Chempath Flashcards
1
Q
Distinguish between HONK and DKA
A
Anion gap (ketones in DKA increase anion gap)
2
Q
Thyroid cancers
- Medullary
- Papillary
- Follicular
- Anaplasitc
A
Features
- MEN2, Calcitonin, Parafrollicular “C” cells
- Psammoma bodies
- Nodules and mets
- Elderly
3
Q
Rate limiting haem synthesis
A
AminoLenvulinic Acid synthase
4
Q
Deficiency of this –> high urea
A
Hypoxanthine-guanine phosphoribosyltransferase (HGPRT)
in e.g. Lesch Nyhan Syndrome
Hyperuricaemia, Gout, PRT (Prutt)
5
Q
Gynaecomastia + wants viagra
A
Prolactinoma (prolactin will be >6000)
6
Q
Rounded mass with glands and mucin in Liver
A
Met from pancreatic adenocarcinoma
7
Q
Histology of acute fatty liver hep
A
Ballooned cells, mallory denk bodies, neutrophils
8
Q
Alcoholic hepatitis with fibrosis histology
A
Ballooned cells, mallory denk bodies, MEGAMITOCHONDRIA, pericentricular fibrosis
9
Q
Alpha Fetoprotein raised in?
A
Hepatocellular Carcinoma, pregnancy, testicular Ca
10
Q
What type of Br can be seen in urine?
A
Unconjugated only (e.g. haemolysis)
11
Q
High Br, high ALP, high GGT
A
Could be drug induced cholestasis
12
Q
Corrected calcium
A
measured + 0.02(40-albumin)
13
Q
Baby with seizures, low Ca, low PTH
A
Primary hypoparathyroidism in e.g. Di George
14
Q
Low mood after renal transplant for longstnading renal disease (high Ca, high PTH)
A
Tertiary hyperparathyroidism
15
Q
B12 vs folate deficiency
A
B12: glossitis, jaundice, dementia, other AI conditions, vegans
Folate: diarrhoea, methotrexate
IBD can cause either (methotrexate->folate, loss of terminal ileum absorption->B12)
16
Q
Vitamins B1 B2 B3 (Niacin) B6
A
B1 - Wernicke’s encephalopathy/Korsakov Syndrome/beri beri –> cardio/neuro (RBC transketeolase)
B2 - Riboflavin (glossitis, RBC glutanthione reductase)
B3 Niacin - Pellagra - dementia, diarrhoea, dermatitis
B6 - Pyridoxine (dermatitis, anaemia, neuropathy)
17
Q
What does Denosumab target?
A
RANK-L on Osteoclasts (inhibit) for osteoporosis or bony mets
18
Q
Allopurinol interacts with
A
Azathioprine
19
Q
Acute intermittent porphyria Ix
A
Urine porphobilinogen (and Urine Aminolevulinic Acid)
20
Q
In guthrie how do you measure
Hypothyroid
CF
MCADD
A
TSH
Immunoreactive trypsinogen
Acylcarnitine
21
Q
Normal anion gap
A
18mM
22
Q
Primary hyperparathyroidism Vit D levels
A
Vit D is low as it is consumed
23
Q
High Ca + haematuria
A
Renal stone
24
Q
Band keropathy
A
Long term hyperCa
25
Addisons + primary hypothyroidism + diabetes
Schmidt syndrome (AIPS2)
26
HTN + Adrenal mass (3 causes)
Phaeo, Conns, Cushings
27
High functioning adrenal (3 causes)
Cushings, Conns, CAH
28
Low functioning adrenal
Sepsis, haemorrhage, discontinuation of steroids, Addisons
29
MI Markers
Troponin - rises within 4-6 hours, peaks 12-24 hours, remains high for 3-10 days
CK - rises withing 24 hours (check if double MI)
Myoglobin rises quickly
30
MEN 1
Pituitary, Pancreas, Parathyroid
31
MEN 2a
Parathyroid, Phaeo, Thyroid (med)
32
Men 2b
Phaeo, Thygoid, Ganglioneuroma
33
Tertiary hyperparathyroidism
Often in people with CKD
Longstanding 2° hyperparathyroidism --> gland hyperplasia --> permanent dysregulated high secretions of TSH --> 1° hyperparathyroidism picture
End result: High PTH, high Calcium, variable PO4 levels
34
T1DM has low Na, everything else is normal. Diagnosis?
