Metabolic

Question 1

Vitamin deficiency

A, B1 (Thiamine), B3 (Niacin), B6, B9(folic acid), C, D, E, K

Answer 1

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

Question 2

Conn’s syndrome (Primary hyperaldosteronism) features

Answer 2

Hypertension
Hypokalaemia
Metabolic alkalosis
Sodium normal or at the high end of normal

Question 3

Familial hypercholesterolaemia: what kind of genetic condition

Answer 3

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

Question 4

Obesity classification

Answer 4

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

Question 5

QRISK2 may underestimate the risk in some patients. Which?

Answer 5

patients with a serious mental health disorder and those taking antipsychotics
HIV
autoimmune conditions such as SLE

Question 6

Statin target lipid fall

Answer 6

40% reduction in non-HDL cholesterol after 3 months

otherwise, increase dose

Question 7

Statin secondary prevention dose

Answer 7

Atorvastatin 80 mg

Question 8

Glycemic index of food

High, medium, low

Answer 8

High: white rice, white bread, baked potato
Medium: Couscous, boiled new potato
Low: fruit and vegetables, peanuts

Question 9

Hyperkalaemia: ECG changes

Answer 9

Tall T, small P, widened QRS

Question 10

Hyperkalaemia: Causes

Answer 10

AKI
Drugs - ACEi, ARB, spironolactone, ciclosporin, heparin
Metabolic acidosis
Addison's disease
Rhabdomyolysis
Massive blood transfusion

Question 11

Best source of Vitamin D

Answer 11

Cod liver oil

Question 12

Type 1 DM: Should QRISK2 be used?

Answer 12

No. Use the followings

1. Older than 40 years
2. Had DM for more than 10 years
3. Established nephropathy
4. Have other CVD risk factors

Question 13

Food with high potassium

Answer 13

bananas, oranges, kiwi fruit, avocado, spinach, tomatoes

Question 14

Statin and pregnancy

Answer 14

Statins should be discontinued in women 3 months before conception due to the risk of congenital defects

Question 15

Hypercalcaemia first-line management

Answer 15

IV fluid, rehydration

Question 16

CVD lifestyle modification

Answer 16

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

Question 17

Hypokalaemia with hypertension; Diseases

Answer 17

Cushing’s syndrome
Conn’s syndrome (primary hyperaldosteronism)
Liddle’s syndrome
11-beta hydroxylase deficiency

Question 18

Hypokalaemia without hypertension; Diseases

Answer 18

diuretics
GI loss (e.g. Diarrhoea, vomiting)
renal tubular acidosis (type 1 and 2**)
Bartter's syndrome
Gitelman syndrome

Question 19

Which of blood parametres are decreased in acute phase response?

Answer 19

albumin
transthyretin (formerly known as prealbumin)
transferrin
retinol binding protein
cortisol binding protein

Question 20

Asymptomatic hyperuricaemia; should it be treated?

Answer 20

NO.

Question 21

Hyperlipidaemia: physical activity recommendations

Answer 21

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

Question 22

In which situations QRISK2 should not be used?

Answer 22

• 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

Question 23

In which situations patients should be referred to specialist lipids clinic even if QRISK2 is low?

Answer 23

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

Question 24

Patient taking simvastatin and lipids are still high

Answer 24

Switch to atrovastatin 80 mg as atorvastatin is now the treatment of choice

Question 25

SIADH (characterised by hyponatraemia secondary to the dilutional effects of excessive water retention) causes

Answer 25

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

Question 26

metastatic hypercalcaemia

Which level should be admitted to hospital immediately?

Answer 26

adjusted serum calcium concentration greater than 3.0 mmol/L

Question 27

Causes of predominantly hypercholesterolaemia

Answer 27

nephrotic syndrome
cholestasis
hypothyroidism

Question 28

Causes of predominantly hypertriglyceridaemia

Answer 28

diabetes mellitus (types 1 and 2)
obesity
alcohol
chronic renal failure
drugs: thiazides, non-selective beta-blockers, unopposed oestrogen
liver disease