Non-specific features Flashcards
What are the causes of pruritus?
- psychogenic
- dry skin, senile
- sunburn
- dermatological (scabies, dermatitis, insect bites, pediculosis, psoriasis, pityriasis rose, fungal)
- herpes zoster
- hyperthyroidism
- tumours (lymphomas, leukemias, carcinoid syndrome, CNS neoplasms)
- drug ingestion
- chronic renal failure
- polycythaemia
- obstructive biliary disease and jaundice
- AIDS
- pregnancy
What are the causes of short lasting fever?
- viral, bacterial infection
* infarction
What are the causes of long lasting fever?
- fungal, bacterial, viral infection, parasitic infection
- neoplasms
- connective tissue disease
- drugs
- metabolic and inherited diseases
What are the main categories of causes of menorrhagia?
1) Uterine origin
2) Endocrine disturbances
3) Other
What are the uterine causes of menorrhagia?
- functional
- uterine fibroids
- endometrial polyps
- endometrial hyperplasia
- endometriosis
- adenomyosis
- IUDs
- malpositions of uterus: retroversion, retroflexion
- cervix uteri: erosions, polyps
- acute/chronic endometritis
What are the endocrine causes of menorrhagia?
- pituitary
- thyroid (hypothyroidism)
- ovarian
What are the other causes of menorrhagia (other than uterine and endocrine)?
- drugs
- hypertension
- diabetes mellitus
- blood dyscrasias
- chronic nephritis
- vit A deficiency
- chronic pelvic inflam.
- acute systemic infections/disorders
Compare fatigue vs weakness?
Fatigue:
• non-specific
• sense of weariness or loss of energy
• lassitude, aesthenia, lethargy, tiredness
Weakness:
• umbrella term for muscle fatigue, aching, inability to contract appropriately
• deficiency of bodily strength and healthy vigour
What is the pathophysiology of fatigue?
Imbalance between energy produced by body and energy expenditure
• normal events: exercise with no rest, lack of sleep, low food
• disorders, diseases and abnormal situations
What is the pathophysiology of weakness?
Reduction in ability of cells (especially muscles) to produce ATP for energy production
Cells require: • nutrients • blood supply • oxygen • hormonal stimulation • electrolytes • neural stimulation
What are the causes of hepatomegaly?
- Vascular congestion (congestive cardiac failure)
- Biliary duct obstruction
- Infiltrative
- Inflammatory and infective
- Cirrhosis (early)
- Tumours (hepatoma, haemangioma, mets from bowl)
- Cysts
What are the infiltrative causes of hepatomegaly?
- bone marrow (leukaemia, lymphoma)
- fat (alcohol fatty liver)
- glycogen storage disease)
- amyloid
- iron (haemochromatosis)
- granuloma (TB, sarcoidosis)
What are the infiltrative and infective causes of hepatomegaly?
- hepatitis
- mono, cytomegalovirus, typhoid fever, liver abscess, bartonella
- Crohn’s
What are the causes of localized lymphadenopathy?
- infection in drainage of node (streptococcal tonsillitis, pharyngitis, ear infections, tooth abscess)
- metastatic carcinoma from a primary tumour in drainage of node
- early stage lymphoma
What are the causes of generalised lymphadenopathy?
- infections (mono, toxoplasmosis, cytomegalovirus, septicaemia)
- lymphoma
- lymphatic leukemias
- connective tissue diseases
What are the causes of splenomegaly?
- Infections
- Blood disorders in which there are more red blood cells to be phagocytosed
- Venous Congestion
- Infiltrations
- Miscellaneous
What are the infectious causes of splenomegaly?
- either acute, sub-acute or chronic eg
- infectious mononucleosis
- malaria
- TB
- brucellosis
- septicaemia
- schistosomiasis
- hydatid cysts
- abscess
What are the phagocytosing causes of splenomegaly?
- haemolytic anaemia
* polycythaemia vera
What are the venous congestion causes of splenomegaly?
- portal hypertension
- portal vein or splenic vein obstruction
- right heart failure
- congestive heart failure
What are the infiltrative causes of splenomegaly?
Storage diseases
• Gaucher’s disease
Neoplastic cells
• leukemias
• malignant lymphomas
• myelofibrosis
What is the temperature for fever?
> 37oC
What is the pathophysiology of fever?
