08-15-2007, 09:00 AM
for wilson disease,
liver biopsy ( not ser cerulosplasmin)
for pry scl cholangitis
is ERCP or Transhepatic cholangiogram ( not liver biopsy)
for hep B and C
is liver biopsy.
the best screening test for SLE is ANA. if negative then SLE can be ruled out.
joint fluid analysis is used in making diagnosis of acute gout. uric acid levels are not useful. some people may have high level and no gout. uric acid level may be normal or low level during a gout episode
ser cr kinase and aldolase (raised up to 50x) in suspected cases of inflammatory myopathy
confirm with muscle biopsy
CT Scan for head injury.
no need for contrast cos blood does not enhance
in the first hrs following subarachnoid bleeding when ct is normal, the single most important test is lumbar puncture ( if RBC is absent then r/o SAH)
for iron def anemia is bone marrow aspirate for fe staining..... this is rarely done.
beware of ser ferritin levels. a low level is specific for fe def but a high level may be seen in malig or inflammation
initial test for MG = anti Ach receptor antibodies ( yes, its not tensilon..the serology is supposed to be better)
best/ most accurate test= EMG
the best test for determining renal artery stenosis is renal angiography
the best NON-INVASIVE test is captopril renogram.
for sarcoidosis is biopsy
ACE levels are elevated ( non-sp...may be used for ff up)
uveitis and conjustivitis seen in 25%
for PULM EMB,
gold standard test for diagnosis is pulm angiog ( this is invasive so it is not the first test to be performed)
V/Q ratio is second best but the one we are more likely to perform first. if it dx PE, no need for angio. in the post op pt, do spiral CT cos v/q are usu abN in these pts.
nil for parkinson's dis
dx is clinical
MRI for MS.
for pemphigus and pemphigoid is skin biopsy and immunofluorescence
pemphigus.....intercellular deposits of IgG and C 3 in epidermis
pemphigoid.....ab at dermo-epidermal junction
for primary syphilis is dark field microscopy.
VDRL and RPR have 25% false negative.
for secondary sypilis, VDRL and RPR have 100% accuracy
for achalasia
best screening is barium swallow
best diagnostic is manometry
in osteomyelitis, when the X ray film is normal, the best test is MRI.
it is same sensitivity with technitium scan but better specificity than it.
single most important evaluation tool for growth evaluation = growth chart.
single most important diagnostic study is xray of left wrist and hand for bone age
most important in ingestion of corrosives=upper endoscopy for determining extent of injury
for organophosphorus poisoning, best test is RBC cholinesterase level. takes a while for results to be available so dont wait for results. treat pt based on S+ S
ser Fe >500ug/dl is severe poisoning
>10% carboxyhb is sympotmatic
>70% leads to death
ser salicylate (6hrs after ingestion)<35mg% ...pt will be asymptomatic
.................................................>100mg% potentially fatal
ser alcohol >100mg% is legally drunk in most states
................>500mg% is fatal in the non-tolerant person
acetaminophen 150mg/kg is toxic for children <12yrs
..........................7.5g in single dose is toxic for adults
ser lead >10ug/dl is abnormal
.............44-7oug/dl....treat with isingle drug eg dmsa
.............>70ug/dl.......hospitalise and treat with 2 drugs
HIV PCR is preferred virology assay for infants with HIV in the developing countries.
(hey this is very expensive....about US$300! most of the pts cannot pay. they would rather wait and see!!!)
gold standard test for obstructive sleep apnoea = polysomnography
best initial test for ovulation
BBT and midluteal progesterone level
similar INITIAL tests for luteal phase defect
confirmatory test= endometrial biopsy
ABDOMINAL ULTRASOUND....study of choice in diagnosis and follow up of abdominal aortic aneurysms
DISECTING AORTIC ENEURYSM..
diagnosis..
-chest xray ,helical CT scan in stable pts.transesophageal echcardiogram in unstable pts
-gold standard in diagnosis..is aortogram.
polymyositis... best diagnosis is muscel biopsy
Best Initial test for
Ankylosing spondylitis is X-ray of the Sacro-iliac joint
If clinical suspecion is high but X-ray is negative then do a CT scan
HLA-B27 is NOT specific for diagnosis, it's just that if it is negative the diagnosis can be excluded
Steatorrhoea - fat malabsorption
Quantitative estimation of stool fat
Carbohydrate malabsorption
D-Xylose test
Herpes Encephelitis
HSV PCR - gold standard
CSF finding is lymphocytic pleocytosis, Increased erythrocytes, elevated protein
mainly affects the temporal lobe
Addison's disease
Cosyntropin stimulation test - increase in Cortisol
Best test for Sarcoidosis
Biopsy - shows Noncaseating granloma biopsy for sarcoidosis: where? palpable lymph nodes, skin lesions, salivary glands, transbronchial lung biopsy. these are good sites.
for definetive diagnosis of - Herpes Simplex Virus (HSV)
ruptured Vesicle or debrided Ulcer fluid Culture
CYSTIC FIBROSIS....SWEET-CHLORIDE TEST
TUBEROUS SCLEROSIS White patches on skin - seen with WOOD LAMP'S.
