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?
All Answer Choices A. 15 B. 30 C. 130 D. 290 E. 4 F. 2.2 G. 90
A
G. 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?
All Answer Choices A. 15 B. 30 C. 130 D. 290 E. 4 F. 2.2 G. 90
A
E. 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?
All Answer Choices A. 15 B. 30 C. 130 D. 290 E. 4 F. 2.2 G. 90
A
D. 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?
All Answer Choices A. 15 B. 30 C. 130 D. 290 E. 4 F. 2.2 G. 90
A
E. 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?
All Answer Choices A. 15 B. 30 C. 130 D. 290 E. 4 F. 2.2 G. 90
A
D. 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. Wilson's disease B. Chronic hepatitis C C. Primary hepatocellular carcinoma D. Chronic hepatitis B E. Crigler Najjar syndrome F. Hepatitis A G. Primary biliary cirrhosis H. Budd-Chiari syndrome
A
A. 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. Wilson's disease B. Chronic hepatitis C C. Primary hepatocellular carcinoma D. Chronic hepatitis B E. Crigler Najjar syndrome F. Hepatitis A G. Primary biliary cirrhosis H. Budd-Chiari syndrome
A
D. 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. Wilson's disease B. Chronic hepatitis C C. Primary hepatocellular carcinoma D. Chronic hepatitis B E. Crigler Najjar syndrome F. Hepatitis A G. Primary biliary cirrhosis H. Budd-Chiari syndrome
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. Wilson's disease B. Chronic hepatitis C C. Primary hepatocellular carcinoma D. Chronic hepatitis B E. Crigler Najjar syndrome F. Hepatitis A G. Primary biliary cirrhosis H. Budd-Chiari syndrome
A
F. 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. Wilson's disease B. Chronic hepatitis C C. Primary hepatocellular carcinoma D. Chronic hepatitis B E. Crigler Najjar syndrome F. Hepatitis A G. Primary biliary cirrhosis H. Budd-Chiari syndrome
A
H. Budd-Chiari syndrome
11
Q
A liver enzyme raised after a myocardial infarction
A. Aspartate transaminase B. Alanine transaminase C. Gamma globulin D. Albumin E. Alkaline phosphatase F. Gamma glutamyl transpeptidase G. Prothrombin time H. Total bilirubin I. Activated partial thromboplastin time J. Direct bilirubin
A
A. Aspartate transaminase
12
Q
A test of the integrity of the extrinsic pathway
A. Aspartate transaminase B. Alanine transaminase C. Gamma globulin D. Albumin E. Alkaline phosphatase F. Gamma glutamyl transpeptidase G. Prothrombin time H. Total bilirubin I. Activated partial thromboplastin time J. Direct bilirubin
A
G. Prothrombin time
The intrinsic pathway is initiated by the activation of the ‘contact factor’ of plasma and can be measured by the a PTT test. The extrinsic pathway is initiated by the release of tissue factor and can be measured by the PT test.
13
Q
An enzyme markedly raised in obstructive jaundice along with direct bilirubin
A. Aspartate transaminase B. Alanine transaminase C. Gamma globulin D. Albumin E. Alkaline phosphatase F. Gamma glutamyl transpeptidase G. Prothrombin time H. Total bilirubin I. Activated partial thromboplastin time J. Direct bilirubin
A
E. Alkaline phosphatase
14
Q
Raised in alcohol abuse
A. Aspartate transaminase B. Alanine transaminase C. Gamma globulin D. Albumin E. Alkaline phosphatase F. Gamma glutamyl transpeptidase G. Prothrombin time H. Total bilirubin I. Activated partial thromboplastin time J. Direct bilirubin
A
F. Gamma glutamyl transpeptidase
15
Q
Levels can be affected by diet
A. Aspartate transaminase B. Alanine transaminase C. Gamma globulin D. Albumin E. Alkaline phosphatase F. Gamma glutamyl transpeptidase G. Prothrombin time H. Total bilirubin I. Activated partial thromboplastin time J. Direct bilirubin
A
D. Albumin
16
Q
Levels can be affected by diet
A. Aspartate transaminase B. Alanine transaminase C. Gamma globulin D. Albumin E. Alkaline phosphatase F. Gamma glutamyl transpeptidase G. Prothrombin time H. Total bilirubin I. Activated partial thromboplastin time J. Direct bilirubin
A
D. Albumin
17
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. Anti-DsDNA B. Anti-gastric parietal cell antibodies C. Anti-acetylcholine receptor antibody D. Ham's test E. c-ANCA F. Anti-scl70 G. Anti-smooth muscle antibody H. Anti-endomysial antibodies I. ANA J. p-ANCA K. Osmotic fragility test L. Anti-GAD M. Anti-mitochondrial antibody
A
H. Anti-endomysial antibodies
Coeliac disease: Anti-endomysial antibodies/ Tissue-transglutaminase antibodies
18
Q
A 60-year-old woman with hypothyroidism presents with progressive dyspnoea and tiredness. FBC reveals macrocytic anaemia.
A. Anti-DsDNA B. Anti-gastric parietal cell antibodies C. Anti-acetylcholine receptor antibody D. Ham's test E. c-ANCA F. Anti-scl70 G. Anti-smooth muscle antibody H. Anti-endomysial antibodies I. ANA J. p-ANCA K. Osmotic fragility test L. Anti-GAD M. Anti-mitochondrial antibody
A
B. Anti-gastric parietal cell antibodies
Pernicious anaemia: Anti-intrinsic factor antibodies, and gastric parietal antibodies.
19
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-DsDNA B. Anti-gastric parietal cell antibodies C. Anti-acetylcholine receptor antibody D. Ham's test E. c-ANCA F. Anti-scl70 G. Anti-smooth muscle antibody H. Anti-endomysial antibodies I. ANA J. p-ANCA K. Osmotic fragility test L. Anti-GAD M. Anti-mitochondrial antibody
A
E. c-ANCA
Wegener’s : Antibody to Proteinase-3 : 3 is the 3rd letter of the alphabet; c-ANCA
20
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-DsDNA B. Anti-gastric parietal cell antibodies C. Anti-acetylcholine receptor antibody D. Ham's test E. c-ANCA F. Anti-scl70 G. Anti-smooth muscle antibody H. Anti-endomysial antibodies I. ANA J. p-ANCA K. Osmotic fragility test L. Anti-GAD M. Anti-mitochondrial antibody
A
K. Osmotic fragility test
Spherocytosis: Osmotic fragility test.
21
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-DsDNA B. Anti-gastric parietal cell antibodies C. Anti-acetylcholine receptor antibody D. Ham's test E. c-ANCA F. Anti-scl70 G. Anti-smooth muscle antibody H. Anti-endomysial antibodies I. ANA J. p-ANCA K. Osmotic fragility test L. Anti-GAD M. Anti-mitochondrial antibody
A
M. Anti-mitochondrial antibody
PBC - AMA E2 subtype of pyruvate dehydrogenase complex
22
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-DsDNA B. Anti-gastric parietal cell antibodies C. Anti-acetylcholine receptor antibody D. Ham's test E. c-ANCA F. Anti-scl70 G. Anti-smooth muscle antibody H. Anti-endomysial antibodies I. ANA J. p-ANCA K. Osmotic fragility test L. Anti-GAD M. Anti-mitochondrial antibody
A
L. Anti-GAD
Type 1 diabetes: Anti-Glutamic acid decarboxylase antibodies (Anti-GAD).
23
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-DsDNA B. Anti-gastric parietal cell antibodies C. Anti-acetylcholine receptor antibody D. Ham's test E. c-ANCA F. Anti-scl70 G. Anti-smooth muscle antibody H. Anti-endomysial antibodies I. ANA J. p-ANCA K. Osmotic fragility test L. Anti-GAD M. Anti-mitochondrial antibody
A
D. Ham’s test
Paroxysmal nocturnal haemoglobinuria (PNH): Ham’s test.
