General questions- causes Flashcards
Respiratory causes of clubbing?
- IPF
- Bronchiectasis
- Bronchial carcinoma
- Mesothelioma
- Empyema
- CF
- Asbestosis
- Lung abcess
Causes of clubbing and crackles?
- IPF
- Bronchogenic carcinoma
- Asbestosis
- Bronchiectasis
Causes of bronchiectasis
Congenital: - Cystic fibrosis - Young’s syndrome - Kartagener’s syndrome - Sequestered bronchopulmonary segments Infection: - TB - Measles - Varicella - Pertussis - Obstruction - Foreign body - Bronchogenic carcinoma Immunodeficiency - Congenital: - Hypogammaglobulinaemia - Acquired: HIV Aspiration Traction - IPF - COPD
Causes of upper lobe fibrosis
- Ankylosing spondylitis
- Allergic bronchopulmonary aspergillosis
- Hypersensitivity pneumonitis
- Coal workers pneumoconiosis
- sarcoidosis
- TB
- Histiocytosis X
- Histoplasmosis
- Radiation
Causes of lower zone fibrosis
- Asbestosis
- Drugs: bleomycin, Busulphan, Cyclophosphamide, Methotrexate, Amiodarone, Nitrofurantoin, Sulphasalazine, Gold
- IPF
- Connective tissue disease- scleroderma, PM, DM, Sjorgrens, SLE, MCTD
- RA
Causes of transudative pleural effusions
- CCF
- Chronic liver disease
- Chronic renal failure
- Hypoalbumianemia- malnutrition, sepsis
- Hypothyroidism
- Meigs syndrome
Causes of exudative pleural effusions
- Malignancy
- Pneumonia
- COnnective tissue disease
- Infarction/ PE
- TB
- sarcoidosis
- Drugs: quinidine, procainamide, hydralazine, Bromocriptine, Methotrexate, Methylsergide, nitrofuratoin
Differential diagnosis of dullness at lung bases
- pleural thickening
- consolidation
- collapse
- fibrosis
- raised hemidiaphragm
Causes of SVCO
- Bronchogenic carcinoma- SCLC
- Lymphoma
- Thrombosis
- Thymoma
- Teratoma
- Aortic aneurysm
- Post radiation fibrosis
Indications for lobectomy/pneumonectomy
- cancer
- emphysema
- bronchiectasis
- cystic fibrosis
- IPF
- TB
- Aspergillosis
Causes of cor pulmonale
- IPF
- COPD
- OSA
- Kyphoscoliosis
- neuromuscular weakness
Causes of pulmonary hypertension
WHO classification
- Primary arterial htn- idiopathic pul.htn, familial pul.htn, disease related to collagen vascular disease, HIV and drugs
- Pulmonary venous hypertension: LVF/CCF
- Chronic hypoxia: COPD, IPF, OSA, Kyphoscoliosis
- Thrombotic/embolic disease: PE, sickle cell
- Miscellaneous: sarcoidosis, Langerhans cell histiocytosis
Causes of clubbing
Abdominal: -IBD - Cirrhosis - Coeliac disease Respiratory: - Bronchiectasis - Cancer - IPF - Abscess - Asbestosis - Cystic fibrosis - Empyema Cardiac: - Congenital cyanotic heart disease - Atrial myxoma - SBE Miscellaneous: - Hyperthyroidism - Fistulae - Infected grafts - Familial - Idiopathic
Causes of leuchonychia
- Hypoalbuminaemia- malnutrition, malabsorption, protein losing enteropathy, nephrotic syndrome
- Cirrhosis
- Idiopathic
- Familial
- Arsenic poisoning
- Heavy metal poisoning
- chemotherapy
Causes of Koilonychia
- Idiopathic
- Familial
- Chronic iron def anaemia
- Nail-patella syndrome
- Exposure to solvents
- Peripheral vascular disease
Causes of spider naevi
- Childhood
- pregnancy
- OCP
- cirrhosis
- thyrotoxicosis
Causes of acanthosis nigricans
- obesity
- T2DM
- PCOS
- hypothyroidism
- GI malignancy
- Acromegaly
- Cushings syndrome
causes of gynaecomastic
- physiological
- hypogonadism
- cirrhosis
- Drugs: spironolactone, digoxin, cimetidine, oestrogens
- Thyrotoxicosis
- Klienfelters syndrome
Causes of chronic liver disease
- Alcohol
- Viral hepatitis
- NAFLD
- Drug induced liver injury
- autoimmune hepatitis/PBC
- Haemochromatosis
Causes of jaundice
Pre-hepatic:
- Congenital haemolysis: Heridary spherocytosis/HE, sickle cell, G6DP
- Acquired haemolysis: AIHA, malaria
Hepatic:
- Hepatitis- alcohol, viruses, DILI, ischaemia, AIH
- Rotor/Dubin-Johnson
