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Clinical school: 100 cases > 100 Cases in Clinical Medicine > Flashcards

100 Cases in Clinical Medicine Flashcards

1
Q

What are the commonest causes of a persistent dry cough?

A
  1. Asthma (50%)
  2. Sinusitis and postnasal drip (25%)
  3. GORD (20%)
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2
Q

What are the most likely causes of microcytic anaemia in pre-menopausal women?

A

Menstrual loss

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3
Q

What are the most likely causes of microcytic anaemia in men/post-menopausal women?

A

Loss from GI tract

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4
Q

What symptoms warrant investigation for possible colorectal carcinoma?

A
  • Iron-deficiency (microcytic) anaemia (in men and post-menopausal women)
  • Altered bowel habits for >1 month
  • Rectal bleeding
  • Family history of colorectal carcinoma
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5
Q

How does kidney failure cause hyperparathyroidism?

A
  • Increased serum phosphate due to reduced renal clearance
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6
Q

What are the causes of loin pain?

A
  • Pyelonephritis
  • Obstructive uropathy
  • Renal infarction
  • Renal cell carcinoma
  • Renal papillary necrosis
  • Renal calculi
  • Glomerulonephritis
  • Polycystic kidney disease
  • Medullary sponge kidney
  • Loin-pain haematuria syndrome
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7
Q

What are the causes of obesity?

A
  • Genetic
  • Environmental (e.g. excess food intake and lack of exercise)
  • Hormonal (hypothyroidism, Cushing’s syndrome, polycystic ovarian syndrome, hyperprolactinaemia)
  • Alcohol-induced pseudo-Cushing’s syndrome
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8
Q

What are the symptoms of hypercalcaemia?

A
  • Confusion
  • Difficulty concentrating
  • Fatigue
  • Muscle weakness
  • Abdominal pain
  • Nausea
  • Vomiting
  • Polydipsia
  • Constipation
  • Polyuria
  • Dehydration
  • Nephrolithiasis
  • Hypertension
  • Short QT if RCG
  • Bone changes
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9
Q

What are the causes of hypercalcaemia?

A
  • Hyperparathyroidism (primary accounts for 90% if cases of hypercalcaemia)
  • Malignancy (multiple myeloma common)
  • Sarcoidosis
  • Carcinoid syndrome from squamous cell carcinoma
  • Tertiary hyperparathyroidism (due to renal failure)
  • Thyrotoxicosis
  • Vitamin D intoxication
  • Thiazide diuretics
  • Adrenal insufficiency
  • TB
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10
Q

What are the causes of generalised muscle weakness?

A
  • Myasthenia gravis
  • Motor neuron disease
  • Muscular dystrophies
  • Dystrophia myotonica
  • Polymyositis
  • Miscellaneous myopathies: thyrotoxic, hypothyroid, Cushing’s, alcoholic
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11
Q

What are the triad of symptoms usually associated with reactive arthritis?

A
  1. Seronegative and usually affects lower limbs
  2. Conjunctivitis
  3. Non-specific urethritis (NSU)
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12
Q

What are the causes of an acute monoarthritis?

A
  • Reactive arthritis
  • Gonococcal arthritis
  • Septic arthritis
  • Spondyloarthritis (e.g. ankylosing spondylitis, psoriatic arthritis)
  • Viral arthritis
  • Rheumatoid arthritis
  • Gout
  • Pseudogout
  • Lyme disease
  • Haemorrhagic arthritis
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13
Q

What are the most likely causes of unilateral knee pain?

A
  • Trauma
  • Septic arthritis
  • Gout
  • Pseudogout
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14
Q

What distinguishes the crystals of gout from pseudogout?

A
  • Gout is caused by uric acid crystals and is -ve birefringent under polarised light
  • Pseudogout is caused by calcium phosphater crystals and is +ve birefringent under polarised light
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15
Q

What is the term used to describe a combination of anaemia, neutropenia and thrombocytopenia?

A

Pancytopenia

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16
Q

What are the different causes of macrocytic anaemia?

A
  • Folate deficiency
  • Vitamin B12 deficiency
  • Hypothyroidism
  • Certain drugs (e.g. azathioprine, methotrexate)
  • Primary acquired sideroblastic anaemia or myelodysplasic syndomes
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17
Q

What are the symptoms of anaemia?

A
  • Headache
  • Fatigue
  • Breathlessness
  • Dizziness
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18
Q

What are the symptoms of serious vitamin B12 deficiency?

A
  • Peripheral neuropathy
  • Degeneraltion of posterior columns and pyramidal tracts (resulting in sensory loss and difficulties walking)
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19
Q

What is pernicious anaemia?

A

Autoimmune disease caused by production of auto-antibodies that inhibit binding of vitamin B12 to intrinsic factor, causing B12 deficiency

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20
Q

What are the causes of nephrotic syndrome?

