General inspection (I) Flashcards
Differentiate the underlying cause of the following smells:
- sickly sweet acetone smell
- Sweet smell
- Ammonia fish smell
- Fecal matter smell
- Alcohol smell
- Foul/ necrotic tissue smell
- Metallic smell
□ Ketoacidosis: sickly sweet acetone smell
□ Liver failure: sweet smell (fetor hepaticus)
□ End-stage Chronic Renal Failure: ammonia fishy breath (uraemic fetor)
□ Severe bowel obstruction: fecal contamination of breath when belching
□ Alcoholism
□ Foul-smelling: chronic abscesses (lungs, bronchiectasis, skins)
□ Metal-like: melaena, other bleeding
Differentiate underlying causes of the following skin changes: Thin skin Tight and shiny Yellow Hyperpigmentation Erythematous
□ Thin skin → Cushing’s syndrome □ Tight and shiny → scleroderma □ Yellow → jaundice, uraemia □ Hyperpigmentation → Addison’s disease (esp at scars, skin creases, linea alba) □ Erythematous
Describe characteristic body habitus of Marfan syndrome.
- Disproportionately long extremities - Arachnodactyly (spider fingers): long and slender fingers - High-arched palate - Arm span > height - Funnel or pigeon chest
Describe characteristic body habitus of Turner syndrome.
- Weblike neck
- Low set ears
- Broad chest with wide nipples
- Limb swelling, short fingers and toes
- Stunted growth and sexual characteristics
Describe characteristic body habitus of Klinefelter syndrome (Eunuchoid).
- Tall stature with long limbs
- Poor muscle tone and stunted muscle growth
- Stunted sexual characteristics (small penis and testicles, reduced facial hair)
- Infertility
- Gynaecomastia
Describe characteristic body habitus of Cushingoid.
- Purplish striae
- Central obesity
- Plethora
- Buffalo hump
- Moon face
- Proximal myopathy
Describe the test for hydration status on skin.
pinched skin does not return to original position immediately
Describe symptoms of mild, moderate, severe and very severe dehydration.
Mild:
- Thirst
- Dry mucous membrane
- Concentrated urine
Moderate:
+ thirst
+ reduced skin turgor
+ Tachycardia
Severe: \+ Sunken eyes (decreased eyeball pressure) \+ Collapsed veins (gaunt face) \+ Postural hypotension \+ Oligouria (<400mL/day)
Very Severe:
+ Coma
+ Signs of shock
List normal values for pulse, BP, resp. rate and temp.
□ Pulse: 60-100/min
□ BP: 80/120
□ Respiratory rate: 12-16/min
□ Temperature: 36.6 – 37.2 degrees C (oral)
Define temp limits for hypothermia, normal, fever and hyperpyrexia.
<35C = hypothermia
36.6 – 37.2C (oral) = normal
>41.6C = hyperpyrexia (life-threatening!)
List 2 causes for hypothermia and 3 causes for hyperpyrexia.
hypothermia
→ Exposure to coldness
→ Hypothyroidism
hyperpyrexia
→ Heat stroke from exposure/ excessive exertion
→ Malignant hyperthermia
→ Neuroleptic malignant syndrome (reaction to antipsychotics)
List causes for continued fever. (Temperature does not return to normal, without fluctuation)
Typhoid
Drug fever
Malignant hyperthermia
Causes of malignant hyperthermia.
Drug- induced:
Exposure to anesthetic agents e.g. halothane
Exposure to muscle relaxants: suxamethonium
List 3 causes of relapsing fever. (Temperature returns to normal for days before rising again)
- Malaria:
Tertian (3 day pattern, peaks every other day) e.g. Plasmodium vivax, P. ovale
Quartan (4 day pattern, peaks every 3 days) e.g. P. malariae - Pyogenic infection
- Lymphoma: Pel-Ebstein fever of Hodgkin disease
List causes of intermittent fever. (Temperature returns to normal each day)
- Pyogenic infections
- Miliary tuberculosis
- Lymphoma
List facial changes caused by hypothyroidism.
- Thickened + coarse face
- Periorbital puffiness
- Rough and dry skin
- Loss of outer eyebrows
List facial changes caused by Grave’s disease.
- Exophthalmos
- Lid lag
- Chemosis
- Ophthalmoplegia
List facial changes caused by Scleroderma.
- Beak, punched nose
- Tight shiny skin
- Telangiectasia
- Periorbital tethering
List facial changes caused by Mitral stenosis.
- Malar flush
- Bluish discolouration of
the rest of face
List facial changes caused by Down’s syndrome.
- Small chin
- Flat nasal bridge
- Slanted eyes
- Small mouth
+ large tongue
Differentiate underlying causes of Malar flush
lupus and polycythemia vera, mitral valve stenosis, chronic alcoholism Cushing's syndrome Pheochromocytoma Menopausal syndromes
Recall the nonmonic of MALAR in mitral stenosis
M - malar flush A - A-fib L - Left heart failure A - Apex beat displacement R - Right heart failure
Underlying cause of Heliotropic rash (purple, peri-orbital, itchy and burning)
Dermatomyositis (rare, connective tissue disease)
- Concurrent with muscle weakness, fever, and joint aches
Ddx complete and partial ptosis.
Ptosis: drooping eyelids
→ Complete ptosis: CN III palsy
→ Partial ptosis: partial CN III palsy, Horner syndrome,
myasthenia gravis
