W18 - EMQ on enzymes, chemistry

Question 1

Which one is increased in a patient with Paget’s disease of the bone?

Answer 1

C) Alkaline phosphatase (ALP)

Question 2

Which one is increased in a patient with osteomalacia?

Answer 2

C) Alkaline phosphatase

(osteomalacia => lack of vitamin D => rise in PTH (2ndary hyperPTH) due to low calcium => increase bone formation and hence turnover => high ALP)

Question 3

Which one is increased in a patient following an acute MI?

Answer 3

D) AST

Heart muscle releases firstly troponins, CK (MB), then AST, then LDH (in order of highest [] to lowest [])

Question 4

Which one is raised in Addison’s disease?

Answer 4

Potassium

Question 5

Which one of the above is most increased in a patient with jaundice caused by a gallstone?

Answer 5

C) Alkaline phosphatase (OBSTRUCTIVE JAUNDICE)

• AST and ALT might also be raised, but ALP will be v high!

Question 10

What does this CXR show?

Answer 10

huge hilar lymph nodes on both sides = Bilateral hilar lymphadenopathy

Question 11

What does this CXR show?

Answer 11

Bilateral hilar lymphadenopathy

Question 13

Which one is most increased in a patient with jaundice caused by viral hepatitis?

Answer 13

ViraL = ALT (B)

ALT wins over AST in VIRAL hepatitis

Question 14

Which one is most increased in a patient with jaundice caused by chronic alcoholic cirrhosis?

Answer 14

D) Aspartate amino transferase (AST)

In alcoholic cirrhosis, you’ve got high AST, ALT, GGT but the HIGHEST in a chronic alcoholic cirrhosis will be AST

Question 15

Which one is most increased in a patient with prostatic carcinoma?

Answer 15

A) Acid phosphatase (we’ve now changed the name to prostate specific antigen/PSA)

Question 16

45 year old Afro-Carribean man presents with dyspnoea. Which is the most helpful investigation?

A) FBC

B) U&E

C) CXR

D) ECG

E) Echocardiogram

Answer 16

C) CXR

although all are useful, a CXR can pick up or exclude many possible diagnoses

if pt was orthopnoiec, E) echo would’ve been more useful to investigate HF

Question 19

45 year old Afro-Carribean man presents with dyspnoea. His calcium is 2.82 (2.20-2.60).

• What do you think he has?
• What result do you expect from his PTH?
• What is his treatment plan?

Answer 19

• What do you think he has? sarcoidosis
• What result do you expect from his PTH? suppressed to undetectable levels
• What is his treatment plan? steroids (which will normalise both the calcium and treat the lung problem)

Question 20

How does sarcoidosis cause hypercalcaemia?

Answer 20

Sarcoidosis is a systemic disease where macrophages express 1 alpha hydroxylase