Metabolic medicine

Question 1

What is the criteria called used to diagnose Familial Hypercholesterolemia?

Answer 1

Simon-Broome

Question 2

What is the mutation in that causes Familial Hypercholesterolemia?

Answer 2

LDL-receptor protein

Question 3

How is familial hypercholesterolemia inherited?

Answer 3

Autosomal Dominant

Question 4

How can Hypercalcemia be treated?

Answer 4

• Normal saline
• Bisphosphonates, calcitonin

Question 5

What can hyponatremia cause?

Answer 5

Cerebral oedema

Question 6

How is hyponatremia treated?

Answer 6

• Normal saline
• Hypertonic 3% saline if acute and severe

Question 7

How is hypernatremia usually treated?

Answer 7

Normal saline
- diuretics possibly considered

Question 8

How can hypomagnesium be treated?

Answer 8

• Oral Magnesium (MG citrate) or IV magnesium (sulfate)

Question 9

How can hypermagnesium technically be treated?

Answer 9

• IV Calcium gluconate (works in opposite direction)
• Loop diuretic
• Haemodialysis

Question 10

How can hypocalcemia be treated?

Answer 10

• IV calcium gluconate (10 ml 10% solution over 10 mins) (ECG monitoring required), often 50 mL/hour
• Asymptomatic: PO calcium gluconate

Question 11

HYPOKALEMIA: iv PREPS

Question 12

If both magneisum and potassium are low what is given first?

Answer 12

Magnesium

Question 13

How can central diabetes insipidus be treated?

Answer 13

Desmopressin

Question 14

How can nephrogenic DI be treated?

Answer 14

• Thiazides
• Low salt / protein diet

Question 15

What can be used in the treated of SIADH? (3)

Answer 15

• Fluid restriction
• Demeclocycline (reduces responsiveness of CT to ADH)
• ADH (vasopressin) receptor antagonists

Question 16

What can happen if SIADH is treated too quickly?
- Or any hyponatremia for that matter?

Answer 16

Osmotic demyelination syndrome (Central pontine myelinolysis)

Question 17

How does ezetimibe work?

Answer 17

Inhibits cholesterol receptors on enterocytes, decreasing cholesterol absorption in the small intestine

Question 18

SIADH causes what electrolyte abnormality?

Answer 18

Hyponatremia

Question 19

Metformin in dehydration may cause what?

Answer 19

Lactic acidosis

Question 20

Sodium bicarbonate is used in what?

Answer 20

Metabolic acidosis

Question 21

what is a normal anion gap?

Answer 21

10 to 18

Question 22

Acetazolamide ca cause what electrolyte abnormalities?

Answer 22

Hypomagnesemia
Hypokalemia

Question 23

Max infusion rate of K+

Answer 23

10mmol per hour

Question 24

Asymptomatically elevated uric acid is treated how?

Answer 24

With nothing

Question 25

What is Chvostek sign and Trousseau sign associated with?

Answer 25

Hypocalcemia

Question 26

Vasopressin receptor antagonist example

Answer 26

Tolvaptan (may be used in ADPKD, SIADH w. hyponatremia)

Question 27

What are the electrolyte abnormalities in Refeeding syndrome?

Answer 27

- Low Mg - Low K+ - Low Phosphate - May cause low Ca2+ - Thiamine deficiency also - ?Oedema

Question 28

What are the electrolyte abnormalities in Tumour-lysis syndrome?

Answer 28

- High K+ - High Urate - High Phosphate - Low Ca2+ - Low LDH

Question 29

Heparin and Beta blockers both cause what electrolyte abnormality?

Answer 29

Hyperkalemia

Question 30

What type of RTA is associated with hyperkalemia?

Answer 30

Type 4 (decreased aldosterone)

Question 31

What RTA is associated with bone conditions (osteomalacia, multiple myeloma)? - Also hypokalemic

Answer 31

Type 2 RTA

Question 32

What is the risk of giving too much 0.9% saline?

Answer 32

Hyperchloraemic metabolic acidosis

Question 33

Maintenance electrolytes:

Answer 33

Approximately 1 mmol/kg/day of potassium, sodium and chloride

Question 34

Sum up pediatric fluid prescribing in terms of how much water to give per kg for each weight?

Answer 34

- 1st 10kg of weight: 100ml/kg - 2nd 10kgs (10 - 20 kg): 50ml/kg - Over 20kgs: 20ml/kg REMEMBER 100 -> 50 -> 20

Question 35

Maintenance fluid/water per kg per day:

Answer 35

25-30 ml/kg/day of water

Question 36

Maintenance glucose per day:

Answer 36

50-100 g/day

Question 37

2 main potassium fluids (percentages) and mmol etc

Answer 37

- 0.3% potassium chloride in 0.9% NaCl = 40mmol / L (max rate is over 4 hrs) - 0.15% potassium chloride in 0.9% NaCl = 20 mmol/L (max rate is over 2 hours)

Question 38

Max rate at which 0.3% potassium chloride in 0.9% NaCl can be given? (1 litre)

Answer 38

4 hrs per Litre (as 40mmol per Litre)

Question 39

Max rate at which 0.15% potassium chloride in 0.9% NaCl can be given? (1 litre)

Answer 39

2 hrs per Litre (as 20 mmol per Litre)

Question 40

What RTA is associated with renalstones and the distal tubule also hpokalemic and fails to excrete H+

Answer 40

Type 1