ChemPath Flashcards by Camilla Pople

What is the syndrome where there is a complete absence of HPRT (yperxanthine guanine phosphoribosyl transferase?

Lesch Nyhan Syndrome

X linked
Developmental delay at 6 months
Hyperuricaemia, choreiform movement, spasticity

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The inheritance pattern of familial hypercholesterolaemia is:
A. Autosomal recessive
B. X linked
C. Autosomal dominant 
D. Mitochondrial

C. Autosomal dominant

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Phenylketonuria is an deficiency of which enzyme?

Phenylalanine hydroxylase

-There is a build up of toxic phenylalanine

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How do you treat galactosaemia?

Avoid milk

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What is used as a tumour marker to monitor medullary carcinoma of the thyroid?

Carcinoembryonic antigen (CEA)

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In primary hyperthyroidism what biochemistry would you see?

High T3/T4 and low TSH

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What is used as a tumour marker to monitor papillary and follicular thyroid cancer?

Thyroglobulin

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What is Schmidt’s syndrome?

Addison’s disease + hypothyroidism

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What is the gold standard test to diagnose Cushing's disease?
A. Low dose dexamethasone test
B. High dose dexamethasone test 
C. Sampling from the pituitary (IPSS)
D. Short SynACTHen test

C. IPSS

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In a pituitary function triple test which of the following are administered:
A. GHRH
B. TRH
C. Glucose
D. Insulin
E. ACTH

A, B and D

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Which tests are used to diagnose acromegaly?
A. Short synacthen test
B. Plasma cortisol levels
C. IGF levels 
D. Glucose tolerance test 
E. Urine cortisol levels

C and D can both be used

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Name an endogenous marker of GFR?

Serum creatinine

A clinical alternative is Cystatin C

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What features must an endogenous marker of GFR have?
A. Not plasma bound
B. Small 
C. Freely filtered by glomerulus 
D. Neutral charge 
E. Not modified by the tubules

A, C and E

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What is the gold standard measure of GFR?

Inulin

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How is more likely to have a higher serum creatinine level?
A. An old man
B. A women 
C. Caucasian 
D. Body builder

D. body builder
Muscularity increases serum creatinine
Women and older people have lower levels
Black ethnicity have higher levels

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Name three drugs that would predispose to pre renal AKI?

NSAIDs, diuretics, calcineurin inhibitors, ACEi or ARBs

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Which of the following is not a cause of pre-renal AKI?
A. True volume depletion 
B. Hypertension 
C. Oedematous state
D. Selective renal ischaemia
E. Drugs affecting the glomerular flow

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Name 3 causes of Chronic kidney disease?

Diabetes, Hypertension, polycystic kidney disease, chronic glomerulonephritis, Atherosclerotic kidney disease

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What is the main electrolyte imbalance you will see in chronic kidney disease?
A. Hypernatraeia
B. Hyperkalamia
C. Hyponatraemia
D. Hypernatraemia

B. Hyperkalaemia

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What ECG changes might you see with in a patient with severe hyperkalaemia?

Peaked T waves, loss of P waves, widened QRS. Eventually VF

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How do you calculate osmolality?

2(Na + K) + urea + glucose

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How do you calculate the anion gap?

Na + K - Chloride - bicarb

If the anion gap goes up you know there are toxins in the blood e.g. ketones

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Which of the following would you NOT see a raised ALP?
A. Paget's disease
B. Pregnancy 
C. Hepatitis
D. Osteoporosis 
E. Osteomalacia

D. Osteoporosis - the biochemistry is unchanged

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What is the enzyme marker for acute pancreatitis?

Amylase

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Which form of creatine kinase is used as a marker of cardiac muscle damage? A. CK-MM B. CK-MB C. CK-BB

B. CK-MB | This enzyme doesn't rise quickly

``` Which of the following is a cause for raised Creatine kinase? A. Dehydration B. Haemolytic anaemia C. Caucasian D. Severe exercise ```

D. Severe exercise | Other causes include: Afro Caribbean ethnicity, MI, Myopathy, muscle damage due to any other cause

``` Which of the following is the current marker of choice for myocardial injury ? A. Myoglobin B. Cardiac troponin C. CK-MB D. Haemoglobin ```

B. Cardiac troponin Rises 4-6 hours post MI and peaks at 12-24 hours It remains elevated for 3-10 days --Therefore must measure at 6 hours and then at 12 hours after the onset of chest pain

``` In toxicology, which sample has the longest timeframe to detect drugs? A. Blood B. Urine C. Hair D. Faeces ```

C. Hair sample - Drugs incorporated into hair so can give long term information - Blood = drugs detected for no more than 12 hours - Urine = drugs detected for no more than 2-3 days

How long after an MI would the levels of cardiac troponin peak?

12-24 hours

What biochemistry would you see in primary hyperparathyroidism?

High calcium, normal or high PTH

``` Which of the following is not a cause of metabolic alkalosis? A. Panic attack B. Vomiting C. Hypokalaemia D. Ingestion of bicarbonate ```

Give 3 causes of hypokalaemia

D&V, diuretics, Insulin, Cushings

``` A 50 year old Asian woman is referred to the Diabetes clinic after presenting to her GP with polyuria and polydipsia. When tested, she has a fasting whole blood glucose of 6.3 mmol/L and 6.4 mmol/L when tested again a week later. A. Impaired Fasting Glucose B. Acarbose C. Gliclazide (sulfonylurea) D. Impaired Glucose Tolerance E. Orlistat F. Nateglinide (Meglitinide) G. Metformin (biguanide) H. Diabetes Mellitus Type 1 I. Diabetic Ketoacidosis J. Cranial Diabetes Insipidus K. Lactic Acidosis L. Nephrogenic Diabetes Insipidus M. Diabetes Mellitus Type 2 N. Hyperosmolar Non-Ketotic Coma O. Pioglitazone (Thiazolidinedione) ```

M. Diabetes Mellitus Type 2 If the patient is symptomatic: - Fasting glucose >= 7 (whole blood >=6.1) - Random glucose >=11.1 If asymptomatic the same criteria apply but must be on 2 occasions.

``` You are on call in Casualty when a thin 35 year old woman is brought in by the paramedics. She is a known diabetic who admits to not taking her insulin in the past few days as she has been feeling ill with a cold. She phoned the ambulance due to severe abdominal pains and seems confused as to where she is. A. Impaired Fasting Glucose B. Acarbose C. Gliclazide (sulfonylurea) D. Impaired Glucose Tolerance E. Orlistat F. Nateglinide (Meglitinide) G. Metformin (biguanide) H. Diabetes Mellitus Type 1 I. Diabetic Ketoacidosis J. Cranial Diabetes Insipidus K. Lactic Acidosis L. Nephrogenic Diabetes Insipidus M. Diabetes Mellitus Type 2 N. Hyperosmolar Non-Ketotic Coma O. Pioglitazone (Thiazolidinedione) ```

I. Diabetic Ketoacidosis

``` A recently diagnosed 48 year old opera singer was noted by her diabetic nurse to have unacceptably high blood sugar levels, despite strict calorie control and oral metformin. Which class of drug could be added to reduce insulin resistance further? A. Impaired Fasting Glucose B. Acarbose C. Gliclazide (sulfonylurea) D. Impaired Glucose Tolerance E. Orlistat F. Nateglinide (Meglitinide) G. Metformin (biguanide) H. Diabetes Mellitus Type 1 I. Diabetic Ketoacidosis J. Cranial Diabetes Insipidus K. Lactic Acidosis L. Nephrogenic Diabetes Insipidus M. Diabetes Mellitus Type 2 N. Hyperosmolar Non-Ketotic Coma O. Pioglitazone (Thiazolidinedione) ```

O. Pioglitazone (Thiazolidinedione)

``` A 40 year old builder who was constantly being advised by his GP to lose weight, suffered a serious head injury whilst at work, for which he had to go to A&E. He has now been discharged, but a few days later he notices that since the brick fell on his head, he has been passing water almost two or three times an hour and is always thirsty despite drinking lots of water. His GP does a fasting plasma glucose, which is 5.3 mmol/L. A. Impaired Fasting Glucose B. Acarbose C. Gliclazide (sulfonylurea) D. Impaired Glucose Tolerance E. Orlistat F. Nateglinide (Meglitinide) G. Metformin (biguanide) H. Diabetes Mellitus Type 1 I. Diabetic Ketoacidosis J. Cranial Diabetes Insipidus K. Lactic Acidosis L. Nephrogenic Diabetes Insipidus M. Diabetes Mellitus Type 2 N. Hyperosmolar Non-Ketotic Coma O. Pioglitazone (Thiazolidinedione) ```

J. Cranial Diabetes Insipidus

I. Diabetic Ketoacidosis

``` A 34 year old obese woman presents to her GP complaining of polyuria and polydipsia. Her blood pressure is 145/95mmHg and her whole blood glucose level is 12.0mmol/L. Further examination reveals she has a moon face and purple striae. Which hormone is most likely to be in excess. A. Prolactin B. Cushing's disease C. Glucagon D. Cortisol E. Ectopic ACTH-producing tumour F. Autonomic neuropathy G. Exogenous insulin H. Irritable bowel syndrome I. Respiratory alkalosis J. Coronary heart disease K. Testosterone L. Diabetic ketoacidosis M. Endogenous insulin N. Metabolic alkalosis ```

D. Cortisol

``` A diabetic patient presents unconscious. Arterial blood gases reveal the following; pH 7.9 and paCO2 8.4. What is the metabolic abnormality. A. Prolactin B. Cushing's disease C. Glucagon D. Cortisol E. Ectopic ACTH-producing tumour F. Autonomic neuropathy G. Exogenous insulin H. Irritable bowel syndrome I. Respiratory alkalosis J. Coronary heart disease K. Testosterone L. Diabetic ketoacidosis M. Endogenous insulin N. Metabolic alkalosis ```

N. Metabolic alkalosis

``` A diabetic patient presents to A&E with muscle weakness, cramps and hypotonia. She was only recently placed on insulin replacement therapy. Investigations reveal hypokalaemia. Assuming the patient is otherwise healthy, which hormone is most likely to be responsible for the potassium levels. A. Prolactin B. Cushing's disease C. Glucagon D. Cortisol E. Ectopic ACTH-producing tumour F. Autonomic neuropathy G. Exogenous insulin H. Irritable bowel syndrome I. Respiratory alkalosis J. Coronary heart disease K. Testosterone L. Diabetic ketoacidosis M. Endogenous insulin N. Metabolic alkalosis ```

G. Exogenous insulin

``` A 48 year old man presents with pigmented skin, hyperglycaemia and a cushingoid appearance. A high dose dexamethasone test revealed there was a significant suppression of cortisol by day 2 of the test. What is the most likely cause of this glucocorticoid excess. A. Prolactin B. Cushing's disease C. Glucagon D. Cortisol E. Ectopic ACTH-producing tumour F. Autonomic neuropathy G. Exogenous insulin H. Irritable bowel syndrome I. Respiratory alkalosis J. Coronary heart disease K. Testosterone L. Diabetic ketoacidosis M. Endogenous insulin N. Metabolic alkalosis ```

B. Cushing's disease

``` A 52 year old woman with a 20 year history of type II diabetes mellitus is referred to the gastroenterology clinic because she has recently developed episodic diarrhoea. What is the most likely complication of diabetes in this patient. A. Prolactin B. Cushing's disease C. Glucagon D. Cortisol E. Ectopic ACTH-producing tumour F. Autonomic neuropathy G. Exogenous insulin H. Irritable bowel syndrome I. Respiratory alkalosis J. Coronary heart disease K. Testosterone L. Diabetic ketoacidosis M. Endogenous insulin N. Metabolic alkalosis ```

F. Autonomic neuropathy

A 65 year old man reports feeling lethargic and is found to have ‘impaired glucose tolerance’ by his GP. A. Fasting plasma glucose 5.9mmol/l. 2hrs post OGTT plasma glucose 11.5mmol/l B. Fasting whole blood glucose 6.0 mmol/l. Osmolarity 352 mOsm/kg. C. Plasma glucose 1.45mmol/l, pH 7.58, pCO2 8.1kPa. D. Plasma glucose 14 mmol/l; pH 7.2; pCO2 3.0 kPa. Urine positive for ketones E. Fasting plasma glucose 6.9 mmol/l. 2hrs post OGGT plasma glucose 10.5 mmol/l F. Plasma osolarity 285 mOsm/kg, anion gap 19 mM. Glucose normal. G. Plasma glucose 1.0mmol/l, pH 7.58, pCO2 2.4kPa H. Plasma glucose 1.45 mmol/l; pH 7.58; pCO2 2.4 kPa. I. Fasting plasma glucose 7.9mmol/l. 2hrs post OGTT glucose 11.1mmol/l.

E. Fasting plasma glucose 6.9 mmol/l. 2hrs post OGGT plasma glucose 10.5 mmol/l

A 24 year old with type I diabetes is admitted to A + E with shortness of breath and a respiratory rate of 35. He is also drowsy. A. Fasting plasma glucose 5.9mmol/l. 2hrs post OGTT plasma glucose 11.5mmol/l B. Fasting whole blood glucose 6.0 mmol/l. Osmolarity 352 mOsm/kg. C. Plasma glucose 1.45mmol/l, pH 7.58, pCO2 8.1kPa. D. Plasma glucose 14 mmol/l; pH 7.2; pCO2 3.0 kPa. Urine positive for ketones E. Fasting plasma glucose 6.9 mmol/l. 2hrs post OGGT plasma glucose 10.5 mmol/l F. Plasma osolarity 285 mOsm/kg, anion gap 19 mM. Glucose normal. G. Plasma glucose 1.0mmol/l, pH 7.58, pCO2 2.4kPa H. Plasma glucose 1.45 mmol/l; pH 7.58; pCO2 2.4 kPa. I. Fasting plasma glucose 7.9mmol/l. 2hrs post OGTT glucose 11.1mmol/l.

H. Plasma glucose 1.45 mmol/l; pH 7.58; pCO2 2.4 kPa.

An obese 40 year old woman is found on a routine blood test to have ‘impaired fasting glucose’ A. Fasting plasma glucose 5.9mmol/l. 2hrs post OGTT plasma glucose 11.5mmol/l B. Fasting whole blood glucose 6.0 mmol/l. Osmolarity 352 mOsm/kg. C. Plasma glucose 1.45mmol/l, pH 7.58, pCO2 8.1kPa. D. Plasma glucose 14 mmol/l; pH 7.2; pCO2 3.0 kPa. Urine positive for ketones E. Fasting plasma glucose 6.9 mmol/l. 2hrs post OGGT plasma glucose 10.5 mmol/l F. Plasma osolarity 285 mOsm/kg, anion gap 19 mM. Glucose normal. G. Plasma glucose 1.0mmol/l, pH 7.58, pCO2 2.4kPa H. Plasma glucose 1.45 mmol/l; pH 7.58; pCO2 2.4 kPa. I. Fasting plasma glucose 7.9mmol/l. 2hrs post OGTT glucose 11.1mmol/l.

B. Fasting whole blood glucose 6.0 mmol/l. Osmolarity 352 mOsm/kg.

A 14 year old type I diabetic attends clinic for a routine appointment. His daily record shows well managed blood glucose levels and he complains of no other problems. A. Fasting plasma glucose 5.9mmol/l. 2hrs post OGTT plasma glucose 11.5mmol/l B. Fasting whole blood glucose 6.0 mmol/l. Osmolarity 352 mOsm/kg. C. Plasma glucose 1.45mmol/l, pH 7.58, pCO2 8.1kPa. D. Plasma glucose 14 mmol/l; pH 7.2; pCO2 3.0 kPa. Urine positive for ketones E. Fasting plasma glucose 6.9 mmol/l. 2hrs post OGGT plasma glucose 10.5 mmol/l F. Plasma osolarity 285 mOsm/kg, anion gap 19 mM. Glucose normal. G. Plasma glucose 1.0mmol/l, pH 7.58, pCO2 2.4kPa H. Plasma glucose 1.45 mmol/l; pH 7.58; pCO2 2.4 kPa. I. Fasting plasma glucose 7.9mmol/l. 2hrs post OGTT glucose 11.1mmol/l.

F. Plasma osolarity 285 mOsm/kg, anion gap 19 mM. Glucose normal.

H. Plasma glucose 1.45 mmol/l; pH 7.58; pCO2 2.4 kPa.

``` A 49 year old man complains of recent severe pain in his left first toe, both knees and ankles. This occurred after a heavy Friday night out. On examination there was marked swelling and redness of the toe. The pain was especially evident if touched A. Lactic acid accumulation B. Ethanol C. Leukaemia D. Idiopathic E. Lesch-Nyhan Syndrome F. Glucose 6 phosphatase deficiency G. Hyperlipidaemia H. Diet I. Low dose aspirin J. Thiazide diuretics K. High dose asprin L. Renal Failure ```

B. Ethanol

``` A 55 year old man complains of swelling of his legs, pain in his ankles and left big toe and tiredness. On examination, there is oedema of his legs, swelling and redness on his ankles and left MTP joint. He has gross proteinurea and the serum albumin is 30 g/L A. Lactic acid accumulation B. Ethanol C. Leukaemia D. Idiopathic E. Lesch-Nyhan Syndrome F. Glucose 6 phosphatase deficiency G. Hyperlipidaemia H. Diet I. Low dose aspirin J. Thiazide diuretics K. High dose asprin L. Renal Failure ```

L. Renal Failure

``` A 48 year old gentleman develops a painful right big toe two days after being admitted into hospital with a BP of 180/120. A. Lactic acid accumulation B. Ethanol C. Leukaemia D. Idiopathic E. Lesch-Nyhan Syndrome F. Glucose 6 phosphatase deficiency G. Hyperlipidaemia H. Diet I. Low dose aspirin J. Thiazide diuretics K. High dose asprin L. Renal Failure ```

J. Thiazide diuretics

``` A 58-year old man presents with lethargy and generalised weakness. He has a 2 year history of upper abdominal pain especially after meals and suffered a myocardial infarct 3 years ago. Recently he has noticed swelling in his right first toe. Examination reveals tenderness in the epigastrium. No masses are felt and there is no organomegaly. Endoscopy reveals an active duodenal ulcer A. Lactic acid accumulation B. Ethanol C. Leukaemia D. Idiopathic E. Lesch-Nyhan Syndrome F. Glucose 6 phosphatase deficiency G. Hyperlipidaemia H. Diet I. Low dose aspirin J. Thiazide diuretics K. High dose asprin L. Renal Failure ```

I. Low dose aspirin

``` An 8 year old boy, showing signs of slow development, presents with a painful right knee which on examination was hot and swollen. Scratch marks on his face were also observed. An aspiration of the synovial fluid from the joint revealed crystals which were negatively birefringent. A. Lactic acid accumulation B. Ethanol C. Leukaemia D. Idiopathic E. Lesch-Nyhan Syndrome F. Glucose 6 phosphatase deficiency G. Hyperlipidaemia H. Diet I. Low dose aspirin J. Thiazide diuretics K. High dose asprin L. Renal Failure ```

E. Lesch-Nyhan Syndrome

``` Mr Smith has a history of end-stage renal failure. Routine blood tests demonstrate an adjusted serum calcium of 3.2mmol/L and elevated PTH levels. A. Paget’s Disease B. Hypocalcaemia C. Hypercalcaemia D. Secondary Hyperparathyroidism E. Diabetes Mellitus F. Amyloidosis G. Papillary Carcinoma H. Medullary Carcinoma I. Osteomalacia J. Tertiary Hyperparathyroidism K. Multiple Myeloma ```

J. Tertiary Hyperparathyroidism

``` Mrs Jones presents to her GP complaining of abdominal pain, bone pain, nausea and constipation. Her adjusted serum calcium was found to be 3.2mmol/L with undetectable PTH. Serum electrophoresis demonstrates a monoclonal band. A. Paget’s Disease B. Hypocalcaemia C. Hypercalcaemia D. Secondary Hyperparathyroidism E. Diabetes Mellitus F. Amyloidosis G. Papillary Carcinoma H. Medullary Carcinoma I. Osteomalacia J. Tertiary Hyperparathyroidism K. Multiple Myeloma ```

K. Multiple Myeloma

``` Chronic renal failure is one of the commonest causes of hypercalcaemia. What is the commonest cause of end stage renal failure in Europe? A. Paget’s Disease B. Hypocalcaemia C. Hypercalcaemia D. Secondary Hyperparathyroidism E. Diabetes Mellitus F. Amyloidosis G. Papillary Carcinoma H. Medullary Carcinoma I. Osteomalacia J. Tertiary Hyperparathyroidism K. Multiple Myeloma ```

E. Diabetes Mellitus

``` A 45 year old smoker has recently been diagnosed with lung cancer. He has raised levels of calcium but low levels of PTH A. Tertiary hyperparathyroidism B. Paget's disease of the bone C. Primary hypoparathyroidism D. Primary hyperparathyroidism E. Hypercalcaemia F. Pseudopseudohypoparathyroidism G. Secondary hyperparathyroidism H. Malignant hypercalcaemia I. Pseudohypoparathyroidism J. Hypocalcaemia ```

H. Malignant hypercalcaemia

``` A 20yr old gentleman presents to his GP with a lump in his neck. He has noticed the lump getting bigger. Examination reveals the lump to be in the thyroid gland. FNA and cytology reveals the diagnosis. A. Paget’s Disease B. Hypocalcaemia C. Hypercalcaemia D. Secondary Hyperparathyroidism E. Diabetes Mellitus F. Amyloidosis G. Papillary Carcinoma H. Medullary Carcinoma I. Osteomalacia J. Tertiary Hyperparathyroidism K. Multiple Myeloma ```

G. Papillary Carcinoma

``` A 32 year old female complains for severe thirst. On further questioning she also suffers from mild depression, abdominal pains and has a history of broken bones. Her calcium levels are raised. A. Tertiary hyperparathyroidism B. Paget's disease of the bone C. Primary hypoparathyroidism D. Primary hyperparathyroidism E. Hypercalcaemia F. Pseudopseudohypoparathyroidism G. Secondary hyperparathyroidism H. Malignant hypercalcaemia I. Pseudohypoparathyroidism J. Hypocalcaemia ```

D. Primary hyperparathyroidism

``` A 37 year old man has a round face, short metacarpals and metatarsals. He complains of mild depression and has a carpopedal spasm. Plasma PTH is raised and alk phos is slightly raised too. A. Tertiary hyperparathyroidism B. Paget's disease of the bone C. Primary hypoparathyroidism D. Primary hyperparathyroidism E. Hypercalcaemia F. Pseudopseudohypoparathyroidism G. Secondary hyperparathyroidism H. Malignant hypercalcaemia I. Pseudohypoparathyroidism J. Hypocalcaemia ```

I. Pseudohypoparathyroidism

