Chemical Pathology Flashcards
1
Q
A 65-year-old chronic alcoholic presents to the A&E Department with a minor head injury. On examination he is found to be pale. Blood tests show a high MCV. What is the likeliest result of MCV (fl) in a normal person? A. 130 B. 30 C. 15 D. 4 E. 290 F. 90 G. 2.2
A
F. 90
2
Q
A 40-year-old woman presents with a two month history of tiredness, intermittent pyrexia and abdominal pain. On examination she has an enlarged palpable spleen. Blood tests show anaemia with a raised white cell count. What is the likeliest result of a white cell count (x 109 per l) in a normal person? A. 130 B. 30 C. 15 D. 4 E. 290 F. 90 G. 2.2
A
D. 4
3
Q
A 5-year-old boy presents with a purpuric rash and petechiae following a recent viral infection. Blood tests showed thrombocytopenia. What is the likeliest result of a platelet count (x109/l) in a normal adult? A. 130 B. 30 C. 15 D. 4 E. 290 F. 90 G. 2.2
A
E. 290
4
Q
A 35-year-old man presents with hypertension. Blood tests show normal sodium, urea and glucose and a raised potassium. What is the likeliest result of potassium (mmol/l) in a normal person? A. 130 B. 30 C. 15 D. 4 E. 290 F. 90 G. 2.2
A
D. 4
5
Q
A 70-year-old woman presents in a coma with a long history of polyuria and polydipsia. Investigations show that her plasma osmolarity is raised. What is the likeliest result of plasma osmolarity (mmol/l) in a normal person? A. 130 B. 30 C. 15 D. 4 E. 290 F. 90 G. 2.2
A
E. 290
6
Q
A 14-year-old boy presents with symptoms of chronic liver failure. LFTs display abnormally high levels of transaminases with normal alk phos & bilirubin levels. There’s marked accumulation of copper-associated protein in hepatocytes obtained from a biopsy. His serum copper levels and caeruloplasmin are abnormally low. A. Primary hepatocellular carcinoma B. Chronic hepatitis B C. Wilson's disease D. Crigler Najjar syndrome E. Chronic hepatitis C F. Budd-Chiari syndrome G. Primary biliary cirrhosis H. Hepatitis A
A
C. Wilson’s disease
7
Q
A 30-year-old Thai male presents to a day surgery unit for a cholecystectomy. His LFTs reveal very elevated transaminases with normal bilirubin & alk phos levels. Microscopy of a liver biopsy identifies antigens from a dsDNA virus in the cytosol of hepatocytes. A. Primary hepatocellular carcinoma B. Chronic hepatitis B C. Wilson's disease D. Crigler Najjar syndrome E. Chronic hepatitis C F. Budd-Chiari syndrome G. Primary biliary cirrhosis H. Hepatitis A
A
B. Chronic hepatitis B
8
Q
A 58-year-old woman presents with recent onset of Jaundice. LFTs reveal increased bilirubin & markedly elevated alk phos & normal transaminases. Further investigations uncovered raised IgM and serum cholesterol. Anti mitochondrial antibodies are also detected. A liver biopsy shows enlargement of the portal tracts by white blood cells and granulomas. Bile ducts are also less than normal. A. Primary hepatocellular carcinoma B. Chronic hepatitis B C. Wilson's disease D. Crigler Najjar syndrome E. Chronic hepatitis C F. Budd-Chiari syndrome G. Primary biliary cirrhosis H. Hepatitis A
A
G. Primary biliary cirrhosis
9
Q
A 48-year-old male returning from a 6mths round the world trip presents with a recent Hx of nausea, anorexia & distaste for cigarettes. He developed jaundice; his urine became dark and his stools pale. His spleen was palpable. Investigations showed bilirubinuria, increased urinary urobilinogen & a raised serum AST & ALT. Within 4 weeks his symptoms had completely subsided. A. Primary hepatocellular carcinoma B. Chronic hepatitis B C. Wilson's disease D. Crigler Najjar syndrome E. Chronic hepatitis C F. Budd-Chiari syndrome G. Primary biliary cirrhosis H. Hepatitis A
A
H. Hepatitis A
10
Q
A 55-year-old woman presents with a short Hx of nausea and abdominal pain; tender hepatomegaly and ascities. LFTs show mildly raised transaminases, bilirubin and normal alk phos. The woman also had polycythaemia rubra vera. Liver biopsy suggests venous outflow obstruction. A. Primary hepatocellular carcinoma B. Chronic hepatitis B C. Wilson's disease D. Crigler Najjar syndrome E. Chronic hepatitis C F. Budd-Chiari syndrome G. Primary biliary cirrhosis H. Hepatitis A
A
F. Budd-Chiari syndrome
11
Q
A liver enzyme raised after a myocardial infarction A. Gamma glutamyl transpeptidase B. Aspartate transaminase C. Alkaline phosphatase D. Albumin E. Total bilirubin F. Direct bilirubin G. Alanine transaminase H. Activated partial thromboplastin time I. Gamma globulin J. Prothrombin time
A
B. Aspartate transaminase
12
Q
A test of the integrity of the extrinsic pathway A. Gamma glutamyl transpeptidase B. Aspartate transaminase C. Alkaline phosphatase D. Albumin E. Total bilirubin F. Direct bilirubin G. Alanine transaminase H. Activated partial thromboplastin time I. Gamma globulin J. Prothrombin time
A
J. Prothrombin time
13
Q
An enzyme markedly raised in obstructive jaundice along with direct bilirubin A. Gamma glutamyl transpeptidase B. Aspartate transaminase C. Alkaline phosphatase D. Albumin E. Total bilirubin F. Direct bilirubin G. Alanine transaminase H. Activated partial thromboplastin time I. Gamma globulin J. Prothrombin time
A
C. Alkaline phosphatase
14
Q
Raised in alcohol abuse A. Gamma glutamyl transpeptidase B. Aspartate transaminase C. Alkaline phosphatase D. Albumin E. Total bilirubin F. Direct bilirubin G. Alanine transaminase H. Activated partial thromboplastin time I. Gamma globulin J. Prothrombin time
A
A. Gamma glutamyl transpeptidase
15
Q
Levels can be affected by diet
A
D. Albumin
16
Q
A 26-year-old receptionist presents to her GP with a history steatorrhoea, abdominal pain and weight loss, as well as feeling tired all the time. Initial blood tests reveal a microcytic anaemia.
