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.

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 ( 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).

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).

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.

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.

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).

What are the absolute refractory indications for emergency Renal Replacement Therapy (Haemodialysis) in AKI ('AEIOU')?

Acidosis (severe metabolic acidosis pH 6.5 mmol/L refractory to medical treatment), Intoxications (lithium, salicylates, ethylene glycol), Overload (refractory pulmonary oedema), and Uraemic pericarditis/encephalopathy.

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.

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.

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).

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.

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.

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).

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 ( 100 mOsm/kg) and urine Na+ >30 mmol/L. Diabetes Insipidus: Hypernatraemia/high serum osmolality with dilute urine (<300 mOsm/kg).

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 30 mm/hr (or CRP >30 mg/L).

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).

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.

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).

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.

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).

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.

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).

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).

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.

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).

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.

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.

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.

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).

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.

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 6 consecutive hours.

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.

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.

Level: intermediate
Languages: en → en
Cards: 32
Markdown: UKMLA & PLAB 1 Medicine I (NICE Guidelines): Cardiology, Respiratory, Gastroenterology, Endocrinology & Renal Pathways (.md)

Flashcards (32)

#	Front (Term / Question)	Back (Definition / Answer)
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.