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Practical Internal Medicine > Revision cards > Flashcards

Revision cards Flashcards

1
Q

Causes of chest pain:

A
  1. MI
  2. Angina
  3. Pulmonary embolism/ infraction
  4. Malignancy
  5. Osteoarthritis
  6. Herpes zoster
  7. Aortic dissection/ aneurysm
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2
Q

Causes of melena:

A

1.Esophagusitis
2.Peptic ulcer
3.Gastric erosion
4.Gastric tumor
5.Vascular malformation

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3
Q

Causes of disturbance Consciousness:

A

1.Hepatic & renal failure
2.Hypothyroidism
3.Hyper & Hypo ( Mg , Na , K )
4.Hyper & hypothermia
5.Severe metabolic/ respiratory ( acidosis or alkalosis)

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4
Q

Causes of SOB ( dyspnea):

A

1.Acute Pulmonary edema **
2.COPD**
3.Pulmonary embolism
4.Diabetic ketoacidosis
5.Uremia
6. chronic HF
7.Myocardial ischemia
8.Sever anemia
9.Obesity

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5
Q

Causes of cough:

A
  1. Post-nasal drip
  2. Any inflammation in airways
  3. COPD
  4. TB
  5. Pulmonary edema
  6. Interstitial fibrosis
  7. Carcinoma
  8. Asthma
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6
Q

Causes of hemoptysis:

A

1.Acute bronchitis
2.Bronchial carcinoma
3.TB
4.Lung abscess
5.Truma
6.Pulmonary infraction
7.Acute LHF
8.Mitral stenosis & aortic
aneurysm
9.Leukemia & anticoagulation

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7
Q

Causes of vomiting :

A

1.Hepatitis
2.UTI
3.Antibiotics & NSAID
4.Diabetic ketoacidosis
5.Migraine
6.Appendicitis
7.Anorexia nervosa

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8
Q

Causes of diarrhea:

A

1.Cholera
2.Giardiasis
3.Shegella
4.Staph. aureus
5.E.coli
6.Bacillus cereus
7.Amebiasis( E.hystolytica)

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9
Q

Causes of abdominal pain:

A

1.Appendicitis
2.Cholecystitis
3.Pancreatictis
4.Peptic ulcer
5.Ovarian cyst
6.Aortic aneurysm
7.Hepatitis
8.Informatry bowel disease

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10
Q

Causes of dysphagia:

A

1.Lower esophageal rings
2.Peptic structure
3.Carcinoma
4.Esophageal spasms
5.Progressive Systemic
sclerosis
6.achalasia
7.Tonsillitis

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11
Q

causes of leg edema:

A

1.heart failure
2.Chronic venous disease
3.Prolonged standing
sitting
4. obesity
5. pregnancy
6. dvt

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12
Q

causes of pitting edema:

A

1.Heart valve problem
2.Low protein levels Lung
disease
3.CHF
4.Liver disease Kidney disease
5.DVT

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13
Q

Obvious weight loss even when food intake has increased is seen in

A
  1. thyrotoxicosis,
  2. diabetes mellitus,
  3. lymphoma,
  4. malabsorption.
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14
Q

Wasting may be associated with:

A

chronic alcohol abuse,
HIV infection,
malignancy,
anorexia nervosa

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15
Q

Dyspnoea

A

(shortness of breath) is an undue awareness of breathing.

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16
Q

Abnormal increased inspiratory movement indicates what? and it’s evident by:

A

it indicates Dyspnea or breathlessness.
-Dilation of alae nasi.
-Indrawing of suprasternal fossa, supraclavicular fossae, and intercostals spaces due to the use of accessory muscles

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17
Q

The use of accessory muscles is characteristic of patients with _________ and __________

A

chronic obstructive pulmonary disease (COPD) and severe acute asthma.

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18
Q

Abnormal increased expiratory movement evident by

A

-The patients assume upright or sitting position grasping a bed table or the back of the chair (Tripod position
-The patients exhale through their mouth with pursed lip and this is called (pursed lip breathing).

