# UKMLA & PLAB 1 Medicine I (NICE Guidelines): Cardiology, Respiratory, Gastroenterology, Endocrinology & Renal Pathways

> High-yield NICE clinical guidelines covering hypertension, atrial fibrillation, acute coronary syndrome, asthma, COPD, GI bleeding, liver disease, diabetes mellitus, thyroid disorders, and AKI/CKD.

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- **Markdown URL:** https://flashcards.world/flashcards/sets/94ad7000-816e-4530-a7b0-90135d741bd8.md
- **Level:** intermediate
- **Languages:** en → en
- **Total Cards:** 32

## Flashcards (32 Cards)

| # | Front (Term / Prompt) | Back (Definition / Answer) | Example | Multiple-Choice Options |
| :--- | :--- | :--- | :--- | :--- |
| 1 | In Acute Upper GI Bleeding (NICE CG141), which score is used at initial assessment BEFORE endoscopy vs. AFTER endoscopy? | Glasgow-Blatchford Score (GBS) is used pre-endoscopy (score 0 allows outpatient management); Rockall Score is used post-endoscopy to predict rebleeding and mortality. |  |  |
| 2 | What is the diagnostic triad and hallmark fluid-management difference between Hyperosmolar Hyperglycaemic State (HHS) and DKA? | HHS features hypovolaemia, severe hyperglycaemia (≥30 mmol/L) without significant ketonaemia (<3.0 mmol/L) or acidosis (pH >7.3), and hyperosmolality (≥320 mOsm/kg); managed primarily with IV 0.9% NaCl fluid resuscitation before low-dose insulin (0.05 units/kg/hr only if glucose plateaus). |  |  |
| 3 | What dangerous adverse effect must all patients starting Carbimazole or Propylthiouracil be counselled to report immediately? | Agranulocytosis (presenting as sore throat, mouth ulcers, or unexplained fever)—patients must stop the drug and have an urgent Full Blood Count (FBC). |  |  |
| 4 | Under NICE NG115 for COPD, when do you escalate from LAMA+LABA dual therapy to LAMA+LABA+ICS triple therapy in patients WITHOUT asthmatic features? | When the patient has ≥1 severe exacerbation (requiring hospitalization) or ≥2 moderate exacerbations within a year, or if blood eosinophils are ≥300 cells/µL during an exacerbation on dual therapy. |  |  |
| 5 | What is the immediate medical management of suspected Acute Variceal Upper GI Bleeding before endoscopy? | Resuscitate (restrictive transfusion threshold Hb <70 g/L), give IV Terlipressin AND prophylactic IV broad-spectrum antibiotics immediately (before endoscopy), and perform urgent endoscopy within 12–24 hours for band ligation. |  |  |
| 6 | In a haemodynamically stable patient with NSTEMI, which score determines whether immediate/early (<72h) coronary angiography is indicated per NICE? | The GRACE score: if predicted 6-month mortality is >3.0% (intermediate-to-high risk), offer coronary angiography within 72 hours alongside dual antiplatelet therapy and fondaparinux (unless immediate angiography planned). |  |  |
| 7 | What are the absolute refractory indications for emergency Renal Replacement Therapy (Haemodialysis) in AKI ('AEIOU')? | Acidosis (severe metabolic acidosis pH <7.15 refractory to medical therapy), Electrolyte derangement (K+ >6.5 mmol/L refractory to medical treatment), Intoxications (lithium, salicylates, ethylene glycol), Overload (refractory pulmonary oedema), and Uraemic pericarditis/encephalopathy. |  |  |
| 8 | According to NICE NG28 for Type 2 Diabetes Mellitus, when should an SGLT2 inhibitor (e.g., dapagliflozin/empagliflozin) be added alongside Metformin from the outset? | Whenever the patient has established chronic heart failure, established atherosclerotic cardiovascular disease (ASCVD), or high QRISK2 (>10%), titrating metformin first to check tolerability before adding the SGLT2i. |  |  |
| 9 | In Emergency Management of Severe Hyperkalaemia (K+ ≥6.5 mmol/L or ECG changes), what is the mechanism of IV Calcium Gluconate vs. Insulin-Dextrose? | 10 mL of 10% IV Calcium Gluconate stabilizes the cardiac myocardium within minutes (does NOT lower serum K+); IV soluble insulin (10 units) in 25g glucose drives K+ intracellularly. |  |  |
