Plama Proteins - High - Low Acute phase proteins M Protein

Albumin - High: dehydration - Low: malabsorption, liver fail, nephrotic, burns CRP and ESR - Liver prod in inflam/infect - Raised ESR but normal CRP in SLE, Myeloma M protein: - Paraprotein seen in Myeloma - Serum free light chains and urinary Bence Jones can be seen

Data interpretation Flashcards by francois prinsloo

Causes of hyponatraemia

Hypovolaemic: Addison’s (Low Aldosterone = Low Na and H2O reabsorption)

Euvolaemic: SIADH (Inc water retention, Urine high osmolality), H2O toxicity (Urine osmolality under 100 - v dilute)

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Potassium (think intake, shift, loss)

Causes hypo

Causes hyper

Hypokalaemia

Low intake (eating disorder, alcohol)
Shift into cells (alkalosis, drug - salbutamol, refuting syndrome)
Loss: GI (D&V), Renal (diuretics, hypomagneisa, hyperaldosteronism - Conn’s, Cushings)

Hyperkalaemia

IV fluids (Hartmanns)
Shift out of cells (acidosis, swapped for H+), Tissue damage
Reduced loss: kidney disease, drugs (ACEi/ARB), Addisons

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Measures of renal fucntion

Creatinine (beware in bodybuilders - Cr prod by muscle)
Urea (from protein)
eGFR (using creatinine/sex/age)

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Bone profile

Osteoporosis
Malacia
Pagets
mets
Primary hyperparathyroidism

Ca, PO4, ALP

N,N,N
L,L,H
N,N,H
H,H,H
H,L,H

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Causes of hypocalcaemia

Vit D def
Renal failure (low active Vit D)
Hypopara
Hypomagnesia

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Causes of hypercalcemia

Primary Hyperparathyroid
Cancer (mets, myeloma)
Sarcoidosis (granuloma cAMP mediated Ca release)
Thiazide diuretics

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Useful tests for hypocalcaemia

Vit D
U&E
Mg
PTH

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Magnesium

low
link

Poor intake/alc/malabsorption

Shifts into cells (treat DKA, referring)

Loss (diarrhoea, diuretics)

Hypomagnesia and Hypokalaemia are linked

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LFTs

Eg
Which are non-specific
Raised in hepatocellular damage
Billiary outflow block

AST, ALT, Bilirubin, GGT, ALP, Albumin

AST - muscle ALP - bone

AST+ALT

ALP+GGT

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What is seen in failing liver?

Poor synthetic = low albumin, raised INR

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Iron studies

TIBC (transferrin sats)
Serum Iron
High ferritin

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Compensation for metabolic acidosis

Inc resp rate

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Compensation for respiratory acidosis

Inc in bicarbonate

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Compensation speeds

Resp compensation = quick

Metabolic compensation = days

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Causes of:

Resp acidosis
Resp alkalosis
Metabolic acidosis
Metabolic alkalosis

Pneumonia, oedema, Pulmonary fibrosis, PE, COPD

Hyperventilation always

Calculate anion gap (normal = bicarb loss - diarrhoea or RTA, High excess acid - ketoacidoiss, lactic acidosis, renal failure)

Vomiting, hypercalcemia, hyperaldosteronism

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Causes of resp failure

T1 things that block O2 = pulmonary oedema, pulmonary fibrosis, pneumonia, PE

T2 affect blow off = COPD, muscle weakness, resp centre depression

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Enzymes as markers:

Amylase
Lipase
CK
LDH

Amylase: Pancreas and salivary glands
Raised - acute pancreatitis, pancreas Ca, salivary gland disease (mumps, tumour), DKA, morphine.

