MRCPI GM Part II Written key terms

Euvolaemic hyponatraemia caused by excessive ADH release, with concentrated urine, continued urinary sodium loss and low serum osmolality, typically triggered by drugs, small-cell lung cancer or CNS disease.

Neurological injury, classically central pontine myelinolysis, following overly rapid correction of chronic hyponatraemia, presenting with dysarthria, dysphagia, quadriparesis or reduced consciousness days after sodium rises.

Concentrated sodium chloride solution used in severe symptomatic hyponatraemia to raise serum sodium in controlled increments, with frequent monitoring to avoid overcorrection and demyelination.

Acute metabolic emergency of absolute or relative insulin deficiency with hyperglycaemia, ketonaemia and metabolic acidosis, managed with fluid resuscitation, fixed-rate intravenous insulin and potassium replacement.

Profound hyperglycaemia with marked hyperosmolality and dehydration in type 2 diabetes, with minimal ketosis; managed by cautious fluid replacement and insulin once circulating volume is restored.

Calculated difference between measured cations and anions, used to classify metabolic acidosis as high-gap (ketones, lactate, toxins, renal failure) or normal-gap (bicarbonate loss, renal tubular acidosis).

High-anion-gap metabolic acidosis from excess lactate production or impaired clearance, seen in shock, sepsis, hypoperfusion, metformin accumulation and seizures, and a marker of illness severity.

Life-threatening organ dysfunction caused by a dysregulated host response to infection, operationalised as a rise in SOFA score of at least two points; septic shock adds vasopressor need and raised lactate.

Sepsis with persistent hypotension requiring vasopressors to maintain mean arterial pressure and a serum lactate above 2 mmol/L despite adequate fluid resuscitation.

Bedside screening score for suspected infection using respiratory rate 22 or more, altered mentation and systolic blood pressure 100 mmHg or less; prognostic, not diagnostic, for sepsis.

Acute diffuse inflammatory lung injury with bilateral opacities and severe hypoxaemia not fully explained by cardiac failure, graded by the ratio of arterial oxygen to inspired oxygen.

Placing a ventilated patient face down for prolonged periods to improve oxygenation and reduce mortality in moderate-to-severe acute respiratory distress syndrome.

Respiratory support delivered through a mask, used in hypercapnic exacerbations of COPD and cardiogenic pulmonary oedema to reduce intubation and mortality; contraindicated with impaired consciousness or unprotected airway.

Hypoxaemia with hypercapnia (arterial carbon dioxide above 6 kPa) from alveolar hypoventilation, seen in COPD, neuromuscular weakness, obesity and sedative excess; oxygen must be titrated.

Daytime hypercapnia and hypoxaemia in a patient with obesity and no other cause of hypoventilation, often with obstructive sleep apnoea; managed with weight loss and positive airway pressure.

Structured evaluation of gait, balance, vision, cognition, medications, continence and environment in an older person who has fallen, guiding multifactorial intervention to prevent recurrence.

Acute fluctuating disturbance of attention and awareness due to an underlying medical cause, common in older inpatients; hyperactive, hypoactive and mixed subtypes occur and it predicts mortality.

Age-related decline in physiological reserve across multiple systems, increasing vulnerability to stressors; operationalised by the Fried phenotype or the Rockwood cumulative deficit index.

Multidisciplinary evaluation of medical, functional, psychological and social needs of an older person, producing a coordinated care plan that improves survival and reduces institutionalisation.

Acute coronary occlusion causing transmural ischaemia with ST elevation in contiguous leads; requires emergency reperfusion by primary percutaneous coronary intervention or fibrinolysis where timely PCI is unavailable.

Emergency coronary angioplasty, usually with stenting, as the preferred reperfusion strategy for ST-elevation myocardial infarction when it can be delivered promptly by an experienced team.

Cardiac biomarker released in myocardial injury; serial measurement with a validated algorithm allows rapid rule-in or rule-out of acute myocardial infarction when interpreted with clinical context.

Deeply inverted or biphasic anterior T waves in a pain-free patient, indicating critical proximal left anterior descending stenosis and imminent anterior infarction; exercise testing is contraindicated.

Heart failure with normal or near-normal left ventricular ejection fraction and evidence of raised filling pressures or diastolic dysfunction; managed with diuretics, SGLT2 inhibitors and comorbidity control.

