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Internal Medicine > MBBS deck > Flashcards

MBBS deck Flashcards

1
Q

Causes of Clubbing

A 
Causes of Clubbing
Respiratory 
-Cancer
 - Bronchogenic Ca
        -Lung Mets
        -Pleural Mesothelioma
        - Oseophageal cancer
	COPD
	Tuberculosis
•	Suppurative Lung Disease
  - Lung Abscess
         - Empyema
         - Bronchiectasis
•	Cystic Fibrosis 
•	Interstitial Lung disease
           - Sarcoidosis
           - Fibrosing alveolitis
           - Asbestosis etc.
•	Pulmonary AV fistuala
Cardiovascular
•	Congenital Cyanotic Heart disease
   - Tetralogy of Fallot (ToF)
   - Coarctation of aorta
          - Pulmonary stenosis (critical)
•	Subacute Bacterial endocarditis
•	Eisenmenger’s syndrome
•	Left Atrial myxoma
•	Isolated Toe clubbing 
   - PDA with Shunt reversal
          - Called Eisenmenger PDA
Abdomen
•	Liver Cirrhosis
•	Neoplasm
   - Colorectal Ca
          - Gastric Ca
          - GI lymphoma 
          - Hepatoma
•	Inflammatory BD
    - Crohn’s Disease
           - Ulcerative colitis
•	Malabsorption
           - Celiac disease
           - Whipple’s disease
           - Cystic Fibrosis
-	Intestinal Polyposis
Other
•	Hyperthyroidism 
           - Particularly Graves
•	Idiopathic
•	Thymoma
•	Thalassemia
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2
Q

Causes of Hepatomegaly

A 
Infection
•	Viral		
            -Hepatitis  -
             - EBV
•	Bacterial	
            -Weil’s disease (leptospiro.) 
            - Syphilis
•	Parasitic
             -Hydatid cyst
             -Schistosomiasis, 
              -Amoebic abscess,
              - Malaria
              - Leishmaniasis
Malignancy
•	Hepatocellular carcinoma
•	Metastases – GI, Lung, breast and melanomas
Hematologic
	Myeloproliferative
        -Myelofibrosis
        -CML
	Lymphoma
-Hodgkin’s
        - Non-Hodgkin’s
	Leukaemia
-ALL
      -AML
	Sickle cell
-Hepatic sequestration
      -Extramedullary  
       haematopoiesis
Hepatic congestion
	Cardiac failure
	Hepatic vein thrombosis
Storage disorders
	Wilson’s
	Haemochromatosis
	Gaucher’s
Infiltrative
	Sarcoidosis
	Amyloidosis
Biliary obstruction; e.g. Pancreatic Ca
Fatty Liver (NASH)
Early cirrhosis
Whipple’s disease
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3
Q

Causes of Tender Hepatomegaly

A 
•	Hepatitis
•	Rapid liver enlargement
o	Rt heart failure
o	Budd-Chiari Syndrome
o	Hepatoma
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4
Q

Causes of Splenomegaly

A 
Infection  
•	Bacterial – Subacute bacterial endocarditis
•	Viral - CMV, EBV
•	Parasite - Malaria
Haematological
•	Lymphoproliferative
  - Lymphoma
  - Chronic LL
•	Myeloproliferative disease    - Myelofibrosis
   -Chronic ML
   -Polycythemia vera
   -Essential  thrombo.
•	Thalassemia
•	Sickle cell
Vascular congestion  
•	Cirrhosis
•	Hepatic vein
    obstruction
Connective Tissue
•	RA, SLE
Storage disorders
•	Gaucher’s disease
•	Niemann-Pick disease
Infiltrative
•	Amyloidosis
•	Sarcoidosis
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5
Q

Causes of Massive Splenomegaly (>8cm)

A 
Infection  
•	Visceral Leishmaniasis (Kala-azar)
•	Malaria
•	Schistosomiasis
Haematologic
•	Myeloproliferative
          - CML, Myelofibrosis
•	Sickle cell
  -Splenic Sequestration in   
               the young, HbSC disease

• Storage Disorder
o Gaucher’s
• Idiopathic Tropical (Africa & South-East Asia)

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6
Q

Causes of Moderate Splenomegaly (4 -8 cm)

A

Lymphoproliferative disorders
• Hodgkins disease
• Chronic lymphoytic leukemia,
Cirrhosis with portal hypertension

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7
Q

Causes of Palpable Kidneys

A 
•	Thin individual
•	AD Polycystic kidney disease
•	Maligancy
           - Renal Cell Cancer
           - Wilm’s Tumour  
              (Nephroblastoma)
•	Hydronephrosis (Can be bilateral rarely)
•	Renal Cyst / Abscess
•	Amyloidosis (Can be bilateral rarely)
•	Hypertrophy of a single functioning kidney
•	Nephropathy
o	HIV
o	Sickle cell
o	Diabetes
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8
Q

