miscellaneous

Question 1

how to calculate anion gap in metabolic acidosis

what is the normal ranges

Answer 1

(Na+ + K+) - (Cl- + HCO-3)

10-18 mmol/L

Question 2

what things can result in a normal anion gap + metabolic acidosis (hyperchloraemic metabolic acidosis)

Answer 2

• gastrointestinal bicarbonate loss:
  prolonged diarrhoea: may also result in hypokalaemia ureterosigmoidostomy
  fistula
• renal tubular acidosis
• drugs: e.g. acetazolamide
  ammonium chloride injection
• Addison’s disease

ABCD
Addison’s
Bicarb loss
Chloride
Drugs

Question 3

what can result in a raised anion gap?
(in metabolic acidosis)

Answer 3

• lactate:
  shock, sepsis, hypoxia
• ketones:
  diabetic ketoacidosis, alcohol
• urate: renal failure
• acid poisoning: salicylates, methanol

Question 4

tx of severe hyperkalaemia - (≥ 6.5 mmol/L) or with ECG changes

Answer 4

IV calcium gluconate: to stabilise the myocardium to reduce risk of arrhythmia
insulin/dextrose infusion: short-term shift in potassium from ECF to ICF to reduce potassium
other treatments such as nebulised salbutamol may be given to temporarily lower the serum potassium

Further management
stop exacerbating drugs e.g. ACE inhibitors
treat any underlying cause
lower total body potassium
calcium resonium
loop diuretics
dialysis

Question 5

ulnar nerve damage

Answer 5

Ulnar injury at wrist : marked claw
Ulnar injury at elbow : less claw but get worse before getting better

Question 6

reason for isolated fever in well patient in first 24 hours following surgery

Answer 6

physiological reaction to operation

Question 7

what to offer for smoking cessation

Answer 7

nicotine replacement therapy (NRT), varenicline or bupropion

Question 8

stop smoking services in preg

Answer 8

1. NHS stop smoking services / CBT
2. NRT
   varenicline and bupropion are contraindicated

Question 9

Four D’s of pellagra (vitamin B3 deficiency)
+ what can cause it

Answer 9

Diarrhoea
Dermatitis
Dementia
Death

may occur as a consequence of isoniazid therapy

Question 10

falls

Question 11

frailty

Question 12

causes of folic acid deficiency

Answer 12

phenytoin
methotrexate
pregnancy
alcohol excess

Question 13

Consequences of folic acid deficiency:

Answer 13

macrocytic, megaloblastic anaemia
neural tube defects

Question 14

what is boerhaave’s syndrome

Answer 14

spontaneous rupture of the oesophagus that occurs as a result of repeated episodes of vomiting

Question 15

Boerhaave’s syndrome dx

Answer 15

CT contrast swallow