Imm/metabolic med

Question 1

in tx of anaphylaxis, how often can you repeat doses of adrenaline?

Answer 1

5 mins

Question 2

Oral allergy syndrome is strongly linked with??

Answer 2

history of allergic rhinitis and seasonal pollen allergy

would present as allergy to certain foods

Question 3

6 months - 6 years adrenaline dose for anaphylaxis =

Answer 3

150 mcg (0.15ml 1 in 1,000)

Question 4

Anaphylaxis: A child aged 6-11 years should be administered adrenaline at a dose of?

Answer 4

300mcg (0.3ml), repeated every 5 minutes if necessary

Question 5

A man presents with an area of dermatitis on his left wrist. He thinks he may be allergic to nickel. Which one of the following is the best test to investigate this possibility?

Answer 5

skin patch test

Question 6

Patients who have had emergency treatment for anaphylaxis should be observed for??

Answer 6

6-12h from onset of sx

Question 7

You are teaching a man about how to use an EpiPen (adrenline auto-injector). What is the most appropriate advice about where to inject the pen?

Answer 7

anterolateral aspect of middle third of thigh

Question 8

13+ years old: adrenaline dose?

Answer 8

500mcg` (0.5ml)

Question 9

After a suspected anaphylactic reaction in adults and young people aged 16 years or older, timed blood samples for mast cell tryptase should be taken as follows:

Answer 9

As soon as possible after emergency treatment has started

A second sample ideally within 1-2 hours ( but no later than 4 hours ) from the onset of symptoms

Question 10

dose chlorphenamine?

Answer 10

10mg

Question 11

What is the most suitable test to investigate possible food allergy?

Answer 11

skin prick testing

Question 12

severe hyponatraemia (< 120 mmol/L) mx?

Answer 12

hypertonic saline 3%

Question 13

SIADH - drug causes:

Answer 13

carbamazepine, sulfonylureas, SSRIs, TCAs

Question 14

hyponatremia with low serum osmolality and concentrated urine (urinary sodium >40 mEq/L) with high urine osmolality (>100 mOsm/kg) levels

Answer 14

SIADH

Question 15

LFT raised in pregnancy?

Answer 15

ALP

Question 16

siadh tx?

Answer 16

fluid restriction

Question 17

what can cause euvolaemic hyponatraemia?

Answer 17

hypothyroidism

Question 18

mutated in familial hypercholesterolaemia??

Answer 18

LDL receptor

Question 19

broad QRS, tall tented T =

Answer 19

hyperkalaemia

also sinusoidal pattern, with very wide QRS complexes, bizarre deep T-waves in V1 and V2 and peaked T-waves in V4 and V5

Question 20

statin and should be started as primary prevention against cardiovascular disease. Atorvastatin primary and secondary doses?

Answer 20

primary prevention - 20mg

secondary - 80mg

Question 21

Acute pancreatitis may cause?

Answer 21

hypocalcaemia

Question 22

Raised ALP in the presence of normal LFT’s should raise suspicion of

Answer 22

malignancy - bone ca/mets

Question 23

hypocalcaeamia ecg?

Answer 23

prolonged QT

rare: AF, torsades de pointes

Question 24

Hypercholesterolaemia rather than hypertriglyceridaemia:

Answer 24

nephrotic syndrome
cholestasis,
hypothyroidism

Question 25

drugs can cause hypokalaemia?

Answer 25

thiazide | acetazolamide

Question 26

first line tx in severe hypercalcaemia?

Answer 26

IVI

Question 27

Rapid correction of hyponatraemia can cause?

Answer 27

osmotic demyelination syndrome

Question 28

SIADH and cerebral salt wasting are differentiated by?

Answer 28

fluid status (euvolaemic in siadh, hypovolaemic in cerebral salt wasting)

Question 29

tendon xanthomata and cholesterol levels meet the diagnostic criteria for

Answer 29

familial hypercholesterolaemia

Question 30

what is the most serious electrolyte abnormality that can complicate acute kidney injury.?

Answer 30

hyperkalaemia

Question 31

single most useful test in determining the cause of hypocalcaemia??

Answer 31

PTH

Question 32

Hypernatraemic dehydration in children is associated with jittery movements, increased muscle tone, hyperreflexia, convulsions, drowsiness or coma - mx?

Answer 32

replace slowly to reduce the chances of cerebral oedema - NS 0.9%

Question 33

Bleeding gums | vitamin?

Answer 33

C

Question 34

Diarrhoea, confusion and eczematous skin | vitamin?

Answer 34

Niacin (B3) - pellagra

Question 35

osteomalacia viatmin>

Answer 35

D

Question 36

34M ED 1/7 hx intermittent, severe colicky left flank pain, radiates to the groin. PMH includes recurrent renal stones and Sjogren’s syndrome. No FHx. His blood tests show the following: K 2.1. CT KUB) identifies a small left ureteric stone. An ECG is also performed, which shows U waves and flat T waves. underlying dx?

Answer 36

renal tubular acidosis causes hypokalaemia

Question 37

causes hypokalaemia complications include osteomalacia _____?

Answer 37

Type 2 RTA | Fanconi syndrome

Question 38

causes hypokalaemia complications include nephrocalcinosis and renal stones causes include idiopathic, rheumatoid arthritis, SLE, Sjogren's, amphotericin B toxicity, analgesic nephropathy ???

Answer 38

Type 1 RTA

Question 39

RTA ABG?

Answer 39

hyperchloraemic metabolic acidosis (normal anion gap)

Question 40

urea is raised disproportionately to the creatinine. dx?

Answer 40

dehydration

Question 41

carpopedal spasm caused by | inflating the blood-pressure cuff to a level above the systolic blood pressure in patients with hypocalcaemia????????

Answer 41

trousseau's sign

Question 42

seen in hypocalcemia; tapping over the facial nerve causes twitching of the facial muscles. sign?

Answer 42

chvostek's sign

Question 43

A 24-year-old man is involved in a road traffic accident. His right leg is trapped for 6 hours whilst he is moved. On examination his foot is insensate and a dorsalis pedis pulse is only weakly felt. Which of the biochemical abnormalities listed below is most likely to be present?

Answer 43

hyperkalaemia | compartment syndrome

Question 44

Hypophosphataemia can be caused by?

Answer 44

DKA | consider parenteral phosphate replacement therapy alongside insulin tx

Question 45

heparin causes which electrolyte abnormality?

Answer 45

hyperkalaemia

Question 46

The maximum rate of IV potassium infusion that can be conducted without monitoring is>

Answer 46

10mmol/h

Question 47

Treatment of asymptomatic hyperuricaemia in an attempt to prevent gout?

Answer 47

none

Question 48

longer term hypercalcaemia advice?

Answer 48

stay hydrated

Question 49

Causes of raised alkaline phosphatase (ALP)

Answer 49

liver: cholestasis, hepatitis, fatty liver, neoplasia Paget's osteomalacia bone metastases hyperparathyroidism renal failure physiological: pregnancy, growing children, healing fractures

Question 50

Respiratory alkalosis can result in hypocalcaemia -

Answer 50

if normal phostphate levels | normal ALP

Question 51

perioral paresthesia and a prolonged QT interval?

Answer 51

hypocalcaemia