chem_path_flashcards

Question 1

Which of these is a plant product?

Answer 1

Ergocalciferol

Question 2

Where is 25 hydroxylase found?

Answer 2

Liver

Question 3

Where is 1 hydroxylase found?

Answer 3

Kidney

Question 4

What is the first symptom of osteoporosis?

Answer 4

Fracture

Question 5

What is the plasma calcium level in a patient with osteoporosis?

Answer 5

2.4 mmol/L

Question 6

Which has the lowest calcium?

Answer 6

Osteoporosis

Question 7

76yo with previous MI has BP of 140/80 on atenolol. Is there evidence to lower his BP further?

Answer 7

Add thiazide diuretic and lower to 120/80

Question 8

76yo with previous MI has BP of 140/80 on atenolol. Thiazide diuretic was added. His LDL is 3.0mmol on atorvastatin 80mg. Is there evidence to add a further lipid lower agent?

Answer 8

No

Question 9

Is there real evidence that good glucose control prevent complications?

Answer 9

Yes

Question 10

How long does it take to see benefit from good glucose control?

Answer 10

5 years

Question 11

Which study suggests that tight control increases mortality?

Answer 11

Accord

Question 12

Hyperkalaemia is a side effect of which of the following drugs?

Answer 12

Ramipril

Question 13

Hypokalaemia is a side-effect of which of the following drugs?

Answer 13

Furosemide

Question 14

A 67-year-old man was started on Bendroflumethiazide for hypertension 2 weeks ago. He has had D& V for 2 days. He has dry mucous membranes and decreased skin turgor. Na+: 129 mmol/L. What is the management?

Answer 14

Volume replacement with 0.9% saline

Question 15

A 57-year-old woman has breathlessness worse on lying flat. Her past medical history includes a non-STEMI. She is on ramipril, bisoprolol, aspirin and simvastatin. She has elevated JVP, bibasal crackles and bilateral leg oedema. Na+: 128 mmol/L. What is the management?

Answer 15

Fluid restrict and treat underlying cause

Question 16

A 55-year-old man has jaundice. He has a past history of excessive alcohol intake. He has multiple spider naevi, shifting dullness and splenomegaly. Na+: 122 mmol/L. What is the management?

Answer 16

Fluid restrict and treat underlying cause

Question 17

A 40-year-old woman presents with fatigue, weight gain, dry skin and cold intolerance. On examination she looks pale. Na+: 130 mmol/L. What is the management?

Answer 17

Fluid restrict and thyroxine replacement

Question 18

A 45-yeard-old woman presents with dizziness and nausea. On examination she looks tanned and has postural hypotension. Na+: 128 mmol/L. K+: 5.5 mmol/L. What is the management?

Answer 18

Fluid restrict and hydrocortisone and fludrocortisone

Question 19

A 62-year-old man has chest pain, cough and weight loss. He looks cachectic. He has a 30 pack year smoking history. Na+: 125 mmol/L. What is the likely diagnosis?

Answer 19

SIADH due to lung tumour

Question 20

A 20-year-old man presents with polyuria and polydipsia. On examination he has bitemporal hemianopia. Na+: 150 mmol/L. What is the likely diagnosis?

Answer 20

Central diabetes insipidus

Question 21

A 20-year-old man presents with polyuria and polydipsia. On examination he has bitemporal hemianopia. Na+: 150 mmol/L. How would you manage?

Answer 21

5% dextrose and treat underlying case

Question 22

A 65-year-old man with type 2 diabetes mellitus and hypertension presents with malaise and drowsiness. He is on a basal bolus insulin regimen, ramipril, amlodipine, simvastatin and aspirin. Na+: 125 mmol/L. K+: 6.5 mmol/L. How would you manage?

Answer 22

10 ml 10% calcium gluconate + 50 ml 50% dextrose + 10 units of insulin + Nebulized salbutamol + Treat the underlying cause

Question 23

A 50-year-old man is referred with hypertension that has been difficult to control despite maximum doses of amlodipine, ramipril and bisoprolol. K+: 3.0 mmol/L. What is the initial investigation?