A
J. Anti-endomysial antibodies (Coeliac disease)
17
Q
A 60-year-old woman with hypothyroidism presents with progressive dyspnoea and tiredness. FBC reveals macrocytic anaemia. A. Anti-GAD B. c-ANCA C. Anti-smooth muscle antibody D. ANA E. Ham's test F. Osmotic fragility test G. p-ANCA H. Anti-mitochondrial antibody I. Anti-DsDNA J. Anti-endomysial antibodies K. Anti-acetylcholine receptor antibody L. Anti-scl70 M. Anti-gastric parietal cell antibodies
A
M. Anti-gastric parietal cell antibodies (Pernicious anaemia)
18
Q
A 40-year-old plumber presents to his GP with a history of wheezing and lethargy, along with recurrent nose bleeds. On examination he has crackles in his upper left lung field. Urine dipstick is positive for blood and protein. A. Anti-GAD B. c-ANCA C. Anti-smooth muscle antibody D. ANA E. Ham's test F. Osmotic fragility test G. p-ANCA H. Anti-mitochondrial antibody I. Anti-DsDNA J. Anti-endomysial antibodies K. Anti-acetylcholine receptor antibody L. Anti-scl70 M. Anti-gastric parietal cell antibodies
A
B. c-ANCA (Wegener’s)
19
Q
A 30-year-old market trader presents with tiredness and jaundice, and further history reveals he suffered from a chest infection one week previously. On examination mild splenomegaly is noted, and blood tests show reticulocytosis, hyperbilirubinaemia, and spherocytosis. A. Anti-GAD B. c-ANCA C. Anti-smooth muscle antibody D. ANA E. Ham's test F. Osmotic fragility test G. p-ANCA H. Anti-mitochondrial antibody I. Anti-DsDNA J. Anti-endomysial antibodies K. Anti-acetylcholine receptor antibody L. Anti-scl70 M. Anti-gastric parietal cell antibodies
A
F. Osmotic fragility test (Spherocytosis)
20
Q
An 80-year-old retired clerk presents with a 2-month history of skin itching and lethargy. Examination is normal. LFTs are: bilirubin 6umol/l (reference range 0-17umol/l); ALT 24U/l (reference range 0-31U/l); Alk Phos 500U/l (reference range 30-130U/l). A. Anti-GAD B. c-ANCA C. Anti-smooth muscle antibody D. ANA E. Ham's test F. Osmotic fragility test G. p-ANCA H. Anti-mitochondrial antibody I. Anti-DsDNA J. Anti-endomysial antibodies K. Anti-acetylcholine receptor antibody L. Anti-scl70 M. Anti-gastric parietal cell antibodies
A
H. Anti-mitochondrial antibody (Primary biliary cirrhosis)
21
Q
A 10-year-old girl presents with weight loss, polyuria, tachypnoea, vomiting. Looks very dehydrated. Beta hydroxybutyrate is raised in the blood. A. Anti-GAD B. c-ANCA C. Anti-smooth muscle antibody D. ANA E. Ham's test F. Osmotic fragility test G. p-ANCA H. Anti-mitochondrial antibody I. Anti-DsDNA J. Anti-endomysial antibodies K. Anti-acetylcholine receptor antibody L. Anti-scl70 M. Anti-gastric parietal cell antibodies
A
A. Anti-GAD (Type 1 diabetes)
22
Q
A 55-year-old woman is warned of future risk of AML given her recent diagnosis of PNH following a spontaneous cerebral venous sinus thrombosis. A. Anti-GAD B. c-ANCA C. Anti-smooth muscle antibody D. ANA E. Ham's test F. Osmotic fragility test G. p-ANCA H. Anti-mitochondrial antibody I. Anti-DsDNA J. Anti-endomysial antibodies K. Anti-acetylcholine receptor antibody L. Anti-scl70 M. Anti-gastric parietal cell antibodies
A
E. Ham’s test (Paroxysmal nocturnal haemoglobinuria)
23
Q
A 40-year-old woman presents with polyuria and polydipsia. She has a fasting glucose 5.1mmol/L and an oral glucose tolerance test value of 5.0mmol/L. She has a corrected calcium of 2.80mmol/L and a PTH of 7.2pmol/L. A. Malignancy B. Lung cancer C. Impaired fasting glucose D. Hypocalcaemia E. Secondary hyperthyroidism F. Diabetes mellitus type 2 G. Impaired glucose tolerance H. Diabetes mellitus type 1 I. Crohn’s disease J. Primary hyperparathyroidism K. Psychogenic polydipsia L. Gestational diabetes M. Tuberculosis N. Sarcoidosis O. Vitamin D deficiency
A
J. Primary hyperparathyroidism
24
Q
A 35-year-old Afro-Caribbean woman presents with polyuria and polydipsia. She also complains of a dry cough. She has a fasting glucose of 5.8mmol/L and an oral glucose tolerance test value of 6.5mmol/L. She has a corrected calcium of 2.7mmol/L and a PTH of <0.1pmol/L. A. Malignancy B. Lung cancer C. Impaired fasting glucose D. Hypocalcaemia E. Secondary hyperthyroidism F. Diabetes mellitus type 2 G. Impaired glucose tolerance H. Diabetes mellitus type 1 I. Crohn’s disease J. Primary hyperparathyroidism K. Psychogenic polydipsia L. Gestational diabetes M. Tuberculosis N. Sarcoidosis O. Vitamin D deficiency
