Revision cards Flashcards
Causes of chest pain:
- MI
- Angina
- Pulmonary embolism/ infraction
- Malignancy
- Osteoarthritis
- Herpes zoster
- Aortic dissection/ aneurysm
Causes of melena:
1.Esophagusitis
2.Peptic ulcer
3.Gastric erosion
4.Gastric tumor
5.Vascular malformation
Causes of disturbance Consciousness:
1.Hepatic & renal failure
2.Hypothyroidism
3.Hyper & Hypo ( Mg , Na , K )
4.Hyper & hypothermia
5.Severe metabolic/ respiratory ( acidosis or alkalosis)
Causes of SOB ( dyspnea):
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
Causes of cough:
- Post-nasal drip
- Any inflammation in airways
- COPD
- TB
- Pulmonary edema
- Interstitial fibrosis
- Carcinoma
- Asthma
Causes of hemoptysis:
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
Causes of vomiting :
1.Hepatitis
2.UTI
3.Antibiotics & NSAID
4.Diabetic ketoacidosis
5.Migraine
6.Appendicitis
7.Anorexia nervosa
Causes of diarrhea:
1.Cholera
2.Giardiasis
3.Shegella
4.Staph. aureus
5.E.coli
6.Bacillus cereus
7.Amebiasis( E.hystolytica)
Causes of abdominal pain:
1.Appendicitis
2.Cholecystitis
3.Pancreatictis
4.Peptic ulcer
5.Ovarian cyst
6.Aortic aneurysm
7.Hepatitis
8.Informatry bowel disease
Causes of dysphagia:
1.Lower esophageal rings
2.Peptic structure
3.Carcinoma
4.Esophageal spasms
5.Progressive Systemic
sclerosis
6.achalasia
7.Tonsillitis
causes of leg edema:
1.heart failure
2.Chronic venous disease
3.Prolonged standing
sitting
4. obesity
5. pregnancy
6. dvt
causes of pitting edema:
1.Heart valve problem
2.Low protein levels Lung
disease
3.CHF
4.Liver disease Kidney disease
5.DVT
Obvious weight loss even when food intake has increased is seen in
- thyrotoxicosis,
- diabetes mellitus,
- lymphoma,
- malabsorption.
Wasting may be associated with:
chronic alcohol abuse,
HIV infection,
malignancy,
anorexia nervosa
Dyspnoea
(shortness of breath) is an undue awareness of breathing.
Abnormal increased inspiratory movement indicates what? and it’s evident by:
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
The use of accessory muscles is characteristic of patients with _________ and __________
chronic obstructive pulmonary disease (COPD) and severe acute asthma.
Abnormal increased expiratory movement evident by
-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).
Tachypnea
is an increase in respiratory rate.
T/F?
When there is dyspnea, there is tachypnea.
TRUE
اذا هو مختنق اكيد يزيّد نفسه
بس مو شرط اذا يتنفس سريع معناها مختنق
D doesn’t come without T
T/F?
When there is tachypnea, there is dyspnea.
FALSE
Flexed hand and arm occurs in:
hemiplegics
claw hand occurs in
ulnar nerve palsy
whats the most common cause of hand deformity
Trauma
long thin fingers are seen in
Marfan’s syndrome (arachnodactyly)
Patients with Marfan’s syndrome may be recognized by
hands with arachnodactyly
tall stature,
dislocated lenses
a high-arched palate.
A brownish stain on the fingers and nails is seen in _________. It is caused by ______
-cigarette smokers
-it’s caused by TAR
(not nicotine)
bluish discoloration of the ends of the fingers indicates
cyanosis
white color in digits suggests
Raynaud’s phenomenon.
in __________, there is overgrowth of the facial skeleton, coarsening of features and an increase in soft tissue size
acromegaly
features of acromegaly
-overgrowth of the facial skeleton,
-coarsening of features
-an increase in soft tissue size
why might some patients have warm hands? what are some of the causes?
due to peripheral vasodilatation
eg
-fever,
-acute exacerbation of COPD,
-thyrotoxicosis.
why might some patients have cold hands? what are some of the causes?
due to peripheral vasoconstriction
e.g.
-ischemia,
-hypotension,
-vasospasm (Raynaud’s phenomenon).
define Koilonychia
soft, thin, easily broken (brittle) and spoon– shaped (concave) nail that may occur in iron deficiency anemia, lichen planus, hemochromatosis, and repeated detergent exposure.
causes of koilonychia
-iron deficiency anemia,
-lichen planus,
-hemochromatosis,
-repeated detergent exposure.
