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Which of the following statements is true?
Which of the following statements is true?
Which of the following statements is true?
Which of the following statements is true?
Which of the following statements is true?
Which of the following statements is true?
Which of the following statements is true?
Which of the following statements is true?
Which of the following statements is true?
Which of the following statements is true?
In anaerobic conditions, the metabolism of glucose produces lactate.
Where in the body can lactate be converted back into glucose?
Lactic acidosis occurs due to either increased lactate production or decreased lactate clearance.
What clinical situation might account for decreased lactate clearance?
Where in the cell does the metabolism of pyruvate occur during the citric acid cycle?
Ribose is a sugar required for the production of nucleic acids.
Which biochemical pathway is involved in the production of ribose?
Which biochemical pathway is important in maintaining the structure and function of mature erythrocytes?
Which vitamin is required as a cofactor for the enzyme transketolase?
Glycogen storage diseases (GSDs) occur due to inherited deficiencies of enzymes involved in glycogen formation or breakdown. With appropriate treatment, patients with von Gierke’s disease (GSD type I) can survive to adult age.
What symptom or sign is likely to be prominent?
Which hormone activates lipoprotein lipase and promotes triacylglycerol synthesis?
Which amino acid is required for production of thyroxine?
Which protein is converted into biliverdin as part of its degradation process?
You are reviewing blood results on a 49-year-old man who has presented with cirrhosis related to excess alcohol consumption. You note that he has metabolic alkalosis.
Which of the following is the likely primary pathological mechanism?
A 21-year-old male medical student who has been feeling non-specifically unwell for several days is noticed to have slightly icteric sclerae by his girlfriend and has liver function tests performed. The results of these are normal apart from a serum bilirubin concentration of 44 μmol/l (3–17). His urine does not contain bilirubin.
Which of the following is the most likely diagnosis?
A 64-year-old woman who is treated with subcutaneous teriparatide for osteoporosis, comes to the clinic for review. She has now been taking the medication for 2 months.
Which of the following is most useful in measuring the response to teriparatide?
A 74-year-old woman is asked to attend the endocrine clinic having had a routine blood test at the GP surgery which revealed hypercalcemia with a calcium of 2.88 mmol/l. She has had mild asthma for the past 40 years, takes a salbutamol inhaler, and uses amlodipine for control of blood pressure. Physical examination is unremarkable with a blood pressure of 122/82, pulse is 65 and regular. Heart sounds are normal, her chest is clear. Her BMI is 23. Renal function is normal with a creatinine of 82.
Which of the following is the most likely cause of her hypercalcemia?
You are reviewing a man with familial hypertriglyceridemia who has presented to the surgeons with pancreatitis. He asks about why he suffers from this condition.
Which of the following best describes the metabolism of VLDL (predominant triglyceride) particles?
A 75-year-old man with symptoms of prostatism over the last 5–6 months comes to the clinic for review. Abdominal examination is unremarkable, he has no renal masses and does not have a palpable bladder. PR is unremarkable. He has a serum prostate-specific antigen (PSA) concentration of 7.0 ng/ml, and his creatinine is 150 μmol/l.
Which of the following statements is true with regard to this result?
A 72-year-old man has pain in his left hip which has progressively worsened over the past six months, such that his movement is now severely limited. Examination reveals severe limitation of flexion and external rotation of the left hip. A hip X-ray shows gross deformity of the joint with loss of joint space and extensive new bone formation. You suspect Paget’s disease.
Which of the following is most likely to be elevated?
A 54-year-old woman has undergone some blood tests as part of an employment health screen. She reports she is in good health and, being very health conscious, takes regular vitamin and mineral supplements. She is taking bendrofluazide 2.5 mg for hypertension and her blood pressure is 132/82 mmHg. The only abnormalities are a serum calcium concentration of 2.94 mmol/l and a phosphate level just under the lower end of the normal range.
Which of the following is the most likely cause?
A 72-year-old woman presents to the Emergency department with gradually worsening nausea, vomiting and drowsiness. According to relatives she has suffered from a chronic cough for some time, and has gradually lost weight. She continues to smoke 10 cigarettes per day.
Examination reveals a blood pressure of 148/82, pulse is 72 and regular. Auscultation of the chest reveals crackles and quiet wheeze consistent with COPD. Abdomen is soft and nontender with a BMI of 22. Bloods taken in the emergency department reveal a creatinine of 175 micromol/l (60-110), and a calcium of 3.4 mmol/l, (2.1-2.65).