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19
Q

Tachypnea

A

is an increase in respiratory rate.

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20
Q

T/F?
When there is dyspnea, there is tachypnea.

A

TRUE

اذا هو مختنق اكيد يزيّد نفسه
بس مو شرط اذا يتنفس سريع معناها مختنق

D doesn’t come without T

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21
Q

T/F?
When there is tachypnea, there is dyspnea.

A

FALSE

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22
Q

Flexed hand and arm occurs in:

A

hemiplegics

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23
Q

claw hand occurs in

A

ulnar nerve palsy

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24
Q

whats the most common cause of hand deformity

A

Trauma

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25
Q

long thin fingers are seen in

A

Marfan’s syndrome (arachnodactyly)

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26
Q

Patients with Marfan’s syndrome may be recognized by

A

hands with arachnodactyly
tall stature,
dislocated lenses
a high-arched palate.

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27
Q

A brownish stain on the fingers and nails is seen in _________. It is caused by ______

A

-cigarette smokers
-it’s caused by TAR

(not nicotine)

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28
Q

bluish discoloration of the ends of the fingers indicates

A

cyanosis

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29
Q

white color in digits suggests

A

Raynaud’s phenomenon.

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30
Q

in __________, there is overgrowth of the facial skeleton, coarsening of features and an increase in soft tissue size

A

acromegaly

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31
Q

features of acromegaly

A

-overgrowth of the facial skeleton,
-coarsening of features
-an increase in soft tissue size

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32
Q

why might some patients have warm hands? what are some of the causes?

A

due to peripheral vasodilatation

eg
-fever,
-acute exacerbation of COPD,
-thyrotoxicosis.

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33
Q

why might some patients have cold hands? what are some of the causes?

A

due to peripheral vasoconstriction

e.g.
-ischemia,
-hypotension,
-vasospasm (Raynaud’s phenomenon).

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34
Q

define Koilonychia

A

soft, thin, easily broken (brittle) and spoon– shaped (concave) nail that may occur in iron deficiency anemia, lichen planus, hemochromatosis, and repeated detergent exposure.

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35
Q

causes of koilonychia

A

-iron deficiency anemia,
-lichen planus,
-hemochromatosis,
-repeated detergent exposure.
(idiopathic or congenital)

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36
Q

Koilonychia is divided into two stages: Some clinicians use the water-drop test to confirm such an abnormality

A

Stage I: flattening of the nail plates.

Stage II: the edges became everted upward and the nail appears concave giving to the term spoon shaped nails.

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37
Q

how to confirm koilonychia?

A

Some clinicians use the water-drop test

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38
Q

define Leukonychia

A

Whitening of the nail that presents as total whitening due to chronic liver disease and hypoalbuminemia.

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39
Q

cause of Leukonychia

A

chronic liver disease and hypoalbuminemia

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40
Q

causes of finger pitting

A

Psoriasis,
alopecia areata,
eczema and
fungal infection

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41
Q

define Splinter hemorrhages

A

Linear hemorrhages in the nail occur due to trauma (most common cause), vasculitis, rheumatoid arthritis, infective endocarditis and psoriasis.

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42
Q

causes of Splinter hemorrhages

A

-trauma (most common),
-vasculitis,
-rheumatoid arthritis,
-infective endocarditis
-psoriasis.

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43
Q

define Onycholysis

A

Separation of the nail plate from the nail bed which occurs in trauma, psoriasis, and thyroid diseases.

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44
Q

Onycholysis

A

-trauma,
-psoriasis, and
-thyroid diseases.

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45
Q

Yellow nails are seen in

A

yellow nail syndrome which is a triad of slowly growing yellow nails, pleural effusion, and bronchiectasis.

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46
Q

Red half moons in the nails suggest…?

A

Red lunulae due to congestive heart failure

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47
Q

Blue half moons of the nails suggest….?