- Gilberts/ Crigler-Najar
Post hepatic:
- Obstruction- stones, tumour, PSC, LNs, Strictures
causes of ascites
- cirrhosis
- CCF
- chronic kidney disease- nephrotic
- Portal vein thrombosis/Budd chiari
- Mesothelioma/peritoneal mets
- TB
- constrictive pericarditis
- Malabsorption syndromes
- Ovarian cancer/fibroma
- Myxoedema
Causes of isolated splenomegaly
Massive:
- CML
- Myelofibrosis
- Kala-azar
- malaria
Moderate:
- CLL
- portal hypertension
Mild:
- SBE, CMV, EBV
- Schistosomiasis
- Feltys
- AIHA
- Lymphoid malignancy
Causes of hepatosplenomegaly
- Cirrhosis with portal hypertension
- Lymphoproliferative disease- CLL
- Myeloproliferative disease- CML
- infection
- amyloidosis
- Glycogen storage disease
- Lysosomal storage disease- Gauchers, Neimann Pick
- Haemochromatosis
- Wilsons disease
Causes of epigastric mass
- carcinoma- stomach, pancreas, colon
- Lymphoma
- AAA
- caudate lobe of liver
Causes of right iliac fossa mass
- renal transplant
- caecal cancer
- appendix mass
- Crohns inflammatory mass
- faeces
- ovarian tumour
Causes of left iliac fossa mass
- colon cancer
- renal transplant
- ovarian tumour
- faeces
- diverticular mass/abcess
causes of unilateral renal enlargement
- hydronephrosis
- renal carcinoma
- renal cyst
- congenital abnormality- horseshoe kidney
- unilaterally palpable bilateral pathology
Causes of bilateral renal enlargement
- ADPKD
- Tuberous sclerosis
- Von Hippel Lindau
- Bilateral hydronephrosis
- Amyloidosis
- congential abnormalities
Causes of aortic stenosis
- calcific
- bicuspid
- rheumatic
Indications for aortic valve replacement in aortic stenosis
Symptomatic- syncope, angina, dyspnoea
Asymptomatic, mean gradient >40mmHg and:
- LVEF <45%
- Reduction in BP with exercise
- VT
- Valve area <0.6cm
- LVH >15mm
TAVR/TAVI if meet criteria but mod-high surgical risk
Causes of aortic regurgitation
Acute:
- Aortic dissection
- Infective endocarditis
- Rheumatic heart disease
- Prosthetic valve failure
Chronic:
- HTN
- Bicuspid aortic valve
- Ankylosing spondylitis
- Marfans syndrome
- Rheumatic heart disease
- Endocarditis
- Syphilis
- Osteogenesis imperfecta
Indications for aortic valve replacement in aortic regurgitation
Acute AR- severity anything more than mild
Chronic- if symptomatic Asymptomatic + any of: - Dilated LV - EF <50% - Regurgitant fraction >50% -
Causes of mitral stenosis
- Rheumatic heart disease
- Degenerative – severe calcification
- Non-valvular: LA thrombus, atrial myxoma, endocarditis vegetations
- Congenital:
Cor triatriatum
Shone’s syndrome
Mucopolysaccharidoses
Bronchial carcinoid - Drugs: methylsergide, cabergoline
Indications for percutaneous mitral balloon valvulopasty in mitral stenosis
Symptomatic- NYHA II+ & moderate/sever MS
Asymptomatic with
- moderate (MVA 1-1.5cm2 or mean gradient 5-10mmHg)
- severe (MVA <1cm2, mean gradient >10mmHg)
- PASP 50mmHg at rest, rises to >60mmHg on exercise
- new AF
PAWP >25mmHg
NYHA III-IV should have surgery ideally
Causes of mitral regurgitation
Myxomatous degeneration Functional secondary to LV dilatation Ischaemic Rheumatic Mitral valve prolapse - Idiopathic - Hereditary -Connective tissue disease
Indications for mitral valve repair in MR
- EF 30-60% + LV end systolic >40mm
- severe MR and new AF or PASP >50mmHg
Causes of tricuspid regurgitation
- pul.htn
- Endocarditis
- Ebsteins anormaly
- Carcinoid syndrome
- Rheumatic fever
Causes of pul. stenosis
- Congenital- maternal rubella, tetralogy of fallot, foetal alcohol syndrome
- Occasionally rheumatic fever
Causes of left sided heart failure
- HTN
- IHD
- valve disease
- cardiomyopathy- DCM, restrictive, hypertrophic
- myocarditis
Causes of right sided heart failure
- Cor pulmonale
