SBA buzzwords Flashcards
SOB on exertion
Wheeze
Chronic productive cough
COPD
COPD investigation
Post-bronchodilator spirometry
Fever
Chronic cough
Weight loss
Asian
TB
Red Ziehl-Nelson stain
Acid fast bacilli
TB
TB treatment
Rifampicin
Isoniazid
Pyrazinamide
Ethambutamol
Rifampicin side effect
Orange tears
Isoniazid side effect
Peripheral neuropathy
Pyrazinamide side effect
Hepatitis
Ethambutamol
Colour blindness
Steatorrhoea, DM Clubbing Recurrent infections Bronchiectasis Sodium >60 mmol
CF
Shipyard/power station worker
End-inspiratory crackles
Non productive cough
Mesothelioma
Exposure to mouldy hay
Farmer’s lung (hypersensitivity pneumonitis)
Exposure to birds
Bird fancier’s lung (hypersensitivity pneumonitis)
Exposure to silica
Nodular shadowing
Egg shell nodules
Hypersensitivity pneumonitis
Horner’s syndrome
Arm pain
Pancoast tumour
Hypercalcaemia
Ectopic PTH
Constipated, tired
Epithelial cells
Squamous cell carcinoma
Lung cancer with:
Neuroendocrine symptoms
Paraneoplastic syndromes
Small cell carcinoma
Small cell producing ACTH
Cushings
Small cell producing ADH
SiADH
Small cell producing Anti Ca abs
Lambert Eaton syndrome
Lung cancer:
Of goblet cell origin
Non-smoker
Female
Adenocarcinoma
Fever SOB Productive cough Bronchial breath sounds Coarse creps
Pneumonia
Assessed with CURB65
Pneumonia
CURB 65 components
CRP Urea RR BP Age >65 y/o
Pneumonia treatment
IV clarithromycin, oral amoxicillin
Rusty sputum
Younger patient
S pneumonia
Small segmental infiltrates, sinusitis, pharyngitis, laryngitis
Chlamydia pneumonia
Adolescent (pneumonia)
Erythema nodosum
Pericarditis
Haemolytic anaemia
Mycoplasma pneumonia
Pneumonia with abscesses
Staph aureus
Purulent dark sputum (pneumonia)
Klebsiella
Pneumonia in AIDS with widespread infiltrates and low O2 sats
Normal CXR
Dry cough and SOB
Pneumocystitis jiroveci
Pneumonia with: Low Na Low albumin SOB, muscle cramping Air conditioning exposure
Legionella pneumophila
Pneumonia with: Hepatosplenomegaly Conjunctivitis Arthralgia Lower lobe consolidation Bird exposure
Chlamydophila psittaci
Child coughing up blood
Inhaled foreign body
Night cough
Intermittent wheeze
Eczema/hayfever
Diurnal variation
Stable asthma
Severe exacerbation of asthma treatment
60% O2 via facemask
Back to back nebs
Systemic steroids
Life threatening exacerbation of asthma treatment
IV magnesium sulphate, intubation
Silent chest, apparent improving O2, fatigue, bradycardia
Life-threatening exacerbation of asthma
Anacrotic pulse
Breathlessness, syncope
Angina on exertion
Aortic stenosis
Narrow pulse pressure, ejection systolic murmur radiating to carotids
Aortic stenosis
Pink frothy sputum
Post MI
Mitral regurgitation
Graham Steel murmur
Mitral regurgitation
Displaced apex beat, pan systolic murmur radiating to axilla
Mitral regurgitation
Late systolic murmur with mid-systolic click
Mitral prolapse
Murmur with Barlow syndrome
Mitral prolapse
Decrescendo diastolic murmur
Aortic regurgitation
Displaced apex beat with early diastolic murmur heard in expiration over left sternal edge
Aortic regurgitation
Pansystolic murmur at lower left sternal edge
Tricuspid regurgitation
Murmur associated with large V waves in JVP
Tricuspid regurgitation
Rumbling mid-diastolic murmur heard loudest at apex with tapping apex beat and loud first heart sound
Mitral stenosis
Muffled heart sounds following lupus/malignancy
Pericardial effusion
Positive valsalva manoeuvre
Harsh ejection systolic murmur
Sudden unconsciousness in young person
Hypertrophic Obstructive CardioMyopathy (HOCM)
Machine-line murmur with bounding pulse, wide pulse pressure and left supraclavicular thrill
Patent Ductus Arteriosus
Dyspnoea, orthopnoea
Fine inspiratory crepitations
Heart failure
Increased BNP
Heart failure
Gold standard investigation for heart failure
Transoesophageal echo
Heart failure CXR signs
Alveolar oedema Kerley B lines Cardiomegaly Diversion of upper lobes Effusion
Petechiae, microvascular haematuria, Janeway lesion, splinter haemorrhages
