Clinical Exam

Question 1

Neurology

Motor testing: comment on

Answer 1

Posture
Muscle bulk
Tone
Power
Co-ordination
Reflexes

Question 2

Neurology

Drift

Answer 2

Downward: Pyramidal weakness
Upward: Cerebellar disease
Usually only the fingers/any direction: Loss of proprioception - pseudoathetosis

Question 3

Neurology

Fasciculations

Answer 3

• associated with LMN sign
• • can be coarse or fine
• Causes:
  > MND
  > Motor root compression
  > Peripheral neuropathy
  > Primary Myopathy
  > Thyrotoxicosis

Question 4

Myotonia

Answer 4

abnormality of tone that is worse after active movement
- test: tapping on muscle (thenar eminence), tight fist then open

Question 5

Past pointing

Answer 5

Side of the cerebellar lesion

Question 6

Causes of hepatomegaly

Answer 6

Massive:
- Metastates
- Alcoholic liver disease with fatty infiltration
- Myeloproliferative disorders
- RHF
- HCC

Moderate:
- above
- Fatty liver
- Haem: CML, lymphoma
- Haemochromatosis

Mild:
- above
- hepatitis
- cirrhosis
- biliary obstruction
-Infiltrative: amyloid/sarcoid
- granulomatous disease
- Hydatid disease
- HIV
- Ischaemia

Question 7

Causes of Splenomegaly

Answer 7

Massive:
- CML
- myelofibrosis
- Primary lymphoma of the spleen, Hairy cell leukaemia, malaria

Moderate:
- portal HTN
- Lymphoma
- Leukaemia

Mild:
- Other MPD
- haemolytic anaemia (warm)
- ifection: EBV, hepatitis, IE
- CiTD: RA, SLE, PAN
- Infiltrative : amyloidosis, sarcoid

Question 8

Renal masses

Answer 8

Bilateral:
- PKD
- Hydronephrosis
- hypernephroma
- Acute renal vein thrombosis
- Amyloid, lymphoma
- Acromegaly

Unilateral:
- RCC
- hydropnephrosis
- PKD
- Acute renal vein thrombosis

if you find PKD:
- BP
- examine urine for haematuria and proteinuria
- Anaemia or polychythaemia
- check of cerebral aneurysm

Question 9

Hepatosplenomegaly

Answer 9

• CLD with portal HTN
• Haem: MPD, lymphoma, leukaemia, PA, Sickle cell
• Infection: Acute viral hepatitis, EBV, CMV
• Infiltrative: amyloid, sarcoid
• CTD: SLE
• Acromegaly
• Thyrotoxicosis

Question 10

Pansystolic murmur

Answer 10

MR, TR, VSD, AP shunt

Question 11

Mid systolic

Answer 11

AS, PS, HCM, ASD (pulm flow)

Question 12

Early systolic

Answer 12

VSD, Acute MR, TR

Question 13

Late systolic

Answer 13

MVP, papillary muscle dysfunction

Question 14

Early diastolic

Answer 14

AR, PR

Question 15

Mid ddiastolic

Answer 15

MS, TS, Atrial myxoma, Austin Flint, Carey Coombs of ARF

Question 16

Causes of diffuse goitre

Answer 16

• Idiopathic
• P: puberty, post-partum, pregnancy
• Grave’s
• Thyroiditis
• Simple goitre secondary iodine deficiency
• Goitrogens - iodine excess, lithium, phneylbutazone
• Inborn errors

Question 17

Causes of hyperthyroidism

Answer 17

1. Grave’s
2. Toxic adenoma, MNG
3. Iodine excess (from iodine def) - Jod-Basedow phenomenon
4. Drugs: Amiodarone, Lithium
5. Post-partum thyroiditis
6. Initial stage of hashimoto’s

Secondary:
Pituitary or ectopic
Hydatiform mole or choriocarcinoma
Struma Ovarrii
Factitious

Question 18

Causes of hypothyroidism

Answer 18

Primary: Goitre
- Chronic thyroiditis (Hashimoto’s Riedel’s)
- Drugs: Lithium, Amiodarone
- Iodine deficiency
- Iodine induced hypothyroidism: Wolff Chiakoff
- Inborn error

Primary without goitre:
- Idiopathic atrophy
- Treatment: RAI, Surgery
- Agenesis or lingual thyroid
- Unresposniveness to TSH

Secondary: low TSH
Tertirary: Hypothalamic lesions

Question 19

Neurological sx of hypothyroidism

Answer 19

Common:
- entrapment
- Delayed relaxation of reflex
- Nerve deafness

Uncommon:
- Peripheral neuropathy
- Proximal myopathy wiht normal CK
- Hypokalaemic periodic paralysis
- Cerebellar sx
- Coma
- Psychosis
- CVA