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Chem Path Flashcards

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1
Q

Osmolarity=

A

2(Na + K) + Urea + Glucose

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2
Q

Osmolar gap=

A

Osmolality (measured) - Osmolarity (calculated)

Normal less than 2

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3
Q

Anion Gap=

A

(Na + K) - (Cl +HCO3)

Normal= 14-18

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4
Q

Normal range of Na

A

135-145

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5
Q

Hyponatraemia Sx

A

N+V
Confusion
Seizures
Coma

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6
Q

True Hyponatraemia

A

Low osmolality

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7
Q

Causes of True Hyponatraemia

A

Hypervolaemic - Organ failure (CCF, Cirrhosis, Neophrotic)
Euvolaemic - Endocrine (HoTy, Adrenal insuf., SIADH)
Hypovolaemic - Loss (D+V, Salt losing neph., Diuretics)

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8
Q

Differentiating causes of Hypovolaemic HoNa

A

Urinary Na >20= renal (diuretic, Addison’s, Salt losing neph.)
Urinary Na less than 20= non renal (D+V)

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9
Q

SIADH feats

A

True, euvolaemic HoNa w/ Urinary Na >20
Urine osm >100! (usually > serum osm)
No adrenal, renal or thyroid dysfunction

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10
Q

Hypernatraemia Sx

A

Thirst
Confusion
Seizures + ataxia
Coma

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11
Q

Hypernatraemia causes

A

Hypovolaemic
Euvolaemic
Hypervolaemic

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12
Q

Hypovolaemic HyperNa causes

A 
GI loss (D+V)
Skin loss (sweating, burns)
Renal loss (loop diuretics, osmotic diuresis, renal disease)
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13
Q

Euvolaemic HyperNa causes

A 
Resp loss (tachypnoea)
Skin loss (sweating, fever)
Renal loss (Diabetes insipidus)
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14
Q

Hypervolaemic HyperNa causes

A 
Mineralocorticoid excess (Conn's)
Hypertonic saline infusion
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15
Q

Diabetes insipidus

A

Polyuria, polydipsia + dilute urine (osm less than 2)

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16
Q

8 hour fluid deprivation test

A

Normal - Concentrate urine >600 osm/kg
Primary polydipsia - Concentrate urine >400-600
Cranial DI - Concentrate urine after desmopressin
Nephrogenic DI - No urine concentration

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17
Q

Potassium normal range

A

3.5-5

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18
Q

Hypokalaemia causes

A 
GI loss (vomiting)
Renal loss (hyperaldosteronism, excess cortisol, osmotic diuresis)
Redistribution into cells (insulin, alkalosis)
Rare (Tubular acidosis T1+2, Bartter's, Liddle's, Gitelman's)
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19
Q

Hyperkalaemia causes

A 
Excessive intake (oral, parenteral, blood transfusion)
Transcellular movement (acidosis, insulin shortage, tissue damage/catabolic state)
Decreased excretion (ARF, CRF, Sprionolactone, Addison's NSAIDs, ACEi)
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20
Q

Adult maintenance fluid requirement

A

25-30ml/kg/day

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21
Q

Paediatric maintenance fluid requirement

A

1st 10 kg: 100ml/kg/day
2nd 10kg: 50ml/kg/day
Each kg after: 20ml/kg/day

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22
Q

Normal serum osmolality

A

275-295

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23
Q

Causes of HoNa w/ normal osmolality

A

Spurious, Drip arm sample, PseudoHoNa (hyperlipidaemia/paraproteinaemia) - everything normal except Na + Hx of DM or metabolic synd.