A
N. Sarcoidosis
25
Q
A 15-year-old girl presents with weight loss, polyuria and polydipsia. Over the last few months she reports feeling increasingly tired and complains of perianal itching. On examination you notice a small perianal abscess. Her fasting glucose is 22.3mmol/L. His corrected calcium is 2.5mmol/L and his PTH is 7.0pmol/L. A. Malignancy B. Lung cancer C. Impaired fasting glucose D. Hypocalcaemia E. Secondary hyperthyroidism F. Diabetes mellitus type 2 G. Impaired glucose tolerance H. Diabetes mellitus type 1 I. Crohn’s disease J. Primary hyperparathyroidism K. Psychogenic polydipsia L. Gestational diabetes M. Tuberculosis N. Sarcoidosis O. Vitamin D deficiency
A
H. Diabetes mellitus type 1
26
Q
A 56-year-old obese woman presents with polyuria and polydipsia. She complains of tiredness and depression. Her fasting glucose is 4.9mmol/L and her OGTT is 4.5mmol/L. She has a corrected calcium of 2.4mmol/L and a PTH of 7.1mmol/L. A. Malignancy B. Lung cancer C. Impaired fasting glucose D. Hypocalcaemia E. Secondary hyperthyroidism F. Diabetes mellitus type 2 G. Impaired glucose tolerance H. Diabetes mellitus type 1 I. Crohn’s disease J. Primary hyperparathyroidism K. Psychogenic polydipsia L. Gestational diabetes M. Tuberculosis N. Sarcoidosis O. Vitamin D deficiency
A
K. Psychogenic polydipsia
27
Q
A 58-year-old Afro-Caribbean gentleman presents with polyuria, polydipsia and weight loss. He has an oral glucose tolerance test of 10.1mmol/L. His corrected calcium is 2.5mmol/L and his PTH is 7.0pmol/L. A. Malignancy B. Lung cancer C. Impaired fasting glucose D. Hypocalcaemia E. Secondary hyperthyroidism F. Diabetes mellitus type 2 G. Impaired glucose tolerance H. Diabetes mellitus type 1 I. Crohn’s disease J. Primary hyperparathyroidism K. Psychogenic polydipsia L. Gestational diabetes M. Tuberculosis N. Sarcoidosis O. Vitamin D deficiency
A
G. Impaired glucose tolerance
28
Q
Varies with posture when sample is taken. A. Glucose B. ALP C. Cortisol D. ALT E. Albumin F. Potassium G. Urea H. Triglycerides I. Creatinine Kinase
A
E. Albumin
29
Q
Varies with exercise A. Glucose B. ALP C. Cortisol D. ALT E. Albumin F. Potassium G. Urea H. Triglycerides I. Creatinine Kinase
A
I. Creatinine Kinase
30
Q
Increases during pregnancy A. Glucose B. ALP C. Cortisol D. ALT E. Albumin F. Potassium G. Urea H. Triglycerides I. Creatinine Kinase
A
B. ALP
31
Q
Varies with race A. Glucose B. ALP C. Cortisol D. ALT E. Albumin F. Potassium G. Urea H. Triglycerides I. Creatinine Kinase
A
I. Creatinine Kinase
32
Q
Most likely to vary with time of sampling A. Glucose B. ALP C. Cortisol D. ALT E. Albumin F. Potassium G. Urea H. Triglycerides I. Creatinine Kinase
A
C. Cortisol
33
Q
A 19-year-old woman admitted to hospital with acute asthma suffered a cardiac arrest after treatment. She was already taking several medications for her respiratory condition. What drug excess is likely to have caused this problem? A. GI system B. High therapeutic index C. Warfarin D. Rosiglitazone E. Low therapeutic index F. Conjugation by sulphate/gluconaride G. Poor compliance H. Lungs I. Theophylline J. Oxidation by cytochrome P450 K. Gentamicin L. Digoxin M. Kidneys N. Liver
A
I. Theophylline
34
Q
Failure to respond to drug therapy is commonly caused by what? A. GI system B. High therapeutic index C. Warfarin D. Rosiglitazone E. Low therapeutic index F. Conjugation by sulphate/gluconaride G. Poor compliance H. Lungs I. Theophylline J. Oxidation by cytochrome P450 K. Gentamicin L. Digoxin M. Kidneys N. Liver
A
G. Poor compliance
35
Q
Lipid soluble drugs require metabolism by the liver in two phases. What is Phase I? A. GI system B. High therapeutic index C. Warfarin D. Rosiglitazone E. Low therapeutic index F. Conjugation by sulphate/gluconaride G. Poor compliance H. Lungs I. Theophylline J. Oxidation by cytochrome P450 K. Gentamicin L. Digoxin M. Kidneys N. Liver
