Chempath Flashcards
Man with cough, SoB and weight loss. Hyponatraemia, low serum osmolality, urine Na and osmolality were inappropriately normal
SIADH secondary to small cell lung cancer
Low plasma sodium, low urine sodium
Primary/psychogenic polydipsia
Man who has been in a car accident, raised sodium and plasma osmolality, low urine
osmolality
cranial DI
What is a (liver enzyme) sign that your patient has been taking cocaine?
AST
Temporal arteritis test which will help with diagnosis? (blood result)
ESR
- Woman comes in with bitemporal hemianopia, 2cm mass, and a raised prolactin 1400
- Woman comes in with no visual change, 4mm mass, and raised prolactin 1400
- Nonfunctional macroadenoma
- Prolactinoma
Raised prolactin, raised TSH, raised T4
TSHoma
Patient can’t fit in her shoes or put on her wedding ring and has prognathism, what test do you need to do to confirm?
Serum IGF then OGTT
BP 190/100, thin skin, overweight, high-normal sodium, low normal potassium, OGTT done (glucose high normal), what other test do you need to do?
Cushings - low dose dexamethasone suppression test then inferior petrosal sinus sampling
Pt with low Na, High K + postural hypotension (disease and test)
addison’s, Synacthen test
An elderly gentleman has massively elevated ALP on its own, and the other results are
normal. He also reports a history of headaches.
Paget’s
A 57 year old man presents following hematemesis and is found to have high ALT + GGT, slightly raised ALP, and low Albumin
Cirrhosis
Woman with colicky abdominal pain, markedly raised ALP, other LFTs also deranged
Acute cholestasis
Deficiency of which enzyme leads to hyperuricemia
HGPRT
Which enzyme regulates the rate limiting step in the haem biosynthesis pathway?
ALA synthase
Which enzyme is raised in osteomalacia?
ALP
What enzyme is raised in mumps?
Amylase-S (saliva)
High calcium, normal phosphate, low PTH, high ALP, patient feels tired
Hypercalcaemia of malignancy
72 year old with headache: high CA, normal phosphate, normal PTH, high ALP
Paget’s
Baby with seizures: low Ca, low PTH
Hypopth - digeorge
Vegan with megaloblastic anaemia - Vitamin deficiency?
B12
Person with Crohn’s with megaloblastic anaemia - vit deficiency?
B12/ B9 (folate)
Patient with Pellagra - Vit deficiency?
B3 (niacin)
Young patient with bowed legs - Vit defiency?
Vit D
What is the most common cause of acute pancreatitis?
Gallstones
Which cancer typically causes an increase in calcitonin?
Medullary carcinoma of the thyroid
Low TSH and high T4 following viral infection, what is the diagnosis?
Viral/ De Quervian’s thyroiditis
Which thyroid cancer most commonly metastasises to the lymph nodes?
Papillary
T1DM with hypoglycaemia, what is the management option if no IV access?
IM Glucagon
Swollen joint, needle-shaped aspirate with negative birefringence, which enzyme manufactures the material that makes up the crystals?
Xanthine oxidase
Acute gout
colchicine or nsaid
Publican with diabetes, fatty stools, weight loss, ‘slate grey skin’ and joint pains. What is the underlying diagnosis causing this?
Haemochromatosis
5yr old, tetany, bone pain. Widened epiphyses + ‘Cupping’ of metaphysis shown on x-ray. What is the cause?
Rickets
What enzyme to confirm cardiac failure?
BNP
What liver enzyme is raised in MI
AST
What does Denosumab target?
RANK Ligand
PCSK9 inhibitor - evolucumab, what does it halve?
LDL
Which disease do you see in both MEN1 and MEN2a? Acromegaly, primary hyperparathyroidism, medullary thyroid cancer, phaeochromocytoma
Primary HyperPTH
High PTH and low Ca, what can this be – osteomalacia, osteoporosis, primary
hyperparathyroidism
osteomalacia
What would be high in the most common cause of CAH?
Sex steroid hormones and ACTH
Which hormone leads to release of prolactin?
TRH
Woman presents worried because she has low glucose when she tests using daughter’s meter (her daughter has T1DM) but denies taking any drugs. Low glucose, high insulin, low C peptide, she has a high BMI?
a. Factitious/ surreptitious insulin (i.e. taking too much external insulin)
b. Surreptitious gliclazide
c. Type 1 diabetes mellitus
d. Anorexia nervosa
e. Insulinoma
Factitious/ surreptitious insulin
Person is discharged after surgery, who had a bilateral hemianopia, with removal of pituitary adenoma. Consultant says it is alright to discharge them. What do you prescribe the patient on discharge?
