clinical signs Flashcards
rusty sputum
pneumococcal pneumonia
frothy pink sputum
pulmonary oedema
fetid odour of sputum
bronchiectasis/lung abscess
history of pneumonia can lead to
bronchiectasis or pulmonary fibrosis
severe measles or whooping cough can lead to
bronchiectasis
drugs which can lead to pulmonary fibdrosis
methotrexate, amiodarone, nitrofurantoin
alpha-1-antitrypsin deficiency is a genetic cause of
emphysema
purse lipped breathing
COPD
wasting of intrinsic muscles of hand can occur when there is
T1 nerve invasion by apical lung cancer
fine tremor can be caused by the use of
beta blockers
bounding pulse
CO2 retention
pulsus paradoxus is seen in
cardiac tamponade or constrictive pericarditis
raised JVP suggests
- cor pulmonale OR
- SVC obstruction due to lung cancer (but this will be accompanied by oedema of face and neck)
chemosis
conjunctival oedema seen due to hypercapnia secondary to COPD
barrel chest
emphysema
intercostal recession
partial laryngeal/tracheal obstruction
tracheal deviation causes
- pulmonary fibrosis/collapse= deviation towards the side of the collapse
- tension pneumothorax/effusion= away from the pathology
transmission of vibrations in the chest are reduced in
pneumothorax or pleural effusion
chest pain when lying flat
decubitus angina second to heart failure
some causes of finger clubbing
- non small cell lung cancer
- idiopathic pulmonary fibrosis
- bronchiectasis, lung abscess, cystic fibrosis
- sarcoidosis
- atrial myxoma
- crohn’s/UC
- cirrhosis
collapsing/waterhammer pulse
aortic regurgitation
malar flush
mitral stenosis
splinter haemorrhages
IE, IV drug abuse, rheumatic heart disease, Lupus
liver disease causing xanthelasma
primary billiary cirrhosis
parasternal heave
left ventricular hypertrophy
hepatomegaly with pulsation
tricuspid regurgitation
causes of ascites
liver cirrhosis, viral hepatitis, alcoholism, advanced cancers
radiofemoral delay
coarctation of aorta
pronator drift
upper motor neuron lesion (contralateral pyramidal tract)
aortic regurgitation is best heard during
expiration with patient sitting upright and leaning forwards
nerve for palmar abduction of thumb
median
nerve for palmar adduction of thumb
ulnar
Dysdiadochokinesis
cerebellar syndrome or multiple sclerosis
Hemiplegic gait description and cause
Arm adducted at the shoulder, flexed elbow and wrist, leg extended
and adducted at the hip, knee extended, and ankle plantar-flexed
The patient lurches his upper body toward the unparalysed side to elevate the pelvis
and swing the paralysed leg round. The plantar-flexed foot scrapes along the ground.
caused by unilateral upper motor neuron lesion on contralateral side to affected limb
apraxic gait
Parkinson’s gait
Slow and shuffling
Steppage gait
common peroneal nerve palsy/spinal lesion
The patient flexes the
knee and lifts the foot high to clear the toes from the ground. As it is returned to the
ground, there is a loud slapping noise.
Ataxic gait
wide based gait. The feet are planted wide apart and patient
sways to one or both sides while walking. Attempting to walk heel-to-toe makes ataxic
gait more pronounced.
implies either cerebellar, vestibular or sensory impairment.
optic nerve test
snellen chart, check visual fields, test light reflexes and accommodation
jaw jerk test used to test
trigeminal nerve
facial nerve test
screw up eyes, puff out cheeks, raise eyebrows, purse lips and show teeth
Rinne’s test
The vibrating tuning fork (512Hz) is held on the mastoid until the sound is no
longer heard. It is then held near the external acoustic meatus and the sound should continue
to be heard. In conductive hearing loss, bone conduction is better than air conduction and the
sound is not heard at the external acoustic meatus. In sensorineural hearing loss, both air and
bone conduction are decreased by a similar amount
Weber’s test
Weber’s test: A vibrating tuning fork (512Hz) is held against the forehead in the midline. The
vibrations are normally perceived equally in both ears because bone conduction is equal. In
conductive hearing loss, the sound is louder in the abnormal ear than in the normal ear. In
sensorineural hearing loss, the sound appears louder in the normal ear. The sensitivity of the
test can be increased by having the patient block their external ear canals with their index
fingers.
Koilonychia
spoon-shaped nails, suggesting chronic iron-deficiency
Spider naevi
multiple spider naevi suggest underlying liver
disease with increased circulating oestrogens.
Dupuytren’s contracture
(fibrosis and shortening of the palmar aponeurosis).
Usually idiopathic or familial but there is a possible unproven association with
trauma, diabetes, epilepsy, alcoholism and liver disease.
Kayser-Fleischer rings
(Wilson’s disease). These are brown rings that encircle
the iris, resulting from copper deposition. In the early stages they are best seen
with a slit lamp, but later they can be seen with the naked eye
telangiectasia
(Hereditary Haemorrhagic Telangiectasia (HHT /
Osler-Weber-Rendu syndrome) affects the face, oral mucosa, GI tract, lungs, liver and
brain, resulting in recurrent haemorrhage)
Angular stomatitis
may be caused by deficiency
of Vitamin B6, B12, folate or iron.
Glossitis, an abnormal smooth red appearance of the tongue
Painful glossitis
is seen in Vitamin B12 or folate deficiency whereas glossitis due to irondeficiency
tends to be painless.
Gynaecomastia
may be due to increased
circulating oestrogens in liver failure.
Murphy’s sign
acute cholecystitis- finds inflamed gallbladder
stiffness in RA
significant early morning stiffness (>60 mins usually)
& joints stiffen up again after period of rest/ in evening
stiffness in OA
minimal to moderate early morning stiffness (<30 mins
usually) & joints made worse by activity. Also stiffen up in
evening.
eyelid lag
eyelid retraction
lid lag- hypothyroidism
lid retraction- hyperthyroidism
