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MRCP PACES > Abdominal > Flashcards

Abdominal Flashcards

1
Q

How might patients with PKD present?
(FIVE)

A

More recently genetic screening of relatives of PKD patients
Hypertension
Renal failure
Haematuria
Abdominal pain from bleeding into cyst/infection

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2
Q

Inheritance of PKD

A

Autosomal dominant
ADPKD 1 - 80% chromosome 16
ADPKD 2 - Chromosome 4
Autosomal recessive in childhood

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3
Q

Difference between the types of PKD

A

ADPKD 2 associated with less severe, with later onset and later progression to renal failure

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4
Q

Treatment of PKD
(FIVE)

A

Control of hypertension
Control of hyperlipidaemia
High fluid, low salt diet
Renal replacement therapy
Transplant

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5
Q

Extra-renal manifestations of PKD
(FOUR)

A

Hypertension
Hepatic cysts
Pancreatic cysts
Cerebral aneurysms

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6
Q

Indications for nephrectomy in PKD
(FIVE)

A

Avoided if possible
To make room for transplant
Progression to renal cell carcinoma
Bleeding - haematuria
Recurrent/chronic infections
Chronic pain

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7
Q

Is nephrectomy always necessary for transplant in PKD?

A

No, but sometimes necessary to make room for transplant.

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8
Q

What would indicate a mass is kidney rather than liver or spleen?
(THREE)

A

Get above it
Moves with inspiration
Ballottable

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9
Q

Differentials for unilateral enlarged kidney
(FOUR)

A

PKD with one nephrectomy
Renal cell carcinoma
Simple kidney cysts
Hydronephrosis

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10
Q

Differentials for bilateral enlarged kidneys
(FIVE)

A

PKD
Bilateral renal cell carcinoma
Bilateral hydronephrosis
Tuberous sclerosis
Amyloidosis

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11
Q

Investigations for enlarged kidneys
(FIVE)

A

Blood pressure
U+E
Urine dip protein/blood
USS abdomen +/- biopsy
Genetic studies for ADPKD

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12
Q

Causes of end stage renal failure
(FOUR)

A

Hypertension
Diabetes
PKD
Glomerulonephritis

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13
Q

When should renal transplantation work up start?

A

When approaching ESRF but before requiring dialysis - best outcomes

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14
Q

Define end stage renal failure

A

GFR of less than 15 ml/min

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15
Q

Barriers to renal transplant
(FIVE)

A

Availability of matched donor kidney
Malignancy
Ongoing infection
Ongoing vasculitis
Severe obesity due to technical difficulty

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16
Q

Side effects of long term immunosuppression
(EIGHT)

A

Increased risk of infection - bacterial/viral/fungal
Malignancy - particularly skin cancer
Thin skin - steroids
Easy bruising - steroids
Cushingoid appearance - steroids
Hirsutism - ciclosporin
Gum hyperplasia - ciclosporin
Tremor - tacrolimus

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17
Q

Things to look for in renal transplant patient
(SEVEN)

A

Fluid status
Evidence of HD - tunneled lines/needled fistula
Evidence of PD - catheter
Side effects of immunosuppression
Cause of renal failure:
Diabetes - fingerprick/injection site
Enlarged kidneys - PKD
Hepatosplenomegaly - amyloidosis

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18
Q

Complications following renal transplant
(SEVEN)

A

Acute rejection
Chronic rejection
Infection with immunosuppression - CMV/PCP
Skin malignancy
Ciclosporin nephrotoxicity
Recurrence of original disease
Post transplant lymphoproliferation

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19
Q

Signs of chronic liver disease
(NINE)

A

Hepatomegaly
Jaundice
Leuconychia
Clubbing
Dupuytren’s contracture
Xanthelasma
Spiner naevi
Caput medusa
Gynaecomastia

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20
Q

Signs of decompensated liver disease
(FOUR)

A

Ascites
Asterixis
Altered consciousness - encephalopathy
Jaundice

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21
Q

Causes of chronic liver disease
(NINE)