Which of the following malignancies would you consider as the most likely underlying cause?
A 62-year-old woman with type 2 diabetes being treated with a thiazide and a beta-blocker for hypertension is found to have a serum potassium concentration of 3.2 mmol/l. Her blood pressure is 156/94 mmHg; serum creatinine concentration is 115 μmol/l.
What is the most likely cause of the hypokalaemia?
A 44-year-old pharmacist presents with a history of recurrent episodes of faintness, sweating and tremor, occurring particularly in the late morning or late afternoon. An insulinoma is suspected. The patient is admitted for 3 days’ consecutive overnight fasting with blood glucose measurements in the morning. She remains asymptomatic during her admission and the lowest blood glucose concentration is 4.4 mmol/l. On discharge from hospital, she reports that her symptoms have recurred.
What would be the most useful investigation to establish the diagnosis?
A 55-year-old woman presents to the clinic some 2 years after diagnosis with type 2 diabetes mellitus. Her weight is 86 kg, body mass index 36 kg/m. Current medication is oral metformin 1g twice per day. Other past history of note includes a previous inferior myocardial infarction some 5 years earlier. On examination her BP is 142/82, pulse is 72 and regular. Her chest is clear, there is mild pitting oedema of both ankles which may be related to use of amlodipine. A recent HbA1c is 71 mmol/mol, and her creatinine is 95 micromol/l.
Which of the following is the most appropriate intervention?
A 42-year-old man presented with a 3-month history of lethargy and tiredness. His urine tested positive for glucose, and a random blood glucose concentration was 8.3 mmol/l. An oral glucose tolerance test (OGTT) revealed: glucose concentration at baseline at 5.6 mmol/l, rising to 9.3 mmol/l at 120 minutes.
Which of the following statements is correct?
Which one of the following enzymes is specifically raised in the serum of patients with Gaucher’s disease?
A 73-year-old man is referred to the Emergency Department by his GP. He has been feeling increasingly nauseous over the past few days and is known to have CKD3. His U&E are very deranged, with a potassium of 7.5 mmol/l, a creatinine of 430 micromol/l and a urea of 29.1 mmol/l. On examination his BP is 149/85 mmHg, pulse is 85/min and regular. He does not appear to be in fluid overload.
Which of the following is the most effective way to rapidly reduce his potassium in this situation?
You are asked to review a 45-year-old obese woman who is jaundiced; you suspect that she may have primary biliary cirrhosis with accumulation of bile salts.
Which of the following best fits the metabolism of bile acids?
A 55-year-old chronic heavy smoker is brought to the Emergency Department with a 2-day history of polyuria, polydipsia, nausea and progressive drowsiness. On examination, he is lethargic and confused. A chest radiograph shows a round shadow in the right mid-zone with enlarged hilar lymph nodes on the right side. An ECG is normal except for a narrowed QT interval and notching of the terminal portion of the QRS most prominent in V1.
What is the most likely metabolic abnormality in this case?
A 52-year-old woman is admitted to the surgical unit with an episode of moderate to severe acute pancreatitis who has eaten little over the last 24 hours due to severe nausea. You are asked to give an opinion as to the best way to meet her nutritional needs.
Which of the following is the most appropriate initial way to manage them?
A 27-year-old woman presents with global weakness, lethargy and numbness of her extremities, which has worsened over the past 6 weeks; she admits to intermittent diarrhoea. On examination in the Emergency Department, she is markedly underweight with a body mass index (BMI) of only 18 kg/m. Her blood pressure is 100/70 mmHg and blood testing reveals hypokalaemia, raised chloride levels, low serum bicarbonate and a pH of 7.31.
Which of the following diagnoses seems most likely in this case?
A 71-year-old man is referred by his GP to the Emergency Department, having presented with increasing nausea, shortness of breath and lethargy. The results of initial investigations include a serum Cr concentration of 654 μmol/l and a K of 6.2 mmol/l.
Which of the following best suggests a specific cause for his kidney disease?
A 68-year-old man undergoes a routine health check-up, which includes a physical examination and various laboratory investigations. An elevated BMI of 35 kg/m is noted and he has abnormal results as follows: fasting blood glucose 6.6 mmol/l; corrected calcium 2.01 mmol/l; ALP activity 232 U/l (upper limit of reference range – 150); TSH 10.1 mU/l; Cr clearance (calculated) 70 ml/min (normal range: 85 – 125 μmol/min).
Which one of the following parameters would be considered of least concern?