A

chronic cyanotic state
e.g. Eisenmenger’s syndrome.

clubbing هذول نلكة عدهم هم

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48
Q

Dark blue nail lunulae are sometimes found in….?

A

-Wilson’s disease (excess copper)
-hemochromatosis (excess iron)
-in patients on antimalarial drugs or minocycline.

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49
Q

Half-and-half nails (white proximally and red-brown distally) are seen in

A

uremia (CKD) and normally due to aging.

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50
Q

define Digital clubbing

A

it is a deformity of the finger or toe nails characterized by a focal bulbous enlargement of the terminal segments of the fingers and/or toes due to proliferation of connective tissue between nail matrix and the distal phalanx. There is also increased sponginess of the soft tissue at the base of the nail.

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51
Q

Causes of Clubbing

A

*Respiratory
Primary and metastatic carcinoma
Intrathoracic suppuration
Bronchiectasis
Empyema
Lung abscess
Idiopathic pulmonary fibrosis (cryptogenic fibrosing alveolitis)
Asbestosis

*Cardiovascular
Cyanotic congenital heart disease
Bacterial endocarditis

*Alimentary
Hepatic cirrhosis
Ulcerative colitis
Crohn’s disease
Coeliac disease
Other

*Familial clubbing
Occupational (e.g., jackhammer operators)

52
Q

Clinical stages of finger clubbing are:

A

**Stage I **
In this stage the angle between the nail bed and adjacent skin of the finger (nail bed angle) is obliterated.
(Schamroth’s window test)

Stage II
In this stage the nail loses its longitudinal ridges and becomes convex from above down ward as well as from side to side

**Stage III **
In this stage there is a fluctuation of the nail bed. (A spongy feel)

Stage IV
In this stage the terminal segment of the finger becomes like the end of a drum stick

53
Q

Palmar creases are pale in anemia, where the hemoglobin level is usually ______

A

<7 g/dL

54
Q

Palmar erythema is a characteristic bright red eminences and pulps of the finger that occur in ________

A

pregnancy,
thyrotoxicosis,
hepatic failure,
may be idiopathic.

55
Q

causes of excessive SWEATING of the hands

A

idiopathic
psychogenic
thyrotoxicosis.

56
Q

what are the types of hand tremor?

A
  1. Postural tremor
    a. fine tremor
    b. coarse tremor
  2. Flapping tremor (asterixis)
57
Q

what are the causes of Postural tremor (fine/coarse)

A
  • Anxiety.
  • Drugs e.g. ß-agonists (salbutamol), theophylline, and tricyclic antidepressants.
  • Excessive tea or coffee drinking.
  • Endocrine e.g. thyrotoxicosis, pheochromocytoma, and hypoglycemia.
58
Q

causes of Flapping tremor (asterixis).

A

*Organ failure
e.g. respiratory, cardiac, or renal.

*Metabolic disturbances e.g.
hypoglycemia,
hypokalemia,
hypomagnesemia.

*Drugs e.g.
antiepileptic (barbiturates, sodium
valproate, phenytoin, or carbamazepine), and
metoclopramide.

***CNS **e.g.
intracerebral hemorrhage, subdural
hematoma, subarachnoid hemorrhage, or cerebral
ischemia.

من الملاحظات:
hepatic and urimic encephalopathy,
type 2 resp. failure

59
Q

Cyanosis

A

a bluish discoloration of the skin and mucous membrane resulting from an increased quantity of** reduced hemoglobin** or of hemoglobin derivatives in the small blood vessels of those areas.

60
Q

at what level does cyanosis become apparent?

A

it becomes apparent when the concentration of reduced hemoglobin in capillary blood exceeds 5 g/dl.