A

Alcoholic liver disease
Non-alcoholic fatty liver disease
Viral hepatitis
Autoimmune hepatitis
Primary biliary cholangitis
Primary sclerosing cholangitis
Haemochromatosis
Alpha-1-antitrypsin deficiency
Wilson’s disease

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22
Q

Investigations for chronic liver disease
(ELEVEN)

A

Full history
Alcohol history
Basic bloods - FBC, U+E, LFT, clotting
HBV, HCV, HIV tests
Ferritin and iron studies
Caeruloplasmin
Autoantibody screen
AFP
Ascitic tap
USS abdomen
CT +/- biopsy

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23
Q

Autoantibodies for chronic liver disease
(FOUR)

A

ANA - PSC
Smooth muscle antibody - PSC, AIH
Anti mitochondrial antibody - PBC
Anti LKM antibody - AIH

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24
Q

Presentation of primary biliary cirrhosis
(THREE)

A

Fatigue
Pruritus
Chronic liver disease

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25
Q

Complications of primary biliary cirrhosis
(THREE)

A

Chronic liver disease
Cirrhosis
Hepatocellular carcinoma

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26
Q

Treatment of primary biliary cirrhosis
(TWO)

A

Ursodeoxycholic acid
Transplant

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27
Q

Signs of underlying cause of chronic liver disease
(FIVE)

A

Tattoos - viral hepatitis
Injection marks - viral hepatitis
Signs of diabetes - NAFLD
Slate grey pigmentation - haemochromatosis
Venesection - haemochromatosis

28
Q

Causes of jaundice
(THIRTEEN)

A

Pre-hepatic:
Gilbert’s syndrome
Haemolytic anaemia
Thalassaemia
Intra-hepatic hepatocellular:
Viral hepatitis
Alcoholic hepatitis
Autoimmune hepatitis
Decompensated cirrhosis
Intra-hepatic cholestasis:
PBC
PSC
Post-hepatic:
Gallstones
Pancreatic cancer
Cholangiocarcinoma
Pancreatitis

29
Q

Complications of cirrhosis
(FOUR)

A

Portal hypertension
Variceal haemorrhage
Hepatic encephalopathy
Spontaneous bacterial peritonitis

30
Q

What to look for on ascitic tap?
(FIVE)

A

Albumin for SAAG
Amylase for pancreatitis
Cytology for cancer
Microscopy and culture for infection
WCC for SBP (>250 neut)

31
Q

What does a high SAAG indicate?
(TWO)

A

Low protein - cirrhosis
High protein - heart failure

32
Q

What does a low SAAG indicate?
(FIVE)

A

Low protein - nephrotic syndrome, TB peritonitis
High protein - cancer, pancreatitis, TB

33
Q

Causes of ascites
(SEVEN)

A

Cirrhosis
Cancer
Congestive heart failure
Infection - viral hepatitis
Immune - PBC, PSC, AIH
Infiltrative - amyloidosis
Iron - haemochromatosis

34
Q

Treatment of cirrhotic ascites
(FOUR)

A

Stop alcohol
Low salt diet
Diuretics
Transplant

35
Q

Indications for liver transplant
(THREE)

A

Cirrhosis (ALD, NAFLD, viral hepatitis, autoimmune, haemochromatosis)
Acute hepatic failure (paracetamol)
Hepatocellular carcinoma

36
Q

Selection of patients for liver transplant

A

MDT approach
Significant liver dysfunction
UK end stage liver disease score

37
Q

Signs of portal hypertension
(TWO)

A

Caput medusae
Splenomegaly

38
Q

Contraindications to liver transplant
(FOUR)

A

IV drug abuse
Ongoing alcohol excess
Significant medical comorbidities (cardio/ceberbrovascular disease)
Metastases in malignancy

39
Q

Complications of haemochromatosis
(FIVE)

A

Diabetes
Cirrhosis
Testicular atrophy
CCF
Pseudogout

40
Q

Inheritance of haemochromatosis

A

Autosomal recessive
HFE mutation
Chromosome 6

41
Q

Treatment of haemochromatosis
(FIVE)

A

Venesection
Alcohol avoidance
Screen for HCC
Monitor cardiac function
HbA1c monitoring

42
Q

Signs to look for in splenomegaly
(THREE)

