phisiology 31.05 Flashcards
Which of the following features does not put a patient at risk of refeeding syndrome?
BMI < 16 kg/m
Alcohol abuse
Thyrotoxicosis
Chemotherapy
Diuretics
Diuretics increase the risk of re-feeding syndrome through a process of increasing the risk of depletion of key electrolytes.
A 73 year old lady is admitted for a laparoscopic cholecystectomy. During her pre-operative assessment it is noted that she is receiving furosemide for the treatment of hypertension. Approximately what proportion of the sodium that is filtered at the glomerulus will be subsequently excreted?
Up to 25%
Up to 75%
Between 3 and 5%
<2%
Between 1 and 2%
The loop diuretics can lead to marked increases in the amount of sodium excreted. They act in the medullary and cortical aspects of the thick ascending limb of the loop of Henle. This results in a decreased medullary concentration gradient and increases free water excretion (as well as loss of sodium). Because loop diuretics result in the loss of both sodium and water they are less frequently associated with hyponatraemia than thiazide diuretics (these latter agents act in the cortex and do not affect urine concentrating ability).
Which of the following is not linked to excess glucocorticoids?
Osteonecrosis
Osteoporosis
Hypokalaemia
Hyponatraemia
Growth retardation in children
There are many adverse effects associated with excess glucocorticoids. Thinning of the skin, osteonecrosis and osteoporosis are all common. Steroids are associated with retention of sodium and water. Potassium loss may occur and hypokalaemic alkalosis has been reported.
A 54-year-old woman is admitted to the Surgical Admissions Unit with abdominal pain. Blood tests taken on admission show the following:
Magnesium 0.40 mmol/l (normal value 0.7-1.0 mmol/l)
Which one of the following factors is most likely to be responsible for this result?
Excessive resuscitation with intravenous saline
Digoxin therapy
Diarrhoea
Hypothermia
Rhabdomyolysis
Diarrhoea
A 55-year-old man with a history of type 2 diabetes mellitus, bipolar disorder and chronic obstructive pulmonary disease has bloods taken during a pre operative assessment of an inguinal hernia repair:
Na+ 125 mmol/l K+ 3.8 mmol/l Bicarbonate 24 mmol/l Urea 3.7 mmol/l Creatinine 92 µmol/l
Due to his smoking history a chest x-ray is ordered which is reported as normal. The Consultant asks you what is the most likely cause for the hyponatraemia?
Metformin
Lithium
Carbamazepine
Sodium valproate
Pioglitazone
SIADH - drug causes: carbamazepine, sulfonylureas, SSRIs, tricyclics
Lithium can cause diabetes insipidus but this is generally associated with a high sodium. Lithium only tends to cause raised antidiuretic hormone levels following a severe overdosage.
Which of the following stimulates prolactin release or action?
Leutinising hormone
Dopamine
Thyrotropin releasing hormone
Oestrogen
Follicle stimulating hormone
TRH stimulates prolactin release. Dopamine suppresses the release of prolactin.
Which of the following is responsible for the release and synthesis of calcitonin?
Parathyroid glands
Anterior pituitary
Thyroid gland
Posterior pituitary
Adrenal glands
Calcitonin has the opposite effect of PTH and is released from the thyroid gland.
Which of the following does not cause a normal anion gap acidosis?
Pancreatic fistula
Acetazolamide
Uraemia
Ureteric diversion
Renal tubular acidosis
Normal Gap Acidosis: HARDUP
H - Hyperalimentation/hyperventilation A - Acetazolamide R - Renal tubular acidosis D - Diarrhoea U - Ureteral diversion P - Pancreatic fistula/parenteral saline Uraemia will typically cause a high anion gap acidosis. It is one of the unmeasured anions.
Which of the following features does not put a patient at risk of refeeding syndrome?
BMI < 16 kg/m
2
Alcohol abuse
Thyrotoxicosis
Chemotherapy
Diuretics
Diuretics increase the risk of re-feeding syndrome through a process of increasing the risk of depletion of key electrolytes.
A 55-year-old man with a history of type 2 diabetes mellitus, bipolar disorder and chronic obstructive pulmonary disease has bloods taken during a pre operative assessment of an inguinal hernia repair:
Na+ 125 mmol/l K+ 3.8 mmol/l Bicarbonate 24 mmol/l Urea 3.7 mmol/l Creatinine 92 µmol/l
Due to his smoking history a chest x-ray is ordered which is reported as normal. The Consultant asks you what is the most likely cause for the hyponatraemia?
Metformin
Lithium
Carbamazepine
Sodium valproate
Pioglitazone
SIADH - drug causes: carbamazepine, sulfonylureas, SSRIs, tricyclics
Lithium can cause diabetes insipidus but this is generally associated with a high sodium. Lithium only tends to cause raised antidiuretic hormone levels following a severe overdosage.
Which of the following does not cause a normal anion gap acidosis?
Pancreatic fistula
Acetazolamide
Uraemia
Ureteric diversion
Renal tubular acidosis
Normal Gap Acidosis: HARDUP
H - Hyperalimentation/hyperventilation A - Acetazolamide R - Renal tubular acidosis D - Diarrhoea U - Ureteral diversion P - Pancreatic fistula/parenteral saline Uraemia will typically cause a high anion gap acidosis. It is one of the unmeasured anions.
Hyperparathyroidism mosct common symptom?
Fatigue
Spirometry of emphysema?
Increased total lung capacity!
What is a ligametnum venosum?
Obliterated ductus venosus
Umbilical vein - round ligament
Raised gastrin without concomitant increase in HCl?
Pernicious anemia
