AKT REVISION - ENDOCRINOLOGY

Question 1

Alkaptonuria (AKU) is also known as:

Select one:

a. Black bone disease
b. Black tongue disease
c. Red foot disease
d. Blue skin disease

Answer 1

BLACKBONE DISEASE

Question 2

A key early diagnostic feature seen in babies with AKU is:

Select one:

a. Pigmented palmar skin creases
b. Stiff hips and knees
c. Failure to thrive
d. Darkly pigmented urine seen in nappies

Answer 2

Darkly pigmented urine seen in nappies

Question 3

The gold standard diagnostic test in patients with suspected AKU is:

Select one:

a. Plasma sample for HGA levels
b. Retinal screening for HGA deposits
c. Urine for organic acid analysis
d. Cultured fibroblast for HGA staining

Answer 3

Urine for organic acid analysis

Question 4

The key difference clinically in the presentation of adults with AKU and Ankylosing spondylitis (AS) is:

Select one:

a. Sacroiliac joint sparing in AKU
b. Morning stiffness more pronounced in AKU
c. A negative HLA-B27 test in AKU
d. Small joint sparing in AKU

Answer 4

Sacroiliac joint sparing in AKU

Question 5

Which are the characteristic clinical signs of AKU in adults:

Select one or more:

a. Urine darkly pigmented after being left to stand
b. Ears – blue cartilage
c. Pigmented nail beds
d. Eyes– dark brown-black spots
e. Periumbilical discolouration
f. Joint ochronosis- darkly pigmented joint at time of surgery

Answer 5

Urine darkly pigmented after being left to stand

Ears – blue cartilagE

Eyes– dark brown-black spots

Joint ochronosis- darkly pigmented joint at time of surgery

Question 6

Regarding the prescribing of diabetes medication, which of the following statements are true?

Select one or more:

Diabetes medication prescribing now accounts for nearly 10% of all prescription costs

Prescriptions should only be issued for one month at a time due to the risk of hypoglycaemia

Prescriptions for diabetics are free across the UK

There are seven classes of oral blood-glucose-lowering drugs

Medications tend to be switched rather than combined in order to achieve control

Answer 6

The correct answers are: Diabetes medication prescribing now accounts for nearly 10% of all prescription costs,

There are seven classes of oral blood-glucose-lowering drugs

Question 7

Which of the following have an evidence base for preventing or treating complications of diabetes?

Select one or more:

ACE inhibitors

Bendroflumethiazide

Statins

H2 receptor antagonists

Orlistat

Answer 7

ACE inhibitors

Statins

Question 8

Which of the following are components of a high quality medication review?

Select one or more:

Checking that the medication is effective for the patient

Exploring side effects

Identifying use of over-the-counter and complementary medicines

Returning unused medication to the practice

Ensuring the medication is a cost-effective choice

Answer 8

Checking that the medication is effective for the patient

Exploring side effects

Identifying use of over-the-counter and complementary medicines

Ensuring the medication is a cost-effective choice

Question 9

According to NICE, which of the following statements regarding diabetic medication and HbA1c targets are true?

Select one or more:

If HbA1c levels are not adequately controlled by a single drug which is being taken correctly, and rise to 58 mmol/mol or higher, drug treatment should be intensified

If a patient is on a single drug to control their diabetes, and the drug is not associated with hypoglycaemia, the target HbA1c level should be 48 mmol/mol

For a patient taking more than one drug for diabetes, the target HbA1c level should be 56 mmol/mol

Consideration should be given to de-intensifying treatment in patients with an HbA1c of less than 48 mmol/mol

All patients should have the same HbA1c targets

Answer 9

If HbA1c levels are not adequately controlled by a single drug which is being taken correctly, and rise to 58 mmol/mol or higher, drug treatment should be intensified,

If a patient is on a single drug to control their diabetes, and the drug is not associated with hypoglycaemia, the target HbA1c level should be 48 mmol/mol,

Consideration should be given to de-intensifying treatment in patients with an HbA1c of less than 48 mmol/mol

Question 10

The Scottish Government Polypharmacy Model of Care Group have recommended that a treatment approach to minimise symptoms related to hyperglycaemia rather than targeting an HbA1c level should be taken in which of the following patient groups?

Select one or more:

Age over 80

Resident in a nursing home

Dementia

End-stage kidney disease

Learning disability

Answer 10

Age over 80

Resident in a nursing home

Dementia

End-stage kidney disease

Question 11

AKI diagnosis, where is it more ?

Primary

Secondary

Tetiary

Answer 11

AKI is diagnose more in the primary care

Question 12

AKI means worsening of kidney function over a short period of time ?

Answer 12

TRUE

Question 13

AKI definition. Which three tools are used to define AKI?

Answer 13

A. Serum creatinine rise in 48 hours of 26 micromol/L or more

B. Serum creatinine rise of 50% or more in 7 days

C. Urine output fall 6 hours to less than 0.5ml/hour/kg

AKI is owrsening of kidney function in context of an acute illness

Question 14

What proportion of cases of AKI start in the community?

Select one:

10%

20%

40%

60%

Answer 14

60%

Question 15

What are common causes of AKI

Answer 15

Sepsis

Hypoperfusion

Obstruction

Question 16

All of the following but one puts a person at risk of AKI

Which of the following factors put a person at increased risk of AKI?

Select one or more:

Increasing Age

Physical incapacity

Dementia

Chronic kidney disease

COPD

Diabetes mellitus

Chemotherapy

Answer 16

COPD

Question 17

Aptient takes the following medication for RA. All of the follwoing but one puts the patient at risk of RA

In a patient with rheumatoid arthritis which of the following medications puts them at risk of AKI?

Select one or more:

Naproxen

Ibuprofen

Paracetamol

Gold

Methotrexate

Answer 17

PARACETAMOL

Question 18

All of the following but one puts a heart failure patient at risk of AKI

Select one or more:

Ramipril

Candesartan

Furosemide

Spironolactone

Eplereone

Bisoprolol

None of the above

Answer 18

NONE OF THE ABOVE

Question 19

You are the duty doctor and notified by the laboratory that a patient has AKI stage 2.

Which of the following are the appropriate actions in response to this?

Select one or more:

Leave this for the patients own GP to deal with tomorrow

Access the patients notes to review past history and medications

Identify why the blood test was taken

Telephone the patient/carer and find out how the patient is

Immediately arrange admission to hospital

Answer 19

Access the patients notes to review past history and medications,

Identify why the blood test was taken,

Telephone the patient/carer and find out how the patient is

Question 20

The level of which ion needs to be considered when assessing the severity of AKI

Select one:

Sodium

Potassium

Calcium

Answer 20

Potassium

Question 21

Which of the following are considered specific exposures which may cause an episode of AKI?

Select one or more:

Diarrhoea and vomiting

Sepsis

Major surgery

Recent coronary angiogram

Treatment with trimethoprim

Answer 21

Diarrhoea and vomiting,

Sepsis,

Major surgery,

Recent coronary angiogram

Question 22

Which of the following are appropriate immediate actions in assessment of the patient with AKI?

Select one or more:

Urine dipstick testing

Renal ultrasound scan

Blood pressure check

Catheterisation to monitor urine output

Nephrology referral

Answer 22

Urine dipstick testing

Blood pressure check

Urine dipstick results showing haematuria and proteinuria, without urinary tract infection or trauma due to catheterisation.? Think Acute nephritis