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PACES Active Recall Flashcards

1
Q

COPD GOLD Stages

A
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2
Q

COPD MRC Dyspnoea Scale

A
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3
Q

Causes of Spider Naevi [5]

A

Pathophysiology: Excess of oestrogen

Normal in childhood
Pregnancy
Oral contraceptive pill
Chronic liver disease
Thyrotoxicosis

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4
Q

Troisier’s Sign
(Virchow’s Node)

A

Enlarged lymph node at left supraclavicular fossa - Suggestive of gastric adenocarcinoma

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5
Q

Causes of Acanthosis Nigricans [6]

A

T2DM
Paraneoplastic Syndrome
Thyroid Dysfunction
Acromegaly
Cushing’s Disease
Obesity

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6
Q

Hand Signs in CLD [4]

A

Leuconychia
Nail Clubbing
Palmar Erythema
Dupuytren’s Contracture

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7
Q

Signs of Portal Hypertension [4]

A

Splenomegaly
Caput Medusae
Oesophageal Varices
Ascites

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8
Q

Causes of CLD [6]

A

Common
1. Alcoholic Liver Disease
2. HBV / HCV - Look for tattoos
3. NASH - Usually overweight

Less Common
4. Autoimmune eg AIH, PBC, PSC
5. Metabolic eg Haemochromatosis, Wilson’s, A1-AT Deficiency, Cystic Fibrosis
6. Drugs - Methotrexate, Isoniazid, Amiodarone, Phenytoin

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9
Q

Complications of CLD [7]

A

Portal Hypertension
UBGIT - Variceal vs Gastric Ulcers
Ascites
SBP
Hepatic Encephalopathy
Hepato-Renal Syndrome
Hepato-Pulmonary Syndrome

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10
Q

Define: Decompensated CLD

A

Combination of ascites, encephalopathy, hepato-renal syndrome, hepato-pulmonary syndrome in acute setting

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11
Q

Grading of Hepatic Encephalopathy

A

West-Haven Criteria

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12
Q

Grading of CLD Severity

A

Child-Pugh Score

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13
Q

Approach to Jaundice

A

Pre-Hepatic Causes
- Excessive RBC breakdown
- AIHA, Malaria, Sickle Cell Disease

Hepatic Causes
- Hepatocyte Injury
- Viral Hepatitis, Ischaemia, Hypoxia, Paracetamol

Post-Hepatic Causes
- Bile outflow obstruction
- Gallstones, pancreatic head cancer

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14
Q

Pathophysiology of Hepato-Renal Syndrome

A

Liver dysfunction leads to inadequate hepatic breakdown of vasoactive substances, leading to excessive renal vasoconstriction.

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15
Q

Approach to Ascites

A

Serum:Ascites Albumin Gradient (SAAG)
- Low SAAG: Albumin is being lost into ascites ie EXUDATE
- High SAAG: Albumin remains in serum ie TRANSUDATE

Transudative Ascites
- CLD with Portal Hypertension
- Heart Failure
- Nephrotic Syndrome
- Budd-Chiari Syndrome

Exudative Ascites
- Malignancy
- Tuberculous Peritonitis
- Ovarian Disease eg Meig Syndrome

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16
Q

Severity Grading of Acute Alcoholic Hepatitis

A

Main biochemical test is INR, which is a component of both tests scores below

  1. Maddrey’s Test
    - Estimates mortality rate
    - Guides use of steroids as treatment
  2. MELD Score
    - Estimates 90-day survival rate
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17
Q

Causes of Epigastric Mass [5]

A

Gastric Carcinoma - Look for Virchow’s Node
Pancreatic Carcinoma - Look for jaundice
Lymphoma
Caudate Lobe of Liver

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18
Q

Causes of RIF Mass [5]

A

Crohn’s Disease
Caecal Carcinoma
Ovarian Tumour
Renal Transplant
Ileocaecal Mass (Abscess, Appendix)

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19
Q

Causes of LIF Mass [5]

A

Sigmoid Carcinoma
Diverticular Mass / Abscess
Faecal Loading
Ovarian Tumour
Renal Transplant

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20
Q

Liver Transplant Criteria

A

King’s College Criteria
Variables differ depending on whether it’s Paracetamol-related liver injury or not

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21
Q

Signs of Chronic Immunosuppression [6]

A

Increased skin pigmentation
Multiple skin warts
Prematurely-aged skin
Skin malignancies (BCC, SqCC)
Fine tremor (Ciclosporin toxicity)
Gingival hypertrophy

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22
Q

Commonest Causes of ESRF [4]

A

DM
ADPKD
Chronic Glomerulonephritis
Hypertension (Blacks)

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23
Q

Opportunistic Infections in Renal Transplant [5]

A

CMV
Pneumocystis Jirovecii
EBV
BK Virus
JC Virus (leading to PMFL)

