Metabolic Flashcards
Vitamin deficiency
A, B1 (Thiamine), B3 (Niacin), B6, B9(folic acid), C, D, E, K
A - night-blindness
B1 - Beriberi, Wernicke-Korsakoff syndrome, heart failure, polyneuropathy
B3 - Pellagra 3D (Dermatitis, diarrhoea, dementia)
B6 - anaemia, Irritability, seizure
B9 - Megaloblastic anaemia, neural tube defects
C - scurvy (gingivitis, bleeding)
D - Rickets, osteomalacia
E - peripheral neuropathy, mild haemolytic anaemic in newborn
K - Haemorrhagic disease of newborn, bleeding diathesis
Conn’s syndrome (Primary hyperaldosteronism) features
Hypertension
Hypokalaemia
Metabolic alkalosis
Sodium normal or at the high end of normal
Familial hypercholesterolaemia: what kind of genetic condition
Autosomal dominant
if one parent is affected, arrange testing in children by age 10
if both parents are affected, arrange testing in children by age 5
Obesity classification
BMI Old NICE 25 - 29.9 Overweight Overweight 30 - 34.9 Obese Obese I 35 - 39.9 Clinically obese Obese II > 40 Morbidly obese Obese III
QRISK2 may underestimate the risk in some patients. Which?
patients with a serious mental health disorder and those taking antipsychotics
HIV
autoimmune conditions such as SLE
Statin target lipid fall
40% reduction in non-HDL cholesterol after 3 months
otherwise, increase dose
Statin secondary prevention dose
Atorvastatin 80 mg
Glycemic index of food
High, medium, low
High: white rice, white bread, baked potato
Medium: Couscous, boiled new potato
Low: fruit and vegetables, peanuts
Hyperkalaemia: ECG changes
Tall T, small P, widened QRS
Hyperkalaemia: Causes
AKI Drugs - ACEi, ARB, spironolactone, ciclosporin, heparin Metabolic acidosis Addison's disease Rhabdomyolysis Massive blood transfusion
Best source of Vitamin D
Cod liver oil
Type 1 DM: Should QRISK2 be used?
No. Use the followings
- Older than 40 years
- Had DM for more than 10 years
- Established nephropathy
- Have other CVD risk factors
Food with high potassium
bananas, oranges, kiwi fruit, avocado, spinach, tomatoes
Statin and pregnancy
Statins should be discontinued in women 3 months before conception due to the risk of congenital defects
Hypercalcaemia first-line management
IV fluid, rehydration
CVD lifestyle modification
at least 5 portions of fruit and vegetables per day
2 portions of fish per week, including a portion of oily fish
4 to 5 portions of unsalted nuts, seeds and legumes per week
Hypokalaemia with hypertension; Diseases
Cushing’s syndrome
Conn’s syndrome (primary hyperaldosteronism)
Liddle’s syndrome
11-beta hydroxylase deficiency
Hypokalaemia without hypertension; Diseases
diuretics GI loss (e.g. Diarrhoea, vomiting) renal tubular acidosis (type 1 and 2**) Bartter's syndrome Gitelman syndrome
Which of blood parametres are decreased in acute phase response?
albumin transthyretin (formerly known as prealbumin) transferrin retinol binding protein cortisol binding protein
Asymptomatic hyperuricaemia; should it be treated?
NO.
Hyperlipidaemia: physical activity recommendations
each week aim for at least 150 minutes of moderate intensity aerobic activity or
75 minutes of vigorous intensity aerobic activity or a mix of moderate and vigorous aerobic activit
In which situations QRISK2 should not be used?
- type 1 diabetics
- patients with an estimated glomerular filtration rate (eGFR) less than 60 ml/min and/or albuminuria
- patients with a history of familial hyperlipidaemia
In which situations patients should be referred to specialist lipids clinic even if QRISK2 is low?
a total cholesterol concentration > 7.5and
a family history of premature coronary heart disease.
OR
a total cholesterol concentration of more than 9.0 or a non HDL cholesterol concentration of more than 7.5 mmol/litre even in the absence of family history
Patient taking simvastatin and lipids are still high
Switch to atrovastatin 80 mg as atorvastatin is now the treatment of choice
