ChemPath Flashcards
What is the syndrome where there is a complete absence of HPRT (yperxanthine guanine phosphoribosyl transferase?
Lesch Nyhan Syndrome
- X linked
- Developmental delay at 6 months
- Hyperuricaemia, choreiform movement, spasticity
The inheritance pattern of familial hypercholesterolaemia is: A. Autosomal recessive B. X linked C. Autosomal dominant D. Mitochondrial
C. Autosomal dominant
Phenylketonuria is an deficiency of which enzyme?
Phenylalanine hydroxylase
-There is a build up of toxic phenylalanine
How do you treat galactosaemia?
Avoid milk
What is used as a tumour marker to monitor medullary carcinoma of the thyroid?
Carcinoembryonic antigen (CEA)
In primary hyperthyroidism what biochemistry would you see?
High T3/T4 and low TSH
What is used as a tumour marker to monitor papillary and follicular thyroid cancer?
Thyroglobulin
What is Schmidt’s syndrome?
Addison’s disease + hypothyroidism
What is the gold standard test to diagnose Cushing's disease? A. Low dose dexamethasone test B. High dose dexamethasone test C. Sampling from the pituitary (IPSS) D. Short SynACTHen test
C. IPSS
In a pituitary function triple test which of the following are administered: A. GHRH B. TRH C. Glucose D. Insulin E. ACTH
A, B and D
Which tests are used to diagnose acromegaly? A. Short synacthen test B. Plasma cortisol levels C. IGF levels D. Glucose tolerance test E. Urine cortisol levels
C and D can both be used
Name an endogenous marker of GFR?
Serum creatinine
A clinical alternative is Cystatin C
What features must an endogenous marker of GFR have? A. Not plasma bound B. Small C. Freely filtered by glomerulus D. Neutral charge E. Not modified by the tubules
A, C and E
What is the gold standard measure of GFR?
Inulin
How is more likely to have a higher serum creatinine level? A. An old man B. A women C. Caucasian D. Body builder
D. body builder
Muscularity increases serum creatinine
Women and older people have lower levels
Black ethnicity have higher levels
Name three drugs that would predispose to pre renal AKI?
NSAIDs, diuretics, calcineurin inhibitors, ACEi or ARBs
Which of the following is not a cause of pre-renal AKI? A. True volume depletion B. Hypertension C. Oedematous state D. Selective renal ischaemia E. Drugs affecting the glomerular flow
B.
Name 3 causes of Chronic kidney disease?
Diabetes, Hypertension, polycystic kidney disease, chronic glomerulonephritis, Atherosclerotic kidney disease
What is the main electrolyte imbalance you will see in chronic kidney disease? A. Hypernatraeia B. Hyperkalamia C. Hyponatraemia D. Hypernatraemia
B. Hyperkalaemia
What ECG changes might you see with in a patient with severe hyperkalaemia?
Peaked T waves, loss of P waves, widened QRS. Eventually VF
How do you calculate osmolality?
2(Na + K) + urea + glucose
How do you calculate the anion gap?
Na + K - Chloride - bicarb
If the anion gap goes up you know there are toxins in the blood e.g. ketones
Which of the following would you NOT see a raised ALP? A. Paget's disease B. Pregnancy C. Hepatitis D. Osteoporosis E. Osteomalacia
D. Osteoporosis - the biochemistry is unchanged
What is the enzyme marker for acute pancreatitis?
Amylase
Which form of creatine kinase is used as a marker of cardiac muscle damage?
A. CK-MM
B. CK-MB
C. CK-BB
B. CK-MB
This enzyme doesn’t rise quickly
Which of the following is a cause for raised Creatine kinase? A. Dehydration B. Haemolytic anaemia C. Caucasian D. Severe exercise
D. Severe exercise
Other causes include: Afro Caribbean ethnicity, MI, Myopathy, muscle damage due to any other cause
Which of the following is the current marker of choice for myocardial injury ? A. Myoglobin B. Cardiac troponin C. CK-MB D. Haemoglobin
B. Cardiac troponin
Rises 4-6 hours post MI and peaks at 12-24 hours
It remains elevated for 3-10 days
–Therefore must measure at 6 hours and then at 12 hours after the onset of chest pain
In toxicology, which sample has the longest timeframe to detect drugs? A. Blood B. Urine C. Hair D. Faeces
C. Hair sample
- Drugs incorporated into hair so can give long term information
- Blood = drugs detected for no more than 12 hours
- Urine = drugs detected for no more than 2-3 days
How long after an MI would the levels of cardiac troponin peak?
12-24 hours
What biochemistry would you see in primary hyperparathyroidism?
High calcium, normal or high PTH
Which of the following is not a cause of metabolic alkalosis? A. Panic attack B. Vomiting C. Hypokalaemia D. Ingestion of bicarbonate
A.
Give 3 causes of hypokalaemia
D&V, diuretics, Insulin, Cushings
A 50 year old Asian woman is referred to the Diabetes clinic after presenting to her GP with polyuria and polydipsia. When tested, she has a fasting whole blood glucose of 6.3 mmol/L and 6.4 mmol/L when tested again a week later. A. Impaired Fasting Glucose B. Acarbose C. Gliclazide (sulfonylurea) D. Impaired Glucose Tolerance E. Orlistat F. Nateglinide (Meglitinide) G. Metformin (biguanide) H. Diabetes Mellitus Type 1 I. Diabetic Ketoacidosis J. Cranial Diabetes Insipidus K. Lactic Acidosis L. Nephrogenic Diabetes Insipidus M. Diabetes Mellitus Type 2 N. Hyperosmolar Non-Ketotic Coma O. Pioglitazone (Thiazolidinedione)
M. Diabetes Mellitus Type 2
If the patient is symptomatic:
- Fasting glucose >= 7 (whole blood >=6.1)
- Random glucose >=11.1
If asymptomatic the same criteria apply but must be on 2 occasions.
You are on call in Casualty when a thin 35 year old woman is brought in by the paramedics. She is a known diabetic who admits to not taking her insulin in the past few days as she has been feeling ill with a cold. She phoned the ambulance due to severe abdominal pains and seems confused as to where she is. A. Impaired Fasting Glucose B. Acarbose C. Gliclazide (sulfonylurea) D. Impaired Glucose Tolerance E. Orlistat F. Nateglinide (Meglitinide) G. Metformin (biguanide) H. Diabetes Mellitus Type 1 I. Diabetic Ketoacidosis J. Cranial Diabetes Insipidus K. Lactic Acidosis L. Nephrogenic Diabetes Insipidus M. Diabetes Mellitus Type 2 N. Hyperosmolar Non-Ketotic Coma O. Pioglitazone (Thiazolidinedione)
I. Diabetic Ketoacidosis
A recently diagnosed 48 year old opera singer was noted by her diabetic nurse to have unacceptably high blood sugar levels, despite strict calorie control and oral metformin. Which class of drug could be added to reduce insulin resistance further? A. Impaired Fasting Glucose B. Acarbose C. Gliclazide (sulfonylurea) D. Impaired Glucose Tolerance E. Orlistat F. Nateglinide (Meglitinide) G. Metformin (biguanide) H. Diabetes Mellitus Type 1 I. Diabetic Ketoacidosis J. Cranial Diabetes Insipidus K. Lactic Acidosis L. Nephrogenic Diabetes Insipidus M. Diabetes Mellitus Type 2 N. Hyperosmolar Non-Ketotic Coma O. Pioglitazone (Thiazolidinedione)
O. Pioglitazone (Thiazolidinedione)
A 40 year old builder who was constantly being advised by his GP to lose weight, suffered a serious head injury whilst at work, for which he had to go to A&E. He has now been discharged, but a few days later he notices that since the brick fell on his head, he has been passing water almost two or three times an hour and is always thirsty despite drinking lots of water. His GP does a fasting plasma glucose, which is 5.3 mmol/L. A. Impaired Fasting Glucose B. Acarbose C. Gliclazide (sulfonylurea) D. Impaired Glucose Tolerance E. Orlistat F. Nateglinide (Meglitinide) G. Metformin (biguanide) H. Diabetes Mellitus Type 1 I. Diabetic Ketoacidosis J. Cranial Diabetes Insipidus K. Lactic Acidosis L. Nephrogenic Diabetes Insipidus M. Diabetes Mellitus Type 2 N. Hyperosmolar Non-Ketotic Coma O. Pioglitazone (Thiazolidinedione)
J. Cranial Diabetes Insipidus
You are on call in Casualty when a thin 35 year old woman is brought in by the paramedics. She is a known diabetic who admits to not taking her insulin in the past few days as she has been feeling ill with a cold. She phoned the ambulance due to severe abdominal pains and seems confused as to where she is. A. Impaired Fasting Glucose B. Acarbose C. Gliclazide (sulfonylurea) D. Impaired Glucose Tolerance E. Orlistat F. Nateglinide (Meglitinide) G. Metformin (biguanide) H. Diabetes Mellitus Type 1 I. Diabetic Ketoacidosis J. Cranial Diabetes Insipidus K. Lactic Acidosis L. Nephrogenic Diabetes Insipidus M. Diabetes Mellitus Type 2 N. Hyperosmolar Non-Ketotic Coma O. Pioglitazone (Thiazolidinedione)
I. Diabetic Ketoacidosis
A 34 year old obese woman presents to her GP complaining of polyuria and polydipsia. Her blood pressure is 145/95mmHg and her whole blood glucose level is 12.0mmol/L. Further examination reveals she has a moon face and purple striae. Which hormone is most likely to be in excess. A. Prolactin B. Cushing's disease C. Glucagon D. Cortisol E. Ectopic ACTH-producing tumour F. Autonomic neuropathy G. Exogenous insulin H. Irritable bowel syndrome I. Respiratory alkalosis J. Coronary heart disease K. Testosterone L. Diabetic ketoacidosis M. Endogenous insulin N. Metabolic alkalosis
D. Cortisol
A diabetic patient presents unconscious. Arterial blood gases reveal the following; pH 7.9 and paCO2 8.4. What is the metabolic abnormality. A. Prolactin B. Cushing's disease C. Glucagon D. Cortisol E. Ectopic ACTH-producing tumour F. Autonomic neuropathy G. Exogenous insulin H. Irritable bowel syndrome I. Respiratory alkalosis J. Coronary heart disease K. Testosterone L. Diabetic ketoacidosis M. Endogenous insulin N. Metabolic alkalosis
N. Metabolic alkalosis
A diabetic patient presents to A&E with muscle weakness, cramps and hypotonia. She was only recently placed on insulin replacement therapy. Investigations reveal hypokalaemia. Assuming the patient is otherwise healthy, which hormone is most likely to be responsible for the potassium levels. A. Prolactin B. Cushing's disease C. Glucagon D. Cortisol E. Ectopic ACTH-producing tumour F. Autonomic neuropathy G. Exogenous insulin H. Irritable bowel syndrome I. Respiratory alkalosis J. Coronary heart disease K. Testosterone L. Diabetic ketoacidosis M. Endogenous insulin N. Metabolic alkalosis
G. Exogenous insulin
A 48 year old man presents with pigmented skin, hyperglycaemia and a cushingoid appearance. A high dose dexamethasone test revealed there was a significant suppression of cortisol by day 2 of the test. What is the most likely cause of this glucocorticoid excess. A. Prolactin B. Cushing's disease C. Glucagon D. Cortisol E. Ectopic ACTH-producing tumour F. Autonomic neuropathy G. Exogenous insulin H. Irritable bowel syndrome I. Respiratory alkalosis J. Coronary heart disease K. Testosterone L. Diabetic ketoacidosis M. Endogenous insulin N. Metabolic alkalosis
B. Cushing’s disease
A 52 year old woman with a 20 year history of type II diabetes mellitus is referred to the gastroenterology clinic because she has recently developed episodic diarrhoea. What is the most likely complication of diabetes in this patient. A. Prolactin B. Cushing's disease C. Glucagon D. Cortisol E. Ectopic ACTH-producing tumour F. Autonomic neuropathy G. Exogenous insulin H. Irritable bowel syndrome I. Respiratory alkalosis J. Coronary heart disease K. Testosterone L. Diabetic ketoacidosis M. Endogenous insulin N. Metabolic alkalosis
F. Autonomic neuropathy
A 65 year old man reports feeling lethargic and is found to have ‘impaired glucose tolerance’ by his GP.
