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PHASE 3B > Data Interpretation + Radiology > Flashcards

Data Interpretation + Radiology Flashcards

1
Q

2 major groups of IV fluids? Which are used less frequently due to a risk of anaphylaxis?

A

Crystalloids: solutions of small molecules in water e.g. NaCl, Hartmann’s, dextrose
Colloids: solutions of larger organic molecules e.g. albumin, Gelofusine
Colloids

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2
Q

5 Rs for prescribing IV fluids?

A

Resus, routine maintenance, replacement, redistribution, reassessment

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3
Q

Findings of hypervolaemia?

A

Increased RR>20 breaths/ minute, decreased oxygen SATs, bilateral crackles on auscultation
Hypertension, elevated JVP
Increased urine output, abdominal distension, peripheral oedema, fluid chart= positive fluid balance, weight gain

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4
Q

Findings of hypovolaemia?

A

High HR>90 BPM, hypotension, prolonged CRT, non-visible JVP
Decreased GCS if volume depleted
Increased output from wounds and drains, decreased urine output, fluid chart= negative fluid balance, weight loss, other sources of fluid loss

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5
Q

If hypovolaemic next step? Administer what bolus initially?

A

Initiate fluid resus- DON’T IF HYPERVOLAEMIC
500ml of a crystalloid solution e.g. NaCl 0.9%/ Hartmann’s solution over less than 15 minutes

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6
Q

After administering an initial 500ml bolus for resus, do what? If clinical evidence of ongoing hypovolaemia? Repeat process up until what total?

A

Reassess using ABCDE approach
Further 250-500ml bolus of crystalloid solution, reassess using ABCDE approach
2000ml–> expert help if still

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7
Q

If complex comorbidities e.g. HF, renal failure and/ or elderly what bolus should be given? If normovolaemic, but signs of shock do what?

A

250ml
Seek expert help immediately

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8
Q

If patient able to meet their fluid and/ or electrolyte needs orally/ enterally no further what required? Unable? Will likely need what? Don’t have above issues, but unable to meet fluid requirement? When should be administered?

A

No further IV fluids
Consider if complex fluid issues, electrolyte replacement issues, abnormal fluid redistribution issues
Fluid replacement and/ or redistribution
Routine maintenance IV fluids- during daytime hours to prevent sleep disturbance

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9
Q

What is the daily maintenance fluid requirements as per NICE guidelines? What should weight-based potassium prescriptions be rounded to? What should NOT be manually added to fluids?

A

25-30ml/ kg/ water + approx 1 mmol/kg/day of K+, Na+ and Cl- and approx 50-100g/ day of glucose to limit starvation ketosis
The nearest common fluids
Potassium

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10
Q

Who should you use the lower range for volume per kg? Other patient groups who you should take a more cautious approach to fluid prescribing?

A

Obese patients
Elderly patients
Patients with renal impairment/ cardiac failure
Malnourished patients at risk of refeeding syndrome

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11
Q

NG fluids/ enteral feeding is preferable when maintenance needs are more than how many days? Patients requiring a slightly different approach than the routine fluid maintenance regimen?

A

3 days
Those with existing fluid or electrolyte deficits or excesses, ongoing abnormal fluid or electrolyte losses, redistribution and other complex issues

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12
Q

Where to put the 6 chest ECG electrodes?

A

V1: 4th IC space at right sternal edge
V2: 4th IC space at left sternal edge
V3: midway between V2 and V4 electrodes
V4: 5th IC space in MC line
V5: left anterior axillary line at same horizontal level as V4
V6: left mid-axillary line at same horizontal level as V4 & V5

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13
Q

Leads for inferior view of the heart? Lateral view? Anterior view? Septal view?

A

II, III & aVF
I, aVL, aVR, V5 & V6
V3 & V4
V1 & V2

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14
Q

DRSABCDE for chest X-rays? Mnemonic for assessing image quality?

