More SAQ

Question 1

Medical management of Cushings

Answer 1

Metyrapone

Ketoconazole

Question 2

Where and how does aldosterone act

Answer 2

Distal convoluted tubule and collecting duct of kidney.
Reabsorbs sodium in exchange for potassium and hydrogen. Water follows sodium. Creates hypernatraemia, hypertension, hypokalaemia and metabolic alkalosis.

Question 3

How to differentiate between primary hyperaldosteronism and secondary aldosteronism and give a cause for each.

Answer 3

Primary e.g. Conn’s (unilateral adrenal hyperplasia) has a high plasma aldosterone but low plasma renin.
Secondary e.g. renal artery stenosis, CHF, diuretics and nephritic syndrome (continuous RAAS activation), will have a high serum aldosterone and renin.

Question 4

3 features in acute adrenocortical failure (Addisonisn crisis)

Answer 4

Hypotensive shock
Hypovolaemic shock
Hypoglycaemia

Question 5

1. 3 causes of hypontraemia

2. 3 symptoms and signs fo hyponatraemia

Answer 5

1. SIADH, thiazide diuretics, oedematous states e.g. liver failure, heart failure, Addison’s and adrenal insufficiency, diarrhoea.
2. Symptoms = headache, lethargy, myalgia and cramps, nausea. Signs = altered mental state/confusion, signs of causes e.g. peripheral oedema, tachycardia.

Make sure you correct Na slowly to prevent cerebral oedema!

Question 6

1. 3 causes of hypernatraemia.

2. Symptoms and signs of hypernatraemia

Answer 6

1. Diabetes insipidus, excessive sweating e.g. marathon running, Conns and hyperaldosteronism, severe burns.
2. Lethargy, weakness, confusion, irritability, myoclonic jerks and seizures.

Question 7

1. 3 causes of hypokalaemia
2. Signs and symptoms of hypokalaemia
3. ECG changes

Answer 7

1. Diuretics, hyperaldosteronism (Conn’s), bulimia, diarrhoea, burns, low magnesium.
2. Myalgia, lethargy, paraesthesia, constipation
3. U waves, T wave flattening, PR prolongation, ST depression.

Question 8

1. 3 causes of hyperkalaemia
2. Signs and symptoms of hyperkalaemia
3. ECG changes.

Answer 8

1. Addison’s, CKD, AKI, spironolactone.
2. Palpitations, nausea, myalgia, paresthesia, bradycardia, muscle weakness
3. Tall T waves, flat P waves, sine wave, VF.

Question 9

1. 3 causes of hypocalcaemia.

2. Signs and symptoms of hypocalcaemia.

Answer 9

1. Hypoparathyroidism, vitamin D deficiency, tumour lysis syndrome.
2. Chvostek’s sign, tetany, seizures, muscle cramps, parasthesia, confusion.

Question 10

1. 3 cause of hypercalcaemia

2. Signs and symptoms of hypercalcaemia

Answer 10

1. Hyperparathyroidism, malignancy (breast, lung, bladder), thiazide diuretics, CKD
2. Bone pain, osteoporosis, confusion, depression, lethargy, muscle weakness, abs pain, n+v, anorexia, renal colic, polyuria, polydipsia.

Question 11

2 hormones in calcium homeostasis

Answer 11

Parathyroid and calcitonin.

Question 12

Do osteoclasts release calcium or use it to lay down bone?

Answer 12

They release is bu breaking bone down.

Osteoblasts use calcium to lay down bone.

Question 13

2 signs O/E of acute pancreatitis

Answer 13

Periumbilical discolouration - Cullen’s sign

Flank discolouration – Grey-Turner’s sign

Question 14

Where is the pain in chronic pancreatitis

Answer 14

Epigastric, may radiate to back. Worse 30mins after meals, relieved by sitting forward.

Question 15

1 investigation (not imaging) for chronic pancreatitis

Answer 15

faecal elastase (reduced in chronic pancreatitis).

Question 16

Key thing the med school would put in a Hx for HAV

Answer 16

Distaste for cigarettes

Question 17

Blood tests for Wilson’s disease

Answer 17

Serum caeruloplasmin
Serum copper (this is low because the copper is in the tissues not the blood!)

Question 18

Mechanism of action of Fondaparinux

Answer 18

Activate anti-thrombin III

Question 19

Mechanism of action of aspirin

Answer 19

Inhibit production of thromboxane A2

Question 20

Mechanism of action of Clopidogrel

Answer 20

Inhibit ADP binding to platelet receptor

Question 21

Bone profile blood results in osteoporosis

Answer 21

calcium, phosphate and ALP are mostly normal

Question 22

Difference between bulbar palsy and pseudo bulbar palsy and give some causes for each

Answer 22

Bulbar palsy = LMN lesion of CN 9, 10 and 12. Causes include MND, poliomyelitis, neurosyphilis, Guillian-Barre.

Pseudobulbar palsy = UMN lesion of CN 9, 10 and 12. Causes include bilateral CVA of internal capsule, MS, head injury.

Question 23

S+S of bulbar palsy V pseudobulbar palsy

Answer 23

Bulbar = absent gag reflex, wasted fasciculations tongue, nasal speech.

Pseudobulbar = increased gag reflex, spastic tongue, “Donald Duck’ dysphonic voice.

Question 24

Long term complication of Bell’s palsy

Answer 24

Corneal ulceration

Question 25

Complete cranial nerve III palsy produces what features?

Cause of an isolated CN3 palsy

Answer 25

Fixed, dilated
Complete ptosis (paralysis of elevator palpebral superioris)
Down and out pupil

Posterior communicating artery aneurysm

Question 26

Metabolic cause of proximal myopathy

Answer 26

Thyrotoxicosis

Question 27

Do plantars flex or extend in cauda equina

Answer 27

Flex/normal (LMN)

Question 28

A lesion of cranial nerves IX and X may produce what features?

Answer 28

Dysphonia due to vocal cord paralysis

Question 29

Difference in muscles with UMN and LMN lesions

Answer 29

LMN = hypotonia, flaccid weakness, atrophy, fasciculations.
UMN = hypertonia, spastic weakness (stiffness), extensor positive Babinski sign
Clonus

Question 30

Which of the following is NOT a cause of hepatomegaly
malaria
chronic renal failure
leukaemia
right heart failure
alcoholic hepatitis

Answer 30

chronic renal failure

Question 31

Major side effects of statin

Answer 31

Myalgia

Hepatocellular damage + jaundice.

Question 32

Difference in symptoms between tumours of pancreas head and body/tail

Answer 32

Head = painless jaundice
Body/head = epigastric pain, anorexia, weight loss.

Question 33

What is a complication of transjugaular intrahepatic portosystemic shunt?

Answer 33

Hepatic encephalopathy as ammonia is shunted into systemic system.

Question 34

Nail sign due to hypoalbuminaemia

Answer 34

Leuconychia

White discolouration

Question 35

What blood test could be a marker/risk factor for prematurity

Answer 35

Fibronectin.

Question 36

Difference between induction and augmentation of labour

Answer 36

Induction = initiate labor before spontaneous onset has occurred to achieve a normal vaginal delivery.
Augmentation = enhancement of the uterine contractility in a woman who has begun labor