Clinical presentations Flashcards
1
Q
Abdominal distension
A
Intestinal obstruction Ascites Intestinal ischaemia Abdominal mass Pregnancy Obesity
2
Q
RUQ abdominal mass
A
Hepatic: Hepatomegaly
Biliary: Cholangiocarcinoma; Cholecystitis; Gallstones and biliary colic
3
Q
Epigastric abdominal mass
A
Gastric: Gastric cancer
Pancreatic: Pancreatic abscess (pancreatitis); Pancreatic cancer; Pancreatic pseudocyst (pancreatitis)
Hepatic: Hepatomegaly
4
Q
LUQ abdominal mass
A
Splenic: Splenomegaly
Gastric: Gastric cancer
Pancreatic: Pancreatic cancer; Pancreatic pseudocyst (pancreatitis); Pancreatic abscess (pancreatitis)
Renal: Hydronephrosis (urinary tract calculi); Renal cell carcinoma; Polycystic kidney disease
5
Q
Right iliac fossa abdominal mass
A
Gastrointestinal: Appendix mass or abscess (appendicitis); Colorectal carcinoma; Crohn’s disease; Hernias (femoral, inguinal, miscellaneous)
Infection: Tuberculosis
Renal: Renal transplantation
Gynaecological: Ovarian tumour; Ovarian cyst
6
Q
Suprapubic abdominal mass
A
Urological: Urinary retention; Bladder cancer
Gynaecological: Pregnancy; Fibroids
7
Q
Left iliac fossa abdominal mass
A
Renal: Renal transplantation
Gynaecological: Ovarian cyst; Ovarian tumour
Gastrointestinal: Diverticular disease; Colorectal carcinoma; constipation; Hernias (inguinal, femoral, miscellaneous); Crohn’s disease
8
Q
Right/left flank abdominal mass
A
Hydronephrosis (urinary tract calculi)
Renal cell carcinoma
Polycystic kidney disease
9
Q
Umbilical abdominal mass
A
Gastrointestinal: Periumbilical and umbilical hernia; Gastric cancer; Colorectal carcinoma; Lymphoma (Hodgkin’s and non-Hodgkin’s)
Vascular: Abdominal aortic aneurysm
10
Q
RUQ abdominal pain
A
Biliary: Gallstones and biliary colic; Cholecystitis
Hepatic: Hepatitis (viral, alcoholic, autoimmune); Hepatocellular carcinoma; Liver abscesses
Gastrointestinal: Colorectal carcinoma
11
Q
Epigastric abdominal pain
A
Gastric: Peptic ulcer disease and gastritis; GORD; Gastric cancer; Dyspepsia
Pancreatic: Pancreatitis; Pancreatic cancer
Cardiac: Ischaemic heart disease (angina pectoris, acute coronary syndrome, myocardial infarction)
12
Q
LUQ abdominal pain
A
Splenic: Abscess; Splenomegaly; Splenic rupture (traumatic injury incl. blunt, penetrating, crush and blast); Splenic infarction (cancer, antiphospholipid syndrome, atrial fibrillation/flutter, sickle cell disease)
Gastrointestinal: Colorectal carcinoma
13
Q
Right/left flank abdominal pain
A
Vascular: Aortic dissection
Renal: Urinary tract calculi; Pyelonephritis (UTI); Renal cell carcinoma; Polycystic kidney disease
14
Q
Lower abdominal pain
A
Urological: UTI; Urinary retention; Urinary tract calculi
Gynaecological: Ovarian torsion (ovarian cyst); Endometriosis; Ectopic pregnancy; Pelvic inflammatory disease; Ruptured ovarian cyst; Ovarian tumour
Gastrointestinal: Appendicitis; Diverticular disease; Ulcerative colitis; Crohn’s disease; Colorectal carcinoma; Constipation
15
Q
Central and diffuse abdominal pain
A
Gastrointestinal: Intestinal obstruction; GI perforation (open abdominal surgery incl. laparotomy, laparoscopic abdominal surgery); Functional dyspepsia and IBS
Infectious: Gastroenteritis and infectious colitis; Peritonitis
Vascular: Intestinal ischaemia; Abdominal aortic aneurysm
Metabolic: Diabetic ketoacidosis (DM); Addisonian crisis (adrenal insufficiency); Hypercalcaemia
Haematological: Sickle cell disease
Inflammatory: Vasculitides
16
Q
Abnormal LFTs: raised aminotransferases
A
Liver failure Cirrhosis Viral hepatitis Alcoholic hepatitis Autoimmune hepatitis Non-alcoholic steatohepatitis (NASH) Wilson's disease Sepsis syndromes
17
Q
Abnormal LFTs: markedly raised ALP
A
Extrahepatic biliary obstruction
Intrahepatic cholestasis
18
Q
Abnormal LFTs: moderately raised ALP
A
Hepatic: Viral hepatitis; Alcoholic hepatitis; Autoimmune hepatitis; Non-alcoholic steatohepatitis; Amyloidosis; Sarcoidosis; Tuberculosis; Liver abscesses; Sepsis syndromes
