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chem Flashcards

1
Q

osmolality equation

A

2(Na +K) + glucose + urea

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2
Q

what is the difference between osmolality and osmolarity

A

osmolality = /kg, more accurate

osmolarity = /litre, more practical

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3
Q

what is the biggest contributor to osmolality

A

sodium

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4
Q

what is osmolality gap

A

difference between calculated and measured osmolality, due to things not included in calc (sugars, alcohol)

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5
Q

what is pseudohyponatraemia

A

reduced Na, normal/high osmolality

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6
Q

HYPOvolaemic HYPOnatraemia with LOW urinary sodium

A

extra renal loss (vomiting, diarrhoea, burns)

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7
Q

HYPOvolaemic HYPOnatraemia with RAISED urinary sodium

A

renal loss (diuretics, renal loss)

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8
Q

HYPERvolaemic HYPOnatraemia with LOW urinary sodium

A

CCF, cirrhosis, nephrotic syndrome

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9
Q

HYPERvolaemic HYPOnatraemia with RAISED urinary sodium

A

CKD

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10
Q

EUvolaemic HYPOnatraemia with LOW urinary sodium

A

psychogenic polydipsia

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11
Q

EUvolaemic HYPOnatraemia with RAISED urinary sodium

A

hypothyroid, SIADH, adrenal insufficiency

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12
Q

HYPOvolaemic HYPERnatraemia

A

osmotic diuresis, diarrhoea, burns

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13
Q

HYPERvolaemic HYPERnatraemia

A

hyperaldosteronism

hypertonic 3% saline

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14
Q

hypernatraemia management

A

oral water intake

slow IV 5% dextrose

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15
Q

causes of central diabetes insipidus

A

pituitary surgery, irradiation, tumour

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16
Q

central diabetes insipidus management

A

desmopressin

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17
Q

causes of nephrogenic diabetes insipidus

A

electrolyte disturbance (hypokalaemia, hyperglycaemia)

drugs (lithium)

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18
Q

nephrogenic diabetes insipidus management

A

thaizides

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19
Q

diabetes insipidus investigations

A

glucose - exclude DM

K - exclude hypo

Ca - exclude hyper

water deprivation test

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20
Q

hypokalaemia features

A

muscle weakness, cramps, hypotonia

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21
Q

causes of hypokalaemia - increased loss

A

GI loss (d+v, high output stoma)

renal loss (conn’s, diuretics)

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22
Q

causes of hypokalaemia - increased cellular influx

A

insulin

beta agonists

refeeding syndrome

metabolic alkalosis

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23
Q

hypokalaemia investigations

A

Mg - correct if low

if raised BP, aldosterone: renin ratio

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24
Q

hypokalaemia management

A

mild-moderate (2.5-3.5) - oral sando K

severe (<2.5) IV replacement, continuous ECg

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25
Q

hyperkalaemia ECG features

A

tall tented T waves, small p, wide QRS

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26
Q

hyperkalaemia causes - artifact

A

haemolysis

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27
Q

hyperkalaemia causes - iatrogenic

A

massive blood transfusion

excess supplmentation

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28
Q

hyperkalaemia - reduced excretion

A

renal disease

addison’s

drugs (ACEi, ARB, K sparing diuretics)

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29
Q

hyperkalaemia - increased cellular release

A

tissue breakdown

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30
Q

hyperkalaemia investigations

A

renal function

cortisol/ short ACTHen test

CK

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31
Q

hyperkalaemia management

A

if >6.5 or ECG changes

IV calcium gluconate

IV insulin w/ dextrose

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32
Q

what hormone has the opposite affect to PTH

A

calcitonin

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33
Q

hypocalcaemia features

A

peri-oral paraesthesia, long QT, spasm, tetany

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34
Q

hypocalcaemia causes

A

osteomalacia

hypoparathyroidism

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35
Q

hypocalcaemia investigations

A

ECG

bloods (Mg, phosphate, PTH, ALP)

dexa

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36
Q

hypocalcaemia management

A

mild (>1.9) - oral calcium/ vit D supplement

severe - IV calcium gluconate

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37
Q

hypercalcaemia features

A

stones, bones, abdo groins, psychic moans

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38
Q

hypercalcaemia causes (raised PTH)

