January Revision 2024-2025

January Revision 2024-2025. BC6062.

A group of men sitting at a table Description automatically generated with medium confidence.

Section A.

[Audio] Cirrhosis of the liver can be caused by? all of the above options.

[Audio] Which of the following is the most sensitive marker of liver injury? aminotransferases.

[Audio] Which of the following cell types found in the liver are the effector cells of fibrosis: stellate cells.

[Audio] Which of the following is a specific cardiac biomarker of myocardial infarction: troponin I.

[Audio] In primary hypercholesterolaemia the blood cholesterol in heterozygotes is: >7.8 mmol/l.

[Audio] Which of the following is not a feature of non-alcoholic steatohepatitis (NASH) lymphoid follicles.

[Audio] Increases in intracellular free cholesterol result in: decreased HMG CoA (hydroxymethylglutaryl-coenzyme A) reductase.

[Audio] A 4-year-old child was reviewed at the children's hospital with hepatosplenomegaly and mental retardation. Biopsy reveals accumulation of sphingomyelin. What is the disease? Niemann Pick's.

[Audio] Treatment regimes for type II diabetics can include: all of the above options.

[Audio] The non-enzymatic glycosylation product haemoglobin A1C reflects glycaemia: over the last 2 months.

[Audio] Statins are first line drugs for lowering LDL-cholesterol and their major mechanism of action is: HMG CoA reductase inhibitors.

[Audio] Respiratory alkalosis develops when respiratory activity: lowers plasma pCO2 to below to normal levels.

[Audio] As a result of the aging process, changes in the ability to regulate pH through renal compensation is the result of: a reduction in the number of functional nephrons.

[Audio] Which of the following patients is at most risk for hypomagnesaemia: a 55-year-old chronic alcoholic.

[Audio] The haemoglobin buffer system helps prevent drastic alterations in pH when: the plasma pCO2 is rising or falling.

[Audio] Which patient is at more risk of an electrolyte imbalance? an 8-month-old with a fever of 40oC and diarrhoea.

[Audio] A 48- year-old male with renal failure, missed his dialysis and was feeling sick, what could be the reason? metabolic acidosis.

[Audio] Which of the following laboratory results below indicates compensated metabolic alkalosis? high pCO2, high bicarbonate, high pH.

[Audio] Which of the following does not cause hypokalaemia: renal failure.

[Audio] Which patient below would have a potassium level of 5.5 (normal potassium levels are 3.5 to 5.1): a patient with Addison's disease.

[Audio] Which of the following liver function tests (LFTs) are specific for cirrhosis: none of the above alternatives.

[Audio] In the differential diagnosis of cholestatic or hepatocellular (hepatic) jaundice which of the following biochemical measurements are important: all of the above options.

[Audio] Which of the following is the most useful cardiac biomarker of myocardial infarction (MI): creatine kinase.

[Audio] Type I diabetes is characterised by: islet cell autoantibodies.

[Audio] The oral glucose tolerance test (OGTT) is diagnostic for diabetes when: the blood glucose at 2 hr greater than 11 mmol/l.

[Audio] Thyroid stimulating hormone (TSH), tri-iodothyronine (T3) and Thyroxine (T4) measurements are important in the biochemical investigation of: all of the above.

[Audio] A 19-year-old male presented with tendon xanthoma and had a plasma cholesterol level of 20 mmol/l, triglyceride of 0.9 mmol/l and electrophoresis showed increased β- lipoprotein (LDL). What do these results indicate: a homozygotic form of hypercholesterolaemia.

[Audio] Cholesterol is transported from extra hepatic tissue to the liver by which of the following lipoproteins? HDL.

[Audio] Over 1000 mutations have been described for the LDL receptor, where do the majority occur: within the EGF precursor homology domain.

[Audio] A 15-year-old boy is admitted to the A&E department of a local hospital. He is fatigued, with ketones in his urine. These clinical and laboratory findings indicate. diabetic ketoacidosis (DKA) condition.

[Audio] Chronic diarrhoea causes a severe loss of bicarbonate ions, resulting in: metabolic acidosis.

[Audio] The major contributors to the osmolarities of the extracellular fluid (ECF) and the intracellular fluid (ICF) are: sodium and potassium.

[Audio] Which of the following is most appropriate for a female suffering from type 1 diabetes with a blood pH of 7.2, HCO3 of 17 mmol/L and pCO2 of 20 mm Hg. metabolic acidosis.

[Audio] After obtaining an Electrocardiography (ECG) on a patient you notice that an ST wave depression is present along with an inverted T wave and prominent U wave. What analyte would be the cause of this finding (normal potassium levels are 3.5 to 5.1): potassium level of 2.2.

[Audio] Which of the following compounds can act as an acid when dissolved in water: H2CO3, H2PO4- AND NH4+ All of the above.

[Audio] An 87-year-old woman had a bad cold. After two weeks she complained that, "It's gone to my chest, can't stop coughing and it feels tight in my chest and I am unable to breathe!" What could be the possible reason? respiratory acidosis.

[Audio] Under normal circumstances, during respiratory acidosis the chemoreceptors monitoring the pCO2 of the plasma and CSF will eliminate the problem by: decrease in pulmonary ventilation rates.

[Audio] A mismatch between carbon dioxide generation in peripheral tissues and carbon dioxide excretion in the lungs is a: respiratory acid-base disorder.

[Audio] When a normal pulmonary response does not reverse respiratory acidosis, the kidneys respond by: increasing the rate of hydrogen ion secretion.

[Audio] Which of the following are not associated with metabolic alkalosis? hypoaldosteronism.

