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PACES > Abdo > Flashcards

Abdo Flashcards

1
Q

Signs of chronic liver disease - general inspection (4)

A

Cachexia
Icterus
Excoriation
Bruising

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2
Q

Signs of chronic liver disease - hands (4)

A

Leuconychia
Clubbing
Dupuytrens contractures
Palmar erythema

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3
Q

Signs of chronic liver disease - face (3)

A

Xanthelasma
Parotid swelling
Fetor hepaticus

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4
Q

Signs of chronic liver disease - chest and abdo (5)

A

Spider naevi
Caput Medusa
Reduced body hair
Gynaecomastia
Testicular atrophy

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5
Q

Evidence of decompensation in liver patient (3)

A

Ascites - shifting dullness
Asterixis
Encephalopathy

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6
Q

Causes of hepatomegaly (6)

A

Cirrhosis (alcoholic)
Carcinoma (secondaries)
Congestive cardiac failure
Infectious - HBV/HCV
Immune - PBC/PSC/autoimmune hepatitis
Infiltrative - amyloid/myeloproliferative disorders

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7
Q

NILS screen (7)

A

Autoantibodies/immunoglobulins - AMA, ASMA, anti LKM, ANA, ANCA
Hep B/C serology
Ferritin
Caeruloplasmin
Alpha 1 antitrypsin
AFP
EBV/CMV

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8
Q

Complications of cirrhosis (8)

A

Variceal haemorrhage
portal HTN
Hepatic encephalopathy
SBP
Ascites
HCC
Hepatorenal syndrome
Clotting disorders

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9
Q

Causes of Ascites (3)

A

Cirrhosis
Carcinomatosis
CCF

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10
Q

Causes of palmar erythema (5)

A

Cirrhosis
Hyperthyroidism
RA
Pregnancy
Polycythaemia

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11
Q

Causes of gynaecomastia (6)

A

Physiological - puberty /senility
Kleinfelters syndrome
Cirrhosis
Drugs - sprionolactone/digoxin
Testicular tumour/orchidectomy
Endocrinopathy - hyper/hypothyroidism/ addisons

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12
Q

Signs of haemochromatosis (7)

A

Increased skin pigmentation
Stigmata of chronic liver disease
Hepatomegaly
Venesection
Liver biopsy
Joint replacement
Abdominal rooftop incision

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13
Q

Evidence of complications of haemochromatosis (4)

A

Bronze diabetes - Injection sites
Hypogonadism
CCF
Arthropathy - pseudogout

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14
Q

Autoantibody for PBC

A

AMA

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15
Q

Autoantibody for autoimmune hepatitis

A

ASMA

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16
Q

Inheritance of haemochromatosis

A

Autosomal recessive
Chromosome 6
HFE gene mutation - regulates gut iron absorption
Carrier rate 1:10
Males affected earlier - no periods

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17
Q

Investigation of haemochromatosis and results (8)

A

Raised ferritin
Raised transferrin saturation
Reduced total iron binding capacity
Liver biopsy
Genotyping
Blood sugars (diabetes)
ECG/CXR/echo (CCF)
Liver USS /AFP (HCC)

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18
Q

Treatment of haemochromatosis (4)

A

Regular venesection (1 unit per week until deficient, then 1 unit 3-4 times/year)
Avoid alcohol
Surveillance for HCC
Liver transplant - 50% 1 year survival, high mortality due to cardiac and infectious complications

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19
Q

Family screening for haemochromatosis (3)

A

Iron studies
Liver biopsy
Genotype analysis

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20
Q

Examination findings associated with splenomegaly (8)

A

Anaemia
Lymphadenopathy
Purpura
LUQ mass - moves inferomedially, has notch, dull to percussion, cannot get above
Hepatomegaly
Stigmata of chronic liver disease
Splinter haemorrhages/murmurs
Rheumatoid hands - felty syndrome

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21
Q

Causes of massive splenomegaly >8cm (4)