A
J. Oxidation by cytochrome P450
36
Q
Drugs are mainly excreted by which organ? A. GI system B. High therapeutic index C. Warfarin D. Rosiglitazone E. Low therapeutic index F. Conjugation by sulphate/gluconaride G. Poor compliance H. Lungs I. Theophylline J. Oxidation by cytochrome P450 K. Gentamicin L. Digoxin M. Kidneys N. Liver
A
M. Kidneys
37
Q
The effect of which drug can be measured by the surrogate marker HbA1C A. GI system B. High therapeutic index C. Warfarin D. Rosiglitazone E. Low therapeutic index F. Conjugation by sulphate/gluconaride G. Poor compliance H. Lungs I. Theophylline J. Oxidation by cytochrome P450 K. Gentamicin L. Digoxin M. Kidneys N. Liver
A
D. Rosiglitazone
38
Q
A 58-year-old man presents to your A&E complaining of chest pain and palpitations. He says he takes several drugs for his 'heart problems' and admits to being diabetic. What drug could be causing his problems? A. GI system B. High therapeutic index C. Warfarin D. Rosiglitazone E. Low therapeutic index F. Conjugation by sulphate/gluconaride G. Poor compliance H. Lungs I. Theophylline J. Oxidation by cytochrome P450 K. Gentamicin L. Digoxin M. Kidneys N. Liver
A
L. Digoxin
39
Q
Peak and trough levels of this drug should be taken A. Carbamazepine B. Clonazepam C. Aspirin D. Phenobarbitone E. Warfarin F. Theophylline G. Gentamicin H. Heparin - Low molecular weight I. Ethosuximide J. Heparin - unfractionated K. Lithium L. Phenytoin M. Digoxin N. Ciclosporin
A
G. Gentamicin
40
Q
Symptoms of under-treatment and toxicity may be similar A. Carbamazepine B. Clonazepam C. Aspirin D. Phenobarbitone E. Warfarin F. Theophylline G. Gentamicin H. Heparin - Low molecular weight I. Ethosuximide J. Heparin - unfractionated K. Lithium L. Phenytoin M. Digoxin N. Ciclosporin
A
M. Digoxin
41
Q
Decreased excretion, increased plasma concentration and increased risk of toxicity may occur when this taken in conjunction with thiazide diuretics A. Carbamazepine B. Clonazepam C. Aspirin D. Phenobarbitone E. Warfarin F. Theophylline G. Gentamicin H. Heparin - Low molecular weight I. Ethosuximide J. Heparin - unfractionated K. Lithium L. Phenytoin M. Digoxin N. Ciclosporin
A
K. Lithium
42
Q
Is ototoxic and nephrotoxic A. Carbamazepine B. Clonazepam C. Aspirin D. Phenobarbitone E. Warfarin F. Theophylline G. Gentamicin H. Heparin - Low molecular weight I. Ethosuximide J. Heparin - unfractionated K. Lithium L. Phenytoin M. Digoxin N. Ciclosporin
A
G. Gentamicin
43
Q
Requires regular monitoring of APTT A. Carbamazepine B. Clonazepam C. Aspirin D. Phenobarbitone E. Warfarin F. Theophylline G. Gentamicin H. Heparin - Low molecular weight I. Ethosuximide J. Heparin - unfractionated K. Lithium L. Phenytoin M. Digoxin N. Ciclosporin
A
J. Heparin - unfractionated
44
Q
A man was put into custody after driving under the influence of drugs. On arrest he was reported as acting extremely aggressive and paranoid. He also claimed his heart was racing. One hour later he was found dead. There was suspicion of police brutality. A. Ethanol B. Amphetamines C. Cannabis D. Cocaine E. Benzodiazepines F. Ecstasy G. Methadone H. Paracetamol I. Organophosphate J. Cyanide K. Carbon monoxide L. Heroin M. Police brutality N. Aspirin O. Methanol P. Strychnine
A
D. Cocaine
45
Q
A 24-year-old woman goes to a party where she has some pills. She subsequently becomes feverish and confused. She was found to be hyperthermic and blood results showed a raised urea and creatinine, her myoglobin was also found to be high. A. Ethanol B. Amphetamines C. Cannabis D. Cocaine E. Benzodiazepines F. Ecstasy G. Methadone H. Paracetamol I. Organophosphate J. Cyanide K. Carbon monoxide L. Heroin M. Police brutality N. Aspirin O. Methanol P. Strychnine
A
F. Ecstasy
46
Q
James Pond comes to A&E claiming he’s been poisoned. Minutes later he dies. His skin was brick red and there was a faint odour of almonds. A. Ethanol B. Amphetamines C. Cannabis D. Cocaine E. Benzodiazepines F. Ecstasy G. Methadone H. Paracetamol I. Organophosphate J. Cyanide K. Carbon monoxide L. Heroin M. Police brutality N. Aspirin O. Methanol P. Strychnine
A
J. Cyanide
47
Q
Following a death in the family, a young woman is brought into the hospital with confusion. On inspection she appears jaundiced. Her friend reports that she had been vomiting earlier and that she had found an empty medicine bottle in her room. A. Ethanol B. Amphetamines C. Cannabis D. Cocaine E. Benzodiazepines F. Ecstasy G. Methadone H. Paracetamol I. Organophosphate J. Cyanide K. Carbon monoxide L. Heroin M. Police brutality N. Aspirin O. Methanol P. Strychnine
A
H. Paracetamol
48
Q
A man was found collapsed on the floor of his room and his breathing was found to be severely depressed. A urine test was found to be positive for 6-MAM. A. Ethanol B. Amphetamines C. Cannabis D. Cocaine E. Benzodiazepines F. Ecstasy G. Methadone H. Paracetamol I. Organophosphate J. Cyanide K. Carbon monoxide L. Heroin M. Police brutality N. Aspirin O. Methanol P. Strychnine
A
L. Heroin
49
Q
A 30-year-old farmer presents to casualty complaining of diarrhoea and painful mouth ulcers. On questioning he admitted accidentally ingesting liquid paraquat A. Atropine B. Desferrioxamine C. Gastric lavage D. Naloxone E. Hyperbaric oxygen F. Dicobalt edentate G. Activated charcoal H. Glucagon I. N-acetylcysteine J. Symptomatic and Supportive treatment K. Haemodialysis
A
G. Activated charcoal
50
Q
A 15-year-old girl presents with sweats and hyperventilation indicative of a severe metabolic acidosis; after taking a large number of salicylate tablets A. Atropine B. Desferrioxamine C. Gastric lavage D. Naloxone E. Hyperbaric oxygen F. Dicobalt edentate G. Activated charcoal H. Glucagon I. N-acetylcysteine J. Symptomatic and Supportive treatment K. Haemodialysis
A
K. Haemodialysis
51
Q
A 26-year-old woman collapses after a massive overdose of atenolol. She remains in cardogenic shock despite initial treatment with IV atropine A. Atropine B. Desferrioxamine C. Gastric lavage D. Naloxone E. Hyperbaric oxygen F. Dicobalt edentate G. Activated charcoal H. Glucagon I. N-acetylcysteine J. Symptomatic and Supportive treatment K. Haemodialysis
A
H. Glucagon
52
Q
A pregnant 30-year-old woman is found drowsy in her rented flat. She complains of severe nausea for the last 3 hours. Her carboxyhaemoglobin level is 41%. A. Atropine B. Desferrioxamine C. Gastric lavage D. Naloxone E. Hyperbaric oxygen F. Dicobalt edentate G. Activated charcoal H. Glucagon I. N-acetylcysteine J. Symptomatic and Supportive treatment K. Haemodialysis
A
E. Hyperbaric oxygen
53
Q
A 25-year-old man is delirious and hyperpyrexial after taking a pill in a club. He is hyperreflexic and is hyponatraemic A. Atropine B. Desferrioxamine C. Gastric lavage D. Naloxone E. Hyperbaric oxygen F. Dicobalt edentate G. Activated charcoal H. Glucagon I. N-acetylcysteine J. Symptomatic and Supportive treatment K. Haemodialysis
A
J. Symptomatic and supportive treatment
54
Q
An 18 year old female is brought in to A&E from a rave in the early hours of the morning. On initial examination she is agitated with a heart rate of 120 bpm. She is very sweaty and has wide dilated pupils A. Desferrioxamine B. Naloxone C. Carbon Monoxide D. Methanol E. Salicylates F. Lithium G. Tricyclic antidepressants H. Ecstasy I. Paracetamol J. Organophosphates K. Acetylcysteine
A
H. Ecstasy
55
Q
A 25 year old male is admitted with hyperventilation. He is sweating and appears nauseous. He says that he has ringing in his ears. Blood gases show that he has mixed acid-base disturbance A. Desferrioxamine B. Naloxone C. Carbon Monoxide D. Methanol E. Salicylates F. Lithium G. Tricyclic antidepressants H. Ecstasy I. Paracetamol J. Organophosphates K. Acetylcysteine
A
E. Salicylates
56
Q
An 80 year old man and his 79 year old wife were brought in after a neighbour found them collapsed in their home. On questioning the neighbour it was found that the couple had not been feeling well for a few weeks and had been complaining of nausea, headaches and dizziness A. Desferrioxamine B. Naloxone C. Carbon Monoxide D. Methanol E. Salicylates F. Lithium G. Tricyclic antidepressants H. Ecstasy I. Paracetamol J. Organophosphates K. Acetylcysteine
A
C. Carbon Monoxide
57
Q
