common presentations Flashcards
Haematemesis
Oesophagitis/gastritis Hiatus herniia PUD (gastric or duodenal) Varices Mallory weiss Oesophageal cancer Gastric cancer AV malformation Vascular angiodysplasia Hereditary hemorrhagic telangiectasia Scleroderma Aorto enteric fistula
Umbilical pain
Early appendicitis AAA Mild pancreatitis Early mesenteric thrombus Eosophagitis Gastritis PUD Associated distention and peritonism Gastric outlet Large bowel obstruction Ileocaecal valve competent Stricture Volvulus Hernia Small bowel - billous/faecal vomit Gallstone adhesion hernia Intussception
Rectal Bleed
Haemorrhoids Rectal polyp/cancer Anal polyp/cancer Anal fissure Anal fistula Radiation proctitis Diverticular disorder Angiodysplasia Colitis Infections Ischaemic gut Colon polyp/tumour/cancer Vasculitis Anastomotic leak Angiodysplasia AV Crohn's Coeliac Aorto-enteric fistula Small bowel tumour Meckel's diverticulum
Constipation
Always ask if passing wind Peristalsis IBS Drugs - opioids, iron tablets, calcium blockers, antidepressants Hypothyroid, Hyperclacaemia, Hypoklaememia Spinal cord compression MS Renal failure Parkinson's Idiopathic megacolon Slow transit DM - autonomic neuropathic Scleroderma Low fibre Dehydration Bowel obstruction Colon cancer Sigmoid volvulus Pelvic masses - uterine fibroids, ovarian tumour Colon stricture Diverticular Radiation If not pushing - haemorrhoids, anal fissure Physiological - slow transit, outlet obstruction, animus, rectocele, sigmoidocele
Flank Pain
MSK Nephrolithiasis Leaky AAA Spinal fracture, mets, disc prolapse Pyelonephritis Renal cancer Renal abscess Perforated ulcer Basal pneumonia
Ascites
Increased portal venous pressure:
Pre hepatic - portal vein compression, thrombosis, shistosomiasis
Hepatic - cirrobisis, acute hepatic necrosis, viral hepatitis
Post - budd chiari, myeloproliferative, constrictive pericarditis, RHF, hypercoaguable statesHypoproteinuria:Renal disease
Acute chronic liver disorder
Malnutrition/malabsorption
Protein losing enteropathy
Chronic peritoneal inflammation:TB, fungal, carcinoma, post irradiation
Leakage of lymphatics:Congenital, surgical trauma, primary or secondary lymphatic malignancy
Other - pancreatic ascites, billows ascites, urinary ascites
Ascites treatment
Sodium restriction 60-90mg day
Spirinolactone then add thiazide
Paracentesis
Treat SBP (>250)
Venous obstruction - angiogram and platy
Portal HTN - trans jugular intrahepatic portosystemic shunt
Portovenous shunt –> if refractory medical or carcinomatous peritoneal cavity –> subcut to SVC
Incontinence
Abnormal faeces:
Sphincter defect - obstetric, postanorectal surgery, perineal trauma
Neuropathic - LMN - stretch pudendal neuropathy, DM
Demylination UMN - stroke, tumour, demylination
Rectal prolapse
Congenital anorectal malformation
Normal sphincter
Faecal impaction
Diarrhoea
Dementia or mentally retarded
Neck lumps
Lymphadenopathy
Sebaceous cysts
LipomasMidline - thyroid nodule, thyroglossal cyst, dermoid cystThyroid nodule - colloid cysts, follicular adenoma, hyperplastic nodule, carcinoma, papillary, follicular cancer, medullary, anapaestic
Anterior triangle - brachial cyst, carotid body tumour, carotid aneurysm, lateral thyroid, parotid, cystic hygroma, laryngocele
Posterior triangle - developmental remnants, cystic hygroma, bronchial sinus cyst, vpancoast tumour, cervical rib
Submandibular - salivary gland, cervicofacial actinomycosis, siadaldenitis, sialolithiasis, neoplasm
Goitre - hashimoto’s, graves, nutrient, suppurative, transient, sarcoidosis, dyshormogensisLaryngocele, pharyngeal pouch
Skin ulcers
Traumatic
Decubitus
Venous, varicose veins, thrombophlebitis
Arterial insufficiency
Skin infarct thrombus
Vasculitis - SLE, RA, scleroderma, buerger’s, PAN
Infective - topical, TB, Myco ulcers, post cellulitis
