UCL MBBS (Fach) / Data interpretation (Lektion)

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• Path - Tuberculin sensitivity tests ---
• Histo Macro Micro Explain causal / other links to signs, symptoms, prognosis Common examples?
• Path - Tumour markers CEA - Colon AFP - Liver CA125 - Ovary CA19-9 - Pancreas Ca15-3 - Breast PSA - Prostate Calcitonin - Medullary thyroid Thyroglobulin - follicular/papillary thyroid Paraproteins - multiple myeloma
• Path - Autoimmune antibodies Connective tissue disorders SLE - dsDNA, histones RA - CCP, rheumatoid factor Sjoegren's - Ro, La Jo - poly-/dermatomyositis CREST - Scl70; diffuse systemic sclerosis - Topoisomerase 1 Liver PBC, PSC, AIH, vasculitides Other Thyroid Pernicious anaemia
• Path - Blood film abnormalities incl. abnormal cells (RBC, smear) Holly-Jolly, Pappenheimer bodies, other inclusion bodies
• Path - cyt P450 Inducers St Johns Wort Rifampicin AED: Carbamzepine, phenytoin, barbiturates, e.g. phenobarbital Chronic alcohol & smoking Griseofulvin Sulfonylureas Inhibitors Macrolides: clarithromycin, erythromycin Azole antifungals: triconazole, fluconazole, ketoconazole Chloramphenicol, ciprofloxacin Isoniazid Omeprazole Cimetidine Allopurinol Amiodarone Sufonamides Quin(id)ine Acute acohol Grapefruit Juice
• Path - Light's criteria Likely an exudative process if LDH > 30 (or higher than 2/3 upper limit of normal for serum) or protein ratio > 0.5 and LDH ratio > 0.6 Likely an transudative process if LDH < 25 → DDx of ex-/transudative pleural effusions
• Well's score VTE
• ASA score American Society of Anaesthesiology (ASA) Score A five category physical status classification system for assessing a patient before surgery. Healthy patient Mild systemic disease Severe systemic disease Severe systemic disease that is a constant threat to life A moribund patient who is not expected to survive without the operation
• Fundoscopy: Hypertensive retinopathy Grade 1 - Generalised arteriolar constriction - silver wiring and vascular tortuosities Grade 2 - + irregularly located, tight constrictions (AV nipping) Grade 3 - + cotton wool spots and flame haemorrhages Grade 4 - + swelling of the optic disk (papilledema) → diabetic retinopathy, maculopathy Cotton wool spots (ischaemia), blot haemorrhages, flame haemorrhages, hard exudates
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• Drugs: Opioid conversion factors Morphine → diamorphine: /3 ??other
• CXR - Cavitating lesion DDx Malignancy TB Atypical pneumonia: Klebsiella Abscess
• Path: Anatomy of the kidney Micro - Histology Glomeruli: endothelial, epithelia, mesangial, podocytes Tubules Interstitium Non-glomerular vessels Macro Blood supply Patterns of glomerular involvement Focal vs diffuse segmental vs global cresenteric
• DEXA scan Dual-Energy X-ray Absorptiometry for Bone Mineral Density Osteoporosis/-penia based on T-Score
• Hypercalcaemia Causes: Malignancy (bone mets, myeloma), 1°/3° hyperparathyroid, sarcoid, thiazides, Vit D toxicity Symptoms: Moans, groans (dudenal ulver, pancreatitis, renal stones), stones, bones Polyuria / -dipsia, thirst ECG: short QT → arrythmias Management: Acutely: Fluids, bisphophonates (e.g. IV pamidronate) Long-term: Treat underlying cause; cincacalcet for hyperparathyroid Hypocalciuric hypercalcaemia: Mutations in Ca2+ sensing receptors in parathyroid gland and/or kidney → normocalcaemic hyercalciuria ⇒ calcium-oxalate kidney stones
• Hyperprolactinaemia Causes: Pregnancy Oral contraception -- HRT Pituitary adenoma - micro vs macro Drugs -- antipsychotics  Symptoms: Breast discharge Treatment: cabergoline
• Path: renal immunology Autoantibodies Anti-Nuclear Antibodies → SLE, Sjogren's autoimmune hepatitis, sclerodermaAnti-Neutrophil Cytoplasm Antibody: cytoplsamic (anti-proteinase 3) / perinuclear (anti-myeloperoxidase) → SLE Anti-GBM antibodies: α3 chain of type IV collagen → pulmonary-renal syndrome (Goodpasture's) Linear / granular / few (pauci) deposits → Anti-GBM / Immune complex / ANCA-associated glomerulonephritis Cresentic glomerulonephritis
• Hypocalcaemia Causes: Vit D deficiencySigns: Spasms, tinglingECG: Long QT intervalManagement: oral Ca2+ 10 min 10% calcium gluconate IV over 30min
• Hyperkalaemia Normal range:  3.5 - 4.9/5.3 Causes: Kidney failure, cell lysis, K+-sparing diuretics; Addison's; artefactSigns: ConfusionECG: Tall, tented T-waves ⇒ flattened P ⇒ short PR ⇒ wide QRS ⇒ sinusoidTreatment Cardiac protection: 10 ml 10% Calcium gluconate IV over 10 min 10 units of soluble insulin in 50 ml of 50% dextrose over 20 min Salbutamol inhalers Later: Frusomide or dialysis / filtration if refractory
• Hypokalaemia Normal range: 3.5 - 4.9 Causes: Loop diuretics, N+V, enteric fistula Conn's (also ↑BP, ↑Na+), alkalosis, steroids / Cushings / ACTH Hypokalaemic periodic paralysis Symptoms: Weakness, hypotonia, cramps, hyporeflexia, palpitations, light-headedness Management: Oral (>2.5 mmol/L, 80mmol/24h) / IV (<2.5mmol/L, <20mmol/hr, <40mmol/L) replacement
• Hyponatraemia Normal range 135 - 145 Causes Hypovolaemia:  N+V, dehydration, Addison's, diuretic renal failure, diuretics excess; urinary Na+ for loss in kidneys vs loss in gut Euvolaemic: SIADH, polydipsia Hypervolaemic: Heart / Liver / Kidney failure; nephrotic syndrome Treatment: (not too fast - 0.5 mmol/L/hr - 10 mmol/L/d) Treat the underlying cause Cautious rehydration NaCl 0.9% Fluid restriction Vaptans to excrete free water Emergency: hypertonic saline 1.8%
• ABG: Raised / normal anion gap metabolic acidosis Raised Lactic acid - ischaemia, shock, infection Ketones - diabetes, alcohol Urate - renal failure Toxins - salicylate, biguanides, ethylene glycol, methanol Normal RTA Diarrhoea Addison's disease Pancreatic fistula Drugs - acetazolamide Ammonium chloride ingestion Metabolic alkalosis: vomiting, K+ depletion, burns, ingestion of base
• Lipid blood tests LDH, HDL, ratio, total, cholesterol, triclycerides Statins, fibrates, ezetemibe, colestyramine

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