Work Up indications

Question 1

Two sets of blood cultures from separate venipuncture sites are indicated for signs of:

Answer 1

Bacteremia/Septicemia

*(s/t stuff like sepsis, infective endocarditis etc.)

Question 2

urine culture is indicated for signs of:

Answer 2

Urinary tract infection

*(Pt with dysuria and pyuria etc.)

Question 3

In pt with abnormal UA
(ex: proteinuria, urinary RBC casts)

Serum Complement Levels are indicated for concerns of:

Answer 3

Glomerulonephritis

*(may also have HTN)

Question 4

Evaluation of hematuria can include ___
for signs of nephrolithiasis (flank pain, urinary crystals)

Answer 4

Renal Ultrasound

Question 5

Bladder U/S is indicated for concerns of (2):

Answer 5

Urinary Retention
Urinary Tract Obstruction
aka Hydronephrosis

Question 6

Renal Ultrasound is indicated for concerns of (2):

Answer 6

Hydronephrosis (s/t Urinary Retention/Obstruction)
Nephrolithiasis

Question 7

CT scan of the sinuses is indicated for concerns of:

Answer 7

Sinusitus

Question 8

With obstructive uropathy, a ____ should be performed in ALL patients being evaluated for BPH sxs, creatinine elevation or CKD

Answer 8

renal ultrasound

*Typically reveals hydronephrosis;

Question 9

bilateral small kidneys on ultrasonography suggests (2)

Answer 9

Chronic Kidney Disease (Bilateral)

Renal Artery Stenosis (Unilateral)

*Atherosclerotic renovascular disease can lead to bilateral renal artery stenosis & bilateral small kidneys
(**predisposes patients to AKI following initiation of an ACE/ARB)

Question 10

Intravenous insulin infusion is indicated for patients with severe hyperglycemia aka blood glucose > __mg/dL

Answer 10

400+

*but it increases risk of hypoglycemia in pts w/ BGL <180 mg/dL

Question 11

Upright abdominal x-ray (KUB) is indicated for concerns of (2):

Answer 11

SBO
Perf Bowel

*Illeus

Question 12

This imaging is done only in hemodynamically stable patients

Answer 12

CT scanning

Question 13

focused bedside Abdominal ultrasound indicated for hemodynamically unstable pts with suspected:

Answer 13

AAA

Question 14

Esophagography with Gastrograffin (water-soluble) contrast evaluates for (2)

Answer 14

esophageal perforation
Achalasia

Question 15

Flexible bronchoscopy visualizes the proximal airway lumen and diagnosis/ evaluates for

Answer 15

tracheobronchial injury

Question 16

Needle manometry confirms this diagnosis

Answer 16

Compartment Syndrome

Needle manometry: measures compartment pressures → a delta pressure (DBP − compartment pressure)
≤30 mm Hg strongly suggests CS

Question 17

Transesophageal echocardiogram evaluates for (2)

Answer 17

Aortic Dissection (in HD-Unstable or ↑ Cr pts)
Valvular Pathologies (Infective Endocarcitis)

Question 18

HIGH-dose aspirin and troponin levels should be considered in patients presenting with suspected:

Answer 18

acute coronary syndrome
(unstable angina, NSTEMI, STEMI)

Question 19

Is indicated in all patients with high-risk acute coronary syndrome (unstable angina, NSTEMI, STEMI)

Answer 19

Coronary angiography

Question 20

[Imaging] is a useful diagnostic measure in acute STEMI

aka acute ECG changes + troponin elevations

Answer 20

Coronary angiography

Question 21

nerve conduction studies are indicated for concerns of:

Answer 21

peripheral neuropathy
sensory deficits

↓ velocity = demyelination or compression
( MS, carpal tunnel syndrome)

Question 22

Pts with either of the following signs may need what type of evaluation?
–Abnormal neurologic examination (FND, seizures, weakness)

–Signs of increased ICP (papilledema, night-time wakening due to headache)

–Differences compared to prior headaches: Change in frequency, intensity, characteristics (present on awakening)

–New at age >40 or after trauma

Answer 22

Neuroimaging
CT head or Brain MRI

(to r/o a mass)