Malignant - SCC, BCC, melanoma
Neurotrophic, DM, peripheral neuropathy
Haem - spherocytosis, leprosy
Pyoderma gangrenosumIX: ABI, venous duplex, biopsy
Dysphagia
Bulbar, pseudo bulbar, myasthenic
Pharyngeal pouch, mediastinal mass, AAAVascular abnormality
Nutcracker oesophagus
CREST
Chagas
Dysmotility - barium swallow –> achalasia, oesophageal spasm, non-specific
Oesophagitis - candida, peptic, eosinophilicStricture:Drugs - bisphosphonates, NSAIDs, iron tablet, zidovudineIron deficiency - web
Benign - peptic, fibrous rings, eosionophilicMalignant - thyroid, oesophageal, carcinoma stomach
Tonsilitis - schatzkiring, Patternson-Brown kelly syndrome
Haematuria and Dysuria
White cells - infections, bladder, urethritis, pyelonephritis, prostate
Blood at start - urethra and prostateBlood at end - pyelo and bladder
Red cells - glomerular - IgA, thin membrane, glomerulonephritis (Glomerular disease - minimal change, thin basement membrane, membranous GN, focal segmental, post infectious, membranoproliferazive, HSP, SLE, good pasture)
Stones + Infarct + infection = painful and carcinoma or urethral stricture
PCKD + trauma - painless, vascular malformation, bladder radiation, BPH
Infarct - IE, SLE, PAN
Bladder, prostate, renal cell, renal pelvic carcinoma
Haemoglobin - haemolytic anaemia
Myoglobin - rhabdo, viral myositis (snake bite, influenza, statin)
Dark - bilirubin, rifampicin, porphyria, urethral dysuria
Stone Stricture, phimosis, mental stenosis
Reactive arthritis
UTI, STI
Prostatitis
Urethral caruncle
Vaginitis
Vaginal prolapse
Bladder, prostate, urethral carcinoma
Chronic diarrhoea
IBS, hypothyroid, carcinoid
Inflammation - IBD, diverticular, microscopic colitis
Infection - C difficile, guardia, cryptosporidium, entamoeba
Malabsorption - coeliac, pancreatic (chronic pancreatitis, cancer) tropical sprue, lactose deficiency, Whipples, crohn’s, lymphoma, short loop
Overflow - colon cancer, ovarian cancerMeds - digoxin, metformin, H2, orlistat, antibiotics, thiazide, laxative
Coeliac, small bowel bacterial overgrowth
Anal pain
Without swelling: Anal fissure ANal herpes Ulcerative proctitis Proctalgia fugax Solitary rectal ulcer Tenesmus
Painful swelling: Perianal haematoma Strangulated internal haemorrhoid Abscess - perianal, ischiorectal Pilonidal sinus Fistula-in-ano
Red flags - weight loss, change in bowel habit, fever, recurrent (Crohn’s)
Carpal Tunnel
Idiopathic Acromegaly Amyloid DM Hypothyroid Occupation Myeloma Paget's Pregnancy + Premenstrual oedema RA Tophaceous gout Trauma Fibrosis Granulomatous disorder - TB
Haemoptysis
Acute infection - URTI, acute bronchitis - COMMONEST
Chronic bronchitis
Bronchiectasis
Lobar pneumonia (rusty) + staph
TBNeoplasms - mets, bronchial cancer
PE
Foreign body
Cardiac - CCF, Mitral stenosis, AV malformation
Anticoags, haemophilia, leukaemia
Vasculitis - Wegener’s, Good pasture, PAN, SLE, HHT
Idiopathic pulmonary haemosiderosis
Post-operative fever
Inflammatory reaction to surgery Reaction to blood products Malignant hyperthermia Drug fever Toxic Shock MI Stroke Infarct in operated tissue Transplant rejection Seroma Underlying disease Haematoma Subarachnoid Atelectasis Early wound infection Aspiration penumonitis UTI Surgical site infection Pneumonia Septic thrombophlebitis Septicaemia Calculus Cholcystitis OM Meningitis Transufion related acute infection Fat embolism MI Leakage C difficile Intraabdominal abscess DVT/PE Foeign body Deep wound infection Leaky anastamosis Osteomyletis Sinusitis Catheter related Cavernous sinus infection Infected serumInfected prosthesis Alcohol withdrawal
Bowel obstruction
Mechanical - adhesions, neoplasm, hernia, IBD, intussception, volvulus
Functional - Paralytic ileum, inflammation, metabolic (hypokalaemia, hypercalcemia), drugs (anti-choliniergics), pseudo obstruction (Ogilvie, Chagas, DM, Hirschprung, collagen vascular, Kawasaki)