24
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. Impaired glucose tolerance B. Secondary hyperthyroidism C. Psychogenic polydipsia D. Crohn’s disease E. Gestational diabetes F. Primary hyperparathyroidism G. Hypocalcaemia H. Lung cancer I. Tuberculosis J. Impaired fasting glucose K. Malignancy L. Diabetes mellitus type 1 M. Diabetes mellitus type 2 N. Vitamin D deficiency O. Sarcoidosis
A
F. Primary hyperparathyroidism
25
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. Impaired glucose tolerance
B. Secondary hyperthyroidism
C. Psychogenic polydipsia
D. Crohn’s disease
E. Gestational diabetes
F. Primary hyperparathyroidism
G. Hypocalcaemia
H. Lung cancer
I. Tuberculosis
J. Impaired fasting glucose
K. Malignancy
L. Diabetes mellitus type 1
M. Diabetes mellitus type 2
N. Vitamin D deficiency
O. Sarcoidosis
```
O. Sarcoidosis
26
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. Impaired glucose tolerance
B. Secondary hyperthyroidism
C. Psychogenic polydipsia
D. Crohn’s disease
E. Gestational diabetes
F. Primary hyperparathyroidism
G. Hypocalcaemia
H. Lung cancer
I. Tuberculosis
J. Impaired fasting glucose
K. Malignancy
L. Diabetes mellitus type 1
M. Diabetes mellitus type 2
N. Vitamin D deficiency
O. Sarcoidosis
```
L. Diabetes mellitus type 1
27
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. Impaired glucose tolerance
B. Secondary hyperthyroidism
C. Psychogenic polydipsia
D. Crohn’s disease
E. Gestational diabetes
F. Primary hyperparathyroidism
G. Hypocalcaemia
H. Lung cancer
I. Tuberculosis
J. Impaired fasting glucose
K. Malignancy
L. Diabetes mellitus type 1
M. Diabetes mellitus type 2
N. Vitamin D deficiency
O. Sarcoidosis
```
C. Psychogenic polydipsia
28
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. Impaired glucose tolerance
B. Secondary hyperthyroidism
C. Psychogenic polydipsia
D. Crohn’s disease
E. Gestational diabetes
F. Primary hyperparathyroidism
G. Hypocalcaemia
H. Lung cancer
I. Tuberculosis
J. Impaired fasting glucose
K. Malignancy
L. Diabetes mellitus type 1
M. Diabetes mellitus type 2
N. Vitamin D deficiency
O. Sarcoidosis
```
A. Impaired glucose tolerance
29
Varies with posture when sample is taken.
```
A. Creatinine Kinase
B. ALT
C. Urea
D. Potassium
E. Cortisol
F. Albumin
G. Glucose
H. Triglycerides
I. ALP
```
F. Albumin
Plasma renin activity also varies with posture - it rises in the upright position. Some people have so-called benign postural and/or exercise-induced albuminuria.
30
Varies with exercise
```
A. Creatinine Kinase
B. ALT
C. Urea
D. Potassium
E. Cortisol
F. Albumin
G. Glucose
H. Triglycerides
I. ALP
```
A. Creatinine Kinase
31
Increases during pregnancy
```
A. Creatinine Kinase
B. ALT
C. Urea
D. Potassium
E. Cortisol
F. Albumin
G. Glucose
H. Triglycerides
I. ALP
```
I. ALP
32
Varies with race
```
A. Creatinine Kinase
B. ALT
C. Urea
D. Potassium
E. Cortisol
F. Albumin
G. Glucose
H. Triglycerides
I. ALP
```
A. Creatinine Kinase
33
Most likely to vary with time of sampling
```
A. Creatinine Kinase
B. ALT
C. Urea
D. Potassium
E. Cortisol
F. Albumin
G. Glucose
H. Triglycerides
I. ALP
```
E. Cortisol
34
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. Kidneys
B. Conjugation by sulphate/gluconaride
C. Oxidation by cytochrome P450
D. Poor compliance
E. Lungs
F. Low therapeutic index
G. Liver
H. Theophylline
I. High therapeutic index
J. Digoxin
K. Gentamicin
L. Rosiglitazone
M. Warfarin
N. GI system
```
H. Theophylline
35
Failure to respond to drug therapy is commonly caused by what?
```
A. Kidneys
B. Conjugation by sulphate/gluconaride
C. Oxidation by cytochrome P450
D. Poor compliance
E. Lungs
F. Low therapeutic index
G. Liver
H. Theophylline
I. High therapeutic index
J. Digoxin
K. Gentamicin
L. Rosiglitazone
M. Warfarin
N. GI system
```
D. Poor compliance
36
Lipid soluble drugs require metabolism by the liver in two phases. What is Phase I?
```
A. Kidneys
B. Conjugation by sulphate/gluconaride
C. Oxidation by cytochrome P450
D. Poor compliance
E. Lungs
F. Low therapeutic index
G. Liver
H. Theophylline
I. High therapeutic index
J. Digoxin
K. Gentamicin
L. Rosiglitazone
M. Warfarin
N. GI system
```
C. Oxidation by cytochrome P450
37
Drugs are mainly excreted by which organ?
```
A. Kidneys
B. Conjugation by sulphate/gluconaride
C. Oxidation by cytochrome P450
D. Poor compliance
E. Lungs
F. Low therapeutic index
G. Liver
H. Theophylline
I. High therapeutic index
J. Digoxin
K. Gentamicin
L. Rosiglitazone
M. Warfarin
N. GI system
```
A. Kidneys
38
The effect of which drug can be measured by the surrogate marker HbA1C
```
A. Kidneys
B. Conjugation by sulphate/gluconaride
C. Oxidation by cytochrome P450
D. Poor compliance
E. Lungs
F. Low therapeutic index
G. Liver
H. Theophylline
I. High therapeutic index
J. Digoxin
K. Gentamicin
L. Rosiglitazone
M. Warfarin
N. GI system
```
L. Rosiglitazone
39
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. Kidneys
B. Conjugation by sulphate/gluconaride
C. Oxidation by cytochrome P450
D. Poor compliance
E. Lungs
F. Low therapeutic index
G. Liver
H. Theophylline
I. High therapeutic index
J. Digoxin
K. Gentamicin
L. Rosiglitazone
M. Warfarin
N. GI system
```
J. Digoxin
Possible features of DIGOXIN TOXICITY include:
arrhythmia: the most common arrhythmias are ventricular extrasystoles, ventricular bigeminy / trigeminy and atrial tachycardia with complete heart block
anorexia, nausea and vomiting and occasionally, diarrhoea
confusion especially in the elderly
yellow vision (xanthopsia), blurred vision and photophobia
40
Peak and trough levels of this drug should be taken
```
A. Aspirin
B. Clonazepam
C. Digoxin
D. Phenobarbitone
E. Heparin - unfractionated
F. Warfarin
G. Heparin - Low molecular weight
H. Gentamicin
I. Ciclosporin
J. Ethosuximide
K. Phenytoin
L. Theophylline
M. Lithium
N. Carbamazepine
```
H. Gentamicin
41
Symptoms of under-treatment and toxicity may be similar
```
A. Aspirin
B. Clonazepam
C. Digoxin
D. Phenobarbitone
E. Heparin - unfractionated
F. Warfarin
G. Heparin - Low molecular weight
H. Gentamicin
I. Ciclosporin
J. Ethosuximide
K. Phenytoin
L. Theophylline
M. Lithium
N. Carbamazepine
```
C. Digoxin
42
Decreased excretion, increased plasma concentration and increased risk of toxicity may occur when this taken in conjunction with thiazide diuretics
```
A. Aspirin
B. Clonazepam
C. Digoxin
D. Phenobarbitone
E. Heparin - unfractionated
F. Warfarin
G. Heparin - Low molecular weight
H. Gentamicin
I. Ciclosporin
J. Ethosuximide
K. Phenytoin
L. Theophylline
M. Lithium
N. Carbamazepine
```
M. Lithium
43
Is ototoxic and nephrotoxic
```
A. Aspirin
B. Clonazepam
C. Digoxin
D. Phenobarbitone
E. Heparin - unfractionated
F. Warfarin
G. Heparin - Low molecular weight
H. Gentamicin
I. Ciclosporin
J. Ethosuximide
K. Phenytoin
L. Theophylline
M. Lithium
N. Carbamazepine
```
H. Gentamicin
44
Requires regular monitoring of APTT
```
A. Aspirin
B. Clonazepam
C. Digoxin
D. Phenobarbitone
E. Heparin - unfractionated
F. Warfarin
G. Heparin - Low molecular weight
H. Gentamicin
I. Ciclosporin
J. Ethosuximide
K. Phenytoin
L. Theophylline
M. Lithium
N. Carbamazepine
```
E. Heparin - unfractionated
45
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. Benzodiazepines
B. Ethanol
C. Heroin
D. Ecstasy
E. Methanol
F. Strychnine
G. Cyanide
H. Organophosphate
I. Methadone
J. Paracetamol
K. Cocaine
L. Cannabis
M. Police brutality
N. Carbon monoxide
O. Aspirin
P. Amphetamines
```
K. Cocaine
EBE and BE as breakdown products of cocaine:
EME = ecgonine methyl ester
BE = benzoylecgonine
They are the two degredation products of cocaine produced by pseudocholinesterases and hydrolysis respectively.