| 10 | In Community-Acquired Pneumonia (CAP), what are the components of the CURB-65 score and how does the score guide management? | Confusion (AMTS ≤8), Urea >7 mmol/L, Respiratory rate ≥30/min, BP <90 systolic or ≤60 diastolic, Age ≥65. Score 0–1: home (amoxicillin); Score 2: hospital inpatient (amoxicillin + clarithromycin); Score 3–5: severe/ICU consideration (co-amoxiclav + clarithromycin). |  |  |
| 11 | What are the three diagnostic biochemical criteria for Diabetic Ketoacidosis (DKA) according to JBDS UK guidelines? | 1) Ketonaemia ≥3.0 mmol/L (or >2+ ketonuria), 2) Blood glucose >11.0 mmol/L (or known diabetes), and 3) Venous bicarbonate <15.0 mmol/L and/or venous pH <7.3. |  |  |
| 12 | What is the first-line treatment to induce and maintain remission in mild-to-moderate Ulcerative Colitis (proctitis/proctosigmoiditis) per NICE? | Topical (rectal) aminosalicylate (mesalazine suppository or enema) first-line; add oral mesalazine if remission is not achieved within 4 weeks. |  |  |
| 13 | What are the four foundational disease-modifying 'Four Pillars' of pharmacotherapy in Heart Failure with Reduced Ejection Fraction (HFrEF)? | 1) ACEi/ARB or ARNI (sacubitril/valsartan), 2) Beta-blocker (bisoprolol/carvedilol), 3) Mineralocorticoid receptor antagonist (spironolactone/eplerenone), and 4) SGLT2 inhibitor (dapagliflozin/empagliflozin). |  |  |
| 14 | How do you differentiate Syndrome of Inappropriate ADH (SIADH) from Cranial/Nephrogenic Diabetes Insipidus on paired serum and urine osmolality? | SIADH: Euvolaemic hyponatraemia with low serum osmolality (<275 mOsm/kg), inappropriately concentrated urine (>100 mOsm/kg) and urine Na+ >30 mmol/L. Diabetes Insipidus: Hypernatraemia/high serum osmolality with dilute urine (<300 mOsm/kg). |  |  |
| 15 | According to Truelove and Witts' criteria, what defines Acute Severe Ulcerative Colitis? | ≥6 bloody stools per day PLUS at least one marker of systemic toxicity: temperature >37.8°C, heart rate >90 bpm, haemoglobin <105 g/L, or ESR >30 mm/hr (or CRP >30 mg/L). |  |  |
| 16 | According to NICE NG196 for Atrial Fibrillation, which score assesses stroke risk and which assesses bleeding risk, and what is the first-line anticoagulant? | CHA2DS2-VASc assesses stroke risk (offer anticoagulation if ≥2 in men orWomen, consider if 1 in men); ORBIT score assesses modifiable bleeding risk; first-line therapy is a DOAC (apixaban, rivaroxaban, edoxaban, or dabigatran). |  |  |
| 17 | What is the classic biochemical profile of Addison's disease (Primary Adrenal Insufficiency) and its definitive diagnostic test? | Hyponatraemia, hyperkalaemia, hypoglycaemia, and metabolic acidosis; diagnosed definitively by a 9 am cortisol and Short Synacthen (ACTH stimulation) test showing failure of cortisol to rise after 250 mcg tetracosactide. |  |  |
| 18 | Which common medication classes make up the 'DAMN' drugs that must be withheld ('Sick Day Rules') during Acute Kidney Injury? | Diuretics, ACE inhibitors / ARBs, Metformin (risk of lactic acidosis), and NSAIDs (plus aminoglycosides). |  |  |
| 19 | According to the updated 2024 BTS/NICE/SIGN joint Asthma guideline (NG245), what is the diagnostic test sequence and first-line treatment for newly diagnosed adult asthma? | Diagnosis uses eosinophil count/FeNO (≥50 ppb) or bronchodilator reversibility spirometry. SABA-alone is no longer recommended: start AIR (anti-inflammatory reliever: low-dose ICS/formoterol inhaler as needed) as Step 1. |  |  |
| 20 | What is the target oxygen saturation and first-line ventilatory support for a COPD exacerbation with decompensated Type 2 Respiratory Failure (pH 7.28, PaCO2 7.5 kPa)? | Target SpO2 88–92% via Venturi mask; if respiratory acidosis (pH 7.25–7.35 and PaCO2 >6.5 kPa) persists despite 1 hour of optimal medical therapy and controlled O2, initiate BiPAP (Non-Invasive Ventilation). |  |  |
| 21 | According to NICE NG136, what is the diagnostic threshold for Stage 1 vs. Stage 2 Hypertension using Clinic BP vs. ABPM/HBPM? | Stage 1: Clinic BP ≥140/90 mmHg AND subsequent ABPM/HBPM daytime average ≥135/85 mmHg. Stage 2: Clinic BP ≥160/100 mmHg AND ABPM/HBPM ≥150/95 mmHg. |  |  |
