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Y3 TRANSITION > Biochemistry > Flashcards

Biochemistry Flashcards

1
Q

Sodium follows water everywhere. True/False?

A

False

Water follows sodium!(WafS)

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2
Q

Concentration of Na inside the cell is more than concentration of Na outside the cell. True/False?

A

False

Concn of Na outside cell is greater than inside

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3
Q

What does mineralocorticoid activity refer to?

A

Sodium retention in exchange for potassium and/or hydrogen ions

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4
Q

What is the main steroid in the body with mineralocorticoid activity?

A

Aldosterone

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5
Q

Excess mineralocorticoid activity causes what?

A

Sodium retention

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6
Q

What effect does sodium loss have upon water?

A

Sodium loss means water loss (water follows sodium!)

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7
Q

Outline what happens in terms of sodium and water when blood pressure drops

A

Decreased blood pressure causes sodium + water retention in order to compensate and bring blood pressure up

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8
Q

Which hormone controls water reabsorption?

A

ADH

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9
Q

What effect does ADH have on water reabsorption and thus urine output?

A

Causes increased water reabsorption (anti-diuresis), producing low-volume concentrated urine

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10
Q

Concentrated/small volume urine has a high omolality. True/False?

A

True

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11
Q

What are the main causes of decreased sodium levels?

A

Too much water

Too little sodium

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12
Q

What are the main causes of increased sodium levels?

A

Too little water

Too much sodium

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13
Q

Decreased sodium levels can be due to too much water. How can this arise?

A

SIADH (inappropriate ADH secretion)

Compulsive water drinking

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14
Q

Decreased sodium levels can be due to too little sodium. How can this arise?

A 
Sodium loss (renal insufficiency, gut fistulae)
Decreased sodium intake (rare)
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15
Q

Increased sodium levels can be due to too little water. How can this arise?

A 
Water loss (diabetes insipidus)
Decreased water intake
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16
Q

Increased sodium levels can be due to too much sodium. How can this arise?

A

IV medication
Drowning in sea
High-salt feeds

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17
Q

Outline pathogenesis of Addison’s disease

A

Adrenal insufficiency;can’t make enough aldosterone;can’t retain enough sodium;lose sodium + water;low ECF volume, so patient is dehydrated + dizzy

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18
Q

What is the main osmotic stimulus for ADH release?

A

High sodium (high osmolality) causes increased ADH

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19
Q

Does hypovolaemia cause increased or decreased ADH release?

A

Increased ADH release (to compensate for loss of fluid)

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20
Q

Outline the main treatment for too much sodium

A

Loop diuretic

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21
Q

Outline the treatment for SIADH

A

Fluid restrict to 0.5l

Sodium should rise

22
Q

Outline the treatment for diabetes insipidus

A

Desmopressin (synthetic ADH)

23
Q

Outline the treatment for too little sodium

A

Sodium supplement

24
Q

List features of Addison’s disease

A 
Skin pigmentation (high ACTH)
Dizziness
Low BP
Hyponatraemia
Hyperkalaemia
25
Q

State the diagnostic test for adrenal insufficiency

A

Short synacthen test

26
Q

What are the two types of adrenal insufficiency?

A

Primary e.g. Addison’s

Secondary e.g. long-term use of CCS

27
Q

List ECG changes found in hyperkalaemia

A

Tall tented T waves

Broad QRS

28
Q

Give symptoms of hyperkalaemia

A

Muscle weakness

Paraesthesia

29
Q

List causes of hyperkalaemia

A 
Reduced excretion (renal failure, hypoaldosteronism)
Redistribution (metabolic acidosis, rhabdomyolysis, insulin deficiency)
Increased intake (potassium salts)
30
Q

List treatment options for hyperkalaemia

A

Calcium gluconate
Insulin
50% dextrose
Dialysis

31
Q

What is pseudohyperkalaemia?

A

Increase in concentration of potassium due to its movement out of cells in a haemolysed blood sample

32
Q

List symptoms of hypercalcaemia

A 
Confusion
Abdominal pain
Renal stones
Polyuria, polydipsia
Constipation
33
Q

List the common causes of hypercalcaemia

A

Primary hyperparathyroidism
Hypercalcaemia of malignancy
Thiazide diuretic therapy
Sarcoidosis

34
Q

Outline treatment for hypercalcaemia

A

IV fluids
Biphosphonates
Treat cause e.g. surgery

35
Q

What is familial benign hypercalcaemia?

A

High calcium is sensed by the parathyroid as normal, therefore the patient has normal PTH and high calcium

36
Q

By what mechanisms, does the kidney regulate blood volume?

A

Renal excretion of sodium
Renal excretion of water
via RAAS system

37
Q

List ways in which hyponatraemia is assessed

A 
Serum sodium (plasma osmolality)
Urine sodium (volume status)
38
Q

How do you distinguish between hyponatraemia and pseudohyponatraemia?

A

Measure serum osmolality (normal in pseudo)

39
Q

How do you distinguish between central and nephrogenic diabetes insipidus?

A

DDAVP, synthetic analogue of ADH
Central is due to a lack of ADH
Nephrogenic is due to reduced response to ADH

40
Q

What type of lung cancer is most associated with the production of ADH?

A

Small cell carcinoma

41
Q

What type of lung cancer is most associated with hypercalcaemia?

A

Squamous cell carcinoma

42
Q

Patients with adrenal insufficiency are less able to retain infused saline (sodium) than normal subjects. True/ False?

A

True

Addison’s patients are unable to hold onto sodium

43
Q

How do you distinguish between primary and secondary adrenal insufficiency?

A

Measure ACTH

Reduced in secondary insufficiency

44
Q

List the role of PTH

A

Bone resorption (increase calcium)
Activate vitamin D in kidneys (increase calcium)
Increase GI calcium absorption

45
Q

Why is rehydration so important in hypercalcaemia patients?

A

It interferes with proximal tubular reabsorption of sodium and so causes loss of sodium and water patients are usually dehydrated

46
Q

List drugs that are at risk of causing hyperkalaemia

A

Potassium-sparing diuretics (eg, spironolactone)
NSAIDs
ACE inhibitors.
Angiotensin-receptor blockers (ARBs)

47
Q

Give two side effects of rhabdomyolysis

A

Acute renal failure

Disseminated intravascular coagulation

48
Q

What gross findings suggest contamination with potassium EDTA, the anticoagulant used in the purple top (FBC) bottle?

A

Gross hypocalcaemia

Gross hyperkalaemia

49
Q

What is meant by a high vs low urine osmolality?

A 
High = concentrated urine
Low = dilute urine
50
Q

How do you test for secondary adrenal insufficiency?

A

Short synacthen test

It would show a suppressed ACTH

Y3 TRANSITION (10 decks)

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