Gastrointestinal

Question 1

leukonychia

Answer 1

white spots on nails

- hypoalbuminaemia or CLD

Question 2

kiloonychia

Answer 2

spooning on nails

- iron deficiency e.g. due to GI bleed

Question 3

nail clubbing

Answer 3

• IBD, cirrhosis, lymphoma, coeliacs disease

Question 4

tendon xanthomata, corneal arcus and xanthelasma

Answer 4

• hyperlipidaemia e.g. due to PBC, cholestasis

Question 5

Dupuytren’s contracture

Answer 5

• CLD, DM, heavy labour, trauma, phenytoin, familial

Question 6

palmar erythema

Answer 6

• CLD, pregnancy, hyperthyroidism, RA

Question 7

pale palmar creases and conjunctival pallor

Answer 7

• anaemia

Question 8

Flapping/Hepatic Tremor

Answer 8

• hepatic encephalopathy, respiratory/ renal failure

Question 9

Bruising

Answer 9

• CLD due to thrombocytopenia, clotting factors, falls

Question 10

IVDU marks

Answer 10

• risk of hepatitis B&C

hep A more travel related

Question 11

Cushingoid

Answer 11

(moon face, acne, hirsute)

- alcohol excess

Question 12

angular stomatitis and glossitis

Answer 12

• iron/folate/B12 deficiency

Question 13

Fetor hepatitis

Answer 13

(musty, sweet odour of the breath)

- hepatic failure

Question 14

mouth ulcers, episcleritis and conjuctivitus

Answer 14

• associated with IBD

Question 15

gynaecomastia

Answer 15

• CLD, testicular failure, drugs

Question 16

loss of secondary hair

Answer 16

• CLD

Question 17

spider naevir

Answer 17

• > 5 suggests CLD

Question 18

bruising on abdomen due to pancreatitis

Answer 18

CULLEN’S - central/front

GREY-TURNERS - flank

Question 19

signs of peritonitis

Answer 19

rebound tenderness

guarding

Question 20

shifting dullness

Answer 20

> 1/5L of ascites

Question 21

erythema nodosum and pyoderma gangrenosum

Answer 21

• IBD

Question 22

right hypochondriac pain DDx

Answer 22

gallstones
hepatitis
ascending cholangitis 
cardiac and lung causes
peptic ulcer disease

Question 23

epigastric pain DDx

Answer 23

MI, pneumonia
oesophagitis
peptic ulcer disease
epigastric hernias

Question 24

left hypochondriac pain DDx

Answer 24

splenomegaly
spleen abscess/ rupture
peptic ulcer disease
lung and cardiac

Question 25

right lumbar pain DDx

Answer 25

``` ureteric colic pyelonephritis UTI kidney stones constipation ```

Question 26

umbilical pain DDx

Answer 26

``` early appendicitis ruptured AAA pancreatitis IBD Meckel's diverticulum ```

Question 27

left lumbar pain DDx

Answer 27

``` diverticulitis ureteric colic pyelonephritis UTI kidney stones constipation ```

Question 28

right iliac fossa pain DDx

Answer 28

``` late appendicitis ovarian torsion/ cyst ectopic pregnancy caecum obstruction Crohn's disease inguinal and femoral hernias (strangulated) ```

Question 29

hypogastric pain DDx

Answer 29

testicular torsion urinary retention cystitis placental abruption

Question 30

left iliac fossa pain DDx

Answer 30

``` diverticular disease IBD ovarian torsion/ cyst ectopic pregnancy caecum obstruction Crohn's disease inguinal and femoral hernias (strangulated) ```