examination

Question 1

Causes of clubbing

Answer 1

Thoracic (~70%):
- Lung cancer
- Chronic suppurative conditions: pulmonary tuberculosis, bronchiectasis, lung abscess, empyema, cystic fibrosis
- Mesothelioma
- Fibroma
- Pulmonary fibrosis

Cardiovascular:
- Cyanotic congenital heart disease
- Infective endocarditis
- Arteriovenous shunts and aneurysms

Gastrointestinal:
- Cirrhosis
- Inflammatory bowel disease
-Coeliac disease

Others:
􏱲 Thyrotoxicosis (thyroid acropachy)
􏱲 Primary hypertrophic osteoarthropathy

Question 2

Conditions associated with facial flushing

Answer 2

Physiological
􏱲 Fever
􏱲 Exercise
􏱲 Heat exposure 􏱲 Emotional
Drugs (e.g. glyceryl trinitrate, calcium channel blockers, nicotinic acid)
Anaphylaxis

Endocrine
􏱲 Menopause
􏱲 Androgen deficiency (in men)
􏱲 Carcinoid syndrome
􏱲 Medullary thyroid cancer

Others
􏱲 Serotonin syndrome
􏱲 Food/alcohol ingestion
􏱲 Neurological (e.g. Frey’s syndrome)
􏱲 Rosacea
􏱲 Mastocytoses

Question 3

features to note in any lump/swelling (SPACESPIT)

Answer 3

-Size (MEASURE WITH CALLIPERS)
-Position (sites)
- Attachments (tissue/muscle,mobile?)
- Consistency
-Edge (well,poor,regular/irregular)
-Surface and shape (smooth/nodular)
-Pulsation, thrills and bruits
- Inflammation:
􏱲 Redness
􏱲 Tenderness
􏱲 Warmth
- Transillumination