Chemical Flashcards
(261 cards)
1
Q
List causes of a high anion gap metabolic acidosis (GOLDMARK)
A
Glycols (ethylene glycol and propylene glycol) [overdose], Oxoproline [chronic paracetamol use, usually malnourished women], L-lactate [sepsis], D-lactate [short bowel syndrome], Methanol [overdose], Aspirin [overdose. Initially causes respiratory alkalosis but in moderate/severe overdose causes metabolic acidosis], Renal failure, Ketoacidosis [DKA, alcoholic, starvation]
2
Q
Vitamin A deficiency manifestation
A
Retinol (Vit A) = Colour blindness
3
Q
Vitamin D deficiency manifestation
A
Cholecalciferol (Vit D) = Osteomalacia/rickets
4
Q
Vitamin E deficiency manifestation
A
Tocopherol (Vit E) = Anaemia, neuropathy
5
Q
Vitamin K deficiency manifestation
A
Phytomenadione (Vit K) = Defective clotting
6
Q
Vitamin B1 deficiency manifestation
A
Thiamine (Vit B1) = Beri-beri -> Neuropathy -> Wernicke syndrome
7
Q
Vitamin B2 deficiency manifestation
A
Riboflavin (Vit B2) = Glossitis
8
Q
Vitamin B3 deficiency manifestation
A
Niacin (Vit B3) = Pellagra
9
Q
Vitamin B6 deficiency manifestation
A
Pyridoxine (Vit B6) = Dermatitis, anaemia
10
Q
Vitamin B12 deficiency manifestation
A
Cobalamin (Vit B12) = Pernicious anaemia/Megaloblastic anaemia
11
Q
Vitamin C deficiency manifestation
A
Ascorbic acid (Vit C) = Scurvy
12
Q
Folate deficiency manifestation
A
Folic acid = Megaloblastic anaemia, NTD
13
Q
Vitamin A excess manifestation
A
- Exfoliation, hepatitis
- Hypercalcaemia
- Neuropathy
- Renal stones
14
Q
The enzyme expressed by sarcoid lung tissue which causes hypercalcaemia
A
1a-hydroxylase (= rate limiting step in Vitamin D production!)
15
Q
Costochondral swelling
A
Rickets
16
Q
Looser’s Zones = pseudofractures
A
Osteomalacia
17
Q
Colle’s Fracture
A
Osteoporosis (fracture of wrist from extended hand)
18
Q
Band Keratopathy
A
Hypercalcaemia (calcium deposits on eyes)
19
Q
Osteitis Fibrosa Cystica
A
Hypercalcaemia – get brown tumours in bone
20
Q
Cancer which releases PTHrP
A
Small cell lung cancer
21
Q
Brown tumours in bone
A
Hyperparathyroidism (activated osteoclasts form multinucleated giant cells)
22
Q
Hypercalcaemia in summer only
A
Sarcoidosis (macrophages in lung express 1α-hydroxylase, but not enough Vit D in winter to activate)
23
Q
Chvostek’s Sign
A
Hypocalcaemia = twitch when flick cheek
24
Q
Trousseau’s Sign
A
Hypocalcaemia = inflate BP cuff causes carpal spasm
25
Jigsaw/mosaic pattern in bone
Paget’s Disease (disordered bone remodelling)
26
Most reliable sign of hypovolaemia in hyponatraemia
Low urine Na+ (<20)
27
Molecule causing vasodilation and low BP in cirrhosis
Nitric Oxide
28
Tendon Xanthoma
Familial hypercholesterolaemia
29
Eruptive xanthomas (papules on skin)
Primary Hypertriglyceridaemia, Diabetes
30
Gross xanthelasma
Primary Biliary Cirrhosis
31
Monoclonal used in hereditary hypercholesterolaemia
Evolocumab = PCSK9 monoclonal
32
Diabetes Control and Complications Trial (DCCT)
Type 1 DM: tight control improves outcomes
33
UK Prospective Diabetes Study (UKPDS)
Takes 15 years to have CVD benefit – but this benefit lasts 10 years
34
ACCORD Study
Intensive treatment in older diabetics increases mortality
35
ADVANCE Study
Looser control works better in older people
36
Drug added to long-term poorly controlled diabetes with ESTABLISHED CVD
Empagliflozin (SGLT2 inhibitor) or liraglutide (GLP-1 agonist)
37
Breathing type in metabolic acidosis
Kussmaul Breathing (deep laboured)
38
Diabetes drug causing metabolic acidosis
Metformin (prevents lactase to glucose conversion)
39
3 biochemical definitions of diabetes
Fasting plasma glucose > 7.0mM, Plasma glucose after GTT > 11.1mM at 2hrs, HbA1c > 48mmol/mol
40
Impaired Glucose Tolerance definition
Plasma glucose after GTT 7.8 – 11.1mM at 2hrs
41
Low blood glucose, but high C-peptide. What test should you do?
