Metabolic

Question 1

What is main problem of hyponatraemia

Answer 1

Cerebral oedema

Question 2

How treat symptomatic hyponatraemia

Answer 2

Hypertonic saline (3%)

Question 3

What is cutoff sodium level to have to use hypertonic saline

Answer 3

Below 120mmol/L

Question 4

What is risk of rapid correction of hypernatraemia

Answer 4

Cerebral oedema

Question 5

Markers of deydration on bloods

Answer 5

Polycythaemia
Hypernatraemia
Urea raised out of proportion to creatinine

Question 6

Euvolaemic causes of hyponatraemia

Answer 6

Hypothyroidism
SIADH
Addisons

Question 7

Causes of hyponatraemia with high urinary sodium

Answer 7

SIADH
Hypothyroidism
Addisons
Diuretics

Question 8

Preferred form of giving calcium if hypocalcaemic

Answer 8

Calcium gluconate as calcium chloride irritant

Question 9

When give IV calcium gluconate in hypocalcaemia

Answer 9

Prolonged QT
Tetany
Seizures

Question 10

Which drugs can cause hyperkalaemia

Answer 10

ACEi
ARB
Spironolactone
Heparin

Question 11

Criteria for diagnosing FH

Answer 11

Simon broome

Question 12

Management of asymptomatic hyperuricaemia

Answer 12

No need for allopurinol etc so no treatment

Question 13

What is methaemoglobinaemia

Answer 13

When there is increased levels of haemoglobin where Fe2+ has been converted to Fe3+ which cant bind oxygen

Question 14

What are causes of methaemoglobinaemia

Answer 14

Congenital
Acquired- Poppers typically due to nitrate

Question 15

What causes chocolate coloured blood and chocolate cyanosis

Answer 15

methaemoglobinaemia

Question 16

Presentation of methaemoglobinaemia

Answer 16

Chocolate cyanosis
SOB, anxiety
Acidosis- arrythmias, confusion, seizures
Normal pO2 but reduced sats

Question 17

What are pO2 and oxygen sats in methaemoglobinaemia

Answer 17

Normal pO2
Reduced sats

Question 18

Management of methaemoglobinaemia

Answer 18

IV methylene blue

Question 19

Causes of hypophosphataemia

Answer 19

Insulin treatment
Liver failure
Refeeding
Hyperparathyroidism

Question 20

What happens if hypophosphataemic

Answer 20

Red cell haemolysis
Muscle weakness and rhabdo
CNS dysfunction
Messes up WCC and platelets

Question 21

Management of hypophosphataemia

Answer 21

If mild will resolve
If severe give IV phosphate

Question 22

What causes hypophosphataemia in DKA

Answer 22

Insulin treatment

Question 23

Blood gas findings of renal tubular acidosis

Answer 23

Hyperchloraemic metabolic acidosis
Hypokalaemia seen
Normal anion gap

Question 24

What are the 4 types of renal tubular acidosis and what is pathology for each

Answer 24

Type 1- DCT affected
Type 2- PCT affected
Type 3- DCT and PCT
Type 4- RAAS

Question 25

Complications of type 1 RTA

Answer 25

Hypokalaemia Nephrocalcinosis->renal stones

Question 26

Causes of T1 RTA

Answer 26

idiopathic, RA, SLE, Sjogren's, amphotericin B toxicity, analgesic nephropathy

Question 27

Causes of T2 RTA

Answer 27

Fanconi syndrome, Wilson's disease, outdated tetracyclines, carbonic anhydrase inhibitors

Question 28

Complications of T2 RTA

Answer 28

Hypokalaemia Osteomalacia

Question 29

What is scoring system for malnutrtion

Answer 29

MUST

Question 30

What is problem of giving statin and macrolide

Answer 30

Can get myopathy leading to elevated CK levels

Question 31

Who should be on a statin

Answer 31

Established CVD Q-RISK >10% T1DM - nephropathy - over 40 - had DM >10 years

Question 32

What is monitoring for statins

Answer 32

LFTs at baseline, 3 months and 12 months

Question 33

When stop statins based off LFTs

Answer 33

If transaminitis reaches over 3x upper limit

Question 34

How manage transaminitis from statins

Answer 34

If reaches over 3x upper limit then stop

Question 35

What is danger of using excess NaCl

Answer 35

Hyperchloraemia metabolic acidosis

Question 36

When fluid prescribing what is daily requirement for glucose to avoid starvation ketosis

