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Medicine Extras > Gold Standard Vs 1st Line Investigation > Flashcards

Gold Standard Vs 1st Line Investigation Flashcards

1
Q

Renal Colic

A

1st: X-Ray KUB + USS

GOLD: Non-Contrast CT KUB

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2
Q

Stroke / TIA

A

1st: CT Head (MRI is often unavailable or contraindicated

GOLD: MRI

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3
Q

Coeliac Disease

A

1st:
IgG Tissue-Transglutaminase (BEST)
IgG Anti-Endomysial Antibody (LESS SPECIFIC)

GOLD (And required by NICE):
Endoscopy + Duodenal biopsy

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4
Q

Crohn’s Disease

A

1st: Calprotectin++ (Tells you it is Crohn’s/UC)

GOLD: Endoscopy + Biopsy

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5
Q

Ulcerative Colitis

A

1st: Faecal Calprotectin++ (Tells you it is Crohn’s/UC), P-anca +ve

GOLD: Colonoscopy + biopsy

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6
Q

Osteoarthritis

A

1st and GOLD: X-Ray (Think L.O.S.S)

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7
Q

Rheumatoid Arthritis

A

1st line for progression: X-Ray + Other Imaging.

GOLD: Anti-Cyclic-Citrullinated-Peptide++

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8
Q

Pericarditis

A

1st: ECG:
Widespread “Saddle” ST-Elevation
Minor PR depression.
Suppressed QRS waves

2nd: Imaging: Echo or CT.

GOLD: Cardiac Catheterisation

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9
Q

Acute Pancreatitis

A

1st and GOLD: Pancreatic Enzymes++ (Lipase/Amylase)

2nd: Other bloods + calculate PANCREAS score. (Enzymes in PANCREAS score are ALT/AST)

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10
Q

Sjogren’s Syndrome

A

1st: Schirmer’s test - tears travel <10mm

2nd: Serum antibodies (SSA+?/SSB+?/CCP-?/RF?)
Anti-RO (SSA) most common
Anti-LA (SSB) most specific

GOLD: Minor salivary-gland biopsy

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11
Q

Gout

A

1st and GOLD: Joint aspiration for needle (-)birefringent crystals.

Assume it is septic arthritis until proven otherwise

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12
Q

Pseudogout

A

1st and GOLD: Joint aspiration for rhomboid (+)birefringent crystals.

Assume it is septic arthritis until proven otherwise

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13
Q

Septic Arthritis

A

1st and GOLD: Joint aspiration and culture

Do this BEFORE starting broad-abx so there is no interference with the culture.

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14
Q

Osteomyelitis

A

1st: Plain X-Ray (Not very sensitive, progress to CT)

GOLD: Bone biopsy (Only if pt is clinically stable, do this BEFORE abx)

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15
Q

Systemic Lupus Erythematosus (SLE)

A

1st: Serum Anti-Nuclear-Antibodies (ANA)
Inflammatory markers: raised ESR, normal CRP

GOLD: Anti-Double-Stranded-DNA (Anti-dsDNA)

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16
Q

Myocardial Infarction

A

1st and GOLD: ECG + Serum Troponin

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17
Q

Cardiac Failure

A

1st: Serum-B-Type Natriuretic Peptide (BNP)

GOLD: Echocardiogram (Ejection fraction + structure)

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18
Q

Valvular Heart Disease

A

1st: ECG + Auscultation

GOLD: Echocardiogram (Doppler + structure)

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19
Q

Congenital Heart Diseases

VSD/ASD/TetFalot

A

1st: ECG + Ascultation

GOLD: Transthoracic Echocariogram

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20
Q

Primary Sclerosing Cholangitis

A

1st: ALP/GGT, AST/ALT, Billirubin, Albumin, pANCA

GOLD: MRCP (Magnetic-Resonance Cholangio-Pancreatography)

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21
Q

Myasthenia Gravis

A

1st: Serum Anti-ACh-Antibodies (Sensitivity 50-95%)
2nd: Edrophonium (Tensilon) test

GOLD: There is no adequate gold standard.

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22
Q

Testicular Cancer

A

1st: Hormones such as ßHCG (Seminoma) / ∂FP (Non-Seminoma) + examination.

GOLD: Testicular Ultrasound

23
Q

Bowel obstruction

A

(Before specifying what the cause is)

1st: Abdominal X-Ray or DRE if distal.

GOLD: Not-contrast CT abdomen

24
Q

Diabetes Insipidus

A

1st: 24-hour urine collection (Confirm polyuria)

GOLD: Water Deprivation + Desmopressin Test

25
Q

Fibromyalgia

A

1st: Serum CRP/ESR/ACCP/ANA to rule out others.

