Clinical Signs

Question 1

3 causes of Beau’s lines

Answer 1

1 fever
2 cachexia
3 malnutrition

Question 2

What is leuconychia a clinical sign of

Answer 2

Hypoalbuminaemia

Question 3

What are mees’ lines a sign of. (3)

Answer 3

• arsenic poisoning
• CKD
• chemotherapy

Question 4

What is nail fold erythema and telangiectasia a sign of

Answer 4

SLE

Question 5

What are half and half’ or Terry’s nails a sign of?

Answer 5

Prox white-pink, distal red-brown

Sign of chronic renal failure/cirrhosis

Question 6

What are blue nails sign of (3)

Answer 6

. Cyanosis
• Wilson’s disease
• Ochronosis (blue-black discolor due to deposition of phenols eg hydroquinone )

Question 7

What are reddish blue nails sign of

Answer 7

Polycythemia

Question 8

What are cherry red nails sign of

Answer 8

Carbon monoxide poisoning

Question 9

Name CVS causes of clubbing (2)

Answer 9

Infective endocarditis!!!

Cyanotic heart disease

Question 10

Causes splinter haemorrhages

Answer 10

Infective endocarditis

Vasculitis

Question 11

3 causes koilonychia

Answer 11

Iron deficiency
Fungal infection
Raynaud’s disease

Question 12

Clubbing causes CVS (3)

Answer 12

• Cyanotic congenital heart disease
• IE
• PHT
• atrial myxoma (rare)

( rare: axillary a aneurysm or brachial anteriovenous malformations if unilat)

Question 13

3 resp causes clubbing

Answer 13

Lung metastasis or bronchial carcinoma
Chronic lung suppuration: Bronchiectasis, Lung abscess, Empyema
Chronic lung disease: pulmonary tb, interstitial lung disease
Pulmonary ht
(Uncommon: CF, asbestosis, bronchial av aneurysm unilat)
(Idiopathic pulmonary fibrosis)

Question 14

3 GIT causes clubbing

Answer 14

Cirrhosis (esp biliary, hepatic)
IBD esp uc
Malabsorption eg Coeliac disease
(Rare: neurogenic diaphragmatic tumours, pregnancy)

Question 15

1 endocrine cause clubbing

Answer 15

Thyrotoxicosis

rare: 2° parathyroidism

Question 16

Causes of high gradient (serum to ascites albumin >11g/L.) (6)

Answer 16

Cirrhosis (97% of these high gradient pts have portal HT)
Alcoholic hepatitis
Fulminant hepatic failure
Congestive heart failure
Constrictive pericarditis (cardiac ascites)
Budd-chiari syndrome (hepatic vein thrombosis) or veno-occlusive disease

Question 17

Causes of low gradient (serum : ascites albumin < 11 g/l) -4

Answer 17

Peritoneal carcinomatosis
TB.
Pancreatic ascites
Nephrotic syndrome

Question 18

Approach to clubbing (12)

Answer 18

Primary: idiopathic, inherited. Rare.

Secondary

3 heart

• cyanotic congenital heart disease eg tricuspid abnormalities, tetralogy of fallot (5 Ts)
• endocarditis (! infective)
• atrial myxoma (rare)
• pulmonary ht

3 lung

• suppurative lung disease: empyema, abscess, bronchiectasis,cystic fibrosis
• Chronic lung disease: pulmonary tb, interstitial lung disease
• bronchial carcinoma, lung metastases
• pulmonary ht

3 git

• IBD esp Chrohn’s
• Cirrhosis biliary /hepatic
• malabsorption eg coeliac

3 other

• thyroid acropachy (= graves disease manifestation) or ca
• hodgkin’s lymphoma
• pulmonary hypertension

Question 19

Name 3 “other” causes of clubbing

Answer 19

• PHT
• Hodgkin’s lymphoma
• thyroid acropachy (graves) or cancer

Question 20

Name 4 causes asterixis

Answer 20

• Metabolic encephalopathy: hepatic encephalopathy, renal failure, resp failure, hypoglycaemia, heart failure
• electrolyte abnormalities: hypokalaemia, hypo Mg
• medication side effects: antiepileptics, opiates, levodopa, anticholinergics, benzo, lithium, barbiturates
• focal brain lesions: haemorrhage, infarction, neoplasia, cerebral toxoplasmosis, viral encephalitis

Question 21

Identify picture 2

Answer 21

Koilonychia
Causes: iron deficiency anaemia, haemochromatosis, SLE

Question 22

Approach to oedema? (4)

Answer 22

• Increased hydrostatic pressure (Increased total extracellular fluid): hf, DVT, pregnancy, excess iv fluid eg renal failure, pelvic tumour
• decreased oncotic pressure (low albumin): nephrotic syndrome, chronic liver disease, malabsorption eg Chron’s disease, malnutrition
• increased capillary permeability: soft tissue infection/inflammation, sepsis, drugs eg CCB, angio-oedema (allergy)
• lymphatic obstruction (non-pitting): malignant infiltration, congenital abnormality eg Milroy’s disease, radiation injury , elephantiasis ; infection eg filariasis, lymphogranuloma venereum