A. Fasting plasma glucose 5.9mmol/l. 2hrs post OGTT plasma glucose 11.5mmol/l
B. Fasting whole blood glucose 6.0 mmol/l. Osmolarity 352 mOsm/kg.
C. Plasma glucose 1.45mmol/l, pH 7.58, pCO2 8.1kPa.
D. Plasma glucose 14 mmol/l; pH 7.2; pCO2 3.0 kPa. Urine positive for ketones
E. Fasting plasma glucose 6.9 mmol/l. 2hrs post OGGT plasma glucose 10.5 mmol/l
F. Plasma osolarity 285 mOsm/kg, anion gap 19 mM. Glucose normal.
G. Plasma glucose 1.0mmol/l, pH 7.58, pCO2 2.4kPa
H. Plasma glucose 1.45 mmol/l; pH 7.58; pCO2 2.4 kPa.
I. Fasting plasma glucose 7.9mmol/l. 2hrs post OGTT glucose 11.1mmol/l.
E. Fasting plasma glucose 6.9 mmol/l. 2hrs post OGGT plasma glucose 10.5 mmol/l
A 24 year old with type I diabetes is admitted to A + E with shortness of breath and a respiratory rate of 35. He is also drowsy.
A. Fasting plasma glucose 5.9mmol/l. 2hrs post OGTT plasma glucose 11.5mmol/l
B. Fasting whole blood glucose 6.0 mmol/l. Osmolarity 352 mOsm/kg.
C. Plasma glucose 1.45mmol/l, pH 7.58, pCO2 8.1kPa.
D. Plasma glucose 14 mmol/l; pH 7.2; pCO2 3.0 kPa. Urine positive for ketones
E. Fasting plasma glucose 6.9 mmol/l. 2hrs post OGGT plasma glucose 10.5 mmol/l
F. Plasma osolarity 285 mOsm/kg, anion gap 19 mM. Glucose normal.
G. Plasma glucose 1.0mmol/l, pH 7.58, pCO2 2.4kPa
H. Plasma glucose 1.45 mmol/l; pH 7.58; pCO2 2.4 kPa.
I. Fasting plasma glucose 7.9mmol/l. 2hrs post OGTT glucose 11.1mmol/l.
H. Plasma glucose 1.45 mmol/l; pH 7.58; pCO2 2.4 kPa.
An obese 40 year old woman is found on a routine blood test to have ‘impaired fasting glucose’
A. Fasting plasma glucose 5.9mmol/l. 2hrs post OGTT plasma glucose 11.5mmol/l
B. Fasting whole blood glucose 6.0 mmol/l. Osmolarity 352 mOsm/kg.
C. Plasma glucose 1.45mmol/l, pH 7.58, pCO2 8.1kPa.
D. Plasma glucose 14 mmol/l; pH 7.2; pCO2 3.0 kPa. Urine positive for ketones
E. Fasting plasma glucose 6.9 mmol/l. 2hrs post OGGT plasma glucose 10.5 mmol/l
F. Plasma osolarity 285 mOsm/kg, anion gap 19 mM. Glucose normal.
G. Plasma glucose 1.0mmol/l, pH 7.58, pCO2 2.4kPa
H. Plasma glucose 1.45 mmol/l; pH 7.58; pCO2 2.4 kPa.
I. Fasting plasma glucose 7.9mmol/l. 2hrs post OGTT glucose 11.1mmol/l.
B. Fasting whole blood glucose 6.0 mmol/l. Osmolarity 352 mOsm/kg.
A 14 year old type I diabetic attends clinic for a routine appointment. His daily record shows well managed blood glucose levels and he complains of no other problems.
A. Fasting plasma glucose 5.9mmol/l. 2hrs post OGTT plasma glucose 11.5mmol/l
B. Fasting whole blood glucose 6.0 mmol/l. Osmolarity 352 mOsm/kg.
C. Plasma glucose 1.45mmol/l, pH 7.58, pCO2 8.1kPa.
D. Plasma glucose 14 mmol/l; pH 7.2; pCO2 3.0 kPa. Urine positive for ketones
E. Fasting plasma glucose 6.9 mmol/l. 2hrs post OGGT plasma glucose 10.5 mmol/l
F. Plasma osolarity 285 mOsm/kg, anion gap 19 mM. Glucose normal.
G. Plasma glucose 1.0mmol/l, pH 7.58, pCO2 2.4kPa
H. Plasma glucose 1.45 mmol/l; pH 7.58; pCO2 2.4 kPa.
I. Fasting plasma glucose 7.9mmol/l. 2hrs post OGTT glucose 11.1mmol/l.
F. Plasma osolarity 285 mOsm/kg, anion gap 19 mM. Glucose normal.
A 24 year old with type I diabetes is admitted to A + E with shortness of breath and a respiratory rate of 35. He is also drowsy.