DDAVP (desmopressin)
Which of these is a common finding in someone who has portal hypertension?
a. Splenomegaly
b. Hepatomegaly
c. Spider Naevi in distribution of Superior vena cava (SVC)
d. Hand flapping
e. Jaundice
Splenomegaly
A man has gout and is kept up at night by it. His symptoms are relieved by ibuprofen, but when he stops taking it, the symptoms come back. His neighbour is on allopurinol, and he would like to be on it too. What medication would need to be altered for them to be able to be prescribed allopurinol?
Azathioprine
Cushing disease person – Which is the best investigation to confirm the suspected diagnosis?
High dose dex
What does the number of True positives divided by the total number who have the disease describe?
Sensitivity (poSITtive, senSITive)
Commonest cause of hypocalcaemia in community
vit d deficiency
which adrenal zone produces cortisol and which produces aldosterone?
Cortisol - Zona Fasciculata
Aldosterone - Zona Glomerulosa
Which enzyme does allopurinol inhibit
Xanthine oxidase
Alcoholic has severe abdominal pain, rigid abdomen - he has acute pancreatitis. What blood test will confirm the diagnosis?
lipase
What active enzyme in sarcoidosis patients causes hypercalcaemia
1 alpha hydroxylase
What is the commonest cause of hypercalcaemia in the community?
Primary hyperparathyroidism
What hormone is produced by fat cells, and has receptors in the hypothalamus?
Leptin
Deficiency of which plasma protein occurs in patients with liver disease and a movement disorder?
Ceruloplasmin
Increased insulin sensitivity results in low plasma glucose and occurs in
a) PCOS
b) Phaeochromocytoma
c) Cushing’s disease
d) ACTH deficiency
e) Acromegaly
ACTH deficiency (cortisol makes you less sensitive to insulin)
Clinical features of hypercalcaemia include which one of the following?
a) Polyuria and polydipsia
b) Tetany
c) Hypotension
d) Diarrhoea
e) Easy bruising
Polyuria and polydipsia
Which one of the following is correct in a patient with moderate alcohol intake?
a) Elevated HDL
b) AST is nearly normal
c) NormalGGT
d) Normal triglycerides
e) Reduced albumin
Elevated HDL
An 82 year old nursing home resident is brought in by ambulance to A&E with a 5-day history of reduced oral intake and increased confusion. On examination, her AMTS is 2/10. She has a heart rate of 99bpm, lying BP of 108/52 mmHg and sitting BP of 82/48. Her mucous membranes are very dry.
Blood test results: Na 154
K 3.6
Bicarbonate 19 Urea 52 Creatinine 223 Plasma glucose 48
What does she have and what to give?
Hyperosmolar Hyperglycaemic state - 0.9% sodium chloride
A 39-year-old woman presents to the outpatient clinic with an incidental
finding of a 5cm mass on liver ultrasound. What is the most likely cause?
1) liver cyst 2) hemangioma
note - hydatid cyst is rare, it is cystic echinoccocosis (tapeworm)
A 50 year old man has tetany. Investigations: Calcium 1.95 mmol/L (2.2-2.6) Phosphate 0.7 mmol/L (0.8-1.5) PTH 27.2 pmol/L (1.6-8.5) Creatinine 90 mol/L (60-120) What is the likely diagnosis?
Osteomalacia
A neonate presents with a salt losing crisis, and is thought to have congenital adrenal hyperplasia. What is the commonest enzyme deficiency that causes this? Name the enzyme
21-hydroxylase deficiency
Patient with ?CML treated with cytotoxic chemotherapy. Table comparing bloods U&Es before and after the chemo.
Pre-chemo: normal urea, normal creatinine, high leukocytes, …?
Post-chemo: high urea, high creatinine, normal leukocytes, low Ca?, high phos
What is the new diagnosis?
tumour lysis syndrome
Carbimazole use and side effects
For hyperthyroidism, s/e include rashes (common) and agranulocytosis (rare but it came up in 2022 so remember this)
Which of the following drugs causes hypoglycaemia
Quinine, Thiazide, Statin, Glucagon, prednisone
Quinine
21-hydroxylase deficiency -sodium and potassium?
Low sodium, high potassium
21-hydroxylase deficiency is the most common cause of congenital adrenal hyperplasia. reduced cortisol/aldosterone -> salt loss
Diabetes insipidus - side effect of what drug?
Lithium
A 58 year old man presents with weight loss and palpitations. Laboratory results are presented below. To relieve his palpitations, which treatment would you start him on urgently?
IX
T4 – high
TSH – low
Amiodarone
Digoxin
Doxasosin
Lithium carbonate
Propanolol
Propranolol
