Chapter 3 - Data Interpretation Flashcards by David Wheeler

3 causes of microcytic anaemia?

Iron deficiency anaemia

Thalassaemia
Sideroblastic anaemia

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4 causes of normocytic anaemia?

Anaemia of chronic disease + acute blood loss

Haemolytic anaemia
Renal failure (chronic)

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5 causes of macrocytic anaemia?

B12/folate deficiency + excess alcohol + liver disease

Hypothyroidism
Haem disease beginning with ‘M’ - myeloproliferative, myelodysplastic, multiple myeloma

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3 causes of high neutrophils?

Bacterial infection

Tissue damage (inflam/infarct/malig)
Steroids

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4 causes of low neutrophils?

Viral infection + clozapine + carbimazole

Chemo/radiotherapy

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3 causes of high lymphocytes?

Viral infection

Lymphoma, CLL

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3 causes of reduced production-related low platelets?

Drugs (e.g. penicillamine) + infection + haem ‘M’s

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5 causes of increased destruction low platelets?

HEPARIN
Hypersplenism, DIC, ITP, HUS/TTP

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Causes of high platelets?

Reactive = bleeding, tissue damage, postsplenectomy
Primary = myeloproliferative disorders

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3 causes of hypovolaemic hyponatraemia?

Fluid loss (D+V) + diuretics (any)

Addison’s

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3 causes of euvolaemic hyponatraemia?

SIADH, psychogenic polydipsia, hypothyroidism

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5 causes of hypervolaemic hyponatraemia?

Heart + renal failure

Liver failure/nutritional failure (both = hypoalbuminaemia), thyroid failure

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Causes of SIADH?

SIADH
- Small cell lung tumour
- Infection
- Abscess
- Drugs
- Head injury

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Drugs that cause SIADH?

Carbamazepine + antipsychotics

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Causes of hypernatraemia?

All D’s
- dehydration
- drips (excess IV saline)
- drugs
- diabetes insipidus

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Causes of hypokalaemia + mnemonic?

DIRE
- Drugs (loop + thiazide diuretics)
- Inadequate intake/Intestinal loss (D+V)
- Renal tubular acidosis
- Endocrine Excess (Cushing’s, Conn’s)

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Causes of hyperkalaemia + mnemonic?

DREAD
- Drugs (K-sparing diuretics, ACEi’s/ARBs)
- Renal failure
- Endocrine (Addison’s)
- Artefact (clotted sample)
- DKA

Method to distinguish between pre-renal, renal, and post-renal causes of AKI?

Pre-renal - urea rise&raquo_space; creatinine rise
Renal - creatinine rise&raquo_space; urea rise with no palpable bladder/kidney
Post-renal - creatinine rise&raquo_space; urea rise with palpable bladder/kidney (hydronephrosis)

Causes of pre-renal AKI?

Dehydration/shock (hypovolaemia)
Renal artery stenosis (triggered by NSAIDs/ACEi’s/ARBs)

Causes of renal AKI?

INTRINSIC
- Ischaemia (secondary to pre-renal)
- Nephrotoxic antibiotics
- Tablets (ACEi’s, NSAIDs)
- Radiological contrast
- Negatively birefringent crystals (gout)
- Syndromes (glomerulonephritides)
- Inflammation (vasculitis)
- Cholesterol emboli

Nephrotoxic antibiotics?

Gentamicin, vancomycin, tetracyclines

Causes of post-renal AKI?

In lumen = stone, sloughed papilla
In wall = tumour (renal cell, transitional cell), fibrosis
External pressure = BPH, prostate cancer, lymphadenopathy, aneurysm

Non-liver causes of raised ALP?

ALKPHOS
- any fracture
- liver damage (post-hepatic)
- Kancer (lol)
- Paget’s & Pregnancy
- HyperPTH
- Osteomalacia
- Surgery

How to distinguish between pre-hepatic, intrahepatic, and post-hepatic liver damage?

Pre-hepatic = only bilirubin rise
Intrahepatic = bilirubin + transaminases rise
Posthepatic = bilirubin + ALP rise (cholestatic/obstructive picture)

Causes of prehepatic LFT derangement/jaundice?

Haemolysis Gilbert's/Crigler-Najjar syndromes

Causes of intrahepatic LFT derangement/jaundice?

Hepatitis + cirrhosis + fatty liver Malignancy Metabolic (Wilson's, haemochromatosis) Heart failure causing hepatic congestion

Causes of posthepatic LFT derangement/jaundice?

In lumen = stone (gallstone), drugs causing cholestasis In wall = tumour (cholangiocarcinoma), PBC/PSC Extrinsic pressure = pancreatic/gastric cancer, lymphadenopathy

Drugs that cause hepatitis/cirrhosis?

Paracetamol overdose Statins Rifampicin

Drugs that cause cholestasis?

Flucloxacillin + Co-amoxiclav Nitrofurantoin Steroids Sulphonylureas

Method for changing dose of levothyroxine?

Use TSH level If <0.5 = decrease dose If 0.5-5 = keep same dose If >5.5 = increase dose Always increase/decrease by smallest increment provided unless grossly hypo/hyperthyroid

6 drugs with a narrow therapeutic index?

Digoxin Theophylline Lithium Phenytoin Gentamicin + Vancomycin

3 treatments for drug toxicity?

Omit drug (+/- alternative if required) Supportive measures e.g. IV fluids Give antidote (if available)

Confusion, nausea, visual halos, arrhythmia - toxicity of which drug?

Digoxin

Early = coarse tremor, intermediate = tiredness, late = arrhythmias, seizures, coma, renal failure, diabetes insipidus - toxicity of which drug?

Lithium (fine tremor in chronic use)

Gum hypertrophy, ataxia, nystagmus, peripheral neuropathy, teratogenicity - toxicity of which drug?

Phenytoin

Gentamicin and vancomycin cause which toxicities?

Ototoxicity + nephrotoxicity

2 main dosing regimens for gentamicin?

Most patients = high-dose regimen = 5-7mg/kg OD IV Renal failure = divided daily dosing = 1mg/kg 12hrly (renal failure) or 8hrly (endocarditis)

When should gentamicin be measured for monitoring?

6-14 hours after the last dose (says on the nomogram anyway)

Brand name of prothrombin complex concentrate?

Beriplex

Substance name of vitamin K?

Phytomenadione