Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Oishi's 5th year flashcards > Chem Path hard to recall > Flashcards

Chem Path hard to recall Flashcards

1
Q

What liver enzyme is raised after MI?

A

AST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which enzyme is markedly raised in obstructive jaundice along with direct bilirubin?

A

ALP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which liver enzyme is most raised in alcohol abuse?

A

GGT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What test is used for Paroxysmal nocturnal haemoglobinuria (PNH)?

A

Ham’s test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What Ab can be looked for in T1DM?

A

Anti-GAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define impaired glucose tolerance

A

Fasting: <7mmol/L
2hr: 7.8 - 11.1mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which liver enzyme increases in pregnancy?

A

ALP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Lipid soluble drugs require metabolism by the liver in two phases. What is Phase I?

A

Oxidation by cytochrome P450

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Features of digoxin toxicity?

A

Arrhythmia
Anorexia, nausea and vomiting and occasionally, diarrhoea
Confusion especially in the elderly
Yellow vision (xanthopsia), blurred vision and photophobia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name a drug which decreased excretion, increased plasma concentration and increased risk of toxicity may occur when this taken in conjunction with thiazide diuretics

A

Lithium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are 2 breakdown products of cocaine?

A 
EME = ecgonine methyl ester
BE = benzoylecgonine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Symptoms of ecstasy OD?

A 
Hyperthermia
Dilated pupils
Agitation
Confusion
Raised urea and creatinine
Raised myoglobin
Hyponatraemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can be tested in urine for heroin/opioid detection?

A

6-MAM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What Tx can be used for beta blocker OD?

A

IV atropine

Glucagon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Symptoms of TCA OD?

A 
Drowsy
Tachycardia
Wide QRS
Dilated pupils
Hyperreflexia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Symptoms of salicyclate OD?

A 
Hyperventilation
Nausea
Sweating
Ringing in the ears
Metabolic acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What sample is required for use with gas chromatography mass spectroscopy?

A

Blood sample

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which technique can be used to test for benzodiazepines and various antipsychotic drugs?

A

Liquid chromotography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which technique can be used to analyse samples of stool, liver and also urine?

A

Thin layer chromotography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which drug is not excreted into saliva?

A

THC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is Nelson’s syndrome?

A

An enlargement of an adrenocorticotropic hormone-producing tumour in the pituitary gland, following surgical removal of both adrenal glands in a patient with Cushing’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Levels of which steroid are raised in the serum of CAH patients?

A

17-Hydroxyprogesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Increased levels of what hormone are seen in the urine of CAH patients?

A

Pregnanetriol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

The sodium and potassium pattern seen in CYP21 deficiency?

A

Hyponatreamia with Hyperkalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do you calculate creatinine clearance?

A

Creatine clearance = (creatinine’s urine concentration)* (Vol) / (plasma creatinine concentration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the gold standard for measuring glomerular filtration rate (GFR)

A

Inulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is A good indicator of renal function?

A

Serial creatinine readings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What enzyme is Useful in staging and monitoring treatment of extracapsular spread of prostatic carcinoma?

A

Acid phosphatase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which enzyme rapidly rises post myocardial infarction but then rapidly declines and is a useful marker of reinfarction?

A

Creatine Kinase (MB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

A 3 year old unimmunised boy presents with Mumps. Which enzyme is likely to be raised?

A

Amylase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

A 19 year old African boy presented with cervical lymph nodes, 3 month history of night sweats and a 3kg weight loss. Lymph node biopsy showed the presence of Reed-Sternberg cells loss. Following chemotherapy which enzyme would you expect to be elevated?

A

LDH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Organophosphonate poisoning symptoms? (SLUDGE)

A 
Salivation
Lacrimation
Urination
Defecation
GI upset
Emesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Antibodies associated with autoimmune hepatitis?

A

ASMA

ANA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Which enzyme is most likely to be raised in autoimmune hepatitis?

A

AST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Which enzyme is most likely to be raised in PBC?

