Blood and nutrition

Question 1

What is GPD6 deficiency?

Answer 1

An inborn error of carbohydrate metabolism

Sufferers are susceptible to haemolytic anaemia

Question 2

Which of these does NOT have a risk of haemolysis in GPD6 deficiency?

• Dapsone
• Nitrofurantoin
• Ciprofloxaicn
• Gentamicin
• Co-trimoxazole

Answer 2

Gentamicin

Question 3

‘Risk and severity of haemolysis in GPD6 deficiency is almost always dose-related’
TRUE OR FALSE?

Answer 3

TRUE

Question 4

Which safety warnings should be remebered with epoetnis?

Answer 4

• Risk of severe cutaneous adverse reactions including SJS
• Chance of over-correction of Hb conc in patients with CKD, range 10-12ng/L
• Risk of tumour progression and reduced survival in cancer patients, only if associated with chemo

Question 5

Which of these conditions do NOT usually require prophylaxis of iron-deficient anaemia?

• Crohns disease
• Pregnancy
• Menorrhagia
• Diabetes
• Haemodialysis

Answer 5

Diabetes

Question 6

How can iron deficiency anaemia be treated in pregnancy?

Answer 6

Ferrous sulphate 200mg BD/TDS

Question 7

How much elemental iron is in 300mg ferrous sulphate?

Answer 7

60mg

Question 8

How much elemental iron is in 200mg ferrous fumarate?

Answer 8

65mg

Question 9

Which oral iron is usually given for prophylaxis of iron-deficient anaemia?

Answer 9

Ferrous sulphate 200mg OD

Question 10

What counselling should be given to patients on oral iron?

Answer 10

• Take with food to reduce GI side effects
• Take with a full glass of orange juice as vitamin C can aid absorption
• May colour stools

Question 11

How long should treatment for iron-deficiency anaemia continue for?

Answer 11

3 months after blood levels return to normal

Question 12

Can IV iron be given in pregnancy?

Answer 12

Should be avoided if possible, especially in the first trimester

Question 13

What is the most serious side effect associated with IV iron?

Answer 13

Severe hypersensitivy reactions such as life-threatening anaphylaxis

Question 14

‘Oral iron can cause constipation’

True or false?

Answer 14

True - avoid in faecal impaction

Question 15

Why should iron tablets ALWAYS be kept out of reach of children?

Answer 15

Important cause of accidental overdose in children

20mg/kg can cause symptoms of toxicity

Question 16

Why should folic acid not be given alone for emergency treatment of undiagnosed megaloblastic anaemia?

Answer 16

May cause neuropathy

Given with B12

Question 17

Which vitamins are deficient in megaloblastic anaemia?

Answer 17

B9 (folic acid) and B12 (hydroxocobalamin)

Question 18

How should folic acid be given to prevent methotrexate side effects?

Answer 18

5mg once weekly, given on a different day to methotrexate

Question 19

For megaloblastic anaemia, how long is folic acid treatment usually given for?

Answer 19

4 months

5mg OD

Question 20

How is iron overload treated?

Answer 20

Dessferioxamine

Question 21

What supplement is given to treat thassalaemia?

Answer 21

Iron

Question 22

What is the normal serum conc of sodium?

Answer 22

133-146mmol/L

Question 23

What are some symptoms of hypernatraemia?

Answer 23

• Convulsions
• Thirst/dehydration
• Postural hypotension
• Tachycardia

Question 24

Name some drugs that can cause HYPERnatraemia?

Answer 24

• Oral contraceptives
• Corticosteroids
• Lithium
• Sodium bicarb / sodium in IV abx

Question 25

What are some symptoms of hyponatraemia?

Answer 25

- Drowsiness - Confusion - Convulsions - Headaches - Cramps

Question 26

Which do NOT cause hyponatraemia? - Antidepressants - Loop diuretics - Desmopressin - Prednisolone - Carbamazepine

Answer 26

Prednisolone - corticosteroids cause high Na

Question 27

'Intestinal absorption of sodium and water is decreased by glucose/carbohydrates' True or false?

Answer 27

FALSE - absorption is enhanced by these

Question 28

How is hyperchloraemia (high Cl-) treated?

Answer 28

Sodium bicarbonate

Question 29

What is the normal serum Ca level?

Answer 29

2.1 - 2.58 mmol/L

Question 30

How is hypercalcaemia treated?

Answer 30

Bisphosphonates or corticosteroids

Question 31

Which is a side effect of alendronic acid? - Hyperkalaemia - Hypercalcaemia - Hyperphosphatemia - Hypocalcaemia

Answer 31

Hypocalcaemia

Question 32

Some symptoms of hypercalcaemia?

