Case History Flashcards
Nocturia, frequency, urgency, post-micturition dribbling, poor stream/flow, hesitancy, incomplete emptying
BPH
Weight loss, loin pain, haematuria, abdominal mass, varicocele, HTN
RCC
LUTS, weight loss, fatigue, night sweats, bone pain, male
Prostate cancer
Painless non-transilluminable testis lump, haemospermia
Testicular cancer
Dysuria, frequency, urgency, suprapubic pain, haematuria, polyuria, incontinence, confusion in elderly
Cystitis
Loin pain, fever, pyuria, back pain, severe headache, associated cystitis symptoms
Pyelonephritis
Pain in perineum/rectum/scrotum/penis/bladder/lower back, fever, malaise, nausea, urinary symptoms, swollen or tender prostate on examination
Prostatitis
Renal colic, restlessness, nausea and vomiting, haematuria, dysuria
Renal stones
Rise in creatinine >26 micromoles per L within 48h, rise in creatinine >1.5x baseline within 7 days, urine output <0.5ml per kg per h for >6 consecutive days
AKI
Oliguria, high creatinine, hyperkalaemia, uraemia, hypocalcaemia/hyperphosphataemia
AKI
Painless visible haematuria, urgency, suprapubic/pelvic mass/pain, recurrent UTI, paint etc
Bladder cancer
Abnormal kidney structure of function for >3 months with implications for health
Chronic kidney disease
Skin lesion, dysuria +/- discharge, urethral pain, penile discomfort/pruritus
Urethritis
Proteinuria, Haematuria, HTN
Nephritic syndrome
Proteinuria, hypercholesterolaemia, hypoalbuminaemia
Nephrotic syndrome
HTN, abdo/flank pain, headaches, LUTS, palpable kidneys
PKD
Can be painful if large, transillumination as fluid filled, can palpate cyst and testis separately
Epididymal cyst
Painless unless infected, non-tender smooth cystic swelling, transluminates
Hydrocele
Feels like a bag of worms, dragging/soreness/heaviness of scrotum
Varicocele
Malaise, nausea, anorexia, jaundice, pruritis, Asterixis, Dupuytren’s contractures, Leukonychia, Spider naevi
Liver failure
Interlobular bile ducts are damaged by chronic autoimmune granulomatous inflammation causing cholestasis
PBC
RUQ pain, fever/WCC and jaundice
Cholangitis
Progressive cholestasis with bile duct inflammation and strictures, affects ducts inside and outside the liver
PSC
Severe epigastric pain that radiates to the back, anorexia, fever, jaundice, Grey Turner’s sign, N&V, tachycardia
Acute pancreatitis
Colicky RUQ pain that radiates to back, worse after eating large or fatty meals
Biliary colic
RUQ pain that radiates to back, fever/increased WCC, Murphy’s sign
Acute cholecystitis
Epigastric pain that goes through to the back, Sitting forward or hot water bottles on epigastrum/back relieves, alcohol makes it worse, Nausea and vomiting, decreased appetite, malabsorption
Chronic pancreatits
Malaise, increased temperature/pulse/respiratory rate, anorexia, diarrhoea, vomiting, tender hepatomegaly +/- jaundice, bleeding, ascites
Alcoholic hepatitis
Ataxia, confusion, nystagmus, memory impairment
Wernicke-Korsakoff encephalopathy
Submucosal venous dilatation secondary to increased portal pressures
Varices
Ascites, clubbing, palmar erythema, xanthelasma, spider naevi, hepatomegaly, peripheral oedema, nail changes
Cirrhosis
Loose stools, vomiting, abdo pain
Fever, fatigue, headache, myalgia
Infective diarrhoea
Viral infective diarrhoea
Fatigue, arthralgia, weakness, hypogonadism, slate-grey or brownish/bronze skin, chronic liver disease, heart failure, arrhythmias
Haemochromatosis
Depression, neurotic behavioural problems, tremor, dysarthria, involuntary movements, dysphagia, reduced memory, eventual dementia, hepatitis, cirrhosis, Kayser-Fleischer ring
Wilson’s
Fever, malaise, anorexia, weight loss, RUQ pain, Hepatomegaly, chronic liver disease, evidence of decompensation, bruit over liver
Liver tumours
