Random Clinical Flashcards
(34 cards)
Causes of raised JVP (>4cm)
Heart Failure Cardiac Temponade Restrictive pericarditis Fluid overload e.g. renal disease Superior vena cava obstruction
Interpret the following CSF results. Given are the tests and normal ranges.
Appearance (clear), White cells (<5), predominant white cell (all mononuclear), protein (0.2-0.4), glucose (>60%)
a) cloudy & viscous 900 mononuclear 5 <30%
b)
- Clear
- 100
- Mononuclear
- 0.6
- > 60%
c)
- Cloudy and Turbid
- 5,000
- Polymorphs
- 8
- 35%
d) Fibrin web 400 Mononuclear 0.4 30%
a) Is TB meningitis
- WCC Less high than normal bacterial men but raised 50-1000
- High protein
- Low glucose
b) Viral
Clear, raised white cells (10-1000),
- normal/high protein
- normal glucose
c) bacterial: cloudy & think, very high white cell count, polymorphs and very high protein
d)
Fibrin web, high WCC (not as high as bacterial)
- Low protein
- Normal/low protein
Bacteria in Newborns
group B strep
E. coli
listeria monocytogenes
Bacteria in young children
N. meningitidis
Strep pneumonia
Haemophilus influenza
Bacteria in teens/adults
N. meningitides
Strep pneumonia
Virus
VZV, enterovirus, HSV, HIV, mumps
Fungal
Cryptococcus neoformans
Additional Tests after LP
- culture: grow bacteria
- PCR for virus
- Electrophoresis: oligoclonal bands (MS)
- Acid-fast stain TB
- Xanthochromia/bilirubin: subarachnoid
- Cytology: malignant cells
Subarachnoid Haemorrhage in LP
Usually blood stained, normal white blood cells,
Red cells high, normal or high protein, glucose normal or high
Treatment for TB
RIPE
Rifampicin: 600-900mg
Isoniazid: 15mg/kg
Pyrazinamide: 2.5g
Ethambutol 30mg/kg
All PO 3 times a week
What cause of large bowel obstruction appears as a large coffee bean on AXR?
Sigmoid Volvulus
What width should the large and small bowel be on AXR
Large= 5cm (except the caecum which is 8cm)
Small= 3cm
Name 3 ways of identifying pneumoperitoneum on XR
CXR: air under diaphragm (gastric air bubble under left is normal)
Rigler’s sign: see both sides of bowel wall (normally only inner wall is viable) contrast of air inside bowel
Football sign: round area of air, mostly found in neonates.
Causes of perforation
obstruction gallstone disease inflammatory conditions (Crohn's) Appendicitis Trauma
What does thumb printing of the bowel on AXR suggest?
Oedema of the bowel wall, occurs in inflammatory bowel disease and ischaemic colitis
If you see an enlarged colon, question if it inflammatory bowel disease-related toxic megacolon (particularly UC)
Talk through how to interperate an abdo x ray
- Projection
- Patient details
- Technical Adequacy (entire abdo)
- Obvious abnormalities
- Systematic review
- Foreign bodies
- Assess bowel (large then small, size, abnormalities, extra or intraluminal content (air is black, faeces are mottled grey
- Liver, spleen, gallbladder (size, gallstones (most radiolucent))
- Abdominal aorta (calcifications, aneurysm, if suspecting dissection look for psoas muscle shadow (normally present)
- Kidney stones
- Bones (pelvic & hip& spine) - Summary: key findings, diagnosis, management plan * differentials
Example of describing AXR for small bowel obstruction in OSCE.
This is an AP supine abdominal radiograph. From the identifying markers, I would like ensure it is the correct patient and check the date. A view of the entire abdomen are included in this film.
There are multiple loops of small bowel obstruction. It is the small bowel due to the central distribution & valvulae commiventes.
There is no evidence of hernia or previous surgery. There is no evidence of extraluminal air. The abdominal aorta is not visible and the bladder seems a normal size. There are no apparent bony abnormalities.
In summary, this is an abdominal radiograph showing small bowel obstruction with no evidence of perforation. I would like to arrange an erect chest X-ray to look for free air under the diaphragm.
Differentials for the cause of small bowel obstruction would be adhesions, neoplasia, incarcerated hernias and strictures.
Management of small bowel obstruction
- NBM
- Drip & Suck IV access for IV fluids & NG tube
- Bloods: FBC, U&E, LFT, CRP, clotting, group & save (prepare for theatre)
- Erect CXR
- Urgent surgical review for further imaging to surgical intervention
Causes of blood on urinalysis
Haematuria or in women form menstrual peroid
Ketones
↑DKA & starvation
NB:↑Glucose, metabolic acidosis & ↑ketones for DKA
If no ketones with high glucose = HONK hyperosmolar non ketotic state
- ask patient if they are deliberately trying to lose weight & when they last ate
Nitrites & leukocytes
↑ suggest bacterial infection
leukocytes are non-specific
Nitrites only produced by gram negative bacteria. Some infections will be negative.
protein
↑renovascular, glomerular, tubulointersitial disease, pre-eclampsia & hypertension
Can be benign (exercise, postal)
In nephrotic syndrome (low albumin, oedema, raised cholesterol & proteinuria) must measure protein loss in 24 hours
Glucose
↑diabetes: especially HONK or DKA
can be raised in pregnancy
Specific gravity
Concentrating and diluting status of the kidney
↑dehydration, HF, liver failure, syndrome of inappropriate ADH (SIADH)
↓diabetes insipidus & ↑fluid intake
