Ix + Tx Flashcards
Cushing’s syndrome/disease: 1st-line Ix?
raised plasma/urine cortisol
overnight dexamethasone suppression test
Cushing’s syndrome: 1st-line Tx?
Metyrapone/Fluconazole (inhibit cortisol synthesis)
Cushing’s disease: Gold Ix?
CRH test (cortisol increases)
Cushing’s disease: 1st-line Tx?
trans-sphenoidal surgery
Metyrapone/Fluconazole (inhibit cortisol synthesis)
Acromegaly: Gold Ix?
OGTT (no suppression)
raised IGF-1
Acromegaly: 1st-line Tx?
transsphenoidal surgery
octreotide (SST analogue)
Prolactinoma: 1st-line Tx?
cabergoline (dopamine agonist)
NFPA: 1st-line Tx?
cabergoline (dopamine agonist)
Carcinoid tumour: Gold Ix?
raised 24hr urinary 5-HIAA (serotonin metabolite)
Carcinoid tumour: 1st-line Tx?
surgical resection
Carcinoid crisis: 1st-line Tx?
octreotide (somatostatin analogue)
Conn’s syndrome: 1st-line Ix?
aldosterone:renin ratio (raised aldosterone)
K+ in Conn’s syndrome?
low
Conn’s syndrome: Gold Ix?
raised aldosterone, which is not suppressed with 0.9% saline or fludrocortisone)
Conn’s syndrome: 1st-line Tx?
laparoscopic adrenalectomy
(spironolactone 4 weeks pre-op)
K+ in Addison’s?
high
(sodium + cortisol are both low)
Addison’s: 1st-line Ix?
morning serum cortisol
Addison’s: Gold Ix?
synacthen test
(cortisol 30 mins after IM tetracosactide <550 nmol/L)
Addison’s: 1st-line Tx?
hydrocortisone + fludrocortisone
Secondary adrenal insufficiency: 1st-line Ix?
low ACTH
Secondary adrenal insufficiency: 1st-line Tx?
hydrocortisone
SIADH: 1st-line Ix?
low serum Na, high urine Na
SIADH: Gold Ix?
no response to 1-2L 0.9% saline
SIADH: 1st-line Tx?
restrict fluid
acute: IV hypertonic saline + furosemide
long-term: tolvaptan/demeclocycline
Hyperparathyroidism: 1st-line Ix?
24hr urine (high Ca), MRI
Primary hyperparathyroidism: 1st-line Tx?
resection
Secondary hyperparathyroidism: 1st-line Tx?
vit D, cinacalcet (calcimimetic)
Hypoparathyroidism: 1st-line Tx?
calcium, calcitriol (active vit D)
Pheochromocytoma: 1st-line Ix?
raised plasma metanephrines
Pheochromocytoma: Gold Ix?
MIBG scan
Pheochromocytoma: 1st-line Tx?
phenoxybenzamine then resection
Hypercalcemia: 1st-line Tx?
IV fluids, bisphosphonate, calcitonin
Hypocalcemia: 1st-line Tx?
Acute: IV calcium gluconate
Chronic: colecalciferol, adcal
Hyperkalemia: 1st-line Tx?
Mild: polysytrene sulfonate resin
Severe: IV calcium gluconate + insulin + glucose
Hypokalemia: 1st-line Tx?
Mild: SANDO-K
Severe: IV K
Cellulitis: 1st-line Ix?
serology (e.g. Strep pyogenes)
Cellulitis: 1st-line Tx?
penicillin, flucloxacillin
Necrotising fasciitis: 1st-line Tx?
debridement, IV benzylpenicllin + clindamycin
HF: Gold Ix?
echo
AAA + TAA: Gold Ix?
CTA
Aortic dissection: Gold Ix?
CTA
ACS: Gold Ix?
coronary angiography (/catheterisation), SPECT
AF: 1st-line Tx?
CCB, beta-blocker, anticoagulant (if 2+ CHA2DS2 VASC)
AFL: 1st-line Tx?
anticoagulant (e.g. dalteparin) then DC cardioversion
Unstable AVRT/AVNRT: 1st-line Tx?
DC cardioversion
Stable AVRT/AVNRT: 1st-line Tx?
IV adenosine
Long QT: 1st-line Tx?
IV isoprenaline
VF: Acute Tx?
DC cardioversion
VF: Long-term Tx?
ICD
Complete heart block: 1st-line Tx?
IV atropine, pacemaker
AVRT/AVNRT: Gold Tx?
catheter ablation
Sympomatic BBB: 1st-line Tx?
beta-blocker
PVD: 1st-line Ix?
ankle-brachial pressure index, doppler USS
PVD: Gold Ix?
CTA
PVD: 1st-line Tx?
clopidogrel (P2Y12i)
Pericarditis: 1st-line Tx?
NSAID for 2 wks, colchicine for 2 wks
Pericardial effusion: 1st-line Tx?
pericardiocentesis
IE: Tx if NOT staph?
benzylpenicillin, gentamicin
IE: Tx if S.aureus?
flucloxacillin
IE: Tx if MRSA?
vancomycin
ANY valve pathology: Gold Ix?
TOE
(EXCEPT pulmonary stenosis = TTE)
Mitral stenosis: Gold Tx?
percutaneous mitral balloon valvotomy
Cardiomyopathy: Gold Ix?
echo
Rheumatic fever: 1st-line Tx?
benzylpenicllin, analgesia, diazepam (for chorea)
TGA: 1st-line Tx?
atrial switch operation
PDA: 1st-line Tx?
closed surgically, indomethacin (prostaglandin inhibitor)
Spondyloarthropathy: 1st-line Tx?
DMARD (e.g. methotrexate)
Volvulus: 1st-line Tx?
Ladd’s procedure, GI decompression (with NG tube)
Thalassaemia: 1st-line Tx?
blood transfusions every 2-4 wks
Sideroblastic anaemia: Gold Ix?
bone marrow smear (ring sideroblasts with Perl’s stain)
Sideroblastic anaemia: 1st-line Tx?
pyridoxine
Sickle cell: Gold Ix?
Hb electrophoresis (80-95% HbS + absent HbA)
Sickle cell: Acute Tx?
IV fluids, analgesia, O2
Sickle cell: Preventative Tx?
hydroxycarbamide
Hereditary spherocytosis: Gold Ix?
EMA binding test (low fluorescent intensity)
Hereditary spherocytosis: 1st-line Tx?
folic acid
G6PD deficiency: Gold Ix?
G6PD enzyme assay
Complicated malaria: 1st-line Tx?
IV artesunate
Uncomplicated malaria: 1st-line Tx?
riamet/quinine
Autoimmune haemolytic anaemia: Gold Ix?
DAT/Coombs (+ve)
Autoimmune haemolytic anaemia: 1st-line Tx?
corticosteroids
Anaemia of chronic disease: 1st-line Ix?
EPO injections
Aplastic anaemia: Gold Ix?
bone marrow biopsy
Aplastic anaemia: 1st-line Tx?
bone marrow transplant (from HLA identical sibling donor)
OR
immunosuppression with ATG + cyclosporine
B12 deficiency: 1st-line Tx?
IM hydroxycobalamin
CML: 1st-line Tx?
Imatinib (tyrosine kinase inhibitor)
CLL: Gold Ix?
peripheral blood flow cytometry
CLL: 1st-line Tx?
chemo + IV Ig
Hodgkin’s lymphoma: 1st-line Tx?
ABVD
(adriamycin, bleomycin, vinblastine, decarbazine)
Non-Hodgkin’s lymphoma: 1st-line Tx?
R-CHOP
(rituximab, cyclophosphamide, hydroxy-daunorubicin, vincristine/oncovin, prednisolone)
MM: 1st-line Tx?
