Clinical cases and overview of systems Flashcards
What is angioedema?
Immunological deficiency of C1 esterase inhibitor. Complement activated on minot trauma e.g. dental treatment. Swelling and risk to airway.
You are presented with an axial scan through the brain which shows a convex white shape protruding inwards from the outer LHS. What is the diagnosis, signs and treatment?
Extradural haemorrhage from middle meningeal artery
Confusion, LoC
Cut into skull 2cm up from zygomatic arch, drill hole and drain blood to release pressure
You are presented with an axial scan through the brain which shows white all the way down the entire side of the brain. What is the diagnosis and why does it occur?
Subdural haematoma
Occurs slowly and in elderly due to cerebral atrophy and anticoagulant medication, where bridging veins in that region undergo trauma
You are presented with an axial scan through the brain of a white circle in the central portion of the brain. What is the diagnosis and when does it occur?
Subarachnoid haemorrhage
Spontaneous or secondary to trauma
What are the signs seen in Horner’s syndrome?
One side of patient abnormal. Smaller pupil of affected side (myosis). Ptosis (hooded eyelid). Enophthalmos (eye sunken back). Less sweating on that side of face.
What are the causes of Horner’s syndrome?
Neck lesions pressing on sympathetic nerve plexus lying on surface of carotid artery
What would a child look like if they presented with Impetigo (staphylococcal skin infection)?
Would you treat?
What could be prescribed as treatment?
Golden crusted lesions
No - highly contagious
Fusidic acid ointment or penicillin if systemic
What is indicated if a patient has pitting oedema where a depression is left where the thumb has been?
Cardiac disease or lymphedema
If you see a red/purple lesion on the palate that is not typical or erythroplakia, and the pt has similar skin lesions, what would you suspect?
Kaposi’s sarcoma associated with HHV8
If patient coughing, ask if they bring up any phlegm. If the colour is yellow/green what does this indicate?
May have upper/lower respiratory tract infection - defer treatment until better
A patient presents with a lump in the neck that moves up when the tongue sticks out. What could be a congenital cause?
Thyroglossal cyst - embryologically thyroid gland develops at base of tongue (foramen caecum = remnants). As it descents down the tract to where the thyroid gland is thyroglossal cysts can form
If a patient presents with prominent supraorbital ridges, small frontal sinuses, coarse ST profile ie big lips, large extremities and spaced out teeth, what may they have?
What causes this?
Acromegaly - excess growth hormone secreted by the pituitary gland
If a patient has Addisons disease from adrenal hypofunction, what clinical feature would you notice and why does this occur?
Pigmentation of the buccal mucosa and palms of hands - melanocyte stimulating hormone is chemically similar to ACTH caused intrinsic staining
If a patients left side of face is not moving but the forehead is spared, what has been affected?
Upper motor neurone
If a patients entire left side of face is not moving, what has been affected? If it is idiopathic, what is it called?
Lower motor neurone
Bell’s palsy
What is a complication of long-term steroids? What are some of the clinical features?
Cushing’s syndrome
Moon face, buffalo hump, increase susceptibilty infections, stretch marks from thin skin, gynocomastia, peptic ulceration risk, diabetes, osteoporosis (pt put on bisphosphonates), bruising, females lack periods and have beards
In a glossopharyngeal nerve palsy, the uvula will be deviating to one side. If it is pulled to the left side, which side is the nerve affected?
Right side (pulling away as this side is weak)
In a hypoglossal nerve palsy, the patient has pushed their tongue out but it is deviated to the left. What side has the nerve been affected?
Left. The right side is strong and pushes tongue over to affected side
If a patient has idiopathic thrombocytic purpura (ITP), what will the patient have wrong?
What are these patients given in terms of treatment?
Low platelet count and haemorrages in skin
Prescribed steroids to increase platelet production not by platelet transfusion
What is erythema nodosum? What does it indicate?
Raised painful plaques on shins
Non-specific indicator of disease. IBD and viral
How does herpatic whitlow occur?
What should you do to prevent it?
If you treat a pt with coldsores with an open wound on finger
Wear gloves, treat pt once coldsore healed
What are the 9 features used to describe a lump?
1) Site
2) Size and shape (can say max and min dimension)
3) Surface (smooth or oscillated)
4) Edge (well defined or ill defined)
5) Consistency (hard, soft, rubbery or fluctuant ie fluid, or pulsatile)
6) Fixation/tethering
7) Effects on adjacent structures (nerves)
8) ? Enlargement of draining lymph nodes (may indicate lump infected or malignant)
9) Transilluminability (if fluid filled)
What radiographic changes would you expect to see in Rheumatoid arthritis?
Joint space narrowing
Osteopenia
Erosions
What radiographic changes would you expect to see in Osteoarthritis?
Joint space narrowing
Subchondral sclerosis
Osteophytes (outgrowths of bone)
Subchondral cysts
Describe a total knee replacement and what should you do in terms of antibiotic cover?
PTFE and titanium with intermate interface between prosthesis and bone. Lasts 15 years
Surgeons may ask for cover for bacteraemia producing procedures as risk of infective joint replacement - but amoxicillin has poor bone penetration and cover is not recommended
What are the extraintestinal signs of inflammatory bowel disease?
Pyoderma gangrenosum - on lateral side of ankle
Erythema nodosum - on shins
Uveitis - unequal pupil
How many lobes are in the right and left lungs?
R=3 L=2
On a chest xray, what is the costophrenic angle and what should be seen?
Between the thoracic wall and diaphragm
Radiolucency should be seen below left hemidiaphragm = gastric air bubble
Any radiolucency below right hemidiaphragm = pathological
Where is an inhaled foreign body more likely to end up?
In the right lung as the right main bronchus more vertical and the opening is higher
What would the differences be on a chest xray for lobar pneumonia and diffuse interstitial pneumonia?
Lobar = localised radio-opacity to one lobe Diffuse = Radio-opacities distributed more evenly through the lungs
What should you ask about if you see a patient with corneal arcus (white ring around iris)?
Ask about CVS history
Sign of hypertriglyceridemia and raised cholesterol
What is ascites/distended abdomen?
Pathological fluid in abdomen, will need ascitic tap (needle in abdomen to draw fluid out). Seen in severe malnutrition.
What is dupuytren’s contracture?
Contraction of palmar fascia where little finger and ring finger flexed. Idiopathic, drinking too much alcohol, older antiepileptic drugs can cause this.
What is erythema ab igne?
Arises in pts with painful joints e.g. from arthritis - pt puts something hot to relieve pain and gets a marbled effect on skin
What are the causes of a DVT and how can you identify it?
High oestrogen contraceptive pill, immobility, pelvic surgery, smoking, pregnancy, long travel
Calf is tender, red, swollen and usually unilateral. If pt C/O sharp pleuritic chest pain then pulmonary embolism
