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Year 5 - PSA > Data interpretation > Flashcards

Data interpretation Flashcards

1
Q

Q3.1

A

Stop
- clozapine - agranulocytosis
- propanolol and ibuprofen - CI in asthmatics

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2
Q

Causes of microcytic anaemia
1. Most common
2. TAILS

A

Most common - IDA

T – Thalassaemia
A – Anaemia of chronic disease
I – Iron deficiency anaemia
L – Lead poisoning
S – Sideroblastic anaemia

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3
Q

Causes of normocytic anaemia
1. Most common
2. 3A2H

A

Most common: anaemia of chronic disease and acute blood loss

A – Acute blood loss
A – Anaemia of Chronic Disease
A – Aplastic Anaemia
H – Haemolytic Anaemia
H – Hypothyroidism

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4
Q

Macrocytic anaemia
1. Most common
2. Megaloblastic
3. Normoblastic

A
  1. B12 deficiency/ folate deficiency
    Excess alcohol
    Liver disease (non-alcoholic causes included)
  2. B12 deficiency/ folate deficiency
  3. Alcohol
    Reticulocytosis (usually from haemolytic anaemia or blood loss)
    Hypothyroidism
    Liver disease
    Drugs such as azathioprine
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5
Q

Neutrophilia causes

A

MC: Bacterial infection
- tissue damage
- steroids

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6
Q

Neutropenia

A

MC: Viral infection, clozapine, carbimazole

  • chemo/radiotherapy
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7
Q

Lymphocytosis

A

MC: Viral infection

  • Lymphoma
  • Chronic lymphocytic leukemia
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8
Q

Neutropenic sepsis

A

Patient on anti-cancer or immunosuppressant treatment gets neutropenia <1

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9
Q

Thrombocytopenia

A

M/C: Drugs e.g. penicillamine and heparin

  • Reduced production: infection, drugs e.g. penicillamine, myelodysplasia, myelofibrosis, myeloma
  • Reduced destruction: heparin, hypersplenism, DIC, ITP, haemolytic uremic syndrome
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10
Q

Hyponatraemia
1. Hypovolaemic
2. Euvolaemic
3. Hypervolaemic

A
  1. M/C: fluid loss (esp. diarrhoea and vomiting) + diuretics (any type)
    - Addison’s
  2. SIADH, psychogenic polydipsia, hypothyroidism
  3. M/C: HF, renal failure
    - liver failure, nutritional failure (both causing hypoalbuminaemia)
    - Thyroid failure (hypothyroidism, can be euvolaemic too)
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11
Q

Causes of SIADH

A

S mall cell lung tumours
I nfection
A bscess,
D rugs (especially carbamazepine and antipsychotics)
H ead injury

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12
Q

Causes of hypernatraemia (4Ds)

A

Dehydration
Drips (too much saline)
Drugs
Diabetes insipidus

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13
Q

Hypokalaemia (DIRE)

A

M/C: Drugs (loop and thiazide diuretics)

Inadequate intake or intestinal loss (e.g. vomiting/diarrhoea)
Renal tubular acidosis
Endocrine (Cushing’s and Conn’s)

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14
Q

Hyperkalaemia (DREAD)

A

M/C: Drugs (K+ sparing diuretics and ACE-i)

Renal failure
Endocrine (Addison’s disease)
Artefact (v common, due to clotted sample
DKA

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15
Q

What can a raised urea be a sign of?

A

AKI and upper GI bleed

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16
Q

Why is urea raised in upper GI bleed

A

Urea is a breakdown product
of amino acids (such as globin chains in haemoglobin) (blood broken down by gastric juice and urea absorbed)

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16
Q
  1. What to do if raised urea but normal creatinine in a patient who is not dehydrated (i.e. does not have prerenal failure)
A

Check Hb –> if low, possible GI bleed

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17
Q

Types of AKI

A
  1. Pre-renal (70%)
  2. Intrinsic (10%)
  3. Post-renal (i.e. obstructive, 20%)
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18
Q

Pre-renal AKI (70%)
1. Biochemical disturbance
2. Causes

A
  1. Urea rise&raquo_space; creatinine rise
    • Dehydration (or if severe, shock) of any cause, e.g. sepsis, blood loss.
      - Renal artery stenosis (RAS)∗
19
Q

Intrinsic AKI (10%)
1. Biochemical disturbance
2. Causes (INTRINSIC)

A
  1. Urea rise «creatinine rise, bladder or hydronephrosis not palpable
  2. M/C: N + T

I schaemia (due to prerenal AKI, causing acute tubular necrosis)
N ephrotoxic antibiotics ∗∗
T ablets (ACEI, NSAIDs)
R adiological contrast
I njury (rhabdomyolysis)
N egatively birefringent crystals (gout)
S yndromes (glomerulonephridites)
I nflammation (vasculitis)
C holesterol emboli

20
Q

Post-renal AKI (20%)
1. Biochemical disturbance
2. Causes (lumen, wall, external pressure)

A
  1. Urea rise «creatinine rise, bladder or hydronephrosis may be palpable
  2. In lumen: stone or sloughed papilla

In wall: tumour (renal cell, transitional cell), fibrosis

External pressure: benign prostatic hyperplasia, prostate cancer, lymphadenopathy, aneurysm

21
Q

Note regarding differentiating severe pre-renal AKI with high creatinine and intrinsic/obstructive AKI

A

multiply the urea by 10; if it exceeds the creatinine (showing a relatively greater increase in urea compared to creatinine) then this suggests a pre-renal aetiology.

