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second year!! > investigations > Flashcards

investigations Flashcards

1
Q

IgA nephropathy presentation

A

in 20s
gross or microscopic haematuria following UTI
mild proteinuria
hypertension

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2
Q

investigations of IgA nephropathy

A

histology shows IgA deposits and glomerular mesangial proliferation

urinalysis:
- blood and protein positive
urine microscopy: RBC, WBC

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3
Q

high dose dexamesthasone test shows

high cortisol and low ACTH

A

adrenal adenoma

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4
Q

high dose dexamesthasone test shows low cortisol

A

Cushing’s disease

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5
Q

high dose dexamethasone shows high cortisol and high ACTH

A

ectopic ACTH

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6
Q

when to do a dexamethasone test

A

investigate cushing syndrome

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7
Q

investigation for bladder cancer

A

cystoscopy

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8
Q

investigations for kidney stones

A

urine dipstick- rule out infection and shows haematuria
blood test- check calcium and kidney function
non-contrast CT KUB- initial investigation of choice!!

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9
Q

diagnosis of ankylosing spondylitis

A

Xray

schobers test

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10
Q

“very active boys short stature”

A

perthe’s disease

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11
Q

presentation of perthe’s disease

A

unilateral pain/limp- progressive
loss of internal rotation and abduction
positive trendelenburg

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12
Q

presentation of transient synovitis of the hip

A

following URTI

ages 2-10

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13
Q

investigations for transient synovitis

A

xray- exclude perthes disease
MRI- exclude osteomyelitis
CRP- normal

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14
Q

management of transient synovitis of the hip

A

NSAIDs and rest

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15
Q

investigations for perthes disease

A

xray- hanging rope sign

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16
Q

management of perthes disease

A

regular xrays
severe= joint replacement
subluxations= osteotomy of femoral head + acetabulum

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17
Q

investigations of SUFE

A

xray- flein line

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18
Q

management of SUFE

A

urgent surgery- to pin femoral head

risk of AVN

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19
Q

investigation for septic arthritis

A

joint aspiration- for culture
raised CRP
diagnosis- kocher criteria

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20
Q

management of septic arthritis in kids

A 
urgent irrigation and debridement 
IV antibiotics (fluclox?)
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21
Q

baby regurgitates food and has chronic hiccups

A

GORD

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22
Q

investigations for pyloric stenosis

A

USS- hypertrophic pyloric muscle

olive shaped mass in RUQ

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23
Q

presentation of intussusception

A

child unwell
red current jelly stools
palpable sausage mass
vomit and colicky abdo pain

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24
Q

management of intussesception

A

air enema retraction

surgical: laparoscopic surgery

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25
Q

presentation of severe dehydration in babys

A

drowsy
absent urine output
weak pulse
increase capillary refill

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26
Q

management of neonatal sepsis

A

IV benzyl-penicillin + gentamicin

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27
Q

prolonged jaundice + pale/chalky stools and dark urine

A

biliary atresia

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28
Q

Ptosis + dilated pupil

A

third nerve palsy

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29
Q

definitive management in acute closed angle glaucoma

A

Laser peripheral iridotomy

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30
Q

causative organism of epididymo-orchitis in individuals with a low STI risk

A

E.coli

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31
Q

treatment of thyroid storm

A

admission for monitoring
May need supportive care with fluid resuscitation, anti-arrhythmic medication and beta-blockers
Antithyroid drugs- Carbimazole (methimazole) or propylthiouracil

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32
Q

treatment of choice in replaspsed graves

A

radio-iodine

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33
Q

dexamethasone effect in thyroid

A

blocks the conversion of T4 to T3

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34
Q

presentation of myxoedema coma

A 
confusion and hypothermia
bradycardia
heart block, T wave inversion
type 2 resp failure
adrenal failure in some
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35
Q

Papillary thyroid cancer

A

mostly female
good prognosis
most common
lymph node metastases

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36
Q

follicular carcinoma thyroid

A

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

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37
Q

management of follicular carcinoma

A

If minimally invasive- usually treated by a thyroid lobectomy, if significant vascular invasion consider a total thyroidectomy

38
Q

medullary thyroid cancer

A

Cancer of parafollicular (C) cells
secrete calcitonin
part of MEN-2
Both lymphatic and haematogenous metastasis

39
Q

Anaplastic thyroid cancer

A

Not responsive to treatment- best treatment is resection

Local invasion is a common feature

40
Q

management of ramsay hunt syndrome

A

aciclovir and prednisolone

41
Q

initial management of rheumatoid arthritis

A

start a DMARD- usually methotrexate
also can start steroid or NSAID for symptom relief
if doesnt respond to DMARD- biologic- TNF alpha drugs

42
Q

associated conditions with ank spondylitis

A

anterior uveitis, aortitis, pulmonary fibrosis and amyloidosis

43
Q

xray of ank spondylitis

A

sclerosis and fusion of the sacroiliac joints

bony spurs from the vertebral bodies > syndesmophytes (producing a “bamboo spine”)

44
Q

imaging investigations for ank spondlylitis

A

MRI can detect earlier signs

xray

45
Q

Treatment for ank spondylitis

A

physiotherapy
exercise
NSAIDs
anti-TNF inhibitors for more aggressive disease

46
Q

management of reactive arthritis

A

1st- NSAIDs
2nd- steroid (injections)
3rd- DMARD

47
Q

antibodies in dermatomyositis

A

ANA,
Anti-Jo-1,
myositis specific antibodies

48
Q

If scaphoid fracture suspected but xray is negative

A

Splint and xray in 2 weeks

49
Q

impetigo management

A

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).