46
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. Benzodiazepines
B. Ethanol
C. Heroin
D. Ecstasy
E. Methanol
F. Strychnine
G. Cyanide
H. Organophosphate
I. Methadone
J. Paracetamol
K. Cocaine
L. Cannabis
M. Police brutality
N. Carbon monoxide
O. Aspirin
P. Amphetamines
```
D. Ecstasy
47
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. Benzodiazepines
B. Ethanol
C. Heroin
D. Ecstasy
E. Methanol
F. Strychnine
G. Cyanide
H. Organophosphate
I. Methadone
J. Paracetamol
K. Cocaine
L. Cannabis
M. Police brutality
N. Carbon monoxide
O. Aspirin
P. Amphetamines
```
G. Cyanide
48
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. Benzodiazepines
B. Ethanol
C. Heroin
D. Ecstasy
E. Methanol
F. Strychnine
G. Cyanide
H. Organophosphate
I. Methadone
J. Paracetamol
K. Cocaine
L. Cannabis
M. Police brutality
N. Carbon monoxide
O. Aspirin
P. Amphetamines
```
J. Paracetamol
49
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. Benzodiazepines
B. Ethanol
C. Heroin
D. Ecstasy
E. Methanol
F. Strychnine
G. Cyanide
H. Organophosphate
I. Methadone
J. Paracetamol
K. Cocaine
L. Cannabis
M. Police brutality
N. Carbon monoxide
O. Aspirin
P. Amphetamines
```
C. Heroin
50
A 30-year-old farmer presents to casualty complaining of diarrhoea and painful mouth ulcers. On questioning he admitted accidentally ingesting liquid paraquat
```
A. Dicobalt edentate
B. Hyperbaric oxygen
C. Atropine
D. N-acetylcysteine
E. Symptomatic and Supportive treatment
F. Haemodialysis
G. Desferrioxamine
H. Activated charcoal
I. Glucagon
J. Naloxone
K. Gastric lavage
```
H. Activated charcoal
**activated charcoal is NOT helpful in poisoning with: cyanide, iron, ethanol, lithium, acid or alkali, pesticides;
51
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. Dicobalt edentate
B. Hyperbaric oxygen
C. Atropine
D. N-acetylcysteine
E. Symptomatic and Supportive treatment
F. Haemodialysis
G. Desferrioxamine
H. Activated charcoal
I. Glucagon
J. Naloxone
K. Gastric lavage
```
F. Haemodialysis
52
A 26-year-old woman collapses after a massive overdose of atenolol. She remains in cardogenic shock despite initial treatment with IV atropine
```
A. Dicobalt edentate
B. Hyperbaric oxygen
C. Atropine
D. N-acetylcysteine
E. Symptomatic and Supportive treatment
F. Haemodialysis
G. Desferrioxamine
H. Activated charcoal
I. Glucagon
J. Naloxone
K. Gastric lavage
```
I. Glucagon
53
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. Dicobalt edentate
B. Hyperbaric oxygen
C. Atropine
D. N-acetylcysteine
E. Symptomatic and Supportive treatment
F. Haemodialysis
G. Desferrioxamine
H. Activated charcoal
I. Glucagon
J. Naloxone
K. Gastric lavage
```
B. Hyperbaric oxygen
54
A 25-year-old man is delirious and hyperpyrexial after taking a pill in a club. He is hyperreflexic and is hyponatraemic
```
A. Dicobalt edentate
B. Hyperbaric oxygen
C. Atropine
D. N-acetylcysteine
E. Symptomatic and Supportive treatment
F. Haemodialysis
G. Desferrioxamine
H. Activated charcoal
I. Glucagon
J. Naloxone
K. Gastric lavage
```
E. Symptomatic and Supportive treatment
55
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. Tricyclic antidepressants
B. Desferrioxamine
C. Carbon Monoxide
D. Paracetamol
E. Acetylcysteine
F. Naloxone
G. Salicylates
H. Lithium
I. Ecstasy
J. Organophosphates
K. Methanol
```
I. Ecstasy
Both TCA OD and ecstasy OD can cause wide dilated pupils.
Ecstasy is more likely to lead to agitation and TCA drowsiness.
ecstasy may induce vasopressin secretion and an SIADH, with hyponatraemia
56
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. Tricyclic antidepressants
B. Desferrioxamine
C. Carbon Monoxide
D. Paracetamol
E. Acetylcysteine
F. Naloxone
G. Salicylates
H. Lithium
I. Ecstasy
J. Organophosphates
K. Methanol
```
G. Salicylates
57
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. Tricyclic antidepressants
B. Desferrioxamine
C. Carbon Monoxide
D. Paracetamol
E. Acetylcysteine
F. Naloxone
G. Salicylates
H. Lithium
I. Ecstasy
J. Organophosphates
K. Methanol
```
C. Carbon Monoxide
58
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. Tricyclic antidepressants
B. Desferrioxamine
C. Carbon Monoxide
D. Paracetamol
E. Acetylcysteine
F. Naloxone
G. Salicylates
H. Lithium
I. Ecstasy
J. Organophosphates
K. Methanol
```
A. Tricyclic antidepressants
points very clearly to TCA overdose (reflexes and widened QRS complexes).
59
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. Tricyclic antidepressants
B. Desferrioxamine
C. Carbon Monoxide
D. Paracetamol
E. Acetylcysteine
F. Naloxone
G. Salicylates
H. Lithium
I. Ecstasy
J. Organophosphates
K. Methanol
```
J. Organophosphates
60
Which of the techniques can be used to test for all classes of drugs of abuse (DOA)?
```
A. Thin layer chromotography
B. Liver sample
C. Liquid chromotography
D. Paracetamol
E. Barbituates
F. Drugs of abuse (DOA)
G. Blood sample
H. Stool sample
I. Urine sample
J. Immunoassay
K. Benzodiazepines
```
J. Immunoassay
61
What sample is required for use with gas chromatography mass spectroscopy?
```
A. Thin layer chromotography
B. Liver sample
C. Liquid chromotography
D. Paracetamol
E. Barbituates
F. Drugs of abuse (DOA)
G. Blood sample
H. Stool sample
I. Urine sample
J. Immunoassay
K. Benzodiazepines
```
G. Blood sample
62
Colorimetric can be used to test for which drug commonly taken in overdose?
```
A. Thin layer chromotography
B. Liver sample
C. Liquid chromotography
D. Paracetamol
E. Barbituates
F. Drugs of abuse (DOA)
G. Blood sample
H. Stool sample
I. Urine sample
J. Immunoassay
K. Benzodiazepines
```
D. Paracetamol
63
Which of the above techniques can be used to test for benzodiazepines and various antipsychotic drugs?
```
A. Thin layer chromotography
B. Liver sample
C. Liquid chromotography
D. Paracetamol
E. Barbituates
F. Drugs of abuse (DOA)
G. Blood sample
H. Stool sample
I. Urine sample
J. Immunoassay
K. Benzodiazepines
```
C. Liquid chromotography
64
Which of the above techniques can be used to analyse samples of stool, liver and also urine?
```
A. Thin layer chromotography
B. Liver sample
C. Liquid chromotography
D. Paracetamol
E. Barbituates
F. Drugs of abuse (DOA)
G. Blood sample
H. Stool sample
I. Urine sample
J. Immunoassay
K. Benzodiazepines
```
A. Thin layer chromotography
65
Which option is the best specimen for assessing long-term drug use?
```
A. Cocaine
B. Morphine
C. Toxicology
D. THC
E. Paracetamol
F. Blood
G. Forensics
H. MDMA
I. Urine
J. Saliva
K. Hair
```
K. Hair
66
Which drug is found in the most addict related deaths?
```
A. Cocaine
B. Morphine
C. Toxicology
D. THC
E. Paracetamol
F. Blood
G. Forensics
H. MDMA
I. Urine
J. Saliva
K. Hair
```
B. Morphine
67
Which option is responsible for the analysis of samples for drugs and poisons?
```
A. Cocaine
B. Morphine
C. Toxicology
D. THC
E. Paracetamol
F. Blood
G. Forensics
H. MDMA
I. Urine
J. Saliva
K. Hair
```
C. Toxicology
68
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. Cocaine
B. Morphine
C. Toxicology
D. THC
E. Paracetamol
F. Blood
G. Forensics
H. MDMA
I. Urine
J. Saliva
K. Hair
```
J. Saliva
69
Which drug is not excreted into saliva?