A

ALP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

SCID is frequently caused by a deficiency in which enzyme?

A

Adenosine deaminase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

A worried mother brings her obese 12 year old son to the GP, saying that he avoids exercise and has been recently found to be skipping his PE lessons. When confronted about this, the boy claimed that ‘it hurts when he exercises’. The skeptical GP was about to say ‘no pain, no gain’, when he remembered a lecture in medical school about McArdle’s glycogen storage disease (type V), which causes stiffness following exercise. He referred the boy for a muscle biopsy, which confirmed a deficiency in an enzyme involved in glycogen metabolism. Name this enzyme.

A

Mycophosphorylase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Fabry’s disease occurs due to an X-linked disorder of glycolipid metabolism due to deficiency of which enzyme?

A

Galctosidase A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

A 10 year old boy is brought by his mother to your clinic. He is very thin, but has a distended abdomen. What is it that his diet does not contain to cause this?

A

Protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

A 40 year old woman is brought in by her husband. He explains that she has started getting up during the night and going for walks and then forgetting her way home. She says she has terrible diarrhoea day and night and she wakes to go to the toilet. On examination she has a tremor and you see red scaly patches on her skin. Which vitamin is she most likely to be deficient in?

A

Niacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

A 10yr old female who recently emigrated from south East Asia presents to A&E with kidney stones. While talking to the parents it is noted that she has particular problems seeing in dim light. What vitamin deficiency does she have?

A

Vitamin A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

32 year old female presented with weight loss and anxiety. The thyroid gland was enlarged, firm, fleshy and pale, infiltrated by lymphocytes. Askanazy cells were noted.

A

Hashimoto’s thyroiditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

A 12 yr old male presents with 1/7 of fever. Thyroid swelling and tenderness on palpation was noted. Histologically, the gland was infiltrated by neutrophils and lymphocytes. This child had not been vaccinated against the MMR. Diagnosis?

A

Giant cell thyroiditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the recommended therapy used in an attack of acute intermittent porphyria?

A

Haem arginate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Anti-inflammatory drug that is contraindicated in patients with porphyria?

A

Diclofenac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Drug that can result in chronic porphyria?

A

Alcohol?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Drug recommended for management in acute attacks of anxiety.

A

Diazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

A second drug that is contraindicated in patients with porphyria that is not an NSAID

A

Co-trimoxazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Autosomal dominantly inherited porphyria with neurovisceral manifestations only, resulting from porphobilinogen (PBG) deaminase deficiency.

A

Acute intermittent porphyria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Neurotoxic product(s) of heme breakdown producing neurovisceral damage in certain porphyrias

A

5-aminolevulinic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Autosomal dominantly inherited (or spontaneous mutation) porphyria with cutaneous manifestations only, resulting from uroporphyrinogen decarboxylase deficiency

A

Porphyria cutanea tarda

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Enzyme that catalyses the rate-limiting step of heme breakdown

A

ALA synthase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Product(s) of heme breakdown resulting in photosensitivity (i.e. cutaneous) damage in certain porphyrias

A

Activated porphyrins and oxygen free radicals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

In diabetics, which substance is formed in increased quantities in cells that do not require insulin for glucose uptake? It is injurious to those cells:

A

Sorbitol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

2 examples of localised amyloidosis?

A

Alzheimer’s

T2DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What 3 hormones are given in combined pituitary function test?

A

GnRH
TRH
Insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

A 6 year old boy presents with episodic abdominal pain and recurrent acute pancreatitis. The plasma is found to have a milky appearance and chylomicrons are found in the plasma following a period of fasting. What deficiency does he have?

A

Lipoprotein lipase deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Lipid profile in alcohol abuse and why?

A

Decreases fatty acid oxidation
High HDL
High VLDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Lipid profile in nephrotic syndrome and why?

A

Apolipoprotein A is lost (hence low HDL) and there is a compensatory increase in apolipoprotein B100 hence
High VLDL
High LDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Lipid profile in diabetes and renal failure and why?

