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Diagnostic Sciences > Non-specific features > Flashcards

Non-specific features Flashcards

1
Q

What are the causes of pruritus?

A
  • 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
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2
Q

What are the causes of short lasting fever?

A
  • viral, bacterial infection

* infarction

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3
Q

What are the causes of long lasting fever?

A
  • fungal, bacterial, viral infection, parasitic infection
  • neoplasms
  • connective tissue disease
  • drugs
  • metabolic and inherited diseases
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4
Q

What are the main categories of causes of menorrhagia?

A

1) Uterine origin
2) Endocrine disturbances
3) Other

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5
Q

What are the uterine causes of menorrhagia?

A
  • functional
  • uterine fibroids
  • endometrial polyps
  • endometrial hyperplasia
  • endometriosis
  • adenomyosis
  • IUDs
  • malpositions of uterus: retroversion, retroflexion
  • cervix uteri: erosions, polyps
  • acute/chronic endometritis
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6
Q

What are the endocrine causes of menorrhagia?

A
  • pituitary
  • thyroid (hypothyroidism)
  • ovarian
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7
Q

What are the other causes of menorrhagia (other than uterine and endocrine)?

A
  • drugs
  • hypertension
  • diabetes mellitus
  • blood dyscrasias
  • chronic nephritis
  • vit A deficiency
  • chronic pelvic inflam.
  • acute systemic infections/disorders
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8
Q

Compare fatigue vs weakness?

A

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

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9
Q

What is the pathophysiology of fatigue?

A

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

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10
Q

What is the pathophysiology of weakness?

A

Reduction in ability of cells (especially muscles) to produce ATP for energy production

Cells require:
• nutrients
• blood supply
• oxygen
• hormonal stimulation
• electrolytes
• neural stimulation
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11
Q

What are the causes of hepatomegaly?

A
  • Vascular congestion (congestive cardiac failure)
  • Biliary duct obstruction
  • Infiltrative
  • Inflammatory and infective
  • Cirrhosis (early)
  • Tumours (hepatoma, haemangioma, mets from bowl)
  • Cysts
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12
Q

What are the infiltrative causes of hepatomegaly?

A
  • bone marrow (leukaemia, lymphoma)
  • fat (alcohol fatty liver)
  • glycogen storage disease)
  • amyloid
  • iron (haemochromatosis)
  • granuloma (TB, sarcoidosis)
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13
Q

What are the infiltrative and infective causes of hepatomegaly?

A
  • hepatitis
  • mono, cytomegalovirus, typhoid fever, liver abscess, bartonella
  • Crohn’s
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14
Q

What are the causes of localized lymphadenopathy?

A
  • 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
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15
Q

What are the causes of generalised lymphadenopathy?

A
  • infections (mono, toxoplasmosis, cytomegalovirus, septicaemia)
  • lymphoma
  • lymphatic leukemias
  • connective tissue diseases
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16
Q

What are the causes of splenomegaly?

A
  • Infections
  • Blood disorders in which there are more red blood cells to be phagocytosed
  • Venous Congestion
  • Infiltrations
  • Miscellaneous
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17
Q

What are the infectious causes of splenomegaly?

A
  • either acute, sub-acute or chronic eg
  • infectious mononucleosis
  • malaria
  • TB
  • brucellosis
  • septicaemia
  • schistosomiasis
  • hydatid cysts
  • abscess
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18
Q

What are the phagocytosing causes of splenomegaly?

A
  • haemolytic anaemia

* polycythaemia vera

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19
Q

What are the venous congestion causes of splenomegaly?

A
  • portal hypertension
  • portal vein or splenic vein obstruction
  • right heart failure
  • congestive heart failure
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20
Q

What are the infiltrative causes of splenomegaly?

A

Storage diseases
• Gaucher’s disease

Neoplastic cells
• leukemias
• malignant lymphomas
• myelofibrosis

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21
Q

What is the temperature for fever?

A

> 37oC

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22
Q

What is the pathophysiology of fever?

A

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

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23
Q

What are heat cramps?

A
  • 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
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24
Q

What is heat syncope?

A
  • sudden loss of consciousness
  • due to cutaneous vasodilation and drop in BP
  • weak pulse, skin cool and moist
  • rest horizontal in cool with fluids
25
Q

What is heat exhaustion?

A
  • 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
26
Q

What is heatstroke?

A
  • 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)
27
Q

What is drug fever?

A
  • illicit drugs
  • fever after administration of drug and dissipating after it ceases
  • treat by stoping drug
28
Q

What is malignant hyperthermia?

