investigations Flashcards
(91 cards)
1
Q
IgA nephropathy presentation
A
in 20s
gross or microscopic haematuria following UTI
mild proteinuria
hypertension
2
Q
investigations of IgA nephropathy
A
histology shows IgA deposits and glomerular mesangial proliferation
urinalysis:
- blood and protein positive
urine microscopy: RBC, WBC
3
Q
high dose dexamesthasone test shows
high cortisol and low ACTH
A
adrenal adenoma
4
Q
high dose dexamesthasone test shows low cortisol
A
Cushing’s disease
5
Q
high dose dexamethasone shows high cortisol and high ACTH
A
ectopic ACTH
6
Q
when to do a dexamethasone test
A
investigate cushing syndrome
7
Q
investigation for bladder cancer
A
cystoscopy
8
Q
investigations for kidney stones
A
urine dipstick- rule out infection and shows haematuria
blood test- check calcium and kidney function
non-contrast CT KUB- initial investigation of choice!!
9
Q
diagnosis of ankylosing spondylitis
A
Xray
schobers test
10
Q
“very active boys short stature”
A
perthe’s disease
11
Q
presentation of perthe’s disease
A
unilateral pain/limp- progressive
loss of internal rotation and abduction
positive trendelenburg
12
Q
presentation of transient synovitis of the hip
A
following URTI
ages 2-10
13
Q
investigations for transient synovitis
A
xray- exclude perthes disease
MRI- exclude osteomyelitis
CRP- normal
14
Q
management of transient synovitis of the hip
A
NSAIDs and rest
15
Q
investigations for perthes disease
A
xray- hanging rope sign
16
Q
management of perthes disease
A
regular xrays
severe= joint replacement
subluxations= osteotomy of femoral head + acetabulum
17
Q
investigations of SUFE
A
xray- flein line
18
Q
management of SUFE
A
urgent surgery- to pin femoral head
risk of AVN
19
Q
investigation for septic arthritis
A
joint aspiration- for culture
raised CRP
diagnosis- kocher criteria
20
Q
management of septic arthritis in kids
A
urgent irrigation and debridement IV antibiotics (fluclox?)
21
Q
baby regurgitates food and has chronic hiccups
A
GORD
22
Q
investigations for pyloric stenosis
A
USS- hypertrophic pyloric muscle
olive shaped mass in RUQ
23
Q
presentation of intussusception
A
child unwell
red current jelly stools
palpable sausage mass
vomit and colicky abdo pain
24
Q
management of intussesception
A
air enema retraction
surgical: laparoscopic surgery
25
presentation of severe dehydration in babys
drowsy
absent urine output
weak pulse
increase capillary refill
26
management of neonatal sepsis
IV benzyl-penicillin + gentamicin
27
prolonged jaundice + pale/chalky stools and dark urine
biliary atresia
28
Ptosis + dilated pupil
third nerve palsy
29
definitive management in acute closed angle glaucoma
Laser peripheral iridotomy
30
causative organism of epididymo-orchitis in individuals with a low STI risk
E.coli
31
treatment of thyroid storm
admission for monitoring
May need supportive care with fluid resuscitation, anti-arrhythmic medication and beta-blockers
Antithyroid drugs- Carbimazole (methimazole) or propylthiouracil
32
treatment of choice in replaspsed graves
radio-iodine
33
dexamethasone effect in thyroid
blocks the conversion of T4 to T3
34
presentation of myxoedema coma
```
confusion and hypothermia
bradycardia
heart block, T wave inversion
type 2 resp failure
adrenal failure in some
```
35
Papillary thyroid cancer
mostly female
good prognosis
most common
lymph node metastases
36
follicular carcinoma thyroid
Second commonest
Incidence slightly higher in regions of relative iodine deficiency
Tend to spread haematogenously
Diagnosis depends on invasion of the capsule or vascular invasion
lymph node swelling rare
Prognosis good
If minimally invasive- usually treated by a thyroid lobectomy, if significant vascular invasion consider a total thyroidectomy
37
management of follicular carcinoma
If minimally invasive- usually treated by a thyroid lobectomy, if significant vascular invasion consider a total thyroidectomy
38
medullary thyroid cancer
Cancer of parafollicular (C) cells
secrete calcitonin
part of MEN-2
Both lymphatic and haematogenous metastasis
39
Anaplastic thyroid cancer
Not responsive to treatment- best treatment is resection
| Local invasion is a common feature
40
management of ramsay hunt syndrome
aciclovir and prednisolone
41
initial management of rheumatoid arthritis
start a DMARD- usually methotrexate
also can start steroid or NSAID for symptom relief
if doesnt respond to DMARD- biologic- TNF alpha drugs
42
associated conditions with ank spondylitis
anterior uveitis, aortitis, pulmonary fibrosis and amyloidosis
43
xray of ank spondylitis
sclerosis and fusion of the sacroiliac joints
| bony spurs from the vertebral bodies > syndesmophytes (producing a “bamboo spine”)
44
imaging investigations for ank spondlylitis
MRI can detect earlier signs
| xray
45
Treatment for ank spondylitis
physiotherapy
exercise
NSAIDs
anti-TNF inhibitors for more aggressive disease
46
management of reactive arthritis
1st- NSAIDs
2nd- steroid (injections)
3rd- DMARD
47
antibodies in dermatomyositis
ANA,
Anti-Jo-1,
myositis specific antibodies
48
If scaphoid fracture suspected but xray is negative
Splint and xray in 2 weeks
49
impetigo management
Wound care with regular cleaning, topical antiseptic or antibiotic.- topical hydrogen peroxide 1% cream or fusidic acid 2% cream tds
Oral Flucloxacillin can be used if infection is extensive.
