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OSCE 3 > Data Interpretation > Flashcards

Data Interpretation Flashcards

1
Q

What is a normal pH and H+ value on an ABG?

A

pH 7.35-7.45

H+ 35-45

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2
Q

What is a normal PaO2 value on an ABG?

A

11-13 kPa

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3
Q

What is a normal PaCO2 value on an ABG?

A

4.7-6.0 kPa

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4
Q

What is a normal HCO3 value on an ABG?

A

22-26

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5
Q

Outline how interpretation of an ABG should be approached

A

O2 - is the patient hypoxaemic? in respiratory failure?
pH - acidotic or alkalotic
CO2 - does it match with pH? is it the cause?
HCO3 - does it match the pH? is it the cause?
Is there compensation? What is the cause of the disturbance?

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6
Q

How is PaO2 interpreted for a patient on O2?

A

PaO2 should be 10 kPa less than inspired %

E.g. 40% = 30 kPa

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7
Q

How is type 1 respiratory failure defined?

A

Hypoxaemia (<8 kPa) with normo/hypocapnia (<6)

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8
Q

How is type 2 respiratory failure defined?

A

Hypoxaemia (<8 kPa) with hypercapnia (>6)

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9
Q

Give 2 causes of type 1 respiratory failure

A

Pulmonary oedema
Bronchoconstriction
PE

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10
Q

Give 2 causes of type 2 respiratory failure

A 
COPD
Pneumonia 
Rib fracture
Obesity 
Guillain-Barre 
Motor neuron disease 
Opiate overdose
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11
Q

What is the main mechanism of type 1 and type 2 respiratory failure?

A

1 - V/Q mismatch

2 - Alveolar hypoventilation

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12
Q

What is the base excess?

A

Surrogate marker of metabolic acidosis/alkalosis

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13
Q

What does a high base excess mean?

A

HCO3 is high - metabolic alkalosis or compensated respiratory acidosis

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14
Q

What does a low base excess mean?

A

HCO3 is low - metabolic acidosis or compensated respiratory alkalosis

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15
Q

Is it possible to have respiratory and metabolic acidosis or respiratory and metabolic alkalosis?

A

Yes

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16
Q

How is a mixed acidosis/alkalosis identified?

A

CO2 and HCO3 will move in opposite directions

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17
Q

Give 2 causes of respiratory acidosis

A 
Opiates 
Guillain Barre
COPD
Asthma 
Iatrogenic
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18
Q

Give 2 causes of respiratory alkalosis

A 
Panic attack 
Pain 
Hypoxia
PE
Pneumothorax
Iatrogenic
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19
Q

Give 2 causes of metabolic acidosis

A

Increased acid production/ingestion
Decreased acid excretion
GI/renal HCO3 loss

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20
Q

Give 2 causes of metabolic alkalosis

A 
Vomiting 
Diarrhoea 
Diuretics 
HF
Nephrotic syndrome 
Cirrhosis 
Conn's syndrome 
Milk-alkali syndrome
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21
Q

Give 2 causes of mixed acidosis

A

Cardiac arrest

Multi-organ failure

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22
Q

Give 2 causes of mixed alkalosis

A

Cirrhosis with diuretic use
Hyperemesis gravidarum
Excessive ventilation in COPD

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23
Q

What is the anion gap, what is the normal value and how is it calculated?

A

Determines presence of unmeasured anions in metabolic acidosis
Normal value 4-12 mmol/L
Na - (Cl + HCO3)

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24
Q

Give 2 causes of an increased anion gap

A

DKA
Lactic acidosis
Aspirin overdose

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25
Q

Give 2 causes of a decreased anion gap

A

Diarrhoea/ileostomy
Renal tubular acidosis
Addison’s disease

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26
Q

Outline how spirometry/PEFR results are interpreted

A

FEV1/FVC ratio - if <70% then obstructive
If obstructive - FEV1 % predicted (severity) and reversibility (COPD vs asthma)
If not obstructive - FVC % predicted (low = restrictive)

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27
Q

How is reversibility defined on spirometry?

