Chem Path

Question 1

Deficiency in a vegan woman

Answer 1

B12 and Iron and probably lots of other things

Question 2

Intrinsic Factor deficiency causes…

Answer 2

B12 deficiency

Question 3

Polyendocrinopathies (Schmidt’s Syndrome)

Answer 3

Addisons, T1DM, Hypothyroidism. Also associated with pernicious anaemia and coeliac disease so B12 deficiency again

Question 4

Crohn’s Nutritional deficiency due to affected terminal ileum

Answer 4

B12

Question 5

Coeliac Can Cause

Answer 5

Iron, calcium, folate and b12

Question 6

Indian woman presents with tiredness with macrocytic anaemia. and is vegan

Answer 6

B12 deficiency

Question 7

Patient with coeliac has glossitis and blood film shows macrocytic anaemia

Answer 7

B12 deficiency

Question 8

Patient with dementia symptoms and dermatitis and diarrhoea

Answer 8

B3/Niacin causing Pellagra

Question 9

6 year old boy with bowed legs

Answer 9

Rickets. Vit D deficiency

Question 10

A patient with high PTH. You suspect osteomalacia

Answer 10

Vit D deficiency

Question 11

What do you give in Wernicke’s encephalopathy

Answer 11

Thiamine (B1)

Question 12

What deficiency causes Beri Beri?

Answer 12

Thiamine (B1)

Question 13

What deficiency raises PTH levels?

Answer 13

Vitamin D

Question 14

Only raised ALP. with bone pain

Answer 14

Paget’s

Question 15

LFT’s for: Intrahepatic cholestasis abnormality

Answer 15

Raised ALP and bilirubin

Question 16

LFT’s for Cirrhosis

Answer 16

Raised AST and ALT

Question 17

LFT’s for Gilberts

Answer 17

Mildly raised unconjugated bilirubin, all else normal

Question 18

LFT’s for Viral Hepatitis

Answer 18

ALT>AST

Question 19

LFT’s for Paracetamol Overdose

Answer 19

Massively raised AST and ALT

Question 20

LFT’s for Alcoholic Liver Disease

Answer 20

AST>ALT

Question 21

LFT’s for Gallstones

Answer 21

Raised ALP and conjugated bilirubin

Question 22

Haemachromatosis and what stain is used

Answer 22

Build up of iron in liver and dye used is Prussian blue stain

Question 23

Rate limiting enzyme in haem synthesis

Answer 23

ALA Synthase

Question 24

Deficiency leads to high urate levels and can cause Lesch Nyhan syndrom

Answer 24

HGPRT

Question 25

What condition and enzyme deficiency can present as a salt wasting crisis

Answer 25

CAH and 21 hydroxylase deficiency

Question 26

What can be used to diagnose Beta Thalassaemia trait?

Answer 26

HbA2 levels raised.

Question 27

What enzyme is raised in mumps

Answer 27

Amylase

Question 28

What do you see in a patient with T1DM's kidneys

Answer 28

Renal sclerosis

Question 29

Emphysema in a non-smoker

Answer 29

A1AT deficiecny

Question 30

Normal Ca, Phosphate and PTH levels

Answer 30

Ca 2.2-2.6 Phosphate 0.8-1.4 PTH 0.8-8.5

Question 31

Osteoporosis Bloods

Answer 31

Normal

Question 32

Osteomalacia Bloods

Answer 32

``` Low Vitamin D Raised PTH Raised ALP Low/Normal calcium Low/Normal Phosphate ```

Question 33

Breast Cancer with Mets Bone Bloods

Answer 33

``` Raised ALP Raised Calcium Low PTH Raised Phosphate Vit D can be anything ```

Question 34

Paget's Disease Bone Bloods

Answer 34

Raised ALP | Rest Normal

Question 35

Primary Hyperparathyroidism Bone Bloods

Answer 35

``` Raised (or inappropriately normal) PTH Raised Calcium Low Phosphate Variable ALP Variable Vitamin D ```

Question 36

Renal Bone Disease Bone Bloods

Answer 36

``` Low or Borderline Calcium Raised PTH Increased Phosphate ALP raised or normal Vitamin D normal Due to decreased 1 alpha hydroxylase ```

Question 37

Hypoparathyroidism Bone Bloods

Answer 37

``` Low PTH Low Calcium Raised Phosphate Normal Vitamin D Normal ALP ```

Question 38

What would the potassium be in a patient with untreated DKA be?

Answer 38

Raised Potassium

Question 39

How to calculate osmolality

Answer 39

2(Na+K)+urea+glucose

Question 40

How to calculate anion gap

Answer 40

Na+K-Cl-Bicarb

Question 41

Impaired Glucose tolerance values

Answer 41

7.8-11.1

Question 42