- Left sided heart failure
- RV cardiomyopathy
- pulmonary and tricuspid valve problems
Causes of constrictive pericarditis
- idiopathic
- radiotherapy
- uraemia
- TB
- Malignancy
- Autoimmune
- Post-traumatic
Causes of PDA
- idiopathic
- congenital rubella
- high altitude
- prostaglandins
- prematurity
Associations with coarctation
Bicuspid aortic valve VSD Mitral valve prolapse PDA Turner’s syndrome Marfan’s syndrome Berry aneurysms NF1
Causes of spastic gait
Demyelination Cerebral palsy Transverse myelitis MND Spinal cord compression Syringomyelia Anterior spinal artery infarction Hereditary spastic paraparesis Tropical spastic paraparesis Parasagittal meningioma Fredreich’s ataxia B1 deficiency B12 deficiency
Causes of parkinsonism
Parkinson’s disease Parkinson’s plus syndrome Vascular parkinsonism MPTP, manganese Neuroleptics, antiemetics Huntington’s disease Wilson’s disease Dementia pugilistica NPH
Causes of hemiparesis
Infarction/haemorrhage Space occupying lesion Demyelination Trauma AVM
Causes of proximal weakness
Hypothyroidism Cushing’s Inflammatory myopathies: PM, DM Toxins: alcohol, statins Muscular dystrophies Metabolic myopathies: McArdle’s Myasthenia/LEMS GBS/CIDP Cord lesion
Causes of pseudobulbar palsy
Infarction/haemorrhage Demyelination MND Tumours Traumatic brain injury Neurodegenerative disorders Neurosyphilis
Causes of bulbar palsy
Infarction/haemorrhage Tumour Demyelination Myasthenia MND Polio Syringobulbia
Causes of chorea
Sydenham’s chorea Drug-induced: OCP, anti-convulsants Pregnancy PRV Infarction Wilson’s disease Huntington’s disease Spinocerebellar ataxias Ataxia telangiectasia Prion disease
Causes of cerebellar syndrome
Infection/haemorrhage Demyelination Tumour Alcohol, carbamazepine, phenytoin Vitamin B12, copper, vitamin E deficiency Hypothyroidism Spinocerebellar ataxias Ataxia telangiectasia Fredreich’s ataxia Multiple systems atrophy Paraneoplastic syndrome
Causes of Ptosis
CN III palsy Horner’s syndrome Myasthenia gravis Myotonic dystrophy Oculopharyngeal muscular dystrophy Chronic progressive external ophthalmoplegia
Causes of Ophthalmoplegia
Thyroid eye disease Myasthenia gravis Chronic progressive external ophthalmoplegia Kearns-Sayre Miller-Fisher syndrome Cranial nerve palsies Brainstem lesion
causes of downbeat nystagmus
Arnold-Chiari malformation
Syringobulbia
Demyelination
Drug toxicity – Phenytoin
Causes of upbeat nystagmus
Demyelination
Stroke
Wernickes encephalopathy
Causes of absent ankle jerks and extensor plantars
Implies mixed upper and lower MN:
- Mixed pathology- PN and cervical myelopathy
- MND
- Fredrichs ataxia
- B12 def
- Syringomyelia
- neurosyphilis
- tumours of cauda or conus
Causes of radiculopathy
Disc herniation Cervical and lumbar spondylosis Spinal stenosis Compression: Tumours, abscess, metastasis GBS Infection: CMV, Borrelia, Zoster
Causes of sensorimotor neuropathy
Diabetes
B12/Folate
Alcohol
Drugs: Metronidazole, nitrofurantoin, cisplatin, vincristine, amiodarone, isoniazid
Hypothyroidism
Renal failure
Liver failure
Infections – VZV, HIV, leprosy, syphillis
Vasculitis – SLE, Sarcoidosis, RA, Cyroglobulinaemia
Causes of motor neuropathy
Diabetes (Amyotrophy) Porphyria Heavy metal toxicity – Lead GBS/CIDP Myeloma/MGUS Multifocal motor neuropathy with conduction block
Causes of motor neuropathy
Diabetes (Amyotrophy) Porphyria Heavy metal toxicity – Lead GBS/CIDP Myeloma/MGUS Multifocal motor neuropathy with conduction block
Causes of sensory neuropathy
Paraneoplastic
Sjogren’s syndrome
Drugs
Fredreich’s ataxia
Causes of mononeuritis multiplex
Diabetes mellitus Alcohol Primary vasculitis: PAN, Churg-Strauss Secondary vasculitis: RA, SLE, cryoglobulinaemia, sarcoid Infection – HIV Paraneoplastic
