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Metabolic Flashcards

1
Q

Causes of hypocalcaemia (8)
Hint
Remembering Low Calcium Destroys Patient People’s Brains

A
  1. Rhabdomyolysis
  2. Low magnesium, hypoparathyroidism
  3. CKD
  4. Deficiency vit D
  5. Pseudohypoparathyroidism
  6. Pancreatitis (acute)
  7. Blood transfusion massive
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2
Q

Mx of hypocalcaemia (2)

A

IV calcium gluconate, 10ml of 10% solution over 10 minutes

ECG monitoring

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3
Q

Signs and symptoms of acute hypocalcaemia (4)

ECG finding

A
  1. Trousseau’s sign
  2. Chvostek’s sign
  3. Muscle spasm
  4. Perioral paraesthesia
    ECG prolonged QT
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4
Q

What is Trousseau’s sign?

A

Sign in hypocalcaemia

BP cuff on, wrist flexion and finger adduction

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5
Q

What is Chvostek’s sign

A

Tapping over parotid causes facial muscles to twitch

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6
Q

Signs + symptoms of chronic hypocalcaemia (2)

A
  1. Depression

2. Cataracts

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7
Q

Vitamin deficiencies
Vit B9
Name
Deficiency

A

Folic acid
Megaloblastic anaemia
Neural tube defects in pregnancy

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8
Q

Vitamin deficiencies
Vit B3
Name
Deficiency

A

Niacin

Pellagra - 3 D’s, dermatitis, diarrhoea, dementia

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9
Q

Vitamin deficiencies
Vit B12
Name
Deficiency

A

Cyanocobalamin

  1. Megaloblastic anaemia
  2. Peripheral neuropathy
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10
Q

Vitamin deficiencies
Vit B1
Name
Deficiency

A

Thiamine

  1. polyneuropathy
  2. Wernicke-Korsakoff syndrome
  3. heart failure
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11
Q

Vitamin deficiencies
Vit C
Name
Deficiency

A

Ascorbic acid
Scurvy
Gingivitis
Bleeding

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12
Q

Vitamin deficiencies
Vit A
Name
Deficiency

A

Retinoids

Night blindness

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13
Q

Vitamin deficiencies
Vit B6
Name
Deficiency

A

Pyridoxine
Anaemia
Irritability
Seizures

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14
Q

Vitamin deficiencies
Vit D
Name
Deficiency

A

Ergocalciferol, cholecalciferol

  1. Rickets
  2. Osteomalacia
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15
Q

Vitamin deficiencies
Vit B7
Name
Deficiency

A

Biotin
Dermatitis
Seborrhoea

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16
Q

Vitamin deficiencies
Vit E
Name
Deficiency

A

Tocopherol, tocotrienol
Haemolytic anaemia in newborns
Ataxia
Peripheral neuropathy

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17
Q

Vitamin deficiencies
Vit K
Name
Deficiency

A

Naphthoquinone

Haemorrhage

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18
Q

Causes ALP (7)

A

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

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19
Q

BMI classification

A 
<18.5 Underweight 
18.5-24.9 Normal 
25-29.9 Overweight
30-34.9 Obese I
34.9-39.9 Obese II
>40 Obese III
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20
Q

Familial hypercholesterolaemia

When should you suspect familial hypercholesterolaemia?

A
  1. Total cholesterol >7.5
    OR
  2. Hx or FH of 1st degree relative with CHD event <60yo
21
Q

What drugs can cause impaired glucose tolerance? (9)

Hint: CABINS TFT

A

CABINS TFT

  1. Ciclosporin
  2. Antipsychotics
  3. BBs
  4. Interferon alpha
  5. Nicontinic acids
  6. Steroids
  7. Thiazides
  8. Furoseimde
  9. Tacrolimus
22
Q

Familial hypercholesterolaemia
If one parent has above condition when would you test the child?
If both parents have above conditions when would you test the child?

A

Aged 10

Aged 5

23
Q

How do you diagnose familial hypercholesterolaemia?

A

Simon Broome Criteria
Adults total cholesterol >7.5 and LDL >4.9
Children total cholesterol >6.7 and LDL >4.0

AND
Tendon xanthoma in pt or 1st or 2nd degree relative
OR
DNA based evidence of familial hypercholesterolaemia

24
Q

Familial hypercholesterolaemia

Possible diagnosis criteria

A 
FH of:
MI <50yo in 2nd degree relative
OR
MI <60yo in 1st degree relative 
OR
FH of raised cholesterol levels
25
Q

Familial hypercholesterolaemia

Mx

A

Refer to specialist
First line
1. High dose statins

26
Q

How long prior to conception should you discontinue statins and why?

