Histopathological diagnosis as an essential aid to diagnosis Flashcards
What blood tests do you want to do for somebody who has had a fit and why
prolactin (GOES HIGH IN A REAL FIT). If it’s not high then it’s a pseudofit
Look at electrolytes too
What things do you want to exclude as a cause of fit
Hypocalcaemia
Hyponatraemia
Hypoglycaemia
Hypokalaemia (more often affects the heart)
What are the reference ranges for the following:
Na K U Cr Calcium
(you need to know these 5 as they won’t give you reference ranges in the exam)
Na= 135-145mM K= 3-5.5mM U= 7-20mM Cr= 60-110mM Calcium= 2.2-2.7mM
What drug can you give if someone is fitting continuously
Diazepam or lorezepam…. you can’t just leave them having a fit
What is the commonest brain tumour
Metastases
Why could the cortisol be low but the ACTH high in a patient with a primary brain tumour
If the primary brain tumour metastasised to the adrenal glands, then the cancer could reduce the amount of functioning adrenal tissue. So cortisol would fall which would mean no suppression of ACTH release.
This would go on to cause lo Na+ and high K+
Cheese like histology and mutinucleated cells might represent what
TUBERCULOSIS!
Caseating granulomata and multinucleated giant cells
What type of organism is seen in microscopy if TB
Acid fast bacilli (AFBs)
Causes of adrenocortical failure
Tuberculous Addison’s disease (commonest worldwide)
Autoimmune Addison’s disease (commonest in UK)
What is the treatment for TB
4 Abx for 2 months then 2 Abx
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Why do you have to give 4 Abx for 2 months
Because TB is a slow glowing bacteria, it takes 2 months to do the culture to work out which Abx it is sensitive to
Key histopathological feature of TB
The histopathological findings reveal caseating (cheeselike) granulomata
What is interesting about TB
Tuberculosis has been known as a mimic of other diseases for many years
