Core Clinical Problems Flashcards
1
Q
Abdominal distension/ Weight gain (9)
A
- Abdominal/pelvic mass (tumour/ abscess)
- Ascites
- Hepatosplenomegaly
- Polycystic kidneys
- Pregnancy
- Obesity
- Hypothyroidism
- Cushing’s
2
Q
Abdominal/ loin/ pelvic pain (20)
A
- cholecystitis/ biliary colic, pancreatitis, appendicitis, diverticulitis
- perforated peptic ulcer
- large and small bowel obstruction
- colitis/ Crohn’s disease
- leaking aortic aneurysm
- mesenteric ischaemia
- pelvic inflammatory disease
- endometriosis
accident to ovarian cyst - UTI
- Urinary calculi
- ectopic pregnancy
- placental abruption
- renal tract infection
- renal stone (hypercalcaemia)
- renal tumour
- congenital pelvi-uretric obstruction
- MSK
- indigestion/ heartburn/ reflux/ oesophagitis
- upper abdominal pain (peptic ulcer, somatisation, child abuse, drug reaction)
3
Q
Abnormal/ irregular vaginal bleeding (8)
A
- Menstrual: fibroids, PID, Endometriosis, Dysfunctional uterine bleeding
- post-menopausal: atrophic vaginitis, malignancy, HRT, polyps
- irregular: polyps, breakthrough, cervical cancer
- Endocrine: hypo/hyperthyroidism, PCOS, hyperprolactinaemia, menopause
- Sexual abuse
- In pregnancy: miscarriage, ectopic pregnancy, antepartum haemorrhage, cancer, polyps
- Post partum haemorrhage: trauma, atonic uterus, retained products, infection
- Somatisation
4
Q
Abnormal/ unsteady gait (4)
A
- limb deformity
- cerebral/ cerebellar mets
- muscular dystrophy
- cerebral palsy
5
Q
Abnormal blood test result (3)
A
- anaemia: low folate/ B12, haemolysis, bleeding, pregnancy, erythropoietin deficiency
- hyperlipidaemia
- blood gases
6
Q
Altered Mood (6)
A
- depression
- bipolar affective disorder
- abuse
- frontal lobe mets
- drug reaction
- substance misuse
7
Q
Anxiety (7)
A
- phobia
- GAD
- panic disorder
- separation anxiety
- OCD
- drug effects
- substance misuse
8
Q
Arrested Intellectual Development (6)
A
- congenital disorders (downs syndrome/ fragile X)
- Cerebral palsy
- congenital hypothyroidism
- epilepsy
- sensory deficits
- behavioural disorders
9
Q
Back and Neck Pain (4)
A
- MSK
- nerve root compression
- spinal cord injury
- spondyloarthritis
10
Q
Behavioural Problems (5)
A
- personality traits/ disorders
- gender/ sexual orientation
- disordered impulse control
- ADHD
- Conduct disorders
11
Q
Blocked Nose (9)
A
- common cold
- hayfever
- acute/chronic rhinosinusitis
- nasal polyps
- septal deviation
- adenoid hypertrophy
- abscess
- neoplasia
- drug reaction
12
Q
Breast Lump (4)
A
- benign: fibroadenoma, cyst
- malignant
- pregnancy changes
- gynaecomastia
13
Q
Bruising (5)
A
- Haematological causes: thrombocytopenia, purpura, leukaemia, haemophilia, von willebrand disease
- liver disease
- senile purpura
- infection (meningitis)
- trauma (child abuse)
14
Q
Chest Pain (7)
A
- cardiac: MI, angina, pericarditis
- respiratory: PE, pneumonia, pleurisy, pleural effusion, lung cancer
- GI: oesophagitis, peptic ulcer
- muscular
- trauma: fractured rib
- somatisation
- anxiety disorder
15
Q
Cold Extremities
A
- Reynaud’s disease
- microvascular disease (diabetes)
- peripheral vascular disease