A

Anaemia
Lymphadenopathy
Purpura

43
Q

Signs of causes of splenomegaly
(FOUR)

A

Lymphadenopathy - haem/infective
Chronic liver disease signs - portal hypertension
Rheumatoid hands - Felty’s syndrome
Thyroid exam - hyperthyroid

44
Q

Causes of mild-moderate splenomegaly
(FIVE)

A

Portal hypertension
Myeloproliferative disorders
EBV
Infective endocarditis
Haemolytic anaemia

45
Q

Causes of massive splenomegaly
(THREE)

A

CML
Myelofibrosis
Chronic malaria

46
Q

Investigations for splenomegaly
(SIX)

A

FBC and blood film
USS abdomen
Autoimmune screen
CT if concern for malignancy
Thick and thin blood films
Consider bone marrow aspirate

47
Q

Indications for splenectomy
(TWO)

A

Rupture
Haematological (ITP/hereditary spherocytosis)

48
Q

Splenectomy work up
(FOUR)

A

Pneumococcal vaccine
Meningococcal vaccine
Haemophilus influenzae type B vaccine
Lifelong prophylactic abx

49
Q

Presentation of haemochromatosis
(SEVEN)

A

Family screening
Asymptomatic with elevated ferritin
Fatigue
Arthralgia
Diabetes
Bronze pigmentation
Cardiomyopathy

50
Q

Screening for haemochromatosis

A

First degree relatives with haemochromatosis
Baseline ferritin and transferrin saturation
Genetic HFE screening

51
Q

Tests in haemochromatosis
(FOUR)

A

HbA1c
Liver USS
AFP
Echo

52
Q

Hereditary spherocytosis inheritance

A

Autosomal dominant

53
Q

Hereditary spherocytosis presentation
(FOUR)

A

Anaemia
Jaundice
Splenomegaly
Screening programmes of first degree relative

54
Q

Complications of hereditary spherocytosis
(THREE)

A

Aplastic crisis (due to infection)
Anaemia
Gallstones

55
Q

Investigations for hereditary spherocytosis
(SEVEN)

A

FBC
Reticulocyte count
Blood film
LDH
Haptoglobin
Coomb’s test
EMA binding test/osmotic fragility test

56
Q

Treatment of hereditary spherocytosis
(THREE)

A

Folic acid
Treat complications
Consider splenectomy

57
Q

Types of renal transplant

A

Live relative
Live altruistic
Cadaveric neuro death
Cadaveric circulatory death

58
Q

Causes of gynaecomastia
(SIX)

A

Puberty
Increasing age
Kleinfelter’s syndrome
Cirrhosis
Drugs (spironolactone)
Orchidectomy

59
Q

Investigations for inflammatory bowel disease
(SIX)

A

FBC, U+E, LFT, CRP
Folate, B12
Stool cultures
Faecal calprotectin
AXR
Endoscopy and biopsy

60
Q

Differences between Crohn’s and UC
(FOUR)

A

UC - large bowel (particularly sigmoid and rectum), crohn’s -anywhere
UC - only mucosa, Crohn’s - transmural
UC - no fistulae, Crohn’s - fistulae
UC - fibrosis (lead pipe), Crohn’s not

61
Q

Management of acute IBD

A

IV fluids
IV steroids

62
Q

Surgical referral for IBD
(THREE)

A

If dilatation on AXR
If fistulating or obstructive disease
If flare is refractory to medical management

63
Q

What is coeliac disease

A

Autoimmune disorder
Hypersensitivity to gluten containing products
Results in villous atrophy and malabsorption

64
Q

What is dermatitis herpetiformis

A

Associated with coeliac disease
Blistering itchy rash
On extensor surfaces

65
Q

Investigations for coeliac disease
(SIX)

A

Bloods:
- FBC
- Ferritin, B12, folate
- U+E, LFT
- IgA ttg
- Immunoglobulins
Endoscopy and biopsy

66
Q

Management of coeliac disease
(THREE)

A

Gluten avoidance
Dietician to support with gluten avoidance
Correct nutritional deficiencies

MRCP PACES (5 decks)

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