typical presentations and things difficult to remember

Question 1

classical phaeochromocytoma symptoms

Answer 1

(labile or postural hypotension,
headache, 
palpitations, 
pallor 
sweating

Question 2

Causes of gum hypertrophy

Answer 2

1. Scurvy
2. Pregnancy
3. Acute polymelocytic leukaemia
4. Drugs
   a. Phenytoin
   b. Nifedipine
   c. Ciclosporin

Question 3

Drugs causing peripheral neuropathy:

Answer 3

1. TCAs
2. Amiodarone
3. Metronidazole
4. Nitrofurantoin
5. AZT
6. Isoniazid
7. Phenytoin

Question 4

Causes of finger Clubbing

Answer 4

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

Question 5

Causes of cyanosis

Answer 5

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)

Question 6

Weight gain ddx

Answer 6

1. Pregnancy
2. Excessive caloric intake
3. Endocrine
   a. PCOS
   b. Cushing’s
   c. Hypothyroidism
   d. Hypothalamic disease
   e. Acromegaly
4. Drugs
   a. Steroids
   b. OCP
   c. Antidepressants
   d. Anticonvulsants
5. Depression
6. Fluid:
   a. CCF
   b. Renal failure
   c. Cirrhosis
   d. Lymphatic

Question 7

Absent radial pulse:

Answer 7

1. Aoritc dissection with subclavian involvement
2. Trauma/surgery/catheterisation
3. Arterial embolism
4. Takayasu’s arteritis

Question 8

Impalpable apex beat:

Answer 8

1. Obesity/thick chest wall
2. Lung pathology: emphysema
3. Pericardial effusion
4. Dextrocardai

Question 9

Bilaterally reduced expansion:

Answer 9

1. Obesity
2. Lung pathology (emphysema, bronchial athma, diffuse pulmoanry fibrosis)
3. Chest cage pathology eg ankylosing spondylitis
4. Neuromuscular pathology (GB syndrome, MS, MND etc)

Question 10

INCREASED vocal femitus:

Answer 10

Consolidation, Cavitation, Collapse with patent main bronchus

Question 11

DECREASED vocal fremitus:

Answer 11

pleural pathology (effusion, pneumothorax), collapse with obstructed main bronchus

Question 12

Spider naevi

Answer 12

normal in women, OCP, prengancy, liver failure

Question 13

causes of massive splenomegaly:

Answer 13

1. Myelofibrosis
2. Idiopathic tropical splenomegaly
3. Chronic myeloid leukaemia
4. Kala-azar
5. Shistosomiaisis

Question 14

other causes of moderate&mild splenomegaly

Answer 14

1. Blood dyscrasias: leukaemia, haemolysis, polycythaemia rubra vera
2. Lymphoma
3. Infections: EBV, septicaemia, bacterial endocarditis, malaria
4. Portal HTN
5. Storage disease

Question 15

causes of hepatomegaly:

Answer 15

1. Tumours: either malignant or bening
2. Cysts
3. Hepatitis: infectious
4. Other infections: EBV, bacterial
5. Hepatic vein obstruction - budd chiari
6. storage diseases: haemochromatosis, glycogen
7. tricuspid regurgitation
8. right heart failure

Question 16

palpable liver without being enlarged:

Answer 16

riedel’s lobe
emphysema
gall bladder

Question 17

DDx CHest pain

Answer 17

1. Anginal (Stable)
2. ACS
3. Aortic dissection
4. Pericarditis
   * ** GORD
5. PE
6. Pneumothorax
7. Penumonia/ pleurisy
8. Musculoskeletal
9. Pre-herpes zoster
10. trauma

Question 18

Palpitations DDx and Qs

Answer 18

1. Frequency and if paroxysmal
2. FHx (WPW, RVAH)
3. THyrotoxicosis
   4, ? Infective endocarditis
4. Stimulant use: coffee, energy drinks, tea, amphetamines
5. Anaemia
6. Anxiety

Question 19

Vertigo DDx

Answer 19

1. BPPV - lasts seconds, provokes by head movements
2. Meniere’s disease - can last hours, tinnitus, hearing loss, sense of fullness in the ear
3. Labyrinthytis - almost constant, previous infection, discharge
4. Trauma
5. DRUGS
   —-Vestibular:
   Aminoglycosides (gentamicin)
   Furosemide
   Quinine
   Salicylate
   — Cerebellar:
   Phenytoin
   EtOH

Question 20

Acute single episode of headache :

Answer 20

SAH
Idiopathic cranial HN
Cerebral vein thrombosis
Acute Meningitis, encephalitis
Acute carotid dissection
\+/- GCA

Question 21

Subacute progressive headache

Answer 21

Raise ICP (tumour, abscess, Idiopathic intracranial HTN)
Infections - meningitis, encephalitis
Temporal arteritis