Epigastric pain that radiates to back and is relieved by sitting forward, painless obstructive jaundice, anorexia, weight loss, diabetes, acute pancreatitis, jaundice and palpable gallbladder, epigastric mass, hepatomegaly, splenomegaly, lymphadenopathy, ascites
Pancreatic cancer
Coffee ground vomit, melaena, hypotension, tachycardia
Upper GI bleed
Weight loss, polyuria, polydipsia
T1DM
Polydipsia, polyuria, glycosuria
T2DM
Cough, sputum, dyspnoea, wheeze, tachypnoea, accessory breathing, decreased expansion, quiet breath sounds, cyanosis
COPD
Intermittent dyspnoea, wheeze, cough that’s often nocturnal, sputum, intermittent dyspnoea, wheeze, cough that’s often nocturnal, sputum
Asthma
Cough, haemoptysis, dyspnoea, chest pain, weight loss, recurrent pneumonia, cachexia, anaemia, clubbing, consolidation, collapse, pleural effusion
Bronchus carcinoma
Chest pain, dyspnoea, weight loss, recurrent pleural effusion
Malignant mesothelioma
Sudden onset breathlessness, pleuritic chest pain, haemoptysis, tachypnoea, tachycardia, raised JVP
PE
Low-grade fever, night sweats, weight loss, malaise, cough, haemoptysis
TB
Fever, rigors, malaise, dyspnoea, cough, haemoptysis, pleuritic pain, cyanosis, confusion, tachypnoea, tachycardia
Pneumonia
Dyspnoea and other emphysema symptoms, cirrhosis, cholestatic jaundice if child
Alpha-1-antitrypsin deficiency
Dyspnoea, dry cough, bibasal crackles
Pulmonary fibrosis
Erythema nodosum, bilateral hilar lymphadenopathy, pulmonary infiltrates, heart block, VT, HF, anterior uveitis, chronic meningitis, seizures, neuropathy, hepatic granuloma, hypercalcaemia
Sarcoidosis
Dilatation, ciliary dysfunction, inflammation
Bronchiectasis
Failure to thrive, meconium ileus, cough, wheeze, recurrent infections, bronchiectasis, pneumothorax
Cystic fibrosis
Dyspnoea, dullness to percussion, cough, quieter breath sounds, pleuritic chest pain
Pleural effusion
Stable patient, sudden onset pleuritic chest pain, dyspnoea, cough
Pneumothorax
Hypotension, respiratory distress, low sats, tachycardia, shock, severe chest pain, pneumothorax symptoms
Tension pneumothorax
Exertional dyspnoea, lethargy and fatigue, ankle swelling, accentuated pulmonic component to the 2nd heart sound, tricuspid regurgitation murmur, fatigue, peripheral oedema, cyanosis
PH
Angina, syncope, heart failure, dyspnoea, ejection systolic crescendo decrescendo murmur, narrow pulse pressure
Aortic stenosis
Exertional dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, displaced and hyperdynamic apex beat, decrescendo early diastolic murmur, Austin flint murmur, wide pulse pressure, collapsing pulse
Aortic regurgitation
Progressive dyspnoea, haemoptysis, hoarseness, dysphagia, bronchial obstruction, apical mild diastolic rumble, loud opening S1 snap, rumbling mid-diastolic murmur, mitral facies
Mitral stenosis
Exertional dyspnoea, fatigue, palpitations, displaced, hyperdynamic apex beat, pansystolic murmur at apex
Mitral regurgitation
Constricting/heavy discomfort to the chest, jaw, neck, shoulders or arms
Symptoms brought on by exertion
Symptoms relieved within 5 mins or rest or GTN
Typical angina
Angina of increasing frequency or severity that occurs on minimal exertion or at rest
Unstable angina
Acute central chest pain lasting >20 mins, nausea, sweatiness, dyspnoea, palpitations
ACS
An ACS with ST-segment elevation or new-onset LBBB
STEMI
Dyspnoea, fatigue, orthopnoea, poor exercise tolerance, nocturnal cough, wheeze, nocturia, cold peripheries, Peripheral oedema, ascites, nausea, facial engorgement, epistaxis
Heart failure
Splinter haemorrhages, Osler’s nodes, Janeway lesions, Roth spots, Fever
IE
Chaotic irregular rhythm with an irregular ventricular rate, asymptomatic, palpitations, dyspnoea, chest pains, fatigue
AF
Palpitations, breathlessness, chest pain, dizziness, syncope, fatigue, saw-tooth pattern
Atrial flutter
