Investigations Flashcards by Jack Griffiths

BPH/prostatic carcinoma

PSA

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SLE

anti-dsDNA antibody

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Goodpasture’s syndrome

anti-GBM antibody

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APCKD

USS renal tract

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Multiple myeloma

Plasma electrophoresis (monoclonal gammopathy)

Urine analysis (Bence-Jones protein)

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Motor Neuron Disease

EMG = single best

MRI = exclude cord compression + visualise bulbar palsy

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Horner’s syndrome

Apraclonidine hydrochloride

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Huntington’s disease

Genetic analysis (>39 CAG repeats)

CT/MRI –> symmetrical atrophy of stratum + butterfly dilation of lateral ventricles

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Idiopathic pulmonary fibrosis

High resolution CT

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Cystic fibrosis

Sweat test (80-125mmol/L)

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COPD

Lung function test

FEV1/FVC <70%

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Sputum culture

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Lung cancer

Bronchoscpoy + biopsy

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Blood in pleural aspirate

Pleural biopsy

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What test is used to diagnose a SYMPTOMATIC suspected diabetic patient?

Fasting venous blood glucose >7.0mmol/L

Random blood glucose >11.0mmol/L

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What test is used to diagnose an ASYMPTOMATIC suspected diabetic patient?

The same as with symptomatic patients but on TWO occasions

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What result from an oral glucose tolerance test confirms diabetes?

Venous BG > 11.1mmol/L 2 houts after a 75g glucose bolus

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What result from an OGTT diagnoses impaired glucose tolerance?

Venous BG between 7.8 and 11.1 mmol/L

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What investigation would you do with a patient with suspected WILSON’S DISEASE?

Ceruloplasmin level +++

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What investigation would you do with a patient with suspected HAEMOCHROMATOSIS?

Total iron-binding capacity —

i.e. HAEMATINICS

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What is the earliest serological marker of acute HepA infection?

Hepatitis A IgM

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What serological marker can confirm CHRONIC (>3months) HepC infection?

Hepatitis C Ab

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What test for phaeochromocytoma?

24 hour urinary catecholamines

VANILLYLMANDELIC ACID

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What test for Addison’s?

Short SynActhen

FAILURE for cortisol to rise

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What test for Cushing's?

FIRST!!! = Free urinary cortisol +++++ Dexamethasone suppression test

What test for congenital adrenal hyperplasia?

17-hydroxyprogesterone There is an AD deficieny of 21-hydroxylase

What test for carcinoid tumour?

24 hour urinary 5-hydroxyindole acetic acid | breakdown product of 5-HT

Cystitis

MSU for MC&S

Renal colic (calculi)

xray KUB

Kidney transplant problems

Renal biopsy

Renal TB

Three early morning MSU for MC&S + Z-N stain

Pulmonary embolism - initial investigation

CXR

Pulmonary embolism - clear on CXR - next appropriate step?

V/Q perfusion scan

Pulmonary embolism - patchy shadowing on CXR - next appropriate step?

CTPA

Pneumonia shown on CXR

Sputum culture

Tension PTX

No investigations --> cannula into 2nd ICS at MCL

Dermatomyositis / polymyositis

Muscle biopsy

Sjogrens syndrome

Schirmer's test

Takayasu's arteritis

Angiography

Gout

Joint aspiration + microscopy Negatively birefringent, needle-shaped crystals

Giant cell arteritis (+/- polymyalgia rheumatica)

Temporal artery biopsy

Suspected gastric cancer

URGENT endoscopy

Dyspepsia without red flag symptoms persisting despite lifestyle changes

H pylori stool antigen test

Crohn's disease

Barium swallow and follow through

Oesophageal rupture

Gastrografin

Coeliac

Anti-endomyseal antibodies

Renal failure - initial best investigation?

Serum U+Es and creatinine | determine current level of renal function

Abdominal bruits / renovascular disease

Renal arteriography

Hydronephrosis

Abdominal USS

Renal cyst

Abdominal USS

Renal cell carcinoma

CT with biopsy Renal USS

Amyloidosis (renal involvement)

Biopsy of rectal mucosa --> stain with Congo Red

Polycystic kidney disease

USS kidneys CT KUB

Renal stones

CT KUB

High blood pressure

24hour ambulatory BP to eliminate essential hypertension

Hypothyroidism

TFTs BEST out of these is the TSH

Rheumatoid arthritis

RHEUMATOID FACTOR Antibody = anti-CCP

Thalassaemia

Hb electrophoresis

Pericarditis

ECG! (not ECHO)

Acute cord compression

MRI spine

PCOS

USS pelvis

MEN syndromes

CT / MRI

Diabetes insipidus

Water deprivation +/- desmopressin

Colon cancer

Colonoscopy Screen at 50yo (40yo if +ve FHx)

Aortic dissection

******BEST = CT scan

Nephrotic syndrome (diabetic)

24 hour urine protein

Pericarditis

******FIRST = ECG ***next = ECHO

Variant angina

Coronary angiography

Pharyngeal pouch / Zenker's diverticulum

Barium swallow

Oesophageal stricture (absolutely no suggestion of malignancy)

Barium swallow

Oesophageal cancer

OGD + biopsy

Achalasia

******BEST = oesophageal manometry ***FIRST = Barium swallow - 'bird's beak'

Diffuse oesophageal spasm

******BEST = oesophageal manometry ***Barium swallow --> "corkscrew" appearance

Suspected hypercalcaemia

******PTH and serum calcium Bone imaging (xray)