investigations Flashcards
IgA nephropathy presentation
in 20s
gross or microscopic haematuria following UTI
mild proteinuria
hypertension
investigations of IgA nephropathy
histology shows IgA deposits and glomerular mesangial proliferation
urinalysis:
- blood and protein positive
urine microscopy: RBC, WBC
high dose dexamesthasone test shows
high cortisol and low ACTH
adrenal adenoma
high dose dexamesthasone test shows low cortisol
Cushing’s disease
high dose dexamethasone shows high cortisol and high ACTH
ectopic ACTH
when to do a dexamethasone test
investigate cushing syndrome
investigation for bladder cancer
cystoscopy
investigations for kidney stones
urine dipstick- rule out infection and shows haematuria
blood test- check calcium and kidney function
non-contrast CT KUB- initial investigation of choice!!
diagnosis of ankylosing spondylitis
Xray
schobers test
“very active boys short stature”
perthe’s disease
presentation of perthe’s disease
unilateral pain/limp- progressive
loss of internal rotation and abduction
positive trendelenburg
presentation of transient synovitis of the hip
following URTI
ages 2-10
investigations for transient synovitis
xray- exclude perthes disease
MRI- exclude osteomyelitis
CRP- normal
management of transient synovitis of the hip
NSAIDs and rest
investigations for perthes disease
xray- hanging rope sign
management of perthes disease
regular xrays
severe= joint replacement
subluxations= osteotomy of femoral head + acetabulum
investigations of SUFE
xray- flein line
management of SUFE
urgent surgery- to pin femoral head
risk of AVN
investigation for septic arthritis
joint aspiration- for culture
raised CRP
diagnosis- kocher criteria
management of septic arthritis in kids
urgent irrigation and debridement IV antibiotics (fluclox?)
baby regurgitates food and has chronic hiccups
GORD
investigations for pyloric stenosis
USS- hypertrophic pyloric muscle
olive shaped mass in RUQ
presentation of intussusception
child unwell
red current jelly stools
palpable sausage mass
vomit and colicky abdo pain
management of intussesception
air enema retraction
surgical: laparoscopic surgery
presentation of severe dehydration in babys
drowsy
absent urine output
weak pulse
increase capillary refill
management of neonatal sepsis
IV benzyl-penicillin + gentamicin
prolonged jaundice + pale/chalky stools and dark urine
biliary atresia
Ptosis + dilated pupil
third nerve palsy
definitive management in acute closed angle glaucoma
Laser peripheral iridotomy
causative organism of epididymo-orchitis in individuals with a low STI risk
E.coli
treatment of thyroid storm
admission for monitoring
May need supportive care with fluid resuscitation, anti-arrhythmic medication and beta-blockers
Antithyroid drugs- Carbimazole (methimazole) or propylthiouracil
treatment of choice in replaspsed graves
radio-iodine
dexamethasone effect in thyroid
blocks the conversion of T4 to T3
presentation of myxoedema coma
confusion and hypothermia bradycardia heart block, T wave inversion type 2 resp failure adrenal failure in some
Papillary thyroid cancer
mostly female
good prognosis
most common
lymph node metastases
follicular carcinoma thyroid
Second commonest
Incidence slightly higher in regions of relative iodine deficiency
Tend to spread haematogenously
Diagnosis depends on invasion of the capsule or vascular invasion
lymph node swelling rare
Prognosis good
If minimally invasive- usually treated by a thyroid lobectomy, if significant vascular invasion consider a total thyroidectomy
management of follicular carcinoma
If minimally invasive- usually treated by a thyroid lobectomy, if significant vascular invasion consider a total thyroidectomy
medullary thyroid cancer
Cancer of parafollicular (C) cells
secrete calcitonin
part of MEN-2
Both lymphatic and haematogenous metastasis
Anaplastic thyroid cancer
Not responsive to treatment- best treatment is resection
Local invasion is a common feature
management of ramsay hunt syndrome
aciclovir and prednisolone
initial management of rheumatoid arthritis
start a DMARD- usually methotrexate
also can start steroid or NSAID for symptom relief
if doesnt respond to DMARD- biologic- TNF alpha drugs
associated conditions with ank spondylitis
anterior uveitis, aortitis, pulmonary fibrosis and amyloidosis
xray of ank spondylitis
sclerosis and fusion of the sacroiliac joints
bony spurs from the vertebral bodies > syndesmophytes (producing a “bamboo spine”)
imaging investigations for ank spondlylitis
MRI can detect earlier signs
xray
Treatment for ank spondylitis
physiotherapy
exercise
NSAIDs
anti-TNF inhibitors for more aggressive disease
management of reactive arthritis
1st- NSAIDs
2nd- steroid (injections)
3rd- DMARD
antibodies in dermatomyositis
ANA,
Anti-Jo-1,
myositis specific antibodies
If scaphoid fracture suspected but xray is negative
Splint and xray in 2 weeks
impetigo management
Wound care with regular cleaning, topical antiseptic or antibiotic.- topical hydrogen peroxide 1% cream or fusidic acid 2% cream tds
Oral Flucloxacillin can be used if infection is extensive.