```
A. Cocaine
B. Morphine
C. Toxicology
D. THC
E. Paracetamol
F. Blood
G. Forensics
H. MDMA
I. Urine
J. Saliva
K. Hair
```
D. THC
70
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. Haemorrhage
B. Vomiting
C. SIADH
D. Cushing’s syndrome
E. Diuretic use
F. Artifactual
G. Diabetic ketoacidosis
H. Diarrhoea
I. Alcohol abuse
J. Addison's disease
K. Acute Renal Failure
L. Rhabdomyolysis
M. Renal tubular acidosis
```
J. Addison's disease
71
A 76 year woman with known congestive cardiac failure presenting with digoxin toxicity
```
A. Haemorrhage
B. Vomiting
C. SIADH
D. Cushing’s syndrome
E. Diuretic use
F. Artifactual
G. Diabetic ketoacidosis
H. Diarrhoea
I. Alcohol abuse
J. Addison's disease
K. Acute Renal Failure
L. Rhabdomyolysis
M. Renal tubular acidosis
```
E. Diuretic use
72
Following a severe car crash, a patient’s ECG shows a broad QRS complex with peaked T waves.
```
A. Haemorrhage
B. Vomiting
C. SIADH
D. Cushing’s syndrome
E. Diuretic use
F. Artifactual
G. Diabetic ketoacidosis
H. Diarrhoea
I. Alcohol abuse
J. Addison's disease
K. Acute Renal Failure
L. Rhabdomyolysis
M. Renal tubular acidosis
```
L. Rhabdomyolysis
73
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. Haemorrhage
B. Vomiting
C. SIADH
D. Cushing’s syndrome
E. Diuretic use
F. Artifactual
G. Diabetic ketoacidosis
H. Diarrhoea
I. Alcohol abuse
J. Addison's disease
K. Acute Renal Failure
L. Rhabdomyolysis
M. Renal tubular acidosis
```
F. Artifactual
74
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. Haemorrhage
B. Vomiting
C. SIADH
D. Cushing’s syndrome
E. Diuretic use
F. Artifactual
G. Diabetic ketoacidosis
H. Diarrhoea
I. Alcohol abuse
J. Addison's disease
K. Acute Renal Failure
L. Rhabdomyolysis
M. Renal tubular acidosis
```
G. Diabetic ketoacidosis
75
A 68 year old woman, K+ = 3.0 mmol/L with a history of congestive cardiac failure complains of general discomfort.
```
A. Addison's disease
B. Insulin administration
C. Artefactual
D. Renal tubular disease
E. Laxative abuse
F. Burns
G. Rhabdomyalysis
H. Hypokalaemia
I. Cushing's disease
J. Hyperkalaemia
K. Diuretic use
```
K. Diuretic use
76
An ECG of a 27 year old man in casualty shows peaked T waves in leads V2 and V3.
```
A. Addison's disease
B. Insulin administration
C. Artefactual
D. Renal tubular disease
E. Laxative abuse
F. Burns
G. Rhabdomyalysis
H. Hypokalaemia
I. Cushing's disease
J. Hyperkalaemia
K. Diuretic use
```
J. Hyperkalaemia
77
A 2 month old infant vomits profusely, pH = 7.57, H+= 26 nmol/L, HCO3= 50 mmol/L
```
A. Addison's disease
B. Insulin administration
C. Artefactual
D. Renal tubular disease
E. Laxative abuse
F. Burns
G. Rhabdomyalysis
H. Hypokalaemia
I. Cushing's disease
J. Hyperkalaemia
K. Diuretic use
```
H. Hypokalaemia
78
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. Addison's disease
B. Insulin administration
C. Artefactual
D. Renal tubular disease
E. Laxative abuse
F. Burns
G. Rhabdomyalysis
H. Hypokalaemia
I. Cushing's disease
J. Hyperkalaemia
K. Diuretic use
```
A. Addison's disease
79
A 15 year old girl with K+ = 3.2 mmol/L admits to taking Bisacodyl over several months to lose weight.
```
A. Addison's disease
B. Insulin administration
C. Artefactual
D. Renal tubular disease
E. Laxative abuse
F. Burns
G. Rhabdomyalysis
H. Hypokalaemia
I. Cushing's disease
J. Hyperkalaemia
K. Diuretic use
```
E. Laxative abuse
80
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. Drip arm sample
B. Renal tubular acidosis
C. Vomiting
D. Addison's disease
E. Diuretics
F. Diarrhoea
G. Fistula
H. Delayed separation
I. Haemolysis
J. Corticosteroid use
K. Renal failure
```
B. Renal tubular acidosis
81
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. Drip arm sample
B. Renal tubular acidosis
C. Vomiting
D. Addison's disease
E. Diuretics
F. Diarrhoea
G. Fistula
H. Delayed separation
I. Haemolysis
J. Corticosteroid use
K. Renal failure
```
F. Diarrhoea
82
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. Drip arm sample
B. Renal tubular acidosis
C. Vomiting
D. Addison's disease
E. Diuretics
F. Diarrhoea
G. Fistula
H. Delayed separation
I. Haemolysis
J. Corticosteroid use
K. Renal failure
```
H. Delayed separation
83
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. Drip arm sample
B. Renal tubular acidosis
C. Vomiting
D. Addison's disease
E. Diuretics
F. Diarrhoea
G. Fistula
H. Delayed separation
I. Haemolysis
J. Corticosteroid use
K. Renal failure
```
D. Addison's disease
84
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. Drip arm sample
B. Renal tubular acidosis
C. Vomiting
D. Addison's disease
E. Diuretics
F. Diarrhoea
G. Fistula
H. Delayed separation
I. Haemolysis
J. Corticosteroid use
K. Renal failure
```
I. Haemolysis
85
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. Normal
B. Nephrogenic diabetes insipidus
C. SIADH
D. Alcohol abuse
E. Cranial Diabetes insipidus
F. Dehydration
G. Iatrogenic
H. Psychogenic polydipsia
I. Illicit drug abuse
J. Diuretic excess
```
C. SIADH
86
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. Normal
B. Nephrogenic diabetes insipidus
C. SIADH
D. Alcohol abuse
E. Cranial Diabetes insipidus
F. Dehydration
G. Iatrogenic
H. Psychogenic polydipsia
I. Illicit drug abuse
J. Diuretic excess
```
G. Iatrogenic
The most common precipitant of hyponatremia in patients after surgery is the iatrogenic infusion of hypotonic fluids. This is exacerbated by pain and nausea, both of which cause nonosmotic release of ADH. The commonest cause of "SIADH" in cancer patients is not brain involvement, it's nausea from chemotherapy - just that with chemo, the ADH is a "physiologically appropriate" response to nausea
87
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. Normal
B. Nephrogenic diabetes insipidus
C. SIADH
D. Alcohol abuse
E. Cranial Diabetes insipidus
F. Dehydration
G. Iatrogenic
H. Psychogenic polydipsia
I. Illicit drug abuse
J. Diuretic excess
```
E. Cranial Diabetes insipidus
History of skull fracture points to cranial DI.
Nephrogenic diabetes insipidus can be seen in chronic renal insufficiency, lithium toxicity, hypercalcemia,
hypokalemia, and tubulointerstitial disease. (None of which this pt seems to have)
88
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. Normal
B. Nephrogenic diabetes insipidus
C. SIADH
D. Alcohol abuse
E. Cranial Diabetes insipidus
F. Dehydration
G. Iatrogenic
H. Psychogenic polydipsia
I. Illicit drug abuse
J. Diuretic excess
```
H. Psychogenic polydipsia
89
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. Normal
B. Nephrogenic diabetes insipidus
C. SIADH
D. Alcohol abuse
E. Cranial Diabetes insipidus
F. Dehydration
G. Iatrogenic
H. Psychogenic polydipsia
I. Illicit drug abuse
J. Diuretic excess
```
F. Dehydration
90
Normovolaemic and hyponatraemic
```
A. Chronic renal failure
B. Pernicious anaemia
C. SIADH
D. COPD
E. Cardiac failure
F. Diuretic excess
G. Achalasia
H. Guillain-Barre syndrome
I. Osteomalacia
J. Acromegaly
K. Vomiting
```
C. SIADH
91
Hypovolaemic with urinary Na+<10 mmol/L
```
A. Chronic renal failure
B. Pernicious anaemia
C. SIADH
D. COPD
E. Cardiac failure
F. Diuretic excess
G. Achalasia
H. Guillain-Barre syndrome
I. Osteomalacia
J. Acromegaly
K. Vomiting
```
K. Vomiting
92
Raised JVP, peripheral oedema and urinary Na+<10 mmol/L
```
A. Chronic renal failure
B. Pernicious anaemia
C. SIADH
D. COPD
E. Cardiac failure
F. Diuretic excess
G. Achalasia
H. Guillain-Barre syndrome
I. Osteomalacia
J. Acromegaly
K. Vomiting
```
E. Cardiac failure
93
Hypotension with urinary Na+>20 mmol/L
```
A. Chronic renal failure
B. Pernicious anaemia
C. SIADH
D. COPD
E. Cardiac failure
F. Diuretic excess
G. Achalasia
H. Guillain-Barre syndrome
I. Osteomalacia
J. Acromegaly
K. Vomiting
```
F. Diuretic excess
94
Hypervolaemic with urinary Na+>20 mmol/L
```
A. Chronic renal failure
B. Pernicious anaemia
C. SIADH
D. COPD
E. Cardiac failure
F. Diuretic excess
G. Achalasia
H. Guillain-Barre syndrome
I. Osteomalacia
J. Acromegaly
K. Vomiting
```
A. Chronic renal failure
95
A 46 year old female presents with confusion and complains of hallucinations. On further questioning she reveals that she has been feeling generally tired and weak for the last 8 weeks. During this period she has lost 8 kg in weight. Her past history revealed an episode of TB 22 years ago. Her electrolyte results revealed Sodium 105 mmol/l; potassium 5.5 mmol/l and osmolality 220 mmol/l.
