Metabolic Medicine Flashcards
1
Q
What LFT lowers as part of acute infection?
A
Albumin (negative acute phase protein)
*This is because albumin is a negative acute-phase reactant, meaning its production decreases during inflammation or infection.
2
Q
Hyperkalaemia blood gas?
A
Metabolic acidosis (compete with hydrogen across cell membranes in distal tubule)
3
Q
Beta blocker electrolyte derangement?
A
Hyperkalaemia
4
Q
LMWH and unfractionated heparin electrolyte derangement?
A
Hyperkalaemia
5
Q
Hypocalcaemia features?
A
- Tetany
- Perioral paraesthesia
- Chronic = depression, cataracts
- ECG = Prolonged QT
6
Q
Trousseau’s sign in hypocalcaemia?
A
- Carpal spasm if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic
- Wrist flexion and fingers are drawn together
- Seen in around 95% of patients with hypocalcaemia and around 1% of normocalcaemic people
7
Q
Chvostek’s sign?
A
- Tapping over parotid causes facial muscles to twitch
- Seen in 70% of patients with hypocalcaemia and around 10% of normocalcaemic people
8
Q
Hypercalcaemia management?
A
- 3-4L normal saline per day
- Following rehydration bisphosponates may be used = take 2-3 days to work with maximal effect being seen at 7 days
- Others = calcitonin (quicker effect than bisphosphonates), steroids in sarcoidosis
9
Q
Hypercalcaemia Rx in pt who cannot tolerate aggressive fluid resuscitation?
A
- Loop diuretics e.g. furosemide
- Should be used with caution as may worsen e- derangement and volume depletion
10
Q
SIADH causes?
A
- Malignancy = SCLC, pancreas, prostate
- Neurological
- Infection = TB, pneumonia
- Drugs = Sulfonylureas, SSRI, TCA, Carbamazepine, Vincristine, Cyclophosphamide
- PEEP, Porphyrias
11
Q
SIADH Rx?
A
- Slow correction to avoid CPM
- Fluid restrict
- Demeclocycline = reduces responsiveness of collecting tubule cells to ADH
- ADH (vasopressin) receptor antagonists have been developed
12
Q
Primary prevention statin?
A
Atorvastatin 20mg OD
13
Q
Secondary prevention statin?
A
Atorvastatin 80mg OD
14
Q
Primary prevention statin criteria?
A
- 10 year cardiovascular risk QRISK2 >=10%
- Most Type 1 Diabetics
- CKD if eGFR < 60ml/min/m^2
15
Q
Secondary prevention statin criteria?
A
- Known IHD
- Cerebrovacular disease
- PAD
16
Q
QRISK2 use age cutoff?
A
85
17
Q
When should QRISK2 not be used?
A
- T1DM
- eGFR <60 and/or albuminuria
- Familial hyperlipidaemia
18
Q
When to consider familial hypercholesterolaemia?
A
- Total cholesterol > 7.5
- Personal/FHx premature CHD (<60 y/o)
19
Q
Statins for T1DM?
A
- > 40 y/o
- DM for >10y
- Established nephropathy
- Have other CVD risk factors
20
Q
Statins for CKD?
A
- All pts with CKD
- 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?
A
Obese, I
23
Q
BMI 35-39.9?
A
Clinically obese, II
24
Q
BMI >40?
A
Morbidly obese, III
25
Vitamin A name and deficiency state?
1. Retinoids
2. Night blindness (nyctalopia)
26
Vitamin B1 name and deficiency state?
1. Thiamine
2. Beriberi, polyneuropathy, Wernicke-Korsakoff syndrome, HF
27
Vitamin B3 name and deficiency state?
1. Niacin
2. Diarrhoea, Dementia, Dermatitis
28
Vitamin B6 name and deficiency state?
1. Pyridoxine
2. Anaemia, irritability, seizures
29
Vitamin B7 name and deficiency state?
1. Biotin
2. Dermatitis, seborrhoea
30
Vitamin B9 name and deficiency state?
1. Folic acid
2. Megaloblastic anaemia, NTD in pregnancy
31
Vitamin B12 name and deficiency state?
1. Cyanocobalamin
2. Megaloblastic anaemia, peripheral neuropathy
32
Vitamin C name and deficiency state??
1. Ascorbic acid
2. Scurvy = gingivitis, bleeding
33
Vitamin D name and deficiency state?
1. Ergocalciferol, cholecalciferol
2. Rickets, osteomalacia
34
Vitamin E name and deficiency state?
1. Tocopherol, tocotrienol
2. Mild haemolytic anaemia in newborn infants, ataxia, peripheral neuropathy
35
Vitamin K name and deficiency state?
1. Naphthoquinone
2. Haemorrhagic disease of the newborn, bleeding diathesis
36
Familial hypercholesterolaemia mushkies?
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
Familial hypercholesterolaemia case findings?
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
Clinical diagnosis of Familial hypercholesterolaemia?
Simon Broome criteria
39
Familial hypercholesterolaemia Rx?
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
Does asymptomatic hyperuricaemia need to be treated?
No
41
Classification of hyperuricaemia causes?
1. Increased cell turnover
2. Reduced renal excretion of uric acid
42
Hyperuricaemia associations?
1. Hyperlipidaemia
2. Hypertension
3. Metabolic syndrome
43
Increased synthesis causes of hyperuricaemia?
1. Lesch-Nyhan disease
2. Myeloproliferative disorders
3. Diet rich in purines
4. Exercise
5. Psoriasis
6. Cytotoxics
44
Decreased excretion causes of hyperuricaemia?
1. Drugs = low dose aspirin, diuretics, pyrazinamide
2. Pre-eclampsia
3. Alcohol
4. Renal failure
5. Lead
45
Raised ALP and raised calcium?
1. Bone metastases
2. Hyperparathyroidism
46
Raise ALP and low calcium?
1. Osteomalacia
2. Renal failure
47
Physiological causes of raised ALP?
1. Pregnancy
2. Growing children
3. Healing fracture