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24
Q

Abdominal Scars

A
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25
Abdominal Scars
26
Abdominal Scars
27
Abdominal Scars
28
Abdominal Scars
29
Abdominal Scars
30
Abdominal Scars
31
Abdominal Scars
32
Abdominal Scars
33
Abdominal Scars
34
Thoracic Scars
35
Thoracic Scars
36
Thoracic Scars
37
Thoracic Scars
38
Thoracic Scars
39
Thoracic Scars
40
Indications for Nephrectomy in ADPKD [5]
Persistent pain Chronic infection Cyst rupture (leading to haematuria) Kidney trauma Make room for transplanted kidney
41
Causes of Bilateral Asterixis [4]
Metabolic Encephalopathy Hepatic Failure Renal Failure Hypercapnoea Drug Intoxication (Barbiturates, Phenytoin)
42
Causes of Bilateral Renal Cysts [5]
ADPKD Multiple simple cysts Tuberous Sclerosis von Hippel Lindau Syndrome Trisomies (Patau, Edward, Down)
43
Causes of Single Palpable Kidney [4]
ADPKD Hydronephrosis Renal Hypertrophy Renal Cell Carcinoma
44
Causes of Bilateral Palpable Kidneys [6]
ADPKD Multiple simple cysts Tuberous Sclerosis von Hippel Lindau Syndrome Trisomies (Patau, Edward, Down) Amyloidosis
45
Extra-Renal Manifestations of ADPKD [4]
Cerebral Aneurysms (Stroke, CN III Palsy) Liver Cysts [Common] Pancreatic, Splenic Cysts [Less Common] MVP, AR [Increased incidence but unclear association]
46
Aortic Stenosis Prognosis
Prognosis is based on presenting complaint Chest Pain: Median survival of 5 years Breathlessness: Median survival of 3 years Syncope: Median survival of 18 months
47
Causes of Aortic Stenosis [3]
1. Calcific degeneration 2. Congenital (bicuspid valve) 3. Rheumatic disease
48
Aortic Stenosis Markers of Severity [2]
1. Aortic valve area (in relation to body surface area) 2. Mean valve gradient
49
Indications for Aortic Stenosis Surgery
1. Symptomatic AS 2. MVP >40 (Severe Grade) + Any of the following: A. LV dysfunction (EF < 45%) B. Abnormal response to exercise C. Ventricular tachycardia D. LVH > 15mm E. Valve area < 0.6 (Severe Grade) 2. Going for CABG anyway
50
Types of Transplant Rejection [4]
51
Classic Immunosuppression Side-Effects [6]
1. All - Increased infection, skin malignancies 2. Prednisolone - Cushingoid Syndrome 3. Cyclosporine - Gum hypertrophy 4. Tacrolimus - Tremor 5. MMF - Nausea and vomiting 6. Azathioprine - Bone marrow suppression
52
Contraindications to Renal Transplant [3]
1. Active malignancy (must be cancer-free for 2 years) 2. Active infection 3. Advanced atheromatous disease (relative contraindication)
53
B Symptoms of Non-Hodgkin's Lymphoma [3]
1. Fever > 38.0 2. Weight loss of >10% body weight over 6 months 3. Drenching night sweats
54
Causes of Massive Splenomegaly [2]
Spleen enlarges to >20cm 1. CML 2. Myelofibrosis
55
Causes of Mild Splenomegaly [5]
1. Lymphoma 2. CLL 3. Liver cirrhosis with portal hypertension 4. Infections - Malaria, leishmaniasis, schistomiasis 5. Felty's Syndrome (Splenomegaly, rheumatoid arthritis, neutropaenia)
56
Causes of Hepatosplenomegaly [7]
Causes of Hepatosplenomegaly [7] Common Causes 1. Infections - Malaria, Leishmaniasis 2. Myeloproliferative Disorders - CML, Myelofibrosis - Associated with anaemia 3. Lymphoproliferative Disorders - Lymphadenopathy - Constitutional symptoms 4. Portal Hypertension - Look for other CLD signs Uncommon Causes 5. Wilson's Disease - Kayser-Fleisher Rings - Parkinsonism features 6. Haemochromatosis - Look for venesection marks 7. Rare Causes - Gaucher's Disease - Niemann-Pick Disease
57
UMN Signs [6]
1. Spastic paresis 2. Hyperreflexia 3. Hypertonia 4. No muscle wasting 5. No fasciculations 6. Positive Babinski (Upgoing plantars)
58
LMN Signs [6]
1. Flaccid paralysis 2. Hyporeflexia 3. Hypotonia 4. Muscle wasting 5. Fasciculations 6. Negative Babinski (Downgoing plantars)
59
Spot Diagnosis 1. LMN signs - Hyporeflexia - Hypotonia - Muscle wasting (particularly distally, leading to inverted champagne bottle shape of legs) 2. Distal weakness 3. Distal sensory loss in glove-and-stocking distribution 5. Bilateral pes cavus 6. Bilateral foot drop
Charcot-Marie-Tooth Disease
60
Bronchiectasis Investigations 7 Labs 2 Radio
Labs 1. FBC (Neutrophilia) 2. Serum IgG, IgM, IgA (Hypoglammaglobulinaemia) 3. A1AT Levels 4. Aspergillus Precipitins, Serum IgE (ABPA) 5. Autoantibodies (CTD) 6. CF Sweat Test 7. Sputum AFB + TB PCR Radiology 1. CXR 2. HRCT Thorax - Classic Signs: Tram tracks, signet ring - Reid Classification
61
Lung Upper Lobe Fibrosis "CHARTS"
Coal Miner's Pneumoconiosis Histiocytosis Ankylosing Spondylitis Radiation Tuberculosis Sarcoidosis, Silicosis
62
Lung Lower Lobe Fibrosis "CAIRO"
Connective Tissue Disease (eg Scleroderma, SLE) Asbetosis Idiopathic Pulmonary Fibrosis Rheumatoid Arthritis Others: Medications (Amiodarone, Methotrexate, Chemotherapy)

PACES Active Recall (3 decks)

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