[Audio] Which of the following options are associated with metabolic acidosis? A decreased blood pCO2.

[Audio] What other factors should be taken into account to assess the patient's overall cardiovascular risk? While the lipid profile is important, other factors must be taken into account to assess global cardiovascular risk. These factors vary from one risk assessment method to another, but routinely will include age, gender, smoking status, diabetic status, blood pressure, and personal and family history of cardiovascular disease. The most widely used method to assess risk is based on the Framingham Risk Equation, which requires the input of age, gender, total and HDL-cholesterol, systolic blood pressure and smoking status. This man was a non-smoker and had a SBP of 140 mmHg, and his calculated 10-year risk of cardiovascular disease is 11%..

[Audio] Outline the laboratory tests currently used to assess GFR and their limitations. Exogenous markers – Inulin, Iohexol, EDTA Cromium-51 Clearance = (Urinary Conc. X Urinary flow)/Plasma conc. = GFR eGFR equations –Cockcroft-Gault, MDRD, CKD-EPI Hierarchy of GFR testing- Accuracy vs practical use.

[Audio] Describe in detail the metabolic changes that can lead to diabetic ketoacidosis and the treatment options for type 1. Details of normal effects of insulin – role of liver, muscle, adipose tissue. Type I and II differences. Diabetic ketoacidosis, details hyperglycaemia, lipolysis and ketones - increased free fatty acids (FFA's) in the plasma, increased gluconeogenesis, increased ketogenesis, counterregulatory hormone details, glycosuria, dehydration, diagram of consequences. Details of nutrition/drug therapy to maintain normal blood glucose. Eating synchronised with insulin, short, medium and long acting. Metformin, thiazolidinediones and sulfonylureas. Details of total carbohydrate, protein restriction, lipid-lowering diets, BDA 1992, ADA 1995, evidence from DCCT trials ADD MORE.

[Audio] Compare and contrast the causes and laboratory investigation of pseudohyperkalaemia and pseudohyponatraemia. Causes – Pseudohyperkalaemia (Plasma potassium results should not be reported if the specimen is haemolysed or if plasma was not separated from cells within a few hours after the blood was taken. Pseudohyperkalaemia, due to in vitro leakage of potassium from cells into plasma, is often misinterpreted, sometimes with dangerous consequences. This may occur if there has been a delay in separating the plasma from the cells, particularly if the blood sample has been refrigerated, when the activity of the Na+/K+ -ATPase pump is slowed. A rare familial form of pseudohyperkalaemia is thought to be due to defective red cell membranes in hereditary spherocytosis. Thrombocytosis and leucocytosis can also result in pseudohyperkalaemia. Also, beware of blood tubes contaminated with potassium-EDTA (ethylenediamine tetra-acetic acid): blood samples for potassium assay should usually be collected in lithium heparin tubes. The causes of hyperkalaemia are summarized in Box 5.2, and can be classified into renal and non-renal causes). – Pseudohyponatraemia Indirect reading ISE issue Raised total protein Raised Lipids Lab Investigation Potassium – ETDA pattern – chelation of Mg Ca and raise K Drip arm pattern, Serum indices (haemolysis) Sodium – Measure Tot Protein and Lipids Direct vs indirect ISE reading Plasma Osmolality.

[Audio] What is the significance of abnormal liver function? Liver function test has several components and four of them are enzymes- alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT). Interpreting abnormal LFTs When interpreting liver function test results, it is essential to consider patient`s clinical history, symptoms, risk factors, drug history, alcohol history. Careful examination of these factors helps to determine the real cause of abnormal liver function test results. For instance, travelling to developing countries, IV drug use, tattoos are all risk factors for viral hepatitis. Looking at the drugs that patient is taking may help to exclude drug induced liver injury. After careful examination of LFT results, it is possible to determine the type of liver damage. ALT is typically raised when the hepatocytes are damaged e.g. hepatitis. On the other hand, ALP and GGT activity appears high in conditions that cause blockage of bile duct or biliary inflammation. However, in many liver conditions, numerous enzymes can be raised at the same time. In this case, the enzyme with the highest plasma concentration determines the type of liver injury. It is worth sometimes to repeat liver function test to exclude a temporary increase of liver enzymes due to a non- specific cause. It is not enough to look just at the individual component of the liver function test. For example, high serum aminotransferases (ALT, AST) will prompt a clinician to request further tests such as viral serology and autoantibody screen, to confirm the diagnosis. Whereas, high results for ALP, GGT, bilirubin, suggesting cholestatic conditions, will be followed by imaging techniques..

[Audio] Describe how urinary albumin can be used in monitoring kidney disease? Urine Albumin, or microalbumin, is a biomarker of CKD (chronic kidney disease). Microalbumin is a very small amount of albumin in urine. Microalbumin test (ACR- albumin/creatinine ratio) is used to detect early signs of kidney damage. ACR test is more sensitive than a urine dipstick test that is also used to detect proteins as it can detect very small amounts of albumin present in urine. In a healthy person, kidneys filter waste from blood and excrete with urine. Proteins get reabsorbed and re-used. However when kidney function is impaired, proteins leak through and get excreted with urine. Albumin is one of the first proteins to leak when kidneys are damaged. Patients with ACR (albumin/creatinine ratio) >2.5 mg/mmol in males, and >3.5 mg/mmol in females require repeated ACR testing on two more occasions to confirm microalbuminuria. It is important to be aware that apart from kidney damage there are few other causes of microalbuminuria- uncontrolled hypertension, UTI, heart failure, menstrual contamination, strenuous exercise and others..