Investigations 2

Question 1

First line & diagnosis of COPD is done by ?

Answer 1

Spirometry

Post bronchodilator spirometry. This should be carried out 15-20 mins after the person has had a SABA.

Question 2

What values would indicate airflow obstruction?

Answer 2

A FEV1/FVC of <0.7

Question 3

Go over the grading of airflow obstruction

Answer 3

Stage 1: Mild
FEV1 80% of predicted value

Stage 2: Moderate
FEV1 50-79% predicted value

Stage 3:Severe
FEV1 30-49% predicted value

Stage 4:Very severe
FEV1 <30% of predicted value
or
FEV1 <50% of predicted value with respiratory failure

Question 4

When reading an ABG, how do you know if there is respiratory failure ? Talk through the steps

Answer 4

1. First check pH. If its low= acidosis and if high = alkalosis
2. Then find out if its respiratory or metabolic.
   - if respiratory the pH and co2 will be opposite e.g one low and the other high

• if its metabolic the pH and o2 will be the same e.g both high

3. Is it compensated?
   - If Bicarb or BE is out of range Bicarb:<22 or >26// BE: -2 or +2 then its UNcompensated

Question 5

What is Apical shadowing on CXR? (7 things)

Answer 5

An observation on a CXR that can be considered an abnormal finding. It has many possible causes such as:

• Hiatial hernia
• Pneumonia
• Pleural effusion
• Pulmonary oedema
• Malignancy
• Sarcoidosis
• Pneumothorax

Question 6

What would you find on a Macroscopic examination of the lungs in patients with asthma? (3 things)

Answer 6

1. Overdistended lungs
2. Small areas of atelectasis
   (a collapse of one or more areas in the lung)
3. Thick mucus plugs in proximal bronchi containing whorls of shed epithelium

Question 7

What microscopic finding may you see in the sputum of an asthmatic patient ?

Answer 7

Curschmann spirals

Question 8

What is a common side effect of TB drugs ?

Answer 8

Peripheral neuropathy

Question 9

What are some causes of acute bilateral alveolar opacities on a CXR? (5 things)

Answer 9

• Infection
• Fluid
• Blood
• ARDS
• Embolism

Question 10

What causes hyaline membrane formation’ in the lungs?

Answer 10

The accumulation of dead cells/ proteins

Question 11

What would decrease the risk of a overdistension of the lungs in a patient with ARDS that is on mechanical ventilation?

Answer 11

A low tidal volume

Question 12

What is Lofgren’s syndrome ? What are the main symtpoms?

Answer 12

An acute subset of sarcoidosis in Scandinavian patients.

Characterised by:

• Erythema nordosum
• Bilateral hilar lymphadenopathy
• Polyarthralgia (pain in several joints)
• or Polyarthritis (any type of arthritis that affects >5 joints)

Question 13

What condition causes muddy brown casts on urinalysis? and what causes this condition?

Answer 13

Acute tubular necrosis (ATN)
- This is where the kidney’s tubules become damaged which can lead to an AKI.

Causes of ATN include:

• Nephrotoxic drugs
• Renal ischaemia
• Sepsis

Question 14

What is the triad of symptoms you would expect to see in nephrotic syndrome ? What would you expect to see on the pathology report of the kidney biopsy?

Answer 14

Triad:

1. Oedema
2. Proteinuria
3. Hypoalbuminaemia

Biopsy:

1. Sclerosis in some glomeruli
   - This is scarring or hardening of the glomeruli = the glomeruli cannot function adequately.

Question 15

What is the triad of symptoms you would expect to see in nephrotic syndrome ? What would you expect to see on the pathology report of the kidney biopsy?

Answer 15

Triad:

1. Oedema
2. Proteinuria
3. Hypoalbuminaemia

Biopsy:

1. Sclerosis in some glomeruli
   - This is scarring or hardening of the glomeruli = the glomeruli cannot function adequately.

Question 16

What finding on abdominal CT would you find in turners syndrome?

Answer 16

Horse shoe kidney (they are connected like a horse shoe)

Question 17

What condition are kimmelstiel-wilson nodules the the pathognomonic finding for?

Answer 17

Diabetic nephropathy

Question 18

What is the first treatment for diabetic nephropathy ?

Answer 18

ACEi

Question 19

How do you know if there is a complete or partial compensation ?

Answer 19

Complete compensation:

Partial compensation:

Uncompensated:

Question 20

How do you know if a patient is a chronic retainer?

Answer 20

They will have a raised Bicarbonate level

Question 21

Patients with respiratory alkalosis will have a high pH and low PaCO2 level. What conditions may you see this in? (2 things)

Answer 21

• PE

- Hypoventilation

Question 22

How do you work out ABG’s?

Answer 22

• using tic tac toe method
• Acid. Normal Base
• Anything less than normal value is a acid and anything greater is a base.

NOTE:
base = metabolic
acid = resp

to find out if its compensated- look at the pH. if its outside range =

2 things under basic = compensated

nothing under basic = not compensating

1 thing under basic that is out of range = partially compensating

1 thing under basic but in range = uncompensated

Question 23

What is the first thing you would do when investigating TB?

