Past paper corrections Chempath Flashcards
What enzyme should be measured before administering azathioprine?
Thiopurine methyltransferase
How is LMWH monitored in a patient with renal failure?
anti xa assay
Diabetic patient recently started ACEi/ARB, now has high creatinine and urea. What is the underlying cause?
Patient presenting with serum Na 130, all other electrolytes within range. Urinary Na 40, Urine Osmolality 680. What is the most likely diagnosis.
how would you manage the patient?
SIADH
normal serum sodium is 135-145
fluid restriction
Boy had pituitary mass removed. He felt a bit dizzy and serum sodium was 129. Observations and all other U&Es showed he was fit to be discharged. What’s the most important medication for him to be prescribed to take as outpatient
Prednisolone -> you have to replace cortisol first as patient has hypopituitarism due to surgery adrenal insufficency. 1st line = hydrocortisone. 2nd = prednioslone, dexamethasone
A patient with T1DM has missed an insulin dose and now presents vomiting with Kussmaul respiration. What is the most likely PCO2 on their ABG?
3.5 kPA !!!
normal is 4.6 - 6.4 kPa
Given bloods that showed normal sodium, low potassium and something else. Guess the most likely bicarbonate to the nearest whole number (normal 22-30)
39
low potassium means high bicarbonate
Patient with hypokalaemia. Predict the bicarb result?
39!!
learn normal range for bicarb = 22-30
name the drug used for patients with type 2 diabetes which inhibits the enzyme alpha glucosidase in the brush border membrane of the small bowel
acarbose
name a DDP-4 inhibitor
SITA-gliptin
(“site of action” - for spelling)
What blood marker is used to check for recurrence of papillary thyroid cancer post resection?
thyroglobulin
A patient presents with new-onset type 2 diabetes, an enlarged jaw and forehead and carpal-tunnel syndrome. Which investigation would be most useful to diagnose the likely cause?
oral glucose tolerance test
What investigation/test is used to monitor someone on LMWH with renal failure?
anti-xa assay
2cm pituitary mass. Prolactin level: 1400
What’s the diagnosis?
non functioning pituitary adenoma!!!
<1000 prolactin -> stress, recent breast of vaginal exam, hypothyroidism, PCOS
1000 - 5,000 = non functioning pituitary adenoma
> 5,000 = prolactinoma!!
Note low dose dex suppression test -> failure to suppress = cushings syndrome. Also shown by high 24 hour urine cortisol or high late night salivary cortisol
Step 2 = measure serum ACTH. low = adrenal tumour (do ct) or exogenous glucocorticoid. High = pituitary sampling for ACTH. if high = pituitary tumour. Low = ectopic acth secretion so CT chest abdomen
What is raised when a cell undergoes haemolysis?
potassium
What drug causes hypoglycaemia
Quinine, Thiazide, Statin, Glucagon, prednisone - others cause hyperglycemia
Which of the following is Vitamin D from plants?
ergocalciferol
Baby/young child with 21-alpha-OH, what would be likely serum levels?
Low sodium & high potassium
No aldosterone to bring about potassium excretion and sodium reabsorption
Addison’s patient is admitted in adrenal crisis. Her BP is low. What fluid should be given?
IV hydrocortisone
30yo man comes to ED having taken a drug overdose. ABG below.
metabolic acidosis
aspirin
Which liver enzyme can be measured in the blood and specifically suggests obstructive jaundice if levels are found to be raised?
gamma -glutamyl transferase GGT
A 24 year old patient with known type 1 diabetes presents having missed her insulin, and is now vomiting with Kussmaul’s respiration. Predict the likely bicarbonate concentration in this patient. (bicarbonate reference range 22-29 mmol/L)
- Bicarb is less than 18 in DKA
as it is a metabolic acidosis!
hypoglycemia treatment
IM glucagon
Which adrenal zone produces cortisol?
Zona fasciculata. Salt SUGAR sex
What enzyme does allopurinol inhibit?
xanthine oxidase
What active enzyme in sarcoidosis patients causes hypercalcaemia
1 alpha hydroxylase
What is the commonest cause of hypercalcaemia in the community?
primary hyperparathyroidism
Deficiency of which plasma protein occurs in patients with liver disease and a movement disorder?
ceruloplasmin
60 year old man with BMI of 28 has abdo pain. His LFTs - high total BR, high ALP, high ALT, high AST, high GGT, high creatine kinase. What is the most likely diagnosis?
obstructive jaundice due to gallstones
GGT is high !!
Increased insulin sensitivity results in low plasma glucose and occurs in which of the following conditions?
ACTH deficiency
What is increased in urine in hemolytic jaundice?
urobilinogen
Which of the following binds to receptors in the adrenal and stimulates aldosterone release?
angiotensin 2
MEN2 medullary thyroid adenoma. What hormone would you measure?
calcitonin
⁃ You measure thyroglobulin for papillary thyroid cancer
T1DM? with hypoglycaemia, What is the management option if no IV access
IM glucagon
PCSK9 inhibitor - evolucumab, what does it halve?
LDL levels
ToF - what type of shunt?
right to left shunt
What would be high in most common cause of CAH
ACTH
Which hormone leads to release of prolactin?
thyrotrophin-releasing hormone
best investigation to confirm a diagnosis of cushings disease (its when the pituitary is affected). think of it as disease = serious! vs syndrome so involves the head
pituitary sampling for ACTH. used to be high dose dex but no longer done!
Diabetic patient recently started ACEi/ARB, now has high creatinine and urea. What is the underlying cause?
renal artery stenosis
