investigation interpretation Flashcards
Normal LP results
clear 10-20 pressure WBC count: 0-5 cells/µL >60% of serum glucose Protein level: < 45 mg/dL
Bacterial menignitis LP
Cloudy
low glucose,
high protein
10 - 5,000 polymorphs/mm³
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
TB LP result
slightly cloudly, fibrin web appearance
low glucose
high protein
10 - 1,000 lymphocytes/mm³
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
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
Acute Vs chronic S subdural hematoma on CT
Acute is hyperdense… Light
Chronic is hypodense… dark
Crises suture lines
Classic bloods of dengue fever
Low platelet and high ALT is typical
Bloods of someone previously immunised against hep b
Anti hbs positive (either exposure of immunisation, negative in chronic disease)
Most common and second most common UTI in sexually active women
E Coli
Then staphylococcus saprophyticus (gram positive coccus)
causes of abnormally low or abnormally high hba1c
low: sickle cell, gp6d def, heritary spherocytosis
high: vit b12, folate, iron def anaemia. splenectomy
negatively birefringent crystals vs positively birefringent crystals
negatively is gout, positively is pseudo
ECG features of hypothermia
J-waves are associated with hypothermia
… small hump at the end of the QRS complex
Organism implicated in rocky mountain spotted fever
Rickettsia rickettsii
Diagnosis…. Congo red staining: apple-green birefringence
Amyloidosis. Also serum amyloid precursor (SAP) scan
Bence Jones protein
Multiple myeloma AND waldenstroms macroglobulinemia or patients with chronic B cell lymphocytic leukaemia
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
Test for lead poisoning
Serum lead,
microcytic anaemia. Blood film shows red cell abnormalities includingbasophilic stipplingand clover-leaf morphology,
urinary coproporphyrin
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
Perl’s stain on liver biopsy
Haemochromatosis (diagnosed by transferrin saturation)
Sideroblastic anaemia shows Perl’s stain on blood film
Target cells on blood film
IDA.- with pencil’ poikilocytes
or post splenectomy - with Howell-Jolly bodies, pappenheimer bodies
Which phase determine the length of the cell cycle
G1
pANCA can also be positive in…
IBD (mostly UC)
Connective tissue disease SLE RA sjrogens
Autoimmune hepatitis
Bartonella organism, what is diagnosis
Cat scratch disease
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 cariniipneumonia
. 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