``` A 67 year old Caucasian woman complains of pain in her clavicle and recent loss of hearing. X-rays show localized enlargement of bone. Blood biochemistry revealed normal calcium and phosphate levels however her alk phos is very high. A. Tertiary hyperparathyroidism B. Paget's disease of the bone C. Primary hypoparathyroidism D. Primary hyperparathyroidism E. Hypercalcaemia F. Pseudopseudohypoparathyroidism G. Secondary hyperparathyroidism H. Malignant hypercalcaemia I. Pseudohypoparathyroidism J. Hypocalcaemia ```

B. Paget's disease of the bone

``` A 52 year old man has recently had a kidney transplant. He now complains of stiff joints and abdominal pain. On investigation his blood pressure was raised and his calcium was raised. A. Tertiary hyperparathyroidism B. Paget's disease of the bone C. Primary hypoparathyroidism D. Primary hyperparathyroidism E. Hypercalcaemia F. Pseudopseudohypoparathyroidism G. Secondary hyperparathyroidism H. Malignant hypercalcaemia I. Pseudohypoparathyroidism J. Hypocalcaemia ```

A. Tertiary hyperparathyroidism

``` A 50 year old woman presents with pain and stiffness in her hands. On further questioning she reveals that she also has pain in her back, hips and knees, which is worse in the evenings. A. Osteoporosis B. Rheumatoid arthritis C. Pseudogout D. Osteomalacia E. Gout F. Septic arthritis G. Osteoarthritis H. Ankylosing spondylitis I. Paget's disease J. Primary hyperparathyroidism K. Myeloma ```

G. Osteoarthritis

``` A 40 year woman presents with pain, swelling and stiffness in her hands. On further questioning she revels that she also has pain in her wrists, shoulders and knees which is worse in the mornings. A. Osteoporosis B. Rheumatoid arthritis C. Pseudogout D. Osteomalacia E. Gout F. Septic arthritis G. Osteoarthritis H. Ankylosing spondylitis I. Paget's disease J. Primary hyperparathyroidism K. Myeloma ```

B. Rheumatoid arthritis

``` A 60 year old woman presents with pain in her back and knees. It was noted that she had bowed legs, and her blood tests revealed a lone increase in Alkaline Phosphatase. A. Osteoporosis B. Rheumatoid arthritis C. Pseudogout D. Osteomalacia E. Gout F. Septic arthritis G. Osteoarthritis H. Ankylosing spondylitis I. Paget's disease J. Primary hyperparathyroidism K. Myeloma ```

I. Paget's disease

``` A 50 year old obese, hypertensive man presents with a 2 day history of a painful, swollen, red toe. On further questioning he reveals that the symptoms had started the morning after the office party, where he ingested large amounts of alcohol. A. Osteoporosis B. Rheumatoid arthritis C. Pseudogout D. Osteomalacia E. Gout F. Septic arthritis G. Osteoarthritis H. Ankylosing spondylitis I. Paget's disease J. Primary hyperparathyroidism K. Myeloma ```

E. Gout

I. Paget's disease

A 50 year old man was admitted to hospital in a confused state. He was dyspnoeic and had a cough productive of sputum. He was unable to give a coherent history but one of the casualty officers knew him to be a type 1 diabetic patient with a history of COPD. Arterial blood: pH 7.18, pCO2 7.4kPa, Bicarbonate: 20 A. Acute respiratory alkalosis with co-existent metabolic acidosis B. Respiratory acidosis C. Compensated respiratory alkalosis D. Respiratory alkalosis E. Metabolic alkalosis with compensatory hypoventilation F. Metabolic acidosis G. Mixed respiratory and metabolic acidosis H. Metabolic alkalosis I. Compensatory metabolic alkalosis

G. Mixed respiratory and metabolic acidosis

A young woman was admitted to hospital 8 hours after she had taken an overdose of aspirin. Arterial blood: H+ - 30nmol/L, pH – 7.53, pCO2 – 2.0kPa A. Acute respiratory alkalosis with co-existent metabolic acidosis B. Respiratory acidosis C. Compensated respiratory alkalosis D. Respiratory alkalosis E. Metabolic alkalosis with compensatory hypoventilation F. Metabolic acidosis G. Mixed respiratory and metabolic acidosis H. Metabolic alkalosis I. Compensatory metabolic alkalosis

A. Acute respiratory alkalosis with co-existent metabolic acidosis

A young woman was admitted to hospital unconscious, following a head injury. A skull fracture was demonstrated on radiography and a CT scan revealed extensive cerebral contusions. The respiratory rate was increased, at 38/min. 3 days after admission, the patient’s condition was unchanged. Arterial blood: H+ - 36nmol/L, pH – 7.44, pCO2 – 3.6kPa, Bicarbonate – 19mmol/L A. Acute respiratory alkalosis with co-existent metabolic acidosis B. Respiratory acidosis C. Compensated respiratory alkalosis D. Respiratory alkalosis E. Metabolic alkalosis with compensatory hypoventilation F. Metabolic acidosis G. Mixed respiratory and metabolic acidosis H. Metabolic alkalosis I. Compensatory metabolic alkalosis

C. Compensated respiratory alkalosis

A 45 year old man was admitted to hospital with a history of persistent vomiting, He had a long history of dydpepsia but had never sought advice for this, preferring to treat himself with proprietary remedies. On examination, he was obviously dehydrated and his respiration was shallow. Arterial blood: H+ - 28nmol/L, pH – 7.56, pCO2 – 7.2kPa, Bicarbonate – 45mmol/L. Serum: Na+ - 146, K+ - 2.8, Urea – 34.2. A barium meal showed pyloric stenosis, thought to be due to scaring caused by peptic ulceration. A. Acute respiratory alkalosis with co-existent metabolic acidosis B. Respiratory acidosis C. Compensated respiratory alkalosis D. Respiratory alkalosis E. Metabolic alkalosis with compensatory hypoventilation F. Metabolic acidosis G. Mixed respiratory and metabolic acidosis H. Metabolic alkalosis I. Compensatory metabolic alkalosis

E. Metabolic alkalosis with compensatory hypoventilation

A young man sustained injury to the chest in a road traffic accident. Effective ventilation was compromised by a large flail segment. Arterial blood: pO2 – 8kPa, pCO2 – 8kPa, pH – 7.24, H+ - 58nmol/L, Bicarbonate – 25mmol/L A. Acute respiratory alkalosis with co-existent metabolic acidosis B. Respiratory acidosis C. Compensated respiratory alkalosis D. Respiratory alkalosis E. Metabolic alkalosis with compensatory hypoventilation F. Metabolic acidosis G. Mixed respiratory and metabolic acidosis H. Metabolic alkalosis I. Compensatory metabolic alkalosis

B. Respiratory acidosis

``` Which of these is associated with Wilson’s disease? A. IgM B. Myoglobin C. IgE D. C3 E. IgA F. Pre-albumin G. Paraprotein H. Caeruloplasmin I. Alpha-1-antitrypsin J. IgD K. C4 L. CSF M. AFP N. CRP O. Transferrin P. Albumin ```

H. Caeruloplasmin

``` Increases of what is a cardiovascular risk factor? A. IgM B. Myoglobin C. IgE D. C3 E. IgA F. Pre-albumin G. Paraprotein H. Caeruloplasmin I. Alpha-1-antitrypsin J. IgD K. C4 L. CSF M. AFP N. CRP O. Transferrin P. Albumin ```

N. CRP

``` What is the major antagonist of serine proteases at a site of injury? A. IgM B. Myoglobin C. IgE D. C3 E. IgA F. Pre-albumin G. Paraprotein H. Caeruloplasmin I. Alpha-1-antitrypsin J. IgD K. C4 L. CSF M. AFP N. CRP O. Transferrin P. Albumin ```

I. Alpha-1-antitrypsin

``` Which is associated with type 1 hypersensitivity? A. IgM B. Myoglobin C. IgE D. C3 E. IgA F. Pre-albumin G. Paraprotein H. Caeruloplasmin I. Alpha-1-antitrypsin J. IgD K. C4 L. CSF M. AFP N. CRP O. Transferrin P. Albumin ```

C. IgE

``` Which can act as a source of amino acids? A. IgM B. Myoglobin C. IgE D. C3 E. IgA F. Pre-albumin G. Paraprotein H. Caeruloplasmin I. Alpha-1-antitrypsin J. IgD K. C4 L. CSF M. AFP N. CRP O. Transferrin P. Albumin ```

P. Albumin

``` A 70 year old female presents to A&E having fallen over and hit her head. She complains of vision deterioration. Her X-ray showed a ‘pepper pot’ skull and a bone marrow biopsy showed > 30% plasma cells. A. Emphysema B. Alpha-1-antitrypsin deficiency C. Hodgkin's lymphoma D. Sarcoidosis E. Wilson's disease F. Pollycythaemia rubra vera G. Asthma H. Monoclonal gammopathy I. Pneumonia J. Myeloma K. Acute renal failure L. Tuberculosis M. Waldenstrom's macroglobulinaemia N. Amyloidosis O. Chronic myeloid leukaemia P. Hypoalbuminaemia ```

J. Myeloma

``` A 60 year old male presents to his GP with symptoms of tiredness, dizziness and loss of vision. He has lymphadenopathy and splenomegaly. Serum electrophoresis shows an IgM spike. A. Emphysema B. Alpha-1-antitrypsin deficiency C. Hodgkin's lymphoma D. Sarcoidosis E. Wilson's disease F. Pollycythaemia rubra vera G. Asthma H. Monoclonal gammopathy I. Pneumonia J. Myeloma K. Acute renal failure L. Tuberculosis M. Waldenstrom's macroglobulinaemia N. Amyloidosis O. Chronic myeloid leukaemia P. Hypoalbuminaemia ```

M. Waldenstrom's macroglobulinaemia

``` 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. A. Emphysema B. Alpha-1-antitrypsin deficiency C. Hodgkin's lymphoma D. Sarcoidosis E. Wilson's disease F. Pollycythaemia rubra vera G. Asthma H. Monoclonal gammopathy I. Pneumonia J. Myeloma K. Acute renal failure L. Tuberculosis M. Waldenstrom's macroglobulinaemia N. Amyloidosis O. Chronic myeloid leukaemia P. Hypoalbuminaemia ```

N. Amyloidosis

``` How do daily requirements of water for neonates compare with those of adults? A. Vitamin D B. Twice adult requirements C. Pierre-Robin sequence D. Oesophageal atresia E. Defect in renal phosphorylation F. > 6 times adult requirements G. Phosphate H. Cerebral palsy I. Kallman's syndrome J. Calcium K. Alkaline phosphatase L. Defect in receptor M. Defect in renal hydroxylation N. > 3 times adult requirements O. Kernicterus P. Nectrotising enterocolitis ```

F. > 6 times adult requirements

``` A 35 year old smoker present to A&E with shortness of breath. He has unintentionally lost weight over the past year. Chest X-ray shows emphysematous changes and FBC shows raised LFTs. A. Emphysema B. Alpha-1-antitrypsin deficiency C. Hodgkin's lymphoma D. Sarcoidosis E. Wilson's disease F. Pollycythaemia rubra vera G. Asthma H. Monoclonal gammopathy I. Pneumonia J. Myeloma K. Acute renal failure L. Tuberculosis M. Waldenstrom's macroglobulinaemia N. Amyloidosis O. Chronic myeloid leukaemia P. Hypoalbuminaemia ```

B. Alpha-1-antitrypsin deficiency

``` High fluid intake in neonates during the first week of life is associated with increasing frequency of this condition. A. Vitamin D B. Twice adult requirements C. Pierre-Robin sequence D. Oesophageal atresia E. Defect in renal phosphorylation F. > 6 times adult requirements G. Phosphate H. Cerebral palsy I. Kallman's syndrome J. Calcium K. Alkaline phosphatase L. Defect in receptor M. Defect in renal hydroxylation N. > 3 times adult requirements O. Kernicterus P. Nectrotising enterocolitis ```

P. Nectrotising enterocolitis

``` A 3-day-old baby presents with jaundice and has raised levels of unconjugated bilirubin. During examination, he is found to be irritable and has increased muscle tone and lies with an arched back (opisthotonus) A. Vitamin D B. Twice adult requirements C. Pierre-Robin sequence D. Oesophageal atresia E. Defect in renal phosphorylation F. > 6 times adult requirements G. Phosphate H. Cerebral palsy I. Kallman's syndrome J. Calcium K. Alkaline phosphatase L. Defect in receptor M. Defect in renal hydroxylation N. > 3 times adult requirements O. Kernicterus P. Nectrotising enterocolitiis ```

O. Kernicterus

``` An X-Ray performed on a preterm baby showed fraying, splaying and cupping of long bones. A blood test showed raised levels of this component. A. Vitamin D B. Twice adult requirements C. Pierre-Robin sequence D. Oesophageal atresia E. Defect in renal phosphorylation F. > 6 times adult requirements G. Phosphate H. Cerebral palsy I. Kallman's syndrome J. Calcium K. Alkaline phosphatase L. Defect in receptor M. Defect in renal hydroxylation N. > 3 times adult requirements O. Kernicterus P. Nectrotising enterocolitiis ```

K. Alkaline phosphatase

``` Pseudo vitamin D deficiency 1 is associated with this defect. A. Vitamin D B. Twice adult requirements C. Pierre-Robin sequence D. Oesophageal atresia E. Defect in renal phosphorylation F. > 6 times adult requirements G. Phosphate H. Cerebral palsy I. Kallman's syndrome J. Calcium K. Alkaline phosphatase L. Defect in receptor M. Defect in renal hydroxylation N. > 3 times adult requirements O. Kernicterus P. Nectrotising enterocolitiis ```

M. Defect in renal hydroxylation

``` In diabetics, this substance is formed in increased quantities in cells that do not require insulin for glucose uptake. It is injurious to those cells: A. Elevated serum osmolarity B. Amyloid C. Glucose D. Albumin E. Lipoprotein lipase F. Ketone bodies G. HDL cholesterol H. LDL cholesterol I. Insulitis J. Sorbitol ```

J. Sorbitol

``` The infant of a mother whose haemoglobin A1C was 9.8% during pregnancy is noted to be irritable, then display seizure activity soon after birth. What substance is decreased in the baby to explain these findings: A. Elevated serum osmolarity B. Amyloid C. Glucose D. Albumin E. Lipoprotein lipase F. Ketone bodies G. HDL cholesterol H. LDL cholesterol I. Insulitis J. Sorbitol ```

C. Glucose

``` A patient with a diagnosis of type 1 diabetes mellitus has not taken any insulin for several days. Her breath has a fruity odour. What is detectable in her urine to explain this finding: A. Elevated serum osmolarity B. Amyloid C. Glucose D. Albumin E. Lipoprotein lipase F. Ketone bodies G. HDL cholesterol H. LDL cholesterol I. Insulitis J. Sorbitol ```

F. Ketone bodies

``` 50 year old male has serum glucose values of 145 and 167 mg/dL on visits to his physician last month. His body mass index is 31. He has not had any major illnesses. The islets of Langerhans in his pancreas may demonstrate: A. Elevated serum osmolarity B. Amyloid C. Glucose D. Albumin E. Lipoprotein lipase F. Ketone bodies G. HDL cholesterol H. LDL cholesterol I. Insulitis J. Sorbitol ```

B. Amyloid This patient has type 2 diabetes, associated with amyloid deposition. Examples of localised amyloidosis are Alzheimer's disease and Type 2 Diabetes. In Alzheimer’s the unique peptide is the beta-amyloid protein (Abeta) and in type 2 diabetes it is the islet amyloid polypeptide (IAPP) also known as amylin. IAPP is an important player in the formation of amyloid deposits and the progression of type 2 diabetes, and may contribute to early beta cell death.

``` An 11 year old girl has had a month-long course of weight loss despite eating and drinking large amounts of food and fluid. A urinalysis shows pH 5.5, sp gr 1.022, 4+ glucose, no blood, no protein, and 4+ ketones. What most likely prededed the clinical appearance of her disease: A. Elevated serum osmolarity B. Amyloid C. Glucose D. Albumin E. Lipoprotein lipase F. Ketone bodies G. HDL cholesterol H. LDL cholesterol I. Insulitis J. Sorbitol ```

I. Insulitis Inflammation of the islets of langerhans. They are infiltrated by T and B lymphocytes, macrophages and dendritic cells.

``` GH, PRL, FSH. Which three anterior pituitary hormones are missing? A. LH, ACTH, TSH B. Prolactinoma C. Cortisol replacement D. Saline E. Thyroxine replacement F. Estrogen therapy G. VP, LH, TSH H. Addison’s disease I. Sheehan’s syndrome J. Hypothyroidism K. Anorexia Nervosa L. Graves’ disease ```

A. LH, ACTH, TSH

``` A 41-yrs-old bank manager consulted his GP to request Viagra. He was also embarrassedA 41-yrs-old bank manager consulted his GP to request Viagra. He was also embarrassed as he had developed gynaecomastia. Serum PRL came back as 16000 mU/L. A. LH, ACTH, TSH B. Prolactinoma C. Cortisol replacement D. Saline E. Thyroxine replacement F. Estrogen therapy G. VP, LH, TSH H. Addison’s disease I. Sheehan’s syndrome J. Hypothyroidism K. Anorexia Nervosa L. Graves’ disease ```

B. Prolactinoma

``` Mrs. Jones is 30 yrs-old and has been trying to get pregnant for the past 2 yrs – without success. On a hot summer’s day she visits her GP, complaining that she is depressed as she has put on 3 stones despite trying ‘every diet under the sun’. The GP notices she was wearing a woolly coat and gloves. A. LH, ACTH, TSH B. Prolactinoma C. Cortisol replacement D. Saline E. Thyroxine replacement F. Estrogen therapy G. VP, LH, TSH H. Addison’s disease I. Sheehan’s syndrome J. Hypothyroidism K. Anorexia Nervosa L. Graves’ disease ```

J. Hypothyroidism

``` A CPFT confirms a diagnosis of hypopituitarism in Mr. Smith. What is the immediate treatment he should be given? A. LH, ACTH, TSH B. Prolactinoma C. Cortisol replacement D. Saline E. Thyroxine replacement F. Estrogen therapy G. VP, LH, TSH H. Addison’s disease I. Sheehan’s syndrome J. Hypothyroidism K. Anorexia Nervosa L. Graves’ disease ```

C. Cortisol replacement

``` A 15-yrs-old school girl with a BMI of 17 complains of amenorrhoea. Blood test results reveal low estrogen, LH and FSH. GH concentration was 24 mU/L. A. LH, ACTH, TSH B. Prolactinoma C. Cortisol replacement D. Saline E. Thyroxine replacement F. Estrogen therapy G. VP, LH, TSH H. Addison’s disease I. Sheehan’s syndrome J. Hypothyroidism K. Anorexia Nervosa L. Graves’ disease ```

K. Anorexia Nervosa

``` A 32 year old librarian presents to your clinic complaining of blurring of her vision and amenorrhoea. She has a BMI of 22 and is generally well but has noticed some white secretions from her breast over the past 3 months. What would be a first line investigation for this lady? A. GH B. Insulin C. Combined Pituitary Function Test D. TSH E. Thyroid function Tests F. Prolactinoma G. ACTH H. Pituitary infarction I. Short Synacthen Test J. Benign nipple discharge K. LH L. Trauma M. CT SCAN ```

M. CT SCAN

``` A 56 year old gentlemen presents to his GP with a history of weight gain and lethargy despite trying to lose weight. He also notices that he has been using his electric heater much more recently despite the recent warm weather. Which hormone is likely to be raised? A. GH B. Insulin C. Combined Pituitary Function Test D. TSH E. Thyroid function Tests F. Prolactinoma G. ACTH H. Pituitary infarction I. Short Synacthen Test J. Benign nipple discharge K. LH L. Trauma M. CT SCAN ```

D. TSH

``` Mrs Smith is to have a CPFT. She has been starved overnight, IV access has been gained and she was weighed this morning. 100 mcg LHRH and 200 mcg TRH have been combined in a syringe. What other hormone should be added to the mixture before it is administered to the patient for the test to be complete? A. GH B. Insulin C. Combined Pituitary Function Test D. TSH E. Thyroid function Tests F. Prolactinoma G. ACTH H. Pituitary infarction I. Short Synacthen Test J. Benign nipple discharge K. LH L. Trauma M. CT SCAN ```

B. Insulin

``` A 53 year old man presents to his GP with headaches and poor eyesight. He has also noticed that his shoes are now too small for him. His GP tells him he thinks he should have a test done to detect the levels of a specific hormone in his blood. What is this hormone? A. GH B. Insulin C. Combined Pituitary Function Test D. TSH E. Thyroid function Tests F. Prolactinoma G. ACTH H. Pituitary infarction I. Short Synacthen Test J. Benign nipple discharge K. LH L. Trauma M. CT SCAN ```

A. GH

``` A 32 year old librarian presents to your clinic complaining of blurring of her vision and amenorrhoea. She has a BMI of 22 and is generally well but has noticed some white secretions from her breast over the past 3 months. What is the MOST likely diagnosis? A. GH B. Insulin C. Combined Pituitary Function Test D. TSH E. Thyroid function Tests F. Prolactinoma G. ACTH H. Pituitary infarction I. Short Synacthen Test J. Benign nipple discharge K. LH L. Trauma M. CT SCAN ```

F. Prolactinoma

``` A 60 year old woman presents with lethargy. Further questioning reveals she has gained weight. An assessment of her mental state suggests she is depressed. A. Thyroid insufficiency B. Corticotrophin insufficiency C. Gonadotrophin insufficiency D. Androgen insufficiency E. Growth hormone insufficency ```

A. Thyroid insufficiency

``` A 53 year old man presents with a loss of libido and erectile dysfunction. A. Thyroid insufficiency B. Corticotrophin insufficiency C. Gonadotrophin insufficiency D. Androgen insufficiency E. Growth hormone insufficency ```

D. Androgen insufficiency

``` A 32 year old woman presents to her GP with abdominal pain and nausea. She has also been feeling increasingly tired in the afternoon. On leaving her GP, she feels very faint and collapses. A. Thyroid insufficiency B. Corticotrophin insufficiency C. Gonadotrophin insufficiency D. Androgen insufficiency E. Growth hormone insufficency ```

B. Corticotrophin insufficiency

``` A 53 year old overweight woman presents with hypertension (140 / 90mm Hg), a triglyceride level of 160mg / dL and a waist circumference of 39 inches. She complains of constant thirst and nocturia. A. Diabetes B. Familial hypertriglyceridaemia C. Renal failure D. Metabolic syndrome E. Lipoprotein lipase deficiency F. Alcohol abuse G. Hypothyroidism H. Biliary obstruction I. Polygenic hypercholesterolaemia ```