A

Details: patient name, age/ DOB, sex, type of film- PA/ AP(assume PA if no label,) erect/ supine, correct L/R marker, inspiratory/ expiratory series
RIPE: rotation- medial clavicle ends equidistant from spinous processes/ inspiration- at least 6 anterior ribs, poor inspiration/ hyperexpanded?/ projection- straight vs oblique, entire lung fields, scapulae outside lung fields, visualise vertebral bodies behind heart border/ exposure- left hemidiaphragm should be visible to the spine and the vertebrae should be visible behind the heart
Soft tissues and bones- ribs, sternum, spine, clavicles- symmetry, fractures, dislocations, lytic lesions, density, swelling, loss of tissue planes, SC air, masses, breast shadows, calcification- great vessels, carotids
Airway and mediastinum- trachea deviated?
Breathing- lung fields, costophrenic & cardiophrenic angles
Circulation- heart & aortic knuckle(ONLY ON PA CXRs,) cardiomegaly- valvular heart disease, cardiomyopathy, pulmonary HTN & pericardial effusion/ widened mediastinum, mediastinal shift?
Diaphragm- elevation, pneumoperitoneum?
Extras- ECG tabs/ oxygen tubing, no broken bones, no pacemaker, no sternal wires/ valves visible

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15
Q

Reasons for requesting a chest X-ray?

A

NG tube placement, change in oxygen requirement or SOB, pleuritic chest pain, septic screen- fever of unclear cause
In community= non-resolving cough>3 weeks, weight loss in a smoker

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16
Q

Causes of true and apparent tracheal deviation?

A

True= pushing of trachea: large pleural effusion or tension pneumothorax
Pulling of trachea: consolidation with associated lobar collapse
Apparent: rotation of patient can given appearance of apparent tracheal deviation- inspect clavicles to rule out presence of rotation

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17
Q

Causes of unilateral/ asymmetrical and bilateral hilar enlargement? Pushed or pulled by what? Cause of visible pleura? Absence of lung markings due to what?

A

Unilateral= underlying malignancy/ bilateral= sarcoidosis
Pushed by enlarging soft tissue mass/ pulled by lobar collapse
Mesothelioma
Pneumothorax

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18
Q

What makes up most of the right heart border? The left heart border? Reduced definition of the right border is typically associated with what? Left heart border? Syndrome resulting in the abnormal position of the colon between the liver and diaphragm–> appearance of free gas under the diaphragm?

A

Right atrium
Left ventricle
Right middle lobe consolidation
Lingular consolidation
Chilaiditi syndrome

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19
Q

What can costophrenic blunting indicate? Reduced definition of the aortic knuckle can occur in what? Space of the aortopulmonary window can be lost as a result of what?

A

Fluid or consolidation in the area, secondary to lung hyperinflation as a result of diaphragmatic flattening e.g. COPD
Aneurysm
Mediastinal lymphadenopathy e.g. malignancy

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20
Q

Normal view of small bowel on AXR? Large bowel? 3/6/9 approach?

A

Central position in the abdomen, valvulae conniventes(mucosal folds that cross the full width of the bowel)
Peripheral position in the abdomen- transverse and sigmoid colon occupy variable positions, haustra, contains faeces
Small bowel= 3cm, colon= 6cm, caecum= 9cm

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21
Q

Soft tissue organs visible on abdominal X-rays? Bones visible? Added densities are due to what?
What approach?

A

Liver, spleen, kidneys, psoas muscles, bladder & lung bases
Lower ribs, lumbar spine, sacrum, coccyx, pelvis and proximal femora
Artefact or calcified soft tissue
BBC approach- bowel & other organs, bones, calcification & artefact

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22
Q

Other organs & structures on abdominal X-ray?

A

Lung bases, liver, gallbadder- cholecystectomy clips/ calcified gallstones, stomach, psoas muscles, kidneys, spleen, bladder

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23
Q

Views used to look at hip X-rays? Approach?

A

AP either standing or supine- usually both legs internally rotated to obscure femoral neck length
Lateral- lying supine, knees flexed, hip abducted and externally rotated (frog-leg position)
ABCS: adequacy/ alignment, bones, cartilage & joint spaces, soft tissue

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24
Q

3 rings on pelvic X-rays? Joint spaces? Acetabulum? Proximal femur?

