Short cases FYI Flashcards
Peripheral Vs. Central Cyanosis
< 80% oxygenated Hb
Peripheral - vascular constriction in Raynaud’s, cryoglobulinaemia, frost bite, circulatory failure
Central - inadequate oxygenation such as respiratory failure or mixture of Venous and Arterial blood
Koilonychia
Spoon shaped nails secondary to Fe deficiency
Onochylysis
Separation of the nail from bed
- Psoriasis (also with nail pitting)
- Fungal infection
- Thyrotoxicosis
- Trauma
Arachnodactyly
Marfans syndrome
Description of acromegaly hands
Large “doughy” hands
Differing causes of Anaemia
Heart failure - Lower limb predominant with raised JVP and pulsatile liver
Liver Failure. -Ascites
Nephrotic - often periorbital
Causes of Oedema
Non-pitting
- Lymphoedema
Pitting
- CCF
- Hypoalbumin due to CLD, Nephrotic syndrome
- DVT
- Myxoedema with hypothyroidism
- Drugs; CCB, NSAIDS
Causes of Lymphadenopathy
- Viral infection i.e EBV, CMV, HIV
- Local bacterial infection with reactive hyperplasia
- Tb
- Haematological - Lymphoma (usually Hodgkins), Leukaemia (depending on age), solid organ mets (L) supraclavidular - Troisier)
- Sarcoidosis
- Brucellosis or Pasturella
- Connective tissue diseases i.e. RA (Feltys syndrome), SLE
Lymphadenopathy with Splenomegaly
- Lymphoma
- Chronic Lymphocytic Leukaemia
- Acute Lymphocytic leukaemia
- RA with Feltys syndrome
- HIV
- Disseminated Tb
Causes of Gynaecomastia
- Puberty
- Chronic liver disease
- Kleinfelters syndrome (16 x more likely to get male breast cancer), Kallmans syndrome with anosmia (hypogonadotropic, hypogonadism)
- Testicular failure
- Sprinolactone use for CLD, CCF, Addisons disease requiring mineralocorticoid replacement
- Digoxin
- Oestrogen therapy
- Bronchial carcinoma
** Cushings get Lipomastia!**
Causes of Hirsutism
- Cushings
- PCOS (oligomenorrhoea, hyperandrogism, polycystic ovaries)
- Congenital adrenal hyperplasia
- Phenytoin
- Ciclosporin
- Androgen secreting ovarian malignancy
** Hypertrichosis is generalized excess hair growth in any sex, which is nonandrogenic in origin**
Rx Hirsutism
- Weight loss
- Cease offending drugs
- OCP
- Metformin
- Sprinolactone
- Laser hair removal
Causes of leg ulcers
- Trauma
- Arterial insufficiency - lateral aspect - loss of hair, absent pulses, painful
- Venous insufficiency - medial aspect
- Mixed venous and arterial
- Neuropathic - at pressure points
- Autoimmune (pyoderma gangrenous, Feltys syndrome, SLE)
- Burgers disease - young patient with smoking Hx
Causes of gum hypertrophy
- Phenytoin
- Ciclosporin
- Myelomonocytic leukaemia
Describing pulse
- Slow rising = anacrotic, plateau = MR, AS, MS
- Collapsing = water hammer pulse = AR
- Jerky pulse = HOCM
- Dancing carotids = Corrigans sign = AR
Describing JVP
- Double flicker = normal JVP
- Prominent V wave = TR
- Loss of A wave = AF
- Cannon A wave = CHB, Junctional rhythm
Normal apex beat
5th intercostal space at mid-clavicular line, of normal character
Describing apex beat
- Thrusting, Volume loaded = MR, AS
- Heaving, Pressure loaded = AS
- Tapping = MS
- Double apex beat = HOCM
- Missing apex beat - thick chest wall, apex behind rib, emphysema, dextrocardia
Loud first heart sound
- Mitral stenosis
Loud second heart sound
- Pulmonary stenosis
Soft first heart sound
- MR
- TR
Soft second heart sound
- AS
- PR
Split second heart sound
- Pulmonary hypertension
- Atrial septal defect
- RBBB
Reverse splitting of second heart sound
- Aortic stenosis
Tracheal deviation
Towards side
- Collapse
- Pneumonectomy
- Fibrosis
Away from side
- PTX
- Pleural effusion
Dullness to percussion
- Stony dullness; effusion
- Dullness; consolidation, mass, collapse
Dullness to percussion
- Stony dullness; effusion
- Dullness; consolidation, mass, collapse
Prolonged expiratory phase
> 6 seconds