A

Not enough active lipoprotein lipase to chop off triglyceride
High VLDL
Low HDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Lipid profile in hypothyroidism and why?

A

Apo receptor on liver doesn’t function properly
High VLDL
High LDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Function of lipoprotein lipase?

A

enzyme present on vascular endothelium,
etc, which is involved in the breakdown of Triglycerides (TG) from lipoproteins such as VLDL into fatty acids and glycerol so that TG can be taken into cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Function of cholesterol ester transferase?

A

transfer cholesterol esters from HDL to IDL or LDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Lipid profile in biliary obstruction?

A

high VLDL, LDL and HDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Which molecule is formed by the gut after a meal and is the main carrier of dietary triglycerides?

A

Chylomicron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is the smallest lipoprotein which carries cholesterol from extra-hepatic tissues to the liver for excretion?

A

HDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Which molecule is present in the fasting state in cases of lipoprotein lipase deficiency?

A

Chylomicron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

The first intermediate formed after VLDL particles synthesised by the liver are degraded?

A

Intermediate density lipoprotein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

How do daily requirements of water for neonates compare with those of adults?

A

> 6 times adult requirements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

High fluid intake in neonates during the first week of life is associated with increasing frequency of which condition.

A

Necrotising enterocolitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Pseudo vitamin D deficiency 1 is associated with which defect.

A

Defect in renal hydroxylation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What could be going on in a child with x-ray features of vit D deficiency (metaphyseal flaring and osteopaenia) but a LOW ALP?

A

Hypophosphatasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

A 3-week-old male is seen by a paediatrician because of severe jaundice that appeared at birth and has been worsening ever since. Dx?

A

Crigler-Najjar syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

A young boy presents to his GP with jaundice. He is also found to have haemoglobinuria, splenomegaly and anaemia. His mother reveals that he was jaundiced at birth and needed a blood transfusion. Dx?

A

G6PD deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

A 15-month-old boy is brought to the paediatric clinic by his parents because of delayed dentition, poor growth and development, frequent crying, weakness, and constipation. Dx?

A

Rickets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

A 18 month old male is brought to the paediatrician by his mother because of repeated, self-mutilating biting of his fingers and lips and delayed motor development. The patient’s mother has also noticed abundant, orange-coloured “sand” (uric acid crystals) in the child’s nappies. Dx?

A

Lesch-Nyhan syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What 2 things does the Guthrie test check for?

A

PKU

Hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

First line screen for inherited metabolic disorders?

A

Plasma and urine amino acids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

A 2-month Canadian neonate presents with failure to thrive, jaundice and sepsis. Which inherited metabolic disorder might he have?

A

Type 1 tyrosinaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

A male infant presents with failure to thrive, neurological signs (including tremor) and tachypnea. From our metabolic disorders screen, which 1st line test is likely to be abnormal?

A

Plasma ammonia

Likely to have a urea cycle defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

A neonate has seizures, conjugated hyperbilirubinaemia and the 3rd year med student’s clinical observation is that “he looks weird!” From our metabolic disorders screen, which 1st line test is likely to be abnormal and what kind of inborn metabolic disorder might he have?

A

Very long chain fatty acids

peroxisomal disorder of glycosylation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

A post mortem diagnosis of an inborn error of metabolism is investigated in a case of “sudden infant death”. What deficiency is the most likely cause?

A

Medium chain acyl coA dehydrogenase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

A neonate with a history of feeding difficulties presents with jaundice, cataracts and sepsis. What deficiency is the most likely cause?

A

Galactase-1-phosphate uridyl transferase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Chronic renal failure is one of the commonest causes of hypercalcaemia. What is the commonest cause of end stage renal failure in Europe?

A

DM

85
Q

A 37 year old man has a round face, short metacarpals and metatarsals. He complains of mild depression and has a carpopedal spasm. Plasma PTH is raised and alk phos is slightly raised too. Dx?

A

Albright’s hereditary osteodystrophy

86
Q

What type of hyperparathyroidism does Albright’s hereditary osteodystrophy cause and why?