A

15% increase in FEV1

400ml increased capacity

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28
Q

Name 2 obstructive respiratory diseases

A

Asthma
COPD
Cystic fibrosis
Emphysema

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29
Q

Name 2 restrictive respiratory diseases

A 
Interstitial lung disease 
Pulmonary oedema 
Chest wall deformity 
Neuromuscular disease 
Obesity 
Pregnancy
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30
Q

How do the flow/volume loops differ in appearance for restrictive and obstructive disease?

A

Restrictive - same as normal but smaller

Obstructive - church and steeple (COPD)

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31
Q

What is transfer factor? What can it be reduced by?

A

Measure of gas exchange in lungs

Reduced by emphysema, ILD, anaemia, pulmonary vascular disease

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32
Q

Give 2 causes of hypochromic microcytic anaemia

A 
Thalassaemia 
Anaemia of chronic disease 
Iron deficiency anaemia
Lead poisoning 
(TAIL)
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33
Q

Give 2 causes of macrocytic anaemia

A 
Folate deficiency/foetus
Alcoholic liver disease 
Thyroid (hypo)
Reticulocytosis 
B12 deficiency 
Cirrhosis/cytotoxics 
(FAT RBC)
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34
Q

What is the most likely diagnosis if iron, transferrin and ferritin are all raised?

A

Haemochromatosis

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35
Q

What haematological disease may occur in someone with an autoimmune background?

A

Pernicious anaemia

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36
Q

What does a raised APTT, PT and D-dimer indicate when fibrinogen is reduced?

A

Disseminated intravascular coagulation

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37
Q

What is Churg-Strauss syndrome?

A

Rare systemic vasculitis affecting small-to-medium vessels which is associated with severe asthma and eosinophilia

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38
Q

What rare adverse drug reaction can cause platelet depletion?

A

Heparin induced thrombocytopaenia

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39
Q

What does an elevated urea and creatinine indicate?

A

Acute kidney injury

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40
Q

What does an elevated urea indicate?

A

Dehydration

Upper GI bleed

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41
Q

What does a reduced creatinine indicate?

A

Reduced muscle mass

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42
Q

What does a reduced sodium indicate?

A 
Nephrotic syndrome 
Cirrhosis
HF
SIADH
GI loss 
Diuretic use
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43
Q

What does an elevated sodium indicate?

A

Diabetes insipidus
Primary aldosteronism
Fluid loss (burns, D&V)
Excess saline

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44
Q

What does a reduced potassium indicate?

A 
Diuretic use 
D&amp;V
Pyloric stenosis 
Cushing's syndrome 
Conn's syndrome
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45
Q

What does an elevated potassium indicate?

A

Drugs (K sparing diuretics, ACEi)
Rhabdomyolysis
Oliguric renal failure
Addison’s disease

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46
Q

What causes an elevated bilirubin?

A

Acute/chronic liver disease

Gilbert’s syndrome

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47
Q

What causes an elevated AST and ALT?

A

Hepatitis

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48
Q

What causes an elevated AST, ALT and ALP?

A

Gallstones

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49
Q

What causes an elevated GGT (when ALP is normal)?

A

Alcohol excess

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50
Q

What does an isolated rise in ALP indicate?

A

Paget’s disease
Bony metastases
Primary sclerosing cholangitis

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51
Q

What tests are used to diagnose primary biliary cholangitis?

A

Anti-mitochondrial antibody
Smooth muscle antibody
Serum IgM

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52
Q

What blood results are seen in upper GI bleed?

A

Increased urea (normal creatinine)
Decreased haemoglobin
Increased WCC (no infection)
Increased platelets

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53
Q

What TFT results indicate primary hypothyroidism?

A

TSH increased

T3 and T4 decreased

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54
Q

What TFT results indicate primary hyperthyroidism?

A

TSH decreased

T3 and T4 increased

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55
Q

Give 2 causes of reduced calcium

A 
Vitamin D deficiency 
Osteomalacia
Chronic kidney disease 
Hyperparathyroidism
Acute rhabdomyolysis
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56
Q

Give 2 causes of raised calcium

A 
Malignancy 
Sarcoidosis
Thyrotoxicosis
Lithium
Tertiary hyperparathyroidism
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57
Q

What blood tests can be used to diagnose rheumatoid arthritis?

A

Rheumatoid factor

Anti-cyclic citrullinated peptide

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58
Q

What blood tests can be used to diagnose SLE?