22
Q

Nephrotoxic antibiotics

A

Gentamicin, vancomycin and tetracyclines

23
Q

How is AKI usually triggered in renal artery stenosis

A

ACE-i or NSAIDs

24
Q

Liver function: markers of hepatocyte injury or cholestasis

A
  • bilirubin
  • alanine aminotransferase (ALT) and the less commonly measured
    aspartate aminotransferase (AST)
  • alkaline phosphatase (alk phos or ALP).
25
Q

Liver function: synthesis markers

A
  • albumin
  • vitamin K-dependent clotting factors (II, VII, IX and X) measured via prothrombin time (PT)/international normalized ratio (INR).
26
Q

What would a raised bilirubin on its own indicate?

A

A raised bilirubin on its own indicates prehepatic jaundice
(Same as single raised urea indicates pre-renal injury)

bilirubin is a breakdown product of haemoglobin, think haemolysis

27
Q

Common causes of a raised Alk Phos (ALKPHOS)

A

Any fracture
Liver damage (posthepatic)
K (for kancer)
Paget’s disease of bone and Pregnancy
Hyperparathyroidism, Osteomalacia, and Surgery.

28
Q

Deranged LFTs: pre-hepatic
1. Biochem
2. Causes

A
  1. Single raised bilirubin
  2. M/C: Haemolysis
  • Gilbert’s and Crigler-Najjar syndromes
29
Q

Deranged LFTs: intra-hepatic
1. Biochem
2. Causes

A
  1. Raised bilirubin AND raised AST/ALT
  2. M/C: hepatitis, cirrhosis, malignancy
  • Fatty liver
  • Metabolic (Wilson’s disease/haemochromatosis)
  • HF (causing hepatic congestion)
30
Q

Deranged LFTs: post-hepatic (obstructive)
1. Biochem
2. Causes (in lumen, in wall, ext pressure)

A
  1. Raised bilirubin AND raised ALP

2.M/C: Gallstones, drugs causing cholestasis, gastric/pancreatic cancer

In lumen: gallstones, drugs causing cholestasis

In wall: tumour (cholangiocarcinoma), PBC, sclerosing cholangitis

Ext pressure: pancreatic or gastric cancer, lymph node

31
Q

Common causes of hepatitis and cirrhosis

A

(1) alcohol
(2) viruses (Hepatitis A–E, CMV, and EBV)
(3) drugs (paracetamol overdose, statins, rifampicin)
(4) autoimmune (primary biliary cirrhosis, primary sclerosing
cholangitis, and autoimmune hepatitis).

32
Q

Drugs causing cholestasis

A

Flucloxacillin
CO-AMOXICLAV
nitrofurantoin
steroids
sulphonylureas

33
Q

TFTs: Low T4, high TSH
1. Type of hypothyroidism
2. Cause

A
  1. Primary hypothyroidism (low T4 causes high TSH)
  2. Hashimoto’s thyroiditis, drug-induced hypothyroidism
34
Q

TFTs: Low T4, low TSH
1. Type of hypothyroidism
2. Cause

A
  1. Secondary hypothyroidism (low TSH from pituitary causes low T4)
  2. Pituitary tumour or damage
35
Q

TFTs: High T4, low TSH
1. Type of hypothyroidism
2. Cause

A
  1. Primary hyperthyroidism (high T4 causes low TSH)
  2. Grave’s disease, toxic nodular goitre, drug-induced
36
Q

TFTs: high T4, high TSH
1. Type of hypothyroidism
2. Cause

A
  1. Secondary hyperparathyroidism (high TSH from pituitary causes high T4)
  2. Pituitary tumour
37
Q

How to interpret and change levothyroxine dose following TFT results (TSH range mIU/L)

A

<0.5 Decrease dose

0.5–5 Nil action – same dose

> 5 Increase dose

38
Q

Digoxin toxicity

A

Confusion, nausea, visual halos, and arrhythmias

39
Q

Lithium toxicity

A

Early: tremor
Intermediate: tiredness
Late: arrhythmias, seizures, coma, renal failure, and diabetes insipidus

40
Q

Phenytoin toxicity

A

Gum hypertrophy, ataxia, nystagmus, peripheral neuropathy, and teratogenicity

41
Q

Gentamicin/vancomycin toxicity

A

Ototoxicity and nephrotoxicity

42
Q

Paracetamol metabolism and overdose

A

Metabolised by glutathione
In excess, glutathione is depleted and NAPQI builds up (toxic) –> acute liver damage

43
Q

Which are the vitamin K-dependent clotting factors

A

II, VII, IX, and X

44
Q

Warfarinised patients: what to do in major bleed

A
  • stop warfarin
  • give 5–10 mg IV phytomenadione (vitamin K)
  • give prothrombin complex (e.g. Beriplex®)

https://bnf.nice.org.uk/treatment-summaries/oral-anticoagulants/#vitamin-k-antagonists

45
Q

Drugs that cause hyponatraemia

A

Carbamazepine, diuretics, SSRIs (esp citalopram), Antipsychotics (esp

Year 5 - PSA (10 decks)

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