Data Interpretation Flashcards by Roshan Patel

Give some causes of microcytic anaemia

Iron Deficiency Anaemia
Thalassaemia
Sideroblastic anaemia

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Give some causes of normocytic anaemia

Anaemia of chronic disease
Acute blood loss
Haemolytic anaemia
Renal failure

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Give some causes of macrocytic anaemia

B12/folate deficiency (megaloblastic)
Excess alcohol
Liver disease
Hypothyroidism
Myeloproliferative and myelodysplastic disorders
Multiple myeloma

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What can cause hypernatraemia?

D’s

Dehydration
Drips (IV saline)
Drugs - effervescent tablets or IV with high sodium
Diabetes insipidus

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What can cause hyponatraemia?

Hypovolaemic - fluid loss (D&V), Addisons, diuretics

Euvolaemic - SIADH, psychogenic polydipsia, hypothyroid

Hypervolaemic - Heart failure, renal failure, liver failure, nutritional failure, thyroid failure (hypo)

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What can cause neutrophilia (high neutrophils)?

Bacterial Infection
Tissue damage - inflammation, infarction, malignancy
Steroids

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What can cause neutropenia?

Viral infection
Chemo/radio
Clozapine
Carbimazole

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What can cause lymphocytosis (high)?

Viral infection
Lymphoma
Chronic Lymphocytic Leukaemia

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What causes thrombocytopenia?

Low production:
- Infection
- Drugs - penicillamine
- Myelodysplasia, myelofibrosis, myeloma
Destruction:
- Heparin
- Hypersplenism
- DIC
- ITP
- Haemolytic uraemic syndrome/TTP

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What causes thrombocytosis?

Reactive:

Bleeding
Tissue damage - infection, inflammation, malignancy
Post-splenectomy

Primary
- Myeloproliferative disorders

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What causes hypokalaemia?

DIRE:
Drugs - loop and thiazide diuretics
Inadequate intake/intestinal loss
Renal tubular acidosis
Endocrine - cushings/conn's

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What causes hyperkalaemia?

DREAD:
Drugs - potassium sparing diuretics and ACE inhibitors
Renal failure
Endocrine - addisons
Artefact
DKA

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What can a raised urea indicate?

Kidney Injury

Upper GI bleed - raised urea with normal creatinine in pt. who isn’t dehydrated –> check Hb, if low, likely upper GI bleed

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What can cause pre-renal AKI?

Dehydration - sepsis, blood loss etc.

Renal artery stenosis

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How does a pre-renal AKI appear biochemically?

Urea rise > creatinine rise

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What can cause an intrinsic/renal AKI?

INTRINSIC:
Ischaemia - causes acute tubular necrosis
Nephrotoxic abx - gentamicin, vancomycin and tetracyclines
Tablets - ACE inhibitors/NSAID's
Radiological contrast
Injury - rhabdomyolysis
Negative birefringent crystals - gout
Syndromes - glomerulonephritis
Inflammation - vasculitis
Cholesterol emboli

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How does a Renal AKI appear biochemically?

Urea rise < Creatinine rise

Bladder/hydronephrosis not palpable

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What can cause a post renal AKI?

In Lumen - stone, sloughed papilla

Wall - tumour (RCC), fibrosis

External pressure - BPH, prostate cancer, lymphadenopathy, aneurysm

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How does a post-renal AKI appear biochemically?

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Urea rise < creatinine rise

Bladder/hydronephrosis may be palpable

Which blood results would you use to assess for hepatocyte injury or cholestasis?

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Look at:

Bilirubin
ALT (and AST less commonly)
Alk Phos

Which blood results would you use to assess the synthetic function of the liver?

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Albumin

- Vitamin K dependent clotting factors - PT/INR

What can cause a raised alkaline phosphatase?

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Fractures
Post-hepatic liver damage
Cancer
Paget’s disease of bone
Pregnancy
Hyperparathyroidism
Osteomalacia
Surgery

What causes pre-hepatic liver function derangement?

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Haemolysis

Gilbert’s and Crigler-Najjar syndrome

What causes hepatic liver function derangement?

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Fatty liver
Hepatitis
Cirrhosis
Malignancy
Metabolic - Wilson's/Haemochromatosis
Heart Failure

What causes post hepatic LFT derangement?

Lumen - gallstone, drugs causing cholestasis Wall - tumour (cholangiocarcinoma), PBC, PSC Extrinsic - pancreatic/gastric cancer, lymph node

What drugs cause cholestasis?

``` Flucloxacillin Co-amoxiclav Nitrofurantoin Steroids Sulphonylureas ```

What are the signs of pulmonary oedema seen on X-ray?

``` Alveolar oedema (bat wings) Kerly B Lines Cardiomegaly Enlarged blood vessels in upper zone Pleural effusions ```

Which drugs commonly require monitoring?

``` Digoxin Theophylline Lithium Phenytoin Gentamicin ```

What is typically done when drug's are monitored?

Assess clinical state | Measure serum drug level

What are the features of digoxin toxicity?

Confusion Nausea Visual halos Arrhythmia

What are the features of lithium toxicity?

Early - tremor Intermediate - tiredness Late - arrhythmia, seizure, coma, renal failure, diabetes insidious

What are the features of phenytoin toxicity?

``` Gum hypertrophy Ataxia Nystagmus Peripheral neuropathy Teratogenicity ```

What are the features of gentamicin and vancomycin toxicity?

Ototoxicity | Nephrotoxicity

What is the dose range of gentamicin normally and in infective endocarditis?

Peak (1h post dose) : IE - 3/5mg/L Others - 5-10mg/L Trough (just before next dose): IE - <1mg/L Others - <2mg/L

What are the three treatments recommended for drug toxicities (generic)?

1 Stop drug 2 Supportive measures - IV fluids 3 Give antidote if available

What factors help you determine the gentamicin dose?

Patient weight and renal function

What is the typical dose for gentamicin?

5-7mg/kg OD

What is the typical dose for gentamicin in pt. with renal failure or infective endocarditis? (severe creatinine clearance <20mL/min)

Divided daily dosing 1mg/kg - every 12 hr in renal failure - every 8 hr in infective endocarditis

What does gentamicin monitoring entail?

- Measure levels at particular times - 6-14hr after infusion | - Use nomogram to determine level and adjust dosing accordingly

How is a gentamicin dose adjusted?

You change the frequency of the dose rather than the dose itself - need to reach therapeutic level

What is the management for a paracetamol overdose?

N-Acetyl Cysteine if over the line on nomogram | Supportive measures

How is a warfarin OD managed in a major bleed?

- Stop Warfarin - 5-10mg IV Vit K - Prothrombin complex (beriplex)

How is a warfarin OD managed if there is no bleed?

INR <6 - Reduce warfarin dose INR 6-8 - Omit warfarin for 2 days then reduce dose INR >8 - Omit warfarin and give 1-5mg oral vit K

How is a warfarin OD managed if there is minor bleeding?

INR>5 IV Vit K 1-3mg and omit warfarin

How is warfarin monitored?

Monitor INR Target 2.5 normally Target 3.5 if: - Recurrent thromboemboli - Metal replacement heart valve

Data Interpretation Flashcards

(45 cards)