Metabolic

Question 1

What electrolyte disturbance is seen in type I renal tubular acidosis?

Answer 1

Hypokalaemia

Question 2

What lab results suggest SIADH?

Answer 2

Hyponatremia, hypo-osmolar serum and hyper-osmolar urine with increased urinary sodium

Question 3

What blood tests are performed 3 months after starting a statin?

Answer 3

Lipid profile and LFTs

Question 4

What fluid replacement is indicated in patients with acute, severe, symptomatic hyponatraemia (< 120 mmol/L)?

Answer 4

Hypertonic saline (3% NaCL)

Question 5

What is the first line management of hypercalcaemia secondary to malignancy?

Answer 5

Lifestyle advice e.g. maintaining good hydration (drinking 3-4 L of fluid per day), provided there are no contraindications (such as severe renal impairment or heart failure

Question 6

What are the features of type 2 renal tubular acidosis?

Answer 6

Hypokalaemia, osteomalacia

Question 7

What electrolyte disturbance is seen in type 4 renal tubular acidosis?

Answer 7

Hyperkalaemia

Question 8

What are the causes of a raised ALP?

Answer 8

• Liver: cholestasis, hepatitis, fatty liver, neoplasia
• Paget’s
• Osteomalacia
• Bone metastases
• Hyperparathyroidism
• Renal failure
• Physiological: pregnancy, growing children, healing fractures

Question 11

Describe the management of a patient with deficiencies in both magnesium and potassium, with evidence of clinical and biochemical dehydration

Answer 11

Intravenous magnesium replacement first then potassium replacement

Question 12

What is a potential complication of correcting hyponatraemia too rapidly?

Answer 12

Osmotic demyelination syndrome

Question 13

What is a potential complication of correcting hypernatraemia too rapidly?

Answer 13

Cerebral oedema

Question 14

What are the differentials for hypertension with low potassium?

Answer 14

Conn’s, Cushing’s, renal artery stenosis and Liddle’s

Question 15

What is the most appropriate first line investigation for hypertension with low potassium?

Answer 15

Plasma renin and aldosterone levels

Quantifying the renin and angiotensin levels will help to distinguish the cause, before going on to more specialised tests

Question 16

What pathologies are associated with a low renin and a high aldosterone level?

Answer 16

Cushing’s and Conn’s

Question 17

What pathology is associated with a low renin and a high aldosterone level?

Answer 17

Renal artery stenosis

Question 18

Marked hyponatremia alongside a low serum osmolality and high urine osmolality

What is the diagnosis?

Answer 18

SIADH

Question 19

What is the short-term treatment of SIADH?

Answer 19

Fluid restriction

Question 20

What drugs can lead to hypokalaemia?

Answer 20

Thiazide and loop diuretics

Question 21

What ABG results are associated with renal tubular acidosis?

Answer 21

Hyperchloraemic, normal anion gap metabolic acidosis

Question 22

What ECG results are associated with hyperkalaemia

Answer 22

Tall-tented T waves, small P waves, widened QRS leading to a sinusoidal pattern and asystole

Question 23

What are the drug causes of SIADH?

Answer 23

Carbamazepine, sulfonylureas, SSRIs, tricyclics

Question 24

Patient with acute severe hyponatramia becomes unconscious.

What complication has occured?

Answer 24

Cerebral oedema

Question 25

What findings on ABG are associated with vomiting?

Answer 25

Hypokalaemia with alkalosis

Question 26

Raised ALP in the presence of normal LFT's should raise suspicion of what diagnosis?

Answer 26

Malignancy, particularly bone cancer/metastases

Question 27

A 56-year-old presents to the emergency department with a 1-month history of worsening exertional breathlessness, orthopnoea, and ankle swelling. They are hyponatraemic. What is the most likely underlying cause?

Answer 27

Heart failure

Question 28

Management of low phosphate in DKA?

Answer 28

Parenteral phosphate replacement therapy

Question 29

Most appropriate fluid replacement in patients with ssuspected hypovolemic hyponatraemia?

Answer 29

Isotonic normal saline

Question 30

What blood findings are normal in early pregnancy?

Answer 30

Mild anaemia and elevated ALP

Question 31

What electrolyte imbalances is most likely to be found in acute pancreatitis?

Answer 31

Hypocalcemia

Question 32

What ABG results are seen in renal tubular acidosis?

Answer 32

Hyperchloraemic, normal anion gap metabolic acidosis

Question 33

First line management in euvolemic and hypervolemic hyponatraemic patients who don't have severe symptoms?

Answer 33

Fluid restriction

Question 34

Name one complication of type 1 renal tubular acidosis

Answer 34

Renal stones

Question 35

What is the first line management of patients with suspected hypercalcaemia?

Answer 35

IV fluids

Question 36

What is the most common ECG change in hypocalcaemia?

Answer 36

Prolonged QTc interval