GOLD: No gold standard. Diagnosis via exclusion. 11 out of 18 tender spots.

26
Q

Hypertension

A

1st: Clinical BP monitoring (>150 = >80 / >140 = <80)

GOLD: Ambulatory Monitoring (ABPM)

27
Q

Abdominal Aortic Aneurysm

A

1st and GOLD: Abdominal Ultrasound (Screening men >65 too)

For further investigations, you would do a CT.

28
Q

Duchenne Muscular Dystrophy

A

1st: rise in serum creatinine kinase

2nd: genetic testing
(combined 1st and 2nd diagnoses 95% of cases)

GOLD: muscle biopsy - absence of dystrophin

29
Q

Giant cell arteritis

A

1st: raised ESR and CRP

GOLD: temporal artery biopsy

30
Q

Cushing’s

A

1st: Cortisol Levels

GOLD: Overnight Dexamethasone Suppression Test

ACTH levels to work out primary or secondary

31
Q

Addison’s

A

1st: Serum electrolytes decreased Na, increased K

GOLD: Synacthen test - ACTH stimulation test - no response = Addison’s.

32
Q

HCC

A

GOLD: Ultrasound of Liver

1st: Enzymes / Hx

33
Q

Lung Cancer

A

1st: CXR

GOLD: CT Chest (Biopsyis ultimately gold, but can only be done if CT shows it is acessible)

34
Q

Spinal Cord Compression / Damage

A

1st: Spine X-Ray (Quick and cheap)

GOLD: MRI Spine

35
Q

Gullian Barre

A

1st: Lumbar puncture (Essential- Raised proteins)

GOLD: Nerve conduction study

36
Q

Brugada

A

1st: ECG

GOLD (Not perfect): Na+ Channel-Blocker Test

37
Q

Diabetes Mellitus

A

Gold: Any of the following

Random plasma glucose >11.1 + Symptoms

Fasting plasma glcose >7

HbA1c > 48

38
Q

Pancreatitis

A

1st: Serum amylase / lipase

GOLD: 2 out of 3 of:
Epigastric pain, raised amylase, abnormal CT scan pathology

39
Q

Autoimmune hepatitis

A

1st: Autoantibodies: ANA, ASMA (most specific), p-ANCA

GOLD: liver biopsy

40
Q

Screening:

Cervical Cancer

A

25-64 years old

-Cell biopsy

41
Q

Screening:

Aortic Aneurysm

A

> 65 years old

-Abdominal Ultrasound

42
Q

Screening:

Bowel Cancer

A

60-74 years old
-Faecal sample kit.

-Soon to expand to 56-year-olds.

43
Q

Screening:

Breast Cancer

A

50-70 years old

-X-Ray Mammogram.

44
Q

Screening:

Diabetic Eye

A

All diabetics >12 years old.

45
Q

Screening:

Prostate Cancer

A

TRICK QUESTION: THIS IS NOT DONE

-Although, it is controversial.

46
Q

Klinefelter’s

A

1st: Low testosterone and high FSH/LH at puberty.

GOLD: Karyotype (Ideally from an amniotic biopsy).

47
Q

Aortic Dissection

A

1st: CT Scan (Often all you need)

GOLD: MRI

48
Q

Thyroid cancer

A

1st: Blood - T3 and T4 levels

GOLD: Fine-needle aspiration

49
Q

Multiple sclerosis

A

1st and GOLD: MRI head

Other: Lumbar puncture

50
Q

Ascending cholangitis

A

1st: bloods - inflammatory markers & LFTs
2nd: USS - thick walled gallbladder & stones

GOLD: contrast CT

51
Q

Beta thalassemia

A

1st and GOLD: Hb electrophoresis

Other: X-ray - “Hair-on-end” appearance

52
Q

Prostate Cancer

A

First-line: Multi-Parametric MRI (Has now replaced TRUS Biopsy)

Gold Standard: TRUS Biopsy
(But MRI is ALWAYS done first; some cancers are not clinically significant)

53
Q

Multiple Myeloma

A
  1. (FBC, U&Es etc)
    Protein Electrophoresis:
    -Serum: ++igA/G
    -Urine, ++igA/G (Bence Jones)

Gold Standard: Bone-marrow biopsy (Plasma cells raised significantly)

Imaging: Full-body MRI for lytic lesions and infiltration of bone-marrow.

54
Q

Achalasia

A

1st line: Endoscopy (To rule out malignancy, not very sensitive)

2nd line: Barium swallow (May miss early disease)

GOLD: Manometry (Measure pressure at different levels while patient attempts to swallow)

Medicine Extras (24 decks)

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