Data interpretation

Question 1

Sodium

Answer 1

Normal range: 135-145 mmol/L

• Hyponatraemia: assess patient’s fluid status (hypovolaemic, euvolaemic, hypervolaemic)
• Hypernatraemia: D’s

Question 2

Hypernatraemia

Answer 2

• Drugs = IV preparations w/ high sodium content
• Drips = too much IV saline
• Diet = too much Na
• Diabetes insipidus

Question 3

Anaemia

Answer 3

Can be categorised into macrocytic, microcytic and normocytic

• Look at Hb (if low = anaemia)
• Look at MCV (if high - macrocytic, if normal - normocytic, if low - microcytic)

Question 4

Microcytic anaemia

Answer 4

SLIT

• Sideroblastic
• Lead poisoning
• IDA
• Thalassemia

Question 5

Normocytic anaemia

Answer 5

CARDPMH

Question 6

Neutrophilia

Answer 6

• Bacterial infection
• Tissue damage (inflammation/infarct/malignancy)
• Steroids

Question 7

Neutropenia

Answer 7

• Viral infection
• Chemo/radiotherapy
• Clozapine (AP)
• Carbimazole (anti-thyroid)

Question 8

Lymphocytosis

Answer 8

• Viral infection
• Lymphoma
• Chronic lymphocytic leukaemia

Question 9

Neutropenic sepsis

Answer 9

Pts undergoing radiotherapy and/or chemotherapy are at risk of neutropenia (or pancytopenia) in response to infection
- Carries much higher mortality rate = must be given urgent IV broad spectrum abx

Question 10

Thrombocytopenia

Answer 10

1) Reduced production

2) Increased destruction

Question 11

Reduced platelet production

Answer 11

• Infection (usually viral)
• Drugs = penicillamine (RA Rx)
• Myleodysplasia, myelofibrosis, myeloma

Question 12

Increased platelet destruction

Answer 12

• Heparin
• Hypersplenism
• DIC
• ITP
• HUS/TTP

Question 13

Thrombocytosis

Answer 13

May be reactive or primary

Question 14

Reactive thrombocytosis

Answer 14

• Bleeding
• Tissue damage (infection/infarct/malignancy)
• Post-splenectomy

Question 15

Primary thrombocytosis

Answer 15

Myeloproliferative disorders

Question 16

SIADH causes

Answer 16

S = small cell lung tumours 
I = infection 
A = abscess
D = drugs (carbamazepine + APs)
H = head injury

Question 17

HyperK+ causes (DREAD)

Answer 17

D = drugs (K+ sparing diuretics, ACEI)
R = renal failure 
E = endocrine (Addison's disease)
A = artefact (v. common, clotted sample, venepuncture on for too long, taken from drip arm)
D = DKA

Question 18

HypoK+ causes (DIRE)

Answer 18

D = drugs (loop, thiazide diuretics)
I = inadequate intake/intestinal losses
R = renal tubular acidosis 
E = endocrine (Cushing's and Conn's syndrome)

Question 19

Hyponatraemia

Answer 19

• Hypovolaemic
• Euvolaemic
• Hypervolaemic

Question 20

Hypovolaemic

Answer 20

• Fluid loss (D+V)
• Addison’s disease
• Diuretics

Question 21

Euvolaemic

Answer 21

• SIADH
• Psychogenic polydipsia
• Hypothyroidism

Question 22

Hypervolaemic

Answer 22

• Heart failure
• Renal failure
• Liver failure (hypoalbuminaemia)
• Nutritional failure (hypoalbuminaemia)
• Thyroid failure

Question 23

Raised urea?

Answer 23

• Kidney injury
• Upper GI haemorrhage
• Raised urea w/ normal Cr in a patient wh is not dehydrated (no pre-renal failure) - prompt a look at Hb (if low probably due to GI bleed)

Question 24

Types of AKI

Answer 24

• Pre-renal
• Renal
• Post-renal

Question 25

Pre-renal AKI

Answer 25

- Urea rises more than Cr - Dehydration/shock and renal artery stenosis - 70%

Question 26

Renal

Answer 26

- Urea rises less than Cr rise - Bladder/hydronephrosis not palpable - Causes can be remembered as INTRINSIC - 10%

Question 27

INTRINSIC

Answer 27

``` I = Ischaemia (prerenal AKI, causing ATN) N = Nephrotoxic abx e.g. gentamycin, vancomycin, tetracyclines T = Tablets (ACEi, NSAIDs) R = Radiological contrast I = Injury (rhabdomyolysis) N = Negatively birefringent crystals (gout) S = syndromes (GN) I = Inflammation (vasculitis) C = Cholesterol emboli ```

Question 28

Post-renal

Answer 28

- Urea rises less than Cr rise - Bladder/hydronephrosis may be palpable, depending on level of obstruction - Can be due to obstruction in lumen, in wall or because of external pressure - 20%

Question 29

Post-renal AKI - luminal causes

Answer 29

- Stone | - Sloughed papilla

Question 30

Post-renal AKI - wall causes

Answer 30

- Tumour (RCC, transitional cell) | - Fibrosis

Question 31

Post-renal AKI - external pressure causes

Answer 31

- BPH - Prostate Ca - Lymphadenopathy - Aneurysm

Question 32

LFTs

Answer 32

1) Hepatocyte injury/cholestasis - bilirbun, ALT/AST, ALP | 2) Synthetic function - albumin, vit K dependent clotting factors (INR)

Question 33

Vit K dependent CFs

Answer 33

2, 7, 9, 10

Question 34

Causes of raised ALP

Answer 34

``` ALKPHOS A - Any fracture L - Liver damage (post-hepatic) K - 'K'ancer P - Paget's disease of bone/Pregnancy H - Hyperparathyroidism O - Osteomalacia S - Surgery ```