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24
Q

TURP syndrome

A

Hyponatraemia from water absorbed through damaged prostate

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25
Differentiating Causes of Hypervolaemic HoNa
Urinary Na >20= Renal (ARF, CRF) | Urinary Na less than 20= Non renal (CCF, Cirrhosis)
26
Central pontine myelinosis
Pseudobulbar palsy, Paraparesis, Locked in syndrome due to Correcting HoNa too quickly Increase Na by no more than 12mmol/L in 1st 24h
27
SIADH causes
Malignancy (SCLC, pancreas, prostate, lymphoma) CNS disorders (meningoenceph., haem, abscess) Resp (TB, pneumonia, abscess) Drugs (opiates, SSRIs, Carbamazepine)
28
Addison's bloods
HypoNa, HyperK, HypoGly, Urine Na >20
29
Bartter syndrome
Autosomal recessive HypoK, Alkalosis + HoTN Hypercalciuria + Nephrocalcinosis
30
Short SynACTHen
Cortisol measured at 0, ACTH given at 30mins + Cortisol measured at 60 mins Final Cortisol less than 550= production defect
31
Long SynACTHen
1mg ACTH given and measure cortisol at 24h >900= Secondary (Pituitary problem) NB Secondary also has HypoK NOT HyperK less than 900= Primary
32
OGTT for Acromegaly
75mg Glucose should decrease GH to 2 = Acromegaly
33
Schmidst's syndrome
AI polyendocrine syndrome | Addison's, HoTy + T1DM
34
Kallman's syndrome
Hypogonadotrophic Hypogonadism | Low LH + FSH + Anosmia
35
Renal Tubular Acidosis
HypoK w/ Acidosis T1 - Distal tubule (HypoCa) T2 - Proximal Tubule (Fanconi -> HyperPhos -> Ricketts) T3 - Both T4 - Defect in adrenals (HyperK - deficiency of Aldosterone)
36
Drugs that causes nephrogenic DI
Lithium, Demeclocycline (used to Tx SIADH!)
37
Causes of conn's
``` ABCD Adrenal Adenoma Bilateral nodular hyperplasia Ca of adrenals Defective gene (GRA) ```
38
Causes of Elevated anion gap Metabolic acidosis
``` MUDPILES Methanol Uraemia DKA Propylene glycol Isoniazid Lactic acidosis Ethylene glycol Salicylates ```
39
Causes of HoNa w/ high osmolality
Glucose, Mannitol, EtOH
40
Gilbert's
Isolated unconj bili
41
Crigler-Najjar
Isolated unconj bili (more constant and severe than Gilbert's)
43
Alcoholic liver disease LFTs
``` High AST> High ALT (AST:ALT>1) High GGT (chronic) ```
43
Hepatitis LFTs
High AST=High ALT
43
Cholestatic LFTs
High GGT + ALP then Increased AST, ALT + Bili (conj)
44
NAFLD LFTs
High AST + ALT (AST:ALT less than 1) + High GGT
45
Paracetamol poisoning LFTs
V high (>1000) AST + ALT > increase in GGT + ALP
46
Alcohol abuse LFTs
Isolated GGT increase
47
Dubin Johnson LFTs
Isolated conj bili
48
HCC LFTs
High AFP + any LFT picture (therefore unlikely to be answer unless AFP given!)
49
ALP
High ALP w/ High GGT confirms liver cause | Also increases w/ bone disease (e.g. Paget's) + Pregnancy
51
Acute intermittent porphyria Ez Def
Autosomal Dominant | Porphobilinogen deaminase deficiency
52
Acute Intermittent Porphyria Sx
Abdo pain, seizures, N+V, muscle weakness, peripheral neuropathy after stress e.g. alcohol or infection No cutaneous Sx
53
Porphyria Cutanea Tarda
Uroporphyrinogen decarboxylase deficiency | Sx: Vesicles on sun exposed sites
54
X linked sideroblastic Anaemia (Type of Porphyria)
ALA Synthase deficiency
55
Congenital erythropoietic porphyria
Uroporhyrinogen synthase deficiency
56
Hereditary coproporhyria
Copropophyrinogen oxidase deficiency
57
Variegate porphyria
Protopophyrinogen oxidase deficiency
58
Erythropoietic protoporphyria
Ferrochelatase deficiency
59
Anterior pituitary hormones
``` GH TSH ACTH Prolactin LH FSH ```
60
Posterior pituitary hormones
ADH (Vasopressin) | Oxytocin
61
Ca causing Bone Mets
BLT w/ a Kosher Pickle (prostate)
62
Dexamethasone Suppresion test
No suppression = Cushing's syndrome (low ACTH- primary hypercortisolism) or Ectopic ACTH Suppression after high dose= Cushing's disease
63
Tx of Phaeo
Short acting alpha blocker then Long acting alpha blocker then Beta blocker then Surgery
64
Phenytoin toxicity
HoTN, Heart block, Ventricular Arr., Ataxia, Nystagmus
65
Digoxin toxicity
Arr., Prolonged PR, Bradycardia, Xanthopsia
66
Lithium toxicity
D+V, Dysarthria + Coarse tremor
67
Gentamicin toxicity
Tinnitus, Deafness, Nystagmus, RF
68
Theophylline toxicity
N+D, taccy, Arr., Headache, Seizure | NB Toxicity precipitated by Erythromycin and Cipro
69
Procainamide toxicity
Rash, Fever, Agranulocytosis + DI-SLE
70
Methotrexate toxicity
Hepatotoxic, Ulcerative stomatitis, Leukopoenia, Pulmonary fibrosis