D. Metabolic syndrome

``` A 6 year old boy presents with episodic abdominal pain and recurrent acute pancreatitis. The plasma is found to have a milky appearance and chylomicrons are found in the plasma following a period of fasting. A. Diabetes B. Familial hypertriglyceridaemia C. Renal failure D. Metabolic syndrome E. Lipoprotein lipase deficiency F. Alcohol abuse G. Hypothyroidism H. Biliary obstruction I. Polygenic hypercholesterolaemia ```

E. Lipoprotein lipase deficiency

``` A 28 year old male stock broker presents with palpitations and tension headaches. His plasma cholesterol is 7mmol / L and plasma triglycerides are measured as 30mmol /L A. Diabetes B. Familial hypertriglyceridaemia C. Renal failure D. Metabolic syndrome E. Lipoprotein lipase deficiency F. Alcohol abuse G. Hypothyroidism H. Biliary obstruction I. Polygenic hypercholesterolaemia ```

F. Alcohol abuse

``` A 45 year old woman presents with a history of weight gain, constipation and bradycardia. Cholesterol measurement is 6.7 m mol / L and plasma triglycerides are measured at 9mmol/L. A. Diabetes B. Familial hypertriglyceridaemia C. Renal failure D. Metabolic syndrome E. Lipoprotein lipase deficiency F. Alcohol abuse G. Hypothyroidism H. Biliary obstruction I. Polygenic hypercholesterolaemia ```

G. Hypothyroidism

``` A 56 year old jaundiced man presents with a raised cholesterol of 6.9 mmol/L. A. Diabetes B. Familial hypertriglyceridaemia C. Renal failure D. Metabolic syndrome E. Lipoprotein lipase deficiency F. Alcohol abuse G. Hypothyroidism H. Biliary obstruction I. Polygenic hypercholesterolaemia ```

H. Biliary obstruction

``` The molecule that is formed by the gut after a meal and is the main carrier of dietary triglycerides A. Apolipoprotein A B. Apolipoprotein C. Lipoprotein lipase D. High density lipoprotein (HDL) E. HMG coA reductase F. Cholesterol acyl transferase G. Triglyceride H. Chylomicron I. Intermediate density lipoprotein J. Low density lipoprotein (LDL) K. Very low density lipoprotein (VLDL) L. Gamma-glutyl transferase ```

H. Chylomicron

``` This is present on capillaries of adipose tissue and skeletal muscle and it removes triglyceride from lipoproteins. A. Apolipoprotein A B. Apolipoprotein C. Lipoprotein lipase D. High density lipoprotein (HDL) E. HMG coA reductase F. Cholesterol acyl transferase G. Triglyceride H. Chylomicron I. Intermediate density lipoprotein J. Low density lipoprotein (LDL) K. Very low density lipoprotein (VLDL) L. Gamma-glutyl transferase ```

C. Lipoprotein lipase

``` The smallest lipoprotein which carries cholesterol from extra-hepatic tissues to the liver for excretion. A. Apolipoprotein A B. Apolipoprotein C. Lipoprotein lipase D. High density lipoprotein (HDL) E. HMG coA reductase F. Cholesterol acyl transferase G. Triglyceride H. Chylomicron I. Intermediate density lipoprotein J. Low density lipoprotein (LDL) K. Very low density lipoprotein (VLDL) L. Gamma-glutyl transferase ```

D. High density lipoprotein (HDL)

``` This molecule is present in the fasting state in cases of lipoprotein lipase deficiency. A. Apolipoprotein A B. Apolipoprotein C. Lipoprotein lipase D. High density lipoprotein (HDL) E. HMG coA reductase F. Cholesterol acyl transferase G. Triglyceride H. Chylomicron I. Intermediate density lipoprotein J. Low density lipoprotein (LDL) K. Very low density lipoprotein (VLDL) L. Gamma-glutyl transferase ```

H. Chylomicron

``` The first intermediate formed after VLDL particles synthesised by the liver are degraded. A. Apolipoprotein A B. Apolipoprotein C. Lipoprotein lipase D. High density lipoprotein (HDL) E. HMG coA reductase F. Cholesterol acyl transferase G. Triglyceride H. Chylomicron I. Intermediate density lipoprotein J. Low density lipoprotein (LDL) K. Very low density lipoprotein (VLDL) L. Gamma-glutyl transferase ```

I. Intermediate density lipoprotein

``` How do daily requirements of water for neonates compare with those of adults? A. Defect in renal hydroxylation B. Kernicterus C. Cerebral palsy D. Oesophageal atresia E. Alkaline phosphatase F. Vitamin D G. Nectrotising enterocolitis H. Phosphate I. Kallman's syndrome J. > 3 times adult requirements K. Defect in renal phosphorylation L. Defect in receptor M. > 6 times adult requirements N. Twice adult requirements O. Calcium P. Pierre-Robin sequence ```

M. > 6 times adult requirements

``` High fluid intake in neonates during the first week of life is associated with increasing frequency of this condition. A. Defect in renal hydroxylation B. Kernicterus C. Cerebral palsy D. Oesophageal atresia E. Alkaline phosphatase F. Vitamin D G. Nectrotising enterocolitis H. Phosphate I. Kallman's syndrome J. > 3 times adult requirements K. Defect in renal phosphorylation L. Defect in receptor M. > 6 times adult requirements N. Twice adult requirements O. Calcium P. Pierre-Robin sequence ```

G. Nectrotising enterocolitis

``` A 3-day-old baby presents with jaundice and has raised levels of unconjugated bilirubin. During examination, he is found to be irritable and has increased muscle tone and lies with an arched back (opisthotonus) A. Defect in renal hydroxylation B. Kernicterus C. Cerebral palsy D. Oesophageal atresia E. Alkaline phosphatase F. Vitamin D G. Nectrotising enterocolitis H. Phosphate I. Kallman's syndrome J. > 3 times adult requirements K. Defect in renal phosphorylation L. Defect in receptor M. > 6 times adult requirements N. Twice adult requirements O. Calcium P. Pierre-Robin sequence ```

B. Kernicterus

``` An X-Ray performed on a preterm baby showed fraying, splaying and cupping of long bones. A blood test showed raised levels of this component. A. Defect in renal hydroxylation B. Kernicterus C. Cerebral palsy D. Oesophageal atresia E. Alkaline phosphatase F. Vitamin D G. Nectrotising enterocolitis H. Phosphate I. Kallman's syndrome J. > 3 times adult requirements K. Defect in renal phosphorylation L. Defect in receptor M. > 6 times adult requirements N. Twice adult requirements O. Calcium P. Pierre-Robin sequence ```

E. Alkaline phosphatase

``` Pseudo vitamin D deficiency 1 is associated with this defect. A. Defect in renal hydroxylation B. Kernicterus C. Cerebral palsy D. Oesophageal atresia E. Alkaline phosphatase F. Vitamin D G. Nectrotising enterocolitis H. Phosphate I. Kallman's syndrome J. > 3 times adult requirements K. Defect in renal phosphorylation L. Defect in receptor M. > 6 times adult requirements N. Twice adult requirements O. Calcium P. Pierre-Robin sequence ```

A. Defect in renal hydroxylation

``` A 3-week-old male is seen by a paediatrician because of severe jaundice that appeared at birth and has been worsening ever since. A. 21 hydroxylase deficiency B. Crigler-Najjar syndrome C. Rickets D. Pellagra E. Ehlers-Danlos syndrome F. Lesch-Nyhan syndrome G. Alpha 1 antitrypsin deficiency H. 17 alpha hydroxylase deficiency I. Phenylketonuria J. Hereditary spherocytosis K. Scurvy L. Rheumatoid arthritis M. Folate deficiency N. Glucose-6-phosphate dehydrogenase deficiency O. Autism P. 5 alpha reductase deficiency ```

B. Crigler-Najjar syndrome

``` A young boy presents to his GP with jaundice. He is also found to have haemoglobinuria, splenomegaly and anaemia. His mother reveals that he was jaundiced at birth and needed a blood transfusion. A. 21 hydroxylase deficiency B. Crigler-Najjar syndrome C. Rickets D. Pellagra E. Ehlers-Danlos syndrome F. Lesch-Nyhan syndrome G. Alpha 1 antitrypsin deficiency H. 17 alpha hydroxylase deficiency I. Phenylketonuria J. Hereditary spherocytosis K. Scurvy L. Rheumatoid arthritis M. Folate deficiency N. Glucose-6-phosphate dehydrogenase deficiency O. Autism P. 5 alpha reductase deficiency ```

N. Glucose-6-phosphate dehydrogenase deficiency

``` A 15-month-old boy is brought to the paediatric clinic by his parents because of delayed dentition, poor growth and development, frequent crying, weakness, and constipation. A. 21 hydroxylase deficiency B. Crigler-Najjar syndrome C. Rickets D. Pellagra E. Ehlers-Danlos syndrome F. Lesch-Nyhan syndrome G. Alpha 1 antitrypsin deficiency H. 17 alpha hydroxylase deficiency I. Phenylketonuria J. Hereditary spherocytosis K. Scurvy L. Rheumatoid arthritis M. Folate deficiency N. Glucose-6-phosphate dehydrogenase deficiency O. Autism P. 5 alpha reductase deficiency ```

C. Rickets

``` A newborn is evaluated by a paediatrician after the obstetrician performing the delivery was unable to tell whether the child is male or female. A. 21 hydroxylase deficiency B. Crigler-Najjar syndrome C. Rickets D. Pellagra E. Ehlers-Danlos syndrome F. Lesch-Nyhan syndrome G. Alpha 1 antitrypsin deficiency H. 17 alpha hydroxylase deficiency I. Phenylketonuria J. Hereditary spherocytosis K. Scurvy L. Rheumatoid arthritis M. Folate deficiency N. Glucose-6-phosphate dehydrogenase deficiency O. Autism P. 5 alpha reductase deficiency ```

A. 21 hydroxylase deficiency

``` A 18 month old male is brought to the paediatrician by his mother because of repeated, self-mutilating biting of his fingers and lips and delayed motor development. The patient’s mother has also noticed abundant, orange-coloured “sand” (uric acid crystals) in the child’s nappies. A. 21 hydroxylase deficiency B. Crigler-Najjar syndrome C. Rickets D. Pellagra E. Ehlers-Danlos syndrome F. Lesch-Nyhan syndrome G. Alpha 1 antitrypsin deficiency H. 17 alpha hydroxylase deficiency I. Phenylketonuria J. Hereditary spherocytosis K. Scurvy L. Rheumatoid arthritis M. Folate deficiency N. Glucose-6-phosphate dehydrogenase deficiency O. Autism P. 5 alpha reductase deficiency ```

F. Lesch-Nyhan syndrome

``` An abnormality tested for by the Guthrie blood spot test A. Cystic Fibrosis B. Medium chain acyl CoA dehydrogenase deficiency (MCAD) C. Organic acidurias D. Congenital adrenal hyperplasia E. PKU F. Galactosaemia G. Biotinidase deficiency H. Congenital hypothyroidism I. Homocystinuria J. Sickle cell K. Urea cycle disorders ```

E. PKU

``` An abnormaility that is tested for using electrophoresis A. Cystic Fibrosis B. Medium chain acyl CoA dehydrogenase deficiency (MCAD) C. Organic acidurias D. Congenital adrenal hyperplasia E. PKU F. Galactosaemia G. Biotinidase deficiency H. Congenital hypothyroidism I. Homocystinuria J. Sickle cell K. Urea cycle disorders ```

J. Sickle cell

``` A fatty acid oxidation defect A. Cystic Fibrosis B. Medium chain acyl CoA dehydrogenase deficiency (MCAD) C. Organic acidurias D. Congenital adrenal hyperplasia E. PKU F. Galactosaemia G. Biotinidase deficiency H. Congenital hypothyroidism I. Homocystinuria J. Sickle cell K. Urea cycle disorders ```

B. Medium chain acyl CoA dehydrogenase deficiency (MCAD)

``` An abnormality that is indicated by a high level of TSH A. Cystic Fibrosis B. Medium chain acyl CoA dehydrogenase deficiency (MCAD) C. Organic acidurias D. Congenital adrenal hyperplasia E. PKU F. Galactosaemia G. Biotinidase deficiency H. Congenital hypothyroidism I. Homocystinuria J. Sickle cell K. Urea cycle disorders ```

H. Congenital hypothyroidism

``` An abnormality that may result in androgenisation and pigmentation among other signs and symptoms A. Cystic Fibrosis B. Medium chain acyl CoA dehydrogenase deficiency (MCAD) C. Organic acidurias D. Congenital adrenal hyperplasia E. PKU F. Galactosaemia G. Biotinidase deficiency H. Congenital hypothyroidism I. Homocystinuria J. Sickle cell K. Urea cycle disorders ```

D. Congenital adrenal hyperplasia

``` A 2-month Canadian neonate presents with failure to thrive, jaundice and sepsis. You are screening for metabolic disorders, what 1st line test would you recommend? A. Urine organic acids B. Urine sugar chromotography C. Amino acids (urine and plasma) D. Galactase-1-phosphate uridyl transferase E. Glucose and lactate F. Medium chain acyl coA dehydrogenase G. Very long chain fatty acids H. Plasma ammonia I. Plasma lactate J. Transferrin glycoforms ```

C. Amino acids (urine and plasma)

``` A male infant presents with failure to thrive, neurological signs (including tremor) and tachypnea. From our metabolic disorders screen, which 1st line test is likely to be abnormal? A. Urine organic acids B. Urine sugar chromotography C. Amino acids (urine and plasma) D. Galactase-1-phosphate uridyl transferase E. Glucose and lactate F. Medium chain acyl coA dehydrogenase G. Very long chain fatty acids H. Plasma ammonia I. Plasma lactate J. Transferrin glycoforms ```

H. Plasma ammonia

``` A neonate has seizures, conjugated hyperbilirubinaemia and the 3rd year med student’s clinical observation is that “he looks weird!” From our metabolic disorders screen, which 1st line test is likely to be abnormal? A. Urine organic acids B. Urine sugar chromotography C. Amino acids (urine and plasma) D. Galactase-1-phosphate uridyl transferase E. Glucose and lactate F. Medium chain acyl coA dehydrogenase G. Very long chain fatty acids H. Plasma ammonia I. Plasma lactate J. Transferrin glycoforms ```

G. Very long chain fatty acids

``` A post mortem diagnosis of an inborn error of metabolism is investigated in a case of “sudden infant death”. What deficiency is the most likely cause? A. Urine organic acids B. Urine sugar chromotography C. Amino acids (urine and plasma) D. Galactase-1-phosphate uridyl transferase E. Glucose and lactate F. Medium chain acyl coA dehydrogenase G. Very long chain fatty acids H. Plasma ammonia I. Plasma lactate J. Transferrin glycoforms ```

F. Medium chain acyl coA dehydrogenase

``` A neonate with a history of feeding difficulties presents with jaundice, cataracts and sepsis. What deficiency is the most likely cause? A. Urine organic acids B. Urine sugar chromotography C. Amino acids (urine and plasma) D. Galactase-1-phosphate uridyl transferase E. Glucose and lactate F. Medium chain acyl coA dehydrogenase G. Very long chain fatty acids H. Plasma ammonia I. Plasma lactate J. Transferrin glycoforms ```

D. Galactase-1-phosphate uridyl transferase

B. Ethanol

L. Renal Failure

J. Thiazide diuretics

I. Low dose aspirin

E. Lesch-Nyhan Syndrome

J. Tertiary Hyperparathyroidism

K. Multiple Myeloma

E. Diabetes Mellitus

``` Chvostek’s sign and trousseau’s sign are positive in A. Paget’s Disease B. Hypocalcaemia C. Hypercalcaemia D. Secondary Hyperparathyroidism E. Diabetes Mellitus F. Amyloidosis G. Papillary Carcinoma H. Medullary Carcinoma I. Osteomalacia J. Tertiary Hyperparathyroidism K. Multiple Myeloma ```

B. Hypocalcaemia

G. Papillary Carcinoma

D. Primary hyperparathyroidism

H. Malignant hypercalcaemia

I. Pseudohypoparathyroidism

B. Paget's disease of the bone

A. Tertiary hyperparathyroidism

G. Osteoarthritis

B. Rheumatoid arthritis

``` A 24 year old man presents with pain and stiffness in his buttocks and lower back which is worse when he wakes up in the mornings, but eases after he has gone to the gym. On further questioning he reveals that he has had 2 similar episodes in the past. A. Osteoporosis B. Rheumatoid arthritis C. Pseudogout D. Osteomalacia E. Gout F. Septic arthritis G. Osteoarthritis H. Ankylosing spondylitis I. Paget's disease J. Primary hyperparathyroidism K. Myeloma ```

H. Ankylosing spondylitis

E. Gout

I. Paget's disease

G. Mixed respiratory and metabolic acidosis

A. Acute respiratory alkalosis with co-existent metabolic acidosis

C. Compensated respiratory alkalosis

E. Metabolic alkalosis with compensatory hypoventilation

B. Respiratory acidosis

H. Caeruloplasmin

N. CRP

I. Alpha-1-antitrypsin

C. IgE

P. Albumin

J. Myeloma

M. Waldenstrom's macroglobulinaemia

N. Amyloidosis

``` A 19 year old student presents to A&E with shortness of breath, cough and pleuritic chest pain. Sputum is sent for culture and FBC shows a raised CRP. A. Emphysema B. Alpha-1-antitrypsin deficiency C. Hodgkin's lymphoma D. Sarcoidosis E. Wilson's disease F. Pollycythaemia rubra vera G. Asthma H. Monoclonal gammopathy I. Pneumonia J. Myeloma K. Acute renal failure L. Tuberculosis M. Waldenstrom's macroglobulinaemia N. Amyloidosis O. Chronic myeloid leukaemia P. Hypoalbuminaemia ```

I. Pneumonia

B. Alpha-1-antitrypsin deficiency

``` Useful in staging and monitoring treatment of extracapsular spread of prostatic carcinoma A. Alkaline phosphatase B. Creatine kinase C. Renin D. Triglyceride E. Angiotensin converting enzyme (ACE) F. Alanine aminotransferase G. Porphobilinogen deaminase H. Acid phosphatase I. Lactate dehydrogenase J. Acetylcholinesaterase ```

H. Acid phosphatase

``` Reflects increased osteoblastic activity and may be raised in osteomalacia and rickets A. Alkaline phosphatase B. Creatine kinase C. Renin D. Triglyceride E. Angiotensin converting enzyme (ACE) F. Alanine aminotransferase G. Porphobilinogen deaminase H. Acid phosphatase I. Lactate dehydrogenase J. Acetylcholinesaterase ```

A. Alkaline phosphatase

``` Indicates a feature of biliary outflow obstruction rather than hepatocellular damage A. Alkaline phosphatase B. Creatine kinase C. Renin D. Triglyceride E. Angiotensin converting enzyme (ACE) F. Alanine aminotransferase G. Porphobilinogen deaminase H. Acid phosphatase I. Lactate dehydrogenase J. Acetylcholinesaterase ```

A. Alkaline phosphatase

``` This enzyme is more liver-specific although its changes are parallel to that of aspartate aminotransferase A. Alkaline phosphatase B. Creatine kinase C. Renin D. Triglyceride E. Angiotensin converting enzyme (ACE) F. Alanine aminotransferase G. Porphobilinogen deaminase H. Acid phosphatase I. Lactate dehydrogenase J. Acetylcholinesaterase ```

F. Alanine aminotransferase

``` Raised in active sarcoidosis A. Alkaline phosphatase B. Creatine kinase C. Renin D. Triglyceride E. Angiotensin converting enzyme (ACE) F. Alanine aminotransferase G. Porphobilinogen deaminase H. Acid phosphatase I. Lactate dehydrogenase J. Acetylcholinesaterase ```

E. Angiotensin converting enzyme (ACE)

``` 71 year old man has a 3 month history of severe back pain. On further questioning he has also experienced urinary frequency, dysuria, nocturia and has lost 6kg in the past 7 months. What enzyme would you expect to find elevated in this patient? A. LDH B. GGT C. Creatine Kinase (MB) D. Troponin E. Creatine Kinase (MM) F. Glucagon G. Alkaline Phosphatase H. AST I. Creatine Kinase (BB) J. Amylase K. Insulin ```

G. Alkaline Phosphatase

``` Which enzyme rapidly rises post myocardial infarction but then rapidly declines and is a useful marker of reinfarction? A. LDH B. GGT C. Creatine Kinase (MB) D. Troponin E. Creatine Kinase (MM) F. Glucagon G. Alkaline Phosphatase H. AST I. Creatine Kinase (BB) J. Amylase K. Insulin ```

C. Creatine Kinase (MB)

``` A 3 year old unimmunised boy presents with Mumps. Which enzyme is likely to be raised? A. LDH B. GGT C. Creatine Kinase (MB) D. Troponin E. Creatine Kinase (MM) F. Glucagon G. Alkaline Phosphatase H. AST I. Creatine Kinase (BB) J. Amylase K. Insulin ```

J. Amylase

``` A 19 year old African boy presented with cervical lymph nodes, 3 month history of night sweats and a 3kg weight loss. Lymph node biopsy showed the presence of Reed-Sternberg cells loss. Following chemotherapy which enzyme would you expect to be elevated? A. LDH B. GGT C. Creatine Kinase (MB) D. Troponin E. Creatine Kinase (MM) F. Glucagon G. Alkaline Phosphatase H. AST I. Creatine Kinase (BB) J. Amylase K. Insulin ```

A. LDH

``` Which enzyme would you expect to see decline late in chronic pancreatitis? A. LDH B. GGT C. Creatine Kinase (MB) D. Troponin E. Creatine Kinase (MM) F. Glucagon G. Alkaline Phosphatase H. AST I. Creatine Kinase (BB) J. Amylase K. Insulin ```

J. Amylase

``` A 66-year-old man presents to his GP complaining of back and hip pain. His sister also wanted him to mention that his neighbours have complained that his radio has become increasingly loud in the last few weeks. Due to his brother presenting with tibial bowing and similar bone pain 2 years previously the GP sends him for radiological investigation. Osteolytic changes are noted and further bone scans reveal osteoporosis circumscripta in the Skull. Prostate examination and PSA testing are unremarkable. Which of the above would be most raised? A. CKBB B. CKMB C. Lactate Dehydrogenase D. Gamma Glutamyl Transpeptidase E. Alpha-amylase F. Glucose G. Placental Dehydrogenase H. Calcium I. Creatanine J. Plasma Cholinesterase K. Cardiac Troponin L. Alkaline Phosphatase M. Prostate Specific Antigen ```

L. Alkaline Phosphatase