``` Patient with bloods: Raised glucose Raised Potassium Acidotic pH Low Bicarb ```

Answer 42

DKA

Question 43

``` Patient with bloods Raised glucose Raised Na Raised osmolality Normal pH Normal Bicarb ```

Answer 43

HONK

Question 44

What would bicarbonate levels be in pyloric stenosis?

Answer 44

Raised bicarbonate levels. | You get a hypochloraemic hypokalaemic metabolic alkalosis

Question 45

Low Sodium, High potassium, low Mg

Answer 45

Addison's

Question 46

High sodium, low potassium, HTN

Answer 46

Conn's

Question 47

A 67-year-old woman presented with confusion 2 days after a cholecystectomy. She had experienced some pain postoperatively, largely relieved by analgesia. On examination, she was disoriented, her heart rate was 66 beats per minute and her blood pressure was 162/82 mmHg. She only had minor discomfort of the abdomen. The urine sodium was 90mmol/l (NR 20-200mmol/l depending on hydration of patient). The figure below shows the colours you would see on the dipstick after it has been dipped in the urine, and it was yellow in colour, consistent with an SG of 1.030. Investigations: Haemoglobin 130 g/L (115-165) MCV 92 fL (80-96) white cell count and platelet count normal serum sodium 120 mmol/L (137-144) serum potassium 3.7 mmol/L (3.5-4.9) serum urea 3 mmol/L (2.5-7.0) serum creatinine 90 µmol/L (60-110) serum albumin 36 g/L (37-49) random plasma glucose 5 mmol/L

Answer 47

SIADH

Question 48

High serum osmolality and high sodium. Low urine osmolality

Answer 48

DI

Question 49

High serum osmolality High potassium

Answer 49

DKA

Question 50

Impaired glucose tolerance test Diabetes glucose tolerance Fasting glucose diabetes Impaired fasting glucose

Answer 50

7.8-11 >11 >7 6.1-6.9

Question 51

High LH High FSH All else normal

Answer 51

Premature ovarian failure

Question 52

Slightly raised prolactin | Rest normal

Answer 52

Non-functioning adenoma

Question 53

Significantly raised prolacting

Answer 53

Prolactin secreting macroadenoma

Question 54

Raised GH, others suppressed. How to daignose

Answer 54

Acromegaly, glucose tolerance test

Question 55

Myxoedema

Answer 55

Raised TSH | Low T3, Low T4

Question 56

Polyuria, polydipsia, hyponatraemia and high serum osmolality, high serum glucose

Answer 56

Diabnetes Mellitus, Pseudohyponatraemia

Question 57

Polyuria, polydipsia, high serum osmolality, low urine osmolality

Answer 57

DI

Question 58

Patient three days post OP, has low sodium, raised urine osmolality. Euvolaemic

Answer 58

SIADH

Question 59

`Hypovolaemic hyponatraemia

Answer 59

D+V, Diuretics, Salt losing nephropathy | If urine sodium is low, then it's likely to be non-kidney

Question 60

Hypervolaemic hyponatraemia

Answer 60

Kidney, liver and heart failures

Question 61

Euvolaemic hyponatraemia

Answer 61

Hypothyroidism, Adrenal Insufficiency, SIADH.

Question 62

Low Sodium, High Potassium, HTN

Answer 62

Addison's

Question 63

Woman with thin skin, proximal myopathy, impaired fasting glucose. DM excluded already, what test to do and what diagnosis?

Answer 63

Dexamethasone suppression test | Cushing's syndrome

Question 64

Polyuria, polydypsia, low sodium on bloods, normal serum osmolality. What test to do next?

Answer 64

Blood glucose as it may be pseudohyponatraemia

Question 65

Patient notices swollen big fingers and ring doesn't fit anymore. What test to do next?

Answer 65

Oral glucose tolerance test Acromegaly Measure GH levels

Question 66

Addison's disease test

Answer 66

Short SynACTHen test

Question 67

Best way to monitor blood glucose control over a period of 2-3 months

Answer 67

HbA1C

Question 68

What hormone lowers calcium levels

Answer 68

calcitonin

Question 69

Raised TSH, Raised T4, Low T3

Answer 69

TSH secreting tumour OR poor sensitivity to TSH (ie body doesn't recognise T4 is present enough so TSH is high)