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Metabolic Flashcards

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1
Q

Causes of hypocalcaemia (8)
Hint
Remembering Low Calcium Destroys Patient People’s Brains

A
  1. Rhabdomyolysis
  2. Low magnesium, hypoparathyroidism
  3. CKD
  4. Deficiency vit D
  5. Pseudohypoparathyroidism
  6. Pancreatitis (acute)
  7. Blood transfusion massive
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2
Q

Mx of hypocalcaemia (2)

A

IV calcium gluconate, 10ml of 10% solution over 10 minutes

ECG monitoring

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3
Q

Signs and symptoms of acute hypocalcaemia (4)

ECG finding

A
  1. Trousseau’s sign
  2. Chvostek’s sign
  3. Muscle spasm
  4. Perioral paraesthesia
    ECG prolonged QT
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4
Q

What is Trousseau’s sign?

A

Sign in hypocalcaemia

BP cuff on, wrist flexion and finger adduction

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5
Q

What is Chvostek’s sign

A

Tapping over parotid causes facial muscles to twitch

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6
Q

Signs + symptoms of chronic hypocalcaemia (2)

A
  1. Depression

2. Cataracts

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7
Q

Vitamin deficiencies
Vit B9
Name
Deficiency

A

Folic acid
Megaloblastic anaemia
Neural tube defects in pregnancy

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8
Q

Vitamin deficiencies
Vit B3
Name
Deficiency

A

Niacin

Pellagra - 3 D’s, dermatitis, diarrhoea, dementia

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9
Q

Vitamin deficiencies
Vit B12
Name
Deficiency

A

Cyanocobalamin

  1. Megaloblastic anaemia
  2. Peripheral neuropathy
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10
Q

Vitamin deficiencies
Vit B1
Name
Deficiency

A

Thiamine

  1. polyneuropathy
  2. Wernicke-Korsakoff syndrome
  3. heart failure
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11
Q

Vitamin deficiencies
Vit C
Name
Deficiency

A

Ascorbic acid
Scurvy
Gingivitis
Bleeding

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12
Q

Vitamin deficiencies
Vit A
Name
Deficiency

A

Retinoids

Night blindness

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13
Q

Vitamin deficiencies
Vit B6
Name
Deficiency

A

Pyridoxine
Anaemia
Irritability
Seizures

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14
Q

Vitamin deficiencies
Vit D
Name
Deficiency

A

Ergocalciferol, cholecalciferol

  1. Rickets
  2. Osteomalacia
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15
Q

Vitamin deficiencies
Vit B7
Name
Deficiency

A

Biotin
Dermatitis
Seborrhoea

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16
Q

Vitamin deficiencies
Vit E
Name
Deficiency

A

Tocopherol, tocotrienol
Haemolytic anaemia in newborns
Ataxia
Peripheral neuropathy

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17
Q

Vitamin deficiencies
Vit K
Name
Deficiency

A

Naphthoquinone

Haemorrhage

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18
Q

Causes ALP (7)

A

Liver: cholestasis, hepatitis, fatty liver, neoplasia
Paget’s
Osteomalacia
Bone mets
Hyperparathyroidism
Renal failure
Physiological: pregnancy, growing children, healing fractures

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19
Q

BMI classification

A 
<18.5 Underweight 
18.5-24.9 Normal 
25-29.9 Overweight
30-34.9 Obese I
34.9-39.9 Obese II
>40 Obese III
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20
Q

Familial hypercholesterolaemia

When should you suspect familial hypercholesterolaemia?

Study These Flashcards
A
  1. Total cholesterol >7.5
    OR
  2. Hx or FH of 1st degree relative with CHD event <60yo
21
Q

What drugs can cause impaired glucose tolerance? (9)

Hint: CABINS TFT

Study These Flashcards
A

CABINS TFT

  1. Ciclosporin
  2. Antipsychotics
  3. BBs
  4. Interferon alpha
  5. Nicontinic acids
  6. Steroids
  7. Thiazides
  8. Furoseimde
  9. Tacrolimus
22
Q

Familial hypercholesterolaemia
If one parent has above condition when would you test the child?
If both parents have above conditions when would you test the child?

Study These Flashcards
A

Aged 10

Aged 5

23
Q

How do you diagnose familial hypercholesterolaemia?