hyperlipidaemia
35
High K, low Na, urine osmolality >20
CKD/Renin (RAS) cause not aldosterone
36
Urine osmolality > plasma osmolality
SIADH
37
Low K, alkalosis, hypotension, hypercalciuria
Bartter Syndrome
| DELETE
38
Low K and acidosis
Renal tubular acidosis
39
Non-alcoholic fatty liver disease LFTs
High ALT and AST ratio 1:1
High GGT
Normal Br and Alb
40
Low caeruloplasmin
Wilsons
41
Vitamin C deficiency affects what thing to cause bleeding gums and poor dentition?
Collagen
42
Vit E deficiency
Haemolytic anaemia, areflexia, ataxia
43
Vit B6 deficiency
AKA Pyroxidine
Dermatitis, peripheral neuropathy, sideroblastic anaemia
Can be caused by isoniazid
44
Fair skin, brittle hair, developmental delay, intellectual disability
Homocystinuria
45
Glucose-6-phosphate dehydrogenase, hypoglycaemia, big kidneys and liver
von Gierke's syndrome
46
Toxic encephalopathy causing poor feeding, hypotonia and seizures
Sweet odour and sweaty feet
Maple Syrup Urine disease
47
Cherry-red spot and dymorphia
LYsosomal storage disorder (e.g. Fabry's)
48
Phenytoin toxicity
ataxia and low BP
49
Lithium SEs
tremor and thirst
50
Gentamicin toxicity
Ears and kidneys
Tinnitus - ringing in ear
Gentleman caller ringing
51
Low vit D, low Ca, high PTH
Osteomalacia (not 2° hyperparathyroidism as vit D is the causative problem)
52
Chronic renal failute, high Ca, high PTH
3° hyperparathyroid
53
Thiamine (B1) test
Red cell trasketolase activity
54
Floppy neonate not feeding
| Cataract and conjugated jaundice post milk feed
Galactosaemia
55
Why do you give Calcium gluconate in hyperkalaemia
As it is cardioprotective and helps prevent fatal dyrhythmia (does not lower K)
56
CKMB is useful for what in heart medicine
detecting re-infarction as levels rapidly return to normal so would know if was a second one
57
In an SIADH picture what must you exclude before diagnosing SIADH?
Drugs causing it
58
1. Causes of pseudo-hyponatraemia
| 2. what will the osmolality be doing?
1. High lipids or proteins or a spurious sample
2. The osmolality will be normal (low in true hyponatraemia)
It is caused by dilution
59
High PTH but high PO4 and low Ca
Pseudohyperparathyroidism (Martin-Albright Syndrome)
Generic resistance to PTH
High PTH but Ca and PO4 respond as if low PTH
60
Anion gap MUDPILES (or KULT)
```
Metformin
*Uraemia
*DKA (Ketones)
Paraldehyde
Iron
*Lactic acid
Ethanol/methanol
Salicylates
```
* Are KUL
Non* are all the Toxins
61
Low sodium, all else (K+, CL-?) normal. Glucose before OGTT is 4.9, 2 hours later is 10 ish. Diagnosis?
Impaired Glucose Tolerance
62
A teenager presents with a history of several weeks of increased thirst (polydipsia), increased urination (polyuria) / High urinary output and weight loss - diagnosis?
Type 1 diabetes mellitus
63
High [Na+ / Sodium]
low [K+ / Potassium]
high (Urine osmolality)
diagnosis?
Conn's syndrome
64
pH below 7.35 – Acidosis
K+ - high
Metabolic acidosis present
Diagnosis?
Type 1 diabetes mellitus in DKA
65
```
High sodium (173),
high potassium,
plasma osmolality ~400 (NR 275-290)
urine osmolality ~600 (NR 500-850)
Diagnosis?
```
SIADH
If urine osmolality 2x plasma osmolality, likely to be SIADH
66
What enzyme raised in mumps?