Question 23

Lumbar puncture is warranted for features of

Answer 23

Meningitis:
•headache with fever
• nuchal rigidity

SAH
ICP

Question 24

Tonometry is used to evaluate for

Answer 24

increased intraocular pressure

(which can cause severe eye pain and headache if pressure changes acutely like in angle-closure glaucoma)

Question 25

Polysomnography can be used to diagnose

Answer 25

Narcolepsy
Sleep Apnea
–Obstructive sleep apnea (OSA)
–Central sleep apnea

Question 26

ERCP is usually done to treat (2)

Answer 26

Cholangitis
Choledocolithiasis
Gallstone pancreatitis

Question 27

gallstone pancreatitis typically have an elevated __ level (>150)

Answer 27

alanine aminotransferase (ALT)

⭐ (ALP is also often elevated but is nonspecific).

Question 28

The diagnosis can be confirmed with a fasting serum lipid profile.

Answer 28

hypertriglyceridemia (>1,000 mg/dL)
–Familial hypertriglyceridemia

⭐ can lead to acute pancreatitis, MIs, and can cause eruptive xanthomas.

Question 29

The hepatobiliary iminodiacetic acid (HIDA) scan can be used for evaluating ___ in patients with indeterminate ultrasound findings.

Answer 29

cholecystitis

⭐ HIDA uses a nuclear tracer that is excreted in bile. Failure to visualize the tracer in the gallbladder suggests obstruction/cholecystitis

Question 30

Kidney biopsy is used to diagnose ___ causes of acute kidney injury.

Answer 30

intrinsic renal

Question 31

____ is indicated for patients with signs of prostate cancer, such as grossly asymmetric enlargement of the prostate, palpable nodules, or persistently elevated PSA levels >4 ng/dL

Answer 31

Prostate biopsy

Question 32

A 24-hour creatinine clearance is typically collected when a precise measure of renal function is needed for:

Answer 32

Evaluation of intrinsic kidney dz
Pre-Eclampsia
evaluation for renal transplant
preparation for hemodialysis

⭐ Not needed for most AKI bc serum Cr is a sufficiently reliable marker of renal function.

Question 33

Throat Culture Indicated for concerns of

Answer 33

Group A streptococcal pharyngitis
(Acute Rheumatic Fever s/t untreated GAS)

Question 34

Though rare, a Lymph node biopsy is generally done for ___.
More commonly it is done for _____.

Answer 34

unexplained lymphadenopathy

cancer staging (breast cancer sentinel to axillary LN bx)

Question 35

Diagnosis is generally made with CT mesenteric angiography.

Answer 35

Acute Mesenteric Ischemia

Question 36

[lab] can help diagnose Salmonella

Answer 36

Stool culture

Question 37

[Imaging series] may be used to detect bowel obstruction (s/t tumor, stricture, etc) within the UPPER gastrointestinal tract (stomach, small bowel).

Answer 37

Upper gastrointestinal series with small-bowel follow-through

Question 38

[diagnostic] is used to test for meningitis

Answer 38

Lumbar puncture

Question 39

Chest physiotherapy is used in patients with ____.

Answer 39

​​​​​​​Bronchiectasis
(aids sputum clearance)

Chest physiotherapy has not been shown to improve clinical outcomes in acute COPD exacerbations

Question 40

IV Magnesium sulfate causes bronchodilation and is used for severe, life-threatening ____ exacerbations.

Answer 40

Asthma

NOT for acute COPD exacerbations

Question 41

___ studies are useful in the diagnostic evaluation of muscle weakness due to myopathic or neuropathic conditions (eg, Guillain-Barré syndrome).

Answer 41

Electromyography and nerve conduction

Question 42

A right-sided precordial ECG should be obtained to confirm the diagnosis of

Answer 42

Right ventricular MI

commonly px with epigastric pain & nausea
Vitals typically, hypotension & bradycardia

Question 43

hemoglobin electrophoresis is used to diagnose:

Answer 43

Sickle cell disease

Question 44

Serum ____ levels, are elevated immediately following seizure. They are used primarily to differentiate real seizures from pseudo-seizures (psychogenic) in adults

Answer 44

prolactin

Question 45

Contrast esophagography is used to evaluate for what?

Answer 45

esophageal rupture

(rare cause of pneumomediastinum)
(pt’s have difficulty swallowing and h/o forceful vomiting)