Abdo

Question 1

Significant negatives in CLD

Answer 1

Evidence of decompensation
Evidence of SBP
Evidence of cause e.g. pigmentation, Kayser-Fleischer rings, tattoos

Question 2

Spontaneous bacterial peritonitis diagnostic criteria

Answer 2

PMN >250mm^3

Question 3

Hep C treatment

Answer 3

Interferon alpha + ribavirin (nucleoside inhibitor)

+/- sofosbuvir (inhibitor of viral RNA synthesis)

Question 4

Treatment for PBC

Answer 4

Ursodeoxycholic acid

Question 5

Treatment for Wilson’s disease

Answer 5

Penicillamine

Question 6

Treatment for Hereditary Haemochromatosis

Answer 6

Venesection and desferrioxamine

Question 7

Treatment for hepatorenal syndrome

Answer 7

IV albumin + terlipressin

Question 8

Treatment for hepatic encephalopathy

Answer 8

lactulose + rifamixin

Question 9

Treatment for ascites

Answer 9

Fluid and salt restrict, spiro, frusemide, tap, daily weights, TIPSS, transplant

Question 10

Causes of chronic liver disease

Answer 10

Alcohol
Viral
NASH
Other: HH, AIH, drugs e.g. methotrexate/amiodarone

Question 11

Complications of chronic liver disease

Answer 11

Decompensation / liver failure
SBP
Portal hypertension
HCC

Question 12

Features of portal hypertension

Answer 12

Splenomegaly
Ascites
Veins: caput medusae, oesophageal varices, haemorrhoids

Question 13

Features of decompensation

Answer 13

Jaundice, coagulopathy, ascites and hepatic encephalopthy

Question 14

Treatment of SBP

Answer 14

Tazocin or cefotaxime and await sensitivities

Question 15

Child-Pugh Grading of Cirrhosis

Answer 15

Albumin
Bilirubin
Clotting
Distension (ascites)
Encephalopathy

Question 16

Causes of portal hypertension (portal pressure >10mmHg)

Answer 16

Pre-hepatic: portal vein thrombosis (e.g. in PV)
Hepatic: cirrhosis
Post-hepatic: HF, tricuspid regurg, constrictive pericarditis, Budd-Chiari

Question 17

Causes of ascites

Answer 17

High SAAG (>1.1g/dL) = portal hypertension e.g. cirrhosis, HF, Budd-Chiari
Low SAAG (>1.1g/dL) = TB, pancreatitis, infection, serositis, malignancy, nephrotic syndrome

Question 18

Significant negatives in ascites

Answer 18

Raised JVP (not HF cause)
Periorbital oedema (not nephrotic cause)
Other evidence of decompensation (jaundice, coagulopathy, encephalopathy)
Signs of CLD e.g. clubbing, koilonychia, gynaecomastia, spider naevi

Question 19

Jaundice + splenomegaly

Answer 19

Haemolysis
CLD –> portal HTN
Viral hepatitis e.g. EBV

Question 20

Jaundice + hepatomegaly

Answer 20

Hepatitis

CLD

Question 21

Jaundice without organomegaly or CLD

Answer 21

Biliary obstruction
Haemolysis
Drugs e.g. OCP, fluclox
Gilbert’s

Question 22

Stigmata of immunsuppression

Answer 22

Cushingoid
Skin tumours e.g. AK, SCC, BCC
Gingival hypertrophy (ciclosporin)
Tremor (calcineurin inhibitors e.g. ciclosporin & tacrolimus)

Question 23

Causes of hepatomegaly

Answer 23

Infective e.g. viral hepatitis, EBV, CMV, malaria
Congestive e.g. RHF, CCF, constrictive pericarditis, Budd-Chiari
Autoimmune
Biliary disease e.g. extrahepatic obstruction, PBC, PSC
Tumours e.g. mets, HCC, lymphoma
Haem e.g. thalassaemia, SCD
Metabolic e.g. haemochromatosis, Wilson’s
Toxins e.g. statins

Question 24

Causes of splenomegaly

Answer 24

Myeloproliferative e.g. CML, MF
Lymphoproliferative e.g. CLL, lymphoma
Infective e.g. malaria, EBV, IE
Haem e.g. SCD, spherocytosis
Portal HTN (cirrhosis)
Inflammation e.g. RA, SLE
Infiltrative e.g. sarcoid and amyloid

Question 25

Felty's syndrome

Answer 25

Rheumatoid arthritis Splenomegaly Neutropenia

Question 26

Function of spleen

Answer 26

``` Phagocytosis of old RBCs and WBCs Phagocytosis of opsonised bugs Antibody production Sequestration of formed blood elements Haematopoiesis ```

Question 27

Indications for splenectomy

Answer 27

``` Trauma Rupture e.g. EBV AIHA ITP Hereditary spherocytosis Hypersplenism e.g. sequestration due to SCD or thalassaemia ```

Question 28

Significant negatives in renal enlargement exam

Answer 28

Renal impairment e.g. pallor, HTN Renal replacement therapy e.g. fistula, tunneled dialysis line or Tenchkoff catheter Immunsuppression e.g. Cushingoid, skin tumours, gingival hypertrophy, tremor Hydrocele secondary to RCC Mitral valve prolapse or hepatomegaly secondary to PCKD

Question 29

Causes of enlarged kidneys

Answer 29

Bilateral: PCKD, bilateral RCC, bialteral cysts e.g. VHL, amyloidosis, tuberous sclerosis Unilateral: simple renal cyst, RCC

Question 30

Functions of the kidney

Answer 30

Elimination of waste Regulation of volume and composition of body fluid Endocrine - EPO, renin and vit D Autocrine function e.g. endothelin, prostaglandins, renal natriuretic peptide

Question 31

Indications for renal transplant to look for on examination

Answer 31

DM - finger pricks, insulin marks on abdomen, lipodystrophy PCKD - ballotable kidneys or nephrectomy scars Connective tissue disease e.g. SLE, SS, RA

Question 32

Commonest indications for renal transplant

Answer 32

Diabetic nephro pathy Glomerulonephritis (idiopathic, immune e.g. SLE, infection e.g. Strep, drugs e.g. penicillamine, infiltrative e.g. amyloid) PCKD HTN

Question 33

Immunosuppressive regimen for renal transplant

Answer 33

Pre-op: alemtuzumab (anti-CD52) | Post-op: short term pred, long term tacrolimus or ciclosporin

Question 34

Complications of renal transplant

Answer 34

Post-op: bleeding, graft thrombosis, infection, urinary leaks Rejection: hyperacute/acute/chronic Drug toxicity: ciclosporin (nephrotoxic, gingival hypertrophy, hepatic dysfunction), tacrolimus (less nephrotoxic, diabetogenic, caridomyopathy, neurotoxicity), steroids, immunosuppresion SEs e.g. infection and malignancy Cardiovascular disease

Question 35

Complications of chronic renal failure

Answer 35

``` Cardiovascular disease Renal osteodystrophy Oedema HTN Electrolyte disturbances: hyperkalaemia, acidosis Anaemia Restless legs Sensory neuropathy ```

Question 36

Stages of chronic renal failure

Answer 36

``` Stage 1 eGR >90 Stage 2 eGFR 60-89 Stage 3a eGFR 45-59 Stage 3b eFGR 30-44 Stage 4 eGFR 16-29 Stage 5 eGFR <15 ```