A

Anti-Smith antibody

Anti-dsDNA antibody

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59
Q

What blood test can be used to diagnose primary biliary cirrhosis?

A

ANCA may be positive

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60
Q

What component of hepatitis B serology is a marker of infection?

A

SAg - surface antigen

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61
Q

What component of hepatitis B serology is a marker of immunity?

A

sAb - surface antibody

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62
Q

What component of hepatitis B serology is a marker of previous infection?

A

cAb - core antibody (IgM acute, IgG persists)

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63
Q

What component of hepatitis B serology is a marker of high infectivity?

A

eAg - e antigen

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64
Q

What component of hepatitis B serology is a marker of low infectivity?

A

eAb - e antibody

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65
Q

What is HBV DNA used for?

A

Diagnosis (along with sAg)

Monitoring response to treatment

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66
Q

What hepatitis B serology results would indicate previous immunisation?

A

Only sAb positive

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67
Q

What hepatitis B serology results would indicate previous infection?

A

cAb positive, sAg negative

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68
Q

What hepatitis B serology results would indicate chronic infection?

A

sAg and cAb positive

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69
Q

How is urosepsis treated?

A

Gentamicin

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70
Q

How is clostridium difficile infection treated?

A

Vancomycin

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71
Q

How is meningitis treated?

A

Ceftriaxone and dexamethasome
+ amoxicillin if listeria
+ benzylpenicillin if meningococcal septicaemia

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72
Q

What information can be obtained from the colour of urine?

A

Straw - normal
Dark - dehydration
Red - haematuria/rifampicin/porphyria/beetroot
Brown - bile pigment/myoglobin/antimalarials

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73
Q

What information can be obtained from the clarity of urine?

A

Clear - normal
Cloudy/debris - UTI
Frothy - protein = nephrotic syndrome

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74
Q

Give 3 causes of haematuria

A 
Kidney disease 
Kidney stones
Tumour 
Infection 
Trauma
75
Q

What does bilirubin in the urine indicate?

A

Biliary tract obstruction

76
Q

What does urobilinogen in the urine indicate?

A

Malaria

Haemolytic anaemia

77
Q

What is the p wave?

A

Atrial depolarisation

78
Q

What is the PR interval?

A

Delay between atria and ventricles

79
Q

What is the QRS complex?

A

Ventricular depolarisation

80
Q

What is the ST segment?

A

Isoelectric line - time between depolarisation and repolarisation of ventricles (contraction)

81
Q

What is the T wave?

A

Ventricular repolarisation

82
Q

What is the RR interval?

A

Time between 2 QRS complexes

83
Q

What is the QT interval?

A

Time taken for ventricles to depolarise and repolarise

84
Q

What are the chest leads?

A

V1-V6

85
Q

What are the limb leads?

A

I, II, III

aVR, aVL, aVF

86
Q

What leads are involved in an inferior MI? What blood vessel is affected?

A

II, III, aVF

Right coronary artery

87
Q

What leads are involved in an anterior MI? What blood vessel is affected?

A

V1-V4

Left anterior descending

88
Q

What leads are involved in a lateral MI? What blood vessel is affected?

A

I, aVL, V5, V6

Left circumflex artery

89
Q

If leads II, III and aVF are affected, what is the location of the MI?

A

Inferior

90
Q

If leads V1-V4 are affected, what is the location of the MI?

A

Anterior

91
Q

If leads I, aVL, V5 and V6 are affected, what is the location of the MI?

A

Lateral

92
Q

What region of the heart is supplied by the right coronary artery?

A

Inferior

93
Q

What region of the heart is supplied by the left anterior descending artery?

A

Anterior

94
Q

What region of the heart is supplied by the left circumflex artery?

A

Lateral

95
Q

What is the QRS axis and how is it determined?

A

Average direction of ventricular depolarisation

Limb leads only

96
Q

What is a normal QRS axis?

A

-30 to +90

97
Q

What is right axis deviation?

A

+90 to +180

98
Q

What is left axis deviation?

A

-30 to -90

99
Q

Outline how to interpret an ECG

A 
Check details and assess quality 
Heart rate 
Rhythm 
QRS axis
P waves
PR interval 
QRS complex
ST segment 
T waves
100
Q

How is heart rate interpreted on ECG?

