Histopathological diagnosis as an essential aid to diagnosis Flashcards
34 year old presented with a fit
- no past history
- no drugs
- no HPI
- SH: work for BBC
- orginally from Somalia in UK for 10 years
What blood test you would like to do
- U&E- HYPOCALCAEMIA, hypokalaemia (affects the heart more), hyponatraemia, hypoglycaemia
- Prolactin- goes up in seizure
Someone has a fit
these are is blood results
NA- 132
K: 5.5
U= 8.0
Cr- 90
calcium - 2.55
What other test are required?
CT head
40 year old man presented with a fit
What drug would you administer for someone in casualty having a fit. if the fit does not spontaneously stop?
- lorazepam
- phenytoin 2x
- might even need to anaesthetise
patient presents with a fit
What does he have?
describe?
midline shift
cerebral oedema around tumour
What is the commonest of brain tumour
metastasis
How would you treat someone with cerebral oedema due to cancer initially
dexamethasone to reduce swelling
and then refer to the oncology team
CT scan shows the patient has an enlarged adrenals
9 am cortisol= 20nm - very low
ACTH = 200(very high)
Na= 132
K+= 5.5
What is the diagnosis?
ad
What are the investigations you will do for someone that you suspect has addisons?
short synacthen
give 250ug synACTHen IM
measure cortisol response
Someone has a massive adrenal gland tumour and causes an adddisonian syndrome further more it has metastasized to the brain and liver
What do you do now?
A. remove both adrenals
B. Liver biopsy
C. keep comfortable and palliate
D. Start chemo
E. Discuss all these option with the patient and get him to choose
E. Discuss all these option with the patient and get him to choose
LIVER biospy is also really important
you do a liver biopsy and it looks like this
this shows giant cell
it could be TB
you see a large caseating granuloma
What is the next investigation?
to acid fast bacilli test - Ziehl Nielson staining
TB
What are the most common causes of Addison’s
TB
in western - autoimmune
What is the treatment for TB
4 antibiotics 2 months
RIPE
Rifampicine
Isoniazid
Pyrazinamide
Ethambutol
Why do you do 2 months
It takes 2 months to grown TB really difficult to grow
Histopathology report of an adrenal mass: sections show fibroconnective tissue and skeletal muscle with well-formed confluent epithelioid granulomata, caseating (cheese-like), with necrosis and Langerhan’s multinucleated giant cells.
The features are those of a necrotising granulomatous inflammation.
What is the final diagnosis?
TB