Ischaemic bowel
Vomiting
Vestibular - vertigo, DPPV, labrinthitis, motion sickness, menderes
GI obstruction - pyloric stenosis, gastroparesis, paralytic ileum, volvulus
Brain - Raised ICP, meningitis, encephalitis, anxiety, migraine
Metabolic - uraemia, DKA, addison’s, toxinsInfection - food poison, enteritis
Acute abdomen - hepatitis, pancreatitis, gallstone, peritoneum, appendix, nephrology, MI, pregnancy, drugs, Child - URTI, pneumonia, OM, UTI, achalasia, oesophageal atresia
Haemoptysis
URTI Acute bronchitis Bronchiectasis TB Pneumonia - necrotising Neoplastic - carcinoma or mets PE Foreign body Cardiac - acute LV failure, mitral stenosis, AV malformation ANticoags, haemophilia, leukaemia,Vasculitis - Wegener's, good pasture, PAN, SLE, HHT Trauma
Acute Diarrhoea
Gastro- Salmonella, campylobacter, shigella, e coli, staph Viral - rotavirus, norovirus, hep A In HIV - cryptosporidium parvum Entomoaba, giardiasis Diethyindescrtion Antibiotic drug reactions contacts, food, travel history
LIF
Acute diverticulits Constipation IBD Ischaemic - af, embolism, athero Pseudomembranous colitis Leaky AAA Locally perforated Cancer UTI Ureter colic Pyelonephritis Shingles Rectus sheath haematoma Sigmoid volvulus Bowel obstruction Hernia Gynae causes
RIF
Appendix Gastroenteritis ureteric colic Pancreatitis Testes torsion Meckel's Small bowel obstruction Caecal volvulus Perforated PUD Pyelonephritiis DKA Acute ileitis Constpiation Caecal diuretic Mesenteric adenitis UTI Cholecystitis Hernia Epiploic Gynae - ectopic, PID, ovary torsion, cyst rupture, haemorrhage, Mittelschmerz
Jaundice
Prehepatic - haemolytic anaemia, Gilberts, sepsis, crippler major, dubin johnson
Hepatocellular - hepatitis, drugs (paracetamol), hepatic (CCF), ischaemia, Budd chair, Cryptospirosis, mets, Wilsons, Alcohol, Reye, Acute cirrhosis, fatty liver
Obstructive - Gallstones, pancreatic cancer, bile duct cancer, hepatic mets, hepatocellular cancerPainless - pancreatic cancer, bile, hepatitis, primary biliary cirrhosis, haemolytic anaemia, CHF, Gilber’’s, cirrhosis, primary sclerosing cholangitis
Haemolytic - megaloblastic, GOPD, spherocytosis
Post op - transfusion, viral, drugs, transfusion, overload, sepsis, chronic liver disorder, cholestasis, thallasseamia major, autoimmune, blood transfusion
Liver cirrhosis
Alcohol
Viral - B and C
NASHimmune - primary sclerosing cholangitis, autoimmune hepatitis (ANA, ASMA, SLA, ALK, MI, ALC)
Biliary - primary biliary cirrhosis, CF, secondary biliary cirrhosis
Genetic - haemochromatosis, OC, Wilson’s
Chronic venous outflow obstruction
Back pain
Mechanical - MSK, discogenic, posterior ligament, facetogenic dysfunction Degenerative Fracture Malignancy - breast, bronchus, prostate, melanoma, thyroid, kidney Multiple myeloma Osteoporosis Spinal stenosis Hypercalcaemia Pagets Spondylothesis Scheuermann's disease Psoriatic Reactive IBD related Epidural abscess Osteomyelitis Diabetes Meningioma Mets Glioma Syrynx Pancreatitis, PUD, Depression, Hypercalcaemia
Cholestasis
Alcoholic hepatitis/cirrhosisDrugs - OCA, amytryptiline, chlorpromazine, gold
Biliary cirrhos
Viiral hepatitis
Cancers and mets
Extrahepatic: Bile duct cancer Pancreatic cancer Other cancer mets Cholangitis PSC Gallstones in common bile duct Pancreatitis Post surgery stricture/oedema
Charcot triad - fever upper abdominal pain + jaundice, acute cholecystitis
Epigastric pain
Acute pancreatitis Gastritis/duodenitis PUDBiliary colic Acute cholecystitis Basal pneumonia Oesophagitis AAA rupture Ascending cholangitis MI Mesenteric ischaemia Acute hepatitis Non ulcer dyspepsia Bowel obstruction Gastric cancer Pancreatic cancer Boerhaave perforation
Hyperlipidaemia
Hyper cholesterol:
Hypothyroid
Cholestasis
