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MSRA > Metabolic Medicine > Flashcards

Metabolic Medicine Flashcards

1
Q

What LFT lowered as part of acute infection?

A

Albumin (negative acute phase protein)

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2
Q

Hyperkalaemia blood gas?

A

Metabolic acidosis (compete with hydrogen across cell membranes in distal tubule)

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3
Q

Beta blocker electrolyte derangement?

A

Hyperkalaemia

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4
Q

LMWH and unfractionated heparin electrolyte derangement?

A

Hyperkalaemia

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5
Q

Hypocalcaemia features?

A
  1. Tetany
  2. Perioral paraesthesia
  3. Chronic = depression, cataracts
  4. ECG = Prolonged QT
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6
Q

Trousseau’s sign in hypocalcaemia?

A
  1. Carpal spasm if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic
  2. Wrist flexion and fingers are drawn together
  3. Seen in around 95% of patients with hypocalcaemia and around 1% of normocalcaemic people
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7
Q

Chvostek’s sign?

A
  1. Tapping over parotid causes facial muscles to twitch
  2. Seen in 70% of patients with hypocalcaemia and around 10% of normocalcaemic people
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8
Q

Hypercalcaemia management?

A
  1. 3-4L normal saline per day
  2. Following rehydration bisphosponates may be used = take 2-3 days to work with maximal effect being seen at 7 days
  3. Others = calcitonin (quicker effect than bisphosphonates), steroids in sarcoidosis
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9
Q

Hypercalcaemia Rx in pt who cannot tolerate aggressive fluid resuscitation?

A
  1. Loop diuretics e.g. furosemide
  2. Should be used with caution as may worsen e- derangement and volume depletion
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10
Q

SIADH causes?

A
  1. Malignancy = SCLC, pancreas, prostate
  2. Neurological
  3. Infection = TB, pneumonia
  4. Drugs = Sulfonylureas, SSRI, TCA, Carbamazepine, Vincristine, Cyclophosphamide
  5. PEEP, Porphyrias
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11
Q

SIADH Rx?

A
  1. Slow correction to avoid CPM
  2. Fluid restrict
  3. Demeclocycline = reduces responsiveness of collecting tubule cells to ADH
  4. ADH (vasopressin) receptor antagonists have been developed
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12
Q

Primary prevention statin?

A

Atorvastatin 20mg OD

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13
Q

Secondary prevention statin?

A

Atorvastatin 80mg OD

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14
Q

Primary prevention statin criteria?

A
  1. 10 year cardiovascular risk QRISK2 >=10%
  2. Most Type 1 Diabetics
  3. CKD if eGFR < 60ml/min/m^2
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15
Q

Secondary prevention statin criteria?

A
  1. Known IHD
  2. Cerebrovacular disease
  3. PAD
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16
Q

QRISK2 use age cutoff?

A

85

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17
Q

When should QRISK2 not be used?

A
  1. T1DM
  2. eGFR <60 and/or albuminuria
  3. Familial hyperlipidaemia
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18
Q

When to consider familial hypercholesterolaemia?

A
  1. Total cholesterol > 7.5
  2. Personal/FHx premature CHD (<60 y/o)
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19
Q

Statins for T1DM?

A
  1. > 40 y/o
  2. DM for >10y
  3. Established nephropathy
  4. Have other CVD risk factors
20
Q

Statins for CKD?

A
  1. All pts with CKD
  2. Increase the dose if a greater than 40% reduction in non-HDL cholesterol is not achieved and the eGFR > 30 ml/min. If the eGFR is < 30 ml/min a renal specialist should be consulted before increasing the dose
21
Q

Statin f/up?

A

At 3m:
1. Repeat full lipid profile
2. if the non-HDL cholesterol has not fallen by at least 40% concordance and lifestyle changes should be discussed with the patient

22
Q

BMI 30-34.9?

23
Q

BMI 35-39.9?

A

Clinically obese, II

24
Q

BMI >40?

