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Chem Path Flashcards

1
Q

Normal pH range

A

7.35 - 7.45

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2
Q

Normal PCO2

A

4.7 - 6kPa

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3
Q

Normal Bicarbonate

A

22 - 30 mmol/L

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4
Q

Normal PO2

A

10 - 13 kPa

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5
Q

Blood gas results in Metabolic Acidosis
pH
HCO3
CO2

A

pH LOW
HCO3 LOW
CO2 normal or LOW in compensation

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6
Q

Causes of Metabolic Acidosis (4)

A
  1. DKA - increased H+ production
  2. Renal tubular - decreased H+ excretion
  3. Intestinal fistula - decreased HCO3
  4. Lactate build up
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7
Q

Blood gas results in Respiratory Acidosis
pH
HCO3
CO2

A

pH LOW
HCO3 normal or HIGH in compensation
CO2 HIGH

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8
Q

Causes of Respiratory Acidosis (4)

A
  1. Impaired gas exchange e.g. pneumonia, COPD
  2. Poor perfusion
  3. Decreased ventilation e.g. head injury
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9
Q

Blood gas results in Metabolic Alkalosis
pH
HCO3
CO2

A

pH HIGH
HCO3 HIGH
CO2 normal/High

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10
Q

Causes of Metabolic Alkalosis (3)

A
  1. D&V
  2. Pyloric stenosis - babies vomit up all their stomach acid
  3. hypokalaemia
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11
Q

Blood gas results in Respiratory Alkalosis
pH
HCO3
CO2

A

pH HIGH
HCO3 normal/LOW
CO2 LOW

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12
Q

Causes of Respiratory Alkalosis (2)

A
  1. Mechanical ventilation

2. Hyperventilating/Panic attack - blow off all your CO2

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13
Q

Why look at the PO2?

A

Gives an indication of lung function, and tissue oxygenation

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14
Q 
What's the problem?
pH		6. 90			(7.35-7.45)
H+		126	nmol/l	(35-46)
pCO2	3.0	kPa		(4.7-6.0)
pO2		 24.0	kPa		(10.0-13.3) 
Bicarbonate 6	mmol/l	(22-30)
A

Metabolic Acidosis with partial respiratory compensation

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15
Q 
What's the problem?
pH		7. 55			(7.35-7.45)
H+		28	nmol/l	(35-46)
pCO2	8.2	kPa		(4.7-6.0)
pO2		10.0	kPa		(10.0-13.3) 
Bicarbonate  51	mmol/l	(22-30)
A

Metabolic Alkalosis with partial respiratory compensation

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16
Q 
What's the problem?
pH		7. 55			(7.35-7.45)
H+		28	nmol/l	(35-46)
pCO2	3.0	kPa		(4.7-6.0)
pO2		 14.4	kPa		(10.0-13.3) 
Bicarbonate  20	mmol/l	(22-30)
A

Respiratory Alkalosis

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17
Q

What’s the problem?

72 year old man
Long history of chronic obstructive airways disease
On diuretics for cardiac failure
Potassium 2.6 mmol/l (3.5-5.5)

pH		7. 41			(7.35-7.45)
H+		39	nmol/l	(35-46)
pCO2	10.4	kPa		(4.7-6.0)
pO2		 7.8	kPa		(10.0-13.3) 
Bicarbonate 47	mmol/l	(22-30)

Which?
Normal
Metabolic Acidosis
Respiratory Acidosis
Metabolic Alkalosis
Respiratory Alkalosis
Mixed metabolic acidosis and respiratory acidosis
Mixed metabolic alkalosis and respiratory alkalosis
Mixed metabolic alkalosis and respiratory acidosis
Mixed metabolic acidosis and respiratory alkalosis

A

Mixed metabolic alkalosis and respiratory acidosis

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18
Q 
A young woman was admitted to hospital 8 hours after she had taken an overdose of aspirin. 
Arterial blood:
pH		  7. 46		(7.35-7.45)
H+		35	nmol/l	(35-46)
pCO2	  2.0	kPa		(4.7-6.0)
pO2		17.8	kPa		(10.0-13.3) 
Bicarbonate 10	mmol/l	(22-30)

Normal
Metabolic Acidosis
Respiratory Acidosis
Metabolic Alkalosis
Respiratory Alkalosis
Mixed metabolic acidosis and respiratory acidosis
Mixed metabolic alkalosis and respiratory alkalosis
Mixed metabolic alkalosis and respiratory acidosis
Mixed metabolic acidosis and respiratory alkalosis

A

Mixed metabolic acidosis and respiratory alkalosis

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19
Q 
Arterial blood:
pH		  6. 93		(7.35-7.45)
H+		116	nmol/l	(35-46)
pCO2	  9.7	kPa		(4.7-6.0)
pO2		65.8	kPa		(10.0-13.3) 
Bicarbonate 15 mmol/l	(22-30)

Normal
Metabolic Acidosis
Respiratory Acidosis
Metabolic Alkalosis
Respiratory Alkalosis
Mixed metabolic acidosis and respiratory acidosis
Mixed metabolic alkalosis and respiratory alkalosis
Mixed metabolic alkalosis and respiratory acidosis
Mixed metabolic acidosis and respiratory alkalosis

A

Mixed metabolic alkalosis and respiratory acidosis

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20
Q

How to calculate the anion gap?

