Metabolic Flashcards
Which virus is commonly associated with nasopharyngeal malignancy
Epstein Barr
Also associated with Burkit’s lymphoma
Which virus is commonly associated with head and neck cancers
HPV (16)
A patient becomes anaemic following mycoplasma pneumonia, his haemoglobin is low, MCV normal and bilirubin is raised, he also has a positive direct antigen test result, what is the likely cause? And what is the most suitable treatment
Autoimmune haemolytic anaemia
Treat with immunosuppressive therapy
Haemolysis can also be induced by antibiotic therapy for pneumonia particularly penicillins
Suggest suitable treatment for CD20 positive T-cell lymphoma
Rituximab
What kind of therapy could cause an autoimmune response in patients being treated for malignant melanoma?
Immunotherapy
Blood glucose lowering agents
1) Injectable therapy associated with weight loss
2) Should be avoided if GFR is less than 60
3) Produces anti hyperglycaemic effects by inhibitions of the DPP-4 enzyme
1) GLP-1 mimetics
2) SGL-2 inhibitors - any of the ‘flozins’
3) Gliptins (DPP-4 inhibitors) e.g. linagliptin
Suggest the appropriate pharmacological agents that could be used to treat a prolactinoma and state the class of these drugs.
Cabergoline and bromocriptine
Dopamin agonists
The actions of PTH and active vitamin D in calcium homeostasis
- Increases serum calcium concentration
- Through: bone resorption, reducing renal excretion and increasing calcium absorption from the bowel
Discuss the factors used to assess Fitness for treatment with regards to cancer patients
1) Performance status
2) Co-morbidities
3) Social circumstances
4) Cognitive ability
5) Informed consent
Discuss the appropriate management of a patient on immunotherapy showing signs of autoimmune disease and possible life threatening disease
Immediately stop immunotherapy and commence dose of steroids of immunosuppressants
Suggest the factors used to determine if adjuvant chemotherapy is a appropriate following surgery
Possible lymph node involvement
Histology - i.e. if cells poorly differentiated
Margins (close margins)
What happens to serum potassium during DKA and explain the mechanisms behind this
Serum potassium is usually elevated due to insulin deficiency, hypertonicity and acidaemia
But total body potassium is low due to diuresis
What happens to serum sodium in DKA and explain the mechanisms behind this
Serum sodium is low to osmotic reflux of water from intracellular to extracellular spaces as a result of hyperglycaemia, this leads to dilutional huponatraemia
Treatment algorithm for DKA
IV fluids (0.9% saline)
IV fixed rate insulin
Potassium is less than 5.5
Withhold bolus regime and continue basal
Likely diagnosis for a women presenting with amenorrhoea, galactorrhora, headaches and lethargy and increased serum prolactin
She is not pregnant
Prolactinoma
Account for 40% of pituitary adenomas
Causes of anion gap acidosis
Diabetic ketoacidosis Alcoholic ketoacidosis lyric acidosis Kidney disease Ingestion of methanol and ethylene glycol
What is the most common type of thyroid cancer
Papillary thyroid cancer
Likely diagnosis of an elderly patient who has fallen at home and been on the floor for some time, their urine looks ‘muddy’ coloured
Acute tubular necrosis due to rhabdomyolysis
A 16 year old male develops haematuria 2 days following an upper respiratory tract infection
IgA nephropathy
A 7 year old girl develops haematuria, she has no significant medical history except for an upper respiratory tract infection 2 weeks ago
Post-strep glomerulonephritis
5 year old child develops nephritic syndrome following a bout of bloody diarrhoea (caused by E. coli infection)
haemolytic uraemia syndrome
List causes of acute tubular necrosis
iodinated contrast ahminoglycosides cisplatin amphotericin NSAIDs Rhabdomyolysis
List causes of acute interstitial nephritis
Betalactams sulphonamides Flouroquinolones Rifampicin PPIs NSAIDs Anti-seizure medications
Causes of rapidly progressive glomerulonephritis
Goodpastures
Lupus
Granulomatosis with polyangitis
Pathological features of rapidly progressive glomerulonephritis
glomerular crescent formnation
ANCA causing early degranulation
Patient presenting with transient thyrotoxicosis followed by hypothyroidism, and neck pain
De Qeurvains thyroiditis or subacute granulomatous thyroiditis
Which MEN syndrome is characterised by parathyroid dysfunction, pituitary and pancreatic tumours such as gastrinomas and often presenting with hypercalaemia
MEN1
Which MEN syndrome is characterised by medullary thyroid cancer, pheochromocytoma, and marfanoid habitus
MEN IIb
Which type of haemolytic anaemia is suspected with a raised MCH (hyperchromic)
Spherocytosis
Diagnostic criteria for diabetes on venous blood glucose