A
  • Diabetes mellitus
  • Minimal change disease
  • Focal/segmental glomerulosclerosis
  • Membranous nephropathy
  • SLE
  • HIV infection
  • Amyloidosis/myeloma
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21
Q

What are the extra-renal symptoms associated with autosomal dominant polycystic kidney disease?

A
  • Hepatic cysts
  • Diverticular disease
  • Inguinal hernias
  • Mitral valve prolapse
  • Intracranial aneurysms
  • Diverticular disease
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22
Q

What are the possible differentials for acute polyarthritis?

A
  • Osteoarthritis
  • Rheumatoid arthritis
  • SLE
  • Gout
  • Seronegative arthritides (including ankylosing spondylitis, psoriasis, Reiter’s disease)
  • Acute viral arthritis
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23
Q

What are the common X-ray signs of rheumatoid arthritis?

A
  • Subluxation
  • Juxta-articular osteoporosis
  • Loss of joint space
  • Bony erosion (5th metatarsophalangeal joint commonly affected)
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24
Q
A
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25
Q

What are the causes of secondary amenorrhoea?

A
  • Hypothalamic/pituitary pathologies (e.g. hypopituitarisum, hypoprolactinaemia)
  • Gonadal failure (e.g. autoimmune ovarian failure, polycystic ovarian syndrome)
  • Uterine damage (e.g. due to post-partum haemorrhage)
  • Adrenal disease (e.g. Cushing’s disease)
  • Thyroid disease (e.g. hyper-/hypothyroidism)

-

26
Q

What are the causes of osteoporosis?

A
  • Multiple myeloma
  • Metastatic carcinoma (especially from prostate, breast, lungs, thyroid and kidneys)
27
Q

What are the causes of generalised lymphadenopathy?

A
  • Infection:
  • Infectious mononucleosis (glandular fever)
  • Toxoplasmosis
  • Cytomegalovirus infection
  • Acute HIV infection
  • TB
  • Brucellosis
  • Syphilis
  • Inflammatory conditions:
  • SLE
  • Rheumatoid arthritis
  • Sarcoidosis
  • Haematological malignancies:
  • Lymphomas
  • Chronic leukaemias
28
Q

What are diseases associated with erythema nodosum?

A
  • Streptococcal infection
  • TB
  • Leprosy
  • Glandular fever
  • Histoplasmosis
  • Coccidioidomycosis
  • Lymphoma
  • Leukaemia
  • Sarcoidosis
  • Pregnancy/oral contraceptives
  • Reaction to sulfonamides
  • UC/Crohn’s disease
29
Q

What are the common causes of pulmonary/renal syndrome?

A
  • Systemic vasculitis:
  • Microscopic polyarteritis
  • Granulomatosis with polyangiitis (Wegener’s syndrome)
  • Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
  • Goodpastures syndrome
  • SLE
30
Q

What are the skin signs related to acute pancreatitis?

A

Grey-Turner’s sign: Bruising around the flank

Cullen’s sign: Bruising around the umbilicus

31
Q

What are typical symptoms of carcinoid symptoms?

A

Intermittent episodes of:

  • Skin flushing
  • Diarrhoea
  • Wheezing
  • Abdominal cramps
32
Q

What is rhabdomyolysis?

A
  • Severe muscle damage and myocyte death following a range of different types of insults
  • It causes a number of severe biochemical disturbances such as hyperkalaemia, as well as acute renal failure (due to myoglobin toxicity to the kidneys)
33
Q

What are the biochemical markers of rhabdomyolysis?

A
  • Raised creatinine kinase
  • Raised serum potassium
  • Raised serum phosphate
  • Raised serum myoglobins (causing brown urine to form and false +ve for blood on urine dip)
34
Q

What are the causes of rhabdomyolysis?

A
  • Prolonged muscular ischaemia
  • Muscular trauma (e.g. crush injuries)
  • Severe hyperkalaemia
  • Excessive exercise
  • Myopathies
  • Drugs (e.g. ciclosporin, statins)
  • Viral infections
35
Q

What tests are available for carpal tunnel syndrome?

A
  • Tinel’s test: Percussion over the median nerve in the carpal tunnel provokes tingling over the sensory distribution of the median nerve
  • Phalen’s manoeuvre: Forced flexion of the wrist for 30-60 seconds exacerbates patient’s symptoms
36
Q

What are risk factors for carpal tunnel syndrome?

A
  • Hypothyroidism
  • Rheumatoid arthritis
  • Diabetes mellitus
  • Acromegaly
  • Obesity
  • Fluid retention (e.g. pregnancy)
  • Repetitive wrist strain/trauma (e.g. prolonged computer use)
37
Q

What are the peripheral causes of vertigo?