Non-hepatic: Pregnancy; Osteomalacia; Paget’s disease of bone; Hyperparathyroidism; Thyrotoxicosis; Diabetes mellitus; Cancer
19
Q
Abnormal LFTs: raised GGT
A
Substance use disorder: alcohol
20
Q
Abnormal LFTs: raised bilirubin
A
Hyperbilirubinaemia
21
Q
Abnormal lung function tests (obstructive)
A
Asthma
COPD
22
Q
Abnormal lung function tests (restrictive)
A
Intrinsic: Pulmonary fibrosis (idiopathic, rheumatoid arthritis, SLE, systemic sclerosis, ankylosing spondylitis, extrinsic allergic alveolitis, pneumoconiosis, drugs)
Extrinsic: Kyphoscoliosis; Neuromuscular (Guillain-Barré syndrome, MND); Obesity
23
Q
Metabolic acidosis: normal anion gap
A
Normal anion gap: loss of bicarbonate
High anion gap: Decreased renal acid excretion (CKD); increased acid production (lactic acidosis: sepsis syndromes; ketoacidosis: diabetic; aspirin overdose)
24
Q
Respiratory acidosis: central depression
A
Drugs: Opiate overdose; Poisoning (TCAs, benzodiazepines, methanol, iron, lithium, digoxin); substance use disorder: drugs, alcohol
Respiratory centre depression
25
Respiratory acidosis: neuromuscular
Muscular dystrophy
MND
Guillain-Barré syndrome
Myasthenia gravis
26
Respiratory acidosis: respiratory
COPD
| Asthma
27
Metabolic alkalosis
Gastrointestinal H+ loss: Nausea and vomiting
Renal H+ loss: Primary hyperaldosteronism
Intracellular H+ shift: Hypokalaemia
28
Respiratory alkalosis: central stimulation
```
Anxiety: generalised anxiety disorder
Pain: palliative care
Fever
Pregnancy
CNS: Traumatic injury incl. blunt, penetrating, crush and blast; Stroke (ischaemic and haemorrhagic); Infection; Cancer
Drugs: Aspirin overdose
```
29
Respiratory alkalosis: respiratory
```
Pulmonary embolism
Asthma
COPD
Pneumonia
Cardiac failure
```
30
Arthralgia: monoarthritis
Degenerative: Osteoarthritis
Inflammatory: Rheumatoid arthritis; Vasculitides; SLE; Sarcoidosis; Behçet's disease; Seronegative arthritides (UC, Crohn's, ankylosing spondylitis, psoriatic arthritis, reactive arthritis)
Infection: Septic arthritis
Metabolic: Crystal arthropathy (gout, pseudogout)
Traumatic injury (incl. blunt, penetrating, crush and blast)
31
Arthralgia: oligoarthritis
Infection: Infective endocarditis
Inflammatory: Seronegative arthritides (reactive arthritis, UC, Crohn's, ankylosing spondylitis; psoriatic arthritis); Rheumatoid arthritis; Vasculitides; SLE; Sarcoidosis; Behçet's disease; Sjögren's syndrome
Degenerative: Osteoarthritis
32
Arthralgia: polyarthritis
Degenerative: Osteoarthritis
Inflammatory: Rheumatoid arthritis; Seronegative arthritides (UC, Crohn's, ankylosing spondylitis, psoriatic arthritis, reactive arthritis); Vasculitides; SLE; Sarcoidosis; Behçet's disease; Sjögren's syndrome
Infection: Bacterial (Lyme disease, gonorrhoea); Viral (infectious mononucleosis, HIV); Post-infective (rheumatic fever)
Metabolic: Crystal arthropathy (gout, pseudogout); Haemochromatosis
Haematological: Sickle cell disease
Cancer
33
Ascites: exudative
Infection
Pancreatitis
Malignancy
34
Ascites: transudative
Hepatic: Cirrhosis
Cardiac: Cardiac failure; Constrictive pericarditis
Renal: CKD; Nephrotic syndrome
Ovarian: ovarian tumour
35
Ascites: haemorrhagic
Malignancy
Traumatic injury (incl. blunt, penetrating, crush and blast)
Acute pancreatitis
36
Back pain
Malignancy: Multiple myeloma; Metastases; Lymphoma; Leukaemia; CNS tumours
Mechanical: Osteoarthritis; Osteoporosis; Spondylosis and spondylolisthesis of the spine; spinal fracture; traumatic injury (incl. blunt, penetrating, crush and blast)
Infection: Osteomyelitis; Discitis of the spine
Inflammatory: Ankylosing spondylitis; Psoriatic spondylitis; Reactive arthritis; Enteropathic arthritis
37
Bradycardia
```
Physiological: Physical fitness; Sleep
Cardiovascular: Ischaemic heart disease (angina pectoris, acute coronary syndrome, myocardial infarction); Cardiomyopathy; Myocarditis; Heart block; Congenital heart disease
CNS: Raised intracranial pressure