A

Pelvic inlet & 2 obturator foramina
Sacroiliac joints(2-4mm) & pubic symphysis(space<5mm)
Iliopectineal line- anterior column/ ilioischial line- posterior column
Proximal femur- Shenton line(interruption–> NOF fracture)
Sacral foramina- arcuate lines should be smooth & symmetrical, angulated–> sacral fracture

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25
What is the adequate anatomy to be visible within the borders of the image? Ensure what are in the midline? Most common intracapsular (NOF) hip fractures? Also what types? Extracapsular fractures occur where?
Usually above iliac crests to 1/3rd down the femoral shaft Coccyx tip and pubic symphysis Sub-capital- just distal to femoral head Transcervical/ basicervical Below the intertrochanteric line
26
What bones to assess on pelvic X-rays?
Cortical outline, bony texture and symmetry of: femur, pelvic bones, any bony mets
27
Cartilaginous joints to observe on pelvic X-rays? Soft tissues?
Acetabular joint- femoral head, joint space 3-5mm, pubic symphysis(>10mm in pubic diastasis- pain worse by weight-bearing/ walking & waddling gait,) sacroiliac joints- space, end-plates Effusion, periosteal reaction, calcification of soft tissues, foreign bodies
28
Key features when describing fractures? Changes in alignment suggest what? ABCS approach?
Angle/ direction of the distal part compared to the anatomical position- forearms= supinated Open vs closed= important, comminuted/ spiral/ transverse/ oblique Fracture, subluxation- partial dislocation, or dislocation Alignment & joint space- narrowing/ calcification/ osteophytes, bone texture, cortices- infection & tumours, soft tissues- swelling, foreign bodies or effusions
29
Describing fracture steps?
1) Where- proximal/ middle/ distal, whether the articular surface is involved 2) Complete fractures: transverse- fracture at right angles--> shaft, oblique- fracture at angle to shaft, spiral- twisting injury, comminuted- 2/ more bone fragments, impacted- bones forced together Incomplete fractures(most common in children): torus/ buckle- bulge in cortex, bowing- bend in bone shaft, greenstick- bending of shaft with fracture on convex surface, salter-harris- involving growth plate 3) Open/ closed fractures 4) Displacement- in terms of the distal fragment to the body e.g. anterior/ posterior- can involve angulation- dorsal/ palmar or varus/ valgus or radial/ ulnar, translation- movement of bones away from each other, rotation- usually difficult to interpret
30
Adequacy needed in a cervical X-ray? Views needed?
From C1 down to the C7/T1 junction Lateral: anterior & posterior longitudinal lines, spinolaminar line- along anterior edge of spinous processes AP view Odontoid/ open- mouth view- peg can be viewed as an increased area of density within the body of C1
31
Soft tissue is best assessed using what? Above C4 pre-vertebral soft tissue should be no longer than what? From C4 onwards?
Lateral views as a light grey opacity on cervical X-rays between vertebral bodies and darker-grey representing trachea- widening--> pre-vertebral haematoma 1/3 of the adjacent vertebral body in width, the width of one whole vertebral body
32
Canadian C-spine rules? High-risk? Low-risk? If low risk do what? At any point not satisfied do what?
Age>/=65 y/o, extremity paraesthesias/ dangerous mechanism, axial load injury, high speed MVC/ rollover/ ejection, bicycle collision, motorized recreational vehicle Comfortable sitting ambulatory at any time, delayed neck pain, no midline tenderness, simple rear-end motor vehicle motor collision Actively rotate neck 45 degrees left and right without issue CT cervical spine
33
Views in wrist X-rays? How is adequacy checked?
Lateral & PA views- oblique may be assed for radial side of wrist Includes distal radius and ulna with no overlap
34
How can alignment of wrist XR in PA view be checked?
Distal radial contour- smooth, distal radial articular surface's position, radial inclination(>25 degrees= fracture,) radial length- loss= impacted radial fracture, Gilula's/ carpal arcs
35