A

3 months

Risk of congenital defects

27
Q

Hypercalcaemia Mx (3)

A
  1. IV fluids 3-4L/24hrs
  2. Bisphosphonates (normally takes 2-3 days to work, max effect D7)
  3. Calcitonin
28
Q

ECG findings for high K+ (3)

A
  1. Tall tented T waves
  2. Small P waves
  3. Widened QRS
29
Q

Causes of hyperkalaemia

DRAMA-CHAPS

A
  1. Drugs - BB
  2. Rhabdomylsis
  3. Addison’s
  4. Massive blood transfusion, metabolic acidosis
  5. ACE inhibitors
  6. Ciclosporin
  7. Heparin
  8. AKI
  9. Potassium sparing diuretics
  10. Spiro
30
Q

Hyperlipidaemia

Who do you offer primary prevention to without the need for a QRISK score?

A
  1. T1DM AND
    - >40yo OR
    - other CVD RF OR
    - T1DM for >10years OR
    - with nephropathy
  2. CKD
  3. Familial hypercholesterolaemia
31
Q

Hyperlipidaemia

Who do you offer primary prevention to? (using QRISK)

A

Anyone under 85yo with QRISK >10%

32
Q

Hyperlipidaemia

Consider primary prevention for ?

A

85 and over without QRISK and think about their RF

33
Q

When would you refer someone with hyperlipidaemia to a specialist?

A

Total cholesterol >9 + LDL >7.5
OR
Familial hypercholesterolaemia guideliens

34
Q

What is primary prevention? + dose

What is secondary prevention? + dose

A

Atorvastatin 20mg

Atorvastatin 80mg

35
Q

All CKD patient should be offered primary prevention. When should you increase the dose?

A

If >40% reduction in LDL is not achieved and the eGFR > 30

If eGFR <30% refer to renal before increasing dose

36
Q

FU for pts started on statins

A

Repeat lipid profile 3 months later
If not >40% reduction in LDL
- lifestyle factors
- increase to 80mg

37
Q

Causes of high sodium (3)

Rate of correction

A
  1. Dehydration
  2. Diabetes insipidus
  3. Excessive IV saline
    No greater than 0.5 mmol/hour correction is appropriate
38
Q

Causes of low K+
Low K+ with alkalosis (4)
Low K+ with acidosis (4)

A

Alkalosis

  1. Thiazides + loop diuretics
  2. Vomiting
  3. Cushings
  4. Conns

Acidosis

  1. Diarrhoea
  2. Renal tubular acidosis
  3. Acetazolamide
  4. Partially treated DKA

Magnesium also, will need to be corrected first before K+ will correct itself

39
Q

Low Na+ causes

Urinary sodium > 20

A

Sodium depletion, renal loss (patient often hypovolaemic)
Diuretics: thiazides, loop diuretics
Addison’s disease
Diuretic stage of renal failure

Patient often euvolaemic
SIADH (urine osmolality > 500 mmol/kg)
Hypothyroidism

40
Q

Low Na+ causes

Urinary sodium < 20

A

Sodium depletion, extra-renal loss

  1. diarrhoea, vomiting, sweating
  2. burns, adenoma of rectum

Water excess (patient often hypervolaemic and oedematous)

  1. secondary hyperaldosteronism: heart failure, liver cirrhosis
  2. nephrotic syndrome
  3. IV dextrose
  4. psychogenic polydipsia
41
Q

What is SIADH?

A

Inappropriate secretion of ADH hormone
ADH acts on distal convoluting tubules and aids water reabsorption back into the bloods.
SIADH therefore increases water absorption into the blood and will cause a hyponaetraemia as the sodium becomes diluted

42
Q

What is diabetes insipidus?

A

Resistance/ distal convoluting tubules does not respond to ADH (vasopressin) therefore nil appropriate reabsorption of water, therefore excessive fluid loss - polyuria and polydipsia

43
Q

Causes of SIADH

Hint: split into categories (MIND-O)

A

Malignancy

  • small cell lung ca
  • pancreas + prostate

Infection

  • TB
  • pneumonia

Neuro

  • stroke
  • SAH/ subdural/ enceph/ meningitis

Drugs

  • sulfonylureas
  • SSRIs
  • TCAs
  • carbamezapine

Other

  • PEEP
  • porphyrias
44
Q

Why must correction of hyponatraemia be done slowly?

A

Risk of central pontine myelinolysis

45
Q

Mx of hyponatraemia secondary to water excess (3)

A
  1. Fluid restrict
  2. Demeclocycline
  3. ADH antagnoists
46
Q

Hypercalcaemia causes

MATH PPAD

A
  1. Malignancy
  2. Acromegaly
  3. Thyrotoxicosis
  4. Primary hyperparathyroidism, Paget’s
  5. Addison’s
  6. Dehydration, drugs - thiazides
47
Q

Features of hypercalcaemia (6)

A

Bones, stones, groans and psychic moans’

  1. Osteoporosis/ osteomalacia
  2. Renal stones and diabetes insipidus (polyuria and polydipsia)
  3. Constipation/ N&V
  4. Psychosis/ memory issues
  5. Corneal calcification
  6. HTN
48
Q

ECG findings of hypercalcaemia (1)

MSRA (22 decks)

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