DIAGNOSTIC TOOLS Flashcards
1
Q
what colour blood bottle would you use to collect blood for a coagulation scree, INR or D-dimer?
A
light blue
2
Q
what colour blood bottle would you use to collect U+E, CRP, LFTs, amylase, TFTs, lipid profile, troponin, Ca, PO4, Mg?
A
yellow
3
Q
what colour blood both would you use to collect FBC, blood film, ESR and HBA1c?
A
purple
4
Q
what colour blood bottle would you use for group and save and crossmatch?
A
pink
5
Q
what colour blood bottle would you use for glucose or lactate?
A
grey
6
Q
how is blood in a FBC purple bottle anti coagulated?
A
EDTA
7
Q
if MCV is low, what type of anaemia does this indicate?
a) microcytic
b) megaloblastic/macrocytic
c) normocytic
A
a) microcytic
8
Q
if MCV is high, what type of anaemia does this indicate?
a) microcytic
b) megaloblastic/macrocytic
c) normocytic
A
b) megaloblastic/macrocytic
9
Q
if MCV is normal, what type of anaemia could this indicate?
a) microcytic
b) megaloblastic/macrocytic
c) normocytic
A
c) normocytic
10
Q
what is the most common cause of normocytic anaemia?
A
chronic disease
11
Q
high WCC might indicate what?
A
infection
malignancy
12
Q
low neutrophils might indicate what?
A
malignancy
13
Q
what 2 things might high neutrophils indicate
A
bacterial infection
inflammation
14
Q
what type of infection might high lymphocytes indicate?
A
viral
15
Q
what other type of disease might cause raised lymphocytes?
A
autoimmune
16
Q
what blood cell might be raised in chronic inflammation and TB infection?
A
monocytes
17
Q
what blood cell might be raised in allergy and parasitic infection?
A
eosinophils
18
Q
what blood marker might be raised post-operatively and during infection and inflammation?
A
platelets
19
Q
give 2 examples of when urea might be raised
A
renal failure
protein load
20
Q
if raised urea was due to protein load not renal failure, what might you expect creatinine to look like in U+Es?
A
normal
21
Q
give 4 causes of raised creatinine
A
renal failure dehydration shock glomerulonephritis pyelonephritis
22
Q
give 2 instances when sodium might be low
A
D+V
thiazide diuretics
kidney disease
Addison’s
23
Q
give 2 instances when sodium might be high
A
hyperaldosteronism
Cushing’s
hypertension
24
Q
give 2 instances when potassium may be low
A
insulin use
non K-sparing diuretics
D+V
25
give 2 instances when potassium might be high
kidney disease
addison's
trauma
diabetes
26
explain why albumin is low in these two situations
a) nephrotic syndrome
b) liver failure
a) leaky glomeruli
| b) none produced
27
to what biological molecule does albumin bind?
bilirubin
28
where is ALT made?
liver
29
what is ALT a marker of?
liver damage
30
what 2 things is AST a marker of?
liver damage
| heart damage
31
explain the LOVE SAKE mnemonic for the relationship between ALT and AST
if ALT higher = viral hepatitis
| if AST higher = alcoholic hepatitis
32
what 2 things is ALP a marker of?
paget's bone disease
| biliary damage/obstruction
33
what clinical sign is elevated bilirubin an indicator of?
jaundice
34
CRP and ESR are both infective markers - what is their different usefulness?
```
CRP = more acute marker
ESR = remains high for a few weeks
```
35
what three things are measured in TFTs?
TSH
| free T3, free T4
36
what clotting pathway is plotted by prothrombin time?
extrinsic
37
what clotting pathway is plotted by activated partial thrombin time?
intrinsic pathway
38
what clotting pathway is plotted by thrombin time?
common pathway
39
what drug is monitored using INR?
warfarin
40
what type of motor neurone damage arises from stroke, tumour or blunt trauma?
upper motor neuron
41
where is the site of an UMN lesion?
above anterior horn
42
what is the effect on the following in an UMN lesion?
a) muscle tone
b) weakness
c) reflexes
a) increased - spasticity
b) increased
c) increased - hypereflexia
43
what 2 reflex signs might you see in an UMN lesion?
babinski's sign
| clonus
44
what is the site of a LMN lesion?
inside or distal to anterior horn
45
what is the effect on the following in an LMN lesion?
a) muscle tone
b) muscle size
c) reflexes
a) decreased - hypotonia + fasciculation
b) atrophy of muscles
c) decreased + arreflexia
46
if there was damage at the point of a spinal cord disc, what would neurone signs look like at that level and below that level?
at that level = LMN signs
| below that level = UMN signs
47
what are the 3 types of jaundice?
pre hepatic, intra-hepatic, post hepatic
48
what type of jaundice are you most likely to be very yellow during?
post hepatic
49
What causes increase breakdown of RBC (haemolysis) leading to excess bilirubin and consequently pre-hepatic jaundice ( unconjugated hyperbilirubinaemia)?
