV NaHCO3 may be used to alkalinize urine and stabilise a less toxic form of myoglobin. ```

Question 36

Features and classification of Chronic renal failure

Answer 36

Progressive and irreversible loss of the excretory and hormone functions of the kidney ≥3mo Stage 1&2 require other evidence of kidney damage ``` Stage GFR 1 >90 2 60-89 3a 45-59 3b 30-44 4 16-29 5 <15 ```

Question 37

Causes of CKD

Answer 37

 DM  HTN ``` Other  RAS  GN  Polycystic disease  SLE  Myeloma and amyloidosis ```

Question 38

Ix for CKD

Answer 38

Blood  ↓Hb, U+E, ESR, glucose, ↓Ca/↑PO4, ↑ALP, ↑PTH  Immune: ANA, dsDNA, ANCA, GBM, C3, C4, Ig, Hep  Film: burr cells Urine: dip, MCS, PCR, BJP Imaging  CXR: cardiomegaly, pleural/pericardial effusion, oedema  AXR: calcification from stones  Renal US - Usually small (<9cm); large: polycystic, amyloid  Bone X-rays: renal osteodystrophy (pseudo#)  CT KUB: e.g. cortical scarring from pyelonephritis Renal biopsy: if cause unclear and size normal

Question 39

Complications of CKD

Answer 39

CRF HEALS  Cardiovascular disease  Renal osteodystrophy  Fluid (oedema) ```  HTN  Electrolyte disturbances: K, H  Anaemia  Leg restlessness  Sensory neuropathy ```

Question 40

Features of renal osteodystrophy

Answer 40

 Osteoporosis: ↓ bone density  Osteomalacia: ↓ mineralisation of osteoid  2°/3° HPT → osteitis fibrosa cystica - Subperiosteal bone resorption - Acral osteolysis: short stubby fingers - Pepperpot skull  May get spinal osteosclerosis → Rugger Jersey spine - Sclerotic vertebral end-plate with lucent centre

Question 41

Mechanism of renal osteodystrophy

Answer 41

 ↓ 1α-hydroxylase → ↓ vit D activation → ↓ Ca → ↑ PTH  Phosphate retention → ↓ Ca and ↑ PTH (directly)  ↑ PTH → activation of osteoclasts ± osteoblasts  Also acidosis → bone resorption

Question 42

Mx of CKD

Answer 42

``` General  Rx reversible causes  Stop nephrotoxic drugs Lifestyle  Exercise  Healthy wt  Stop smoking  Na, fluid and PO4 restriction CV Risk  Statins (irrespective of lipids)  Low-dose aspirin  RxDM Hypertension  Target <140/90 (<130/80 if DM - ACEi) Oedema --> Frusemide Bone Disease --> calcichew (P binder)  Vit D analogues: alfacalcidol (1 OH-Vit D3)  Ca supplements  Cinacalcet: Ca mimetic Anaemia  EPO to raise Hb to 11g/dL (higher = thrombosis risk) ``` Restless Legs -->Clonazepam

Question 43

Positives and negatives of renal transplant

Answer 43

+ve - restores near normal renal function - cheaper than dialysis - allows mobility and rehab - improved survival - good long-term results - better QoL Ive - not all suitable- limited donor supply - still left with progressive CKD - operation morbidity - life-long immunosuppression - malignancy and infection risk

Question 44

Complications of renal transplants

Answer 44

Post-op  Bleeding  Graft thrombosis  Infection  Urinary leaks Hyperacute rejection (minutes)  ABO incompatibility  Thrombosis and SIRS Acute Rejection (<6mo)  ↑ing Cr (± fever and graft pain)  Cell-mediated response  Responsive to immunosuppression Chronic Rejection (>6mo)  Interstitial fibrosis + tubular atrophy  Gradual ↑ in Cr and proteinuria  Not responsive to immunosuppression ↓ Immune Function  ↑ risk of infection: opportunists, fungi, warts  ↑ risk of malignancy: BCC, SCC, lymphoma (EBV) Cardiovascular Disease  Hypertension and atherosclerosis

Question 45

Drugs CI in renal failure

Answer 45

``` Many People Like to Nap Naked Metformin Potassium-sparing diuretics Lithium Tetracyclins Nitrofurantoin NSAIDs ```

Question 46

Drugs that accumulate in renal failure

Answer 46

``` Aminoglycosides, penicillins, cephalosporins LMWH Digoxin Atenolol Methotrexate Sulphonylureas Opiods ```

Question 47

Causes of renovascular disease

Answer 47

 Atherosclerosis in 80%  Fibromuscular dysplasia  Thromboembolism  External mass compression

Question 48

Features of RAS

Answer 48

 Refractory hypertension  Worsening renal function after ACEi/ARB  Flash pulmonary oedema (no LV impairment on echo) --> Renal angiography: gold standard

Question 49

Features of Haemolytic Uraemic Syndrome

Answer 49

 E. coli O157:H7: verotoxin → endothelial dysfunction Features  Young children eating undercooked meat (burgers Bloody diarrhoea and abdominal pain precedes: - MAHA - Thrombocytopenia - Renal failure)

Question 50

Features of thrombotic thrombocytopenia purpura

Answer 50