A

pseudohyperparathyroidism - receptor insensitivity to PTH i.e. end organ resistance to PTH

87
Q

A 24 year old man presents with pain and stiffness in his buttocks and lower back which is worse when he wakes up in the mornings, but eases after he has gone to the gym. On further questioning he reveals that he has had 2 similar episodes in the past. Dx?

A

Ankylosing spondylitis

88
Q

What is the major antagonist of serine proteases at a site of injury?

A

Alpha-1-antitrypsin

89
Q

Which is associated with type 1 hypersensitivity?

A

IgE

90
Q

Increases of what is a cardiovascular risk factor?

A

CRP

91
Q

A 60 year old male presents to his GP with symptoms of tiredness, dizziness and loss of vision. He has lymphadenopathy and splenomegaly. Serum electrophoresis shows an IgM spike. Dx?

A

Waldenstrom’s macroglobulinaemia

92
Q

A 50 year male with multiple myeloma comes to his GP complaining of ankle swelling. Urine dipstick shows proteinuria. On examination he is also noted to have macroglossia and waxy papules on his face. Dx?

A

Amyloidosis

93
Q

What mutation is involved in tangier disease?

A

ABCA1 gene

94
Q

Presentation of tangier disease and blood results?

A

Hepatomegaly, splenomegaly, or classically as enlarged orange tonsils in children
Low blood HDL levels

95
Q

What score, derived from a DEXA scan, describes how a patient’s bone mass varies compared to an age matched control?

A

Z score

96
Q

What is the name of the cholesterol transport channel targeted by the drug Ezetimibe? Where is it found?

A

NPC1L1 (Niemann-Pick C1-like 1) transporter

Found on epithelial cells of the GI tract and hepatocytes and is involved in the absorption of cholesterol from the gut

97
Q

A 38 year old man with hypertension has high plasma sodium and low plasma potassium. He is diagnosed with Conn’s syndrome. What is the likely result of an Aldosterone:Renin ratio in this patient?

A

Elevated

98
Q

In the liver which cytochrome P450 enzyme catalyses the first step in the formation of bile acids via the classical pathway? AKA the rate-limiting step

A

Cholesterol 7 alpha-hydroxylase

99
Q

An obese patient is hypocalcaemic, has an elevated serum phosphate and has an elevated parathyroid hormone (PTH). Upon examination you notice they have short 4th and 5th metacarpals. What is the most likely diagnosis?

A

Albright hereditary osteodystrophy

100
Q

What does Albright hereditary osteodystrophy cause?

A

Pseudohypoparathyroidism

101
Q

In de novo purine synthesis, what kind of feedback do guanylic acid (GMP) and adenylic acid (AMP) have on the enzyme PAT?

A

Negative

102
Q

Which enzyme forms the rate limiting step in de novo purine synthesis?

A

PAT

103
Q

Purines can be made via a de novo synthesis pathway.

What is the name of the other pathway by which purines can be made?

A

Salvage pathway

104
Q

A patient’s blood tests have returned and show they have a low serum sodium level. What investigation should be done to determine if this is a true hyponatraemia?

A

Serum osmolality

105
Q

Where in the gut are bile acids reabsorbed?

A

Terminal ileum

106
Q

What enzyme does Allopurinol inhibit to reduce urate synthesis?

A

Xanthine oxidase

107
Q

A 24 year old lady is referred to a cardiologist. She has irregular yellow growths on her hands and one on her achilles tendon. The cardiologist informs her she has premature atherosclerosis. Blood tests show grossly raised levels of plant sterol in her blood. Which autosomal recessive disorder does she most likely have?

A

Phytosterolemia

ABCG5

108
Q

In familial hypocalciuric hypercalcaemia (FHH), which receptor has suffered a mutation?

A

Calcium Sensing Receptor

109
Q

Cholestyramine is a cholesterol lowering drug. What does Cholestyramine bind to in the gut in order to cause the liver to break down more cholesterol?