A depressed 30 year old woman was brought into A&E after being found by a friend. On examination she appears very drowsy with sinus tachycardia and wide dilated pupils. She has marked reflexes and extensor plantar responses. ECG shows a wide QRS interval A. Desferrioxamine B. Naloxone C. Carbon Monoxide D. Methanol E. Salicylates F. Lithium G. Tricyclic antidepressants H. Ecstasy I. Paracetamol J. Organophosphates K. Acetylcysteine
A
G. Tricyclic antidepressants
58
Q
A 45 year old farm worker is admitted complaining primarily of nausea and vomiting. On further questioning it is revealed that he also has a headache, hypersalivation and he is finding it hard to breathe. On examination the patient appears sweaty and has flaccid paresis of his limb muscles A. Desferrioxamine B. Naloxone C. Carbon Monoxide D. Methanol E. Salicylates F. Lithium G. Tricyclic antidepressants H. Ecstasy I. Paracetamol J. Organophosphates K. Acetylcysteine
A
J. Organophosphates
59
Q
Which of the above techniques can be used to test for all classes of drugs of abuse (DOA)? A. Paracetamol B. Liver sample C. Immunoassay D. Benzodiazepines E. Urine sample F. Drugs of abuse (DOA) G. Liquid chromotography H. Barbituates I. Stool sample J. Blood sample K. Thin layer chromotography
A
C. Immunoassay
60
Q
What sample is required for use with gas chromatography mass spectroscopy? A. Paracetamol B. Liver sample C. Immunoassay D. Benzodiazepines E. Urine sample F. Drugs of abuse (DOA) G. Liquid chromotography H. Barbituates I. Stool sample J. Blood sample K. Thin layer chromotography
A
J. Blood sample
61
Q
Colorimetric can be used to test for which drug commonly taken in overdose? A. Paracetamol B. Liver sample C. Immunoassay D. Benzodiazepines E. Urine sample F. Drugs of abuse (DOA) G. Liquid chromotography H. Barbituates I. Stool sample J. Blood sample K. Thin layer chromotography
A
A. Paracetamol
62
Q
Which of the above techniques can be used to test for benzodiazepines and various antipsychotic drugs? A. Paracetamol B. Liver sample C. Immunoassay D. Benzodiazepines E. Urine sample F. Drugs of abuse (DOA) G. Liquid chromotography H. Barbituates I. Stool sample J. Blood sample K. Thin layer chromotography
A
G. Liquid chromatography
63
Q
Which of the above techniques can be used to analyse samples of stool, liver and also urine? A. Paracetamol B. Liver sample C. Immunoassay D. Benzodiazepines E. Urine sample F. Drugs of abuse (DOA) G. Liquid chromotography H. Barbituates I. Stool sample J. Blood sample K. Thin layer chromotography
A
K. Thin layer chromatography
64
Q
Which option is the best specimen for assessing long-term drug use? A. THC B. Hair C. Cocaine D. Toxicology E. Forensics F. MDMA G. Urine H. Blood I. Saliva J. Paracetamol K. Morphine
A
B. Hair
65
Q
Which drug is found in the most addict related deaths? A. THC B. Hair C. Cocaine D. Toxicology E. Forensics F. MDMA G. Urine H. Blood I. Saliva J. Paracetamol K. Morphine
A
K. Morphine
66
Q
Which option is responsible for the analysis of samples for drugs and poisons? A. THC B. Hair C. Cocaine D. Toxicology E. Forensics F. MDMA G. Urine H. Blood I. Saliva J. Paracetamol K. Morphine
A
D. Toxicology
67
Q
Which option is the best example of a quick, cheap, easy and non-invasive specimen which is likely to be adulterated for forensic drug analysis? Disadvantages include a small window of detection. A. THC B. Hair C. Cocaine D. Toxicology E. Forensics F. MDMA G. Urine H. Blood I. Saliva J. Paracetamol K. Morphine
A
I. Saliva
68
Q
Which drug is not excreted into saliva? A. THC B. Hair C. Cocaine D. Toxicology E. Forensics F. MDMA G. Urine H. Blood I. Saliva J. Paracetamol K. Morphine
A
A. THC
69
Q
A 25 year old male with a history of tuberculosis presenting with a plasma osmolality of 205mmol/l, potassium of 6.3mmol/l and sodium of 115mmol/l. A. Addison's disease B. Cushing’s syndrome C. SIADH D. Diuretic use E. Diabetic ketoacidosis F. Vomiting G. Haemorrhage H. Artifactual I. Acute Renal Failure J. Alcohol abuse K. Renal tubular acidosis L. Rhabdomyolysis M. Diarrhoea
A
A. Addison’s disease
70
Q
