Dr. Hogan Bedside Tut #5

Question 1

petechiae, purpura and ecchymoses is caused by what blood dysfunction?

Answer 1

Thrombocytopenia or other platelet dysfunction

Question 2

what is “spoon-shaped” nails called? why happens?

Answer 2

koilonychia

Question 3

what is shifting dullness test?

Answer 3

percussing abdomen in supine to find fluid line

then side-lying: percuss again to find the dullness has shifted indicating there is indeed ascites

Question 4

which fingers usually indicate Dupeytron’s contractures? name 4 other causes:

Answer 4

3,4,5
Trauma
DM2
HIV
phenytoin with epilepsy

Question 5

5 causes of hypoalbuminaemia:

Answer 5

kwashiorkor
leukonycia
enteropathy (protein losing)
nephrotic syndrome
burns

Question 6

how to identify direction of vein flow in abdomen?

Answer 6

compress veins with 2 fingers, release one and if it flows towards umbilicus it is caput medusae

Question 7

chronic alcoholic looks for what 2 things in the pubic area?

Answer 7

testicular atrophy

change in escutcheon pubic hair

Question 8

what does splenomegaly do to platelets?

Answer 8

thrombocytopenia from trapped platelets in spleen

Question 9

why do you get splenomegaly in chronic liver disease?

Answer 9

portal hypertension: backflow into spleen

Question 10

what are 6 Vitamin K dependent clotting factors?

Answer 10

2,7,9,10, protein C, S

Question 11

4 areas of arterial-venous anastomoses?

Answer 11

lower esophagus
umbilicus
lower rectum
hypophyseal portal system

Question 12

danger of splenomegaly?

Answer 12

massive bleeding from accidental trauma

Question 13

5 causes of massive splenomegaly?

Answer 13

CML
Malaria
myelofibrosis
tropical kalar azar
hairy cell leukaemia

Question 14

what kinds of ophthalmoscopic problems in chronic alcohol consumption?

Answer 14

intranuclear ophthalmoplegia

Question 15

cause of intranuclear ophthalmoplegia ?

Answer 15

degenerating mammillary bodies

Question 16

3 things in Wernicke Encephalopathy?

Answer 16

triad of acute mental confusion, ataxia, and ophthalmoplegia

Question 17

3 main features of Korsakoff psychosis?

Answer 17

confabulation
decreased short term memory
difficulty learning new information

Question 18

3 reasons why HIV people get anaemia?

Answer 18

1. HAART treatment
2. anaemia of chronic inflammation
3. warm autoimmune haemolytic anaemia

Question 19

3 viral causes of warm autoimmune haemolytic anaemia?

Answer 19

HIV
EBV
CMV

Question 20

what do you suspect in anyone with pure right heart failure with little hx of pulmonary fibrosis or lung dysfunction?

Answer 20

IVDU/endocarditis

Question 21

why kind of murmur in tricuspid regurg?

Answer 21

systolic

Question 22

An ostium primum atrial septal defect (ASD) is what? what conditions do you see it with?

Answer 22

located in the most anterior and inferior aspect of the atrial septum. It is the simplest form of atrioventricular (AV) canal or AV septal defect. These defects are often associated with trisomy 21.

Question 23

An ostium secundum atrial septal defect is what?

Answer 23

an abnormally large opening in the atrial septum at the site of the foramen ovale and the ostium secundum.