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Patient Assessment > Condition CF > Flashcards

Condition CF Flashcards

1
Q

Abdominal aortic aneurism

A

Mostly men over 65. Most are aysymptomatic until rupture, but can cause mild to severe persistant central abdominal pain or persistant low back pain. A pulsing feeling may be felt when touching near the umbilicus. There may also be associated vascular claudication in the lower limbs - leg pain and weakness on exercising, quickly releived by rest.

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2
Q

Angina equivalent

A

More common in women. Dyspnoea with little or no chest pain. History of chest tightness and close correlation with exercise.

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3
Q

Aortic disection (thoracic)

A

Very rare. Risk if HBP, known thoracic aortic aneuysm, Marfan’s syndrome or Ehlers-Danlos syndrome. Sudden onset severe, sharp, tearing excruciating chest pain may begin near shoulder blades. Possible sweating , nausea and vomiting. Pain follows the path of dissection. CT,MRI or echocardiogram to investigate/confirm.

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4
Q

Arrhythmia

A

Irregular heart beat. Possible dyspnoea if there is a structural heart abnormality. Can cause collapse or stroke. Other symptoms: palpitations, dizziness, fainting. Possible oliguria and uraemia. Risk factors: Old age, excess alcohol, overweight. History of MI or heart failure. Congenital. Drug reaction.

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5
Q

Atherosclerosis

A

Older people with family history and lifestyle risks (smoking, obesity, alcohol, diet, personality, social deprivation, diabetes). Male or post menopausal women. Asymptomatic at first. Can cause angina, MI, embolism or CVE. May have history of high BP and cholesteral.

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6
Q

DVT

A

Calf pain and tenderness. Low grade fever. Pitting oedema around ankle. Patient may have risk factors: immobility, injury to vein or increased clotting.

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7
Q

Heart failure (dilated cardiomyopathy) - acute

A

Dyspnea - orthopnoea, extremely tired, agitated, pale, clammy, pulse rapid, cool peripheries. Left - more respiratory symptoms - rapid shallow respiration. Wheeze. Unable to speak. Can cause renal failure, hypo or hyperkalaemia, hyponatraemia, thromboembolism, arrhythmia, impaired liver function. Most common cause of premature death.

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8
Q

Heart failure (dilated cardiomyopathy) - chronic

A

Dyspnoea at first with moderate exertion, gradually provoked by less exertion. Orthopnaea - use of pillows, waking in night. Cheyne-stokes respiration. Relapsing and remitting. Fatigue, listlessness, cold peripheries. Swollen ankles. Weight loss. R - Hepatomegaly, ascties and peripheral oedema. L - Pitting oedema, pulmonary oedema & pleural effusion.

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9
Q

Hypertention

A

May be assymptomatic. Hypertensive retinopathy. Can lead to aortic aneurysm and dissection, hypertensive encephalopathy and stroke, heart failure, cardiomegaly, atrial fibrillation, hypertensive nephropathy and kidney failure. More common in black americans and japanese. Can be genetic factors. High salt intake, heavy alcohol consumption, obesity, lack of exercise, drugs. Can indicate renal dysfunction, insulin resistance, phaeocromocytoma, cushings syndrome, adrenal tumour or thyrotoxicosis.

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10
Q

Mitral valve prolapse

A

Risk factors: Older people. High blood pressure. History of rheumatic heart disease, endocarditis, congential heart defect, marfans syndrome. May be asymptomatic. Sharp left sided muscualoskeletal like pain that patient can point to. Shortness of breath, tiredness, dizziness. Can lead to arrhythmia, palpitations, pulmonary hypertension and heart failure.

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11
Q

Myocardial Infaction (MI) - Heart attack

A

Cardiac pain (dull heavy, squeezing, crushing burning) in centre of chest, neck, jaw, arms, possibly back, without exertion. Dyspnoea. Orthopnoea. Discomfort rather than pain. Takes several minutes or longer to develop. Sweating, nausea, vomiting. Collapse/syncope. Pallor. Nitroglycerin does not help. Onset can be sudden or gradual. Women more likely to get non pain symptoms. Most likley caused by blod clot due to atherosclerosis, but can be other reasons.

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12
Q

Peripheral artierial disease

A

In West - atheroscelosis is main cause. 20% have it but only 1 in 4 have symptoms. Associated with diabetes. Pain caused by intermittent vascular claudication in calves, buttock, hip or thigh, when walking or climbing stairs. Quickly releived with rest. Hair loss, numbness or weakness,muscle wasting, ulcers, blue shiny skin - all on legs. Brittle toenails. Erectile dysfunction.

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13
Q

Reynauds phenomenum/disease - primary

A

Mostly young women aged 25 to 30 in temperate climates, genetic link. White fingers triggered by cold, anxiety and stress lasting minutes to hours. Cyanosis and rubor. Not usually painful. Can also affect toes.

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14
Q

Reynauds phenomenum/disease - secondary

A

Older people with vibration injury or thoracic outlet obstruction (TOS), RA or lupus. White fingers triggered by cold, anxiety and stress lasting minutes to hours. Cyanosis and rubor. Can progress to ulceration, necrosis and pain. Can also affect toes.

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15
Q

Ruptured abdominal aortic aneurysm

A

Acute abdominal or lumbopelvic pain - onset in minutes. General malaise and leg weakness. Possible vascular claudication.

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16
Q

Stable angina

A

Effort related cardiac pain (dull heavy, squeezing, crushing burning in centre of chest, neck, jaw, arms, possibly back) similar to MI, but relieved by rest or nitroglycerin. Predicable. Long term. Dyspnoea. Also brought on by emotion, large meal or cold wind. Most likley caused by atherosclerosis in coronary artieries, but can be other reasons.

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17
Q

Temporal Arteritis

A

Headache at front and side of head possibly back or top of head with proximal muscle weakness or tenderness, jaw claudication and visual disturbances - diplopia. Possible history of polymyalgia rheumatica. New headache in older patient - onset may be sudden. Paracetamol does not help. Extreme tiredness, anorexia, weight loss, depression.

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18
Q

Thoracic aortic aneurism

A

Over 50s, risk increasing with age. Men > Women. May be aysymptomatic until rupture, but can cause chest pain, back pain, difficulty breathing, coughing, wheezing, hoursness and difficulty swallowing. Risk factors: Smoking, HBP, Family histoy, marfans, TB.

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19
Q

Unstable angina

A

Very similar to MI. Cardiac pain (dull heavy, squeezing, crushing burning) in centre of chest, neck, jaw, arms, possibly back, at rest. Unpredictable (new onset or rapidly worsening). Lying flat. Nocturnal symptoms. Dyspnoea. Discomfort rather than pain, takes several minutes or longer to develop. Most likley caused by atherosclerosis in coronary artieries, but can be other reasons.

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20
Q

Vascular claudication

A

Bilateral calf pain - cramping aching. Does not depend on spinal position. Agrivated by physical exertion. Pain relieved promptly by rest. Sensory loss in stocking distribution. Cool, dry, scaly skin. Poor nail and hair growth. Decreased or absent pulses. 40-60+ yrs.

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21
Q

Venous hypertension

A

Back or leg pain with varicous veins or history of DVT. Swelling in lower legs. Tiredness. Leathery, flaking or itching skin or ulcers on legs or feet. More likely in older obese inactive or pregnant women.

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22
Q

Referred viceral pain - Heart (Angina, MI)

A

Dull, deep and boring, diffuse pain in central upper thoracics or left arm. Hypersensitive to touch.

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23
Q

Pulmonary embolism

A

Chest pain or dyscomfort similar to MI. Sudden severe persistant dyspnoea. Patient looks anxious. Signs of DVT - ankle oedema, calf tenderness. Smaller embolysm can cause heamoptysis and pleural chest pain. Causes: DVT. Inactivity. Blood vessel damage due to chemotherapy and vasculitis. Blood that clots too easily - Cancer, chemotharapy, radiotherapy, heart failure, thrombophillia, Hughes syndrome. Risk factors: Age > 60. Familial. Obese. Pregnant. Smoker. Combined pill or HRT.