71
Carbamazepine toxicity
Headaches, Ataxia, Abdo pain, SIADH + aplastic An.
72
Cyclosporine toxicity
ARF
73
Ca Normal range
2.2-2.6
74
PTH actions
1. Increase tubular Vit D 25(OH) -> Vit D 1,25(OH)2 2. Mobilise Ca from bone (increase osteoclast activity) 3. Increase renal Ca absorption + PO4 excretion
75
Calcitriol actions (1,25 (OH)2 Vit D)
Increase Ca and PO4 absorption from gut | Bone remodelling
76
Primary Hyperparathyroidism bloods
High Ca, Low PO4, High/N PTH, High/N ALP, N Vit D
77
Renal osteodystrophy (2o HyperPTy) bloods
Low Ca, High PO4, High PTH, High ALP
78
3o HyperPTy bloods
High Ca, Low PO4, High PTH, High/N ALP, N Vit D | NB Autonomous PTH secretion post renal transplant/dialysis
79
Hypoparathyroidism bloods
Low Ca, High PO4, Low PTH, N/low ALP, N Vit D
80
PseudoHoPTy bloods (Albright's osteodystrophy)
Low Ca, High PO4, High PTH | Short stature + 4th+5th metacarpals, rounded facies
81
PseudoPseudoHoTy
Feats of Pseudo (short stature, rounded facies) | Normal Bloods
82
Sx of HyperCa
``` Stones (renal) Bones (pain) Groans (Psych) Moans (abdo pain) Polyuria Muscle weakness ```
83
Sx of HypoCa
``` Perioral parasthesiae Carpopedal spasm Trousseau's sign (BP cuff) Chovstek's sign Hypereflexia Tetany ```
84
Vitamin B1 (thiamine) deficiency
Sx: Wernicke's (confusion, ataxia, ophthalmoplegia) Wet beri beri Test: RBC Transketolase
85
Vitamin B2 (riboflavin deficiency)
Sx: Stomatitis, oily skin rashes, anaemia Test: RBC Glutathione
86
Vitamin B3 (niacin) deficiency
Sx: Pellagra, Casal's necklace rash , Stomatitis, dementia, diarrhoea
87
Vitamin B5 (Pantothenic acid) deficiency
Sx: Chronic parasthesiae
88
Vitamin B7 (Biotin) deficiency
Sx: infertility and poor hair growth
89
Vitamin B9 (folate) deficiency
Sx: Megaloblastic anaemia Test: Normal MMA
90
Vitamin B12 (Cobalamin) deficiency
Sx: Megaloblastic anaemia, glossitis, Peripheral neuropathy Test: Raised MMA
91
Vitamin A (Retinol) deficiency
Sx: Dry skin, hair + cornea, Bitot's spots on conjunctiva, night blindness
92
Vitamin B6 (Pyridoxine) deficiency
Sx: Sideroblastic anaemia + seborrhoeic dermatitis Test: RBC AST Commonly due to Isoniazid
93
Vitamin C (Ascorbic acid) deficiency
Sx: Bleeding in gums, skin and joints + bone weakness
94
Vitamin E (tocopherol) deficiency
Sx: Haemolytic anaemia + spinocerebellar neuropathy (ataxia + areflexia)
95
PKU
Phenylalanine hydroxylase deficiency | Sx: Fair haired, developmental delay between 6-12 months + musty smell
96
Homocysteinuria
Cystathionine synthetase deficiency Sx: V fair skin + brittle hair, developmental delay + LD Tx: Pyridoxine + low methionine diet
97
Galactosaemia
Gal-1-PUT deficiency | Sx: after milk ingestion - poor feed, vomiting, jaundice (conj) + hepatomegaly, hypoglycaemia + sepsis
98
SCAD
Sx: FTT, hypotonia, metabolic acidosis, hyperglycaemia
99
Von Gierke's
GSD T1 Hypoglycaemia in infancy Hepatomegaly +/- splenomegaly
100
Pompe
GSD - lysosomal alpha glucosidase deficiency
101
Cori's
GSD - Amylo 1,6 glucosidase deficiency
102
McArdle's
GSD - Phosphorylase deficiency
103
Maple syrup urine disease
Impaired metabolism of leucine, isoleucine + valine causes encephalopathy Sx: Lethargy, poor feeding, hypotonia Sweet odour + Sweaty feet
104
Fabry's disease
LSD - alpha galactosidase deficiency Sx: developmental delay and dysmorphia "Cherry red spot"
105
Peroxisomal disorders
Disordered beta oxidation of VLCFA Sx: Seizures, dysmorphic, severe hypotonia + jaundice Retinopathy + large fontanelle
106
Gout exacerbating factors
``` Aspirin (other NSAIDs Tx) Chemotherapy Alcohol Psoriasis Thiazides ```
107
Glasgow pancreatitis score
``` PANCREAS PaO2 less than 9 Age >55 Neutrophilia WCC>15 Calcium less than 2 Renal failure urea>16 Ezs - LDH >600 or AST >200 Albumin less than 32 Sugar >10 ```
108
Barth Mitochondrial disorder
Presents at birth w/ Cardiomyopathy, Neutropoenia, Myopathy
109
MELAS Mitochondrial disorder
Presents age 5-15 w/ Mitochondrial Encephalopathy Lactic acidosis Stroke-like episodes
110
Kearns Sayre Mitochondrial disorder
``` Presents age 12-30 w/ CPEO Retinopathy Deafness Ataxia ```
111
Diabetes Dx
``` One test + Sx or 2 tests: Fasting glucose >7 OGTT >11.1 Random glucose >11.1 HbA1c >48 (6.5%) ```
112
Impaired glucose tolerance Dx
Fasting glucose 6.1-6.9 | Random glucose or OGTT 7.8-11.1

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