Data interpretation

Question 1

causes of low MCV anaemia

Answer 1

IDA

Question 2

Causes of normocytic anaemia

Answer 2

anaemia of chronic disease, acute blood loss, haemolytic anaemia, renal failure

Question 3

causes of macrocytic anaemia

Answer 3

B12 deficency
folate deficiency 
excess alcohol;
liver disease 
hypothyroidism 
multiple myeloma

Question 4

What antipsychotic causes agranulocytosis

Answer 4

Clozapine

Question 5

what causes high neutrophils(neutrophillia)

Answer 5

bacterial infection
tissue damage - inflammation, infraction, malignancy
Steroids

Question 6

What causes low neutrophils(neutropenia)

Answer 6

Viral infection
chemotherapy/radiotherapy
clozapine
carbimazole (anti thyroid)

Question 7

What causes high lymphocytes(lymphocytosis)

Answer 7

viral infection
lymphoma
CLL

Question 8

what causes low platelets (thrombocytopenia)

Answer 8

penicillamine 
heparin
myeloma 
hyperspelnism 
infection 
DIC
ITP
HUS/TTP

Question 9

What causes high platelets

Answer 9

bleeding
tissue damage
post-splenectomy

Question 10

What causes hypernatraemia

Answer 10

Dehyration
drips - too much IV saline
drugs - anything w/ high sodium content
Diabetes insipidus - not enough ADH

Question 11

What causes hypovolaemic hyponatraemia

Answer 11

Fluid loss (diarrhoea, vomiting)
Addisons
Diuretics

Question 12

What causes euvolaemic hyponatraemia

Answer 12

SIADH: remember SIADH causes w/ SIADH acronym - Small cell lung tumour, Infection, Abscess, Drugs (esp carbamazepine and antipsychotics), Head injury
psychogenic polydipsia
hypothyroidism

Question 13

What causes hypervolaemic hypontraemia

Answer 13

Heart failure
Renal failure
liver failure or nutritional failure - hypoalbuminaemia
thyroid failure/ hypothyroidism

Question 14

causes of hypokalaemia

DIRE

Answer 14

Drugs - loop and thiazide diuretics
Inadequate intake or intestinal loss - diarrhoea, vomiting
Renal tubular acidosis - amphoteiicin, lithium, ifosfamide
Endocrine - Cushing’s, Conn’s

Question 15

Causes of hyperkalaemia

DREAD

Answer 15

Drugs - spirnonalactone, ACEi
Renal failure
Endocrine - Addison's disease
artefact - clotted blood sample
DKA

Question 16

Causes of raised urea, and how to seperate

Answer 16

Renal failure, upper GI bleed

creatinine won’t rise with upper GI bleed

Question 17

How to tell if a pre-renal AKI

What are the causes

Answer 17

Urea rise > creatinine rise
Dehydration
Renal artery stenosis - ACEi, NSAIDS

Question 18

How to tell if intrinsic AKI

What are the causes

Answer 18

Urea rise < creatinine rise
Bladder or hydronephorsis not palpable 
Remember with INTRINSIC acronym 
Ischaemia - acute tubular necrosis 
Nephrotoxic antibiotics - gent, Vanc, tetracyclines 
Tablets - NSAIDS, ACEi
Radiological contrast
Injury - rhabdomyolysis 
Negatively bifurigent crystals - gout 
Syndromes - GN
Inflammation - vasculitis 
Cholesterol emboli

Question 19

How to tell if post renal AKI

Answer 19

Urea < creatinine

bladder or hydronephorsis may be palpable

Question 20

how to tell if prehepatic liver problem

causes

Answer 20

Bilirubin raised on its own, no other LFT raised
Haemolysis
Gilbert’s
Crigler- Najjar

Question 21

How to tell if intrahepatic liver problem

Answer 21

Biliruib and AST/ALT both raised 
Fatty liver 
hepatitis - alcohol, viruses, paracetamol, statins, rifampicin, PBC, PSC, autoimmune
Cirrhosis  - same as hepatitis 
Malignancy
Metabolic - Wilsons, haemochromatosis 
HF

Question 22

How to tell if post hepatic liver problem

Answer 22

Bilirubin and ALP rise
Stones
Drugs causing cholestasis - flucloxacillin, coamoxiclav, nitrfuratonin, steroids, sulphonylyreas
tumours, PBC, PSC

Question 23

Causes of raised Alk Phos - ALK PPHOS

Answer 23

Any fracture
Liver damage
Kancer
Paget's diseases of pone 
Pregnancy 
Hyperparathyrodism
osteomalacia
Surgery