MaRRoW (R wave in V1, Slurred S wave in V6), Wide QRS, asymptomatic, syncope/presyncope
RBBB
WiLLiaM (Slurred S wave in V1, R wave in V6), Wide QRS, notched top, T wave inversion in lateral leads, asymptomatic, syncope/presyncope
LBBB
PR interval >200ms
1st degree heart block
Progressive lengthening of PR interval, one non-conducted P wave, next PR interval is shorter, light headedness, dizziness, syncope
2nd degree Mobitz I heart block
Constant PR, occasional non-conducted P waves, wide QRS,
2nd degree Mobitz II heart block
Two P waves per QRS, normal consistent PR intervals, SOB, postural hypotension, chest pain
2nd degree heart block 2:1
Dissociation between P waves and QRS so occur at different rates, abnormally shaped QRS, dizziness, blackouts
3rd degree heart block
Abnormal P waves, normal QRS, >150 bpm
Atrial tachycardia
Absent P wave, normal QRS, >100 bpm
AV nodal re-entrant tachycardia
No P waves, regular wide QRS, no T waves, >100 bpm
Ventricular tachycardia
Premature wide QRS with no P wave and then a compensatory pause or QRS and T waves disconcordant
Ventricular ectopic
Syncope, palpitations, may progress to VF, QT interval greatly increased
Prolonged QT syndrome
Short PR interval, delta waves (wide QRS complex that begins slurred), palpitations, severe dizziness, dyspnoea, syncope
WPW syndrome
Usually asymptomatic, pulsatile mass if big, bruit on auscultation, lower back/abdominal pain if expanding rapidly
AAA
Acute onset of severe, tearing abdominal pain with radiation to back, flank and groin, painful pulsatile mass, hypovolemic shock, syncope, nausea, vomiting
Ruptured AAA
Sudden and severe tearing pain in chest radiating to back, hypotension, asymmetrical blood pressure, syncope
Aortic dissection
Pain, Paralysis, Pulseless, Perishingly cold, Pallor, Paraesthesia
Critical limb ischaemia
Pain in lower limbs on exercise, relieved on rest due to intermittent claudication, leg may be pale, cold, loss of hair, skin changes, unremitting pain in foot, especially at night so hangs foot out of bed
Peripheral vascular disease
Sharp, pleuritic chest pain with rapid onset, worse when lying flat and on inspiration, relieved by sitting forward, radiates to trapezius ridge, dyspnoea, cough, hiccups, fever, myalgia, Pericardial rub heard on auscultation, tachycardia, peripheral oedema, increased JVP
Acute pericarditis
Ventricular septal defect, pulmonary stenosis, hypertrophy of RV, overriding aorta
Tetralogy of Fallow
Fatigue, dyspnoea, faintness, palpitations, headache, anorexia, irritability, difficulty concentrating, pallor, tachycardia, systolic flow murmur, cardiac failure
Anaemia
Pallor, fatigue, palpitations, SOB, jaundice, Irregularly contracted cells, bite cells, reticulocytosis, G6PD levels low
G6PD deficiency
Pain in hands and feet, long bone pain, cognitive defects in children, PH and chronic lung disease, splenic sequestration
Sickle cell crisis
Severe anaemia, failure to thrive, skull bossing, hepatosplenomegaly, osteopenia
Beta thalassaemia major
Unilateral calf pain, warmth, swelling, redness, ankle oedema
DVT
Hepatomegaly, splenomegaly, lymphadenopathy, CNS involvement, SVC obstruction, anaemia, infections, bleeding, characteristic blast cells on blood film
ALL
Anaemia, infection, bleeding, bone pain, hepatomegaly, splenomegaly, gum hypertrophy, blast cells with Auer rods
AML
Wt loss, tiredness, fever, sweats, gout, bleeding, abdominal discomfort, anaemia, infection, massive hepatosplenomegaly, Philadelphia chromosome
CML
Wt loss, sweats, anorexia, enlarged, rubbery, non-tender nodes, small mature lymphocytes, smudge cells
CLL
Reed-Sternberg cells, fever and sweating, lymphadenopathy, systemic B symptoms, painful nodes on drinking alcohol
Hodgkin’s lymphoma
Fever and sweating, enlarged, rubbery non-tender lymph nodes, B symptoms, GI and skin involvement, no Reed-Sternberg cells
