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Medical Finals 2020 > Metabolic > Flashcards

Metabolic Flashcards

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USMLE® Step 1 flashcards
1
Q

Give 5 signs or symptoms of hypocalcaemia

A
  • Numbness/Tingling of mouth/lips
  • Impaired orientation/confusion
  • Anxiety
  • Seizures
  • Increased muscle tone
  • Carpopedal spasms
  • Skin abnormalities
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2
Q

What is Trosseau’s sign?

A
  • Occurs in hypocalcaemia

- A blood pressure cuff is inflated above systolic BP and causes a carpopedal spasm

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3
Q

What is Chvostek’s sign?

A
  • Tapping over the facial nerve causes twitching of facial muscles
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4
Q

What ECG changes are seen in hypocalcaemia?

A
  • Prolonged QTc

- Sometimes AF or Torsades de Pointes

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5
Q

Give 4 main causes of hypocalcaemia

A
  • vitamin D deficiency
  • Hypoparathyroidism
  • Rhabdomyolysis
  • Mg deficiency (due to end organ PTH resistance)
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6
Q

How can you treat hypocalcaemia?

A
  • calcium gluconate/calcium replacement 10ml of 10% for severe low calcium levels
  • more milder give 5mmol/6hrs
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7
Q

What are some causes of hypernatraemia?

A
  • diabetes insipidus
  • excessive sodium infusion
  • primary aldosteronism
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8
Q

What is the definition of hyponatraemia and what are 5 common causes?

A

Plasma sodium <130mmol/L

  • Hypovolaemic - Addison’s, Fluid Loss (diarrhoea, dehydration), Drugs (PPI, SSRI, ramipril, diuretics, carbamazepine, tricylcics)
  • Euvolaemic - SIADH
  • Hypervolaemic - Nephrotic syndrome
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9
Q

How might a low sodium present?

A
  • Confusion
  • Headache
  • Lethargy
  • Weakness
  • Abdominal pain
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10
Q

At what rate should sodium be corrected and why?

A

10-12mmol/kg/day

Too fast runs a risk of central pontine myolinosis (CPM). This is demyelination of the pons resulting in lethargy, confusion, paraparesis or a coma. There is a risk of cerebral oedema.

(Acute hypernatraemia can be corrected quicker without worrying about large fluid shifts)

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11
Q

What is SIADH?

A

Syndrome of Inappropriate ADH secretion. There is increased ADH released resulting in increased water retention by the collecting ducts, and increased sodium loss.

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12
Q

What can cause SIADH?

A
  • SCC lung cancer that produces ADH
  • Neurological disorder (stroke, CNS, SAH, meningitis)
  • Infections
  • Drugs (SSRI, sulfonylurea)
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13
Q

What would be seen in investigations for SIADH?

A
  • Low sodium
  • Low plasma osmolarity (increased water retention but electrolyte loss) therefore high urine osmolarity
  • Urine - high sodium, high osmolarity
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14
Q

What drugs cause SIADH?

A
  • SSRI
  • Tricyclics
  • Carbamazepine
  • Vincristine
  • Sulfonylureas
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15
Q

What are some causes of a high lactate?

A
  • Infection (metabolic acidosis, sepsis)
  • Dehydration
  • Seizures
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16
Q

What are some causes of hyperkalaemia?

A
  • Renal disease
  • Increased K+ intake
  • DKA
  • Addison’s
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17
Q

What are some causes of hypokalaemia?

A
  • Increased vomiting
  • Diuretics
  • Pyloric stenosis
  • Addison’s Disease
  • AKI
  • Drugs - ACE-i, K+ sparing diurectics, ARB, heparin
  • Rhabdomyolysis
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18
Q

What is considered moderate and severe hyperkalaemia?

A

Moderate - 6-6.4

Severe - >6.5

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19
Q

What are signs of hyperkalaemia?

A
  • Weakness
  • Fatigue
  • SOB
  • Muscular paralysis
  • Palpitations
  • Chest pain,
  • Lightheadedness
20
Q

What are you immediate management options when you are called to review a patient with a high potassium?

A
  • ECG - check for arrythmias (broad QRS, reduced p-waves, peaked t-waves)
  • Stop potassium intake, diuretics
  • If ECG abnormal: calcium gluconate
  • Insulin + Glucose (10% dextrose 250ml, 10 units immediate release insulin)
  • If K+ remains high then consider salbutamol nebs, dialysis
21
Q

What is your first line management of hypercalcaemia?