Check urine sulphonylurea as could have OD’d on gliclazide (endogenous insulin)
42
Non-Islet Cell Tumour secrete which hormone, causing hypoglycaemia
IGF-2 (binds to insulin receptors, acting like insulin) e.g. mesothelioma, fibroblastoma…
43
Mutation causing congenital hyperinsulinism = hypoglycaemia
Gluc
44
Plasma glucose after GTT at 2hrs?
7.8 – 11.1 mM
45
Non-Islet Cell Tumour secretes which hormone, causing hypoglycaemia?
IGF-2 (binds to insulin receptors, acting like insulin)
## Footnote
e.g. mesothelioma, fibroblastoma…
46
Mutation causing congenital hyperinsulinism = hypoglycaemia?
Glucokinase activating mutations
47
Glucocorticoids secreted by which part of adrenal?
Zona fasciculata
48
Androgens secreted by which part of adrenal?
Zona reticularis
49
Aldosterone secreted by which part of adrenal?
Zona glomerulosa
50
Short SynACTHen test indicates?
Addison’s Disease (don’t make enough cortisol after given synACTH)
51
Syndrome which increases risk of phaeochromocytoma?
MEN II
52
High aldosterone and low renin indicates?
Conn’s (high aldosterone suppresses JGA –> low renin)
53
High aldosterone and high renin indicates?
Renal artery stenosis
54
Brown granular casts in urine indicate?
Acute Tubular Injury
55
Crescents in glomeruli indicate?
Crescent Glomerulonephritis/rapidly progressive glomerulonephritis (Acute Glomerulonephritis)
56
Disease causing renal failure, with non-blanching purpuric rash?
Systemic Vasculitis
57
Drugs which prevent end-stage renal failure?
ACEi
58
Cause of nephrotic syndrome in kids?
Minimal Change Disease – have loss of foot process
59
Antibodies in Membranous Glomerulonephritis?
Antibodies against phospholipase A2
60
Renal disease with microalbuminuria?
Diabetic nephropathy
61
Beta-pleated proteinaceous sheets deposited in kidneys indicate?
Amyloidosis
62
Protein found in urine of multiple myeloma?
Bence-Jones
63
Crystals in urine after drinking antifreeze?
Calcium oxalate
64
Sample blood from which vein to measure levels of illegal drugs?
Femoral vein
65
Which drug cannot be found in hair?
Cannabis (too low levels)
66
Active metabolite of amitriptyline?
Nortriptyline
67
AST : ALT >2 indicates?
Cirrhosis
68
Half-life of albumin?
20 days
69
Most important functional test of liver?
Prothrombin Time
70
Tumour marker in liver cancer?
AFP
71
Beri-Beri caused by what deficiency?
B1 (thiamine)
72
Pernicious anaemia caused by what deficiency?
B12
73
Glossitis (beefy tongue) caused by what deficiency?
B12
74
Test of B12 deficiency?
RBC Transketolase
75
Most common co-existing autoimmune condition in hypothyroid?
Pernicious anaemia
76
Condition with tricuspid and pulmonary stenosis/fibrosis, hepatomegaly with large nodules, raised urine 5HIAA?
Carcinoid Syndrome = tumour in neuroendocrine cells
77
Colourless urine gets oxidised to purple before reaching the lab indicates?