50
Q

shingles management

A

Aciclovir
analgesia
maybe oral steroid but not sure

51
Q

conditions associated with vitiligo

A 
type 1 diabetes mellitus
Addison's disease
autoimmune thyroid disorders
pernicious anaemia
alopecia areata
52
Q

Flat-topped, shiny and firm to touch plaques and papules

A

lichen planus

53
Q

management of lichen planus

A

Emollients
Topical steroid cream (potent)
Oral Prednisolone

54
Q

Patellar tendonitis management

A

rest and physio

55
Q

presentation of patellar tendonitis

A

More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
sore on palpation

56
Q

Osteochondritis dissecans

A

Pain after exercise

Intermittent swelling and locking

57
Q

Chondromalacia patellae

A

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

58
Q

Causes of hypertrichosis

A

drugs: minoxidil, ciclosporin, diazoxide
congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis

main:
porphyria cutanea tarda
anorexia nervosa

59
Q

timing difference between HHS and DKA

A

DKA- comes on in hours

HHS- comes on in days

60
Q

presentation of renal artery stenosis

A 
hypertension
AKI 
flash pulmonary oedema 
CKD
renal bruit
61
Q

renal artery stenosis management

A

statin
ACEi- not in bilateral disease
anti-platelet
surgical angioplasty

62
Q

nephrotic syndrome general management

A 
fluid/salt restriction 
diuretics (IV furosemide)
ACEi/ARB
IV albumin 
anti-coagulation
63
Q

cause of nephrotic syndrome

A

non-proliferative process affecting podocytes

64
Q

nephritic syndrome is indicative of

A

proliferative process affecting endothelial cells/mesangial cells

65
Q

symptoms that point to nephritic syndrome

A

oliguria
haematuria (red cell clasts)
hypertension
some proteinuria

66
Q

classic presentation of IgA nephropathy

A

recurrent macroscopic haematuria in young males following recent URTI

67
Q

IgA nephropathy is associated with

A

HSP- IgA mediated vasculitis

coeliac disease

68
Q

biopsy findings for IgA nephropathy

A 
light microscopy (mesangial cell proliferation?) 
immunofluorescence- IgA and C3 deposits
69
Q

management of IgA nephropathy

A

BP control- ACEi and ARB

70
Q

minimal change disease typical presentation

A

children with nephrotic syndrome

71
Q

what causes minimal change disease

A

T-cell mediated damage of basement membrane + podocytes

72
Q

biopsy result in minimal change

A

normal light microscopy but electron microscopu (podocyte fusion and foot-process effacement)

73
Q

management of minimal change

A

Fluid restriction and reduced salt
prednisolone
Human albumin and furosemide

74
Q

typical presentation of focal segmental glomerulosclerosis

A

young adults with nephrotic syndrome and CKD

75
Q

biopsy of focal segmental glomerulosclerosis

A

light microscopy- focal/segmental sclerosis + hyalinosis
electron microscopy- effacement of foot processes
immunofluorescence- minimal Ig/complement deposition

76
Q

management of focal segmental glomerulosclerosis

A

steroids
+/- immunosuppression
+/- ACEi

77
Q

typical presentation of membranous nephropathy

A

adults with proteinuria and nephrotic syndrome

78
Q

biopsy for membranous nephropathy

A

electron microscopy- thick BM with sub-epithelial electron complex deposits- spike dome appearance

79
Q

management of membranous nephropathy

A

ACEi/ARB- 1st line

immunosuppression (steroids + cyclophosphamide +/- B cell monoclonal antibodies)

80
Q

rapidly progressive glomerulonephritis

A

rapid decline in renal function + glomerular epithelial crescent formation on biopsy

81
Q

management of rapidly progressive glomerulonephritis

A

immunosuppression- steroids + cyclophosphamide + Azathioprine

82
Q

typical presentation of post-streptococcus glomerulonephritis

A

young children/teenagers 7-14 days post strep infection

83
Q

immune complex deposition in post-strep glomerulonephritis

A

IgG, IgM, C3

84
Q

management for renal SLE involvement

A

hydroxychloroquine +/- azathioprine

IV steroids and cyclophosphamide for severe organ involvement

85
Q

investigation for polycystic kidney disease

A

renal US

86
Q

management of polycystic kidney disease

A

tolvaptan

hydration and hypertension management

87
Q

alports syndrome inheritance

A

X-linked dominant

88
Q

presentation of alports syndrome

A

microscopic haematuria
progressive renal failure, proteinuria
ocular manifestations
bilateral sensironeural deafness

89
Q

bunch of grapes appearance/ bouquet of flowers appearance

A

medullary sponge kidney

90
Q

investigation for cholesteatoma

A

CT

MRI

91
Q

Eustachian tube dysfunction may present with:

A 
Reduced or altered hearing
Popping noises or sensations in the ear
A fullness sensation in the ear
Pain or discomfort
Tinnitus

second year!! (7 decks)

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