Normal range?

A

(Na+ + K+) - (Cl- + HCO3)

14 - 18mmol/L

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21
Q

Causes of raised anion gap metabolic acidosis?

a) Endogenous (3)
b) Exogenous (MUD PILES)

A

a) DKA
Lactic acidosis
Starvation

b)
Methanol
Uraemia
Drugs

Paracetamol 
Insecticides
Lithium 
Ethanol
Salicylates (aspirin)
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22
Q

How to measure Osmolality?

A

2(Na + K) + urea + glucose

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23
Q

How to measure the osmolar gap?

A

Measure Osmolality - Calculated Osmolarity

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24
Q

What’s the normal osmolar gap?

A
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25
What could cause an increased osmolar gap?
extra solute present in the plasma e.g. ethanol, methanol
26
What is Osmolality? Units?
Measured total number of particles present in a solution mmol/kg
27
What is Osmolarity? Units?
Calculated total number of particles present in a solution mmol/L
28
Normal range for serum osmolality?
275 - 295 mmol/kg
29
Normal range for sodium?
135 - 145 mmol/L
30
Pathogenesis of HYPOnatraemia?
increased extracellular water, dilutionary effect
31
Level of severe HYPOnatraemia?
32
Signs of HYPOnatraemia? (4)
1. nausea and vomiting 2. confusion 3. seizures 4. coma
33
In true HYPOnatraemia will the osmolality be high or low?
LOW
34
Clinical features of HYPOvolaemia? (7)
1. low BP 2. tachycardia 3. postural hypotension 4. reduced skin turgor 5. dry mucous membranes 6. confusion/drowsiness 7. reduced urine output
35
Clinical signs of HYPERvolaemia? (3)
1. raised JVP 2. bibasal crackles 3. peripheral oedema
36
Classification of hyponatraemia (3)
1. HYPERvolaemic 2. EUvolaemic 3. HYPOvolaemic
37
Causes of HYPERvolaemic HYPOnatraemia? (3)
1. Heart failure 2. Cirrhosis 3. NephrOtic syndrome
38
Causes of HYPOvolaemic HYPOnatraemia? (3)
1. D&V 2. diuretics 3. salt losing nephropathy
39
Causes of SIADH? (4)
1. CNS - trauma, inflammation, abscess 2. Lung - pneumonia, abscess, small cell lung Ca 3. Malignancies - lymphoma, Ewing's sarcoma, lung, GI, GU 4. Drugs - SSRI, TCA, PPI, opiates, amitriptyline
40
Diagnostic test for SIADH?
Short SynACTHen test
41
How would you treat a HYPOvolaemic HYPOnatraemic patient?
Replace with 0.9% N.Saline
42
How would you treat a HYPERvolaemic HYPOnatraemic patient?
Fluid restrict and treat underlying cause
43
What must you NOT do when correcting sodium? | why?
Serum Na must NOT be corrected > 12 mmol/L in the first 24 hours Risk of osmotic demyelination (central pontine myelionlysis)
44
What are the effects of central pontine myelionlysis?
1. quadriplegia 2. pseudobulbar palsy 3. seizures 4. coma 5. death
45
Drugs used to treat SIADH? (2)
1. Vaptans | 2. Demeclocyline
46
What are the two main stimuli for ADH secretion? a. Reduced bld volume & reduced serum osmolality b. Increased bld volume & increased serum osmolality c. Increased bld volume & reduced serum osmolality d. Reduced bld volume & increased serum osmolality
d. Reduced bld volume &; increased serum osmolality
47
Causes of hyponatraemia post-surgery? (2)
1. dilutionary due to over hydration with hypotonic IV fluids 2. transient increase in ADH due to stress of surgery
48
Clinically HYPERnatraemic?
> 145mmol/L
49
Causes of HYPOvolaemic HYPERnatraemia? - GI - Skin - Renal
GI - vomiting, diarrhoea Skin - excessive sweating, burns Renal - loop diuretics, osmotic diuresis
50
Causes of EUvolaemic HYPERnatraemia? - resp - skin - renal
- resp - tachypnoea - skin - excessive sweating, fever - renal - DI
51
Causes of HYPERvolaemic HYPERnatraemia? (2)
1. Hypertonic saline | 2. Conn's syndrome - mineralocorticoid syndrome
52
Signs of HYPERnatraemia? (6)
1. lethargy 2. thirst 3. irritability 4. confusion 5. coma 6. fits
53
What investigations would you order in a patient with suspected diabetes insipidus? a. Serum glucose (exclude diabetes mellitus) b. Serum potassium (exclude hypokalaemia) c. Serum calcium (exclude hypercalcaemia) d. Plasma & urine osmolality e. Water deprivation test
