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RESP > Investigations 2 > Flashcards

Investigations 2 Flashcards

1
Q

First line & diagnosis of COPD is done by ?

A

Spirometry

Post bronchodilator spirometry. This should be carried out 15-20 mins after the person has had a SABA.

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2
Q

What values would indicate airflow obstruction?

A

A FEV1/FVC of <0.7

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3
Q

Go over the grading of airflow obstruction

A

Stage 1: Mild
FEV1 80% of predicted value

Stage 2: Moderate
FEV1 50-79% predicted value

Stage 3:Severe
FEV1 30-49% predicted value

Stage 4:Very severe
FEV1 <30% of predicted value
or
FEV1 <50% of predicted value with respiratory failure

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4
Q

When reading an ABG, how do you know if there is respiratory failure ? Talk through the steps

A
  1. First check pH. If its low= acidosis and if high = alkalosis
  2. Then find out if its respiratory or metabolic.
    - if respiratory the pH and co2 will be opposite e.g one low and the other high
  • if its metabolic the pH and o2 will be the same e.g both high
  1. Is it compensated?
    - If Bicarb or BE is out of range Bicarb:<22 or >26// BE: -2 or +2 then its UNcompensated
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5
Q

What is Apical shadowing on CXR? (7 things)

A

An observation on a CXR that can be considered an abnormal finding. It has many possible causes such as:

  • Hiatial hernia
  • Pneumonia
  • Pleural effusion
  • Pulmonary oedema
  • Malignancy
  • Sarcoidosis
  • Pneumothorax
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6
Q

What would you find on a Macroscopic examination of the lungs in patients with asthma? (3 things)

A
  1. Overdistended lungs
  2. Small areas of atelectasis
    (a collapse of one or more areas in the lung)
  3. Thick mucus plugs in proximal bronchi containing whorls of shed epithelium
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7
Q

What microscopic finding may you see in the sputum of an asthmatic patient ?

A

Curschmann spirals

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8
Q

What is a common side effect of TB drugs ?

A

Peripheral neuropathy

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9
Q

What are some causes of acute bilateral alveolar opacities on a CXR? (5 things)

A
  • Infection
  • Fluid
  • Blood
  • ARDS
  • Embolism
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10
Q

What causes hyaline membrane formation’ in the lungs?

A

The accumulation of dead cells/ proteins

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11
Q

What would decrease the risk of a overdistension of the lungs in a patient with ARDS that is on mechanical ventilation?

A

A low tidal volume

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12
Q

What is Lofgren’s syndrome ? What are the main symtpoms?

A

An acute subset of sarcoidosis in Scandinavian patients.

Characterised by:

  • Erythema nordosum
  • Bilateral hilar lymphadenopathy
  • Polyarthralgia (pain in several joints)
  • or Polyarthritis (any type of arthritis that affects >5 joints)
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13
Q

What condition causes muddy brown casts on urinalysis? and what causes this condition?

A

Acute tubular necrosis (ATN)
- This is where the kidney’s tubules become damaged which can lead to an AKI.

Causes of ATN include:

  • Nephrotoxic drugs
  • Renal ischaemia
  • Sepsis
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14
Q

What is the triad of symptoms you would expect to see in nephrotic syndrome ? What would you expect to see on the pathology report of the kidney biopsy?

A

Triad:

  1. Oedema
  2. Proteinuria
  3. Hypoalbuminaemia

Biopsy:

  1. Sclerosis in some glomeruli
    - This is scarring or hardening of the glomeruli = the glomeruli cannot function adequately.
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15
Q

What is the triad of symptoms you would expect to see in nephrotic syndrome ? What would you expect to see on the pathology report of the kidney biopsy?

A

Triad:

  1. Oedema
  2. Proteinuria
  3. Hypoalbuminaemia

Biopsy:

  1. Sclerosis in some glomeruli
    - This is scarring or hardening of the glomeruli = the glomeruli cannot function adequately.
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16
Q

What finding on abdominal CT would you find in turners syndrome?

A

Horse shoe kidney (they are connected like a horse shoe)

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17
Q

What condition are kimmelstiel-wilson nodules the the pathognomonic finding for?

A

Diabetic nephropathy

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18
Q

What is the first treatment for diabetic nephropathy ?

A

ACEi

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19
Q

How do you know if there is a complete or partial compensation ?

A

Complete compensation:

Partial compensation:

Uncompensated:

20
Q

How do you know if a patient is a chronic retainer?

A

They will have a raised Bicarbonate level

21
Q

Patients with respiratory alkalosis will have a high pH and low PaCO2 level. What conditions may you see this in? (2 things)

A
  • PE

- Hypoventilation

22
Q

How do you work out ABG’s?

A
  • using tic tac toe method
  • Acid. Normal Base
  • Anything less than normal value is a acid and anything greater is a base.

NOTE:
base = metabolic
acid = resp

to find out if its compensated- look at the pH. if its outside range =

2 things under basic = compensated

nothing under basic = not compensating

1 thing under basic that is out of range = partially compensating

1 thing under basic but in range = uncompensated

23
Q

What is the first thing you would do when investigating TB?