```
Sickle cell anaemia
Trauma
Thalassemia
Malaria
hereditary spherocytosis= reduce RBC lifespan
haemolytic anaemia
```
50
how does pre-hepatic jaundice increase the risk of gallstones?
bilirubin is unconjugated/insoluble at this stage so can for billirubinate calculi
51
give 3 causes of intra-hepatic jaundice
```
acute viral hepatitis A,B,c
drug induced liver damage= main cause paracetamol overdose and ecstasy
Gilberts syndrome
alcoholic hepatitis
cirrhosis
Liver cancer
glandular fever =EBV
Primary biliary cirrhosis
```
52
what occurs to the urine in intra-hepatic jaundice and why?
urine is dark
| bilirubin is conjugated/soluble at this stage so is excreted
53
Inflammation, obstruction and damage to the bile duct causes the gallbladder not able to move bile to the digestive system causing post hepatic jaundice= V. yellow. What are the causes?
```
biliary stones
cholecystitis
Pancreatitis acute and chronic
Bile duct cancer
Pancreatic cancer
Gall bladder cancer
```
54
what occurs to urine and stools in post-hepatic jaundice and why?
dark urine
pale stools
biliary drainage is interfered with
55
What are the associated symptoms of jaundice?
itch
Tiredness
Abdo pain
56
what is produced in pancreatic alpha cells?
glucagon
57
what is produced in pancreatic beta cells?
insulin
58
what is produced in pancreatic delta cells?
simvastatin
59
what is the main cause of pancreatitic diabetes?
alcohol
60
What are the 3 key features of mature onset diabetes of the young?
Very strong family link with at least one parent having it, with diabetes in two generations
Occurs before 25
Does not necessarily need insulin
61
what inheritance pattern does mitochondrial diabetes have?
autosomal dominant
62
does mitochondrial diabetes need insulin?
no
63
give 3 microvascular complications of diabetes
neuropathy
nephropathy
retinopathy
64
give 3 macrovascular complications of diabetes
stroke
MI
PVD
erectile dysfunction
65
give 2 skin complications of diabetes
staph
| genital candida
66
what are the 4 A's of palliative care?
analgesia
anti-emetics
anti-muscarinics
anti-anxiety
67
where would you hear the following murmurs?
a) aortic stenosis
b) mitral regurgitation
c) aortic regurgitation
d) mitral stenosis
a) aortic valve
b) axilla
c) tricuspid valve
d) mitral valve
68
where in the heart cycle do the following murmurs occur?
a) aortic stenosis
b) mitral regurgitation
c) aortic regurgitation
d) mitral stenosis
a) ejection systolic
b) pan systolic
c) diastolic
d) diastolic
69
where do the following murmurs radiate?
a) aortic stenosis
b) mitral regurgitation
c) aortic regurgitation
a) carotids
b) axilla
c) tricuspid valve
70
Give 3 examples of drugs when pain is 1-3 or MILD on the analgesic ladder?
NSAIDs
ASA= aspirin
Acetaminophen= paracetamol
71
give 3 examples of drugs you might give if pain is 4-6 or MODERATE on the analgesic ladder
codeine
dihydrocodeine
tramadol
hydro/oxycodone
72
give 3 examples of drugs you might give if pain is 7-10 or SEVERE on the analgesic ladder
morphine
hydromorphine
methadone
fentanyl
73
what is courvoisier's law?
palpable non-tender gallbladder
74
what is murphy's sign?
palpable painful gallbladder
75
what is cullen's sign? what does it occur in?
umbilical bleeding
| pancreatitis
76
what is grey-turner's sign? what does it occur in?
flank bleeding
| pancreatitis
77
what is brown-sequhard syndrome? what two pathways does it affect?
loss of decussation in the spinal column
affects contralateral spinothalamic pathway (pain, temperature)
ipsilateral dorsal column pathway (light touch)
78
what is budd-chiari syndrome? give 3 symptoms
occlusion of hepatic vessels
| pain, ascites, enlargement
79
what is a large version of a macule?
patch
80
what is a large version of a papule?
plaque
81
what is a papule raised more than 1cm?
nodule
82
what is the large version of a vesicle?
bulla
83
what is a deeper version of an erosion?
ulcer
84
what is a sharp sided break in the skin?
fissure
85
what causes scale on the skin?
keratin
86
what does lichenification mean?
thickening
87
what does APACHE stand for?
acute physiological and chronic health evaluation
88
what is APACHE score used to determine?
severity of disease for adults in ICU
89
what test is determined by PaO2, temp, BP, pH, HR, RR, blood tests and GCS?
