Metabolic

Question 1

night blindness

Answer 1

deficiency of vitamin A (retinoids)

Question 2

neuropathy, heart failure, wernicke korsakoff

Answer 2

deficiency of vitamin B1 (thiamine)

Question 3

deficiency of vitamin B3 (niacin)

Answer 3

pellagra (dementia, dermatitis, diarrhoea, death)

Question 4

anaemia, irritability, seizures, peripheral neuropathy

Answer 4

deficiency of vitamin B6 (pyridoxine)

Question 5

dermatitis, seborrhoea

Answer 5

deficiency of vitamin B7 (bitoin)

Question 6

megaloblastic anaemia, neural tube defects

Answer 6

deficiency of vitamin B9 (folic acid)

Question 7

megaloblastic anaemia, peripheral neuropathy

Answer 7

deficiency of vitamin B12 (cynocobalamin)

Question 8

deficiency of vitamin C (ascorbic acid)

Answer 8

SCURVY (gingivitis, bleeding)

Question 9

rickets, osteomalacia

Answer 9

deficiency of vitamin D (calciferol)

Question 10

mild haemolytic anaemia in newborns, ataxia, peripheral neuropathy

Answer 10

deficiency of vitamin E

Question 11

haemorrhagic disease of newborn, bleeding

Answer 11

deficiency of vitamin K

Question 12

headaches, lethargy, dizziness, vomiting, confusion, cramps

Answer 12

hyponatremia

Question 13

3 ways to categorise hyponatremia

Answer 13

acute or chronic (48hrs)
severity (mild 130-134) (moderate 120-130) (severe below 120)
aetiology

Question 14

which class of hyponatremia is caused by dehydration, diuretics, addisonian crisis

Answer 14

hypovolemic

Question 15

which class of hyponatremia is caused by SIADH, hypothyroidism

Answer 15

euvolemic

Question 16

which class of hyponatremia is caused by heart/liver failure, metabolic syndrome

Answer 16

hypervolemic

Question 17

treatment of hyponatremia

Answer 17

hypovolemic: isotonic saline
euvolemic/hypervolemic: fluid restrict (500-1000mls) ? vaptan

Question 18

what type of saline do you use in acute/severe/symptomatic hyponatremia

Answer 18

hypertonic saline

Question 19

if untreated, what can hyponatremia cause

Answer 19

cerebral oedema/herniation

Question 20

if overcorrected, what can hyponatremia cause

Answer 20

central pontine myelinolysis (osmotic demyelination)
causes irreversible locked in syndrome after 2 days

Question 21

what are SCLC, stroke, subdrual, subarachnoid, TB, pneumonia, SSRI, tricyclics, sulph, carbemazepine causes of

Answer 21

SIADH

Question 22

management of hypercalcaemia

Answer 22

rehydrate with normal saline then give bisphosphonates

Question 23

perioral paraesthesia is a sign of what

Answer 23

hypocalcaemia

Question 24

what is trousseaus sign

Answer 24

carpal spasm when brachial occluded in hypocalcaemia

Question 25

what is chvosters sign

Answer 25

tapping the parotid causes facial muscle twitching in hypocalcaemia

Question 26

how do you find the cause of hypocalcaemia

Answer 26

measure the PTH

Question 27

management of hypocalcaemia

Answer 27

IV calcium gluconate

Question 28

ECG change in hypocalcaemia and hypercalcaemia

Answer 28

prolonged QT interval in hypo shortened QT interval in hyper

Question 29

ACEi, ARB, AKI, metabolic acidosis, rhabdomyelosis, massive blood transfusion, addisons and compartment syndrome are causes of what

Answer 29

hyperkalaemia

Question 30

ECG changes in hypokalaemia

Answer 30

prolonged QT and PR U waves sine shaped T waves (flat)

Question 31

cushings, conns and beta hydroxylase deficiency are causes of what

Answer 31

hypokalaemia with hypertension

Question 32

diuretics, D+V and renal tubular acidosis are causes of what

Answer 32

hypokalaemia without hypertension

Question 33

what would renal tubular acidosis show on an ABG

Answer 33

hyperchloraemic metabolic acidosis

Question 34

what are the four types of renal tubular acidosis and what is the potassium level

Answer 34

1. DISTAL (low K) 2. PROXIMAL (low K) 3. MIXED (low K) 4. Hyperkalaemic (high K)

Question 35

familial hypercholesterolaemia - which gene is mutated

Answer 35

mutated gene for LDL receptor

Question 36

dose for primary and secondary prevention with atorvastatin

Answer 36

primary: 20mg secondary: 80mg

Question 37

should you replace the phosphate in DKA if phosphate levels are low

Answer 37

yes

Question 38

maximum potassium transfusion if no cardiac monitor

Answer 38

10mmol/hr

Question 39

most common cause of hypopituitism

Answer 39

non secretory pituitary adenoma

Question 40

urea increased disproportionately to creatinine means

Answer 40

dehydration

Question 41

raised ALP with normal LFTs

Answer 41

bone mets

Question 42

osteomalacia and renal failure

Answer 42

raised ALP with low calcium

Question 43

hyperparathyroid and bone mets

Answer 43

raised ALP with high calcium

Question 44

3 physiological causes of raised ALP

Answer 44

pregnancy children growing healing fractures

Question 45

ECG in hyperkalaemia

Answer 45

sine wave

Question 46

management of hyperkalaemia

Answer 46

calcium gluconate THEN calcium resonium