Non-Hodgkin’s lymphoma
Pepper pot skull, back pain, Bence Jones proteins, OLD CRAB
Multiple myeloma
Fever, chills, headache, cough, splenomegaly, jaundice, confusion, seizures, travel history
Malaria
JAK2 mutation, Headaches and dizziness, itching, fatigue, tinnitus, erythromelalgia, HTN, angina
Polycythaemia
Bleeding following venepuncture, bleeding following trauma
Neonatal bleeding, history of spontaneous bleeding, GI bleeds, haematuria
Moderate/severe haemophilia A
Bruising, epistaxis, pallor, haemoptysis, heavy bleeding from minor trauma, bleeding from tooth loss in childhood, joint pain and stiffness, headache, irritability, vomiting, haematemesis from GI bleed
Haemophilia B
Bleeding from mucosa - epistaxis, menorrhagia, spontaneous bleeding, blood clots during childbirth, spontaneous death
von Willebrand disease
Purpura, epistaxis, menorrhagia, prolonged bleeding from the gums, severe headache, vomiting, fatigue
Immune thrombocytopenia purpura
Flu-like symptoms, purpura, epistaxis, easy bruising, menorrhagia, haemoptysis, headache, abdominal pain, GI bleeding, chest pain
Thrombotic thrombocytopenic purpura
Large bruises, spontaneous bleeding at venepuncture sites or after minor trauma, epistaxis, GI bleeds, confusion and shock, fever, ARDS, purpura, gangrene
DIC
Stiffness of the neck, photophobia, severe headache, fever, feel unwell, rash
Meningitis
Lethargy and fatigue, decreased level of consciousness, fever, occasionally there may be fits
Encephalitis
Contralateral sensory loss, contralateral hemiplegia that’s initially flaccid but becomes spastic, dysphasia, homonymous hemianopia, visuo-spatial deficit, UMN facial weakness that’s forehead sparing
Cerebral infarct
Quadriplegia, locked-in syndrome, facial numbness/paralysis, gaze/vision disturbances, dysarthria and speech impairment, altered consciousness
Brainstem infarct
An ischaemic neurological event with symptoms lasting <24h, they usually have an embolic cause and symptoms usually last a lot shorter than 24h
TIA
Sudden onset excruciating headache, thunderclap, typically occipital, nausea and vomiting, collapse, loss of consciousness, seizures, coma, neck stiffness, Kernig’s sign, Brudzinski’s sign, retinal/subhyaloid/vitreous bleeds
Subarachnoid haemorrhage
Fluctuating level of consciousness +/- physical or intellectual slowing, sleepiness, headache, confusion, increased ICP, seizures, localising neurological symptoms occur later
Subdural haemorrhage
Lucid interval, Rapidly declining GCS, increasingly severe headache, vomiting, seizures, hemiparesis, UMN signs
Extradural haemorrhage
Simultaneous electrical discharge throughout the whole cortex, bilateral and symmetrical motor manifestations and always associated with loss of consciousness and lack of awareness
Generalised seizure
Resting tremor, hypertonia, bradykinesia (Slow to initiate movement, actions slow and decrease in amplitude with repetition, abnormal gait, expressionless face)
Parkinson’s
Pyramidal weakness, spastic paraparesis, changes in sensation, fatigue, chronically increasing bladder involvement, cognitive impairment, dizziness, depression, Usually UMN, loss of colour vision, Lhermitte sign, Uhthoff phenomenon
MS
Stumbling spastic gait, wrist/foot drop, change in appearance of hands, excessive fatigue, UMN (Babinski reflex, increased muscle tone, muscle weakness, overactive reflexes), LMN (Fasciculations, decreased muscle tone, muscle weakness, decreased reflex response), Bulbar (Speech or swallowing difficulties)
MND
Coma, Cerebellar signs (DANISH), nausea and vomiting, seizures
Brain tumour
Recent onset temporal headache, myalgia, malaise, fever. jaw claudication, diplopia, temporal artery may be prominent/tender, bruits over carotid/brachial artery
GCA
