Abdominal System Flashcards
(72 cards)
1
Q
Name the vitamin K dependent clotting factors
A
Factors II, VII, IX and X
2
Q
What does TIPPS stand for in the treatment of varices
A
Transvenous intrahepatic postosystemic shunting
3
Q
Name a potential complication of a TIPS procedure
A
Encephalopathy
4
Q
Give 3 clinical signs on examination that indicate poor liver synthetic function
A
- Cachexia
- Leuconychia
- Easy bruising
5
Q
Recall 5 features of reduced oestrogen breakdown
A
- Palmar erythema
- Spider naevi
- Gynaecomastia
- Reduced axillary and genital hair
- Testicular atrophy
6
Q
Give 2 clinical features of portal hypertension associated with chronic liver disease
A
- Caput medusa
2. Splenomegaly
7
Q
Give 4 clinical features of decompensated chronic liver disease
A
- Jaundice
- Hepatic encephalopathy
- Ascites
- Easy bleeding
8
Q
Recall the 5 ‘classic’ OSCE cases of chronic liver disease
A
- Alcoholic liver disease
- Hepatitis B/C
- Hereditary haemochromotosis
- Primary biliary cirrhosis
- Autoimmune hepatitis
9
Q
Give to clinic findings specific to a patient with alcoholic liver disease
A
- Dupytren’s contracture
2. Enlarged parotids
10
Q
Suggest 3 examination findings associated with hereditary haemochromotosis
A
- Finger prick marks from regular BM testing
- Arthropathy
- Bronze skin pigmentation
11
Q
Give 5 clinical findings associated with primary biliary cirrhosis
A
- Middle aged female
- Xanthelasma
- Excoriation marks
- Easy bruising
- Hepatosplenomegaly
12
Q
Suggest 4 toxic differentials for chronic liver disease
A
- Alcohol
- Methotrexate
- Amiodarone
- Isoniazid
13
Q
Suggest 4 autoimmune differentials for chronic liver disease
A
- Primary biliary cirrhosis
- Autoimmune hepatits
- Primary sclerosing cholangitis
- Sarcoidosis
14
Q
Name the 4 investigations that must be done from an ascitic tap sample in the investigation of chronic liver disease
A
- Fluid cell count and differential
- Protein
- Albumin
- Cultures - aerobic and anaerobic blood bottles required
15
Q
An abdominal ultrasound in the assessment of chronic liver disease will be looking at what? (5)
A
- Evidence of organomegaly
- Look for cirrhosis
- Liver masses
- Ascites
- Assess portal pressure
16
Q
Outline the non pharmacological elements of the management of chronic liver disease
A
- Input from dietician
- Alcohol cessation support
- Vaccinations
- Avoid hepatotoxic agents e.g. NSAIDS
17
Q
Name 3 vaccinations required by patients with chronic liver disease
A
- Hepatitis
- Pneumococcal
- Annual influenza
18
Q
What is the medical treatment for pruritus secondary to chronic liver disease?
A
Colestyramine
19
Q
Why are quinolone antibiotics prescribed to patients with chronic liver disease?
A
Prophylaxis against SBP if they have had a previous episode
20
Q
How do you diagnose Spontaneous bacterial peritonitis?
A
Ascitic tap - positive if neutrophil count is >250 per ml
21
Q
What is the most common causative organism of SBP?
A
E.Coli
22
Q
What are the 7 main differentials to consider for a patient presenting with ascites?
A
- Cirrhosis
- Malignancy
- Heart failure
- Pancreatitis
- Hypoalbuminemia
- Infection e.g. TB
- Hypothyroidism
23
Q
Suggest 2 potential causes of hypoalbuminemia
A
- Nephrotic syndrome
2. Malnutrition
24
Q
On average, how much fluid needs to be present in order to be clinically detectable as abdominal ascites?
A
1500mls
25
Which forms of chronic liver disease are prone to causing hepatosplenomegaly? (3)
1. Primary biliary cirrhosis
2. Alcoholic liver disease
3. Cirrhosis with hepatocellular carcinoma
26
Which autoantibodies would be present in a patient with primary biliary cirrhosis
Anti-mitochondrial antibodies
27
What is the cause of Wilson's disease?