A

IV Fluids

THEN IV Pamindronate (bisphosphonate)

22
Q

What is short synacthen used to diagnose?

A

Addison’s Disease

A synacthen test measures cortisol levels, then give synthetic ACTH and remeasure cortisol
Addison’s is a disease of adrenal insufficiency either primary (due to low ACTH) or secondary (cortisol deficiency).

23
Q

Why is urine osmolality useful in hyponatraemia?

A

A high urine osmolality would indicate SIADH.

24
Q

Give 5 common presenting features of hypercalcaemia?

A
  • Dehydration
  • Psychiatric manifestations
  • Confusion
  • Anorexia
  • Constipation
  • Bone pain
  • Abdominal pain
  • Renal stones (bones, moans, stones, abdominal groans)
25
Q

What are the classic symptoms of abetalipoproteinemia?

A 
A disease characterised by deficiency of fat-soluble vitamins
A - poor night vision, poor vision
D - poor bone and muscle strength
E - myopathies, ataxia
K - easy bruising
(ADEK)
26
Q

What is the maximum rate IV potassium can be given?

A

10mmol/hour

27
Q

What are some causes of hypercalcaemia?

A
  • Hyperparathyroidism
  • Malignancy - myeloma, bone mets (breast, prostate, kidney, thyroid, lung) - PTH will be normal
  • Dehydration, thiazide diuretics
28
Q

What in the blood results might indicate dehydration?

A
  • raised urea
  • raised Hb, haematocrit
  • raised sodium
  • raised albumin
29
Q

What are some physical signs and symptoms of dehydration?

A
  • reduced urine output
  • thirst
  • dry mucous membranes
  • loss of skin turgor
  • sunken eyes
  • tachycardia
  • hypotension
  • delirium
30
Q

How do you manage SIADH?

A

Fluid restrict to 500-1000mls per day

31
Q

What are complications of hypercalcaemia?

A
  • Cardiac arrythmia
  • Coma
  • Cardiac arrest
  • ECG (short QT, osborn wave)
32
Q

What symptoms might a patient with hypernatraemia present with?

A 
Lethargy
Thirst
Weakness
Irritability
Confusion
Coma
33
Q

What would you see on ECG for hypokalaemia?

A

ECG features of hypokalaemia:

  • U waves
  • small or absent T waves (occasionally inversion)
  • prolong PR interval
  • ST depression
  • long QT
34
Q

What is the most likely electrolyte abnormality in someone with chronic alcoholism?

A

Hypomagnesaemia (associated with low K+, low Ca2+, low PO4-, metabolic acidosis)

35
Q

What are the most common side effects of ACE-inhibitors?

A
  • cough

- hyperkalaemia

36
Q

What are the most common side-effects of bendroflumethiazide?

A
  • gout
  • hypokalaemia
  • hyponatraemia
  • impaired glucose tolerance
37
Q

What are the most common side effects of CCB?

A
  • headache
  • flushing
  • ankle oedema
38
Q

What are the most common side effects of BB?

A
  • bronchospasm
  • fatigue
  • cold peripheries
39
Q

What are the most common side effects of Doxazosin? (alpha blocker)

A
  • postural hypotension
40
Q

What electrolyte abnormality leads to long QT?

A

Hypokalaemia
Hypocalaemia

Long QT syndrome is when the QT interval is >450ms which can predispose to Torsade de Pointes

41
Q

What drugs are most commonly responsible for hyperkalaemia?

A
  • ACE-inhibitors,
  • ARBs
  • Potassium sparing diuretics
42
Q

What is considered a low sodium?

A

<130mmol/L

43
Q

What ECG changes are seen in hyperkalaemia?

A
  • tall tented T-waves
  • broad QRS
  • reduced or lack of p-waves
  • sine-wave pattern
  • AV dissociation
44
Q

What is alcoholic ketoacidosis?

A

A metabolic complication of alcohol use and starvation

  • hyperketonemia
  • anion gap metabolic acidosis
  • nausea, vomiting, abdo pain
45
Q

What is the electrolyte abnormalities seen in Addison’s?

A

Low sodium

High potassium, creatinine, urea

46
Q

What electrolyte abnormality is seen in Conn’s syndrome

A

High sodium
Low potassium
Hypertension
Hyperaldosteronism (Primary, usually adrenal adenoma)

47
Q

Diabetes Insipidus results in high or low sodium?

A

High sodium

Medical Finals 2020 (25 decks)

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