```
A. Diarrhoea
B. Addisonian crisis
C. Use of diuretics
D. Renal tubular acidosis
E. Renal Failure
F. Vomiting
G. Drip arm sample
H. Use of corticosteroids
I. Fistula
J. Severe tissue damage
K. Haemolysis
```
B. Addisonian crisis
96
A 78 year old male presents with hypokalaemia. He has previously been diagnosed with congestive heart failure, which has been controlled with medication. Serum sodium was 126 mmol/l and bicarbonate was raised.
```
A. Diarrhoea
B. Addisonian crisis
C. Use of diuretics
D. Renal tubular acidosis
E. Renal Failure
F. Vomiting
G. Drip arm sample
H. Use of corticosteroids
I. Fistula
J. Severe tissue damage
K. Haemolysis
```
C. Use of diuretics
97
A 35 year old male body builder presents to his GP surgery with genital atrophy. Routine blood tests reveal that the patient is hypokalamic.
```
A. Diarrhoea
B. Addisonian crisis
C. Use of diuretics
D. Renal tubular acidosis
E. Renal Failure
F. Vomiting
G. Drip arm sample
H. Use of corticosteroids
I. Fistula
J. Severe tissue damage
K. Haemolysis
```
H. Use of corticosteroids
98
A 19 year old female patient presents to A&E with severe dehydration, and is rapidly infused. Blood samples obtained by a trainee nurse reveals gross hyponatraemia. Glucose levels was also raised markedly.
```
A. Diarrhoea
B. Addisonian crisis
C. Use of diuretics
D. Renal tubular acidosis
E. Renal Failure
F. Vomiting
G. Drip arm sample
H. Use of corticosteroids
I. Fistula
J. Severe tissue damage
K. Haemolysis
```
G. Drip arm sample
99
A 23 year old male patient presents to GI outpatients clinic following disturbances since his return from a one month trip to India. Routine bloods reveal that he is mildly hypokalaemic. Results of rigid sigmoidoscopy were normal
```
A. Diarrhoea
B. Addisonian crisis
C. Use of diuretics
D. Renal tubular acidosis
E. Renal Failure
F. Vomiting
G. Drip arm sample
H. Use of corticosteroids
I. Fistula
J. Severe tissue damage
K. Haemolysis
```
A. Diarrhoea
100
A 45 year old female with long-term poorly controlled asthma presents to her GP complaining of weight gain and excessive sweating. A recent routine abdominal CT scan revealed atrophy of the adrenal glands.
```
A. Aldosterone Secreting Adrenal Adenoma
B. Iatrogenic Cushing’s Syndrome
C. Ectopic ACTH Secretion
D. Schmidt’s Syndrome
E. Adrenal Carcinoma
F. Cushing’s Disease
G. Addisonian Crisis
H. Addison’s Disease
I. Cushing’s Syndrome
J. Multiple Endocrine Neoplasia Syndrome
K. Pseudo-Cushing’s Syndrome
L. Congenital Adrenal Hyperplasia
M. Nelson’s Syndrome
N. Phaeochromocytoma
```
B. Iatrogenic Cushing’s Syndrome
101
The next patient on the endocrine ward round has just received the results of a high dose dexamethasone suppression test. The consultant informs you that the cortisol levels have been suppressed and asks you the most likely cause of this patient’s cushingoid symptoms
```
A. Aldosterone Secreting Adrenal Adenoma
B. Iatrogenic Cushing’s Syndrome
C. Ectopic ACTH Secretion
D. Schmidt’s Syndrome
E. Adrenal Carcinoma
F. Cushing’s Disease
G. Addisonian Crisis
H. Addison’s Disease
I. Cushing’s Syndrome
J. Multiple Endocrine Neoplasia Syndrome
K. Pseudo-Cushing’s Syndrome
L. Congenital Adrenal Hyperplasia
M. Nelson’s Syndrome
N. Phaeochromocytoma
```
F. Cushing’s Disease
the fact that there was significant suppression of cortisol by day 2 of the test means that this COULD NOT be caused by
ectopic ACTH.
If there is not a normal response on the low-dose test, abnormal secretion of cortisol is likely (Cushing's Syndrome).
This could be a result of a cortisol-producing adrenal tumour, a pituitary tumour that produces ACTH, or a tumour in the
body that inappropriately produces ACTH. THe high-dose test can help distinguish a pituitary cause (Cushing's Disease)
from the others:
Cushing's Syndrome caused by an adrenal tumour:
- low dose: no change
- high dose: NO CHANGE
Cushing's Syndrome caused related to ectopic ACTH producing tumour:
- low dose: no change
- high dose: NO CHANGE
Cushing's Syndrome caused by pituitary tumour (Cushing's Disease):
- low dose: no change
- high dose: NORMAL SUPPRESSION
102
A 35 year old female arrives in A&E at 16:30 in a very distressed state. Examination reveals tachycardia and postural hypotension. She complains of ongoing weakness and confusion following a recent operation on her knee. Blood tests reveal hyperkalaemia, hyponatraemia. Further tests measure cortisol levels at 50 nmol/L.
```
A. Aldosterone Secreting Adrenal Adenoma
B. Iatrogenic Cushing’s Syndrome
C. Ectopic ACTH Secretion
D. Schmidt’s Syndrome
E. Adrenal Carcinoma
F. Cushing’s Disease
G. Addisonian Crisis
H. Addison’s Disease
I. Cushing’s Syndrome
J. Multiple Endocrine Neoplasia Syndrome
K. Pseudo-Cushing’s Syndrome
L. Congenital Adrenal Hyperplasia
M. Nelson’s Syndrome
N. Phaeochromocytoma
```
G. Addisonian Crisis
103
A 52 year old male complains of muscle cramps and headaches. Examination reveals hypertension. Blood tests are ordered and reveal a marked hypokalaemia. The renin-aldosterone ratio is noted at 0.02 and the House Officer orders an abdominal CT scan.
```
A. Aldosterone Secreting Adrenal Adenoma
B. Iatrogenic Cushing’s Syndrome
C. Ectopic ACTH Secretion
D. Schmidt’s Syndrome
E. Adrenal Carcinoma
F. Cushing’s Disease
G. Addisonian Crisis
H. Addison’s Disease
I. Cushing’s Syndrome
J. Multiple Endocrine Neoplasia Syndrome
K. Pseudo-Cushing’s Syndrome
L. Congenital Adrenal Hyperplasia
M. Nelson’s Syndrome
N. Phaeochromocytoma
```
A. Aldosterone Secreting Adrenal Adenoma
104
A 65 year old female presents to her new GP 5 years after an operation on her abdomen. She cannot remember the details of the operation but does remember that she was suffering from severe Cushing’s Disease at the time. She now notes a progressive “tanning” of the skin
```
A. Aldosterone Secreting Adrenal Adenoma
B. Iatrogenic Cushing’s Syndrome
C. Ectopic ACTH Secretion
D. Schmidt’s Syndrome
E. Adrenal Carcinoma
F. Cushing’s Disease
G. Addisonian Crisis
H. Addison’s Disease
I. Cushing’s Syndrome
J. Multiple Endocrine Neoplasia Syndrome
K. Pseudo-Cushing’s Syndrome
L. Congenital Adrenal Hyperplasia
M. Nelson’s Syndrome
N. Phaeochromocytoma
```
M. Nelson’s Syndrome
105
A 57 year old Type 1 diabetic woman presents with weight loss, weakness and depression. Examination reveals postural hypotension, hyperpigmentation in the palmar creases and widespread patchy vitiligo. Full blood count is unremarkable but U&Es reveal Na+ 130 mmol/l, K+ 6.0 mmol/l, Urea 7.4 mmol/l and Ca 2+ 2.70 mmol/l.