(idiopathic or congenital)
Koilonychia is divided into two stages: Some clinicians use the water-drop test to confirm such an abnormality
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.
how to confirm koilonychia?
Some clinicians use the water-drop test
define Leukonychia
Whitening of the nail that presents as total whitening due to chronic liver disease and hypoalbuminemia.
cause of Leukonychia
chronic liver disease and hypoalbuminemia
causes of finger pitting
Psoriasis,
alopecia areata,
eczema and
fungal infection
define Splinter hemorrhages
Linear hemorrhages in the nail occur due to trauma (most common cause), vasculitis, rheumatoid arthritis, infective endocarditis and psoriasis.
causes of Splinter hemorrhages
-trauma (most common),
-vasculitis,
-rheumatoid arthritis,
-infective endocarditis
-psoriasis.
define Onycholysis
Separation of the nail plate from the nail bed which occurs in trauma, psoriasis, and thyroid diseases.
Onycholysis
-trauma,
-psoriasis, and
-thyroid diseases.
Yellow nails are seen in
yellow nail syndrome which is a triad of slowly growing yellow nails, pleural effusion, and bronchiectasis.
Red half moons in the nails suggest…?
Red lunulae due to congestive heart failure
Blue half moons of the nails suggest….?
chronic cyanotic state
e.g. Eisenmenger’s syndrome.
clubbing هذول نلكة عدهم هم
Dark blue nail lunulae are sometimes found in….?
-Wilson’s disease (excess copper)
-hemochromatosis (excess iron)
-in patients on antimalarial drugs or minocycline.
Half-and-half nails (white proximally and red-brown distally) are seen in
uremia (CKD) and normally due to aging.
define Digital clubbing
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.
Causes of Clubbing
*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)
Clinical stages of finger clubbing are:
**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
Palmar creases are pale in anemia, where the hemoglobin level is usually ______
<7 g/dL
Palmar erythema is a characteristic bright red eminences and pulps of the finger that occur in ________
pregnancy,
thyrotoxicosis,
hepatic failure,
may be idiopathic.
causes of excessive SWEATING of the hands
idiopathic
psychogenic
thyrotoxicosis.
what are the types of hand tremor?
- Postural tremor
a. fine tremor
b. coarse tremor - Flapping tremor (asterixis)
what are the causes of Postural tremor (fine/coarse)
- Anxiety.
- Drugs e.g. ß-agonists (salbutamol), theophylline, and tricyclic antidepressants.
- Excessive tea or coffee drinking.
- Endocrine e.g. thyrotoxicosis, pheochromocytoma, and hypoglycemia.
causes of Flapping tremor (asterixis).
*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
Cyanosis
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.
at what level does cyanosis become apparent?
it becomes apparent when the concentration of reduced hemoglobin in capillary blood exceeds 5 g/dl.
انتبهوا على الرديوسد ءخوان
what are the causes of central cyanosis
- Cyanotic congenital heart disease
- Respiratory failure
- Heart failure
- Abnormal hemoglobin derivatives e.g. methemoglobin and sulfhemoglobin
where can central cyanosis be seen clinically
it may be found in the mucous membranes and skin
central cyanosis is usually associated with
-Hot extremities
-Clubbing of finger may be present
T/F?
Peripheral cyanosis can be seen in the mucus membranes and skin
FALSE
PERIPHERAL CYANOSIS can be found in the SKIN only
T/F?
Peripheral cyanosis is associated with cold extremities
TRUE
بريفرل = بارد
سنترل = حار
T/F?