A. Fasting plasma glucose 5.9mmol/l. 2hrs post OGTT plasma glucose 11.5mmol/l
B. Fasting whole blood glucose 6.0 mmol/l. Osmolarity 352 mOsm/kg.
C. Plasma glucose 1.45mmol/l, pH 7.58, pCO2 8.1kPa.
D. Plasma glucose 14 mmol/l; pH 7.2; pCO2 3.0 kPa. Urine positive for ketones
E. Fasting plasma glucose 6.9 mmol/l. 2hrs post OGGT plasma glucose 10.5 mmol/l
F. Plasma osolarity 285 mOsm/kg, anion gap 19 mM. Glucose normal.
G. Plasma glucose 1.0mmol/l, pH 7.58, pCO2 2.4kPa
H. Plasma glucose 1.45 mmol/l; pH 7.58; pCO2 2.4 kPa.
I. Fasting plasma glucose 7.9mmol/l. 2hrs post OGTT glucose 11.1mmol/l.
H. Plasma glucose 1.45 mmol/l; pH 7.58; pCO2 2.4 kPa.
A 49 year old man complains of recent severe pain in his left first toe, both knees and ankles. This occurred after a heavy Friday night out. On examination there was marked swelling and redness of the toe. The pain was especially evident if touched A. Lactic acid accumulation B. Ethanol C. Leukaemia D. Idiopathic E. Lesch-Nyhan Syndrome F. Glucose 6 phosphatase deficiency G. Hyperlipidaemia H. Diet I. Low dose aspirin J. Thiazide diuretics K. High dose asprin L. Renal Failure
B. Ethanol
A 55 year old man complains of swelling of his legs, pain in his ankles and left big toe and tiredness. On examination, there is oedema of his legs, swelling and redness on his ankles and left MTP joint. He has gross proteinurea and the serum albumin is 30 g/L A. Lactic acid accumulation B. Ethanol C. Leukaemia D. Idiopathic E. Lesch-Nyhan Syndrome F. Glucose 6 phosphatase deficiency G. Hyperlipidaemia H. Diet I. Low dose aspirin J. Thiazide diuretics K. High dose asprin L. Renal Failure
L. Renal Failure
A 48 year old gentleman develops a painful right big toe two days after being admitted into hospital with a BP of 180/120. A. Lactic acid accumulation B. Ethanol C. Leukaemia D. Idiopathic E. Lesch-Nyhan Syndrome F. Glucose 6 phosphatase deficiency G. Hyperlipidaemia H. Diet I. Low dose aspirin J. Thiazide diuretics K. High dose asprin L. Renal Failure
J. Thiazide diuretics
A 58-year old man presents with lethargy and generalised weakness. He has a 2 year history of upper abdominal pain especially after meals and suffered a myocardial infarct 3 years ago. Recently he has noticed swelling in his right first toe. Examination reveals tenderness in the epigastrium. No masses are felt and there is no organomegaly. Endoscopy reveals an active duodenal ulcer A. Lactic acid accumulation B. Ethanol C. Leukaemia D. Idiopathic E. Lesch-Nyhan Syndrome F. Glucose 6 phosphatase deficiency G. Hyperlipidaemia H. Diet I. Low dose aspirin J. Thiazide diuretics K. High dose asprin L. Renal Failure
I. Low dose aspirin
An 8 year old boy, showing signs of slow development, presents with a painful right knee which on examination was hot and swollen. Scratch marks on his face were also observed. An aspiration of the synovial fluid from the joint revealed crystals which were negatively birefringent. A. Lactic acid accumulation B. Ethanol C. Leukaemia D. Idiopathic E. Lesch-Nyhan Syndrome F. Glucose 6 phosphatase deficiency G. Hyperlipidaemia H. Diet I. Low dose aspirin J. Thiazide diuretics K. High dose asprin L. Renal Failure
E. Lesch-Nyhan Syndrome
Mr Smith has a history of end-stage renal failure. Routine blood tests demonstrate an adjusted serum calcium of 3.2mmol/L and elevated PTH levels. A. Paget’s Disease B. Hypocalcaemia C. Hypercalcaemia D. Secondary Hyperparathyroidism E. Diabetes Mellitus F. Amyloidosis G. Papillary Carcinoma H. Medullary Carcinoma I. Osteomalacia J. Tertiary Hyperparathyroidism K. Multiple Myeloma
J. Tertiary Hyperparathyroidism
Mrs Jones presents to her GP complaining of abdominal pain, bone pain, nausea and constipation. Her adjusted serum calcium was found to be 3.2mmol/L with undetectable PTH. Serum electrophoresis demonstrates a monoclonal band. A. Paget’s Disease B. Hypocalcaemia C. Hypercalcaemia D. Secondary Hyperparathyroidism E. Diabetes Mellitus F. Amyloidosis G. Papillary Carcinoma H. Medullary Carcinoma I. Osteomalacia J. Tertiary Hyperparathyroidism K. Multiple Myeloma
K. Multiple Myeloma
Chronic renal failure is one of the commonest causes of hypercalcaemia. What is the commonest cause of end stage renal failure in Europe? A. Paget’s Disease B. Hypocalcaemia C. Hypercalcaemia D. Secondary Hyperparathyroidism E. Diabetes Mellitus F. Amyloidosis G. Papillary Carcinoma H. Medullary Carcinoma I. Osteomalacia J. Tertiary Hyperparathyroidism K. Multiple Myeloma
E. Diabetes Mellitus
A 45 year old smoker has recently been diagnosed with lung cancer. He has raised levels of calcium but low levels of PTH A. Tertiary hyperparathyroidism B. Paget's disease of the bone C. Primary hypoparathyroidism D. Primary hyperparathyroidism E. Hypercalcaemia F. Pseudopseudohypoparathyroidism G. Secondary hyperparathyroidism H. Malignant hypercalcaemia I. Pseudohypoparathyroidism J. Hypocalcaemia
H. Malignant hypercalcaemia
A 20yr old gentleman presents to his GP with a lump in his neck. He has noticed the lump getting bigger. Examination reveals the lump to be in the thyroid gland. FNA and cytology reveals the diagnosis. A. Paget’s Disease B. Hypocalcaemia C. Hypercalcaemia D. Secondary Hyperparathyroidism E. Diabetes Mellitus F. Amyloidosis G. Papillary Carcinoma H. Medullary Carcinoma I. Osteomalacia J. Tertiary Hyperparathyroidism K. Multiple Myeloma
G. Papillary Carcinoma
A 32 year old female complains for severe thirst. On further questioning she also suffers from mild depression, abdominal pains and has a history of broken bones. Her calcium levels are raised. A. Tertiary hyperparathyroidism B. Paget's disease of the bone C. Primary hypoparathyroidism D. Primary hyperparathyroidism E. Hypercalcaemia F. Pseudopseudohypoparathyroidism G. Secondary hyperparathyroidism H. Malignant hypercalcaemia I. Pseudohypoparathyroidism J. Hypocalcaemia
D. Primary hyperparathyroidism
A 37 year old man has a round face, short metacarpals and metatarsals. He complains of mild depression and has a carpopedal spasm. Plasma PTH is raised and alk phos is slightly raised too. A. Tertiary hyperparathyroidism B. Paget's disease of the bone C. Primary hypoparathyroidism D. Primary hyperparathyroidism E. Hypercalcaemia F. Pseudopseudohypoparathyroidism G. Secondary hyperparathyroidism H. Malignant hypercalcaemia I. Pseudohypoparathyroidism J. Hypocalcaemia
I. Pseudohypoparathyroidism
A 67 year old Caucasian woman complains of pain in her clavicle and recent loss of hearing. X-rays show localized enlargement of bone. Blood biochemistry revealed normal calcium and phosphate levels however her alk phos is very high. A. Tertiary hyperparathyroidism B. Paget's disease of the bone C. Primary hypoparathyroidism D. Primary hyperparathyroidism E. Hypercalcaemia F. Pseudopseudohypoparathyroidism G. Secondary hyperparathyroidism H. Malignant hypercalcaemia I. Pseudohypoparathyroidism J. Hypocalcaemia
B. Paget’s disease of the bone
A 52 year old man has recently had a kidney transplant. He now complains of stiff joints and abdominal pain. On investigation his blood pressure was raised and his calcium was raised. A. Tertiary hyperparathyroidism B. Paget's disease of the bone C. Primary hypoparathyroidism D. Primary hyperparathyroidism E. Hypercalcaemia F. Pseudopseudohypoparathyroidism G. Secondary hyperparathyroidism H. Malignant hypercalcaemia I. Pseudohypoparathyroidism J. Hypocalcaemia
A. Tertiary hyperparathyroidism
A 50 year old woman presents with pain and stiffness in her hands. On further questioning she reveals that she also has pain in her back, hips and knees, which is worse in the evenings. A. Osteoporosis B. Rheumatoid arthritis C. Pseudogout D. Osteomalacia E. Gout F. Septic arthritis G. Osteoarthritis H. Ankylosing spondylitis I. Paget's disease J. Primary hyperparathyroidism K. Myeloma
G. Osteoarthritis
A 40 year woman presents with pain, swelling and stiffness in her hands. On further questioning she revels that she also has pain in her wrists, shoulders and knees which is worse in the mornings. A. Osteoporosis B. Rheumatoid arthritis C. Pseudogout D. Osteomalacia E. Gout F. Septic arthritis G. Osteoarthritis H. Ankylosing spondylitis I. Paget's disease J. Primary hyperparathyroidism K. Myeloma
B. Rheumatoid arthritis
A 60 year old woman presents with pain in her back and knees. It was noted that she had bowed legs, and her blood tests revealed a lone increase in Alkaline Phosphatase. A. Osteoporosis B. Rheumatoid arthritis C. Pseudogout D. Osteomalacia E. Gout F. Septic arthritis G. Osteoarthritis H. Ankylosing spondylitis I. Paget's disease J. Primary hyperparathyroidism K. Myeloma
I. Paget’s disease
A 50 year old obese, hypertensive man presents with a 2 day history of a painful, swollen, red toe. On further questioning he reveals that the symptoms had started the morning after the office party, where he ingested large amounts of alcohol. A. Osteoporosis B. Rheumatoid arthritis C. Pseudogout D. Osteomalacia E. Gout F. Septic arthritis G. Osteoarthritis H. Ankylosing spondylitis I. Paget's disease J. Primary hyperparathyroidism K. Myeloma
E. Gout
A 60 year old woman presents with pain in her back and knees. It was noted that she had bowed legs, and her blood tests revealed a lone increase in Alkaline Phosphatase. A. Osteoporosis B. Rheumatoid arthritis C. Pseudogout D. Osteomalacia E. Gout F. Septic arthritis G. Osteoarthritis H. Ankylosing spondylitis I. Paget's disease J. Primary hyperparathyroidism K. Myeloma
I. Paget’s disease
A 50 year old man was admitted to hospital in a confused state. He was dyspnoeic and had a cough productive of sputum. He was unable to give a coherent history but one of the casualty officers knew him to be a type 1 diabetic patient with a history of COPD. Arterial blood: pH 7.18, pCO2 7.4kPa, Bicarbonate: 20
A. Acute respiratory alkalosis with co-existent metabolic acidosis
B. Respiratory acidosis
C. Compensated respiratory alkalosis
D. Respiratory alkalosis
E. Metabolic alkalosis with compensatory hypoventilation
F. Metabolic acidosis
G. Mixed respiratory and metabolic acidosis
H. Metabolic alkalosis
I. Compensatory metabolic alkalosis
G. Mixed respiratory and metabolic acidosis
A young woman was admitted to hospital 8 hours after she had taken an overdose of aspirin. Arterial blood: H+ - 30nmol/L, pH – 7.53, pCO2 – 2.0kPa
A. Acute respiratory alkalosis with co-existent metabolic acidosis
B. Respiratory acidosis
C. Compensated respiratory alkalosis
D. Respiratory alkalosis
E. Metabolic alkalosis with compensatory hypoventilation
F. Metabolic acidosis
G. Mixed respiratory and metabolic acidosis
H. Metabolic alkalosis
I. Compensatory metabolic alkalosis
A. Acute respiratory alkalosis with co-existent metabolic acidosis
A young woman was admitted to hospital unconscious, following a head injury. A skull fracture was demonstrated on radiography and a CT scan revealed extensive cerebral contusions. The respiratory rate was increased, at 38/min. 3 days after admission, the patient’s condition was unchanged. Arterial blood: H+ - 36nmol/L, pH – 7.44, pCO2 – 3.6kPa, Bicarbonate – 19mmol/L
A. Acute respiratory alkalosis with co-existent metabolic acidosis
B. Respiratory acidosis
C. Compensated respiratory alkalosis
D. Respiratory alkalosis
E. Metabolic alkalosis with compensatory hypoventilation
F. Metabolic acidosis
G. Mixed respiratory and metabolic acidosis
H. Metabolic alkalosis
I. Compensatory metabolic alkalosis
C. Compensated respiratory alkalosis
A 45 year old man was admitted to hospital with a history of persistent vomiting, He had a long history of dydpepsia but had never sought advice for this, preferring to treat himself with proprietary remedies. On examination, he was obviously dehydrated and his respiration was shallow. Arterial blood: H+ - 28nmol/L, pH – 7.56, pCO2 – 7.2kPa, Bicarbonate – 45mmol/L. Serum: Na+ - 146, K+ - 2.8, Urea – 34.2. A barium meal showed pyloric stenosis, thought to be due to scaring caused by peptic ulceration.