A
  • Benign paroxysmal positional vertigo
  • Vestibular neuronitis
  • Meniere’s disease
  • Middle-ear disease
  • Aminoglycoside toxicity
38
Q

What are the central causes of vertigo?

A
  • Brainstem ischaemia
  • Posterior fossa tumour
  • MS
  • Alcohol/drugs
  • Migraine
  • Epilepsy
39
Q

What are defining features of BPPV?

A

Attacks of vertigo are position-dependent and last for <1 min

40
Q

What are defining features of Meniere’s disease?

A
  • Recurrent attacks of vertigo lasting for up to 24hrs each
41
Q

What are the defining features vestibular neuronitis?

A
  • Attack of vertigo does not recur but lasts for several days
42
Q

What are the defining features of drug-related ototoxic vertigo?

A

Vertigo is permanent

43
Q

What are the defining features of vertigo due to brainstem ischaemic attacks?

A
  • Other evidence of widespread vascular disease
  • Long tract signs
44
Q

What are the defining features of vertigo due to MS?

A
  • Initial attacks of vertigo lasting for 2-3 weeks, followed by other symptoms of MS
45
Q

What are the defining features of vertigo due to posterior fossa tumour?

A
  • Other symptoms and signs of space-occupying lesions, such as raised ICP
46
Q

What are the defining features of vertigo due to acoustic neuromas?

A
  • Vertigo + deafness
47
Q

What are the defining features of vertigo due to migraines?

A
  • Vertigo in addition to nausea + vomiting
48
Q

What are the defining features of vertigo due to temporal lobe epilepsy?

A
  • Rotational vertigo in addition to visual and auditory hallucinations
  • Other features of temporal lobe seizures
49
Q

What are the causes of SOB post-MI?

A
  • Another MI
  • Arrhythmias
  • Mitral regurgitation (due to rupture of the chordae tendinae)
  • Perforation of intraventricular septum
  • Peforation of free wall of ventricles
  • PE
50
Q

What are the similarities and differences between signs on examination following mitral regurgitation and intraventricular septum rupture?

A
  • Similarities:
  • Both produce SOB
  • Both produce pansystolic murmur
  • Both produce raised JVP
  • Differences:
  • Intraventricular septum rupture produces murmur that is loudest in lower left sternal edge
  • Mitral regurgitation produces murmur that is loudest at apex
51
Q

What is a J-point at the end of QRS on ECG characteristic of?

A

Hypothermia (disappears on rewarming)

52
Q

How should hypothermia be managed?

A
  • Aim to passively warm patient by 0.5-1°C/hour by covering with insulating blanket
  • If this is not achieved, consider:
  • Warmed IV fluids
  • Warmed inspired oxygen
  • Warmed bladder or peritoneal lavage
53
Q

What the causes of polyuria and polydypsia?

A
  • Diabetes insipidus
  • Diabetes mellitus (common)
  • Renal disease (e.g. chronic renal failure) (common)
  • Psychogenic polydypsia
  • Renal resistance to ADH
  • Hypokalaemia
  • Hypercalcaemia
  • Drugs (e.g. lithium)
54
Q

If a patient is >50 years old and presents with isolated with haematuria, what should be done first before being referred to a nephrologist?

A

Refer to urologist to r/o bladder and prostatic disease

55
Q

What does the sign of arteriovenous nipping suggest on fundoscopy?

A

Hypertension

56
Q

What are the causes of dementia?

A
  • Alzheimer’s disease
  • Vascular dementia
  • Progressive neuological diseases (e.g. MS)
  • Normal pressure hydrocephalus (dementia, ataxia and urinary incontinence)
  • Neurosyphilis
  • Vitamin B12 deficiency
  • Intracranial tumours
  • Subdural haemorrhages
  • Hypothyroidism
  • AIDS dementia
57
Q

What is the typical feature of U&Es in dehydration?

A
  • Normal creatinine
  • Raise urea
58
Q

Tumours from which site are most likely to metastasise to the bone?

A

Carcinoma of the:

  • Lungs
  • Kidneys
  • Prostate
  • Thyroid
  • Breast
59
Q

What are the 4 key characteristics of delirium?

A
  1. Disturbance of consciousness
  2. No obvious preexisting dementia
  3. Confusion that develops acutely (over hours or days) and tends to fluctuate during the day
  4. Evidence of a precipitating cause such as a serious medical condition, substance abuse or medication
    side effect
60
Q
A
61
Q

What are the common treatments for obstructive sleep apnoea (OSA)?

A
  • Encourage weight loss
  • Mandibular advancement splints
  • CPAP
  • Tonsillectomy (common cause of OSA in children)
62
Q

What are the CAGE criteria for screening of alcoholism?

A

Have you felt the need to Cut down drinking?
Have you ever felt Annoyed by criticism of drinking?
Have you had Guilty feelings about drinking?
Did you ever take a morning Eye opener?

Clinical school: 100 cases (3 decks)

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