Infective endocarditis
Scoring for infective endocarditis
Modified Duke Criteria
Irregularly irregular pulse
Atrial fibrillation
ECG shows absent P waves
Atrial fibrillation
Palpitations, SOB, fatigue, syncope in elderly person
Atrial fibrillation
Narrow complex tachycardia with rate >150 bpm and 2:1 block
Atrial flutter
Saw-tooth appearance of ECG
Atrial flutter
Broad complex on ECG of individual with previous MI
Ventricular tachycardia
Pulseless patient needing cardioversion
Ventricular fibrillation
Delta wave (slurred upstroke on ST)
Wolff-Parkinson White syndrome
ECG with:
Broad QRS, uniform P waves with random QRS, cannon waves on JVP
Complete heart block
Collapse when running
Tearing pain to back
Connective tissue disorder
Dissected aortic aneurysm
Friction rub on cardiac auscultation
Pericarditis
Male, post-MI
Chest pain worse on lying down
Pericarditis
Central crushing chest pain radiating to jaw/Left arm
Myocardial infarction
Initial MI intervention
Morphine Oxygen Nitrates Aspirin Reperfusion (thrombolysis/PCI) Clopidogrel Heparin
Beta blocker
ACEi
Risk factors
Statin
Sharp, pleuritic chest pain
Haemoptysis
OCP/long haul travel
Pulmonary embolism
PE scoring system
Wells
Anxiety, paroxysmal hypertension
Phaeochromocytoma
Interscapular murmur
Decreased femoral pulses
Turner’s syndrome
Radio-radial delay
Aortic coarctation
HTN, polymyalgia, polyuria, polydipsia
Increased Na, reduced K
Normal renal function
Increased aldosterone, decreased renin
Conn’s syndrome
ANCA positive, micro aneurysms and MI
Polyarteritis MI
ST depression and T wave inversion on exertion
Normal resting ECG
Stable angina
Exertion chest pain, radiating to jaw
Stable angina
Episodic chest pain on rest
Unstable angina
ST elevation at rest in cycles
Prinzmetal angina
ST depression on ECG with normal angiogram
Syndrome X
Chest pain waking patient up at night, lying down
Decubitus angina
Pleuritic chest pain, low grade fever and pericarditis a few weeks post-MI
Dressler’s syndrome
Right heart failure, pulmonary hypertension
Large A waves in JVP
Cor pulmonale
Pulmonary hypertension, heart failure, shunt reversal
Ventricular septal defect
Harsh pan systolic murmur at left sternal edge with a left parasternal heave
Ventricular septal defect
Wide, fixed, split second heart sound
Ejection systolic murmur in ICS2/3
Atrial septal defect
Anterior leads
V1-V4
Anterior artery on ECG
Left anterior descending
Inferior leads
II, III, aVF
Inferior artery on ECG
Right coronary
Lateral leads
I, V5-V6
Lateral artery on ECG
Circumflex
Raised and fixed JVP
SVC obstruction
Increased JVP on inspiration
Cardiac tamponade
Constrictive pericarditis
Saddle shaped ST elevation on ECG
Acute constrictive pericarditis
S1, QIII, TIII on ECG
Pulmonary embolism
Tall tented T waves on ECG with wide QRS
Hyperkalaemia
Flattened T waves on ECG with prominent U waves
Hypokalaemia
Long QT interval on ECG
Hypocalcaemia
Stroke with receptive aphasia
L temporoparietal
Receptive aphasia
Wernicke’s
Stroke with expressive aphasia
L frontal
Expressive aphasia
Broca’s
Stroke with face/arms involvement >legs
Middle cerebral artery
Stoke with legs involvement> face/arms
Anterior cerebral artery
Stroke with visual involvement
Posterior cerebral artery
Acute vertigo, cerebellar signs, Horner’s
Lateral medullary syndrome
Confusion
Dizziness
Anxiety
Loss of consciousness
Hypoglycaemia
Uni/bilateral headache, pulsating
Nausea and vomiting
Photophobia
Aura
Migraine
Headache like tight band around head
Stress
Tension headache
Jaw claudication, severe headache
Fatigue, weight loss, sore throat
Red face, scalp tenderness
Temporal arteritis
Multinucleated giant cells on artery biopsy
Temporal arteritis
Shooting pains when touching face
Trigeminal neuralgia
Head trauma followed by loss of consciousness, then lucid period
Extradural haemorrhage
Progressively developing head pain and loss of consciousness
Subdural haemorrhage
Severe orbital/temporal pain, occurring in clusters
Cluster headache