A

primary/ tertiary hyperparathyroidism, late stage CKD

if primary hyper, suspect MEN1/2a

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39
Q

hypercalcaemia causes (low PTH)

A

malignancy

hyperthyroid

hypoadrenal

sarcoidosis

thiazides

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40
Q

hypercalcaemia Ix

A

myeloma screen

TFTs, cortisol

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41
Q

hypercalcaemia management

A

fluids

acute - IV normal saline

medical - bisphosphonates (if malignancy)

surgical - parathyroidectomy

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42
Q

isolated raised ALP

A

paget’s disease

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43
Q

alcoholic hepatitis AST:ALT ratio

A

> 2

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44
Q

viral hepatitis AST:ALT ratio

A

<1

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45
Q

hypothyroid autoimmune causes

A

primary atrophic (no goitre)

hashimoto’s (goitre + anti-TPO/TG)

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46
Q

hypothyroid other causes (not autoimmune)

A

iodine deficiency

surgery/ radioactive ablation

drugs - amiodarone, lithium, carbimazole

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47
Q

myxoedema coma management

A

IV liothyronine

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48
Q

what is sick euthyroid

A

in severe illness

reduced T3, T4

initially increased TSH, then reduced

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49
Q

syndrome with increased TSH but normal T3/4

A

subclinical hypothyroidism

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50
Q

what antibody is associated with increased risk of hypothyroid in subclinical hypothyroid

A

anti-TPO

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51
Q

causes of hyperthyroid

A

graves

de quervain’s thyroiditis

thyroid adenoma

amiodarone

toxic multinodular goitre

post-partum

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52
Q

focal lesions on thyroid reuptake scan

A

adenoma

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53
Q

multiple patchy lesions on thyroid reuptake scan

A

toxic goitre

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54
Q

generalised increased uptake on thyroid reuptake scan

A

graves

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55
Q

cold thyroid on reuptake scan

A

de quervain’s

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56
Q

medical management of hyperthyroid

A

carbimazole or propylthiouracil

beta blockers for AF/ palpitations

lugol’s iodine - make pt euthyroid for surgery

radio-iodine - risk permanent hypo

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57
Q

where is the pituitary gland

A

sella turcica just below optic chiasm

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58
Q

malignant causes of hypopituitarism

A

pituitary adenoma

craniopharyngioma

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59
Q

infective causes of hypopituitarism

A

TB

syphilis

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60
Q

infiltrative causes of hypopituitarism

A

sarcoid

lymphoma

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61
Q

iinfarct causes of hypopituitarism

A

sheehan’s

apoplexy

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62
Q

tertiary causes of hypopituitarism

A

kallman’s

prader-willi

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63
Q

what is combined pituitary function test

A

give GnRH, TRH and insulin, measure GH, cortisol, TSH, LH, FSH and prolactin every 30 mins for 2 hrs

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64
Q

hypopituitarism management

A

hydrocortisone

thyroxine

oestrogen/ testosterone

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65
Q

effects of pituitary macroadenoma

A

usually non-functional

bitemporal hemianopia

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66
Q

effects of pituitary microadenoma

A

GH or prolactin secreting

prolactin –> galactorrhoea, gynaecomastia, oligo/amennorhoea, loss of libido, impotence

GH –> acromegaly, organomegaly, heart failure sx, htn, dm, carpal tunnel

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67
Q

acromegaly Ix

A

glucose tolerance test

plasma IGF-1

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68
Q

pituitary adenoma management

A

octreotide (somatostatin analogue)

cabergoline or bromocriptine (dopamine agonist)

pegvisomant (Gh antagonist)

surgery - trans-sphenoidal debulking

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69
Q

most common type of thyroid tumour

A

papillary

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70
Q

second most common thyroid tumour

A

follicular

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71
Q

medullary thyroid cancer features

A

c-cells that produce calcitonin
linked to men2
5% of thyroid cancers

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72
Q

type of thyroid cancer linked with hashimoto’s

A

lymphoma

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73
Q

anaplastic thyroid cancer features

A

elderly patients, poor prognosis

undifferentiated

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74
Q

management of papillary/ follicular thyroid cancer

A

surgery +/- radioactive iodine

replace thyroxine to completely supress TSH

monitor thyroglobulin levels

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75
Q

what is produced in the glomerulosa of adrenals

A

mineralocorticoids (aldosterone)

