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*** Exam Medicine > Clinical Features > Flashcards

Clinical Features Flashcards

1
Q

HF

A

Left
SOB, Orthopnea, PND, Frothy Cough, Cardiomeg, Displaced Apex Beat, effusion

Right
Raised JVP, Peripheral Oed, Hepatomeg

Acute - N+V, Pain?

*ECG - LVH, ST elev, arrythmia, evidence past MI

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2
Q

STEMI

A 
Tight chest, 
N+V,
Pain radiating to arm, 
SOB, 
Sweaty, 
cool clammy peripheries
Hypotension

*ECG - ST el + Q waves + recipricol ST dep

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3
Q

AF and Hypertension

A 
AF
Palpitations, 
irregularly regular pulse
fatigue
>65

*5x risk of stroke / RF - HTN/CAD/DM/Smoking/Old

HTN
Retinal haem
Proteinuria
papilloedema
epistaxis
angina
LVH
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4
Q

AS vs Mitral Regurg

A 
AS
Slow Rising Pulse
Harsh, ejection systolic murmur
Radiating to carotids, heard in right aortic area
LVH, SOB, Chest Pain, Previous Syncope
MR
Pansystolic Murmur, radiating to axilla, heard in mitral area
Displaced apex beat
Pul Oedema
SOB on exertion
Hist I.E
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5
Q

IE

A 
Roth Spots
January Lesions
Splinter Haem
Oslers Nodes
MR

*DUKES staging

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6
Q

Pericarditis

A 
Better leaning forward
Sharp, Central Chest Pain, radiating to left shoulder
Worse on insp
fever
Pericardial rub

*ECG - Saddle shaped

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7
Q

HyperThyroid

A 
Heat Intolerance
Agitated
Weight Loss
Appetite Increase
Palpitation
Tremor
Goitre (with bruit if graves)
Exopthalmus
Lid Lag

*Must do ECG - AF

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8
Q

HypoThyroid

A 
Goitre
Cold Intolerance
Weight Gain
Thin Hair/ Loss
Ammenorhea
Lethargy
Constipation
Bradycardia
Depression
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9
Q

Diabetes

A 
Pear Drop Taste in mouth
Polydipsia, Polyuria
Weight Loss
Dizziness/ Drowsiness
2-6 weeks post infection

complications
Neuropathy/ Ulcers

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10
Q

Cushings

A 
Obese
Striae
Coarse Skin
Buffalo Hump
Moon Face
Gray Complexion
Decreased Libido
Impotent/ Amenorrhea
BP increase
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11
Q

Addison’s

A 
Bronze Colour
Weight Loss
Anorexia
Postural Hypotension
Hypotension
N+V
Fatigue
Hyperkalaemia - Arrythmias
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12
Q

COPD vs Asthma

A

COPD
RESP DISTRESS - SOB, wheeze, Cough,Increased RR, Pursed lip breathing, Acces muscles, barrel chest,
INFECTION - Consolidation? Fever,decreased chest expansion
CO2 ret flap, drowsy

Asthma
Wheeze, cough, sob, atopy

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13
Q

Pneumonia

A 
Tachycard/dysp
Sputum cough (haemop)
Fever
Pain in area of infection
Decreased air entry
Coarse Crackles heard
Increased Tactile/Vocal Frem
Dull Percussion

*CURB 65 score

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14
Q

PE

A 
Pleuritic Pain
Worse on Insp
SOB
Risk Factors for PE
Haemoptysis
Periph Oedema
RR/HR increase and Infection signs

*ECG - S1 Q3 T3

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15
Q

Tension Pneumo/ Effusion

A 
TP
Increased HR/RR
Tracheal Deviation
Decreased air entry affected side
Pain
Effusion
Stony Dull Percusion
Bronchial Breathing
Decreased air entry/decrease tactile frem/breath sounds
Tracheal Deviation
SOB and Pain

*Exudate or transudative - 11.1 g/L

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16
Q

Bronchiectasis

A 
Lots of purulent sputum with cough
Persistant cough
Haemop
Coarse Insp Crackles
Finger Clubbing
wheeze
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17
Q

Lung CA

A 
HOARSE VOICE
Pain
Lymph Nodes - Sub Clav
Clubbing
Haemoptysis
Weight Loss
Appetite Loss
Perhaps bone issues
Cough
Other infections
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18
Q

Sarcoidosis

A 
Bilateral Lymphadenopathy
Erythema Nod
Polyarthralgia
SOB
Wheeze
cough
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19
Q

Oes Ca

A 
HOARSE VOICE
Dyspahgia
Weight Loss and appetite loss
retro-sternal Pain
cough?

*OGD + biopsy / Barium Swallow

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20
Q

Ulcers

A

Epigastric Pain (localised by pointing)
tenderness
heartburn
IF SEVERE - Weight Loss, anorexia

GU - worse when eating
DU - relieved by eating

*Think Complications for PC - haematem/melaena/anaemia

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21
Q

Gallstones

A

Fat Forty Fertile Female Fam Hx

RUQ pain and Guarding
Jaundice
N+V
fever
Murphy’s Sign +ve

*ERCP/ MRCP major diagnostic if in bile duct

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22
Q

Acute Panc vs Panc CA

A 
LUQ radiating to back, Guarding and Tender
Better sitting forward
Fever and Vomiting?
Jaundice?
Pale, Fatty Stools

*Classified-PANCREAS / COMP= Renal Fail/Shock/Sepsis

Panc CA
Palpable mass gallbladder
Painless jaundice
HepatoSplenomegaly

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23
Q

Colon CA L vs R

A 
L
Tenesmus
Altered bowel Habit
Mucus/Blood Stool
PR Mass
R
Weight Loss
Blood in Stool/ Hb Decrease
Abdo Pain
Palp Mass

*RF - IBD/Neop Polyps/ Prev CA
I - FOB, Scopes

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24
Q

Bowel Obs Sm vs L

A 
Sm
Less distension
Nausea earlier
Constipation
Tinkling bowel sounds
Central Abdo, Colicky pain
L
More distension
Later Nausea
Constant Pain
Tympanic Percussion of Abdo

*Comp - Perforation (erect cxray), Sigmoid Volv, Sepsis

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25
Q

Acute Appendix

A 
Fever
Increased HR/RR
Anorexia
Pain starts epigastric and moves RIF
 - Rosving sign +ve
 - Pain over McBurneys Point
 - Rebound Tenderness

*Do preg test if aprop/ 1st management = NBM

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26
Q

Venous Disease

A 
Ulcers
 - Anterior Tibial / medial malleolus
 - Not well circumscribed/ uneven edges
 - No Necrosis
Varicose Veins
Vascular Dermatitis
Warm peripheries, Normal Colour
Moderate Pain
ankle oedema

*RF - DVT / Preg / Pill / Obesity

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27
Q

Arterial Disease

A 
Ulcers
 - Tips of toes and between toes
 - Black, necrosis
 - Well circumscribed
Absent Pulses
Cool peripheries
BIG Pain on exertion, better at rest (unless crit limb isc)
Cap Refill >2secs

*Bueger’s Sign / Brachial Ankle Pressure + Duplex US
T - Stent/ Amputation/ Lifestyle/ Embolectomy?

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28
Q

Breast Lumps

A

Cyst - fluid filled, mid age(perimeno), linked to HRT, mobile
Fat Nec - trauma,skin change, firm, painless, irreg border
FibroAd - young, mouselike, small, mobile, smooth
Phyllodes - growing, defined, necrosis

CA
Asymmetry, hard, tethered, craggy, lymph nodes involved, skin changes, nipple changes (inversion, discharge, pagets)

*Brown/Yellow Discharge = Duct Ectasia
Red - CA or Intra-Duct Pap

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29
Q

IBD

A

UC - Gradual Onset, Bloody diarr, >10 times per day, pain, smoker, Erythema Nod, pyoderma gang, LIF pain

*Compl - Tox megacolon, Perf, CA, PSC?

Crohns - RIF pain, crampy type, not as much bloody diarr, non-smoker, vomiting

  • Compl - Sm Bowel Obs/ Fistula/ Toxic Dilatation
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30
Q

Hepatitis

A 
RUQ pain, 
jaundice (and itch)
N+V
confusion and lethargy
Fever
Hepatomegaly

dark Urine

*if Paracetamol OD - N-acetyl cysteine

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31
Q

Haemachrom (AR)

A

Slate gray, can be bronze if diabetic
Sign of Chronic Liver Disease
Fatigue
Arthrlagia

*Treated with Venesection

32
Q

Alfa 1 antitryp (AR)

A

Affects Lungs, Liver and …

Lung - Productive Cough, SOB on exertion
Liver - Hepatomeg, Ascites, Jaundice

33
Q

Wilsons (AR)

A

Aged 10-40
Hepatitis
Cirrhosis
Hepatic Decomp

Copper buildup, around iris?

*linked to Parkinson’s

34
Q

PBC vs PSC

A

PBC - women
Granulomatous inflam in Bile Duct —> obstruction
xanthelasma, jaundice, hepato/splenomeg, itch

*Anti-Mitochond AB’s // Both Need Transplant!!!

PSC - men
Inflammation of Med/L Bile ducts —> fibrosis —> stasis
Hx of UC (80%)
Jaundice, Itch, Fatigue —> fever + cholangitis

35
Q

Cirrhosis

A

Signs of Chronic Liver Disease!!!
Spider Naevi, Liver Flap, Dupytrens, Caput Medusae, Plmer erythema
Bleeding and Bruising
Jaundice, itch
Haematemesis
Portal Hypertension - Ascites, Varices, Enceph

*T of Ascites - Decrease Na, LVP, Duretic, Transplant

36
Q

Coeliacs

A 
Diarr
Anaemic - decreased B12, Folate and Iron
Anorexia, Weight Loss
Stinking Poo!
 - Dermatitis Herpetiformis

*Crypt Hyperplasia and Sub-total villous atrophy // TTG/IgA

37
Q

HCC

A

Jaundice
Upper Abdo Pain
Weight Loss, pallor
Signs of Chronic Liver Failure… + varies/ascites

*RF - Schistisomis/ Steroids/ Fam Hx/ Cirrhosis
Tumor marker - alfa fetoprotein

38
Q

Anaemia

A

IDA
SOB, fainting, palpitations, Tachycardia, pale palmer crease, pallor, pale conjunctiva, leukonychia, koilonychia, angular stomatitis, Rectal Bleeding, heavy periods

Folate/B12
SOB, diarr, headache, glossitis, fatigue, anorexia, pale palmer crease, pallor, pale conjunctiva

Aplastic
Anaemia + Infection + Bleeding

Pernicious
Loss of IF because of parietal cell gastritis —> atrophy or gastrectomy

39
Q

Leukaemia

A 
Acute
Bleeding, Bruising, infections, anaemia, splenomegaly, bone pain
AML - gum hypertrophy
ALL - Tyrokin Inhib
*Allopurinol in both!

Chronic
Weight loss, tiredness, fever, night sweats (asympt?) Lymphadenopathy.
Massive Splenomegaly!

CML - Tyrosine Kin Inh

40
Q

Lymphoma

A

B symptoms - night sweats, fever, weight loss
Painless Lymphadenopathy
SOB
Infections, Bruising, Bleeding

*Hodgkins defined by Reed-Sternburg Cell

41
Q

Myeloma

A

Ca up
Renal dysfunction
Anaemia
Bone Pain

*Treat Each symptom separately

42
Q

Eczema

A

Atopic/ Contact/ Sebhorric/ Vasculitic

Flexor Surfaces
Erythema
Scratch Marks
Acute Lesions - weepy

*Topical Emolients + Topical CorticoSteroids(hydrocort) + UV therapy +/- ABx’s and Antihistamine

43
Q

Psoriasis

A

Classic Plaque/ Guttate/ Erythrodermic/ Pustular

Red raised plaque, with salmon pink encircling, silver scales on top.
Erythema
Extensor Surfaces
Scratch Marks
Auspitz Sign - removal of plaque = capillary bleeding

