General Flashcards
Rheumatic fever
fever, joint pain recent sore throat chest pain shortness of breath heart murmur pericardial rub signs of cardiac failure asymmetric joint swelling and/or effusion migratory arthritis choreiform movements more common in overcrowded living quarters, poverty
Ross River virus
fever chills muscle aches rash fatigue aching tendons swollen lymph nodes. headache, especially behind the eyes joint pain, swelling and stiffness
Diabetes Mellitus type 2
RF: Patient with cardiovascular event( MI, Stroke, peripheral vascular disease). Age >35 yrs in pacific islander, Chinese, Indian origin Age > 40 yrs with BMI >30 kg/ m2 or hypertension Women with gestational diabetes mellitus Women with polycystic ovarian disease Patient on Anti-psychotics Symptoms - weight loss, lethargy, polyuria, polydipsia recurrent infection poor wound healing blurring of vision reduction of sensation ( touch, vibration and position)
Diabetes Insipidus
Causes Pituitary tumor (craniopharyngioma), pituitary surgery, head injury, Genetic causes and autoimmune disorders. lithium use Symptoms /signs - polyuria, polydipsia, muscle twitching, neurological symptoms due to hypernatremia, neurological signs based on the intracranial pathology ( deafness, focal visual defects, focal functional deficits) evidence of volume depletion.
Pulmonary Embolism
RF - age, DVT, surgery / trauma / fracture past 2 months, active cancer, bed rest >5days, pregnancy / postnatal, Hx/FHx VTE, lower limb paralysis, coagulopathy, weaker: smoking, obesity, sepsis, chronic disease, oestrogen Rx Triad - acute dyspnoea + acute chest pain + RF +/- apprehension / presyncopal sx / fever / cough
Hypocalcaemia
Clinical Features: varies from a mild asymptomatic to a life-threatening. - Acute: paraesthesia, tetany, seizure, abdo pain, arrhythmia, - Prolonged/chronic: papilloedema, cataracts, basal ganglia calcifications, neuropsychiatric manifestations (dementia in adults, anxiety, depression, lethargy, and extrapyramidal symptoms eg. parkinsonism), dermatitis, eczema, hyperpigmentation, psoriasis, brittle hair with patchy alopecia, and brittle nails with characteristic transverse grooves. Rarely: congestive heart failure, angina, and hypotension. NB: Trousseau’s sign may be apparent
Acute Intermittent Porphyria
RF - FHx / female / medications / increased progesterone / decreased caloric or carbohydrate intake / smoking / young adults / weaker: EtOH Triad - acute severe colicky abdominal pain + vomiting/constipation + anxiety/insomnia/agitation Signs / Sx - variable presentation, Sx often out of proportion with signs, or unremarkable exam - may be neuropathic back / leg pains - often tachycardia / palpations / HTN - +/- dark / reddish urine - +/- proximal muscle weakness, reflexes increased early stage/ reduced late stage severe
Alcoholic Liver Disease
RF - EtOH >10SD daily several decades, HCV, iron overload, dyslipidaemia, FHx Triad - hepatitis: acute jaundice + fever + RUQ pain - Signs / Sx - leukonychia / gynaecomastia / caput medusae / encephalopathy / reduced body hair / ascites / facial telangectasia / testicular atrophy / palmar erythema / spider naevi / jaundice / splenomegaly / firm liver / peripheral oedema - elevated serum aminotransferases with AST:ALT reversal (typically <300, AST:ALT >2:1) - serum bilirubin >5, elevated GGT / WCC / INR / neutrophils
Amoebiasis
RF - exposure in endemic areas (tropical developing) / institutionalised / MSM / male Triad - diarrhoea/dysentry + abdo tenderness + RF - +weight loss - +RUQ pain / fever / chills with liver abscess Typical infection days-wks post exposure (may transmit via family / household contact) Liver most common extra-intestinal organ affected
Dissection Thoracic Aorta
RF - HTN, atherosclerotic aneurysmal disease, Marfan’s syndrome, Ehlers Danlos syndrome, bicuspid AV, annulo-aortic ectasia, coarctation, smoking, FHx weaker: >50yrs / GCA / CTD / cocaine use / heavy lifting / pregnancy Triad - sudden severe ripping or tearing pain substernal or interscapular + syncope / HF Sx / acute localised ischaemic Sx + RF Signs / Sx vary - haemodynamic instability / limb ischaemia / mesenteric ischaemia / confusion - heart failure Sx / pericardial tamponade / pleural effusion - aortic insufficiency (diastolic decrescendo murmur)
Raynaud’s syndrome