A. Acute respiratory alkalosis with co-existent metabolic acidosis
B. Respiratory acidosis
C. Compensated respiratory alkalosis
D. Respiratory alkalosis
E. Metabolic alkalosis with compensatory hypoventilation
F. Metabolic acidosis
G. Mixed respiratory and metabolic acidosis
H. Metabolic alkalosis
I. Compensatory metabolic alkalosis
E. Metabolic alkalosis with compensatory hypoventilation
A young man sustained injury to the chest in a road traffic accident. Effective ventilation was compromised by a large flail segment. Arterial blood: pO2 – 8kPa, pCO2 – 8kPa, pH – 7.24, H+ - 58nmol/L, Bicarbonate – 25mmol/L
A. Acute respiratory alkalosis with co-existent metabolic acidosis
B. Respiratory acidosis
C. Compensated respiratory alkalosis
D. Respiratory alkalosis
E. Metabolic alkalosis with compensatory hypoventilation
F. Metabolic acidosis
G. Mixed respiratory and metabolic acidosis
H. Metabolic alkalosis
I. Compensatory metabolic alkalosis
B. Respiratory acidosis
Which of these is associated with Wilson’s disease? A. IgM B. Myoglobin C. IgE D. C3 E. IgA F. Pre-albumin G. Paraprotein H. Caeruloplasmin I. Alpha-1-antitrypsin J. IgD K. C4 L. CSF M. AFP N. CRP O. Transferrin P. Albumin
H. Caeruloplasmin
Increases of what is a cardiovascular risk factor? A. IgM B. Myoglobin C. IgE D. C3 E. IgA F. Pre-albumin G. Paraprotein H. Caeruloplasmin I. Alpha-1-antitrypsin J. IgD K. C4 L. CSF M. AFP N. CRP O. Transferrin P. Albumin
N. CRP
What is the major antagonist of serine proteases at a site of injury? A. IgM B. Myoglobin C. IgE D. C3 E. IgA F. Pre-albumin G. Paraprotein H. Caeruloplasmin I. Alpha-1-antitrypsin J. IgD K. C4 L. CSF M. AFP N. CRP O. Transferrin P. Albumin
I. Alpha-1-antitrypsin
Which is associated with type 1 hypersensitivity? A. IgM B. Myoglobin C. IgE D. C3 E. IgA F. Pre-albumin G. Paraprotein H. Caeruloplasmin I. Alpha-1-antitrypsin J. IgD K. C4 L. CSF M. AFP N. CRP O. Transferrin P. Albumin
C. IgE
Which can act as a source of amino acids? A. IgM B. Myoglobin C. IgE D. C3 E. IgA F. Pre-albumin G. Paraprotein H. Caeruloplasmin I. Alpha-1-antitrypsin J. IgD K. C4 L. CSF M. AFP N. CRP O. Transferrin P. Albumin
P. Albumin
A 70 year old female presents to A&E having fallen over and hit her head. She complains of vision deterioration. Her X-ray showed a ‘pepper pot’ skull and a bone marrow biopsy showed > 30% plasma cells. A. Emphysema B. Alpha-1-antitrypsin deficiency C. Hodgkin's lymphoma D. Sarcoidosis E. Wilson's disease F. Pollycythaemia rubra vera G. Asthma H. Monoclonal gammopathy I. Pneumonia J. Myeloma K. Acute renal failure L. Tuberculosis M. Waldenstrom's macroglobulinaemia N. Amyloidosis O. Chronic myeloid leukaemia P. Hypoalbuminaemia
J. Myeloma
A 60 year old male presents to his GP with symptoms of tiredness, dizziness and loss of vision. He has lymphadenopathy and splenomegaly. Serum electrophoresis shows an IgM spike. A. Emphysema B. Alpha-1-antitrypsin deficiency C. Hodgkin's lymphoma D. Sarcoidosis E. Wilson's disease F. Pollycythaemia rubra vera G. Asthma H. Monoclonal gammopathy I. Pneumonia J. Myeloma K. Acute renal failure L. Tuberculosis M. Waldenstrom's macroglobulinaemia N. Amyloidosis O. Chronic myeloid leukaemia P. Hypoalbuminaemia
M. Waldenstrom’s macroglobulinaemia
A 50 year male with multiple myeloma comes to his GP complaining of ankle swelling. Urine dipstick shows proteinuria. On examination he is also noted to have macroglossia and waxy papules on his face. A. Emphysema B. Alpha-1-antitrypsin deficiency C. Hodgkin's lymphoma D. Sarcoidosis E. Wilson's disease F. Pollycythaemia rubra vera G. Asthma H. Monoclonal gammopathy I. Pneumonia J. Myeloma K. Acute renal failure L. Tuberculosis M. Waldenstrom's macroglobulinaemia N. Amyloidosis O. Chronic myeloid leukaemia P. Hypoalbuminaemia
N. Amyloidosis
How do daily requirements of water for neonates compare with those of adults? A. Vitamin D B. Twice adult requirements C. Pierre-Robin sequence D. Oesophageal atresia E. Defect in renal phosphorylation F. > 6 times adult requirements G. Phosphate H. Cerebral palsy I. Kallman's syndrome J. Calcium K. Alkaline phosphatase L. Defect in receptor M. Defect in renal hydroxylation N. > 3 times adult requirements O. Kernicterus P. Nectrotising enterocolitis
F. > 6 times adult requirements
A 35 year old smoker present to A&E with shortness of breath. He has unintentionally lost weight over the past year. Chest X-ray shows emphysematous changes and FBC shows raised LFTs. A. Emphysema B. Alpha-1-antitrypsin deficiency C. Hodgkin's lymphoma D. Sarcoidosis E. Wilson's disease F. Pollycythaemia rubra vera G. Asthma H. Monoclonal gammopathy I. Pneumonia J. Myeloma K. Acute renal failure L. Tuberculosis M. Waldenstrom's macroglobulinaemia N. Amyloidosis O. Chronic myeloid leukaemia P. Hypoalbuminaemia
B. Alpha-1-antitrypsin deficiency
High fluid intake in neonates during the first week of life is associated with increasing frequency of this condition. A. Vitamin D B. Twice adult requirements C. Pierre-Robin sequence D. Oesophageal atresia E. Defect in renal phosphorylation F. > 6 times adult requirements G. Phosphate H. Cerebral palsy I. Kallman's syndrome J. Calcium K. Alkaline phosphatase L. Defect in receptor M. Defect in renal hydroxylation N. > 3 times adult requirements O. Kernicterus P. Nectrotising enterocolitis
P. Nectrotising enterocolitis
A 3-day-old baby presents with jaundice and has raised levels of unconjugated bilirubin. During examination, he is found to be irritable and has increased muscle tone and lies with an arched back (opisthotonus) A. Vitamin D B. Twice adult requirements C. Pierre-Robin sequence D. Oesophageal atresia E. Defect in renal phosphorylation F. > 6 times adult requirements G. Phosphate H. Cerebral palsy I. Kallman's syndrome J. Calcium K. Alkaline phosphatase L. Defect in receptor M. Defect in renal hydroxylation N. > 3 times adult requirements O. Kernicterus P. Nectrotising enterocolitiis
O. Kernicterus
An X-Ray performed on a preterm baby showed fraying, splaying and cupping of long bones. A blood test showed raised levels of this component. A. Vitamin D B. Twice adult requirements C. Pierre-Robin sequence D. Oesophageal atresia E. Defect in renal phosphorylation F. > 6 times adult requirements G. Phosphate H. Cerebral palsy I. Kallman's syndrome J. Calcium K. Alkaline phosphatase L. Defect in receptor M. Defect in renal hydroxylation N. > 3 times adult requirements O. Kernicterus P. Nectrotising enterocolitiis
K. Alkaline phosphatase
Pseudo vitamin D deficiency 1 is associated with this defect. A. Vitamin D B. Twice adult requirements C. Pierre-Robin sequence D. Oesophageal atresia E. Defect in renal phosphorylation F. > 6 times adult requirements G. Phosphate H. Cerebral palsy I. Kallman's syndrome J. Calcium K. Alkaline phosphatase L. Defect in receptor M. Defect in renal hydroxylation N. > 3 times adult requirements O. Kernicterus P. Nectrotising enterocolitiis
M. Defect in renal hydroxylation
In diabetics, this substance is formed in increased quantities in cells that do not require insulin for glucose uptake. It is injurious to those cells: A. Elevated serum osmolarity B. Amyloid C. Glucose D. Albumin E. Lipoprotein lipase F. Ketone bodies G. HDL cholesterol H. LDL cholesterol I. Insulitis J. Sorbitol
J. Sorbitol
The infant of a mother whose haemoglobin A1C was 9.8% during pregnancy is noted to be irritable, then display seizure activity soon after birth. What substance is decreased in the baby to explain these findings: A. Elevated serum osmolarity B. Amyloid C. Glucose D. Albumin E. Lipoprotein lipase F. Ketone bodies G. HDL cholesterol H. LDL cholesterol I. Insulitis J. Sorbitol
C. Glucose
A patient with a diagnosis of type 1 diabetes mellitus has not taken any insulin for several days. Her breath has a fruity odour. What is detectable in her urine to explain this finding: A. Elevated serum osmolarity B. Amyloid C. Glucose D. Albumin E. Lipoprotein lipase F. Ketone bodies G. HDL cholesterol H. LDL cholesterol I. Insulitis J. Sorbitol
F. Ketone bodies
50 year old male has serum glucose values of 145 and 167 mg/dL on visits to his physician last month. His body mass index is 31. He has not had any major illnesses. The islets of Langerhans in his pancreas may demonstrate: A. Elevated serum osmolarity B. Amyloid C. Glucose D. Albumin E. Lipoprotein lipase F. Ketone bodies G. HDL cholesterol H. LDL cholesterol I. Insulitis J. Sorbitol
B. Amyloid
This patient has type 2 diabetes, associated with amyloid deposition. Examples of localised amyloidosis are Alzheimer’s disease and Type 2 Diabetes. In Alzheimer’s the unique peptide is the beta-amyloid protein (Abeta) and in type 2 diabetes it is the islet amyloid polypeptide (IAPP) also known as amylin. IAPP is an important player in the formation of amyloid deposits and the progression of type 2 diabetes, and may contribute to early beta cell death.