انتبهوا على الرديوسد ءخوان

61
Q

what are the causes of central cyanosis

A
  1. Cyanotic congenital heart disease
  2. Respiratory failure
  3. Heart failure
  4. Abnormal hemoglobin derivatives e.g. methemoglobin and sulfhemoglobin
62
Q

where can central cyanosis be seen clinically

A

it may be found in the mucous membranes and skin

63
Q

central cyanosis is usually associated with

A

-Hot extremities
-Clubbing of finger may be present

64
Q

T/F?
Peripheral cyanosis can be seen in the mucus membranes and skin

A

FALSE
PERIPHERAL CYANOSIS can be found in the SKIN only

65
Q

T/F?
Peripheral cyanosis is associated with cold extremities

A

TRUE

بريفرل = بارد
سنترل = حار

66
Q

T/F?
peripheral cyanosis is associated with clubbing of the fingers

A

FALSE

متصير بس بالسنترل

67
Q

peripheral cyanosis results from _______

A
  1. Exposure to cold
  2. Heart failure
  3. Arterial obstruction
  4. Venous obstruction
68
Q

Cold, sweaty hands may indicate

A

Anxiety

69
Q

Cold, dry hands may indicate

A

Raynaud’s phenomenon

70
Q

Hot, sweaty hands may indicate

A

Hyperthyroidism

71
Q

Large, fleshy, sweaty hands may indicate

A

Acromegaly

72
Q

Dry, coarse skin may indicate

A

Regular water exposure,
Manual occupation,
Hypothyroidism

73
Q

Delayed relaxation of grip may indicate

A

Myotonic dystrophy

74
Q

Deformed hands/fingers may indicate

A

Trauma,
Rheumatoid arthritis,
Dupuytren’s contracture

75
Q

normal pulse rate =

A

60-100 Beat/Min

76
Q

normal levels of blood pressure

A

systolic <130
diastolic <85

77
Q

normal Respiratory Rate

A

12–15 breaths per minute

12 - 20 بمحاضرة د. ياسين هيج بس هي غالبا

78
Q

O2 Saturation

A

> 98%

عند 92% يلا اخلي اوكسجن ماسك

79
Q

Apathy, with poverty of expression and poor eye contact may indicate

A

Depression

80
Q

Apathy, with pale and puffy skin may indicate

A

Hypothyroidism

81
Q

Agitated expression

A

Anxiety, hyperthyroidism, hypomania

82
Q

what’s xanthelasma

A

it is a harmless yellow bump on or near your eyelid skin. (cholesterol deposit)

83
Q

causes of xanthelasma

A

Hyperlipidemia

84
Q

causes of Conjunctival Hemorrhage

A

Infective Endocarditis

يحبها د. ياسين

85
Q

butterfly shaped redness on the skin of the cheeks indicates

A

Systemic lupus erythematosus SLE

86
Q

causes of Peri-Orbital Edema

A

poor sleep,
poor diet
allergies
renal impairment

87
Q

radial puckering
(furrows) around the mouth may indicate

A

systemic sclerosis

88
Q

plethoric appearance (facial swelling and puffiness / moon face) may indicate

A

Cushing’s syndrome

89
Q

whats Telangiectasia

A

minute capillary tortuosities, may be seen on the face in liver disease or in hereditary disorders

90
Q

what is Spider Telangiectasia

A

they’re small cutaneous arteriovenous anastomoses that blanch when pressure is exerted on the central point of the vascular complex

91
Q

Smooth red tongue (Glossitis) indicates

A

iron deficiency

92
Q

angular stomatitis indicates

A

iron deficiency

93
Q

The sternal angle is approximately ____ cm above the right atrium, so
the JVP in health should be _____ cm above this angle when the patient lies at _____ degrees

A

The sternal angle is approximately 5 cm above the right atrium, so
the JVP in health should be ≤4 cm above this angle when the patient lies at 45 degree

94
Q

where can we palpate the pulse in the foot?

