Work Up indications Flashcards
Two sets of blood cultures from separate venipuncture sites are indicated for signs of:
Bacteremia/Septicemia
*(s/t stuff like sepsis, infective endocarditis etc.)
urine culture is indicated for signs of:
Urinary tract infection
*(Pt with dysuria and pyuria etc.)
In pt with abnormal UA
(ex: proteinuria, urinary RBC casts)
Serum Complement Levels are indicated for concerns of:
Glomerulonephritis
*(may also have HTN)
Evaluation of hematuria can include ___
for signs of nephrolithiasis (flank pain, urinary crystals)
Renal Ultrasound
Bladder U/S is indicated for concerns of (2):
Urinary Retention
Urinary Tract Obstruction
aka Hydronephrosis
Renal Ultrasound is indicated for concerns of (2):
Hydronephrosis (s/t Urinary Retention/Obstruction)
Nephrolithiasis
CT scan of the sinuses is indicated for concerns of:
Sinusitus
With obstructive uropathy, a ____ should be performed in ALL patients being evaluated for BPH sxs, creatinine elevation or CKD
renal ultrasound
*Typically reveals hydronephrosis;
bilateral small kidneys on ultrasonography suggests (2)
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)
Intravenous insulin infusion is indicated for patients with severe hyperglycemia aka blood glucose > __mg/dL
400+
*but it increases risk of hypoglycemia in pts w/ BGL <180 mg/dL
Upright abdominal x-ray (KUB) is indicated for concerns of (2):
SBO
Perf Bowel
*Illeus
This imaging is done only in hemodynamically stable patients
CT scanning
focused bedside Abdominal ultrasound indicated for hemodynamically unstable pts with suspected:
AAA
Esophagography with Gastrograffin (water-soluble) contrast evaluates for (2)
esophageal perforation
Achalasia
Flexible bronchoscopy visualizes the proximal airway lumen and diagnosis/ evaluates for
tracheobronchial injury
Needle manometry confirms this diagnosis
Compartment Syndrome
Needle manometry: measures compartment pressures → a delta pressure (DBP − compartment pressure)
≤30 mm Hg strongly suggests CS
Transesophageal echocardiogram evaluates for (2)
Aortic Dissection (in HD-Unstable or ↑ Cr pts)
Valvular Pathologies (Infective Endocarcitis)
HIGH-dose aspirin and troponin levels should be considered in patients presenting with suspected:
acute coronary syndrome
(unstable angina, NSTEMI, STEMI)
Is indicated in all patients with high-risk acute coronary syndrome (unstable angina, NSTEMI, STEMI)
Coronary angiography
[Imaging] is a useful diagnostic measure in acute STEMI
aka acute ECG changes + troponin elevations
Coronary angiography
nerve conduction studies are indicated for concerns of:
peripheral neuropathy
sensory deficits
↓ velocity = demyelination or compression
( MS, carpal tunnel syndrome)
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
Neuroimaging
CT head or Brain MRI
(to r/o a mass)
Lumbar puncture is warranted for features of
Meningitis:
•headache with fever
• nuchal rigidity
SAH
ICP
Tonometry is used to evaluate for
increased intraocular pressure
(which can cause severe eye pain and headache if pressure changes acutely like in angle-closure glaucoma)
Polysomnography can be used to diagnose
Narcolepsy
Sleep Apnea
–Obstructive sleep apnea (OSA)
–Central sleep apnea
ERCP is usually done to treat (2)
Cholangitis
Choledocolithiasis
Gallstone pancreatitis
gallstone pancreatitis typically have an elevated __ level (>150)
alanine aminotransferase (ALT)
⭐ (ALP is also often elevated but is nonspecific).
The diagnosis can be confirmed with a fasting serum lipid profile.
hypertriglyceridemia (>1,000 mg/dL)
–Familial hypertriglyceridemia
⭐ can lead to acute pancreatitis, MIs, and can cause eruptive xanthomas.
The hepatobiliary iminodiacetic acid (HIDA) scan can be used for evaluating ___ in patients with indeterminate ultrasound findings.
cholecystitis
⭐ HIDA uses a nuclear tracer that is excreted in bile. Failure to visualize the tracer in the gallbladder suggests obstruction/cholecystitis
Kidney biopsy is used to diagnose ___ causes of acute kidney injury.
intrinsic renal
____ 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
Prostate biopsy
A 24-hour creatinine clearance is typically collected when a precise measure of renal function is needed for:
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.
Throat Culture Indicated for concerns of
Group A streptococcal pharyngitis
(Acute Rheumatic Fever s/t untreated GAS)
Though rare, a Lymph node biopsy is generally done for ___.
More commonly it is done for _____.
unexplained lymphadenopathy
cancer staging (breast cancer sentinel to axillary LN bx)
Diagnosis is generally made with CT mesenteric angiography.
Acute Mesenteric Ischemia
[lab] can help diagnose Salmonella
Stool culture
[Imaging series] may be used to detect bowel obstruction (s/t tumor, stricture, etc) within the UPPER gastrointestinal tract (stomach, small bowel).
Upper gastrointestinal series with small-bowel follow-through
[diagnostic] is used to test for meningitis
Lumbar puncture
Chest physiotherapy is used in patients with ____.
Bronchiectasis
(aids sputum clearance)
Chest physiotherapy has not been shown to improve clinical outcomes in acute COPD exacerbations
IV Magnesium sulfate causes bronchodilation and is used for severe, life-threatening ____ exacerbations.
Asthma
NOT for acute COPD exacerbations
___ studies are useful in the diagnostic evaluation of muscle weakness due to myopathic or neuropathic conditions (eg, Guillain-Barré syndrome).
Electromyography and nerve conduction
A right-sided precordial ECG should be obtained to confirm the diagnosis of
Right ventricular MI
commonly px with epigastric pain & nausea
Vitals typically, hypotension & bradycardia
hemoglobin electrophoresis is used to diagnose:
Sickle cell disease
Serum ____ levels, are elevated immediately following seizure. They are used primarily to differentiate real seizures from pseudo-seizures (psychogenic) in adults
prolactin
Contrast esophagography is used to evaluate for what?
esophageal rupture
(rare cause of pneumomediastinum)
(pt’s have difficulty swallowing and h/o forceful vomiting)