Lipase
More specific for pancreas

CK
From damaged skeletal muscle
Elevated in:
- Muscle disease (rhabdo, dystrophy, polio, excercise)
- Statins, antipsychotics

LDH
Elevated in haemolysis

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Plama Proteins

High
Low

Acute phase proteins

M Protein

Albumin

High: dehydration
Low: malabsorption, liver fail, nephrotic, burns

CRP and ESR

Liver prod in inflam/infect
Raised ESR but normal CRP in SLE, Myeloma

M protein:

Paraprotein seen in Myeloma
Serum free light chains and urinary Bence Jones can be seen

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Lipid profile

Total cholesterol
HDL
Triglycerides

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Common causes of dyslipidaemia

High total cholesterol, high LDL

FH (hypercholesterol)
Alcohol
DM
Hypothyroid
Liver disease
Obestiy

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Troponin
- Time frame
- Causes
bHCG

Can be seen from 2h -> 7 days

MI, Congestive HF, PE, Sepsis, Myocarditis

(CK, ASR and Lactate dehydrogenase also high following MI)

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Tumour markers

Panc
Ovarian
Prostate
Medullary thyroid
Liver/Testicular (teratoma)
Testes - Seminoma

Ca19-9

Ca-125, bHCG

PSA

Calcitonin

AFP

bHCG

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Albumin Creatinine Ratio. What does this show if high?

Proteinuria

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How to differentiate Pre-renal AKI from ATN

Pre-renal has Low urinary Na and urine concentrated (due to RAAS activation)

in ATN there is high urinary NA and dilute urine

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Pleural Fluid analysis - Unilateral Vs Bilateral - When is pH low - Causes of transudates - Causes of exudates

Uni - exudate Bi - Transudate pH low in Empyema Trans:Congestive HF, Liver fail, nephrotic, hypoalbuminaemia (nutritional) Exudates: Pneumonia, PE, pancreatitis, infection, malignancy, TB, sarcoid

Peritoneal fluid - Causes of transudates - Causes of exudates - High WCC?

Trans: cirrhosis (portal HTN, Congestive HF, hypoalb, nephrotic Ex: Male, pancreatitis SBP

Abnormalities seen in Para OD

Elevated liver enzymes (AST/ALT) Elevated Prothombin time (impaired synthesis) Impaired Kidneys (high Urea, Cr) High anion gap acidosis

Para OD Tx

N-acetylcysteine May cause anaphylaxis

Salicylate OD - Pres - Ix - Tx

Stim resp centre Resp alkalosis + metabolic acidosis (salicylic acid) ABG Sodium bicarbonate

TCA OD - Ix - Tx

ECG: Broad QRS, Tall R Sodium bicarb for arrhythmia Benzo for seizures

Surgical Sieve VITAMIN DIC

``` Vascular Inflammatory Trauma Autoimmune Metabolic Infection Neoplastic ``` Degenerative Idiopathic Congenital

Causes of high prolactin

Physiological: preg Pituitary tumour Antipsychotics/antiemetics (D2 block) Hypothyroidsim PCOS

Conns Signs

HTN HypoK HyperNa

RBC: Microcytic

IDA, sideroblastic, thalassaemia (rhymes with anaemia), chronic disease

RBC: Macrocytic

B12, folate, alcohol, reticulocytosis, aplastic anaemia, myeloproliferative disorders

Normocytic anemia causes

Blood loss, marrow infiltration, chronic disease, haemolytic

Evidence of Haemolysis

High LDH, high bilirubin, low haptoglobin, high reticulocytes, anaemia

Causes of Neutrophilia | Neutropeni

Bacterial infection, Malignancy Chemo/Radio, Felty's

Causes of pancytopenia

Aplastic anaemia, BM infiltration, hypersplenism, Sepsis, SLE

Auer rods in blood assoc

CML, ALL

Coal tests

PT (1972 - VitK/Liver), INR (Comparison of PT between labs), APTT (Intrinsic = factors except VII) Target INR = 2.5 for all, recurrent DVT/Mechanical valve - 3.5

PT, APTT, Fibrinogen Warfarin Heparin Haemophilia Liver disease DIC

PT, APTT, Fibrinogen ``` Warfarin - HNN Heparin - NHN Haemophilia - NHN Liver disease - HHN (synthetic of all factors) DIC - HHL ```

Churg strauss small vessel vasculitis antibodies

pANCA | MPO

Wegners antibodies

cANCA | Proteinase 3

Genetic disease E.g's - AD - AR - XR

- AD: ADPKD, huntingtons, Marfans, NF, tuberous sclerosis (tumours in vital organs) - AR: CF (CFTR), Haemochromatosis (HFE), Wilsons, Thalassaemia - XR: Duchenne/Becker Muscular dystrophy, Haemophilia A/B, G6PDD

Coombs test

Antibodies against RBC

CXR: - White - Black - Grey

Bone Gas Soft tissue

AXR: Indication

Obstruction to bowel | Renal calculi

CT head indication

Decreased GCS Suspected skull fracture (CSF leak) Focal neurology Seizure

When is Contrast CI

Renal impairment

Predisposing factors to pneumothorax

Asthma COPD CF Pulmonary Fibrosis

Lines and dots on CXR (Reticulonodular shadowing)

Pulmonary fibrosis

Upper lobe fibrosis causes: ESCHART