```  Fever  CNS signs: confusion, seizures  MAHA  Thrombocytopenia  Renal failure ```

Question 51

Presentation of PKD

Answer 51

``` MISSHAPES  Mass: abdo mass and flank pain  Infected cyst  Stones  sBP↑  Haematuria or haemorrhage into cyst  Aneurysms: berry → SAH  Polyuria + nocturia  Extra-renal cysts: liver  Systolic murmur: mitral valve prolapse ```

Question 52

Common type of renal stones

Answer 52

Calcium oxalate

Question 53

Ix and Mx of renal stones

Answer 53

Ix - Spiral non-contrast CT-KUB | Rx - Extracorporeal Shockwave Lithotripsy

Question 54

Features, +ve and -ve of haemodialysis

Answer 54

Blood is passed over a semi-permeable membrane against dialysis fluid flowing in the opposite direction, diffusion of small solutes occurs down the concentration gradient. +ve - 4 dialysis free days a week -ve- Disequilibration syndrome, hypotension, time consuming, access problems (AV fistula: thrombosis, stenosis, infection, blockage), fluid restrictions

Question 55

Peritoneal dialysis features, +ve and -ves.

Answer 55

Uses the peritoneum as a semi-permeable membrane. Catheter is inserted into the peritoneal cavity and fluid infused, allowing solutes to diffuse slowly across. - +ve – easily learned; allows mobility; CVS stability; less fluid/food restrictions -ve – frequent exchanged (~ 4 x day); frequent failure; high revenue costs; EPO injection; body image, PD peritonitis, exit site infection, loss of membrane function over time

Question 56

Presentation of hyponatraemia

Answer 56

- n&v, anorexia, malaise, lethargy, headache, confusion irritable - muscle cramps dn seizures - coma, death

Question 57

Mx of hyponatraemia

Answer 57

- Rx cause - replace Na and water slowly (se central potine myelinosis) 0 acute 1mM/h and chronic 10mM/d - if asymptomatic and chronic - fluid restrict - symoptomatic/ dehydrated - 0.9% NS - hypervolaemia - +/- furosemide - seizure/coma - hypertonic saline

Question 58

Causes of hyponatramia

Answer 58

- hypovolaemia > renal loss - diuretics, addisons, renal failure, osmotic diuresis > extra-renal loss - d&v, fistula, SNO, burns - hypervolaemia > cardiac/ renal/ liver failure > nephrotic sun - Euvolaemia > increased osmolality urine - SIADH > decreased osmolality urine - water overload, severe hypothyroidism, gluco-corticoid insufficiency

Question 59

Presentation of hypernatraemia

Answer 59

- thirst - lethargy - weakness - irritable - conufsion - fit/coma - dehydratino

Question 60

Causes of hypernatraemia

Answer 60

- hypovolaemia - d&v, diuretics, osmotic diuresis, sweat, burns - euvolaemia - reduced fluid intakem DI, fever - hypervolaemia - ↑ Aldosterone (↑ BP and hypokaelaemia), hypertonic saline

Question 61

Mx of hypernatraemia

Answer 61

- water - 5% dextrose IV/ 0.9% NS (hypovolaemic) - reduce na by 12mm/d (too fast - cerebral oedema)

Question 62

SIADH - features, causes and Rx

Answer 62

- ↑ NA and ↑ osmolality of urine, (opp in blood), no oedema causes - resp - SCLC, pneumonia, TB CNS - meningo-encephalitis, head injury, SAH Hypothyroidism Cyclophosphamide, SSRI, CBZ, Amitriptyline Rx - treat cause and fluid restrict - +/- vaptans

Question 63

Symptoms and causes of Diabetes insipidus

Answer 63

- polyuria, polydipsia, dehydration Causes - nephrogenic - inherited, high ca, Li, obstructive uropathy - cranial - idiopathic, tumour, trauma, haemorrhage, meningoencephalitis

Question 64

Ix and Rx of DI

Answer 64

Ix - ↑ Na, dilute urine - water deprivation test Rx - desmopressin if cranial

Question 65

Signs and symptoms of hyperkalaemia

Answer 65

- fast, irregular pulse - chest pain - palpitations - weakness - light-headedness

Question 66

Treatment of hyperkalaemia

Answer 66

- NON-URGENT - review meds and rx cause - calcium resonium PO URGENT - ECG changes/ >6.5 - SENIOR HELP - 10mL calcium chloride (10%) IV over 5 min - 50mL of 50% glucose and 10u actrapid over 5-15 min - salbutamol 5mg NEB - +/- haemofiltration - calcium resonium (+lactulose)

Question 67

Signs and symptoms of hypokalaemia

Answer 67

- muscle weakness - hypotonia - hyporeflexia- constipated - cramps - tetany - palpitations - light-headed

Question 68

ECG changes in hypokalaemia

Answer 68

- small/inverted T waves - prominent U waves - Long PR and QT - depressed ST

Question 69

Causes and treatment of hypokalaemia

Answer 69

causes - - increased excretion - diuretics, v&d, cushings, steroids, ACTH, Conn's, pyloric stenosis, purgative abuse, renal tubular disorder, fistula - internal distribution - increase insulin; beta agonist; alkalosis - reduced input - inappropriate IV fluids Treatment - replace magnesium - mild - oral K+ supplement - >80mmol/d - severe - IV KCl 10mmol/h - central if possible

Question 70

Causes of hyperkalaemia

Answer 70

- artefact --> haemolysis; leucko/thrombocytosis; drip arm - Internal distribution --> acidosis; reduced insulin; B-b - Release from cell --> rhabdomyolysis; burns; tumour lysis syndrome - Increased intake --> massive blood transfusion; oral - decreased excretion --> - oliguric renal failure; addisons; K+ sparing diuretics; ACEi; NSAIDs

Question 71

Symptoms of hypocalcaemia

Answer 71