```
A. Adrenal carcinoma
B. Congenital adrenal hyperplasia
C. Adrenal adenoma
D. Conn's syndrome
E. Phaeochromocytoma
F. Iatrogenic Cushing's syndrome
G. Pseudo-Cushing's syndrome
H. Iatrogenic Addison's disease
I. Carney's syndrome
J. Addison's disease
K. Cushing's disease
L. Ectopic ACTH secretion
```
J. Addison's disease
106
A 32 year old woman presents with a one year history of weight loss, fatigue and hirsutism. Examination reveals thin skin, easy bruising, purple abdominal striae and a supraclavicular fat pad. Plasma cortisol and ACTH levels are both raised but suppress after high dose dexamethasone suppression test.
```
A. Adrenal carcinoma
B. Congenital adrenal hyperplasia
C. Adrenal adenoma
D. Conn's syndrome
E. Phaeochromocytoma
F. Iatrogenic Cushing's syndrome
G. Pseudo-Cushing's syndrome
H. Iatrogenic Addison's disease
I. Carney's syndrome
J. Addison's disease
K. Cushing's disease
L. Ectopic ACTH secretion
```
K. Cushing's disease
107
A 64 year old man, who is known to suffer from ulcerative colitis, presents with a long history of weight gain, fatigue and depression. Examination reveals a moon-shaped face, centripetal obesity, thin skin and easy bruising. Serum cortisol levels are elevated and fail to suppress after low dose dexamethasone suppression test.
```
A. Adrenal carcinoma
B. Congenital adrenal hyperplasia
C. Adrenal adenoma
D. Conn's syndrome
E. Phaeochromocytoma
F. Iatrogenic Cushing's syndrome
G. Pseudo-Cushing's syndrome
H. Iatrogenic Addison's disease
I. Carney's syndrome
J. Addison's disease
K. Cushing's disease
L. Ectopic ACTH secretion
```
F. Iatrogenic Cushing's syndrome
108
A 21 year old man presents with rapid palpitations associated with chest tightness, severe headache, tremor and sweating. History reveals that the man had just consumed a large amount of alcohol.
```
A. Adrenal carcinoma
B. Congenital adrenal hyperplasia
C. Adrenal adenoma
D. Conn's syndrome
E. Phaeochromocytoma
F. Iatrogenic Cushing's syndrome
G. Pseudo-Cushing's syndrome
H. Iatrogenic Addison's disease
I. Carney's syndrome
J. Addison's disease
K. Cushing's disease
L. Ectopic ACTH secretion
```
E. Phaeochromocytoma
109
A 27 year old woman presents with a three month history of weight gain, deepening voice and secondary amenorrhoea. Examination reveals clitoromegaly, acne, greasy skin and hirsutism. Serum cortisol is grossly elevated and ACTH levels are undetectable.
```
A. Adrenal carcinoma
B. Congenital adrenal hyperplasia
C. Adrenal adenoma
D. Conn's syndrome
E. Phaeochromocytoma
F. Iatrogenic Cushing's syndrome
G. Pseudo-Cushing's syndrome
H. Iatrogenic Addison's disease
I. Carney's syndrome
J. Addison's disease
K. Cushing's disease
L. Ectopic ACTH secretion
```
A. Adrenal carcinoma
110
The commonest enzyme deficiency seen in CAH
```
A. 17-Hydroxyprogesterone
B. Deoxycortisol
C. Hyponatreamia with Hyperkalaemia
D. Hypernatreamia with Hyperkalaemia
E. Raised ACTH
F. Hypernatreamia with Hypokalaemia
G. 17α-Hydroxylase deficiency
H. Reduced Cortisol
I. Aldosterone
J. 21-Hydroxylase Deficiency
K. 11β-Hydroxylase deficiency
L. Hyponatreamia with Hypokalaemia
M. Pregnanetriol
N. Chromosome 6
O. Normal ACTH levels
```
J. 21-Hydroxylase Deficiency
111
Levels of this steroid are raised in the serum of CAH patients
```
A. 17-Hydroxyprogesterone
B. Deoxycortisol
C. Hyponatreamia with Hyperkalaemia
D. Hypernatreamia with Hyperkalaemia
E. Raised ACTH
F. Hypernatreamia with Hypokalaemia
G. 17α-Hydroxylase deficiency
H. Reduced Cortisol
I. Aldosterone
J. 21-Hydroxylase Deficiency
K. 11β-Hydroxylase deficiency
L. Hyponatreamia with Hypokalaemia
M. Pregnanetriol
N. Chromosome 6
O. Normal ACTH levels
```
A. 17-Hydroxyprogesterone
112
Increased levels are seen in the urine of CAH patients
```
A. 17-Hydroxyprogesterone
B. Deoxycortisol
C. Hyponatreamia with Hyperkalaemia
D. Hypernatreamia with Hyperkalaemia
E. Raised ACTH
F. Hypernatreamia with Hypokalaemia
G. 17α-Hydroxylase deficiency
H. Reduced Cortisol
I. Aldosterone
J. 21-Hydroxylase Deficiency
K. 11β-Hydroxylase deficiency
L. Hyponatreamia with Hypokalaemia
M. Pregnanetriol
N. Chromosome 6
O. Normal ACTH levels
```
M. Pregnanetriol
113
The sodium and potassium pattern seen in CYP21 deficiency.
```
A. 17-Hydroxyprogesterone
B. Deoxycortisol
C. Hyponatreamia with Hyperkalaemia
D. Hypernatreamia with Hyperkalaemia
E. Raised ACTH
F. Hypernatreamia with Hypokalaemia
G. 17α-Hydroxylase deficiency
H. Reduced Cortisol
I. Aldosterone
J. 21-Hydroxylase Deficiency
K. 11β-Hydroxylase deficiency
L. Hyponatreamia with Hypokalaemia
M. Pregnanetriol
N. Chromosome 6
O. Normal ACTH levels
```
C. Hyponatreamia with Hyperkalaemia
114
A doctor suspecting his patient is suffering from CAH has just received some results that proves otherwise
```
A. 17-Hydroxyprogesterone
B. Deoxycortisol
C. Hyponatreamia with Hyperkalaemia
D. Hypernatreamia with Hyperkalaemia
E. Raised ACTH
F. Hypernatreamia with Hypokalaemia
G. 17α-Hydroxylase deficiency
H. Reduced Cortisol
I. Aldosterone
J. 21-Hydroxylase Deficiency
K. 11β-Hydroxylase deficiency
L. Hyponatreamia with Hypokalaemia
M. Pregnanetriol
N. Chromosome 6
O. Normal ACTH levels
```
O. Normal ACTH levels
115
An overweight 35-year old shop-assistant visits her GP complaining of debilitating tiredness. Her periods have also become infrequent in this time. Despite it being a warm day, she wears a coat and jumper inside. On examination, she has a symmetrical painless lump on her neck. The patient has a history of well-controlled SLE.
```
A. Cushing’s disease
B. Prader-Willi Syndrome
C. Alcohol excess
D. PCOS
E. De Quervain’s thyroiditis
F. Hashimoto’s thyroiditis
G. Steroid abuse
H. Type I diabetes
I. Cushing’s syndrome
J. Pregnancy
K. Long-term insulin use
L. Simple Obesity
M. Menopause
N. Type II diabetes
```
F. Hashimoto’s thyroiditis
116
A 14-year old boy visits his GP with his mother, having been recommended to by the school nurse, following an inability to attend PE lessons, due to his weight. Both seem generally unconcerned, with his mother stating that she never makes him do exercise at home anyway. The boy describes McDonalds and Playstation as his favourite hobbies. As a precaution, the GP performs a blood sample, which showed no endocrine abnormalities, but a raised cholesterol.