How is lateral view of wrist obtained? Normal volar tilt? Oblique view? Normal length of articular joint spaces?
Pronated wrist, thumb facing upwards 11 degrees Pronating hand 45 degrees from position used for a lateral view--> radial side, radiocarpal joint, scaphoid, scaphotrapeziotrapezoidal joints 1-2mm
36
Monteggia fracture is what with what? Opposite called what? (MUGGER- MU/GR) Colles' vs Smith fractures? Barton fractures?
Ulnar fracture with possible radial dislocation Galleazzi Colles- extra-articular bowing fracture by FOOSH in dorsiflexion/ palmarflexion Intra-articular fractures of distal radius- can be dorsal(standard,) or volar(reverse)- usually ass w/ subluxation/ dislocation of radiocarpal joint
37
Distal radioulnar dislocation suspected when? What can help with diagnosis? Common cause of triquetral fracture? Most common subtype?
If joint space between distal radius & ulna> 2mm- lateral view FOOSH onto dorsiflexed hand in ulnar deviation--> impingement, shear force or avulsion- dorsal avulsion fracture--> "pooping duck sign"
38
What causes perilunate dislocation?
High impact trauma falling onto a dorsiflexed wrist- best on lateral view- radiolunate articulation remains intact, capitate doesn't articulate and sits dislocated
39
Get AP & lateral XR for thoracic/ lumbar spine if what? Indications for lumbar spine X-ray?
Spinal tenderness on palpation, excessive pain on load bearing Significant trauma, age<20/>50, past medical hx malignancy, AS/ osteoporosis, chronic corticosteroid use, back pain> 6 weeks without improvement
40
What should be aligned on AP/ PA and lateral views of lumbar spine? Inspect what things?
Vertebral bodies and spinous processes, lateral body= vertebral bodies Alignment, loss of vertebral height, disc height- L5/S1 is narrower than L4/L5, vertebral endplates Posterior elements- pedicles, laminae, spinous processes
41
Model used to describe spinal fractures? Unstable if what? Anterior vs middle vs posterior columns?
3 Column model- if 2 columns are injured--> CT/ MRI Anterior 2/3 of vertebral body/ IV disc and anterior longitudinal ligament Posterior vertebral body/ IV disc & posterior longitudinal ligament Lamina, facet joints, spinous processes and associated ligaments
42
Most common type lumbar fracture? Burst fracture? Posterior column- flexion-distraction fracture?
Anterior compression fracture- front part--> wedge shape Vertebral body is crushed in all directions simultaneously- involves 2 columns= unstable When any part of the spinal column breaks away from another part from severe compression/ spine rotation (fracture of the vertebral body with ass transverse/ horizontal fractures of posterior elements)
43
What is spondylosis? Spondylolysis? Spondylolithesis?
Degeneration of IV disc--> disc space narrowing, endplate sclerosis and osteophyte formation, sometimes osteophytes--> neural impingement Fracture= from inferior facet across pars interarticularis to superior facet- can be bilateral and lead to spondylolisthesis- SCOTTY DOG When one vertebra is displaced forward upon another- trauma/ degenerative disease, can--> foraminal stenosis
44
DDx for lytic spinal lesion?
Prostate cancer, BRCA, thyroid cancer, RCC, lung cancer mets or multiple myeloma
45
Views for knee X-ray? Fluid line known as what? If there's one, there is what somewhere?
Lipohaemarthrosis- a fracture
46
2 x views used for an ankle XR?
Mortise view: modified AP view of ankle in 10-20 degree internal rotation so medial and lateral malleoli are in same horizontal plane, lateral view
47
What should you be able to see with an ankle X-ray?
Distal 1/3 of tibia and fibula and talus on mortise view Calcaneum and base of 5th metatarsal on lateral view
48
Assess what for joint involvement on ankle X-rays? Joint widening with no obvious fracture-->?
Joint space on mortise view, medial clear space- widest between medial border of talar bone and lateral border of medial malleolus= superior clear space(between articular spaces of tibia and talus) More proximal fracture e.g. Maisonneuve fracture
49
Ottawa rules for ankle X-rays?