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24
Q

Infectious mononucleosis

A

Severely sore thoat. Swollen gland in neck. Fatigue. Teenagers and young adults.

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25
Q

Infective endocarditis

A

Most common in patients with congenital or valvular heart disease or history of heart surgery. May not be painful. Subacute: Persistent fever, unusually tired, night sweats, weight loss or new signs of heart dysfuction. headache and muscle ache like flu. Acute: Fever. Prominent & changing heart murmers. Petechiae (bleeding spots). Post operative: Fever after heart valve surgery. Any: Subconjunctive haemorrhage. Roths spots in eye. Petechial haemorrage on mucous membranes or rash. Poor dental health. Systemic emboli - eg nail fold infarct. digital clubbing, splinter haemorrhages. Blood in urine. Oslers nodes.

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26
Q

Oral candidiasis

A

Odynophagia. Oral ulcers. White patches on tongue and buccal mucosa. Dysphagia. More common in babies, debilitated patients. Corticosteroid or antibiotics. DM. Immunosuppressed. Cytotoxic therapy. AIDS.

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27
Q

Acute pyelonephritis

A

Pain in the side, lower back and genitals. Fever. Shivering. Chills. Weak and tired. Loss of appetite. Nausea. Vomiting. Diarrhoea. May also show symptoms of lower UTI. Slightly more common in women. Additional for children: irritability, poor feeding, not growing at expected rate, abdonimla pain, jaundice, blood in urine, bed wetting.

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28
Q

Chronic pyelonephritis

A

Many be asymptomatic at first or repeated attacks of pain in the side, lower back and genitals. Fever. Shivering. Chills. Weak and tired. Loss of appetite. Nausea. Vomiting. Diarrhoea. May also show symptoms of lower UTI. Can be caused by obstruction repeated acute attacks or vesico-ureteral reflux.

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29
Q

Pelvic inflamatory disease possibly related to STD (Chlamydia, gonorrhoea)

A

Acute abdominal pain and possible lumbopelvic pain, that increases after menstruation in sexually active female. Fever, chills, dyspareunia (pain during intercourse) and abnormal vaginal discharge.

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30
Q

Urinary tract infection (Lower UTI)

A

Can be asymptomatic. Sudden onset frequency of micturition. Urgency. Dysuria (scalding pain in urethra during micturition). Suprapubic pain during and after voiding. Constant dull pain in pubic region. Back pain. Strangury (intense desire to pass more urine after micturition). Cloudy, unpleaseant smelling urine. Microscopic or visible haematuria. General sense of unwellness. Can lead to septicaemia. Very common. Women > men. Less common in children. Risk factors: Incomplete emptying from obstruction - kidney stones, neurological problems, uterine prolapse, vesico-ureteric reflux. Catheter or stent. Post menopausal vaginitis, or urethritis. DM. Chemotherapy, HIV. Extra risk for women: sexually active, use of diaphram or spermicide. Extra risk for men: enlarged prostrate.

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31
Q

Urinary tract infection (Upper UTI)

A

Uncontrollable shivering. Nausea. Vomiting. Diarrhoea. Moderate to severe pain in side, back or groin that is worse when urinating. May also display symptoms of lower UTI. Can spread from lower to upper. Women> Men, Risk factors as lower UTI

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32
Q

Viral hepatits

A

Headache. Myalgia. Arthralgia. Nausea. Anorexia. Jaundice. Vomitting. Diarrhoea. Abdominal discomfort. Dark urine. Pale stools. Symptoms rarely last more that 3 - 6 weeks. Can lead to acute liver failure, aplastic anaemia or relapsing hepatitis. Been abroad without vaccination (A), sexual contact with carrier (B), IV drug use (C), glandualr fever (Epstein Barr), immunocompromised (Cytomegalovirus)

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33
Q

Parasitic infection

A

Recurrent diarrhoea after recent travel

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34
Q

Bornholm disease /epidemic myalgia/coxsackie viral infection)

A

Severe stabbing chest pain worse when deep breathing, coughing or sudden movements. Pain is intermittent lasting 15 to 30 mins at a time. May also have headache, sore throat and muscle pain. Mainly under 30s and in epidemics during summer and autumn.

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35
Q

Infective/Septic arthritis

A

Hot, red, swollen joint. History of open wound, chronic inflammation or immunosupression.

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36
Q

Osteomyelitis

A

Diffuse aching pain in cervical, thoracic, lumber spine or limb. Sudden high temperature and malaise. Swelling, redness, warmth, tender to touch. Lymph glands swollen. May be history of trauma, DM,RA or sickle cell.

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37
Q

Arachnoiditis

A

Low back and leg pain following myelographic or spinal anaesthetic procedures. Possible cauda equina symptoms.

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38
Q

Herpes Zoster (Shingles)

A

Unilateral NOT bilateral , sharp, burning, recurrent chest pain with skin vesicles after a few days and hypersensitivity in dermosomal pattern. Radiates around chest and improves with antivirals. Reccurs with stress.

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39
Q

Pneumonia

A

Pleuritic chest pain. Dyspnoea. Cough with sputum. Chills. Clamminess. Blueness. Headaches. Loss of appetite. Mood swings. Nausea. Vomiting. Joint pain. Fatigue. Muscle aches. Spread by droplet infection. Can affect healthy individuals, some more predisposed through risk factors: Smoking. URTI. Alcohol. Corticosteroids. Old age. Recent flu injection. Lung disease. HIV. Indoor air pollution. More likely to be viral in children.

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40
Q

Tuberculosis - primary

A

Flu like symptoms. Respiratory chest pain. Lung consolidation and collapse. Obstructive emphysema. Pleural effusion. Meningitis. Pericarditis. Erythema nodosum. Phlyctenular conjunctivitis. Dactylitis. Pulmonary: Chronic cough with haemoptysis. Pyrexia. Pneumonia. Weight loss. Pneumothorax. Can have extra pulmonary symptoms. More common in developing countries. Risk from Smoking. HIV. Malignancy. DM type 1. Chronic renal failure. Silicosis. Malnutricion from GI disease. Vit A, D deficient. Recent measles.

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41
Q

Tuberculosis - milary

A

Respiratory chest pain. Fever. Night sweats. Anorexia. Weight loss. Dry cough. Headache. Crackles. Bone marrow - Anaemia, leucopenia. Extra pulmonary: Seizures, confusion, SOL, cranial nerve palsy, chronic back pain, kyphosis, chord compression, abdominla mass, ascites, Psoas abcess, monoarthritis, haematuria,dysuria, infertility in women, epidydimitis, pericardial effusion. Risk factors: Cancer. HIV. Malnutrician. DM. Silicosis. End stage renal disease. Major surgery.

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42
Q

URTI - cold, pharyngitis, acute bronchitis

A

Rapid onset. Sneeezing, sore throught, watery nasal discharge, cough, possible hearing impairement due to blockage of eustachian tubes. May have severe sore throat, hoarse or lost voice, pain on speaking with unproductive painful cough. May have fever. May develop to respiratory chest pain, retrosternal discomfort in trachea,wheeze, tight chest, mucopurulent sputum, may be blood stained.

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43
Q

URTI - Influenza

A

Sudden fever, aching, headache, anorexia, nausea, vomiting, harsh unproductive cough. Most recover in 3-5 days, but post viral syndrome can last for weeks. Mostly occurs as epidemic.

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44
Q

URTI’s - Sinusitis

A

Persistant headache after a cold or URTI. Dull throbbing pain in the upper face, cheeks, eyes and forhead. Fever, bad breath, reduced sense of smell. Purulent nasal discharge. Toothache. Fever. Worse in the morning.

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45
Q

Labrithitis

A

Constant dizziness. Acute onset. Slowly improves. May have some associated hearing loss or tinnitus. Can be caused by stress, head injury, virus or bacteria. May have had a cold just before.

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46
Q

Pericarditis (or myocarditis)

A

History of MI, cancer, infection, rheumatic fever or blunt trauma to chest. Retrosternal, left of sternum or L or R shoulder sharp pain. Varies with movement and respiration - catches during inpiration, coughing or lying flat. Can point to where pain is. Low grade fever.