```
A. Cushing’s disease
B. Prader-Willi Syndrome
C. Alcohol excess
D. PCOS
E. De Quervain’s thyroiditis
F. Hashimoto’s thyroiditis
G. Steroid abuse
H. Type I diabetes
I. Cushing’s syndrome
J. Pregnancy
K. Long-term insulin use
L. Simple Obesity
M. Menopause
N. Type II diabetes
```
L. Simple Obesity
117
A 29-year old, clinically obese accountant presents with a relapsing of her acne, which had disappeared in her teens. On further questioning, she admits to infrequent periods over the last year, and a greater than normal growth of hair on her face. Blood tests show an elevated serum testosterone.
```
A. Cushing’s disease
B. Prader-Willi Syndrome
C. Alcohol excess
D. PCOS
E. De Quervain’s thyroiditis
F. Hashimoto’s thyroiditis
G. Steroid abuse
H. Type I diabetes
I. Cushing’s syndrome
J. Pregnancy
K. Long-term insulin use
L. Simple Obesity
M. Menopause
N. Type II diabetes
```
D. PCOS
male pattern hair loss that patients get in PCOS. The patient will also have Hirsutism/excess body hair. This is due to excess testosterone.
118
A 33-year old overweight man complains of headaches and visual disturbances which he blames for two car accidents he has been involved in the last month. He has a ruddy appearance, and the GP notes that his weight is mainly concentrated in a ‘pot belly’. The man’s blood pressure is 150/100, and following a 48hr low –dose dexamethasone test, the patient has a cortisol of 500nm/L, and after a 48hr high-dose dexamethasone test, the cortisol was 250nmol/L
```
A. Cushing’s disease
B. Prader-Willi Syndrome
C. Alcohol excess
D. PCOS
E. De Quervain’s thyroiditis
F. Hashimoto’s thyroiditis
G. Steroid abuse
H. Type I diabetes
I. Cushing’s syndrome
J. Pregnancy
K. Long-term insulin use
L. Simple Obesity
M. Menopause
N. Type II diabetes
```
A. Cushing’s disease
119
A 65-year old overweight Indian gentleman presents to his GP, complaining of problems with his eyesight, which has become blurred recently, despite 20/20 vision for the rest of his life. On further questioning, he admits to increased urinary frequency, which he put down to his age, though recalls that he has been drinking more recently. On dip-sticking the urine, glucose was +++, and following a blood test, the blood sugar was 18mmol/L
```
A. Cushing’s disease
B. Prader-Willi Syndrome
C. Alcohol excess
D. PCOS
E. De Quervain’s thyroiditis
F. Hashimoto’s thyroiditis
G. Steroid abuse
H. Type I diabetes
I. Cushing’s syndrome
J. Pregnancy
K. Long-term insulin use
L. Simple Obesity
M. Menopause
N. Type II diabetes
```
N. Type II diabetes
120
An 11 year old boy is taken to the GP by his parents after complaining that “his wee-wee is a funny colour”. The parents reveal that their son hasn’t been too well lately, “He’s been very tired, feeling sick and has had temperature the last few days. We thought he’s just picked up a virus because he had a sore throat about 10days ago, but now that his urine has gone this smoky colour and his eyes are puffy, we thought we’d bring him in…”
```
A. Acute diffuse proliferative glomerulonephritis
B. Goodpasture's
C. Polycystic kidney disease
D. Hypertensive renal damage
E. Alport's disease
F. Henoch-Schonlein purpura
G. Wegener's granulomatosis
H. Cannonball metastases
I. Diabetic nephropathy
J. SLE
K. Clear cell renal carcinoma
L. Bacterial endocarditis
M. Wilms tumour
```
A. Acute diffuse proliferative glomerulonephritis
121
A gentleman who presented with haemoptysis and haematuria. Histology shows the accumulation of macrophages in Bowmans capsule. Immunology reveals the patient is HLA-DR2, and possesses Anti-glomerualr basement membrane antibody.
```
A. Acute diffuse proliferative glomerulonephritis
B. Goodpasture's
C. Polycystic kidney disease
D. Hypertensive renal damage
E. Alport's disease
F. Henoch-Schonlein purpura
G. Wegener's granulomatosis
H. Cannonball metastases
I. Diabetic nephropathy
J. SLE
K. Clear cell renal carcinoma
L. Bacterial endocarditis
M. Wilms tumour
```
B. Goodpasture's
122
A 50 year old male with a persistant runny nose and sinusitis that is worsening. Immunology reveals circulating auto-antibodies against neutrophil cytoplasmic antigents (C-ANCA). Histology also shows the accumulation of macrophages in Bowmans capsule.
```
A. Acute diffuse proliferative glomerulonephritis
B. Goodpasture's
C. Polycystic kidney disease
D. Hypertensive renal damage
E. Alport's disease
F. Henoch-Schonlein purpura
G. Wegener's granulomatosis
H. Cannonball metastases
I. Diabetic nephropathy
J. SLE
K. Clear cell renal carcinoma
L. Bacterial endocarditis
M. Wilms tumour
```
G. Wegener's granulomatosis
123
A 63 year old Scandanavian male presents with painless haematuria, fatigue, weight loss and fever. On examination a mass is found unilaterally in the loin. Family History reveals his father had Von Hippel-Lindau disease.
```
A. Acute diffuse proliferative glomerulonephritis
B. Goodpasture's
C. Polycystic kidney disease
D. Hypertensive renal damage
E. Alport's disease
F. Henoch-Schonlein purpura
G. Wegener's granulomatosis
H. Cannonball metastases
I. Diabetic nephropathy
J. SLE
K. Clear cell renal carcinoma
L. Bacterial endocarditis
M. Wilms tumour
```
K. Clear cell renal carcinoma
124
A 70year old man being investigated for haematuria and loin discomfort develops dyspnoea.
```
A. Acute diffuse proliferative glomerulonephritis
B. Goodpasture's
C. Polycystic kidney disease
D. Hypertensive renal damage
E. Alport's disease
F. Henoch-Schonlein purpura
G. Wegener's granulomatosis
H. Cannonball metastases
I. Diabetic nephropathy
J. SLE
K. Clear cell renal carcinoma
L. Bacterial endocarditis
M. Wilms tumour
```
H. Cannonball metastases
125
A 35-year-old alcoholic presents to A&E with confusion and maleana. On examination, he has signs of chronic liver disease and is pale and clammy. BP is 90/50mmHg and he has a weak thready pulse of 130bpm. Investigations reveal FBC: Hb 6.3g/dl, MCV 108fl, WCC 3.8 x 109/l, Plt 23 x 109/l; U&Es: Na+ 123mmol/l, K+ 4.4mmol/l, urea 27mmol/l, Cr 123umol/l.
```
A. Carcinoma of the prostate
B. Diclofenac
C. Benign prostatic hypertrophy
D. Henoch-Schonlein purpura
E. Rhabdomyolysis
F. Diabetes mellitus
G. Renal artery stenosis
H. Multiple myeloma
I. Haemorrhage
J. IgA nephropathy
```
I. Haemorrhage
126
A 74-year-old man presents to his GP with increasing malaise and back pain associated with hesitancy and poor urinary stream. Subsequent investigations reveal U&Es: Na+ 134mmol/l, K+ 6.4mmol/l, urea 31.2mmol/l, Cr 1023umol/l; PSA 123nmol/l; bilateral hydronephrotic kidneys on USS.
```
A. Carcinoma of the prostate
B. Diclofenac
C. Benign prostatic hypertrophy
D. Henoch-Schonlein purpura
E. Rhabdomyolysis
F. Diabetes mellitus
G. Renal artery stenosis
H. Multiple myeloma
I. Haemorrhage
J. IgA nephropathy
```
A. Carcinoma of the prostate
127
A 61-year-old woman with kown peripheral vascular and ischaemic heart disease is started on an ACEi by her GP. 3 weeks later she is admitted to hospital with increasing confusion and pruritis. Investigations reveal FBC: Hb 12.3g/dl, MCV 85.2fl, WCC 6.8 x 109/l, Plt 403 x 109/l; U&Es: Na+ 130mmol/l, K+ 7.4 mmol/l, urea 37mmol/l, Cr 841umol/l; urinalysis – protein ++, ketones +, blood nil.
```
A. Carcinoma of the prostate
B. Diclofenac
C. Benign prostatic hypertrophy
D. Henoch-Schonlein purpura
E. Rhabdomyolysis
F. Diabetes mellitus
G. Renal artery stenosis
H. Multiple myeloma
I. Haemorrhage
J. IgA nephropathy
```
G. Renal artery stenosis
128
An 84-year-old woman is found collapsed in her flat by a neighbour. She had a fall 3 days prior to her rescue and had been unable to get up or raise the alarm. On admission to hospital investigations reveal FBC: Hb 15.3g/dl, MCV 91.2fl, WCC 23.1 x 09/l, Plt 403 x 109/l; U&Es: Na+ 145mmol/l, K+ 7.1mmol/l, urea 32.9mmol/l, Cr 649umol/l; CK 23,089iu/l.
