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Phase 3 Exams > Exam Findings > Flashcards

Exam Findings Flashcards

1
Q

Causes of clubbing

A

CV: cyanotic heart disease, infective endocarditis
Liver: cirrhosis
Lungs: bronchiectasis, CF, lung abscess, lung cancer, idiopathic pulmonary fibrosis

Other: thyrotoxicosis, IBD, coeliac

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2
Q

Heart failure

A

RHF: ankle/sacral oedema, tender/pulsatile hepatomegaly, raised JVP, hepatojugular reflex, right ventricular heave, S3

LHF: pulmonary oedema, left ventricular heave, S3

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3
Q

Hypertension

A 
Observation: Cushings, CKD
BP: Hypertension, 
Fundi: 'silver wiring'/ haemorrhages/ papilloedema, Heart: LVF signs, S4, carotid bruit
Neuro: focal neuro deficits
Renal: urinalysis
Causes:
radiofemoral delay (CoA), renal/adrenal masses, renal bruit (renal artery stenosis)
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4
Q

Valvular heart disease

A

MS: mitral facies, low pitched rumbling murmur

MR: apex beat displaced, pansystolic murmur

AS: slow-rising pulse, hyperdynamic apex beat, midsystolic ejection murmur

AR: collapsing pulse, displaced beat, decrescendo high pitched murmur

TR: raised JVP, RV heave, pulsatile liver, ascites, peripheral oedema

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5
Q

Lung disease: pneumonia, pleural effusion, pneumothorax, COPD

A

Pneumonia: dull to percussion, bronchial breath sounds and crackles, increased vocal resonance

Pleural effusion: stony dull, reduced/absent breath sounds, reduced vocal resonance

Pneumothorax: hyperresonace, reduced/absent breath sounds, subcut emphysema

COPD: Hoover’s sign, hyperresonant, decreased breath sounds, early inspiratory crackles

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6
Q

Lung disease: ILD, bronchiectasis, asthma, atelectasis

A

ILD: cough, clubbing, crackles

Bronchiectasis: clubbing, crackles (if severe)

Asthma: hyperinflation, inspiratory and expiratory wheeze

Atelectasis: ipsilateral tracheal deviation, absent breath sounds

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7
Q

Chronic liver disease

A

Hands: clubbing, leukonychia, palmar erythema, asterixis
(Muerke’s lines, koilonychia)

Arms: bruising, excoriations (acanthosis nigricans)

Face: scleral icterus, fetor hepaticus
(conjunctival pallor, Keyser-Fleischer rings, xanthelasmata)

Abdomen: gynaecomastia, spider naevi, ascites, caput medusae, hepatosplenomegaly

Legs: oedema, muscle wasting

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8
Q 
Malabsorption:
Anaemia
Fe def
Protein
B12/folate
Thiamine
Vit K, D, A
Fat
A

Anaemia: palmar crease/conjunctival pallor

Iron deficiency: koilonychia, Muerke’s lines

Protein: muscle wasting, oedema

B12/folate: glossitis, angular stomatitis, peripheral neuropathy, SACD (B12)

Thiamine: peripheral neuropathy; ophthalmoplegia, confusion, ataxia

Vitamin K: bruising
Vitamin D: bone pain
Vitamin A: hyperkeratotic oral white patches

Fat: steatorrhoea

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9
Q

Inflammatory Bowel Disease

A

Abdo: CD - terminal ileal mass, abscess; UC - anal fissure

Systemic:
- PSC, chronic liver disease
anaemia
arthritis
skin: erythema nodosum, pyoderma gangrenosum, clubbing
eyes: iritis, episcleritis, conjunctivitis

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10
Q

CKD

A 
In general: 
uraemia (tinge, scratch marks, coagulopathy, pericarditis, peripheral neuropathy)
anaemia
fluid overloaded (JVP, oedema, ascites)
dialysis (fistula, scar)
abdo organs

