EMQ's on Enzymes Flashcards
Which one is increased in a patient with Paget’s disease of the bone?
A) Acid phosphatase B) Alanine aminotransferase (ALT) C) Alkaline phosphatase (ALP) D) Aspartate amino transferase (AST) E) Calcium F) Cholesterol G) Creatinine H) Fructosamine I) Glucose J) HBA1c K) Potassium L) Sodium M) Triglyceride N) Urea O) Vitamin D
C) Alkaline phosphatase (ALP)
Which one is increased in a patient with osteomalacia?
A) Acid phosphatase B) Alanine aminotransferase (ALT) C) Alkaline phosphatase (ALP) D) Aspartate amino transferase (AST) E) Calcium F) Cholesterol G) Creatinine H) Fructosamine I) Glucose J) HBA1c K) Potassium L) Sodium M) Triglyceride N) Urea O) Vitamin D
C) Alkaline phosphatase (ALP)
Due to bone remodelling
Calcium low as VIT D not there to cause uptake in gut
Phosphate low due to excess PTH
Which one is increased in a patient following an acute myocardial infarction?
A) Acid phosphatase B) Alanine aminotransferase (ALT) C) Alkaline phosphatase (ALP) D) Aspartate amino transferase (AST) E) Calcium F) Cholesterol G) Creatinine H) Fructosamine I) Glucose J) HBA1c K) Potassium L) Sodium M) Triglyceride N) Urea O) Vitamin D
G) AST
AST found in muscles and is released during muscle damage/inflammation
High for 3 to 14 days after MI.
These 3 also released:
Troponins - ECG most useful. Trop good for ruling out cardiac causes, not great for confirming cardiac: if theres elevated trop but you’re not sure about the diagnosis
CK - Excessively high CK (usually secondary to massive muscle trauma). Rehydrate and give bicarb to prevent AKI
LDH
Which one is raised in Addison’s disease?
A) Acid phosphatase B) Alanine aminotransferase (ALT) C) Alkaline phosphatase (ALP) D) Aspartate amino transferase (AST) E) Calcium F) Cholesterol G) Creatinine H) Fructosamine I) Glucose J) HBA1c K) Potassium L) Sodium M) Triglyceride N) Urea O) Vitamin D
K) Potassium
Sodium is low in Addisons
What kind of scan to look for abdominal organ metastases?
FDG PET scan
Uptake by cells which need a lot of glucose e.g. Tumours
Kidneys always show up hot
What kind of scan to look for bony mets
Technetium Bisphosphonate
Kidneys always show up hot
What kind of scan to look for neuro endocrine tumours?
Gallium 68 PET/CT
Binds to somatostatin receptors, not glucose
Adrenals and Spleen will always look hot on these scans
Kidneys always show up hot
Which one of these is raised most in patient with jaundice caused by a gallstone?
A) Acid phosphatase B) Alanine aminotransferase (ALT) C) Alkaline phosphatase (ALP) D) Aspartate amino transferase (AST) E) Calcium F) Cholesterol G) Creatinine H) Fructosamine I) Glucose J) HBA1c K) Potassium L) Sodium M) Triglyceride N) Urea O) Vitamin D
C) Alkaline phosphatase (ALP)
Bile duct blockage causes ALP rise
2 most common causes: Gall stones (Usually painful, jaundiced, raised ALP) or Pancreatic Head Cancer (Usually painful, jaundiced, raised ALP)
Which is the preferred management for Severe Alcoholic Hepatitis?
A) Nutritional Support
B) Acycolvir
C) Alcohol abistnence
D) Prednisolone
D) Prednisolone
A) and C) will need to be done, but D is the immediate management
What is the cause of oesophageal varices in Liver failure?
Portal hypertension, secondary to cirrhosis
How do you immediately manage alcoholic patient vomiting blood?
Band ligation and possible sclerotherapy
Management of recurrent esophageal varices rupture
TIPPS
What’s in the portal triad?
Portal vein, hepatic artery, bile duct
Which one is most increased in viral hepatitis?
A) Acid phosphatase B) Alanine aminotransferase (ALT) C) Alkaline phosphatase (ALP) D) Aspartate amino transferase (AST) E) Calcium F) Cholesterol G) Creatinine H) Fructosamine I) Glucose J) HBA1c K) Potassium L) Sodium M) Triglyceride N) Urea O) Vitamin D
B) Alanine aminotransferase (ALT)
though AST and ALT will be raised
viraL = aLt
Which one is most increased in alcoholic cirrhosis?
A) Acid phosphatase B) Alanine aminotransferase (ALT) C) Alkaline phosphatase (ALP) D) Aspartate amino transferase (AST) E) Calcium F) Cholesterol G) Creatinine H) Fructosamine I) Glucose J) HBA1c K) Potassium L) Sodium M) Triglyceride N) Urea O) Vitamin D
D) Aspartate amino transferase (AST)
Alcoholic cirrhosisS = aSt
Due to destruction by repeated episodes of cell death and nodular regeneration