Exogenous pyrogen
- >
- endogenous pyrogen
- >
- prostaglandin E in hypothalamus
- > reset hypothalamic thermostat
- > sympathetic nerves increase heat
- >
- metabolism rate, TH, vasoconstriction, shivering (feel cold, pale, + HR, goosebumps) -> + temp.
a -> + pyrogen product -> + heat until thermostat reached
b -> - pyrogens -> - thermostat -> - sympathetic nerves -> - BMR, vasodilation, hypotonia -> feel hot, warm, red, week -> eventually body return to normal
What are heat cramps?
- slow, painful, skeletal muscle cramps
- last 1-3min
- result of depletion of water and salt
- muscle tenderness, moist skin, SLIGHT temp increase
- treat by cool environment rest and saline solution
What is heat syncope?
- sudden loss of consciousness
- due to cutaneous vasodilation and drop in BP
- weak pulse, skin cool and moist
- rest horizontal in cool with fluids
What is heat exhaustion?
- gradual loss of salt and water
- after exertion in hot environment
- thirst, fatigue, nausea, oliguria, dizzy, GIT symptoms, tachycardia, increased temp
- rest in cool enviro and drink saline solution
What is heatstroke?
- failure of thermoregulatory mechanisms resulting in significant increase in body temp.
- elderly in hot and humid
- decrease sweating, LOC, dizzy, weak, emotional lability, nausea, vomiting, confusion, delirium, blurred vision
- must rapidly reduce core temp. WITHOUT causing vasoconstriction (shivering)
What is drug fever?
- illicit drugs
- fever after administration of drug and dissipating after it ceases
- treat by stoping drug
What is malignant hyperthermia?
- generation of excess heat by uncontrolled skeletal muscle contraction
- rare Autosomal Dominant metabolic disorder
- skeletal muscle rigidity
- cardiac arrhythmia
- hyper metabolic state
- reaction to anesthetic
What is hypothermia?
- core temp < 35oC
- elderly with impaired homeostasis are most at risk
- poor coordination, slurred speech, mental changes, cyanosis, dilated pupils, bradypnoea, weak irregular pulse, tachycardia, diuresis
What does HIV stand for?
Human Immunodeficiency Virus
What are the different types of HIV?
- HIV-1 (more common)
- HIV-2
- AIDS (later stages)
What is the aetiology of HIV?
- retrovirus
- predominantly affects CD4 cells (helper T lymphocytes) -> they do cell immunity
- produces a reverse transcriptase (transcribes its own RNA into DNA that incorporates into DNA of host cell
- opportunistic infections take over (fungal, parasitic, tumours)
What is the incubation period of HIV?
8-10yrs
<30% develop AIDS within 5yrs
What is the transmission and spread of HIV?
Infected individual spreads it by blood and body fluids (semen, cervical and vagina secretions, synovial fluid)
What individuals are at high risk of developing HIV?
- receiving blood transfusion or products prior to 1985
- male to male sex
- IV drug users
- sex with high risk individual
- multiple partners without protection
- females are at higher risk than males
- child born to HIV mother
- some with STIs
What are the clinical features of HIV seroconversion?
- fever, lethargy
- rash
- pharyngitis
- headaches
- arthralgia, myalgia
- anorexia
- DDx with flue and infectious mono
What are the clinical features of AIDS?
- Respiratory (interstitial lung disease, opportunistic, non-hodgkin’s)
- Digestive (sjogren’s, gastroenteritis, candida, lymphoma, herpes simples)
- Nervous (demyelinating, polymyositis, Bell’s palsy, dementia, TIAs, neuropathies)
- Haematopoeitic (thrombocytopenia, lymphoma, lymphadenopathy)
- Eye (vasculitis, inflammation, sarcoma)
- Skin (tinea, impetigo, warts, pityriasis)
- MSK (arthralgia, arthritis, vasculitis, lupus-like)
What are common causes of headaches?
- tension/stress
- muscle spasms
- migraine
- sinusitis
- dehydration
- eye, ear, nose infections
- viral infections
- compression or inflammation of cervical spinal nerves
- cervical spine disorders
- general systemic illnesses and infections
- TMJ disorder
What are less common causes of headaches?
- hormonal changes (PMS, menstrual, perimenopausal)
- meningitis
- expanding lesions (tumour, abscess)
- subdural or extradural haematoma
- cluster headaches
- giant cell arteritis
- head injury
- post-traumatic
- psychogenic
- skull changes (Paget’s, mets)
- electrolyte disturbances
- heat stroke/exhaustion
What are the causes of a distended abdomen?