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76
Q

what is produced in the fasciculata of adrenals

A

glucocorticoids (cortisol)

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77
Q

what is produced in reticularis of adrenals

A

sex hormones

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78
Q

what is produced in adrenal medulla

A

catecholamines

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79
Q

most common cause of addisons in the UK

A

autoimmune

80
Q

most common cause of addison’s worldwide

A

TB

81
Q

addison’s features

A

postural drop, fatigue

weight loss, anorexia

vomiting, salt craving

skin/ mucosal pigmentation

82
Q

addison’s ix

A

9am cortisol >350 excludes hypoadrenalism

synACTHen test - if cortisol rises –> secondary cause (pituitary), if not then primary

hyponatraemia, hyperkalaemia

83
Q

features of addisonian crisis

A

hypotension

hypovolaemia

hypoglycaemia

84
Q

addisons management

A

hydrocortisone (double dose if unwell)

fludrocortisone

85
Q

what is schmidt’s syndrome

A

simultaneous hypoadrenalism and hypothyroid

86
Q

cushings causes

A

primary - adrenal malignancy

secondary - pituitary adenoma, ectopic/ paraneoplastic

iatrogenic (exogenous steroids)

87
Q

cushings ix

A

low dose dexmethasone suppression test - confirm syndrome

high dose dexamethasone suppression test - syndrome vs disease (adenoma)

88
Q

cushings imaging

A

CT CAP/ adrenals

MRI pituitary

89
Q

ectopic cause cushings management

A

ketoconazole, metyrapone, mifepristone

90
Q

primary cushings management

A

adrenalectomy +/- steroid replacement

91
Q

CKD electrolytes

A

reduced NA, raised K, raised urea

92
Q

addisons electrolytes

A

reduced Na, raised K, reduced glucose

93
Q

ethanol electrolytes

A

reduced Na, raised osmolality

94
Q

conn’s syndrome electrolytes

A

raised Na, reduced K

95
Q

D/V electrolytes

A

reduced Na, reduced osmolality, reduced urine osmolality

96
Q

insulin OD electrolytes

A

reduced K, raised pH

97
Q

bartter syndrome electrolytes

A

reduced K, raised pH, raised urinary calcium, hypotension

98
Q

renal tubular acidosis electrolytes

A

reduced K, reduced pH

99
Q

causes of RAISED anion gap metabolic ACIDOSIS

A

methanol/metformin

uraemia

DKA

iron

lactate

ethanol

salicyte

100
Q

causes of NORMAL anion gap metabolic ACIDOSIS

A

diarrhoea

addison’s

renal tubular acidosis

101
Q

kallman’s syndrome features

A

hypogonadotropic hypogonadism

reduced LH, FSH

anosmia

102
Q

what is secondary hypoaldosteronism

A

pituitary defect –> reduced ACTH –> reduced aldosterone, cortisol

103
Q

familial benign hypercalcaemia biochemistry

A

raised PTH, raised Ca, reduced urinary calcium

104
Q

most common cause of secondary hyperparathyroidism

A

chronic renal failure

105
Q

what is pseudohypoparathyroid

A

PTH resistance

raised PTH, raised phosphate, reduced Ca

106
Q

causes of raised serum amylase

A

pancreatitis

mumps

107
Q

ferritin in IDA

A

reduced

108
Q

ferritin in anaemia of chronic disease

A

increased

109
Q

ferritin in thalasaemia

A

normal

110
Q

causes of bence-jones proteins

A

multiple myeloma

amyloid light chain amyloidosis

111
Q

cause of low caeruloplasmin

A

Wilson’s

112
Q

causes of raised CEA

A

colorectal cancer, gastric cancer, pancreatic cancer

113
Q

what is raised aFP associated with

A

hepatocellular carcinoma

114
Q

vitamin B12 deficiency

A

megaolblastic anaemia

hypersegmented neutrophils

can get subacute cord degeneration - ataxia, progressive limb weakness, babinski sign positive

115
Q

what does vitamin E deficiency cause

A

haemolytic anaemia

spino-cerebellar neuropathy - ataxia, areflexia

116
Q

what does vitamin B6 deficiency cause

A

sideroblastic anaemia

seborrhoeic dermatitis

117
Q

what can cause b6 deficiency

A

TB treatment (Isonazid)