e. Water deprivation test
54
Symptoms of DI? (2)
polyuria | polydipsia
55
Types of DI?
1. Cranial - lack of ADH | 2. Nephrogenic - insensitivity to ADH
56
Causes of cranial DI? (3)
1. head trauma 2. tumour 3. surgery
57
How does cranial DI respond to desmopressin?
ability to concentrate urine
58
What is Psychogenic Primary Polydipsia? | - response to 8 hr fluid deprivation test?
common in mentally ill patients, institutionalised patients continuous feeling of thirst, will seek fluids from any source possible able to concentrate urine
59
Cause of EUvolaemic HYPOnatraemia? (3)
1. hypothyroidism 2. SIADH 2. adrenal insufficiency
60
Normal range of potassium?
3.5 - 5.5mmol/L
61
What hormones are involved in potassium homeostasis? (2)
1. Aldosterone | 2. Angiotensin II
62
ECG change associated with HYPERkalaemis?
Peaked T waves
63
Causes of HYPERkalaemia? (7)
1. excessive intake 2. acidosis 3. insulin shortage 4. rhabdomyolysis 5. Addison's disease 6. reduced GFR - renal/cardiac failure 7. drugs
64
Drugs that can cause HYPERkalaemia? (4)
- ACEi, ARB, NSAIDs, K+ sparring diuretics
65
Clinical features of HYPOkalaemia? (3)
1. muscle weakness 2. cardiac arrhythmias 3. polyuria/polydipsia
66
Causes of HYPOkalaemia? (7)
1. Hyperaldosterism Conn's syndrome 2. GI loss 2. Renal loss 4. ostmotic diuresis 5. insulin 6. beta agonists - salbutamol 7. alkalosis
67
Hyperkalaemia is a side-effect of which of the following drugs? a. Furosemide b. Bendroflumethiazide c. Salbutamol d. Ramipril
c. Salbutamol
68
Hypokalaemia is a side-effect of which of the following drugs? a. Spironolactone b. Indomethacin c. Perindopril d. Furosemide
d. Furosemide
69
Normal Calcium range
2.2 - 2.6 mmol/L
70
What happens in response to low calcium? (4)
``` 1. Parathyroids release PTH PTH acts at... 1. Bone - increased calcium resorption 2. Kidney - increases Ca reabsorption - increases PO4 excretion - increases 1a(OH)ase - increases VitD3 3. GI - increases Ca absorption - increases VitD3 absorption ```
71
Enzyme required for rate limiting step in activation of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol (VitD3)? Where?
1-alpha-hydroxylase | kidney
72
Hormones that control Calcium homeostasis?
1. PTH | 2. Calcitriol
73
In what condition is 1alpha-hydroxylase secreted in the lung?
Sarcoidosis | Causes an increase in Ca2+
74
Enzyme required to convert cholecalciferol to 25-hydroxycholecalciferol? Where?
25-hydroxylase | Liver
75
Where is the majority of calcium within the body?
Skeleton (99%)
76
What percentage of plasma calcium is bound to albumin?
50%
77
In sepsis, when albumin is low, what can happen to calcium levels?
low calcium
78
Effects of Vitamin D3? (3)
1. increased calcium absorption from gut 2. increased phosphate absorption from gut 3. bone remodelling
79
Vitamin D3 deficiency in children?
Ricket's
80
Vitamin D3 deficiency in adults?
Osteomalacia
81
What happens to Ca/PO4/ALP/PTH in Vit D deficiency?
``` Low VitD3 Low Ca Low PO4 High PTH High ALP ```
82
Clinical features of Osteomalacia? (3) | Pathonogmonic?
1. Boen pain 2. myalgia 3. increased risk of fractures Looser's zones
83
Clinical features of Ricket's? (4)
1. bowing of bones 2. widened epiphyses at the wrist 3. costochondral swelling 4. myopathy
84
Causes of Osteomalacia? (4)
1. renal failure 2. lack of sunlight 3. chappati's 4. anticonvulsants (sodium valproate) breakdown Vit D3
85
What is Osteoporosis?
Loss of bone density, associated with age
86
What happens to Ca/PO4/ALP/PTH in Osteoporosis?
All normal
87
Clinical features of Osteoporosis? (3)
1. increased liklihood of fractures 2. Typical NOF 3. Typical Colle's
88
Diagnosis of Osteoporosis? | Osteopenia?
DEXA scan | T
89
Risk factors associated with Osteoporosis?
1. Age 2. Childhood illness, failure to reach peak bone density 3. Early menopause 4. sedentery lifestyle 5. smoking 6. alcohol 7. low BMI 8. endocrine - Cushings, hyperprolactinaemia, thyrotoxicosis 9. steroids
90
Treatment of Osteoporosis?
Bisphosphonates e.g. Alendronate
91
Symptoms of HYPOcalcaemia? (3) | Signs (2)