Amylase (Amylase-S from the parotid)
67
What enzyme raised in osteomalacia?
Alkaline phosphatase
68
In rhabdomylosis, which biomarker likely to be raised?
Creatine kinase
69
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?
- Hydrocortisone
- Levothyroxine
- Testosterone/Oestrogens (if not preserving fertility)/Gonadotrophins (if preserving fertility)
- GH
70
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. Which of these medications would need to be altered for them to be able to be prescribed allopurinol?
a. Azothioprine
b. Cyclophosphamide
c. Aspirin
d. Metformin
e. Amlodipine
a. Azothioprine - Apparently, if you give allopurinol with either: Azothioprine or 6-Mercaptopurine it causes overdose of either drug (allopurinol is an enzyme inhibitor, so slows the metabolism of other drugs dependent on the same enzymes, causing their effect to be greatly amplified).
71
```
Interpret blood gas:
pH 7.1,
PCO2 low (2.2 or 3 or something) (ranges were given)
a. metabolic acidosis
b. metabolic alkalosis
c. respiratory acidosis
d. respiratory alkalosis
e. normal
```
a. metabolic acidosis
72
Which of these ions is most likely to be outside it’s normal range in an alkalotic picture with a person who is urinating a lot?
a. Potassium
b. Calcium
c. Sodium
d. Magnesium
e. Chloride
c. Sodium
As they are urinating lots, they are starting to dehydrate (I.e. body water volume becomes low).
This dehydration matters, because the concentration of ions in plasma (i.e. plasma osmolality) will be strengthened by virtue of there being less water in the blood diluting the ions found there. However, this is not the only thing you need to keep track of.
When we become dehydrated from peeing lots, our blood volume decreases, thus lowering our BP. The Kidney can detect this drop in BP and becomes concerned that if blood pressure continues to drop, then eventually it won’t get any blood supply at all for itself. So, the kidney produces renin, which triggers the release of aldosterone. (Aldosterone promotes trading of potassium from the blood into the urine, in exchange for both-water-and-sodium to move from the urine into the blood). However, aldosterone also causes a drop in blood H+ levels, and a rise in blood HCO3- levels. Now, at this point you might want to argue that because they are dehydrating, their low H+ levels will appear more concentrated – making them look normal. And the question says this is an alkalotic patient. However, if you take that approach you also need to do the same for the HC03- levels which are now building up in the blood. Therefore, even though H+ might be pushed into the normal range due to overall volume loss, the HC03- levels will be pushed from merely raised to super high, maintaining an overall alkalotic picture.
So from this it seems likely this patient’s problem is taking place in the context of a maintained high level of aldosterone production, without eventual compensation. The only disease which fits that picture to my knowledge is Diabetes insipidus. As Vasopressin/ADH/VP is better at moving water than aldosterone. Therefore despite maintaining a high aldosterone, you net lose water. Therefore the patient is likely to have Diabetes insipidus.
Therefore if aldosterone is high, in the context of low body volume the ion situation plays out as follows:
Volume depletion due to low vasopressin hormone leads to relativistic raise in Na, K, Ca, Mg + other ions.
Production of Aldosterone leads to excretion of H+ and K+.
Therefore H+ and K+ blood ion concentrations are lowered. Making them appear normal, whilst Na, Ca, Mg + other ions remain high. Except Aldosterone only allows trading of potassium from the blood into the urine, in exchange for water and sodium movement into the blood. Therefore, sodium levels which already appear high due to the volume depletion (due to diabeites insipidous), appear even more deranged. Making Sodium the most likely ion to be outside it’s normal range in an alkalotic picture.
The other possibility is that it might just be simple dehydration, which could lead to a higher-than-normal sodium maybe, as explained by Amir Sam.
73
Which enzyme would you expect to be raised in obstructive jaundice/biliary obstruction?
Alkaline phosphatase
| GGT
74
A man develops signs of hyperthyroidism. Bloods show low TSH and high thyroxine. Does not have good uptake on technetium scan. What is the likely diagnosis?
