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UCL MBBS (Fach) / Data interpretation (Lektion)
Including imaging, biochemistry, lung function tests, etc.
Diese Lektion wurde von eckhard erstellt.
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- ECG - pericarditis ---
- ECG - PE Right axis deviation or RBBB Classical: SI QIII TIII
- Screening tests for coronary artery disease Angiography Stress ECG / echo - exercise or dobutamine
- Functional tests of coronary blood supply Stress test + ECG/Echo
- z Prothrombin Time = PT Use: asses the extrinsic and common pathway TF → VII → Xa → pro-/thrombin → fibrin/-ogen Monitor effect of Warfarin via INR Asses liver damage (synthetic function), and vit K status
- z aPTT Definition: Activated Partial Thromboplastin TimeUse: Assess the intrinsic and common pathways: factors XII, XI, IX, VIII → Xa → pro-/thrombin → fibrin/-ogen Monitor effect of unfractionated heparin Diagnose →α-PL-syndrome: thrombophilia + paradoxical ↑APTT, which doesn't improve with mixing; → haemophilia: ↑APTT, which does improve upon adding factors VIII or IX.
- Electrolyte disturbances ---
- LFT's Obstruction Hepatitis Haemolysis
- Troponin D, I
- D-Dimer ---
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- z Blood glucose Definitions: Fasting glucose: fasting over night Oral glucose tolerance test: fasting, then 75g of glucose in 300ml of water → read befor and after 2h Diagnostic criteria: Diabetes: Increased venous glucose ≅ OGTT/random > 11.1mmol/l, FG > 7mmol/l; x2 or x1 plus symptomatic (blurred vision ∼ retinopathy, thirst ∼ nephropathy, lethargy); alternatively HbA1c > 6.5% IFG: 6 < FG < 7 IGT: 7.8 < OGGT/random < 11.1; higher risk of progession than IFG
- Thyroid function tests ---
- Cushing's disease - tests ACTH - low or high? Dexamethason suppresion test 8mg - supresses cortisol?
- Changes in immunological tests in arthritis & GI disease Antibodies ESR, CRP
- Viral Hepatitis serology Types A-E Info: Transmission, immunization, chronic vs acuteSerology: Ag (core, surface → immunization, e), α-body (IgG chronic, IgA acute) Tx: Novel medications, transplant
- Immunological results in HIV CD4 count
- z CSF interpretation Definition: appearance/colour, glucose, cells (leuko- & erythro-), protein, pH, pressure Findings: Normal: glucose ≥ 60% of plasma, < 5e6 white cells / l, <10e6 red cells / l, protein 0.2-0.4 g/l, pH 7.31, pressure 7-18 cmH2O Bacterial: turbid, ↓glucose, neutrophils, ↑protein Viral: clear, →glucose, lymphocytes, →protein Tuberculosis: clear, ↓glucose, monocytes/lymphocytes, ↑protein Subarachnoid haemorrhage: bloody appearance, ↑RBC; → bilirubin test aftr 12h GBS: ↑protein; MS: lymphocytes, ↑protein Benign intracranial hypertension: ↑opening pressure: diagnostic & therapeutic → Meningitis: symptomes, pathogens, management
- Aminoglycoside levels ---
- Drug monitoring ---
- Bleeding time Use: Assess platelet function + effect of heparin (APTT) Anachronistic → PT, APTT, INR
- Arterial Blood Gas Changes to arterial O2 w/ and w/o raised CO2 Changes to arterial pH and CO2, aka acid-base Anion gap Base excess Hb, glucose, lactate, HCO3- Electrolytes
- ECG - Pulmonary embolism --
- Pathological Sciences --
- Spirometry ---
- ECG - Brady arrhythmias Sick sinus disease AV / BoH blocks of varying degrees: type I = PR > 200ms; 2nd degree type I = WB, type II = Hay; type III Symptoms - Syncope, palpitations, SoB Treatment: Cardioversion, glucagon / atropine, pacemaker
- ECG - Exercise testing ---
- Path -- red cell count & indices Hb, haematocrit, MC, MCH
- Path -- Leucocytosis ---
- Path - Leucopenia ---
- Path Haematinics ---
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- Path - Thombocytosis ---
- Path - Thrombocytopenia Syptoms: Bleeding, bruising Causes Pancytopaenia - bone marrow suppression , infiltration, bleeding ITP - viral prodrome, steroids TTP - pentad of symptoms DIC Consider platelet transfusion
- Path - INR Mechanism: Vit K dependent factors II, VII, IX, X Vitamin K reductase inhibitor Protein C and S inhibition (anticogulatory) ⇒ load with heparin at initiation Monitor 3-monthly, yellow book Management of increased INR 5x5 Prothrombin complex concentrate Target values 2-3 for DVT, 3-4 recurrent DVT on warfarin 2.5 - 3.5 Metallic aortic valve 3-4 metallic mitral valve
- Path - Clotting defects PT, APTT Prothrombotic vs bleeding Thrombophilia screen
- Path - Raised ESR / CRP ---
- Path - Haemoglobinopathies Normal HbA 2α/2β, two loci for α, one for β Genetics - autosomal-reccesive recessive HbS, HbE, HbF Screening during / before pregnancy: electrophoresis → extra band Sickle, thalassaemias (carrier, minor / major) Symptoms: anaemia (very low MCV), haemolysis
- Path - Electrolyte changes Na+ K+ Ca2+ Mg2+, Phosphate, Cl-
- Path - plasma Creatinine / urea ---
- Path - LFT ALP, ALT, Alb, gammaGT, bilirubin Obstruction, liver cell necrosis, haemolysis, aka, post-, -intra-, prehepatic
- Path - pH changes Alkalosis Acidosis
- Path - Enzymes changes Troponin D-dimer LDH Subtypes
- Path - blood glucose GTT: 75mg glucose in 200ml of water ⇒ test after 2h Limits Diabetes: random > 11.1 or fasting > 7.0 mmol/l; twice or symptomatic HbA1c or symptoms alone unreliable IFG: random <11.1 and fasting ∈ [5.6, 7.0] mmol/l IGT: random ∈ [7.8, 11.1] and fasting < 7 mmol/l - higher risk of progression! Manage precursors with lifestyle, diet + annual review Gestational: same cutoffs HbA1c limits Aim < 6.5% or < 43 mmol/mol → Insulin incl prescription, oral hypoglycaemic agents; metformin first-line
- Path - hormones Thyroid Adrenal axis Other: renin / aldosterone, sex hormones
- Path - Immunology - Arthritis ---
- Path - Immunology - GI disease Coeliac - IgA, α-endomysial, gliadin; diarrhoea, failure to thrive, dermatitis herpetitformis Cron's - granulomatous, inflammatory UC
- Path - Immunology - Thyroid disease ---
- Path - Serology - Hepatitis ---
- Path - Serology - HIV Viral / immunological changes
- Path - Bacterial culture results Sputum, urine, blood, stool, CSF Get sensitivity (S) and resistance (R), taylor antibiotics accordingly Takes 3-5 days, longer for AFB
- Path - ABx sensitivity test Senitivity (S), resistance (R)