Porphyria (porphyrinogens = colourless –> oxidised very quickly by UV light in urine)
78
Porphyria with blistering on backs of hands?
Hereditary Coproporphyria (HCP)
79
Light hair and mousy/musky urine odour indicates?
Phenylketonuria (PKU)
80
Deficiency of what enzyme in Phenylketonuria?
Phenylalanine hydroxylase
81
Metabolic disease causing cot death?
MCAD Deficiency
82
Baby smells of sweaty feet indicates?
Isovaleric Acidemia
83
Urine smells sweet, failure to thrive, developmental delay indicates?
Maple Syrup Urine Disease
84
What drug triggers Reye Syndrome?
Aspirin (salicylates)
85
10yo girl with hirsutism, low cortisol, raised ACTH and 17 hydroxyprogesterone indicates?
Congenital Adrenal Hyperplasia = lack 21-hydroxylase
86
Polysplenia and situs inversus indicates?
Biliary atresia
87
Ambiguous genitalia in neonates indicates?
Congenital Adrenal Hyperplasia (increased 17-OH progesterone –> increased androgens)
88
Frontal bossing in kids indicates?
Rickets
89
Caput medusa indicates?
Portal HTN (blood goes back down portal vein to umbilicus)
90
Gilbert’s caused by deficiency in which enzyme?
UDP glucuronyl transferase
91
Mode of inheritance in Gilbert’s?
Autosomal recessive
92
Rate-limiting step of purine metabolism?
PPRP to 5-phosphoribosyl-1-amine (via PAT)
93
Gouty arthropathy, learning difficulty and self-mutilates indicates?
Lesch Nyhan Syndrome (X-linked disease –> males born with no HPRT at all)
94
Gout crystals?
Monosodium urate
95
Name of acute gout?
Podagra
96
Cheesy ear lobes and gouty arthropathy indicates?
Chronic gout = tophaceous
97
Pseudogout crystals?
Calcium pyrophosphate
98
Negatively birefringent, needle-shaped crystals indicate?
Monosodium urate (Gout)
99
Positively birefringent crystals indicate?
Calcium pyrophosphate (pseudogout)
100
Crystals in same axis of polarised light indicate?
Calcium pyrophosphate (pseudogout)
101
Crystals perpendicular to axis of polarised light indicate?
Monosodium urate (gout)
102
Allopurinol inhibits which enzyme?
Xanthine oxidase
103
Never mix allopurinol with what other drug?
Azathioprine (allopurinol interacts with azathioprine metabolism –> makes it last longer in body–> toxic on bone marrow)
104
Form of Vitamin D made after action of 1a-hydroxylase on 25-OH D3?
Calcitriol = active form of Vitamin D
105
Hormone which stimulates 1a-hydroxylase in kidneys to increase Vitamin D3 production?
PTH
106
23 year old who has just started penicillin. Presents with confusion, weakness and seizures. Pale, bruised and breathing deeply indicates?
Acute Tubulointerstitial Nephritis
107
45 year old female with swelling ankles and abdomen. Urine dipstick +++ protein, no blood. Microscope shows thickening of GBM indicates?
Membranous Glomerulonephritis
108
7yo boy with swelling of legs and sacrum. Urine dipstick ++ proteinuria, no blood indicates?
Minimal Change Disease
109
25yo male sees blood in urine. Microscope shows mesangial cell proliferation indicates?
Mesangiocapillary Glomerulonephritis
110
45yo female with swelling ankles, abdomen. Urine dipstick +++ protein, no blood. Microscope shows segmental scarring of glomeruli indicates?
Focal Segmental Glomerulosclerosis
111
Child with excessively sweaty feet, lethargy, poor feeding, hypotonia indicates?
Maple Syrup Urine Disease
112
“Cherry-red spot” in which group of disorders?
Lysosomal Storage Disorders
113
Overdose of this medication causes hypotension and ataxia?
Phenytoin
114
Cortisol not suppressed by low-dose dexamethasone, but suppressed by high-dose indicates?
Cushing’s Disease
115
Increased levels are seen in the urine of congenital adrenal hyperplasia (CAH) patients?