Measures to reduce spread (not sharing towels etc).
shingles management
Aciclovir
analgesia
maybe oral steroid but not sure
conditions associated with vitiligo
type 1 diabetes mellitus Addison's disease autoimmune thyroid disorders pernicious anaemia alopecia areata
Flat-topped, shiny and firm to touch plaques and papules
lichen planus
management of lichen planus
Emollients
Topical steroid cream (potent)
Oral Prednisolone
Patellar tendonitis management
rest and physio
presentation of patellar tendonitis
More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
sore on palpation
Osteochondritis dissecans
Pain after exercise
Intermittent swelling and locking
Chondromalacia patellae
Softening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy
Causes of hypertrichosis
drugs: minoxidil, ciclosporin, diazoxide
congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis
main:
porphyria cutanea tarda
anorexia nervosa
timing difference between HHS and DKA
DKA- comes on in hours
HHS- comes on in days
presentation of renal artery stenosis
hypertension AKI flash pulmonary oedema CKD renal bruit
renal artery stenosis management
statin
ACEi- not in bilateral disease
anti-platelet
surgical angioplasty
nephrotic syndrome general management
fluid/salt restriction diuretics (IV furosemide) ACEi/ARB IV albumin anti-coagulation
cause of nephrotic syndrome
non-proliferative process affecting podocytes
nephritic syndrome is indicative of
proliferative process affecting endothelial cells/mesangial cells
symptoms that point to nephritic syndrome
oliguria
haematuria (red cell clasts)
hypertension
some proteinuria
classic presentation of IgA nephropathy
recurrent macroscopic haematuria in young males following recent URTI
IgA nephropathy is associated with
HSP- IgA mediated vasculitis
coeliac disease
biopsy findings for IgA nephropathy
light microscopy (mesangial cell proliferation?) immunofluorescence- IgA and C3 deposits
management of IgA nephropathy
BP control- ACEi and ARB
minimal change disease typical presentation
children with nephrotic syndrome
what causes minimal change disease
T-cell mediated damage of basement membrane + podocytes
biopsy result in minimal change
normal light microscopy but electron microscopu (podocyte fusion and foot-process effacement)
management of minimal change
Fluid restriction and reduced salt
prednisolone
Human albumin and furosemide
typical presentation of focal segmental glomerulosclerosis
young adults with nephrotic syndrome and CKD
biopsy of focal segmental glomerulosclerosis
light microscopy- focal/segmental sclerosis + hyalinosis
electron microscopy- effacement of foot processes
immunofluorescence- minimal Ig/complement deposition
management of focal segmental glomerulosclerosis
steroids
+/- immunosuppression
+/- ACEi
typical presentation of membranous nephropathy
adults with proteinuria and nephrotic syndrome
biopsy for membranous nephropathy
electron microscopy- thick BM with sub-epithelial electron complex deposits- spike dome appearance
management of membranous nephropathy
ACEi/ARB- 1st line
immunosuppression (steroids + cyclophosphamide +/- B cell monoclonal antibodies)
rapidly progressive glomerulonephritis
rapid decline in renal function + glomerular epithelial crescent formation on biopsy
management of rapidly progressive glomerulonephritis
immunosuppression- steroids + cyclophosphamide + Azathioprine
typical presentation of post-streptococcus glomerulonephritis
young children/teenagers 7-14 days post strep infection
immune complex deposition in post-strep glomerulonephritis
IgG, IgM, C3
management for renal SLE involvement
hydroxychloroquine +/- azathioprine
IV steroids and cyclophosphamide for severe organ involvement
investigation for polycystic kidney disease
renal US
management of polycystic kidney disease
tolvaptan
hydration and hypertension management
alports syndrome inheritance
X-linked dominant
presentation of alports syndrome
microscopic haematuria
progressive renal failure, proteinuria
ocular manifestations
bilateral sensironeural deafness
bunch of grapes appearance/ bouquet of flowers appearance
medullary sponge kidney
investigation for cholesteatoma
CT
MRI
Eustachian tube dysfunction may present with:
Reduced or altered hearing Popping noises or sensations in the ear A fullness sensation in the ear Pain or discomfort Tinnitus
