Micellaneous

Question 1

List 2 key causes of leukonychia

Answer 1

Nail bed trauma

Hypoalbumuinaemia

Question 2

list some causes of hypoalbuminaemia

Answer 2

Acute and chronic inflammatory responses (mainly)
Liver cirrhosis; Heart Failure; Nephrotic syndrome; Malnutrition
(important prognostic factor)

Question 3

List as many causes of clubbing as you can

Answer 3

Thoracic: tumour (benign or malignant): pulmonary malignancy,Thymoma, mesothelioma, oesophageal cancer, idiopathic pulmonary fibrosis, asbestosis, bronchiectasis, empyema, lung abscess, bacterial endo carditis, CF, AV malformations of lung
Non-thoracic: Idiopathic familial osteoarthropathy, IBD, thyroid acropachy, hepatic cirrhosis, coeliac disease

Question 4

What is clubbing?

Answer 4

Loss of normal nail-nail bed angle
Increased nail curvature (later on)
Increased soft tissue bulk over distal phalanges

Question 5

List at 4 causes of asterixis

Answer 5

Liver cirrhosis, Hepatic encephalopathy, opiate OD, acute liver failure (and Wilson’s disease)

Question 6

List causes of palmar erythema

Answer 6

Primary: Idiopathic, hereditary, pregnancy.
Secondary: Liver cirrhosis (Wilson’s disease, haemochromatosis), thyrotoxicosis, RA, salbutamol, topiramate, cholestyramine, amiodarone

Question 7

Although melanonychia can be normal in up to 77% of black men what should be ruled out before assuming it is a normal finding?

Answer 7

Subungual melanoma (if only in one nail)

Question 8

What might dilated nail fold capillaries indicate?

Answer 8

Scleroderma and pulmonary HTN (both relatively rare I think)

Question 9

Causes of angular stomatitis

Answer 9

Candida infection (most commonly), iron deficiency, vitamin B deficiencies

Question 10

List causes of gynocomastic (drug and non-drug)

Answer 10

Drugs (DISCO): Digoxin, Isoniazid, Spironolactone, CCBs, Oestrogens (anabolic steroids)
Non-drug: idiopathic, CKD, liver cirrhosis, hyperthyroidism

Question 11

Define ascites

Answer 11

The accumulation of fluid in the peritoneal cavity

Question 12

Causes of ascites

Answer 12

Liver cirrhosis, malignancies, renal failure, congestive heart failure (believed that portal hypertension is the major factor involved plus hypoalbuniaemia forms a pressure gradient > outflow into abdo cavity)

Question 13

List some of the causes of AF

Answer 13

Cardiac: HTN, valvular disease, Cardiomyopathies, IHD, HF

Non-cardiac - thyrotoxicosis, infection (pneumonia/UTI), Alcohol, Drugs (particularly sympathomimetics)