VAD
(vincristine, adriamycin, dexamethasone)
ITP: 1st-line Tx?
IV Ig, prednisolone
TTP: 1st-line Tx?
plasma exchange (provide ADAMTS-13) with IV methyprednisolone
Heparin induced thrombocytopenia: 1st-line Tx?
stop heparin, lepirudin/danaparoid (thrombin inhibitor)
VWD: Gold Ix?
VWF:RCo assay
Minor bleed in VWD: 1st-line Tx?
desmopressin
Major bleed in VWD: 1st-line Tx?
VWF + factor VIII
Haemophilia: Gold Ix?
factor assay
Minor bleed in haemophilia A: 1st-line Tx?
desmopressin
Major bleed in haemophilia A: 1st-line Tx?
factor VIII
Haemophilia B: 1st-line Tx?
factor IX
DIC: 1st-line Tx?
blood transfusion
Tumour lysis syndrome: 1st-line Tx?
allopurinol or rasburicase
Hyperviscosity syndrome: 1st-line Tx?
plasmapharesis
Crohn’s: Mild/mod Tx?
prednisolone
Crohn’s: Severe Tx?
IV hydrocortisone + metronidazole
Crohn’s: Preventative Tx?
azathioprine
UC: Tx?
5-ASA (e.g. mesalazine)
UC: Preventative Tx?
azathioprine
UC: Preventative Tx?
azathioprine
IBS: 1st-line Tx?
FODMAP diet, mebeverine (antispasmodic)
PUD without H.pylori: 1st-line Tx?
ranitidine (H2 antagonist)
Perianal abscess: Gold Ix?
endoanal USS
Haemorrhoids: 1st-line drug Tx?
docusate (stool softner)
Pseudomembranous colitis: 1st-line Tx?
amoxicillin
Pseudo-obstruction: 1st-line Tx?
IV neostigmine
Achalasia: 1st-line Tx?
Heller’s myotomy, CCB/nitrates
Achalasia: Gold Ix?
manometry
Appendicits: Gold Ix?
CT
Appendicitis: 1st-line Tx?
IV metronidazole then laparoscopic appendectomy
Bowel obstruction: 1st-line Tx?
bowel decompression, fluids, analgesia, antiemetic, Abx
Gastritis: 1st-line Tx?
ranitidine (H2 antagonist), H.pylori eradication (if needed)
H.pylori infection: 1st-line Ix?
serology (IgG)
C-urea breath test
faecal antigen test (uses MAb)
H.pylori: 1st-line Tx?
triple therapy of 2 Abx + 1 PPI for 7-14 days
(e.g. clarithromycin, amoxicillin, omeprazole)
“CAP”
Cocaine overdose: 1st-line Tx?
IV diazepam
Insecticide overdose: Gold Ix?
low RBC acetylcholinesterase activity
Insecticide overdose: 1st-line Tx?
IV atropine every 10 mins
Insecticide overdose: 1st-line Tx?
IV atropine every 10 mins
Hep A: 1st-line Tx?
Sx, vaccinate close contacts
Chronic Hep B: 1st-line Tx?
tenofovir (nucleoside analogue)
Hep B + Hep D: Gold Tx?
SC pegylated IF-alpha 2A
Hep C: 1st-line Tx?
triple therapy with DAA
(NS5Ai - e.g. ledipasvir/ritonavir, NS5Bi - e.g. sofosbuvir/dasabuvir)
Hep C: 1st-line Tx?
vaccinate close contacts
Autoimmune hepatitis: 1st-line Tx?
prednisolone +/- azathioprine
HIV: 1st-line Ix?
sexual Hx, anti-p24
HIV: Gold Ix?
IgG to envelope contents
HIV: 1st-line Tx?