Pain in malleolar zone & bony tenderness at lateral malleolar zone A(tip--> lower 6cm of posterior border of fibula) Bony tenderness at medial malleolar zone B(tip to lower 6cm of posterior border of tibia,) inability to walk four weight-bearing steps immediately after injury & in ED
50
Ottawa rules for foot X-rays? Knee XRs?
Bony tenderness at navicular bone, bony tenderness at base of 5th metacarpal, inability to weightbear both immediately and in ED Age >55y/o, tenderness at head of fibula, isolated tenderness of patella, inability to flex knee to 90 degrees, inability to walk four weight bearing steps after injury and in ED
51
Where does the anterior humerus line lie? Radiocapitellar line lie?
From anterior edge of humerus through capitulum with at least 1/3 capitulum seen anterior to it Line through centre of radius and capitulum
52
What does an anterior fat pad away from the humerus or posterior fat pad between the triceps and posterior humerus indicate? Post traumatic effusion with visible bone fracture usually indicates what? If there's a joint effusion but no trauma hx?
Joint effusion due to haemarthrosis secondary to a fracture Radial head fracture in adults/ supracondylar fracture of distal humerus in child Inflammatory cause
53
Typical XR views for shoulders? XR findings in anterior shoulder dislocation? Posterior shoulder dislocation?
AP & lateral AP: humeral head= medial & inferior--> glenoid fossa, lateral= humeral head lies anterior and inferior to glenoid fossa, also inferior to coracoid process- most in lateral view AP: glenohumeral joint= widened, humeral head= "lightbulb" appearance, lateral= humeral head posterior to glenoid fossa
54
Widening of gap between acromion and clavicle may indicated what? Between clavicle and coracoid process? Normal AC distance? CC distance? Acromiohumeral distance?
Acromioclavicular ligament e.g. tear, coracoclavicular ligament e.g. tear 5-8mm(>8mm= injury) 11-13mm(>13mm= injury) AH= 7-12mm(<7mm= SS tendon tear, >12mm= joint widening due to effusion)
55
Approach for CT head scans? Commonly calcified structures on a CT head?
Blood Can Be Very Bad: blood, cisterns, brain, ventricles, bone Blood: ED, SD, SAH, intracerebral Choroid plexus, pineal gland, basal ganglia & falx
56
4 cisterns to be assessed for effacement? What is sulcal effacement? Loss of grey and white matter differentiation may be due to what?
Ambient- surrounding the midbrain, suprasellar- superior to the sella turcica, quadrigeminal- adjacent to corpora quadrigemina and sylvian- across the insular surface and within the Sylvian fissure Loss of the normal gyral-sulcal pattern of the brain- ass w/ raised ICP Hypoxic brain injury, infarction, tumour, or cerebral abscess
57
Hypodensity means what? Hypersensitivity? Following IV admin of a contrast medium, homogenous enhancement occurs in what? Ring enhancement?
Air, oedema or fat, pneumocephalus Blood, thrombus or calcification- hyperdense MCA= TACS Meningiomas and highly vascular tumours Cerebral abscesses and some types of cerebral mets
58
High-density signal within the lateral walls of the ventricles is likely to represent what? What is hydrocephalus? Early sign of this? What is ventricular effacement?
Choroid plexus CSF in the ventricles- dilation of the temporal horns Thinning of the ventricles- oedema secondary to a mass/ intracranial haemorrhage- follows Monro-Kellie doctrine- increase in blood, CSF fluid/ brain tissue--> decrease in other two, once the others have reached their point of max compensation- further increase--> raised ICP pressure
59
Steps for ABG interpretation?
1) Are they hypoxic?-- if on oxygen, PaO2 should be 10kPa less than % inspired conc FiO2- on 40% oxygen--> PaO2 of 30kPa 2) Is CO2 normal or abnormal- if abnormal does this fit with the current pH(normal/ low CO2 and low pH--> metabolic) 3) Is HCO3- normal? - if abnormal does this fit with the pH(doesn't--> respiratory) 4) Base excess= surrogate of metabolic acidosis or alkalosis High= comp resp acidosis/ met alkalosis Low= met acidosis/ comp resp alkalosis Mixed= CO2 & HCO3- moves in opposite directions
