Histopathological diagnosis as an essential aid to diagnosis Flashcards
34 yr old presented with fit
no PMH, drugs, HPC
SH - works for the BBC
what blood tests
- FBC – might have infection so look for high WCC.
- glucose – hypoglycaemia – only really if they have had too much insulin = hypoglycaemic episode
- Electrolytes – abnormal electrolytes = seizure
electrolyte imbalances that cause seizures
Hypocalcaemia – if cause is metabolic this is most common
Hyponatraemia – generally unwell
Hypoglycaemia – rare to get to seizure level
Hypokalameia – more usually arrhythmia – cardiac more sensitive to K – get VF (same as seizure just in a different organ)
medicine for someone having a fit that doesn’t stop spontaneously
Benzodiazepines – if in status ie seizure for a long time eg diazepam – IV quickest route then PR
Difficult to get venous access in someone actively seizing
Black stuff is cerebral oedema around the lesion
SOL – get a lot of vasogenic oedema – blood vessels leak fluid – put the pressure up even more
Epileptic seizure with SOL = midline shift
what is the most common type of brain tumour
Met are the most common brain tumour – lung in men and breast in women
Meningioma – most common primary
pancreas
L adrenal gland - quite big - abnormal
R adrenal - huge
ddx of the 2 enlarged adrenal glands
Could be bilateral phaeo if congenital
Conn’s can be bilateral but conns tumours are quite small
Addison’s – if replaced by cancer
Low Na and high K – addison’s
Ix to determine the cause of bilateral enlarged adrenal glands
and results in addisons
9am cortisol - very low
ACTH - very high
Synacthen test – low cortisol and high ACTH
causes of addisons
- Adrenal atrophy
- TB
- Met cancer
signs of addison’s
adrenal biopsy
low power
lots of cells around the edge
what are these cells
multinucleated giant cells
dx
TB
acid fast bacilli
mx for systemic TB
Need to take tablets for 6mo – if not you get resistance
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
R and I for the whole 6mo because most bactericidal
E and P in case of resistance
Takes 2 mo fro culture and sensitivity to come back – so need all four initially. If sensitive to all then stop E and P because most SE. If resistant to r or I – carry on with one of the others instead
histopathology of TB
caseating (cheeselike) granulomata
Mx of Addison’s
4mg prednisolone daily
fludrocortisone 100mcg daily
(if with TB:
- Rifampicin – enzyme inducer in the liver
- Drug by mouth goes through hepatic portal vein – 1st pass metabolism wipes out a lot of drugs.
- Rifampicin = pred less effective – so need 5mg which is normally high dose)
