Metabolic/ pharm

Question 1

widespread muscle cramps and numbness of her hands and feet. She also describes a tingling sensation around her mouth.. CX?

Answer 1

low Ca: vitamin D deficiency (osteomalacia)
chronic kidney disease
hypoparathyroidism (e.g. post thyroid/parathyroid surgery)
rhabdomyolysis (initial stages)
magnesium deficiency (due to end organ PTH resistance)
massive blood transfusion
acute pancreatitis (and lleads to long QT)

Question 2

Vitamin D deficieny TX?

Answer 2

Less than 25 nmol/L – vitamin D deficiency
25 to 50 nmol/L – vitamin D insufficiency
50,000 IU once weekly for 6 weeks
4000 IU daily for 10 weeks
Maintenance: 800-2000IU OD

Question 3

Squamous cell carcinoma (skin) af?

Answer 3

Increased PTH (

Question 4

Small cell lung cancer AF?

Answer 4

SIADH,
SmAALl cell lung cancer:
ACTH
ADH
Lambert Eaton syndrome (antibodies against VGCCs)

Question 5

High K causes?

Answer 5

acute kidney injury
drugs*: potassium sparing diuretics, ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, heparin**
metabolic acidosis
Addison’s disease
rhabdomyolysis
massive blood transfusion

Foods that are high in potassium:
salt substitutes (i.e. Contain potassium rather than sodium)
bananas, oranges, kiwi fruit, avocado, spinach, tomatoes
tall-tented T waves, small P waves, widened QRS

Question 6

when do u sus familial hypercholesterolaemia

Answer 6

TC 7.5+, FH of IHD/ CAD before age of 60. test in children at 5 YO if both parents have it, test at 10 YO if 1 parent has it. tendon xanthoma in patients/ 1st degree

Question 7

SE/ CI of sildenafil? (phosphodiesterase V inhibitor)?
Neonates - sed for pulmonary hyptertension

Answer 7

CI: nitrates, nicorandil, hyptension, stroke/ mI in 6 months
SE: visual disturbances
blue discolouration
non-arteritic anterior ischaemic neuropathy
nasal congestion
flushing
gastrointestinal side-effects
headache
priapism

Question 8

Gentamycin (aminoglycoside) Risks?

Answer 8

CI: myasthenia gravis
Risks: ototoxic, nephrotoxic, aKI

Question 9

Organophosphate poisoning? Sx? TX?

Answer 9

Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
also: small pupils, muscle fasciculation
Tx: atropine

Question 10

Prescipitate lithium toxicity (DAMN)?

Answer 10

Diuretics
Ace/ARB
Metronidazole
NSAIDs
tox when 1.5+ (normal 0.4-1)

Question 11

blurry vision, halos around lights, and yellow-green colour perception (xanthopsia)? Which toxicity? Triggering factors?

Answer 11

digoxin. aldo gynacomastia, AV block, brady.
Triggers: low K, low Mg, High Ca, High NA, myocardial ischaemia
hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis
hypoalbuminaemia
hypothermia
hypothyroidism
drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in distal convoluted tubule therefore reduce excretion), ciclosporin. Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics

Question 12

Headache, N_V, fever, vertigo, pink skin, confusion, extrapyramidal features?

Answer 12

Carbon monoxide poisoning:
typical carboxyhaemoglobin levels
< 3% non-smokers
< 10% smokers
TX: 100

Question 13

Low MG Cx?

Answer 13

PPI, TPN
diuretics
total parenteral nutrition
alcohol
hypokalaemia
hypercalcaemia
Gitleman’s and Bartter’s
>0.4 - oral
<0.4 + seizures/tetany give IV

Question 14

Triggers of digoxin tox?

Answer 14

myocardial ischaemia
hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis
hypoalbuminaemia
hypothermia
hypothyroidism
drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in distal convoluted tubule therefore reduce excretion), ciclosporin. Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics

Question 15

Paracetamol OD - when to give Acetylcystine

Answer 15

100 mg/L at 4 hours and 15 mg/L at 15 hours, or
staggered
- 8-24 hours after ingestion over 150 mg/kg
24hrs after presentation with clear jaundiced a and derranged LFTs

Question 16

Paracetamol OD - when to consider transplant

Answer 16

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

Question 17

Chest pain with hypertonic and hyper-reflexive, and his pupils are dilated. His blood pressure is 175/82 mmHg. An ECG shows some QRS widening and QT prolongation, as well as ST depression and T wave inversion in several leads.

Answer 17

MI after cocaine injestion. Give diazepam (caused by coronary vasospasm, benzos smooth muscle relax)

Question 18

Fe OD tx?

Answer 18

Desferrioxamine, a chelating agent

Question 19

Cyanide poisoning TX?

Answer 19

Hydroxocobalamin; also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate

Question 20

Lead poisoning TX?

Answer 20

Dimercaprol, calcium edetate

Question 21

Drugs to avoid in renal failure?

Answer 21

antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin

Question 22

Mixed metabolic acidosis/ tinnitus, lethargy, pyrexia, N+V, seizures, hyperventilation, BM erratic

Answer 22

Salicylate poisoning:
Tx: charcoal, urine alkalisation IV HCO3, haemodialisis (if 700+)

Question 23

Cx of lung fibrosis?

Answer 23

amiodarone
cytotoxic agents: busulphan, bleomycin
anti-rheumatoid drugs: methotrexate, sulfasalazine
nitrofurantoin
ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)

Question 24

Drug induced thrombocytopenia?

Answer 24

quinine
abciximab
NSAIDs
diuretics: furosemide
antibiotics: penicillins, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin