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Gold Standards > Diagnosis > Flashcards

Diagnosis Flashcards

1
Q

acute glomerulonephritis / nephritic syndrome

A

renal biopsy (unless post-strep)

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2
Q

polycystic kidney disease

A

renal US

+/- genetic test

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3
Q

chronic kidney disease

A

proteinuria via spot UAlbumin/Ucreatinine ratio (ACR) especially 1st morning urine

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4
Q

diabetes insipidus

A

-fluid deprivation test (normal response –> progressive urine concentration) = continue to produce dilute urine
(dec Uosm <200 and low spec gravity <1.005)

-desmopressin (ADH) stim test - differentiates nephrogenic vs central type (central = reduces urine output - response to ADH)

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5
Q

epididymitis

A 
scrotal ultrasound (enlarged epididymis &amp; increased testicular blood flow)
UA - pyuria/WBC/bacteriuria
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6
Q

testicular torsion

A

doppler US (decreased blood flow / avascular testicle)

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7
Q

testicular cancer

A 
scrotal US (hypoecholic mass)
alpha-fetoprotein, B-hCG, LDH
-elevated serum α-fetoprotein level defines the tumor as a nonseminoma
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8
Q

definitive dx for UTI

A

urine culture

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9
Q

prostatitis

A

UA and culture (acute, often neg in chronic)

-avoid prostatic massage in ACUTE (may cause bacteremia) but done in chronic to increase bacterial yield

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10
Q

prostate cancer

A

PSA >10 - higher = increased likelihood of CA and mets
DRE
US w/ needle biopsy if PSA >4 (if >10 bone scan too)

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11
Q

bladder cancer

A

cystoscopy w/ biopsy (can be diagnostic or curative)

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12
Q

renal cell carcinoma

A

CT scan

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13
Q

hematuria workup

A

UA/culture
cystoscopy (best for bladder/urethral cancer)
IV pyelogram (kidney, ureters but uses contrast)
US to r/o kidney stones
cytology to r/o bladder cancer

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14
Q

chlamydia or gonorrhea infx

A

nucleic acid amplification

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15
Q

renal artery stenosis

A

renal arteriograph is gold standard (but don’t do if renal failure present)
CT or MR angio (safe if poor renal fx), ultrasound

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16
Q

common indications for CT w/out contrast

A

suspected stroke w/in first 3 hours of sx, closed head injury, diffuse lung disease, soft tissue swelling, infection or trauma of extremities, suspected kidney stone or suspected spinal trauma

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17
Q

shoulder dislocation xray views

A

axillary and “Y” view most helpful (determine ant/pos)

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18
Q

suppurative flexor tenosynovitis

A

MRI / xray often but definitive via aspiration and/or biopsy

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19
Q

patellar fracture

A

sunrise view radiographs

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20
Q

strep pharyngitis

A

throat culture gold standard (definitive dx)

21
Q

peritonsillar abscess

A

CT scan to differentiate cellulitis vs abscess

-can tx based on clinical evidence if not concerned about deeper neck infx

22
Q

acute angle glaucoma

A

Gonioscopy

23
Q

osteomyelitis

A

bone aspiration - gold std

24
Q

septic arthritis

A

ARTHROCENTESIS
WBC > 50K, gram stain / culture
WBC > 1.1K positive in prosthetic joints

25
Q

SLE

A

+ ANA (initial best test, not specific) + RF

+ ANTI DOUBLE-STRANDED DNA & ANTI-SMITH AB 100% specific for SLE, not sensitive

26
Q

scleroderma

A

+ ANTI-CENTROMERE AB - assoc w/ LIMITED/CREST, more specific, better prognosis
+ ANTI-SCL-70 AB - assoc w/ DIFFUSE dz & multiple organ involvement

27
Q

RA

A

+RF best initial (sensitive, not specific), inc CRP, ESR
+ANTI-CYCLIC CITRULLINATED PEPTIDE AB (ANTI-CCP) - most specific for RA
-increased ESR, CRP

28
Q

giant cell / temporal arteritis (GCA)

A
  • dx- clincial
  • increased ESR (>100), inc CRP, normo anemia
  • temporal artery bx (may have skip lesions so negative bx is not for sure) –> bx: MONONUCLEAR LYMPHOCYTE INFLITRATION, MULTINUCLEATED GIANT CELLS, LAMINA CELL DEGRADATION
29
Q

mallory-weiss tears

A

upper endoscopy / EGD

30
Q

peptic ulcer disease or suspected malignancies

A

upper endoscopy / EGD

31
Q

acute crohn’s disease

A

upper GI series (barium swallow, esophagram)

32
Q

C/I if bowel perforation suspected or acute UC

A

lower GI series (barium enema)

-barium is an irritant outside of structures of GI tract

33
Q

achalasia, nutcracker esophagus

A

esophageal manometry (motility study)

34
Q

GERD

A

CLINICAL

  1. ENDOSCOPY - often used 1st if persisetent sx or complications of gerd
  2. ESOPHAGEAL MANOMETRY - dec LES PRESSURE
  3. 24 AMBULATORY PH MONITORING GOLD STD
35
Q

achalasia

A
  • ESOPHAGEAL MANOMETRY - GOLD STD, shows inc LES pressure >40mmHg, dec peristalsis
  • DOUBLE-CONTRAST ESOPHAGRAM “BIRD’S BEAK APPEARANCE OF LES” (narrowing)
  • ENDOSCOPY may be needed to r/o carcinoma or other etiologies
36
Q

esophageal webs & rings

A

BARIUM ESOPHAGRAM (SWALLOW)

37
Q

gastritis

A

ENDOSCOPY GOLD STD = thick, edmatous erosions <0.5cm –> h.pylori testing

38
Q

h.pylori

A

GOLD STD: ENDOSCOPY W/ BX (+RAPID UREASE TEST - staining of specimen)

    • urea breath test (also to confirm eradication after tx - h.pylori converts labeled urea into labeled CO2)
    • h.pylori stool antigetn (HpSA) >90% specific (for infx and to confirm eradication)
    • serologic AB - only useful in confirming infx (NOT iradication bc AB stay elevated after)
39
Q

acute cholangitis

A
  • labs: leukocytosis, cholestasis (inc alk phos and GGT), inc bilirubin > inc ALT/AST
  • US/CT may show dilation of duct
  • CHOLANGIOGRAPHY GOLD STD via ERCP (usually performed once pt afebrile/stable for 48 hrs after IV abx)
40
Q

HCC

A

ULTRASOUND + ALPHA-FETOPROTEIN

41
Q

celiac’s disease

A

+ENDOMYSIAL IgA AB & TRANSGLUTAMINASE AB

+SMALL BOWEL BX DEFINITIVE

42
Q

lactose intolerance

A

HYDROGEN BREATH TEST (test of choice) - hydrogen produced when colonic bacteria ferment the undigested lactose (performed after trial of lactose-free diet)

43
Q

diverticulitis/diverticulosis

A

CT scan test of choice

  • barium enema not done in acute phase
  • inc WBC +guaiac
44
Q

appendicitis

A

CT scan, ultrasound

45
Q

mesenteric ischemia (acute or chronic)

A

acute: ANGIOGRAM is definitive; colonoscopy - patchy, necrotic areas
chronic:
ANGIOGRAM confirms dx; colonoscopy - muscle atrophy w/ loss of villi

46
Q

acute ulcerative colitis + non-acute

A

flex sig in acute disease

-COLONOSCOPY C/I IN ACUTE COLITIS –> RISK OF PERFORATION
-BARIUM ENEMA C/I IN ACUTE –> MAY CAUSE TOXIC MEGA COLON
-colonoscopy - uniform inflammation +/- ulceration in rectum or colon “PSEUDOPOLYPS”
-barium enema - “STOVE PIPE” sign (loss of haustra)
+P-ANCA

47
Q

acute crohn’s + non-acute

A
  • upper GI series w/ small bowel follow-through test of choice in acute dz

-colonoscopy: “SKIP LESIONS” AND “COBBLESTONE APPEARANCE”
-barium enema: “STRING SIGN” narrowed/scarred area
+ASCA

48
Q

PANCYTOPENIA (ALL DEC) CAUSES

A 
Aplastic anemia
Chloramphenicol (mc drug)
Leishmania donovani
Megaloblastic anemia
Paroxysmal nocturnal hemoglobinuria (PNH)
Radiation sickness
Transfusion-associated GVHD

Gold Standards (7 decks)

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