HAART
(2 NRTI + 1 NNRTI
or
2 NRTI + 1 PI)
Amyloidosis: Gold Ix?
biopsy (red-green with congo red)
Lymphoedema: 1st-line Ix?
stemmer’s sign, measure leg size
Lymphoedema: Gold Ix?
lymphoscintigraphy
CO poisoning: Gold Ix?
ABG (>3% in non-smokers + >10% in smokers)
CO poisoning: 1st-line Tx?
100% O2 (until COHb <10%)
Opioid overdose: 1st-line Tx?
IV naloxone (opioid antagonist) every 2 mins
Paracetamol overdose: 1st-line Tx?
IV N-acetylcysteine
Hepatic encephalopathy: Gold Ix?
PHES test
Hepatic encephalopathy: 1st-line Tx?
lactulose (laxative)
Inguinal hernia: 1st-line Tx?
truss
Femoral/umbilical/incisional/epigastric hernia: 1st-line Tx?
hernioplasty
Hiatal hernia: Gold Ix?
barium swallow
Portal HTN: Gold Ix?
HPVG (hepatic portal venous gas) measurement
Gastro-oesophageal varices: 1st-line Tx?
endoscopic banding
Haemochromatosis: 1st-line Tx?
lifelong venesection (3-4x per year)
Wilson’s disease: 1st-line Tx?
penicillamine (chelating agent)
COPD: 1st-line Ix?
spirometry (FEV <80% PV, FEV1/FVC <0.7)
COPD: 1st-line Tx?
SABA + LAMA (e.g. tiotropium bromide)
TB: Gold Ix?
mantoux tuberculin skin test, IGRA (IF-gamma release assays)
Pneumonia: Gold Ix?
CXR (consolidation)
Mild pneumonia: 1st-line Tx?
amoxicillin 5-7 days
Severe pneumonia: 1st-line Tx?
IV co-amoxiclav/clarithromycin 7-10 days
CF: 1st-line Tx?
nebulised dornase alfa (mucolytic)
Pleural effusion: Gold Ix?
thoracentesis
Pleural effusion: 1st-line Tx?
chest drain
Pleural effusion: 1st-line Ix?
CXR (reduced costophrenic angles)
Pneumothorax: 1st-line Ix?
CXR (area of no lung markings)
Pneumothorax: 1st-line Tx?
needle aspiration then chest drain
Empyema: Gold Ix?
thoracocentesis (yellow, turbid, pH <7.2, low glucose)
Empyema: 1st-line Tx?
chest drain
Abx: co-amoxiclav, piperacillin-tazobactam, meropenem
Pulmonary fibrosis: Gold Ix?
HRCT (or lung biopsy)
Pulmonary fibrosis: 1st-line Tx?
pirfenidone (antifibrotic)
Sarcoidosis: 1st-line Ix?
bloods (↑ACE/Ca)
CXR (hilar lymphadenopathy)
Sarcoidosis: Gold Ix?
tissue biopsy (non-caseating granuloma)
Sarcoidosis: 1st-line Tx?
prednisolone
Pulmonary HTN: Gold Ix?
right heart catheterisation (mPAP >25 mmHg)
Pulmonary HTN: 1st-line Tx?
ilorprost (prostanoid)
bosentan (endothelin receptor antagonist)
sildenafil (PDE5i)
SCLC or NSCLC: Gold Ix?
bronchoscopy with EBUS (for histology)
Mesothelioma: Gold Ix?
pleural biopsy
Goodpasture’s: Gold Ix?
kidney biopsy (crescent glomerulus)
Goodpasture’s: 1st-line Tx?
cyclophosphamide, prednisolone
Otitis media: Gold Ix?
otoscope (red + bulging TM)
Sinusitis: 1st-line Tx?
nasal decongestant (e.g. xylometazoline)
co-amoxiclav
Acute epiglottitis: 1st-line Tx?
endotracheal intubation, then IV ceftriaxone
Croup: 1st-line Tx?
steroids (e.g. dexamethasone) with O2
Whooping cough: 1st-line Tx?
clarithromycin
Bronchiolitis: 1st-line Tx?