Question 22

Recurrent headaches

Answer 22

Migraine
Tension headache
Cluster headache
Drugs: nitrates, dipyridamole

TRIGEMINAL NEURALGIA

Question 23

chronic headache

Answer 23

Chronic daily headache syndrome
Hronic migraine
Medication overuse
Cervicogenic

Question 24

DDx Acute painful and prolonged visual disturbance/LOSS

Answer 24

1. Acute angle closure glaucoma
2. GCA
3. Optic neuritis
4. Anterior uveitis
5. Endophthalmitis
6. Orbital ecellulitis

Question 25

DDx acute painless and prolonged visual disturbance/loss

Answer 25

1. Central or branch retinal vein occlusion 2. Central or branch retinal artery occlusion 3. Anterior ischaemic optic neuropathy 4. Retinal detachment or vitreous haemorrhage 5. Macular haemorrhage

Question 26

DDx acute painless and fleeting visual loss

Answer 26

1. Amaurosis fugax | 2. Raised ICP

Question 27

Gradual visual loss DDx

Answer 27

1. Cataracts 2. Diabetic retinopathy 3. Age related macular degeneration 4. Chronic glaucoma

Question 28

acute +/- progressive LIMB WEAKNESS DDx

Answer 28

1. GBS - prior viral/diarrhoeal illness 2. Stroke -speech, LOC, face, RISK FACTORS, AF 3. TIA - speech, resolved completely, risk factors 4. SPINAL CORD COMPRESSION - ? malignancy OR trauma, sphincter disturbance, pain

Question 29

subacute limb weakness ddx

Answer 29

1. MS - episodes where weakness paritally/completely resoved 2. SOL - raised ICP sx 3. Myasthenia gravis - fatiguing 4. Lambert-Eaton - malignancy 5. MND - NO sensory Sx 6. Peripheral neuropathies -sensory Sx burning tingling, anaemia, vegan

Question 30

DDx chronic cough

Answer 30

``` GORD Asthma Post-viral Rhinitis/sinusitis Drugs, eg ACEi Lung tumour TB Interstitial disaese Bronchiectasis ```

Question 31

HAEMOPTYTSIS ddx

Answer 31

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

Question 32

Dyspnoea Progression and onset | Minutes

Answer 32

``` PE Pneumothorax Asthma Ihaled foreign body Acute LVF ```

Question 33

dyspnoea onset over hours- days

Answer 33

Pneumonia Athma IECOPD

Question 34

dyspnoea onset/progression over weeks - years

Answer 34

Anaemia Pleural effusion Neuromuscular disorder AS ``` Months-years: COPD Fibrosis TB Pulmonary HTN ```

Question 35

Weight loss wiht preserved appetite

Answer 35

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

Question 36

Weight loss with norexia

Answer 36

?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)

Question 37

DDx painful swollen leg

Answer 37

``` DDx DVT Cellulitis Ruptured Baker’s cyst Neuropathy ``` Neurological: muscle weaknes, wasting, ssensory, back pain Bladder or bowel problems >> CAUDA EQUINA PE: Haemoptysis, SOB, pleurtic chest pain?

Question 38

Causes of lymphadenopathy

Answer 38

L – Lymphoma and leukaemia I – Infection (see below) S – Sarcoidosis T – Tumours (primary/secondary)

Question 39

Abnormal LFTs ddx

Answer 39

``` • EtOH • Viral hepatitis • PBC, AIH Gilberts • Drugs • Obstructive causes: gallstones, pancreatic ca, liver mets • Haemochromatosis • Wilsons ```

Question 40

Epigastric pain ddx

Answer 40

``` GORD Peptic ulcer Upper GI cancer Depression Cardiac Pancreatitis Gallstones ```

Question 41

``` Jaundice Acute onset (days) ```

Answer 41

Gall stones Acute hepatitis Budd-Chiari Haemolysis

Question 42

Jaundice RECURRENT

Answer 42

Gallstones | Congenital (Gilbert’s syndrome)

Question 43

Jaundice onset subacute

Answer 43

Pancreatic, hepatobilairy malignancy Intrahepatic cholestasis: drugs, autoimmune,infiltrate Right-sided heart failure

Question 44

DDx diarrhoea

Answer 44

* Coeliac * Chron's * Chronic pancreatitis - alcohol * Thyrotoxicosis * Laxative abuse * Carcinoid * Colorectal cancer * Whipple's disease * Bacterial overgrowth * Tropical sprue * Lactose intolerance

Question 45

Blood PR + pain

Answer 45

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

Question 46

Painless PR blood

Answer 46

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

Question 47

Upper GI bleed

Answer 47

``` 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 ```

Question 48

Causes of hematuria:

Answer 48

* 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)

Question 49

Mass in RLQ

Answer 49

1. appendicular mass/abscess 2. carcinoid tumour 3. crohn's grnauloma 4. Carcinoma 5. volvulus 6. trnasplanted kidney

Question 50

DIfferentiation between CML and myelofibrosis

Answer 50

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