Best Initial Diagnostic Test for Gillan-Barre - LP
Gold Standard “ EMG
Duchhene Musc. dystrophy - Muscle Biopsy
Dermatomyositis ------------Muscle biopsy
liver biopsy ( not ser cerulosplasmin)
for pry scl cholangitis
is ERCP or Transhepatic cholangiogram ( not liver biopsy)
for hep B and C
is liver biopsy.
the best screening test for SLE is ANA. if negative then SLE can be ruled out.
joint fluid analysis is used in making diagnosis of acute gout. uric acid levels are not useful. some people may have high level and no gout. uric acid level may be normal or low level during a gout episode
ser cr kinase and aldolase (raised up to 50x) in suspected cases of inflammatory myopathy
confirm with muscle biopsy
CT Scan for head injury.
no need for contrast cos blood does not enhance
in the first hrs following subarachnoid bleeding when ct is normal, the single most important test is lumbar puncture ( if RBC is absent then r/o SAH)
for iron def anemia is bone marrow aspirate for fe staining..... this is rarely done.
beware of ser ferritin levels. a low level is specific for fe def but a high level may be seen in malig or inflammation
initial test for MG = anti Ach receptor antibodies ( yes, its not tensilon..the serology is supposed to be better)
best/ most accurate test= EMG
the best test for determining renal artery stenosis is renal angiography
the best NON-INVASIVE test is captopril renogram.
for sarcoidosis is biopsy
ACE levels are elevated ( non-sp...may be used for ff up)
uveitis and conjustivitis seen in 25%
for PULM EMB,
gold standard test for diagnosis is pulm angiog ( this is invasive so it is not the first test to be performed)
V/Q ratio is second best but the one we are more likely to perform first. if it dx PE, no need for angio. in the post op pt, do spiral CT cos v/q are usu abN in these pts.
nil for parkinson's dis
dx is clinical
MRI for MS.
for pemphigus and pemphigoid is skin biopsy and immunofluorescence
pemphigus.....intercellular deposits of IgG and C 3 in epidermis
pemphigoid.....ab at dermo-epidermal junction
for primary syphilis is dark field microscopy.
VDRL and RPR have 25% false negative.
for secondary sypilis, VDRL and RPR have 100% accuracy
for achalasia
best screening is barium swallow
best diagnostic is manometry
in osteomyelitis, when the X ray film is normal, the best test is MRI.
it is same sensitivity with technitium scan but better specificity than it.
single most important evaluation tool for growth evaluation = growth chart.
single most important diagnostic study is xray of left wrist and hand for bone age
most important in ingestion of corrosives=upper endoscopy for determining extent of injury
for organophosphorus poisoning, best test is RBC cholinesterase level. takes a while for results to be available so dont wait for results. treat pt based on S+ S
ser Fe >500ug/dl is severe poisoning
>10% carboxyhb is sympotmatic
>70% leads to death
ser salicylate (6hrs after ingestion)<35mg% ...pt will be asymptomatic
.................................................>100mg% potentially fatal
ser alcohol >100mg% is legally drunk in most states
................>500mg% is fatal in the non-tolerant person
acetaminophen 150mg/kg is toxic for children <12yrs
..........................7.5g in single dose is toxic for adults
ser lead >10ug/dl is abnormal
.............44-7oug/dl....treat with isingle drug eg dmsa
.............>70ug/dl.......hospitalise and treat with 2 drugs
HIV PCR is preferred virology assay for infants with HIV in the developing countries.
(hey this is very expensive....about US$300! most of the pts cannot pay. they would rather wait and see!!!)
gold standard test for obstructive sleep apnoea = polysomnography
best initial test for ovulation
BBT and midluteal progesterone level
similar INITIAL tests for luteal phase defect
confirmatory test= endometrial biopsy
ABDOMINAL ULTRASOUND....study of choice in diagnosis and follow up of abdominal aortic aneurysms
DISECTING AORTIC ENEURYSM..
diagnosis..
-chest xray ,helical CT scan in stable pts.transesophageal echcardiogram in unstable pts
-gold standard in diagnosis..is aortogram.
polymyositis... best diagnosis is muscel biopsy
Best Initial test for
Ankylosing spondylitis is X-ray of the Sacro-iliac joint
If clinical suspecion is high but X-ray is negative then do a CT scan
HLA-B27 is NOT specific for diagnosis, it's just that if it is negative the diagnosis can be excluded
Steatorrhoea - fat malabsorption
Quantitative estimation of stool fat
Carbohydrate malabsorption
D-Xylose test
Herpes Encephelitis
HSV PCR - gold standard
CSF finding is lymphocytic pleocytosis, Increased erythrocytes, elevated protein
mainly affects the temporal lobe
Addison's disease
Cosyntropin stimulation test - increase in Cortisol
Best test for Sarcoidosis
Biopsy - shows Noncaseating granloma biopsy for sarcoidosis: where? palpable lymph nodes, skin lesions, salivary glands, transbronchial lung biopsy. these are good sites.
for definetive diagnosis of - Herpes Simplex Virus (HSV)
ruptured Vesicle or debrided Ulcer fluid Culture
CYSTIC FIBROSIS....SWEET-CHLORIDE TEST
TUBEROUS SCLEROSIS White patches on skin - seen with WOOD LAMP'S.
Best Initial Diagnostic Test for Gillan-Barre - LP
Gold Standard “ EMG
Duchhene Musc. dystrophy - Muscle Biopsy
Dermatomyositis ------------Muscle biopsy