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Mrcp > investigation interpretation > Flashcards

investigation interpretation Flashcards

1
Q

Normal LP results

A 
clear
10-20 pressure
WBC count: 0-5 cells/µL 
>60% of serum glucose
Protein level: < 45 mg/dL
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2
Q

Bacterial menignitis LP

A

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

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3
Q

Viral menigingitis LP

A

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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4
Q

TB LP result

A

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

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5
Q

difference between TB and bacterial meningitis on LP

A

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

bacterial meningitis has polymorphs, TB is lymphocytes

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6
Q

What blood abnormality would you find in sarcoid and why

A

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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7
Q

Acute Vs chronic S subdural hematoma on CT

A

Acute is hyperdense… Light
Chronic is hypodense… dark

Crises suture lines

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8
Q

Classic bloods of dengue fever

A

Low platelet and high ALT is typical

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9
Q

Bloods of someone previously immunised against hep b

A

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

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10
Q

Most common and second most common UTI in sexually active women

A

E Coli

Then staphylococcus saprophyticus (gram positive coccus)

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11
Q

causes of abnormally low or abnormally high hba1c

A

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

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12
Q

negatively birefringent crystals vs positively birefringent crystals

A

negatively is gout, positively is pseudo

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13
Q

ECG features of hypothermia

A

J-waves are associated with hypothermia

… small hump at the end of the QRS complex

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14
Q

Organism implicated in rocky mountain spotted fever

A

Rickettsia rickettsii

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15
Q

Diagnosis…. Congo red staining: apple-green birefringence

A

Amyloidosis. Also serum amyloid precursor (SAP) scan

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16
Q

Bence Jones protein

A

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

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17
Q

Distinguish between multiple myeloma and waldenstroms macroglobulinemia

A

Waldenstrom’s macroglobulinaemia - Organomegaly with no bone lesions

Multiple myeloma - Bone lesions with no organomegaly

Both can have Bence Jones

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18
Q

Test for lead poisoning

A

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

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19
Q

Morning cortisol of 150 nmol/L. Diagnosis?

A

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

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20
Q

Perl’s stain on liver biopsy

A

Haemochromatosis (diagnosed by transferrin saturation)

Sideroblastic anaemia shows Perl’s stain on blood film

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21
Q

Target cells on blood film

A

IDA.- with pencil’ poikilocytes

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

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22
Q

Which phase determine the length of the cell cycle

A

G1

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23
Q

pANCA can also be positive in…

A

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

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24
Q

Bartonella organism, what is diagnosis

A

Cat scratch disease

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25
Q

Cat scratch disease causative organism

A

Bartonella

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26
Q

Test to diagnose Paget’s disease

A

Increased urine and serum hydroxyproline

Likely to also have high ALP

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27
Q

double-contour sign on knee effusion USS

hyperechoic, irregular band over the superficial margin of the joint cartilage

A

gout

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28
Q

HCV PCR positive, low c3 c4, purpuric rash

A

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

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29
Q

Immunization of hep b. Anti-HBs result interpretation

A

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

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30
Q

Common microbe related to dog bite

A

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

31
Q

Most sensitive and specific tests for SLE

A

ANA is 99% sensitive

Anti-Sm & anti-dsDNA are 99% specific

32
Q

Osteomyelitis in sickle cell, most likely organism

A

Salmonella

33
Q

diagnosis of Cryptosporidium

A

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

34
Q

what conditions is viral LP glucose not normal

A

can be low in mumps / herpes encephalitis

35
Q

what might CSF reveal in listeria

A

pleocytosis, with ‘tumbling motility’ on wet mounts

Treat with amoxi/ampicillin (+Gent if meningitis)

36
Q

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

A

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

37
Q

Patient gets flu-lke symptoms after holiday in hotel

A

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

38
Q

Sewage worker/farmer/vet/abattoire

Flu-like, jaundice, renal failure

A

leptospirosis ((aka well’s)).
Treat with Doxy / Benzylpenicillin

Could be Q fever if pneumonia/endocarditisy picture

39
Q

Schizonts on blood film

A

Falciparum Malaria

40
Q

pinpoint petechial ‘blueberry muffin’ skin lesions

A

congenital cytomegalovirus

41
Q

test to diagnose toxoplasmosis

A

antibody test and Sabin-Feldman dye test

42
Q

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

A

Salmonella (remember Typhoid is in Salmonella group too)

43
Q

gram positive causes of gastroenteritis

A

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

44
Q

history of patient who works in abattoire, likely organism

A 
coxiella burnetii (a type of Rickettsia that causes Q fever)... PUO, +pneumonia/endocarditis
or Leptospirosis. Hepatorenal failure
45
Q

What is serum caeruloplasmin a test for?

A

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

46
Q

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

A

Liver biopsy stain for iron - haemochromatosis

47
Q

What is Rose Bengal plate test for?

A

Screening for Brucellosis, but Brucellosis serology to confirm

48
Q

What is congo red stain sign for

A

apple-green birefringence in amyloidosis

49
Q

What is serum amyloid precursor (SAP) scan for?

A

Amyloidosis (also congo red stain)

50
Q

what are kimmelstiel-wilson nodules?

A

nodules found in glomeruli in diabetic nephropathy

51
Q

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

A

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

52
Q

What are Aschoff bodies the histological sign of

A

Aschoff bodies are granulomatous nodules found in rheumatic heart fever

53
Q

What are Mallory bodies found in

A

Mallory bodies -> alcoholism (hepatocytes)

54
Q

HLA memory aid

A

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

55
Q

Howell Jones Bodies

A

Hyposplenism

Along with target cells, Pappenheimer bodies

56
Q

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

A

Osteomalacia

They’re translucent bands

57
Q

What is a positive Finkelstein test indicate? Pain in wrist

A

De Quervain’s tenosynovitis

Make fist with thumb in fingers, then ulnar deviate and causes pain over radial stylus

Analgesia, steroid injection, immobilisation

58
Q

Starry sky microscopy

A

Burkitt’s lymphoma

Post strep glomerulonephritis renal biopsy

59
Q

Anti-GQ1b antibodies

A

Present in 90% of Miller Fischer syndrome

60
Q

String of beads appearance on Mr angiography of renal artery

A

Fibromuscular dysplasia… Young patient who gets AKI after ACEi

61
Q

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

A

MRI STIR

Short inversion Time Inversion Recovery

62
Q

Investigation to diagnose acute hep c infection

A

HCV RNA

63
Q

Patient with HIV develops Pneumocystis cariniipneumonia

. What type of staining should be applied to the bronchoalveolar lavage to demonstrate the organism?

A

Silver

64
Q

Looser’s zones on XR are seen in which condition

A

Osteomalacia…. Translucent bands

65
Q

ACE levels

A

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

66
Q

BCR-ACL

A

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

67
Q

Anti Hu

A

That Hu-rts

Painful neuropathy and cerebellar syndrome assx w SCLC/neuroblastoma

68
Q

Anti Yo

A

Yo lady give me back my Danish

Cerebellar syndrome assx with Yovarian and breast

69
Q

Anti GAD

A

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

70
Q

Anti Ri

A

Ri-eaaaally can’t see

Ocular opsoclonus and myoclonus assx breast and SCLC

71
Q

Purkinji cell antibodies

A

Peripheral neuropathy in breast cancer

72
Q

What stain do u use for PCP

A

Silver

also used in H Pylori

73
Q

Important false positive for heterophil antibody test (Monospot test)

A

test for Infectious mononucleosis

HIV can cause false positive according to AMU Consultant

Mrcp (21 decks)

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