Pregnanetriol/17-hydroxyprogesterone
116
Sore throat a few days ago –> smoky-colour urine, puffy face, tired indicates?
Acute Proliferative Glomerulonephritis (post-streptococcal glomerulonephritis)
117
Sore throat –> proliferation of mesangium, microscopic haematuria indicates?
IgA nephropathy - proliferation of mesangium is characteristic
118
Gold-standard for measuring GFR?
Inulin
119
What vitamin deficiency in “Muslim woman”?
Vitamin D Deficiency (Muslim woman = hijab!)
120
Enzyme raised in mumps?
Amylase
121
Deficiency of this vitamin causes triad of “3 D’s” = diarrhoea, dermatitis, dementia?
Niacin (B3)
122
End-stage renal failure, with high PTH and high calcium indicates?
Tertiary hyperparathyroidism
123
Serum electrophoresis shows monoclonal band indicates?
Multiple Myeloma
124
Pain and stiffness in lower back and bum – worse in morning, but eases as day goes by indicates?
Ankylosing Spondylitis
125
Serum electrophoresis shows IgM spike indicates?
Waldenstrom’s Macroglobulinaemia
126
A 50 year male with multiple myeloma comes to his GP complaining of ankle swelling. Urine dipstick shows proteinuria. On examination he is also noted to have macroglossia and waxy papules on his face indicates?
Amyloidosis
127
Raised anti-streptolysin O titre (ASOT) indicates?
Post-strep glomerulonephritis
128
Which type of strep is involved in post-strep glomerulonephritis?
Group A beta-haemolytic strep (Strep Pyogenes = preceding pharyngitis)
129
Immunofluorescence of GBM –> granular staining indicates?
Immune complex subtype of Rapidly Progressive Glomerulonephritis
130
Immunofluorescence of GBM –> absent/scant staining indicates?
Pauci-immune subtype of Rapidly Progressive Glomerulonephritis
131
Immunofluorescence of GBM –> linear staining indicates?
Anti-GBM subtype of Rapidly Progressive Glomerulonephritis
132
Kveim Test indicates?
Sarcoidosis (inject sample of spleen from known sarcoid patient into suspected sarcoid patient –> non-caseating granuloma after 6 weeks)
## Footnote
NOT used in UK!
133
Side effect of medication: course tremor and diarrhoea?
Lithium
134
Side effect of medication: prolonged PR interval?
Digoxin
135
Bone pain in arms and legs, shooting pains down left leg, worsening SOB indicates?
Paget’s! (weak woven bone infiltrate bone marrow –> high-output heart failure)
136
Tall P waves and flattened T waves indicate?
Hypokalaemia
137
Boy with episodic abdominal pain and recurrent acute pancreatitis. Plasma has milky appearance and chylomicrons are found in the plasma following a period of fasting indicates?
Lipoprotein lipase deficiency
138
Cause of pseudo-Vitamin D deficiency?
Defect in renal hydroxylation
139
3-week old boy with severe jaundice at birth, worsening ever since indicates?
Crigler-Najjar syndrome = defect in bilirubin metabolism
140
First-line test when screening for metabolic diseases?
Amino acids (urine and plasma)
141
A male infant presents with failure to thrive, neurological signs (including tremor) and tachypnea - what metabolic defect?
Urea Cycle Disorder (neuro signs + tachypnoea = encephalopathy + alkalosis = increased ammonia!)
142
Metabolic disorders causing jaundice and sepsis?
Galactosaemia and tyrosinaemia
143
Deficiency that causes Wernicke’s?
Thiamine (B1)
144
Cause of acute intermittent porphyria?
PBG Deaminase Deficiency (attacks triggered by alcohol, COCP and TB meds)
145
Anion gap formula?
Na + K – Cl - Bicarb
146
Osmolality formula?
2(Na+K) + U + G
147
Newborn starts drinking milk –> conjugated hyperbilirubin, cataracts and GI symptoms indicates?
Galactosaemia (mutation in enzyme –> increased galactose when start drinking milk)
148
Nutritional deficiency causing rash in necklace formation?