Paraplegia, pain, paraesthesia, changes to tendon reflexes, Red flags = Loss of bladder or bowel function, UMN signs in lower limbs, LMN signs in upper limbs
Spinal cord compression
Saddle paraesthesia, bladder/bowel dysfunction, sexual dysfunction, motor problems, lower back pain, bilateral LMN weakness, absent ankle reflex, loss of anal tone/sensation
Cauda equina syndrome
Numbness, tingling, muscle weakness, dropping objects, sharp pains, buzzing sensations in limbs
Nerve lesions
Double vision going down stairs
Trochlear lesion
In index and middle fingers, pins and needles, pain, numbness, weakness and loss of grip
Carpal tunnel
Weakness of small muscles of the hands, deltoid and triceps, bulbar muscles, mastication muscles, worse on exertion, better on rest, ocular symptoms, seizures
MG
Loss of touch, proprioception, temperature/pain, paraesthesia, numbness/tingling/burning or shooting pains, positive Romberg test, distal weakness, proximal weakness, muscle wasting, fasciculations, absent tendon reflexes
Peripheral neuropathies
Flu-like symptoms and a rash 2-4 weeks after infection, Can have persistent generalised lymphadenopathy
HIV
Initial - None or vomiting +/- RUQ pain, later - jaundice, encephalopathy, +/- AKI
Paracetamol overdose
Proteinuria/nephrotic syndrome, cardiomyopathy/arrhythmia/angina, neuropathy/carpal tunnel, malabsorption/perforation/obstruction, purpura/bleeding, hepatosplenomegaly, Howell-Jolly bodies
Amyloidosis
Swelling of an area, reduced range of movement, feeling of heaviness/tightness in limb, recurrent infections
Lymphadenopathy
Gradual drowsiness, Vomiting, Dehydration, abdominal pain, Ketotic breath, tachycardia, hypotension, Kussmal’s breathing, reduced tissue turgor
DKA
Decreased consciousness, severe dehydration, hyperglycaemia, hyperosmolality
HHS
Rapid onset, odd behaviour, sweating, tachycardia, seizures
Hypoglycaemia
Hot and sweaty, diarrhoea, weight loss, anxiety/restlessness, hyperphagia, Periorbital swelling, goitre, tachycardia
Hyperthyroidism
Weight gain, depression, constipation, cold intolerance, brain fog, bradycardia, delayed reflexes
Hypothyroidism
Diffuse goitre, thyroid eye disease, pretibial myxoedema, acropachy
Graves’ disease
A lump in the neck
Thyroid cancer
Chronic glucocorticoid excess, Loss of normal HPA axis feedback mechanisms, Loss of circadian rhythm of cortisol secretion, Central obesity, plethoric complexion, weight gain, purple abdominal striae, mood change, moon face, proximal muscle weakness, gastric ulcers, osteoporosis, hirsutism
Cushing’s syndrome
Large hands, box jaw, thick skin, arthritis, sight problems, HTN, insulin resistance, bitemporal hemiopia
Acromegaly
HTN, nocturia and polyuria, mood disturbance, difficulty concentrating, hypokalaemia, acidosis
Primary hyperaldosteronism
Fatigue, weakness, weight loss. nausea/vomiting, abdominal pain, diarrhoea/constipation, hyperpigmentation if Addison’s, postural hypotension, hypoglycaemia
Adrenal insufficiency/Addison’s
Asymptomatic, fatigue, generalised weakness, muscle cramps and pain, palpitations, arrhythmias, muscle paralysis, rhabdomyolysis, Flat T waves, ST depression, prominent U waves, prolonged PR
Hypokalaemia
Tall tented T waves, prolonged PR, widening of QRS interval, small/absent P waves
Hyperkalaemia
Nausea and vomiting, headache, lethargy, cramps, weakness, confusion, Raised JVP, oedema, ascites
SIADH
Polyuria, polydipsia, dehydration, Dry mucosa, sunken eyes, changes to skin turgidity
Diabetes insipidus
Heartburn, belching, odynophagia, nocturnal asthma, chronic cough, laryngitis, sinusitis, Worse after meals and when lying, relieved by antacids
GORD
Circumferential and continuous inflammation limited to mucosa, no skip lesions, Remissions and exacerbations, LLQ pain, abdominal cramps/discomfort, episodic or chronic diarrhoea +/- blood/mucus or urgency, Fever, malaise, anorexia, wt loss, Clubbing, aphthous oral ulcers, nutritional deficits