An 11 year old girl has had a month-long course of weight loss despite eating and drinking large amounts of food and fluid. A urinalysis shows pH 5.5, sp gr 1.022, 4+ glucose, no blood, no protein, and 4+ ketones. What most likely prededed the clinical appearance of her disease: A. Elevated serum osmolarity B. Amyloid C. Glucose D. Albumin E. Lipoprotein lipase F. Ketone bodies G. HDL cholesterol H. LDL cholesterol I. Insulitis J. Sorbitol
I. Insulitis
Inflammation of the islets of langerhans. They are infiltrated by T and B lymphocytes, macrophages and dendritic cells.
GH, PRL, FSH. Which three anterior pituitary hormones are missing? A. LH, ACTH, TSH B. Prolactinoma C. Cortisol replacement D. Saline E. Thyroxine replacement F. Estrogen therapy G. VP, LH, TSH H. Addison’s disease I. Sheehan’s syndrome J. Hypothyroidism K. Anorexia Nervosa L. Graves’ disease
A. LH, ACTH, TSH
A 41-yrs-old bank manager consulted his GP to request Viagra. He was also embarrassedA 41-yrs-old bank manager consulted his GP to request Viagra. He was also embarrassed as he had developed gynaecomastia. Serum PRL came back as 16000 mU/L. A. LH, ACTH, TSH B. Prolactinoma C. Cortisol replacement D. Saline E. Thyroxine replacement F. Estrogen therapy G. VP, LH, TSH H. Addison’s disease I. Sheehan’s syndrome J. Hypothyroidism K. Anorexia Nervosa L. Graves’ disease
B. Prolactinoma
Mrs. Jones is 30 yrs-old and has been trying to get pregnant for the past 2 yrs – without success. On a hot summer’s day she visits her GP, complaining that she is depressed as she has put on 3 stones despite trying ‘every diet under the sun’. The GP notices she was wearing a woolly coat and gloves. A. LH, ACTH, TSH B. Prolactinoma C. Cortisol replacement D. Saline E. Thyroxine replacement F. Estrogen therapy G. VP, LH, TSH H. Addison’s disease I. Sheehan’s syndrome J. Hypothyroidism K. Anorexia Nervosa L. Graves’ disease
J. Hypothyroidism
A CPFT confirms a diagnosis of hypopituitarism in Mr. Smith. What is the immediate treatment he should be given? A. LH, ACTH, TSH B. Prolactinoma C. Cortisol replacement D. Saline E. Thyroxine replacement F. Estrogen therapy G. VP, LH, TSH H. Addison’s disease I. Sheehan’s syndrome J. Hypothyroidism K. Anorexia Nervosa L. Graves’ disease
C. Cortisol replacement
A 15-yrs-old school girl with a BMI of 17 complains of amenorrhoea. Blood test results reveal low estrogen, LH and FSH. GH concentration was 24 mU/L. A. LH, ACTH, TSH B. Prolactinoma C. Cortisol replacement D. Saline E. Thyroxine replacement F. Estrogen therapy G. VP, LH, TSH H. Addison’s disease I. Sheehan’s syndrome J. Hypothyroidism K. Anorexia Nervosa L. Graves’ disease
K. Anorexia Nervosa
A 32 year old librarian presents to your clinic complaining of blurring of her vision and amenorrhoea. She has a BMI of 22 and is generally well but has noticed some white secretions from her breast over the past 3 months. What would be a first line investigation for this lady? A. GH B. Insulin C. Combined Pituitary Function Test D. TSH E. Thyroid function Tests F. Prolactinoma G. ACTH H. Pituitary infarction I. Short Synacthen Test J. Benign nipple discharge K. LH L. Trauma M. CT SCAN
M. CT SCAN
A 56 year old gentlemen presents to his GP with a history of weight gain and lethargy despite trying to lose weight. He also notices that he has been using his electric heater much more recently despite the recent warm weather. Which hormone is likely to be raised? A. GH B. Insulin C. Combined Pituitary Function Test D. TSH E. Thyroid function Tests F. Prolactinoma G. ACTH H. Pituitary infarction I. Short Synacthen Test J. Benign nipple discharge K. LH L. Trauma M. CT SCAN
D. TSH
Mrs Smith is to have a CPFT. She has been starved overnight, IV access has been gained and she was weighed this morning. 100 mcg LHRH and 200 mcg TRH have been combined in a syringe. What other hormone should be added to the mixture before it is administered to the patient for the test to be complete? A. GH B. Insulin C. Combined Pituitary Function Test D. TSH E. Thyroid function Tests F. Prolactinoma G. ACTH H. Pituitary infarction I. Short Synacthen Test J. Benign nipple discharge K. LH L. Trauma M. CT SCAN
B. Insulin
A 53 year old man presents to his GP with headaches and poor eyesight. He has also noticed that his shoes are now too small for him. His GP tells him he thinks he should have a test done to detect the levels of a specific hormone in his blood. What is this hormone? A. GH B. Insulin C. Combined Pituitary Function Test D. TSH E. Thyroid function Tests F. Prolactinoma G. ACTH H. Pituitary infarction I. Short Synacthen Test J. Benign nipple discharge K. LH L. Trauma M. CT SCAN
A. GH
A 32 year old librarian presents to your clinic complaining of blurring of her vision and amenorrhoea. She has a BMI of 22 and is generally well but has noticed some white secretions from her breast over the past 3 months. What is the MOST likely diagnosis? A. GH B. Insulin C. Combined Pituitary Function Test D. TSH E. Thyroid function Tests F. Prolactinoma G. ACTH H. Pituitary infarction I. Short Synacthen Test J. Benign nipple discharge K. LH L. Trauma M. CT SCAN
F. Prolactinoma
A 60 year old woman presents with lethargy. Further questioning reveals she has gained weight. An assessment of her mental state suggests she is depressed. A. Thyroid insufficiency B. Corticotrophin insufficiency C. Gonadotrophin insufficiency D. Androgen insufficiency E. Growth hormone insufficency
A. Thyroid insufficiency
A 53 year old man presents with a loss of libido and erectile dysfunction. A. Thyroid insufficiency B. Corticotrophin insufficiency C. Gonadotrophin insufficiency D. Androgen insufficiency E. Growth hormone insufficency
D. Androgen insufficiency
A 32 year old woman presents to her GP with abdominal pain and nausea. She has also been feeling increasingly tired in the afternoon. On leaving her GP, she feels very faint and collapses. A. Thyroid insufficiency B. Corticotrophin insufficiency C. Gonadotrophin insufficiency D. Androgen insufficiency E. Growth hormone insufficency
B. Corticotrophin insufficiency
A 53 year old overweight woman presents with hypertension (140 / 90mm Hg), a triglyceride level of 160mg / dL and a waist circumference of 39 inches. She complains of constant thirst and nocturia. A. Diabetes B. Familial hypertriglyceridaemia C. Renal failure D. Metabolic syndrome E. Lipoprotein lipase deficiency F. Alcohol abuse G. Hypothyroidism H. Biliary obstruction I. Polygenic hypercholesterolaemia
D. Metabolic syndrome
A 6 year old boy presents with episodic abdominal pain and recurrent acute pancreatitis. The plasma is found to have a milky appearance and chylomicrons are found in the plasma following a period of fasting. A. Diabetes B. Familial hypertriglyceridaemia C. Renal failure D. Metabolic syndrome E. Lipoprotein lipase deficiency F. Alcohol abuse G. Hypothyroidism H. Biliary obstruction I. Polygenic hypercholesterolaemia
E. Lipoprotein lipase deficiency
A 28 year old male stock broker presents with palpitations and tension headaches. His plasma cholesterol is 7mmol / L and plasma triglycerides are measured as 30mmol /L A. Diabetes B. Familial hypertriglyceridaemia C. Renal failure D. Metabolic syndrome E. Lipoprotein lipase deficiency F. Alcohol abuse G. Hypothyroidism H. Biliary obstruction I. Polygenic hypercholesterolaemia
F. Alcohol abuse
A 45 year old woman presents with a history of weight gain, constipation and bradycardia. Cholesterol measurement is 6.7 m mol / L and plasma triglycerides are measured at 9mmol/L. A. Diabetes B. Familial hypertriglyceridaemia C. Renal failure D. Metabolic syndrome E. Lipoprotein lipase deficiency F. Alcohol abuse G. Hypothyroidism H. Biliary obstruction I. Polygenic hypercholesterolaemia
G. Hypothyroidism
A 56 year old jaundiced man presents with a raised cholesterol of 6.9 mmol/L. A. Diabetes B. Familial hypertriglyceridaemia C. Renal failure D. Metabolic syndrome E. Lipoprotein lipase deficiency F. Alcohol abuse G. Hypothyroidism H. Biliary obstruction I. Polygenic hypercholesterolaemia
H. Biliary obstruction
The molecule that is formed by the gut after a meal and is the main carrier of dietary triglycerides A. Apolipoprotein A B. Apolipoprotein C. Lipoprotein lipase D. High density lipoprotein (HDL) E. HMG coA reductase F. Cholesterol acyl transferase G. Triglyceride H. Chylomicron I. Intermediate density lipoprotein J. Low density lipoprotein (LDL) K. Very low density lipoprotein (VLDL) L. Gamma-glutyl transferase
H. Chylomicron
This is present on capillaries of adipose tissue and skeletal muscle and it removes triglyceride from lipoproteins. A. Apolipoprotein A B. Apolipoprotein C. Lipoprotein lipase D. High density lipoprotein (HDL) E. HMG coA reductase F. Cholesterol acyl transferase G. Triglyceride H. Chylomicron I. Intermediate density lipoprotein J. Low density lipoprotein (LDL) K. Very low density lipoprotein (VLDL) L. Gamma-glutyl transferase
C. Lipoprotein lipase