Progressive worsening headache
Worse on coughing, sneezing, bending
Headaches in morning
Space occupying lesion
Stepwise deterioration in cognitive function
Cardiovascular risk factors
Vascular dementia
Gradual memory loss, impaired speech
Alzheimers dementia
Disinhibition, personality changes, inappropriate behaviour
Normal memory
<65 years
Pick’s disease (frontotemporal dementia)
Myoclonus, memory loss, hallucinations
Rapid progression
CJD
Parkinsonism
Vivid visual hallucinations
Sleep disturbance
Lewy body dementia
Loss of consciousness precipitated by emotion/pain/fear/prolonged standing
Nausea
Pallor
Clonic jerking, no stiffness
Vaso-vagal syncope
Loss of consciousness after reduced cardiac output
Arrhythmia
Pale, slow/absent pulse
Flushing afterwards
Stokes-Adams attack
Head turning –> dizziness and syncope
Carotid sinus syndrome
Tonic-clonic sequence
Tongue biting
Incontinence
Post-ictal confusion
Epilepsy
No loss of consciousness/amnesia/confusion
Pause
Simple partial seizure
No loss of confusion
Aura
Automatisms
Complex partial seizure
Seizure lasting more than 30 mins
Status epileptius
Status epilepticus treatment
IV lorazepam + 50% glucose, IV phenytoin
UMN lesion signs
Spasticity
Hyperreflexia
Babinski +ve
LMN lesion signs
Floppy paralysis
Wasting
Fasciculations
Muscular weakness improving with exercise
Lambert-Eaton syndrome
Lambert-Eaton syndrome antibodies
Pre-synaptic Ca channel
Muscular weakness worse with exercise
Myasthenia gravis
MG antibodies
Anti-ACH
Transient loss of vision, paraesthesia, paralysis, worse in heat
Episodes separate in space and time
Multiple sclerosis
Tremor after alcohol withdrawal
Confusion, crawling sensation
Delirium tremens
Cerebellar signs
Dysdiadocokinesa Ataxia Nystagmus Intention tremor Slurred speech Hyperreflexia
Peripheral neuropathy in alcoholics
B12/folate deficiency
Peripheral neuropathy with glove and stocking distribution
Diabetes
Confusion, ataxia and ophthalmoplegia in alcoholic patient
Wernicke’s encephalopathy
Wernicke’s encephalopathy treatment
IV pabrinex
Anterograde amnesia, confabulation in alcoholic
Korsakoff’s
Cafe au lait spots, axillary freckling, neurofibromas
Neurofibromatosis I
Bilateral acoustic neuroma
Neurofibromatosis II
Telangiectasia, epistaxis, vascular disorder
Osler-Weber-Rendu
Wasting of thenar eminence and weakness in abductor pollicis brevis
Median nerve
Loss of sensation in lateral palmar serve of 3 and a half digits
Median nerve
Median nerve distribution
C6-T1
Wasting of hypothenar eminence and weakness in abductor digiti minimi, claw hand
Ulnar nerve
Sensory loss over medial one and a half digits
Ulnar nerve
Ulnar nerve distribution
C8-T1
Weakness in wrist extension, wrist drop
Radial nerve
Anaesthesia over first dorsal interosseous muscle
Radial nerve
Radial nerve distribution
C5-T1
Paralysis of intrinsic muscles of hand
Loss of sensation in ulnar distribution
Horner’s syndrome may be present
Klumpke’s palsy
Loss of shoulder abduction and elbow flexion
Arm held internally rotated
Waiters tip sign
Erb’s palsy
Weakness in dorsiflexion and eversion of foot
Sensory loss over dorm of foot
Hit inside of knee
Common peroneal nerve
Common perineal nerve distribution
L4-S1
Inability to invert foot or stand on tip toe
Sensory loss on sole of foot
Tibial nerve
Tibial nerve distribution
L4-S3
Shuffling gait
Parkinsons
High stepping gait
Sensory ataxia
Wide based gait
Cerebellar lesion
Gastroenteritis with vomiting shortly after eating food
Staph aureus
Gastroenteritis after eating reheated rice
Bacillus cereus
Haematemesis after sepsis, organ failure
Cushing’s ulcer
Haematemesis after burns
Curling’s ulcer
Recurrent ulceration and high serum gastrin
Zollinger Ellison syndrome
Massive haematemesis, microcytic anaemia and history of alcoholism
Oesophageal varices
Short history of change in bowel habit
Tenesmus and mucus
Rectal carcinoma
History of broad spectrum antibiotics
Green diarrhoea
Clostridium difficile
Pale stool, burping, foul flatus, watery diarrhoea after visiting eastern europe