1. perioral parasthesiae 2. carpopedal spasm 3. neuromuscular excitability 1. Trousseau's 2. Chvostek's
92
What is Trousseau's sign?
flexion of wrist & metacarpal joints and adduction on fingers when BP cuff is applied due to hypocalcemia
93
What is Chvostek's sign?
twitch of facial nerve when masseter at the angle of the jaw is tapped due to hypocalcemia
94
What happens in response to high calcium? | example
Parathyroids release less PTH | e.g. in malignancy, when there is a high calcium, PTH is suppressed
95
What's the commonest cause of hypercalcemia?
primary hyperparathyroidism
96
Causes of primary hyperparathyroidism (3) | Most common?
1. parathyroid adenoma 2. parathyroids hyperplasia 3. parathyroid carcinoma adenoma (80%)
97
Association with parathyroid hyperplasia?
MEN1
98
Clinical features of HYPERcalcaemia? (6)
``` Bones - pain Groans - psychogenic Moans - abdominal pain - constipation, pancreatitis Stones - renal polyuria muscle weakness ```
99
Types of hypercalcaemia in malignancy? (3)
1. Humoral hypercalcaemia due to atopic secretion of PTHrP e.g. small cell lung cancer 2. Metastases to the bone e.g. breast 3. Haematological malignancies e.g. myeloma
100
What happens to Ca/PO4/ALP/PTH in Myeloma?
HIGH Ca HIGH PO4 Normal ALP Normal PTH
101
What happens to Ca/PO4/ALP/PTH in Bone metastasis?
HIGH Ca LOW PO4 HIGH ALP Normal PTH
102
What causes secondary hyperparathyroidism? | How?
CKD causing renal osteodystrophy Damaged kidney doesn't produced sufficient 1alpha-hydroxylase to activate VitD3 therefore calcium falls A fall in Calcium causes an increase in PTH
103
What is tertiary hyperparathyroidism?
When after sustained time of hyperparathyroidism, PTH is then secreted excessively causings an elevated Ca2+
104
What happens to Ca/PO4/ALP/PTH in secondary hyperparathyrodism?
LOW Ca HIGH PO4 HIGH PTH HIGH ALP
105
What happens to Ca/PO4/ALP/PTH in tertiary hyperparathyroidism?
HIGH Ca LOW PO4 Norm/high ALP HIGH PTH
106
What is Paget's disease?
remodelling of the bone with both increase osteoblast & osteoclast activity
107
Clinical features of Paget's Disease? (8)
1. bone pain 2. bone warmth 3. bone deformation 4. increased risk of fracture 5. enlarged skull 6. deafness 7. blindness 8. increased risk of malignancy 9. increased cardiac output
108
What happens to Ca/PO4/ALP/PTH in Paget's Disease?
Norm Ca Norm PO4 HIGH ALP Norm PTH
109
Which has the lowest calcium? a. Primary hyperparathyroidism b. Secondary hyperparathyroidism c. Osteoporosis d. Pagets disease of the bone e. Breast cancer
b. Secondary hyperparathyroidism
110
What causes HYPOparathyroidism? a) primary b) secondary
a) Di George syndrome - due to malfunction parathyroid glands b) post-thyroidectomy
111
What happens to Ca/PO4/ALP/PTH in HYPOparathyroidism?
LOW Ca HIGH PO4 Norm ALP LOW PTH
112
Risk factors for developing renal stones (5)
1. dehydration 2. abnormal pH of urine 3. urine infection 4. renal tubular acidosis 5. anatomical abnormalities
113
Most common type of renal stone? X-ray appearance?
Mixed - radio-opaque
114
Type of renal stones that are radiolucent?
Uric acid, cysteine
115
Type of renal stones formed due to UTI?
Staghorn - triple phosphate "struvite"
116
Enzyme raised in acute pancreatitis?
amylase
117
Marker of muscle damage?
creatine kinase
118
Pathological causes of raised CK? (4)
1. Duchenne's Muscular dystrophy 2. MI 3. Rhabdomyolysis 4. Statin related myopathy
119
Causes for ALP to be raised? (4)
Increased activity in... 1. Liver 2. Bone 3. Intestine 4. Placenta
120
Physiological causes of raised ALP? (2)
1. Pregnancy | 2. Childhood growth spurt
121
Pathological causes of raised ALP? a) Bone (6) b) Liver (4)
``` a) metastasis osteomyelitis osteomalacia Pagets fractures tumours ``` b) hepatitis cirrhosis cholestasis tumours
122
Marker of myocardial injury?
Troponin
123
When do you measure Troponin?
6 hrs 12 hrs post-onset of chest pain remains elevated fro 3 - 10 days
124
Diagnostic Criteria for MI?
Rise in Troponin and gradual fall with at least one of the following symptoms 1. ischaemic symptoms 2. pathologic Q waves of ECG 3. ECG changes 4. coronary artery intervention