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47
Q

Reumatic heart disease - acute rheumatic fever.

A

pericarditis, sore throat, fitting, erythema marginatum, subcutaneous nodules, dyspnoea, syncope, fever, oedema, polyarthritis. Explosive , halting speech. Emotional lability may present first. Chorea at late stage.Children between 5 and 15. Rare in western europe. Endemic in africa, asia and south america. History of recent strep infection or scarlet fever. Risk factors: malnutrition, poverty.

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48
Q

Gastritis

A

Dyspepsia - more discomfort than pain, Anorexia, Nausia, Vomiting, Haematemesis and Melaena. H Pylori is most common cause.

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49
Q

Appendicitis

A

Acute abdominal pain. Sudden onset. Young person. Poorly localised becoming more specific to RLQ within 2-12 hours. Nausea and vomiting. Annorexia, diahrroea.

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50
Q

Coeliac disease

A

Genetic suseptability. More common in northern europe. 1% prevalence in UK. Can present at any age, most common 30-50. Females > males. Linked to hyposplenism. 50% asymptomatic. Oral ulcers. Infants present with diarrhoea, malabsorbtion, failure to thrive. Older childen - delayed growth, puberty delay, mild abdominal distension, short stature in adulthood. Adults: Tiredness, weight loss, folate deficiency, iron deficiency anaemia, dyspepsia, bloating, undernutrition. Risk of osteoporosis.

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51
Q

IBD - crohn’s disease

A

Colicky pain in right lower abdomen, releived by defacation. Diarrhoea. Variable symptoms anywhere in GIT. Oral ulcers. Growth retardation. Sacroiliitis. Fistulous communication with bowel, skin, urinary bladder. General symptoms for IBD: Nausea. Vomiting. Weight loss. Relapse and remittance over years. Conjunctivitis, Iritis, Episcleritis. Mesenteric or portal vein thrombosis. Venous thrombosis. Arthralgia of large joints. Erythema nodosum. Pyoderma gangrenosum. Autoimmune hepititis. gall stones. Metabolic bone disease. Amyloidosis and oxylate caculi. Risk factors: Smokers. Ashkenazi jews. SLE. IBD patients with HLA B27 gene comonly develop AS.

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52
Q

IBD - ulcerative colitis

A

Mild lower abdominal cramps. Dehydration. Bloody diarrhoea. Tenesmus. Dehydration. Anorexia. Palor. Cholangitis and Cholangiocarcinoma. Toxic megacolon. General symptoms for IBD: Nausea. Vomiting. Weight loss. Relapse and remittance over years. Conjunctivitis, Iritis, Episcleritis. Mouth ulcers. Fatty liver. Liver abscess. Mesenteric or portal vein thrombosis. Venous thrombosis. Arthralgia of large joints. Erythema nodosum. Pyoderma gangrenosum. Autoimmune hepititis. gall stones. Metabolic bone disease. Amyloidosis and oxylate caculi. Risk factors: Genetic . Non smokers with appendix. IBD patients with HLA B27 gene comonly develop AS.

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53
Q

Irritable bowel syndrome

A

Colicky abdominal pain associated with defacation. Abdominal distention.Alternating constipation and diarrhoea. Rectal mucus. Feeling of incomplete defacation. Young women > men. Most common cause of GIT referral. Cause of absence from work and impaired quality of life. Stress worsens symptoms.

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54
Q

Ruptured appendix/ Peritonitis

A

Difuse acute abdominal pain in RLQ suddenly relieved, followed by increase in pain. Rigid abdomen. > Young person. Nausea and vomiting. Shortness of breath.

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55
Q

Pleurisy

A

Sharp chest and shoulder pain when breathing deeply, coughing, sneezing or moving. Shortness of breath and dry cough. Hisory of infection. Can point to pain.

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56
Q

Polymyalgia rheumatica

A

Pain and fever with weight loss and depression. Associated with temporal artieritis. Stiffness in the morning for > 45 mins. Extreme tiredness. Loss of appetite. Mostly over 70 when diagnosed. Rare in under 50s. More common in women. Normally starts with shoulders.

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57
Q

RA

A

Episodic pain, swelling and stiffness in joints, especially hands, feet and wrists. Throbbing aching pain, worse in morning for > 1 hour. Joints red and tender to touch. Bilateral. Multiple joints. May also have tiredness, fever, sweating, anorexia, weight loss. can affect eyes, heart and lungs. Can cause joint deformities. Commonly starts age 40 to 50. More women than men. Genetic tendancy.

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58
Q

Sacroiliac syndrome

A

SI joint pain. Radiation to hip, buttock, upper posterior thigh. Stabbing pain on lifting or straightening from stooped. Relieved by sitting or lying.

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59
Q

Frozen shoulder/Adhesive capsulitis

A

Frozen shoulder. Causes unknown but associated with trauma, immobilisation, diabetes (poor blood flow), thyroid issues and cardiac problems. More common in women. Usually non dominant side. Severe pain during freezing phase. Tender to touch. May disturb sleep. Agf: ext rotation. Lying on it. Alf: Arm in sling position. Pain lessens during frozen phase.

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60
Q

Leukemia

A

Tiredness, breathlessness, frequent infections, bleeding gums, nosebleeds in over 60 or children mostly 2 to 5 yrs. Tiredness, weight loss, night sweats, bloating, repeated infections, bruising and bone pain in 40 to 60 yrs.

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61
Q

Hodgkin’s lymphoma (HL) or Non-hodgkin lymphoma (NHL)

A

Swelling of neck armpit or groin. Night sweats. Unexplained weight loss. Persistent tiredness or fatigue. Recurrent infections and longer recovery. Persistant cough or feeling of breathlessness. Persitent itching all over body.

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62
Q

Multiple myeloma

A

Age 50+ Persistant LBP. Worse at night. Osteoporosis. Hypercalcaemia. Anaemia. Renal disease. Infection due to suppressed immune system.

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63
Q

Pituitary tumour (Benign adenoma)

A

Migraine like headache or cluster headache. Depression, anxiety or other mood changes. Can cause acromegaly, cushings.

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64
Q

Thyroid tumour

A

Pain in the neck and sometimes ears. Trouble swallowing. Trouble breathing. Hoarseness, Frequent cough not related to a cold.

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65
Q

Carcinoid bowel tumour/carcinoid syndrome

A

Mostly asymptomatic. Pain like appendicitis if obstruction. Pain in liver (from metastases). Flushing. Wheezing. Diarrhoea. Facial telangiectasia. Jaundice and hepatomegaly (from liver metastases). Carcinoid syndrome symptoms can include cardiac involvementfrom peptide hormones. Most common in appendix (benign) or rectum (malignant).

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66
Q

Colorectal cancer

A

Colicky lower adbominal pain. Rectal bleeding. Peritonitis. Localised abcess. Fistula formation. Aneamia. Weight loss. Palpable mass. Hepatomegaly from metastases. Left colon: Early bleeding and obtruction. Right colon: Amemia, altered bowel habit. Obstruction late. Rectum: Early bleeding, mucus discharge, feeling of incomplete emptying. Common in the west, > 50s, genetic predisposition and dietary factors - red meat and saturated fat, some(5%) have single gene mutation as the cause, IBD with PSC, uterosigmoidostomy, acromegaly, pelvic radiotherapy. Obesity. Smoking. Cholesistectomy. Type 2 diabetes. Reduced risk: Asprin, NSAIDS, statins.Fibre, fruit and veg, calcium, folic acid and omega 3.

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67
Q

Gastric carcinoma

A

50% have ulcer like pain. May be asymptomatic. Dyspepsia. Weight loss. Anorexia, Nausea. Early satiety. Haematemesis. Malaena. Disphagia if Gastro-oesophageal junction is obstructed. Anaemia. Palpable epigastric mass. Jaundice. Ascites. Dermatomyositis. Leading cause of cancer death worldwide. More common in China, Japan, South America. Environmental factors indicated. Men> women. > 50 yrs. Risk factors: salted, pickled, smoked food. Nitrites & Nitrates. Lack of Fresh fruit, veg, vit A, vit C. Genetic, blood group A, CDH1 gene auto somal dominant. History of gastritis (pernicious anaemia). Adenatemous gastric polyps in patient or family. Smoking. Alchohol. Previous partial gastrectomy.