Viral De Quervain’s thyroiditis
Good uptake bilaterally = Grave's Disease, and is due to auto-immune attack on the thyroid by
the body.
Poor uptake = Viral De Quervain's as the virus causes all of the stored thyroxine to be released
and so new technetium markers are unable to be taken up.
75
What can be used to measure the turnover of bone, and is raised in people who have Paget’s, Osteomalacia / Rickets?
Alkaline Phosphatase (ALP)
76
Sodium balance
* Renal artery stenosis
* SIADH secondary to small cell lung carcinoma
* Cranial diabetes insipidus
* Primary/psychogenic polydipsia
* Hypovolaemic hyponatraemia
A. Man with cough, SoB and weight loss. Hyponatraemia, low serum osmolality, urine Na and osmolality were inappropriately normal
B. Elderly woman with C. diff colitis and profuse diarrhoea
C. Low plasma sodium, low urine sodium
D. Man who has been in a car accident, raised sodium and plasma osmolality, low urine osmolality
E. Raised Na, low K, HTN but raised renin
```
A. SIADH secondary to small cell lung cancer
B. Hypovolaemic hyponatraemia
C. Primary/psychogenic polydipsia
D. Cranial DI
E. Renal artery stenosis
```
77
Enzymes
* ESR
* Ca2+
* K+
* ALT
* ALP
* AST
* CRP
A. What enzyme is raised in Paget’s?
B. What would be raised in obstructive jaundice due to gallstones?
C. What would be raised in obstructive jaundice due to pancreatic adenocarcinoma?
D. What is a sign that your patient has been taking cocaine?
E. Refractory, elevated levels of this are an indication for dialysis?
F. Temporal arteritis test which will help with diagnosis?
```
A. ALP
B. ALP
C. ALP
D. AST
E. K+
F. ESR
```
78
Increased calcitonin suggests what type of cancer?
Medullary thyroid carcinoma
79
Both mother and grandmother had medullary thyroid carcinoma and have tested positive for MEN2. What biomarker would be raised in the blood to confirm medullary thyroid cancer?
Calcitonin
80
Congenital adrenal hyperplasia, which enzyme deficiency is most common?
21-alpha hydroxylase
81
Low TSH, raised T3/4 following viral infection. Diagnosis?
Viral thyroiditis/De Quervain's thyroiditis
82
```
72 y/o Afro-Caribbean woman is admitted with acute SOB. PMHx includes hypertension and T2DM. She takes Metformin, Atorvastatin, and Amlodipine. O/E BP is 148/96. Auscultation reveals a 3rd heart sound and bibasal crackles, but no murmurs.
Investigations:
Sodium 142
Potassium 3.5
Urea 12.4
Creatinine 126
Rank the following diagnoses from most to least likely:
a. Essential hypertension
b. Cushing’s syndrome
c. Conn’s syndrome
d. Phaeochromocytoma
e. Addison’s disease
```
a. Essential hypertension
c. Conn’s syndrome
b. Cushing’s syndrome
d. Phaeochromocytoma
e. Addison’s disease
83
Rank the following in order of efficacy at reducing LDL:
a. Atorvastatin
b. Bezafibrate
c. Evolocumab
d. Prednisolone
e. Simvastatin
c. Evolocumab
e. Simvastatin
a. Atorvastatin
b. Bezafibrate
d. Prednisolone
84
What is the most common cause of hypocalcaemia in the community?
Vitamin D deficiency
85
What is the most common cause of hypercalcaemia in the community?
Primary hyperparathyroidism
86
Which blood test may confirm a diagnosis of acute pancreatitis?
Serum amylase
87
Deficiency of which plasma protein occurs in patients with movement disorder and liver disease?
Caeruloplasmin
88
Name a hormone that increases urinary phosphate excretion
Parathyroid hormone
89
Which liver enzyme is associated with obstructive jaundice?
Alkaline phosphatase
90
Which condition occurs in MEN 1 and 2a?
Parathyroid hyperplasia
91
A patient presents in Addisonian crisis with a systolic BP of 90, which fluid should be given?
I.V. 0.9% saline
92
Which enzyme is inhibited by Allopurinol?