Nail Changes - Pitting/ Discolour/ Onycholysis/ Sub ungal Hyperkeratosis

*Topical - Emolients + Vit D3 ana + Topical Ster + Coal Tar
Next - Phototherapy
Systemic - acretin / methotrexate / infliximab

44
Q

ACNE

A

Vulgaris/ Rosacea/ Folliculitis/ Keritosis

Erythema, Pustules, Comedones
Papules
Hirtuism
Greasy Skin
Scarring

*1st - Topical Retinoids + The Pill + Topical ABx’s
2nd - Oral Retinoids + The Pill + refer to dermo

45
Q

CA

A

ABCDE

BCC - Pearly white, small nodule
SCC - Not shiney, more keratotic
MM - Colour change, growing, bleeding, sunburnt, asym, irreg borders

*Breslows and Clarks and TNM
RF - Sunbeds/ Bad sunburn/ Fair skin/ Moles/ Fam Hx

46
Q

Cellulitis

A 
Red/Blue
Swollen
Tender
Hot
Unilateral
Site of Infection

*Staph Aur or Strep pyogenes
T - Mark with pen the borders

47
Q

Osteo Arthritis

A 
Joint Crepitus
Decreased ROM
Joint Tenderness, Joint Instability
Heberdens Nodes
Musc Wasting
*xray
Loss of Joint space
Peri-articular sclerosis
Sub Chondral cysts
Osteophytes
48
Q

Rheumatoid Arthritis

A

DIP and PCP + wrist joints
Rheumatoid Nodules
Ulnar Deviation at MCP
Swann-Neck, Z-shaped thumb, Boutinerres Deform

*xray
Palmer Subluxation at MCP
Decreased Joint Space
Soft Tissue Swelling
Periarticular osteoporosis
49
Q

Septic Artritis

A

Fever, Hot swollen Joint
Pain
Hx of Infection/trauma or Prosthetic Joint

*Blood Culture - Staph/Strep pyogen
Joint aspirate and washout for treating

50
Q

Psoriatic Arthritis

A 
DIP and Sacro-Iliac
Unilateral 
Dactylitis
*Psoriasis present
Pencil-in Cup on xray
51
Q

Ank Spond

A

Back Pain - stiff in morning made better with exercise
Eye Pain
Leg Pain

Worse with Straight Leg raise

52
Q

Hypo Nat

A

N+V
Anorexia
Malaise
Confusion

HypoNat Enceph = Seizures / Coma

*If Acute or Dehydrated - cautious rehydr + frusemide
If Chronic/asymp - Fluid restric + ADH antagonist

53
Q

HyperKal

A

Worrying =
Arrhythmias , Chest Pain, Weakness, irreg pulse

*T - Calcium Gluc - cardiac memb protection
Insulin (actrapid) - push K+ into cells
Calcium Resonium - Increase K+ absorption in Gut

54
Q

HypoKal

A 
Musc weakness
hypotonia
hyporeflexia
palpitation
constipation

*Oral Sando-K

55
Q

HyperCalcaemia

A 
Bones - pain/ path fracture
Thrones - constip/ polyuria
Groans - abdo pain
Moans - depression
Stones - renal or gallstones

*Bisphosphonates

56
Q

HypoCalcaemia

A

SCAMS

Seizure
confused
Anxious
Spasms
musc tone increased

*CKD/ Vit D def // Osteomalacia/ acute panc

57
Q

Stroke

A 
Speech
facial Droop
Hemiplegia
Hemiparesis
Visual Disturbance - homon hemi
Headache
Unconscious
58
Q

SAH

A

Sudden onset, worst ever headache, behind eyes
Unconscious
Photophobia

N+V

*LP done >12 hours to allow xanthyecroma

59
Q

MS

A

Diplopia, painful eye, RAPD
Facial Palsy
Hearing/Balance problems
Depression

Weak painful legs
Lethargic

  • i —> LP - oligoclonal AB’s / Spinal Cord MRI - Gadolinium labelling
60
Q

Parkinsons

A 
Bradykinesia, Tremor and Rigidity. 
Festinant gait
Blank face
Micropathic writing
Postural Instability