``` Spasm(trousseaus) Periorbital paraesthesia Anxious/irritable Seizure and tetany Muscle tone ↑ (colic, dysphagia, wheeze) Orientation impaied Dermatitis Impetigo herpetiformis Chovsteks and cardiomyopathy (long QT) ```

Question 72

Causes of hypocalcaemia

Answer 72

- ↑ PO4 CKD; hypoparathyroid; acute rhabdomyolysis; ↓ Mg, Pseudohypoparathyroidism - ↓PO4 Vit D def, Osteomalacia, (ALP ↑), Acute pancreatitis, over-hydration, resp alkalosis

Question 73

ECG changes and Mx hypocalcaemia

Answer 73

ECG - long QT mild - Ca - 5mmol/6h PO (CKD - alfacalcidol) severe - 10mL or 10% calcium gluconate IV over 30 min - correct alkalosis

Question 74

Symptoms of hypercalcaemia

Answer 74

``` Bones -pain, pathological # Stones - renal Moans - depression, confusion Thrones - polyuria and dipsia Groans - abdo pain, vom and constipaton, pancreatitis, PUD ``` + HTN and pyrexia

Question 75

Causes of hypercalcaemia

Answer 75

- ↑ albumin - cuffed specimen - ↑ urea - dehydrated ↓/- albumin - ↑ PO4 and ALP ↑ - bone met, sarcoid, thyrotoxicosis, Li Normal ALP - myeloma, raised vit d, sarcoid, ↑ HCO3 ↓PO4 - 1/3 hyperparathyroid

Question 76

ECG and Mx hypercalcaemia

Answer 76

- short QT interval - Correct dehydration - IV fluids - Bisphosphonates infuse slowly (SE - flu, myalgia, n,v, low Mg, low Ca, low PO4, bone pain, seizures) - malignancy - chemo

Question 77

Signs and symptoms of anaemia

Answer 77

Symptoms - palpitation - fatigue - SOB - faintness - headache - tinnitus Signs - angular stomatitis - conjunctival pallor - tachycardia - flow murmur - glossitis - koilonychia

Question 78

Causes of microcytic anaemia

Answer 78

``` Thalaessmia Anaemia of chronic disease Iron def Lead poisoning Sideroblastic ```

Question 79

Causes of normocytic anaemia

Answer 79

``` Anaemia of chronic disease Haemolysis Acute blood loss BM failure Renal failure Hypothyroidism Pregnancy ```

Question 80

Causes of macrocytic anaemia

Answer 80

- B12 and folate def - Alcohol - retioculocytosis - cytotoxics - BM failure - Hypothyroidism - Pregnancy

Question 81

Causes of iron, b12 and folate deficiency

Answer 81

- reduced intake diet, malabsorption (gastretomy/coeliacs (CD - folate and B12)), - increased utilisation - growth, pregnancy (tapeworm - b12) - pernicious anaemia (AI against intrinsic factor) - loss iron- GI bleed, menorrhagia DRUGS folate def - trimethoprim, methotrexate, sulphasalazine B12 def - metformin NO Iron def - cimetidine, rantidine

Question 82

Causes of anaemia of chronic disease

Answer 82

malignancy infection - TB Renal failure Inflammation - RA, temporal arteritis

Question 83

Drugs that iron reduces absorption of

Answer 83

``` tetracycline Quinolones bisphosphonates levodopa levothyroxine ```

Question 84

Causes and ix of haemolytic anaemia

Answer 84

Inherited - sickle cell, thalassaemia, spherocytosis, G6PD def, PK def Acquired - AIHA, drug induce, DIC, TTP, physical damage/heart valves, lead, malaria Ix - ↑ reticulocytes, ↑ unco bilirubin, ↑ LDH, ↑ urinary urobilinogen - ↓ free haptoglobin (removed RBC intravascularly)

Question 85

Average daily requirements for an adult

Answer 85

25-30ml/kg/d water 1mmol/kg/d Na/K/Cl 50-100g glucose