MY REVISION - PSA > DATA INTERPRETATION > Flashcards

DATA INTERPRETATION Flashcards

(56 cards)

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1
Q

ANAEMIA
what are the causes of microcytic anaemia?

A
  • iron deficiency
  • thalassaemia
  • sideroblastic anaemia
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2
Q

ANAEMIA
what are the causes of normocytic anaemia?

A
  • anaemia of chronic disease
  • acute blood loss
  • haemolytic anaemia
  • renal failure (chronic)
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3
Q

ANAEMIA
what are the causes of macrocytic anaemia?

A
  • B12/folate deficiency (includes pernicious anaemia)
  • excess alcohol
  • liver disease (including non-alcoholic)
  • hypothyroidism
  • myeloproliferative disease
  • myelodysplasia
  • multiple myeloma
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4
Q

FBC
what are the causes of neutrophilia?

A
  • bacterial infection
  • tissue damage (inflammation/infarct/malignancy)
  • steroids
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5
Q

FBC
what are the causes of neutropenia?

A
  • viral infection
  • chemotherapy or radiotherapy
  • clozapine (anti-psychotic)
  • carbimazole (anti-thyroid)
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6
Q

FBC
what are the causes of lymphocytosis?

A
  • viral infection
  • lymphoma
  • chronic lymphocytic leukaemia (CLL)
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7
Q

FBC
what are the causes of thrombocytopenia (low platelets)?

A

REDUCED PRODUCTION
- infection (usually viral)
- drugs (especially penicillamine)
- myelodysplasia, myelofibrosis, myeloma

INCREASED DESTRUCTION
- heparin
- hypersplenism
- DIC
- ITP
- haemolytic uraemic syndrome
- TTP

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8
Q

FBC
what are the causes of thrombocytosis (high platelets)?

A

REACTIVE
- bleeding
- tissue damage (infection/inflammation/malignancy)
- post splenectomy

PRIMARY
- myeloproliferative disorders

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9
Q

HYPERNATRAEMIA
what are the causes of hypernatraemia?

A

‘all begin with D’

  • dehydration
  • drips (too much IV saline)
  • drugs (e.g. effervescent preparations or IV preparations with high sodium)
  • diabetes insipidus
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10
Q

HYPONATRAEMIA
what are the hypovolaemic causes of hyponatraemia?

A
  • fluid loss (especially D+V)
  • addison’s disease
  • diuretics (any type)
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11
Q

HYPONATRAEMIA
what are the euvolaemic causes of hyponatraemia?

A
  • SIADH
  • psychogenic polydipsia
  • hypothyroidism
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12
Q

HYPONATRAEMIA
what are the causes of hypervolaemic hyponatraemia?

A
  • heart failure
  • renal failure
  • liver failure
  • nutritional failure
  • thyroid failure
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13
Q

HYPONATRAEMIA
what are the causes of SIADH?

A

SIADH
Small cell lung tumours
Infection
Abscess
Drugs (carbamazepine + antipsychotics)
Head injury

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14
Q

HYPOKALAEMIA
what are the causes of hypokalaemia?

A

DIRE
- Drugs (loop and thiazide diuretics)
- inadequate intake or intestinal loss (D+V)
- renal tubular acidosis
- endocrine (cushings and Conns)

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15
Q

HYPERKALAEMIA
what are the causes?

A

DREAD
- Drugs (potassium-sparing diuretics + ACEi)
- renal failure
- endocrine (addisons)
- artefact (very common, due to clotted sample)
- DKA

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16
Q

U&Es
what can a raised urea level indicate?

A
  • AKI (if both urea + creatinine rise)
  • GI bleed (if only urea rises + pt not dehydrated)
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17
Q

AKI
what are the levels for urea and creatinine in:
a. pre-renal AKI
b. intrinsic (renal) AKI
c. post-renal AKI

A

PRE- RENAL
- urea rises more than creatinine (multiply urea x 10, if higher than creatinine = pre-renal)

RENAL
- creatinine rises more than urea

POST-RENAL
- creatinine rises more than urea
- bladder or hydronephrosis may be palpable

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18
Q

AKI
what are the causes of a pre-renal AKI?

A
  • dehydration
  • renal artery stenosis (usually triggered by ACEi or NSAIDS)
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19
Q

AKI
what are the renal (intrinsic) causes of AKI?