Giardia
Bloody diarrhoea + intense abdo pain
Ischaemic colitis
Loos stool associated with weight loss, hyperpigmentation and onycholysis
Thyrotixicosis
Epigastric pain worse with meals/alcohol
Chronic pancreatitis
Rapidly progressive dysphagia (solids, then liquids), weight loss, hypoproteinaemia
Oesophageal carcinoma
Apple core lesion on barium swallow
Oesophageal carcinoma
Progressive difficulty with speech and swallowing
Weak facial muscles, absent jaw jerk
Bulbar palsy
Weight loss + anorexia + Iron deficiency
Signet ring cells
Adenocarcinoma
Generalised ulceration of oesophagus on background of immunosuppression
Oesophageal candidiasis
Purple, plaque like lesions of proliferating spindle cells
Kaposi’s sarcoma
Beading of intrahepatic ducts
Associated with ulcerative colitis
Cholestatic jaundice with raised ALP
Sclerosing cholangitis
Deep necrotic ulceration of shin associated with IBD, vasculitis and haematological malignancy
Pyoderma gangrenosum
Raised bilirubin - jaundice when stressed/acutely ill
Gilbert’s syndrome
Jaundice, diarrhoea and fever after eating infectious food
Hepatitis A
Thrombus in hepatic portal vein secondary to thrombogenic disorders
Budd-Chiari syndrome
Chronic liver disease + jaundice related to antimitochondrial antibodies
Primary biliary cirrhosis
Faecal oral RNA virus leading to jaundice, diarrhoea and fever
Hepatitis A
Infectious dsDNA virus leading to infection and chronic carriage after fluid transmission
Hepatitis C
Iron overload - haemosiderin within hepatocytes leading to bronzed skin and raised transaminase
Genetic haemochromatosis
Copper accumulation leading to Kaiser-Fleischer rings, neuro and liver changes
Wilson’s disease
Pre-hepatic causes of jaundice
Haemolysis
Hepatic causes of jaundice
Autoimmunity, drugs, infection, malignancy
Post-hepatic causes of jaundice
Obstruction via gallstone, tumour, infection, inflammation
Fever, right upper quadrant pain, nausea, icteric sclera worse on fatty foods
Female, fat, forty, fertile
Biliary colic
Charcot’s triad leading to fever, rigours and jaundice
Ascending cholangitis
Unexplained dyspepsia, dysphasia, malaena, anaemia and anorexia
Acanthosis Nigricans
Virchow’s node
Gastric carcinoma
Abdo pain after meals
CLO test positive
Peptic ulcer
Metaplasia of distal oesophagus from squamous to columnar epithelium
Related to GORD
Barrett’s oesophagus
Abdo pain improving with meals, worse with hunger and at night
Duodenal ulcer
Proportion of GIT ulcers which are duodenal
80%
Small haematemesis following repeated retching and vomiting
Mallory Weiss tear
Fullness, epigastric pain, nausea
Radiates to back
Hypokalaemia + anaemia
Acute pancreatitis
Acute pancreatitis score
Modified Glasgow score
Hypoglycaemia upon fasting/exercise
Palpitations, dizziness, syncope, diplopia
Insulinoma
Painless progressive jaundice with mass
Diabetes, smoking, alcohol
Dark urine, pale stools
ALP>AST
Pancreatic adenocarcinoma
Pancreatic cancer marker
Ca19-9
Severe, acute onset abdominal pain
Expansile mass, tachycardia, hypotension
Abdominal aortic aneurysm
Shock, epigastric pain
History of dyspepsia
Rigid abdomen, absent bowel sounds
Perforated peptic ulcer
Pain, nausea, vomiting and bloody diarrhoea
Febrile, tachycardia, distension >6cm
Coffee bean sign
Toxic megacolon
Umbilical to right iliac fossa pain
Nausea and vomiting
Tender over McBurney’s point
Rosving’s sign positive
Appendicitis
Pain, vomiting, altered blood per rectum
Pale, tachycardia, shock
Mesenteric ischaemia
Beak sign on barium swallow
Chest pain and regurgitation of solids and liquids
Achalasia
Decreased calcium, decreased calcitriol, increased phosphate, increased bone resorption, increased ALP
Osteoporosis on DEXA
Due to chronic renal failure
Renal osteodystrophy
Autonomous PTH secretion
Parahyroid adenoma/MEN 1
Increased PTH, increased Ca
Primary hyperparathyroidism
Physiological reaction to low calcium or high phosphate
High PTH
Secondary hyperparathyroidism
