Clinical Signs Flashcards
3 causes of Beau’s lines
1 fever
2 cachexia
3 malnutrition
What is leuconychia a clinical sign of
Hypoalbuminaemia
What are mees’ lines a sign of. (3)
- arsenic poisoning
- CKD
- chemotherapy
What is nail fold erythema and telangiectasia a sign of
SLE
What are half and half’ or Terry’s nails a sign of?
Prox white-pink, distal red-brown
Sign of chronic renal failure/cirrhosis
What are blue nails sign of (3)
. Cyanosis
• Wilson’s disease
• Ochronosis (blue-black discolor due to deposition of phenols eg hydroquinone )
What are reddish blue nails sign of
Polycythemia
What are cherry red nails sign of
Carbon monoxide poisoning
Name CVS causes of clubbing (2)
Infective endocarditis!!!
Cyanotic heart disease
Causes splinter haemorrhages
Infective endocarditis
Vasculitis
3 causes koilonychia
Iron deficiency
Fungal infection
Raynaud’s disease
Clubbing causes CVS (3)
- Cyanotic congenital heart disease
- IE
- PHT
- atrial myxoma (rare)
( rare: axillary a aneurysm or brachial anteriovenous malformations if unilat)
3 resp causes clubbing
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)
3 GIT causes clubbing
Cirrhosis (esp biliary, hepatic)
IBD esp uc
Malabsorption eg Coeliac disease
(Rare: neurogenic diaphragmatic tumours, pregnancy)
1 endocrine cause clubbing
Thyrotoxicosis
rare: 2° parathyroidism
Causes of high gradient (serum to ascites albumin >11g/L.) (6)
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
Causes of low gradient (serum : ascites albumin < 11 g/l) -4
Peritoneal carcinomatosis
TB.
Pancreatic ascites
Nephrotic syndrome
Approach to clubbing (12)
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
Name 3 “other” causes of clubbing
- PHT
- Hodgkin’s lymphoma
- thyroid acropachy (graves) or cancer
Name 4 causes asterixis
- 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
Identify picture 2
Koilonychia
Causes: iron deficiency anaemia, haemochromatosis, SLE
Approach to oedema? (4)
- 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