Other
Hands: leukonychia, Muerke’s lines, fistula, asterixis

Urinalysis, sitting and standing BP, fundoscopy

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11
Q

RA

A

hand abnormalities (5)
neuro: ulnar/medial nerve palsy/foot drop, peripheral neuropathy
rheumatoid nodules (elbow)
Sjogren signs (eye redness, mouth dryness, parotidomegaly), lymphadenopathy, hepatosplenomegaly
other joints (TMJ, C-spine, hip, knee)
lung fibrosis, pericardial rub

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12
Q 
Other arthritides:
Ank spon
Reactive
Psoriatic
Gout
Pseudogout
SLE
Sjögren's
Scleroderma
A

Ank spon: back/SI, bamboo spine
Reiter’s: hip/knee/ankle
Psoriatic: sausage-shaped fingers, pencil-in-cup xray
Gout: tophi, punched-out lesions
Pseudogout: knees/wrists, chondrocalcinosis
SLE: rash, Raynaud’s, livedo reticularis, purpura, alopecia, Sjögren’s, serositis, neuropathy
Scleroderma: CRST, Sjögren’s, pulmonary fibrosis

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13
Q 
Upper limb:
Frozen shoulder
Lateral epicondylitis
Medial epicondylitis
CTS
A

Frozen shoulder: both passive and active limited

Lateral epicondylitis: tenderness over lateral epicondyle, pain on extending fingers against resistance

Medial epi: tenderness over medial epicondyle, pain on flexing fingers against resistance

CTS: Tinel’s sign, Phalen’s test

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14
Q

Thyroid

A

Hyper: weight loss, anxiety, frightened facies, tremor, onycholysis, Graves acropathy, palmar erythema, sinus tachy-AF, prox myopathy, Pemberton’s, exophthalmos (incl opthalmoplegia, corneal ulceration), thyroid stare, lid lag, lid retraction, gynaecomastia, pretibial myxoedema, hyperreflexia

Hypo: mental sluggishness, peripheral cyanosis, palmar creast pallor, CTS, prox myopathy, hung up reflex, alopecia, vitiligo, periorbital oedema, pericardial/pleural effusion, non-pitting oedema, peripheral neuropathy

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15
Q

DM

A

BP

Lower limbs: skin changes, ulcers, infection, pulses, peripheral neuropathy, Charcot’s joints

Face: visual acuity, fundoscopy, candida

Chest: acanthosis nigricans, hepatomegaly

URINE

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16
Q 
Neuro:
LMN
MND
Peripheral neuropathy
GBS
A

LMN: wasting, hyporeflexia, fascicultations

MND: combination UMN and LMN, fasciculations almost always present, reflexes usually, sensation usually fine

Peripheral neuropathy: glove and stocking to all modalities

GBS: flaccid paralysis ascending from lower to upper limbs with reflexes gone but no wasting or sensory changes and sphincters fine

MS: spastic paresis, dorsal column loss, cerebellar and eye signs; nystagmus, intention tremor, scanning speech (Charcot’s triad, rare)

MG: muscle fatigue (upward gaze, Peek sign, prox limb girdle)

PD: mask-like facies, resting tremor, bradykinesia, cogwheel rigidity, micrographia, positive glabellar tap, weakness of upward gaze, slow speech, shuffling and festinating gait

17
Q

HIV

A

?Infection: skin rashes, lymphadenopathy, mouth infections, listen to lungs and feel organs, check perineum for infections, look for meningism

18
Q

Gaits

hemiplegic
parkinsonian
cerebellar
sensory
CP
myopathic
A

Hemiplegic: no flexion, circumduction, flexed hand if severe

Parkinsonian: universal flexion, small steps/shuffling (festinating)

Cerebellar: broad-stand, staggering (towards side of illness), titubation on standing (wobbling around with eyes open)

Sensory: stomping esp in dark

CP (diplegic): walking on tiptoe, slight circumduction and overadduction (scissors gait), flexed arms

Myopathic (waddling): trendelenberg; if bilateral trunk overcorrects to other side -> waddling

Neuropathic (foot drop): high stepping

Choreiform: chorea while walking

Phase 3 Exams (13 decks)

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