Answer 23

CXR

Question 24

How would you know if TB treatment is working? What would you look at on culture?

Answer 24

The time it takes for the TB bacterium to show on culture

Question 25

How do you make an initial diagnosis of TB?

Answer 25

Sputum smear

Question 26

How would you pick up TB in someone who is immunocompromised?

Answer 26

Urinary LAM (Lipoarabinomannan)

Question 27

When investigating malaria. What film allows the microscopist to speciate the malaria?

Answer 27

A thin film

Question 28

What is the purpose of a thick film when investigating malaria?

Answer 28

To identify how many red cells are affected in the disease

Question 29

What is the name of the blood film stain done to investigate malaria?

Answer 29

Giemsa stain

Question 30

What is Amoebiasis and how is this investigated?

Answer 30

A Protozoa. Infection occurs through WATER | Ix: 1. Fresh stool sample characteristic feature: Erythrophagocytic trophozoites

Question 31

What is Cryptococcus and what tests would you do for it?

Answer 31

- Fungus found in soil that affected with pigeon droppings. - Major cause for mortality in HIV patients (common cause of HIV related meningitis) Ix: 1. CSF microscopy 2. Blood cultures (serum cryptococcal Ag lateral flow test.) 3. Urine cultures

Question 32

What tests would you do for histoplasmosis?

Answer 32

A Fungal infection. commonly lives in soil that contains bird/bat droppings - Occurs 3-17 days after they breathe in the fungal spores Ix: 1. Sputum culture 2. Blood test (HG 3 organism) 2. Urine test

Question 33

What tests would you do for toxoplasmosis?

Answer 33

Infection caused by a parasite toxoplasma. - Caught from the stool of cats or infected meat Sx: - sore throat - Swollen glands - Fever Usually goes in 6/52 but if pregnant or immunocompromised can cause serious disease. Ix: Serology IgG + IgM

Question 34

What tests would you do for pneumocystis?

Question 35

How would you investigate listeria? What are the signs and symptoms?

Answer 35

Type of gastroenteritis but this infection is dangerous because it can spread to your CSF Sx: - Darrhoea - muscle aches If spreads: - Stiff neck - HA - Change in mental state - Convulsions Ix: 1. CSF 2. Blood 3. MRI to rule out brainstem involvement

Question 36

What is Cytomegalovirus? How would you investigate this?

Question 37

What is erythema infectiosum? How would you diagnose this?

Question 38

How would you investigate Measles? also what are the symptoms

Answer 38

Highly contagious infection caused by Morbillivirus ``` Sx: Prodromal phase: (lasts 2-4 days) -Fever -cough - Rhinorrhoea - conjunctivitis ``` THEN: - Rash around 4 days Ix: - confirm through lab investigations Oral fluids for IgM,IgG and viral RNA testing

Question 39

How would you investigate Mumps ?

Answer 39

- Aerosol infection, spread via saliva secretions - Infectious 1 week before &after appearance of parotitis (Swelling of the gland in the neck) Ix: - Lab analysis of saliva (to detect IgM)

Question 40

How would you investigate Rubella? & symptoms

Answer 40

S: - Rash - Lymphadenopathy (suboccipital, post-auricular and cervical) - Arthritis and arthralgia Ix: - Need to contact the health protection team who will advise on investigations. - Parvovirus and B19+ measles may be tested

Question 41

How would you investigate EBV?

Answer 41

1. Monospot test | 2. FBC

Question 42

How would you investigate Varicella zoster virus?

Answer 42

Mainly a clinical diagnosis - Swab sample (unroof the chicken pox and take the fluid sample) On exam look for: - Rash - Vesicles (appear in crops) can occur on palms and soles - Small erythematous macule on scalp, face, trunk and proximal limbs PROGRESS OVER 12-14HOURS - Itchy pustules NOT PAINFUL. --> THIS IS SHINGLES - Crusting occurs after 5 days and fall off in 1-2 weeks

Question 43

What are the symptoms of HSV? and how would you investigate infection of the genitals?

Answer 43

S: - Discharge - Tingling/ neuropathic pain of bottom - Blistering lesions - Inguinal lymphadenopathy - Malaise Ix: 1. Examine 2. Take a swab (for PCR testing) 3. Consider STI screening (Gum clinic)

Question 44

When would acyclovir be given to a pregnant woman?

Answer 44

- In the 3rd trimester until birth.

Question 45

What is the screening AND diagnostic test for Lyme disease?

Answer 45

``` Screening: PCR TEST (immunoblot test) ``` Diagnostic: ELIZA Summary: 1. if rash then ELISA test - if that's positive then immunoblot test

Question 46

What test confirms a diagnosis of TB?

Answer 46

3 Deep early morning sputum samples for microscopy for acid fast bacilli

Question 47

What tests would you do when testing for latent TB ? (either one of 2 things) - What would you do if the test is positive ?

Answer 47

1. Mantoux test 2. Interferon gamma release assay (IGRA) Test If any of these tests are positive they should be assessed for active TB