Hormone released by stretched myocardium, measured as BNP or NT-proBNP; low values make heart failure unlikely, while raised values require interpretation in the context of age, renal function and atrial fibrillation.

Stroke prevention with a direct oral anticoagulant or warfarin in atrial fibrillation, decided by validated stroke risk scores and bleeding risk review rather than by rhythm alone.

Clinical score estimating stroke risk in atrial fibrillation from age, sex and vascular comorbidities, used to guide the decision to start anticoagulation.

Abrupt decline in renal function with rising creatinine or falling urine output, staged by KDIGO criteria and classified as prerenal, intrinsic or postrenal; drug review and fluid assessment are central.

Serum potassium above the reference range, risking arrhythmia; managed with cardiac membrane stabilisation by calcium, insulin-dextrose shift, potassium removal and treatment of the cause.

Calculated ratio of urinary to serum sodium relative to creatinine, used to distinguish sodium-avid prerenal states from intrinsic tubular injury, though diuretics and chronic kidney disease limit its value.

Functional renal failure in advanced liver disease or ascites, driven by splanchnic vasodilatation and renal vasoconstriction, diagnosed after excluding other causes and treated with vasoconstrictors and albumin.

Infection of ascitic fluid without an obvious intra-abdominal source, diagnosed by a polymorphonuclear cell count of 250 or more per microlitre; requires prompt antibiotics and albumin.

Score combining bilirubin, albumin, prothrombin time, ascites and encephalopathy to grade cirrhosis severity and inform prognosis and treatment decisions.

IgA tissue transglutaminase antibody with total IgA, used to select patients for duodenal biopsy while on a gluten-containing diet; false negatives occur with IgA deficiency.

Microcytic anaemia from depleted iron stores, confirmed by low ferritin or transferrin saturation; in men and postmenopausal women it requires investigation for gastrointestinal blood loss.

Fever or clinical deterioration in a patient with severe neutropenia, usually after chemotherapy; immediate empirical broad-spectrum antibiotics are required before investigation results return.

Metabolic emergency after rapid lysis of malignant cells, with hyperkalaemia, hyperphosphataemia, hyperuricaemia and hypocalcaemia; prevented by hydration and allopurinol or rasburicase.

Extradural tumour pressing on the spinal cord, causing back pain, weakness, sensory loss and sphincter disturbance; a clinical emergency needing immediate steroids and urgent imaging.

Autoimmune neuromuscular junction disorder with fatigable weakness, often ocular or bulbar, caused by acetylcholine receptor or related antibodies; managed with pyridostigmine and immunosuppression.

Presynaptic neuromuscular disorder with proximal weakness that improves with exercise and autonomic symptoms, associated with voltage-gated calcium channel antibodies and small-cell lung cancer.

Intravenous clot-dissolving treatment given within a restricted time window after excluding haemorrhage, improving functional outcome in eligible patients with disabling deficits.

Endovascular removal of a large vessel occlusion in selected acute ischaemic stroke patients, extending treatment to later time windows when imaging shows salvageable brain tissue.

Large-vessel vasculitis of older adults with headache, jaw claudication and visual loss; high-dose steroids are started immediately and temporal artery biopsy or ultrasound confirms the diagnosis.

Inflammatory condition of older adults with shoulder and hip girdle pain and stiffness, raised inflammatory markers and rapid response to low-dose prednisolone.

Small-vessel vasculitis associated with PR3 or MPO antibodies, causing pulmonary haemorrhage and rapidly progressive glomerulonephritis; treated with steroids and rituximab or cyclophosphamide.

Severe drug-related mucocutaneous reaction with epidermal detachment, managed in a specialist burns or intensive care setting with withdrawal of the culprit drug and supportive care.

Mucocutaneous hypersensitivity reaction, usually drug-induced, with blistering and detachment of a smaller body surface area than toxic epidermal necrolysis; both lie on one spectrum.

Intensely itchy vesicular eruption on extensor surfaces caused by granular IgA deposition in the skin, strongly associated with coeliac disease and treated with dapsone and a gluten-free diet.

Acute life-threatening cortisol deficiency with hypotension, vomiting and hyponatraemia, treated immediately with parenteral hydrocortisone and fluid before confirmatory testing.

Severe thyrotoxicosis with fever, tachyarrhythmia, agitation and multiorgan dysfunction, treated with beta-blockade, thionamide, iodine and supportive care.