Diagnostic Criteria

Question 1

Type 2 Diabetes Mellitus

Answer 1

> 7 fasting, OR
11.1 random/2h OR
48 HbA1C
IDEALLY WITH SYMPTOMS.

If asymptomatic; remeasure, according to WHO.

Question 2

Polycystic Ovarian Syndrome (PCOS)

Answer 2

Rotterdam: 2 of 3 of:

-Ultrasound Findings; 12+ Cysts
-High Androgens OR Signs (Hirsuitism)
-Irregular Periods / No periods

Question 3

Acute Pancreatitis

Answer 3

2/3 of the following:

-Upper abdominal pain (Clinical)
-Amylase 3x Upper Limit of Normal
-Imaging (CT / MRI / USS)

Then PANCREAS acronym used for classifying severe disease. Score >2.

Question 4

Severe Acute Asthma

Answer 4

Any one of

-PEF 33-50%
-Struggles to complete sentences
-Resp Rate >25
-Pulse >110

Question 5

Primary vs Secondary Post-Partum Haemorrhage

Answer 5

> 500ml blood loss
<24 hours of birth

Secondary = 24h to 6 weeks: Usually retained placenta.

Question 6

Low-Lying Placenta, Placenta Praevia Minor, and Placenta Praevia Major.

Answer 6

Diagnosed on TVUSS: 18-20 weeks and beyond.

LLP: <20mm from internal os
PPMinor: Partially covering os
PPMajor: Fully covering os

Question 7

Rheumatoid Arthritis

Answer 7

Point system: 6+ = dx. Notably:

High ACCP/RF titres = 3 points
4-10 small joints = 3 points
>10 joints (1+ small) = 5 points
Duration >6 weeks = 1 point

Question 7

Osteopoenia and Osteoporosis

Answer 7

DEXA Scan:

T-Score < -1 = Osteopoenia

T-Score < -2.5 = Osteoporosis

(Standard deviations away from 25 year old white woman)

Question 8

Osteomalacia

Answer 8

Complex: Majority of people need to first be diagnosed with chronic vitamin D deficiency, which can be done by:

Low Phosphate
Low serum Vit D
High ALP
Normal PTH
Calcium Normal or Low

Way I remember it: Low calcium through poor absorption > ALP rises to break down bone, but this new calcium is immediately lost through kidneys with phosphate.

Question 9

SLE

Answer 9

First: ANA NEEDS to be recorded at a titre over 1:80 (Detectable after over 80 dilutions), THEN:

Needs to score 10 from many domains- these do not need to be recorded at the same time. Examples of high-scoring and non-interfering things are:

Anti-DsDNA Abs = 6
Fever = 2
Autoimmune Haemolysis = 4
Seizures = 5
Cutaneous Lupus (Classic Rash) = 6
Acute Pericarditis = 6
Joint involvement (actual swell) = 6
Proteinuria = 4
Anti-Cardiolipin Abs = 2

Question 10

Sjogren’s

Answer 10

3 out of 4 of:

-Postive Schirmer (<5mm in 5mins)
-Salivary gland involvement
-Anti-Ro / La Abs present
-Minor-salivary gland biopsy (+)

Question 11

Fibromyalgia

Answer 11

> 3 months

6+/9 Pain points

Moderate/Severe Sleep Problems or Fatigue

Note that this can be valid amongst other conditions too.

Question 12

Septic Arthritis

Answer 12

Kocher Criteria, not used for diagnosis, but for clinical suspicion- is meant to differentiate TRANSIENT SYNOVITIS from SA:

WCC > 12
ESR >40
Non weight-bearing
Temperature >38.5

Question 13

Chronic Fatigue / Myalgic Enecephalomyelitis

Answer 13

> 6 Weeks

-Fatigue worsened by exercise
-Post-exertion exacerbation of fatigue that can take days to weeks to recover.
-Unrefreshing Sleep
-Cognition issues

Question 14

Heart Failure:

With Reduced Ejection Fraction

With Preserved Ejection Fraction

Answer 14

Echocardiogram:

<40% = Reduced

40-49% = Mildly Reduced

50%+ = Preserved

BNP is for general-practice screening.

Question 15

Cardiac Tamponade

Answer 15

Beck’s Triad:
-Hypotension, dropping
-Muffled Heart-Sounds
-Elevated JVP

or Echo findings:
-Right ventricle collapses in diastole

-Right atrium collapses in systole (Crushed by ventricle and pericardium)

Question 16

Hypertension, Stage 1,2,3

Answer 16

Clinic:
>140,160,180 Sys
> 90 ,100,110 Dias

Amb (Only for stage-1):
>135/85 for home / day-time

Question 17

Peripheral Vascular Disease

Answer 17

Ankle-Brachial Pressure Index
(Ankle Pressure / Brachial Pressure)

< 0.9 = Peripheral Artery Disease
0.4-0.9 = Moderate PAD
< 0.4 = Severe PAD

> 1.4 = ?Calcified arteries

Question 18

Chronic Obstructive Pulmonary Disease (COPD)

Answer 18

Spirometry: FEV1/FVC ratio:

<0.7 AFTER bronchodilator use is diagnostic.

(IE, not reversible)

Staging done by FEV1;
>80%, <80%, <50%, <30% =
Mild, Mod, Severe, Very Severe

Question 19

Asthma

Answer 19

Reversibility Tests:
-Spirometry Improvement by 12%
-Peak Flow improvement by 20%

Other:
>10% Variation in peak flow measurements BD over 2 weeks.

Children Over 5:
-NEED above spiro first
-FENO if reversibility not shown, but high clinical suspicion.

Question 20

Cystic Fibrosis

Answer 20

Hierarchal:

1: Sodium Sweat-Test (Positive = referral to CF centre, intermediate: Genetic first).
2: Genetic Testing CFTR
3: Physiological Testing

Newborn Blood Spot is NOT diagnostic.

Question 21

Idiopathic Pulmonary Fibrosis

Answer 21

1 - Occupational / Iatrogenic / Other cause MUST be excluded

2 - High-Resolution CT showing “Usual Interstitial Pneumonia”

3 - If HRCT does not show conclusive evidence, multi-focal lung biopsy.