Xanthine oxidase
93
What adrenal gland zone makes Cortisol?
Zona fasiculata
94
Which vitamin deficiency causes pellagra?
Niacin (B3)
95
Which enzyme causes hypercalcaemia in sarcoidosis?
Alpha 1 hydroxylase
96
A patient is found to have a high Na+, low K+, and low renin. What is the likely cause?
Conn’s syndrome
97
Which hormone released from fat cells has hypothalamic receptors?
Leptin
98
A 35 y/o woman presents with neck pain worse on swallowing, she had an URTI 2 weeks prior. Investigations show low TSH, and high T3 and T4. Technetium scanning shows low thyroid uptake. What is the likely diagnosis?
Viral thyroiditis/ de Quervain’s thyroiditis
99
28 y/o woman with IDA has IgA antibodies for tissue transglutaminase. What is the likely diagnosis?
Coeliac disease
100
Which enzyme level or activity should be measured before giving azathioprine?
Thiopurine methyltransferase
101
40 y/o woman presents with headache, but normal visual fields. MRI shows a 4mm pituitary adenoma. Investigations:
```
Cortisol 400 (high end of normal)
ACTH 30 (normal)
Prolactin 1400 (high)
TSH 3.3 (normal)
Free T4 17 (normal)
What is the most likely diagnosis?
a. Acromegaly
b. Hypopituitarism
c. Non-functioning pituitary macroadenoma
d. Prolactinoma
e. TSHoma
```
d. Prolactinoma
102
Which of the following is found in haemolytic jaundice?
a. Raised AST
b. Raised CK
c. Normal bilirubin
d. Pale stools
e. High urobilinogen in urine
e. High urobilinogen in urine
103
60 y/o man with BMI of 28 is referred with abdo pain. Investigations:
```
ALP 650 (most raised result)
ALT 145 (high)
AST 100 (high)
GGT 171 (high)
CK 254 (high)
What is the most likely diagnosis?
a. Acute pancreatitis
b. Alcoholic cirrhosis
c. Haemolytic jaundice
d. Gallstones
e. Alcoholic hepatitis
```
d. Gallstones
104
Increased insulin sensitivity causes low plasma glucose, and features in which of the following?
a. Acromegaly
b. ACTH deficiency
c. Cushing’s disease
d. Phaeochromocytoma
e. PCOS
b. ACTH deficiency
105
40 y/o woman presents with headache and a bitemporal hemianopia. MRI shows a 2cm pituitary adenoma. Investigations:
```
Cortisol 400 (high end of normal)
ACTH 30 (normal)
Prolactin 1400 (high)
TSH 3.3 (normal)
Free T4 17 (normal)
What is the most likely diagnosis?
a. Acromegaly
b. Hypopituitarism
c. Non-functioning pituitary macroadenoma
d. Prolactinoma
e. TSHoma
```
c. Non-functioning pituitary macroadenoma
106
25 y/o man brought to A&E with abdominal pain followed by collapse. His blood pressure shows he is in shock and his blood gas results are:
```
Na+ 120 (low)
K+ 6.2 (high)
HCO3 10.1 (low)
Urea 9.4 (high)
Creatinine 146 (high)
Glucose 2.5 (low)
pH 7.2 (low)
pCO2 3.0 (low)
What is the most likely diagnosis?
a. Acute abdomen
b. Addison’s disease
c. Conn’s syndrome
d. Cushing’s syndrome
e. Diabetic ketoacidosis
```
b. Addison’s disease
107
Which of the following stimulates receptors in the adrenals and leads to aldosterone release?
a. ACTH
b. Angiotensin 2
c. Calcium
d. Renin
e. Sodium
b. Angiotensin 2
108
25 y/o man brought to A&E with abdominal pain followed by collapse. His blood pressure shows he is in shock and his blood gas results are:
```
Na+ 120 (low)
K+ 6.2 (high)
HCO3 10.1 (low)
Urea 9.4 (high)
Creatinine 146 (high)
Glucose 2.5 (low)
pH 7.2 (low)
pCO2 3.0 (low)
Which of the following does the blood gas show?
