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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
Complications of primary biliary cirrhosis (THREE)
Chronic liver disease Cirrhosis Hepatocellular carcinoma
26
Treatment of primary biliary cirrhosis (TWO)
Ursodeoxycholic acid Transplant
27
Signs of underlying cause of chronic liver disease (FIVE)
Tattoos - viral hepatitis Injection marks - viral hepatitis Signs of diabetes - NAFLD Slate grey pigmentation - haemochromatosis Venesection - haemochromatosis
28
Causes of jaundice (THIRTEEN)
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
Complications of cirrhosis (FOUR)
Portal hypertension Variceal haemorrhage Hepatic encephalopathy Spontaneous bacterial peritonitis
30
What to look for on ascitic tap? (FIVE)
Albumin for SAAG Amylase for pancreatitis Cytology for cancer Microscopy and culture for infection WCC for SBP (>250 neut)
31
What does a high SAAG indicate? (TWO)
Low protein - cirrhosis High protein - heart failure
32
What does a low SAAG indicate? (FIVE)
Low protein - nephrotic syndrome, TB peritonitis High protein - cancer, pancreatitis, TB
33
Causes of ascites (SEVEN)
Cirrhosis Cancer Congestive heart failure Infection - viral hepatitis Immune - PBC, PSC, AIH Infiltrative - amyloidosis Iron - haemochromatosis
34
Treatment of cirrhotic ascites (FOUR)
Stop alcohol Low salt diet Diuretics Transplant
35
Indications for liver transplant (THREE)
Cirrhosis (ALD, NAFLD, viral hepatitis, autoimmune, haemochromatosis) Acute hepatic failure (paracetamol) Hepatocellular carcinoma
36
Selection of patients for liver transplant
MDT approach Significant liver dysfunction UK end stage liver disease score
37
Signs of portal hypertension (TWO)
Caput medusae Splenomegaly
38
Contraindications to liver transplant (FOUR)
IV drug abuse Ongoing alcohol excess Significant medical comorbidities (cardio/ceberbrovascular disease) Metastases in malignancy
39
Complications of haemochromatosis (FIVE)
Diabetes Cirrhosis Testicular atrophy CCF Pseudogout
40
Inheritance of haemochromatosis
Autosomal recessive HFE mutation Chromosome 6
41
Treatment of haemochromatosis (FIVE)
Venesection Alcohol avoidance Screen for HCC Monitor cardiac function HbA1c monitoring
42
Signs to look for in splenomegaly (THREE)
Anaemia Lymphadenopathy Purpura
43
Signs of causes of splenomegaly (FOUR)
Lymphadenopathy - haem/infective Chronic liver disease signs - portal hypertension Rheumatoid hands - Felty's syndrome Thyroid exam - hyperthyroid
44
Causes of mild-moderate splenomegaly (FIVE)
Portal hypertension Myeloproliferative disorders EBV Infective endocarditis Haemolytic anaemia
45
Causes of massive splenomegaly (THREE)
CML Myelofibrosis Chronic malaria
46
Investigations for splenomegaly (SIX)
FBC and blood film USS abdomen Autoimmune screen CT if concern for malignancy Thick and thin blood films Consider bone marrow aspirate
47
Indications for splenectomy (TWO)
Rupture Haematological (ITP/hereditary spherocytosis)
48
Splenectomy work up (FOUR)
Pneumococcal vaccine Meningococcal vaccine Haemophilus influenzae type B vaccine Lifelong prophylactic abx
49
Presentation of haemochromatosis (SEVEN)
Family screening Asymptomatic with elevated ferritin Fatigue Arthralgia Diabetes Bronze pigmentation Cardiomyopathy
50
Screening for haemochromatosis
First degree relatives with haemochromatosis Baseline ferritin and transferrin saturation Genetic HFE screening
51
Tests in haemochromatosis (FOUR)
HbA1c Liver USS AFP Echo
52
Hereditary spherocytosis inheritance
Autosomal dominant
53
Hereditary spherocytosis presentation (FOUR)
Anaemia Jaundice Splenomegaly Screening programmes of first degree relative
54
Complications of hereditary spherocytosis (THREE)
Aplastic crisis (due to infection) Anaemia Gallstones
55
Investigations for hereditary spherocytosis (SEVEN)
FBC Reticulocyte count Blood film LDH Haptoglobin Coomb's test EMA binding test/osmotic fragility test
56
Treatment of hereditary spherocytosis (THREE)
Folic acid Treat complications Consider splenectomy
57
Types of renal transplant
Live relative Live altruistic Cadaveric neuro death Cadaveric circulatory death
58
Causes of gynaecomastia (SIX)
Puberty Increasing age Kleinfelter's syndrome Cirrhosis Drugs (spironolactone) Orchidectomy
59
Investigations for inflammatory bowel disease (SIX)
FBC, U+E, LFT, CRP Folate, B12 Stool cultures Faecal calprotectin AXR Endoscopy and biopsy
60
Differences between Crohn's and UC (FOUR)
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
Management of acute IBD
IV fluids IV steroids
62
Surgical referral for IBD (THREE)
If dilatation on AXR If fistulating or obstructive disease If flare is refractory to medical management
63
What is coeliac disease
Autoimmune disorder Hypersensitivity to gluten containing products Results in villous atrophy and malabsorption
64
What is dermatitis herpetiformis
Associated with coeliac disease Blistering itchy rash On extensor surfaces
65
Investigations for coeliac disease (SIX)
Bloods: - FBC - Ferritin, B12, folate - U+E, LFT - IgA ttg - Immunoglobulins Endoscopy and biopsy
66
Management of coeliac disease (THREE)
Gluten avoidance Dietician to support with gluten avoidance Correct nutritional deficiencies

MRCP PACES (5 decks)

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