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MBChB Year 3 > Core Clinical Problems > Flashcards

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
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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)
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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
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4
Q

Abnormal/ unsteady gait (4)

A
  • limb deformity
  • cerebral/ cerebellar mets
  • muscular dystrophy
  • cerebral palsy
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5
Q

Abnormal blood test result (3)

A
  • anaemia: low folate/ B12, haemolysis, bleeding, pregnancy, erythropoietin deficiency
  • hyperlipidaemia
  • blood gases
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6
Q

Altered Mood (6)

A
  • depression
  • bipolar affective disorder
  • abuse
  • frontal lobe mets
  • drug reaction
  • substance misuse
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7
Q

Anxiety (7)

A
  • phobia
  • GAD
  • panic disorder
  • separation anxiety
  • OCD
  • drug effects
  • substance misuse
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8
Q

Arrested Intellectual Development (6)

A
  • congenital disorders (downs syndrome/ fragile X)
  • Cerebral palsy
  • congenital hypothyroidism
  • epilepsy
  • sensory deficits
  • behavioural disorders
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9
Q

Back and Neck Pain (4)

A
  • MSK
  • nerve root compression
  • spinal cord injury
  • spondyloarthritis
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10
Q

Behavioural Problems (5)

A
  • personality traits/ disorders
  • gender/ sexual orientation
  • disordered impulse control
  • ADHD
  • Conduct disorders
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11
Q

Blocked Nose (9)

A
  • common cold
  • hayfever
  • acute/chronic rhinosinusitis
  • nasal polyps
  • septal deviation
  • adenoid hypertrophy
  • abscess
  • neoplasia
  • drug reaction
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12
Q

Breast Lump (4)

A
  • benign: fibroadenoma, cyst
  • malignant
  • pregnancy changes
  • gynaecomastia
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13
Q

Bruising (5)

A
  • Haematological causes: thrombocytopenia, purpura, leukaemia, haemophilia, von willebrand disease
  • liver disease
  • senile purpura
  • infection (meningitis)
  • trauma (child abuse)
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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
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15
Q

Cold Extremities

A
  • Reynaud’s disease
  • microvascular disease (diabetes)
  • peripheral vascular disease
  • connective tissue disorders
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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

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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)
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18
Q

Constipation (9)

A

Diverticular disease;

Irritable bowel syndrome;

Polyps;

Colo-rectal cancer;

Coeliac disease;

Bowel obstruction;

Somatisation;

Hypothyroidism;

Drug reaction

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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

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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

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21
Q

Deliberate Self Harm (6)

A

Depression

Post natal depression

Schizophrenia;

Alcohol/drug misuse;

Bipolar disorder;

Personality disorders

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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

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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

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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

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25
Q

Ear Ache (2)

A
  • otitis media/externa

- refered pain

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26
Q

Falls and Immobility (13)

A

Drugs (e.g. sedatives, antidepressants, antihypertensives);

Syncope;

Postural hypotension;

Arrhythmias;

Myocardial infarction;

Cerebrovascular disease;

Parkinsons disease;

Epilepsy;

Dementia;

Peripheral neuropathy;

Arthritis;

Depression;

Alcohol

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27
Q

Fever

A 
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

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28
Q

Foal Neurological Deficit (6)

A

Stroke;

Multiple sclerosis;

Nerve root compression;

Facial palsy;

Trauma

Migraine

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29
Q

Generalised Weakness (10)

A

Guillain-Barre syndrome;

Myasthenia gravis;

Myopathy;

Cord pathology;

Chronic fatigue syndrome;

Anaemia;

Post viral syndrome;

Myalgic enecephalomyelitis;

Depression;

Diabetes

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30
Q

Haematemesis (5)

A

Mallory-Weiss tear;

Oesophageal varices;

Peptic ulceration;

Malignancy (e.g. gastric)

Drug effects

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31
Q

Haematuria (6)

A

Malignancy (kidney, bladder, prostate);