Endocrine: Hypothyroidism
Electrolyte disturbance: Hyperkalaemia; Hypokalaemia
Infection: Lyme disease
Drugs
Hypothermia
Eating disorder: Anorexia nervosa
```
38
Breast lump
Benign: Physiological; Fibroadenoma; Breast cysts; Mastitis/breast abscesses; Benign ductal disease (duct ectasia and papilloma); Lipoma
Malignant: Breast cancer
39
Breast pain
Cyclical: Physiological; Contraceptives; HRT
Non-cyclical: Breast cancer; Benign ductal disease (duct ectasia and papilloma); Mastitis/breast abscesses; Pregnancy; HRT
Extra-mammary: Chest wall pain; Spinal disorders
40
Calf swelling/pain
Unilateral: DVT; Peripheral vascular disease (acute and chronic limb ischaemia); Cellulitis and erysipelas; Trauma (compartment syndrome); Traumatic injury (incl. blunt, penetrating, crush and blast); Lymphoedema
Bilateral: Hypoalbuminaemia; Lymphoedema; Varicose veins; Peripheral vascular disease (acute and chronic limb ischaemia); Cardiac failure
41
Cerebellar signs (e.g. ataxia, dysdiadochokinesia)
Vascular: Stroke (ischaemic and haemorrhagic); TIA
Infection: Meningitis; Encephalitis; TB
Inflammatory: Sarcoidosis; Multiple sclerosis; Guillain-Barré syndrome; Coeliac disease
Toxic: Chemotherapy; Substance use disorder (alcohol)
Metabolic: Vitamin B12 deficiency; Thiamine deficiency
Endocrine: Hypothyroidism
Malignancy: CNS tumours; Metastases; Paraneoplastic syndromes
Hereditary
Degenerative: Wilson's disease
42
Chest pain
Cardiovascular: Ischaemic heart disease (angina pectoris, acute coronary syndrome, myocardial infarction); Cardiac failure; Pericarditis; Cardiomyopathy; Aortic dissection
Respiratory: Pulmonary hypertension; Sarcoidosis; Pneumothorax; Lung cancer; Asthma; COPD; Pulmonary embolism; Pneumonia
Gastrointestinal: Pancreatitis; GORD; Peptic ulcer disease and gastritis
Musculoskeletal: Vasculitides; Traumatic injury (incl. blunt, penetrating, crush and blast)
Neurological: Spinal radiculopathy; Varicella zoster
Psychiatric: Anxiety disorder (panic disorder); Depressive disorder
43
Clotting profile abnormalities: abnormal APTT
```
Haematological: Haemophilia; Von Willebrand's disease; Antiphospholipid syndrome
Drugs
Vitamin K deficiency
Liver failure
Disseminated intravascular coagulation
```
44
Clotting profile abnormalities: abnormal PT and INR
Drugs
Vitamin K deficiency
Liver failure
Disseminated intravascular coagulation (DIC)
45
Clubbing
Cardiovascular: Congenital heart disease; Infective endocarditis
Respiratory: Lung cancer; Bronchiectasis; Idiopathic pulmonary fibrosis; TB
Gastrointestinal: Crohn's disease; UC; Cirrhosis; Lymphoma; Coeliac disease
46
Confusion (acute)
Vascular: TIA; Stroke (ischaemic and haemorrhagic)
Infection: Intracranial (meningitis, encephalitis); Extracranial (pneumonia, UTI)
Metabolic: Liver failure; CKD; Electrolyte disturbance (hypercalcaemia, hyponatraemia); Hypoxia (type 1 and 2 respiratory failure; Nutritional (vitamin B12 deficiency)
Endocrine: Hypoglycaemia; Hypothyroidism; Thyrotoxicosis; Adrenal insufficiency
Neurological: Post-ictal seizure
Neoplastic: CNS tumours
Drugs: Alcohol misuse; Drug misuse; Opiate overdose; Poisoning (TCAs, benzodiazepines, methanol, iron, lithium and digoxin)
Psychiatric: Psychotic disorders; Bipolar affective disorder
Trauma: Head injury; Intracranial haemorrhage
47
Constipation
Gastrointestinal: Obstruction (diverticular disease, hernia, colorectal carcinoma, UC, Crohn's); Anorectal disease (anal fissure, rectal prolapse); Functional dysplasia and IBS
Endocrine: Diabetes mellitus; Hypothyroidism; Hypercalcaemia
Neurological: Parkinson's disease; MS; Spinal cord injury
Drugs
Psychiatric: Anorexia nervosa
Diet: Low fibre intake; Poor fluid intake
Post-operative
Immobility
48
Cough
Infection: Pneumonia; TB; Upper respiratory tract infection
Respiratory: Asthma; COPD; Bronchiectasis; Lung cancer
Cardiovascular: Cardiac failure
Gastrointestinal: GORD
Drugs
49
Central cyanosis
Infection