Answer 23

Aldosterone: renin ratio

Question 24

30yo patient presents with galactorrhoea. A CT scan of her pituitary shows a large (2cm) macroadenoma. Her prolactin levels is 30,000 (normal <600). What is the diagnosis?

Answer 24

Prolactinoma

Question 25

30yo patient presents with galactorrhoea. A CT scan of her pituitary shows a large (2cm) macroadenoma. Her prolactin levels is 30,000 (normal <600). What is the next investigation?

Answer 25

Combined pituitary function test

Question 26

What is given in the combined pituitary function test?

Answer 26

Insulin (0.15 units/kg), TRH 200mcg, GnRH 100mcg

Question 27

27yo woman with a large (2cm) pituitary adenoma and bitemporal hemianopia. Investigations are below. What is the diagnosis?

Answer 27

Non-functioning pituitary adenoma

Question 28

What management does the patient above need?

Answer 28

Surgery + hormone replacement (hydrocortisone, thyroxine, oestrogen, GH)

Question 29

What dynamic test is needed to make a diagnosis of acromegaly?

Answer 29

Glucose tolerance test

Question 30

Name one other test that will confirm the diagnosis of acromegaly.

Answer 30

IGF-1 levels

Question 31

What is the treatment for acromegaly?

Answer 31

All of the above

Question 32

Rank the below treatments of acromegaly in the order they should be offered

Answer 32

Surgery > Radiotherapy > Carbergoline > Octreotide

Question 33

What is the equation to calculate osmolality?

Answer 33

Osmolality = 2(Na + K) + Urea + Glucose

Question 34

What is the equation to calculate the anion gap?

Answer 34

Anion gap = Na + K – Cl – Bicarb

Question 35

What is a normal anion gap?

Answer 35

16-20 mM

Question 36

What fasting plasma glucose value defines diabetes?

Answer 36

> 7.0 mM

Question 37

What OGTT glucose value defines diabetes?

Answer 37

> 11.1 mM

Question 38

What OGTT glucose value defines impaired glucose tolerance?

Answer 38

7.8 – 11.1 mM

Question 39

What HbA1c value defines diabetes?

Answer 39

≥ 48 mmol/mol

Question 40

What HbA1c value defines impaired glucose tolerance?

Answer 40

≥ 42 mmol/mol

Question 41

31yo presents with profound tiredness. She has been acutely unwell for a few days with vomiting. Na 125, K 6.5, U 10, Glucose 2.9mM. FT4 <5nM. TSH >50mU/l. What does this TSH suggest?

Answer 41

Primary hypothyroidism

Question 42

What explains her hyponatraemia + hyperkalaemia?

Answer 42

Addison’s disease

Question 43

What is the name for Co-existence of Primary hypothyroidism + Addison’s Disease?

Answer 43

Schmidt’s syndrome

Question 44

What is the test for Addison’s?

Answer 44

Synacthen test

Question 45

32yo presents with hypertension. He is noted to have an adrenal mass. He has high urine catecholamines. What is the diagnosis, what urgent treatment is required, and what is the cure?

Answer 45

Phaeochromocytoma, alpha blockade (phenoxybenzamine), surgery

Question 46

Hypertensive 33yo. Na 147, K 2.8, U 4.0, Glucose 4.0 mM. Plasma aldosterone raised. Plasma renin suppressed. What is the diagnosis?

Answer 46

Conns

Question 47

An obese 35 year old patient has the following results: 9am cortisol (Monday): 650 nM. Given 0.5 mg dexamethasone every 6 hours for 48 hours. 9am cortisol (Wednesday) < 50nM. What is the diagnosis?

Answer 47

Pituitary dependent Cushing’s disease

Question 48

What should be done next?

Answer 48

Pituitary MRI

Question 49

An obese 35 year old patient has the following results: 9am cortisol (Monday): 650 nM. Given 0.5 mg dexamethasone every 6 hours for 48 hours. 9am cortisol (Wednesday) 500 nM. What is the diagnosis?

Answer 49

Cushing’s syndrome of indeterminate cause

Question 50

What should be done next?

Answer 50

High dose dexamethasone suppression test