- connective tissue disorders
16
Q
Collapse (11)
A
Anaphylaxis
Cardiovascular: Vasovagal; Stokes Adams; Postural hypotension; Myocardial infarction; Arrhythmias;
Neurologic: Epilepsy; Cerebrovascular disease/accident; Motor neurone disease; Spinal cord compression
Middle ear disease;
Metabolic:
Hypoglycaemia;
Hypocalcaemia;
Inborn errors of metabolism;
Musculoskeletal:
Osteoarthritis;
Infection;
Anaemia;
Alcohol;
Pregnancy:
Placental abruption,
Eclampsia
17
Q
Confusion
A
Acute: Encephalopathy; Sepsis, Post operative, Drug related, Delirium, Alcohol withdrawal, Myocardial infarction, Impaired vision / hearing; Sinusitis, Viral/atypical upper respiratory tract infection, Inhaled foreign body,
Chronic: Alzheimer’s, Multi-infarct dementia, Vascular dementia, Brain tumour, Lewy body dementia, Alcohol induced dementia, Huntingdon’s chorea, Creutzfeldt Jakob disease;
Treatable dementias: Hypothyroidism, Vitamin B12 deficiency, Depression, Anxiety, Hyperparathyroidism, Syphilis, Drug toxicity, Hypoglycaemia, Hypoxia (acute/chronic)
18
Q
Constipation (9)
A
Diverticular disease;
Irritable bowel syndrome;
Polyps;
Colo-rectal cancer;
Coeliac disease;
Bowel obstruction;
Somatisation;
Hypothyroidism;
Drug reaction
19
Q
Cough
A
Respiratory causes: Viral/atypical upper respiratory tract infection; Inhaled foreign body; Asthma; Bronchiectasis; Bronchitis; Bronchial carcinoma; COPD; Pneumonia; Interstitial lung disease;
Non respiratory causes:
Gastro-oesophageal reflux;
Drug reaction;
Sinusitis
20
Q
Deafness (11)
A
Infection (Bacterial, Viral or Fungal)
Trauma;
Neoplasia;
Iatrogenic (Surgical or Drug induced);
Metabolic;
Vascular;
Otosclerosis;
Ménière’s;
Earwax;
Congenital;
Presbyacusis
21
Q
Deliberate Self Harm (6)
A
Depression
Post natal depression
Schizophrenia;
Alcohol/drug misuse;
Bipolar disorder;
Personality disorders
22
Q
Diarrhoea (11)
A
Gastroenteritis
Parasitic infection
Irritable bowel syndrome
Crohn’s disease;
Ulcerative colitis;
Polyps;
Colo-rectal cancer;
Coeliac disease;
Bowel obstruction;
Somatisation;
Drug reaction
23
Q
Difficulty in Swallowing (7)
A
Oesophageal cancer Oesophagitis;
Benign oesophageal stricture;
Barrett’s oesophagus;
Motor neurone disease;
Primary motility disorder;
Mediastinal mass;
Multinodular goitre
24
Q
Dizziness
A
Syncope;
Anaemia;
Hypovolaemic shock;
Dysrhythmias;
Aortic stenosis;
Postural hypotension;
Vertebrobasilar insufficiency;
Brain stem vascular disease;
Infection;
Anxiety;
Epilepsy;
Disseminated sclerosis;
Autonomic neuropathy;
Peripheral neuropathy;
Tumour;
Benign Positional Paroxysmal Vertigo;
Vestibular Neuronitis;
Labyrinthitis;
Ménière’s Disease;
Addison’s Disease;
Hypoglycaemia;
Drug reaction
25
Ear Ache (2)
- otitis media/externa
| - refered pain
26
Falls and Immobility (13)
Drugs (e.g. sedatives, antidepressants, antihypertensives);
Syncope;
Postural hypotension;
Arrhythmias;
Myocardial infarction;
Cerebrovascular disease;
Parkinsons disease;
Epilepsy;
Dementia;
Peripheral neuropathy;
Arthritis;
Depression;
Alcohol
27
Fever
```
With rash:
Meningitis;
Viral exanthenam;
Toxic shock syndrome;
Drug hypersensitivity;
```
```
Without rash:
Meningitis
