MLA Domain 5 · Presentation

Pruritus

8 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 1

Primary biliary cholangitis

Progression to cirrhosis/portal hypertension; HCC risk

recognised feature · 6

Chronic kidney disease

A rapid fall in eGFR, accelerated hypertension, or visible haematuria → investigate for a treatable cause (GN, obstructi

End-stage renal disease & renal replacement therapy

Refractory hyperkalaemia/acidosis/fluid overload or uraemic pericarditis/encephalopathy → urgent dialysis (AEIOU)

Haemorrhoids

Rectal bleeding with change in bowel habit, weight loss, anaemia, or age ≥50/≥60 → investigate for COLORECTAL CANCER, do

Jaundice in pregnancy

Very high bile acids (stillbirth risk); features of pre-eclampsia/HELLP or acute fatty liver of pregnancy (a different e

Myeloproliferative neoplasms & polycythaemia

Arterial/venous thrombosis (stroke, MI, Budd-Chiari, splanchnic) or major bleeding

Primary sclerosing cholangitis

Cholangiocarcinoma (rising CA19-9/new dominant stricture); recurrent bacterial cholangitis

differential of the above · 1

Autoimmune hepatitis

Acute liver failure presentation (coagulopathy/encephalopathy) → urgent specialist