MRCPI GM Part II Written flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Osmotic demyelination syndrome threshold

Over-rapid correction of chronic hyponatraemia causes osmotic demyelination. Limit the rise to 8–10 mmol/L in the first 24 hours, and use hypertonic saline only for seizures, coma, or other severe neurological features.

Anion gap formula

Anion gap equals sodium minus the sum of chloride and bicarbonate, normally 8–12 mmol/L. Add about 2.5 mmol/L for every 1 g/dL fall in albumin, because hypoalbuminaemia lowers the measured gap.

CURB-65 components

Confusion, urea above 7 mmol/L, respiratory rate 30 or more, systolic BP below 90 or diastolic 60 or less, and age 65 or older. Each scores one point and guides admission and severity assessment.

Fried frailty phenotype

Five criteria: unintentional weight loss, exhaustion, low grip strength, slow gait speed and low physical activity. Three or more criteria define frailty; one or two define pre-frailty and predict adverse outcomes.

STOPP and START criteria

STOPP lists potentially inappropriate medicines to stop in older people, such as benzodiazepines and anticholinergics. START lists indicated treatments often omitted, such as statins in established cardiovascular disease and vitamin D in falls.

Hypoactive delirium recognition

A subtype of delirium with reduced activity, flat affect and slowed speech, often mistaken for depression or fatigue. It is frequently missed yet carries a worse prognosis than hyperactive delirium, so actively screen at-risk inpatients.

Septic shock definition

Sepsis with persisting hypotension requiring vasopressors to maintain mean arterial pressure of 65 mmHg or more, together with a serum lactate above 2 mmol/L despite adequate fluid resuscitation.

Anaphylaxis adrenaline dose

Give intramuscular adrenaline 0.5 mg of 1:1000 solution into the anterolateral thigh, repeating every five minutes as needed. Antihistamines and corticosteroids are adjuncts and never replace adrenaline.

ARDS Berlin definition

Acute onset within one week, bilateral opacities on imaging, and a PaO2/FiO2 ratio of 300 mmHg or less on PEEP of at least 5 cmH2O. Ventilate with lung-protective volumes of 6 mL/kg predicted body weight.

DKA insulin and glucose rule

Use a fixed-rate insulin infusion of 0.1 units/kg/h. Add 10% glucose once capillary glucose falls below 14 mmol/L, and continue insulin until ketones clear and pH normalises.

Heart failure quadruple therapy

For heart failure with reduced ejection fraction, combine an ACE inhibitor, ARB or ARNI with a beta-blocker, a mineralocorticoid receptor antagonist and an SGLT2 inhibitor. Each class reduces mortality.

CHA2DS2-VASc anticoagulation threshold

Anticoagulate men with a score of 2 or more and women with 3 or more. Female sex alone scores one point and does not by itself justify anticoagulation for atrial fibrillation.

Severe aortic stenosis criteria

Peak aortic velocity of 4 m/s or more, mean gradient of 40 mmHg or more, or valve area below 1.0 cm². Symptoms, left ventricular dysfunction, or both mandate aortic valve intervention.

Light's criteria for exudate

Pleural fluid is an exudate if the protein ratio to serum exceeds 0.5, the LDH ratio exceeds 0.6, or pleural LDH exceeds two-thirds of the upper limit of normal serum LDH.

COPD spirometric diagnosis

A post-bronchodilator FEV1/FVC ratio below 0.70 confirms persistent airflow obstruction. Severity is then graded by FEV1 percentage predicted, from GOLD 1 to GOLD 4.

Tension pneumothorax decompression

Perform immediate needle decompression without waiting for imaging, in the second intercostal space mid-clavicular line or fifth space anterior axillary line. Definitive chest drain placement follows.

Spontaneous bacterial peritonitis threshold

An ascitic polymorphonuclear cell count of 250 cells/mm³ or more is diagnostic. Start a third-generation cephalosporin immediately rather than waiting for ascitic fluid culture results.

Coeliac serology pitfall

IgA tissue transglutaminase can be falsely negative in IgA deficiency, so request total IgA alongside. Duodenal biopsy while the patient still eats gluten confirms the diagnosis in adults.

Addisonian crisis treatment

Give intravenous hydrocortisone 100 mg immediately, followed by 100–200 mg over 24 hours, plus one litre of 0.9% saline in the first hour. Do not delay treatment for cortisol results.

Phaeochromocytoma blockade sequence

Alpha blockade with phenoxybenzamine or doxazosin must precede any beta blockade. Giving a beta-blocker first leaves alpha-mediated vasoconstriction unopposed and can precipitate hypertensive crisis.

KDIGO acute kidney injury criteria

A creatinine rise of 26.5 µmol/L or more within 48 hours, or to 1.5 times baseline or more within seven days, or urine output below 0.5 mL/kg/h for six hours.

Hyperkalaemia with ECG changes

Give intravenous calcium gluconate first to stabilise the myocardium, then shift potassium intracellularly with insulin–dextrose and nebulised salbutamol. Definitive removal follows later.

Nephrotic syndrome tetrad

Proteinuria above 3.5 g per day, hypoalbuminaemia, generalised oedema and hyperlipidaemia. Adults usually need renal biopsy to identify the underlying glomerular pathology.

Stroke thrombolysis window

Intravenous thrombolysis is licensed within 4.5 hours of symptom onset after CT excludes haemorrhage. Mechanical thrombectomy may be offered up to 24 hours in selected large-vessel occlusion.

Guillain–Barré syndrome features

Ascending symmetrical weakness with reduced or absent reflexes, often after infection. Cerebrospinal fluid shows raised protein with normal cell count, and treatment is intravenous immunoglobulin or plasma exchange.

Giant cell arteritis urgency

Suspect with new headache, jaw claudication or visual symptoms and a raised ESR, often above 50 mm/h. Give high-dose glucocorticoids immediately to prevent blindness, then confirm with biopsy or ultrasound.

Gout crystal identification

Joint aspiration shows needle-shaped, negatively birefringent monosodium urate crystals. Allopurinol is titrated to a serum urate target below 360 µmol/L, with prophylaxis against flares during initiation.

TTP emergency management

Microangiopathic haemolytic anaemia, thrombocytopenia, neurological features, renal impairment and fever suggest thrombotic thrombocytopenic purpura. Arrange urgent plasma exchange without waiting for ADAMTS13 results.

Neutropenic sepsis antibiotic timing

Give empirical anti-pseudomonal beta-lactam antibiotics within one hour of presentation. Do not delay for blood culture results, imaging, or a severity score in a neutropenic patient with fever.

Tumour lysis syndrome abnormalities

Biochemical constellation of hyperkalaemia, hyperphosphataemia, hyperuricaemia and secondary hypocalcaemia after cytotoxic therapy. Treat with vigorous hydration, monitoring, and rasburicase when urate is high.

Malignant spinal cord compression

Back pain with neurological deficit in a patient with cancer is an emergency. Give dexamethasone 16 mg daily and arrange urgent MRI within 24 hours before any definitive oncology treatment.

Severe falciparum malaria treatment

Severe features such as impaired consciousness, acidosis, renal failure or pulmonary oedema require intravenous artesunate. Oral therapy is inadequate, and parasitaemia should be monitored until it clears.