Respiratory: Asthma; Pneumothorax; Right to left pulmonary shunt
Cardiac: Right to left cardiac shunt; Cardiac failure
Haematological: Sickle cell disease; Thalassaemia
50
Peripheral cyanosis
Arterial thrombosis
Sepsis syndromes
Raynaud's phenomena
51
Decreased consciousness
Vascular: Subdural haemorrhage; Subarachnoid haemorrhage; Extradural haemorrhage; Stroke (ischaemic and haemorrhagic)
Infection: Meningitis; Encephalitis
Trauma: Head injury
Hypoxia: Cardiac arrest; Sepsis syndomes; Type 1 respiratory failure; Type 2 respiratory failure
Metabolic: Hypoglycaemia; Liver failure; CKD; Electrolyte disturbance (hypernatraemia, hyponatraemia, hyperkalaemia, hypokalaemia, hypercalcaemia)
Neurological: Raised intracranial pressure; Epilepsy
Malignancy: Space occupying lesion
Drugs
52
Diarrhoea
Gastrointestinal: Infection (gastroenteritis and infectious colitis; Inflammatory bowel disease (UC and Crohn's); Malabsorption (coeliac disease, pancreatic insufficiency); Malignancy (colorectal carcinoma, gastric cancer); Diverticular disease; Overflow diarrhoea
Endocrine: Thyrotoxicosis; Diabetes mellitus
Drugs
53
Diplopia
Monocular: Lens (cataracts), Retina (macular degeneration)
Binocular: Wernicke's encephalopathy; Neurological (cranial nerve palsies, ophthalmoplegic migraine); Endocrine (thyroid ophthalmoplegia); Neuromuscular (Miller Fisher syndrome, myasthenia gravis)
54
Dizziness/blackouts (loss of consciousness)
Vasovagal syncope
Cardiovascular: Arrhythmia (bradycardia, tachycardia); Outflow obstruction (aortic stenosis, cardiomyopathy, pulmonary embolism); Hypotension; Ischaemic heart disease (angina pectoris, acute coronary syndrome, myocardial infarction); Aortic dissection
Neurological: Epilepsy; Stroke; TIA
Metabolic: Hypoglycaemia
55
Dysarthria
Cerebellar: MS; Stroke; CNS tumours
Bulbar and pseudo bulbar: MND; MS
Extrapyramidal: Parkinson's disease
Drugs: Substance use disorder (alcohol)
56
Dyspepsia
Oesophageal: GORD; Oesophageal cancer
Gastroduodenal: Functional dyspepsia; Peptic ulcer disease and gastritis; Gastric cancer; Hiatus hernia
Biliary: Gallstones and biliary colic; Cholecystitis
Drugs: Substance use disorder (alcohol)
Psychiatric: Generalised anxiety disorder; Depressive disorder
57
Dysphagia
Intraluminal: Foreign body
Intramural: Achalasia; GORD; Malignancy (pharyngeal cancer, oesophageal cancer, gastric cancer); Scleroderma; Radiotherapy
Extramural: Retrosternal goitre; Lung cancer; Lymphadenopathy; Aortic aneurysm
Neuromuscular: Stroke; Guillain-Barré syndrome; MND; Myasthenia gravis
58
Dysphasia
CNS tumours
Stroke
Dementia
59
Dysuria
Urinary tract: Urethritis; Urinary tract calculi; Bladder cancer; UTI
Vaginal: Candidiasis; Bacterial vaginosis
Prostatic: Benign prostatic hyperplasia; Epididymitis and orchitis
60
Facial nerve palsy (bilateral)
Autoimmune: Guillain-Barré syndrome; Myasthenia gravis
Infection: Lyme disease; HIV
Sarcoidosis
MND
61
Facial nerve palsy (unilateral)
Infection: TB; Otitis media; Varicella zoster
Inflammation: Sarcoidosis; Lymphoma
Idiopathic: Bell's palsy
Traumatic injury (incl. blunt, penetrating, crush and blast)
Vascular: Stroke
Malignancy: Cholesteatoma; Acoustic neuroma
62
Fatigue
```
Infection
Endocrine: Hypothyroidism; Adrenal insufficiency; Diabetes mellitus
Cardiac: Cardiac failure
Renal: CKD
Hepatic: Liver failure
Malignancy
Anaemia: normocytic, macrocytic, microcytic
Obesity
Drugs
Psychiatric: Depressive disorder
```
63
Upper gastrointestinal bleeding
Bleeding disorders: Thrombocytopaenia; Haemophilia
Swallowed blood: Haemoptysis; Epistaxis
Oesophageal: GORD; Oesophageal varices; Mallory-Weiss tear; Oesophageal cancer
Gastric: Peptic ulcer disease and gastritis; Gastric cancer
Drugs
64
Goitre
Hypothyroidism
Graves' disease
Thyroid nodule
Thyroid cancer
65
Groin swelling
Scrotal: Hydrocoele; Varicocoele
Femoral: Hernia; Saphena varix
Inguinal: Hernia; Lymph nodes
Skin: Lipoma; Epidermoid and pilar cysts (sebaceous cysts)
