Clinical Features Flashcards
HF
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
STEMI
Tight chest, N+V, Pain radiating to arm, SOB, Sweaty, cool clammy peripheries Hypotension
*ECG - ST el + Q waves + recipricol ST dep
AF and Hypertension
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
AS vs Mitral Regurg
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
IE
Roth Spots January Lesions Splinter Haem Oslers Nodes MR
*DUKES staging
Pericarditis
Better leaning forward Sharp, Central Chest Pain, radiating to left shoulder Worse on insp fever Pericardial rub
*ECG - Saddle shaped
HyperThyroid
Heat Intolerance Agitated Weight Loss Appetite Increase Palpitation Tremor Goitre (with bruit if graves) Exopthalmus Lid Lag
*Must do ECG - AF
HypoThyroid
Goitre Cold Intolerance Weight Gain Thin Hair/ Loss Ammenorhea Lethargy Constipation Bradycardia Depression
Diabetes
Pear Drop Taste in mouth Polydipsia, Polyuria Weight Loss Dizziness/ Drowsiness 2-6 weeks post infection
complications
Neuropathy/ Ulcers
Cushings
Obese Striae Coarse Skin Buffalo Hump Moon Face Gray Complexion Decreased Libido Impotent/ Amenorrhea BP increase
Addison’s
Bronze Colour Weight Loss Anorexia Postural Hypotension Hypotension N+V Fatigue Hyperkalaemia - Arrythmias
COPD vs Asthma
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
Pneumonia
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
PE
Pleuritic Pain Worse on Insp SOB Risk Factors for PE Haemoptysis Periph Oedema RR/HR increase and Infection signs
*ECG - S1 Q3 T3
Tension Pneumo/ Effusion
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
Bronchiectasis
Lots of purulent sputum with cough Persistant cough Haemop Coarse Insp Crackles Finger Clubbing wheeze
Lung CA
HOARSE VOICE Pain Lymph Nodes - Sub Clav Clubbing Haemoptysis Weight Loss Appetite Loss Perhaps bone issues Cough Other infections
Sarcoidosis
Bilateral Lymphadenopathy Erythema Nod Polyarthralgia SOB Wheeze cough
Oes Ca
HOARSE VOICE Dyspahgia Weight Loss and appetite loss retro-sternal Pain cough?
*OGD + biopsy / Barium Swallow
Ulcers
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
Gallstones
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
Acute Panc vs Panc CA
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
Colon CA L vs R
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
Bowel Obs Sm vs L
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
Acute Appendix
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
Venous Disease
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
Arterial Disease
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?
Breast Lumps
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
IBD
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
Hepatitis
RUQ pain, jaundice (and itch) N+V confusion and lethargy Fever Hepatomegaly
dark Urine
*if Paracetamol OD - N-acetyl cysteine
Haemachrom (AR)
Slate gray, can be bronze if diabetic
Sign of Chronic Liver Disease
Fatigue
Arthrlagia
*Treated with Venesection
Alfa 1 antitryp (AR)
Affects Lungs, Liver and …
Lung - Productive Cough, SOB on exertion
Liver - Hepatomeg, Ascites, Jaundice
Wilsons (AR)
Aged 10-40
Hepatitis
Cirrhosis
Hepatic Decomp
Copper buildup, around iris?