Niacin = B3 –> pellagra (4 D’s = Diarrhoea, Dermatitis, Dementia, Death)
149
High-dose dexamethasone suppression test –> high ACTH and cortisol indicates?
Ectopic ACTH causing Cushing’s syndrome
## Footnote
NOT pituitary-dependent Cushing’s Disease as would have low cortisol after high-dose dex
150
Abdo pain with bruising below umbilicus/on flank indicates?
Acute Pancreatitis
## Footnote
Below umbilicus = Cullen’s Sign; On flank = Grey-Turner Sign
151
Haemorrhage which features lucid interval?
Extradural
152
Severe headache – fundoscopy reveals preretinal (subhyaloid) haemorrhages; CSF shows xanthochromia. Palpable kidneys bilaterally indicates?
Subarachnoid Haemorrhage
## Footnote
“palpable kidneys” = Polycystic!
153
Cause of episodic diarrhoea in long-term diabetic?
Autonomic Neuropathy
154
Metabolic disease with abnormally long limbs and flushed cheeks?
Homocystinuria
155
Illegal drug which increases CK?
Ecstasy
156
Enzyme defect in Homocystinuria?
Cystathionine beta synthase
157
Most common autoantibody in Hashimoto’s?
Anti-thyroid peroxidase
158
Propylthiouracil (PTU) inhibits this?
Thyroid peroxidase
159
Psychiatric drug which increases calcium?
Lithium
160
Severe hypoglycaemia (symptoms worse after exercise) with sudden weight gain indicates?
Insulinoma
161
Doege-Potter Syndrome?
Paraneoplastic where tumour secretes IGF2 –> low glucose
162
Test to distinguish between chronic and acute liver disease?
Albumin
163
Liver enzyme raised after MI?
AST
164
Immune deposits on the outside of GBM showing “spike and dome” pattern indicates?
Membranous Glomerulonephritis
165
Sharp cramping pain in the back radiating to the groin indicates?
Ureteric stones (renal stones have LOIN to groin)
166
What is Nelson’s Syndrome?
after bilateral adrenalectomy for Cushings –> Addisonian symptoms
167
Cushingoid, but pituitary and adrenals are normal. Heavy drinker indicates?
Pseudo-Cushings = caused by alcoholic liver disease and psych conditions
168
This hormone causes 1-alpha hydroxylation?
PTH
169
Increases intestinal calcium reabsorption?
Calcitriol (1,25 (OH)2 vitamin D)
170
High PTH, low calcium and high phosphate – hands look weird indicates?
Pseudohypoparathyroidism = resistance to PTH
## Footnote
hands look weird = blunting of 4th and 5th knuckles
171
Decreased faecal elastase indicates?
Pancreatic Insufficiency (chronic pancreatitis, CF…)
172
Rate-limiting enzyme in haem synthesis?
ALA synthase
173
Where is B12 absorbed?
Terminal ileum (IBD with terminal ileum resection affected)
174
Where is iron absorbed?
Duodenum and jejunum
175
1st step of Vitamin D metabolism?
Sunlight converts 7-dehydrocholesterol to cholecalciferol (D3)
176
What is 25-OH-D3?
Calcidiol
177
Where is 25-OH-D3 (calcidiol) made?
Liver: D3 hydroxylated to 25-OH-D3
178
What is active form of Vitamin D?
Calcitriol = 1,25-(OH)2-D3
179
Where is calcitriol made?
Kidneys: Calcidiol (25-OH-D3) converted by 1a-hydroxylase to calcitriol (1,25-(OH)2-D3)
180
What hormone triggers formation of calcitriol in kidneys?
PTH
181
Where is Vitamin D absorbed in gut?
Jejunum
182
Sodium and potassium balance in diuretic use?
Lose sodium, retain potassium
183
Treatment of PBC?
B
184
What is the active form of Vitamin D?
Calcitriol = 1,25-(OH)2-D3
185
Where is Vitamin D absorbed in the gut?
Jejunum
186
What is the sodium and potassium balance in diuretic use?
Lose sodium, retain potassium
187
What is the treatment of PBC?
Bile acid sequestrants (cholestyramine)
188
What is normal anion-gap metabolic acidosis?