A 76 year woman with known congestive cardiac failure presenting with digoxin toxicity A. Addison's disease B. Cushing’s syndrome C. SIADH D. Diuretic use E. Diabetic ketoacidosis F. Vomiting G. Haemorrhage H. Artifactual I. Acute Renal Failure J. Alcohol abuse K. Renal tubular acidosis L. Rhabdomyolysis M. Diarrhoea
A
D. Diuretic use
71
Q
Following a severe car crash, a patient’s ECG shows a broad QRS complex with peaked T waves. A. Addison's disease B. Cushing’s syndrome C. SIADH D. Diuretic use E. Diabetic ketoacidosis F. Vomiting G. Haemorrhage H. Artifactual I. Acute Renal Failure J. Alcohol abuse K. Renal tubular acidosis L. Rhabdomyolysis M. Diarrhoea
A
L. Rhabdomyolysis
72
Q
A 53 year old man in hospital following a minor operation was observed to have a potassium of 7.0mmol/l on a routine blood test but clinically well. A repeat test 4 hours later was 4.0mmol/l. A. Addison's disease B. Cushing’s syndrome C. SIADH D. Diuretic use E. Diabetic ketoacidosis F. Vomiting G. Haemorrhage H. Artifactual I. Acute Renal Failure J. Alcohol abuse K. Renal tubular acidosis L. Rhabdomyolysis M. Diarrhoea
A
H. Artifactual
73
Q
An 18 year old woman presents comatose, with a urinary pH of 3.5 and plasma potassium of 6.5mmol/l. 6 hours after treatment potassium drops to 3.1mmol/l. A. Addison's disease B. Cushing’s syndrome C. SIADH D. Diuretic use E. Diabetic ketoacidosis F. Vomiting G. Haemorrhage H. Artifactual I. Acute Renal Failure J. Alcohol abuse K. Renal tubular acidosis L. Rhabdomyolysis M. Diarrhoea
A
E. Diabetic ketoacidosis
74
Q
A 68 year old woman, K+ = 3.0 mmol/L with a history of congestive cardiac failure complains of general discomfort. A. Insulin administration B. Hypokalaemia C. Laxative abuse D. Cushing's disease E. Rhabdomyalysis F. Addison's disease G. Diuretic use H. Artefactual I. Hyperkalaemia J. Burns K. Renal tubular disease
A
G. Diuretic use
75
Q
An ECG of a 27 year old man in casualty shows peaked T waves in leads V2 and V3. A. Insulin administration B. Hypokalaemia C. Laxative abuse D. Cushing's disease E. Rhabdomyalysis F. Addison's disease G. Diuretic use H. Artefactual I. Hyperkalaemia J. Burns K. Renal tubular disease
A
I. Hyperkalaemia
76
Q
A 2 month old infant vomits profusely, pH = 7.57, H+= 26 nmol/L, HCO3= 50 mmol/L A. Insulin administration B. Hypokalaemia C. Laxative abuse D. Cushing's disease E. Rhabdomyalysis F. Addison's disease G. Diuretic use H. Artefactual I. Hyperkalaemia J. Burns K. Renal tubular disease
A
B. Hypokalaemia
77
Q
A 47 year old woman complains of tiredness, muscle weakness, mood swings and loss of appetite over several months. K+= 5.9 mmol/L A. Insulin administration B. Hypokalaemia C. Laxative abuse D. Cushing's disease E. Rhabdomyalysis F. Addison's disease G. Diuretic use H. Artefactual I. Hyperkalaemia J. Burns K. Renal tubular disease
A
F. Addison’s disease
78
Q
A 15 year old girl with K+ = 3.2 mmol/L admits to taking Bisacodyl over several months to lose weight. A. Insulin administration B. Hypokalaemia C. Laxative abuse D. Cushing's disease E. Rhabdomyalysis F. Addison's disease G. Diuretic use H. Artefactual I. Hyperkalaemia J. Burns K. Renal tubular disease
A
C. Laxative abuse
79
Q
A 47 year old female presents to her GP with severe loin pain. On further questioning the patient complains of a 6 month history of recurrent fevers and vomiting with more recent generalised weakness and pain in some of her joints. A subsequent blood test shows hypokalaemia. A. Corticosteroid use B. Vomiting C. Addison's disease D. Diarrhoea E. Diuretics F. Fistula G. Haemolysis H. Renal failure I. Delayed separation J. Drip arm sample K. Renal tubular acidosis
A
K. Renal tubular acidosis
80
Q
A 20 year old medical student presents to his GP with bowel disturbances. He recently returned from holiday in Thailand. Blood tests reveal that he is hypokalaemic. A. Corticosteroid use B. Vomiting C. Addison's disease D. Diarrhoea E. Diuretics F. Fistula G. Haemolysis H. Renal failure I. Delayed separation J. Drip arm sample K. Renal tubular acidosis
A
D. Diarrhoea
81
Q
