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Medicine Year 3 > Metabolic > Flashcards

Metabolic Flashcards

1
Q

Which virus is commonly associated with nasopharyngeal malignancy

A

Epstein Barr

Also associated with Burkit’s lymphoma

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2
Q

Which virus is commonly associated with head and neck cancers

A

HPV (16)

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3
Q

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

A

Autoimmune haemolytic anaemia

Treat with immunosuppressive therapy

Haemolysis can also be induced by antibiotic therapy for pneumonia particularly penicillins

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4
Q

Suggest suitable treatment for CD20 positive T-cell lymphoma

A

Rituximab

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5
Q

What kind of therapy could cause an autoimmune response in patients being treated for malignant melanoma?

A

Immunotherapy

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6
Q

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

A

1) GLP-1 mimetics
2) SGL-2 inhibitors - any of the ‘flozins’
3) Gliptins (DPP-4 inhibitors) e.g. linagliptin

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7
Q

Suggest the appropriate pharmacological agents that could be used to treat a prolactinoma and state the class of these drugs.

A

Cabergoline and bromocriptine

Dopamin agonists

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8
Q

The actions of PTH and active vitamin D in calcium homeostasis

A
  • Increases serum calcium concentration

- Through: bone resorption, reducing renal excretion and increasing calcium absorption from the bowel

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9
Q

Discuss the factors used to assess Fitness for treatment with regards to cancer patients

A

1) Performance status
2) Co-morbidities
3) Social circumstances
4) Cognitive ability
5) Informed consent

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10
Q

Discuss the appropriate management of a patient on immunotherapy showing signs of autoimmune disease and possible life threatening disease

A

Immediately stop immunotherapy and commence dose of steroids of immunosuppressants

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11
Q

Suggest the factors used to determine if adjuvant chemotherapy is a appropriate following surgery

A

Possible lymph node involvement
Histology - i.e. if cells poorly differentiated
Margins (close margins)

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12
Q

What happens to serum potassium during DKA and explain the mechanisms behind this

A

Serum potassium is usually elevated due to insulin deficiency, hypertonicity and acidaemia

But total body potassium is low due to diuresis

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13
Q

What happens to serum sodium in DKA and explain the mechanisms behind this

A

Serum sodium is low to osmotic reflux of water from intracellular to extracellular spaces as a result of hyperglycaemia, this leads to dilutional huponatraemia

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14
Q

Treatment algorithm for DKA

A

IV fluids (0.9% saline)
IV fixed rate insulin
Potassium is less than 5.5
Withhold bolus regime and continue basal

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15
Q

Likely diagnosis for a women presenting with amenorrhoea, galactorrhora, headaches and lethargy and increased serum prolactin
She is not pregnant

A

Prolactinoma

Account for 40% of pituitary adenomas

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16
Q

Causes of anion gap acidosis

A 
Diabetic ketoacidosis 
Alcoholic ketoacidosis 
lyric acidosis 
Kidney disease 
Ingestion of methanol and ethylene glycol
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17
Q

What is the most common type of thyroid cancer

A

Papillary thyroid cancer

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18
Q

Likely diagnosis of an elderly patient who has fallen at home and been on the floor for some time, their urine looks ‘muddy’ coloured

A

Acute tubular necrosis due to rhabdomyolysis

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19
Q

A 16 year old male develops haematuria 2 days following an upper respiratory tract infection

A

IgA nephropathy

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20
Q

A 7 year old girl develops haematuria, she has no significant medical history except for an upper respiratory tract infection 2 weeks ago

A

Post-strep glomerulonephritis

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21
Q

5 year old child develops nephritic syndrome following a bout of bloody diarrhoea (caused by E. coli infection)

A

haemolytic uraemia syndrome

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22
Q

List causes of acute tubular necrosis

A 
iodinated contrast 
ahminoglycosides 
cisplatin 
amphotericin 
NSAIDs
Rhabdomyolysis
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23
Q

List causes of acute interstitial nephritis

A 
Betalactams
sulphonamides 
Flouroquinolones 
Rifampicin 
PPIs
NSAIDs 
Anti-seizure medications
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24
Q

Causes of rapidly progressive glomerulonephritis

A

Goodpastures
Lupus
Granulomatosis with polyangitis

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25
Q

Pathological features of rapidly progressive glomerulonephritis

A

glomerular crescent formnation

ANCA causing early degranulation

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26
Q

Patient presenting with transient thyrotoxicosis followed by hypothyroidism, and neck pain

A

De Qeurvains thyroiditis or subacute granulomatous thyroiditis

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27
Q

Which MEN syndrome is characterised by parathyroid dysfunction, pituitary and pancreatic tumours such as gastrinomas and often presenting with hypercalaemia

A

MEN1

28
Q

Which MEN syndrome is characterised by medullary thyroid cancer, pheochromocytoma, and marfanoid habitus

A

MEN IIb

29
Q

Which type of haemolytic anaemia is suspected with a raised MCH (hyperchromic)