Infection (kidney, bladder, prostate);

Stones;

Trauma;

Glomerulonephritis;

Polycystic disease

32
Q

Haemoptysis (6)

A

Infection (e.g. tuberculosis);

Pulmonary embolism;

Malignancy;

Pulmonary hypertension (e.g. following mitral stenosis);

Bronchiectasis;

Laryngeal cancer

33
Q

Hair Problems

A 
Hair loss:
Male pattern balding,
Hypothyroidism,
Alopecia,
Drug-induced
Hirsutism:
Cushing’s syndrome,
Menopause,
Poly cystic ovarian syndrome (PCOS)
Menopause,
Drug-induced
34
Q

Headache (12)

A

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
Q

Hoarseness (7)

A

Laryngeal malignancy;

Vocal abuse;

Recurrent laryngeal nerve damage:

Bronchial carcinoma,

Thyroid cancer/infiltrating cancer;

Laryngeal inflammation;

Hypothyroidism

36
Q

Faecal Incontinence (4)

A

Pelvic floor trauma, e.g. Childbirth;

Fistula eg: malignancy post radiotherapy

Overflow incontinence

Cauda equina syndrome

37
Q

Female Infertility (3)

A

Anovulatory,

Poly cystic ovarian snydrome (PCOS)

Tubal (Pelvic inflammatory disease/Endometriosis)

38
Q

Itching (13)

A

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
Q

Jaundice (9)

A

Hepatitis;

Liver disease;

Gall stones;

Billiary tract pathology;

Pancreatic cancer;

Cirrhosis;

Drug induced;

Newborn;

Haemolysis

40
Q

Joint pain/ swelling (12)

A

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
Q

Leg pain/ ankle swelling

A

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
Q

Loss of Vision

A

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
Q

Lump in Groin (8)

A

Inguinal hernia;

Femoral hernia;

Hydrocele of cord;

Maldescended testis;

Femoral aneurysm;

Lymphadenopathy;

Lipoma;

Sebaceous cyst

44
Q

Lump in Neck

A

Thyroid;

  • Congenital;
  • Inflammatory;
  • Neoplastic;

Lymph Node

45
Q

Muscle Pain (4)

A

Injury

Polymyalgia Rheumatica

Fibromyalgia

Drug Induced (statins

46
Q

Noisy Breathing (wheeze/ stridor) (5)

A

Asthma;

Chronic obstructive pulmonary disease (COPD);

Bronchial carcinoma;

Bronchiolitis;

Heart failure

47
Q

Numbness and Tingling (13)

A

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
Q

Painful or uncomfortable mouth (5)

A

Dental problems;

Mouth abscess;

Cancer of mouth;

Parotid gland blockage;

Candida

49
Q

Palpitations (12)

A

Stress;

Exercise;

Panic attacks;

Thyrotoxicosis;

Arrhythmias;

Valvular heart disease;

Alcohol;

Tobacco;

Caffeine;

Fever;

Anaemia;

Drugs

50
Q

Paraplegia (11)

A

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
Q

Psychosis (7)

A

Schizophrenia;

Psychotic depression;

Mania;

Delirium;

Dementia;

Puerperal Psychosis;

Drug reactions

52
Q

Birth - large for date

A 
Wrong dates;
Multiple pregnancy;
Diabetes;
Polyhydramnios;
Fibroids;
53
Q

Birth - small for date

A

Intrauterine growth restriction;

Prematurity

54
Q

Raised Blood Pressure

A

Primary (essential) hypertension;

Secondary hypertension

  • Renal artery stenosis
  • Coarcatation of aorta
  • Phaeochromocytoma

Hypertension in pregnancy (pre-eclampsia, eclampsia);

‘White coat syndrome’

55
Q

Rash

A

Without fever:

  • Eczema/dermatitis;
  • Urticaria;
  • Drug reactions;
  • Psoriasis;
  • Lichen planus;
  • Infections;
  • Contact dermatitis.