125
Markers of liver cell damage (5)
``` AST ALT ALP GGT Bilirubin ```
126
Marker of liver function (3)
Glucose Clotting Albumin
127
Marker elevated in chronic alcohol disease?
GGT
128
When are AST/ALT raised?
when hepatocytes die
129
What's the AST:ALT in alcoholic liver disease?
2:1
130
What's the AST:ALT in viral liver disease?
131
Which marker is elevated in cholestasis?
ALP
132
What are porphyrias? | What cell types? (2)
a group of disorders due to a deficiency in enzymes in the make up of Haem causing a build up of toxic haem precursors 1. hepatic 2. erythroid
133
Types of porphyrias? (3)
1. build up of Aminolaevulinic Acid (ALA) 2. build up of Porphobilinogen (PBG) 3. build up of Porphrinogens
134
Areas affected by Porphyrias? a) build up of ALA/PBG b) build up of porphrinogens
1. neuro-visceral | 2. skin
135
Colour of a) porphrinogens b) porphyrins
a) colourless | b) highly coloured
136
What is Acute Intermittent Porphyria? inheritance enzyme deficiency build up of? (2)
Autosomal dominant Hydroxymethylbilane synthase (HMB synthase) 1. ALA 2. PBG
137
Overall area affected in Acute Intermittent Porphyria? Symptoms (10) Signs
1. N&V 2. abdo pain 3. confusion 4. psych disturbances 5. seizures 6. tachycardia 7. hypertension 8. muscle weakness 9. constipation 10. urinary incontinence Port wine urine
138
Precipitating factors of Acute Intermittent Porphyria? (5)
ALA synthase inhibitors 1. steroids 2. ethanol 3. barbiturates 4. stress - surgery/infection 5. reduced calorie intake
139
Hereditary Coproporphyria - inheritance - build up of - symptoms - what skin lesion?
autosomal dominant porphyrins neurovisceral and skin lesions blistering and skin fragility
140
Variegate Porphyria - inheritance - build up of - symptoms - what skin lesion?
autosomal dominant porphyrins neurovisceral and skin lesions blistering and skin fragility
141
Non-acute porphyrias? (3) - area affected? - symptoms (3) - precipitating factor
1. Congenital Erythopoietic Porphyria 2. Erythropoietic Protoporphyria 3. Porphyria Cutanea Tarda skin lesions 1. photsensitivity 2. itching 3. burning sun exposure
142
Treatment of acute porphyrias? (2)
1. IV carbohydrate | 2. Haem arginate
143
``` During acute porphyria, the most useful sample to send is…? Blood CSF Urine Muscle biopsy Stool Skin biopsy ```
Urine
144
Cutaneous erythema without blisters or bullae, most likely indicates a. Erythropoietic protoporphyria b. Congenital erythropoietic porphyria c. Acute intermittent porphyria
a. Erythropoietic protoporphyria
145
What occurs first in response to hypoglycaemia? a. Suppression of insulin b. Release of glucagon c. Release of adrenaline d. Release of cortisol
a. Suppression of insulin
146
Causes of hyperinsulinaemic hypoglycaemia? (3)
1. iatrogenic insulin 2. sulfonylurea excess 3. insulinoma
147
What is C-peptide? a. is the cleavage product of insulin b. is secreted in equimolar amounts to insulin c. has a half-life of 2 hours d. interferes with insulin measurement
b. is secreted in equimolar amounts to insulin
148
Half life of Insulin? | Half life of C peptide?
4 - 6 mins | 30 mins
149
Causes of hypoinsulinaemic hypoglycaemia with positive ketones? (4)
1. alcohol binge with no food 2. pituitary insufficiency 3. addison's 4. liver failure
150
Causes of hypoinsulinaemic hypoglycaemia with negative ketones?
non pancreatic neoplams e.g. fibrosarcomata
151
``` 20 year old female, BMI 17 kg/m2 Lanugo hair noted Finger prick glucose – 3.8mmol/L Routine bloods taken Doctor rung by lab 1 hr later as plasma glucose 2.6 mmol/L ``` a. Undertakes strenuous exercise regularly b. Insulinoma c. Anorexic with poor liver glycogen stores d. Laxative abuse
c. Anorexic with poor liver glycogen stores
152
What would the insulin and C-peptide result be if they had been measured ? a. Low insulin, low C-peptide b. Low insulin, high C-peptide c. High Insulin, lowC-peptide d. High insulin, high C-peptide
a. Low insulin, low C-peptide
153