*L-dopa and dopa decarboxylase inhibitor
+/- MOAB-I
Drug Induced P - Anti-emetic / neuro-leptics (haloper)

61
Q

MG and Dementia

A

AI
muscle fatigue after exercise without any wasting and normal tone/reflexs.
Diplopia

Dementia
Memory loss/ behavioural change/ agitation/ depression/ agnosia

62
Q

Motor Neuron Dis

A 
Dysphagia
Fasciculations
Brisk Reflexs
Musc weakness
Speech decrease
Breathing difficulties
No sensory loss/sphincter loss

*Upper and Lower Motor Lesion SIGNS!!

63
Q

Neuropathies

A

Ulnar - claw hand / wasting / sens loss
Medial - Carpal Tunnel // Tinnels and Phalens
Radial - Wrist drop / weakness / loss sens
Peroneal - foot drop / decrease dorsiflexion / numb dorsum

Medial - C5-8
Radial - C6-8
Ulnar - C8-T1

64
Q

Sepsis

A

Mottled Skin, fever, confused/GCS down, RR/HR increase, BP drop,
Clammy cool peripheries, N+V, oliguria

65
Q

HIV

A

Night Sweats, Weight Loss, fever
Infections - candida/ ulcers/ TB
Diarr
Skin Rashes

66
Q

Returning Traveller (Malaria)

A

Malaria
Delayed onset of symptoms (3-6 weeks)
Fever, Rigors, Tachycardia, Sweating
*Chloraquin

Typhoid
Salmonella - Fever, Headache, Abdo Pain
*Ceftriaxone

Dengue
Mosquitos - Fever and rash + Fatigue

67
Q

Meningitis

A 
Photophob
Neck Stiffness
Headache
Confused
Fever
HR/RR up
Kernels Sign +ve
N+V
68
Q

TB

A 
Abdo Pain
Anorexia/Weight Loss
Fever
Night Sweats
Cough
SOB
Wheeze
Haemop
69
Q

Herpes

A

Sores. Flu-like prodrome then ulcers appear
+/- Dysuria +/- Discharge

Chicken Pox —> shingles

*PCR Testing is Diagnostic

70
Q

PUO

A

Sarcoid/ Lymphoma/ SLE/ Malignancy/ TB

Fever >38 for >3 weeks

71
Q

Mono

A

Cervical Lymph
fever
Pharyngitis
Splenomegaly

*EBV AB’s or PCR

72
Q

AKI

A 
Oliguria/ Haematuria
Palpable kidneys
Pain
Vomiting
JVP up, BP up, Oedema

*Careful of HyperKal

73
Q

Nephritic and Nephrotic

A 
Nephrotic
Hypoalbuminaemia
Hypercholesterolaemia
Oedema
Proteinuria

Nephritic
Haematuria
Hypertension
Proteinuria

74
Q

UTI L vs U

A

L
Urinary Symp - dysuria, oliguria
Supra-Pubic Pain
Haematuria

U
Loin to Groin pain
Infection symptoms (Fever)
N+V

*E-Coli!!!

75
Q

Renal Stone vs PCK

A 
Stone
Loin to groin pain, colic, can’t lie still
Haematuria/ Urgency /Freq up
Fever
Tachycardia
*NSAID treatment
PCK
Irregular Palpable Kidney
Acute Loin Pain
Hypertension
Hepatomegaly
76
Q

Renal CA and Bladder CA and Prostate CA

A

Renal
Abdo Mass + Flank/Loin Pain + Weight Loss + Haematuria

Bladder
Painless Haematuria + recurrent UTI’s + weight loss + Urinary symptoms (Polyuria,hesitancy)

Prostate
Tender bladder, Poor flow, nocturia, freq, hesitancy + weight loss + post Void dribbling

77
Q

Anti-phospholipid Syndrome

A 
Venous Thrombosis (DVT, PE)
Arterial Thrombosis (cerebral ischaemia - stroke/TIA)
Fetal Complications (Spontaneous abortion, premature births)
Thrombocytopenia (not overly severe)

*** Exam Medicine (20 decks)

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