The smallest lipoprotein which carries cholesterol from extra-hepatic tissues to the liver for excretion. A. Apolipoprotein A B. Apolipoprotein C. Lipoprotein lipase D. High density lipoprotein (HDL) E. HMG coA reductase F. Cholesterol acyl transferase G. Triglyceride H. Chylomicron I. Intermediate density lipoprotein J. Low density lipoprotein (LDL) K. Very low density lipoprotein (VLDL) L. Gamma-glutyl transferase
D. High density lipoprotein (HDL)
This molecule is present in the fasting state in cases of lipoprotein lipase deficiency. A. Apolipoprotein A B. Apolipoprotein C. Lipoprotein lipase D. High density lipoprotein (HDL) E. HMG coA reductase F. Cholesterol acyl transferase G. Triglyceride H. Chylomicron I. Intermediate density lipoprotein J. Low density lipoprotein (LDL) K. Very low density lipoprotein (VLDL) L. Gamma-glutyl transferase
H. Chylomicron
The first intermediate formed after VLDL particles synthesised by the liver are degraded. A. Apolipoprotein A B. Apolipoprotein C. Lipoprotein lipase D. High density lipoprotein (HDL) E. HMG coA reductase F. Cholesterol acyl transferase G. Triglyceride H. Chylomicron I. Intermediate density lipoprotein J. Low density lipoprotein (LDL) K. Very low density lipoprotein (VLDL) L. Gamma-glutyl transferase
I. Intermediate density lipoprotein
How do daily requirements of water for neonates compare with those of adults? A. Defect in renal hydroxylation B. Kernicterus C. Cerebral palsy D. Oesophageal atresia E. Alkaline phosphatase F. Vitamin D G. Nectrotising enterocolitis H. Phosphate I. Kallman's syndrome J. > 3 times adult requirements K. Defect in renal phosphorylation L. Defect in receptor M. > 6 times adult requirements N. Twice adult requirements O. Calcium P. Pierre-Robin sequence
M. > 6 times adult requirements
High fluid intake in neonates during the first week of life is associated with increasing frequency of this condition. A. Defect in renal hydroxylation B. Kernicterus C. Cerebral palsy D. Oesophageal atresia E. Alkaline phosphatase F. Vitamin D G. Nectrotising enterocolitis H. Phosphate I. Kallman's syndrome J. > 3 times adult requirements K. Defect in renal phosphorylation L. Defect in receptor M. > 6 times adult requirements N. Twice adult requirements O. Calcium P. Pierre-Robin sequence
G. Nectrotising enterocolitis
A 3-day-old baby presents with jaundice and has raised levels of unconjugated bilirubin. During examination, he is found to be irritable and has increased muscle tone and lies with an arched back (opisthotonus) A. Defect in renal hydroxylation B. Kernicterus C. Cerebral palsy D. Oesophageal atresia E. Alkaline phosphatase F. Vitamin D G. Nectrotising enterocolitis H. Phosphate I. Kallman's syndrome J. > 3 times adult requirements K. Defect in renal phosphorylation L. Defect in receptor M. > 6 times adult requirements N. Twice adult requirements O. Calcium P. Pierre-Robin sequence
B. Kernicterus
An X-Ray performed on a preterm baby showed fraying, splaying and cupping of long bones. A blood test showed raised levels of this component. A. Defect in renal hydroxylation B. Kernicterus C. Cerebral palsy D. Oesophageal atresia E. Alkaline phosphatase F. Vitamin D G. Nectrotising enterocolitis H. Phosphate I. Kallman's syndrome J. > 3 times adult requirements K. Defect in renal phosphorylation L. Defect in receptor M. > 6 times adult requirements N. Twice adult requirements O. Calcium P. Pierre-Robin sequence
E. Alkaline phosphatase
Pseudo vitamin D deficiency 1 is associated with this defect. A. Defect in renal hydroxylation B. Kernicterus C. Cerebral palsy D. Oesophageal atresia E. Alkaline phosphatase F. Vitamin D G. Nectrotising enterocolitis H. Phosphate I. Kallman's syndrome J. > 3 times adult requirements K. Defect in renal phosphorylation L. Defect in receptor M. > 6 times adult requirements N. Twice adult requirements O. Calcium P. Pierre-Robin sequence
A. Defect in renal hydroxylation
A 3-week-old male is seen by a paediatrician because of severe jaundice that appeared at birth and has been worsening ever since. A. 21 hydroxylase deficiency B. Crigler-Najjar syndrome C. Rickets D. Pellagra E. Ehlers-Danlos syndrome F. Lesch-Nyhan syndrome G. Alpha 1 antitrypsin deficiency H. 17 alpha hydroxylase deficiency I. Phenylketonuria J. Hereditary spherocytosis K. Scurvy L. Rheumatoid arthritis M. Folate deficiency N. Glucose-6-phosphate dehydrogenase deficiency O. Autism P. 5 alpha reductase deficiency
B. Crigler-Najjar syndrome
A young boy presents to his GP with jaundice. He is also found to have haemoglobinuria, splenomegaly and anaemia. His mother reveals that he was jaundiced at birth and needed a blood transfusion. A. 21 hydroxylase deficiency B. Crigler-Najjar syndrome C. Rickets D. Pellagra E. Ehlers-Danlos syndrome F. Lesch-Nyhan syndrome G. Alpha 1 antitrypsin deficiency H. 17 alpha hydroxylase deficiency I. Phenylketonuria J. Hereditary spherocytosis K. Scurvy L. Rheumatoid arthritis M. Folate deficiency N. Glucose-6-phosphate dehydrogenase deficiency O. Autism P. 5 alpha reductase deficiency
N. Glucose-6-phosphate dehydrogenase deficiency
A 15-month-old boy is brought to the paediatric clinic by his parents because of delayed dentition, poor growth and development, frequent crying, weakness, and constipation. A. 21 hydroxylase deficiency B. Crigler-Najjar syndrome C. Rickets D. Pellagra E. Ehlers-Danlos syndrome F. Lesch-Nyhan syndrome G. Alpha 1 antitrypsin deficiency H. 17 alpha hydroxylase deficiency I. Phenylketonuria J. Hereditary spherocytosis K. Scurvy L. Rheumatoid arthritis M. Folate deficiency N. Glucose-6-phosphate dehydrogenase deficiency O. Autism P. 5 alpha reductase deficiency
C. Rickets
A newborn is evaluated by a paediatrician after the obstetrician performing the delivery was unable to tell whether the child is male or female. A. 21 hydroxylase deficiency B. Crigler-Najjar syndrome C. Rickets D. Pellagra E. Ehlers-Danlos syndrome F. Lesch-Nyhan syndrome G. Alpha 1 antitrypsin deficiency H. 17 alpha hydroxylase deficiency I. Phenylketonuria J. Hereditary spherocytosis K. Scurvy L. Rheumatoid arthritis M. Folate deficiency N. Glucose-6-phosphate dehydrogenase deficiency O. Autism P. 5 alpha reductase deficiency
A. 21 hydroxylase deficiency
A 18 month old male is brought to the paediatrician by his mother because of repeated, self-mutilating biting of his fingers and lips and delayed motor development. The patient’s mother has also noticed abundant, orange-coloured “sand” (uric acid crystals) in the child’s nappies. A. 21 hydroxylase deficiency B. Crigler-Najjar syndrome C. Rickets D. Pellagra E. Ehlers-Danlos syndrome F. Lesch-Nyhan syndrome G. Alpha 1 antitrypsin deficiency H. 17 alpha hydroxylase deficiency I. Phenylketonuria J. Hereditary spherocytosis K. Scurvy L. Rheumatoid arthritis M. Folate deficiency N. Glucose-6-phosphate dehydrogenase deficiency O. Autism P. 5 alpha reductase deficiency
F. Lesch-Nyhan syndrome
An abnormality tested for by the Guthrie blood spot test A. Cystic Fibrosis B. Medium chain acyl CoA dehydrogenase deficiency (MCAD) C. Organic acidurias D. Congenital adrenal hyperplasia E. PKU F. Galactosaemia G. Biotinidase deficiency H. Congenital hypothyroidism I. Homocystinuria J. Sickle cell K. Urea cycle disorders
E. PKU
An abnormaility that is tested for using electrophoresis A. Cystic Fibrosis B. Medium chain acyl CoA dehydrogenase deficiency (MCAD) C. Organic acidurias D. Congenital adrenal hyperplasia E. PKU F. Galactosaemia G. Biotinidase deficiency H. Congenital hypothyroidism I. Homocystinuria J. Sickle cell K. Urea cycle disorders
J. Sickle cell
A fatty acid oxidation defect A. Cystic Fibrosis B. Medium chain acyl CoA dehydrogenase deficiency (MCAD) C. Organic acidurias D. Congenital adrenal hyperplasia E. PKU F. Galactosaemia G. Biotinidase deficiency H. Congenital hypothyroidism I. Homocystinuria J. Sickle cell K. Urea cycle disorders
B. Medium chain acyl CoA dehydrogenase deficiency (MCAD)
An abnormality that is indicated by a high level of TSH A. Cystic Fibrosis B. Medium chain acyl CoA dehydrogenase deficiency (MCAD) C. Organic acidurias D. Congenital adrenal hyperplasia E. PKU F. Galactosaemia G. Biotinidase deficiency H. Congenital hypothyroidism I. Homocystinuria J. Sickle cell K. Urea cycle disorders
H. Congenital hypothyroidism
An abnormality that may result in androgenisation and pigmentation among other signs and symptoms A. Cystic Fibrosis B. Medium chain acyl CoA dehydrogenase deficiency (MCAD) C. Organic acidurias D. Congenital adrenal hyperplasia E. PKU F. Galactosaemia G. Biotinidase deficiency H. Congenital hypothyroidism I. Homocystinuria J. Sickle cell K. Urea cycle disorders
D. Congenital adrenal hyperplasia
A 2-month Canadian neonate presents with failure to thrive, jaundice and sepsis. You are screening for metabolic disorders, what 1st line test would you recommend? A. Urine organic acids B. Urine sugar chromotography C. Amino acids (urine and plasma) D. Galactase-1-phosphate uridyl transferase E. Glucose and lactate F. Medium chain acyl coA dehydrogenase G. Very long chain fatty acids H. Plasma ammonia I. Plasma lactate J. Transferrin glycoforms
C. Amino acids (urine and plasma)