What is beta-hydroxybutyrate? a. End product of insulin metabolism b. A free fatty acid c. A triglyceride d. A ketone body e. A component of artificial nutrition
d. A ketone body
154
45 year old lady brought in fitting. Recurrently seen GP in previous months due to weight gain and increased appetite Husband reports personality change in last few months. Glucose 1.9 mmol/L Insulin 35 mu/L C-peptide 1000 pmol/L Urine sulponylurea drug screen negative What is the diagnosis? a. Insulinoma b. Cushings syndrome c. Addison’s disease d. Sulphonylurea excess e. Need more information
a. Insulinoma
155
Associated with insulinoma?
MEN1
156
What is Non-islet tumour hypoglycaemia? | - lab results (5)
``` tumour that causes a paraneoplastic syndrome when IG-2 is secreted and binds to IGF-1 and insulin receptors everything low LOW glucose LOW Insulin LOW C-peptide LOW FFAs LOW ketones ```
157
``` Diagnosis of DM Fasting glucose OGTT Random glucose HbA1C ```
Fasting glucose > 7 OGTT > 11.1 Random glucose > 11.1 HbA1C > 48
158
Phenytoin - signs of toxicity (2) - inication - interactions - treatment of toxicity
1. Ataxia 2. Nystagmus - seizures - at high levels, liver becomes saturated and there is a surge in blood levels - omit/reduce dose
159
Digoxin - indication - signs of toxicity (4) - interactions - treatment of toxicity
- arrhythmias 1. Arrhythmias 2. Heart block 3. Confusion 4. Xanthopsia - seeing yellow - levels can increase with hypokalaemia, so reduce dose in elderly/renal failure - Digibind
160
Lithium - indication - signs of toxicity (5) - interactions - treatment of toxicity
Bipolar disorder 1. Tremor 2. Lethargy 3. Fits 4. Arrhythmias 5. Renal failure - excretion impaired by hyponatraemia, low renal function and diuretics - renal failure may need dialysis
161
Gentamicin - indication - signs of toxicity (4) - interactions - treatment of toxicity
- uncontrolled infection 1. Tinnitus 2. Deafness 3. Nystagmus 4. Renal failure - mostly use single daily dosing - omit or reduce dose
162
Theophylline - indication - signs of toxicity (4) - interactions - treatment of toxicity
- Asthma 1. Arrhythmias 2. Anxiety 3. Tremor 4. Convulsions - level can be increased by erythromycin, phenytoin, cimetidine - omit/reduce dose
163
Vitamin A deficiency
Night blindness
164
Vitamin D deficiency (2)
1. Osteomalacia | 2. Rickets
165
Which steroid is made in the zona fasciculata of the adrenal gland?
Cortisol
166
Which steroid is made in the zona glomerulosa of the adrenal gland?
Aldosterone
167
Which steroid is made in the zona reticularis of the adrenal gland?
Cortisol and sex hormones
168
Where are the catecholamines made in the adrenal gland?
medulla
169
``` 31 year old presents with profound tiredness. Acutely unwell a few days. Vomiting Na: 125, K: 6.5, U 10, Glucose 2.9mM. FT4 50mU/l ``` ``` What does this TSH suggest? A. A TSH producing pituitary adenoma B. Graves disease C. A toxic thyroid nodule D. Primary hypothyroidism E. de Quervain’s (viral) thyroiditis. ```
D. Primary hypothyroidism
170
Cushing's syndrome - excess what? - causes (3) - diagnostic test - diagnostic test suggestive of pituitary adenoma
ACTH 1. pituitary adenoma 2. ACTH secreting tumour 3. iatrogenic steroid use - Low dose Dexamethasone - High dose Dexamethasone
171
Clinical features of Cushing's? (12)
``` truncal weight gain moon facies thin skin - easy bruising, striae hirsuitism acne depression & psychosis insomnia oligomenorrhoea proximal myopathy DM osteoporosis ```
172
Addison's syndrome - deficiency in what? (2) - causes (5) - diagnostic test
``` Cortisol and Aldosterone 1. autoimmune 2. TB 3. adrenal tumour deposits 4. adrenal haemorrhage 5. amyloidosis Short SynACTHen test (cortisol will fail to rise) ```
173
Clinical features of Addison's? (9) Lab findings in Addison's? (3)
``` weight loss fatigue depression vomiting diarrhoea postural hypotension pigmentation vitiligo adrenal cortex atrophy ``` low sodium high potassium low glucose
174
Why does increased pigmentation of the palmar creases occur in Addison's?
High ACTH -> high POMC cleavage -> high alpha-MSH -> increased pigmentation of buccal, palmar, scars
