100 Cases in Clinical Medicine Flashcards
1
Q
What are the commonest causes of a persistent dry cough?
A
- Asthma (50%)
- Sinusitis and postnasal drip (25%)
- GORD (20%)
2
Q
What are the most likely causes of microcytic anaemia in pre-menopausal women?
A
Menstrual loss
3
Q
What are the most likely causes of microcytic anaemia in men/post-menopausal women?
A
Loss from GI tract
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
5
Q
How does kidney failure cause hyperparathyroidism?
A
- Increased serum phosphate due to reduced renal clearance
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
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
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
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
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
11
Q
What are the triad of symptoms usually associated with reactive arthritis?
A
- Seronegative and usually affects lower limbs
- Conjunctivitis
- Non-specific urethritis (NSU)
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
13
Q
What are the most likely causes of unilateral knee pain?
A
- Trauma
- Septic arthritis
- Gout
- Pseudogout
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
15
Q
What is the term used to describe a combination of anaemia, neutropenia and thrombocytopenia?
A
Pancytopenia
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
17
Q
What are the symptoms of anaemia?
A
- Headache
- Fatigue
- Breathlessness
- Dizziness
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)
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
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
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
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
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)
24
Q
A
25
What are the causes of secondary amenorrhoea?
- 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
What are the causes of osteoporosis?
- Multiple myeloma
- Metastatic carcinoma (especially from prostate, breast, lungs, thyroid and kidneys)
27
What are the causes of generalised lymphadenopathy?
* 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
What are diseases associated with erythema nodosum?
- Streptococcal infection
- TB
- Leprosy
- Glandular fever
- Histoplasmosis
- Coccidioidomycosis
- Lymphoma
- Leukaemia
- Sarcoidosis
- Pregnancy/oral contraceptives
- Reaction to sulfonamides
- UC/Crohn's disease
29
What are the common causes of pulmonary/renal syndrome?
* Systemic vasculitis:
- Microscopic polyarteritis
- Granulomatosis with polyangiitis (Wegener's syndrome)
- Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
* Goodpastures syndrome
* SLE
30
What are the skin signs related to acute pancreatitis?
Grey-Turner's sign: Bruising around the flank
Cullen's sign: Bruising around the umbilicus
31
What are typical symptoms of carcinoid symptoms?
Intermittent episodes of:
- Skin flushing
- Diarrhoea
- Wheezing
- Abdominal cramps
32
What is rhabdomyolysis?
- 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
What are the biochemical markers of rhabdomyolysis?
- 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
What are the causes of rhabdomyolysis?
- Prolonged muscular ischaemia
- Muscular trauma (e.g. crush injuries)
- Severe hyperkalaemia
- Excessive exercise
- Myopathies
- Drugs (e.g. ciclosporin, statins)
- Viral infections
35
What tests are available for carpal tunnel syndrome?
- 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
What are risk factors for carpal tunnel syndrome?
- Hypothyroidism
- Rheumatoid arthritis
- Diabetes mellitus
- Acromegaly
- Obesity
- Fluid retention (e.g. pregnancy)
- Repetitive wrist strain/trauma (e.g. prolonged computer use)
37
What are the peripheral causes of vertigo?
- Benign paroxysmal positional vertigo
- Vestibular neuronitis
- Meniere's disease
- Middle-ear disease
- Aminoglycoside toxicity
38
What are the central causes of vertigo?
- Brainstem ischaemia
- Posterior fossa tumour
- MS
- Alcohol/drugs
- Migraine
- Epilepsy
39
What are defining features of BPPV?
Attacks of vertigo are position-dependent and last for \<1 min
40
What are defining features of Meniere's disease?
- Recurrent attacks of vertigo lasting for up to 24hrs each
41
What are the defining features vestibular neuronitis?
- Attack of vertigo does not recur but lasts for several days
42
What are the defining features of drug-related ototoxic vertigo?
Vertigo is permanent
43
What are the defining features of vertigo due to brainstem ischaemic attacks?
- Other evidence of widespread vascular disease
- Long tract signs
44
What are the defining features of vertigo due to MS?
- Initial attacks of vertigo lasting for 2-3 weeks, followed by other symptoms of MS
45
What are the defining features of vertigo due to posterior fossa tumour?
- Other symptoms and signs of space-occupying lesions, such as raised ICP
46
What are the defining features of vertigo due to acoustic neuromas?
- Vertigo + deafness
47
What are the defining features of vertigo due to migraines?
- Vertigo in addition to nausea + vomiting
48
What are the defining features of vertigo due to temporal lobe epilepsy?
- Rotational vertigo in addition to visual and auditory hallucinations
- Other features of temporal lobe seizures
49
What are the causes of SOB post-MI?
- Another MI
- Arrhythmias
- Mitral regurgitation (due to rupture of the chordae tendinae)
- Perforation of intraventricular septum
- Peforation of free wall of ventricles
- PE
50
What are the similarities and differences between signs on examination following mitral regurgitation and intraventricular septum rupture?
* 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
What is a J-point at the end of QRS on ECG characteristic of?
Hypothermia (disappears on rewarming)
52
How should hypothermia be managed?
* 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
What the causes of polyuria and polydypsia?
- 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
If a patient is \>50 years old and presents with isolated with haematuria, what should be done first before being referred to a nephrologist?
Refer to urologist to r/o bladder and prostatic disease
55
What does the sign of arteriovenous nipping suggest on fundoscopy?
Hypertension
56
What are the causes of dementia?
- 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
What is the typical feature of U&Es in dehydration?
- Normal creatinine
- Raise urea
58
Tumours from which site are most likely to metastasise to the bone?
Carcinoma of the:
- Lungs
- Kidneys
- Prostate
- Thyroid
- Breast
59
What are the 4 key characteristics of delirium?
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
61
What are the common treatments for obstructive sleep apnoea (OSA)?
- Encourage weight loss
- Mandibular advancement splints
- CPAP
- Tonsillectomy (common cause of OSA in children)
62
What are the CAGE criteria for screening of alcoholism?
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?