Nephrotic Drugs - thiazide, cyclosporin, carbamazepine
Hypertryglycerides: obesity, DM Cushing Alcohol renal failure
Drugs - oanzapine, steroids, oestrogen, SSRIPrimary familial hyperchoelsterolaemia
Anorexia - increased LDL
HCC - increased LDL
Hepatitis - increased VLDL
Odynophagia
GORD Oesophageal spasm Candidia HSV CMV Pill induced Cancer Achalasia
Peritonism
Acute:
Primary - splenectomy, cirrhosis, nephrotic syndrome
Secondary - Perforation - gallbladder, appendix, ulcer, diverticular, Crohn’s
Infection - appendix, abscess, pyosalpinx
Ischaemia - volvulus, mesenteric, ischaemia, strangulated hernia
Chemical - blood, bile
Chronic - infection (TB and candida), carcinomatosis, chemical (talc powder on gloves)
RUQ pain
Biliary colic Cholecystitis Duodenal ulcer Pancreatitis Basal pneumonia Ascending cholangitis Gastric ulcer Small bowel obstruction Appendix Hepatitis Pyelonephritis Ovarian pathology
MMSE
Orientation Registration Attention and calculation Recall Language
Dengue
Fever
haemorrhage
Low platelet
Leaky capillary - ascites, pleural effusion, low haematocrit 70%, low albumin
Tests - FBC, leukopenia, platelets, LFT (increased AST, ALT, low albumin), UEC
Parkinsonism
Parkinsons
CUD
Drugs - antipsychotics, metoclopramide, lithium, sodium valproate, manganese, tetraberazine
Neurodegenerative - levy body dementia, progressive supra nuclear palsy, impaired up and down gaze, cognitive impairment, bulbar symptoms
MSA - parkinsons, cerebellar, autonomicCorticobasilar degeneration - dystonia, myoclonus, alien limb + parkinsons
Anoxic, genetic, Fragile X, Huntington, Wilsons
Chronic Cough
Dry: GORD Postnatal drip Lung cancer COPD Drugs Interstitial lung disease Pulmonary oedema -CCF Pleurisy - RA/SLE Fibrosing alveoli's, penumoconious, sarcoid
Productive: Bronchiectasis TB COPD Lung cancer Congenital - CF, Kartagener Lung abscess Foreign body - late Extrinsic alveolitis
ASTHMA in both
SOB - minutes
Acute asthma Anaphylaxis Laryngeal oedema PE Pneumothorax AMI, mitral regurg Flash P oedema Croup Foreign body Epiglottitis Angina A stenosis Arrhythmia in HF Acidosis Uraemia
SOB - weeks - months
COPD Chronic asthma Heart failure Pulmonary fibrosis Pneumoconisis, sarcoid, allergic alveolitis Anaemia Bronchiectasis Decondition Pleural effusions Pul HTN Mesothelium Pulmonary TB Kyphoscoliosis MND Ankylosing Spondlyitis
Dysphasia
Fluent - input or receptive and comprehension
Wernickes - fluent, poor comprehension, poor repitiion
Conduction - good comp, poor repitition
Transcortical sensory - poor comprehension, good repetition
Non fluent - good comprehension, difficult articulation
Broca - good comp, poor reputation
Transcortical motor - good comprehension, good reputation
GLOBAL
Pleural effusion
Common: Pneumonia TB Pulmonary infarct Pluerisy, empyema Malignancy CCF Subphrenic abscess, pancreatitis
Uncommon: Lowered protein - nephrotic, liver failure --> lymphoma SLE, RA ARF Post MI syndrome Megs Asbestos Myxoedema Uraemia - failure kidney
Painful shoulder
Rotator cuff tendinopathy Frozen shoulder Subacromial bursitis Bicepital tendinitis Glenoid labral tears OA Polymalgia rheymatiuca Posterior dislocation Recurrent subluxation Neoplasia - pancoast and bone Referred - diaphragm, gallbladder Axillary vein thrombosis Gout/psuedo - rare Winged scapula Cervical spine Avascular necrosis and post fracture
Clipping bra/touching shoulder blade - internal rotation
Combing hair - external rotation - frozen shoulder
Pain at night - capsule or cuff
Fatigue
Depression/anxietyViral or post viral OSA Cardiac failure PUD Anaemia HIV/AIDSMalignancy Hypo/hyperthyroid Addison's DM Kidney failure Liver cirrhosis Respiratory - COPD/ashtma Neuro - Parkinsons, MS, Myasthenia Met - hypokalemia, magnesium, haemochormatosis Nutrient - coeliac Cushing SLE/RA Post infectious RRV Barmah