175
Treatment of Addison's? (2)
1. Hydrocortisone to replace cortisol | 2. Fludrocortisone to replace Aldosterone
176
Conn's syndrome - excess what? - causes - diagnostic test?
Aldosterone Adrenal tumour of zona glomerulosa Renin:Aldosterone ratio
177
Clinical features of Conn's (3)
uncontrollable hypertension high sodium low potassium
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Treatment of Conn's (2)
1. Spironolactone (ARB) before surgery | 2. Surgery to remove tumour
179
Phaeochromocytoma - excess what - causes - diagnostic test
Adrenaline/NA adrenal tumour of the medulla 24hr urinary catecholamines
180
Clinical features of Phaeochromocytoma (11)
``` hypertension tachycardia panic sensation nervousness clammy pale arrhythmias headache sweating CNS exciteability seizures ```
181
Treatment of Phaeo? (5)
1. fluid resuscitation 2. 24 hour urinary catecholamine collection 3. alpha blockade preparation to prevent hypovolaemic crisis 4. beta blockade to tachycardia ++ 5. surgery
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Hypertensive 33 year old. Na 147, K 2.8, U 4.0. Glucose 4.0 mM Plasma aldosterone raised. Plasma renin suppressed. Diagnosis?
Primary hyperaldosteronism | Conn's
183
A 30-year-old woman complains of galactorrhoea and amenorrhoea. A CT scan of her pituitary shows a large (2cm) macroadenoma. What complication of a large pituitary tumour should you examine for?
Bitemporal hemianopia
184
A 30-year-old woman complains of galactorrhoea and amenorrhoea. A CT scan of her pituitary shows a large (2cm) macroadenoma. Her prolactin level comes back at 30,000 (normal
C. Prolactinoma
185
Clinical features of Prolactinoma? (9)
``` galactorrhoea oligomenorrhoea amenorrhoea infertility reduced libido osteoporosis headaches pituitary insufficiency bitemporal hemianopia ```
186
Diagnosis of prolactinoma? (2)
1. Prolactin > 2000mU | 2. MRI pituitary
187
Management of prolactinomas? (2)
1. DA agonists e.g. Bromocriptine, Cabergoline | 2. Surgery
188
Side effects of Bromocriptine? (5)
1. N&V 2. cramps 3. psychomotor excitation 4. dykinesias 5. postural hypotension
189
Combined Pituitary Function Test (CPFT) - what is it for?
Assesment of the function of the anterior pituitary a) when suspecting a tumour b) following tumour surgery
190
What is involved in CPFT? (3)
1. Insulin tolerance Test - adequate GH 2. TRH Test - thyroid pathology 3. GRH Test - indication of hypopituitarism
191
Laron dwarfism - inheritance - what
autosomal recessive | variant of GH receptor in insensitive to GH
192
Endocrine Related short stature - diagnosis (2) - risks associated with GH therapy (3)
1. Insulin tolerance test 2. growth charts 1. risk of leukaemia 2. antibody resistance 3. headaches
193
Types of DI? (3)
1. Central/Cranial/Neurogenic - failure to produce ADH 2. Nephrogenic - failure to respond to ADH 3. Dispogenic - failure to initiate thirst drive due to damage to hypothalamus
194
Target tissues of thyroid hormone? (9)
1. Endo - GnRH, Prolaction secretion 2. CNS 3. SNS - increases response to NA/Adrenaline 4. Bone 5. CVS - increases contractility, increase HR 6. Skeletal muscle - increases muscular contraction 7. Liver - increases gluconeogeneis, glycogenolysis, cholesterol synthesis 8. Haematopoetic - increases EPO 9. GI - increases gut motility
195
HYPOthyroidism - what - who - causes (4) - lab results
``` destruction/atrophy of thyroid gland F>M 1. autoimmune - antibodies destroy thyroid gland 2. transient due to viral infection 3. iodine deficiency 4. drug induced e.g. lithium, amiodarone ``` HIGH TSH LOW T3/T4
196
Causes of secondary HYPOthyroidism? (4) | - lab results
1. post-thyroidectomy 2. post pituitary surgery 3. Radioiodine 4. Drug induced LOW TSH LOW T3/T4
197
Hashimotos Thyroiditis - what - who - clinical features - association
Autoimmune hypothyroidism causing plasma cell infiltration elderly women goitre present initial "hashitoxicosis"
198
Treatment of HYPOthyroidism?
Replacement with Levothyroxine (T4)
199
Clinical Features of HYPOthyroidism (10)
