chem_path_flashcards
Which of these is a plant product?
Ergocalciferol
Where is 25 hydroxylase found?
Liver
Where is 1 hydroxylase found?
Kidney
What is the first symptom of osteoporosis?
Fracture
What is the plasma calcium level in a patient with osteoporosis?
2.4 mmol/L
Which has the lowest calcium?
Osteoporosis
76yo with previous MI has BP of 140/80 on atenolol. Is there evidence to lower his BP further?
Add thiazide diuretic and lower to 120/80
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?
No
Is there real evidence that good glucose control prevent complications?
Yes
How long does it take to see benefit from good glucose control?
5 years
Which study suggests that tight control increases mortality?
Accord
Hyperkalaemia is a side effect of which of the following drugs?
Ramipril
Hypokalaemia is a side-effect of which of the following drugs?
Furosemide
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?
Volume replacement with 0.9% saline
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?
Fluid restrict and treat underlying cause
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?
Fluid restrict and treat underlying cause
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?
Fluid restrict and thyroxine replacement
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?
Fluid restrict and hydrocortisone and fludrocortisone
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?
SIADH due to lung tumour
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?
Central diabetes insipidus
A 20-year-old man presents with polyuria and polydipsia. On examination he has bitemporal hemianopia. Na+: 150 mmol/L. How would you manage?
5% dextrose and treat underlying case
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?
10 ml 10% calcium gluconate + 50 ml 50% dextrose + 10 units of insulin + Nebulized salbutamol + Treat the underlying cause
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?
Aldosterone: renin ratio
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?
Prolactinoma
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?
Combined pituitary function test
What is given in the combined pituitary function test?
Insulin (0.15 units/kg), TRH 200mcg, GnRH 100mcg
27yo woman with a large (2cm) pituitary adenoma and bitemporal hemianopia. Investigations are below. What is the diagnosis?
Non-functioning pituitary adenoma
What management does the patient above need?
Surgery + hormone replacement (hydrocortisone, thyroxine, oestrogen, GH)
What dynamic test is needed to make a diagnosis of acromegaly?
Glucose tolerance test
Name one other test that will confirm the diagnosis of acromegaly.
IGF-1 levels
What is the treatment for acromegaly?
All of the above
Rank the below treatments of acromegaly in the order they should be offered
Surgery > Radiotherapy > Carbergoline > Octreotide
What is the equation to calculate osmolality?
Osmolality = 2(Na + K) + Urea + Glucose
What is the equation to calculate the anion gap?
Anion gap = Na + K – Cl – Bicarb
What is a normal anion gap?
16-20 mM
What fasting plasma glucose value defines diabetes?
> 7.0 mM
What OGTT glucose value defines diabetes?
> 11.1 mM
What OGTT glucose value defines impaired glucose tolerance?
7.8 – 11.1 mM
What HbA1c value defines diabetes?
≥ 48 mmol/mol
What HbA1c value defines impaired glucose tolerance?
≥ 42 mmol/mol
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?
Primary hypothyroidism
What explains her hyponatraemia + hyperkalaemia?
Addison’s disease
What is the name for Co-existence of Primary hypothyroidism + Addison’s Disease?
Schmidt’s syndrome
What is the test for Addison’s?
Synacthen test
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?
Phaeochromocytoma, alpha blockade (phenoxybenzamine), surgery
Hypertensive 33yo. Na 147, K 2.8, U 4.0, Glucose 4.0 mM. Plasma aldosterone raised. Plasma renin suppressed. What is the diagnosis?
Conns
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?
Pituitary dependent Cushing’s disease
What should be done next?
Pituitary MRI
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?
Cushing’s syndrome of indeterminate cause
What should be done next?
High dose dexamethasone suppression test