Generalized Lymphadenopathy

A 
Infection
-Viral such as -HIV, Ebstein Barr virus,   CMV, Measles, Mumps,  Rubella, Viral Hepatitis, 
-Bacterial	 e.g - IE, Tb, Syphilis
-Fungal- Histoplasmosis
-Protozoal.  -Toxoplasmosis, Filariasis, - Leishmaniasis
-Malignancy
o	Leukaemia	
-ALL, CLL
oLymphoma	
      -Hodgkin’s, Non-Hodgkin’s
Metastatic Solid Tumour
Connective Tissue Disease 	RA, SLE
Drugs-	Phenytoin, hydrallazine, -	allopurinol
Other Sarcoidosis
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9
Q

Causes of Ascites

A 
Portal (SAAG > 1.1g/dL)
•	Exudative (Protein > 2.5g/L)
o	Budd-Chiari
o	CCF
•	Transudative (Protein  2.5g/dL)
o	Intra-abdominal malignancy
o	Intra-abdominal infection e.g. Tb
o	Pancreatitis
•	Transudative (Protein
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10
Q

Causes of Local Edema

A 
inflammation /infection venous or lymphatic obstruction 
•	thrombophlebitis 
•	chronic lymphangitis 
•	resection of regional lymph nodes 
•	filariasis
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11
Q

Some Causes of Generalized Edema

A 
Increased hydrostatic pressure 
Increased fluid retention
•	Cardiac causes e.g. CHF 
•	Hepatic causes e.g. cirrhosis 
•	Renal causes e.g. acute and 
•	chronic renal failure
Vasodilators (especially CCBs) 
Refeeding edema
Decreased oncotic pressure 
Hypoalbuminemia
Hormonal 
•	hypothyroidism 
•	exogenous steroids 
•	pregnancy 
•	estrogen
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12
Q

Causes of Jaundice

A

Unconjugated

Prehepatic
•	Hemolytic anemia
 - Sickle Cell Anemia -
 - Hereditary Spherocytosis
        - Hereditary Elliptocytosis   
•	Gilbert’s syndome
•	Hematoma resorption
Conjugated
Hepatic
•	Viral – Hepatits A B, C
•	Leptospirosis
•	Hepatic Abscess
Post Hepatic
•	Choledocholithiasis
•	Ascending Cholangitis
•	Sclerosing cholangitis
•	Pancreatits
•	Cancer at head of Pancreas or Ampule
•	Methastatic cancer
•	Foreign body in CBD eg. worm
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13
Q

Causes of Tachpnea/SOB

A 
Cardiovascular 
•	acute MI 
•	CHF/LV failure 
•	aortic stenosis
•	mitral stenosis 
•	elevated pulmonary venous pressure
Respiratory 
Airway disease
•	asthma 
•	COPD exacerbation 
•	upper airway obstruction (foreign body, mucus plugging, anaphylaxis) 
Parenchymal lung disease
•	ARDS 
•	pneumonia 
•	interstitial lung disease
 	Pulmonary vascular dis.
•	PE 
•	pulmonary HTN 
•	pulmonary vasculitis
Pleural disease
•	pneumothorax 
•	pleural effusion
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14
Q

Neuromuscular and chest wall disorders

A
  • C-spine injury
  • polymyositis, myasthenia gravis, Guillain-Barri syndrome
  • kyphoscoliosis
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15
Q

Causes of Cough

A 
Airway Irritants
•	Inhaled smoke, dusts, fumes
•	Aspiration astric contents (GERD)
•	Oral secretion
•	Foreign body
•	Postnasal drip 
Airway Disease
•	URTI including postnasal drip and sinusitis
•	Acute or chronic bronchitis
•	Bronchiectasis
•	Neoplasm
•	External compression by node or mass lesion
•	Asthma
•	COPD 
Parenchymal Disease
•	Pneumonia
•	Lung abscess
•	Interstitial lung disease 
•	CHF 
Drug-induced (e.g. ACE inhibitor)
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16
Q

Differentials of Hemoptysis

A 
Airway Disease
•	Acute or chronic bronchitis
•	Bronchiectasis
•	Bronchogenic CA
•	Bronchial carcinoid tumour 
Parenchymal Disease
•	Pneumonia 
•	TB 
•	Lung abscess
Miscellaneous:
•	Goodpasture’s syndrome
•	Idiopathic pulmonary hemosiderosis 
Vascular Disease
•	PE
•	Elevated pulmonary venous pressure:
LVF
Mitral stenosis
•	Vascular malformation
Miscellaneous
•	Impaired coagulation
•	Pulmonary endometriosis

Internal Medicine (2 decks)

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