A

Morbidly obese, III

25
Q

Vitamin A name and deficiency state?

A
  1. Retinoids
  2. Night blindness (nyctalopia)
26
Q

Vitamin B1 name and deficiency state?

A
  1. Thiamine
  2. Beriberi, polyneuropathy, Wernicke-Korsakoff syndrome, HF
27
Q

Vitamin B3 name and deficiency state?

A
  1. Niacin
  2. Diarrhoea, Dementia, Dermatitis
28
Q

Vitamin B6 name and deficiency state?

A
  1. Pyridoxine
  2. Anaemia, irritability, seizures
29
Q

Vitamin B7 name and deficiency state?

A
  1. Biotin
  2. Dermatitis, seborrhoea
30
Q

Vitamin B9 name and deficiency state?

A
  1. Folic acid
  2. Megaloblastic anaemia, NTD in pregnancy
31
Q

Vitamin B12 name and deficiency state?

A
  1. Cyanocobalamin
  2. Megaloblastic anaemia, peripheral neuropathy
32
Q

Vitamin C name and deficiency state??

A
  1. Ascorbic acid
  2. Scurvy = gingivitis, bleeding
33
Q

Vitamin D name and deficiency state?

A
  1. Ergocalciferol, cholecalciferol
  2. Rickets, osteomalacia
34
Q

Vitamin E name and deficiency state?

A
  1. Tocopherol, tocotrienol
  2. Mild haemolytic anaemia in newborn infants, ataxia, peripheral neuropathy
35
Q

Vitamin K name and deficiency state?

A
  1. Naphthoquinone
  2. Haemorrhagic disease of the newborn, bleeding diathesis
36
Q

Familial hypercholesterolaemia mushkies?

A

Familial hypercholesterolaemia (FH) is an autosomal dominant condition that is thought to affect around 1 in 500 people. It results in high levels of LDL-cholesterol which, if untreated, may cause early cardiovascular disease (CVD). FH is caused by mutations in the gene which encodes the LDL-receptor protein.

37
Q

Familial hypercholesterolaemia case findings?

A
  1. Suspect if: total cholesterol >7.5 and/or personal/FHx of CHD < 60 y/o
  2. Children of affected parents = if one parent affected arrange testing <10 y/o, if both parents affected arrange testing < 5y/o
38
Q

Clinical diagnosis of Familial hypercholesterolaemia?

A

Simon Broome criteria

39
Q

Familial hypercholesterolaemia Rx?

A
  1. Referral to specialist lipid clinic
  2. High dose statins usually 1st line
  3. 1st degree relatives have a 50% chance of having the disorder and should therefore be offered screening.
  4. Statins should be discontinued in women 3 months before conception due to the risk of congenital defects
40
Q

Does asymptomatic hyperuricaemia need to be treated?

41
Q

Classification of hyperuricaemia causes?

A
  1. Increased cell turnover
  2. Reduced renal excretion of uric acid
42
Q

Hyperuricaemia associations?

A
  1. Hyperlipidaemia
  2. Hypertension
  3. Metabolic syndrome
43
Q

Increased synthesis causes of hyperuricaemia?

A
  1. Lesch-Nyhan disease
  2. Myeloproliferative disorders
  3. Diet rich in purines
  4. Exercise
  5. Psoriasis
  6. Cytotoxics
44
Q

Decreased excretion causes of hyperuricaemia?

A
  1. Drugs = low dose aspirin, diuretics, pyrazinamide
  2. Pre-eclampsia
  3. Alcohol
  4. Renal failure
  5. Lead
45
Q

Raised ALP and raised calcium?

A
  1. Bone metastases
  2. Hyperparathyroidism
46
Q

Raise ALP and low calcium?

A
  1. Osteomalacia
  2. Renal failure
47
Q

Physiological causes of raised ALP?

A
  1. Pregnancy
  2. Growing children
  3. Healing fracture

MSRA (25 decks)

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