Upper/lower respiratory tract infection;
Sepsis;
UTI;
Malaria;
Cellulitis;
Neutropenic infection
```
Pyrexia of unknown origin (PUO)
Febrile convulsions
28
Foal Neurological Deficit (6)
Stroke;
Multiple sclerosis;
Nerve root compression;
Facial palsy;
Trauma
Migraine
29
Generalised Weakness (10)
Guillain-Barre syndrome;
Myasthenia gravis;
Myopathy;
Cord pathology;
Chronic fatigue syndrome;
Anaemia;
Post viral syndrome;
Myalgic enecephalomyelitis;
Depression;
Diabetes
30
Haematemesis (5)
Mallory-Weiss tear;
Oesophageal varices;
Peptic ulceration;
Malignancy (e.g. gastric)
Drug effects
31
Haematuria (6)
Malignancy (kidney, bladder, prostate);
Infection (kidney, bladder, prostate);
Stones;
Trauma;
Glomerulonephritis;
Polycystic disease
32
Haemoptysis (6)
Infection (e.g. tuberculosis);
Pulmonary embolism;
Malignancy;
Pulmonary hypertension (e.g. following mitral stenosis);
Bronchiectasis;
Laryngeal cancer
33
Hair Problems
```
Hair loss:
Male pattern balding,
Hypothyroidism,
Alopecia,
Drug-induced
```
```
Hirsutism:
Cushing’s syndrome,
Menopause,
Poly cystic ovarian syndrome (PCOS)
Menopause,
Drug-induced
```
34
Headache (12)
Tension headache;
Migraine;
Cluster headache;
Intra-cranial haemorrhage;
Brain tumour;
Pituitary tumour;
Extra cranial causes (nasal, ear, teeth);
Meningitis;
Facial pain;
Temporal arteritis;
Trigeminal neuralgia;
Drug reaction
35
Hoarseness (7)
Laryngeal malignancy;
Vocal abuse;
Recurrent laryngeal nerve damage:
Bronchial carcinoma,
Thyroid cancer/infiltrating cancer;
Laryngeal inflammation;
Hypothyroidism
36
Faecal Incontinence (4)
Pelvic floor trauma, e.g. Childbirth;
Fistula eg: malignancy post radiotherapy
Overflow incontinence
Cauda equina syndrome
37
Female Infertility (3)
Anovulatory,
Poly cystic ovarian snydrome (PCOS)
Tubal (Pelvic inflammatory disease/Endometriosis)
38
Itching (13)
Lichen simplex;
Urticaria;
Pruritis ani
Pruritis vulvae;
Allergy;
Iron deficiency;
Liver disease;
Renal failure;
Malignancy;
Thyroid dysfunction;
Polycythaemia;
Diabetes (type 2);
Scabies;
Obstetric Cholestasis
39
Jaundice (9)
Hepatitis;
Liver disease;
Gall stones;
Billiary tract pathology;
Pancreatic cancer;
Cirrhosis;
Drug induced;
Newborn;
Haemolysis
40
Joint pain/ swelling (12)
Arthritis (osteo/rheumatoid);
Psoriatic arthropathy;
Crystal arthritis (Gout);
Seronegative spondylo-arthritis;
Shoulder impingement;
Tendonitis;
Infection;
Trauma;
Haemophilia Synovitis;
Rheumatic fever;
Juvenile arthritis;
Reactive arthritis
41
Leg pain/ ankle swelling
Peripheral vascular disease;
Sciatica;
Deep vein thombosis (DVT);
Varicose veins;
Neuropathy;
Lymphoedema;
Joint trauma;
Ankle swelling:
- Cardiac failure,
- Acute glomerulonephritis;
- Acute/chronic renal failure;
- Hepatic failure;
- Hypoalbuminaemia;
- Pelvic mass;
- Venous insufficiency
42
Loss of Vision
Acute:
- Ischaemic optic neuropathy (arteritic/ non-arteritc),
- Retinal artery occlusion,
- Retinal vein occlusion,
- Retinal detachment,
- Retrobulbar neuritis,
- Amaurosis fugax,
- Vitreous haemorrhage;
Chronic:
- Macular degeneration,
- Glaucoma,
- Cataract,
- Diabetic maculopathy,
- Refractive error (myopia),
- Malignancy;
Congenital
43