A
  1. Posterior Tibial Artery:
    At The Ankle Just
    Posterior And Inferior To The Medial Malleolus
  2. Dorsalis Pedis:
    at The Superior Surface Of The Foot Between The Bases Of The First And Second Metatarsals
95
Q

causes of Transverse grooves on nails

A

it occurs as a sequela of any severe systemic illness that affects growth of the nail matrix

96
Q

Capillary Refill

A

< 2 sec

97
Q

Nail-fold infarctions may be signs of

A

a vasculitic process

98
Q

_____________’s angle refers to the angulation between the nail plate and the skin below the nail

A

Lovibond’s

99
Q

Lovibond’s angle

A

Normally it is less than 180°.
When clubbing is present, the angle is at least 180°, or more.

100
Q

Causes of elevated JVP

A

1) Heart failure.
2) High right ventricular filling pressures; such as:
1. pulmonary embolism,
2. chronic pulmonary hypertension,
3. Cardiac tamponade
4. Pericardial constriction
5. Mechanical obstruction of the superior vena cava (most often caused by lung cancer) may cause extreme, non pulsatile elevation of the JVP.

101
Q

اشياء ذكرها د ياسين بالسشن مهمة

Signs of Iron deficiency anemia

A

-conjunctival pallor
-palmer pallor
-koilonychia
-angular stomatitis/cheillosis
-glossitis

102
Q

اشياء ذكرها د ياسين بالسشن مهمة

Signs of infective endocarditis

A

-conjunctival haemorrhage
-clubbing fingers
-osler’s nodes
-splinter haemorrhage

103
Q

Irregular pulse indicates

A

Extrasystole beats

104
Q

Regularly irregular pulse indicates

A

Sinus arrhythmia

105
Q

Irregularly irregular pulse indicates

A

Atrial fibrillation

106
Q

define

Melena

A

black tarry feces

107
Q

melena is associated with ______

A

upper gastrointestinal bleeding
causes :

Upper GIT tract bleeding
Peptic ulcer disease

Features:
Black tarry stool
Offensive smell
Difficult flush away

108
Q

Clot of blood in stool is a sign of

A

bleeding from colon
may be causes of :
1. cancer
2. Diverticular bleeding
3. Infection cloitis
4. Inflammatory bowel disease

109
Q

causes of bloody cough

A

TB infection
Bronchitis
Bronchiectasis

110
Q

causes of fine tremor:

A

A-dialysis
B-sympathetic overactivity
C-thyrotoxicosis

111
Q

causes of flapping tremor:

A

A-hepatic encephalopathy
B-urimic encephalopathy
C-type 2 Respiratory failure

112
Q

define

Purpura

A

purple-colored spots and patches that occur on the skin, and in mucus membranes

من التسليكات

113
Q

causes of purpura

A

Caused when small blood vessels leak blood under your skin’s surface.

من التسليكات

114
Q

define

Ecchymosis

A

dark purple spot forms on skin when blood leaks out of blood vessels into the top layer of skin.

من التسليكات

115
Q

define

Hematoma

A

a bad bruise. It happens when an injury causes blood to collect and pool under the skin.

من التسليكات

116
Q

Spider nevi

A

isa collection of small, dilated arterioles (blood vessels) clustered very close to the surface of the skin.

من التسليكات

117
Q

palmer erythmya

A

skin condition that makes the palms of hands turn red.
Caused by liver diseases, such as liver cirrhosis, hemochromatosis, and Wilson disease.

من التسليكات

118
Q

Tongue fissure

A

iron defficiency anemia

من التسليكات

119
Q

Geographic tongue

A

Vit B2 defficiency

120
Q

Dehydrated tongue:

A

if the tongue is dry and rough, in shock patients

121
Q

furred tongue

A

tongue appear with white coating especialy in smokers

122
Q

trush

A

بياض او تقرح بسقف الحلگ او باللسان

123
Q

Cyanosis + Clubbing =

A

cyanotic CHD & Pulmonary AV shunt

124
Q

Cyanosis without Clubbing

A

=infective endocarditis or Ulcerative colitis

125
Q
A

Practical Internal Medicine (1 decks)

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