Investigations Flashcards
Dizziness/Vertigo Inv
1.FBC (Haemoglobin)
2.Blood glucose
3.ECG
4.Holter monitor
5.Chest x-ray (?bronchial CA)
6.CT or MRI
7.Audiometry
8.Caloric test
9.Electrocochleography
10.Electroculography and Rotational test
11.Brain evoked potentials
Subfertility Inv
1.FBC, UEC, LFT
2.Urine MCS
3.TFT
4.Serum Prolactin
5.FSH, LH
6.Estrogen, Progesterone
7.Mid- luteal hormone assessment
(21st day serum progesterone)
8.Transvaginal USS
IF all normal:
9.HSG (Hysterosalpingogram): an X-ray procedure that shows patency or blockage of fallopian tubes and the size and shape of uterus.
10.Sperm analysis
12.UPT
13.Other antenatal tests
Amenorrhea Ix: 6 categories
UPT
FBE, UEC
BSL, TFT
Serum Prolactin
FSH, LH, E, P
Pelvic USS
Pheochromocytoma
Dx, Mx
1.24 hr urine collection for CREATININE
2.Total catecholamines (NE, Adrenaline)
3.VanillylMandelic acid (VMA)
4.Metanephrines
Blood test:-
1.FBC
2.BSL
3.Serum Cortisol
4.Plasma aldosterone
5.Renin activity
6.Aldosterone/renin ratio
1.GENETIC testing [MEN syn: or history of MEN 2 (pheochromocytoma, Medullary thyroid CA, parathyroid Adenoma)]
Imaging:-
1.US/CT/ MRI
2.MIBG (iodine-123 meta-iodobenzylguanidine):
-{Nuclear medicine scanning for detection of extra Adrenal tumors & Metastatic deposits.: specific and sensitive}
CAUSE:
-benign tumour of the chromaffin cells of the Adrenal Medulla which secrete catecholamines (adrenaline,
noradrenaline and dopamine).
-The average size is about 5-6 cm in
diameter when detected.
-It may arise sporadically
or less commonly it may be a part of syndromes such as multiple endocrine neoplasia (MEN)
syndrome.
-They can be inherited (10%).
Approximately 10% of tumours
are malignant which metastasise into:
lymphatic tissues,
lung,
liver,
bones
brain
The clinical presentation depends on:
- the activity of the tumour
-relative amounts of adrenaline with alpha and beta effects
-noradrenaline with alpha effects.
Often the tumours secrete only intermittently or are only discovered as an incidental finding investigating other conditions.
Mx:-
1-2 weeks BEFORE Surgery:
1.Alpha and Beta receptor blockade
(Done to prevent Operative Adrenal Crisis due to Catecholamine surge with life threatening HTN.)
DURING Surgery:
1.Nitroprusside and Phentolamine: To control BP surge.
Discharge after 2-3 days (if no complications).
PRE-OPERATIVE COMPLICATIONS:(7)
1.Depletion of intravascular volume (Alpha effect: constriction of vessels)
2.HTN
3.Stroke
4.Renal failure
5.AMI
6.CHF
7.Arrhythmias
Most severe Complications: -
PHAECHROMOCYTOMA CRISIS (6)
1.Obtundation (reduced consciousness)
2.Shock
3.DIC
4.Seizures
5.Rhabdomyolysis (: also in overdose MDMA, opiods)
6.Acute Renal failure
Hyperthyroidism:- Inv
Hashimoto’s
Grave’s
Thyroid cancer
Multi nodular goitre
1.TSH
2.Thyroid USS
3.Radioiodine uptake scan
(Cancer- cold nodule
Hyper functioning Adenoma- hot nodule)
Hashimoto’s thyroiditis:-
4.TPOAb:(Thyroid Per-oxidase antibody)
Grave’s:-
5.Anti- TSH receptor antibody
Thyroid cancer:- (produces hypothyroid symptoms)
6.Throglobulin
(Thyroglobulin is a protein made by the follicular cells of the thyroid gland. It is used by the thyroid gland to produce T3 and T4)
Anti- TSH receptor antibody (Thyroid Stimulating Hormone Receptor:(TSHR) antibody ie. TRAb)
Haemolytic Uraemic Syndrome Inv
1.FBC, ESR/CRP
2.UEC, LFT
3.Stool MCS (Shiga toxin)
4.Serum LDH (an enzyme released from damaged cells, therefore a marker of cellular damage)
