presentations

Question 1

causes of hepatosplenomegaly

Answer 1

hepatic: cirrhosis with portal hypertension

Haematological: myeloproliferative, CML, lymphoma, leukaemia

Infection: viral hepatitis, malaria

Infiltrative: sarcoid, amyloid

Question 2

epigastric pain and vomitiing

Answer 2

GI:
pancreatitis
dudoenal perf
cholangitis/cholecystisis

Cardiac/vascular:
MI
ruptured AAA

Other:
DKA

Question 3

Resp clubbing

Answer 3

lung cancer
fibrosis
Suppurative: CF, bronchiectasis, empyema

Question 4

Cardiac Clubbing

Answer 4

CIA

Congenital cyanotic heart disease
Infective endocarditis
Atrial myxoma

Question 5

GI Clubbing

Answer 5

IBD
Cirrhosis

Question 6

Endocrine Clubbing

Answer 6

Thyrotoxicosis

Question 7

conductive hearing loss

Answer 7

infection: otitis media
Degenerative: otosclerosis, ruptures tympanic membrane
obstructive: wax/ foreign body

Question 8

old age forgetful

Answer 8

dementias:
alzheimers (memory, dressing, word finding)
parkinsons: movements,tremors, less emotional face
VAscular: sudden step and RF
lewy body: hallucinations/sleep disturbances
depression: mood
neurology: encephalitis, meningitis, SOL

Organic:
hypothyoid
infections (infection screen)
B12 deficiency
HIV/AIDS/siphylis (blood tests probably)

Question 9

crackles

Answer 9

inspiratory and expiratory think airway disaese or infection
bronchiectasis
CF
pneumonia

Inspiratory only especailly end ispiratory
fibrosis
oedema

Question 10

sensorineural hearing loss

Answer 10

Congenital:
-Infective: toxoplasmosis/CMV
-genetic: alports, Osteogenesis imperfecta

Acquired:
-sudden sensorineural hearing loss (often no known cause)
-degenerative: presbyacusis, occupational
-neoplastic: acoustic neuroma

-Degenerative: presbacyusis

Question 11

you see a stoma

Answer 11

Look at the contents

hands around and ask them to cough to check for hernia

spouted = ileostomy as contents are irritating to the skin. Liquid stool = liquid stool , ileal conduit = spouted with urine

flush = solid stool = colostomy

Question 12

Loop vs end colostomy

Answer 12

loop is normally to protect a distal anastamosis

joined side to side in the abdomen with the ends closed off

Question 13

Answer 13

ileal conduit

Question 14

causes of hepatomegaly

Answer 14

Common are the 3 Cs

precirrhotic: hepatitis (alcohol, NALFD, Viral, AI)
Cardiac: (RHF/Tricuspid regurg)
Cancer: (craggy, bruit, ascites)

storage/Infiltrative

Question 15

Causes of splenomegaly

Answer 15

Massive: CML, myelofibrosis, leishmaniasis, malaria

Large: hepato-splemegaly, myeloproliferative disorders

Mild: Infective endocarditis, amyloidosis

Question 16

large kidney

Answer 16

bilateral: ADPKD, distal obstruction (hydronephrosis)

unilateral: pyelo, hydronephrosis from ureteric obstruction, liver cyst, renal cancer, other kidney failed

Question 17

Ataxia

Answer 17

Cerebellar:
strokes
SOL
MS
wernicke’s
GBS Miller Fischer varient

Peripheral:
Diabetes
B12 deficiency
alcohol

If ascending motor weakness as well CIDP/GBS

Question 18

tremor

Answer 18

parkinsons: resting, worse with distraction

benign: worse with use

metabolic: hyperthyroid, phaoechromocytoma, hypocalcaemia

Anxiety

Question 19

tone

Answer 19

high:
pyramidal (UMN): hypertonia, clasp knife rigidity, spasticity (usually uni directional)

extrapyrimadal (basal ganglia): lead pipe rigidity, cogwheel if parkinsons

Question 20

stoma

Answer 20

Site
spout
skin
contents
hernia