60
Causes of respiratory alkalosis?
Anxiety, pain, hypoxia, PE, pneumothorax, iatrogenic
61
Calculating anion gap? Causes of high anion gap metabolic acidosis? Normal anion gap met acidosis?
Na+-(Cl- + HCO3-)- usually for metabolic acidosis to determine presence of unmeasured anions(main one= albumin) Normal= 4-12 mmol/L DKA, lactic acidosis, aspirin overdose, renal failure GI loss, renal tubular disease, Addison's disease
62
Causes of metabolic alkalosis? Mixed resp and met acidosis? Met alkalosis?
Vomiting/ diarrhoea, Loop/ thiazide diuretics, HF, nephrotic syndrome, cirrhosis, Conn's syndrome, iatrogenic Cardiac arrest, multi-organ failure Liver cirrhosis in addition to diuretic use, hyperemesis gravidarum, excessive ventilation in COPD
63
Blood tests needed for suspected iron deficiency anaemia? For vit B12 deficiency? Causes vit B12 def?
FBC, CRP, serum ferritin Serum cobalamin, FBC- anaemia & macrocytosis, blood film- hyperseg neutrophils and oval macrocytes--> anti-IF, anti-gastric parietal cell antibodies Meds, GI surgery, pregnancy, multiple myeloma
64
Secondary testing for B12 deficiency? Tx?
Total plasma homocysteine- raised, plasma methylmalonic acid- raised, holotranscobalamin- more sensitive(reduced) IM B12 injections--> increased reticulocytes within 7-10 days
65
Where is folate absorbed in the bowel? What received before folate replacement? Causes?
Terminal ileum- B12 replacement due to risk of precipitating subacute degeneration of the spinal cord Dietary, alcoholism, GI disorders, pregnancy, haem disorders, exfoliative skin disorders, meds
66
Primary testing for folate deficiency? Secondary testing?
Serum folate level and FBC--> megaloblasts in peripheral blood & raised MCV Red cell folate, plasma total homocysteine- high
67
What is the RDW? MCH? MCHC?
Range from largest red cell--> smallest red cell Amount of Hb per RBC Average conc Hb in a given volume of blood
68
Causes of a raised ALP? If raised markedly compared to ALT? If ALT is?
Bony mets/ primary bone tumours, vitamin D deficiency, recent bone fractures, renal osteodystrophy Cholestatic pattern of injury Hepatocellular pattern of injury
69
Causes of isolated bilirubin with normal ALT & ALP levels?
(Pre-hepatic causes of jaundice)- Gilberts' syndrome- most common, haemolysis- check blood film, FBC, reticulocyte count, haptoglobin and LDH levels
70
Ix to assess synthetic liver function?
Serum bilirubin, serum albumin, PTT, serum blood glucose
71
Causes of unconjugated hyperbilirubinaemia? Conjugated hyperbilirubinaemia?
Haemolysis, impaired hepatic uptake- drugs, CCF, impaired conjugation- Gilbert's HCC injury, cholestasis
72
Causes of reduced albumin? ALT> AST ass with what? AST>ALT?
Liver disease, inflammation, protein-losing enteropathies or nephrotic syndrome Chronic liver disease, cirrhosis and acute alcoholic hepatitis
73
Causes of acute HCC injury? Chronic HCC injury? Less common chronic causes?
Poisoning, infection- hep A &B, liver ischaemia Alcoholic fatty liver disease, non-alcoholic fatty liver disease, PBC A1AT deficiency, Wilson's disease, haemochromatosis
74
What is the prothrombin time?
Time taken for blood to clot via the extrinsic pathway- INR = standardised version of this test- affected by liver disease, DIC, vitamin K deficiency, warfarin levels
75
What is APTT? Can indicate issues with what?
Activated partial thromboplastin time- time taken to clot via the intrinsic pathway Factors VIII, IX & XI(haemophilia A, B & C, VWD, APS)
76
Conditions increasing bleeding time? What does thrombin time test? Due to what?
VWD, Bernard- Soulier syndrome- GpIb def, Glanzmann thrombasthenia- GpIIb/ IIIa def, TTP/ ITP/ HUS/ DIC, thrombocytopaenia How fast fibrinogen is converted to fibrin by thrombin DIC, liver failure, malnutrition, abnormal fibrinolysis
77
Other tests along with a coagulation screen? Antiplatelets & aspirin affect what? All anticoagulants increase what?
FBC, LFTs, albumin, D-dimer Increase bleeding time, but won't affect PT or APTT The PT/ INR & APTT
78
Picture of bacterial meningitis? Viral meningitis? TB meningitis?
