MRCP(UK) Part 1 flashcards

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

STEMI ECG criteria

ST elevation of at least 1 mm in two contiguous limb leads, or at least 2 mm in leads V2-V3 in men, with reciprocal changes and a compatible clinical syndrome.

Cardiac tamponade features

Hypotension, raised jugular venous pressure and muffled heart sounds (Beck's triad), with pulsus paradoxus above 10 mmHg, electrical alternans on ECG and a large pericardial effusion.

Severe aortic stenosis criteria

Aortic valve area below 1.0 cm2, peak jet velocity of 4 m/s or more, or mean gradient of at least 40 mmHg; symptoms and left ventricular function determine timing of valve replacement.

Light's criteria

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 serum upper limit of normal.

CURB-65 score components

Confusion, urea above 7 mmol/L, respiratory rate 30 or more, systolic blood pressure under 90 or diastolic 60 or less, and age 65 or over; each scores one point.

Obstructive sleep apnoea diagnosis

An apnoea-hypopnoea index of 5 or more per hour combined with typical symptoms, or an index of 15 or more alone, confirmed on a sleep study.

Wilson disease findings

Low caeruloplasmin, high urinary copper, Kayser-Fleischer rings, Coombs-negative haemolytic anaemia and neuropsychiatric features; ATP7B mutations cause impaired biliary copper excretion.

Hepatitis B serology markers

HBsAg indicates current infection, anti-HBs immunity, HBeAg high infectivity, and anti-HBc IgM acute or recent infection; anti-HBc IgG persists for life after exposure.

Child-Pugh score components

Bilirubin, albumin, INR, ascites and encephalopathy, each graded 1 to 3, giving class A (5-6), B (7-9) or C (10-15) with progressively worsening prognosis.

Short Synacthen test interpretation

Serum cortisol measured at 0, 30 and 60 minutes after 250 micrograms of tetracosactide; a peak below 500 nmol/L indicates adrenal insufficiency and requires confirmatory testing.

Diagnostic criteria for diabetes

HbA1c of 48 mmol/mol or more, fasting glucose 7.0 mmol/L or more, or two-hour glucose 11.1 mmol/L or more on OGTT; repeat to confirm unless symptoms are typical.

SIADH diagnostic criteria

Euvolaemic hyponatraemia with low plasma osmolality, inappropriately concentrated urine above 100 mOsm/kg, urine sodium above 30 mmol/L, and normal thyroid and adrenal function.

KDIGO AKI definition

Rise in creatinine of 26 micromol/L or more within 48 hours, or to 1.5 times baseline within 7 days, or urine output below 0.5 mL/kg/h for 6 hours.

Treatment of hyperkalaemia

Calcium gluconate for cardiac membrane stabilisation, insulin with dextrose and nebulised salbutamol to shift potassium intracellularly, then removal with dialysis or potassium binders.

Nephrotic syndrome definition

Proteinuria above 3.5 g per 24 hours with hypoalbuminaemia, oedema and hyperlipidaemia; causes include minimal change disease, membranous nephropathy and diabetic nephropathy.

Albuminocytological dissociation

Raised cerebrospinal fluid protein with a normal cell count, classically seen in Guillain-Barre syndrome and also in chronic inflammatory demyelinating polyneuropathy.

McDonald criteria concept

Diagnosis of multiple sclerosis requires demyelinating lesions disseminated in space and time, supported by MRI, cerebrospinal fluid oligoclonal bands and exclusion of alternative diagnoses.

Wernicke encephalopathy triad

Ophthalmoplegia or nystagmus, ataxia and confusion caused by thiamine deficiency; give parenteral thiamine immediately before glucose to prevent progression to Korsakoff syndrome.

Gout crystal appearance

Needle-shaped, negatively birefringent monosodium urate crystals under polarised light microscopy of joint aspirate; pseudogout crystals are rhomboid and positively birefringent.

Antibodies in systemic sclerosis

Anti-centromere antibodies associate with limited cutaneous disease and pulmonary hypertension; anti-topoisomerase (anti-Scl-70) antibodies associate with diffuse disease and interstitial lung disease.

Giant cell arteritis features

Age over 50, new headache, jaw claudication, scalp tenderness, visual loss and ESR usually above 50; give high-dose corticosteroids immediately before temporal artery biopsy.

Findings in iron deficiency

Low ferritin, low serum iron and raised total iron-binding capacity with microcytic hypochromic anaemia; ferritin is an acute phase reactant and may be normal during inflammation.

Philadelphia chromosome

Reciprocal translocation t(9;22) producing the BCR-ABL1 fusion tyrosine kinase, diagnostic of chronic myeloid leukaemia and treated with tyrosine kinase inhibitors such as imatinib.

TTP pathophysiology

Severe deficiency of ADAMTS13 causes platelet-rich microthrombi with microangiopathic haemolytic anaemia, thrombocytopenia, neurological and renal features; treat with urgent plasma exchange.

Severe falciparum malaria treatment

Intravenous artesunate is first line for severe disease, defined by impaired consciousness, acidosis, renal failure, pulmonary oedema or parasitaemia above 2 percent.

Jarisch-Herxheimer reaction

Fever, rigors and hypotension within hours of starting treatment for syphilis, caused by release of treponemal antigens; managed supportively without stopping penicillin.

Cytochrome P450 inducers

Rifampicin, carbamazepine, phenytoin, phenobarbital and St John's wort increase enzyme activity, lowering concentrations of warfarin, oral contraceptives and many other drugs.

Zero-order drug kinetics

Elimination at a constant rate independent of plasma concentration, so small dose increases cause large rises in level; phenytoin, ethanol and high-dose salicylates behave this way.

Nikolsky sign

Extension of blistering when lateral pressure is applied to skin, positive in pemphigus vulgaris and toxic epidermal necrolysis, indicating intraepidermal or full-thickness epidermal cleavage.

Dermatitis herpetiformis

Intensely itchy vesicles on extensor surfaces with granular IgA deposits in the dermal papillae; strongly associated with coeliac disease and responds to a gluten-free diet.

Hypoactive delirium features

Withdrawal, reduced movement and slowed speech that is easily mistaken for depression or dementia; occurs in older patients and carries a higher mortality than the hyperactive subtype.

STOPP and START criteria

Screening tools listing potentially inappropriate medicines to stop and beneficial medicines omitted, used to structure medication review in older adults and reduce adverse drug events.