APACHE score
90
what test must be performed before an ABG can be performed?
Allen's test
91
what would a low pH and low CO2 indicate on an ABG?
respiratory acidosis
92
what would a high pH and high HCO3- indicate on an ABG?
metabolic alkalosis
93
what would low pH, low CO2 but high HCO3 indicate on ABG?
respiratory alkalosis with metabolic compensation
94
what is normal pH on an ABG?
7.4
95
what 2 urine markers are raised in infection?
nitrates
| leukocytes
96
what is the optic disc and optic cup in the view of an eye in fundoscopy?
bright disc
97
what is the macula and fovea in the view of an eye in fundoscopy?
```
fovea = dark patch
macula = just behind
```
98
how do you distinguish between arteries and veins in fundoscopy?
arteries = thinner and paler
99
what type of retinopathy is indicated by micro aneurysms?
diabetic
100
what do flame and splinter haemorrhages indicate?
hypertensive changes
101
what do dot and blot haemorrhages indicate?
diabetic changes
102
what 3 things do vitreous haemorrhages indicate?
diabetic changes
trauma
retinal/vitreous detachment
103
what stage retinopathy is indicated by hard and soft (cotton wool) exudates?
diabetic/hypertensive grade 3
104
if vasculature is narrowed/nipped, what retinopathy might this indicate?
hypertensive
105
if vasculature is more tortuous, what retinopathy might this indicate?
hypertensive
106
if new vessels are present in the eye, what retinopathy might this indicate?
diabetic
107
if vasculature shows signs of silver/copper wiring, what retinopathy might this indicate?
hypertensive
108
what 3 things might be indicated by papilloedema
malignant hypertension
hypertension grade 4
raised ICP
109
what is indicated by optic disc cupping?
glaucoma
110
what is the difference between a cyst, sinus and fistula?
```
cyst = inside a structure, walls not compromised
sinus = pouch into a structure, 1 wall compromised
fistula = pouching through a structure, both walls/sides compromised
```
111
complete the clubbing pneumonic for causes of clubbing
```
Cyanotic heart disease
Lung pathology
Ulcerative colitis
Billiary cirrhosis
Birth defects
Infective endocarditis
Neoplasm
GI malabsorption
```
112
what is the ABCDEF pneumonic for lung causes of clubbing
```
Abscess
Bronchiectasis
Cystic fibrosis
Don't say COPD!!
Empyema
Fibrosis
```
113
what ratio should optic cup to disc be?
a) 1/30
b) 1/15
c) 1/3
d) 1/5
c) 1/3
114
what colour is a healthy optic disc?
pale pink/yellow
115
What 3 endocrine conditions can cause diabetes?
Untreated cushings
Acromegaly = excess growth hormone producti
Pheochromocytomas = catecholamine secreting hormone
116
What is Rovsing sign?
It is for appendicitis
| Palpate on the left lumbar area and pain in the right lumbar area
117
what do p450 inhibitors do to drugs metabolised by p450
decreases metabolism = INCREASES drug's effects
118
what do p450 inducers do to drugs metabolised by p450
increases metabolism = REDUCES drug's effects
119
drugs metabolised by p450 - COW PATS
```
C = carbamazepine, ciclosporin, citalopram
O = OCP
W = warfarin
```
```
P = phenytoin
A = acetylcholinesterase inhibitors
T = theophylline and tacrolimus
S = statins and steroids
```
120
p450 inducers - CRAP GPS
```
C = carbamazepine
R = rifampicin
A = alcohol (chronic)
P = phenytoin
```
```
G = griseofulvin
P = phenobarbital
S = sulphonylureas
```
121
p450 inhibitors - SICKFACES.COM Group
```
S = sodium valproate
I = isoniazid
C = cimetidine
K = ketoconazole
F = fluoxetine
A = alcohol (binge)
C = chloramphenicol
E = erythromycin
S = sulfonamides
C = ciprofloxacin
O = omeprazole
M = metronidazole
G = grapefruit juice
```
122
effect of p450 inhibitors on INR
increase INR (reduce metabolism of warfarin = increase anticoagulant effects)
123
effect of p450 inducers on INR
decrease INR (increase metabolism of warfarin = decrease anticoagulant effects)