Bicarb loss from GI/kidneys (replaced by chloride)
189
What is the cause of Familial Hypercholesterolaemia?
Deficiency in LDL receptor
190
What drug is used to reduce triglycerides?
Fibrates (gemfibrozil)
191
What is the effect of lipoprotein lipase/apo-C deficiency?
Increased chylomicrons and VLDLs
192
Which diuretic increases renal stones?
Loop diuretic = increases calcium in urine
193
Which diuretic treats chronic renal stones?
Thiazide diuretic (bendroflumethazide) = increases calcium reabsorption
194
Which diuretic causes hyperkalaemia?
Spironolactone = aldosterone antagonist (all other diuretics cause low Na and K)
195
What does the posterior pituitary make?
ADH and oxytocin
196
What metabolic disorder causes very fair skin, brittle hair and convulsions?
Homocystinuria
197
What metabolic disorder causes excessively sweaty feet?
Maple Syrup Urine Disease
198
What condition is indicated by a baby with dysmorphia and cherry-red spot on trunk?
Fabry’s Disease (cherry-red spot = lysosomal storage disorder)
199
What drugs cause isolated rise in GGT?
Enzyme-inducing drugs (carbamazepine, phenytoin)
200
What drug increases PR interval and causes bradycardia?
Digoxin
201
What test differentiates between primary and secondary Addison’s?
Long synACTHen test (after 24hrs: cortisol <900 is primary)
202
What is the corrected calcium formula?
Serum calcium + 0.02(40-serum albumin)
203
What MEN type is associated with hyperparathyroid?
MEN 1 (= pit, para, panc)
204
Which organ releases angiotensinogen?
Liver
205
What converts angiotensinogen to angiotensin 1?
Renin
206
Where does aldosterone act in the kidneys?
Mineralocorticoid receptor on principal cells in cortical collecting tubules
207
What is the main cause of hyperkalaemia?
Renal impairment (less K excreted)
208
What do gliptins inhibit?
DPP4 (DPP4 breaks down GLP-1)
209
What is a consequence of hyperventilation in respiratory alkalosis?
Low ionised calcium –> tetany
210
Which area of the adrenal releases adrenaline?
Medulla
211
What provides negative feedback on prolactin?
Dopamine
212
What does TRH increase besides TSH?
Prolactin
213
What are the components of the Combined Pituitary Function Test?
Insulin, TRH, LHRH
214
What are normal Combined Pituitary Function Test results?
Glucose <2.2, Cortisol 550, GH 10
215
What is the first-line investigation in acromegaly?
Glucose Tolerance Test (GTT) = GH stays >2 when should be suppressed
216
What is the histological feature of minimal change disease?
Loss of foot process
217
What is the main cause of drug-induced cholestasis?
Co-amoxiclav
218
What causes Acute Intermittent Porphyria?
HMB synthase deficiency (autosomal dominant)
219
What does a TSH > 50 suggest in a 31-year-old with profound tiredness?
Primary hypothyroidism
220
What explains both hypothyroidism and Addison's disease in a 31-year-old?
Schmidt's syndrome
221
What is the test for Addison's disease?
SynACTHen test <10 nM is diagnostic
222
When may a synACTHen test be difficult to assess for a patient with suspected Addison's?
Night shift workers due to a reverse circadian rhythm - cortisol levels may peak at different times
223
What is Conn's syndrome also known as?
Primary Hyperaldosteronism
224
What is true about aldosterone in Conn's syndrome?
Aldosterone is LOW
225
What is the diagnosis if aldosterone is LOW?
Cushing's syndrome
226
Which dynamic test confirms the diagnosis of Cushing's syndrome?
Dexamethasone suppression test: 1mg Dex = cortisol falls to 0 in normal person
227
What is the commonest cause of Cushing's syndrome?
Cushing's disease (pituitary dependent) = 85%
228
What is the management after surgery for an adrenal tumour causing Cushing's syndrome?
Exogenous cortisol replacement (Oral Pred 3mg OD) and wean for a year when cortisol is 200 nM
229
What is the investigation for large haematuria?