a. Metabolic alkalosis
b. Metabolic acidosis
c. Respiratory alkalosis
d. Respiratory acidosis
e. Mixed metabolic alkalosis and respiratory acidosis
```
b. Metabolic acidosis
109
Which of the following can cause hypoglycaemia?
a. Atorvastatin
b. Bendrofluazide
c. Glucagon
d. Prednisolone
e. Quinine
a. Atorvastatin
110
Which of the following findings is consistent with moderate alcohol intake?
a. Reduced albumin
b. Elevated HDL
c. Nearly normal AST
d. Normal GGT
e. Normal triglycerides
b. Elevated HDL
111
```
40 y/o woman has post-partum haemorrhage and is then unable to breastfeed. Investigations:
Cortisol <50 (very low)
ACTH <10 (very low)
Prolactin <50 (very low)
TSH 0.9 (normal)
Free T4 12 (normal)
What is the most likely diagnosis?
a. Acromegaly
b. Hypopituitarism
c. Non-functioning macrodenoma
d. Prolactinoma
e. TSHoma
```
b. Hypopituitarism
112
Which of the following would be consistent with obstructive jaundice?
a. Normal ALP
b. Normal AST
c. Normal GGT
d. Dark stools
e. Increased bilirubin in the urine
e. Increased bilirubin in the urine
113
```
Pituitary
• TSHoma
• Non-functional macroadenoma
• Prolactinoma
• Hypothyroidism
```
A. Woman comes in with bitemporal hemianopia, 2cm mass, and a raised prolactin 1400
B. Woman comes in with no visual change, 4mm mass, and raised prolactin 1400
C. Raised prolactin, raised TSH, raised T4
D. High TSH low T4
A. Non-functional macroadenoma
B. Prolactinoma
C. TSHoma
D. Hypothyroidism
114
```
Calcium homeostasis
• Hypoparathyroidism
• Bone metastases
• Osteoporosis
• Osteomalacia
• Hyperparathyroidism
```
```
A. Calcium low, PTH high
B. Calcium high, PTH low
C. Calcium high, PTH high
D. Calcium low, PTH low
E. Calcium normal, PTH normal
```
```
A. Osteomalacia
B. Bone metastases
C. Hyperparathyroidism
D. Hypoparathyroidism
E. Osteoporosis
```
115
```
Investigations
• Oral glucose tolerance test
• HbA1c
• Inferior petrosal sinus sampling
• Synacthen test
• Fluid deprivation test
```
A. 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?
B. BP 190/100, thin skin, overweight, high-normal sodium, low normal potassium, OGTT done (glucose high normal)
C. Pt with low Na, High K + postural hypotension
D. Diabetic visiting his GP for a routine appointment
E. Patient with low sodium, potassium normal, low plasma osmolality and urine osmolality was 70
```
A. Oral glucose tolerance test
B. Inferior petrosal sinus sampling
C. Synacthen test
D. HbA1c
E. Fluid deprivation test
```
116
```
LFTs
• Gilbert’s
• Paget’s
• Viral hepatitis
• Cirrhosis
• Alcoholic hepatitis
• Acute cholestasis
```
A. 24 year old asymptomatic man with isolated rise in unconjugated bilirubin (all other results (ALT, ALP etc normal)
B. 22 year old student with two weeks anorexia, fever and malaise – ALT was most elevated, raised ALP + GGT
C. Woman with colicky abdominal pain, markedly raised ALP, other LFTs also deranged
D. A 57 year old man presents following hematemesis and is found to have high ALT + GGT, slightly raised ALP, and low Albumin
E. An elderly gentleman has massively elevated ALP on its own, and the other results are normal. He also reports a history of headaches.
