Chris Isles

Question 1

Questions to ask jaundiced

Answer 1

• itch (cholestasis)
• dark urine
• pale stools
• pain? (gallstones, cholangitis)
• weight loss
  (pancreatic cancer)
• blood transfusion
  (HBV, HCV)
• foreign travel
  (HAV)
• medications
• alcohol intake
• occupation

Question 2

Stigmata of chronic liver disease

Answer 2

spider nevi 
palmar erythema 
dupuytren's 
gynaecomastia 
loss of body hair 
parotid swelling 
testicular atrophy

Question 3

Signs of portal hypertension

Answer 3

ascites
splenomegaly
distended abdominal veins

Question 4

Signs of hepatic encephalopathy

Answer 4

Confusion
Flap (asterixis)
Hepatic fetor
Constructional apraxia

Question 5

Other signs to look for in jaundiced patient

Answer 5

pallor (haemolytic anaemia)
weight loss 
scratch marks (obstructive jaundice) 
tattoos/body piercing/needle tracks 
urine and stools (pale urine, dark stools) 
palpable gall bladder

Question 6

Courvoisier’s law

Answer 6

palpable gallbladder doesn’t mean gallstones - suggests pancreatic cancer

Question 7

Murphy’s sign suggests what

Answer 7

acute cholecystitis
- take deep breath in while palpating subcostal area.
pain on INSPIRATION

Question 8

Troisier’s sign

Answer 8

intra-abdominal malignancy

- hard left supraclavicular node (Virchow’s node)

Question 9

Investigations for jaundice

Answer 9

abdo USS *
Routine bloods
Viral studies

Question 10

5 commonest causes of hepatomegaly

Answer 10

in UK: 
cardiac failure 
fatty liver (alcoholic or NASH) 
early cirrhosis 
cancer (liver secondaries)
infections (HAV, EBV)

Question 11

Causes of hepatomegaly (give more than 5)

Answer 11

cardiac failure 
fatty liver (alcoholic, NASH)
early cirrhosis 
cancer 
infections 
Other chronic liver disease (PBC, PSC, CAH, Hep)
myeloproliferative (CML)
Lymphoproliferative (CLL, lymphoma)

Question 12

Describing hepatomegaly

Answer 12

Size
Consistency (soft, firm, hard)
Surface - smooth or irregular
Tender - heart failure, hepatitis

Question 13

Causes of splenomegaly

Answer 13

CML 
Myelofibrosis 
Malaria 
Kala-azar 
Gaucher's disease

Question 14

How to tell whether you can feel spleen or kidney?

Answer 14

spleen might have a notch
kidney is ballotable
spleen dull to percuss, kidney band of resonance
spleen enlarges to RIP, kidney moves down on insp

Question 15

Causes of hepatosplenomegaly (and what would you look for?)

Answer 15

Myeloproliferative - pallor, purpura)
Lymphoproliferative (lymph nodes)
Cirrhosis with portal HTN (signs of chronic liver disease)

Question 16

Signs of ascites

Answer 16

Adominal distension
flank dullness which shifts
fluid thrill

Question 17

Causes of ascites

Answer 17

CCCC
Cirrhosis: with portal hypertension (alcoholic)
Cancer (ovarian, breast, gastric, colonic, hepatocellular carcinoma)
Cardiac (severe RHF or constrictive pericarditis)
Venous thrombosis
Others: TB, pancreatitis, nephrotic syndrome, myxoedema

Question 18

what would cause bilateral palpable kidneys

Answer 18

polycystic kidneys !!!
renal cancer
hydrnephrosis
amylodosis

Question 19

recognising a renal transplant

Answer 19

scar in LIF/RIF
feels like bar of soap
chec scars from previous tunnelled line or PD catheter

Question 20

3 commonest reasons leading for a renal transplant

Answer 20

diabetes
hypertensive renal disease
glomerulonephritis

Question 21

kidney injuries in patients with transplant

Answer 21

rejection 
calcineurin toxicity 
obstruction 
renal artery stenosis 
recurrence of original disease (IgA nephropathy, FSGS)

Question 22

Four Cs of interstitial lung disease

Answer 22

Cirrhosis
Crackles (fine)
Cough (dry)
Clubbing

Question 23

Causes of interstitial lung disease

Answer 23

idiopathic 
allergic 
occupational (asbestosis)
connective tissue (rheumatoid)
drugs (amiodarone)

Question 24

things to comment on in resp exam

Answer 24

chest expansion 
trachea 
percussion note 
breath sounds 
added sounds 
vocal resonance

Question 25

Key signs of asthma /COPD

Answer 25

vesicular breath sounds with expiratory wheeze (COPD might have a few crackles)

Question 26

Severe signs of COPD

Answer 26

``` pursed lip breathing use of accessory muscles tracheal tug hyperinflation of lungs increased AP diameter ```

Question 27

Key signs of pleural effusion

Answer 27

stony dullness with reduced vesicular breath sounds

Question 28

What is bronchial breathing

Answer 28

high pitched blowing sound the sound you hear over trachea Darth Vader sound

Question 29

Interstitial lung disease key signs

Answer 29

fine inspiratory (velcro) crackles

Question 30

Investigations for interstitial lung disease

Answer 30

CXR: 'reticular' pattern HRCT: honeycomb

Question 31

Bronchiectasis key signs

Answer 31

coarse insp and exp crackles, wheeze if coexistent COPD

Question 32

Differential to bronchiectasis

Answer 32

``` Interstitial lung disease - both have clubbing B: productive cough ILD: dry cough PFTS (B is obstructive and ILD is restrictive) HRCT (B signet ring and honeycomb lung) ```