Autosomal recessive genetic defect in ATP7B on chromosome 13 resulting in reduced copper excretion in the bile and resultant accumulation in other body organs such as the liver and brain
28
What blood ceruloplasmin level is diagnostic of Wilson's disease?
< 180mg/L
29
Recall 3 'classical differentials' for craggy hepatomegaly
1. Hepatocellular carcinoma
2. Polycystic liver disease
3. Hydatid cyst
30
Why would you perform a urine dipstick in a patient presenting with craggy hepatomegaly?
Check for haematuria which may indicate ADPCKD
31
Which primary malignancies commonly metastasise to the liver?
1. GI tract tumours including stomach, pancreas and colon
2. Lung
3. Breast
4. Ovarian
5. Melanoma
32
What features in a patient with chronic live disease would warrant consideration of transplantation?
1. Progressive jaundice
2. Diuretic resistant ascites
3. hepatocellular carcinoma
33
Differential diagnoses for bilaterally palpable enlarged kidneys
1. Normal kidneys in a slim patient
2. Hydronephrotic kidneys secondary to obstruction
3. Amyloidosis
4. Tuberous sclerosis
5. Von Hippel Lindau
34
Differential diagnoses for a single palpable kidney
1. Palpable right kidney in slim individual
2. Hypertrophy of a single functioning kidney
3. Neoplastic diseaes
4. Unilateral hydronephrosis secondary to obstruction
35
Name the surgical scar made from a kidney transplant
Rutherford Morrison scar in the right iliac fossa
36
Suggest 7 potential signs of inadequate renal replacement therapy
1. Tachypnoea
2. Raised JVP
3. Peripheral oedema
4. Asterexis
5. Confusion
6. Excoriation marks
7. Pericardial rub
37
Which genetic abnormalities are seen in patients with autosomal dominant polycystic kidney disease?
Majority have a mutation in PKD-1 on chromosome 16, some have a mutation of PKD-2 on chromosome 4
38
What are the extra-renal features of autosomal dominant polycystic kidney disease?
1. Hepatic cysts
2. Intracranial Berry aneurysms
3. Mitral valve prolapse
39
Which renal cystic conditions are at a high risk of neoplastic transformation?
1. Tubular sclerosis
| 2. Von Hippel Lindau
40
Suggest 4 procedures that can be used to assess the synthetic function of the liver
1. Bilirubin
2. Albumin
3. Prothrombin time
4. Serum blood glucose
41
At what bilirubin level will jaundice become clinically apparent?
>60 umol/l
42
Link the colour combinations of urine and stool to the potential cause classification of the patients jaundice
Normal urine + normal stool - prehepatic jaundice
Dark urine + normal stool - hepatocellular jaundice
Dark urine + pale stool - post hepatic jaundice
43
Suggest 4 potential causes of unconjugated hyperbilirubinaemia
1. Haemolytic anemia
2. Congestive cardiac failure
3. Drugs
4. Gilbert's syndrome
44
Suggest 7 clinical findings on general examination that are associated with anemia
1. Pallor
2. Jaundice - haemolysis or chronic liver disease
3. Pigmented skin from secondary haemochromotosis
4. Koilonychia - iron deficiency
5. Angular stomatitis
6. Telangiectasia
7. Lymphadenopathy
45
Why are LFTs included in the investigatory work up of a patient with anemia?
Raised bilirubin indicates haemolysis
46
What test can be used to screen a patient with anemia for sickle cell disease/ thalassaemia?
Hb electrophoresis
47
Suggest 4 potential causes of a microcytic anemia
1. Iron deficiency
2. Thalassaemia
3. Lead poisoning
4. Sideroblastic anemia
48
Name a drug that can cause a macrocytic anemia
Methotrexate
49
Give 3 congenital causes of haemolytic anemia
1. Sickle cell disease
2. G6PD deficiency
3. Spherocytosis
50
What are the 2 main differentials to consider for an AKI presenting with Haematuria/ haemoptysis?