66
Gynaecomastia
```
Physiological: Puberty (growth disorder)
Malignancy: Testicular cancer
Endocrine: Thyrotoxicosis; Hypogonadism
Hepatic: Cirrhosis
Renal: CKD
Drugs
```
67
Haematuria
Bladder: Bladder cancer
Kidney: UTI; Urinary tract calculi; Glomerulonephritis; Polycystic kidney disease; Renal cell carcinoma
Urethra: Urethritis
Prostate: Benign prostatic hyperplasia; Prostate cancer
Haematological: Haemophilia; Thrombocytopaenia; Sickle cell disease
Traumatic injury (incl. blunt, penetrating, crush and blast)
Drugs
68
Haemoptysis
Respiratory: Malignancy (lung cancer); Infection (TB, pneumonia, abscess); COPD; Bronchiectasis; Vasculitides; Traumatic injury (incl. blunt, penetrating, crush and blast)
Cardiovascular: Pulmonary embolism; Pulmonary hypertension; Cardiac failure
Coagulopathy: Thrombocytopaenia
69
Headache (acute)
Traumatic injury (incl. blunt, penetrating, crush and blast)
Infection: Meningitis; Encephalitis
Acute closed-angle glaucoma
Hypertension
Vascular: Haemorrhage (subarachnoid, subdural, extradural)
70
Hemiparesis
Vascular: Haemorrhage (subdural, extradural); Stroke
Neurological: Epilepsy; MS; CNS tumours; Migraine
Infection: Cerebral abscess
71
Hepatomegaly
Hepatic: Hepatitis; Cirrhosis; Liver abscesses; Liver cysts
Biliary: Primary biliary cirrhosis; Primary sclerosing cholangitis
Cardiac: Constrictive pericarditis; Cardiac failure
Malignancy: Metastases; Hepatocellular carcinoma
Infiltration: Amyloidosis; Sarcoidosis; Haemochromatosis
72
Hyperbilirubinaemia (unconjugated)
Overproduction: Haemolytic anaemia; Gallstones and biliary colic
Impaired hepatic uptake: Cardiac failure; Drugs
Impaired conjugation: Gilbert's syndrome
Neonatal jaundice
73
Hypercalcaemia
Sarcoidosis
Primary hyperparathyroidism
Cancer
Multiple myeloma
74
Hyperkalaemia
Increased release: Metabolic acidosis; Diabetes mellitus
| Reduced excretion: Renal (CKD); Endocrine (adrenal insufficiency); Drugs
75
Hypernatraemia
Decreased water intake: Acute confusion; Dementia
Non-renal water loss: Diarrhoea; Fever; Burns injury
Renal water loss: Hypercalcaemia; Diabetes insipidus
Sodium excess: Primary hyperaldosteronism
76
Hypoalbuminaemia
Reduced synthesis: Liver failure; Malnutrition
Increased losses: Nephrotic syndrome; Protein-losing enteropathy (coeliac disease, UC, Crohn's); Burns injury Bullous skin lesion (pemphigoid)
77
Hypocalcaemia
Low PTH: Thyroidectomy
High PTH: Vitamin D deficiency (CKD, liver failure, osteomalacia); Metastases; Acute pancreatitis; Sepsis syndromes; Drugs
78
Hypoglycaemia
Sepsis syndromes
Adrenal insufficiency
Malnutrition
Drugs: Substance use disorder (alcohol)
79
Hypokalaemia
Renal losses: Diuretics
Gastrointestinal: Nausea and vomiting; Diarrhoea
Endocrine: Cushing's syndrome; Primary hyperaldosteronism
80
Hyponatraemia
Hypovolaemic: GI losses (diarrhoea, nausea and vomiting, intestinal obstruction); Renal losses (CKD, adrenal insufficiency, drugs); Burns injury
Euvolaemic: Endocrine (hypothyroidism, adrenal insufficiency); SIADH (respiratory = pneumonia, lung cancer; neurological = CNS tumours, head injury; drugs
Hypervolaemic: Cardiac (cardiac failure); Hepatic (cirrhosis); Renal (nephrotic syndrome, CKD)
81
Hypotension
Volume depletion: Haemorrhage (GI bleeding, traumatic injury); GI losses (diarrhoea); Renal losses (diabetes insipidus, diabetes mellitus, acute kidney injury); Burns injury
Infection: Sepsis syndromes
Autonomic failure: Neurodegenerative (Parkinson's disease); Neuropathy (diabetes mellitus, Guillain-Barré syndrome)
Drugs
82
Hypoxia (type 1 respiratory failure)
```
Asthma
COPD
Pulmonary embolism
Pneumothorax
Pneumonia
Idiopathic pulmonary fibrosis
Acute respiratory distress syndrome
```
83
Hypoxia (type 2 respiratory failure)
Respiratory: Asthma; COPD; Obstructive sleep apnoea
Central depression: Respiratory centre depression; Drugs (opiate overdose, poisoning)
Neuromuscular: Guillain-Barré syndrome; MND; Myasthenia gravis; Muscular dystrophy
