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Semester 3 > Diagnosis / Investigations > Flashcards

Diagnosis / Investigations Flashcards

1
Q

What investigations do you do for MS

A

Full blood count, check inflammatory markers, urea & electrolytes, liver function, TFT (thyroid function), calcium and B12 levels

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2
Q

How to check for MS (diagnostic tests) and their positive results

A

MRI scan shows white spot (plaques) (scarring)

Evoked potentials show delayed latency in brain response (because of demyelination)

Check oligoclonal bands in CSF and blood serum taken from lumbar puncture and blood test

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3
Q

Diagnostic criteria for MS

A

Dissemination in space (more than one area of CNS affected)

Dissemination in time (damage has occurred at more than one time)

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4
Q

What is DSM-5 used to diagnosis

A

Schizophrenia, depression and GAD

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5
Q

What are the 5 symptoms of DSM-5 and which 3 do you need atleast one of for a schizophrenia diagnosis

A

3 that are needed : delusions, Hallucinations and disorganized speech

Other two: disorganized/catatonic behaviour and negative symptoms

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6
Q

3 conditions for DSM-5 diagnosis of schizophrenia

A

3 of the 5 symptoms, ongoing for atleast 6 months and not attributable to another condition like substance abuse

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7
Q

Bipolar type 1 diagnosis

A

Atleast one mania episode that lasts 7 days or severe enough to cause hospitalisation

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8
Q

Bipolar type 2

A

Atleast 1 hypomanic episode for atleast 4 days and one or more major depressive episode

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9
Q

What is the FAST campaign

A

Campaign launched in 2009
F: Face (drooped on one side)
A: Arms (can they raise both arms and keep them there?)
S: Speech (slurred speech)
T: Time (call 911 if you see a single one of these signs)

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10
Q

First investigation for potential stroke patient

A

CT scan

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11
Q

Hypodense areas indicate?

A

Ischemic attack caused cytotoxic oedma (hypodense because its water)

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12
Q

Tests to do for stroke patients and why

A

Serum glucose: hypoglycemia can mimic stroke symptoms, hyperglycemia is associated with intracerebral bleeding

ECG - rule out arrhythmia and heart failure

Troponin - rule out myocardial ischaemia

Electrolyte - disturbances can cause mimics

Renal function - can contraindicate some mediations

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13
Q

3 symptoms needed for TACS (total anterior circulation stroke)

A

Unilateral weakness (and/or sensory deficit)
Homonymous heminopia
Higher cerebral dysfunction

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14
Q

How to classify patient as having PACS (partial anterior circulatory stroke)

A

2 of the following:
- Unilateral weakness (and/or sensory deficit)
- Homonymous heminopia

Or just higher cerebral dysfunction (language, perception, memory, attention and problem solving)

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15
Q

Symptoms needed for POCS (posterior circulation syndrome) diagnosis

A

One of the following:
- Cranial nerve palsy and contralateral motor/sensory deficit
- Bilateral motor/sensory deficit
- conjugate eye movement disorder
- cerebellar dysfunction (vertigo, nystagmus or ataxia)
- isolated Homonymous heminopia (just that no other symptoms)

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16
Q

symptoms needed for LACS diagnosis

A

One of the following symptoms:
- pure sensory stroke
- pure motor stroke
- sensori-motor stroke
- Ataxic hemiparesis - combination of ataxia and hemiparesis (weakness of one side of body)

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17
Q

3 types of intracerebral haemorrahage/haematoma

A

Subdural or extradural haematoma,

subarachnoid or intraventricular haemorrahge

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18
Q

Presentation of subarachnoid haemorrahage

A

Thunderclap headache, peaks within 1-5 mins, vomiting, photophobia, neck stiffness, muscle aches, potentially decreased consciousness

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19
Q

What happens if CT for subarachnoid haemorrahage after 6 hours is inconclusive

A

Wait atleast 12 hours then do lumbar puncture, RBC breaks down into bilirubin which is a marker test for SA haemorrahage

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20
Q

Acronym for DSM-5 diagnosis of depression and what they stand for

A

S - Sleep disturbance
I - Interest loss (anhedonia)
G - Guilt or worthlessness
E - Energy loss
C - Concentration problems
A - Appetite changes
P - Psychomotor retardation/agitation
S - Suicidal thoughts

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21
Q

What must be present for a DSM-5 diagnosis of major depression

A

5 or more out of the SIGECAPS symptoms must be present during the same 2-week period and represent a change from previous functioning. Atleast one of the symptoms has to be depressed mood or anhedonia. And not better explained by substance abuse or side effects

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22
Q

3 levels of severity of DSM-5 diagnosis of depression

A

Mild, moderate and severe

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23
Q

Describe mild depression (DSM-5)

A

Few if any symptoms numbered more than what is required for diagnosis (so they have 5 or 6 symptoms of SIGECAPS), intensity is distressing but manageable and only result in minor functional impairement

24
Q

Severe depression (DSM-5)

A

Symptoms numbered substantially more than what is required for diagnosis (so they have 7 or 8 symptoms of SIGECAPS), intensity is seriously distressing and unmanageable and only result in major functional impairement

25
Q

Moderate depression (DSM-5)

A

Symptoms are between mild and severe depression

26
Q

Definition of persistent depressive disorder

A

Depressed mood for more days than not in a year that lasts for atleast 2 years, and patient has never been without symptoms for more than 2 months at a time

27
Q

Treatment resistant depression

A

Failure to respond to atleast two antidepressant drugs of different classes taken at adequate doses for atleast 4 weeks

28
Q

Tools to aid diagnosis of depression

A

PHQ-2, PHQ-9 and Edinburgh postnatal depression scale

29
Q

Two questions asked in the PHQ-2 (patient health questionnaire) and what happens if there is a positive answer to one or more of the questions

A
  • “over the past 2 weeks have you felt down, depressed or hopeless?”
  • “over the past 2 weeks have you felt little intrest or pleasure in doing things?”

If yes to any then move to PHQ-9

(These two questions ask about the two needed symptoms for depression diagnosis (anhedonia and depressed mood))

30
Q

Mnemonic for DSM-5 diagnosis of GAD

A

RIFDIM
R - restlessness
I - irritability
F - fatigue
D - difficulty concentrating
I - insomnia
M - Muscle tension

31
Q

What criteria is needed for a DSM-5 diagnosis of GAD

A
  • Excessive anxiety and worry occurring more days than not for atleast 6 months
  • individuals find it difficult to control worry
  • 3 or more of the 6 symptoms RIFDIM
  • the anxiety, worry or physical symptoms can cause social or occupational dysfunction
  • not to do with a substance or other medical condition
  • not better explained by another mental disorder
32
Q

Screening tools to help diagnosis GAD

A

GAD-2 and GAD-7

33
Q

What are the two GAD-2 questions

A

Over the last two weeks how often have you felt bothered by the following:

  • Feeling nervous anxious or on-edge?
  • Not being able to stop or control worrying
34
Q

How does a snellen chart work

A

Ask a person to stand 6 meters away from chart and read letters going down, a result like 6/6 means they have perfect vision. The numerator is how far they are standing from the snellen chart, the denominator is the distance a normal person would be able to see those letters in. E.g if you have a score of 6/12 that means you are standing 6 meters but can only see what a person at 12 meters would be able to see

35
Q

Describe rinner’s test

A

A struck turning fork placed on mastoid bone first and asked when sound is no longer heard then you take it out and place it next to ear and asked when sound stops.

36
Q

Describe webers test

A

Struck tuning fork placed in middle of forehead and asked which ear hears it louder or if it’s heard the same in both ears

37
Q

Describe results of Rinnes and Weber test for conductive hearing loss

A

Conductive hearing loss means there’s some sort of mechanical blocking in the external or middle ear.

That means for Rinnes test you have bone conduction > air conduction (Rinnes negative result)

And for the webers test you should have sound be louder in affected ear (sound lateralises to affected ear”

38
Q

Describe Rinne’s and Webers results for sensorineural hearing loss

A

In sensorineural hearing loss the inner ear or auditory nerve is damaged which affects overall sensitivity to sound

This mean in Rinne’s test you have Air conduction > Bone conduction (Rinne’s positive result) just like in a normal ear but it’s just diminished

In Webers test because the problem is sensorineural the sound will be heard lounder in the unaffected ear (sound lateralisation to the unaffected ear)

39
Q

Diagnosis for Parkinson’s

A
  • Bradykinesia + tremor and / or rigidity
  • absence of red flags (signs that show it’s not Parkinson’s)
  • clear response to dopaminergic therapy
  • levadopa-induced dyskinesia
  • resting tremor
  • olfactory loss
40
Q

Red flags that indicate a condition is not likely Parkinson’s

A
  • symmetrical onset (Parkinson’s is usually asymmetrical)
  • early hair abnormality and falls
  • poor levadopa response
  • early dementia
  • ataxia and apraxia
41
Q

What is SIGECAPS mnemonic for

A

DSM-5 symptoms for depression

42
Q

What is DIG FAST mnemonic for

A

Bipolar disorder / they are the mania symptoms

43
Q

What is RIFDIM a mnemonic for?

A

DSM-5 symptoms of GAD

44
Q

Investigations for Alzheimer’s disease

A

-MRI
-FDG-PET scan (measures glucose in certain areas of the brain), in AD patients this test shows decreased glucose metabolism in certain areas
- Amyloid-PET scan
- CSF (lumbar puncture) to test for beta amyloid and tau (phospho-tau specifically)

45
Q

Memantine

A

NMDA receptor antagonist used to help slow down progression of Alzheimer’s

46
Q

What is the DAS 28, its components and what is it used for

A

DAS28 is used to assess how active Rheumatoid arthritis is,

  • it looks at 28 joins which are the 10 PIP, 10 MCP, 2, shoulder, elbows, wrists and knees and measure from 1-10 or (1-100) the tenderness and swelling
  • asks the patient how they feel from 1-100
  • take a blood test and look for ESR (erythrocyte sedimentation rate) and CRP c-reactive protein)
  • put that all in the DAS28 calculator
47
Q

What are the margins and what they mean for results of the DAS 28 calculator

A

<2.6 == remission
>= 2.6 - <= 3.2 == low activity
>3.2 - <= 5.1 == moderate activity
>5.1 == high activity

You start at <2.6, 6 is the number difference beween 2.6 and 3.2, next in line is a different in 9 (so like the 3 times table) so from 3.2 to 5.1 and above 5.1 is high activity

48
Q

Two main antibodies found in Rheumatoid arthritis

A
  • Rheumatoid factor
  • Anti-CCP antibodies
49
Q

Difference between chronic and acute pain

A

Acute lasts less than 3 months
Chronic lasts more than 3 months

50
Q

Rheumatoid hand signs

A
  • Ulnar deviation - fingers deviate towards ulnar side (pinky)
  • Bontonniere (buttonhole) deformity - you have PIP flexion and DIP hyperextension
  • Swan-neck deformity - opposite of button hole deformity, you have PIP hyperextension and DIP flexion (looks like a swan-neck)
  • Synovitis - visible swelling of MCP and PIP joints
  • Rheumatoid nodules - firm, non-tender lumps under the skin often at pressure points like ur fingerprint
51
Q

What do u see in seronegative arthrtides and what is the most common one

A
  • spinal and sacroiliac inflammation
  • asymmetrical joints
  • most common is ankylosing spondylitis
52
Q

Test for ankylosing spondylitis

A

Schober’s test - tell patient to bend over and see if the distance between their vertebrae increases

53
Q

Does Rheumatoid arthritis improve or worsen with activity and when time are the symptoms the worst

A

Improves with activity and worst in the morning

54
Q

Where does spinal cord terminate

A

L1

55
Q

Diagnosis of rheumatoid arthritis

A
  • blood test for Rheumatoid factor and anti-CCP
  • imagine (x-ray)
  • decreased bone density around affected joint
  • soft tissue swelling
  • narrowing of joint space
  • bony erosion
56
Q

What type of lens do people with astigmatism wear

A

Cylindrical lenses

Semester 3 (13 decks)

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