A

Regular - count number of large squares between QRS complexes and divide by 300
Irregular - count number of QRS complexes on rhythm strip and multiply by 6
State if normal, bradycardic or tachycardic

101
Q

How is heart rhythm interpreted on ECG?

A

Mark consecutive QRS complexes on a piece of paper and shift along to check if distance is the same

102
Q

How is QRS axis interpreted on ECG?

A

Check leads I, II and III
Normal - II most positive
Right - III most positive
Left - l most positive

103
Q

How are p waves interpreted on ECG?

A

Present or absent

Followed by QRS complexes - sinus rhythm

104
Q

How is the PR interval interpreted on ECG?

A

Should be 120-200ms (3-5 small squares)
Prolonged - AV block
Shortened - normal or accessory pathway

105
Q

What is first degree AV block?

A

Fixed prolonged PR interval

106
Q

What is second degree (Mobitz I) AV block?

A

PR interval slowly increases and then QRS is dropped (Wenckebach)

107
Q

What is second degree (Mobitz II) AV block?

A

PR interval is fixed and QRS is dropped

108
Q

What is third degree AV block?

A

Complete

Unrelated P waves and QRS complexes

109
Q

How are QRS complexes interpreted on ECG?

A

Normal 120ms
Width - broad = ectopic, BBB
Height - tall = ventricular hypertrophy, tall/slim person
Morphology - delta wave

110
Q

What is benign early repolarisation?

A

J point segment exists where the S can be elevated which is normal but looks similar to ST elevation (MI)

111
Q

How is the ST segment interpreted on ECG?

A

Elevation - acute MI

Depression - myocardial ischaemia

112
Q

What is the definition of an elevated ST segment?

A

> 1mm (limb) or >2mm (chest) in >2 leads

113
Q

What is the definition of a depressed ST segment?

A

> /=0.5mm in >/= leads

114
Q

How are T waves interpreted on ECG?

A

Tall tented - hyperacute STEMI, hyperkalaemia
Inversion - in leads other than VI and III = ischaemia, BBB, PE, LV hypertrophy, illness
Biphasic - ischaemia, hypokalaemia
Flattened - ischaemia, electrolyte imbalance

115
Q

What may be the first sign of an MI on an ECG?

A

Tall tented T waves

116
Q

How can you determine if bundle branch block is left or right?

A

Right - V1-3

Left - V4-6

117
Q

Give 2 causes of inverted T waves

A 
Normal (VI and III)
Ischaemia 
BBB
PE
LV hypertrophy 
Illness
118
Q

What is ascites?

A

Accumulation of fluid in the peritoneal cavity, usually due to portal hypertension caused by cirrhosis

119
Q

When is ascites clinically detectable?

A

Over 500mls

120
Q

What are the main signs/symptoms of ascites?

A

Distended abdomen
Hyper-resonance on percussion
Shifting dullness
Shortness of breath (diaphragmatic splinting)

121
Q

What investigation is used to confirm ascites?

A

Ascitic tap/paracentesis

122
Q

What ascitic fluid results would indicate spontaneous bacterial peritonitis?

A 
Cloudy 
Protein high (>4)
WCC high (>250), neutrophil predominant 
SAAG low (<1.1)
123
Q

What ascitic fluid results would indicate pancreatitis?

A

Cloudy
Amylase higher than serum
SAAG low (<1.1)

124
Q

What ascitic fluid results would indicate tuberculosis?

A 
Chylous
Protein high (>4)
WCC high (>250), lymphocyte predominant 
Glucose less than serum 
RCC high (>100)
SAAG low (<1.1)
125
Q

What ascitic fluid results would indicate malignancy?

A

Bloody
Glucose less than serum
RCC high (>100)
SAAG low (<1.1)

126
Q

What ascitic fluid results would indicate cirrhosis?

A 
Clear/straw 
WCC low (<250)
SAAG high (>1.1)
127
Q

What is the SAAG?

A

Serum ascitic albumin gradient - indirect measure of portal hypertension (serum-ascitic)

128
Q

What does a high SAAG indicate?

A

Transudate

Portal hypertension - cirrhosis, hepatic failure

129
Q

What does a low SAAG indicate?