Elevated opening pressure, WBC count- primarily polymorphonuclear leukocytes & protein level, low glucose level- cloudy & turbid appearance(same as fungal meningitis) Normal/ elevated opening pressure, elevated WBC & protein, normal glucose- clear appearance Opaque, elevated opening pressure, elevated WBC, low glucose, elevated protein level
79
SAH on CSF fluid? GBS?
Blood-stained initially, then xanthochromia>12 hours later, elevated opening pressure, WBC, RBC, protein level, normal glucose Clear/ xanthochromia, normal/ elevated opening pressure, elevated protein, normal WBC, glucose
80
MS on CSF fluid?
Clear appearance, normal opening pressure, 0-20 cells/ microlitres- mainly lymphocytes, normal glucose, mildly elevated protein
81
Presence of HBsAg always implies what? Beyond 6 months? Presence of anti-HBs means what? Anti-HBc IgM? What replaces this?
Active infection, chronic infection Immunity to HBV- from cleared infection or vaccination Recent infection within the last 6 months- anti-HBc IgG
82
HBeAg can be used to distinguish between what? Anti-HBe indicates what? Who is a higher HBV- DNA viral load expected in? Associated with what?
Active and inactive chronic infection Acquired natural immunity In patients with active chronic infection- an increased risk of progression to cirrhosis and hCC
83
Spirometry findings in obstructive lung disease? Causes? Restrictive disease? Causes?
Reduced FVC & FEV1, FVC0.7 Pulmonary fibrosis, pneumoconiosis, pulmonary oedema, lobectomy/ pneumonectomy, parenchymal lung tumours Kyphoscoliosis, NMDs, CNDs, obesity/ pregnancy
84
Normal pleural fluid findings?
Clear pH= 7.6-7.64 <2% protein <1000/mm^3 WBCs Glucose similar to that of plasma LDH <50% plasma conc Amylase 30-110 U/L Triglycerides<2mmol/L Cholesterol 3.5-6.5mmol/L
85
What are transudative pleural effusions defined as? Exudative?
Caused by factors that alter hydrostatic pressure, pleural permeability and oncotic pressure e.g. CHF, liver cirrhosis, severe hypoabluminaemia, nephrotic syndrome Changes to the local factors that influence the formation and absorption of pleural fluid e.g. malignancy, infection, trauma, pulmonary infarction and PE
86
Diagnostics for transudative and exudative pleural effusions?
Transudate= <30g/L w/ normal serum protein level Exudate= >30 g/L w/ normal serum protein level
87
What are Light's criteria more accurate for? Considered an exudate if what are present? If thought to be transudative, but Light's suggest exudate what should be examined?
Exudative: 1) Ratio of pleural fluid: serum protein>0.5 2) Ratio of pleural fluid: serum LDH>0.6 3) Pleural fluid LDH> 2/3 upper limit of normal serum value Serum pleural fluid protein gradient
88
Things to look at for pleural fluid?
Colour, pleural fluid LDH, glucose, pleural pH, amylase, WBCs, cholesterol and triglycerides
89
Purulent pleural fluid suggests what? Milky? Bloody? Straw- coloured w/ smell of ammonia? Food particles? Black pleural fluid?
Empyema Chylothorax/ pseudochylothorax- lympthatic obstruction Trauma Urinothorax Oesophageal rupture Aspergillus niger infection, malignant melanoma, haemorrhage and haemolysis ass w/ SCLC
90
Pleural fluid LDH> 1000 IU/L suggests what? Glucose<3.4mmol/ L / < 1.6mmol/L? pH<7.3?
Empyema, malignancy or rheumatoid effusion Empyema, rheumatoid pleuritis and effusions ass w/ TB, malignancy and oesophageal rupture Empyema and rheumatoid disease Same as causes of low glucose
91
Pleural fluid amylase levels>110IU/L? WBC count in transudates and exudates? Pleural fluid lymphocytosis and neutrophil dominant effusions? Eosinophilia?
Pancreatitis, malignancy or ruptured oesophagus Trans<1000cells/microL/ >50,000 cells/ microL TB, sarcoidosis or malignancy Empyema or PE Presence of air or blood(PE/ benign asbestosis) in pleural space
92
Triglyceride and cholesterol levels diagnostic for chylothorax and pseudochylothorax?
Triglyceride>1.24mmol/L, cholesterol<5.18 mmol/L <0.56mmol/L, cholesterol>5.18 mmol/L

PHASE 3B (11 decks)

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