Study These Flashcards
A

Simon Broome Criteria
Adults total cholesterol >7.5 and LDL >4.9
Children total cholesterol >6.7 and LDL >4.0

AND
Tendon xanthoma in pt or 1st or 2nd degree relative
OR
DNA based evidence of familial hypercholesterolaemia

24
Q

Familial hypercholesterolaemia

Possible diagnosis criteria

Study These Flashcards
A 
FH of:
MI <50yo in 2nd degree relative
OR
MI <60yo in 1st degree relative 
OR
FH of raised cholesterol levels
25
Familial hypercholesterolaemia | Mx
Refer to specialist First line 1. High dose statins
26
How long prior to conception should you discontinue statins and why?
3 months | Risk of congenital defects
27
Hypercalcaemia Mx (3)
1. IV fluids 3-4L/24hrs 2. Bisphosphonates (normally takes 2-3 days to work, max effect D7) 3. Calcitonin
28
ECG findings for high K+ (3)
1. Tall tented T waves 2. Small P waves 3. Widened QRS
29
Causes of hyperkalaemia | DRAMA-CHAPS
1. Drugs - BB 2. Rhabdomylsis 3. Addison's 4. Massive blood transfusion, metabolic acidosis 5. ACE inhibitors 6. Ciclosporin 7. Heparin 8. AKI 9. Potassium sparing diuretics 10. Spiro
30
Hyperlipidaemia | Who do you offer primary prevention to without the need for a QRISK score?
1. T1DM AND - >40yo OR - other CVD RF OR - T1DM for >10years OR - with nephropathy 2. CKD 3. Familial hypercholesterolaemia
31
Hyperlipidaemia | Who do you offer primary prevention to? (using QRISK)
Anyone under 85yo with QRISK >10%
32
Hyperlipidaemia | Consider primary prevention for ?
85 and over without QRISK and think about their RF
33
When would you refer someone with hyperlipidaemia to a specialist?
Total cholesterol >9 + LDL >7.5 OR Familial hypercholesterolaemia guideliens
34
What is primary prevention? + dose | What is secondary prevention? + dose
Atorvastatin 20mg | Atorvastatin 80mg
35
All CKD patient should be offered primary prevention. When should you increase the dose?
If >40% reduction in LDL is not achieved and the eGFR > 30 | If eGFR <30% refer to renal before increasing dose
36
FU for pts started on statins
Repeat lipid profile 3 months later If not >40% reduction in LDL - lifestyle factors - increase to 80mg
37
Causes of high sodium (3) | Rate of correction
1. Dehydration 2. Diabetes insipidus 3. Excessive IV saline No greater than 0.5 mmol/hour correction is appropriate
38
Causes of low K+ Low K+ with alkalosis (4) Low K+ with acidosis (4)
Alkalosis 1. Thiazides + loop diuretics 2. Vomiting 3. Cushings 4. Conns Acidosis 1. Diarrhoea 2. Renal tubular acidosis 3. Acetazolamide 4. Partially treated DKA Magnesium also, will need to be corrected first before K+ will correct itself
39
Low Na+ causes | Urinary sodium > 20
Sodium depletion, renal loss (patient often hypovolaemic) Diuretics: thiazides, loop diuretics Addison's disease Diuretic stage of renal failure Patient often euvolaemic SIADH (urine osmolality > 500 mmol/kg) Hypothyroidism
40
Low Na+ causes | Urinary sodium < 20
Sodium depletion, extra-renal loss 1. diarrhoea, vomiting, sweating 2. burns, adenoma of rectum Water excess (patient often hypervolaemic and oedematous) 1. secondary hyperaldosteronism: heart failure, liver cirrhosis 2. nephrotic syndrome 3. IV dextrose 4. psychogenic polydipsia
41
What is SIADH?
Inappropriate secretion of ADH hormone ADH acts on distal convoluting tubules and aids water reabsorption back into the bloods. SIADH therefore increases water absorption into the blood and will cause a hyponaetraemia as the sodium becomes diluted
42
What is diabetes insipidus?
Resistance/ distal convoluting tubules does not respond to ADH (vasopressin) therefore nil appropriate reabsorption of water, therefore excessive fluid loss - polyuria and polydipsia
43
Causes of SIADH | Hint: split into categories (MIND-O)
Malignancy - small cell lung ca - pancreas + prostate Infection - TB - pneumonia Neuro - stroke - SAH/ subdural/ enceph/ meningitis Drugs - sulfonylureas - SSRIs - TCAs - carbamezapine Other - PEEP - porphyrias
44
Why must correction of hyponatraemia be done slowly?
Risk of central pontine myelinolysis
45
Mx of hyponatraemia secondary to water excess (3)
1. Fluid restrict 2. Demeclocycline 3. ADH antagnoists
46
Hypercalcaemia causes | MATH PPAD
1. Malignancy 2. Acromegaly 3. Thyrotoxicosis 4. Primary hyperparathyroidism, Paget's 5. Addison's 6. Dehydration, drugs - thiazides
47
Features of hypercalcaemia (6)
Bones, stones, groans and psychic moans' 1. Osteoporosis/ osteomalacia 2. Renal stones and diabetes insipidus (polyuria and polydipsia) 3. Constipation/ N&V 4. Psychosis/ memory issues 5. Corneal calcification 6. HTN
48
ECG findings of hypercalcaemia (1)
Short QT

MSRA (22 decks)

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