typical presentations and things difficult to remember Flashcards
classical phaeochromocytoma symptoms
(labile or postural hypotension, headache, palpitations, pallor sweating
Causes of gum hypertrophy
- Scurvy
- Pregnancy
- Acute polymelocytic leukaemia
- Drugs
a. Phenytoin
b. Nifedipine
c. Ciclosporin
Drugs causing peripheral neuropathy:
- TCAs
- Amiodarone
- Metronidazole
- Nitrofurantoin
- AZT
- Isoniazid
- Phenytoin
Causes of finger Clubbing
Respiratory: malignancy, infection (abscess, empyema), bronchiectasis, fibrosing alveolitis, cystic fibrosis, TB, mesothelioma
Cardiac: congenital cyanotic heart disease (fallot’s tetralogy, transposition of the great arteries), acyanotic heart disease (PDA with reversal of shunt (clubbing in toes only), infective nedocarditis
Subclavian artery aneurysm (unilateral clubbing)
GIT disease (cirrhosis, PBC, IBD, malabsorptio, coelic, whipple’s disease)
Thyroid (hyper)
Familial
Causes of cyanosis
Cyanosis (non-oxygenated Hb >5g/dl)
Peripheral : shock (hypovolemic, cardiogenic, septic), cold weather (Rynaud’s), arterial/venous occlusion
Central: respiratory failure, congenital heart disease, hemoglobin abnormalities (methaemoglobinaemia, HbM disease, NADH diaphorase)
Weight gain ddx
- Pregnancy
- Excessive caloric intake
- Endocrine
a. PCOS
b. Cushing’s
c. Hypothyroidism
d. Hypothalamic disease
e. Acromegaly - Drugs
a. Steroids
b. OCP
c. Antidepressants
d. Anticonvulsants - Depression
- Fluid:
a. CCF
b. Renal failure
c. Cirrhosis
d. Lymphatic
Absent radial pulse:
- Aoritc dissection with subclavian involvement
- Trauma/surgery/catheterisation
- Arterial embolism
- Takayasu’s arteritis
Impalpable apex beat:
- Obesity/thick chest wall
- Lung pathology: emphysema
- Pericardial effusion
- Dextrocardai
Bilaterally reduced expansion:
- Obesity
- Lung pathology (emphysema, bronchial athma, diffuse pulmoanry fibrosis)
- Chest cage pathology eg ankylosing spondylitis
- Neuromuscular pathology (GB syndrome, MS, MND etc)
INCREASED vocal femitus:
Consolidation, Cavitation, Collapse with patent main bronchus
DECREASED vocal fremitus:
pleural pathology (effusion, pneumothorax), collapse with obstructed main bronchus
Spider naevi
normal in women, OCP, prengancy, liver failure
causes of massive splenomegaly:
- Myelofibrosis
- Idiopathic tropical splenomegaly
- Chronic myeloid leukaemia
- Kala-azar
- Shistosomiaisis
other causes of moderate&mild splenomegaly
- Blood dyscrasias: leukaemia, haemolysis, polycythaemia rubra vera
- Lymphoma
- Infections: EBV, septicaemia, bacterial endocarditis, malaria
- Portal HTN
- Storage disease
causes of hepatomegaly:
- Tumours: either malignant or bening
- Cysts
- Hepatitis: infectious
- Other infections: EBV, bacterial
- Hepatic vein obstruction - budd chiari
- storage diseases: haemochromatosis, glycogen
- tricuspid regurgitation
- right heart failure
palpable liver without being enlarged:
riedel’s lobe
emphysema
gall bladder
DDx CHest pain
- Anginal (Stable)
- ACS
- Aortic dissection
- Pericarditis
* ** GORD - PE
- Pneumothorax
- Penumonia/ pleurisy
- Musculoskeletal
- Pre-herpes zoster
- trauma
Palpitations DDx and Qs
- Frequency and if paroxysmal
- FHx (WPW, RVAH)
- THyrotoxicosis
4, ? Infective endocarditis - Stimulant use: coffee, energy drinks, tea, amphetamines
- Anaemia
- Anxiety
Vertigo DDx
- BPPV - lasts seconds, provokes by head movements
- Meniere’s disease - can last hours, tinnitus, hearing loss, sense of fullness in the ear
- Labyrinthytis - almost constant, previous infection, discharge
- Trauma
- DRUGS
—-Vestibular:
Aminoglycosides (gentamicin)
Furosemide
Quinine
Salicylate
— Cerebellar:
Phenytoin
EtOH
Acute single episode of headache :
SAH Idiopathic cranial HN Cerebral vein thrombosis Acute Meningitis, encephalitis Acute carotid dissection \+/- GCA
Subacute progressive headache
Raise ICP (tumour, abscess, Idiopathic intracranial HTN)
Infections - meningitis, encephalitis
Temporal arteritis
Recurrent headaches
Migraine
Tension headache
Cluster headache
Drugs: nitrates, dipyridamole
TRIGEMINAL NEURALGIA
chronic headache
Chronic daily headache syndrome
Hronic migraine
Medication overuse
Cervicogenic
DDx Acute painful and prolonged visual disturbance/LOSS
- Acute angle closure glaucoma
- GCA
- Optic neuritis
- Anterior uveitis
- Endophthalmitis
- Orbital ecellulitis
DDx acute painless and prolonged visual disturbance/loss
- Central or branch retinal vein occlusion
- Central or branch retinal artery occlusion
- Anterior ischaemic optic neuropathy
- Retinal detachment or vitreous haemorrhage
- Macular haemorrhage
DDx acute painless and fleeting visual loss
- Amaurosis fugax
2. Raised ICP