A

Myeloproliferative disorders - CML and myelofibrosis
Tropical infections - malaria, visceral leishmaniasis/kala-azar

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22
Q

Causes of moderate splenomegaly 4-8cm (4)

A

Myeloproliferative disorders
Lymphoproliferative disorders
Infiltration - gauchers and amyloidosis

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23
Q

Causes of a palpable spleen tip (4)

A

Myelo/lymphoproliferative disorders
Portal HTN
Infections - EBV, endocarditis, infective hepatitis
Haemolytic anaemia

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24
Q

Investigations for splenomegaly (7)

A

USS abdo
FBC and blood film
CT chest and abdo
Bone marrow aspirate and trephine
Lymph node biopsy
Thick and thin films (malaria)
Viral serology

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25
Q

Indications for splenectomy (3)

A

Rupture - trauma
Haematological - ITP and hereditary spherocytosis

26
Q

Splenectomy work up (3)

A

Vaccination - pneumococcus, meningococcus and haemophilus influenza 2 weeks prior
Prophylactic penicillin
Medic alert bracelet

27
Q

Clinical signs of renal failure - peripheral (4)

A

HTN
AV fistulae
Tunnelled dialysis line
Immunosuppressant stigmata - cushingoid, gum hypertrophy ciclosporin

28
Q

Clinical signs renal failure - abdominal (7)

A

Palpable kidney
Iliac fossa scar +/- transplanted kidney
Urine dip - proteinuria/haematuria
External genitalia - varicocele
Hepatomegaly (PKD)
Indwelling catheter - obstructive uropathy
Peritoneal dialysis scars/catheter

29
Q

Causes of unilateral renal enlargement (4)

A

PKD
Renal cell carcinoma
Simple cysts
Hydronephrosis

30
Q

Causes of bilateral renal enlargement (4)

A

PKD
Bilateral renal cell carcinoma (rare)
Bilateral hydronephrosis
Tuberous sclerosis - renal angiomyolipomata and cysts

31
Q

Derm signs of tuberous sclerosis (4)

A

Shagreen patches
Ash leaf spots
Facial angiofibromas
Ungual fibromas

32
Q

Investigations for renal failure (6)

A

U&Es
Urine cytology
USS KUB
IV urogram
CT
Genetic studies - ADPKD

33
Q

What is autosomal dominant polycystic kidney disease? Which genes are involved?

A

Progressive replacement of normal kidney tissue by cysts leading to renal enlargement and renal failure
Prevalence 1:1000
ADPKD1 85% chromosome 15/16
ADPKD2 15% chromosome 4
End stage renal failure by age 40-60
Earlier in ADPKD1

34
Q

What are typical presenting symptoms of ADPKD? (4)

A

HTN
Recurrent UTIs
Abdominal pain - bleeding into cyst/cyst infection
Haematuria

35
Q

Other organs involved in ADPKD (3)

A

Hepatic cysts and hepatomegaly
Intracranial berry aneurysms
Mitral valve prolapse

36
Q

Treatment of ADPKD (4)

A

Treat HTN
Nephrectomy for bleeds/infection/size
Dialysis
Renal transplant

37
Q

Signs of liver transplant (5)

A

Rooftop or Mercedes Benz scar
Stigmata of chronic liver disease
Skin pigmentation - haemochromatosis
Tattoos/needle marks - infective
Stigmata of immunosuppressive medications

38
Q

Signs of immunosuppressive medications (5)

A

Ciclosporin - gum hypertrophy and HTN
Steroids - cushingoid appearance, thin skin, ecchymoses

39
Q

Top 3 reasons for liver transplant

A

Cirrhosis
Acute hepatic failure - hep A/B and paracetamol overdose
Hepatic malignancy

40
Q

Success of liver transplant

A

80% 1 year survival
70% 5 year survival

41
Q

Causes of gum hypertrophy - drugs (3)

A

Ciclosporin
Phenytoin
Nifedipine

42
Q

Causes of gum hypertrophy (5)