A

INTRINSIC
- Ischaemia (due to pre-renal AKI, causing acute tubular necrosis)
- Nephrotoxic antibiotics (esp GENTAMICIN, VANCOMYCIN + tetracyclines)
- Radiological contrast
- Injury (rhabdomyolysis)
- Negatively birefringent crystals (gout)
- Syndromes (glomerulonephritides)
- Inflammation (vasculitis)
- cholesterol emboli

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20
Q

AKI
what are the post-renal causes of AKI?

A

IN LUMEN
- renal stone

IN WALL
- tumour
- fibrosis

EXTERNAL PRESSURE
- BPH
- prostate cancer
- lymphadenopathy
- aneurysm

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21
Q

LFTs
what are the causes of raised ALP?

A

ALKPHOS
- any fracture
- liver damage (post hepatic)
- cancer
- pagets disease of the bone and pregnancy
- hyperparathyroidism
- osteomalacia
- surgery

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22
Q

LFTS
what is the pattern of LFT derangement in
a. prehepatic jaundice
b. intrahepatic jaundice
c. post-hepatic jaundice

A

PRE-HEPATIC
- raised bilirubin

INTRAHEPATIC
- raised bilirubin
- raised AST/ALT

POST-HEPATIC
- raised bilirubin
- raised ALP

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23
Q

LFTs
what are the causes of pre-hepatic jaundice?

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A
  • haemolysis
  • gilbert’s syndrome
24
Q

LFTs
what are the causes of intrahepatic jaundice?