``` A 71-year-old man presents to his GP with increasing tiredness and back pain. He also describes increasing urinary frequency, a feeling of incomplete voiding and perineal pain. On examination investigation reveals a tender lower thoracic spine and a palpable bladder. Prostatic biopsy histology reveals a Gleason score of 9. Which of the above would you also expect to be raised? A. CKBB B. CKMB C. Lactate Dehydrogenase D. Gamma Glutamyl Transpeptidase E. Alpha-amylase F. Glucose G. Placental Dehydrogenase H. Calcium I. Creatanine J. Plasma Cholinesterase K. Cardiac Troponin L. Alkaline Phosphatase M. Prostate Specific Antigen ```

M. Prostate Specific Antigen

``` A 67-year-old man, BMI 27, presents to A+E having collapsed with chest pain and nausea at his local social club dinner. Past medical history revealed he had been suffering from increasing breathlessness over the last month when walking to the post office to collect his weekly pension. Upon further questioning he admitted to the use of his wife’s ‘chest pain relief spray’ twice in the last week. Having argued with his wife before presenting to A+E and it is now 12 hours since the onset of the chest pain therefore, which of the above would aid you most in determining whether he had suffered an acute myocardial infarction? A. CKBB B. CKMB C. Lactate Dehydrogenase D. Gamma Glutamyl Transpeptidase E. Alpha-amylase F. Glucose G. Placental Dehydrogenase H. Calcium I. Creatanine J. Plasma Cholinesterase K. Cardiac Troponin L. Alkaline Phosphatase M. Prostate Specific Antigen ```

K. Cardiac Troponin

``` A semi-conscious 6-year-old-boy presents to A+E with his father, a farmer who suspects he has accidentally drunk something from one of the barns in which he was playing. Prior to his collapse the boy had been found vomiting in the yard in the time period before presentation at A+E he had become increasingly restless, irritable, nauseous, had suffered extreme diarrhoea and seemed to be dribbling saliva uncontrollably. On examination the boy was found to have bradycardia, hypotension, reduced muscle tone, constricted pupils and a decreasing respiratory rate. Which of the above is most likely to be decreased? A. CKBB B. CKMB C. Lactate Dehydrogenase D. Gamma Glutamyl Transpeptidase E. Alpha-amylase F. Glucose G. Placental Dehydrogenase H. Calcium I. Creatanine J. Plasma Cholinesterase K. Cardiac Troponin L. Alkaline Phosphatase M. Prostate Specific Antigen ```

J. Plasma Cholinesterase

``` A 44-year-old woman known to have multi-focal ER and PR negative breast cancer that is inoperable is admitted with sudden onset of nausea, vomiting, polyuria and delirium. She also has reduced muscle strength and her husband describes her marked personality change and increased thirst over the previous few days as well as increasing back and hip pain not well relieved with her oral morphine preparation. Pelvic radiology reveals Osteolytic lesions. Which of the above do you think would be raised given her presenting A. CKBB B. CKMB C. Lactate Dehydrogenase D. Gamma Glutamyl Transpeptidase E. Alpha-amylase F. Glucose G. Placental Dehydrogenase H. Calcium I. Creatanine J. Plasma Cholinesterase K. Cardiac Troponin L. Alkaline Phosphatase M. Prostate Specific Antigensymptoms? ```

H. Calcium

``` A 55 year old man presents to A & E with a crushing central chest pain which radiates down his left arm. 3 hours later his blood tests show a large increase in a cardiac enzyme. This increase is still present when he is discharged 3 days later. Which enzyme is most likely to be raised? A. AST B. Lactase Dehydrogenase C. Amylase D. Cardiac Troponin E. Bone Alkaline Phosphatase F. Creatine Kinase G. Uroporphyrinogen decarboxylase H. Alpha-1 Antitryspin I. Liver Alkaline Phosphatase J. Acid Phosphatase K. Gamma Glutanyl Transferase ```

D. Cardiac Troponin

``` A 53 year old woman presents to her GP because she has become increasingly tired recently. She also complains of itching which keeps her awake at night. On examination both scratch marks and signs of jaundice are found. Abnormalities in her blood tests include anti-mitochondrial antibodies. Which enzyme is most likely to be raised? A. AST B. Lactase Dehydrogenase C. Amylase D. Cardiac Troponin E. Bone Alkaline Phosphatase F. Creatine Kinase G. Uroporphyrinogen decarboxylase H. Alpha-1 Antitryspin I. Liver Alkaline Phosphatase J. Acid Phosphatase K. Gamma Glutanyl Transferase ```

I. Liver Alkaline Phosphatase

``` A 45 year old woman with known gallstones presents to A & E with abdominal pain which radiates to her back. The pain is relieved by sitting forward. The pain has been constant for several hours and she has also vomited twice. Which enzyme is most likely to be raised? A. AST B. Lactase Dehydrogenase C. Amylase D. Cardiac Troponin E. Bone Alkaline Phosphatase F. Creatine Kinase G. Uroporphyrinogen decarboxylase H. Alpha-1 Antitryspin I. Liver Alkaline Phosphatase J. Acid Phosphatase K. Gamma Glutanyl Transferase ```

C. Amylase

``` A 34 year old woman previously diagnosed with Hashimoto’s thyroiditis presents to her GP complaining of anorexia, amenorrhea and increasing fatigue. On examination she is found to have palmar erythema. Her blood tests show anti-smooth muscle and anti-nuclear antibodies. Which enzyme is most likely to be raised? A. AST B. Lactase Dehydrogenase C. Amylase D. Cardiac Troponin E. Bone Alkaline Phosphatase F. Creatine Kinase G. Uroporphyrinogen decarboxylase H. Alpha-1 Antitryspin I. Liver Alkaline Phosphatase J. Acid Phosphatase K. Gamma Glutanyl Transferase ```

A. AST

``` A 60 year old presents to his GP because of the onset of deafness in his right ear. He also mentions suffering from recurrent back pain. The gentleman has a bowed tibia. A. AST B. Lactase Dehydrogenase C. Amylase D. Cardiac Troponin E. Bone Alkaline Phosphatase F. Creatine Kinase G. Uroporphyrinogen decarboxylase H. Alpha-1 Antitryspin I. Liver Alkaline Phosphatase J. Acid Phosphatase K. Gamma Glutanyl Transferase ```

E. Bone Alkaline Phosphatase

``` An elderly man turns up at his GP complaining of tiredness and a troublesome back pain. His wife interrupts to say that he keeps getting up during the night to go to the toilet. On further questioning concerning his waterworks, he admits to some difficulty in passing urine and a feeling of incomplete voiding. You order some blood tests. Which enzyme is most likely to be raised? A. Lactate dehydrogenase B. Glucagon C. Mycophosphorylase D. Adenosine deaminase E. Alkaline phosphotase F. Prostate specific antigen G. Alanine aminotransferase H. Porphobilinogen deaminase I. Glucose-6-phosphate J. Galctosidase A ```

F. Prostate specific antigen

``` A 3-month-old boy was admitted to hospital with failure to thrive, and a persistent cough. On examination his height and weight were below the third centile. Subsequent immunological investigations have shown marked T- and B-cell lymphopaenia and hypogammaglobulinaemia, suggestive of severe combined immunodeficiency (SCID). This disorder is frequently caused by a deficiency in which enzyme? A. Lactate dehydrogenase B. Glucagon C. Mycophosphorylase D. Adenosine deaminase E. Alkaline phosphotase F. Prostate specific antigen G. Alanine aminotransferase H. Porphobilinogen deaminase I. Glucose-6-phosphate J. Galctosidase A ```

D. Adenosine deaminase

``` A worried mother brings her obese 12 year old son to the GP, saying that he avoids exercise and has been recently found to be skipping his PE lessons. When confronted about this, the boy claimed that ‘it hurts when he exercises’. The skeptical GP was about to say ‘no pain, no gain’, when he remembered a lecture in medical school about McArdle’s glycogen storage disease (type V), which causes stiffness following exercise. He referred the boy for a muscle biopsy, which confirmed a deficiency in an enzyme involved in glycogen metabolism. Name this enzyme. A. Lactate dehydrogenase B. Glucagon C. Mycophosphorylase D. Adenosine deaminase E. Alkaline phosphotase F. Prostate specific antigen G. Alanine aminotransferase H. Porphobilinogen deaminase I. Glucose-6-phosphate J. Galctosidase A ```

C. Mycophosphorylase

``` A 36 year old pregnant woman presents with abdominal pain in the right upper quadrant. Blood tests reveal elevation of liver enzymes, in a pattern which suggests biliary outflow obstruction. Which enzyme is likely to be the most elevated? A. Lactate dehydrogenase B. Glucagon C. Mycophosphorylase D. Adenosine deaminase E. Alkaline phosphotase F. Prostate specific antigen G. Alanine aminotransferase H. Porphobilinogen deaminase I. Glucose-6-phosphate J. Galctosidase A ```

E. Alkaline phosphotase

``` A young man presents with a history of recurrent febrile illness associated with painful parasthesiae in his hands and feet. On examination, you notice small red papules clustered in his pelvic and thigh region. Urine dipstick shows protein +++. The patient complains that no doctor has been able to find out what is wrong with him. However, having recently passed your path exam, you suspect he might have Fabry’s disease, an X-linked disorder of glycolipid metabolism due to deficiency of which of the above? A. Lactate dehydrogenase B. Glucagon C. Mycophosphorylase D. Adenosine deaminase E. Alkaline phosphotase F. Prostate specific antigen G. Alanine aminotransferase H. Porphobilinogen deaminase I. Glucose-6-phosphate J. Galctosidase A ```

J. Galctosidase A

``` A 10 year old boy is brought by his mother to your clinic. He is very thin, but has a distended abdomen. What is it that his diet does not contain to cause this? A. Caeruloplasmin B. Viatamin K C. Lipid D. Niacin E. Protein F. Thiamine G. Riboflavin H. Fluoride I. Folate J. Iodine K. Carbohydrate L. Iron M. Vitamin D ```

E. Protein

``` A 50 year old homeless man walks into A and E. He is very thin, smells of alcohol and is vomiting. On neurological examination, you note he has nystagmus and walks with a broad based gait. You give him advice on how to stop drinking, what else would you give? A. Caeruloplasmin B. Viatamin K C. Lipid D. Niacin E. Protein F. Thiamine G. Riboflavin H. Fluoride I. Folate J. Iodine K. Carbohydrate L. Iron M. Vitamin D ```

F. Thiamine

``` You see a young boy in your clinic. He complains of bone pain and he says he has felt unwell for a few weeks. On examination he is knock-kneed and walks with a waddling gait. What would you be most likely to treat him with? A. Caeruloplasmin B. Viatamin K C. Lipid D. Niacin E. Protein F. Thiamine G. Riboflavin H. Fluoride I. Folate J. Iodine K. Carbohydrate L. Iron M. Vitamin D ```

M. Vitamin D

``` A 16 year old girls presents with pain in her joints and her Mother says that she has become increasingly forgetful over recent times. Last week she put a pan of water on the stove and forgot about it until it boiled dry and melted the pan. On examination you notice Kayser-Fleischer rings in the eyes. What is this girl most likely to be deficient in? A. Caeruloplasmin B. Viatamin K C. Lipid D. Niacin E. Protein F. Thiamine G. Riboflavin H. Fluoride I. Folate J. Iodine K. Carbohydrate L. Iron M. Vitamin D ```

A. Caeruloplasmin

``` A 40 year old woman is brought in by her husband. He explains that she has started getting up during the night and going for walks and then forgetting her way home. She says she has terrible diarrhoea day and night and she wakes to go to the toilet. On examination she has a tremor and you see red scaly patches on her skin. Which vitamin is she most likely to be deficient in? A. Caeruloplasmin B. Viatamin K C. Lipid D. Niacin E. Protein F. Thiamine G. Riboflavin H. Fluoride I. Folate J. Iodine K. Carbohydrate L. Iron M. Vitamin D ```

D. Niacin

``` An 85 year old smoker lady is brought to the GP by concerned relatives. She lives alone and has become increasingly withdrawn. On close questioning it appears that over the past few months she has been smoking more heavily and surviving on little more than tea and toast. A. Vitamin K deficiency B. Vitamin E deficiency C. Vitamin A deficiency D. Magnesium deficiency E. Iron deficiency F. Copper deficiency G. Vitamin B6 deficiency H. Vitamin B1 deficiency I. Sodium deficiency J. Vitamin B12 deficiency K. Folic Acid deficiency L. Vitamin D deficiency M. Vitamin C deficiency N. Vitamin C excess ```

M. Vitamin C deficiency

``` A 39 year old house wife is referred to clinic with a 6 month history of fatigue and depression, as well as "burning feet". She also gives a one month history of tingling in her fingers and toes at night A. Vitamin K deficiency B. Vitamin E deficiency C. Vitamin A deficiency D. Magnesium deficiency E. Iron deficiency F. Copper deficiency G. Vitamin B6 deficiency H. Vitamin B1 deficiency I. Sodium deficiency J. Vitamin B12 deficiency K. Folic Acid deficiency L. Vitamin D deficiency M. Vitamin C deficiency N. Vitamin C excess ```

J. Vitamin B12 deficiency

``` An 18 year old cystic fibrosis sufferer presents to A&E, with a long history of severe steatorrhoea. Recently he has started to bruise easily and experience severe protracted nose bleeds. The patient is now distraught after the onset both melena and haematuria today. A. Vitamin K deficiency B. Vitamin E deficiency C. Vitamin A deficiency D. Magnesium deficiency E. Iron deficiency F. Copper deficiency G. Vitamin B6 deficiency H. Vitamin B1 deficiency I. Sodium deficiency J. Vitamin B12 deficiency K. Folic Acid deficiency L. Vitamin D deficiency M. Vitamin C deficiency N. Vitamin C excess ```

A. Vitamin K deficiency

``` A young Muslim woman presents to her GP complaining of generalised pain in her muscles which “hurts her down to her bones” and tiredness as even getting up from a chair is difficult. A. Vitamin K deficiency B. Vitamin E deficiency C. Vitamin A deficiency D. Magnesium deficiency E. Iron deficiency F. Copper deficiency G. Vitamin B6 deficiency H. Vitamin B1 deficiency I. Sodium deficiency J. Vitamin B12 deficiency K. Folic Acid deficiency L. Vitamin D deficiency M. Vitamin C deficiency N. Vitamin C excess ```

L. Vitamin D deficiency

``` A 56 year old is man found unconscious on the street and is admitted to A&E. On regaining consciousness he is found to be long standing alcoholic. A. Vitamin K deficiency B. Vitamin E deficiency C. Vitamin A deficiency D. Magnesium deficiency E. Iron deficiency F. Copper deficiency G. Vitamin B6 deficiency H. Vitamin B1 deficiency I. Sodium deficiency J. Vitamin B12 deficiency K. Folic Acid deficiency L. Vitamin D deficiency M. Vitamin C deficiency N. Vitamin C excess ```

H. Vitamin B1 deficiency

``` A woman planning to get pregnant with a history of previous pregnancies complicated by spina bifida comes to see you A. Folic acid B. Copper C. Vitamin A D. Vitamin E E. Iron F. Increase complex carbohydrates G. Vitamin C H. Increase protein I. Reduce protein J. Vitamin D K. Reduce unsaturated fats L. Reduce saturated fats ```

A. Folic acid

``` An elderly lady from a residential home presents with widespread bone pain and a history of fractures. A. Folic acid B. Copper C. Vitamin A D. Vitamin E E. Iron F. Increase complex carbohydrates G. Vitamin C H. Increase protein I. Reduce protein J. Vitamin D K. Reduce unsaturated fats L. Reduce saturated fats ```

J. Vitamin D

``` A 45 year lorry driver with a BMI of 35 comes to see you complaining of chest pains when he exerts himself. A. Folic acid B. Copper C. Vitamin A D. Vitamin E E. Iron F. Increase complex carbohydrates G. Vitamin C H. Increase protein I. Reduce protein J. Vitamin D K. Reduce unsaturated fats L. Reduce saturated fats ```

L. Reduce saturated fats

``` A 30 year old woman presents with heavy periods, you notice on examination she has brittle hair and her nails are spoon shaped A. Folic acid B. Copper C. Vitamin A D. Vitamin E E. Iron F. Increase complex carbohydrates G. Vitamin C H. Increase protein I. Reduce protein J. Vitamin D K. Reduce unsaturated fats L. Reduce saturated fats ```

E. Iron

``` A routine exam of an overweight 50 year old Asian lady reveals a plasma glucose level of 12mmol/l. A. Folic acid B. Copper C. Vitamin A D. Vitamin E E. Iron F. Increase complex carbohydrates G. Vitamin C H. Increase protein I. Reduce protein J. Vitamin D K. Reduce unsaturated fats L. Reduce saturated fats ```

F. Increase complex carbohydrates

``` A 50-year-old unemployed actor who is an alcoholic, presents to hospital with peripheral neuropathy and worsening loss of memory. On examination, he also has ataxia, nystagmus and mild pedal oedema. He is admitted for investigation where the nurses notice he is confabulating. A. Vitamin K B. Vitamin D C. Vitamin B12 (cobalamin) D. Vitamin E E. Vitamin B6 (pyridoxine) F. Nicotinic Acid (niacin) G. Vitamin A H. Vitamin C I. Folate J. Vitamin B1 (thiamin) ```

J. Vitamin B1 (thiamin)

``` A 38-year-old women presents with dyspepsia and shortness of breath on exercise. Blood tests show a severe anaemia, which on investigation is found to be megaloblastic. Gastric biopsies taken at endoscopy show severe atrophic gastritis, predominantly in the corpus. Anti-parietal cell antibodies are detected in the serum A. Vitamin K B. Vitamin D C. Vitamin B12 (cobalamin) D. Vitamin E E. Vitamin B6 (pyridoxine) F. Nicotinic Acid (niacin) G. Vitamin A H. Vitamin C I. Folate J. Vitamin B1 (thiamin) ```

C. Vitamin B12 (cobalamin)

``` A 52-year-old man suffers from longstanding chronic pancreatitis. This has lead to steatorrhoea. He presents with recurrent epistaxis, malaena and haematuria. On examination he also has numerous bruises on his arms and shins. A. Vitamin K B. Vitamin D C. Vitamin B12 (cobalamin) D. Vitamin E E. Vitamin B6 (pyridoxine) F. Nicotinic Acid (niacin) G. Vitamin A H. Vitamin C I. Folate J. Vitamin B1 (thiamin) ```

A. Vitamin K

``` An eighty-year-old woman who lives alone is visited by social services after a worried neighbour says she has not seen her for a few months. On questioning she admits that she has hardly left her flat for four months as she has become increasingly agoraphobic. She has been surviving on tinned soup and crackers. Her GP finds she has swollen, bleeding gums, and bruises over her shins. Her skin shows a hyperkeratotic popular rash and petechial haemorrhages. A. Vitamin K B. Vitamin D C. Vitamin B12 (cobalamin) D. Vitamin E E. Vitamin B6 (pyridoxine) F. Nicotinic Acid (niacin) G. Vitamin A H. Vitamin C I. Folate J. Vitamin B1 (thiamin) ```

H. Vitamin C

``` A 3-year-old Indian boy whose parents are strict vegans is taken to his GP with a cough. On examination of his chest, he is found to have anterior protusion of the sternum. The GP also notices that he has lumbar lordosis and bowing of the legs. A. Vitamin K B. Vitamin D C. Vitamin B12 (cobalamin) D. Vitamin E E. Vitamin B6 (pyridoxine) F. Nicotinic Acid (niacin) G. Vitamin A H. Vitamin C I. Folate J. Vitamin B1 (thiamin) ```

B. Vitamin D

A 35yr old female vegan presents to her GP with a history of tiredness and fatigue. On investigation her blood test shows an MCV of 125fl and a Hb of 9.4 g/dL.Serum folate is normal. When looking under the microscope abnormally large reticulocytes (megaloblasts) were noted. A. Anaemia of chronic disease B. Vitamin B12 deficiency due to lack of intrinsic factor post-gastrectomy C. Vitamin B12 deficiency due to lack of dietary intake D. Vitamin A deficiency E. Chronic renal failure F. Liver disease G. Thalassaemia H. Vitamin B12 deficiency due to malabsorption because of surgical removal of the ileum I. Vitamin B12 deficiency due to lack of intrinsic factor because of pernicious anaemia J. Folate deficiency due to lack of dietary intake K. Iron deficiency anaemia L. Sideroblastic anaemia M. Ulcerative colitis

C. Vitamin B12 deficiency due to lack of dietary intake

A 65yr old female with blonde hair and blue eyes with a long history of rheumatoid arthritis and Hashimoto’s thyroiditis presents to her GP with tiredness and fatigue. On investigation her blood test shows an MCV of 125fl and a Hb of 9.4 g/dL. When looking under the microscope abnormally large reticulocytes (megaloblasts) were noted. A. Anaemia of chronic disease B. Vitamin B12 deficiency due to lack of intrinsic factor post-gastrectomy C. Vitamin B12 deficiency due to lack of dietary intake D. Vitamin A deficiency E. Chronic renal failure F. Liver disease G. Thalassaemia H. Vitamin B12 deficiency due to malabsorption because of surgical removal of the ileum I. Vitamin B12 deficiency due to lack of intrinsic factor because of pernicious anaemia J. Folate deficiency due to lack of dietary intake K. Iron deficiency anaemia L. Sideroblastic anaemia M. Ulcerative colitis

I. Vitamin B12 deficiency due to lack of intrinsic factor because of pernicious anaemia

A 55yr old female with a history of small bowel resection due to chronic inflammatory bowel disease presents to her GP with tiredness and fatigue. On investigation her blood test shows an MCV of 125fl and a Hb of 9.4 g/dL. When looking under the microscope abnormally large reticulocytes (megaloblasts) were noted. A. Anaemia of chronic disease B. Vitamin B12 deficiency due to lack of intrinsic factor post-gastrectomy C. Vitamin B12 deficiency due to lack of dietary intake D. Vitamin A deficiency E. Chronic renal failure F. Liver disease G. Thalassaemia H. Vitamin B12 deficiency due to malabsorption because of surgical removal of the ileum I. Vitamin B12 deficiency due to lack of intrinsic factor because of pernicious anaemia J. Folate deficiency due to lack of dietary intake K. Iron deficiency anaemia L. Sideroblastic anaemia M. Ulcerative colitis

H. Vitamin B12 deficiency due to malabsorption because of surgical removal of the ileum

A 25yr old Asian female who is a vegetarian presents to her GP with tiredness and fatigue. On questioning her periods were noted to be particularly heavy. On investigation her blood test shows an MCV of 80fl, Hb 9.4 g/dL and MCH 22pg. A. Anaemia of chronic disease B. Vitamin B12 deficiency due to lack of intrinsic factor post-gastrectomy C. Vitamin B12 deficiency due to lack of dietary intake D. Vitamin A deficiency E. Chronic renal failure F. Liver disease G. Thalassaemia H. Vitamin B12 deficiency due to malabsorption because of surgical removal of the ileum I. Vitamin B12 deficiency due to lack of intrinsic factor because of pernicious anaemia J. Folate deficiency due to lack of dietary intake K. Iron deficiency anaemia L. Sideroblastic anaemia M. Ulcerative colitis

K. Iron deficiency anaemia

A 10yr old female who recently emigrated from south East Asia presents to A&E with kidney stones. While talking to the parents it is noted that she has particular problems seeing in dim light. A. Anaemia of chronic disease B. Vitamin B12 deficiency due to lack of intrinsic factor post-gastrectomy C. Vitamin B12 deficiency due to lack of dietary intake D. Vitamin A deficiency E. Chronic renal failure F. Liver disease G. Thalassaemia H. Vitamin B12 deficiency due to malabsorption because of surgical removal of the ileum I. Vitamin B12 deficiency due to lack of intrinsic factor because of pernicious anaemia J. Folate deficiency due to lack of dietary intake K. Iron deficiency anaemia L. Sideroblastic anaemia M. Ulcerative colitis

D. Vitamin A deficiency