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68
Q

Oesophageal tumour

A

Oesophageal chest pain. Progressive painless dysphagia. Bolus obstruction. Extreme weight loss in late stages. Cachexia. Hoarseness. Fistulation to trachea causing coughing, pneumonia, pleural effusion. Lymphadenopathy. metatastic spread.Squamous call carcinoma common in asia & africa. Risk factors - smoking, alchohol excess, betel nuts, tobacco, coeliac disease, achalasia, post cricoid web, post caustic stricture, tylosis. Adenocarcinoma increasing in West due to prevalence of GORD and Barrets oesophagus.

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69
Q

Oral cancer

A

Trismus (Pain opening mouth). Solitary Ulcer. White or red patch. Fixed lump. Lip numbness without trauma or infection. Cervical lymphadenopathy.Common worlwide. Incidence in UK increased by 25% over last decade. Risk factors: Poor diet, smoking, tobacco chewing, acohol excess, HPV virus. Chewing betel nuts (asia). Older adults. Men> women.

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70
Q

Benign prostatic hyperplasia (BPH)

A

Primary symptoms: Hesitancy. Poor prolonged flow. Sensation of incomplete emptying. Secondary symptoms: Frequency. Urgency. Urge incontinence. Emergency symptoms: Acute urinary retention. Anuria, painful distended bladder. Chronic symptoms: Chronc urinary reterntion. Pain free bladder dystention that can lead to hydroureter, hydronephrosis and renal failure or acute urinary retention. Men only. From age 40 prostate increases in size. Symptoms are common in > 60. 50% of > 80 have lower UT symptoms.

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71
Q

Prostate cancer

A

Symptoms same as BPH. (Hesitancy. Frequency. Urgency. Urinary retention. Anuria. Painful distended bladder. Mets cause lumbar and pelvic pain, weight loss, anaemia, obstruction of the ureters. Common in Northern Europe and USA, rare in China and Japan. > black population. 2nd most common malignancy in men. Rare < 50 yrs. Ave 70 yrs.

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72
Q

Renal adenocarcinoma

A

May be asymptomatic at first. Heamaturia. Loin pain, mass. Some have only one of these, some all three. Disorders of coagulation (too much) due to hormones from tumour. Rarely may present with neuropathy. Most common malignant tumour of the kidneys in adults. Males > females. 65 - 75 yrs. Unlikely < 40.

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73
Q

Testicular tumour

A

Painless testicular lump. Possible testicular ache. Possible gyneacomastia. Uncommon.Men. Age 20-40.

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74
Q

Urothelial tumour (Bladder, ureteral, urethral or Kidney tumour)

A

Painless, visible haematuria. Can also cause obstruction or dysuria. Males > Femles. Unlikely under 40. Mostly in urinary bladder and mostly benign

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75
Q

Hepatic tumour - Hepatocellular carcinoma (HCC)

A

May be asymptomatic at first. Features of cirrhosis if present. If no cirrhosis - Abdominal pain and weight loss. Possible hepatic rupture with abdominla bleeding. Most common primary liver tumour. 6th most common cause of cancer worldwide. More in asia, southern europe than northern europe. Risk factors: > In men. > with age. Cirrhosis major factor. Hep B infection. 4x risk if HBeAg present.

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76
Q

Pancreatic cancer (carcinoma)

A

Asymptomatic at first. Upper abdominal pain radiating to the lower back. Asymptomatic at first. Jaundice, loss of appetite, Cachexia, Depression, Vomiting from duodenal obstruction, Lymphadenopathy, scratch marks (Obstructive jaundice), venous thrombosis. Affects 1 in 1000 over 70s. Men> women 2:1. Risk factors: age, smoking, acute pancreatitis. DM. Obesity. Diet rich in red meat and lacking fruit and veg. 5 to 10 % patients have genetic predisposition.

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77
Q

Primary bone tumour

A

Gradual onset diffuse aching pain. Fatigue, weight loss fever, anaemia and unexplained fractures. More likely in young people or osteochondroma in hips, shoulders or pelvis.

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78
Q

Spinal tumour (Mets)

A

Age 50+ History of breast, prostate, lung or kidney cancer. Gradual onset of pain, worse at night. Weight loss. Fatigue.

79
Q

Spinal tumour (Primary)

A

Rare. Mostly young adults. Focal pain in the neck or back that is worse in the morning, with weakness or numbness in limbs or changes in bowel and bladder habits. Pain is severe on direct manipulation, does not diminish with rest and is worse at night. Loss of appitite, unexpected weight loss, nausea, vomiting, fever, chills or shakes. Mostly benign.

80
Q

Brain stem or cerebellar tumour

A

Ptosis, dysphagia, dysarthria, diplopia. Dizziness or vertigo continuous with gradual onset. Possible convulsions or conciousness change. CN signs. Nystagmus changes in different fields of gaze, lasts for > 1m and does not fatigue.

81
Q

Brain tumour

A

Can be asymptomatic. Headache with progressive or constant neurological signs and symptoms. Vomiting. Fits. Changes to vision. History of cancer. Wakes with headache in morning.

82
Q

Primary Lung Tumours

A

Cough. Haemoptysis. Bronchial obstruction. Stridor. Chest pain. Nerve entrapment (Horner’s syndrome due to sympathetic nerves - ptosis, enopthalmos, miosis, hypohidrosis of face or pancoasts syndrome die to brachial plexus - pain in shoulder and inner arm, atrophy in hand). Dyspnoea. Dysphagia from mediastinal spread. Arrythmia or pericardial effusion from pericardium invasion. Swelling of neck, face, conjuntival oedema, headache from Superior Vena cava obstruction. Vocal cord parallysis or bovine cough if laryngeal nerve is affected. Mets can cause anorexia, weight loss, finger clubbing, liver , bone and neurological symptoms. Hormones can also be secreted from the tumour - SIADH (small cell - anti diuretics), andrenocorticotropic hormones (small cell) or hyper calcaemia (squamous). Men> women. 18% of all cancer deaths. Increasing in women. Causes and risk factors: Smoking. Passive smoking. Pollution. Ocupation - industrial materials ( e.g. silica, asbestos).

83
Q

Acoustic neuroma

A

Gradual onset, but constant symptoms. Hearing loss in one ear (may be sudden). Tinnitus. Vertigo. Facial numbness, tingling or pain. Possible headache, but rare. Ataxia. Can be realted to neurofibromatosis.

84
Q

Cervical spondylosis with radiculopathy

A

Common cause of neck pain. More common over 45, even more over 60. Sharp burning arm pain in dermatome distribution. One side only. Gradual onset. Agf: looking behind. All: neck flexion or hands on head.

85
Q

Cervical stenosis/Cervical myelopathy

A

Age 30 to 60 most common. Head and neck pain. Worse with extension, lat flex or rotation. Better with flexion. Hand numbness, hoarseness, vertigo, tinnitus, deafness. Spastic gait. Drop attacks. ataxia. Loss of hand function. Poss loss of bl & bwl function. Cogwheel hyperreflexia.

86
Q

Osteophitic Intercostal neuritis

A

Chest pain in patient with history of arthritis (osteophytes) or diabetes. Sharp stabbing pain, numbness and tingling. Bilateral. Can radiate to back. May also have abdominal pain, fever and pain in arms and shoulders.

87
Q

Cluster headache

A

Severe sharp burning or peircing headache with lacrimation and rhinorrhoea that occurs in bouts over several weeks. Usually on one side, often around the eye. More common in men. Sudden onset. Lasts 15 m to 3 hrs. May be seasonal or triggered by smoking or alcohol. Restlessness and agitation. Wakes patient at night.