NG tube/IV fluids, O2
OA: 1st-line Tx?
NSAID
Mild RA: 1st-line Tx?
NSAID + corticosteroids
Severe RA: 1st-line Tx?
methotrexate (DMARD)
Gout: 1st-line Tx (acute)?
colchicine + prednisolone
Gout: 1st-line Tx (prevent)?
allopurinol + febuxostat
Pseudogout: 1st-line Tx?
methotrexate (DMARD)
Osteoporosis: Gold Ix?
DEXA scan for T-score (< -2.5)
Fibromyalgia: 1st-line Tx?
antidepressants (e.g. amitriptyline), anticonvulsants (e.g. pregabalin)
Sjogren’s: 1st-line Ix?
Schirmer tear test (<10 mm in 5 mins), salivary gland biopsy
Wegener’s granulomatosis: 1st-line Ix?
urinalysis (proteinuria, haematuria)
Wegener’s granulomatosis: Gold Ix?
renal biopsy
Polyarteritis nodosa: 1st-line Ix?
bloods (anaemia, ↑WCC/ESR)
angiography (micro-aneurysms)
Polyarteritis nodosa: Gold Ix?
renal biopsy
Paget’s disease: 1st-line Ix?
bloods (↑ALP), ↑urinary hydroxyproline
Septic arthritis: 1st-line Tx?
urgent aspiration then Abx for 2 wks
Osteomyelitis: Gold Ix?
bone biopsy + culture
SLE: 1st-line Tx?
prednisolone, chloroquine
aPL syndrome: Gold Ix?
anticardiolipin test
lupus anticoagulant test
anti-B2-glycoprotein test
(persistent +ve in 1 of these)
aPL syndrome? 1st-line Tx?
aspirin/clopidogrel
DM/PM: Gold Ix?
muscle biopsy
DM/PM: 1st-line Tx?
prednisolone, methotrexate, chloroquine
Scleroderma: 1st-line Ix?
bloods (anaemia)
urine (proteinuria)
hand X-ray (Ca deposits)
barium swallow (esophageal dysmotility)
Scleroderma: 1st-line Tx?
CCB, ACEi, methotrexate
Osteomalacia: 1st-line Tx?
calcium D3 forte, calcitriol
Depression: 1st-line Ix?
PHQ-9 questionnaire
Depression: 1st-line Tx?
psychological therapy (e.g. CBT), SSRi (e.g. sertraline)
Wrist drop: Gold Ix?
EMG (radial)
Claw hand: Gold Ix?
EMG (ulnar)
Foot drop: Gold Ix?
EMG (common peroneal branch of sciatic)
Brown-Sequard: 1st-line Ix?
clinical, MRI
Brain tumour: Gold Ix?
biopsy (via burr hole)
UMN + LMN lesions: 1st-line Tx?
baclofen/botox (muscle relaxant), physio
Myasthenia gravis: Gold Ix?
EMG, Edrophonium/Tensilon test
Myasthenia gravis: 1st-line Tx?
pyridostigmine (anti-cholinesterase)
MND: 1st-line Ix?
clinical, NCS/EMG
MND: 1st-line Tx?
riluzole (Na channel blocker which inhibits glutamate)
Guillain-Barre syndrome: Gold Ix?
NCS
Guillain-Barre syndrome: 1st-line Tx?
IV Ig (5 days)
PD: Gold Ix?
MRI head (atrophy)
PD: 1st-line Tx?
ropinirole (dopamine agonist)
PD: Gold Tx?
levodopa
HD: Gold Ix?
genetic test (>35 CAG repeats)
HD: 1st-line Tx?
SSRI
Benzodiazepine (chorea)
Haloperidol (antipsychotic)
Migraine: 1st-line Tx?
sumatriptan
Tension headache: 1st-line Tx?
aspirin
Cluster headache: Acute Tx?