A male infant presents with failure to thrive, neurological signs (including tremor) and tachypnea. From our metabolic disorders screen, which 1st line test is likely to be abnormal? A. Urine organic acids B. Urine sugar chromotography C. Amino acids (urine and plasma) D. Galactase-1-phosphate uridyl transferase E. Glucose and lactate F. Medium chain acyl coA dehydrogenase G. Very long chain fatty acids H. Plasma ammonia I. Plasma lactate J. Transferrin glycoforms
H. Plasma ammonia
A neonate has seizures, conjugated hyperbilirubinaemia and the 3rd year med student’s clinical observation is that “he looks weird!” From our metabolic disorders screen, which 1st line test is likely to be abnormal? A. Urine organic acids B. Urine sugar chromotography C. Amino acids (urine and plasma) D. Galactase-1-phosphate uridyl transferase E. Glucose and lactate F. Medium chain acyl coA dehydrogenase G. Very long chain fatty acids H. Plasma ammonia I. Plasma lactate J. Transferrin glycoforms
G. Very long chain fatty acids
A post mortem diagnosis of an inborn error of metabolism is investigated in a case of “sudden infant death”. What deficiency is the most likely cause? A. Urine organic acids B. Urine sugar chromotography C. Amino acids (urine and plasma) D. Galactase-1-phosphate uridyl transferase E. Glucose and lactate F. Medium chain acyl coA dehydrogenase G. Very long chain fatty acids H. Plasma ammonia I. Plasma lactate J. Transferrin glycoforms
F. Medium chain acyl coA dehydrogenase
A neonate with a history of feeding difficulties presents with jaundice, cataracts and sepsis. What deficiency is the most likely cause? A. Urine organic acids B. Urine sugar chromotography C. Amino acids (urine and plasma) D. Galactase-1-phosphate uridyl transferase E. Glucose and lactate F. Medium chain acyl coA dehydrogenase G. Very long chain fatty acids H. Plasma ammonia I. Plasma lactate J. Transferrin glycoforms
D. Galactase-1-phosphate uridyl transferase
A 49 year old man complains of recent severe pain in his left first toe, both knees and ankles. This occurred after a heavy Friday night out. On examination there was marked swelling and redness of the toe. The pain was especially evident if touched A. Lactic acid accumulation B. Ethanol C. Leukaemia D. Idiopathic E. Lesch-Nyhan Syndrome F. Glucose 6 phosphatase deficiency G. Hyperlipidaemia H. Diet I. Low dose aspirin J. Thiazide diuretics K. High dose asprin L. Renal Failure
B. Ethanol
A 55 year old man complains of swelling of his legs, pain in his ankles and left big toe and tiredness. On examination, there is oedema of his legs, swelling and redness on his ankles and left MTP joint. He has gross proteinurea and the serum albumin is 30 g/L A. Lactic acid accumulation B. Ethanol C. Leukaemia D. Idiopathic E. Lesch-Nyhan Syndrome F. Glucose 6 phosphatase deficiency G. Hyperlipidaemia H. Diet I. Low dose aspirin J. Thiazide diuretics K. High dose asprin L. Renal Failure
L. Renal Failure
A 48 year old gentleman develops a painful right big toe two days after being admitted into hospital with a BP of 180/120. A. Lactic acid accumulation B. Ethanol C. Leukaemia D. Idiopathic E. Lesch-Nyhan Syndrome F. Glucose 6 phosphatase deficiency G. Hyperlipidaemia H. Diet I. Low dose aspirin J. Thiazide diuretics K. High dose asprin L. Renal Failure
J. Thiazide diuretics
A 58-year old man presents with lethargy and generalised weakness. He has a 2 year history of upper abdominal pain especially after meals and suffered a myocardial infarct 3 years ago. Recently he has noticed swelling in his right first toe. Examination reveals tenderness in the epigastrium. No masses are felt and there is no organomegaly. Endoscopy reveals an active duodenal ulcer A. Lactic acid accumulation B. Ethanol C. Leukaemia D. Idiopathic E. Lesch-Nyhan Syndrome F. Glucose 6 phosphatase deficiency G. Hyperlipidaemia H. Diet I. Low dose aspirin J. Thiazide diuretics K. High dose asprin L. Renal Failure
I. Low dose aspirin
An 8 year old boy, showing signs of slow development, presents with a painful right knee which on examination was hot and swollen. Scratch marks on his face were also observed. An aspiration of the synovial fluid from the joint revealed crystals which were negatively birefringent. A. Lactic acid accumulation B. Ethanol C. Leukaemia D. Idiopathic E. Lesch-Nyhan Syndrome F. Glucose 6 phosphatase deficiency G. Hyperlipidaemia H. Diet I. Low dose aspirin J. Thiazide diuretics K. High dose asprin L. Renal Failure
E. Lesch-Nyhan Syndrome
Mr Smith has a history of end-stage renal failure. Routine blood tests demonstrate an adjusted serum calcium of 3.2mmol/L and elevated PTH levels. A. Paget’s Disease B. Hypocalcaemia C. Hypercalcaemia D. Secondary Hyperparathyroidism E. Diabetes Mellitus F. Amyloidosis G. Papillary Carcinoma H. Medullary Carcinoma I. Osteomalacia J. Tertiary Hyperparathyroidism K. Multiple Myeloma
J. Tertiary Hyperparathyroidism
Mrs Jones presents to her GP complaining of abdominal pain, bone pain, nausea and constipation. Her adjusted serum calcium was found to be 3.2mmol/L with undetectable PTH. Serum electrophoresis demonstrates a monoclonal band. A. Paget’s Disease B. Hypocalcaemia C. Hypercalcaemia D. Secondary Hyperparathyroidism E. Diabetes Mellitus F. Amyloidosis G. Papillary Carcinoma H. Medullary Carcinoma I. Osteomalacia J. Tertiary Hyperparathyroidism K. Multiple Myeloma
K. Multiple Myeloma
Chronic renal failure is one of the commonest causes of hypercalcaemia. What is the commonest cause of end stage renal failure in Europe? A. Paget’s Disease B. Hypocalcaemia C. Hypercalcaemia D. Secondary Hyperparathyroidism E. Diabetes Mellitus F. Amyloidosis G. Papillary Carcinoma H. Medullary Carcinoma I. Osteomalacia J. Tertiary Hyperparathyroidism K. Multiple Myeloma
E. Diabetes Mellitus
Chvostek’s sign and trousseau’s sign are positive in A. Paget’s Disease B. Hypocalcaemia C. Hypercalcaemia D. Secondary Hyperparathyroidism E. Diabetes Mellitus F. Amyloidosis G. Papillary Carcinoma H. Medullary Carcinoma I. Osteomalacia J. Tertiary Hyperparathyroidism K. Multiple Myeloma
B. Hypocalcaemia
A 20yr old gentleman presents to his GP with a lump in his neck. He has noticed the lump getting bigger. Examination reveals the lump to be in the thyroid gland. FNA and cytology reveals the diagnosis. A. Paget’s Disease B. Hypocalcaemia C. Hypercalcaemia D. Secondary Hyperparathyroidism E. Diabetes Mellitus F. Amyloidosis G. Papillary Carcinoma H. Medullary Carcinoma I. Osteomalacia J. Tertiary Hyperparathyroidism K. Multiple Myeloma
G. Papillary Carcinoma
A 32 year old female complains for severe thirst. On further questioning she also suffers from mild depression, abdominal pains and has a history of broken bones. Her calcium levels are raised. A. Tertiary hyperparathyroidism B. Paget's disease of the bone C. Primary hypoparathyroidism D. Primary hyperparathyroidism E. Hypercalcaemia F. Pseudopseudohypoparathyroidism G. Secondary hyperparathyroidism H. Malignant hypercalcaemia I. Pseudohypoparathyroidism J. Hypocalcaemia
D. Primary hyperparathyroidism
A 45 year old smoker has recently been diagnosed with lung cancer. He has raised levels of calcium but low levels of PTH A. Tertiary hyperparathyroidism B. Paget's disease of the bone C. Primary hypoparathyroidism D. Primary hyperparathyroidism E. Hypercalcaemia F. Pseudopseudohypoparathyroidism G. Secondary hyperparathyroidism H. Malignant hypercalcaemia I. Pseudohypoparathyroidism J. Hypocalcaemia
H. Malignant hypercalcaemia
A 37 year old man has a round face, short metacarpals and metatarsals. He complains of mild depression and has a carpopedal spasm. Plasma PTH is raised and alk phos is slightly raised too. A. Tertiary hyperparathyroidism B. Paget's disease of the bone C. Primary hypoparathyroidism D. Primary hyperparathyroidism E. Hypercalcaemia F. Pseudopseudohypoparathyroidism G. Secondary hyperparathyroidism H. Malignant hypercalcaemia I. Pseudohypoparathyroidism J. Hypocalcaemia
I. Pseudohypoparathyroidism
A 67 year old Caucasian woman complains of pain in her clavicle and recent loss of hearing. X-rays show localized enlargement of bone. Blood biochemistry revealed normal calcium and phosphate levels however her alk phos is very high. A. Tertiary hyperparathyroidism B. Paget's disease of the bone C. Primary hypoparathyroidism D. Primary hyperparathyroidism E. Hypercalcaemia F. Pseudopseudohypoparathyroidism G. Secondary hyperparathyroidism H. Malignant hypercalcaemia I. Pseudohypoparathyroidism J. Hypocalcaemia
B. Paget’s disease of the bone
A 52 year old man has recently had a kidney transplant. He now complains of stiff joints and abdominal pain. On investigation his blood pressure was raised and his calcium was raised. A. Tertiary hyperparathyroidism B. Paget's disease of the bone C. Primary hypoparathyroidism D. Primary hyperparathyroidism E. Hypercalcaemia F. Pseudopseudohypoparathyroidism G. Secondary hyperparathyroidism H. Malignant hypercalcaemia I. Pseudohypoparathyroidism J. Hypocalcaemia
A. Tertiary hyperparathyroidism
A 50 year old woman presents with pain and stiffness in her hands. On further questioning she reveals that she also has pain in her back, hips and knees, which is worse in the evenings. A. Osteoporosis B. Rheumatoid arthritis C. Pseudogout D. Osteomalacia E. Gout F. Septic arthritis G. Osteoarthritis H. Ankylosing spondylitis I. Paget's disease J. Primary hyperparathyroidism K. Myeloma
