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Phase 4 OSCE > Metabolic derangements > Flashcards

Metabolic derangements Flashcards

1
Q

Urea can be raised in renal failure.

Give 2 more causes of a raised urea?

A

Bleeding

Infection

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2
Q

How do you classify hyponatraemia and give examples of what can cause it

A

Hypovolaemia - D + V, diuretics
Euvolaemic - Addisons, hypothyroidism or SIADH (if conc urine)
High volume - heart, liver or renal failure// nephrotic syndrome

Usually due to medical illness - HF, MI, Ca, CAP/HAP

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3
Q

Give drugs which cause hyponatraemia

A 
Diuretics (thiazide>loop) 
PPIs
SSRIs 
Anti-epileptics 
ACE-I/ARBs
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4
Q

What can give a false result of hyponatraemia (pseudohyponatraemia) ?

A

Taking the blood sample from a drip arm
Hyperlipidaemia
Alcohol excess

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5
Q

What investigation work up would you do for someone with hyponatraemia?

A
  • VBG (check its correct)
  • Paired osmolality - serum + urine (>20 in urine if addisons/renal failure)
  • 9am cortisol (Addisons)
  • TFT (hypothyroidism)
  • BM
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6
Q

In hyponatraemia, why do you bring the sodium up cautiously?

A

Risk of pontine myelinolysis

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7
Q

How do you treat a patient with mild hyponatraemia?

A

Fluid restrict

Can give ADH antagonist (demeclocycline)

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8
Q

How do you treat hypernatraemia?

A

5% dextrose
(or 0.9% saline if they are hypovolaemic)

Aim correction for 10mmol/L per 24hours

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9
Q

A 84 year old lady comes in generally unwell. She has N&V, a headache, leg cramps and is itching.
Her BP is 165/100 and has peripheral oedema.
What electrolyte disturbance does she have?

A

Uraemia

CV - HTN, CAD, pericarditis, peripheral and pulmonary oedema
CNS - insomnia, confusion, headache, seizures, encephalopathy
Peripheral NS - peripheral neuropathy, cramps, restless les, oxidative stress
GI - N&N and anorexia
Haem - anaemia
Skin - itching, dry skin

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10
Q

What would a high urea and a normal Cr make you worry about?

A

GI bleed

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11
Q

What can cause uraemia?

A

Less urea clearance - hypovolaemia
Less renal clearance - AKI/CKD, steroids
Increased urease synthesis - GI haemorrhage or high protein diet

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12
Q

A 44 year old complains of thirst and lethargy. She has swollen legs and a BP of 170/102 but has not been going for a wee as regularly. She appears flushed in the face and has a dry mouth.
What could be the cause of this?

A

Hypernatraemia
DI
Lithium
Fever

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13
Q

What are the causes of hypernatraemia?

A

Low volume - D+V, diuretics or renal disease
Normal volume - DI, lithium, fever
High volume - fluid overload (too much IV saline)

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14
Q

How do you treat hypernatraemia?

A

PO water // IV H20 + dextrose

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15
Q

What are you at risk of if you bring the sodium down too quickly in hypernatraemia?

A

Cerebral oedema

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16
Q

Give some of the causes of SIADH

A

Ca - SC lung

Drugs - PPI, SSRI, Metformin, NSAIDs, opiates, diuretics, chemo agents

CNS - stroke, GBS, SLE

17
Q

What are some of the causes of hypokalaemia

A

Increased loss - GI N+V

Drugs - diuretics, steroids, insulin, salbutamol,

Cushings, Conns
Alkalosis
Mg deficiency

18
Q

What investigation work up should you do for hypokalaemia?

A

U&E, Mg (stuggle to correct if this is abnormal)
VBG (check correct - correct alkalosis)
BM

19
Q

What are the ECG changes seen in hypokalaemia

A 
PRSTTU 
PR - long 
ST - depressed 
T - inverted 
U - waves
20
Q

What are the ECG changes seen in hyperkalaemia

A 
PPRQRST
P - absent  
PR - long 
QRS - wide 
T - tall and tented
21
Q

What is pheochromocytoma associated with?

A

MEN (bilateral)

Neurofibromatosis

22
Q

What investigation work up would you do for pheochromocytoma?

A

Bloods - glucose, Ca and Hb (all high)
Urine - 24hr urine collection for Cr and total catecholamines
Imagine - abdominal CT

23
Q

Give some causes of hypercalcaemia

A

Endocrine - addisons, phaeo, thyrotoxicosis
Drugs - thiazide diuretics
Malignancy - SC lung ca, Breast
Granulomata - Sarcoid and TB

24
Q

What would an annual r/v for a diabetic include?

A 
Patient education + modifiable RF 
CVS assessment - BMI, BP, pulses 
Foot check 
Urine dip + bloods (HbA1c/lipids) 
Injection site check 
Eye check at ophthalmology
25
Q

Most common causes of goitre:
Worldwide:
Developed countries:
Medications:

A

Most common causes of goitre:
Worldwide: Iodine deficiency
Developed countries: hasthimoto’s thyroiditis and graves disease
Medications: lithium and amiodarone

26
Q

What is graves disease?

A

It is a AI disease with TSH receptor antibodies that mimic TSH causing gland hyperplasia and increased T3 + T4

27
Q

What are the 4 graves specific signs?

A

Exopthalmos
Opthalmoplegia
Pretibial myxoedema (infiltration/dermopathy of the skin)
Thyroid acropathy (clubbing/swelling of the fingers and toes)

Phase 4 OSCE (6 decks)

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