100% 15L O2 via non-rebreathable mask + SC sumatriptan
Cluster headache: Preventative Tx?
CCB
Trigeminal neuralgia: 1st-line Tx?
carbamazepine (anticonvulsant)
Epilepsy: 1st-line Ix?
CT head (look for space-occupying lesion)
Epilepsy: Gold Ix?
EEG
Generalised seizures: 1st-line Tx?
sodium valproate
(teratogenic; 2nd line = carbamazepine/lamotrigine)
Focal seizures: 1st-line Tx?
carbamazepine
(2nd = lamotrigine)
Dementia: 1st-line Ix?
MMSE (mini mental state examination)
Alzheimer’s: 1st-line Tx?
rivastigmine/donepezil (acetylcholinesterase inhibitors)
Renal colic: 1st-line Ix?
KUB-XR
Renal colic: Gold Ix?
NCCT-KUB
Renal colic: 1st-line Tx?
analgesia, antiemetic, CCB/alpha-blocker
AKI: Gold Ix?
KDIGO, renal biopsy (if intrarenal)
AKI: Common 1st-line Tx?
furosemide (loop diuretic)
SAH: Gold Ix?
CT head (white, star-shape)
SAH: 1st-line Tx?
nimodipine (CCB) + IV fluids, endovascular coiling
EDH: Gold Ix?
CT head (bright white, lemon-shape)
EDH: 1st-line Tx?
IV mannitol, thrombectomy
SDH: Gold Ix?
CT head (dark, sickle shape)
SDH: 1st-line Tx?
IV mannitol, burr hole craniotomy
Amaurois fugax: 1st-line Tx?
aspirin/warfarin
Meningitis: Tx in GP?
IM benzylpenicillin
Meningitis: Tx in hospital?
IV cefotaxime/ceftriaxone
Encephalitis: 1st-line Tx?
IV acyclovir
Intracerebral haemorrhage: Gold Ix?
CT head (bright white, roughly spherical area)
Intracerebral haemorrhage: 1st-line Tx?
IV mannitol, burr hole craniotomy or stereotactic clot aspiration
TIA: 1st-line Tx?
aspirin then lifelong clopidogrel (P2Y12i)
Ischaemic stroke: 1st-line Tx?
IV alteplase (thrombolysis) within 4.5 hrs, then lifelong clopidogrel (P2Y12i)
MS: Gold Ix?
2+ CNS lesions disseminated in time + space
MS: Tx (acute)?
IV benzylpenicillin
MS: Tx (frequent relapse)?
SC interferon-1A/B
MS: Tx (symptomatic)?
baclofen (muscle relaxant)
Lambert-Eaton: Gold Ix?
EMG (amplitude greatly↑post-exercise)
Lambert-Eaton: 1st-line Tx?
prednisolone, IV Ig, amifampridine (K channel blocker)
CTS: 1st-line Ix?
phalen’s test (only flex wrist for 1 min)
tinel’s test (tap median nerve → tingling)
CTS: Gold Ix?
EMG (median)
Charcot-Marie-Tooth: 1st-line Ix?
FHx, clinical (e.g. high arch)
Charcot-Marie-Tooth: Gold Ix?
genetic test
(nerve biopsy from calf if inconclusive)
Charcot-Marie-Tooth: 1st-line Tx?
physio
DMD: 1st-line Ix?
FHx, bloods (↑creatinine)
DMD: Gold Ix?
genetic test
(nerve biopsy from calf if inconclusive)
DMD: 1st-line Tx?
physio, oral steroids
Testicular cancer: Gold Ix?
scrotal USS
Testicular cancer: 1st-line Tx?
inguinal orchiectomy
BPH: 1st-line Tx?
tamsulosin (alpha-1 blocker)
BPH: Gold Tx?