RF - female, FHx, connective TD, vibration injury, Buerger’s disease (small-mid vessel vasculitis), weaker: smoking / cold / ischaemic injury / migraine / glaucoma Triad - digital colour / sensory changes + intermittent secondary to cold or stress + self-resolution in minutes-hours
Hypothyroidism
RF: female sex 30-50 yrs FHx of autoimmune disease Turner’s and Down’s syndromes Use of amiodarone or lithium Sx : weakness lethargy cold sensitivity constipation weight gain depression menstrual irregularity myalgia Signs: dry or coarse skin eyelid oedema thick tongue facial oedema coarse hair bradycardia deep voice diastolic hypertension with or without narrow pulse pressure delayed relaxation of tendon reflexes goitre
Multinodular goitre
RF: living in an iodine-deficient region Sx: hyperphagia, weight loss, sweating, heat intolerance, nervousness, palpitations, oligomenorrhoea, hyperdefecation, mood change, weight loss, tachycardia/tachyarrhythmia Signs: goitre (can be small or non-palpable), symptoms of neck compression (dysphagia, dyspnoea, choking sensation, thoracic inlet obstruction - a Pemberton sign), warm moist skin, stare, lid lag, tremor, proximal muscle weakness
Metabolic Syndrome
Insulin resistance, impaired glucose tolerance, abdominal obesity, reduced HDL-cholesterol levels, elevated triglycerides, and hypertension. RF: Obesity, an atherogenic diet, and physical inactivity
Graves disease
RF: FHx autoimmune thyroid disease female sex tobacco use Clinical findings: heat intolerance sweating palpitations fine tremor tachycardia diffuse goitre orbitopathy upper eyelid retraction irritability wide pulse pressure cardiac flow murmur moist, velvety skin scalp hair loss onycholysis pretibial myxoedema
Charcot-Maree-Tooth Syndrome
Genetic - strong family history Feats - Abnormal gait - twisting ankles, slapping feet - Pes cavus - high foot arch, hammer toes - Distal muscle weakness - “champagne bottle” calves - Paraesthesia - distal>proximal - Hypo/areflexia
Acromegaly
acral overgrowth (enlarged extremities eg nose, ears, jaw, hands, feet) soft tissue changes increased sweating impaired glucose tolerance neuropathy arthritis hypertension cardiomyopathy sleep apnoea
Addison’s Disease
F>M RF: anticoagulants (adrenal haemorrhage) weight loss skin pigmentation postural hypotension nausea, vomiting and diarrhoea, Hyperkalaemia, hyponatraemia- not always Hypoglycaemia Hypercalcaemia
Conns Syndrome
RF: Family history of condition Family history of early onset of HTN and/or stroke Clinical findings: High BP nocturia, polyuria lethargy mood disturbance difficulty concentrating
Cushing’s Syndrome
RF: exogenous corticosteroid use, pituitary/adrenal adenoma Clinical findings: facial plethora Central obesity Muscle weakness supraclavicular fullness violaceous striae menstrual irregularities HTN, DM Premature osteoporosis Mood- depression/anxiety/psychosis
De Quervains Thyroiditis
Pain in the anterior neck radiating to the ears or jaw Recent URTI Fever, malaise, myalgia, tremor
Type I DM
5-15 years RF- Geography (Scandinavia, UK) polyuria polydipsia weight loss blurred vision acute presentation with nausea, vomiting, abdominal pain, tachypnoea, tachycardia, lethargy
Haemochromatosis
RF: -middle age (40s-50s -male gender -white ancestry -family history of condition Clinical findings: -fatigue -weakness -arthralgias - including pseudogout, and chronic arthropathy -hepatomegaly -diabetes mellitus -impotence in males -loss of libido -skin pigmentation -May begin as a bronzing of the skin but then progress to grey or brown
Thoracic outlet syndrome
RF: Cervical rib or bony abnormalities, Trauma (upper body), Poor Posture/hunching, Repetitive overhead activity, Large breasts or implants, Obesity, Increasing age, Female Clinical findings: Pain - head, neck, upper back, anterior chest, shoulder, arm, forearm, and/or hand Paraesthesias - arms, hands, and/or fingers Circulatory changes in upper extremity Upper extremity fatigue
Antiphospholipid syndrome
RF: hx of SLE, autoimmune diseases History of one of: - 1 or more episodes of venous, arterial, or microvascular thrombosis confirmed - Three or more consecutive pregnancy losses at <10 weeks’ gestation and/or unexplained fetal death >10 weeks’ gestation -Premature delivery (<34 weeks’ gestation) due to pre-eclampsia, placental abruption, or intrauterine growth restriction
Henoch Schonlein Purpura
Child 2-8yo post URTI Palpable purpura (symmetrical LL) Abdominal pain Arthritis/arthralgia Renal involvement