88
Q

Fibromyalgia

A

Muscle aches, stiffness and fatigue in multiple areas of the body, often including thoracic spine. Pain is continuous but severity may vary. Can be burning, sharp, stabbing or aching. Extra sensitivity to pain and pain on light touch. Aggrivated by cold, stress, damp, overexertion, sedentary positions, poor posture. May be sensitive to bright lights. Associated headaches like migraine, IBS and depression. May affect sleep and cause concentration difficulties. More likely in women. Familial tendancy. May be triggered by a stressful event.

89
Q

Haemorrage - Cerebellar

A

Headache with rapid reduction of conciousness. Nystagmus. Devated gaze. Cerebellar symptoms (ataxia, lack of proprioception and balance)

90
Q

Haemorrage - Intracerebral

A

Headache , weakness, paralysis (one side) and confusion. Rapid onset. 10% of strokes. Risk factors: Hypertension. Aneurysm. Severe headache and dramatic loss of brain function leading to coma.

91
Q

Haemorrage - Subarachnoid

A

5% of strokes. Sudden devastating headache. Vomiting and posible coma. Can be followed by less severe headaches. Neck stiffness. Papiloedema. Can present like severe migraine. Risk factors: anurysm or arteriovenous malformation. Menegitis, SLE, Marfans, Ehlers-Danlos.

92
Q

Haemorrage - Subdural and extradural

A

Caused by head injury and can cause death if not treated promptly. Can be weeks or months after injury. Symptoms fluctuate. Headache, drowsiness, sensory loss, hemiparesis, epilepsy followed by stupor and coma, but can resolve spntaneously.

93
Q

Horner’s syndrome

A

Miosis (constricted pupil), ptosis (drooping eyelid), anhydrosis (reduced sweating), possible enopthalmus (inset eyeball). Possible bloodshot conjunctiva.

94
Q

Migraine

A

Moderate to severe headache with or without aura. Throbbing pain at front or side of head. Possible nausea and vomiting. Women > men. Begins in early childhood. May be sensitive to light and sound.

95
Q

Neurogenic claudication

A

Bilateral or unilateral pain in low back, buttocks, thigh, calves, feet. Sciatic distribution. Pain increases with extension or walking, decreases with flexion, rest and sitting. Burning pain and numbness. Segmental sensory loss. Normal pulses. Good skin nutriton. 40-60+ yrs.

96
Q

Post herpetic nueralgia

A

20% of people who have had shingles. Over 50. Itching and hypersensitivity to touch in affected area. Can cause sleeping dificulties.

97
Q

Raised ICP

A

Throbbing headache worse in the morning and vomiting possibly without nausea. Worse when lying. Papileodema. Cranial nerve III or VI palsy. Tinitus and dyplopia. Benign raised ICP more common in women 20 - 40.

98
Q

Trigeminal neuralgia

A

Women > men. Over 40. Chronic. Episodic. Headache and excrutiating face pain in short attacks < 2 mins. Like an electric shock. Sudden onset. Unilateral. Mostly lower face. May be triggered by light touch.

99
Q

Dementia

A

Memory loss. Difficulty with problem solving and language. > 65. Gradual onset. Patient may not be able to look after themselves. May also have balance problems and tremor.

100
Q

MS

A

Extreme tiredness. Numbness and tingling. Blurring of vision. Problems with motility and balance. Muscle weakness and tightness. Unlikely to have all symptoms at once. Episodic. Unpredictable. Can lead to loss of vision in one eye, colour blindness, eye pain, light flashes when moving eye, double vision. Neuropathic pain - stabbing, burning with extreme sensitivity. Pain in muscles and joints. Ataxia. tremor. Dizziness. Vertigo. Cognitive dysfunction. Depression. Anxiety. Sexual problems. Frequency. Urgency. Nocturia. Constipation. Bowel and bladder Incontinence. Dysphagia. Dysphasia. Age 20 to 40 most common.

101
Q

Parkinsons

A

Shuffling gait. Resting tremor. Difficulty starting movements. Slow movement. Stiff and inflexible muscles. Depression. Insomnia. Anosmia. Memory problems.

102
Q

Parietal lobe lesion

A

Headache with sensory or balance problems.

103
Q

Dorsal column lesion.

A

Back pain with balance and sensory problems.

104
Q

Cranial nerve lesion

A

Problems with senses, balance, face and throat. May be due to tumour, heamorrhage or contusion.

105
Q

Tension headache

A

Headache that lasts for 30m to several hours. Not severe enough to prevent everyday activities. Ache on both sides of head. Tight neck muscles. Pressure behing the eyes. Women> men. Teenagers and adults. Chronic - > 15 times a month. Can be triggered by stress, squinting, posture, lack of exercise, noise, bright light,dehydration missing meals, tiredness, some smells.

106
Q

Motor Neuron Disease

A

Normally starts with painless weakness in hand, shoulder or foot. Possible twitching of muscles, cramping and atrophy. Dysarthria. Dysphagia. Shortness of breath. Headache in the morning.Progresses at a constant rate. Swallowing difficulty. Excessive yawning. Emotional changes. Dementia.

107
Q

Chronic kidney disease (CKD)/ Glomerolunephritis

A

Can be asymptomatic at first until it presents with signs and symptoms of renal failure. Uraemia. Hypertension. Oedema, fluid retention. Protienuria. Anaemia. Nocturia can be an early symptom. Tiredness, breathlessness. At end stage: Pruritis, anorexia, nausea, vomiting, hiccups, twitching, fits, drowsiness and coma. Hypertensive encephalopathy. 10% of adults in developed nations have mild CKD. Causes: Congenital genetic. Renal artery stenosis. Hypertention. Glomerular disease (IgA nephropathy). Interstitial disease. Systemic inflammatory disease (SLE, vasculitis). DM. Unkown causes. Immunological injury (immune reaction triggered by streptococcus), inherited abnormality.

108
Q

Chronic liver failure

A

May be painless. Confusion followed by coma. Changes to intellect, personality, emotions, speech and consciousness with or without neurological signs. Convulsions may occur. Flapping tremor and hyper reflexia. Portal hypertension. Variceal bleeding, Ascites, hepatorenal syndrome - kidney failure. Caused by liver disease.

109
Q

Cirrhosis of the liver

A

Can be asymptomatic. Highly variable. Weakness, fatigue, muscle cramps, weight loss, anorexia, nausea, vomiting, upper abdominal discomfort. Hepatic insufficiency (jaundice, circualory changes, endocrine changes (menstrual, impotence etc.) heamorragic tendancy. Hepatic encephalopathy. Digital clubbing. Dupuytrens contracture. Can also lead to shortness of breath, hepatopulmonary syndrome, hypoalbuminaemia. Any age. Important cause of premature death and morbidity. Most common causes: Chronic viral hepatitis. Prolonged excessive alcohol consumption. Other causes: Non alcoholic fatty liver disease. Autoimmune (PSC & PBC). Secondary biliary (obstruction) or cystic fibrosis. Genetic (haemochromatosis (iron), Wilsons disease (copper), antitrypsin deficiency). Unknown cause. Chronic venous outflow obstruction

110
Q

Osteoarthritis

A

Women > men. Familial tendancy. Over 50s, younger with trauma or obesity. Pain worse in evening, agrivated by use, relieved by rest. Stiffness for 30 m in morning and after rest. Swelling, crepitus, limited ROM, mild inflamation, muscle wasting, joint deformity. Monoarticular or aysymetrical. Knee, hip, feet, ankle, lumbar spine (with sciatic nerve involvement). Risk factors: injury, obesity.

111
Q

Cervical facet syndrome

A

Commonly caused by RTC. Can be caused by posture. - sitting for long periods , driving, desk job. Intermittent, dull achy pain in neck, upper back, shoulders and base of skull. Headache.

112
Q

Drug related headache

A

Side effect, rebound or withdrawal. Drug or alcohol dependance. Taking painkillers. Angina spray (Nitrates). Diet pills. Birth control pills. Menoupause hormones. Caffeine withdrawal.