Question 24

TSH and Thyroxine dose

Answer 24

TSH <0.5 - reduce dose
TSH 0.5-5 keep same dose
TSH >5 - Increase dose

Question 25

Signs of pulmonary oedema on CXR

Answer 25

bilateral, fluffy white areas
ABCDE signs
Alveolar oedema - batwing
Kerley B lines
Cardiomegaly
Diversion of blood to upper lobes - vessels become bigger
pleural effusion - unilateral, blunted costophrenic angle

Question 26

Signs of pneumonia on CXR

Answer 26

Unilateral fluffy consolidation

Question 27

Signs of fibrosis on CXR

Answer 27

Bilateral, honeycomb

Question 28

rough check for seeing if someone is hypoxic on O2

Answer 28

FIO2 - 10 should be bigger than PaO2

Question 29

Signs of type 1 resp faulure

Answer 29

Hypoxia
Low or normal PaCO2 
caused by VQ mismatch 
Normal or fast breathing 
anything damaging heart and lungs causing SOB

Question 30

Signs of type 2 resp failure

Answer 30

Hypercapnic
high PaCO2 - caused by inadequate ventilation
Slow/shallow breathing
blue bloater COPD, neuromuscular failure, restrictive chest wall abnormalities

Question 31

what causes respiratory alkalosis

Answer 31

Rapid breathing - due to disease or anxiety

Question 32

what causes respiratory acidosis

Answer 32

T2RF

Question 33

What causes metabolic alkalosis

Answer 33

vomtiing
diuretics
conn’s syndrome

Question 34

What causes metabolic acidosis

Answer 34

lactic acidosis
DKA
renal failure
Methanol/ethylene glycol intoxication

Question 35

what causes elevated ST waves on ECG

Answer 35

STEMI

Pericariditis - widespread

Question 36

what causes ST depression on ECG

Answer 36

Ischaemia - flat, only depressed in some leads

Digoxin - down sloping in all leads

Question 37

what causes high T waves on ECG

Answer 37

hyperkalaemia

Question 38

what common drugs require monitoring

Answer 38

digoxin
theophylline
lithium 
pheytoin
gentamicin 
vancomycin

Question 39

S/E of digoxin

Answer 39

Confusion
Nausea
visual halos
arrytnmias

Question 40

S/E of lithium

Answer 40

Early - tremor
Intermediate - tiredness
Late - arrhythmia, seizures, coma, renal failure, diabetes insipidus

Question 41

S/E of phenytoin

Answer 41

Gum hypertrophy 
Ataxia
Nystagmus
Peripheral neuropathy 
Teratogenicity

Question 42

S/E of gentamicin

Answer 42

Ototoxciity

nephrotoxicity

Question 43

S/E of vancomycin

Answer 43

Ototoxicity

Nephrotoxicity

Question 44

Gentamicin monitoring - normal people

Answer 44

Usually given 5-7mg/kg once daily
measure gentamicin level at particular time e.g 6 hours after infusion started
use monogram to look at level
each level has an area, e.g if it falls in the 36 hour area, then change to 5-7mg/kg every 36 hours instead of 24
reduce dosing frequency by 12 hours
If above 48hr level, repeats level and only redone when <1mg/L

Question 45

Gentamicin monitoring - renal failure and endocarditis

what is the peak and trough ranges in IE

Answer 45

Give 1mg/kg every 8 hours for endocarditis, every 12 hours for renal failure = divided daily dosing
Peak (1hr after dose) should be 3-5mg –> adjust if not
Trought (just before next dose) should be <1

Question 46

Normal range of gentamicin in divided daily dosing regimes not for IE - peak and trough
what do if high/low

Answer 46

Peak (1h after dose) - 5-10 - adjust dose if outside this
Normal trough (just before next dose) is <2 - adjust schedule if outside this

Question 47

Paracetamol OD nonogram

Answer 47

Look at line
If at the time taken, their paracetamol conc is below the line, don’t require N-acetly cysteine (unless staggered dose or time of ingestion unknown)

Question 48

Warfarin INR - what’s the target, how to interpret, when to stop

Answer 48

INR should be 2.5, unless recurrent thromboembolism or metal replacement valve = 3.5
INR <6 = reduce dose
INR 6-8 = omit warfarin for 2d then reduce dose
INR >8 = omit warfarin and give 1-5mg oral Vit K
If minor bleeding and INR > 5, give IV vit K instead of oral
If there is a major bleed, stop warfarin, give 5-10mg Vit K and prothrombin complex