A
  • 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
29
Q

What is hypothermia?

A
  • 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
30
Q

What does HIV stand for?

A

Human Immunodeficiency Virus

31
Q

What are the different types of HIV?

A
  • HIV-1 (more common)
  • HIV-2
  • AIDS (later stages)
32
Q

What is the aetiology of HIV?

A
  • 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)
33
Q

What is the incubation period of HIV?

A

8-10yrs

<30% develop AIDS within 5yrs

34
Q

What is the transmission and spread of HIV?

A

Infected individual spreads it by blood and body fluids (semen, cervical and vagina secretions, synovial fluid)

35
Q

What individuals are at high risk of developing HIV?

A
  • 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
36
Q

What are the clinical features of HIV seroconversion?

A
  • fever, lethargy
  • rash
  • pharyngitis
  • headaches
  • arthralgia, myalgia
  • anorexia
  • DDx with flue and infectious mono
37
Q

What are the clinical features of AIDS?

A
  • 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)
38
Q

What are common causes of headaches?

A
  • 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
39
Q

What are less common causes of headaches?

A
  • 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
40
Q

What are the causes of a distended abdomen?

A
  • fat
  • flatus/faeces
  • fulminating neoplasm
  • fluid
  • foetus
41
Q

What are the mechanisms behind a bleeding tendency?

A
  • low platelets
  • low coagulating factors
  • defective vessel wall
42
Q

What are the causes of jaundice?

A

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)

43
Q

What is shifting dullness in the abdomen?

A
  • indication that there is fluid causing the distension

* ascites

44
Q

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?

A
  • Chronic liver failure from alcoholism
  • bronchus carcinoma mets to the liver
  • chest x-ray
  • liver function test
  • platelet, bilirubin, clotting factor count
45
Q

What is the pathophysiology of a bleeding tendency in liver disease?

A

decreased vitamin storage capacity in the liver

46
Q

What is the pathophysiology of melena in liver disease?

A

portal venous hypertension -> oesophageal varices -> ruptures

47
Q

What is the cause, findings on full blood count in a patient with: fatigue, dyspnoea, headaches, light headed, glossitis, GIT discomforts, anorexia, sensory changes?

A
  • pernicious anaemia -> B12 deficiency
  • macrocytic
  • confirm with endoscop
48
Q

What is the cause, findings on full blood count in a patient with: fatigue, dyspnoea, light headed, splenomegaly, slight jaundice?

A
  • haemolytic anaemia
  • abnormal shape RBCs
  • few RBCs
49
Q

What is the cause, findings on full blood count in a patient with: fatigue, palpitations, dyspnoea, recurrent infections, pallor, bruising?

A
  • aplastic anaemia (leukemia, lymphoma)
  • normal RBCs but few

• confirm with bone marrow biopsy

50
Q

What is the cause, findings on full blood count in a patient with: fatigue, palpitations, dyspnoea, recent duodenal ulcer?

A
  • iron deficiency anaemia

* microcytic and hypochromic

51
Q

What are the causes of fainting?

A
  • low O2
  • low glucose
  • low water
  • low BP
  • alcohol and drugs
  • stroke
  • seizures
52
Q

Compare Hodgkins to Non-hodgkins lymphoma

A 
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
53
Q

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?

A
  • Hodgkins lymphoma (#1 until proven otherwise)
  • Non-hodgkins
  • leukemia
  • TB
54
Q

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?

A
  • hypothyroidism
  • menopause
  • depression
  • thyroid and pituitary function
  • female repro exam
  • screen for depression
  • fasting glucose and lipids
55
Q

What are the causes of hypothyroidism?

A
  • Hashimotos disease (autoimmune)
  • iodine deficiency
  • under medication of hypothyroidism
  • TSH pituitary problem
56
Q

Why don’t we give aspirin to kids < 13 yrs?

A
  • they develop idiopathic thrombocytopenic purpura

* acute onset of petechiae and purport in large areas of the body

57
Q

What is the DDx of a 7yr old with acute onset of petechiae and purpura over large areas of body?

A
  • recently given aspirin
  • trauma
  • acute lymphocytic leukemia
  • acute meningitis
  • child abuse
58
Q

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?

A
  • all blood elements effected

* it is leukemia

59
Q

What are the clinical features of leukemia? how do you investigate?

A

• bone pain, unplanned weight loss, night sweats

Overcrowding:
• bleeding tendency, anaemia

• increased incidence of infections

lymph node biopsy, bone marrow biopsy

Diagnostic Sciences (7 decks)

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