A

Drugs
Scurvy
Acute myelomonocytic leukaemia
Pregnancy
Familial

43
Q

Skin signs in transplant patients (6)

A

Actinic keratosis
Squamous cell carcinoma (100x risk)
Basal cell carcinoma (10x risk)
Malignant melanoma (10x risk)
Viral warts
Cellulitis

44
Q

Peripheral stigmata of renal disease (4)

A

AV fistula - thrill/dressings
Tunnelled dialysis line
Scars in neck/chest wall
Leg oedema

45
Q

What scars might you see on the abdomen of a renal patient? (3)

A

Iliac fossa scar from transplant
Flank scar from nephrectomy
Peritoneal dialysis scars

46
Q

What signs might help decide cause of kidney disease? (7)

A

Enlarged kidneys - ADPKD
Visual impairment/finger prick marks/injection sites - diabetes
Sclerodactyly, typical facies - systemic sclerosis
Rheumatoid hands/nodules - RA
Hepatosplenomegaly - amyloid
Other organ transplantation - calcineurin inhibitor nephrotoxicity
Ungual fibromata, adenoma sebaceum, polycystic kidneys - tuberous serosis

47
Q

What side effects of treatment might be visible in renal transplant patients? (6)

A

Fine tremor - tacrolimus
Cushingoid appearance - steroids
Gum hypertrophy- ciclosporin
HTN - ciclosporin/tacrolimus
Skin damage/malignancy - ciclosporin/azathioprine
Scars from dialysis access/transplants

48
Q

What will you find with a kidney-pancreas transplant on examination?

A

Lower midline abdominal incision
Palpable kidney in iliac fossa but no overlying scar
Evidence of previous diabetes eg visual impairment
Often younger patients

49
Q

Top 3 causes for renal transplant

A

Glomerulonephritis
Diabetic nephropathy
ADPKD

50
Q

What are some complications of renal transplant? (8)

A

Rejection
Infection secondary to immunosuppression - pneumocystis/CMV
Skin malignancy
Post transplant lymphoproliferative disease
HTN and hyperlipidaemia causing CV disease
Immunosuppressant drug side effects
Recurrence of original disease
Chronic graft dysfunction

51
Q

What is the success rate of renal transplant?

A

90% 1 year graft survival
50% 10 year graft survival - better with live related donor grafts

52
Q

Causes of clubbing - GI (5)

A

IBD
Malabsorption
Coeliac disease
Liver cirrhosis
Oesophageal cancer

53
Q

What are examination findings in PBC? (6)

A

Hepatomegaly
Hyperpigmentation
Splenomegaly in latter stages
Jaundice
Xanthelasma
Cirrhosis features

54
Q

What are treatments for PBC? (5)

A

Ursodeoxycholic acid
Sedating anti histamines
colestyramine
Steroids and azathioprine if overlap with autoimmune hepatitis
Transplant

55
Q

How can causes of jaundice be divided? (3)

A

Pre hepatic: haemolysis
Intra hepatic: liver disease
Post hepatic: biliary obstruction

56
Q

What are signs and features of portal hypertension? (5)

A

Varices
Splenomegaly
Caput medusae
Ascites
Gastropathy

57
Q

What scoring system can be used to risk stratify patients for liver transplant?

A

UK model for end stage liver disease

58
Q

What are causes of Gynaecomastia? (7)

A

Physiological: puberty
CLD
Medications: spironolactone, digoxin
Primary hypogonadism: 5alpha reductase, androgen insensitivity
Tumours producing bHCG
Secondary hypogonadism: kallmans, orchidectomy
Hyperthyroidism

59
Q

What is a common complication of TIPS?

A

Encephalopathy

60
Q

What scoring system is used for decompensated liver disease? And what are the criteria? (6)

A

Child Pugh
Bilirubin
Albumin
INR
Encephalopathy
Ascites

PACES (6 decks)

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