``` A 65 yr old woman presents with a four week Hx of weight gain, tiredness, constipation and a puffy face. On Ix she is found to have a TSH level of 20mU/l and a free T4 level of 7pmol/l A. Toxic multinodular goitre B. Single toxic adenoma C. Papillary thyroid cancer D. Sick euthyroid E. Post Grave’s disease F. Follicular thyroid cancer G. Primary hypothyroidism H. Medullary thyroid cancer I. Post partum thyroiditis J. Grave’s Disease K. Subacute granulomatous thryroiditis ```

G. Primary hypothyroidism

``` A 35 yr old woman presents with pain in her neck which radiates to her upper neck, jaw and throat. The pain is worse on swallowing. She has a Hx of an upper respiratory tract infection two weeks ago. On Ix she has a free T4 of 30pmol/l, free T3 of 11pmol/l and a TSH level of 0.1mU/l. On technetium scanning of the thyroid there is low iodine uptake. A. Toxic multinodular goitre B. Single toxic adenoma C. Papillary thyroid cancer D. Sick euthyroid E. Post Grave’s disease F. Follicular thyroid cancer G. Primary hypothyroidism H. Medullary thyroid cancer I. Post partum thyroiditis J. Grave’s Disease K. Subacute granulomatous thryroiditis ```

K. Subacute granulomatous thryroiditis

``` A 30 yr old woman presents with a Hx of weight loss, diarrhoea, tremor and a marked swelling at the front of her neck. On Ix she is found to have a TSH level of 0.05mU/l a free T4 level of 30pmol/l and a free T3 of 12pmol/l. On technetium scanning the thyroid shows increased iodine uptake. A. Toxic multinodular goitre B. Single toxic adenoma C. Papillary thyroid cancer D. Sick euthyroid E. Post Grave’s disease F. Follicular thyroid cancer G. Primary hypothyroidism H. Medullary thyroid cancer I. Post partum thyroiditis J. Grave’s Disease K. Subacute granulomatous thryroiditis ```

J. Grave’s Disease

``` A 25 year old male patient, in hospital with viral meningitis is found to have a slightly raised TSH and slightly low free T4. A. Toxic multinodular goitre B. Single toxic adenoma C. Papillary thyroid cancer D. Sick euthyroid E. Post Grave’s disease F. Follicular thyroid cancer G. Primary hypothyroidism H. Medullary thyroid cancer I. Post partum thyroiditis J. Grave’s Disease K. Subacute granulomatous thryroiditis ```

D. Sick euthyroid

``` A 70 yr old lady is found to have a tumour of the thyroid gland. She is also found to have high levels of circulating calcitonin A. Toxic multinodular goitre B. Single toxic adenoma C. Papillary thyroid cancer D. Sick euthyroid E. Post Grave’s disease F. Follicular thyroid cancer G. Primary hypothyroidism H. Medullary thyroid cancer I. Post partum thyroiditis J. Grave’s Disease K. Subacute granulomatous thryroiditis ```

H. Medullary thyroid cancer

``` 25 Year old female presents with recent weight loss despite increased appetite and irritability. On examination, she was noted to have a tremor, exophthalmos and was tachycardic, a pretibial myxoedema and a beefy red tongue were noted. A firm, moderately enlarged goitre was palpated. Histologically, the gland showed hyperplasia of the acinar epithelium and infiltrated lymphocytes A. Follicular adenoma B. Riedel's thyroiditis C. Simple parenchymal goitre D. Graves' disease E. Hashimoto's thyroiditis F. Iatrogenic hypothyroidism G. Toxic nodular goitre H. Giant cell thyroiditis I. Simple colloid goitre J. Functioning adenoma ```

D. Graves' disease

``` 32 year old female presented with weight loss and anxiety. The thyroid gland was enlarged, firm, fleshy and pale, infiltrated by lymphocytes. Askanazy cells were noted. A. Follicular adenoma B. Riedel's thyroiditis C. Simple parenchymal goitre D. Graves' disease E. Hashimoto's thyroiditis F. Iatrogenic hypothyroidism G. Toxic nodular goitre H. Giant cell thyroiditis I. Simple colloid goitre J. Functioning adenoma ```

E. Hashimoto's thyroiditis

``` 48 year old diabetic female on metformin (sulphonylurea) presented with increased weight gain and dry skin A. Follicular adenoma B. Riedel's thyroiditis C. Simple parenchymal goitre D. Graves' disease E. Hashimoto's thyroiditis F. Iatrogenic hypothyroidism G. Toxic nodular goitre H. Giant cell thyroiditis I. Simple colloid goitre J. Functioning adenoma ```

F. Iatrogenic hypothyroidism

``` 22 yr old male presents with stridor. On examination, a multi-nodular thyroid is noted. A. Follicular adenoma B. Riedel's thyroiditis C. Simple parenchymal goitre D. Graves' disease E. Hashimoto's thyroiditis F. Iatrogenic hypothyroidism G. Toxic nodular goitre H. Giant cell thyroiditis I. Simple colloid goitre J. Functioning adenoma ```

I. Simple colloid goitre

``` A 12 yr old male presents with 1/7 of fever. Thyroid swelling and tenderness on palpation was noted. Histologically, the gland was infiltrated by neutrophils and lymphocytes. This child had not been vaccinated against the MMR A. Follicular adenoma B. Riedel's thyroiditis C. Simple parenchymal goitre D. Graves' disease E. Hashimoto's thyroiditis F. Iatrogenic hypothyroidism G. Toxic nodular goitre H. Giant cell thyroiditis I. Simple colloid goitre J. Functioning adenoma ```

H. Giant cell thyroiditis

``` Recommended therapy used in an attack of acute intermittent porphyria, A. Chlorpromazine B. Diclofenac C. Nystatin D. Propanolol E. Co-trimoxazole F. Alcohol G. Diazepam H. Haem arginate ```

H. Haem arginate

``` Anti-inflammatory drug that is contraindicated in patients with porphyria A. Chlorpromazine B. Diclofenac C. Nystatin D. Propanolol E. Co-trimoxazole F. Alcohol G. Diazepam H. Haem arginate ```

B. Diclofenac

``` Drug that can result in chronic porphyria A. Chlorpromazine B. Diclofenac C. Nystatin D. Propanolol E. Co-trimoxazole F. Alcohol G. Diazepam H. Haem arginate ```

F. Alcohol

``` Drug recommended for management in acute attacks of anxiety. A. Chlorpromazine B. Diclofenac C. Nystatin D. Propanolol E. Co-trimoxazole F. Alcohol G. Diazepam H. Haem arginate ```

G. Diazepam

``` A second drug that is contraindicated in patients with porphyria that is not an NSAID A. Chlorpromazine B. Diclofenac C. Nystatin D. Propanolol E. Co-trimoxazole F. Alcohol G. Diazepam H. Haem arginate ```

E. Co-trimoxazole

``` Autosomal dominantly inherited porphyria with neurovisceral manifestations only, resulting from porphobilinogen deaminase deficiency. A. ALA dehydratase deficiency B. Activated porphyrins and oxygen free radicals C. Uroporphyrinogen III D. Acute intermittent porphyria E. Porphyria cutanea tarda F. 5-aminolevulinic acid G. Toxic porphyria H. ALA synthase ```

D. Acute intermittent porphyria

``` Neurotoxic product(s) of heme breakdown producing neurovisceral damage in certain porphyrias A. ALA dehydratase deficiency B. Activated porphyrins and oxygen free radicals C. Uroporphyrinogen III D. Acute intermittent porphyria E. Porphyria cutanea tarda F. 5-aminolevulinic acid G. Toxic porphyria H. ALA synthase ```

F. 5-aminolevulinic acid

``` Autosomal dominantly inherited (or spontaneous mutation) porphyria with cutaneous manifestations only, resulting from uroporphyrinogen decarboxylase deficiency A. ALA dehydratase deficiency B. Activated porphyrins and oxygen free radicals C. Uroporphyrinogen III D. Acute intermittent porphyria E. Porphyria cutanea tarda F. 5-aminolevulinic acid G. Toxic porphyria H. ALA synthase ```

E. Porphyria cutanea tarda

``` Enzyme that catalyses the rate-limiting step of heme breakdown A. ALA dehydratase deficiency B. Activated porphyrins and oxygen free radicals C. Uroporphyrinogen III D. Acute intermittent porphyria E. Porphyria cutanea tarda F. 5-aminolevulinic acid G. Toxic porphyria H. ALA synthase ```

H. ALA synthase

``` Product(s) of heme breakdown resulting in photosensitivity (i.e. cutaneous) damage in certain porphyrias A. ALA dehydratase deficiency B. Activated porphyrins and oxygen free radicals C. Uroporphyrinogen III D. Acute intermittent porphyria E. Porphyria cutanea tarda F. 5-aminolevulinic acid G. Toxic porphyria H. ALA synthase ```

B. Activated porphyrins and oxygen free radicals

What is the main enzyme involved in the salvage pathway in purine metabolism?

HPRT = hyperxanthine guanine phsophoribosyl transferase.

``` When treating chronic gout, which drug cannot be taken with allopurinol? A. Methotrexate B. Azathioprine C. NSAIDs D. ACEi ```

B. Azathioprine Azathioprine is metabolised to mercaptopurine and then to thioninosinate which interferes with purine metabolism. Allopurinal makes mercaptopurine last longer making it more toxic to the BM.

In lipid metabolism, what does the gene PCSK9 code for?

Proprotein coverts subtilising/kexin type 9 | -Its function is to bind to LDL receptors and promote their degradation

Name a cause of secondary hyperlipidaemia?

Pregnancy, hypothyroidism, diabetes, gout, obesity

``` A 65-year-old chronic alcoholic presents to the A&E Department with a minor head injury. On examination he is found to be pale. Blood tests show a high MCV. What is the likeliest result of MCV (fl) in a normal person? A. 2.2 B. 15 C. 290 D. 90 E. 30 F. 130 G. 4 ```

D. 90

``` A 40-year-old woman presents with a two month history of tiredness, intermittent pyrexia and abdominal pain. On examination she has an enlarged palpable spleen. Blood tests show anaemia with a raised white cell count. What is the likeliest result of a white cell count (x 109 per l) in a normal person? A. 2.2 B. 15 C. 290 D. 90 E. 30 F. 130 G. 4 ```

G. 4

``` A 5-year-old boy presents with a purpuric rash and petechiae following a recent viral infection. Blood tests showed thrombocytopenia. What is the likeliest result of a platelet count (x109/l) in a normal adult? A. 2.2 B. 15 C. 290 D. 90 E. 30 F. 130 G. 4 ```

C. 290

``` A 35-year-old man presents with hypertension. Blood tests show normal sodium, urea and glucose and a raised potassium. What is the likeliest result of potassium (mmol/l) in a normal person? A. 2.2 B. 15 C. 290 D. 90 E. 30 F. 130 G. 4 ```

G. 4

``` A 70-year-old woman presents in a coma with a long history of polyuria and polydipsia. Investigations show that her plasma osmolarity is raised. What is the likeliest result of plasma osmolarity (mmol/l) in a normal person? A. 2.2 B. 15 C. 290 D. 90 E. 30 F. 130 G. 4 ```

C. 290

``` A 14-year-old boy presents with symptoms of chronic liver failure. LFTs display abnormally high levels of transaminases with normal alk phos & bilirubin levels. There’s marked accumulation of copper-associated protein in hepatocytes obtained from a biopsy. His serum copper levels and caeruloplasmin are abnormally low. A. Chronic hepatitis C B. Primary biliary cirrhosis C. Crigler Najjar syndrome D. Primary hepatocellular carcinoma E. Wilson's disease F. Budd-Chiari syndrome G. Hepatitis A H. Chronic hepatitis B ```

E. Wilson's disease

``` A 30-year-old Thai male presents to a day surgery unit for a cholecystectomy. His LFTs reveal very elevated transaminases with normal bilirubin & alk phos levels. Microscopy of a liver biopsy identifies antigens from a dsDNA virus in the cytosol of hepatocytes. A. Chronic hepatitis C B. Primary biliary cirrhosis C. Crigler Najjar syndrome D. Primary hepatocellular carcinoma E. Wilson's disease F. Budd-Chiari syndrome G. Hepatitis A H. Chronic hepatitis B ```

H. Chronic hepatitis B

``` A 58-year-old woman presents with recent onset of Jaundice. LFTs reveal increased bilirubin & markedly elevated alk phos & normal transaminases. Further investigations uncovered raised IgM and serum cholesterol. Anti mitochondrial antibodies are also detected. A liver biopsy shows enlargement of the portal tracts by white blood cells and granulomas. Bile ducts are also less than normal. A.. Chronic hepatitis C B. Primary biliary cirrhosis C. Crigler Najjar syndrome D. Primary hepatocellular carcinoma E. Wilson's disease F. Budd-Chiari syndrome G. Hepatitis A H. Chronic hepatitis B ```

B. Primary biliary cirrhosis

``` A 48-year-old male returning from a 6mths round the world trip presents with a recent Hx of nausea, anorexia & distaste for cigarettes. He developed jaundice; his urine became dark and his stools pale. His spleen was palpable. Investigations showed bilirubinuria, increased urinary urobilinogen & a raised serum AST & ALT. Within 4 weeks his symptoms had completely subsided A.. Chronic hepatitis C B. Primary biliary cirrhosis C. Crigler Najjar syndrome D. Primary hepatocellular carcinoma E. Wilson's disease F. Budd-Chiari syndrome G. Hepatitis A H. Chronic hepatitis B ```

G. Hepatitis A

``` A 55-year-old woman presents with a short Hx of nausea and abdominal pain; tender hepatomegaly and ascities. LFTs show mildly raised transaminases, bilirubin and normal alk phos. The woman also had polycythaemia rubra vera. Liver biopsy suggests venous outflow obstruction. A.. Chronic hepatitis C B. Primary biliary cirrhosis C. Crigler Najjar syndrome D. Primary hepatocellular carcinoma E. Wilson's disease F. Budd-Chiari syndrome G. Hepatitis A H. Chronic hepatitis B ```

F. Budd-Chiari syndrome Triad: abdo pain, ascites, hepatomegaly It is caused by occlusion of the hepatic veins

``` A liver enzyme raised after a myocardial infarction A. Alanine transaminase B. Total bilirubin C. Albumin D. Gamma globulin E. Gamma glutamyl transpeptidase F. Direct bilirubin G. Alkaline phosphatase H. Activated partial thromboplastin time I. Prothrombin time J. Aspartate transaminase ```

J. Aspartate transaminase

``` A test of the integrity of the extrinsic pathway A. Alanine transaminase B. Total bilirubin C. Albumin D. Gamma globulin E. Gamma glutamyl transpeptidase F. Direct bilirubin G. Alkaline phosphatase H. Activated partial thromboplastin time I. Prothrombin time J. Aspartate transaminase ```

I. Prothrombin time

``` An enzyme markedly raised in obstructive jaundice along with direct bilirubin A. Alanine transaminase B. Total bilirubin C. Albumin D. Gamma globulin E. Gamma glutamyl transpeptidase F. Direct bilirubin G. Alkaline phosphatase H. Activated partial thromboplastin time I. Prothrombin time J. Aspartate transaminase ```

G. Alkaline phosphatase

``` Raised in alcohol abuse A. Alanine transaminase B. Total bilirubin C. Albumin D. Gamma globulin E. Gamma glutamyl transpeptidase F. Direct bilirubin G. Alkaline phosphatase H. Activated partial thromboplastin time I. Prothrombin time J. Aspartate transaminase ```

E. Gamma glutamyl transpeptidase

``` Levels can be affected by diet A. Alanine transaminase B. Total bilirubin C. Albumin D. Gamma globulin E. Gamma glutamyl transpeptidase F. Direct bilirubin G. Alkaline phosphatase H. Activated partial thromboplastin time I. Prothrombin time J. Aspartate transaminase ```

C. Albumin

``` A 26-year-old receptionist presents to her GP with a history steatorrhoea, abdominal pain and weight loss, as well as feeling tired all the time. Initial blood tests reveal a microcytic anaemia. A. Osmotic fragility test B. Anti-endomysial antibodies C. Ham's test D. c-ANCA E. Anti-gastric parietal cell antibodies F. Anti-acetylcholine receptor antibody G. Anti-smooth muscle antibody H. p-ANCA I. Anti-DsDNA J. ANA K. Anti-scl70 L. Anti-GAD M. Anti-mitochondrial antibody ```

B. Anti-endomysial antibodies

``` A 60-year-old woman with hypothyroidism presents with progressive dyspnoea and tiredness. FBC reveals macrocytic anaemia. A. Osmotic fragility test B. Anti-endomysial antibodies C. Ham's test D. c-ANCA E. Anti-gastric parietal cell antibodies F. Anti-acetylcholine receptor antibody G. Anti-smooth muscle antibody H. p-ANCA I. Anti-DsDNA J. ANA K. Anti-scl70 L. Anti-GAD M. Anti-mitochondrial antibody ```

E. Anti-gastric parietal cell antibodies

``` A 40-year-old plumber presents to his GP with a history of wheezing and lethargy, along with recurrent nose bleeds. On examination he has crackles in his upper left lung field. Urine dipstick is positive for blood and protein. A. Osmotic fragility test B. Anti-endomysial antibodies C. Ham's test D. c-ANCA E. Anti-gastric parietal cell antibodies F. Anti-acetylcholine receptor antibody G. Anti-smooth muscle antibody H. p-ANCA I. Anti-DsDNA J. ANA K. Anti-scl70 L. Anti-GAD M. Anti-mitochondrial antibody ```

D. c-ANCA

``` A 30-year-old market trader presents with tiredness and jaundice, and further history reveals he suffered from a chest infection one week previously. On examination mild splenomegaly is noted, and blood tests show reticulocytosis, hyperbilirubinaemia, and spherocytosis. A. Osmotic fragility test B. Anti-endomysial antibodies C. Ham's test D. c-ANCA E. Anti-gastric parietal cell antibodies F. Anti-acetylcholine receptor antibody G. Anti-smooth muscle antibody H. p-ANCA I. Anti-DsDNA J. ANA K. Anti-scl70 L. Anti-GAD M. Anti-mitochondrial antibody ```

A. Osmotic fragility test

``` An 80-year-old retired clerk presents with a 2-month history of skin itching and lethargy. Examination is normal. LFTs are: bilirubin 6umol/l (reference range 0-17umol/l); ALT 24U/l (reference range 0-31U/l); Alk Phos 500U/l (reference range 30-130U/l). A. Osmotic fragility test B. Anti-endomysial antibodies C. Ham's test D. c-ANCA E. Anti-gastric parietal cell antibodies F. Anti-acetylcholine receptor antibody G. Anti-smooth muscle antibody H. p-ANCA I. Anti-DsDNA J. ANA K. Anti-scl70 L. Anti-GAD M. Anti-mitochondrial antibody ```

M. Anti-mitochondrial antibody

``` A 10-year-old girl presents with weight loss, polyuria, tachypnoea, vomiting. Looks very dehydrated. Beta hydroxybutyrate is raised in the blood. A. Osmotic fragility test B. Anti-endomysial antibodies C. Ham's test D. c-ANCA E. Anti-gastric parietal cell antibodies F. Anti-acetylcholine receptor antibody G. Anti-smooth muscle antibody H. p-ANCA I. Anti-DsDNA J. ANA K. Anti-scl70 L. Anti-GAD M. Anti-mitochondrial antibody ```

L. Anti-GAD

``` A 55-year-old woman is warned of future risk of AML given her recent diagnosis of PNH following a spontaneous cerebral venous sinus thrombosis. A. Osmotic fragility test B. Anti-endomysial antibodies C. Ham's test D. c-ANCA E. Anti-gastric parietal cell antibodies F. Anti-acetylcholine receptor antibody G. Anti-smooth muscle antibody H. p-ANCA I. Anti-DsDNA J. ANA K. Anti-scl70 L. Anti-GAD M. Anti-mitochondrial antibody ```

C. Ham's test

``` A 40-year-old woman presents with polyuria and polydipsia. She has a fasting glucose 5.1mmol/L and an oral glucose tolerance test value of 5.0mmol/L. She has a corrected calcium of 2.80mmol/L and a PTH of 7.2pmol/L. A. Impaired fasting glucose B. Crohn’s disease C. Tuberculosis D. Diabetes mellitus type 2 E. Gestational diabetes F. Sarcoidosis G. Vitamin D deficiency H. Lung cancer I. Primary hyperparathyroidism J. Diabetes mellitus type 1 K. Impaired glucose tolerance L. Psychogenic polydipsia M. Hypocalcaemia N. Secondary hyperthyroidism O. Malignancy ```

I. Primary hyperparathyroidism

``` A 35-year-old Afro-Caribbean woman presents with polyuria and polydipsia. She also complains of a dry cough. She has a fasting glucose of 5.8mmol/L and an oral glucose tolerance test value of 6.5mmol/L. She has a corrected calcium of 2.7mmol/L and a PTH of <0.1pmol/L. A. Impaired fasting glucose B. Crohn’s disease C. Tuberculosis D. Diabetes mellitus type 2 E. Gestational diabetes F. Sarcoidosis G. Vitamin D deficiency H. Lung cancer I. Primary hyperparathyroidism J. Diabetes mellitus type 1 K. Impaired glucose tolerance L. Psychogenic polydipsia M. Hypocalcaemia N. Secondary hyperthyroidism O. Malignancy ```

F. Sarcoidosis

``` A 15-year-old girl presents with weight loss, polyuria and polydipsia. Over the last few months she reports feeling increasingly tired and complains of perianal itching. On examination you notice a small perianal abscess. Her fasting glucose is 22.3mmol/L. His corrected calcium is 2.5mmol/L and his PTH is 7.0pmol/L. A. Impaired fasting glucose B. Crohn’s disease C. Tuberculosis D. Diabetes mellitus type 2 E. Gestational diabetes F. Sarcoidosis G. Vitamin D deficiency H. Lung cancer I. Primary hyperparathyroidism J. Diabetes mellitus type 1 K. Impaired glucose tolerance L. Psychogenic polydipsia M. Hypocalcaemia N. Secondary hyperthyroidism O. Malignancy ```

J. Diabetes mellitus type 1