Ulcerative colitis
Transmural inflammation affecting any part of the gut, from mouth to anus. There are skip lesions and a cobblestone appearance, abdominal pain, weight loss, right iliac fossa pain, bloody diarrhoea and urgency, pain on defecation, clubbing, oral aphthous ulcers, skin/joint/eye problems
Crohn’s disease
Dermatitis herpetiformis, stinking stools, steatorrhoea, diarrhoea, abdo pain, bloating, nausea and vomiting, wt loss, fatigue, weakness, anaemia, osteomalacia, angular stomatitis
Coeliac
Abdominal pain/discomfort - relieved by defecation
Bloating
Change in bowel habit - stool form/frequency
Urgency, incomplete evacuation, abdominal bloating/distension, mucus in stool, worsening of symptoms after food
IBS
Vomiting, progressive dysphagia, anorexia and weight loss
Oesophageal cancer
Anorexia, nausea, weight loss, anaemia, dysphagia, vomiting, epigastric pain
Gastric cancer
Pain, mass, bleeding, change in bowel habit, weight loss, vomiting, obstruction
Colon cancer
Epigastric pain that’s worse on eating and relieved by antacids
Gastric ulcers
Epigastric pain after meals and at night that’s relieved by eating or milk
Duodenal ulcers
Periumbilical pain that moves to right iliac fossa, Guarding, tender mass in RIF, pyrexia, anorexia, nausea and vomiting, Rovsing’s sign
Appendicitis
Pain that’s initially colicky but then diffuse and higher than in LBO, vomiting following pain that’s earlier than in LBO, less abdominal distension than LBO, increased bowel sounds
Small bowel obstruction
More constant and diffuse pain than SBO, more abdominal distension than SBO, bowel sounds normal –> increased –> none, palpable mass, vomiting later or absent, constipation earlier then SBO
Large bowel obstruction
LIF pain with tenderness, palpable LIF mass, constipation, tachycardia, fever
Diverticulitis
Epigastric pain, nausea and vomiting, dyspepsia
Gastritis
Painful joints stiff for 30 or less in the morning and gets worse throughout the day. Distal Heberden nodes. Proximal Bouchard nodes
Osteoarthritis
Acute monoarthropathy with severe joint inflammation. Joints are hot, swollen and painful
Gout
Knee, Hot, swollen, tender joint. Might have recently injured the joint
Pseudogout
Lower back pain and stiffness that’s worse with rest and improves with movement. Sacroiliac pain, flares of worsening symptoms
Ankylosing spondylitis
Inflammatory joint pain, plaques of psoriasis, onycholysis, dactylitis, enthesitis
Psoriatic arthritis
Painful, swollen, stiff joints for more than an hour in the morning, better with movement, Swan neck thumb, ulnar deviation, boutonniere deformity, Z thumb, Rheumatoid nodules, Sjogren’s, Anaemia of chronic disease, Keratoconjunctivitis sicca, pleural disease (usually asymptomatic), Pericarditis (symptomatic uncommon)
Rheumatoid arthritis
Conjunctivitis, urethritis, arthritis. Can’t see, can’t pee, can’t climb a tree
Reactive arthritis
Hot, swollen, painful, restricted joint, fever
Septic arthritis
Child with limp or reluctance to weight bear, non specific pain at site of infection, low grade fever, malaise + fatigue
Osteomyelitis
Butterfly rash, weight loss, fever, fatigue, joint pain, mouth ulcers
SLE
Bone pain worse at night, constant or intermittent, resistant to analgesia, may increase in intensity, atypical bony or soft tissue swelling/masses, pathological fractures, mobility issues, inflammation and tenderness
Bone tumour
Fatigue, brain fog, pain, morning stiffness
Fibromyalgia
Bone pain and tenderness, dull ache that’s worse on weight bearing, fractures - especially neck of femur, muscle weakness - waddling gait/difficulty with stairs
Osteomalacia
Stunted growth, hypotonia, knock-kneed/bow-legged
Rickets
Arthritis, dry eyes and mouth
Sjogren’s