Gradual visual loss DDx
- Cataracts
- Diabetic retinopathy
- Age related macular degeneration
- Chronic glaucoma
acute +/- progressive LIMB WEAKNESS DDx
- GBS - prior viral/diarrhoeal illness
- Stroke -speech, LOC, face, RISK FACTORS, AF
- TIA - speech, resolved completely, risk factors
- SPINAL CORD COMPRESSION - ? malignancy OR trauma, sphincter disturbance, pain
subacute limb weakness ddx
- MS - episodes where weakness paritally/completely resoved
- SOL - raised ICP sx
- Myasthenia gravis - fatiguing
- Lambert-Eaton - malignancy
- MND - NO sensory Sx
- Peripheral neuropathies -sensory Sx burning tingling, anaemia, vegan
DDx chronic cough
GORD Asthma Post-viral Rhinitis/sinusitis Drugs, eg ACEi Lung tumour TB Interstitial disaese Bronchiectasis
HAEMOPTYTSIS ddx
DDx
Infective: TB, bronchitis, pneumonia
Neoplastic: primary or metastatic
Vascular: PE, LVF & pulmonary oedema, AVM
Inflammatory: Wegener;s, Goodpasture, SLE
Traumatic & iatrogenic
Drugs: warafin, cocaine
Dyspnoea Progression and onset
Minutes
PE Pneumothorax Asthma Ihaled foreign body Acute LVF
dyspnoea onset over hours- days
Pneumonia
Athma
IECOPD
dyspnoea onset/progression over weeks - years
Anaemia
Pleural effusion
Neuromuscular disorder
AS
Months-years: COPD Fibrosis TB Pulmonary HTN
Weight loss wiht preserved appetite
Malabsorption: Diarrhoea, constipation, abdo pain, comiting, mouth ulcers
Diabetes: Polydipsia, polyuria, fatigue, infections
Hyperthyroid: Anxiety, fast heart rate, tremor, heat intolerance, increased appetite, eye symptoms, diarrhoea
Weight loss with norexia
?Addisons Weakness, dizziness, excessive sweating, skin PIGMENTATION
Pancreatit Assess EtOH, gallstones
Depression How has your mood been lately? Early-morning wakening, reduced appetite, anergia, anhedonia
?Infection Night sweats, fever, rigors, malaise, cough, sputum, rashes, SOB
?Malignant PR bleeding, changes in bowel habit, cough, haemoptysis, bruising (haematological)
DDx painful swollen leg
DDx DVT Cellulitis Ruptured Baker’s cyst Neuropathy
Neurological: muscle weaknes, wasting, ssensory, back pain
Bladder or bowel problems»_space; CAUDA EQUINA
PE: Haemoptysis, SOB, pleurtic chest pain?
Causes of lymphadenopathy
L – Lymphoma and leukaemia
I – Infection (see below)
S – Sarcoidosis
T – Tumours (primary/secondary)
Abnormal LFTs ddx
• EtOH • Viral hepatitis • PBC, AIH Gilberts • Drugs • Obstructive causes: gallstones, pancreatic ca, liver mets • Haemochromatosis • Wilsons
Epigastric pain ddx
GORD Peptic ulcer Upper GI cancer Depression Cardiac Pancreatitis Gallstones
Jaundice Acute onset (days)
Gall stones
Acute hepatitis
Budd-Chiari
Haemolysis
Jaundice RECURRENT
Gallstones
Congenital (Gilbert’s syndrome)
Jaundice onset subacute
Pancreatic, hepatobilairy malignancy
Intrahepatic cholestasis: drugs, autoimmune,infiltrate
Right-sided heart failure
DDx diarrhoea
- Coeliac
- Chron’s
- Chronic pancreatitis - alcohol
- Thyrotoxicosis
- Laxative abuse
- Carcinoid
- Colorectal cancer
- Whipple’s disease
- Bacterial overgrowth
- Tropical sprue
- Lactose intolerance
Blood PR + pain
Blood mixed with stool – source proximal to sigmoid colon: Colitis
Blood streaked on stool – sigmoid or anorectal: Anal tumour
Blood separate from stool: Colitis
Blood on toilet paper: Anal fissure
Painless PR blood
Mixed with stool: Colonic tumour
On the stool: Rectal tumour
Separate from stool: Haemorrhoids
Diverticular disease – arterial blood
Angiodysplasia – venous blood
CRCa
Blood on toilet paper: Haemorrhoids - unless thrombosed
Upper GI bleed
Bleeding dueodenal/gastric (peptic) ulcer Gastro-oesophageal varices Erosive oeophagogastritis Mallory-Weiss tear Drug related: NSAIDs Anticoagulants Steroids Alcohol Oesophageal/gastric tumours - benign or malignangt
Causes of hematuria:
- Cancer: bladder (TCC,SCC), kidney(adenocarcinoma), renal pelvis/ ureter (TCC), prostate
- Stones: kidney, ureteric, bladder
- Infection: bacterial (&TB), parasitic(schistosomiasis), infective urethritis
- Inflammation: cyclophosphamide cystitis, interstitial cystitis
- Trauma: kidney, bladder, urethra (e.g. traumatic catheterization), pelvic fracture causing urethral rupture
- Renal cystic disease (e.g. medullary sponge kidney)
Mass in RLQ
- appendicular mass/abscess
- carcinoid tumour
- crohn’s grnauloma
- Carcinoma
- volvulus
- trnasplanted kidney
DIfferentiation between CML and myelofibrosis
Massive splenomegaly with very high WCC is in BOTH
BLood film in CML: numerous granulocytes at varying stages of maturation. In myelofibrosis - teardrop cells due to haemopoeisis not in bone marrow
Marrow biopsy in CML: numerous granulocytes at varying stages of maturation. In myelofibrosis - firbosis