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AMC MCQ > Diagnosis by Physical Examination > Flashcards

Diagnosis by Physical Examination Flashcards

1
Q

Plethoric complexion

A

Chronic alcoholics (alcohol may produce a pseudo-Cushing syndrome)

Cushing disease

Polycythaemia

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2
Q

Thickening of the subcutaneous tissues

A

Chronic alcoholism

Acromegaly

Myxoedema (The puffiness of the eyelids may simulate the true subcutaneous oedema of kidney disease)

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3
Q

Diagnostic facies: Acromegalic

A

Enlarged characteristic face: Large supra-orbital ridge that causes frontal bossing, a broad nose and a prominent broad and square lower jaw

Enlarged tongue

Soft tissue swelling of the nose, lips and ears

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4
Q

Marfan Syndrome

A

Subluxation of the lens of the eye

High-arched palate

Tall stature

Arachnodactyly

Chest deformities

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5
Q

Diagnostic facies: Adenoidal

A

Narrow nose/nares

High-arched palate (the ‘Gothic’ palate)

Prominent incisor teeth

Undershot jaw with a perpetually open mouth and ‘stupid’ expression

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6
Q

Diagnostic facies: Alcoholic

A

Plethoric face

Thickened ‘greasy’ skin

Rhinophyma + Telangiectasia

Suffused (‘bloodshot’) conjunctivae (AKA: RED EYE - 4U Dr. Mo)

Rosacea

Parotid swelling

Prominent lower lip with
cheilitis of corners of mouth

Smell of stale alcohol or very ‘minty’ sweet breath (masking effect)

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7
Q

Systemic sclerosis: CREST syndrome (bird-like)

A

Beaking of the nose

Limitation of mouth opening

Puckering or furrowing of the lips

Fixed facial expression

Telangiectasia on the face and hands

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8
Q

Diagnostic facies: Thalassaemia Major (Chipmunk)

A

Bossing of the skull

Hypertrophy of the maxillae (expose the upper teeth)

Prominent malar eminences

Depression of the bridge of the nose

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9
Q

Diagnostic facies: Choleric (similar to the Hippocratic facies)

A

Pale face with cold clammy skin

Sunken eyes

Hollow cheeks

Forlorn, apathetic look

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10
Q

Diagnostic facies: Hippocratic

A

This describes the deathly, mask-like features of advanced peritonitis or streptococcal septicaemia

Sunken eyes

‘Gaunt’ face

‘Collapsed’ temples

Dry and crusty lips

Clammy forehead

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11
Q

Congenital syphilis (bulldog face)

A

Saddle nose due to the sunken bridge of the nose

Interstitial keratitis

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12
Q

Diagnostic facies: Cushingoid (moon shape)

A

Plethora (rubicund)

Hirsutism (more obvious in women)

Acne

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13
Q

Facial nerve palsy

A

Unilateral drooping of the corner of the mouth

Flattening of the nasolabial fold

Upper motor neurone (UMN) type: the forehead movement is spared

Lower motor neurone (LMN) type (e.g. Bell palsy, Ramsay–
Hunt syndrome): lack of forehead muscle tone

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14
Q

Horner syndrome

A

Dysfunction of cervical sympathetic output

Ipsilateral:

Partial ptosis
Miosis
Enophthalmos
Anhidrosis

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15
Q

Diagnostic facies: Mitral disease

A

Mitral valve disease, especially mitral stenosis

Flushed or rosy cheeks with a bluish tinge (dilatation of the malar capillaries).

It is associated with pulmonary hypertension

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16
Q

Down syndrome (Mongoloid face)

A

Lowset ears

Protruding tongue

Mongoloid slant of the eyes with epicanthic folds

Mouth hanging

Facial flat profile with crowded features

Round head

Dysplastic open and peripheral silver iris spots (Brushfield spots)

17
Q

Myopathy/myasthenia gravis (Myopathic face)

A

Expressionless

‘Tired’-looking face with bilateral ptosis

18
Q

Dystrophia myotonia (Myotonic face)

A

Frontal baldness

Expressionless triangular facies

Partial ptosis

Cataracts

Temporal muscle atrophy

19
Q

Myxoedemic (hypothyroidism)

A

Apathetic look and is ‘puffy’ with possible periorbital oedema

Broadening of the lower part of the face

Skin (not the sclera) may appear yellow (due to hypercarotenaemia), dry and coarse

Thin, coarse and listless hair

Loss or thinning of the outer third of the eyebrows

Enlarged tongue

Speaks with a ‘thickened’, croaking, slow speech

20
Q

Paget disease (Pagetic face)

A

Skull enlargement, notably of the frontal and parietal areas (the head circumference is usually greater than 55 cm, which is abnormal)—the ‘hat doesn’t fit any more’ hallmark.

Increased bony warmth

Deafness

21
Q

Diagnostic facies: Parkinsonian

A

Mask-like facies with lack of facial expression

Fixed unblinking stare

22
Q

Peutz–Jeghers

A

Pigmented macules (1–5 mm in diameter) occur on lips, buccal mucosa and fingers

23
Q

Diagnostic facies: Risus sardonicus

A

Tetanus, strychnine poisoning and Wilson’s disease

A grin-like appearance of hypertonic facial muscles

24
Q

Diagnostic facies: Smoker’s

A

A face older than the years with premature gross wrinkling of the skin

Stained teeth

Deep raspy voice

‘Loose’ cough

Smell of tobacco

25
Q

Diagnostic facies: Thyrotoxic (hyperthyroidism)

A

The prominent eyes (sclera may not be covered by the lower eyelid) and conjunctivitis.

The thyroid stare (a frightened expression)

26
Q

Turner syndrome

A

Ptosis—‘fish-like’ mouth

Small chin (micrognathia)

Low-set ears and deafness.

Webbing of the neck (classic sign)

Cardiac lesions: Coarctation of the aorta and pulmonary stenosis

27
Q

Uraemic Syndrome

A

A sallow ‘muddy’ complexion with uraemic fetor

Ammoniacal halitosis

28
Q

Enlarged tongue

A

Acromegaly

Hypothyroidism

Amyloidosis

Down syndrome

29
Q

Telangiectasia

A

Systemic sclerosis / CREST syndrome

Liver disease (e.g. alcoholism)

30
Q

Clubbing of fingers: Lung disease

A

carcinoma

bronchiectasis

cystic fibrosis

abscess/empyema

pulmonary fibrosis

31
Q

Clubbing of fingers: Heart disease

A

infective endocarditis

cyanotic congenital heart disease

32
Q

Clubbing of fingers: Liver disease

A

cirrhosis

33
Q

Clubbing of fingers: Gastrointestinal disease

A

Ulcerative colitis

Crohn disease

Coeliac disease

34
Q

Increased general pigmentation: Drugs

A

Amiodarone

Antibiotics (busulphan, bleomycin, minocycline)

Antimalarials (chloroquine/hydroxychloroquine)

Arsenic, gold, silver

Chemotherapy

Dapsone

Oral contraceptive pill (OCP)

Phenothiazines

Photochemotherapy (PUVA)

Psoralens

Thiazides

35
Q

Increased general pigmentation: Tumours

A

Lymphomas

Acanthosis nigricans

Metastatic melanoma

AMC MCQ (56 decks)

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