Data interpretation

Question 2

Hypernatraemia causes

Answer 2

“D”

dehydration
drugs - effervescent tablets or IV with high sodium
drips - IV saline
diabetes insipidus

Question 3

causes of microcytic anaemia

Answer 3

iron deficiency
thalassaemia
sideroblastic anaemia

Question 4

normocytic anaemia

Answer 4

chronic disease
acute blood loss
haemolytic anaemia
renal failure

Question 5

macrocytic anaemia

Answer 5

B12 and folate
excess alcohol
liver disease
hypothyroidism
M haem - myeloproliferative, myelodysplastic, myeloma

Question 6

high neutrophils

Answer 6

bacterial infection
tissue damage (inflammation, infarct, malignancy)
steroids

Question 7

low neutrophils

Answer 7

viral infection
chemo or radiotherapy
clozapine
carbimazole

Question 8

high lymphocytes

Answer 8

viral infection
lymphoma
CLL

Question 9

low platelets

Answer 9

reduced production: infection viral, drugs like penicillamine, myelodysplasia, myelofibrosis, myeloma

reduced destruction: heparin, hypersplenism, DIC, ITP, haemolytic uraemia syndrome, thrombotic thrombocytopenia purpura

Question 10

high platelets

Answer 10

reactive: bleeding, tissue damage, post-splenectomy

primary: myeloproliferative

Question 11

hyponatraemia: hypovolaemia

Answer 11

fluid loss D+V
Addisons
diuretics

Question 12

hyponatraemia: euvolaemia

Answer 12

SIADH
psychogenic polydipsia
hypothyroidism

Question 13

hyponatraemia: hypervolaemic

Answer 13

HF
RF
LF - hypoalbuminaemia
nutritional value - hypoalbuminaemia
thyroid failure (hypo can be euvolaemic too)

Question 14

SIADH causes

Answer 14

Small cell LC
Infection
Abscess
Drugs: carbamazepine, antipsychotics
Head injury

Question 15

hypokalaemia

DIRE

Answer 15

Drugs: loop and thiazide
Inadequate intake or intestinal loss D+V
Renal tubular necrosis
Endocrine (cushings or conns)

Question 16

hyperkalaemia

DREAD

Answer 16

Drugs: potassium sparing diuretics, ACEi
Renal failure
Endocrine: Addisons
Artefact: haemolysed sample
DKA

Question 17

raised urea

Answer 17

kidney injury
upper GI bleed as blood broken down and absorbed
big bloody steak

raised urea with normal creatinine in not dehydrated - check Hb

Question 18

raised Alkaline phosphatase

ALKPHOS

Answer 18

Any fracture
Liver damage
Kancer
Paget’s disease of bone and Pregnancy
Hyperparathyroidism
Osteomalacia
Surgery

Question 19

what does raised bilirubin indicate?

Answer 19

pre hepatic jaundice causes

• haemolysis
• gilberts syndrome

Question 20

What might a bilirubin raise with associated AST/ ALT raise indicate?

Answer 20

intrahepatic liver damage

fatty liver, hepatitis, cirrhosis, malignancy, Wilsons disease, haemachromatosis, heart failure causing hepatic congestion

Question 21

what might a raised bilirubin and raised ALP suggest?

Answer 21

post hepatic - obstructive jaundice

in lumen: stone, drugs

wall: tumour, primary biliary cirrhosis, sclerosing cholangitis

extrinsic: pancreatic or gastric cancer, lymph node

Question 22

what are some drugs that cause cholestasis?

Answer 22

like fluclox, co-amox, nitrofurantoin, steroids and suphonylureas

Question 23

what are some drugs that may cause hepatitis or cirrhosis?

Answer 23

paracetamol
statins
rifampicin

Question 24

signs of pulmonary oedema

ABCDE

Answer 24

Alveolar oedema (bat wings)
B- lines Kerley (interstitial oedema)
Cardiomegaly
Diversion of blood to upper lobes (upper zone vessels larger than in lower zone)
Effusions

Question 25

respiratory alkalosis causes

Answer 25

rapid breathing - disease or anxiety

Question 26

respiratory acidosis causes

Answer 26

type 2 resp failure causes COPD, drug overdose, chest wall abnormalities, neuromuscular etc

Question 27

metabolic alkalosis causes

Answer 27

vomiting diuretics conns

Question 28

metabolic acidosis

Answer 28

lactic acidosis DKA renal failure ethanol, methanol

Question 29

what are some common drugs with narrow therapeutic indexes and require monitoring?

Answer 29

digoxin theophylline lithium phenytoin gentamicin vancomycin

Question 30

digoxin toxicity

Answer 30

confusion nausea visual halos arrhythmias

Question 31

lithium toxicity

Answer 31

early - tremor intermediate - tiredness late - arrhythmia, seizures, coma, renal failure, diabetes insipidus

Question 32

phenytoin toxicity

Answer 32

gum hypertrophy ataxia nystagmus peripheral neuropathy teratogenicity

Question 33

gentamicin toxicity

Answer 33

ototoxicity nephrotoxicity

Question 34

vancomycin toxicity

Answer 34

ototoxicity nephrotoxicity

Question 35

how is gentamicin monitored?

Answer 35

- levels measured 6-14h after infusion started - use nomogram to plot and determine if dosing intervals need changing - if point on nomogram rests above q48h, repeat gentamicin level and re-dose when conc is <1mg/L

Question 36

what causes liver damage in paracetamol overdose?

Answer 36

accumulation of toxic NAPQI which depletes glutathione levels which NAC replenishes -> reducing NAPQI formation

Question 37

what is the normal target INR for patients on warfarin?

Answer 37

2.5 unless recurrent VTE while on it then 3.5 higher than 2.5 in metal valve replacement patients

Question 38

what to do in major bleed while on warfarin?

Answer 38

stop warfarin give 5-10mg IV vitamin K dried prothrombin complex (beriplex)

Question 39

what to do if INR 5-8? a) with minor bleed b) without bleed

Answer 39

a) omit warfarin and give 1-5mg IV vitamin K b) omit warfarin for 2 days and reduce dose

Question 40

what to do if INR >8?

Answer 40

no bleed- omit warfarin and give 1-5mg PO vitamin K minor bleed - omit warfarin and five 1-5mg vitamin K IV!!