Section 3 - Data Interpretation

Question 1

FBC Interpretation (Low Hb)

Answer 1

Anaemia (Consult the MCV to narrow DDx):
* Microcytic - Iron deficiency, Thalassemia, Sideroblastia.
* Normocytic - Chronic Disease, Bleeding, Haemolysis.
* Macrocytic - B12/Folate Deficiency, Alcoholism, Liver Disease.

Question 2

FBC Interpretation (Abnormal WCC)

Answer 2

**Neutrophilia **- Bacterial Infection, Steroids
**Neutropenia - **Viral Infection, Chemo. Clozapine, Carbimazole.
Lymphocytosis - Viral Infection, Lymphoma, CLL.

Question 3

FBC Interpretation (Abnormal Platelets)

Answer 3

Thrombocytopaenia:
* Reduced Production - Infection, Drugs (Penicillamine), Myelodysplasia.
* Increased Destruction - Heparin, Hypersplenism, DIC, ITP, HUS.

Thrombocytosis:
* Reactive (Bleeding, Trauma, Inflammation)
* Primary (Myeloproliferation)

Question 4

U&E Interpretation (Sodium)

Normal Range - 135 mmol/L - 145 mmol/L

Answer 4

Hypernatremia (“D”) - Dehydration, Drugs, Drips, DI.

Hyponatremia (Consult the Fluid Balance to narrow DDx) -
* Hypovolemic - Fluid loss & Diuretics
* Euvolemic - SIADH, Psychogenic Polydipsia.
* Hypervolemic - HF, Renal Failure, Liver Failure.

Drugs - Effervescent Tablets and High Sodium preparations.

Question 5

U&E Interpretation (Potassium)

Normal Range - 3.5 - 5.0 mmol/L

Answer 5

Hypokalemia (DIRE) - Drugs (Thiazide/Loop Diuretics), Inadequate intake/Intestinal loss, Renal Tubular Acidosis, Endocrine (Cushing’s/Conn’s).

Hyperkalemia (DREAD) - Drugs (K Sparing Diuretics, ACEi), Renal Failure, Endocrine (Addison’s), Artefact, DKA (Treatment)

Question 6

U&E Interpretation - AKI (Raised Urea/Creat.)

Answer 6

Prerenal (Urea Rise > Creat. Rise):
* Dehydration
* Renal Artery Stenosis

Intrinsic (Creatinine Rise > Urea):
* Ischemia
* Nephrotoxicity
* Rhabdomyolysis
* Gout
* Vascultitis

Postrenal (Creatinine Rise > Urea):
* Stone
* Tumour
* BPH

Question 7

U&E Interpretation (Deranged LFTs)

Answer 7

**Prehepatic (Increased Bilirubin) - **Haemolysis & Gilbert’s.

**Intrahepatic (Increased Bili. + AST/ALT) - **Hepatitis, Cirrhosis, Malignancy, Fatty Liver.

Posthepatic (Increased Bili. + ALP) - Obstruction, Cholestatic Drugs (Flucloxacillin, Co-Amoxiclav, Nitrofurantoin, Steroids, Sulphonylureas).

Question 8

TFT Interpretation (Hypothyroidism)

Answer 8

Primary (Low T4, Increased TSH):
* Hashimoto’s Thyroiditis
* Drug Induced Hypothyroid

Secondary (Low T4, Low TSH):
* Pituitary Disease

Question 9

TFT Interpretation (Hyperthyroidism)

Answer 9

Primary (Increased T4, Low TSH):
* Grave’s
* Toxic Goitre
* Drug Induced
Secondary (Increased T4, Increased TSH):
* Pituitary Adenoma

Question 10

CXR - Assessing the Quality of the Film

(“PRIM”)

Answer 10

Projection - AP, PA or Lateral
Rotation - Equal distance between spinous processes and clavicles.
Inspiration - 7th Anterior Rib should transect the diaphragm.
Markings - Any additional markings?

Question 11

CXR - Assessing the Structures

(“A-E”)

Answer 11

Airway - Tracheal Deviation
Breathing (Lungs) - White areas suggest effusion, pneumonia, oedema or fibrosis. (Check the costophrenic angles).
Circulation (Heart) - Should be less then 50% of lungs in PA.
Diaphragm
Everything Else - Mediastinal Widening?, Rib Fractures/Lytic Lesions?

Question 12

Causes of Metabolic Acidosis

(“Left Total Knee Replacement”)

Answer 12

• Lactosis
• Toxins
• Ketoacidosis
• Renal Failure

Question 13

Interpreting Drug Monitoring Results

Answer 13

Inadequate Response & Inadequate Concentration -
* Increase dose by smallest possible increment.
Adequate Response & Low/Normal Concentration-
* No change
Adequate Response & High Concentration -
* Reduce dose (Omit if there is evidence of Toxicity)