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A
  • fatty liver
  • hepatitis (alcohol, viral, drug (paracetamol, statins, rifampicin) and autoimmune)
  • cirrhosis
  • malignancy
  • metabolic (wilsons, haemochromatosis)
  • heart failure
25
LFTs what are the causes of post-hepatic jaundice?
IN LUMEN - gallstones - drugs (flucloxacillin, co-amoxiclav, nitrofurantoin, steroids + sulphonylureas) IN WALL - cholangiocarcinoma - primary biliary cirrhosis - sclerosing cholangitis EXTERNAL PRESSURE - pancreatic or gastric cancer - lymph node
26
HYPOTHYROIDISM what are the TFT results for primary and secondary hypothyroidism?
PRIMARY ( - low T4 - raised TSH SECONDARY - low T4 - low TSH
27
HYPOTHYROIDISM what are the causes of primary hypothyroidism?
- hashimotos thyroiditis - drug-induced hypothyroidism
28
HYPOTHYROIDISM what are the causes of secondary hypothyroidism?
pituitary tumour or damage
29
HYPERTHYROIDISM what are the TFT results for primary and secondary hyperthyroidism?
PRIMARY - raised T4 - low TSH SECONDARY - raised T4 - raised TSH
30
HYPERTHYROIDISM what are the causes of primary hyperthyroidism?
- graves disease - toxic nodular goitre - drug induced hyperthyroidism
31
HYPERTHYROIDISM what are the causes of secondary hyperthyroidism?
pituitary tumour
32
LEVOTHYROXINE DOSE ADJUSTMENT how do you adjust the dose of levothyroxine from TFT results?
- use TSH as guide (should be 0.5-5 mIU/L) - change by smallest increment offered TSH <0.5 = decrease dose TSH 0.5-5 = no action (same dose) TSH >5 = increase dose
33
CXR how do you check the quality of the film?
PRIM - Projection (PA = normal, if AP, the heart will appear larger. If no label = PA) - Rotation (distance between spinous process + clavicles on each side are equal = no rotation) - Inspiration (if 7th anterior (down-sloping) rib transects diaphragm = adequate) - Markings (if radiographer has spotted anything)
34
CXR what structures should you check on a chest x-ray?
- heart - lungs - trachea - mediastinum - bones
35
CXR what should you check for the heart?
- the heart should be <50% of the width of the lungs in PA film - if it is >50% then cardiomegaly should be considered
36
CXR what are the signs that are seen on CXR in heart failure?
ABCDE - alveolar oedema (bat wings) - kerley B lines (interstitial oedema) - cardiomegaly - dilation of upper lobe vessels - pleural effusion
37
CXR what should you look for in the lungs on chest x-ray?
white areas - effusion = unilateral + solid - pneumonia = unilateral + fluffy - oedema = bilateral + fluffy - fibrosis = bilateral + honeycomb
38
CXR what should you consider with trachea in chest x-ray?
check if trachea is central - deviation towards affected side = lobe collapse - deviation away from affected side = pneumothorax
39
CXR what should you check with the mediastinum in chest x-rays?
whether the mediastinum is widened widened + tracheal deviation = upper lobe collapse widened without tracheal deviation = aortic dissection
40
CXR what should you look out for with the bones on chest x-rays?
look for rib fractures or lytic lesions (suggest metastatic disease)
41
CXR what are the difficult areas of a chest x-ray?
- costophrenic angles = if not sharp, pleural effusion - air under right hemidiaphragm = bowel perforation or recent surgery - air under left hemidiaphragm = normal - triangle behind heart (sail sign) = lower lobe collapse - something in apices = TB or apical tumour
42
ECG how do you calculate rate?
- count no. peaks in rhythm strip and x 6 or - 300 / no. large squares between each QRS
43
ECG how do you check rhythm?
- check if P waves followed by QRS = sinus - no P waves + irregular = AF
44
ECG what should you check with PR interval?
- >1 large square = 1st degree heart block - increasing then missing QRS = 2nd degree heart block (mobitz type 1) - 2 or 3 P waves for every QRS = 2nd degree heart block (mobitz type 2) - no relationship between P and QRS = 3rd degree heart block
45
ECG what should you check with QRS complexes?
WIDTH - <3 small squares = no BBB - >3 small squares = BBB present HEIGHT - add largest deflection in V1 to largest deflection in V6, if sum exceeds 3.5 large squares = left ventricular hypertrophy (LVH) - if small complexes throughout = pericardial effusion
46
ECG how do you determine the type of bundle branch block?
LEFT BUNDLE BRANCH BLOCK - WiLLiaM - W deflection in V1 - M deflection in V6 RIGHT BUNDLE BRANCH BLOCK - MaRRoW - M deflection in V1 - W deflection in V6
47
ECG what should you check for ST segment?
ELEVATION - ST segment flat + only raised in some leads = infarction - ST segment convex + raised in all leads = pericarditis DEPRESSION - ST segment flat + only depressed in some leads = infarction - ST segment down-sloping in all leads = digoxin treatment
48
ECG what should you check for T waves?
HEIGHT - > 2/3 height of QRS = hyperkalaemia INVERSION - normal in aVR and I - in other leads suggests an old infarct/LVH
49
ABG what is the method for reading ABGs?
- check FiO2 if pt on oxygen (FiO2 - 10, should be more than PaO2. If not, pt is hypoxic) - check for respiratory failure (type 1 = low PaO2 + low/normal PaCO2, type 2 = low PaO2 and high PaCO2) - check acid status (<7.35 = acidosis, >7.45 = alkalosis) - metabolic = change in HCO3 - respiratory = change in CO2 - compensation = change in both HCO3 and CO2
50
INSULIN DOSING ADJUSTMENTS IN T1DM if the blood glucose keeps rising overnight, how should you adjust the insulin regimen?
- suggests basal insulin is too low - increase the dose of basal insulin (long-acting, e.g. levemir)
51
INSULIN DOSING ADJUSTMENTS IN T1DM if the blood glucose keeps falling overnight, how should you adjust the insulin regimen?
- suggests the basal insulin is too high - reduce the basal insulin dose (long-acting, e.g. levemir)
52
INSULIN DOSING ADJUSTMENTS IN T1DM if the blood glucose keeps rising between breakfast and lunch, how would you adjust the insulin regimen?
suggests the short acting insulin before breakfast is too low increase dose of short-acting insulin before breakfast (e.g. novorapid)
53
INSULIN DOSING ADJUSTMENTS IN T1DM if the blood glucose keeps rising between lunch and tea, how would you adjust the insulin regimen?
- suggests the short-acting insulin dose before lunch is too low - increase the dose of short-acting insulin before lunch (e.g. novorapid)
54
INSULIN DOSING ADJUSTMENTS IN T1DM if blood glucose keeps falling after lunch, how would you adjust the insulin regimen?
- suggests the dose of short-acting insulin before lunch to too high - reduce short-acting insulin dose before lunch (e.g. novorapid)
55
CHOLESTEROL DOSING how would you adjust the dose of statins if non-HDL cholesterol reduced by < 40% within 3 months of starting treatment?
- increase the dose of statin
56
CHOLESTEROL DOSING when would you increase the dose of statins?
if non-HDL cholesterol has not increased by >40% within 3 months of starting treatment, then the dose of statin needs to be increased
MY REVISION - PSA
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