Which of the following patterns of serum lipids is most characteristic of diabetes mellitus in white patients?
A 48-year-old woman with known renal disease presents to the Emergency Department. Her admission biochemistry profile shows a serum K concentration of 6.2 mmol/l; her ECG is abnormal.
Which ECG abnormality is most likely to have occurred earliest as her hyperkalaemia developed?
A 72-year-old woman is admitted to the Emergency Department with nausea, vomiting and complaining of yellow visual field discoloration. On further questioning it transpires she has mixed up her tablets and been taking 250 mcg of digoxin per day for the last 2 weeks.
Which of the following biochemical abnormalities, if present, would exacerbate her symptoms of digoxin poisoning?
A 42-year-old man with type 1 diabetes mellitus, which was diagnosed 23 years ago, is admitted to hospital with diabetic ketoacidosis. He is complaining of abdominal pain and has vomited a number of times. On examination his temperature is 38.0°C, BP is 100/70 mmHg, pulse is 100/min and regular. His respiratory rate is elevated at 30.
Which of the following findings on admission would most suggest an identifiable acute event has precipitated his diabetic ketoacidosis?
A 75-year-old woman is being followed by her GP for suspected developing primary hypothyroidism. She complains of tiredness all the time and has gained 3 kg in weight. On examination her BP is 132/82 mmHg, and pulse is 62 bpm and regular; her BMI is elevated at 32 kg/m.
Which of the following biochemical changes would you most expect to be able to detect first?
A 70-year-old man with symptoms of prostatism has a serum prostate-specific antigen (PSA) level of 20 μg/l (normal value, < 4 μg/l).
Which one of the following statements about the clinical importance of this result is the most likely?
Blood buffers are essential for maintaining the body’s acid-base balance.
Which of the following is a blood buffer?
A 19-year-old woman presents to the Emergency Department, for the third time over the past 6 months, with hypertension and abdominal pain associated with significant distress. She has been diagnosed as suffering from acute intermittent porphyria. You are writing a management plan for colleagues in the event she presents on a further occasion for treatment.
Which of the following is the most useful intervention?
A young couple in their 20’s come to the genetics clinic wanting to discuss the risk of future children they may have suffering from liver failure. Apparently, a niece died in very early childhood, suffering from progressive jaundice in infancy. No other family members have been affected, and the family remember there was a marked rise in unconjugated bilirubin in the child.
Which of the following fits best with the underlying inherited condition?
The renin-angiotensin-aldosterone system is responsible for the maintenance of normal arterial blood pressure. Many factors influence the release of aldosterone.
Which of the following would increase aldosterone secretion?
You are investigating the effects of a new agent in the treatment of elevated LDL cholesterol.
Which of the following is a key feature of low-density lipoproteins (LDL)?
An overweight 32-year-old woman presents with a short history of painless jaundice. There is no previous history of illness and, apart from jaundice, the only signs of chronic liver disease are spider naevi on the upper body. Initial investigations reveal a Hb of 127 g/l, MCV 105 fl, serum bilirubin 162 μmol/l, AST 182 U/l, ALT 81 U/l, ALP 224 U/l and GGT 200 U/l.
Which of the following is the most likely diagnosis?
A 38-year-old woman with type 1 diabetes reports at her regular clinic review that she has been experiencing frequent episodes of hypoglycaemia during the previous 6 months, despite reducing her overall dose of insulin by almost 50%. Her HbA1c in the clinic is 36 mmol/mol having been 45 mmol/mol a year previously. She also says she has lost some weight and that her periods are becoming scanty and irregular, and wonders if she is having an early menopause. Her gonadotrophin concentrations are low.
What is the most likely cause of the reduction in her insulin requirement?
A 24-year-old woman undergoes resection of the terminal ileum with fashioning of an ileostomy for Crohn’s disease. Some 2 weeks after surgery, she is making a good recovery and is eating a high-energy, low-residue diet, but has a high ileostomy volume, necessitating intravenous fluid replacement. Her serum calcium concentration is 1.82 mmol/l, phosphate 1.28 mmol/l, alkaline phosphatase 82 U/l (normal < 150 U/l), albumin 30 g/l, creatinine 80 μmol/l.
Prior to surgery, her corrected serum calcium concentration was 2.18 mmol/l and her albumin 36 g/l.
What is the most likely cause of her hypocalcaemia?
Which of the following fluids would be the most appropriate to replace the fluid being lost in a patient with a paralytic ileus draining 2 litres of fluid a day through a nasogastric tube?