- fat
- flatus/faeces
- fulminating neoplasm
- fluid
- foetus
What are the mechanisms behind a bleeding tendency?
- low platelets
- low coagulating factors
- defective vessel wall
What are the causes of jaundice?
Pre-hepatic:
• destruction of RBCs (haemolytic, pernicious anaemia)
Hepatic:
• bilirubin uptake, conjugation or transport to bile issue (hepatitis, drugs, cirrhosis)
Post-hepatic:
• obstruction of bilirubin excretion of biliary canaliculi (gall stone, bile duct carcinoma, head of pancreas carcinoma, gall bladder carcinoma)
What is shifting dullness in the abdomen?
- indication that there is fluid causing the distension
* ascites
What is the DDx of a 52yr old man with 6/12Hx of abdominal distension and shifting dullness , lassitude? Heavy smoker, high alcohol intake, bruises? No hepatomegaly, splenomegaly, spider naevi, gynaecomastia.
What investigations would you do?
- Chronic liver failure from alcoholism
- bronchus carcinoma mets to the liver
- chest x-ray
- liver function test
- platelet, bilirubin, clotting factor count
What is the pathophysiology of a bleeding tendency in liver disease?
decreased vitamin storage capacity in the liver
What is the pathophysiology of melena in liver disease?
portal venous hypertension -> oesophageal varices -> ruptures
What is the cause, findings on full blood count in a patient with: fatigue, dyspnoea, headaches, light headed, glossitis, GIT discomforts, anorexia, sensory changes?
- pernicious anaemia -> B12 deficiency
- macrocytic
- confirm with endoscop
What is the cause, findings on full blood count in a patient with: fatigue, dyspnoea, light headed, splenomegaly, slight jaundice?
- haemolytic anaemia
- abnormal shape RBCs
- few RBCs
What is the cause, findings on full blood count in a patient with: fatigue, palpitations, dyspnoea, recurrent infections, pallor, bruising?
- aplastic anaemia (leukemia, lymphoma)
- normal RBCs but few
• confirm with bone marrow biopsy
What is the cause, findings on full blood count in a patient with: fatigue, palpitations, dyspnoea, recent duodenal ulcer?
- iron deficiency anaemia
* microcytic and hypochromic
What are the causes of fainting?
- low O2
- low glucose
- low water
- low BP
- alcohol and drugs
- stroke
- seizures
Compare Hodgkins to Non-hodgkins lymphoma
Hodgkins: • young adults with Hx of infectious mono • reed steinburg cell • arise in lymph node • orderly progression
Non-hodgkins: • from T cells and B cells • arise in nodes or extra-nodal • unpredictable proliferation • middle age and elderly • poor prognosis
What is the DDx of a 20yr old male with unilateral enlarged lobulated non-tender cervical lymph nodes, 3/12 Hx of fatigue, fever, night sweats, weight loss and pruritus?
- Hodgkins lymphoma (#1 until proven otherwise)
- Non-hodgkins
- leukemia
- TB
What is the DDx of a 52yr old female with fatigue, loss of mental agility, constipation and feeling constantly cold? What investigations would you do?
- hypothyroidism
- menopause
- depression
- thyroid and pituitary function
- female repro exam
- screen for depression
- fasting glucose and lipids
What are the causes of hypothyroidism?
- Hashimotos disease (autoimmune)
- iodine deficiency
- under medication of hypothyroidism
- TSH pituitary problem
Why don’t we give aspirin to kids < 13 yrs?
- they develop idiopathic thrombocytopenic purpura
* acute onset of petechiae and purport in large areas of the body
What is the DDx of a 7yr old with acute onset of petechiae and purpura over large areas of body?
- recently given aspirin
- trauma
- acute lymphocytic leukemia
- acute meningitis
- child abuse
What is the DDx of a 13 yr old with low Hb, extremely high WCC, slight elevation of neutrophils, many blast cells, very low platelets?
- all blood elements effected
* it is leukemia
What are the clinical features of leukemia? how do you investigate?
• bone pain, unplanned weight loss, night sweats
Overcrowding:
• bleeding tendency, anaemia
• increased incidence of infections
lymph node biopsy, bone marrow biopsy