113
Q

Anaemia

A

Tiredness, shortness of breath, heart palpitations. Could indicate a stomach ulcer, stomach or bowel cancer or lack of iron in diet

114
Q

Dehydration headache

A

Diffuse headache with dry mouth and feeling of thirst. Lightheadedness. Dark coloured strong smelling urine. Passing urine less often. Tiredness.

115
Q

Muscle enzyme deficiency syndrome

A

Limb pain with painful contractions post exercise. Family history. Later onset is less severe. Changes to diet and lifestyle can reduce symptoms. Can also affect heart, liver or kidneys.

116
Q

Acute liver failure

A

May be painless. Mental changes from hepatic encephalopathy progress from stupor to coma. Jaundice, vomiting, hypoglycaemia. Uncommon. Caused by paracetamol overdose, viral infection or poison.

117
Q

Acute pancreatitis

A

Severe, constant abdominal pain in upper L or middle abdomen.May radiate to back, L shoulder blade and iner-scapular region. Builds up/spreads over 15 to 60 mins.Triggered by eating high fat content food. Worse lying down. Nausea. Vomitting. Hypoxia, Hypovolaemic shock. Oliguria. Caused by gallstones, alcohol, post-ERCP or idiopathic. Men - more likely alcohol, women - gallstones. Rarely caused by surgery, trauma, birth defect, metabolic or drugs, petrochemicals, infection, renal failure, transplants or severe hypothermia.

118
Q

Alchoholic liver disease (ALD)

A

May be painless. Jaundice. Malnutrition. Features of portal hypertension (ascites, encephalopathy). Features of cirrhosis. Can lead to liver failure. Alcohol is one fo the most common causes of chronic liver disease. Average age is falling. 10% of alcoholics have cirrhosis at death. Incidence in women increasing. Unexplained rib fractures can indicate alcohol misuse. Risk factors: Continuous drinking. Genetic factors. Possible nutritional factors associated with choline (part of vit B complex) deficiency.

119
Q

Gastrooesophageal reflux disease

A

Odynophagia. Heatburn. Oesophageal chest pain. Can mimic pain of angina - Worse when exercising. Relieved by nitrates. Worse when supine, related to eating and drinking. Often radiates to back. Regurgitation when bending, straining , lying down. Waterbrash. Waking up at night choking. Dysphagia. Acid laryngitis. Recurrent chest infections, chronic cough. Asthma. 30% of population get reflux. Obesity. Dietary factors. Defective oesophageal clearance. Hiatus hernia. Abnormal sphincter. Delayed gastric emptying. Increased intra abdominal pressure. Smokers.

120
Q

Oral ulcers

A

Local pain at ulcer site. Causes: Idiopathic. Premenstrual. Fungal. Viral. Barterial. Crohn’s disease. Coeliac disease. Dermatological conditions. Drugs. SLE. Neoplasia.

121
Q

Peptic ulcer - gastric or duodenal

A

Recurrent abdominal pain - localised to epigastrium (pointing sign), related to food, episodic. Pain when stomach is empty. pain releived by vomiting or antacids or H2 agonists. Disturbed sleep. May be no pain in elderly patients being treated with NSAIDS. Vomiting, Anorexia, Nausia, Sense of undue repletion after meals. Silent ulcer - no symptoms. Anemia. Can cause obstruction. Higher prevalence in developing countries. M > F especially duodenal. Risk factors: Smoking, NSAIDS.

122
Q

Perforated ulcer

A

Rigid abdomen. Sudden onset acute agonising diffuse abdominal pain. Pale and sweating. May have history of ulcer, but it may have been asymptomatic.

123
Q

Ectopic pregnancy

A

Acute abdominal pain in sexually active woman with missed or spotty last period 6-8 weeks before. Sudden onset.

124
Q

Endometriosis

A

Chronic recurrent abdominal and possible lumbopelvic pain related to menstrual cycle with recent increase in pain. May pass blood in stool or rarely cough it up. Heavy or painful periods. Fertility problems. Depression. Pain during and after sex. Bleeding between periods. Exhastion and tiredness. Risk faactors: IUD use or post abortion. Genetic. Afro caribean, Asian.

125
Q

Mitelschmertz

A

Acute abdominal pain between periods (while ovlating)

126
Q

Ovarian cyst

A

May be asymptomatic. Pelvic pain dull or severe and sharp. Nausea, vomiting. Pain during sex. Difficulty emptying bowels and frequent urinating. Heavy light or irrregular periods. Bloating. Feeling full. Difficulty getting pregnant. Linked to endomatriosis an polycycstic ovary syndrome.

127
Q

Primary dysmenorrhoea

A

Chronic recurrent abdominal pain in lower abdomen, pelvis and possibly inner thighs, related to menstrual cycle.

128
Q

Ruptured ovarian cyst

A

Intense pain and bleeding with other symptoms of ovarian cyst. Women 18 to 35.

129
Q

Diffuse idiopathic skeletal hyperostosis (DISH).

A

Thoracic pain and possibly neck or lumbar pain, but more stiffness and increasingly restricted ROM. Worse in morning. Possible dyphagia or hoarseness. Males > 60. Not genetic and no organs affected.

130
Q

Myesthenia gravis

A

Ptosis. Diplopia. of eye muscles. Slurred speech. Swallowing problems. Neck or limb weakness (arms or legs). Mostly painless, but muscles may ache.

131
Q

Haemophillia

A

Genetic condition. Inabilty to clot. Bruising. Joint pain and stiffness. Hot swollen tender joints..

132
Q

AS

A

More common in young men. Low back pain and stiffnesss that improves with exercise. Costovertebral and hip joints. Heel, pubic, ischial pain. Acchillies tendonitis. Heel pain. Loss of lordosis. Increased kyphosis. Uveitis. Aortitis. Fatigue. Starts from pelvis and moves up. May be family history. Increased risk of CV diesease.

133
Q

Scheuermanns disease

A

Thoracic pain with midscapular fatigue and deformity. More common in males. Can also occur in female gymnasts or weight lifting adolecents.

134
Q

Cystic fibrosis

A

Bronchiectasis. Spontaneous pneumothorax. Haemoptysis. Nasal polyps. Respiratory failure. Cor pulmonale. Lobar collapse. Malabsorbtion. Steatorrhoea. Intestinal obstruction. Billiary cirrhosis and portal hypertention. Gallstones. Diabetes. Delayed puberty. Infertility in men. Stress incontinence. Psychosocial problems. Osteoporosis. Arthropathy. Cutaneous vasculitis. The most common fatal genetic disease in caucasians. Autosomal recessive. 1:25 are carriers. Incidence 1:2500 live births. Diagnosed in childhood.

135
Q

Autoimmune hepatitis

A

May resemble viral hepatitis at first or insidious asymptomatic onset. Fatigue, anorexia and jaundice. Can also cause vitiligo, epistaxis (nosebleed), amenorrhoea. More common in women 11 to 30. Strong association with other autoimmune diseases (pernicious anaemia, thyroiditis, rheumatoid arthritis, ulcerative colitis).

136
Q

Asthma

A

Respiratory chest pain. Chest tightness, dyspnoea, wheeze and cough. Airflow obstruction. Possible chest pain. Likely to be brought on by exercise, cold weather, airborne allergens, pollutants, viral URTIs. Relieved by rest. May also have nasal polyps and eczema. Can be intermittent or persistant (constant symptoms). Worse in morning and maybe at night. Variant where cough is the main symptom. Atopy - tendancy towards alergies. Very common. Genetic. Environmental factors. Possible role for microbes, diet, vitamins, breastfeeding, air pollution, obesity. Allergy - eg to pets or dust mites. May be affected by chilhood exposures. Drug related - beta blockers, NSAIDS, pill, choliergic agents, prostaglandin F2alpha and betel nuts. Occupational asthma is caused by working with certain substances.