1. low metabolic rate 2. reduced appetite 3. weight gain 4. low HR 5. constipation 6. lethargy 7. increased sensitivity to cold 8. slow speech 9. thickened skin 10. brittle nails and hair
200
HYPERthyroidism - what - who - causes (4) - lab results
``` increased level of thyroid hormone F>M 1. Grave's 2. Multinodular goitre 3. Toxic adenoma 4. DeQuervain's Thyroiditis 5. Post-partum thyroiditis ``` LOW TSH HIGH T3/T4
201
Clinical Features of HYPERthryoidism (10)
``` increased metabolic rate increased appetitie weight loss exopthalamus/lid lag increased HR diarrhoea tremor low tolerance to heat agitation sweating ```
202
What is De Quervain's thyroiditis? | Symptoms (3)
Self-limiting post-viral thyrotoxicosis 1. painful goitre 2. malaise 3. fever
203
What is Grave's disease?
Tsh stimulating antibodies cause an increase in TSH
204
What is Plummer's disease? | - associations (2)
toxic multi-nodular goitre 1. AF 2. heart failure
205
Which thyroid conditions have high uptake on radioisotope scan? (3)
1. Grave's 2. Plummer's/Toxic Multi-nodular goitre 3. Solitary toxic adenoma
206
Complication of hypothyroidism during pregnancy?
Neonatal cretinism - elevated TSH LOWT3/T4 -> mental retardation, growth arrest, deafness, immature body proportions
207
Treatment of high uptake HYPERthyroidism?(3)
1. Beta blockers 2. Carbimazole/Propylthiouracil to block TSH 3. Surgery
208
Thyroid Neoplasms (4)
1. Papillary 2. Medullary 3. Follicular 4. Aplastic
209
Papillary Thyroid Carcinoma - who - associations (2) - treatment
F>M aged 30-40years 1. MEN-1 2. BRAF mutations Surgery and radioiodine
210
Follicular Thyroid Carcinoma - who - associations (2)
- F>M middle aged 1. aggressive 2. mets to lung & bone
211
Medullary Thryoid Carcinoma | - associations (2)
1. MEN-2 | 2. Produces calcitonin - lowers calcium
212
Aplastic thyroid Carcinoma
very aggressive p53 mutation elderly population
213
Vitamin A deficiency
Nigh blindness
214
Vitamin D deficiency (2)
1. Osteomalacia | 2. Rickets
215
Vitamin E deficiency (Tocophenol) (2)
1. Anaemia | 2. Neuropathy
216
Vitamin K deficiency | - investigation
Clotting defective | PTT
217
Thiamin deficiency B1 (3)
1. Bert Beri 2. Neuropathy 3. Wernicke's encephalopathy
218
Vitamin B2
Glossitis
219
Vitamin B6 Pyridoxine (2)
1. Dermatitis | 2. Anaemia
220
Vitamin B12
Pernicious anaemia
221
Vitamin C
Scurvy
222
Folate deficiency (2)
1. Megaloblastic anaemia | 2. Neural tube defects
223
Vitamin B3 Niacin (3)
Pellagra 1. Dementia 2. Dermatitis 3. Diarrhoea
224
Iron deficiency
Hypochromic anaemia
225
Iodine deficiency (2)
1. Goitre | 2. Hypothyroid
226
Zinc deficiency
Dermatitis
227
Copper deficiency
Anaemia
228
Fluoride deficiency
Dental caries
229
Phenylketonuria PKU - what - screening test - outcomes - management
- phenylalanine hydroxyl are deficiency causes a build up of phenylalanine - Guthrie test - progressive developmental delay and mental retardation - dietary avoidance of phenylalanine
230
Congenital hypothyroidism - what - screening test - presentation (5) - results (2) - management
- dysgenesis of thyroid gland, can be due to iodine deficiency or maternal carbimazole - Guthrie test - baby has 1. Poor feeding 2. Somnolence 3. Reduced crying 4. Lethargy 5. Constipation - high TSH low T4 - L-thyroxine replacement
231
Cystic Fibrosis - mutation - outcome - affected organs (5) - screening test
- CFTR - viscous secretions which can cause ductal blockages 1. Respiratory tract 2. Pancreas 3. Biliary tract 4. Liver 5. Kidney - Guthrie test
232
Medium Chain AcylCoA Dehydrogenase Deficiency MCADD - what - inheritance pattern - risks (3) - screening - management
- Inherited disorder if fatty acid metabolism, unable to produced ketones -> hypoglycaemia and hypoketouria 1. Stress 2. Illness 3. Exercise - Guthrie test - avoid fasting, cannot feed >every 8 hours about in first year of life, >10 hours thereafter
233
What does the Guthrie Test screen for? (5)
``` Must Heel Prick Small Child MCADD Congenital hypothyroidism PKU Sickle cell CF ```

Pathology (7 decks)

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