A 45-year-old man is admitted to the Emergency Department unconscious and hyperventilating. His breath smells of alcohol. He owns a garage which apparently has money problems, and according to colleagues who accompany him to the Emergency Department, he has been drinking at work.
Which of the following findings would most suggest that ethylene glycol had been consumed?
A 17-year-old girl presents with excess hair and amenorrhea. She is normotensive. Her prolactin levels are normal but she has a raised 17α-hydroxyprogesterone level and testosterone.
What is the most likely diagnosis?
A 48-year-old woman is referred to the gastroenterology clinic for review. She has no significant past medical history of note, and drinks one bottle of wine per week. On examination her BP is 150/82 mmHg, and pulse is 67 bpm and regular; her BMI is 29 kg/m. Her abdomen is soft and non-tender. Blood testing has revealed elevated ALT, AST and GGT; the AST:ALT ratio is 1:1.2.
Which of the following is the most likely diagnosis?
A 24-year-old, unconscious man is admitted to the Emergency Department. No history is available. The results of arterial blood gas analysis are: pH 7.1, pCO 7.0 kPa, pO 8.2. HCO 17.1 mmol/l.
These results indicate which one of the following acid–base disturbances?
An 82-year-old woman has a calculated glomerular filtration rate (GFR) of 45 ml/min.
Which of the following is likely to have the greatest impact on her measured estimated GFR (eGFR)?
A 22-year-old woman has been admitted to the hospital on three occasions over the past year with episodes of abdominal pain, nausea, vomiting, constipation and restlessness. She has suffered from a photosensitive rash characterizing blisters and fragility for which she now wears factor 50 sun screen for most of the summer.
Which of the following is the most likely diagnosis?
A 19-year-old man is admitted by ambulance after falling into a river. He is pulled out by two friends but is thought to have inhaled a significant quantity of water. On examination in the Emergency Department his saturation is 90% on O by mask. He is drowsy but conscious, with bradycardia, BP of 90/60 mmHg and a temperature of 34.8°C. Auscultation of his chest reveals wheeze and crackles consistent with fluid inhalation.
Which one of the following is the most likely biochemical imbalance to be seen?
You are asked to review a 71-year-old patient who has received excess blood transfusions and saline fluid replacement after a bleed following left total hip replacement. You estimate that approximately a 20% increase in his blood volume has occurred.
What physiological process is most likely to correct this abnormality?
A 25-year-old man is found to have a fasting serum triglyceride concentration of 4.2 mmol/l at a routine examination for life insurance. His serum cholesterol concentration is 5.4 mmol/l; liver function tests are normal apart from a γ-glutamyl-transferase activity of 114 U/l (upper limit of normal, 55 U/l), AST which is elevated at 198, (upper limit of normal is 47 U/l), and ALT is elevated at 92 U/l (upper limit of normal 50). He claims to be in good health but has a history of epilepsy for which he is taking sodium valproate. His body mass index is 24 kg/m.
What is the most likely cause of the abnormal findings?
A patient in the intensive care unit following liver transplant surgery has a metabolic alkalosis with a pH of 7.56 and an elevated serum bicarbonate.
Which of the following is the most likely cause?
A 22-year-old aid worker is admitted to the Emergency Department from the local airport; he apparently suffered from profuse watery diarrhoea during the flight and collapsed soon after walking from the plane. He has no past medical history of note. On examination his BP is 80/60 mmHg, pulse is 95 bpm and regular, he is severely dehydrated and has soiled himself during the ambulance journey. You suspect he has cholera.
Which of the following is the mechanism by which cholera leads to fluid loss?
A 45-year-old man with a history of Type 1 diabetes comes to the nephrology clinic for review. His GP has attempted to start an ACE inhibitor, but was unable to. Although his creatinine stayed relatively stable, a significant increase in his potassium was seen; his BP is 142/82 mmHg.
Which one of the following is the most likely diagnosis?
A 20-year-old man presents with mild jaundice following a flu-like illness. Following review by a gastroenterologist, he has been told that a diagnosis of Gilbert’s syndrome is probable.
Which of the following laboratory tests is most likely to confirm this diagnosis
A 30-year-old man is referred to the rheumatology clinic complaining of pain in his hips and back on walking. He has also begun to develop a dusky pigmentation discoloration, affecting his ears in particular, and has some calcification of the pinnae on examination. There is a family history of alkaptonuria.
Which step in metabolism is altered in a patient with alkaptonuria?