With fever:

  • Meningitis;
  • Viral exanthenam;
  • Toxic shock syndrome;
  • Drug hypersensitivity;
56
Q

Rectal bleeding

A

Colorectal cancer;Colorectal polyps;
Crohn’s disease;

Ulcerative colitis;

Proctitis;

Diverticular disease;

Anal fissure;

Haemorrhoids;

Enteritis

57
Q

Recurrent Infections

A

HIV

Cystic Fibrosis

Congenital immunological defects

58
Q

Red/ painful eye (11)

A

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
Q

Sexually Transmitted Infection (genital discharge)

A

Hepatitis (B and C);

HIV;

Chlamydia;

Syphilis;

Gonorrhoea;

Candida;

Trichomonas;

Cervical cancer

60
Q

Shortness of Breath

A

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
Q

Sick Child

A

Meningitis;

Encephalitis;

Septicaemia;

Pneumonia;

Neonatal collapse;

Convulsions;

Allergy/anaphylaxis;

Head injury;

Diabetic Ketoacidosis;

Child abuse

62
Q

Skin Lumps (12)

A

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
Q

Sleep Problems (6)

A

Disorders of initiating and maintaining sleep (DIMS);

Disorders of excessive somnolence (DOES);

Daytime sleepiness (hypersomnia);

Depression;

Anxiety disorders;

Drug reactions

64
Q

Sore Throat (4)

A

Tonsillitis;

Glandular fever;

Peritonsilar abscess;

Laryngopharyngeal reflux

65
Q

Squint (9)

A

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
Q

Sudden Death (5)

A

SIDS;

Acute MI;

Pulmonary embolism;

Stroke;

Arrhythmias (including inherited cardiac arrhythmias)

67
Q

Swelling in Scrotum (7)

A

Testicular cancer;

Hydrocele;

Epididymal cyst;

Varicocele;

Testicular torsion;

Epididymo-orchitis;

Inguinal hernia

68
Q

Thirst (6)

A

Diabetes mellitus;

Diabetes insipidus;

Hypercalcaemia;

Renal failure;

Psychogenic;

Drug reactions

69
Q

Tinnitus (5)

A

Sensorineural hearing loss;

Vestibular Schwannoma;

Other Cerebellopontine angle tumours;

Vascular causes, e.g. carotid artery stenosis;

Drugs

70
Q

Tiredness

A

Somnolence:

  • Sleep apnoea,
  • Narcolepsy

Fatigue:

  • Chronic fatigue syndrome;
  • Anaemia;
  • Chronic fatigue syndrome;
  • Post viral syndrome;
  • Myalgic enecephalomyelitis;
  • Depression;
  • Diabetes
71
Q

Trauma

A

Accidental:

  • Burns;
  • Fractures;
  • Lacerations;
  • Contusions

Non accidental:

  • Domestic violence;
  • abuse (physical / sexual);
  • Deliberate self harm;
  • Alcohol misuse
  • Shock
72
Q

Tremor (8)

A

Parkinsons disease;

Anxiety;

Hyperthyroidism;

Drugs;

Inherited;

Alcohol;

Cerebellar disorders;

Psychological

73
Q

Unconscious Patient (15)

A

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
Q

Urinary Symptoms (5)

A

Prostatic hypertrophy;

Infection;

Renal tract malignancy;

Unstable bladder;

Incontinence:

  • Stress;
  • Urge;
  • Overflow;
  • Fistulae;
  • Child abuse;
  • Constipation
75
Q

Vomiting (13)

A

Bowel obstruction;

Peptic ulcer;

Gastric ulcer;

Gastroenteritis;

Raised intracranial pressure;

Hyperemesis;

Drugs;

Liver disease;

Post operative;

Migraine;

Diabetic Ketoacidosis;

Addisons;

Renal Failure;

76
Q

Weight loss/ loss of appetite (4)

A

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

MBChB Year 3 (7 decks)

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