Blood Chemistry For Diagnosis

Question 1

Chromogranin A conc raised?

Answer 1

Could be carcinoid syndrome

Used as tumour marker

Question 2

Why is somatostatin receptor scintography used?

Answer 2

Use a compound to bind to somatostatin receptors on tumour

Question 3

Serotonin means

Answer 3

Carcinoid tumours in lung and gut

Question 4

Oxytocin and ADH for

Answer 4

Posterior pituitary, serum competing is a cleavage product for ADH

Question 5

Serum calcitonin for…

Answer 5

Medullary c cells of thyroid

Question 6

Circadian rhythm of pituitary hormones is controlled by?

Answer 6

Supraoptic nucleus

Question 7

Neural tube defects?

Answer 7

Maternal serum alpha-fetoprotein, feral ultrasound

Question 8

Alpha fetoprotein?

Answer 8

Produced by yolk sac and feral liver, most abundant protein

Question 9

Alpha fetoprotein high and low levels?

Answer 9

High- spina bifida

Low- downs

Question 10

In hyperventilation, respiratory alkalosis what happens?

Answer 10

Calcium binds to albumin, hydrogen leaves to bind to bicarbonate

Question 11

What does nitrous oxide do?

Answer 11

Convert B12 from active monovalent to inactive bivalent.

Active b12 is coenzyme for methionine synthase needed to create methyl groups for synthesis of DNA.

Question 12

Meningism?

Answer 12

Headache, neck stiffness, photophobia often with nausea and vomiting

Question 13

Requirements for CSF labels?

Answer 13

1. Microbiology
2. Biochemistry
3. Decreasing cell count

Question 14

Subarachnoid haemorrhage diagnosis?

Answer 14

6hour delay CSF will show bilirubin

Question 15

Most common cause of subarachnoid haemorrhage?

Answer 15

Berry aneurysm

Question 16

Meningitis glass test?

Answer 16

With blanching if rash doesn’t fade, then meningitis.

Question 17

Why is protein high in meningitis?

Answer 17

More permeable blood brain barrier allowing more proteins to enter CSF

Question 18

Difference in bacterial meningitis and tuberculous meningitis?

Answer 18

WBC raised in both, but in bacterial it’s polymorphs and tuberculous lymphocytic

Question 19

Protein levels in meningitis?

Answer 19

Tuberculous very high 6mol, bacterial more than 2.5

Fungal elevated and viral less than 1.5

Question 20

Glucose in meningitis?

Answer 20

Viral more than 50%, fungal less than 50%, bacterial and tuberculous less than 2.5 mol

Question 21

Multiple sclerosis testing?

Answer 21

Oligoclonal banding; positive in CSF not serum

Question 22

How to diagnose Alzheimer’s from CSF?

Answer 22

Low conc of Abets42 in CSF and high tau.

Question 23

Apolipoprotein E in plaque formation?

Answer 23

ApoE4 promotes plaque formation and ApoE2 inhibits

Question 24

Drippy nose, nasal secretions?

Answer 24

Test for asialotransferrin which is high in CSF only

Question 25

Altered states of consciousness: | AEIOU TIPS?

Answer 25

``` Alcohol Epilepsy, electrolyte disorders, hepatic encephalopathy Insulin, in born errors of metabolism Opiates, overdose, oxygen(hypoxia) Uraemia Trauma, temp, toxins, tumour Infection- sepsis, men,enca Psychogenic, poisons Space occupying, stroke, seizure and shock ```

Question 26

How to test for hypoxia brain injury?

Answer 26

Neuron specific enolase, released after neuronal cell death.

Question 27

What can cause cerebral oedema?

Answer 27

Diabetic ketoacidosis, hyperosmolar hyperglycaemia with insulin, hyponatraemia

Question 28

What can cause hyponatraemia?

Answer 28

Excessive IV of hypotonic fluids Syndrome of inappropriate ADH secretion Ectopic ADH-small cell lung carcinoma MDMA

Question 29

Signs of encephalitis?

Answer 29

Altered consciousness for more than 24hours, lethargy change in personality Fever Seizures High WBC in CSF

Question 30

Low serum caeruloplasmin copper?

Answer 30

Wilson’s disease

Question 31

Accumulation of amino acids?

Answer 31

Phenyketonuria

Question 32

Accumulation of carbohydrates?

Answer 32

Galactosaemia

Question 33

Accumulation of mucopolysaccharides?

Answer 33

Hurler syndrome

Question 34

Accumulations of sphingolipids?

Answer 34

Gaucher disease

Question 35

Why is phenytoin used?

Answer 35

For epilepsy, 10-20mg/L Higher dose causes a much greater conc

Question 36

Phenytoin on fit d metabolism?

Answer 36

Phenytoin activates enzyme that inactivate vit d leading to decreased calcium absorption. Low calcium causes parathormone secretion to release calcium from bone.

Question 37

Hoe does risperidone cause increased prolactin?

Answer 37

Risperidone blocks dopamine receptor, anterior pituitary, prolactin releasing cells cause high serum prolactin.

Question 38

How to treat bipolar

Answer 38

Lithium

Question 39

Effect of lithium on endocrine?

Answer 39

Hypothyroidism, because its taken up by the gland reducing thyroxine release Increased sensitivity to ADH causing polyuria Hypercalcaemia- I adjusts calcium receptors in parathyroid glans causing increase parathyroid secretion

Question 40

Effects of opiates on hypogonadism?

Answer 40

Reduced gonadotrophin secretion, hyperprolactinaemia, antiepileptics increase SHGB and suppress HPA axis

Question 41

Pseudocholinesterase deficiency?

Answer 41

Prolonged effect of suxamethonium

Question 42

Test for neural tube defects?

Answer 42

Maternal serum alpha fetoprotein

Question 43

Test for meningitis?

Answer 43

Increased white blood cells

Question 44

Test for subarachnoid haemorrhage?

Answer 44

Xanthocromia

Question 45

Test for multiple sclerosis?

Answer 45

Oligoclonal banding

Question 46

Test for Alzheimer’s

Answer 46

Elevated tau and low Abeta42

Question 47

Test for drippy nose?

Answer 47

Beta transferrin

Question 48

Test for hypoxia brain injury?

Answer 48

Neuron specific enolase

Question 49

Test for encephalitis

Answer 49

Increased white blood cells

Question 50

Test for night blindness

Answer 50

Vit a deficiency in blood

Question 51

Drug monitoring for epilepsy?

Answer 51

Phenytoin

Question 52

Drug monitoring for bipolar disorders

Answer 52

Lithium