peripheral cyanosis is associated with clubbing of the fingers
FALSE
متصير بس بالسنترل
peripheral cyanosis results from _______
- Exposure to cold
- Heart failure
- Arterial obstruction
- Venous obstruction
Cold, sweaty hands may indicate
Anxiety
Cold, dry hands may indicate
Raynaud’s phenomenon
Hot, sweaty hands may indicate
Hyperthyroidism
Large, fleshy, sweaty hands may indicate
Acromegaly
Dry, coarse skin may indicate
Regular water exposure,
Manual occupation,
Hypothyroidism
Delayed relaxation of grip may indicate
Myotonic dystrophy
Deformed hands/fingers may indicate
Trauma,
Rheumatoid arthritis,
Dupuytren’s contracture
normal pulse rate =
60-100 Beat/Min
normal levels of blood pressure
systolic <130
diastolic <85
normal Respiratory Rate
12–15 breaths per minute
12 - 20 بمحاضرة د. ياسين هيج بس هي غالبا
O2 Saturation
> 98%
عند 92% يلا اخلي اوكسجن ماسك
Apathy, with poverty of expression and poor eye contact may indicate
Depression
Apathy, with pale and puffy skin may indicate
Hypothyroidism
Agitated expression
Anxiety, hyperthyroidism, hypomania
what’s xanthelasma
it is a harmless yellow bump on or near your eyelid skin. (cholesterol deposit)
causes of xanthelasma
Hyperlipidemia
causes of Conjunctival Hemorrhage
Infective Endocarditis
يحبها د. ياسين
butterfly shaped redness on the skin of the cheeks indicates
Systemic lupus erythematosus SLE
causes of Peri-Orbital Edema
poor sleep,
poor diet
allergies
renal impairment
radial puckering
(furrows) around the mouth may indicate
systemic sclerosis
plethoric appearance (facial swelling and puffiness / moon face) may indicate
Cushing’s syndrome
whats Telangiectasia
minute capillary tortuosities, may be seen on the face in liver disease or in hereditary disorders
what is Spider Telangiectasia
they’re small cutaneous arteriovenous anastomoses that blanch when pressure is exerted on the central point of the vascular complex
Smooth red tongue (Glossitis) indicates
iron deficiency
angular stomatitis indicates
iron deficiency
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
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
where can we palpate the pulse in the foot?
- Posterior Tibial Artery:
At The Ankle Just
Posterior And Inferior To The Medial Malleolus - Dorsalis Pedis:
at The Superior Surface Of The Foot Between The Bases Of The First And Second Metatarsals
causes of Transverse grooves on nails
it occurs as a sequela of any severe systemic illness that affects growth of the nail matrix
Capillary Refill
< 2 sec
Nail-fold infarctions may be signs of
a vasculitic process
_____________’s angle refers to the angulation between the nail plate and the skin below the nail
Lovibond’s
Lovibond’s angle
Normally it is less than 180°.
When clubbing is present, the angle is at least 180°, or more.
Causes of elevated JVP
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.
اشياء ذكرها د ياسين بالسشن مهمة
Signs of Iron deficiency anemia
-conjunctival pallor
-palmer pallor
-koilonychia
-angular stomatitis/cheillosis
-glossitis
اشياء ذكرها د ياسين بالسشن مهمة
Signs of infective endocarditis
-conjunctival haemorrhage
-clubbing fingers
-osler’s nodes
-splinter haemorrhage
Irregular pulse indicates
Extrasystole beats
Regularly irregular pulse indicates
Sinus arrhythmia
Irregularly irregular pulse indicates
Atrial fibrillation
define
Melena
black tarry feces
melena is associated with ______
upper gastrointestinal bleeding
causes :
Upper GIT tract bleeding
Peptic ulcer disease
Features:
Black tarry stool
Offensive smell
Difficult flush away
Clot of blood in stool is a sign of
bleeding from colon
may be causes of :
1. cancer
2. Diverticular bleeding
3. Infection cloitis
4. Inflammatory bowel disease
causes of bloody cough
TB infection
Bronchitis
Bronchiectasis
causes of fine tremor:
A-dialysis
B-sympathetic overactivity
C-thyrotoxicosis
causes of flapping tremor:
A-hepatic encephalopathy
B-urimic encephalopathy
C-type 2 Respiratory failure
define
Purpura
purple-colored spots and patches that occur on the skin, and in mucus membranes
من التسليكات
causes of purpura
Caused when small blood vessels leak blood under your skin’s surface.
من التسليكات
define
Ecchymosis
dark purple spot forms on skin when blood leaks out of blood vessels into the top layer of skin.
من التسليكات
define
Hematoma
a bad bruise. It happens when an injury causes blood to collect and pool under the skin.
من التسليكات
Spider nevi
isa collection of small, dilated arterioles (blood vessels) clustered very close to the surface of the skin.
من التسليكات
palmer erythmya
skin condition that makes the palms of hands turn red.
Caused by liver diseases, such as liver cirrhosis, hemochromatosis, and Wilson disease.
من التسليكات
Tongue fissure
iron defficiency anemia
من التسليكات
Geographic tongue
Vit B2 defficiency
Dehydrated tongue:
if the tongue is dry and rough, in shock patients
furred tongue
tongue appear with white coating especialy in smokers
trush
بياض او تقرح بسقف الحلگ او باللسان
Cyanosis + Clubbing =
cyanotic CHD & Pulmonary AV shunt
Cyanosis without Clubbing
=infective endocarditis or Ulcerative colitis