A

Bile acids

110
Q

In bile acid synthesis Acyl-CoA cholesterol acyltransferase (ACAT) is the enzyme that converts cholesterol into what?

A

Cholesterol ester

111
Q

What enzyme would you classically expect to be raised in Paget’s disease of bone?

A

Alkaline Phosphatase

112
Q

The van den Bergh reaction is used to measure serum bilirubin via fractionation. What kind of bilirubin is measured with the direct reaction?

A

Conjugated

113
Q

What is the gold standard investigation for quantification of urinary protein loss, not typically performed in clinical practice?

A

24 Hour Urine Collection

114
Q

In sarcoidosis, production of which enzyme by granulomatous tissue can lead to hypercalcaemia?

A

1 alpha hydroxylase

PTHrP is another mechanism

115
Q

A 14 month old boy presents showing signs of delayed motor development and self-mutilation of the lips and fingers. He is found to have hyperuricaemia.
What is the condition and what enzyme is deficient in this condition?

A

Lesch Nyhan syndrome

HGPRT

116
Q

Lomitapide is a low density lipoprotein lowering drug.

What protein does Lomitapide inhibit?

A

Microsomal triglyceride transfer protein

117
Q

Which protein, found in blood plasma, exchanges triglycerides and cholesterol esters between lipoproteins?

A

Cholesteryl ester transfer protein (CETP)

118
Q

Name a drug used in the treatment of non-acute gout to reduce urate levels by increasing the fractional excretion of uric acid?

A

Probenecid

119
Q

In a patient with pseudopseudohypoparathyroidism, what would you expect the serum calcium level to be?

A

Normal

120
Q

A 29 year old man presents with eruptive xanthomas and a yellow discolouration to the palm. Blood tests reveal high total cholesterol and triglyceride levels. Genetic studies reveal ApoE2. What is the diagnosis?

A

Type 3 hyperlipoproteinemia

121
Q

A 26 year old man presents to his GP with a yellow nodule on his achilles tendon. You notice a bluey grey ring around his cornea and yellow irregularly shaped deposits around his eyelids. Low density lipoprotein (LDL) is raised whereas high density lipoprotein (HDL) and triglycerides are normal. Genetic studies reveal a LDL receptor mutation. What is the diagnosis?

A

Familial Hypercholesterolemia

122
Q

ecg signs of hyperkalaemia?

A 
Bradycardia
Loss of p waves
Prolonged pr interval
Broad QRS
Tented T waves
Junctional or escape rhythms
123
Q

What is defined as a severe hypocalcaemia and what would you treat it with?

A

Corrected calcium <1.9

IV calcium gluconate

124
Q

Definition of DKA?

A

Ketones >3
pH <7.3
BM >15

125
Q

What glucose level is needed for HHS?

A

BM >30

126
Q

Which type of T2DM medication can cause a euglycaemic DKA and why?

A

SGLT2 inhibitors
They fast pre-operatively but still take their SGLT2 inhibitor –> this causes glucose to be peed out and also stimulates glucagon release which increases glucose
They are fasted before and after operation so they get an absolute insulin deficiency –> go into DKA

127
Q

Equation for anion gap and normal value?

A

Anion gap = Na + K - Cl - Bicarb

Normal = 14-18mM

128
Q

Causes of raised anion gap?

A

Ketoacidosis - DKA, alcoholic, starvation
Uraemia - renal failure
Lactic acidosis
Toxins - Ethylene glycol, methanol, paraldehyde, salicyclate

129
Q

Types of hyponatraemia?

A

Hypovolaemic
Euvolaemic
Hypervolaemic

130
Q

Causes of hypovolaemic hyponatraemia?

A

D&V
Diuretics
Salt losing nephropathy

131
Q

Causes of euvolaemic hyponatraemia?

A

Hypothyroidism
Addison’s
SIADH

132
Q

Causes of hypervolaemic hyponatraemia?

A

CCF
Liver failure
Renal failure

133
Q

Causes of hypernatraemia?