Lump in Groin (8)
Inguinal hernia;
Femoral hernia;
Hydrocele of cord;
Maldescended testis;
Femoral aneurysm;
Lymphadenopathy;
Lipoma;
Sebaceous cyst
44
Lump in Neck
Thyroid;
- Congenital;
- Inflammatory;
- Neoplastic;
Lymph Node
45
Muscle Pain (4)
Injury
Polymyalgia Rheumatica
Fibromyalgia
Drug Induced (statins
46
Noisy Breathing (wheeze/ stridor) (5)
Asthma;
Chronic obstructive pulmonary disease (COPD);
Bronchial carcinoma;
Bronchiolitis;
Heart failure
47
Numbness and Tingling (13)
Carpal tunnel syndrome;
Generalised peripheral neuropathy;
Multiple sclerosis;
Stroke;
Transient ischaemic attacks;
Epilepsy;
Migraine;
Drugs;
Anxiety/Panic;
Hyperventilation;
Disc prolapse,
Degeneration of vertebra,
Sciatica
48
Painful or uncomfortable mouth (5)
Dental problems;
Mouth abscess;
Cancer of mouth;
Parotid gland blockage;
Candida
49
Palpitations (12)
Stress;
Exercise;
Panic attacks;
Thyrotoxicosis;
Arrhythmias;
Valvular heart disease;
Alcohol;
Tobacco;
Caffeine;
Fever;
Anaemia;
Drugs
50
Paraplegia (11)
Spinal injuries;
Malignancy causing spinal cord compression;
Acute disc prolapse;
Neurofibroma/meningioma;
Epidural abscess;
Post infectious transverse myelitis;
Congenital disorders e.g. spina bifida;
Guillian-Barre syndrome;
Multiple sclerosis;
Motor neurone disease;
Spinal cord infarction
51
Psychosis (7)
Schizophrenia;
Psychotic depression;
Mania;
Delirium;
Dementia;
Puerperal Psychosis;
Drug reactions
52
Birth - large for date
```
Wrong dates;
Multiple pregnancy;
Diabetes;
Polyhydramnios;
Fibroids;
```
53
Birth - small for date
Intrauterine growth restriction;
| Prematurity
54
Raised Blood Pressure
Primary (essential) hypertension;
Secondary hypertension
- Renal artery stenosis
- Coarcatation of aorta
- Phaeochromocytoma
Hypertension in pregnancy (pre-eclampsia, eclampsia);
‘White coat syndrome’
55
Rash
Without fever:
- Eczema/dermatitis;
- Urticaria;
- Drug reactions;
- Psoriasis;
- Lichen planus;
- Infections;
- Contact dermatitis.
With fever:
- Meningitis;
- Viral exanthenam;
- Toxic shock syndrome;
- Drug hypersensitivity;
56
Rectal bleeding
Colorectal cancer;Colorectal polyps;
Crohn’s disease;
Ulcerative colitis;
Proctitis;
Diverticular disease;
Anal fissure;
Haemorrhoids;
Enteritis
57
Recurrent Infections
HIV
Cystic Fibrosis
Congenital immunological defects
58
Red/ painful eye (11)
Acute/chronic conjunctivitis;
Corneal abrasion/ulcer;
Blepharitis;
Dry eyes;
Glaucoma;
Acute angle glaucoma;
Anterior uveitis;
Scleritis;
Iritis
Foreign body:
- Mode of injury (high/low velocity, thermal, chemical);
- Type of material (dust, metal, glass, chemical);
- Site (e.g. conjunctival, corneal, intraocular);
Superficial ocular foreign body
59
Sexually Transmitted Infection (genital discharge)
Hepatitis (B and C);
HIV;
Chlamydia;
Syphilis;
Gonorrhoea;
Candida;
Trichomonas;
Cervical cancer
60
Shortness of Breath
Cardiac failure;
COPD;
Pneumonia;
Asthma;
Pulmonary embolism;
Pleural effusion;
Pneumothorax;
Pulmonary fibrosis;
Lung cancer;
Anaemia;
Metabolic Acidosis (ARF/DKA);
Respiratory distress:
- Neonatal (Respiratory distress syndrome);
- Adult;
Congenital pneumonia;
Pneumothorax;
With stridor:
- Croup;
