K1.v · Lactate & Ketones

This viva will examine metabolism and nutrition. Describe the metabolic and hormonal changes that occur during the following: (a) prolonged starvation (b) reintroduction of nutrition in a malnourished patient

This viva will explore your understanding of acid-base physiology. Please interpret the following blood gas: pH: 7.30 Na: 133 mmol/L pCO2: 19 mmHg K: 4.8 mmol/L pO2: 79 mmHg Cl: 104 mmol/L HCO3: 9.0 mmol/l Lactate: 7.5 mmol/L FiO2: 30%, Temp: 37.5C Base Excess: - 16.4 mmol/L

This viva will explore your understanding of acid-base physiology. List the abnormalities in this arterial blood gas analysis. FiO2 0.5 pH 7.1 PCO2 25 mmHg (3.3 kPa) PO2 100 mmHg (13.3 kPa) HCO3- 7 mmol/L Base deficit -19.9 Na+ 133 mmol/L K+ 4.5 mmol/L Cl- 105 mmol/L Anion gap 25 Lactate 7 mmol/L

This viva will assess your knowledge of renal physiology. Please interpret the following blood gas: Temperature 37.5°C pH 7.31 BE -4 mEq/L pCO2 39 mmHg (5.2 kPa) Na+ 136 mmol/L pO2 84 mmHg (11.2 kPa) K+ 3.0 mmol/L HCO3 18 mmol/L Cl- 101 mmol/L FiO2 30% Lactate 3.4 mmol/L

This viva will assess your knowledge of hepatic function and lactate physiology. Which letter on the diagram points to the functional unit of the liver? (Image removed from report).

The initial information given to the candidates was – This is an analysis of urine from a patient on the intensive care unit: Glucose negative Ketones trace pH 6.0 urobilinogen moderate Specific gravity >1.030 You will be asked to comment upon these findings In this viva candidates were asked to explain the physiological basis to the urinanlysis provided above. Further knowledge was sought in reference to ketones and ketone body generation and metabolism, generation of urobilinogen and significance of specific gravity.