| 22 | According to NICE guidelines, what is the first-line definitive treatment vs. antithyroid drug regimen for Graves' Disease? | Radioactive iodine (I-131) is recommended by NICE as first-line definitive treatment for adults unless antithyroid drugs are likely to achieve remission or unsuitable (e.g., pregnancy, Thyroid Eye Disease); Carbimazole is the first-line antithyroid drug (Propylthiouracil in 1st trimester of pregnancy). |  |  |
| 23 | What is the HbA1c target in Type 2 Diabetes managed by lifestyle/single drug NOT associated with hypoglycaemia vs. a drug associated with hypoglycaemia (e.g., sulfonylurea)? | 48 mmol/mol (6.5%) for lifestyle or metformin alone; 53 mmol/mol (7.0%) if on a drug associated with hypoglycaemia (relax to 53 mmol/mol if HbA1c rises to ≥58 mmol/mol on single therapy). |  |  |
| 24 | When should Rate Control vs. Rhythm Control be chosen first-line in Atrial Fibrillation per NICE guidelines? | Rate control (beta-blocker or rate-limiting CCB like diltiazem; NOT diltiazem in HFrEF) is first-line for most patients; Rhythm control (cardioversion) is first-line if new-onset (<48h), reversible cause, heart failure caused by AF, or hemodynamic instability. |  |  |
| 25 | In Chronic Kidney Disease (NICE NG203), when should an SGLT2 inhibitor (dapagliflozin) be initiated alongside an ACEi/ARB? | Offer an SGLT2 inhibitor to CKD patients on maximum tolerated ACEi/ARB if they have Type 2 Diabetes and ACR >30 mg/mmol (consider if ACR 3–30), or in non-diabetic CKD with ACR ≥22.6 mg/mmol (200 mg/g). |  |  |
| 26 | What are the clinical features that distinguish Life-Threatening Asthma from Acute Severe Asthma in adults? | Life-threatening ('33, 92, CHEST'): PEF <33% best/predicted, SpO2 <92%, PaO2 <8 kPa, 'Normal' or raised PaCO2 (4.6–6.0 kPa), silent chest, cyanosis, poor respiratory effort, arrhythmia/hypotension, or exhaustion/confusion. |  |  |
| 27 | How do you distinguish Nephrotic Syndrome from Nephritic Syndrome clinically and biochemically? | Nephrotic triad: Heavy proteinuria (>3.5 g/24h or PCR >300 mg/mmol), hypoalbuminaemia (<30 g/L), and peripheral oedema (plus hyperlipidaemia). Nephritic: Haematuria (red cell casts), hypertension, oliguria, and mild-to-moderate proteinuria. |  |  |
| 28 | Under NICE NG136, what is the Step 1 antihypertensive drug of choice for a 62-year-old white patient without type 2 diabetes vs. a 48-year-old patient with type 2 diabetes? | Age ≥55 or Black African/African-Caribbean origin (without T2DM): Calcium Channel Blocker (CCB, e.g., amlodipine). Age <55 or any patient with T2DM: ACE inhibitor (ramipril) or ARB. |  |  |
| 29 | What are the NICE criteria for offering Long-Term Oxygen Therapy (LTOT) in chronic stable COPD? | PaO2 <7.3 kPa on two occasions at least 3 weeks apart, OR PaO2 7.3–8.0 kPa with secondary polycythaemia, nocturnal hypoxaemia, peripheral oedema, or pulmonary hypertension (in non-smokers). |  |  |
| 30 | In UK JBDS management of DKA, when do you start 10% Dextrose alongside 0.9% Sodium Chloride, and how is Fixed-Rate Intravenous Insulin Infusion (FRIII) dosed? | FRIII is started at 0.1 units/kg/hour; once blood glucose falls below 14.0 mmol/L, start 10% Dextrose at 125 mL/hr IN ADDITION to 0.9% NaCl while continuing the insulin infusion to clear ketones. |  |  |
| 31 | According to KDIGO / NICE criteria, how is Stage 1 Acute Kidney Injury (AKI) defined? | Serum creatinine rise of ≥26.5 µmol/L within 48 hours, OR a ≥1.5 to 1.9-fold rise from baseline within 7 days, OR urine output <0.5 mL/kg/hr for >6 consecutive hours. |  |  |
| 32 | Under NICE NG136, what is the Step 4 treatment for Resistant Hypertension (uncontrolled on A + C + D) depending on serum potassium? | If K+ ≤4.5 mmol/L: add low-dose spironolactone. If K+ >4.5 mmol/L: add an alpha-blocker (doxazosin) or beta-blocker. |  |  |

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