A

CXR

24
Q

How would you know if TB treatment is working? What would you look at on culture?

A

The time it takes for the TB bacterium to show on culture

25
Q

How do you make an initial diagnosis of TB?

A

Sputum smear

26
Q

How would you pick up TB in someone who is immunocompromised?

A

Urinary LAM (Lipoarabinomannan)

27
Q

When investigating malaria. What film allows the microscopist to speciate the malaria?

A

A thin film

28
Q

What is the purpose of a thick film when investigating malaria?

A

To identify how many red cells are affected in the disease

29
Q

What is the name of the blood film stain done to investigate malaria?

A

Giemsa stain

30
Q

What is Amoebiasis and how is this investigated?

A

A Protozoa. Infection occurs through WATER

Ix:
1. Fresh stool sample
characteristic feature: Erythrophagocytic trophozoites

31
Q

What is Cryptococcus and what tests would you do for it?

A
  • Fungus found in soil that affected with pigeon droppings.
  • Major cause for mortality in HIV patients (common cause of HIV related meningitis)

Ix:

  1. CSF microscopy
  2. Blood cultures (serum cryptococcal Ag lateral flow test.)
  3. Urine cultures
32
Q

What tests would you do for histoplasmosis?

A

A Fungal infection. commonly lives in soil that contains bird/bat droppings
- Occurs 3-17 days after they breathe in the fungal spores

Ix:

  1. Sputum culture
  2. Blood test (HG 3 organism)
  3. Urine test
33
Q

What tests would you do for toxoplasmosis?

A

Infection caused by a parasite toxoplasma.
- Caught from the stool of cats or infected meat

Sx:

  • sore throat
  • Swollen glands
  • Fever

Usually goes in 6/52 but if pregnant or immunocompromised can cause serious disease.

Ix:
Serology IgG + IgM

34
Q

What tests would you do for pneumocystis?

A
35
Q

How would you investigate listeria? What are the signs and symptoms?

A

Type of gastroenteritis

but this infection is dangerous because it can spread to your CSF

Sx:

  • Darrhoea
  • muscle aches

If spreads:

  • Stiff neck
  • HA
  • Change in mental state
  • Convulsions

Ix:

  1. CSF
  2. Blood
  3. MRI to rule out brainstem involvement
36
Q

What is Cytomegalovirus? How would you investigate this?

A
37
Q

What is erythema infectiosum? How would you diagnose this?

A
38
Q

How would you investigate Measles? also what are the symptoms

A

Highly contagious infection caused by Morbillivirus

Sx:
Prodromal phase: (lasts 2-4 days)
-Fever
-cough 
- Rhinorrhoea 
- conjunctivitis

THEN:
- Rash around 4 days

Ix:
- confirm through lab investigations
Oral fluids for IgM,IgG and viral RNA testing

39
Q

How would you investigate Mumps ?

A
  • Aerosol infection, spread via saliva secretions
  • Infectious 1 week before &after appearance of parotitis (Swelling of the gland in the neck)

Ix:
- Lab analysis of saliva (to detect IgM)

40
Q

How would you investigate Rubella? & symptoms

A

S:

  • Rash
  • Lymphadenopathy (suboccipital, post-auricular and cervical)
  • Arthritis and arthralgia

Ix:
- Need to contact the health protection team who will advise on investigations.

  • Parvovirus and B19+ measles may be tested
41
Q

How would you investigate EBV?

A
  1. Monospot test

2. FBC

42
Q

How would you investigate Varicella zoster virus?

A

Mainly a clinical diagnosis

  • Swab sample (unroof the chicken pox and take the fluid sample)

On exam look for:

  • Rash
  • Vesicles (appear in crops) can occur on palms and soles
  • Small erythematous macule on scalp, face, trunk and proximal limbs PROGRESS OVER 12-14HOURS
  • Itchy pustules NOT PAINFUL. –> THIS IS SHINGLES
  • Crusting occurs after 5 days and fall off in 1-2 weeks
43
Q

What are the symptoms of HSV? and how would you investigate infection of the genitals?

A

S:

  • Discharge
  • Tingling/ neuropathic pain of bottom
  • Blistering lesions
  • Inguinal lymphadenopathy
  • Malaise

Ix:

  1. Examine
  2. Take a swab (for PCR testing)
  3. Consider STI screening (Gum clinic)
44
Q

When would acyclovir be given to a pregnant woman?

A
  • In the 3rd trimester until birth.
45
Q

What is the screening AND diagnostic test for Lyme disease?

A 
Screening:
PCR TEST (immunoblot test)

Diagnostic:
ELIZA

Summary:

  1. if rash then ELISA test
    - if that’s positive then immunoblot test
46
Q

What test confirms a diagnosis of TB?

A

3 Deep early morning sputum samples for microscopy for acid fast bacilli

47
Q

What tests would you do when testing for latent TB ? (either one of 2 things)

  • What would you do if the test is positive ?
A
  1. Mantoux test
  2. Interferon gamma release assay (IGRA) Test

If any of these tests are positive they should be assessed for active TB

RESP (5 decks)

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