Answer 36

50-100g/day irrespective of weight

Question 37

Most common cause of primary hyperparathyroidism

Answer 37

Solitary adenoma

Question 38

Initial hyperkalaemia mangement

Answer 38

Calcium gluconate and insulin/dextrose infusion

Question 39

How is calcium resonium administered

Answer 39

Enema

Question 40

Management of primary hyperparathyroidism

Answer 40

Definitively total parathyroidectomy If not appropriate for parathyroidectomy surgery then give cinacalcet calcimimetic

Question 41

What can give for primary hyperparathyroidism if not eligible/suitable for surgery

Answer 41

Cinacalcet- calcimimetic as acts on calcium sensor

Question 42

How calculate anion gap

Answer 42

Sodium+potassium-bicarb- chloride

Question 43

Why give pyridoxine with isoniazid

Answer 43

To prevent peripheral neuropathy

Question 44

What causes bone disease in CKD

Answer 44

High phosphate drags calcium from bones

Question 45

What is STOPP tool

Answer 45

Used in older patients to identify if need a medication

Question 46

What is START tool

Answer 46

Tool which identifies medications which require additional protective protective medications for example needing a PPI on something which causes ulcers

Question 47

Vitamin C deficiency presentation

Answer 47

Bruising and bleeding Joint pain Weakness and malaise

Question 48

Causes of normal anion gap metabolic acidosis

Answer 48

Bicarb loss - diarrhoea - fistula Renal tubular acidosis Addisons NaCl overdose Drugs- acetazolamide

Question 49

Raised anion gap metabolic acidosis

Answer 49

Lactate froms sepsis, shock Ketones from DKA and alcohol Uraemia Salicylates and methanol

Question 50

Management of salicylates overdose

Answer 50

IV sodium bicarbonate if arrhythmias or widened QRS Dialysis if pulmonary oedema or metabolic acidosis

Question 51

What happens to chlorine if vomiting

Answer 51

Goes down a lot

Question 52

Amyloidosis presentation

Answer 52

Most commonly- SOB and weakness Nephrotic syndrome- oedema Macroglossia Carpal tunnel syndrome Hepatosplenomegaly Restrictive cardiomyopathy

Question 53

Metabolic changes seen in refeeding syndrome

Answer 53

Hypokalaemia Hypomagnaesaemia Hypophosphataemia

Question 54

In refeeding syndrome, what is most likely cause of torsades des pointes

Answer 54

Hypomagnaesaemia

Question 55

ECG findings of hypomagnaesaemia

Answer 55

Same as hypokalaemia

Question 56

If have received adequate nutrition but are still hypocalcaemic, what electrolyte are you likely deficient in

Answer 56

Magnesium as vital for PTH release

Question 57

What is recommended infusion rate for potassium

Answer 57

10mmol/hour If go above then needs to be done on ITU with cardiac monitoring

Question 58

In HHS what is desired fluid balance after 12 hours

Answer 58

+3-6 Litres

Question 59

Causes of SIADH

Answer 59

Drugs CNS pathlogy- SAH, meningitis, encephalitis Surgery Pneumonia Small cell cancer

Question 60

Drug causes of SIADH

Answer 60

Carbamazepine Opiates TCAs PPIs SSRIs

Question 61

Causes of hypernatraemia

Answer 61

HHS Diabetes inspidus Dehydration Excess saline

Question 62

Management of severe hypernatraemia

Answer 62

Fluids with dextrose 5% and NaCl

Question 63

Risk of rapid hyponatraemia correction

Answer 63

Central pontine myelinolysis

Question 64

Hypokalaemia causes

Answer 64

D&V Conns and cushings Alkalosis RTA Thiazides and loop Insulin and salbutamol Refeeding

Question 65

Hypokalaemia management

Answer 65

3-3.5= sandoK tablets Less than 3 or symptomatic= IV KCl

Question 66

Chvostek vs trousseaus sign

Answer 66

Chvostek= cheek Trousseaus= blood pressure

Question 67

Hypocalcaemia causes

Answer 67

Osteomalacia chronic kidney disease hypoparathyroidism (e.g. post thyroid/parathyroid surgery) pseudohypoparathyroidism rhabdomyolysis magnesium deficiency massive blood transfusion acute pancreatitis

Question 68

Hypercalcaemia causes

Answer 68

Primary PTH Tertiary PTH Cancer - myeloma - mets - PTHrp from squamous lung and RCC Sarcoid Thiazides

Question 69

How calculate osmolarity vs osmolality

Answer 69

Osmolality= osmometer Osmolarity= 2(Na+K)+Urea+Glucose