USS and x-ray (Kidney stones)
230
What is diagnostic of primary hyperparathyroidism?
Calcium 2.82 (2.2-2.6) and PTH 3.0 (1.1-6.8 pM)
231
What investigation would you order for suspected sarcoidosis?
PA chest radiograph showing bilateral hilar lymphadenopathy
232
What are the stimuli for aldosterone secretion?
Angiotensin II and Hyperkalaemia
233
What are the two main causes of hyperkalaemia in an exam?
Renal failure and ACEi/ARBs
234
What are the two most common causes of AKI in the hospital?
Reduced perfusion and iatrogenic ATN
235
What is the gold standard for drug identification?
Full scan gas chromatography-mass spectrometry
236
What is the most useful sign of hypovolaemia?
Low urine sodium (<20)
237
If unsure about the cause of hyponatraemia, what can you give the patient?
250ml saline
238
What is the risk of correcting hyponatraemia with saline rapidly?
Central pontine myelinolysis
239
How is a 70 yr-old man with a 3-day history of diarrhoea and altered mental status treated?
Correct water deficit with 5% dextrose and extracellular fluid volume depletion with 0.9% saline
240
What cells does aldosterone act in the kidney?
Principal cells in the cortical collecting tubule
241
What are the top two causes of hyperkalaemia?
Renal impairment and medication (ACEi, ARBs, aldosterone antagonists)
242
What is the main ECG change associated with hyperkalaemia?
Peaked T waves
243
What electrolyte disturbance can salbutamol cause?
Hypokalaemia
244
Which drug causes hyperkalaemia?
Ramipril
245
Which drug causes hypokalaemia?
Furosemide
246
What is the diagnosis for hypovolaemic hyponatraemia?
Volume replacement with 0.9% sodium chloride
247
What is the diagnosis for a 57-year-old woman with breathlessness and elevated JVP?
Hypervolaemic hyponatraemia due to heart failure
248
What is the diagnosis for a 55-year-old man with jaundice and a history of excessive alcohol intake?
Hypervolaemic hyponatraemia due to cirrhosis
249
What is the diagnosis for a 45-year-old woman with dizziness and postural hypotension?
Euvolaemic hyponatraemia due to Addison's disease
250
What is the diagnosis for a 62-year-old man with chest pain, cough, and weight loss?
Possible malignancy, further investigation needed
251
What is the treatment for short synATCHen test?
Treat with hydrocortisone and fludrocortisone
252
What is the diagnosis for a 62-year-old man with chest pain, cough, weight loss, and cachexia?
SIADH due to lung cancer
## Footnote
Plasma osmolality will be low and urine will be high. Need to do chest x-ray and chest CAP. Fluid restrict and treat malignancy.
253
What is the diagnosis for a 20-year-old man with polyuria, polydipsia, and bitemporal hemianopia?
Hypernatraemia due to loss of water
## Footnote
AVP deficiency (previously diabetes insipidus).
254
What ALT:AST ratio suggests alcoholic hepatitis?
>2.0
## Footnote
<1.0 suggests cirrhosis.
255
What are the causes of ALT or AST over >1000?
Hepatitis virus, toxins (paracetamol, drugs e.g., mushrooms), ischaemia.
256
What sign indicates acute vs chronic liver dysfunction?
Prothrombin time increase = acute
## Footnote
Albumin = chronic.
257
What hearing deficits are caused by Paget's disease?
Nerve and conductive hearing loss
## Footnote
Conductive = bone loss; nerve = compression of VIII due to bone growth around foramen.
258
Which enzymes rise following a myocardial infarction (MI)?
CK (MB), LDH
## Footnote
AST - takes a day to peak/rise.
259
How do Addison's disease sodium and potassium levels compare to Conn's syndrome?
Addison's: low sodium, high potassium
## Footnote
Conn's: high sodium, low potassium.
260
How to differentiate renal artery stenosis from Conn's syndrome?
Renin is suppressed in Conn's syndrome
## Footnote
Renin is not suppressed in renal artery stenosis.
261
What scan is used for suspected bone metastases?
Tec-99 bisphosphonate scan.