Symptoms of hyperglycaemia AND fasting blood glucose feted once >7 OR random blood glucose >11.1
Diagnostic criteria for diabetes using HbA1C (and contraindications)
> 48 mmol/mol
avoid in pregnancy, children and type 1
Smudge or smear cells are seen in which haematological malignancy
Chronic lymphocytic leukaemia
Which haematological malignancy is most likely to cause massive splenomegaly
Chronic myeloid leukaemia
Small bowel lymphoma is often associated with which autoimmune disease
Coeliac
What kind of anaemia is likely to occur in chronic kidney disease
Normocytic
A 15 year old boy presents with jaundice and pallor, a blood film shows Heinz bodies
G6PD deficiency
Appropriate diagnostic investigation for Addison’s disease
ACTH stimulation test
Appropriate diagnostic test for diabetes insipidus
water deprivation test
Appropriate diagnostic test for Cushing’s syndrome
- Overnight (low dose) dexamethasone suppression test
- 24hr urinary free cortisol
- late night salivary cortisol
Appropriate diagnostic test for acromegaly
Oral glucose tolerance test with growth hormone measurements
A 40-year-old woman presents with a 7 day hx of fevers to 40°C (104°F), shaking, chills, myalgias, and pharyngitis. She had also developed a severe neck pain that radiated to her ear and jaw. She has noted rapid heartbeat, palpitations, tremor, and feeling hot. Over the past few days she has become more fatigued and has noted feeling cold easily, what is the likely diagnosis
de quervain’s thyroiditis
Hx of viral infection, neck pain
Hyperthyroidism followed by hypothyroidism
Which form of thyroid cancer is associated with raised serum calcitonin?
medullary
Which acute haematological malignancy is more likely to cause hepatoplenomegaly?
Acute Lymphocytic Leukaemia
Auer rods are seen in which haematological malignancy?
Acute myeloid leukaemia
Autoimmune haemolytic anaemia can occur in which haematological malignancy?
Chronic Lymphocytic Leukaemia
In which haematological malignancy are smudge cells seen?
Chronic Lymphocytic Leukaemia
Which haematological malignancy can differentiate to a high grade lymphoma?
Chronic Lymphocytic Leukaemia
Suggest suitable investigations to confirm a diagnosis of subacute thyroiditis
Radioactive iodine uptake scan
uptake low in thyroiditis phase
Non painful lesion on the anterior aspect of the shin
hx of type 1 diabetes
Necrobiosis lipodica diabeticorum
Most common cause of vasculitis in children, a rash with palpable purpura is present in all cases
Henoch-Schonlein purpura
Most appropriate test to screen for diabetic nephropathy
Early morning urine for albumin to creatinine ratio
A 6 year old child presents with renal failure and a palpable abdominal mass, what is the most likely causes?
- Multi-cystic dysplastic kidney (more common)
- Autosomal recessive polycystic kidney disease
What type of metabolic abnormality occurs in renal tubular acidosis
Normal anion gap metabolic acidosis
What kind of metabolic abnormality occurs in renal failure, in terms of acidosis or alkalosis
Raised anion gap metabolic acidosis
Which strep infection is usually responsible for post strep. glomerulonephritis
Strep. pyogenes
What urine findings are likely to be seen in a patient with acute interstitial nephritis
Acute interstitial nephritis causes an ‘allergic’ type picture consisting usually of raised urinary WCC, IgE, and eosinophils, alongside impaired renal function
State the typical plasma and urine osmolality findings in a patient with diabetes insipidus
Diabetes insipidus is characterised by a high plasma osmolality and a low urine osmolality
The following are features of which urological disease
- visible haematuria
- ache in the left loin
- left varicocele
- feeling intermittently hot and sweaty
Renal cell carcinoma
Varicocele due to occlusion of left testicular vein
Most common cause of hyperparathyroidism
single parathyroid adenoma
Discuss the role of the independent assessor in live donor transplant
o Ensure donors are not being forced against their will or coerced into donation
o Ensure no reward has been sought or offered
o Ensure donor has capacity
Pulmonary Fibrosis is a side effect of which chemotherapy agent
Bleomycin, methotrexate and cyclophosphamide
Chemotherapeutics that classically cause myelosupression/agranulocytosis
Methotrexate
Cyclophosphamide
Flurouracil
How can acute tubular necrosis and acute interstitial nephritis be distinguished on urine dip?
Interstitial nephritis characterised by:
presence of leukocytes +++
(greater WBCs than RBCs)
Metabolic abnormalities associated with sepsis
high lactate
Metabolic acidosis with raised anion gap
In what pathological process/disease would you expect to find kimmelsteil-Wilson lesion and where?
Diabetic nephropathy
In the glomerulus