A

Spherocytosis

30
Q

Diagnostic criteria for diabetes on venous blood glucose

A

Symptoms of hyperglycaemia AND fasting blood glucose feted once >7 OR random blood glucose >11.1

31
Q

Diagnostic criteria for diabetes using HbA1C (and contraindications)

A

> 48 mmol/mol

avoid in pregnancy, children and type 1

32
Q

Smudge or smear cells are seen in which haematological malignancy

A

Chronic lymphocytic leukaemia

33
Q

Which haematological malignancy is most likely to cause massive splenomegaly

A

Chronic myeloid leukaemia

34
Q

Small bowel lymphoma is often associated with which autoimmune disease

A

Coeliac

35
Q

What kind of anaemia is likely to occur in chronic kidney disease

A

Normocytic

36
Q

A 15 year old boy presents with jaundice and pallor, a blood film shows Heinz bodies

A

G6PD deficiency

37
Q

Appropriate diagnostic investigation for Addison’s disease

A

ACTH stimulation test

38
Q

Appropriate diagnostic test for diabetes insipidus

A

water deprivation test

39
Q

Appropriate diagnostic test for Cushing’s syndrome

A
  • Overnight (low dose) dexamethasone suppression test
  • 24hr urinary free cortisol
  • late night salivary cortisol
40
Q

Appropriate diagnostic test for acromegaly

A

Oral glucose tolerance test with growth hormone measurements

41
Q

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

A

de quervain’s thyroiditis

Hx of viral infection, neck pain
Hyperthyroidism followed by hypothyroidism

42
Q

Which form of thyroid cancer is associated with raised serum calcitonin?

A

medullary

43
Q

Which acute haematological malignancy is more likely to cause hepatoplenomegaly?

A

Acute Lymphocytic Leukaemia

44
Q

Auer rods are seen in which haematological malignancy?

A

Acute myeloid leukaemia

45
Q

Autoimmune haemolytic anaemia can occur in which haematological malignancy?

A

Chronic Lymphocytic Leukaemia

46
Q

In which haematological malignancy are smudge cells seen?

A

Chronic Lymphocytic Leukaemia

47
Q

Which haematological malignancy can differentiate to a high grade lymphoma?

A

Chronic Lymphocytic Leukaemia

48
Q

Suggest suitable investigations to confirm a diagnosis of subacute thyroiditis

A

Radioactive iodine uptake scan

uptake low in thyroiditis phase

49
Q

Non painful lesion on the anterior aspect of the shin

hx of type 1 diabetes

A

Necrobiosis lipodica diabeticorum

50
Q

Most common cause of vasculitis in children, a rash with palpable purpura is present in all cases

A

Henoch-Schonlein purpura

51
Q

Most appropriate test to screen for diabetic nephropathy

A

Early morning urine for albumin to creatinine ratio

52
Q

A 6 year old child presents with renal failure and a palpable abdominal mass, what is the most likely causes?

A
  • Multi-cystic dysplastic kidney (more common)

- Autosomal recessive polycystic kidney disease

53
Q

What type of metabolic abnormality occurs in renal tubular acidosis

A

Normal anion gap metabolic acidosis

54
Q

What kind of metabolic abnormality occurs in renal failure, in terms of acidosis or alkalosis

A

Raised anion gap metabolic acidosis

55
Q

Which strep infection is usually responsible for post strep. glomerulonephritis

A

Strep. pyogenes

56
Q

What urine findings are likely to be seen in a patient with acute interstitial nephritis

A

Acute interstitial nephritis causes an ‘allergic’ type picture consisting usually of raised urinary WCC, IgE, and eosinophils, alongside impaired renal function

57
Q

State the typical plasma and urine osmolality findings in a patient with diabetes insipidus

A

Diabetes insipidus is characterised by a high plasma osmolality and a low urine osmolality

58
Q

The following are features of which urological disease

  • visible haematuria
  • ache in the left loin
  • left varicocele
  • feeling intermittently hot and sweaty
A

Renal cell carcinoma

Varicocele due to occlusion of left testicular vein

59
Q

Most common cause of hyperparathyroidism

A

single parathyroid adenoma

60
Q

Discuss the role of the independent assessor in live donor transplant

A

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

61
Q

Pulmonary Fibrosis is a side effect of which chemotherapy agent

A

Bleomycin, methotrexate and cyclophosphamide

62
Q

Chemotherapeutics that classically cause myelosupression/agranulocytosis

A

Methotrexate
Cyclophosphamide
Flurouracil

63
Q

How can acute tubular necrosis and acute interstitial nephritis be distinguished on urine dip?

A

Interstitial nephritis characterised by:
presence of leukocytes +++
(greater WBCs than RBCs)

64
Q

Metabolic abnormalities associated with sepsis

A

high lactate

Metabolic acidosis with raised anion gap

65
Q

In what pathological process/disease would you expect to find kimmelsteil-Wilson lesion and where?

A

Diabetic nephropathy

In the glomerulus

Medicine Year 3 (6 decks)

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