Autonomous parathyroid function
After transplant
Tertiary hyperparathyroidism
Hypertension, diabetes, glomerulonephritis
Fatigue, anorexia, pruritus, bone pain, oedema
Increased urea, increased creatinine, increased phosphate, decrease calcium, increase potassium
Normocytic, normochromic anaemia
Chronic renal failure
Terminal haematuria
Following travel to Middle East/Africa
Fevers, malaise, eosinophilia
Squamous cell carcinoma
Schistosomiasis
Acute renal failure
Granular/muddy brown cell casts
Acute tubular necrosis
Multiple aneurysms, irregular constrictions
Polyarteritis nodosa
Acute renal failure
White cell casts
Acute pyelonephritis
Hypoalbuminaemia
Oedema
Lipid abs
Proteinuria
Thromboembolism, hyperlipidaemia, increased infection risk
Nephrotic syndrome
Proteinuria Haematuria Azotemia Red cell casts Oliguria HTN
Inflammatory process, increased urea, increased creatinine
Nephritic syndrome
Multiple large bilateral cysts in kidneys
UTIs, haematuria, hypertension
PKD 1/2 mutation
High risk of Berry aneurysm, mitral valve prolapse
Autosomal dominant polycystic kidney disease
Renal failure in childhood
Hypertension, portal hypertension, congenital hepatic fibrosis
Autosomal recessive polycystic kidney disease
Middle aged patient
Haemoptysis
Haematuria and hypertension
Linear immunofluorescence on renal biopsy
T4 glomerular basement membrane antibodies
Goodpasture’s syndrome
Wegener’s granulomatosis antibodies
cANCA
Upper respiratory tract infection, lower respiratory tract infection, renal effects (haematuria, RBC casts)
Wegener’s granulomatosis
Granulomatosis with polyangiitis
Glomerulonephritis in children post-upper respiratory tract infection/immunisation/allergy
Minimal change disease
Obstructive urinary symptoms
Back pain
Craggy, nodular prostate
Loss of midline sulcus
Prostate cancer
Transitional zone hyperplasia of the prostate
Obstructive urinary symptoms
Smoothly enlarged prostate
Benign prostatic hyperplasia
Male patients 60-70 years old
Painless haematuria lacking casts
Relating to azo dyes
Transitional Cell Carcinoma
Diarrhoea, vomiting, increased urea/creatinine
Thrombocytopenia
E coli 0157
Haemolytic Uraemia Syndrome
Post-renal failure
Confusion, abdominal pain
Large, palpable bladder
Urinary retention
Loin to groin pain
Vomiting
Writhing in agony
Haematuria
Renal colic
Urine dip with nitrates, blood, leukocytes
Increased frequency
Urinary tract infection
Weight loss, nigh sweats Loin pain, dysuria Blood, leukocytes, -ve nitrates Sterile pyruia Positive mantoux
TB
WBC casts
Tubulointerstitial nephritis
RC casts
Glomerulonephritis
Centripetal obesity, bruises, darkened palmar creases, recent onset diabetes
Cushing’s syndrome
Pituitary adenoma secreting ACTH
Cushing’s disease
Polyuria, polydipsia, pituitary tumour, trauma
Central diabetes insipidus
Polyuria, polydipsia
Hereditary, hypercalcaemia, lithium, thiazide diuretic
Nephrogenic diabetes insipidus
Polyuria, polydipsia
Associated with schizophrenia
Urine osmolality same with fluid deprivation and after desmopressin
Psychogenic polydipsia
Generalised weakness, hyporeflexia, ataxia, lethargy, confusion
Hyponatraemia, high urine osmolality, hypoosmolality
Syndrome of inappropriate ADH
Coarse features, widely spaced teeth, slanting forehead, protruding jaw
Growth hormone secreting pituitary tumour
Acromegaly
Adrenal insufficiency
GI disturbance, weight loss, postural hypertension
High potassium, low sodium
Addison’s disease
Aldosterone producing adenoma
Low potassium, high sodium, high bicarb
High aldosterone, low renin
Metabolic alkalosis
Conn’s syndrome
Parathyroid tumour
Pituitary adenoma
Pancreatic tumour (Zollinger-Ellison syndrome)
Multiple Endocrine Neoplasia 1
Phaeochromocytoma
Amyloid-producing thyroid tumour
Primary hyperparathyroidism
Multiple Endocrine Neoplasia 2a
Phaeochromocytoma
Amyloid-producing tumour
Marfan’s syndrome
Organ fibrosis
Multiple Endocrine Neoplasia 2b
Insomnia, palpitations, weight loss, increased appetite
Hyperthyroidism