137
Q

Eczema

A

Areas of skin that are itchy, dry, cracked, sore and red. Episodic. Most common on hands, backs of elbows, knees and face. Scratching makes it worse and can disrupt sleep. Area can turn temporarily darker or lighter after condition improves

138
Q

Mallory - Weiss syndrome

A

Haematemisis after violent retching or vomiting. Melaena (blood in stool). Oesophageal pain. Risk factors: Alcoholism, eating disorders, severe morning sickness in pregnancy. Possibly hiatus hernia and NSAID abuse. Mostly men over 60.

139
Q

Compartment syndrome

A

Pain on passive movement of a muscle with sensory loss. Muscle may have a woody or solid feel. Mostly in calf or forearm. Can be acute (caused by injury) or chronic (caused by repetitive exercise such as running or cycling).

140
Q

Costochondritis

A

Sharp chest pain worse when lying down, deep breathing, physical activity, coughing or sneezing. Can be gradual onset or sudden. May be unilateral or bilateral and cover multiple ribs. May be caused by severe coughing, physical strain, infection or wear and tear. Females > 50

141
Q

Tietze’s syndrome

A

Sharp chest pain worse when lying down, deep breathing, physical activity, coughing or sneezing. There may also be swelling. Can be gradual onset or sudden. Unilateral. May be caused by severe coughing, physical strain, infection or wear and tear. Young adults under 40.

142
Q

Intercostal muscle injury/strain

A

Thoracic pain that radiates around chest and is aggrivated by yawning or stretching. History of trauma.

143
Q

Muscle strain (limb)

A

Dull aching limb pain, swelling and local tenderness with history of trauma or overuse.

144
Q

Muscle strain (lumbar)

A

Lumbopelvic pain that came on while lifting or twisting

145
Q

Piriformis syndrome

A

Pain tingling and numbness in the buttocks. Pain can be severe. Can be triggered by sitting, running, climbing stairs or applying pressure to piriformis muscle. Can cause some sciatic symptoms.

146
Q

Prolapsed intervertabral disc with radiculopathy (lumbar)

A

Age 30-50 yrs. Men > Women. Following twisting event. Severe LBP and then leg pain to below knee. Patient leans away from medial lesion or towards lateral lesion. May be LMN symptoms at site of lesion and possible UMN below lesion if posterior.

147
Q

Rib fracture

A

History of trauma or osteoporosis. Chest pain worse on deep inspiration, coughing, sneezing and while lying supine. Patient can point to where it hurts. Most commonly posteriolateral. Worse at night.

148
Q

Stress fracture

A

History of overuse, especially running or jumping. Common in tibia, metatarsals, navicular.

149
Q

Haemothorax

A

Sharp chest pain in lung or rib area with side bending or deep breathing after trauma.

150
Q

Slipped rib

A

Chest pain with popping or clunking with certain activities.

151
Q

Whiplash

A

Painfull neck and shoulders. Tender muscles. Migraine like headaches. Stiff neck. Mostly car accident related. Caused by acceleration-deceleration. Other causes: backwards fall, skiing, horse riding. Reduced ROM.

152
Q

Chronic obstructive pulmonary disease (COPD)

A

Chronic bronchitis: Cough and sputum on most days for > 3 months in 2 consec year. COPD: impaired nutrition, weight loss, muscle weakness. Smoker’s cough (with black particles). Haemoptysis. Breathlessness. Morning headaches. Pink puffers: Thin and breathless. Blue bloaters: Oedema, hypercapnia, polycythaemia. Peripheral oedema. Pitting oedema. COPD is chronic bronchitis and emphysema. >40 yrs. Causes: Tobacco, biomass fuels (dev countries). Unsusual to develop COPD if smoked less than 10 pack years. Other risk factors: Occupation (coal, cadmium), Air pollution, Low birth weight, maternal smoking (lung growth), Infections, low socioeconomic status, nutrition, cannabis, genetic factors, airway hyperreactivity.

153
Q

Spontaneous pneumothorax

A

Sudden onset pleural chest pain. Dyspnoea. Can be spontanious, iatrogenic or due to trauma. Risk factors: Smoking. Tall stature. Existing lung disease.

154
Q

Anxiety

A

Dizziness or vertigo, tinnitus or tremors with or without hyperventialation. History of stress or emotional trauma.

155
Q

Hyperventilation syndrome

A

Breathlessness, tight chest, fast breathing, frequent sighing, tingling fingers, arms, mouth, muscle stiffness, trembling hands, dizziness, blurred vision, faintness, headaches, palpitations, tachycardia, cold hands and feet, shivering. Warm feeling in head, sickness, abdominal pain, tension, anxiety, fatigue, insomnia. History of stress.

156
Q

Haemorrhoids (Piles)

A

Pain around anus. Bright red rectal bleeding after defecation. Mucus discharge. Itching anus. Unkown cause, but associated with constipation and straining. May develop initially during pregnancy.

157
Q

Cervicogenic headache

A

Unilateral headache with reduced ROM in neck, Neck shoulder and arm pain. Made worse by neck movement or posture.

158
Q

Facet syndrome (Lumbar)

A

Low back or thoracic pain with local tenderness. Radiation to groin, buttock, thigh. Knee to chest relieves lumber pain. Limb pain in non dermatomal pattern with no neuro signs.

159
Q

Postural syndrome

A

Chronic thoracic pain or neck pain and stiffness with imbalanced muscle tighness and history of bad posture.

160
Q

Adrenal disorders - Addison’s disease (hypoadrenalism)

A

First - Fatigue, lethargy, depression, iritability, anorexia, unintentional weight loss, frequency, thirst, salt craving, dehydration. Later - Nausea, vomiting, diarrhoea, joint or back pain. Muscle cramps. Reduced libido. Irregualr periods. Low blood sugar.

161
Q

Adrenal disorders - Cushing’s syndrome (hypercortisolism)

A

Weight gain, thin skin, easy to bruise. Bone weakness. Loss of libido. Can be caused by corticosteroids.

162
Q

Graves’ disease - (overactive thyroid)

A

Hyperactivity, mood swings, anxiety, insomnia, frequency of bowel and bladder, steatorrhoea, sweating, sensitivity to heat, weight loss, light or no periods, infertility, loss of libido.

163
Q

Hashimoto’s thyroiditis or other hypothyroidism

A

Tiredness, sensitivity to cold, weight gain, constipation, depression, slow movements and thoughts, muscle aches and cramps, dry scaly skin, loss of libido, btittle hair and nails, carpal tunnel syndrome, irregular or heavy periods. Gradial onset.

164
Q

Hypothalamic/Pituitary - Acromegaly

A

Joint pain, carpal tunnel syndrome. Sweating, fatigue. Headaches.Loss of libido. Abnormal periods. Erectile dysfunction.

165
Q

Polycystic ovary syndrome

A

Irregular or no periods. Difficulty getting pregnant. Hirsuitism. Weight gain. Hair loss or thinning on head. Oily skin or acne.

166
Q

Urinary calculi (renal colic) /Nephrolithiasis (Kidney stones)/Obstructive nephropathy.

A

Renal colic - suden pain in the loin that radiates round the flank and often to the testes or labium. L1 sensory distribution. Pain steadily increases over a few minutes, causing patient to restlessly try to obtain relief by changing position or pacing the room. Pallor, sweating, and often vomiting. They may groan in agony. Dysuria, frequency and heatamuria may occur. Constant pain may last 2 hours to several days, with only slight variations in severity. Attack may be followed by intermittent dull pain in the loin or back. May also have frequency and haematuria. Risk factors: Diet (high protein, low fibre), not drinking enough fluid, hypercalcaemia, genetic predisposition, inactive, only one kidney works, already has disease of small intestine e.g. crohn’s. Drugs: aspirin, antacids, calcuim and Vit D, some antibiotics, HIV meds, anti epileptic drugs.

167
Q

Acute cholecystitis/Cholelithiasis

A

Diffuse pain in right upper & central abdomen, right shoulder tip,neck scapula and thoracic spine (bilary colic). Pain severe and prolonged up to several hours after a fatty meal or at night after a drink. Possible nausea and vomiting. Pain not relieved by vomiting. Fever. Jaundice in only 10% of case. Mostly caused by cholelithiasis, but can be due to sickle cell, parasites, tumour or endocopic stent insertion.