G. Osteoarthritis
A 40 year woman presents with pain, swelling and stiffness in her hands. On further questioning she revels that she also has pain in her wrists, shoulders and knees which is worse in the mornings. A. Osteoporosis B. Rheumatoid arthritis C. Pseudogout D. Osteomalacia E. Gout F. Septic arthritis G. Osteoarthritis H. Ankylosing spondylitis I. Paget's disease J. Primary hyperparathyroidism K. Myeloma
B. Rheumatoid arthritis
A 24 year old man presents with pain and stiffness in his buttocks and lower back which is worse when he wakes up in the mornings, but eases after he has gone to the gym. On further questioning he reveals that he has had 2 similar episodes in the past. A. Osteoporosis B. Rheumatoid arthritis C. Pseudogout D. Osteomalacia E. Gout F. Septic arthritis G. Osteoarthritis H. Ankylosing spondylitis I. Paget's disease J. Primary hyperparathyroidism K. Myeloma
H. Ankylosing spondylitis
A 50 year old obese, hypertensive man presents with a 2 day history of a painful, swollen, red toe. On further questioning he reveals that the symptoms had started the morning after the office party, where he ingested large amounts of alcohol. A. Osteoporosis B. Rheumatoid arthritis C. Pseudogout D. Osteomalacia E. Gout F. Septic arthritis G. Osteoarthritis H. Ankylosing spondylitis I. Paget's disease J. Primary hyperparathyroidism K. Myeloma
E. Gout
A 60 year old woman presents with pain in her back and knees. It was noted that she had bowed legs, and her blood tests revealed a lone increase in Alkaline Phosphatase. A. Osteoporosis B. Rheumatoid arthritis C. Pseudogout D. Osteomalacia E. Gout F. Septic arthritis G. Osteoarthritis H. Ankylosing spondylitis I. Paget's disease J. Primary hyperparathyroidism K. Myeloma
I. Paget’s disease
A 50 year old man was admitted to hospital in a confused state. He was dyspnoeic and had a cough productive of sputum. He was unable to give a coherent history but one of the casualty officers knew him to be a type 1 diabetic patient with a history of COPD. Arterial blood: pH 7.18, pCO2 7.4kPa, Bicarbonate: 20
A. Acute respiratory alkalosis with co-existent metabolic acidosis
B. Respiratory acidosis
C. Compensated respiratory alkalosis
D. Respiratory alkalosis
E. Metabolic alkalosis with compensatory hypoventilation
F. Metabolic acidosis
G. Mixed respiratory and metabolic acidosis
H. Metabolic alkalosis
I. Compensatory metabolic alkalosis
G. Mixed respiratory and metabolic acidosis
A young woman was admitted to hospital 8 hours after she had taken an overdose of aspirin. Arterial blood: H+ - 30nmol/L, pH – 7.53, pCO2 – 2.0kPa
A. Acute respiratory alkalosis with co-existent metabolic acidosis
B. Respiratory acidosis
C. Compensated respiratory alkalosis
D. Respiratory alkalosis
E. Metabolic alkalosis with compensatory hypoventilation
F. Metabolic acidosis
G. Mixed respiratory and metabolic acidosis
H. Metabolic alkalosis
I. Compensatory metabolic alkalosis
A. Acute respiratory alkalosis with co-existent metabolic acidosis
A young woman was admitted to hospital unconscious, following a head injury. A skull fracture was demonstrated on radiography and a CT scan revealed extensive cerebral contusions. The respiratory rate was increased, at 38/min. 3 days after admission, the patient’s condition was unchanged. Arterial blood: H+ - 36nmol/L, pH – 7.44, pCO2 – 3.6kPa, Bicarbonate – 19mmol/L
A. Acute respiratory alkalosis with co-existent metabolic acidosis
B. Respiratory acidosis
C. Compensated respiratory alkalosis
D. Respiratory alkalosis
E. Metabolic alkalosis with compensatory hypoventilation
F. Metabolic acidosis
G. Mixed respiratory and metabolic acidosis
H. Metabolic alkalosis
I. Compensatory metabolic alkalosis
C. Compensated respiratory alkalosis
A 45 year old man was admitted to hospital with a history of persistent vomiting, He had a long history of dydpepsia but had never sought advice for this, preferring to treat himself with proprietary remedies. On examination, he was obviously dehydrated and his respiration was shallow. Arterial blood: H+ - 28nmol/L, pH – 7.56, pCO2 – 7.2kPa, Bicarbonate – 45mmol/L. Serum: Na+ - 146, K+ - 2.8, Urea – 34.2. A barium meal showed pyloric stenosis, thought to be due to scaring caused by peptic ulceration.
A. Acute respiratory alkalosis with co-existent metabolic acidosis
B. Respiratory acidosis
C. Compensated respiratory alkalosis
D. Respiratory alkalosis
E. Metabolic alkalosis with compensatory hypoventilation
F. Metabolic acidosis
G. Mixed respiratory and metabolic acidosis
H. Metabolic alkalosis
I. Compensatory metabolic alkalosis
E. Metabolic alkalosis with compensatory hypoventilation
A young man sustained injury to the chest in a road traffic accident. Effective ventilation was compromised by a large flail segment. Arterial blood: pO2 – 8kPa, pCO2 – 8kPa, pH – 7.24, H+ - 58nmol/L, Bicarbonate – 25mmol/L
A. Acute respiratory alkalosis with co-existent metabolic acidosis
B. Respiratory acidosis
C. Compensated respiratory alkalosis
D. Respiratory alkalosis
E. Metabolic alkalosis with compensatory hypoventilation
F. Metabolic acidosis
G. Mixed respiratory and metabolic acidosis
H. Metabolic alkalosis
I. Compensatory metabolic alkalosis
B. Respiratory acidosis
Which of these is associated with Wilson’s disease? A. IgM B. Myoglobin C. IgE D. C3 E. IgA F. Pre-albumin G. Paraprotein H. Caeruloplasmin I. Alpha-1-antitrypsin J. IgD K. C4 L. CSF M. AFP N. CRP O. Transferrin P. Albumin
H. Caeruloplasmin
Increases of what is a cardiovascular risk factor? A. IgM B. Myoglobin C. IgE D. C3 E. IgA F. Pre-albumin G. Paraprotein H. Caeruloplasmin I. Alpha-1-antitrypsin J. IgD K. C4 L. CSF M. AFP N. CRP O. Transferrin P. Albumin
N. CRP
What is the major antagonist of serine proteases at a site of injury? A. IgM B. Myoglobin C. IgE D. C3 E. IgA F. Pre-albumin G. Paraprotein H. Caeruloplasmin I. Alpha-1-antitrypsin J. IgD K. C4 L. CSF M. AFP N. CRP O. Transferrin P. Albumin
I. Alpha-1-antitrypsin
Which is associated with type 1 hypersensitivity? A. IgM B. Myoglobin C. IgE D. C3 E. IgA F. Pre-albumin G. Paraprotein H. Caeruloplasmin I. Alpha-1-antitrypsin J. IgD K. C4 L. CSF M. AFP N. CRP O. Transferrin P. Albumin
C. IgE
Which can act as a source of amino acids? A. IgM B. Myoglobin C. IgE D. C3 E. IgA F. Pre-albumin G. Paraprotein H. Caeruloplasmin I. Alpha-1-antitrypsin J. IgD K. C4 L. CSF M. AFP N. CRP O. Transferrin P. Albumin
P. Albumin
A 70 year old female presents to A&E having fallen over and hit her head. She complains of vision deterioration. Her X-ray showed a ‘pepper pot’ skull and a bone marrow biopsy showed > 30% plasma cells. A. Emphysema B. Alpha-1-antitrypsin deficiency C. Hodgkin's lymphoma D. Sarcoidosis E. Wilson's disease F. Pollycythaemia rubra vera G. Asthma H. Monoclonal gammopathy I. Pneumonia J. Myeloma K. Acute renal failure L. Tuberculosis M. Waldenstrom's macroglobulinaemia N. Amyloidosis O. Chronic myeloid leukaemia P. Hypoalbuminaemia
J. Myeloma
A 60 year old male presents to his GP with symptoms of tiredness, dizziness and loss of vision. He has lymphadenopathy and splenomegaly. Serum electrophoresis shows an IgM spike. A. Emphysema B. Alpha-1-antitrypsin deficiency C. Hodgkin's lymphoma D. Sarcoidosis E. Wilson's disease F. Pollycythaemia rubra vera G. Asthma H. Monoclonal gammopathy I. Pneumonia J. Myeloma K. Acute renal failure L. Tuberculosis M. Waldenstrom's macroglobulinaemia N. Amyloidosis O. Chronic myeloid leukaemia P. Hypoalbuminaemia
M. Waldenstrom’s macroglobulinaemia
A 50 year male with multiple myeloma comes to his GP complaining of ankle swelling. Urine dipstick shows proteinuria. On examination he is also noted to have macroglossia and waxy papules on his face. A. Emphysema B. Alpha-1-antitrypsin deficiency C. Hodgkin's lymphoma D. Sarcoidosis E. Wilson's disease F. Pollycythaemia rubra vera G. Asthma H. Monoclonal gammopathy I. Pneumonia J. Myeloma K. Acute renal failure L. Tuberculosis M. Waldenstrom's macroglobulinaemia N. Amyloidosis O. Chronic myeloid leukaemia P. Hypoalbuminaemia
N. Amyloidosis
A 19 year old student presents to A&E with shortness of breath, cough and pleuritic chest pain. Sputum is sent for culture and FBC shows a raised CRP. A. Emphysema B. Alpha-1-antitrypsin deficiency C. Hodgkin's lymphoma D. Sarcoidosis E. Wilson's disease F. Pollycythaemia rubra vera G. Asthma H. Monoclonal gammopathy I. Pneumonia J. Myeloma K. Acute renal failure L. Tuberculosis M. Waldenstrom's macroglobulinaemia N. Amyloidosis O. Chronic myeloid leukaemia P. Hypoalbuminaemia
I. Pneumonia
A 35 year old smoker present to A&E with shortness of breath. He has unintentionally lost weight over the past year. Chest X-ray shows emphysematous changes and FBC shows raised LFTs. A. Emphysema B. Alpha-1-antitrypsin deficiency C. Hodgkin's lymphoma D. Sarcoidosis E. Wilson's disease F. Pollycythaemia rubra vera G. Asthma H. Monoclonal gammopathy I. Pneumonia J. Myeloma K. Acute renal failure L. Tuberculosis M. Waldenstrom's macroglobulinaemia N. Amyloidosis O. Chronic myeloid leukaemia P. Hypoalbuminaemia
B. Alpha-1-antitrypsin deficiency
