General examination

Question 1

How long should the middle steps in handwashing take?

Answer 1

At least 15 seconds

Question 2

What does poverty of expression suggest`?

Answer 2

Parkinonism

Question 3

What does a startled expression suggest>

Answer 3

Hyperthyrodisim

Question 4

What does apathy with poverty of expression and poor eye contact suggest?

Answer 4

Hypothyroidism

Question 5

What does agitated expression suggest?

Answer 5

Anxiety, hyperthyroidism, hypomania

Question 6

What can a warm temperature be due to`?

Answer 6

Vasodialtion from elevated arterial CO2 levels

Hyperthyroidism

Question 7

What can cold hands suggest?

Answer 7

Vasoconstriction

Can occur in HF

Question 8

What are different things that can be seen on nails?

Answer 8

Beau's lines
Clubbing 
Leuconychia
Lindsays nails
Kolonychia
Muehrcke's lines
Nail fold telangictasia
Onychomycosis
Pitting
Onchylosis
Splinter haemorrhage
Yellow nail

Question 9

What does beau’s lines look like and a differential diagnosis?

Answer 9

Transerse grooves

Severe illnesss that affects growth of the nail matrix

Question 10

What does clubbing look like and a differential diagnosis?

Answer 10

Loss of angle between nail fold and nail plate

Serious cardiac, respiratory or GI disease

Question 11

What does leuconychia look like and a differential diagnosis?

Answer 11

White spots, ridges or complete discoloration of nail

Duet o trauma, infection, poisoning chemo and vit deficiency

Question 12

What does Lindsay nails look like and a differential diagnosis?

Answer 12

White/btown half and half nails

CKD

Question 13

What does koilonychoia look like and a differential diagnosis?

Answer 13

Spoon shaped depression of nail plate

Iron deficiency anaemia, lichen planus, repeated exposure to detergents

Question 14

What does Muehrcke’s lines look like and a differential diagnosis?

Answer 14

Narrow, white transverse lines

Decreasedd protein synthesos or protein loss

Question 15

What does nail fold telangiectasia look like and a differential diagnosis?

Answer 15

Dilated capillaries and erythema t nail fold

Connective tissue disorder, including systemic sclerosis, systemic lupus erythmatous, dermatoymotisis

Question 16

What does ONYCHOLYSIs look like and a differential diagnosis?

Answer 16

Nail seperate from nail bed

Psoriasis, fungal infection traumam, thyrotoxicosis, tetracyclines

Question 17

What does onchomyocis look like and a differential diagnosis?

Answer 17

Thickened of nail plate with white, yellow or brown discolouration
Fungal infection

Question 18

What does pitting look like and a differential diagnosis?

Answer 18

Fine or coarse pits in nail

Psoriasis, eczema, alopecia areta, lichen planus

Question 19

What does splinter haemorrhage look like and a differential diagnosis?

Answer 19

Small red streaks the lie longintudinally in nail plate

Trauma, IE

Question 20

What does yellow nails look like and a differential diagnosis?

Answer 20

Yellow discoloration ad thickened

Yellow nail syndrome

Question 21

What are some causes of clubbing?

Answer 21

Thoracic- Lung cancer, chronic suppurative conditions” Pulmonary TB, bronchiectasis, lung abscess, empyema and CF, mesothelioma, fibroma, PF
Cardiovascular: Cyanotic congenital heath disease, IE, arteriovenous shunts and aneurys,
GI: Cirrhosis, IBD, Coelcac
Others” Thyrotoxicosis, primary hypertrophic osteoarthropathy

Question 22

Google the examination for clubbing

Answer 22

Ok smelly

Question 23

When is clubbing likely?

Answer 23

If the interphalangeal depth ratio is more than 1
If the nail fold angle is more than 190 degrees
If the Schamroth’s window sign is absent

Question 24

When does depigmentation occur?

Answer 24

Vitiligo

Question 25

What can cause hyperpigmentation?

Answer 25

Excess of ACTH

Question 26

What is haemochromatosis

Answer 26

Inherited condition of excesive iron absorption results in skin hyperpigmentation due to iron deposits and increased melanin prooduction

Question 27

What is haemosiderin?

Answer 27

Product of haemoglobin breakdwon is deposted in the skin of the lower legs following subcutaneous extravastion of blood due to venous insufficiency

Question 28

What can easy brusing be due to?

Answer 28

Reflection of skin and connective tissue fragility due to advancing age or glucocorticoid usage

Question 29

What is hypercarotenemia?

Answer 29

Occurs due to excessive ingestion of cerotene containing vegetables or in situations of impaired metabolism such as hypothyroidism or anaorexia nervosa Yellowish discoloration of face, palms and soles bur not sclera

Question 30

What can skin discolouration be due to?