```
A. Gilbert’s
B. Viral hepatitis
C. Acute cholestasis
D. Cirrhosis
E. Paget’s
```
117
```
Biochem
• 2
• 3
• 4.5
• 6.1
• 10
• 11.5
• 35
• 284
• 304
• 334
```
A. Bicarbonate in a pyloric stenosis patient
B. What is the likely K+ value in a patient with DKA
C. Man with impaired glucose tolerance, their fasting value
D. Anion gap calculation
E. Osmolarity calculation
```
A. 35
B. 3
C. 6.1
D. Na + K - HCO3 - Cl
E. 2(Na + K) + U + G
```
118
```
Enzymes
• Amylase-S
• Amylase-P
• Alkaline Phosphatase
• Glucose 6 phosphate dehydrogenate
• Creatinine Kinase
• ALA Synthase
• HGPRT
```
A. Deficiency of which enzyme leads to hyperuricemia?
B. Which enzyme regulates the rate limiting step in the haem biosynthesis pathway?
C. Which enzyme is raised in osteomalacia?
D. Which/What enzyme is raised in mumps?
E. In Rhabdomyolysis, which biomarker is likely to be raised?
```
A. HGPRT
B. ALA Synthase
C. Alkaline Phosphatase
D. Amylase-S
E. Creatinine Kinase
```
119
```
Calcium and Bone Handling
• Hypoparathyroidism
• Renal osteodystrophy
• Tertiary hyperparathyroidism
• Paget’s disease
• Metastatic disease
```
A. High calcium, normal phosphate, low PTH, high ALP, patient feels tired
B. 72 year old with headache: high CA, normal phosphate, normal PTH, high ALP
C. Baby with seizures: low Ca, low PTH
D. Pt presents with low mood after renal transplant following longstanding renal disease: high Ca, high PTH
E. 10 year old with seizures: low Ca, high PO4, high PTH
```
A. Metastatic disease
B. Paget’s disease
C. Hypoparathyroidism
D. Tertiary hyperparathyroidism
E. Renal osteodystrophy
```
120
```
Vitamin Deficiencies
• B3 deficiency
• B12 deficiency
• Folate deficiency
• Calcium deficiency
• Vitamin D deficiency
```
```
A. Vegan with megaloblastic anaemia
B. Person with Crohn’s with megaloblastic anaemia
C. Patient with Pellagra
D. Young patient with bowed legs
E. Patient with High PTH
```
```
A. B12 deficiency
B. Folate deficiency
C. B3 deficiency
D. Vitamin D deficiency
E. Calcium deficiency
```
121
What is the most common cause of acute pancreatitis?
Gallstones
122
Which cancer typically causes an increase in calcitonin?
Medullary carcinoma of the thyroid
123
Low TSH and high T4 following viral infection, what is the diagnosis?
Viral thyroiditis/ De Quervain’s thyroiditis
124
Which thyroid cancer most commonly metastasises to the lymph nodes?
Papillary
125
Which enzyme is raised in Paget’s, Osteomalacia etc. and is caused by osteoblast activation?
Alkaline phosphatase
126
Patient with GI conditions, lack of which substance leads to B12 being malabsorbed?
Intrinsic factor
127
T1DM with hypoglycaemia, what is the management option if no IV access?
IM Glucagon
128
Swollen joint, needle-shaped aspirate with negative birefringence, which enzyme manufactures the material that makes up the crystals?
Xanthine Oxidase
129
Treatment for gout, specifically one you should use acutely (i.e. not allopurinol)
Colchicine or an NSAID
130
Publican with diabetes, fatty stools, weight loss, ‘slate grey skin’ and joint pains. What is the underlying diagnosis causing this?
Haemochromatosis (joint pain, skin changes, pancreatitis, liver deposition)
131
5yr old, tetany, bone pain. Widened epiphyses + ‘Cupping’ of metaphysis shown on x-ray. What is the cause?
Rickets
132
A girl comes, overweight, irregular periods, flare of acne and hirsutism. Diagnosis?
Polycystic ovarian syndrome
133
What enzyme to confirm cardiac failure?
Brain Natriuretic Peptide
134
What liver enzyme is raised in MI?
Aspartate aminotransferase (AST)
135
Old man who fell over, been on floor for days. Severely dehydrated. Dark urine. Not blood on microscopy. What causes the dark urine?
Myoglobin
136
Old man who fell over, been on floor for days. Severely dehydrated. Dark urine. What enzyme will be high (>5x upper limit of normal)?
Creatine Kinase
137
PCSK9 inhibitor - evolucumab, what does it halve?
