investigation interpretation Flashcards by Sam Naylor

Normal LP results

clear
10-20 pressure
WBC count: 0-5 cells/µL 
>60% of serum glucose
Protein level: < 45 mg/dL

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Bacterial menignitis LP

Cloudy
low glucose,
high protein
10 - 5,000 polymorphs/mm³

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Viral menigingitis LP

clear/cloudy
60-80% of plasma glucose (normal) except sometimes low in mumps & herpes enceph
normal/raised protein
15 - 1,000 lymphocytes/mm³

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TB LP result

slightly cloudly, fibrin web appearance
low glucose
high protein
10 - 1,000 lymphocytes/mm³

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difference between TB and bacterial meningitis on LP

both can be cloudy but TB is slightly cloudy (fibrin web)

bacterial meningitis has polymorphs, TB is lymphocytes

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What blood abnormality would you find in sarcoid and why

hypercalcaemia due to increased activation of vit d as a result of increased activity of 1α hydroxylase produced by the sarcoid macrophages

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Acute Vs chronic S subdural hematoma on CT

Acute is hyperdense… Light
Chronic is hypodense… dark

Crises suture lines

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Classic bloods of dengue fever

Low platelet and high ALT is typical

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Bloods of someone previously immunised against hep b

Anti hbs positive (either exposure of immunisation, negative in chronic disease)

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Most common and second most common UTI in sexually active women

E Coli

Then staphylococcus saprophyticus (gram positive coccus)

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causes of abnormally low or abnormally high hba1c

low: sickle cell, gp6d def, heritary spherocytosis
high: vit b12, folate, iron def anaemia. splenectomy

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negatively birefringent crystals vs positively birefringent crystals

negatively is gout, positively is pseudo

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ECG features of hypothermia

J-waves are associated with hypothermia

… small hump at the end of the QRS complex

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Organism implicated in rocky mountain spotted fever

Rickettsia rickettsii

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Diagnosis…. Congo red staining: apple-green birefringence

Amyloidosis. Also serum amyloid precursor (SAP) scan

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Bence Jones protein

Multiple myeloma AND waldenstroms macroglobulinemia or patients with chronic B cell lymphocytic leukaemia

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Distinguish between multiple myeloma and waldenstroms macroglobulinemia

Waldenstrom’s macroglobulinaemia - Organomegaly with no bone lesions

Multiple myeloma - Bone lesions with no organomegaly

Both can have Bence Jones

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Test for lead poisoning

Serum lead,
microcytic anaemia. Blood film shows red cell abnormalities includingbasophilic stipplingand clover-leaf morphology,
urinary coproporphyrin

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Morning cortisol of 150 nmol/L. Diagnosis?

9 am cortisol between 100-500nmol/l is inconclusive and requires further investigation with a short synacthen test

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Perl’s stain on liver biopsy

Haemochromatosis (diagnosed by transferrin saturation)

Sideroblastic anaemia shows Perl’s stain on blood film

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Target cells on blood film

IDA.- with pencil’ poikilocytes

or post splenectomy - with Howell-Jolly bodies, pappenheimer bodies

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Which phase determine the length of the cell cycle

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pANCA can also be positive in…

IBD (mostly UC)
Connective tissue disease SLE RA sjrogens
Autoimmune hepatitis

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Bartonella organism, what is diagnosis

Cat scratch disease

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Cat scratch disease causative organism

Bartonella

Test to diagnose Paget's disease

Increased urine and serum hydroxyproline Likely to also have high ALP

double-contour sign on knee effusion USS | hyperechoic, irregular band over the superficial margin of the joint cartilage

gout

HCV PCR positive, low c3 c4, purpuric rash

Hepatitis C infection is associated with type II (mixed) cryoglobulinaemia.

Immunization of hep b. Anti-HBs result interpretation

Over 100, fine 10-100 give another dose Under 10 , test for past infection and give full course again (3 doses)

Common microbe related to dog bite

Animal bites are generally polymicrobial but the most common isolated organism is Pasteurella multocida

Most sensitive and specific tests for SLE

ANA is 99% sensitive | Anti-Sm & anti-dsDNA are 99% specific

Osteomyelitis in sickle cell, most likely organism

Salmonella

diagnosis of Cryptosporidium

Cryptosporidium can be diagnosed by modified Ziehl-Neelsen staining of stool to reveal red cysts

what conditions is viral LP glucose not normal

can be low in mumps / herpes encephalitis

what might CSF reveal in listeria

pleocytosis, with 'tumbling motility' on wet mounts Treat with amoxi/ampicillin (+Gent if meningitis)

What is the diagnosis for CSF with pleocytosis, with 'tumbling motility' on wet mounts

Listeria. Treat with amoxi/ampicillin (+Gent if meningitis)

Patient gets flu-lke symptoms after holiday in hotel

Legionnaire's disease.. May have hyponat, dry cough and derranged LFTs too TREAT WitH ERYTHRO

Sewage worker/farmer/vet/abattoire | Flu-like, jaundice, renal failure

leptospirosis ((aka well's)). Treat with Doxy / Benzylpenicillin Could be Q fever if pneumonia/endocarditisy picture

Schizonts on blood film

Falciparum Malaria

pinpoint petechial 'blueberry muffin' skin lesions

congenital cytomegalovirus

test to diagnose toxoplasmosis

antibody test and Sabin-Feldman dye test

what organism would you expect to be the cause in osteomyelitis in Sickle Cell Anaemia

Salmonella (remember Typhoid is in Salmonella group too)

gram positive causes of gastroenteritis

Staph A and Bacillus cereus Both cause vomiting with 6hr, but BC can alternatively cause diarrhoea after 6hr others listed were gram neg or protozoa

history of patient who works in abattoire, likely organism

``` coxiella burnetii (a type of Rickettsia that causes Q fever)... PUO, +pneumonia/endocarditis or Leptospirosis. Hepatorenal failure ```

What is serum caeruloplasmin a test for?

reduced in Wilsons, along with reduced serum copper (!)

What is Perl's Prussian Blue stain a test for?

Liver biopsy stain for iron - haemochromatosis

What is Rose Bengal plate test for?

Screening for Brucellosis, but Brucellosis serology to confirm

What is congo red stain sign for

apple-green birefringence in amyloidosis

What is serum amyloid precursor (SAP) scan for?

Amyloidosis (also congo red stain)

what are kimmelstiel-wilson nodules?

nodules found in glomeruli in diabetic nephropathy

Numerous Howell-Jolly bodies and pencil cells seen...diagnosis?

Howell-Jolly bodies are seen in hyposplenism and pencil cells are a feature of iron-deficiency. Both of these are seen in coeliac disease.

What are Aschoff bodies the histological sign of

Aschoff bodies are granulomatous nodules found in rheumatic heart fever

What are Mallory bodies found in

Mallory bodies -> alcoholism (hepatocytes)

HLA memory aid

SjogR3n's - DR3 Rheumatoid 4rthritis (RA - R4) HLA-A3=hA3mochromatosis HLA-B51 =B5hcet's disease HLA-DQ2/DQ8= coeliaQ Disease HLA-DR2 =naRcolepsy/GoodpastuRe's== R2

Howell Jones Bodies

Hyposplenism Along with target cells, Pappenheimer bodies

Looser's zones x-ray are most characteristically associated with which one of the following conditions?

Osteomalacia They're translucent bands

What is a positive Finkelstein test indicate? Pain in wrist

De Quervain's tenosynovitis Make fist with thumb in fingers, then ulnar deviate and causes pain over radial stylus Analgesia, steroid injection, immobilisation

Starry sky microscopy

Burkitt's lymphoma Post strep glomerulonephritis renal biopsy

Anti-GQ1b antibodies

Present in 90% of Miller Fischer syndrome

String of beads appearance on Mr angiography of renal artery

Fibromuscular dysplasia... Young patient who gets AKI after ACEi

What investigation do you do in patients presenting with flare of thyroid eye disease?

MRI STIR | Short inversion Time Inversion Recovery

Investigation to diagnose acute hep c infection

HCV RNA

Patient with HIV develops Pneumocystis carinii pneumonia . What type of staining should be applied to the bronchoalveolar lavage to demonstrate the organism?

Silver

Looser's zones on XR are seen in which condition

Osteomalacia.... Translucent bands

ACE levels

ACE levels have a sensitivity of 60% and specificity of 70% and are therefore not reliable in the diagnosis of sarcoidosis although they may have a role in monitoring disease activity

BCR-ACL

associated mostly with chronic myeloid leukaemia It is the result of the Philadelphia chromosome Imatinib is an nhibitor of the tyrosine kinase associated with the BCR-ABL defect

Anti Hu

That Hu-rts Painful neuropathy and cerebellar syndrome assx w SCLC/neuroblastoma

Anti Yo

Yo lady give me back my Danish Cerebellar syndrome assx with Yovarian and breast

Anti GAD

Gaaaaad you're stiff, Stiff man syndrome, diffuse hypertonia Breast colorectal SCLC

Anti Ri

Ri-eaaaally can't see Ocular opsoclonus and myoclonus assx breast and SCLC

Purkinji cell antibodies

Peripheral neuropathy in breast cancer

What stain do u use for PCP

Silver also used in H Pylori

Important false positive for heterophil antibody test (Monospot test)

test for Infectious mononucleosis HIV can cause false positive according to AMU Consultant