5.Reticulocyte count
6.Blood smear (Shistocytes, altho non-specific)
7.Serum haptoglobin (: a protein made by liver. Decreased Haptoglobin: indicative of RBC breakdown)
8.Coagulation profile
9.Total , conj. and unconj. Bilirubin
Diabetes (DKA) Inv
1.FBC, UCE (Mg, K, Na, Ca,PO4), LFT
2.Random blood sugar (serum glucose)
3.ABG/VBG
4.Blood ketones
5.Septic workup
6.Urine dipstick (ketones) + MCS
7.ECG (HyperK changes)
First presentation:-
1.Insulin antibody
2.anti-GAD (glutamic acid decarboxylase) antibody
Ddx causes:
3.Celiac screen
4.TFT
Confirmed:-
1. Hourly BGL, bedside ketone testing
2. 2hr then 2-4 hr - VBG, UEC, Ca, Mg, PO4
Hypercalcemia Inv
1.FBC
2.UEC +eGFR
3.LFT+ ALP
4.Albumin
5.Phosphate
6.24 hr urinary calcium
7.Calcium
8.Corrected calcium
9.Vit D
10.Parathyroid level
11.TSH- free T4
12. (?ECG: complication)
Global development delay Inv
1.Full developmental assessment (with pediatrician)
2.Psychological assessment
3.Hearing and vision
4.Metabolic disease screening
5.Lead screening
6.Genetic testing
7.Endocrine studies
8.Neuroimaging
9.EEG
10.CT scan
Leukaemia Inv & Mx
1.FBC
2.Blood smear
3.Serum folate and B12 (to rule out anemia cause
4.Blood culture
5.Chest X-ray (enlarged Thymus/ possible mediastinal mass)
6.USG of abdomen (Splenomegaly)
7.LP
8.Bone marrow aspiration
Mx(6)
1.Chemo,
2.Radiotherapy
3.Antibiotics for infection
4.Blood Transfusion
5.Platelets (for bleeding)
6.Bone marrow Transplant
(C&c celiac : vit b9 and 12 too)
Recurrent miscarriage Inv
Basic + Causes of recurrent miscarriage + pre-natal testing:
1.FBC, UEC, LFT, ESR/CRP
2.Blood group and Rh
3.TFT
4.BSL
5.UPT (r/o pregnancy)
6.Pelvic USG
7.Karyotyping (chromosomal abnormalities)- her and her partner
8.SLE antibodies
9.Thrombophilia screen for clotting problem
10. Anti-phospholipid antibody
Ante-natal Ix:
11.Chicken pox and Rubella (german measles) antibodies
12.Hepatitis serology
13.STI screen with consent
Vit B12 deficiency Inv
1.Hematological-(Mean corpuscular volume): MCV>100fL
2.Serum B12 levels
3.Storage levels
4.IFA: Intrinsic factor antibodies
5.MMA: Methyl Malonic Acid
6. HomoCysteine - more for Folate
Antibiotic induced diarrhea Ix
1.FBC
2.UEC
3.ESR/CRP
4.Iron studies
5.TFT
6.Stool test for MCS/OCP (Ova, Cyst, Parasite)
7.Toxin serology for C. Difficile / tissue culture assay or PCR)
8.Sigmoidoscopy can show the characteristic pseudomembrane plaque appearance in about half of affected patients. It is usually performed if rapid diagnosis is needed or in a patient who has ileus. (disruption of paristalsis)
Leg Dermatomes: Power, Reflex
Hip:
Flexion (L1,L2)
Extension (L5,S1)
Adduction (L2,L3)
Abduction (L4,L5)
Knee:
Flexion (S1) (same as plantar reflex)
Extension (L3, L4) (same as knee reflex)
Ankle:
Dorsiflexion (L4, L5)
Plantar flexion (S1, S2)
Inversion (L4)
Eversion (L5, S1) (same as ankle reflex)
Reflexes:
Knee (L3, L4) (same as knee extension)
Ankle (L5, S1) (same as ankle eversion)
Plantar (S1) (same as knee flexion)
Spirometry result
1.FEV1/FVC -:
N or Incr- Normal or Restrictive,
< 80%- Obstructive
2.FVC- :
N-Pure Obstructive,
Decreased- Mixed obstructive-restrictive
3.FEV1-
difference in post and pre-Bronchodilator
<12% then irreversible :COPD,
>12% reversible: Asthma
Osteopenia Ix
1.FBE
2.UEC
3.LFT
4.KFT
5.TFT
6.serum PTH
7.Vit D
8.Ca level
9.urinary Bence-Jones protein
10.X-ray of bone and chest
11.bone scan/DEXA