``` EAA Sarcoid Coal Histiocytosis Ank Spond Radiation TB ```

Lower lobe fibrosis: RASCO

``` RA Asbestosis Sclerodera Sryptogenic Other: drug (amiodarone ```

Unilateral pleural effusion

Exudates Malig, PE, Pneumonia, RA

Pulmonary oedema causes

``` HF Acute MI ARDS Renal failure Aggressive fluids ```

Bat Wing cause on CXR

Perihilar consolidation e.g. in acute pulmonary oedema due to HF

HF CXR (ABCDE

Alveolar oedema Kerley B line/ Batwing Cardiomegaly Distension of venous system Effusion

What is bright on diffusion weight MRI

Stroke (diffusion restriction)

CXR Mitral valve disease

Prominent L atrial appendage LA enlargement Cardiomegaly

CXR bronchial Ca

``` Pulmonary mets Effusion Consolidation/pneumonia Lung collapse Boney mets HIlar LN ```

Caveatting lung lesion DDx

``` TB Pneumonia Squam cell ca Abscess Vascular (Wegner's - cANCA) Rheumatoid nodule ```

Hetrogenous ring enhancing cerebral mass

Glioma - astrocytoma - glioblastoma multiforme

Ischaemic bowel AXR

Free pass in abdo, gas in bowel wall

Perforation AXR

Gas in peritoneal space (always pathological

What is P-mitrale and when is it seen

Mitral stenosis Bifid P-wave

Normal length QRS

0.12-0.3 (3-5 small sq)

FEV1 in obstructive Vs Restrictive

Obs: under 0.7 Restrict: over 0.8

Urinalysis: ``` Bilirubin Blood Glucose Ketones Leukocytes Nitrites pH Protein Specific gravity Urobilinogen ```

``` Bilirubin: liver disease Blood: Glomerular damage, menstruation (contamination) Glucose: DM Leukocytes: UTI Nitrites: UTI pH: RTA Protein: Glomerular damage, Bence Jones Urobilinogen: Liver disease, haemolysis ```

LP - bacterial - viral - SAH

Bacterial: - high protein and WCC - Low glucose - Turbid Viral - normal protein, - leukocytosis - Glucose low/normal - Clear Xanthochromia

QRisk3

Risk MI/Stroke in next 10 years - Age - Ethnic group - Postcode - Other Hx (smoking, RA, Angina etc)

FRAX

Fracture risk

When to secure airway according to GCS

under 8

Causes of postural hypotension

``` Idiopathic Dehydration Drug (diuretics/vasodilation) Autonomic neuropathy (DM) MS ```

SIADH Na, Serum Osmolality, urine osmolality,

Low serum Na Low serum osmolality High urine osmolality

Low sodium in urine + AKI =

Prerenal cause