A 62-year-old man is admitted to resus with a low GCS. Blood gases taken on admission show the following:
IV access is obtained and bloods are taken. He is given supportive care with oxygen and fluids.
Renal function results show:
Which one of the following diagnoses would be most consistent with these results?
Correct Answer B:
This patient has a raised anion gap metabolic acidosis which may be caused by methanol poisoning. Massive pulmonary embolism is unlikely given the pO2 as is diabetic ketoacidosis given the blood glucose.
Metabolic acidosis Metabolic acidosis is commonly classified according to the anion gap. This can be calculated by: (Na+ + K+) - (Cl- + HCO3-). If a question supplies the chloride level then this is often a clue that the anion gap should be calculated. The normal range = 10-18 mmol/L.
Normal anion gap ( = hyperchloraemic metabolic acidosis):
Raised anion gap:
Metabolic acidosis secondary to high lactate levels may be subdivided into two types:
Potential complications of Paget's disease include each of the following except:
Paget's disease of the bone:
Paget's disease is a disease of increased but uncontrolled bone turnover. It is thought to be primarily a disorder of osteoclasts, with excessive osteoclastic resorption followed by increased osteoblastic activity. Paget's disease is common (UK prevalence 5%) but symptomatic in only 1 in 20 patients.
Predisposing factors:
Clinical features - only 5% of patients are symptomatic:
Indications for treatment include bone pain, skull or long bone deformity, fracture, periarticular Paget's:
Complications:
*Usually normal in this condition but hypercalcaemia may occur with prolonged immobilization.
Which one of the following immunoglobulins is involved in the activation of B-cells?
Correct Answer A:
IgD is involved in the activation of B-cells.
Immunoglobulins:
The table below summarises the characteristics of the 5 types of immunoglobulin found in the body:
A 25-year-old woman presents with a symmetrical arthropathy affecting her hands. On examination she has synovitis of the 2nd and 3rd metacarpophalangeal joints.
What type of HLA allele is most associated with this condition?
Correct Answer C:
Rheumatoid arthritis - HLA DR4.
This patient has rheumatoid arthritis.
HLA associations:
HLA antigens are encoded for by genes on chromosome 6. HLA A, B and C are class I antigens whilst DP, DQ, DR are class II antigens. Questions are often based around which diseases have strong HLA associations.
The most important associations are listed below:
HLA-A3:
HLA-B5:
HLA-B27:
HLA-DQ2/DQ8:
HLA-DR2:
HLA-DR3:
HLA-DR4:
*Type 1 diabetes mellitus is associated with HLA-DR3 but is more strongly associated with HLA-DR4.
Which one of the following is in direct anatomical contact with the right kidney?
Correct Answer E:
Renal anatomy:
The tables below show the anatomical relations of the kidneys:
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