118
Q

what does B1 deficiency cause

A

wernicke’s encephalopathy, korsakoff’s syndrome

beri-beri wet - like heart failure
dry - ascending nervous system impairment

119
Q

what does vitamin A deficiency cause

A

night blindness, conjunctival bitot’s spots

predisposed to measles, diarrhoea

120
Q

what does vitamin B2 deficiency cause

A

angular stomatitis, glossitis and/or corneal ulceration

121
Q

features of homocystinuria

A

very fair skin, brittle hair

developmental delay

convulsions, skeletal abnormalities, thrombotic episodes

122
Q

what do you supplement homocystinuria pts with

A

B6

123
Q

PKU features

A

fair hair, developmental delay, severely impaired IQ, eczema, seizures

124
Q

von gierke’s syndrome features

A

hypoglycaemia

hepatomegaly, enlarged kidneys

125
Q

maple syrup urine disease features

A

toxic encephalopathy (lethargy, poor feeding, hypotonia, seizures)

sweet odour, sweaty feet

126
Q

fabry’s syndrome features

A

developmental delay with dysmorphia

cherry red spots

deafness, blindness, movement disorders

127
Q

SCAD deficiency features

A

failure to thrive, hypotonia, metabolic acidosis, hyperglycaemia

128
Q

galactosaemia features

A

vomiting, jaundice, hepatomegaly after milk ingestion

129
Q

toxicity features of phenytoin

A

hypotension

heart block

ventricular arrhythmias

ataxia

130
Q

toxicity features of lithium

A

D+V, coarse tremor, dysarthria

convulsions

renal failure

131
Q

toxicity features of gentamicin

A

deafness, renal failure, balance/ vision issues

toxicity potentiated by kidney function, use of vancomycin

132
Q

toxicity features of digoxin

A

tiredness, blurred vision, nausea, abdo pain, confusion

prolonged PR, bradycardia

133
Q

toxicity features of theophylline

A

nausea, diarrhoea

tachycardia, arrhythmias, headaches, seizures

potentiated by erythromycin, ciprofloxacin

134
Q

toxicity features of procainamide

A

fever, rash

agranulocytosis

135
Q

toxicity features of methotrexate

A

ulcerative stomatitis

leukocytopenia

pulmonary fibrosis

136
Q

toxicity features of carbamezapine

A

headaches, ataxia, abdo pain

SIADH

aplastic anaemia

137
Q

toxicity features of cyclosporine

A

acute renal failure

138
Q

what electrolyte abnormality does metabolic alkalosis cause

A

HYPOkalaemia

139
Q

acute renal failure biochemical picture

A

HYPERkalaemia

metabolic acidosis

140
Q

what electrolyte abnormality can carbamezapine cause

A

hyponatraemia

141
Q

PTH resistance with low calcium

A

pseudohypoparathyroidism

142
Q

PTH resistance with normal calcium

A

pseudopseudohypoparathyroidism

143
Q

test for thiamine deficiency

A

red blood cell transketolase activity

144
Q

test for B2 (riboflavin) deficiency

A

red blood cell glutathione reductase

145
Q

riboflavin deficiency manifestation

A

glossitis

mouth ulceration

dry skin

146
Q

test for B6 (pyridoxine) deficiency

A

red cell aspartate aminotransferase

147
Q

B6 deficiency manifestation

A

seborrhoeic dermatitis like rash

angular chellitis

confusion, neuropathy

can be cause by isoniazid

148
Q

conn’s syndrome picture

A

hypertension

hypokalaemia

metabolic alkalosis

149
Q

gout vs pseudogout birefringence

A

gout = negatively birefringent

pseudogout = positive birefringence

150
Q

gout exacerbating factors

A

alcohol

aspirin

thiazide diuretics

chemo

151
Q

acute gout management

A

NSAIDS, colchicine

152
Q

long term gout management

A

allopurinol

153
Q

causes of metabolic acidosis with raised anion gap

A

methanol

uraemia

DKA

propylene glycol

isoniazid

lactic acidosis (shock, infection , ischaemia)

ethylene glycol

salicylates

154
Q

anion gap calculation

A

Na + K - HCO3 - Cl

155
Q

chronic renal failure phosphate

A

RAISED

156
Q

which bone cells produce ALP

A

osteoblasts

157
Q

cataracts, poor feeding, lethargy, conjugated hyperbilirubinaemia with hepatomegaly and reducing sugars in urine after starting milk

A

galactosaemia

158
Q

alcohol abuse and chronic pancreatitis can cause reduced absorption of fat soluble vitamins and as such cause

A

osteomalacia

159
Q

reduced absorption of dietary vitamin D causes what bloods

A

LOW 25-hydroxy-cholecalciferol

HIGH 1,25-dihydroxy-cholecalciferol

160
Q

which vitamin D metabolite is produced following hydroxylation in the kidney stimulated by PTH?

