Histopathological diagnosis as an essential aid to diagnosis

Question 1

34 yr old presented with fit

no PMH, drugs, HPC

SH - works for the BBC

what blood tests

Answer 1

• FBC – might have infection so look for high WCC.
• glucose – hypoglycaemia – only really if they have had too much insulin = hypoglycaemic episode
• Electrolytes – abnormal electrolytes = seizure

Question 2

electrolyte imbalances that cause seizures

Answer 2

Hypocalcaemia – if cause is metabolic this is most common

Hyponatraemia – generally unwell

Hypoglycaemia – rare to get to seizure level

Hypokalameia – more usually arrhythmia – cardiac more sensitive to K – get VF (same as seizure just in a different organ)

Question 3

medicine for someone having a fit that doesn’t stop spontaneously

Answer 3

Benzodiazepines – if in status ie seizure for a long time eg diazepam – IV quickest route then PR

Difficult to get venous access in someone actively seizing

Question 4

Answer 4

Black stuff is cerebral oedema around the lesion

SOL – get a lot of vasogenic oedema – blood vessels leak fluid – put the pressure up even more

Epileptic seizure with SOL = midline shift

Question 5

what is the most common type of brain tumour

Answer 5

Met are the most common brain tumour – lung in men and breast in women

Meningioma – most common primary

Question 6

Answer 6

pancreas

Question 7

Answer 7

L adrenal gland - quite big - abnormal

Question 8

Answer 8

R adrenal - huge

Question 9

ddx of the 2 enlarged adrenal glands

Answer 9

Could be bilateral phaeo if congenital

Conn’s can be bilateral but conns tumours are quite small

Addison’s – if replaced by cancer

Low Na and high K – addison’s

Question 10

Ix to determine the cause of bilateral enlarged adrenal glands

and results in addisons

Answer 10

9am cortisol - very low

ACTH - very high

Synacthen test – low cortisol and high ACTH

Question 11

causes of addisons

Answer 11

• Adrenal atrophy
• TB
• Met cancer

Question 12

signs of addison’s

Answer 12

Question 13

Answer 13

adrenal biopsy

low power

lots of cells around the edge

Question 14

what are these cells

Answer 14

multinucleated giant cells

Question 15

dx

Answer 15

TB

Question 16

Answer 16

acid fast bacilli

Question 17

mx for systemic TB

Answer 17

Need to take tablets for 6mo – if not you get resistance

Rifampicin

Isoniazid

Pyrazinamide

Ethambutol

R and I for the whole 6mo because most bactericidal

E and P in case of resistance

Takes 2 mo fro culture and sensitivity to come back – so need all four initially. If sensitive to all then stop E and P because most SE. If resistant to r or I – carry on with one of the others instead

Question 18

histopathology of TB

Answer 18

caseating (cheeselike) granulomata

Question 19

Mx of Addison’s

Answer 19

4mg prednisolone daily

fludrocortisone 100mcg daily

(if with TB:

• Rifampicin – enzyme inducer in the liver
• Drug by mouth goes through hepatic portal vein – 1^st pass metabolism wipes out a lot of drugs.
• Rifampicin = pred less effective – so need 5mg which is normally high dose)