``` A 56-year-old obese woman presents with polyuria and polydipsia. She complains of tiredness and depression. Her fasting glucose is 4.9mmol/L and her OGTT is 4.5mmol/L. She has a corrected calcium of 2.4mmol/L and a PTH of 7.1mmol/L. A. Impaired fasting glucose B. Crohn’s disease C. Tuberculosis D. Diabetes mellitus type 2 E. Gestational diabetes F. Sarcoidosis G. Vitamin D deficiency H. Lung cancer I. Primary hyperparathyroidism J. Diabetes mellitus type 1 K. Impaired glucose tolerance L. Psychogenic polydipsia M. Hypocalcaemia N. Secondary hyperthyroidism O. Malignancy ```

L. Psychogenic polydipsia

``` A 58-year-old Afro-Caribbean gentleman presents with polyuria, polydipsia and weight loss. He has an oral glucose tolerance test of 10.1mmol/L. His corrected calcium is 2.5mmol/L and his PTH is 7.0pmol/L. A. Impaired fasting glucose B. Crohn’s disease C. Tuberculosis D. Diabetes mellitus type 2 E. Gestational diabetes F. Sarcoidosis G. Vitamin D deficiency H. Lung cancer I. Primary hyperparathyroidism J. Diabetes mellitus type 1 K. Impaired glucose tolerance L. Psychogenic polydipsia M. Hypocalcaemia N. Secondary hyperthyroidism O. Malignancy ```

K. Impaired glucose tolerance

``` Varies with posture when sample is taken A. ALT B. Cortisol C. Creatinine Kinase D. Potassium E. ALP F. Albumin G. Urea H. Triglycerides I. Glucose ```

F. Albumin

``` Varies with exercise A. ALT B. Cortisol C. Creatinine Kinase D. Potassium E. ALP F. Albumin G. Urea H. Triglycerides I. Glucose ```

C. Creatinine Kinase

``` Increases during pregnancy A. ALT B. Cortisol C. Creatinine Kinase D. Potassium E. ALP F. Albumin G. Urea H. Triglycerides I. Glucose ```

E. ALP

``` Varies with race A. ALT B. Cortisol C. Creatinine Kinase D. Potassium E. ALP F. Albumin G. Urea H. Triglycerides I. Glucose ```

C. Creatinine Kinase

``` Most likely to vary with time of sampling A. ALT B. Cortisol C. Creatinine Kinase D. Potassium E. ALP F. Albumin G. Urea H. Triglycerides I. Glucose ```

B. Cortisol

``` A 19-year-old woman admitted to hospital with acute asthma suffered a cardiac arrest after treatment. She was already taking several medications for her respiratory condition. What drug excess is likely to have caused this problem? A. Digoxin B. Kidneys C. Conjugation by sulphate/gluconaride D. GI system E. Lungs F. High therapeutic index G. Liver H. Rosiglitazone I. Poor compliance J. Gentamicin K. Oxidation by cytochrome P450 L. Warfarin M. Theophylline N. Low therapeutic index ```

M. Theophylline

``` Failure to respond to drug therapy is commonly caused by what? A. Digoxin B. Kidneys C. Conjugation by sulphate/gluconaride D. GI system E. Lungs F. High therapeutic index G. Liver H. Rosiglitazone I. Poor compliance J. Gentamicin K. Oxidation by cytochrome P450 L. Warfarin M. Theophylline N. Low therapeutic index ```

I. Poor compliance

``` Lipid soluble drugs require metabolism by the liver in two phases. What is Phase I? A. Digoxin B. Kidneys C. Conjugation by sulphate/gluconaride D. GI system E. Lungs F. High therapeutic index G. Liver H. Rosiglitazone I. Poor compliance J. Gentamicin K. Oxidation by cytochrome P450 L. Warfarin M. Theophylline N. Low therapeutic index ```

K. Oxidation by cytochrome P450

``` Drugs are mainly excreted by which organ? A. Digoxin B. Kidneys C. Conjugation by sulphate/gluconaride D. GI system E. Lungs F. High therapeutic index G. Liver H. Rosiglitazone I. Poor compliance J. Gentamicin K. Oxidation by cytochrome P450 L. Warfarin M. Theophylline N. Low therapeutic index ```

B. Kidneys

``` The effect of which drug can be measured by the surrogate marker HbA1C A. Digoxin B. Kidneys C. Conjugation by sulphate/gluconaride D. GI system E. Lungs F. High therapeutic index G. Liver H. Rosiglitazone I. Poor compliance J. Gentamicin K. Oxidation by cytochrome P450 L. Warfarin M. Theophylline N. Low therapeutic index ```

H. Rosiglitazone

``` A 58-year-old man presents to your A&E complaining of chest pain and palpitations. He says he takes several drugs for his 'heart problems' and admits to being diabetic. What drug could be causing his problems? A. Digoxin B. Kidneys C. Conjugation by sulphate/gluconaride D. GI system E. Lungs F. High therapeutic index G. Liver H. Rosiglitazone I. Poor compliance J. Gentamicin K. Oxidation by cytochrome P450 L. Warfarin M. Theophylline N. Low therapeutic index ```

A. Digoxin

``` Peak and trough levels of this drug should be taken A. Clonazepam B. Lithium C. Ciclosporin D. Gentamicin E. Aspirin F. Digoxin G. Phenobarbitone H. Phenytoin I. Carbamazepine J. Theophylline K. Ethosuximide L. Warfarin M. Heparin - unfractionated N. Heparin - Low molecular weight ```

D. Gentamicin

``` Symptoms of under-treatment and toxicity may be similar A. Clonazepam B. Lithium C. Ciclosporin D. Gentamicin E. Aspirin F. Digoxin G. Phenobarbitone H. Phenytoin I. Carbamazepine J. Theophylline K. Ethosuximide L. Warfarin M. Heparin - unfractionated N. Heparin - Low molecular weight ```

F. Digoxin

``` Decreased excretion, increased plasma concentration and increased risk of toxicity may occur when this taken in conjunction with thiazide diuretics A. Clonazepam B. Lithium C. Ciclosporin D. Gentamicin E. Aspirin F. Digoxin G. Phenobarbitone H. Phenytoin I. Carbamazepine J. Theophylline K. Ethosuximide L. Warfarin M. Heparin - unfractionated N. Heparin - Low molecular weight ```

B. Lithium

``` Is ototoxic and nephrotoxic A. Clonazepam B. Lithium C. Ciclosporin D. Gentamicin E. Aspirin F. Digoxin G. Phenobarbitone H. Phenytoin I. Carbamazepine J. Theophylline K. Ethosuximide L. Warfarin M. Heparin - unfractionated N. Heparin - Low molecular weight ```

D. Gentamicin

``` Requires regular monitoring of APTT A. Clonazepam B. Lithium C. Ciclosporin D. Gentamicin E. Aspirin F. Digoxin G. Phenobarbitone H. Phenytoin I. Carbamazepine J. Theophylline K. Ethosuximide L. Warfarin M. Heparin - unfractionated N. Heparin - Low molecular weight ```

M. Heparin - unfractionated

``` A man was put into custody after driving under the influence of drugs. On arrest he was reported as acting extremely aggressive and paranoid. He also claimed his heart was racing. One hour later he was found dead. There was suspicion of police brutality. A. Cocaine B. Methanol C. Cyanide D. Ethanol E. Heroin F. Carbon monoxide G. Paracetamol H. Strychnine I. Organophosphate J. Methadone K. Cannabis L. Aspirin M. Amphetamines N. Ecstasy O. Benzodiazepines P. Police brutality ```

A. Cocaine

``` A 24-year-old woman goes to a party where she has some pills. She subsequently becomes feverish and confused. She was found to be hyperthermic and blood results showed a raised urea and creatinine, her myoglobin was also found to be high. A. Cocaine B. Methanol C. Cyanide D. Ethanol E. Heroin F. Carbon monoxide G. Paracetamol H. Strychnine I. Organophosphate J. Methadone K. Cannabis L. Aspirin M. Amphetamines N. Ecstasy O. Benzodiazepines P. Police brutality ```

N. Ecstasy

``` James Pond comes to A&E claiming he’s been poisoned. Minutes later he dies. His skin was brick red and there was a faint odour of almonds. A. . Cocaine B. Methanol C. Cyanide D. Ethanol E. Heroin F. Carbon monoxide G. Paracetamol H. Strychnine I. Organophosphate J. Methadone K. Cannabis L. Aspirin M. Amphetamines N. Ecstasy O. Benzodiazepines P. Police brutality ```

C. Cyanide

``` Following a death in the family, a young woman is brought into the hospital with confusion. On inspection she appears jaundiced. Her friend reports that she had been vomiting earlier and that she had found an empty medicine bottle in her room. A. . Cocaine B. Methanol C. Cyanide D. Ethanol E. Heroin F. Carbon monoxide G. Paracetamol H. Strychnine I. Organophosphate J. Methadone K. Cannabis L. Aspirin M. Amphetamines N. Ecstasy O. Benzodiazepines P. Police brutality ```

G. Paracetamol

``` A man was found collapsed on the floor of his room and his breathing was found to be severely depressed. A urine test was found to be positive for 6-MAM. A. . Cocaine B. Methanol C. Cyanide D. Ethanol E. Heroin F. Carbon monoxide G. Paracetamol H. Strychnine I. Organophosphate J. Methadone K. Cannabis L. Aspirin M. Amphetamines N. Ecstasy O. Benzodiazepines P. Police brutality ```

E. Heroin

``` A 30-year-old farmer presents to casualty complaining of diarrhoea and painful mouth ulcers. On questioning he admitted accidentally ingesting liquid paraquat A. Haemodialysis B. Glucagon C. N-acetylcysteine D. Gastric lavage E. Symptomatic and Supportive treatment F. Naloxone G. Activated charcoal H. Atropine I. Hyperbaric oxygen J. Desferrioxamine K. Dicobalt edentate ```

G. Activated charcoal

``` A 15-year-old girl presents with sweats and hyperventilation indicative of a severe metabolic acidosis; after taking a large number of salicylate tablets A. Haemodialysis B. Glucagon C. N-acetylcysteine D. Gastric lavage E. Symptomatic and Supportive treatment F. Naloxone G. Activated charcoal H. Atropine I. Hyperbaric oxygen J. Desferrioxamine K. Dicobalt edentate ```

A. Haemodialysis

``` A 26-year-old woman collapses after a massive overdose of atenolol. She remains in cardogenic shock despite initial treatment with IV atropine A. Haemodialysis B. Glucagon C. N-acetylcysteine D. Gastric lavage E. Symptomatic and Supportive treatment F. Naloxone G. Activated charcoal H. Atropine I. Hyperbaric oxygen J. Desferrioxamine K. Dicobalt edentate ```

B. Glucagon

``` A pregnant 30-year-old woman is found drowsy in her rented flat. She complains of severe nausea for the last 3 hours. Her carboxyhaemoglobin level is 41%. A. Haemodialysis B. Glucagon C. N-acetylcysteine D. Gastric lavage E. Symptomatic and Supportive treatment F. Naloxone G. Activated charcoal H. Atropine I. Hyperbaric oxygen J. Desferrioxamine K. Dicobalt edentate ```

I. Hyperbaric oxygen

``` A 25-year-old man is delirious and hyperpyrexial after taking a pill in a club. He is hyperreflexic and is hyponatraemic A. Haemodialysis B. Glucagon C. N-acetylcysteine D. Gastric lavage E. Symptomatic and Supportive treatment F. Naloxone G. Activated charcoal H. Atropine I. Hyperbaric oxygen J. Desferrioxamine K. Dicobalt edentate ```

E. Symptomatic and Supportive treatment

``` An 18 year old female is brought in to A&E from a rave in the early hours of the morning. On initial examination she is agitated with a heart rate of 120 bpm. She is very sweaty and has wide dilated pupils A. Desferrioxamine B. Paracetamol C. Naloxone D. Salicylates E. Carbon Monoxide F. Tricyclic antidepressants G. Ecstasy H. Organophosphates I. Lithium J. Acetylcysteine K. Methanol ```

G. Ecstasy

``` A 25 year old male is admitted with hyperventilation. He is sweating and appears nauseous. He says that he has ringing in his ears. Blood gases show that he has mixed acid-base disturbance A. Desferrioxamine B. Paracetamol C. Naloxone D. Salicylates E. Carbon Monoxide F. Tricyclic antidepressants G. Ecstasy H. Organophosphates I. Lithium J. Acetylcysteine K. Methanol ```

D. Salicylates

``` An 80 year old man and his 79 year old wife were brought in after a neighbour found them collapsed in their home. On questioning the neighbour it was found that the couple had not been feeling well for a few weeks and had been complaining of nausea, headaches and dizziness A. Desferrioxamine B. Paracetamol C. Naloxone D. Salicylates E. Carbon Monoxide F. Tricyclic antidepressants G. Ecstasy H. Organophosphates I. Lithium J. Acetylcysteine K. Methanol ```

E. Carbon Monoxide

``` A depressed 30 year old woman was brought into A&E after being found by a friend. On examination she appears very drowsy with sinus tachycardia and wide dilated pupils. She has marked reflexes and extensor plantar responses. ECG shows a wide QRS interval A. Desferrioxamine B. Paracetamol C. Naloxone D. Salicylates E. Carbon Monoxide F. Tricyclic antidepressants G. Ecstasy H. Organophosphates I. Lithium J. Acetylcysteine K. Methanol ```

F. Tricyclic antidepressants

``` A 45 year old farm worker is admitted complaining primarily of nausea and vomiting. On further questioning it is revealed that he also has a headache, hypersalivation and he is finding it hard to breathe. On examination the patient appears sweaty and has flaccid paresis of his limb muscles A. Desferrioxamine B. Paracetamol C. Naloxone D. Salicylates E. Carbon Monoxide F. Tricyclic antidepressants G. Ecstasy H. Organophosphates I. Lithium J. Acetylcysteine K. Methanol ```

H. Organophosphates

``` Which of the above techniques can be used to test for all classes of drugs of abuse (DOA)? A. Stool sample B. Blood sample C. Thin layer chromotography D. Liquid chromotography E. Drugs of abuse (DOA) F. Barbituates G. Liver sample H. Immunoassay I. Paracetamol J. Urine sample K. Benzodiazepines ```

H. Immunoassay

``` What sample is required for use with gas chromatography mass spectroscopy? A. Stool sample B. Blood sample C. Thin layer chromotography D. Liquid chromotography E. Drugs of abuse (DOA) F. Barbituates G. Liver sample H. Immunoassay I. Paracetamol J. Urine sample K. Benzodiazepines ```

B. Blood sample

``` Colorimetric can be used to test for which drug commonly taken in overdose? A. Stool sample B. Blood sample C. Thin layer chromotography D. Liquid chromotography E. Drugs of abuse (DOA) F. Barbituates G. Liver sample H. Immunoassay I. Paracetamol J. Urine sample K. Benzodiazepines ```

I. Paracetamol

``` Which of the above techniques can be used to test for benzodiazepines and various antipsychotic drugs? A. Stool sample B. Blood sample C. Thin layer chromotography D. Liquid chromotography E. Drugs of abuse (DOA) F. Barbituates G. Liver sample H. Immunoassay I. Paracetamol J. Urine sample K. Benzodiazepines ```

D. Liquid chromotography

``` Which of the above techniques can be used to analyse samples of stool, liver and also urine? A. Stool sample B. Blood sample C. Thin layer chromotography D. Liquid chromotography E. Drugs of abuse (DOA) F. Barbituates G. Liver sample H. Immunoassay I. Paracetamol J. Urine sample K. Benzodiazepines ```

C. Thin layer chromotography

``` Which option is the best specimen for assessing long-term drug use? A. Hair B. Forensics C. THC D. Urine E. Blood F. Morphine G. Paracetamol H. Cocaine I. Saliva J. Toxicology K. MDMA ```

A. Hair

``` Which drug is found in the most addict related deaths? A. Hair B. Forensics C. THC D. Urine E. Blood F. Morphine G. Paracetamol H. Cocaine I. Saliva J. Toxicology K. MDMA ```

F. Morphine

``` Which option is responsible for the analysis of samples for drugs and poisons? A. Hair B. Forensics C. THC D. Urine E. Blood F. Morphine G. Paracetamol H. Cocaine I. Saliva J. Toxicology K. MDMA ```

J. Toxicology

``` Which option is the best example of a quick, cheap, easy and non-invasive specimen which is likely to be adulterated for forensic drug analysis? Disadvantages include a small window of detection. A. Hair B. Forensics C. THC D. Urine E. Blood F. Morphine G. Paracetamol H. Cocaine I. Saliva J. Toxicology K. MDMA ```

I. Saliva

``` Which drug is not excreted into saliva? A. Hair B. Forensics C. THC D. Urine E. Blood F. Morphine G. Paracetamol H. Cocaine I. Saliva J. Toxicology K. MDMA ```

C. THC

``` A 25 year old male with a history of tuberculosis presenting with a plasma osmolality of 205mmol/l, potassium of 6.3mmol/l and sodium of 115mmol/l. A. Alcohol abuse B. Diarrhoea C. Diabetic ketoacidosis D. Haemorrhage E. Vomiting F. Artifactual G. Acute Renal Failure H. Cushing’s syndrome I. Rhabdomyolysis J. Renal tubular acidosis K. Diuretic use L. Addison's disease ```

L. Addison's disease

``` A 76 year woman with known congestive cardiac failure presenting with digoxin toxicity A. Alcohol abuse B. Diarrhoea C. Diabetic ketoacidosis D. Haemorrhage E. Vomiting F. Artifactual G. Acute Renal Failure H. Cushing’s syndrome I. Rhabdomyolysis J. Renal tubular acidosis K. Diuretic use L. Addison's disease ```

K. Diuretic use

``` Following a severe car crash, a patient’s ECG shows a broad QRS complex with peaked T waves. A. Alcohol abuse B. Diarrhoea C. Diabetic ketoacidosis D. Haemorrhage E. Vomiting F. Artifactual G. Acute Renal Failure H. Cushing’s syndrome I. Rhabdomyolysis J. Renal tubular acidosis K. Diuretic use L. Addison's disease ```

I. Rhabdomyolysis

``` A 53 year old man in hospital following a minor operation was observed to have a potassium of 7.0mmol/l on a routine blood test but clinically well. A repeat test 4 hours later was 4.0mmol/l. A. Alcohol abuse B. Diarrhoea C. Diabetic ketoacidosis D. Haemorrhage E. Vomiting F. Artifactual G. Acute Renal Failure H. Cushing’s syndrome I. Rhabdomyolysis J. Renal tubular acidosis K. Diuretic use L. Addison's disease ```

F. Artifactual

``` An 18 year old woman presents comatose, with a urinary pH of 3.5 and plasma potassium of 6.5mmol/l. 6 hours after treatment potassium drops to 3.1mmol/l. A. Alcohol abuse B. Diarrhoea C. Diabetic ketoacidosis D. Haemorrhage E. Vomiting F. Artifactual G. Acute Renal Failure H. Cushing’s syndrome I. Rhabdomyolysis J. Renal tubular acidosis K. Diuretic use L. Addison's disease ```

C. Diabetic ketoacidosis

``` A 68 year old woman, K+ = 3.0 mmol/L with a history of congestive cardiac failure complains of general discomfort. A. Diuretic use B. Burns C. Rhabdomyalysis D. Renal tubular disease E. Hypokalaemia F. Insulin administration G. Hyperkalaemia H. Addison's disease I. Laxative abuse J. Artefactual K. Cushing's disease ```

A. Diuretic use

``` An ECG of a 27 year old man in casualty shows peaked T waves in leads V2 and V3. A. Diuretic use B. Burns C. Rhabdomyalysis D. Renal tubular disease E. Hypokalaemia F. Insulin administration G. Hyperkalaemia H. Addison's disease I. Laxative abuse J. Artefactual K. Cushing's disease ```

G. Hyperkalaemia

``` A 2 month old infant vomits profusely, pH = 7.57, H+= 26 nmol/L, HCO3= 50 mmol/L A. Diuretic use B. Burns C. Rhabdomyalysis D. Renal tubular disease E. Hypokalaemia F. Insulin administration G. Hyperkalaemia H. Addison's disease I. Laxative abuse J. Artefactual K. Cushing's disease ```

E. Hypokalaemia

``` A 47 year old woman complains of tiredness, muscle weakness, mood swings and loss of appetite over several months. K+= 5.9 mmol/L A. Diuretic use B. Burns C. Rhabdomyalysis D. Renal tubular disease E. Hypokalaemia F. Insulin administration G. Hyperkalaemia H. Addison's disease I. Laxative abuse J. Artefactual K. Cushing's disease ```

H. Addison's disease

``` A 15 year old girl with K+ = 3.2 mmol/L admits to taking Bisacodyl over several months to lose weight. A. Diuretic use B. Burns C. Rhabdomyalysis D. Renal tubular disease E. Hypokalaemia F. Insulin administration G. Hyperkalaemia H. Addison's disease I. Laxative abuse J. Artefactual K. Cushing's disease ```

I. Laxative abuse

``` A 47 year old female presents to her GP with severe loin pain. On further questioning the patient complains of a 6 month history of recurrent fevers and vomiting with more recent generalised weakness and pain in some of her joints. A subsequent blood test shows hypokalaemia. A. Haemolysis B. Drip arm sample C. Corticosteroid use D. Diuretics E. Vomiting F. Diarrhoea G. Renal tubular acidosis H. Fistula I. Delayed separation J. Addison's disease K. Renal failure ```

G. Renal tubular acidosis

``` A 20 year old medical student presents to his GP with bowel disturbances. He recently returned from holiday in Thailand. Blood tests reveal that he is hypokalaemic. A. Haemolysis B. Drip arm sample C. Corticosteroid use D. Diuretics E. Vomiting F. Diarrhoea G. Renal tubular acidosis H. Fistula I. Delayed separation J. Addison's disease K. Renal failure ```

F. Diarrhoea

``` A junior doctor received a blood report from the pathology lab for a 50 year old male who was recovering from an inguinal hernia repair. The report described the patient as being hyperkalaemic. Most of the porters at the hospital were on strike at the time. A. Haemolysis B. Drip arm sample C. Corticosteroid use D. Diuretics E. Vomiting F. Diarrhoea G. Renal tubular acidosis H. Fistula I. Delayed separation J. Addison's disease K. Renal failure ```

I. Delayed separation