- Foreign body;
- Whooping cough
61
Sick Child
Meningitis;
Encephalitis;
Septicaemia;
Pneumonia;
Neonatal collapse;
Convulsions;
Allergy/anaphylaxis;
Head injury;
Diabetic Ketoacidosis;
Child abuse
62
Skin Lumps (12)
Basal cell carcinoma;
Squamous cell carcinoma;
Bowens disease;
Actinic keratosis;
Melanoma;
Atypical naevi;
Basal cell papilloma;
Dermatofibroma;
Keratoacanthoma;
Port wine stains;
Strawberry naevi;
Mongolian blue spot
63
Sleep Problems (6)
Disorders of initiating and maintaining sleep (DIMS);
Disorders of excessive somnolence (DOES);
Daytime sleepiness (hypersomnia);
Depression;
Anxiety disorders;
Drug reactions
64
Sore Throat (4)
Tonsillitis;
Glandular fever;
Peritonsilar abscess;
Laryngopharyngeal reflux
65
Squint (9)
Long sightedness (hypermetropia);
Poor vision in one eye;
Cataract;
Retinal/optic nerve;
Developmental problems;
Neurological disease (Nerve Palsy);
Thyroid eye disease;
Myasthenia gravis;
Raised intracranial pressure
66
Sudden Death (5)
SIDS;
Acute MI;
Pulmonary embolism;
Stroke;
Arrhythmias (including inherited cardiac arrhythmias)
67
Swelling in Scrotum (7)
Testicular cancer;
Hydrocele;
Epididymal cyst;
Varicocele;
Testicular torsion;
Epididymo-orchitis;
Inguinal hernia
68
Thirst (6)
Diabetes mellitus;
Diabetes insipidus;
Hypercalcaemia;
Renal failure;
Psychogenic;
Drug reactions
69
Tinnitus (5)
Sensorineural hearing loss;
Vestibular Schwannoma;
Other Cerebellopontine angle tumours;
Vascular causes, e.g. carotid artery stenosis;
Drugs
70
Tiredness
Somnolence:
- Sleep apnoea,
- Narcolepsy
Fatigue:
- Chronic fatigue syndrome;
- Anaemia;
- Chronic fatigue syndrome;
- Post viral syndrome;
- Myalgic enecephalomyelitis;
- Depression;
- Diabetes
71
Trauma
Accidental:
- Burns;
- Fractures;
- Lacerations;
- Contusions
Non accidental:
- Domestic violence;
- abuse (physical / sexual);
- Deliberate self harm;
- Alcohol misuse
- Shock
72
Tremor (8)
Parkinsons disease;
Anxiety;
Hyperthyroidism;
Drugs;
Inherited;
Alcohol;
Cerebellar disorders;
Psychological
73
Unconscious Patient (15)
Cardiac (e.g. dysrhythmia, shock);
Infection (e.g. meningitis, encephalitis);
Hypoxia;
Hypercarbia;
Drugs;
Neurological disease:
Stroke;
subarachnoid haemorrhage;
Cerebral tumour;
Epilepsy (post ictal);
Eclampsia (post ictal);
Trauma (head injury);
Metabolic disorders (hypoglycaemia, hypothyroidism);
Poisoning (carbon monoxide);
Hypothermia
74
Urinary Symptoms (5)
Prostatic hypertrophy;
Infection;
Renal tract malignancy;
Unstable bladder;
Incontinence:
- Stress;
- Urge;
- Overflow;
- Fistulae;
- Child abuse;
- Constipation
75
Vomiting (13)
Bowel obstruction;
Peptic ulcer;
Gastric ulcer;
Gastroenteritis;
Raised intracranial pressure;
Hyperemesis;
Drugs;
Liver disease;
Post operative;
Migraine;
Diabetic Ketoacidosis;
Addisons;
Renal Failure;
76
Weight loss/ loss of appetite (4)
Mechanisms of weight loss:
- Insufficient protein/energy intake
(e. g. change in appetite, eating disorders/anorexia);
- Impaired digestion/absorption (e.g. short gut syndrome);
- Increased catabolism
(e. g. sepsis, malignancy, diabetes, hyperthyroidism);
Depression;
Chronic disease (e.g. renal failure);
Dysphagia