Answer 30

Abnormal pigments such as the sallow yellow brownish tinge in CKD Bluish tinge is due to abnormal haemoglobns such as sulphaemoglibin or methaemoglobin or by drugs such as dapspne

Question 31

What drugs cause abnormla skin colouration and what colour?

Answer 31

Mepacrine (yellow) Amiodarone (bluish grey) Phenothiazines (slate grey)

Question 32

When is jaundice normally detectable?

Answer 32

Above 50 micro mol/l

Question 33

What is pallor?

Answer 33

Pallor can result from anaemia in which there is a reduction in circulating oxy haemoglobin in the dermal and subconjunctival capillaries or from vasoconstriction due to cold exposure or sympathetic activation

Question 34

What causes facial flushing?

Answer 34

``` Fever Exercise Heat exposure Emotional Mneopause Androgen deficiency Carcinoid syndrome Medullary thyroid cancer Serotonin syndrome Food/alcohol ingestion Neurological Rosacea Mastocytoses ```

Question 35

What BMI is underweight in non asian and asian

Answer 35

Under 18.15

Question 36

What BMI is normal in non asian and asian

Answer 36

18. 5-24.9 | 18. 5-22.9

Question 37

What BMI is overweight in non asian and asian

Answer 37

25-29.2 | 23-24.9

Question 38

What BMI is obese t in non asian and asian

Answer 38

30-39.9 | 25-29.9

Question 39

What BMI is mrobidly obese in non asian and asian

Answer 39

More than 40 | more than 30

Question 40

What are some causes of oedema?

Answer 40

Venous Lymphatic Inflammatory Allergic

Question 41

What are features to note in any lump or swelling?

Answer 41

``` Size Position Attachments- Fixed or mobile Consistency- Soft to stony hard Edge- Delineated or ill defined, regular or irregular, sharp or rounded Surface and shape Pulsation, thrills and bruits Infalmmation- Redness, tenderness warmth Transillumination- Pen torcch. Cystic swelling will light up ```

Question 42

What can cause a bruit?

Answer 42

If blood flow through a lump is increased, a systolic murmur may be heard With sufficient flow a thrill may be palpable

Question 43

What is the examination sequence?

Answer 43

Inspect the lump, noting any change in the colour or texture of the overlying skin Define the sit and shape of lump Measure its size and record the findings diagrammatically Gently palpate for tenderness of change in skin temperature Feel the lump on one side, see and feel if a bulge occurs on the opposite side. Confirm the flucttion in two planes. Fluctation usually indicates that the lump contains fluid, although some soft lipomas can feel fluctuant Auscultate for vascular brutis Transilluminate

Question 44

What size are normal nodes?

Answer 44

Less than 0.5cm in diamater

Question 45

What do normal nodes feel like?

Answer 45

Soft

Question 46

What do abnormal nodes fee; like?

Answer 46

Hodgkins lymphoma is rubbery TB may be matted Metastiatic cancer they feel hard

Question 47

What are the facial features of hypothyrodism

Answer 47

Sparese, coarse hair and eyebrows, periorbital puffiness, dry, waxy skin, apathetic expression, macroglossia

Question 48

What are the facial features of graves disease

Answer 48

Staring appearance due to lid retraction, proptosis, evidence of weight loss

Question 49

What are the facial features of hypopituitarism

Answer 49

Pale, often unwrinckled skin with loss of hair

Question 50

What are the facial features of acromegalu

Answer 50

Thickened, coarse skin with enlarged nose and frontal bones, prognathism, widely spcaed teeth, macroglossia

Question 51

What are the facial features of cushings syndrome

Answer 51

Moon shaped plethroci facries

Question 52

What are the facial features of osteogenesis imperfecta

Answer 52

Blue sclera

Question 53

What are the facial features of herediatry haemorrhagic telangiectasia

Answer 53

Telangiectasia on and around lips

Question 54

What are the facial features of systemic sclerosis

Answer 54

Tight skin constricting mouth, beaking of nose, loss of nasolabial folds

Question 55

What are the facial features of myotonic dystrophy

Answer 55

Frontal balding, paucity of expression, bilateral ptsosis

Question 56

What are the facial features of down;'s sdynreome

Answer 56

Flat facial profile, upslanting palpebral fissures, snall, low set ears, macroglossia, brushfield spots in iris

Question 57

What are the facial features of SLE

Answer 57

Butterfly erythematosu rash on cheeks

Question 58

What does turner's syndrome look lije?

Answer 58

Due to loss of X Delyaed puberty in girls Short stature, webbing of neck, small chin, low set ears, low hairline, short fourth finger, increased carrying angle at the elbows and widely spaced nipples