LDL levels
138
Which molecule takes cholesterol and moves it to liver and steroidogenesis organs?
high-density lipoprotein
| HDL
139
Which disease do you see in both MEN1 and MEN2a?
Primary hyperparathyroidism
140
Vitamin deficiency that causes megaloblastic anaemia & neural tube defects?
Folate
141
High PTH, high vit D and low Ca, what can this be?
Osteomalacia
142
Low plasma sodium (124) and urine specific gravity of 1.000 cause?
Psychogenic polydipsia
143
What would be high in the most common cause of CAH?
Sex steroid hormones & ACTH
144
Which hormone leads to release of prolactin?
TRH
145
Red cell lysis, what ion is raised:
a. Potassium
b. Sodium
c. Calcium
d. Bicarbonate
a. Potassium
146
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
b. Surreptitious gliclazide
c. Type 1 diabetes mellitus
d. Anorexia nervosa
e. Insulinoma
a. Factitious/ surreptitious insulin
147
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?
a. DDAVP
b. Fludrocortisone
c. Testosterone
a. DDAVP (hydrocortisone if an option)
148
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
a. Splenomegaly
149
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. Which of these medications would need to be altered for them to be able to be prescribed allopurinol?
Azathioprine
150
pH 7.1, pCO2 low (2.2 or 3 or something)
a. metabolic acidosis
b. metabolic alkalosis
c. respiratory acidosis
d. respiratory alkalosis
a. metabolic acidosis
151
A Girl develops a throat infection. She is given amoxicillin, and a rash develops. It is later found out that she has infectious mononucleosis, and her symptoms persist
a. Drug reaction
b. Penicillin allergy
c. Mastocytosis
a. Drug reaction
152
Cushing disease person – Which is the best investigation to confirm the suspected diagnosis?
a. High dose dexamethasone suppression test
b. Low dose dexamethasone suppression test
c. Long synacthen test
d. Short synacthen test
e. Inferior petrosal sinus sampling
e. Inferior petrosal sinus sampling
Previously, high dose dexamethasone suppression test
153
What does the number of True positives divided by the total number who have the disease describe?
a. Positive predictive value
b. Negative predictive value
c. Sensitivity
d. Specificity
e. Z score
c. Sensitivity
154
Which of these ions is most likely to be outside its normal range in an alkalotic picture (& if person is urinating a lot????)?
a. Potassium
b. Calcium
c. Sodium
d. Magnesium
a. Potassium
155
Shows you a Blood gas and a couple of biomarker values (e.g. urea I think), which demonstrates hypoxia, then asks you which part of it would indicate that the patient requires immediate dialysis
Hyperuricaemia
156
```
Rank the following diagnoses in order of expected measured serum potassium, with (1) being the highest potassium and (5) being the lowest.
A. Phaeochromocytoma
B. Conn's syndrome
C. Pneumonia
D. Addison's disease
E. Cushing's disease
```
```
D. Addison's disease
C. Pneumonia
E. Cushing's disease
A. Phaeochromocytoma
B. Conn's syndrome
```
157
Five patients (Patient A to E) each have a blood gas sample sent to the laboratory. The clinical details of the cases are detailed below. Rank these cases on the expected pH from (1) lowest pH (acidosis) to (5) highest pH (alkalosis)
Patient A, a 59 year old with with very long standing COPD who has an acute exacerbation and is feeling breathless.
Patient B, is having a panic attack, is hyperventilating and complains of tetany
Patient C, a 17 year old with type 1 diabetes who omits his insulin.
Patient D, a 58 year old with very long standing COPD who is currently quite well
Patient E, has a cardiac arrest and has blood gases show a low p02 and a high pC02
Patient D, a 58 year old with very long standing COPD who is currently quite well
Patient A, a 59 year old with with very long standing COPD who has an acute exacerbation and is feeling breathless.
Patient B, is having a panic attack, is hyperventilating and complains of tetany
Patient E, has a cardiac arrest and has blood gases show a low p02 and a high pC02
Patient C, a 17 year old with type 1 diabetes who omits his insulin.