1. Vasculitis
| 2. Goodpasture's syndrome
51
Give 3 clinical symptoms of uraemia
1. GI upset
2. Drowsiness
3. Tremor
52
Which 3 antibodies would you test for on initial investigation of a patient presenting with AKI?
1. ANA - SLE
2. ANCA - Vasculitis
3. Anti-GBM - Goodpasture's syndrome
53
Give 4 indications for dialysis of a patient with severe AKI
1. Refractory hyperkalemia
2. Metabolic acidosis
3. Uraemia
4. Fluid overload
54
Give 4 factors of the HPC that you must ask about when taking a Hx from a patient with ESKD
1. When was renal failure first diagnosed?
2. Cause of renal failure
3. Mode of renal replacement therapy
4. Normal eGFR levels
55
Which genetic cause of CKD is associated with sensorineural deafness?
Alport's syndrome
56
Name the 4 most common causes of CKD requiring dialysis in the UK
1. Diabetes
2. Hypertension
3. Glomerulonephritis
4. Genetic kidney disease e.g. polycystic kidneys
57
Suggest 5 clinical signs that can be associated with long term immunosuppression post solid organ transplant
1. Skin lesions e.g. warts, keratoses, BCCs
2. Mout Ulcers
3. Bruising and Cushingoid appearance
4. Gingival hypertrophy (Ciclosporin)
5. Hirsuitism (Ciclosporin)
58
Name 2 calcineurin inhibitors
1. Ciclosporin
| 2. Tacrolimus
59
Give 3 possible complications associated with immunosuppresiosnj with calcineurin inhibitors
1. Tremor
2. Hypertension
3. CKD
60
Name 2 anti proliferative agents used in post transplant immunosuppression
1. Azathioprine
| 2. Mycophenolate
61
Outline the 3 drugs used as prophylaxis against opportunistic infections in patients on post solid organ transplant immunosuppression
1. Co-trimoxazole - PCP
2. Valganciclovir - Viral reactivation/ infection with donor CMV
3. Azithromycin - prevent chest infections in lung transplant recipients.
62
Recall the classic triad of symptoms associated with nephrotic syndrome
1. Proteinuria
2. Hypoalbuminaemia
3. Oedema
63
Which cause of nephrotic syndrome is associated with both hepatomegaly and splenomegaly?
Amyloidosis
64
Why is primary nephrotic syndrome known as the 'disease of 3s'?
Diagnosis required a proteinuria >3g/ day
1/3 of adults with the diagnosis have minimal change disease
1/3 FSGS
1/3 membranous nephropathy, of whom:
1/3 spontaneously remit
1/3 remain nephrotic with stable disease
1/3 progress to end stage renal failure
65
Define Still's disease
A rare auto inflammatory disease characterised by a triad of fever, joint pain and a distinctive salmon coloured bumpy rash
66
In which other organs may cysts be found in patients with autosomal dominant polycystic kidney disease?
1. Liver
2. Spleen
3. Pancreas
67
What are the symptoms of Wilson's disease?
1. Chronic liver disease
2. Parkinsonisms
3. Other movement disorders e.g. ataxia, dystonia
More rarely:
1. Heart failure (cardiomyopathy)
2. Proximal renal tubular acidosis
3. Hypoparathyroidism
68
What is another name for coeliac disease?
Gluten enteropathy
69
Name the 2 autoantibodies that are used in the diagnosis of coeliac disease
1. Anti-endomysial
| 2. Anti-gliadin
70
Name an antispasmodic that can be used in the treatment of irritable bowel syndrome
Mebeverine
71
Suggest 3 bits of advice to impart to a patient with a new diagnosis of irritable bowel syndrome
1. Keep regular mealtimes
2. Drink plenty of fluid while restricting caffeine and alcohol
3. Reducing intake of foods that are high in insoluble fibre
72
Recall the 5 stages of CKD based on a patient's eGFR
```
Stage 1 - >90
Stage 2 - 60-90
Stage 3 - 30-59
Stage 4 - 15-29
Stage 5 < 15
```