Answer 32

- Nausea and vomiting - Confusion - Loss of appetite - Headache - Depression

Question 33

What can be used to treat hypercalcaemia in malignancy?

Answer 33

Calcitonin

Question 34

What is the normal serum potassium range?

Answer 34

3.5-5.3 mmol/L

Question 35

Symptoms of hyperkalaemia?

Answer 35

Ventricular fibrillation, cardiac arrest

Question 36

Name some drugs that cause hyperkalaemia?

Answer 36

- ACEi/ ARBs - Heparins - Beta blockers - Potassium sparing diuretics (eplenerone, amiloride,spiro) - NSAIDs - Ciclosporin + tacrolimus - Trimethoprim

Question 37

Which drug does NOT cause hyperkalaemia? - Losartan - Enoxaparin - Simvastatin - Co-trimoxazole - Nebivolol

Answer 37

Simvastatin

Question 38

How should hyperkalaemia be treated?

Answer 38

Mild+ no ECG changes - calcium resonium Severe - IV calcium gluconate Also insulin, glucose + salbutamol

Question 39

What are some signs of hypokalaemia?

Answer 39

Arrythmias, muscle hypotonia

Question 40

Which drugs can cause hypokalaemia?

Answer 40

- Insulin - Beta agonists - Diuretics - Theophylline - Corticosteroids

Question 41

Which does NOT cause low potassium? - Terbutaline - Dexamethasone - Levemir - Bumetanide - Tamsulosin

Answer 41

Tamsulosin

Question 42

How should hypokalaemia caused by a loop diuretic be treated?

Answer 42

Potassium sparing diuretic | Preferred if caused by diuretic

Question 43

What is an 'acute porphyria'?

Answer 43

Genetic deficiency in haem biosynthesis | Can cause haemolytic anaemia

Question 44

Name the fat soluble vitamins?

Answer 44

D, E, A, K

Question 45

Is vitamin C water soluble?

Answer 45

Yes

Question 46

What is retinol?

Answer 46

Vitamin A

Question 47

Can vitamin A be given in pregnancy?

Answer 47

No, teratogenic

Question 48

What can vitamin A deficiency cause?

Answer 48

Ocular defects/dry eyes | Increased susceptibility to infection

Question 49

What is ascorbic acid?

Answer 49

Vitamin C

Question 50

Scurvy is caused by which deficiency?

Answer 50

Vitamin C | Can also cause gingival bleeding

Question 51

Rickets is caused by which deficiency?

Answer 51

Rickets

Question 52

What is colecalciferol?

Answer 52

Vitamin D3

Question 53

'Vitamin D is needed for dietary absorption of calcium' | True or false?

Answer 53

True

Question 54

How is vitamin D replaced in renal impairment?

Answer 54

Alfacalcidol / calcitriol | Hydroxylated version

Question 55

What is tocopherol?

Answer 55

Vitamin E

Question 56

What is another name for vitamin K?

Answer 56

Phytomenadione

Question 57

Which vitamin is given to newborn babies to prevent neonatal haemorrhage?

Answer 57

Vitamin K

Question 58

What is vitamin B1?

Answer 58

Thiamine

Question 59

What is niacin / nicotinic acid?

Answer 59

Vitamin B3

Question 60

What is vitamin B6 and when is it used?

Answer 60

Pyridoxine Given with isoniazid/penicillamine to prevent neuropathy Can also treat PMT

Question 61

Which B vitamin can strengthen hair and nails?

Answer 61

B7 biotin

Question 62

Which vitamin is often deficient in vegans?

Answer 62

B12

Question 63

What is vitamin B9?

Answer 63

Folic acid

Question 64

What dose of folic acid is recommended in pregnancies with a high risk of neural tube defects?

Answer 64

5mg OD before conception till 12 weeks

Question 65

Which of these woman should be told to take folic acid 400mcg once daily until week 12 of their pregnancy? - 20 year old woman expecting first child who has asthma - 35 year old woman expecting second child, whos first child was born with a congenital malformation - 27 year old woman with epilepsy taking levetiracetam - 30 year old woman with type 2 diabetes expecting her first child - 32 year old woman with sickle cell anaemia expecting her third child

Answer 65

20 year old woman expecting first child who has asthma The rest all have high risk of neural tube defects and should take folic acid 5mg OD

Question 66

What supplements are recommended for a pregnant woman with sickle cell anaemia?

Answer 66

5mg folic acid daily for whole pregnancy