A 
D&V
Uncompensated losses - dementia, fasting for surgery
Diabetes insipidus
Conn's
Iatrogenic
134
Q

Causes of hypokalaemia?

A

GIT losses: vomiting, diarrhoea
Redistribution into cells: insulin, salbutamol, alkalosis
Renal losses: Conn’s, loop diuretics, Bartter’s syndrome, thiazide diuretics, Gitelman syndrome, renal tubular acidosis
Very poor dietary intake

135
Q

Causes of hyperkalaemia?

A

Extracellular shift

  • Acidosis
  • Rhabdomyolysis

Decreased excretion

  • Renal: AKI, CKD
  • Drugs: spironolactone, ACE inhibitors
  • Addison’s
136
Q

Indications for dialysis?

A 
Acidosis (metabolic)
Electrolytes (refractory hyperkalaemia) 
Ingested toxins 
Overload (pulmonary oedema) 
Uraemia (symptomatic)
137
Q

Criteria for HHS?

A

pH >7.3
Osmolarity >320mOsm
BM >30mM

138
Q

Causes of pseudohyponatraemia?

A

Hyperlipidaemia

Hyperproteinaemia

139
Q

Criteria fro diagnosing SIADH?

A 
Hyponatraemia <135
Plasma osmolality <270
Urine osmolality >100
Urine sodium >20
Euvolaemia
No evidence of adrenal, renal or thyroid dysfunction
140
Q

Causes of redistributive hypokalaemia?

A 
Insulin
Metabolic alkalosis
Adrenaline
Salbutamol
Re-feeding syndrome
141
Q

Characteristics of Bartter syndrome?

A

Hypokalaemia
Alkalosis
Hypotenision
Hypercalcuria

142
Q

Mutations in bartter syndrome?

A

NKCC2

ROMK

143
Q

Characteristics of renal tubular acidosis?

A

Acidosis

Hypokalaemia

144
Q

Which drugs might cause an isolated rise in GGT?

A

Carbamazepine
Phenytoin
Phenobarbitone

145
Q

Which syndrome causes an unconjugated bilirubinaemia?

A

Gilbert’s

Crigler najjar

146
Q

Which syndrome causes a conjugated bilirubinaemia?

A

Dublin Johnson

147
Q

Features of Schmidt’s syndrome? (Polyendocrine syndrome type 2)

A

Addison’s
T1DM
hypothyroidism

148
Q

What enzyme to measure in someone with acute parotitis?

A

Amylase

149
Q

Long-term complication of b12 deficiency?

A

Subacute combined degenration of cord - ataxia and progressive weakness in limbs and trunk, positive babinski

150
Q

Features of Vit C deficiency?

A

Bleeding gums, skin and joints

Bone brittleness

151
Q

Features of Vit E deficiency?

A

Haemolytic anaemia

Spino-cerebellar neuropathy - ataxia and arreflexia

152
Q

Features of Vit B6 deficiency?

A

Sideroblastic anaemia

Seborrhoeic dermatitis

153
Q

Cause of B6 deficiency?

A

Isoniazid tx

154
Q

Dx of B6 deficiency?

A

RBC aspartate aminotransferase levels

155
Q

Features of homocystinuria?

A

Fair skin
Brittle hair
Developmental delay

156
Q

Features of PKU?

A

Fair skin
Developmental delay
Low IQ

157
Q

Features of Von Gierke’s disease

A

Hypoglycaemia
Hepatomegaly
Kidney enlargement

158
Q

Features of maple syrup urine disease?

A 
Lethargy
Poor feeding
Hypotonia
Sweet odour
Sweaty feet
159
Q

Pathognomonic feature of lyosomal storage disorders and give an example of one?

A

Cherry red spot

Fabry’s disease

160
Q

Features of Fabry’s disease?

A

Developmental disease + dysmorphia

May be organomegaly

161
Q

When do features arise in galactosaemia?

A

After milk ingestion

162
Q

Features of phenytoin toxicity?

