Clinical knowledge Flashcards
Lung mass
Differentials:
- Malignancy (primary or secondary)
- Infection - TB, lung abscess from pneumonia, aspergillosis
- Inflammatory - vasculitis, amyloidosis, Sarcoidosis
Specific history
- Cough, shortness of breath, haemoptysis, chest pain, fever, weight loss
- Social - occupational exposure, smoking, travel history
Examination
- Wheeze, added sounds, clubbing, lymphadenopathy
Investigations
- Sputum MC+S
MDT investigations
- PET scan
- EBUS + biopsy
Breast Lump
Differentials
- Malignancy
- Benign disease eg fibroadenoma, abscess or cyst
History
- Breast symptoms eg skin changes, pain, nipple discharge or inversion
- Systemic features - fever, weight loss, lymphadenopathy
- DH - oestrogen exposure eg contraceptive pill/HRT
- Social - breastfeeding, smoking,
Examination
- Breast - size, number, fluctuant, tethering, skin changes, location
- Lymphadenopathy
MDT investigations
- Tripple assessment - hx and examination, mammogram/US and biopsy
Histopathology
- HER 2/ER/ progesterone receptor expression
GI/colorectal mass
Differentials
- Malignancy (primary or secondary)
-Inflammatory bowel disease - ulceration, abscess
- Diverticular disease
History
- GI symptoms - altered bowel habit, abdominal pain, PR bleeding, dyspepsia, mouth ulcers
- General - weight loss, fever, anaemia
- FHx
- Social - smoking
Examination
- GI - abdomen, palpation for pain and masses, RP examination
- General - lymphadenopathy, anaemia
Investigations
- FBC - anaemia, CRP
- Faecal calprotectin, anti TTG
- Stool culture
MDT
- Gastroscopy or colonoscopy and biopsy
Liver lesion
Differentials
- Malignancy - primary or secondary
- Benign eg haemangioma
- Infective - abscess
History
- GI symptoms - abdominal pain, dyspepsia, altered bowel habit, heamatemesis
- Features of liver dysfunction - jaundice, ascites, bruising, spider neaevae
- Systemic features - fever, weight loss
- Risk factors - IVDU, alcohol
Examination
- Abdominal exam - palpate for masses, pain, hepatosplenomegaly
- Jaundice, ascites, caput medusae, spider naevae
- Lymphadenopathy
Investigations
- FBC, U+E, LFTs, clotting
- Non invasive liver screen - hepatitis (autoimmune and viral), EBV
- Liver US
MDT
- CT/MRI
- Biopsy
Thyroid nodule
Differentials
- Malignancy
- Benign disease - cyst or nodule, toxic nodular goitre
History
- Symptoms - pain, eating or speaking problems, features of airway compromise
Hyperthyroidism - sweating, weight loss, tremor
Hypothyroidism - cold intolerance, muscle weakness, fatigue
Examination
- Neck examination - mass - number, size, fluctance, tenderness, tethering, border
- Lymphadenopathy
- General examination - tremor, hyper or hyporeflexia, eye changes
Investigations
- Bloods - including TFTs and calcium (parathyroid involvement)
- ECG - arrhythmias
MDT
- Thyroid scintigraphy
- US and fine needle aspiration
Kidney Mass
Differentials
- Malignant disease - primary or secondary
- Benign disease - cyst, benign renal tumour
- Infective - abscess
History
- Abdominal pain - flank pain, haematuria, dysuria, polyuria
- Generalised - weight loss, fever
Examination
- Abdominal mass, flank tenderness
- General - lymphadenopathy
Investigations
- Bloods - FBC, U+E, LFTs, clotting, CRP
- Urine dip - urine MC+S
MDT
- Imaging - CT/MRI
- US biopsy
- PET scan
Uterine/ovarian lesion
Differentials
- Malignancy
- Benign - cyst on ovary, uterine fibroid
History
- Abdomial symptoms - bloating, pain, change in bowel habit
- Gynae/obstetric and sexual history - menstruation, PV discharge
General - weight loss
Examination
- Abdominal examination - masses
- Pelvic examination - masses, tenderness
- Lymphadenopathy
- General - anaemia
Investigations
- Bloods - FBC, U+E, LFTs, Ca 125 (ovarian Ca)
MDT
- Further imaging eg CT/MRI
- Biopsy
- PET CT
Brain lesion
Differentials
- Malignancy - primary or secondary
- Benign process - meningioma, adenoma
- Infective - abscess
- Haematoma
History
- Specific - headache, visual changes, weakness, ataxia, speech disturbance, features of raised ICP eg vomiting
General - fever, weight loss, features of endocrine imbalance eg menstrual changes, lactation
Examination
- Neurological examination - cranal nerves, upper and lower limbs, fundoscopy for papilloedema
- General - lymphadenopathy
Investigations
- FBC, U+E, LFT, Coagulation, CRP
- Endocrine profile - TFTs, prolactin
MDT
- CT/MRI
- Biopsy
Pancreatic lesion
Differentials
- Malignancy (adenocarcinoma)
- Benign - cyst/pseudocyst
History
- Abdominal symptoms - pain, change in bowel habit, vomiting, nausea
Symptoms of diabetes - polyuria/ thirst
General - fatigue, weight loss, jaundice
Examination
- Abdominal
- Generalised - jaundice, lymphadenoapthy
Investigations
- FBC, U+E, LFT, clotting
- Blood glucose
- Ca 19-9
MDT
- Imaging