*linked to Parkinson’s
PBC vs PSC
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
Cirrhosis
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
Coeliacs
Diarr Anaemic - decreased B12, Folate and Iron Anorexia, Weight Loss Stinking Poo! - Dermatitis Herpetiformis
*Crypt Hyperplasia and Sub-total villous atrophy // TTG/IgA
HCC
Jaundice
Upper Abdo Pain
Weight Loss, pallor
Signs of Chronic Liver Failure… + varies/ascites
*RF - Schistisomis/ Steroids/ Fam Hx/ Cirrhosis
Tumor marker - alfa fetoprotein
Anaemia
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
Leukaemia
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
Lymphoma
B symptoms - night sweats, fever, weight loss
Painless Lymphadenopathy
SOB
Infections, Bruising, Bleeding
*Hodgkins defined by Reed-Sternburg Cell
Myeloma
Ca up
Renal dysfunction
Anaemia
Bone Pain
*Treat Each symptom separately
Eczema
Atopic/ Contact/ Sebhorric/ Vasculitic
Flexor Surfaces
Erythema
Scratch Marks
Acute Lesions - weepy
*Topical Emolients + Topical CorticoSteroids(hydrocort) + UV therapy +/- ABx’s and Antihistamine
Psoriasis
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
ACNE
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
CA
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
Cellulitis
Red/Blue Swollen Tender Hot Unilateral Site of Infection
*Staph Aur or Strep pyogenes
T - Mark with pen the borders
Osteo Arthritis
Joint Crepitus Decreased ROM Joint Tenderness, Joint Instability Heberdens Nodes Musc Wasting
*xray Loss of Joint space Peri-articular sclerosis Sub Chondral cysts Osteophytes
Rheumatoid Arthritis
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
Septic Artritis
Fever, Hot swollen Joint
Pain
Hx of Infection/trauma or Prosthetic Joint
*Blood Culture - Staph/Strep pyogen
Joint aspirate and washout for treating
Psoriatic Arthritis
DIP and Sacro-Iliac Unilateral Dactylitis *Psoriasis present Pencil-in Cup on xray
Ank Spond
Back Pain - stiff in morning made better with exercise
Eye Pain
Leg Pain
Worse with Straight Leg raise
Hypo Nat
N+V
Anorexia
Malaise
Confusion
HypoNat Enceph = Seizures / Coma
*If Acute or Dehydrated - cautious rehydr + frusemide
If Chronic/asymp - Fluid restric + ADH antagonist
HyperKal
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
HypoKal
Musc weakness hypotonia hyporeflexia palpitation constipation
*Oral Sando-K
HyperCalcaemia
Bones - pain/ path fracture Thrones - constip/ polyuria Groans - abdo pain Moans - depression Stones - renal or gallstones
*Bisphosphonates
HypoCalcaemia
SCAMS
Seizure confused Anxious Spasms musc tone increased
*CKD/ Vit D def // Osteomalacia/ acute panc
Stroke
Speech facial Droop Hemiplegia Hemiparesis Visual Disturbance - homon hemi Headache Unconscious
SAH
Sudden onset, worst ever headache, behind eyes
Unconscious
Photophobia
N+V
*LP done >12 hours to allow xanthyecroma
MS
Diplopia, painful eye, RAPD
Facial Palsy
Hearing/Balance problems
Depression
Weak painful legs
Lethargic
- i —> LP - oligoclonal AB’s / Spinal Cord MRI - Gadolinium labelling
Parkinsons
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)
MG and Dementia
AI
muscle fatigue after exercise without any wasting and normal tone/reflexs.
Diplopia
Dementia
Memory loss/ behavioural change/ agitation/ depression/ agnosia
Motor Neuron Dis
Dysphagia Fasciculations Brisk Reflexs Musc weakness Speech decrease Breathing difficulties No sensory loss/sphincter loss
*Upper and Lower Motor Lesion SIGNS!!
Neuropathies
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
Sepsis
Mottled Skin, fever, confused/GCS down, RR/HR increase, BP drop,
Clammy cool peripheries, N+V, oliguria
HIV
Night Sweats, Weight Loss, fever
Infections - candida/ ulcers/ TB
Diarr
Skin Rashes
Returning Traveller (Malaria)
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
Meningitis
Photophob Neck Stiffness Headache Confused Fever HR/RR up Kernels Sign +ve N+V
TB
Abdo Pain Anorexia/Weight Loss Fever Night Sweats Cough SOB Wheeze Haemop
Herpes
Sores. Flu-like prodrome then ulcers appear
+/- Dysuria +/- Discharge
Chicken Pox —> shingles
*PCR Testing is Diagnostic
PUO
Sarcoid/ Lymphoma/ SLE/ Malignancy/ TB
Fever >38 for >3 weeks
Mono
Cervical Lymph
fever
Pharyngitis
Splenomegaly
*EBV AB’s or PCR
AKI
Oliguria/ Haematuria Palpable kidneys Pain Vomiting JVP up, BP up, Oedema
*Careful of HyperKal
Nephritic and Nephrotic
Nephrotic Hypoalbuminaemia Hypercholesterolaemia Oedema Proteinuria
Nephritic
Haematuria
Hypertension
Proteinuria
UTI L vs U
L
Urinary Symp - dysuria, oliguria
Supra-Pubic Pain
Haematuria
U
Loin to Groin pain
Infection symptoms (Fever)
N+V
*E-Coli!!!
Renal Stone vs PCK
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
Renal CA and Bladder CA and Prostate CA
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
Anti-phospholipid Syndrome
Venous Thrombosis (DVT, PE) Arterial Thrombosis (cerebral ischaemia - stroke/TIA) Fetal Complications (Spontaneous abortion, premature births) Thrombocytopenia (not overly severe)