Musculoskeletal: Flail chest (traumatic injury); Kyphoscoliosis
84
Jaundice
Pre-hepatic: Congenital haemolysis (sickle cell disease, thalassaemia); Acquired haemolysis (malaria)
Hepatic: Infection (viral hepatitis, liver abscesses, sepsis syndromes); Autoimmune (autoimmune hepatitis); Hepatic (cirrhosis); Malignancy (metastases); Hereditary (Wilson's disease, haemochromatosis); Drugs (alcohol misuse)
Obstructive: Drugs; Pancreatic cancer; Primary biliary cirrhosis; Primary sclerosing cholangitis; Gallstones and biliary colic
85
Hyperbilirubinaemia (conjugated)
Hepatocellular dysfunction: Infection (viral hepatitis, liver abscesses, sepsis syndromes); Hepatic (cirrhosis, non-alcoholic steatohepatitis, alcoholic hepatitis); Autoimmune (autoimmune hepatitis); Malignancy (hepatocellular carcinoma); Infiltration (amyloidosis, sarcoidosis, lymphoma); Hereditary (Wilson's disease, haemochromatosis); Drugs
Obstruction: Gallstones and biliary colic; Pancreatic cancer; Primary biliary cirrhosis; Primary sclerosing cholangitis; Drugs
86
Nausea and vomiting
Gastrointestinal: GORD; Peptic ulcer disease and gastritis; Cholecystitis; Pancreatitis; Gastroenteritis and infectious colitis; Appendicitis; Intestinal obstruction; Peritonitis
Endocrine: Diabetic ketoacidosis; Addisonian crisis; Hypercalcaemia
Neurological: Raised intracranial pressure; Meningitis; Migraine; Head injury
Ophthalmological: Acute closed-angle glaucoma
ENT: Vestibular neuritis and labyrinthitis
Pregnancy
Drugs: alcohol misuse; drug misuse; poisoning; paracetamol overdose
87
Anterior triangle neck swellings
Moves with swallow: Thyroglossal cysts; Thyroid nodules; Goitre
Fixed with swallow: Salivary gland tumour; Lymphadenopathy; Lymphoma
88
Posterior triangle neck swellings
Lymphadenopathy
| Lymphoma
89
Night sweats
Infection: Infective endocarditis; Osteomyelitis; TB; HIV
Endocrine: Thyrotoxicosis; Phaeochromocytoma; Menopause; Carcinoid syndrome
Malignancy: Lymphoma; Solid tumours
Drugs: Poisoning (TCAs, benzodiazepines, methanol, iron, lithium and digoxin)
90
Nipple discharge
Milky: Late pregnancy; Puberty (growth disorder); Lactation; Duct ectasia; Prolactinoma
Purulent: Breast abscess
Serous: Early pregnancy; Breast cancer
Blood-stained: Mastitis; Breast cancer
91
Oedema (ankle/pitting)
```
Cardiac: Cardiac failure
Hepatic: Cirrhosis; Liver failure
Renal: Nephrotic syndrome; CKD
Endocrine: Hypothyroidism
Lymphoedema
Drugs
```
92
Palpitations
Anaemia
Cardiac: Arrhythmia (supraventricular tachycardia, ventricular tachycardia, atrial fibrillation/flutter); Permanent pacing; Valvular disease (mitral stenosis, mitral regurgitation, aortic stenosis, aortic regurgitation, tricuspid regurgitation); Cardiomyopathy
Endocrine: Phaechromocytoma; Hypoglycaemia; Thyrotoxicosis
Psychiatric: Panic disorder; Generalised anxiety disorder; Depressive disorder; Somatisation
Fever
Pregnancy
Drugs: alcohol misuse; drug misuse
93
Pancytopaenia
Autoimmune: SLE
Hypersplenism: Splenomegaly
Aplastic anaemia: Infection (HIV); Drugs (chemotherapy, hormone therapy and biological agents); Radiotherapy
Megaloblastic anaemia: Macrocytic anaemia
Marrow infiltration: Myelofibrosis; Metastases; Lymphoma; Leukaemia; Multiple myeloma
Sepsis syndromes
94
Papilloedema
Raised intracranial pressure
Optic nerve: Optic neuritis (MS); Infiltration (sarcoidosis, lymphoma, CNS tumours)
Globe: Glaucoma; Posterior uveitis
Vascular: Central retinal vein occlusion; Malignant hypertension
95
Peripheral neuropathy
Endocrine: Diabetes mellitus; Hypothyroidism
Infection: Varicella zoster; Lyme disease; HIV
Inflammation: Vasculitides
Autoimmune: Guillain-Barré syndrome; Rheumatoid arthritis
Renal: CKD
Malignancy: Multiple myeloma
Nutritional: Vitamin B12 deficiency
Drugs: Substance use disorder (alcohol)
96
Petechiae and purpura
Infection: Meningococcal septicaemia (meningitis, infective endocarditis, sepsis syndromes)