A

Hypotension
Heart block
Ventricular arrhythmias
Ataxia

163
Q

Features of lithium toxicity?

A

D&V
Dysarthria
Coarse tremor

164
Q

Features of gentamicin toxicity?

A

Ototoxic

NEphrotoxic

165
Q

Features of digoxin toxicity?

A 
Tiredness
Blurred vision
Nausea and abdo pain
Renal failure
Prolonged PR interval
Bradycardia
166
Q

Features of theophylline toxicity?

A 
nausea
diarrhoea
tachycardia and arrhythmia
headaches
seizures
167
Q

Which drugs potentiate theophylline toxicity?

A

Erythromycin

Ciprofloxacin

168
Q

Features of procainamide toxicity?

A

Drug induced lupus
rash
fever
agranulocytosis

169
Q

Features of carbamazepine toxicity?

A 
headache
ataxia
abdo pain
SIADH
aplastic anaemia
170
Q

What is the effect of alkalosis on the urine pH and why does this happen?

A

Paradoxical aciduria
Low plasma hydrogen ions leads to increased potassium uptake into cells and hypokalaemia
To maintain homeostasis potassium is exchanged for hydrogen ions in DCT (hydrogen excreted) causing aciduria

171
Q

Terrible 3 C’s which cause aplastic anaemia?

A

Carbamazepine
Chloramphenicol
Carbimazole

172
Q

How can SIADH be remembered?
2 low in blood
2 high in urine
3 exclusions everywhere else

A
  1. 2 low in blood - hyponatraemia + hypoosmolar
  2. 2 high in urine - hypernatraemia >20 + high osmolality
  3. No renal/adrenal/thyroid disease + No hypovolaemia + no drugs contributing
173
Q

Difference between SIADH and cerebral salt wasting syndrome?

A

Primary event in SIADH is high vasopressin release

Primary event in CSW is high renal sodium loss (ANP)

174
Q

Features of Albright’s hereditary osteodystrophy?

A 
Short height
Short 4th and 5th metacarpals
Low intelligence
Basal ganglia calcification
DM
obesity
Hypogonadism
Hypothyroidism
175
Q

Blood results of pseudohypoparathyroidism? Why does it occur?

A

High PTH
Low Calcium
High Phosphate
PTH receptor insensitivity in PCT

176
Q

What is pseudopseudohypoparathyroidism?

Blood results?

A

Normal biochemistry

Similar features to pseudohypoparathyroidism due to genetic imprinting

177
Q

How to test for thiamine deficiency?

A

RBC transketolase activity

178
Q

How to test for riboflavin deficiency?

A

RBC glutathione reductase assay

179
Q

Effect of ischaemia on potassium?

A

Raises potassium

180
Q

Effect of Addison’s on calcium?

A

Hypercalcaemia

181
Q

2 drugs classically associated with nephrogenic diabetes insipidus?

A

Lithium

Demeclocycline

182
Q

Causes of Conn’s syndrome?ABCD

A

Adrenal adenoma
Bilateral nodular hyperplasia
Carcinoma of adrenals
Defective gene (GRA)

183
Q

CAT MUDPILES causes of metabolic acidosis with raised anion gap?

A 
C - CO, Cyanide, Congenital HF
A - Aminoglycosides
T -  Teophylline
M — Methanol
U — Uremia (chronic kidney failure)
D — Diabetic ketoacidosis
P — Paracetamol
I — Infection, Iron, Isoniazid, Inborn metabolism error
L — Lactic acidosis
E — Ethylene glycol
S — Salicylates
184
Q

What does metabolic acidosis with a normal anion gap imply?

A

Loss of bicarb

Ingestion of hydrogen

185
Q

What does a raised osmolar gap suggest?

A 
Ethanol
Methanol
Ethylene glycol
Acetone
Lactic acidosis
DKA
Chronic renal failure
186
Q

Why does myeloma not cause a raised ALP?