A

1,25-dihydroxy-cholecalciferol

161
Q

causes of raised ALP

A

liver related (cholestasis, hepatitis, fatty liver, tumour)

drugs (phenytoin, erythromycin, carbamezapine, verapamil)

bone disease (paget’s, renal osteodystrophy, fracture)

vitamin D deficiency, secondary hyperparathyroidism

malignancy (bone metastases, breast, colon, Hodgkin’s lymphoma)

162
Q

vitamin D3 deficiency (Pellagra)

A

dementia

diarrhoea

dermatitis

death

163
Q

symptoms of vitamin E deficiency

A

haemolytic anaemia

spinocerebellar degeneration

peripheral neuropathy

164
Q

list the fat soluble vitamins

A

A

D

E

K

165
Q

how many half lives does a drug take to reach steady state

A

4-5

166
Q

hypoketotic hypoglycaemia with hepatomegaly and cardiomyopathy

A

MCADD

167
Q

pituitary failure leads to lack of

A

ACTH

TSH

168
Q

biochemical cause of acute pancreatitis

A

hypercalcaemia

169
Q

drugs that lead to reduced serum K concentration

A

calcium resonium

insulin

salbutamol

sodium bicarbonate

170
Q

which toponin is the best marker of MI

A

Troponin I

171
Q

best enzyme marker to detect reinfarction of heart

A

CK MB

172
Q

what is a cause of facitious hypoglycaemia other than exogenous insulin

A

sulfonylureas

173
Q

cyanide poisoning first line

A

hydroxocobalamin

174
Q

MEN1 features

A

Pituitary adenoma

Parathyroid hyperplasia

Pancreatic tumours

(3 Ps)

175
Q

MEN 2A features

A

Parathyroid hyperplasia

Medullary thyroid carcinoma

Phaeochromocytoma

176
Q

MEN 2B features

A

Medullary thyroid carcinoma

Phaeochromocytoma

marfanoid body habitus

mucosal neuromas

177
Q

inheritance of MEN disorders

A

autosomal dominant

178
Q

gilbert’s inheritance

A

autosomal recessive

179
Q

enlarged orange tonsils, with hepatomegaly, splenomegaly

A

tangier disease

180
Q

what can’t you give with azathioprine in pts with TPMT deficiency

A

allopurinol

181
Q

term for increased bone density

A

osteosclerosis

182
Q

looser zones

A

osteomalacia

183
Q

which cholesterol transport channel does ezetimibe target

A

NPC 1L1

184
Q

cardiac protection in hyperkalaemia

A

calcium gluconate

185
Q

how to determine if it is a true hyponatraemia

A

serum osmolality

186
Q

where are bile acids reabsorbed

A

terminal ileum

187
Q

which enzyme has reduced activity in Gilbert’s

A

UDP glucuronyl transferase

188
Q

rickets x ray findings

A

widened epiphysis at wrists

bowed legs

189
Q

allopurinol MOA

A

xanthine oxidase inhibition

190
Q

in sarcoidosis, granulomatous tissue can produce which enzyme to lead to hypecalcaemia

A

1-alpha hydroxylase

191
Q

ApoE4 gives increased risk of developing what

A

alzheimers

192
Q

what can rapid correction of hyponatraemia cause

A

central pontine myelinolysis

193
Q

central pontine myelinolysis symptoms

A

lethargy, issues speaking, swallowing, walking

194
Q

condition where there is almost complete failure of PCT to reabsorb molecules

A

fanconi syndrome

195
Q

causes of fanconi syndrome

A

congenital

wilson’s disease

treatracyclines

MM

lead poisoning

Path (hopefully more condensed) (5 decks)

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