Inflammation: Vasculitides; SLE; Rheumatoid arthritis
Haematological: Clotting profile abnormalities
Musculoskeletal: Ehlers-Danlos syndrome
Drugs
Amyloidosis
97
Exudative pleural effusion
Infection: Pneumonia; TB
Inflammation: SLE; Sarcoidosis; Vasculitides
Malignancy: Lung cancer; Mesothelioma
Traumatic injury (incl. blunt, penetrating, crush and blast)
Gastrointestinal: Pancreatitis
98
Transudative pleural effusion
Cardiac: Cardiac failure; Constrictive pericarditis
Hepatic: Liver failure
Renal: Nephrotic syndrome; Peritoneal dialysis
Endocrine: Hypothyroidism
Ovarian: Meig's syndrome (ovarian tumour)
Hypoalbuminaemia
99
Polydipsia
Endocrine: Primary hyperaldosteronism; Diabetes insipidus; Diabetes mellitus
Drugs
Psychogenic polydipsia
100
Polyuria
Endocrine: Diabetes insipidus; Diabetes mellitus
Drugs
Psychogenic polydipsia
101
Postural hypotension
Volume depletion: Hypotension; Sepsis syndromes; Diabetes insipidus; Adrenal insufficiency
Autonomic: Neurodegenerative (Parkinson's disease); Neuropathy (diabetic)
Drugs
102
Proximal myopathy
Endocrine: Thyrotoxicosis; Hypothyroidism; Osteomalacia; Cushing's syndrome
Infection: HIV; Influenza
Inflammation: Vasculitides; Idiopathic inflammatory myopathies (incl. polymyositis, dermatomyositis)
Hereditary: Muscular dystrophies
Drugs: Substance use disorder (alcohol)
103
Raised inflammatory markers: CRP
Infection
Inflammation
Malignancy
104
Raised inflammatory markers: ESR
```
Infection
Inflammation
Autoimmune
Malignancy
Renal: CKD; Nephrotic syndrome
Haematological: Anaemia
Obesity
```
105
Raised jugular venous pressure
Non-pulsatile: Superior vena cava obstruction
Pulsatile: Cardiac (right heart failure, tricuspid regurgitation, constrictive pericarditis); Respiratory (COPD, cor pulmonale); Abdominal (ascites, pregnancy
106
Seizure
Vascular: Subarachnoid haemorrhage; Stroke
Infection: Brain abscess; TB; HIV; Meningitis; Encephalitis
Inflammation: MS; Vasculitides; SLE; Sarcoidosis
Trauma: Head injury
Metabolic: Hypoxia (T2RF, T1RF); Hypoglycaemia; Electrolyte disturbance (hyperkalaemia, hypokalaemia, hypernatraemia, hyponatraemia)
Drugs: Substance use disorder (alcohol)
Malignancy: Brain metastases; CNS tumours
Neurological: Epilepsy
Degenerative: Alzheimer's dementia
Endocrine: Thyrotoxicosis
107
Sensory disturbance
Neuropathy: Mononeuropathy (carpal tunnel syndrome); Radiculopathy (spinal); Polyneuropathy (endocrine = diabetes mellitus; drugs = alcohol misuse; nutritional = vitamin B12 and folate deficiency; infection = syphilis, HIV; inflammation = vasculitides)
Spinal cord: CNS tumours; Cervical spondylosis; MS
Brainstem: Stroke; TIA; CNS tumours; Brain abscess
Thalamic: Stroke; TIA; CNS tumours; Brain abscess
Epilepsy
Migraine
Drugs:
108
Spastic paraparesis
Vascular: Spinal cord infarction
Infection: TB; Syphilis; AIDS myelopathy (HIV); Epidural abscess
Inflammation: MS; Sarcoidosis; Paraneoplastic syndromes
Malignancy: CNS tumours
Hereditary: MND
Traumatic injury (incl. blunt, penetrating, crush and blast)
109
Splenomegaly
Massive: Malignancy (chronic myeloid leukaemia, myelofibrosis, lymphoma; Infection (HIV)
Moderate: Haematological (haemolytic anaemia, thalassaemia, sickle cell disease, hereditary spherocytosis); Hepatic (cirrhosis); Infection (infective endocarditis, infectious mononucleosis, TB, malaria, HIV); Inflammation (SLE, rheumatoid arthritis); Traumatic injury (incl. blunt, penetrating, crush and blast); Malignancy (lymphoma, multiple myeloma, metastases)
110
Sweating
Endocrine: Diabetic autonomic neuropathy Thyrotoxicosis; Hypoglycaemia; Menopause; Phaeochromocytoma; Carcinoid syndrome
Infection: TB; HIV
Malignancy: Lymphoma
Psychiatric: Panic disorder; Drug misuse
Alcohol withdrawal
111
Sinus tachycardia
Physiological: Exercise; Pain; Fever; Pregnancy
Cardiovascular: Myocardial infarction; Cardiac failure; Constrictive pericarditis; Hypotension; Sepsis syndromes
Respiratory: Pulmonary embolism; Asthma; COPD