TURP (transurethral resection of the prostate)
Diffuse proliferative + memranoproliferative glomerulonephritis: 1st-line Tx?
ACEi/ARB
Nephrotic syndrome: 1st-line Ix?
(minimal change, focal segmental glomerulosclerosis, membranous nephropathy)
urinalysis (protein >3.5g/day), bloods (low albumin), oedema
Nephrotic syndrome: 1st-line Tx?
(minimal change, focal segmental glomerulosclerosis, membranous nephropathy)
prednisolone
Varicocele + testicular torsion: Gold Ix?
venography or doppler USS
Epididymal cyst + hydrocele: Gold Ix?
scrotal USS
Ovarian torsion: 1st-line Ix?
pelvic USS (whilpool sign)
Ovarian torsion: 1st-line Tx?
laparoscopic detorsion or oophorectomy
Wilm’s tumour: Gold Ix?
renal biopsy
Wilm’s tumour: 1st-line Tx?
nephrectomy
ADPKD: Gold Ix?
USS (cysts)
ADPKD: 1st-line Tx?
ACEi
ARPKD: Gold Ix?
antenatal/neonatal USS (cysts)
APKD: 1st-line Tx?
ACEi, mechanical ventilation
Chlamydia + gonorrhea: Gold Ix?
NAAT (vulvovaginal swab in females, first-pass urine in males)
Syphilis: Gold Ix?
SEROLOGY
- specific = T.pallidum antigen
- non-specific = RPR (rapid plasma reagin), VDRL (veneral disease research lab)
Ectopic pregnancy: Gold Ix?
transvaginal USS
Ectopic pregnancy: 1st-line Tx?
laparoscopic salpingectomy (/methotrexate)
RCC: Gold Ix?
CT with contrast, renal biopsy
RCC: 1st-line Tx?
nephrectomy
advanced: temsirolimus (mTOR inhibitor)
UTI: Gold Ix?
MSU (microscopy, culture, sensitivity)
UTI: 1st-line Tx?
Uncomplicated: trimethoprim/nitrofurantoin for 3 days Complicated: trimethoprim/nitrofurantoin for 7 days
(N.B. Trimethoprim is TERATOGENIC)
Prostate cancer: Gold Ix?
TRUS (transrectal ultrasound) + biopsy
Prostate cancer: 1st-line Tx?
Non-metastatic: prostatectomy
Metastatic: androgen receptor blocker (e.g. bicalutamide)
Prolapse: 1st-line Ix?
examination using a sim’s speculum
Prolapse: 1st-line Tx?
vaginal pessary
Bladder cancer: Gold Ix?
cystoscopy with biopsy, CT urogram
Bladder cancer: 1st-line Tx?
Non-muscle invasive:
TURBT (transurethral resection of bladder tumour)
Muscle invasive:
radical cystectomy
CKD: 1st-line Ix?
bloods (anaemia, ↓Ca, ↑phosphate/SCr)
USS (small kidneys)
CKD: Gold Ix?
GFR <60ml/min/1.63m3 for >3 months
CKD: 1st-line Tx?
furosemide, ACEi/ARB
CKD: Gold Tx?
kidney transplant
Nephritic syndrome: 1st-line Ix?
(IgA/Berger’s, post-strep, Goodpasture’s, SLE nephropathy)
urinalysis (<2 g/day), haematuria
IgA nephropathy / Berger’s: Gold Ix?
renal biopsy (mesangial proliferation, IgA + C3 deposits)
IgA nephropathy / Berger’s: 1st-line Tx?
ACEi
Post-strep glomerulonephritis: 1st-line Tx?
Abx
Goodpasture’s syndrome: 1st-line Tx?
plasmapheresis (remove Ab), immunosuppression
SLE nephropathy: 1st-line Tx?
immunosuppression (steroids, cyclophosphamide, rituximab)
Myasthenia gravis: Gold Ix?
EMG, Tensilon/Edrophonium test