``` An 82 year old female caught a bad cold on a flight to Heathrow for a holiday from India, where she has lived all her life. Six days later she comes into A+E weak, confused with abdominal pain. Blood tests show a potassium of 6.2mmol/L. A. Haemolysis B. Drip arm sample C. Corticosteroid use D. Diuretics E. Vomiting F. Diarrhoea G. Renal tubular acidosis H. Fistula I. Delayed separation J. Addison's disease K. Renal failure ```

J. Addison's disease

``` A 72 year old male is referred to cardiothoracic surgery outpatients following an episode of unconsciousness. The patient had an aortic valve replacement operation 5 years ago. Following investigation the valve is found to have malfunctioned. A blood test shows that the patient is hyperkalaemic. A. Haemolysis B. Drip arm sample C. Corticosteroid use D. Diuretics E. Vomiting F. Diarrhoea G. Renal tubular acidosis H. Fistula I. Delayed separation J. Addison's disease K. Renal failure ```

A. Haemolysis

``` A 65 year old lady presents to A & E with her son who describes decreasing mental function over the last week or so. On questioning you discover that she is a smoker with a 40 pack year history and that she has had a chronic, productive cough for several weeks. Bloods include Na=120, K=4.5, Cl=85, HC03=22, serum osmolality=260 A. Cranial Diabetes insipidus B. SIADH C. Alcohol abuse D. Diuretic excess E. Psychogenic polydipsia F. Dehydration G. Illicit drug abuse H. Normal I. Nephrogenic diabetes insipidus J. Iatrogenic ```

B. SIADH

``` A 75 year old lady is recovering from a hip replacement after fracturing her neck of femur. The post-operative period has been uneventful but today you, the F1, notice that her blood results are slightly abnormal: Na=126, K=3.2, serum osmolality=262. You consult your registrar, who tells you not to worry and advises ‘watchful waiting’. A. Cranial Diabetes insipidus B. SIADH C. Alcohol abuse D. Diuretic excess E. Psychogenic polydipsia F. Dehydration G. Illicit drug abuse H. Normal I. Nephrogenic diabetes insipidus J. Iatrogenic ```

J. Iatrogenic

``` A young drama student attends clinic complaining of polyuria and sleep disturbance. Her past medical history includes an appendicectomy, a skull fracture, and hayfever. Her biochemistry reveals Na=148, K=3.6. She denies excessive fluid intake. A. Cranial Diabetes insipidus B. SIADH C. Alcohol abuse D. Diuretic excess E. Psychogenic polydipsia F. Dehydration G. Illicit drug abuse H. Normal I. Nephrogenic diabetes insipidus J. Iatrogenic ```

A. Cranial Diabetes insipidus

``` A male medical student consults you after a lecture on disorders of acid-base balance and ion handling. He is concerned that his high fluid intake (2-3litres/day) may be causing a ‘dilutional hyponatraemia’ as he finds it hard to concentrate in lectures. Initial investigations include biochemistry: Na=126, K=3.8, pH=7.39. A. Cranial Diabetes insipidus B. SIADH C. Alcohol abuse D. Diuretic excess E. Psychogenic polydipsia F. Dehydration G. Illicit drug abuse H. Normal I. Nephrogenic diabetes insipidus J. Iatrogenic ```

E. Psychogenic polydipsia

``` A 37 year old banker presents to A & E complaining of nausea and dizziness. He describes treating his hangover this morning with a ‘good run’ and tells you that he had a coffee to ‘steady himself’ before coming in. On examination you note a mild tachycardia and cannot confidently assess his JVP. Routine bloods reveal Na=152, K=4.1, urea=25, creatinine=190. A. Cranial Diabetes insipidus B. SIADH C. Alcohol abuse D. Diuretic excess E. Psychogenic polydipsia F. Dehydration G. Illicit drug abuse H. Normal I. Nephrogenic diabetes insipidus J. Iatrogenic ```

F. Dehydration

``` Normovolaemic and hyponatraemic A. SIADH B. Chronic renal failure C. Pernicious anaemia D. COPD E. Diuretic excess F. Achalasia G. Cardiac failure H. Acromegaly I. Vomiting J. Guillain-Barre syndrome K. Osteomalacia ```

A. SIADH

``` Hypovolaemic with urinary Na+<10 mmol/L A. . SIADH B. Chronic renal failure C. Pernicious anaemia D. COPD E. Diuretic excess F. Achalasia G. Cardiac failure H. Acromegaly I. Vomiting J. Guillain-Barre syndrome K. Osteomalacia ```

I. Vomiting

``` Raised JVP, peripheral oedema and urinary Na+<10 mmol/L A. . SIADH B. Chronic renal failure C. Pernicious anaemia D. COPD E. Diuretic excess F. Achalasia G. Cardiac failure H. Acromegaly I. Vomiting J. Guillain-Barre syndrome K. Osteomalacia ```

G. Cardiac failure

``` Hypotension with urinary Na+>20 mmol/L A. . SIADH B. Chronic renal failure C. Pernicious anaemia D. COPD E. Diuretic excess F. Achalasia G. Cardiac failure H. Acromegaly I. Vomiting J. Guillain-Barre syndrome K. Osteomalacia ```

E. Diuretic excess

``` Hypervolaemic with urinary Na+>20 mmol/L A. . SIADH B. Chronic renal failure C. Pernicious anaemia D. COPD E. Diuretic excess F. Achalasia G. Cardiac failure H. Acromegaly I. Vomiting J. Guillain-Barre syndrome K. Osteomalacia ```

B. Chronic renal failure

``` A 23 year old male patient presents to GI outpatients clinic following disturbances since his return from a one month trip to India. Routine bloods reveal that he is mildly hypokalaemic. Results of rigid sigmoidoscopy were normal A. Severe tissue damage B. Renal tubular acidosis C. Vomiting D. Renal Failure E. Fistula F. Use of diuretics G. Drip arm sample H. Haemolysis I. Use of corticosteroids J. Diarrhoea K. Addisonian crisis ```

J. Diarrhoea

``` A 46 year old female presents with confusion and complains of hallucinations. On further questioning she reveals that she has been feeling generally tired and weak for the last 8 weeks. During this period she has lost 8 kg in weight. Her past history revealed an episode of TB 22 years ago. Her electrolyte results revealed Sodium 105 mmol/l; potassium 5.5 mmol/l and osmolality 220 mmol/l. A. Severe tissue damage B. Renal tubular acidosis C. Vomiting D. Renal Failure E. Fistula F. Use of diuretics G. Drip arm sample H. Haemolysis I. Use of corticosteroids J. Diarrhoea K. Addisonian crisis ```

K. Addisonian crisis

``` A 78 year old male presents with hypokalaemia. He has previously been diagnosed with congestive heart failure, which has been controlled with medication. Serum sodium was 126 mmol/l and bicarbonate was raised. A. Severe tissue damage B. Renal tubular acidosis C. Vomiting D. Renal Failure E. Fistula F. Use of diuretics G. Drip arm sample H. Haemolysis I. Use of corticosteroids J. Diarrhoea K. Addisonian crisis ```

F. Use of diuretics

``` A 35 year old male body builder presents to his GP surgery with genital atrophy. Routine blood tests reveal that the patient is hypokalamic. A. Severe tissue damage B. Renal tubular acidosis C. Vomiting D. Renal Failure E. Fistula F. Use of diuretics G. Drip arm sample H. Haemolysis I. Use of corticosteroids J. Diarrhoea K. Addisonian crisis ```

I. Use of corticosteroids

``` A 19 year old female patient presents to A&E with severe dehydration, and is rapidly infused. Blood samples obtained by a trainee nurse reveals gross hyponatraemia. Glucose levels was also raised markedly. A. Severe tissue damage B. Renal tubular acidosis C. Vomiting D. Renal Failure E. Fistula F. Use of diuretics G. Drip arm sample H. Haemolysis I. Use of corticosteroids J. Diarrhoea K. Addisonian crisis ```

G. Drip arm sample

``` A 45 year old female with long-term poorly controlled asthma presents to her GP complaining of weight gain and excessive sweating. A recent routine abdominal CT scan revealed atrophy of the adrenal glands. A. Aldosterone Secreting Adrenal Adenoma B. Adrenal Carcinoma C. Nelson’s Syndrome D. Cushing’s Syndrome E. Schmidt’s Syndrome F. Ectopic ACTH Secretion G. Addisonian Crisis H. Congenital Adrenal Hyperplasia I. Pseudo-Cushing’s Syndrome J. Phaeochromocytoma K. Multiple Endocrine Neoplasia Syndrome L. Addison’s Disease M. Iatrogenic Cushing’s Syndrome N. Cushing’s Disease ```

M. Iatrogenic Cushing’s Syndrome

``` The next patient on the endocrine ward round has just received the results of a high dose dexamethasone suppression test. The consultant informs you that the cortisol levels have been suppressed and asks you the most likely cause of this patient’s cushingoid symptoms A. Aldosterone Secreting Adrenal Adenoma B. Adrenal Carcinoma C. Nelson’s Syndrome D. Cushing’s Syndrome E. Schmidt’s Syndrome F. Ectopic ACTH Secretion G. Addisonian Crisis H. Congenital Adrenal Hyperplasia I. Pseudo-Cushing’s Syndrome J. Phaeochromocytoma K. Multiple Endocrine Neoplasia Syndrome L. Addison’s Disease M. Iatrogenic Cushing’s Syndrome N. Cushing’s Disease ```

N. Cushing’s Disease

``` A 35 year old female arrives in A&E at 16:30 in a very distressed state. Examination reveals tachycardia and postural hypotension. She complains of ongoing weakness and confusion following a recent operation on her knee. Blood tests reveal hyperkalaemia, hyponatraemia. Further tests measure cortisol levels at 50 nmol/L. A. Aldosterone Secreting Adrenal Adenoma B. Adrenal Carcinoma C. Nelson’s Syndrome D. Cushing’s Syndrome E. Schmidt’s Syndrome F. Ectopic ACTH Secretion G. Addisonian Crisis H. Congenital Adrenal Hyperplasia I. Pseudo-Cushing’s Syndrome J. Phaeochromocytoma K. Multiple Endocrine Neoplasia Syndrome L. Addison’s Disease M. Iatrogenic Cushing’s Syndrome N. Cushing’s Disease ```

G. Addisonian Crisis

``` A 52 year old male complains of muscle cramps and headaches. Examination reveals hypertension. Blood tests are ordered and reveal a marked hypokalaemia. The renin-aldosterone ratio is noted at 0.02 and the House Officer orders an abdominal CT scan. A. Aldosterone Secreting Adrenal Adenoma B. Adrenal Carcinoma C. Nelson’s Syndrome D. Cushing’s Syndrome E. Schmidt’s Syndrome F. Ectopic ACTH Secretion G. Addisonian Crisis H. Congenital Adrenal Hyperplasia I. Pseudo-Cushing’s Syndrome J. Phaeochromocytoma K. Multiple Endocrine Neoplasia Syndrome L. Addison’s Disease M. Iatrogenic Cushing’s Syndrome N. Cushing’s Disease ```

A. Aldosterone Secreting Adrenal Adenoma

``` A 65 year old female presents to her new GP 5 years after an operation on her abdomen. She cannot remember the details of the operation but does remember that she was suffering from severe Cushing’s Disease at the time. She now notes a progressive “tanning” of the skin A. Aldosterone Secreting Adrenal Adenoma B. Adrenal Carcinoma C. Nelson’s Syndrome D. Cushing’s Syndrome E. Schmidt’s Syndrome F. Ectopic ACTH Secretion G. Addisonian Crisis H. Congenital Adrenal Hyperplasia I. Pseudo-Cushing’s Syndrome J. Phaeochromocytoma K. Multiple Endocrine Neoplasia Syndrome L. Addison’s Disease M. Iatrogenic Cushing’s Syndrome N. Cushing’s Disease ```

C. Nelson’s Syndrome Occurs in patients who have had both their adrenal glands removed owing to Cushing's syndrome. They develop macro-adenomas that secrete ACTH

``` A 57 year old Type 1 diabetic woman presents with weight loss, weakness and depression. Examination reveals postural hypotension, hyperpigmentation in the palmar creases and widespread patchy vitiligo. Full blood count is unremarkable but U&Es reveal Na+ 130 mmol/l, K+ 6.0 mmol/l, Urea 7.4 mmol/l and Ca 2+ 2.70 mmol/l. A. Pseudo-Cushing's syndrome B. Iatrogenic Addison's disease C. Carney's syndrome D. Phaeochromocytoma E. Conn's syndrome F. Cushing's disease G. Adrenal carcinoma H. Iatrogenic Cushing's syndrome I. Ectopic ACTH secretion J. Congenital adrenal hyperplasia K. Adrenal adenoma L. Addison's disease ```

L. Addison's disease

``` A 32 year old woman presents with a one year history of weight loss, fatigue and hirsutism. Examination reveals thin skin, easy bruising, purple abdominal striae and a supraclavicular fat pad. Plasma cortisol and ACTH levels are both raised but suppress after high dose dexamethasone suppression test. A. Pseudo-Cushing's syndrome B. Iatrogenic Addison's disease C. Carney's syndrome D. Phaeochromocytoma E. Conn's syndrome F. Cushing's disease G. Adrenal carcinoma H. Iatrogenic Cushing's syndrome I. Ectopic ACTH secretion J. Congenital adrenal hyperplasia K. Adrenal adenoma L. Addison's disease ```

F. Cushing's disease

``` A 64 year old man, who is known to suffer from ulcerative colitis, presents with a long history of weight gain, fatigue and depression. Examination reveals a moon-shaped face, centripetal obesity, thin skin and easy bruising. Serum cortisol levels are elevated and fail to suppress after low dose dexamethasone suppression test. A. Pseudo-Cushing's syndrome B. Iatrogenic Addison's disease C. Carney's syndrome D. Phaeochromocytoma E. Conn's syndrome F. Cushing's disease G. Adrenal carcinoma H. Iatrogenic Cushing's syndrome I. Ectopic ACTH secretion J. Congenital adrenal hyperplasia K. Adrenal adenoma L. Addison's disease ```

H. Iatrogenic Cushing's syndrome

``` A 21 year old man presents with rapid palpitations associated with chest tightness, severe headache, tremor and sweating. History reveals that the man had just consumed a large amount of alcohol. A. Pseudo-Cushing's syndrome B. Iatrogenic Addison's disease C. Carney's syndrome D. Phaeochromocytoma E. Conn's syndrome F. Cushing's disease G. Adrenal carcinoma H. Iatrogenic Cushing's syndrome I. Ectopic ACTH secretion J. Congenital adrenal hyperplasia K. Adrenal adenoma L. Addison's disease ```

D. Phaeochromocytoma

``` A 27 year old woman presents with a three month history of weight gain, deepening voice and secondary amenorrhoea. Examination reveals clitoromegaly, acne, greasy skin and hirsutism. Serum cortisol is grossly elevated and ACTH levels are undetectable A. Pseudo-Cushing's syndrome B. Iatrogenic Addison's disease C. Carney's syndrome D. Phaeochromocytoma E. Conn's syndrome F. Cushing's disease G. Adrenal carcinoma H. Iatrogenic Cushing's syndrome I. Ectopic ACTH secretion J. Congenital adrenal hyperplasia K. Adrenal adenoma L. Addison's disease. ```

G. Adrenal carcinoma

``` The commonest enzyme deficiency seen in CAH A. Pregnanetriol B. Deoxycortisol C. 17α-Hydroxylase deficiency D. Normal ACTH levels E. Aldosterone F. Hyponatreamia with Hypokalaemia G. Raised ACTH H. Hypernatreamia with Hypokalaemia I. Hyponatreamia with Hyperkalaemia J. Chromosome 6 K. 17-Hydroxyprogesterone L. 21-Hydroxylase Deficiency M. Reduced Cortisol N. Hypernatreamia with Hyperkalaemia O. 11β-Hydroxylase deficiency ```

L. 21-Hydroxylase Deficiency

``` Levels of this steroid are raised in the serum of CAH patients A. Pregnanetriol B. Deoxycortisol C. 17α-Hydroxylase deficiency D. Normal ACTH levels E. Aldosterone F. Hyponatreamia with Hypokalaemia G. Raised ACTH H. Hypernatreamia with Hypokalaemia I. Hyponatreamia with Hyperkalaemia J. Chromosome 6 K. 17-Hydroxyprogesterone L. 21-Hydroxylase Deficiency M. Reduced Cortisol N. Hypernatreamia with Hyperkalaemia O. 11β-Hydroxylase deficiency ```

K. 17-Hydroxyprogesterone

``` Increased levels are seen in the urine of CAH patients A. Pregnanetriol B. Deoxycortisol C. 17α-Hydroxylase deficiency D. Normal ACTH levels E. Aldosterone F. Hyponatreamia with Hypokalaemia G. Raised ACTH H. Hypernatreamia with Hypokalaemia I. Hyponatreamia with Hyperkalaemia J. Chromosome 6 K. 17-Hydroxyprogesterone L. 21-Hydroxylase Deficiency M. Reduced Cortisol N. Hypernatreamia with Hyperkalaemia O. 11β-Hydroxylase deficiency ```

A. Pregnanetriol

``` The sodium and potassium pattern seen in CYP21 deficiency. A. Pregnanetriol B. Deoxycortisol C. 17α-Hydroxylase deficiency D. Normal ACTH levels E. Aldosterone F. Hyponatreamia with Hypokalaemia G. Raised ACTH H. Hypernatreamia with Hypokalaemia I. Hyponatreamia with Hyperkalaemia J. Chromosome 6 K. 17-Hydroxyprogesterone L. 21-Hydroxylase Deficiency M. Reduced Cortisol N. Hypernatreamia with Hyperkalaemia O. 11β-Hydroxylase deficiency ```

I. Hyponatreamia with Hyperkalaemia

``` A doctor suspecting his patient is suffering from CAH has just received some results that proves otherwise A. Pregnanetriol B. Deoxycortisol C. 17α-Hydroxylase deficiency D. Normal ACTH levels E. Aldosterone F. Hyponatreamia with Hypokalaemia G. Raised ACTH H. Hypernatreamia with Hypokalaemia I. Hyponatreamia with Hyperkalaemia J. Chromosome 6 K. 17-Hydroxyprogesterone L. 21-Hydroxylase Deficiency M. Reduced Cortisol N. Hypernatreamia with Hyperkalaemia O. 11β-Hydroxylase deficiency ```

D. Normal ACTH levels

``` An overweight 35-year old shop-assistant visits her GP complaining of debilitating tiredness. Her periods have also become infrequent in this time. Despite it being a warm day, she wears a coat and jumper inside. On examination, she has a symmetrical painless lump on her neck. The patient has a history of well-controlled SLE. A. Prader-Willi Syndrome B. Cushing’s syndrome C. Hashimoto’s thyroiditis D. Cushing’s disease E. Simple Obesity F. Menopause G. Alcohol excess H. PCOS I. Type II diabetes J. Steroid abuse K. De Quervain’s thyroiditis L. Pregnancy M. Long-term insulin use N. Type I diabetes ```

C. Hashimoto’s thyroiditis

``` A 14-year old boy visits his GP with his mother, having been recommended to by the school nurse, following an inability to attend PE lessons, due to his weight. Both seem generally unconcerned, with his mother stating that she never makes him do exercise at home anyway. The boy describes McDonalds and Playstation as his favourite hobbies. As a precaution, the GP performs a blood sample, which showed no endocrine abnormalities, but a raised cholesterol. A. Prader-Willi Syndrome B. Cushing’s syndrome C. Hashimoto’s thyroiditis D. Cushing’s disease E. Simple Obesity F. Menopause G. Alcohol excess H. PCOS I. Type II diabetes J. Steroid abuse K. De Quervain’s thyroiditis L. Pregnancy M. Long-term insulin use N. Type I diabetes ```

E. Simple Obesity

``` A 29-year old, clinically obese accountant presents with a relapsing of her acne, which had disappeared in her teens. On further questioning, she admits to infrequent periods over the last year, and a greater than normal growth of hair on her face. Blood tests show an elevated serum testosterone. A. Prader-Willi Syndrome B. Cushing’s syndrome C. Hashimoto’s thyroiditis D. Cushing’s disease E. Simple Obesity F. Menopause G. Alcohol excess H. PCOS I. Type II diabetes J. Steroid abuse K. De Quervain’s thyroiditis L. Pregnancy M. Long-term insulin use N. Type I diabetes ```

H. PCOS

``` A 33-year old overweight man complains of headaches and visual disturbances which he blames for two car accidents he has been involved in the last month. He has a ruddy appearance, and the GP notes that his weight is mainly concentrated in a ‘pot belly’. The man’s blood pressure is 150/100, and following a 48hr low –dose dexamethasone test, the patient has a cortisol of 500nm/L, and after a 48hr high-dose dexamethasone test, the cortisol was 250nmol/L A. Prader-Willi Syndrome B. Cushing’s syndrome C. Hashimoto’s thyroiditis D. Cushing’s disease E. Simple Obesity F. Menopause G. Alcohol excess H. PCOS I. Type II diabetes J. Steroid abuse K. De Quervain’s thyroiditis L. Pregnancy M. Long-term insulin use N. Type I diabetes ```

D. Cushing’s disease

``` A 65-year old overweight Indian gentleman presents to his GP, complaining of problems with his eyesight, which has become blurred recently, despite 20/20 vision for the rest of his life. On further questioning, he admits to increased urinary frequency, which he put down to his age, though recalls that he has been drinking more recently. On dip-sticking the urine, glucose was +++, and following a blood test, the blood sugar was 18mmol/L A. Prader-Willi Syndrome B. Cushing’s syndrome C. Hashimoto’s thyroiditis D. Cushing’s disease E. Simple Obesity F. Menopause G. Alcohol excess H. PCOS I. Type II diabetes J. Steroid abuse K. De Quervain’s thyroiditis L. Pregnancy M. Long-term insulin use N. Type I diabetes ```

I. Type II diabetes

``` A 15 year old overweight schoolgirl presents to her GP complaining of oligomenorrhoea. She is very self conscious and concerned about acne and excessive facial hair. Tests reveal raised serum LH and androgen concentrations. A. Genetic testing B. Chest X-ray C. Urine dipstick D. Exercise tolerance test E. Lipid profile F. Cortisol measurement G. BMI quantification H. Thyroid autoantibodies I. Ovarian ultrasound ```

I. Ovarian ultrasound

``` A 54 year old businessman comes to you with a wound in his foot that has failed to heal over a few weeks. You notice various other minor lesions on both feet and he tells you that he has recently ‘lost feeling’ in his legs. His BMI is 31 and his blood pressure is 145/95. A. Genetic testing B. Chest X-ray C. Urine dipstick D. Exercise tolerance test E. Lipid profile F. Cortisol measurement G. BMI quantification H. Thyroid autoantibodies I. Ovarian ultrasound ```

