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PACES Active Recall > PACES Active Recall > Flashcards

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
Q

Abdominal Scars

A
26
Q

Abdominal Scars

A
27
Q

Abdominal Scars

A
28
Q

Abdominal Scars

A
29
Q

Abdominal Scars

A
30
Q

Abdominal Scars

A
31
Q

Abdominal Scars

A
32
Q

Abdominal Scars

A
33
Q

Abdominal Scars

A
34
Q

Thoracic Scars

A
35
Q

Thoracic Scars

A
36
Q

Thoracic Scars

A
37
Q

Thoracic Scars

A
38
Q

Thoracic Scars

A
39
Q

Thoracic Scars

A
40
Q

Indications for Nephrectomy in ADPKD [5]

A

Persistent pain
Chronic infection
Cyst rupture (leading to haematuria)
Kidney trauma
Make room for transplanted kidney

41
Q

Causes of Bilateral Asterixis [4]

A

Metabolic Encephalopathy

Hepatic Failure
Renal Failure
Hypercapnoea
Drug Intoxication (Barbiturates, Phenytoin)

42
Q

Causes of Bilateral Renal Cysts [5]

A

ADPKD
Multiple simple cysts
Tuberous Sclerosis
von Hippel Lindau Syndrome
Trisomies (Patau, Edward, Down)

43
Q

Causes of Single Palpable Kidney [4]

A

ADPKD
Hydronephrosis
Renal Hypertrophy
Renal Cell Carcinoma

44
Q

Causes of Bilateral Palpable Kidneys [6]

A

ADPKD
Multiple simple cysts
Tuberous Sclerosis
von Hippel Lindau Syndrome
Trisomies (Patau, Edward, Down)
Amyloidosis

45
Q

Extra-Renal Manifestations of ADPKD [4]

A

Cerebral Aneurysms (Stroke, CN III Palsy)
Liver Cysts [Common]
Pancreatic, Splenic Cysts [Less Common]
MVP, AR [Increased incidence but unclear association]

46
Q

Aortic Stenosis Prognosis

A

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
Q

Causes of Aortic Stenosis [3]

A
  1. Calcific degeneration
  2. Congenital (bicuspid valve)
  3. Rheumatic disease
48
Q

Aortic Stenosis Markers of Severity [2]

A
  1. Aortic valve area (in relation to body surface area)
  2. Mean valve gradient
49
Q

Indications for Aortic Stenosis Surgery

A
  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)
  3. Going for CABG anyway
50
Q

Types of Transplant Rejection [4]

A
51
Q

Classic Immunosuppression Side-Effects [6]

A
  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
Q

Contraindications to Renal Transplant [3]

A
  1. Active malignancy (must be cancer-free for 2 years)
  2. Active infection
  3. Advanced atheromatous disease (relative contraindication)
53
Q

B Symptoms of Non-Hodgkin’s Lymphoma [3]

A
  1. Fever > 38.0
  2. Weight loss of >10% body weight over 6 months
  3. Drenching night sweats
54
Q

Causes of Massive Splenomegaly [2]

A

Spleen enlarges to >20cm
1. CML
2. Myelofibrosis

55
Q

Causes of Mild Splenomegaly [5]

A
  1. Lymphoma
  2. CLL
  3. Liver cirrhosis with portal hypertension
  4. Infections - Malaria, leishmaniasis, schistomiasis
  5. Felty’s Syndrome (Splenomegaly, rheumatoid arthritis, neutropaenia)
56
Q

Causes of Hepatosplenomegaly [7]

A

Causes of Hepatosplenomegaly [7]
Common Causes
1. Infections
- Malaria, Leishmaniasis

  1. Myeloproliferative Disorders
    - CML, Myelofibrosis
    - Associated with anaemia
  2. Lymphoproliferative Disorders
    - Lymphadenopathy
    - Constitutional symptoms
  3. Portal Hypertension
    - Look for other CLD signs

Uncommon Causes
5. Wilson’s Disease
- Kayser-Fleisher Rings
- Parkinsonism features

  1. Haemochromatosis
    - Look for venesection marks
  2. Rare Causes
    - Gaucher’s Disease
    - Niemann-Pick Disease
57
Q

UMN Signs [6]

A
  1. Spastic paresis
  2. Hyperreflexia
  3. Hypertonia
  4. No muscle wasting
  5. No fasciculations
  6. Positive Babinski (Upgoing plantars)
58
Q

LMN Signs [6]

A
  1. Flaccid paralysis
  2. Hyporeflexia
  3. Hypotonia
  4. Muscle wasting
  5. Fasciculations
  6. Negative Babinski (Downgoing plantars)
59
Q

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
  4. Bilateral pes cavus
  5. Bilateral foot drop
A

Charcot-Marie-Tooth Disease

60
Q

Bronchiectasis Investigations
7 Labs
2 Radio

A

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
Q

Lung Upper Lobe Fibrosis
“CHARTS”

A

Coal Miner’s Pneumoconiosis
Histiocytosis
Ankylosing Spondylitis
Radiation
Tuberculosis
Sarcoidosis, Silicosis

62
Q

Lung Lower Lobe Fibrosis
“CAIRO”

A

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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