Exophthalmos, pretibial myxoedema
Autoimmune stimulation of TSH-receptor
Grave’s disease
Weight gain, lethargy, constipation
Diffusely enlarged thyroid
Anti-thyroglobulin, anti-microsomal, anti-thyroid peroxidase, anti-TSH-receptor antibodies
Hashimoto’s thyroiditis
Flu like illness –> inflammation and T3/4 release
Hyperthyroid –> hypothyroid –> euthyroid
Pain worse with swallowing, fever
Increased ESR
De Quervain’s thyroiditis
Slow growing, hard, immobile, enlarged thyroid
Fibrotic tissue on biopsy
Difficulty breathing and swallowing
Riedel’s thyroiditis
Rare thyroid cancer in elderly
Hard, rapidly enlarging
Fixed to skin
Anaplastic carcinoma
Thyroid cancer in adolescents and young adults
Orphan Annie eyes, psammoma bodies
Lymphadenopathy
Papillary carcinoma
Thyroid cancer in middle aged
Spread to lung/bone
Follicular carcinoma
Thyroid cancer with calcitonin tumour marker
MEN2
Medullary carcinoma
Lumpy, irregular thyroid
Plummer’s syndrome
Autonomous hyperfunctionign nodules
Toxic multi nodular goitre
Enlarged thyroid due to iodine decifiency, pregnancy, puberty
Simple colloid goitre
Bones, stones, moans, groans
Polyuria, polydipsia
Increased PTH
Primary hyperparathyroidism
Bones, stones, moans, groans
Trousseau’s sign
Chvostek’s sign
Hypercalcaemia
Convulsions
Arrhythmias
Tetany
Paraesthesia
Hypocalcaemia
Hypocalcaemia causes
Chronic kidney disease
Parathyroid failure
Post-thyroidectomy
Hypomagnesaemia
Low calcium and high PTH
Pseudohypoparathyroidism
Hypercalcaemia causes
Hyperparathyroidism, malignancy, vitamin D intoxication, sarcoidosis
Lung cancer secreting ectopic PTH
Hypercalcaemia + bone breakdown
PTHRP secretion
Ischaemic necrosis of pituiary
Post-partum haemorrhage
Hypopituitarism - amenorrhoea
Sheehan’s syndrome
Cushings –> bilateral adenalectomy
Nelson’s syndrome
Weight loss, fatigue, polyuria, polydipsia
Type 1 diabetes mellitus
Hyperglycaemia, ketoacidosis, ketonuria, dehydration, confusion, abdo pain
Kussmal breathing, pear drop breath
Diabetic ketoacidosis
Neuroglycopaenia
Irritable, tired, drowsy
Hypoglycaemia
Breast cancer marker
Ca15-3
Colorectal cancer marker
CEA
Carcinogen risk for hepatocellular cancer
Aflatoxin B1
Carcinogen risk for mesothelioma
Asbestos
Carcinogen risk for prostate cancer
Cadmium
Carcinogen risk for bladder cancer
Aniline dyes/rubber industry
Carcinogen risk for endometrial cancer
Oestrogen
Carcinogen risk for GI lymphoma
Coeliac
Carcinogen risk for gastric cancer
Pernicious anaemia
Carcinogen risk for cervical cancer
Unprotected sex with multiple partners
Carcinogen risk for lymphoma
EBV
Painless punctum attached to skin
Sebaceous cyst
Nodule on extensor surface
Firm and painless
History of rheumatoid arthritis
Rheumatoid nodule
Lump on a scar, solid and itchy
Keloid
Lump on dorsal of foot/hand
Herniation of tendon sheath
Transilluminates
Ganglion
Lump in anterior triangle
Slow growing
Young patient
Cholesterol crystals on FNA
Branchial cyst
Lump in anterior triangle
Lateral mobility
Carotid body aneurysm
Pulsatile lump in neck
Lateral mobility
Pulsatile, bruit
Pressure –> dizziness
Carotid body tumour
Lump with uneven borders
Slightly fluctuant
Not fixed to skin/deep structures
Lipoma
Lump in neck
Fever, lethargy, appetite change, weight loss, sweats
Painful after alcohol
Reed-Sternberg cells
Hodgkin’s lymphoma
Lump in posterior triangle
Regurgitation/difficulty swallowing
Gurgling, bad breath
Pharyngeal pouch
Rubbery lump
Tingling on pressure
Neurofibroma
Large skin abscess made of several boils
Carbuncle
Infection of hair follicle
Furuncle
Low grade tumour from hair follicle
Skin coloured with black central core
Keratoacanthoma
Benign lump
Smooth, hard, mobile
<30y/o
Fibroadenoma
Fibrocystic changes
Multiple cysts and nodules
Oestrogen induced hyperplasia
Fibroadenosis
Large, hot painful lump in breast
Associated with breast feeding
Acute mastitis
Large, hot painful lump in breast
Inability to sleep
Continuous pain
Breast abscess
Painful, erythamtous sub areolar mass
Abscess and inflammation