C. Urine dipstick

``` A 38 year old secretary presents with a 3 month history of increasing fatigue and lethargy. She says that her muscles ‘don’t seem to work any more’ and you note slow relaxing reflexes on neurological examination. She complains of weight gain and seems very depressed. A. Genetic testing B. Chest X-ray C. Urine dipstick D. Exercise tolerance test E. Lipid profile F. Cortisol measurement G. BMI quantification H. Thyroid autoantibodies I. Ovarian ultrasound ```

H. Thyroid autoantibodies

``` A 3 year old child is brought in by his parents who are concerned about his development, both physically and behaviourally. Her mother complains that he is continually eating, despite some feeding difficulties present in early infancy. On examination, you note some mild mental retardation, distinctive facial features and hypogonadism. A. Genetic testing B. Chest X-ray C. Urine dipstick D. Exercise tolerance test E. Lipid profile F. Cortisol measurement G. BMI quantification H. Thyroid autoantibodies I. Ovarian ultrasound ```

A. Genetic testing

``` A 60 year old ex-RAF pilot presents with breathlessness on exercise. Questioning reveals that he has difficulty sleeping and requires 3/4 pillows. He is wheezy but puts that down to a lifetime of smoking (40 pack years). Further examination reveals ankle oedema, crepitations and a displaced apex beat. A. Genetic testing B. Chest X-ray C. Urine dipstick D. Exercise tolerance test E. Lipid profile F. Cortisol measurement G. BMI quantification H. Thyroid autoantibodies I. Ovarian ultrasound ```

B. Chest X-ray

``` A 62 year old Indian gentleman visits his GP, complaining of pins and needles in his feet, which is worse at night. He also mentions that he has been passing urine more often than he used to, and puts this down to the fact that he has been drinking more. Blood tests reveal a fasting plasma glucose of 11.4 mmol/l. A. Type 2 diabetes B. Familial hypercholesterolaemia C. Menopause D. Graves' disease E. PCOS F. Hashimoto's thyroiditis G. Cushing's disease H. Alcohol excess I. Type 1 diabetes J. Cushing's syndrome ```

A. Type 2 diabetes

``` A 21 year old obese student visits her GP, feeling very depressed about her hair loss, which has got progressively worse since the age of 16. She is also worried about the irregularity of her periods, which has been going on for about a year and a half. Serum testosterone is raised. A. Type 2 diabetes B. Familial hypercholesterolaemia C. Menopause D. Graves' disease E. PCOS F. Hashimoto's thyroiditis G. Cushing's disease H. Alcohol excess I. Type 1 diabetes J. Cushing's syndrome ```

E. PCOS

``` A 31 year old research assistant presents to her GP complaining of weight gain. On questioning, she thinks that most of this weight has been put on around her middle, and her face looks much rounder. The patient has a history of ulcerative colitis that is well controlled by medication. A. Type 2 diabetes B. Familial hypercholesterolaemia C. Menopause D. Graves' disease E. PCOS F. Hashimoto's thyroiditis G. Cushing's disease H. Alcohol excess I. Type 1 diabetes J. Cushing's syndrome ```

J. Cushing's syndrome

``` A 45 year old sales assistant presents with extreme tiredness. On examination, the GP notes a painless lump on the front of her neck that moves up with swallowing, and that her hands are cold and dry. The patient has a history of pernicious anaemia. A. Type 2 diabetes B. Familial hypercholesterolaemia C. Menopause D. Graves' disease E. PCOS F. Hashimoto's thyroiditis G. Cushing's disease H. Alcohol excess I. Type 1 diabetes J. Cushing's syndrome ```

F. Hashimoto's thyroiditis

``` A 36 year old woman visits her GP, worried about the chest pain brought on by her daily run in the park. On examination, the GP notes dark patches on the backs of her hands. She mentions that her younger sister has the same dark patches. Serum cholesterol is 9.4 mmol/l. A. Type 2 diabetes B. Familial hypercholesterolaemia C. Menopause D. Graves' disease E. PCOS F. Hashimoto's thyroiditis G. Cushing's disease H. Alcohol excess I. Type 1 diabetes J. Cushing's syndrome ```

B. Familial hypercholesterolaemia

``` An 11 year old boy is taken to the GP by his parents after complaining that “his wee-wee is a funny colour”. The parents reveal that their son hasn’t been too well lately, “He’s been very tired, feeling sick and has had temperature the last few days. We thought he’s just picked up a virus because he had a sore throat about 10days ago, but now that his urine has gone this smoky colour and his eyes are puffy, we thought we’d bring him in…” A. Alport's disease B. Henoch-Schonlein purpura C. Hypertensive renal damage D. Goodpasture's E. Acute diffuse proliferative glomerulonephritis F. Bacterial endocarditis G. Wegener's granulomatosis H. Cannonball metastases I. Clear cell renal carcinoma J. Polycystic kidney disease K. Wilms tumour L. Diabetic nephropathy ```

E. Acute diffuse proliferative glomerulonephritis

``` A gentleman who presented with haemoptysis and haematuria. Histology shows the accumulation of macrophages in Bowmans capsule. Immunology reveals the patient is HLA-DR2, and possesses Anti-glomerualr basement membrane antibody. A. Alport's disease B. Henoch-Schonlein purpura C. Hypertensive renal damage D. Goodpasture's E. Acute diffuse proliferative glomerulonephritis F. Bacterial endocarditis G. Wegener's granulomatosis H. Cannonball metastases I. Clear cell renal carcinoma J. Polycystic kidney disease K. Wilms tumour L. Diabetic nephropathy ```

D. Goodpasture's

``` A 50 year old male with a persistant runny nose and sinusitis that is worsening. Immunology reveals circulating auto-antibodies against neutrophil cytoplasmic antigents (C-ANCA). Histology also shows the accumulation of macrophages in Bowmans capsule. A. Alport's disease B. Henoch-Schonlein purpura C. Hypertensive renal damage D. Goodpasture's E. Acute diffuse proliferative glomerulonephritis F. Bacterial endocarditis G. Wegener's granulomatosis H. Cannonball metastases I. Clear cell renal carcinoma J. Polycystic kidney disease K. Wilms tumour L. Diabetic nephropathy ```

G. Wegener's granulomatosis

``` A 63 year old Scandanavian male presents with painless haematuria, fatigue, weight loss and fever. On examination a mass is found unilaterally in the loin. Family History reveals his father had Von Hippel-Lindau disease. A. Alport's disease B. Henoch-Schonlein purpura C. Hypertensive renal damage D. Goodpasture's E. Acute diffuse proliferative glomerulonephritis F. Bacterial endocarditis G. Wegener's granulomatosis H. Cannonball metastases I. Clear cell renal carcinoma J. Polycystic kidney disease K. Wilms tumour L. Diabetic nephropathy ```

I. Clear cell renal carcinoma

``` A 70year old man being investigated for haematuria and loin discomfort develops dyspnoea. A. Alport's disease B. Henoch-Schonlein purpura C. Hypertensive renal damage D. Goodpasture's E. Acute diffuse proliferative glomerulonephritis F. Bacterial endocarditis G. Wegener's granulomatosis H. Cannonball metastases I. Clear cell renal carcinoma J. Polycystic kidney disease K. Wilms tumour L. Diabetic nephropathy ```

H. Cannonball metastases Cannonball metastases is a description given to a select type of lung metastases in which multiple large masses are evident. Renal cell carcinoma is by far the commonest cause

``` A 35-year-old alcoholic presents to A&E with confusion and maleana. On examination, he has signs of chronic liver disease and is pale and clammy. BP is 90/50mmHg and he has a weak thready pulse of 130bpm. Investigations reveal FBC: Hb 6.3g/dl, MCV 108fl, WCC 3.8 x 109/l, Plt 23 x 109/l; U&Es: Na+ 123mmol/l, K+ 4.4mmol/l, urea 27mmol/l, Cr 123umol/l. A. Diabetes mellitus B. Rhabdomyolysis C. Benign prostatic hypertrophy D. IgA nephropathy E. Multiple myeloma F. Renal artery stenosis G. Henoch-Schonlein purpura H. Carcinoma of the prostate I. Haemorrhage J. Diclofenac ```

I. Haemorrhage

``` A 74-year-old man presents to his GP with increasing malaise and back pain associated with hesitancy and poor urinary stream. Subsequent investigations reveal U&Es: Na+ 134mmol/l, K+ 6.4mmol/l, urea 31.2mmol/l, Cr 1023umol/l; PSA 123nmol/l; bilateral hydronephrotic kidneys on USS. A. Diabetes mellitus B. Rhabdomyolysis C. Benign prostatic hypertrophy D. IgA nephropathy E. Multiple myeloma F. Renal artery stenosis G. Henoch-Schonlein purpura H. Carcinoma of the prostate I. Haemorrhage J. Diclofenac ```

H. Carcinoma of the prostate

``` A 61-year-old woman with kown peripheral vascular and ischaemic heart disease is started on an ACEi by her GP. 3 weeks later she is admitted to hospital with increasing confusion and pruritis. Investigations reveal FBC: Hb 12.3g/dl, MCV 85.2fl, WCC 6.8 x 109/l, Plt 403 x 109/l; U&Es: Na+ 130mmol/l, K+ 7.4 mmol/l, urea 37mmol/l, Cr 841umol/l; urinalysis – protein ++, ketones +, blood nil. A. Diabetes mellitus B. Rhabdomyolysis C. Benign prostatic hypertrophy D. IgA nephropathy E. Multiple myeloma F. Renal artery stenosis G. Henoch-Schonlein purpura H. Carcinoma of the prostate I. Haemorrhage J. Diclofenac ```

F. Renal artery stenosis

``` An 84-year-old woman is found collapsed in her flat by a neighbour. She had a fall 3 days prior to her rescue and had been unable to get up or raise the alarm. On admission to hospital investigations reveal FBC: Hb 15.3g/dl, MCV 91.2fl, WCC 23.1 x 09/l, Plt 403 x 109/l; U&Es: Na+ 145mmol/l, K+ 7.1mmol/l, urea 32.9mmol/l, Cr 649umol/l; CK 23,089iu/l. A. Diabetes mellitus B. Rhabdomyolysis C. Benign prostatic hypertrophy D. IgA nephropathy E. Multiple myeloma F. Renal artery stenosis G. Henoch-Schonlein purpura H. Carcinoma of the prostate I. Haemorrhage J. Diclofenac ```

B. Rhabdomyolysis

``` A 24-year-old man presents to his GP with an increasing rash over his lower limbs and buttocks associated with arthralgia and haematuria. He is admitted to the local hospital where investigations reveal deranged renal function and a raised serum IgA. A. Diabetes mellitus B. Rhabdomyolysis C. Benign prostatic hypertrophy D. IgA nephropathy E. Multiple myeloma F. Renal artery stenosis G. Henoch-Schonlein purpura H. Carcinoma of the prostate I. Haemorrhage J. Diclofenac ```

G. Henoch-Schonlein purpura

``` A 65 yr old lady with ischaemic heart disease and peripheral vascular disease presents at a&e with increasing confusion, hiccups and pruritus. She was started on ACE inhibitors a week ago. A. Myeloma associated ARF B. Renal artery stenosis C. Acute glomerulonephritis D. Acute tubular necrosis E. Renal obstruction F. Wegner’s granulomatous G. Acute interstitial nephritis ```

B. Renal artery stenosis

``` A 21 yr old man is admitted to hospital with multiple fractures after his motorcycle collided into a lorry on the motorway. There is myoglobin in his urine A. Myeloma associated ARF B. Renal artery stenosis C. Acute glomerulonephritis D. Acute tubular necrosis E. Renal obstruction F. Wegner’s granulomatous G. Acute interstitial nephritis ```

D. Acute tubular necrosis

``` A 50 yr old lady with A BMI of 24 who had intermittent pain in the loin, with nausea and vomiting now has a low urine output and urinalysis shows microscopic haematuria. A. Myeloma associated ARF B. Renal artery stenosis C. Acute glomerulonephritis D. Acute tubular necrosis E. Renal obstruction F. Wegner’s granulomatous G. Acute interstitial nephritis ```

E. Renal obstruction

``` A 45 yr old man with known renal problems has bilateral leg oedema. There is blood in his urine, and urine stix testing also confirms the presence of protein. Microscopy also reveals red cell casts. A. Myeloma associated ARF B. Renal artery stenosis C. Acute glomerulonephritis D. Acute tubular necrosis E. Renal obstruction F. Wegner’s granulomatous G. Acute interstitial nephritis ```

C. Acute glomerulonephritis

``` A 25 yr old man presents to his GP with a cough, nasal discharge and swollen legs. He is extremely dehydrated and is taken to hospital.He has a high cANCA titre A. Myeloma associated ARF B. Renal artery stenosis C. Acute glomerulonephritis D. Acute tubular necrosis E. Renal obstruction F. Wegner’s granulomatous G. Acute interstitial nephritis ```

F. Wegner’s granulomatous

``` A 62-year old man presents with lethargy and tiredness. He tells you that he is ‘on painkillers for back pain after a fall at work 6 weeks ago’. On examination he is pale. Blood tests reveal urea 39.2 mmol/L (normal 1.7-8.3) and creatinine 1158 μmol/L (normal 62-106). His records show that he had a creatinine of 90 μmol/L 3 months ago. A. IgA nephropathy B. Urethral stones C. Chronic kidney disease D. Thin membrane nephropathy E. Renal acidosis F. Acute interstitial nephritis G. Ureteric stones H. Hypokalemia I. Hyperkalemia J. Nephrotic syndrome ```

F. Acute interstitial nephritis

``` A 40-year old man presents acutely unwell with back pain that radiates to his groin, and nausea and vomiting. He tells you he has seen blood in his urine. On examination he is febrile. A. IgA nephropathy B. Urethral stones C. Chronic kidney disease D. Thin membrane nephropathy E. Renal acidosis F. Acute interstitial nephritis G. Ureteric stones H. Hypokalemia I. Hyperkalemia J. Nephrotic syndrome ```

G. Ureteric stones

``` A poorly controlled 48-year old diabetic lady presents with a swollen face and ankles. Blood tests show albumin <30g/L (normal 40g/L), ↑ cholesterol and normal creatinine. 24 hour urine collection reveals protein >3g. A. IgA nephropathy B. Urethral stones C. Chronic kidney disease D. Thin membrane nephropathy E. Renal acidosis F. Acute interstitial nephritis G. Ureteric stones H. Hypokalemia I. Hyperkalemia J. Nephrotic syndrome ```

J. Nephrotic syndrome

``` A 25 year old man tells you he had dark brown urine after a sore throat and has since had microscopic haematuria. Renal biopsy reveals proliferation of the mesangium. A. IgA nephropathy B. Urethral stones C. Chronic kidney disease D. Thin membrane nephropathy E. Renal acidosis F. Acute interstitial nephritis G. Ureteric stones H. Hypokalemia I. Hyperkalemia J. Nephrotic syndrome ```

A. IgA nephropathy

``` One of the complications of chronic kidney disease which has ECG features of peaked T waves, loss of the P wave and broad QRS complex A. IgA nephropathy B. Urethral stones C. Chronic kidney disease D. Thin membrane nephropathy E. Renal acidosis F. Acute interstitial nephritis G. Ureteric stones H. Hypokalemia I. Hyperkalemia J. Nephrotic syndrome ```

I. Hyperkalemia

``` The gold standard for measuring glomerular filtration rate (GFR) A. Serum creatinine B. Phosphate excretion C. Bowman's capsule D. 40 mls/min E. Inulin F. Cystatin C G. 20 mls/min H. Glucose I. Iohexol J. Serum urea K. Injected radio-isotopes L. 30 mls/min M. Potassium exccretion N. Serial creatinine readings O. 35 mls/min P. 20 mls/24 hrs ```

E. Inulin

``` Calculate the creatinine clearance for the following renal patient, following a 24 hour urine collection: urine volume 2litres; urine creatinine concentration 3mmol/l and plasma creatinine concentration 208 micro mol/l. A. Serum creatinine B. Phosphate excretion C. Bowman's capsule D. 40 mls/min E. Inulin F. Cystatin C G. 20 mls/min H. Glucose I. Iohexol J. Serum urea K. Injected radio-isotopes L. 30 mls/min M. Potassium exccretion N. Serial creatinine readings O. 35 mls/min P. 20 mls/24 hrs ```

G. 20 mls/min Creatinine clearance = (creatinine urine concentration) * (Vol) / (plasma creatinine concentration) = 3*1.39/0.208 The units have to match so convert the volume into ml/minute

``` Calculate the GFR for the following renal patient, following a 24 hour urine collection: urine volume 2.7litres; urine creatinine concentration 2mmol/l and plasma creatinine concentration 107 micro mol/l. A. Serum creatinine B. Phosphate excretion C. Bowman's capsule D. 40 mls/min E. Inulin F. Cystatin C G. 20 mls/min H. Glucose I. Iohexol J. Serum urea K. Injected radio-isotopes L. 30 mls/min M. Potassium exccretion N. Serial creatinine readings O. 35 mls/min P. 20 mls/24 hrs ```

O. 35 mls/min Creatinine clearance = (creatinine urine concentration) * (Vol) / (plasma creatinine concentration) The unit have to match

``` A good indicator of renal function A. Serum creatinine B. Phosphate excretion C. Bowman's capsule D. 40 mls/min E. Inulin F. Cystatin C G. 20 mls/min H. Glucose I. Iohexol J. Serum urea K. Injected radio-isotopes L. 30 mls/min M. Potassium exccretion N. Serial creatinine readings O. 35 mls/min P. 20 mls/24 hrs ```

N. Serial creatinine readings

``` Reflects the muscle mass of a person A. Serum creatinine B. Phosphate excretion C. Bowman's capsule D. 40 mls/min E. Inulin F. Cystatin C G. 20 mls/min H. Glucose I. Iohexol J. Serum urea K. Injected radio-isotopes L. 30 mls/min M. Potassium exccretion N. Serial creatinine readings O. 35 mls/min P. 20 mls/24 hrs ```

A. Serum creatinine

What is the formula for working out corrected calcium?

Serum Ca +0.02 x (40-serum albumin in g/L) This compensates for the albumin levels e.g. if low albumin levels due to sepsis, bound calcium will be lower but serum calcium will be normal. Therefore it tells you if there is a problem with the albumin or the calcium.

If the Ca is high and the PTH is high or normal what is the cause?

1. Primary hyperparathyroidism | 2. Familial hypocalciuric hypercalcaemia

If the Ca is high and the PTH is low what is the cause?

Malignancy, sarcoid, vitamin D excess, thyrotoxicosis, milk alkali syndrome, thiazide diuretics, hypoadrenalism

How do you treat hypercalcaemia?

Fluids, bisphosphonates, treat underlying cause

``` Which of the following is not a symptoms of hypercalcemia? A. Gallstones B. Confusion C. Polydipsia D. Constipation E. Polyuria ```

A. Gallstones It increases likelihood of KIDNEY stones Bones, moans, stones, groans

``` Renal osteodystrophy occurs due to: A. Primary hyperparathyroidism B. Primary hypoparathyroidism C. Secondary hyperparathyroidism D. Tertiary hyperparathyroidism ```

C. Secondary hyperparathyroidism No vitamin D is synthesised in the kidney causing low levels of calcium = high PTH

Give 3 causes of non PTH driven hypocalcaemia

1. Vitamin D deficiency 2. Chronic kidney disease 3. PTH resistance (psudohyoparathyroidism)

Give 3 causes of PTH driven hypocalcaemia

1. Surgery 2. Autoimmune hypoparathryroidism 3. Congenital absence of parathyroids (DiGeorges)

What biochemistry would you see in pseudohypoparathyroidism?

High PTH Low calcium High Phosphate

What is the most reliable to check if someone is hypovolaemic?

Check the urine sodium - it should be low (unless that are on diuretic)

In SIADH you will see: A. Reduced plasma osmolality and reduced urine osmolality B. Reduced plasma osmolality and raised urine osmolality C. Raised plasma osmolality and raised urine osmolality D. Raised plasma osmolality and reduced urine osmolality

B. Reduced plasma osmolality and raised urine osmolality ADH causes you to hold onto water leading to hyponatraemia and less urine output.

``` When correcting hyponatraemia you must not correct it at more than..... A. 8-10mmol/l in the first 24 hours B. 5-10 mmol/l in the first 24 hours D. 6mmol/l in the first 24 hours D. 15mmol/l in the first hour ```

A. 8-10mmol/l in the first 24 hours If you correct it more than this you risk causing osmotic dymelination (central pontine demyelination).

How do you treat SIADH?

1. Fluid restrict 2. Demeclocycline if fluid restriction isn't sufficient. Reduces collecting tubule responsiveness to ADH 3. Talvaptan = V2 receptor antagonist

List 3 causes of hypernatramia?

1. Elderly and unable to control fluid intake 2. Diabetes insipidus 3. Sweating

List 2 effects of DM on serum sodium

1. Increase in sodium due to osmotic diuresis if uncontrolled 2. Hyperglycaemia draw water out of the cells causing low sodium

How do you treat hypernatramia?

1. 5% dextrose to replace water deficit 2. 0.9% saline to correct ECF volume depletion 3. Serial Na measurements every 4-6 hours

What are the 2 main stimulants for ADH release?

1. Serum osmolality | 2. Blood pressure/volume

What are the two main stimulants for aldosterone release?

1. Potassium levels | 2. Angiotensin II

How do you treat hypervolaemic hyponatraemia?

Fluid restrict and treat underlying cause

How do you treat hypernatraemia?

5% dextrose 0.9% saline Do serial sodium measurements (only give saline if hypovolaemic)

How do you treat hyperkalaemia?

10ml calcium gluconate 100ml dextrose + insulin Nebulised salbutamol

How do you treat hypokalaemia?

If 3-3.5 = oral KcL | If <3 = IV Kcl

Acute tubular necrosis does not respond to restoration of circulating volume. True or False?

True The differences between AKI and ATN: 1. ATN does not respond to restoration of circulation 2. ATN happens with prolonged AKI 3. In ATN you will see casts in the urine.

``` Which of the following is not a complication of chronic renal failure: A. Renal bone disease B. Anaemia C. Metabolic alkalosis D. Hyperkalaemia E. Vascular calcification ```

C. Metabolic alkalosis It causes metabolic acidosis

Measuring BNP helps to assess: A. Atrial function B. Ventricular function

B. Ventricular function

A patient comes in having had a hypo due to excessive administration of insulin. What would you expect their insulin and C-peptide levels to be? A. Low insulin and low C-peptide B. High insulin and high C-peptide C. High insulin and low C-peptide

C. High insulin and low C-peptide A. would be seen in critical illness, fasting, strenuous exercise etc. B. would be seen if endogenous insulin production was causing the hypo C. would be seen when exogenous insulin is causing the hypo

ChemPath Flashcards

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