A

Exudate

Inflammation - malignancy, infection

130
Q

What would an ascitic fluid RCC of >100,000 indicate?

A

Haemorrhage

Trauma

131
Q

How can lactate dehydrogenase be used to analyse ascitic fluid?

A

Opposite of SAAG
Low - transudate
High - exudate

132
Q

CSF results are - cloudy, low glucose, high protein, neutrophils. What is the diagnosis?

A

Bacterial meningitis

133
Q

CSF results are - clear/cloudy, normal glucose, high protein, lymphocytes (neutrophils early). What is the diagnosis?

A

Viral meningitis

134
Q

CSF results are - low glucose, high protein, lymphocytes. What is the diagnosis?

A

Fungal meningitis

135
Q

CSF results are - slightly cloudy, low glucose, high protein, lymphocytes. What is the diagnosis?

A

TB meningitis

136
Q

What would be found in the CSF of a patient with a subarachnoid haemorrhage?

A

Blood/xanthochromia (12 hours)
High WCC/RBC/protein
Normal glucose

137
Q

What would be found in the CSF of a patient with Guillain-Barre?

A

Clear/xanthochromia
Normal WCC/glucose
High protein

138
Q

What would be found in the CSF of a patient with MS?

A 
Clear
Lymphocytes 
Normal glucose
Mild elevation of protein 
Oligoclonal bands on IgG electrophoresis
139
Q

How is pleural fluid characterised?

A

Transudate or exudate

Light’s criteria

140
Q

How is pleural fluid collected?

A

Thoracentesis

141
Q

What are the indications for pleural tap?

A 
Pleuritic pain 
Breathlessness
Coughing
Fever
Fatigue
142
Q

What are the features of transudative pleural fluid?

A

Protein low (<30)
Yellow/clear
Few cells

143
Q

Give 2 causes of transudative pleural fluid

A

Congestive HF
Liver cirrhosis
Nephrotic syndrome
Severe hypoalbuminaemia

144
Q

What are the features of exudative pleural fluid?

A

Protein high (>30)
Cloudy
Increased cells

145
Q

Give 2 causes of exudative pleural fluid

A

Malignancy
Infection (empyema due to pneumonia)
Trauma
PE

146
Q

What pleural fluid type is more accurately diagnosed using Light’s criteria?

A

Exudative

147
Q

What is Light’s criteria?

A

Fluid is considered exudative if any of the following:
Pleural fluid:serum protein >0.5
Pleural fluid:serum LDH > 0.61
Pleural fluid LDH >2/3rds upper limit of normal for serum value

148
Q

How can synovial fluid be characterised?

A 
Normal 
Non-inflammatory 
Inflammatory 
Septic 
Haemarthroses
149
Q

Synovial fluid is - colourless, transparent, normal viscosity, <200 WBCs, <25% neutrophils, gram stain and crystals negative. What is the diagnosis?

A

Normal

150
Q

Synovial fluid is - straw-like/yellow, translucent, increased viscosity, WBCs 200-2000, neutrophils <25%, GS and C negative. What is the diagnosis? What investigations can be done?

A

Non-inflammatory
Osteoarthritis, trauma
WCC/CRP, x-ray, MRI

151
Q

Synovial fluid is - yellow, cloudy, decreased viscosity, WBCs 2000-50000, neutrophils >50%, GS negative, C positive. What is the diagnosis? What investigations can be done?

A

Inflammatory
RA, reactive/psoriatic arthritis, gout/pseudogout
CRP, urate, anti-CCP/RF, x-ray

152
Q

Synovial fluid is - yellow/green, cloudy, decreased viscosity, >50000 WBCs, neutrophils >75%, GS positive, C negative. What is the diagnosis? What investigations can be done?

A

Septic
Staphylococcus aureus, streptococcus, neisseria gonorrhea, eschericia coli (old, IVDU)
WCC/CRP, blood/fluid culture, x-ray

153
Q

Synovial fluid is - red/xanthochromic, bloody, variable viscosity, 200-2000 WBCs, neutrophils 50-75%, GS and C negative. What is the diagnosis? What investigations can be done?

