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
SIADH (characterised by hyponatraemia secondary to the dilutional effects of excessive water retention) causes
Malignancy: small cell lung cancer, also: pancreas, prostate
Neurological: stroke, subarachnoid haemorrhage, subdural haemorrhage ,meningitis/encephalitis/abscess
Infections: TB, peneumonia
Drugs: sulfonylureas, SSRIs, tricyclics, carbamazepine ,vincristine, cyclophosphamide
Others: positive end-expiratory pressure (PEEP)
porphyrias
metastatic hypercalcaemia
Which level should be admitted to hospital immediately?
adjusted serum calcium concentration greater than 3.0 mmol/L
Causes of predominantly hypercholesterolaemia
nephrotic syndrome
cholestasis
hypothyroidism
Causes of predominantly hypertriglyceridaemia
diabetes mellitus (types 1 and 2) obesity alcohol chronic renal failure drugs: thiazides, non-selective beta-blockers, unopposed oestrogen liver disease
