MEDgems

Question 1

TCA overdose

Answer 1

heart block
hypotensive
ataxic gait
dilated pupils

Question 2

gilbert’s syndrome enzyme

Answer 2

UDP glucoronyl transferase

unconjugated bilirubin

Question 3

persistently hypokalaemic
sodium normal
metabolic acidosis

Answer 3

type 1 renal tubular acidosis

Question 4

acidosis is associated with what potassium abnormality?

Answer 4

hypokalaemia

Question 5

why is alkalosis associated with hypokalaemia?

Answer 5

hydrogen potassium transporter
K+ is exchanged for H+

in hypokalaemia there is low K+ in blood

so exchanged with H+, K+ goes out of cells and into blood.

H+ goes into cell so H+ in blood is low = alkalosis

Question 6

sarcoidosis produces which enzyme = hypercalcaemia

Answer 6

1 alpha hydroxylase
= activates vit D
= more absorption of calcium from gut

Question 7

sarcoidosis produces which two things
1)enzyme
2)protein?

Answer 7

1 alpha hydroxylase
PTH related peptide hormone that mimics PTH

Question 8

what is normal osmolality

Answer 8

275-295

Question 9

inadequate function of PCT
glucosuria
hypophoshataemia
hyperuricosuria

Answer 9

fanconi syndrome

Question 10

causes of fanconi syndrome?

Answer 10

congenital
wilson’s
tetracycline
Multiple myeloma
lead poisoning

Question 11

Acyl CoA cholesterol acyltransferase converts cholesterol into what?

Answer 11

ACAT
esterification

Question 12

how does cholesterol ester become VLDL

Answer 12

cholesterol > cholestrol ester via ACAT > very low density lipoprotein by MEPT

Question 13

what reduces low density lipoprotein in the blood?

Answer 13

PCSK9 inhibitor
evolocumab

Question 14

van den bergh reaction measures what?

Answer 14

conjugated serum bilirubin

Question 15

what is osteomalacia?

Answer 15

incomplete mineralisation of bone

caused by vitamin D deficiency

low vit D, calcium, phosphate

high PTH (due to low calcium)
high ALP- bone osteoclast activity

Question 16

DiGeorge syndrome is from _____ of part of ____

what abnormality?

Answer 16

deletion of part of chromosome 22

catch 22
cardiac
abnormal face
thymic aplasia
cleft
hypoparathyroid

do not have parathyroid glands

Question 17

fuller albright is

Answer 17

pseudo hypoparathyroidism

inherited resistance to pth

short 4/5th metacarpal
obese
round face

albright hereditary osteodystrophy

Question 18

aspirin poisoning

Answer 18

metabolic acidosis with respiratory alkalosis

salicylates stimulate resp centre = hyperventilation and inhibit krebs cycle

nausea, dizzy and ringing in ears

Question 19

what is a measure of all particles in a solution and is measured in mmol/kg?

Answer 19

osmolality

Question 20

measure of particles in a solution that varies with temperature?

Answer 20

osmolarity

1 litre of solvent

Question 21

cholesterol transport channel targeted by EZETIMIBE

Answer 21

NPC 1L1

nieman pick C1-Like 1

Question 22

what joint is impacted in gout

Answer 22

1st METATARSOPHALANGEAL

Question 23

what exchanges triglycerides and cholesterol esters?

Answer 23

cholesteryl ester transfer protein

CETP

Question 24

what cytochrome p450 enzyme catalyses first step of Bile acid formation?
in liver

Answer 24

cholesterol 7 alpha hydroxylase

Question 25

increased bone density?

Answer 25

osteosclerosis

Question 26

what is the gold standard for quantifying urine protein loss?

Answer 26

24 hour urine collection - not done anymore

Question 27

steroids on levels of LDL

Answer 27

increases it

Question 28

developmental delay and self mutilation

hyperuricaemia

Answer 28

lesch nyhan syndrome

HGPRT - purine

Question 29

in hyperkalaemia what ECG changes?

Answer 29

absent p waves
tall tented t waves
qrs widens

give calcium gluconate as cardioprotective measure - reduce myocardial excitibility

Question 30

if very thirsty
passing more urine

and urine osmolality is low

water deprivation test done

196mOsmol/kg
desmopressin given

204mOsmol/kg

Answer 30

normal response would be very high increase in osmolality - concentrated

not that much of a change so nephrons not responding

AVP resistance

Question 31

where is bicarbonate reabsorbed

Answer 31

Proximal convoluted tubule

Question 31

what is the normal JVP from right atrium?

Answer 31

8cm -10cm

Question 31

what is a normal JVP?
from the sternal angle

Answer 31

3cm

Question 32

paget disease what enzyme is raised?

Answer 32

alkaline phosphatase

paget’s is boen remodelling

• increased action of osteoblasts

Question 33

how to test for true hyponatraemia?

Answer 33

serum osmolality

low serum osmolality and low sodium is true

Question 34

chvostek and trousseau are both signs for what electrolyte abnormality

Answer 34

hypocalcaemia

neuromuscular excitability
muscle cramps, tetany

Question 35

hba1c is what

what is it measured in ?

what is diabetes

Answer 35

measure of gkycated haemoglobin

mmol/mol

48mmol/mol

11.1 refers to blood sugar level - 11.1mmol/l

Question 36

what do bisphosphonates do?

Answer 36

reduce bone turnover

Question 37

what does denosumab do?

Answer 37

directly increase bone density

monoclonal antibody

inhibits RANKL
which stops RANK on osteoclast being activated

Question 38

what is FEUA

Answer 38

fractional excretion of uric acid
urate is not broken down it is excreted

Question 39

what diabetic medication can cause a hypoglycaemia with a high insulin and high c peptide?

Answer 39

sulfonyl ureas

gliclazlide

Question 40

DEXA scan

bone density variations

<-1 but >-2.5

Answer 40

T score
osteoporosis

Question 41

T score osteopenia

Answer 41

-1-(-2.5)

Question 42

metabolic alkalosis overdose

Answer 42

salicylates

Question 43

what 2 ways can azathioprine be removed?

Answer 43

6 mercaptopurine by
TPMT - thiopurine methyl transferase xanthine oxidase

Question 44

phytosterolemia

Answer 44

increased plant sterols due to deformative abc g5
abc g8