A

Haemarthroses
Trauma, tumour, bleeding disorder
Hb, coagulation studies, x-ray

154
Q

Outline how to interpret a chest x-ray

A

Check details
Assess technical quality - PIER
Briefly mention obvious abnormality
ABCDE or centre out and review areas

155
Q

What features on an x-ray indicate heart failure?

A 
Alveolar oedema 
Kerley B lines 
Cardiomegaly 
Diversion of upper lobe vessels 
Effusions 
Fluid in fissures 
(ABCDEF)
156
Q

What features on an x-ray indicate lobar collapse?

A

Golden S sign - right upper lobe

Sail sign - left lower lobe

157
Q

Outline how an abdominal x-ray is interpreted

A

Check details
Position and exposure
Obvious abnormalities
BINGSCA - bones, inflammation, gas, soft tissues, calcifications, artefacts

158
Q

What does a bamboo spine on abdominal x-ray indicate?

A

Ankylosing spondylitis

159
Q

What are lytic and sclerotic lesions?

A

Lytic - punched out

Sclerotic - white

160
Q

What does a small bowel obstruction look like on abdominal x-ray?

A

Central
Lines all the way across (valvulae conniventes)
Diameter = 3cm

161
Q

What does a large bowel obstruction look like on abdominal x-ray?

A

Peripheral
Lines not all the way across (haustra)
= 6cm in LB and = 9cm in sigmoid/caecum

162
Q

What does a coffee bean sign on abdominal x-ray indicate?

A

Sigmoid volvulus

163
Q

What does an embryo sign on abdominal x-ray indicate?

A

Caecal volvulus

164
Q

What is Rigler’s sign on abdominal x-ray?

A

Pneumoperitoneum due to perforation

Double wall sign

165
Q

What does an apple core sign on abdominal x-ray indicate?

A

Colorectal cancer

166
Q

What does thumbprinting on abdominal x-ray indicate?

A

Colitis

167
Q

What does a lead pipe colon on abdominal x-ray indicate?

A

Ulcerative colitis

168
Q

What units should not be abbreviated on a kardex?

A

Micrograms
Nanograms
Units

169
Q

What drugs have a separate chart?

A

Gentamicin
Warfarin
Insulin
Vancomycin

170
Q

When should thromboprophylaxis be administered?

A

Evening

171
Q

When should metformin be administered?

A

Morning (with breakfast)

172
Q

When should alendronic acid be administered?

A

Weekly before breakfast with lots of water and sitting up for at least 30 minutes

173
Q

When should statins be administered?

A

Night

174
Q

When should diuretics be administered?

A

Morning

175
Q

What should be prescribed on the oral and other drugs page?

A

Oral
Suppositories
Topical
Steroid inhaler

176
Q

What should be done if prescribing antibiotics to a patient on statins?

A

Withhold statin for duration of antibiotic

177
Q

What details should be on a prescription?

A

Patient - full name, address, age/DOB
Medication - name, formulation, strength, dose/instructions, quantity
Prescriber - name, authority, date

178
Q

Name 2 controlled drugs

A 
Morphine 
Codeine
Tramadol 
Pregabalin 
Fentanyl
Oxycodone
179
Q

Name 3 drugs with a narrow therapeutic range

A 
Warfarin
Theophylline
Phenytoin 
Carbamazepine
Digoxin
Lithium
Clozapine
180
Q

What signs/symptoms are associated with hypercapnia?

A

Confusion
Reduced conscious level
Flapping tremor
Bounding pulse

181
Q

How does hyperventilation cause perioral and peripheral paraesthesia?

A

Alkalosis causes hypocalcaemia due to increased albumin binding of calcium

182
Q

Why does vomiting lead to metabolic alkalosis?

A

Loss of H+ in stomach acid causing an increase in free HCO3

Volume depletion causing release of aldosterone which increases HCO3 reabsorption

183
Q

How can sepsis cause metabolic acidosis?

A

Reduced end organ perfusion causes tissue hypoxia and cells undergo anaerobic respiration to produce lactic acid, causing metabolic acidosis

184
Q

How can a cardiac arrest cause a mixed base disorder?

A

Respiratory acidosis caused by hypercapnia due to lack of ventilation
Metabolic acidosis caused by accumulation of anaerobic products

OSCE 3 (3 decks)

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