168
Q

Cholelithiasis/chronic cholecystitis

A

Can be asymptomatic. Recurrent pain in right upper & central abdomen, right shoulder tip,neck scapula and thoracic spine (bilary colic), often at night or after a heavy or fatty meal. Possible nausea and vomiting. Pain not relieved by vomiting. Symptoms of acute cholecystitis but milder. Fat, fair, female, fertile, forty.

169
Q

Hepatic encephalopathy

A

Alteration in mental state and cognitive function.Confusion. Slurred speech, Change in personality. Violent behaviour. Sleepy. Difficult to arouse. Flapping termors. Leads to coma - initially responsive to noxious stimuli, later unresponsive. Patient with liver disease.

170
Q

Wilson’s disease

A

Liver disease (hepatitis, cirrhosis, failure) and neuropsychiatric symptoms (ataxia, prakinsonism, dystonia, dememtia) Copper rings in eyes (Kayser-Fleisher rings) Hypoparathyroidism. Heart and Kidney symptoms. Genetic (Autosomal recessive). 1% have single abnormal copy, but only 1-4 per 100000 have both copies. Symptoms appear between ages 6 and 20.

171
Q

Gilberts syndrome

A

Chronic recurrent abdonimal pain with jaundice. Episodic tiredness, anorexia, nausea, diziness, IBS, concentration problems, general malaise. Triggered by dehydration, fasting, stess, illness, exertion, lack of sleep, surgery, menstruation. Genetic condition

172
Q

Anaphalaxis

A

Itchy skin or raised red rash. Swollen eyes, lips, hands and feet. Felling feint. Swollen mouth, throat, tongue. Breathing and swallowing difficulty. Wheezing. Abdominal pain. Collapse and unconsciousness.

173
Q

Diabetes mellitis

A

Frequent urination. Thirsty. Hungry. Can lead to CV disease, Kidney failure, foot ulcers and eye damage. Blurry vision, headache, fatigue, slow healing, itchy skin, rashes. Diabetic neuropathy. Risk factors: obesity, smoking.

174
Q

Diabetic Ketoacidosis

A

Vomiting (possible coffee grounds), dehydration, deep gasping breath, confusion and possible coma.

175
Q

Osteomalacia/Rickets

A

Diffuse joint and bone pain, especially spine, pelvis and legs. Muscle weakness. Easy fracturing. Risk for elderly, housebound or nursing home or other lack of sunlight.

176
Q

Osteoporosis

A

Pathological fractures. More common in post menopausal women or people with RA, COPD, Hyer or hypo thyroidism, family history, steroids, heavy drinking and smoking.

177
Q

Paget’s disease

A

Bone pain in spine, pelvis, skull, shoulders, arms or legs. Most likely more than one bone. Can also cause joint pain, joint stiffness or compression or damage to nerves. Hearing loss, vertigo, headaches and tinnitus if in skull.

178
Q

Acute calific tendonitis

A

Young or Middle aged adults. Occurs most frequently in supraspinatus tendon. Acute intense stabbing pain in shoulder and upper arm. Tender to touch. Often worse at night. Risk factors: Hyperthyroidism, prone to kidney or gall stones. Familial trait. Diet may influence. Can be triggered by stress to body - injury, operation or illness.

179
Q

Bronchiectasis

A

Chronic productive cough, worse in mornings. Copious puulent sputum and halitosis. Fever, malaise, recurrent infection of lungs and pleura. Recurrent haemoptysis. May be the only symptom in “dry bronchiectasis”. Weight loss, anorexia, lassitude, digital clubbing, failure to thrive in children. Can be congenital: cystic fibrosis, ciliary dysfunction syndromes, primary hypogammaglobulinaemia. Aquired in children: Pneumonia (from whooping cough or measles). Primary TB. Inhaled foreign body. Aquired in adults: Suppurative pneumonia. Pulmonary TB. Allergic bronchopulmonary aspergillosis (asthmatic allergy to mould). Bronchial tumour.

180
Q

Sarcoidosis

A

Can be asymptomatic. Dyspnoea and decreased lung function. Gland enlargement. Skin plaques and nodules. Bone cysts on fingers. Space occupying lesion in brain. Diabetes insipidus. Uveitis. Liver disease. Risk factors: Colder parts of northern europe. > west indian or asians, but eskimos, arabs and chinese rarely affected. Presents in spring and summer. Genetic link - family clustering. Less frequent in smokers.

181
Q

Referred viceral pain - Liver or gall bladder

A

Dull, deep and boring, diffuse pain in right neck, shoulder and scapula or right posterior ribs. Hypersensitive to touch.

182
Q

Referred viceral pain - Stomach

A

Dull, deep and boring, diffuse pain in central mid thoracics or sternum. Hypersensitive to touch.

183
Q

Acute renal failure (ARF)

A

Reduction in urine volume, unless patient has pre-existing renal impairment or is on diuretics. Metabolic acidosis. Hyperkalaemia. Anorexia, nausea, vomiting, confusion, apathy, muscle twitching, hiccups, fits and coma. Anaemia. Pre-renal reversible: Internal bleeding after trauma may be asymptomatic at first. Established: Can be asymptomatic at first. Possible anuria. Hyponatraemia. Hypocalcaemia. Causes: Pre-renal - Heart failure. Blood or fluid loss (trauma). Renal artery oclusion or stenosis. Arteriole disease. Intrinsic renal - Tubular necrosis/toxic/septic/drugs, glomerular disease, interstitial disease. Post-renal - obstruction. Commmon cause: combination of sepsis with NSAIDS.

184
Q

Referred viceral pain - Colon

A

Dull, deep and boring, diffuse pain in central lower abdomen. Hypersensitive to touch.

185
Q

Referred viceral pain - Gall bladder

A

Dull, deep and boring, diffuse pain in right lower anterior ribs, Hypersensitive to touch.

186
Q

Referred viceral pain - Kidneys

A

Dull, deep and boring, diffuse pain in waist, abdominal and pelvic area. Hypersensitive to touch.

187
Q

Referred viceral pain - Small intestine or ovaries

A

Dull, deep and boring, diffuse pain umbilical area. Hypersensitive to touch.

188
Q

Referred viceral pain - Urinary bladder

A

Dull, deep and boring, diffuse pain in pubic area, coccyx and inner thighs or central lower abdomen. Hypersensitive to touch.

189
Q

Chronic pancreatitis

A

Abdominal pain, relieved by leaning forwards or drinking alcohol. Weight loss. Anorexia. avoidance of food. DM (30 - 70%). Diarrhoea. Steatorrhoea (when 90% of exocrine tissue destroyed). Exudate production from lungs. Symptoms of other alcohol and smoking related illnesses. Mostly affects middle aged alchoholic men. Toxic(T): Alcohol (80% of western cases), tobacco, hypercalcaemia, chronic renal failure. (I)diopathic. (G)enetic, cystic fibrosis. (A)utoimmune. (R)ecurrent acute pancreatitis. (O)bstructive: neoplasia, pancreas divisum. NOT GALLSTONES.

190
Q

Thoracic outlet syndrome

A

Sharp burning pain in almost all arm dermatomes. Pain in trapezius. Heavy arm. Tingling in arm. Blue arm if vein compressed .Causes: Extra rib, fibrous muscles. Overuse or sustained postures.

191
Q

Referred viceral pain - Lung or diaphram

A

Dull, deep and boring, diffuse pain in left front and back of neck. Hypersensitive to touch.

192
Q

Benign Positional Vertigo.

A

Sudden dizziness with a particular head position lasting 1-2 mins. Triggered on moving head. Normally > 60 or has suffered trauma. Horizontal nystagmus that fatigues and adapts. May also have nausea or feel feint. No hearing loss.

193
Q

Meniere’s disease

A

Episodic recurrent severe vertigo lasting hours or days. Ear feels full. Tinnitus and hearing loss. Possible hypersensitivity to sound. Anxiety or depression. May be history of diabetes or fluid retention. Age 20 to 60. Familial tendancy.

Patient Assessment (7 decks)

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