Name: Elaine Louise Palmer

Theme: Enzymology

OPTION LIST

A	Alkaline Phosphatase	I	Creatanine
B	Alpha-amylase	J	Gamma Glutamyl Transpeptidase
C	Alpha-fetoprotein	K	Glucose
D	Alanine Transferase	L	Lactate Dehydrogenase
E	Calcium	M	Placental Dehydrogenase
F	CKBB	N	Plasma Cholinesterase
G	CKMB	O	Prostate Specific Antigen
H	CKMM	P	Cardiac Troponin

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

1. A 66-year-old man presents to his GP complaining of back and hip pain. His sister also wanted him to mention that his neighbours have complained that his radio has become increasingly loud in the last few weeks. Due to his brother presenting with tibial bowing and similar bone pain 2 years previously the GP sends him for radiological investigation. Osteolytic changes are noted and further bone scans reveal osteoporosis circumscripta in the Skull. Prostate examination and PSA testing are unremarkable. Which of the above would be most raised?

2. A 71-year-old man presents to his GP with increasing tiredness and back pain. He also describes increasing urinary frequency, a feeling of incomplete voiding and perineal pain. On examination investigation reveals a tender lower thoracic spine and a palpable bladder. Prostatic biopsy histology reveals a Gleason score of 9. Which of the above would you also expect to be raised?

3. A 67-year-old man, BMI 27, presents to A+E having collapsed with chest pain and nausea at his local social club dinner. Past medical history revealed he had been suffering from increasing breathlessness over the last month when walking to the post office to collect his weekly pension. Upon further questioning he admitted to the use of his wife’s ‘chest pain relief spray’ twice in the last week. Having argued with his wife before presenting to A+E and it is now 12 hours since the onset of the chest pain therefore, which of the above would aid you most in determining whether he had suffered an acute myocardial infarction?

4. A semi-conscious 6-year-old-boy presents to A+E with his father, a farmer who suspects he has accidentally drunk something from one of the barns in which he was playing. Prior to his collapse the boy had been found vomiting in the yard in the time period before presentation at A+E he had become increasingly restless, irritable, nauseous, had suffered extreme diarrhoea and seemed to be dribbling saliva uncontrollably. On examination the boy was found to have bradycardia, hypotension, reduced muscle tone, dilated pupils and a decreasing respiratory rate. Which of the above is most likely to be decreased?

5. A 44-year-old woman known to have multi-focal ER and PR negative breast cancer that is inoperable is admitted with sudden onset of nausea, vomiting, polyuria and delirium. She also has reduced muscle strength and her husband describes her marked personality change and increased thirst over the previous few days as well as increasing back and hip pain not well relieved with her oral morphine preparation. Pelvic radiology reveals Osteolytic lesions. Which of the above do you think would be raised given her presenting symptoms?

ANSWERS

1. A

2. O

3. P

4. N

5. E