```
A. Carcinoma of the prostate
B. Diclofenac
C. Benign prostatic hypertrophy
D. Henoch-Schonlein purpura
E. Rhabdomyolysis
F. Diabetes mellitus
G. Renal artery stenosis
H. Multiple myeloma
I. Haemorrhage
J. IgA nephropathy
```
E. Rhabdomyolysis
| [None
129
24-year-old man presents to his GP with an increasing rash over his lower limbs and buttocks associated with arthralgia and haematuria. He is admitted to the local hospital where investigations reveal deranged renal function and a raised serum IgA.
```
A. Carcinoma of the prostate
B. Diclofenac
C. Benign prostatic hypertrophy
D. Henoch-Schonlein purpura
E. Rhabdomyolysis
F. Diabetes mellitus
G. Renal artery stenosis
H. Multiple myeloma
I. Haemorrhage
J. IgA nephropathy
```
D. Henoch-Schonlein purpura
130
A 65 yr old lady with ischaemic heart disease and peripheral vascular disease presents at a&e with increasing confusion, hiccups and pruritus. She was started on ACE inhibitors a week ago.
```
A. Acute tubular necrosis
B. Acute glomerulonephritis
C. Renal artery stenosis
D. Acute interstitial nephritis
E. Myeloma associated ARF
F. Wegner’s granulomatous
G. Renal obstruction
```
C. Renal artery stenosis
131
A 21 yr old man is admitted to hospital with multiple fractures after his motorcycle collided into a lorry on the motorway. There is myoglobin in his urine
```
A. Acute tubular necrosis
B. Acute glomerulonephritis
C. Renal artery stenosis
D. Acute interstitial nephritis
E. Myeloma associated ARF
F. Wegner’s granulomatous
G. Renal obstruction
```
A. Acute tubular necrosis
132
A 50 yr old lady with A BMI of 24 who had intermittent pain in the loin, with nausea and vomiting now has a low urine output and urinalysis shows microscopic haematuria.
```
A. Acute tubular necrosis
B. Acute glomerulonephritis
C. Renal artery stenosis
D. Acute interstitial nephritis
E. Myeloma associated ARF
F. Wegner’s granulomatous
G. Renal obstruction
```
G. Renal obstruction
133
A 45 yr old man with known renal problems has bilateral leg oedema. There is blood in his urine, and urine stix testing also confirms the presence of protein. Microscopy also reveals red cell casts.
```
A. Acute tubular necrosis
B. Acute glomerulonephritis
C. Renal artery stenosis
D. Acute interstitial nephritis
E. Myeloma associated ARF
F. Wegner’s granulomatous
G. Renal obstruction
```
B. Acute glomerulonephritis
134
A 25 yr old man presents to his GP with a cough, nasal discharge and swollen legs. He is extremely dehydrated and is taken to hospital.He has a high cANCA titre
```
A. Acute tubular necrosis
B. Acute glomerulonephritis
C. Renal artery stenosis
D. Acute interstitial nephritis
E. Myeloma associated ARF
F. Wegner’s granulomatous
G. Renal obstruction
```
F. Wegner’s granulomatous
135
A 62-year old man presents with lethargy and tiredness. He tells you that he is ‘on painkillers for back pain after a fall at work 6 weeks ago’. On examination he is pale. Blood tests reveal urea 39.2 mmol/L (normal 1.7-8.3) and creatinine 1158 μmol/L (normal 62-106). His records show that he had a creatinine of 90 μmol/L 3 months ago.
```
A. Hypokalemia
B. Urethral stones
C. Ureteric stones
D. IgA nephropathy
E. Nephrotic syndrome
F. Thin membrane nephropathy
G. Acute interstitial nephritis
H. Hyperkalemia
I. Renal acidosis
J. Chronic kidney disease
```
G. Acute interstitial nephritis
136
A 40-year old man presents acutely unwell with back pain that radiates to his groin, and nausea and vomiting. He tells you he has seen blood in his urine. On examination he is febrile.
```
A. Hypokalemia
B. Urethral stones
C. Ureteric stones
D. IgA nephropathy
E. Nephrotic syndrome
F. Thin membrane nephropathy
G. Acute interstitial nephritis
H. Hyperkalemia
I. Renal acidosis
J. Chronic kidney disease
```
C. Ureteric stones
137
A poorly controlled 48-year old diabetic lady presents with a swollen face and ankles. Blood tests show albumin <30g/L (normal 40g/L), ↑ cholesterol and normal creatinine. 24 hour urine collection reveals protein >3g.
```
A. Hypokalemia
B. Urethral stones
C. Ureteric stones
D. IgA nephropathy
E. Nephrotic syndrome
F. Thin membrane nephropathy
G. Acute interstitial nephritis
H. Hyperkalemia
I. Renal acidosis
J. Chronic kidney disease
```
E. Nephrotic syndrome
138
A 25 year old man tells you he had dark brown urine after a sore throat and has since had microscopic haematuria. Renal biopsy reveals proliferation of the mesangium.
```
A. Hypokalemia
B. Urethral stones
C. Ureteric stones
D. IgA nephropathy
E. Nephrotic syndrome
F. Thin membrane nephropathy
G. Acute interstitial nephritis
H. Hyperkalemia
I. Renal acidosis
J. Chronic kidney disease
```
D. IgA nephropathy
139
One of the complications of chronic kidney disease which has ECG features of peaked T waves, loss of the P wave and broad QRS complex
```
A. Hypokalemia
B. Urethral stones
C. Ureteric stones
D. IgA nephropathy
E. Nephrotic syndrome
F. Thin membrane nephropathy
G. Acute interstitial nephritis
H. Hyperkalemia
I. Renal acidosis
J. Chronic kidney disease
```
H. Hyperkalemia
140
The gold standard for measuring glomerular filtration rate (GFR)
```
A. 20 mls/min
B. Bowman's capsule
C. Phosphate excretion
D. 35 mls/min
E. Glucose
F. Iohexol
G. Cystatin C
H. Potassium exccretion
I. 40 mls/min
J. 30 mls/min
K. Serum creatinine
L. 20 mls/24 hrs
M. Serum urea
N. Inulin
O. Serial creatinine readings
P. Injected radio-isotopes
```
N. Inulin
141
Calculate the creatinine clearance for the following renal patient, following a 24 hour urine collection: urine volume 2litres; urine creatinine concentration 3mmol/l and plasma creatinine concentration 208 micro mol/l.
```
A. 20 mls/min
B. Bowman's capsule
C. Phosphate excretion
D. 35 mls/min
E. Glucose
F. Iohexol
G. Cystatin C
H. Potassium exccretion
I. 40 mls/min
J. 30 mls/min
K. Serum creatinine
L. 20 mls/24 hrs
M. Serum urea
N. Inulin
O. Serial creatinine readings
P. Injected radio-isotopes
```
A. 20 mls/min
142
Calculate the GFR for the following renal patient, following a 24 hour urine collection: urine volume 2.7litres; urine creatinine concentration 2mmol/l and plasma creatinine concentration 107 micro mol/l.
```
A. 20 mls/min
B. Bowman's capsule
C. Phosphate excretion
D. 35 mls/min
E. Glucose
F. Iohexol
G. Cystatin C
H. Potassium exccretion
I. 40 mls/min
J. 30 mls/min
K. Serum creatinine
L. 20 mls/24 hrs
M. Serum urea
N. Inulin
O. Serial creatinine readings
P. Injected radio-isotopes
```
D. 35 mls/min
143
A good indicator of renal function
```
A. 20 mls/min
B. Bowman's capsule
C. Phosphate excretion
D. 35 mls/min
E. Glucose
F. Iohexol
G. Cystatin C
H. Potassium exccretion
I. 40 mls/min
J. 30 mls/min
K. Serum creatinine
L. 20 mls/24 hrs
M. Serum urea
N. Inulin
O. Serial creatinine readings
P. Injected radio-isotopes
```
O. Serial creatinine readings
144
Reflects the muscle mass of a person
```
A. 20 mls/min
B. Bowman's capsule
C. Phosphate excretion
D. 35 mls/min
E. Glucose
F. Iohexol
G. Cystatin C
H. Potassium exccretion
I. 40 mls/min
J. 30 mls/min
K. Serum creatinine
L. 20 mls/24 hrs
M. Serum urea
N. Inulin
O. Serial creatinine readings
P. Injected radio-isotopes
```
K. Serum creatinine
