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Osce urinalysis- LFT

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Osce urinalysis- LFT

  1. 1. OSCE- urinalysis/LFT Phase IIIa sienmingoat
  2. 2. 26yo female, honeymoon/newly-wed Dysuria + frequency + fever <ul><li>10 x5 org/ml- mixed growth </li></ul>
  3. 3. Q + A <ul><li>Antibiotic? Why? </li></ul><ul><ul><li>No </li></ul></ul><ul><ul><li>No significant UTI (mixed) </li></ul></ul><ul><ul><li>No sensitivity test </li></ul></ul><ul><li>Most common agent @ UTI? </li></ul><ul><ul><li>Escherichia coli </li></ul></ul><ul><li>Most common agent @ honeymoon? </li></ul><ul><ul><li>Staphylococcus saprophyticus </li></ul></ul><ul><li>Cause for this result? </li></ul><ul><ul><li>Contamination (X MSU, poor preparation) </li></ul></ul>
  4. 4. Urine dipstick <ul><li>Hematuria ++++ </li></ul><ul><li>Nitrite + </li></ul>
  5. 5. Q + A <ul><li>2 possible Dx? </li></ul><ul><ul><li>UTI </li></ul></ul><ul><ul><li>Urinary tract Stone </li></ul></ul><ul><ul><li>High protein diet? </li></ul></ul><ul><li>Further Ix? </li></ul><ul><ul><li>UFEME (cells, cast) </li></ul></ul><ul><ul><li>U/S KUB </li></ul></ul><ul><ul><li>KUB X-ray (stone, anatomy)-90% </li></ul></ul><ul><ul><li>MCUG (VUR) </li></ul></ul><ul><ul><li>DMSA (renal scarring) </li></ul></ul>
  6. 6. Urine microscopic <ul><li>Dysmorphic RBC (fragmented) </li></ul>
  7. 7. Q + A <ul><li>Causes? </li></ul><ul><ul><li>GN </li></ul></ul><ul><ul><li>Vasculitis (SLE) </li></ul></ul><ul><ul><li>IE </li></ul></ul><ul><ul><li>Stone, Ca, trauma, infections </li></ul></ul><ul><li>Confirmatory tests? </li></ul><ul><ul><li>Renal biopsy </li></ul></ul><ul><ul><li>Cystoscopy </li></ul></ul><ul><ul><li>Renal U/S </li></ul></ul>
  8. 8. 46yo male <ul><li>High serum bilirubin, ALP, AST </li></ul><ul><li>High urine biliruibin </li></ul>
  9. 9. Q + A <ul><li>Interpretation? </li></ul><ul><ul><li>High ALT AST: hepatocellular damage </li></ul></ul><ul><ul><li>High ALP: cholestasis </li></ul></ul><ul><ul><li>High serum/urine bilirubin: conjugated hyperbilirubinemia </li></ul></ul><ul><li>Diagnosis? </li></ul><ul><ul><li>Obstructive jaundice </li></ul></ul><ul><li>4 causes? </li></ul><ul><ul><li>Gallstone/CBD stone </li></ul></ul><ul><ul><li>Ca head of pancreas, bile duct, ampulla </li></ul></ul><ul><ul><li>Sclerosing cholangitis/PBC </li></ul></ul><ul><ul><li>Pancreatitis </li></ul></ul><ul><ul><li>Traumatic stricture (post-ERCP) </li></ul></ul>
  10. 10. Girl 11yo, tachypnea <ul><li>BUSE </li></ul><ul><li>Na, K, CI: N </li></ul><ul><li>Creatinine, urea: high (150 + 12) </li></ul><ul><li>Anion gap: high </li></ul><ul><li>ABG </li></ul><ul><li>pH: 7.05 (low) </li></ul><ul><li>PaO2: 14 (high) </li></ul><ul><li>PaCO2: 2.5 (low) </li></ul><ul><li>HCO3: 2 (low) </li></ul>
  11. 11. Q + A <ul><li>Acid-base abn? </li></ul><ul><ul><li>Partially compensated metabolic acidosis </li></ul></ul><ul><li>Causes? (high anion gap) </li></ul><ul><ul><li>DKA </li></ul></ul><ul><ul><li>Starvation </li></ul></ul><ul><ul><li>Renal failure </li></ul></ul><ul><ul><li>Lactic acidosis (tissue hypoxia/anemia/shock/hemorrhage) </li></ul></ul>
