- liver cirrhosis - chronic kidney disease Congenital heart failure

Medicine 6th Flashcards by May 🫥

Infective endocarditis 1

are non-tender, small erythematous or haemorrhagic macular or nodular lesions on the palms or soles only a few millimeters in diameter that are pathognomonic of infective endocarditis.

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Infective endocarditis 2

IV drug abuse
Infective endocarditis
Structural heart disease
Heart valve injury/replacement
Family history of autoimmune disorders
HIV status
Mucosal bleeding
Head/neck or lung infection
Tick exposure
Constitutional symptoms

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Infective endocarditis 3

Infective endocarditis
Cutaneous vasculitis
Disseminated Intravascular Coagulation (DIC)
Erythema multiforme
Idiopathic thrombocytopenia purpura
Polyarteritis Nodosa
Secondary syphilis
Thrombotic thrombocytopenic purpura
Typhoid Fever

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Dupuytren’s contracture

Alcoholic
Diabetes
Epilepsy
Hand trauma
Hiv
Smokers
Vascular disease

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Peripheral cyanosis

Peripheral vascular circulation

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Palmar erythema

Liver cirrhosis
Polycythemia
Pregnancy

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Differential diagnosis of hypothermia

Alcohol Toxicity
Benzodiazepine Toxicity
Carbon Monoxide Toxicity
Ethylene Glycol Toxicity
Gamma-Hydroxybutyrate Toxicity
Hemorrhagic Stroke
Ischemic Stroke
Opioid Toxicity
Sedative-Hypnotic Toxicity
Targeted Temperature Management (Therapeutic Hypothermia)
Ventricular Fibrillation in Emergency Medicine
Ventricular Tachycardia

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Differential diagnosis in hyperthermia

Infection: malaria, sepsis, meningitis, encephalitis, brain abscess, typhoid fever
Drug/toxin: malignant hyperthermia, withdrawal syndrome from alcohol, cocaine
Endocrine: thyroid storm, diabetic ketoacidosis
Oncology: lymphoma, leukemia

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Warm, moist or sweaty palms

Thyrotoxicosis

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Pigmentation of palmar creases

Addison’s disease but may be normal

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Dry puffy hands

Myxoedema

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Xanthomata

Hyperlipidemia

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Infective endocarditis stigma

Janeway lesions
Osler’s nodes
Splinter haemorrhage
Roth’s spot
petechiae
clubbing
heart murmur
embolic phenomenon
fever

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Leukonychia

Seen in hypoalbuminemia states such as
- nephrotic syndrome
- chronic liver disease

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Pitting nails

Psoriasis
Eczema

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Terry’s nails

liver cirrhosis
chronic kidney disease
Congenital heart failure

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Lindsay’s nails

chronic kidney disease

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Capillary refill time

to check for peripheral perfusion

Tremors

Pill rolling tremors seen in Parkinson’s disease, Parkinsonism
Fine tremors seen in anxiety, alcohol withdrawal, thyrotoxicosis
Flapping tremors/ Axterixis seen in CO2 retention, hepatic encephalopathy, uremic encephalopathy

Xanthelesma

Hyperlipidemia

Chynes stokes breathing

Regular, alternating periods of apnea and hyper apnea
Seen in stroke, congestive heart failure

Increased respiratory depth

brings out metabolic acidosis as seen in Diabetic ketoacidosis

Decreased respiratory depth

pleurisy
fractured ribs
acute abdomen
depression of the respiratory centre by drugs
injury to the medulla

Stridor

indicates upper respiratory tract obstruction

Wheezing

- seen in: Asthma Chronic bronchitis Tuberculosis (unilateral)

Uneven movement of the chest

- pleural effusion - lobar pneumonia - pleural thickening Affected side moves less than the normal side

Paradoxical movement of the chest

Follows multiple rib fractures which cause the affected flail segment of the chest wall to retract instead of expand during inspiration

Clubbing Stage V

- hyperthrophic pulmonary osteoarthropathy

Chronic obstructive pulmonary disease

- pursed lip breathing - trachea tugging - barrel shaped chest as seen in patients with sever airflow obstruction - decreased tactile fremitus - added sounds: rhonchi- copd

Tracheal tugging

Visible descent of the trachea during inspiration

Trachea pulled to the side of the lesion

- lung collapse - interstitial pulmonary fibrosis

Trachea pulled away from the site of the lesion as a result of mediation Al shift

- massive pleural effusion - tension pneumothorax

Cricosternal distance

Refers to the distance between the cricoid cartilage and suprasternal notch. Admits three fingerbreaths

Reduced cricosternal distance

- suggests hyperinflated lungs seen in emphysema

Pulsatile JVP Means there is a right sided problem

- corpulmonale - tricuspid regurgitation

Pulseless JVP

-superior vena cava obstruction

Barrel shaped chest

Seen in patients with increased anterioposterior diameter. As they have severe air flow obstruction. Copd Severe asthma

Pectus carinatum ( pigeon shaped chest)

Seen in secondary to chronic respiratory disease in childhood

Pectus excavatum ( funnel shaped chest)

Developmental defect that arises due to connective tissue disease

Thoracotomy scar or breast surgery

- could suggest malignant pleural effusion

Radiotherapy tattoo

- suggests presence of malignancy - may be associated with well dermacatee inflammation of the skin in the acute stage (pulmonary fibrosis, potentially detectable on auscultation in the longer term)

In respiratory examination of chest

Chest movement Chest expansion Tactile fremitus Percussion note Air entry Breath sounds Added or adventitious sounds Vocal resonance

Raised troponin levels signify

- Coronary artery disease - chronic kidney disease - sepsis - myocarditis - aortic dissection - pulmonary embolism