Smoking = risk factor
Periductal mastitis
Peri-areolar mass
Dilatation and blockage –> inflammation and fibrosis
White discharge
50-60 years old
Duct ectasia
Irregular, hard lump, tethered Nipple inversion, puckering Bloody discharge Ulceration, swelling Peau d'orange
Invasive carcinoma
Itchiness and discharge from nipple
No palpable lump
Ductal carcinoma in situ
Itchy, erythamous, scaly skin over nipple
Erosion and nipple discharge
Paget’s disease
Increase in size of breast
Tear drop appearance
Fibroadenoma appearance
Phyllodes tumour
Milk production without pregnancy
Prolactinoma
Trauma to breast
More common in obese women
Overlying bruising
Hard, irregular lump
Fat necrosis
Ulceration in gaiter region with haemosiderin deposition and lipodermatosclerosis
Oedema and brown discolouration of skin
Common in women after middle age
Venous ulcer
Punched out ulcers Atherosclerosis/vasculitis Low ABPI Absent pulses Shiny, hairless limb
Arterial ulcer
Absent/reduced sensation Found in pressure areas Well perfused, deep penetrating skin Loss of reflexes Diabetes
Neuropathic ulcer
Squamous cell carcinoma from previous scar/burn/ulcer
Irregular, raised edge, blood-stained discharge, painless
Marjolin’s ulcer
Pale, pulseless, painful, perishingly cold, paraesthesia, paralysis
Acute limb ischaemia
Risky ABPI
<0.3
Causes for amputation
Paraethstia, paralysis
Atherogenic emboli to retinala artery
Black curtain over eye
Amaurosis fugax
Distended superficial veins due to venous insufficiency
Varicose veins
Site of local trauma + tissue infection
Swelling, erythema, vesicle and bullae formation over skin
Fever +/- diarrhoea and vomiting
Necrotising fasciitis
Digital ischaemia - reflex vasospasm
Pallor –> cyanosis –> reactive hyperaemia
Associated with rheumatoid conditions, beta blockers
Raynaud’s syndrome
Tired, SOB, conjunctival pallor
Tachycardia
Flow murmur
Coeliac/Crohn’s/GI bleed/menorrhagia
Anaemia
Microcytic anaemia
Hepatospenlomegaly
Jaw protrusion
Thallasaemia
Microcytic anaemia + neuro signs
Phenytoin toxicity
Microcytic anaemia associated with B12 deficiency
Coeliac/alcohol/drugs
Pernicious anaemia
Anaemia with hyperhsegmented neutrophils and erythroblasts
Megaloblastic anaemia
Jaundice and anaemia
Haemolytic anaemia
Anaemia in Adro-Caribbean patients
Symptoms at altitude
Sickle cell disease
Anaemia
Splenomegaly
Spherocytes on film
Osmotic fragility test +ve
Hereditary spherocytosis
Anaemia with jaundice
X linked recessive
Triggers - fava beans, anti-malarial, infection, moth balls
Heinz bodies
G6Pd deficiency
Anaemia - Coomb’s test positive
Autoimmune haemolytic anaemia
Cold-activated anaemia association
Mycoplasma
Warm-activated anaemia association
CML/lymphoma/SLE
Clots, low platelets, rash
Thrombotic Thrombocytopenia Purpura
Petechia with low fibrinogen and clots
Sepsis/vascular insult
Disseminated Intravascular Coagulation
Normocytic anaemia causes
Chronic disease
Liver disease
Blood loss
Pancytopaenia
Hypocellular basement membrane
Absent reticulocytes
Aplastic anaemia
Uncontrolled red blood cell proliferation
Headaches, dizziness, stroke
Mast cells –> pruritus after hot baths
Gout, splenomegaly, plethora
Polycythaemia rubra vera
Excessive red blood cell production due to other disease (COPD/EPO secreting tumour)
Secondary polycythaemia
Randomly high red blood cells
Risk of AML
Idiopathic erythrocytosis
Platelets >600
Hypercoagulable
Nosebleeds/GI/gum bleeding
Essential thrombocytaemia
Menorrhagia + nosebleeds + purpura
Idiopathic thrombocytopenic purpura
Bone marrow failure Child Lymphadenopathy Incrased infections Anaemia Blast cells
Acute Lymphoblastic Leukaemia
Bone marrow failure
Adults
RARA-PML protein
Auer rods
Acute Myeloid Leukaemia
Bone marrow failure
Increased white cell count
Smear cells
Chronic Lymphocytic Leukaemia
Bone marrow failure
25-40 years
Philadelphia chromosome
Chronic myeloid Leukaemia
X linked factor 8 deficiency
Haemophilia A
X linked factor 9 deficiency
Haemophilia B
History of excessive bleeding