Endocrine: Thyrotoxicosis; Phaechromocytoma
Psychiatric: Generalised anxiety disorder; Panic disorder
Drugs
112
Supraventricular tachycardia
Atrioventricular: Wolff-Parkinson-White syndrome
Atrial: Atrial fibrillation/flutter
113
Ventricular tachycardia
Ischaemic heart disease (angina pectoris, acute coronary syndrome, myocardial infarction)
Cardiomyopathy
Electrolyte disturbance: Hyperkalaemia; Hypokalaemia
114
Testicular pain and swelling
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Epididymitis and orchitis
Testicular torsion
Strangulated inguinal hernia
Testicular cancer
Varicocoele
Hydrocoele
Traumatic injury (incl. blunt, penetrating, crush and blast)
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115
Thrombocytopaenia
Increased splenic sequestration: Hypersplenism (splenomegaly)
Reduced platelet production: Pregnancy; Drugs (alcohol misuse, chemotherapy, hormone therapy and biological agents); Malignancy (multiple myeloma, myelofibrosis, lymphoma, leukaemia); Nutritional (vitamin B12 and folate deficiency)
Increased platelet destruction: Autoimmune (immune thrombocytopaenic purpura, SLE, rheumatoid arthritis, antiphospholipid syndrome); Infection (EBV = infectious mononucleosis, hepatitis C, HIV, malaria); Liver failure; Disseminated intravascular coagulation (DIC); Drugs
116
Thyrotoxicosis
Graves' disease
Thyroid nodules
Thyroiditis
Drugs
117
Tinnitus
Auditory: Presbyacusis (sensorineural hearing loss); Otosclerosis (sensorineural hearing loss); Acoustic neuroma; Drugs
Vascular: Stroke
Neurological: MS
118
Tremor
Essential tremor
Parkinson's disease
Cerebellar: Stroke; Infection (TB, HIV, varicella zoster); MS; Vasculitides; CNS tumours
Endocrine: Hypoglycaemia; Thyrotoxicosis; Phaeochromocytoma
Psychiatric: Generalised anxiety disorder
Drugs: Alcohol withdrawal; Opiate withdrawal; Antidepressants
119
Urinary frequency
Infection: UTI; Urethritis (gonorrhoea, chlamydia)
Bladder: Diabetic autonomic neuropathy; Urinary tract calculi; Bladder cancer; Stress incontinence
Prostate: Benign prostatic hyperplasia; Prostate cancer
Pregnancy
Drugs
120
Urinary incontinence
Stress incontinence: Childbirth; Transurethral resection of the prostate
Urge incontinence: Spinal cord compression (incl. cauda equina); Spinal cord injury; Bladder cancer; Bladder outflow obstruction; Stroke; MS
Overflow incontinence: Bladder outflow obstruction
121
Urinary retention
Outflow obstruction: Intraluminal (urinary tract calculi); Intramural (urethral stricture); Extramural (benign prostatic hyperplasia, constipation, pregnancy)
Infection: UTI; Urethritis (gonorrhoea, chlamydia); Genital herpes
Neurological impairment: Spinal cord injury; Diabetic autonomic neuropathy; MS; CNS tumours; Metastases
Traumatic injury (incl. blunt, penetrating, crush and blast)
Post-operative
Drugs
122
Urinary urgency
Infection: UTI; Urethritis (gonorrhoea, chlamydia)
Bladder: Bladder cancer; Stress incontinence; Urinary tract calculi
Prostate: Benign prostatic hyperplasia; Prostate cancer
Pregnancy
123
Visual field defect
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Stroke
TIA
CNS tumours
MS
Traumatic injury (incl. blunt, penetrating, crush and blast)
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124
Weight loss
Gastrointestinal: Peptic ulcer disease and gastritis; Ulcerative colitis; Crohn's disease; Coeliac disease
Infection and immunology
Cancer
Endocrine: Thyrotoxicosis; Diabetes mellitus; Adrenal insufficiency
Cardiac: Cardiac failure
Respiratory: Bronchiectasis; Idiopathic pulmonary fibrosis; Cystic fibrosis
Renal: CKD
Rheumatological: Rheumatoid arthritis; Giant cell arteritis
Neurological: Stroke; Dementia; Parkinson's disease; MND
Psychiatric: Depressive disorder; Anorexia nervosa; Bipolar affective disorder
Drugs: Alcohol misuse; Drug misuse
125
Wheeze
Anaphylaxis
Respiratory: Asthma; COPD; Bronchiectasis; Lung cancer
Cardiac: Cardiac failure
Foreign body
