Data interpretation

Question 1

LFTs: Bilirubin, Alk Phos, alanine aminotransferase (ALT), aspartate aminotransferase (AST) are markers of what?

Answer 1

Hepatocyte injury or cholestasis

Question 2

LFTs: Albumin and vitamin K dependent clotting factors are markers of?

Answer 2

Loss of synthetic function of the liver

Question 3

What are the vit K dependent clotting factors?

Answer 3

II, VII, IX and X

Question 4

How are the vit K dependent clotting factors measured?

Answer 4

PT/INR

Question 5

Raised bilirubin alone indicates?

Answer 5

A pre-hepatic cause - most likely haemolysis

Question 6

Common causes of raised alk phos (other than post hepatic jaundice)

Answer 6

ALK PHOS
Any fracture 
Liver damage (post hepatic)
Kancer
Paget's disease of the bone & Pregnancy 
Hyperparathyroidism
Osteomalacia
Surgery

Question 7

Prehepatic causes of increased bilirubin alone

Answer 7

Haemolysis
Gilbert’s syndrome
Crigler-Najjar syndrome

Question 8

Intrahepatic causes of raised bilirubin and raised AST/ALT

Answer 8

Fatty liver
Hepatitis
Cirrhosis
Malignancy (primary or secondary)
Metabolic: Wilson’s disease/haemochromatosis
Heart failure (causing hepatic congestion)

Question 9

Posthepatic (obstructive) causes of raised bilirubin and raised alk phos

Answer 9

In lumen: stone (gallstones), drugs causing cholestasis e.g. flucoxacillin, coamoxiclav, nitrofurantoin, steroids and sulphonylureas
Extrinsic pressure: pancreatic or gastric cancer, lymph node

Question 10

Causes of hepatitis and cirrhosis

Answer 10

1. Alcohol
2. Viruses e.g. Hep A-E, CMV, and EBV
3. Drugs (paracetamol overdose, statins, rifampicin)
4. Autoimmune (PBC, primary sclerosing cholangitis and autoimmune hepatitis)

Question 11

Primary hypothyroidism biochemistry and causes

Answer 11

Low T4 and raised TSH (TSH trying to compensate for low T4)
Hashimoto’s thyroiditis
Drug-induced hypothyroidism

Question 12

Secondary hypothyroidism biochemistry and causes

Answer 12

Low TSH from pituitary causing low T4

Pituitary tumour or damage

Question 13

Primary hyperthyroidism

Answer 13

High T4 from thyroid causing low TSH
Grave’s disease
Toxic nodular goitre
Drug-induced hyperthyroidism

Question 14

Secondary hyperthyroidism

Answer 14

High TSH from pituitary causing high T4

Pituitary tumour

Question 15

CXR interpretation - image/ quality

Answer 15

Projection - AP or PA
Rotation - spinous processes are equidistant to the clavicles
Inspiration - if the seventh anterior rib (downsloping) dissects the diaphragm then that is adequate
M - markings additional markings where radiographer has spotted an abnormality
Exposure - adequate exposure to give good quality film

Question 16

CXR interpretation: structures

Answer 16

1. Airway - trachea central?
   Deviation - collapse coming toward affected side & pneumothorax pushing away from affected side
2. B - breathing - lung fields
   White area present - unilateral and solid = effusion
   White area - bilateral and fluffy = oedema
   White area - bilateral and honeycomb = fibrosis
   Costophrenic angles sharp? - if not, pleural effusions
   Apices clear? - If not TB or apical tumour
3. Cardiac - Heart - enlarged –> HF?
4. Diaphragm - air under the right hemidiaphragm = perforation or recent surgery - under left side = gastric bubble which is normal
5. Everything else - bones - look for rib fractures & lytic lesions suggestive of metastases