A

Directly stimulates osteoclasts - no effect on osteoblasts

187
Q

RFs for osteoporosis?

A 
BMI <22
Crohn's
Rheumatoid
Ank spond
Prolonged immobility
Premature menopause
188
Q

Causes of raised ALP?

A

Liver - cholestasis, hepatitis, fatty liver
Drugs - phenytoin, carbamazepine, erythromycin
Bones - Paget’s, vit D deficiency
Cancer

189
Q

Classic rash in pellagra (niacin deficiency)?

A

Erythematous, pigmented rash in necklace distribution

190
Q

4D’s of pellagra?

A

Dementia
Diarrhoea
Dermatitis
Death

191
Q

Features of glycogen storage disorder type 1? GLUT

A

Glucose low
Lactic acidosis
Urate high
Triglycerides high

192
Q

A 43 year old lady with Type II Diabetes and previous suicidal ideation presents to A&E confused and drowsy. She is fluctuating in and out of consciousness.
She appears sweaty and is shaking.
Her blood sugar is 1.3 mmol/L.
She has high levels of insulin and a high C-peptide level.
What investigation should be performed to exclude a factitious hypoglycaemia?

A

Blood sulfonylurea levels

193
Q

What vitamin converts cyanide to a renally cleared, less toxic, metabolite and is the first line medication for cyanide poisoning?

A

Hydroxocobalamin

194
Q

What kind of inheritance is shown by the Multiple Endocrine Neoplasia syndromes?

A

Autosomal dominant

195
Q

A 9 year old boy presents to the GP with enlarged orange coloured tonsils. Examination elicits a peripheral neuropathy and blood tests show very low plasma HDL levels. What is the most likely diagnosis?

A

Tangier disease

196
Q

What class of drug must not be co-administered with azathioprine in individuals with TPMT deficiency, else a potentially fatal buildup of toxic metabolites may occur?

A

Xanthine oxidase inhibitors

197
Q

Which term is used to describe increased bone density?

A

Osteosclerosis

198
Q

Looser’s zones are a pathognomonic X-ray finding of which condition?

A

Osteomalacia

199
Q

A 16 year old presents to A&E following an overdose of medications from the family medicine cabinet 4 hours ago. His mother says he took 20 of her antidepressant tablets. Observations show he is tachycardic and hypotensive with a GCS of 14. He has dilated pupils, an ataxic gait and has very flushed hands and feet. He says he feels very thirsty and has a dry mouth. An ECG shows first degree heart block with tachycardia. What class of medication is he likely to have overdosed on?

A

TCA

200
Q

What is the most common cause of hypocalcaemia in the community?

A

Vit D deficiency

201
Q

What is the most common cause of hypercalcaemia in the community?

A

Primary hyperparathyroidism

202
Q

What is the most common cause of hypercalcaemia in the community?

A

Caeruloplasmin

203
Q

Which hormone released from fat cells has hypothalamic receptors?

A

Leptin

204
Q 
33.	60 y/o man with BMI of 28 is referred with abdo pain. Investigations:
ALP 650 (most raised result)
ALT 145 (high)
AST 100 (high)
GGT 171 (high)
CK 254 (high)
What is the most likely diagnosis?
A

Gallstones

205
Q

What is a cause of increased insulin sensitivity?

A

ACTH deficiency

206
Q

Which of the following can cause hypoglycaemia?

a. Atorvastatin
b. Bendrofluazide
c. Glucagon
d. Prednisolone
e. Quinine

A

Atorvastatin

207
Q
  1. Which of the following findings is consistent with moderate alcohol intake?
    a. Reduced albumin
    b. Elevated HDL
    c. Nearly normal AST
    d. Normal GGT
    e. Normal triglycerides
A

Elevated HDL

208
Q
  1. Which of the following would be consistent with obstructive jaundice?
    a. Normal ALP
    b. Normal AST
    c. Normal GGT
    d. Dark stools
    e. Increased bilirubin in the urine
A

Increased bilirubin in urine

Oishi's 5th year flashcards (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions