DIAGNOSTIC TOOLS Flashcards
what colour blood bottle would you use to collect blood for a coagulation scree, INR or D-dimer?
light blue
what colour blood bottle would you use to collect U+E, CRP, LFTs, amylase, TFTs, lipid profile, troponin, Ca, PO4, Mg?
yellow
what colour blood both would you use to collect FBC, blood film, ESR and HBA1c?
purple
what colour blood bottle would you use for group and save and crossmatch?
pink
what colour blood bottle would you use for glucose or lactate?
grey
how is blood in a FBC purple bottle anti coagulated?
EDTA
if MCV is low, what type of anaemia does this indicate?
a) microcytic
b) megaloblastic/macrocytic
c) normocytic
a) microcytic
if MCV is high, what type of anaemia does this indicate?
a) microcytic
b) megaloblastic/macrocytic
c) normocytic
b) megaloblastic/macrocytic
if MCV is normal, what type of anaemia could this indicate?
a) microcytic
b) megaloblastic/macrocytic
c) normocytic
c) normocytic
what is the most common cause of normocytic anaemia?
chronic disease
high WCC might indicate what?
infection
malignancy
low neutrophils might indicate what?
malignancy
what 2 things might high neutrophils indicate
bacterial infection
inflammation
what type of infection might high lymphocytes indicate?
viral
what other type of disease might cause raised lymphocytes?
autoimmune
what blood cell might be raised in chronic inflammation and TB infection?
monocytes
what blood cell might be raised in allergy and parasitic infection?
eosinophils
what blood marker might be raised post-operatively and during infection and inflammation?
platelets
give 2 examples of when urea might be raised
renal failure
protein load
if raised urea was due to protein load not renal failure, what might you expect creatinine to look like in U+Es?
normal
give 4 causes of raised creatinine
renal failure dehydration shock glomerulonephritis pyelonephritis
give 2 instances when sodium might be low
D+V
thiazide diuretics
kidney disease
Addison’s
give 2 instances when sodium might be high
hyperaldosteronism
Cushing’s
hypertension
give 2 instances when potassium may be low
insulin use
non K-sparing diuretics
D+V
give 2 instances when potassium might be high
kidney disease
addison’s
trauma
diabetes
explain why albumin is low in these two situations
a) nephrotic syndrome
b) liver failure
a) leaky glomeruli
b) none produced
to what biological molecule does albumin bind?
bilirubin
where is ALT made?
liver
what is ALT a marker of?
liver damage
what 2 things is AST a marker of?
liver damage
heart damage
explain the LOVE SAKE mnemonic for the relationship between ALT and AST
if ALT higher = viral hepatitis
if AST higher = alcoholic hepatitis
what 2 things is ALP a marker of?
paget’s bone disease
biliary damage/obstruction
what clinical sign is elevated bilirubin an indicator of?
jaundice
CRP and ESR are both infective markers - what is their different usefulness?
CRP = more acute marker ESR = remains high for a few weeks
what three things are measured in TFTs?
TSH
free T3, free T4
what clotting pathway is plotted by prothrombin time?
extrinsic
what clotting pathway is plotted by activated partial thrombin time?
intrinsic pathway
what clotting pathway is plotted by thrombin time?
common pathway
what drug is monitored using INR?
warfarin
what type of motor neurone damage arises from stroke, tumour or blunt trauma?
upper motor neuron
where is the site of an UMN lesion?
above anterior horn
what is the effect on the following in an UMN lesion?
a) muscle tone
b) weakness
c) reflexes
a) increased - spasticity
b) increased
c) increased - hypereflexia
what 2 reflex signs might you see in an UMN lesion?
babinski’s sign
clonus
what is the site of a LMN lesion?
inside or distal to anterior horn
what is the effect on the following in an LMN lesion?
a) muscle tone
b) muscle size
c) reflexes
a) decreased - hypotonia + fasciculation
b) atrophy of muscles
c) decreased + arreflexia
if there was damage at the point of a spinal cord disc, what would neurone signs look like at that level and below that level?
at that level = LMN signs
below that level = UMN signs
what are the 3 types of jaundice?
pre hepatic, intra-hepatic, post hepatic
what type of jaundice are you most likely to be very yellow during?
post hepatic
What causes increase breakdown of RBC (haemolysis) leading to excess bilirubin and consequently pre-hepatic jaundice ( unconjugated hyperbilirubinaemia)?
Sickle cell anaemia Trauma Thalassemia Malaria hereditary spherocytosis= reduce RBC lifespan haemolytic anaemia
how does pre-hepatic jaundice increase the risk of gallstones?
bilirubin is unconjugated/insoluble at this stage so can for billirubinate calculi
give 3 causes of intra-hepatic jaundice
acute viral hepatitis A,B,c drug induced liver damage= main cause paracetamol overdose and ecstasy Gilberts syndrome alcoholic hepatitis cirrhosis Liver cancer glandular fever =EBV Primary biliary cirrhosis
what occurs to the urine in intra-hepatic jaundice and why?
urine is dark
bilirubin is conjugated/soluble at this stage so is excreted
Inflammation, obstruction and damage to the bile duct causes the gallbladder not able to move bile to the digestive system causing post hepatic jaundice= V. yellow. What are the causes?
biliary stones cholecystitis Pancreatitis acute and chronic Bile duct cancer Pancreatic cancer Gall bladder cancer
what occurs to urine and stools in post-hepatic jaundice and why?
dark urine
pale stools
biliary drainage is interfered with
What are the associated symptoms of jaundice?
itch
Tiredness
Abdo pain
what is produced in pancreatic alpha cells?
glucagon
what is produced in pancreatic beta cells?
insulin
what is produced in pancreatic delta cells?
simvastatin
what is the main cause of pancreatitic diabetes?
alcohol
What are the 3 key features of mature onset diabetes of the young?
Very strong family link with at least one parent having it, with diabetes in two generations
Occurs before 25
Does not necessarily need insulin
what inheritance pattern does mitochondrial diabetes have?
autosomal dominant
does mitochondrial diabetes need insulin?
no
give 3 microvascular complications of diabetes
neuropathy
nephropathy
retinopathy
give 3 macrovascular complications of diabetes
stroke
MI
PVD
erectile dysfunction
give 2 skin complications of diabetes
staph
genital candida
what are the 4 A’s of palliative care?
analgesia
anti-emetics
anti-muscarinics
anti-anxiety
where would you hear the following murmurs?
a) aortic stenosis
b) mitral regurgitation
c) aortic regurgitation
d) mitral stenosis
a) aortic valve
b) axilla
c) tricuspid valve
d) mitral valve
where in the heart cycle do the following murmurs occur?
a) aortic stenosis
b) mitral regurgitation
c) aortic regurgitation
d) mitral stenosis
a) ejection systolic
b) pan systolic
c) diastolic
d) diastolic
where do the following murmurs radiate?
a) aortic stenosis
b) mitral regurgitation
c) aortic regurgitation
a) carotids
b) axilla
c) tricuspid valve
Give 3 examples of drugs when pain is 1-3 or MILD on the analgesic ladder?
NSAIDs
ASA= aspirin
Acetaminophen= paracetamol
give 3 examples of drugs you might give if pain is 4-6 or MODERATE on the analgesic ladder
codeine
dihydrocodeine
tramadol
hydro/oxycodone
give 3 examples of drugs you might give if pain is 7-10 or SEVERE on the analgesic ladder
morphine
hydromorphine
methadone
fentanyl
what is courvoisier’s law?
palpable non-tender gallbladder
what is murphy’s sign?
palpable painful gallbladder
what is cullen’s sign? what does it occur in?
umbilical bleeding
pancreatitis
what is grey-turner’s sign? what does it occur in?
flank bleeding
pancreatitis
what is brown-sequhard syndrome? what two pathways does it affect?
loss of decussation in the spinal column
affects contralateral spinothalamic pathway (pain, temperature)
ipsilateral dorsal column pathway (light touch)
what is budd-chiari syndrome? give 3 symptoms
occlusion of hepatic vessels
pain, ascites, enlargement
what is a large version of a macule?
patch
what is a large version of a papule?
plaque
what is a papule raised more than 1cm?
nodule
what is the large version of a vesicle?
bulla
what is a deeper version of an erosion?
ulcer
what is a sharp sided break in the skin?
fissure
what causes scale on the skin?
keratin
what does lichenification mean?
thickening
what does APACHE stand for?
acute physiological and chronic health evaluation
what is APACHE score used to determine?
severity of disease for adults in ICU
what test is determined by PaO2, temp, BP, pH, HR, RR, blood tests and GCS?
APACHE score
what test must be performed before an ABG can be performed?
Allen’s test
what would a low pH and low CO2 indicate on an ABG?
respiratory acidosis
what would a high pH and high HCO3- indicate on an ABG?
metabolic alkalosis
what would low pH, low CO2 but high HCO3 indicate on ABG?
respiratory alkalosis with metabolic compensation
what is normal pH on an ABG?
7.4
what 2 urine markers are raised in infection?
nitrates
leukocytes
what is the optic disc and optic cup in the view of an eye in fundoscopy?
bright disc
what is the macula and fovea in the view of an eye in fundoscopy?
fovea = dark patch macula = just behind
how do you distinguish between arteries and veins in fundoscopy?
arteries = thinner and paler
what type of retinopathy is indicated by micro aneurysms?
diabetic
what do flame and splinter haemorrhages indicate?
hypertensive changes
what do dot and blot haemorrhages indicate?
diabetic changes
what 3 things do vitreous haemorrhages indicate?
diabetic changes
trauma
retinal/vitreous detachment
what stage retinopathy is indicated by hard and soft (cotton wool) exudates?
diabetic/hypertensive grade 3
if vasculature is narrowed/nipped, what retinopathy might this indicate?
hypertensive
if vasculature is more tortuous, what retinopathy might this indicate?
hypertensive
if new vessels are present in the eye, what retinopathy might this indicate?
diabetic
if vasculature shows signs of silver/copper wiring, what retinopathy might this indicate?
hypertensive
what 3 things might be indicated by papilloedema
malignant hypertension
hypertension grade 4
raised ICP
what is indicated by optic disc cupping?
glaucoma
what is the difference between a cyst, sinus and fistula?
cyst = inside a structure, walls not compromised sinus = pouch into a structure, 1 wall compromised fistula = pouching through a structure, both walls/sides compromised
complete the clubbing pneumonic for causes of clubbing
Cyanotic heart disease Lung pathology Ulcerative colitis Billiary cirrhosis Birth defects Infective endocarditis Neoplasm GI malabsorption
what is the ABCDEF pneumonic for lung causes of clubbing
Abscess Bronchiectasis Cystic fibrosis Don't say COPD!! Empyema Fibrosis
what ratio should optic cup to disc be?
a) 1/30
b) 1/15
c) 1/3
d) 1/5
c) 1/3
what colour is a healthy optic disc?
pale pink/yellow
What 3 endocrine conditions can cause diabetes?
Untreated cushings
Acromegaly = excess growth hormone producti
Pheochromocytomas = catecholamine secreting hormone
What is Rovsing sign?
It is for appendicitis
Palpate on the left lumbar area and pain in the right lumbar area
what do p450 inhibitors do to drugs metabolised by p450
decreases metabolism = INCREASES drug’s effects
what do p450 inducers do to drugs metabolised by p450
increases metabolism = REDUCES drug’s effects
drugs metabolised by p450 - COW PATS
C = carbamazepine, ciclosporin, citalopram O = OCP W = warfarin
P = phenytoin A = acetylcholinesterase inhibitors T = theophylline and tacrolimus S = statins and steroids
p450 inducers - CRAP GPS
C = carbamazepine R = rifampicin A = alcohol (chronic) P = phenytoin
G = griseofulvin P = phenobarbital S = sulphonylureas
p450 inhibitors - SICKFACES.COM Group
S = sodium valproate I = isoniazid C = cimetidine K = ketoconazole F = fluoxetine A = alcohol (binge) C = chloramphenicol E = erythromycin S = sulfonamides C = ciprofloxacin O = omeprazole M = metronidazole G = grapefruit juice
effect of p450 inhibitors on INR
increase INR (reduce metabolism of warfarin = increase anticoagulant effects)
effect of p450 inducers on INR
decrease INR (increase metabolism of warfarin = decrease anticoagulant effects)