  12. 12. Hepatitis <ul><li>HBsAg + </li></ul><ul><li>HBeAg + </li></ul><ul><li>Anti HAV IgG + </li></ul><ul><li>Anti HCV + </li></ul>
  13. 13. Q + A <ul><li>Interpretation? </li></ul><ul><ul><li>Acute hepatitis B, or </li></ul></ul><ul><ul><li>If chronic (high infectivity, chronic liver dz) </li></ul></ul><ul><ul><li>Previous hep A + C infection </li></ul></ul><ul><ul><li>HBsAg + anti HBe = recovery from acute </li></ul></ul><ul><ul><li>anti HBs = late/immunity </li></ul></ul><ul><ul><li>HBV DNA = viral replication </li></ul></ul><ul><ul><li>HBeAg = active high infectivity </li></ul></ul><ul><li>Implication of family? </li></ul><ul><ul><li>Sexual + vertical transmission </li></ul></ul><ul><ul><li>Blood donation </li></ul></ul>
  14. 14. Male, cough, LOW, glycosuria, HPT <ul><li>Na: high </li></ul><ul><li>K: low </li></ul><ul><li>HCO3: low </li></ul><ul><li>24h dexa suppression test: serum cortisol high (>1000) </li></ul>
  15. 15. Q + A <ul><li>Dx? </li></ul><ul><ul><li>Brochial CA with ectopic ACTH syndrome </li></ul></ul><ul><ul><li>Small cell Ca of lung, bronchial carcinoid </li></ul></ul><ul><li>Why low K? </li></ul><ul><ul><li>Mineralocorticoid action </li></ul></ul><ul><ul><li>Na water retention + K loss @ collecting ducts </li></ul></ul><ul><li>Lab Ix? </li></ul><ul><ul><li>Serum cortisol/24h urinary cortisol, serum ACTH </li></ul></ul><ul><ul><li>Inferior petrosal sinus sampling (IPSS) </li></ul></ul>
  16. 16. GH + OGTT <ul><li>Describe changes of GH? </li></ul><ul><ul><li>GH suppressed = normal </li></ul></ul><ul><ul><li>No suppression  acromegaly (+ clinical + IGH-1 high) </li></ul></ul><ul><ul><li>False +  poor control DM, hypothyroid, Cushing, anorexia nervosa </li></ul></ul><ul><li>Name other biochem Ix? </li></ul><ul><ul><li>Serum IGH-1 (increase) </li></ul></ul><ul><li>Additional Ix? </li></ul><ul><ul><li>Blood glucose </li></ul></ul><ul><ul><li>ECG/Echo </li></ul></ul><ul><ul><li>MRI pituitary fossa </li></ul></ul><ul><ul><li>Visual field + acuity </li></ul></ul><ul><ul><li>Pituitary fx (hypopituitarism): serum TSH, T4, cortisol, ACTH (low) but high prolactin </li></ul></ul><ul><li>3 clinical features: </li></ul><ul><li>hormonal hypersecretion </li></ul><ul><li>hypopituitarism </li></ul><ul><li>local pressure effect </li></ul>
  17. 17. Mantoux test <ul><li>Method of administration? </li></ul><ul><ul><li>Area of induration measured 48-72h after intradermal injection of tuberculin (purified protein derivative) </li></ul></ul><ul><ul><li>Dorsal surface of forearm </li></ul></ul><ul><li>What is positive result? </li></ul><ul><ul><li>Atleast 10mm (negative if <5mm) </li></ul></ul><ul><ul><li>15mm if has had BCG </li></ul></ul><ul><li>Factors affect result? </li></ul><ul><ul><li>Immunosuppressed </li></ul></ul><ul><ul><ul><li>Miliary TB </li></ul></ul></ul><ul><ul><ul><li>Sarcoidosis </li></ul></ul></ul><ul><ul><ul><li>AIDS </li></ul></ul></ul><ul><ul><ul><li>lymphoma </li></ul></ul></ul>

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