A junior doctor received a blood report from the pathology lab for a 50 year old male who was recovering from an inguinal hernia repair. The report described the patient as being hyperkalaemic. Most of the porters at the hospital were on strike at the time. A. Corticosteroid use B. Vomiting C. Addison's disease D. Diarrhoea E. Diuretics F. Fistula G. Haemolysis H. Renal failure I. Delayed separation J. Drip arm sample K. Renal tubular acidosis
A
I. Delayed separation
82
Q
An 82 year old female caught a bad cold on a flight to Heathrow for a holiday from India, where she has lived all her life. Six days later she comes into A+E weak, confused with abdominal pain. Blood tests show a potassium of 6.2mmol/L. A. Corticosteroid use B. Vomiting C. Addison's disease D. Diarrhoea E. Diuretics F. Fistula G. Haemolysis H. Renal failure I. Delayed separation J. Drip arm sample K. Renal tubular acidosis
A
C. Addison’s disease
83
Q
A 72 year old male is referred to cardiothoracic surgery outpatients following an episode of unconsciousness. The patient had an aortic valve replacement operation 5 years ago. Following investigation the valve is found to have malfunctioned. A blood test shows that the patient is hyperkalaemic. A. Corticosteroid use B. Vomiting C. Addison's disease D. Diarrhoea E. Diuretics F. Fistula G. Haemolysis H. Renal failure I. Delayed separation J. Drip arm sample K. Renal tubular acidosis
A
G. Haemolysis
84
Q
A 65 year old lady presents to A & E with her son who describes decreasing mental function over the last week or so. On questioning you discover that she is a smoker with a 40 pack year history and that she has had a chronic, productive cough for several weeks. Bloods include Na=120, K=4.5, Cl=85, HC03=22, serum osmolality=260 A. Dehydration B. Psychogenic polydipsia C. Normal D. SIADH E. Nephrogenic diabetes insipidus F. Illicit drug abuse G. Iatrogenic H. Diuretic excess I. Alcohol abuse J. Cranial Diabetes insipidus
A
D. SIADH
85
Q
A 75 year old lady is recovering from a hip replacement after fracturing her neck of femur. The post-operative period has been uneventful but today you, the F1, notice that her blood results are slightly abnormal: Na=126, K=3.2, serum osmolality=262. You consult your registrar, who tells you not to worry and advises ‘watchful waiting’. A. Dehydration B. Psychogenic polydipsia C. Normal D. SIADH E. Nephrogenic diabetes insipidus F. Illicit drug abuse G. Iatrogenic H. Diuretic excess I. Alcohol abuse J. Cranial Diabetes insipidus
A
G. Iatrogenic
86
Q
A young drama student attends clinic complaining of polyuria and sleep disturbance. Her past medical history includes an appendicectomy, a skull fracture, and hayfever. Her biochemistry reveals Na=148, K=3.6. She denies excessive fluid intake. A. Dehydration B. Psychogenic polydipsia C. Normal D. SIADH E. Nephrogenic diabetes insipidus F. Illicit drug abuse G. Iatrogenic H. Diuretic excess I. Alcohol abuse J. Cranial Diabetes insipidus
A
J. Cranial Diabetes insipidus
87
Q
A male medical student consults you after a lecture on disorders of acid-base balance and ion handling. He is concerned that his high fluid intake (2-3litres/day) may be causing a ‘dilutional hyponatraemia’ as he finds it hard to concentrate in lectures. Initial investigations include biochemistry: Na=126, K=3.8, pH=7.39 A. Dehydration B. Psychogenic polydipsia C. Normal D. SIADH E. Nephrogenic diabetes insipidus F. Illicit drug abuse G. Iatrogenic H. Diuretic excess I. Alcohol abuse J. Cranial Diabetes insipidus
A
B. Psychogenic polydipsia
88
Q
A 37 year old banker presents to A & E complaining of nausea and dizziness. He describes treating his hangover this morning with a ‘good run’ and tells you that he had a coffee to ‘steady himself’ before coming in. On examination you note a mild tachycardia and cannot confidently assess his JVP. Routine bloods reveal Na=152, K=4.1, urea=25, creatinine=190. A. Dehydration B. Psychogenic polydipsia C. Normal D. SIADH E. Nephrogenic diabetes insipidus F. Illicit drug abuse G. Iatrogenic H. Diuretic excess I. Alcohol abuse J. Cranial Diabetes insipidus
A
A. Dehydration
89
Q
Normovolaemic and hyponatraemic A. Achalasia B. Diuretic excess C. Cardiac failure D. Pernicious anaemia E. Vomiting F. Acromegaly G. COPD H. Osteomalacia I. Chronic renal failure J. Guillain-Barre syndrome K. SIADH
A
K. SIADH