Von Willebrand disease
Liver disease and pancreatic insuffiency
Vitamin K deficiency
Multiple miscarriage
Arterial and venous thromosis
Antiphospholipid syndrome
Spinning sensation
Increased volume of endolymph
Unilateral tinnitus, unilateral sensorineural hearing loss
Meniere’s disease
Fluid from knee effusion forms popliteal cyst
Rupture –> compartment syndrome
Baker’s cyst
Systemic vasculitis associated with HLA B51
Recurrent oral/genital ulceration
Ocular inflammation
Behcet’s disease
Peroneal muscular atrophy (high arched feet)
Inherited neuropathy (starts in puberty)
Weak legs and foot drop
Inverted champagne bottle apprearance
Charcot-Marie-Tooth
Late onset asthma
Eosinophilia
Granulomatous small vessel vasculitis
pANCA +ve
Churg-Strauss syndrome
Small vessel vasculitis
Purpura on buttocks and extensor surfaces
Joint involvement and abdominal pain
Henoch Schonlein Purpur
Ptosis
Miosis
Anhydrosis
Horner’s syndrome
Mucocutaneous freckles on mucosa/soles/pams
GI polyps –> obstruction/bleed
Peutx-Jegher’s syndrome
Uveitis
Urethritis
Arthritis
Reiter’s syndrome
AI inflammatory disorder
Exocrine gland dysfunction
Xerostomia, keratoconjunctivitis
Parotid swelling
Sjogren’s syndrome
Erythema multiforme
Toxic epidermal necrolysis
Hypersensitivity reaction
Stevens-Johnson syndrome
Bilateral renal cell cancer
Retinal and cerebellar haemangioblastoma
Phaeochromocytoma
Von Hippel Lindau syndrome
Idiopathic costochrondritis
Tietze’s syndrome
Lesions to multiple CNS nuclei
Posterior/inferior cerebellar artery occlusion
Dysphagia/dysarthrita/vertigo/horners
Lateral medullary syndrome
OD = tachycardia, bradycardia
Digoxin
OD = hepatic failure
Paracetamol
OD = drowsiness, respiratory depression
Benzodiazepine
OD = respiratory depression, pinpoint pupils
Opiates
OD = tinnitus, vertigo, hyperventilation, metabolic acidosis
Salicylates
OD = salivation, lacrimation, urination, diarrhoea
Organophosphates
OD = bleeding
Warfarin
OD = severe bradycardia/hypotension
Beta blocker
OD = normal blood gas with low sats
Carbon monoxide
Electrolyte imbalance
Anorexia, nausea, malaise, headache, irritability, confusion, weakness, seizures, oedema
Hyponatraemia
Electrolyte imbalance
Lethargy, thirst, weakness, irritability, confusion, coma, fits, dehydration
Hypernatramia
Hyponatramia causes
Water loss in excess of sodium loss Diarrhoea, vomiting, burns Excess saline Diabetes insipidus Osmotic diuresis Primary aldosteronism
Dehydrated causes of hyponatramia
Addison's Renal failure Diuretic excess Osmolar diuresis Diarrhoea, vomiting, burns
Non-dehydrated causes of hyponatraemia
Oedematous - nephrotic syndrome, cardiac failure, cirrhosis, renal failure
No oedema - water overload, severe hypothyroidism, glucocorticoid insufficiency, SIADH
Normal values for Na
135-145
Normal values for K
3.5-4.5
Electrolyte imbalance
Muscle weakness, hypotonia, hyporeflexia, cramps, tetany, palpitations, arrhytmia
Hypokalaemia
Hypokalaemia causes
Diuretics Diarrhoea and vomiting Cushings/steroids Conns syndrome Alkalosis Bulimia Renal tubular failure
Electrolyte imbalance
Fast irregular pulse, chest pain, weakness, palpitations, light headedness
Hyperkalaemia
Hyperkalaemia causes
Oliguric renal failure K sparing diuretics Rhabdomyolysis Metabolic acidosis Addison's Burns ACEi
Electrolyte imbalance Spasm Perioribital paraesthesia Anxiety, irritability Seizures Increased smooth muscle tone Confusion Chvostek's sign
Hypocalcaemia
Electrolyte imbalance Abdo pain, vomitting Constipation Polyuria, polydipsia Depression Anorexia, weight loss Tiredness HTN Confusion Renal stones/failure
Hypercalcaemia
Cause of raised phosphate
CKD Hypoparathyroidism Pseudohypoparathyroidism Acute rhabdomyolysis Hypomagnesaemia
Causes of low phosphate
Osteomalacia, acute pancreatitis, over hydration and respiratory alkalosis
Causes of hypercalcaemia
Malignancy, primary hyperparathyroidism, renal failure, Addison’s, TB, fit D overdose, muscles tumours
Marker of renal function
Creatinine