Measures to reduce spread (not sharing towels etc).
50
shingles management
Aciclovir
analgesia
maybe oral steroid but not sure
51
conditions associated with vitiligo
```
type 1 diabetes mellitus
Addison's disease
autoimmune thyroid disorders
pernicious anaemia
alopecia areata
```
52
Flat-topped, shiny and firm to touch plaques and papules
lichen planus
53
management of lichen planus
Emollients
Topical steroid cream (potent)
Oral Prednisolone
54
Patellar tendonitis management
rest and physio
55
presentation of patellar tendonitis
More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
sore on palpation
56
Osteochondritis dissecans
Pain after exercise
| Intermittent swelling and locking
57
Chondromalacia patellae
Softening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy
58
Causes of hypertrichosis
drugs: minoxidil, ciclosporin, diazoxide
congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis
main:
porphyria cutanea tarda
anorexia nervosa
59
timing difference between HHS and DKA
DKA- comes on in hours
| HHS- comes on in days
60
presentation of renal artery stenosis
```
hypertension
AKI
flash pulmonary oedema
CKD
renal bruit
```
61
renal artery stenosis management
statin
ACEi- not in bilateral disease
anti-platelet
surgical angioplasty
62
nephrotic syndrome general management
```
fluid/salt restriction
diuretics (IV furosemide)
ACEi/ARB
IV albumin
anti-coagulation
```
63
cause of nephrotic syndrome
non-proliferative process affecting podocytes
64
nephritic syndrome is indicative of
proliferative process affecting endothelial cells/mesangial cells
65
symptoms that point to nephritic syndrome
oliguria
haematuria (red cell clasts)
hypertension
some proteinuria
66
classic presentation of IgA nephropathy
recurrent macroscopic haematuria in young males following recent URTI
67
IgA nephropathy is associated with
HSP- IgA mediated vasculitis
| coeliac disease
68
biopsy findings for IgA nephropathy
```
light microscopy (mesangial cell proliferation?)
immunofluorescence- IgA and C3 deposits
```
69
management of IgA nephropathy
BP control- ACEi and ARB
70
minimal change disease typical presentation
children with nephrotic syndrome
71
what causes minimal change disease
T-cell mediated damage of basement membrane + podocytes
72
biopsy result in minimal change
normal light microscopy but electron microscopu (podocyte fusion and foot-process effacement)
73
management of minimal change
Fluid restriction and reduced salt
prednisolone
Human albumin and furosemide
74
typical presentation of focal segmental glomerulosclerosis
young adults with nephrotic syndrome and CKD
75
biopsy of focal segmental glomerulosclerosis
light microscopy- focal/segmental sclerosis + hyalinosis
electron microscopy- effacement of foot processes
immunofluorescence- minimal Ig/complement deposition
76
management of focal segmental glomerulosclerosis
steroids
+/- immunosuppression
+/- ACEi
77
typical presentation of membranous nephropathy
adults with proteinuria and nephrotic syndrome
78
biopsy for membranous nephropathy
electron microscopy- thick BM with sub-epithelial electron complex deposits- spike dome appearance
79
management of membranous nephropathy
ACEi/ARB- 1st line
| immunosuppression (steroids + cyclophosphamide +/- B cell monoclonal antibodies)
80
rapidly progressive glomerulonephritis
rapid decline in renal function + glomerular epithelial crescent formation on biopsy
81
management of rapidly progressive glomerulonephritis
immunosuppression- steroids + cyclophosphamide + Azathioprine
82
typical presentation of post-streptococcus glomerulonephritis
young children/teenagers 7-14 days post strep infection
83
immune complex deposition in post-strep glomerulonephritis
IgG, IgM, C3
84
management for renal SLE involvement
hydroxychloroquine +/- azathioprine
| IV steroids and cyclophosphamide for severe organ involvement
85
investigation for polycystic kidney disease
renal US
86
management of polycystic kidney disease
tolvaptan
| hydration and hypertension management
87
alports syndrome inheritance
X-linked dominant
88
presentation of alports syndrome
microscopic haematuria
progressive renal failure, proteinuria
ocular manifestations
bilateral sensironeural deafness
89
bunch of grapes appearance/ bouquet of flowers appearance
medullary sponge kidney
90
investigation for cholesteatoma
CT
| MRI
91
Eustachian tube dysfunction may present with:
```
Reduced or altered hearing
Popping noises or sensations in the ear
A fullness sensation in the ear
Pain or discomfort
Tinnitus
```
