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MC > Inspection as a Clinical Skill > Flashcards

Inspection as a Clinical Skill Flashcards

1
Q

____________ meaning
the judging of one’s nature, is the art of judging
character from the features of the face

A

Physiognomy, from the Greek physiognomonia,

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2
Q

Thickening of the subcutaneous

tissues may be seen in ____, ______ and ____

A

chronic alcoholism, acromegaly

and myxoedema

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3
Q

The enlarged characteristic face is due to a large supraorbital ridge that causes frontal bossing, a broad nose and a prominent broad and square lower jaw.

Other
features include an enlarged tongue and soft tissue
swelling of the nose, lips and ears

A

Acromegalic

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4
Q

Due to mouth breathing in children: a narrow nose/
nares, a high-arched palate (the ‘Gothic’ palate),
prominent incisor teeth, undershot jaw with a
perpetually open mouth and ‘stupid’ expression

A

Adenoidal

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5
Q

plethoric face, thickened ‘greasy’ skin, telangiectasia, suffused conjunctivae and rosacea.

A

Alcoholic (due to chronic use)

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6
Q

Other features may include rhinophyma,
parotid swelling and characteristic changes to the lips
and corners of the mouth

A

Alcoholic (due to chronic use)

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7
Q

The bird-like features—beaking of the nose,
limitation of mouth opening, puckering or furrowing
of the lips and a fixed facial expression—are due to
binding down of facial skin

A

Bird-like (systemic sclerosis: CREST

syndrome)

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8
Q

Other features of CREST include

_______ and ____

A

telangiectasia on the face and hands

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9
Q

There is bossing of the skull, hypertrophy of the
maxillae (which tends to expose the upper teeth),
prominent malar eminences and depression of the bridge of the nose

A

Chipmunk (thalassaemia major)

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10
Q

The major haemoglobinopathies
cause _______ of the skull and facial bones because
of an increase in the bone marrow cavity.

A

hyperplasia

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11
Q

The patient with _______ has a pale face with cold
clammy skin, sunken eyes, hollow cheeks and a
forlorn, apathetic look (similar to the Hippocratic
facies

A

cholera

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12
Q

The face has a typical ‘moon shape’, plethora, hirsutism

(more obvious in women), acne

A

Cushingoid

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13
Q

This describes the deathly, mask-like features of advanced
peritonitis—sunken eyes; ‘gaunt’ face; ‘collapsed’
temples; dry, crusty lips; and clammy forehead

A

Hippocratic

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14
Q

The typical tall stature, arachnodactyly and chest
deformities, combined with the facial features of a
subluxation of the lens of the eye and high-arched
palate, help to pinpoint the diagnosis

A

Marfanoid (Marfan syndrome)

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15
Q

This is typically shown in flushed or rosy cheeks with
a bluish tinge due to dilatation of the malar capillaries.
It is associated with pulmonary hypertension.

A

Mitral (mitral valve disease, especially

mitral stenosis)

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16
Q

The facial features include a flat profile, with crowded
features, a round head, dysplastic lowset ears,
protruding tongue, mongoloid slant of the eyes with
epicanthic folds, mouth hanging open

A

Mongoloid (Down syndrome)

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17
Q

peripheral silver iris spots in pts with DS

A

Brushfield’s spots

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18
Q

Facial characteristics include an expressionless,

‘tired’-looking face with bilateral ptosis.

A

Myopathic (myopathy/myasthenia gravis)

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19
Q

Typical features include frontal baldness,
expressionless triangular facies, partial ptosis,
cataracts and temporal muscle atrophy

A

Myotonic (dystrophia myotonia)

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20
Q

The face usually has an apathetic look and is ‘puffy’

with possible periorbital oedema

A

Myxoedemic (hypothyroidism)

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21
Q

In pts with Myxedema coma:

The skin (not the sclera)
may appear yellow (due to ______) and is
generally dry and coarse

A

hypercarotenaemia

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22
Q

Type of speech in pts with myxedema coma:

A

The tongue is usually
enlarged and the patient speaks with a ‘thickened’,
croaking, slow speech

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23
Q

The main feature is skull enlargement, notably of the
frontal and parietal areas (the head circumference is
usually greater than 55 cm, which is abnormal)—the ‘hat
doesn’t fit any more’ hallmark.

A

Pagetic (Paget disease)

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24
Q

Other features of Paget:

A

Other features include

increased bony warmth and deafness

25
Q

Characteristic is the mask-like facies with lack of
facial expression and fixed unblinking stare. There is
immobility of the facial muscles

A

Parkinsonian

26
Q 
Pigmented macules (1–5 mm in diameter) occur on
lips, buccal mucosa and fingers.
A

Peutz–Jegher’s

27
Q

A face older than the years with premature gross
wrinkling of the skin, stained teeth, deep raspy voice,
‘loose’ cough, smell of tobacco.

A

Smoker’s

28
Q

The prominent eyes (sclera may not be covered by
the lower eyelid) and conjunctivitis are features of the
_____

A

thyrotoxic patient

29
Q

The facial characteristics include ptosis—‘fishlike’
mouth, small chin (micrognathia), low-set ears and
deafness.

A

Turner syndrome

30
Q

Cardio lesions in Turner syndrome

A

Cardiac lesions include coarctation of the

aorta and pulmonary stenosis

31
Q

Classic sign of Turner syndrome

A

Webbing of the neck is

the classic sign

32
Q

A sallow ‘muddy’ complexion with uraemic fetor—an

ammoniacal halitosis

A

Uraemic

33
Q

Ddx for malar rash

A

SLE, Rosacea, • Erysipelas • Seborrhoeic dermatitis • Photosensitivity eruptions

34
Q

Erythema, scaling with a discrete red advancing
edge on the cheeks and bridge of the nose; the
sharp border, lack of pustules and adherent scale
make it differ from rosacea

A

• SLE

35
Q

Papules, pustules and telangiectasia on an
erythematous background on cheeks, forehead
and chin

A

• Rosacea

36
Q

Painful, erythematous, indurated skin infection

with a well-defined raised edge

A

• Erysipelas

37
Q

Red and scaly rash involving eyebrows, eyelids,

nasolabial folds

A

• Seborrhoeic dermatitis

38
Q

Erythematous on areas that are exposed to the sun

A

• Photosensitivity eruptions

39
Q

Increased browning pigmentation, usually confined

to symmetrical areas of the cheeks

A

Chloasma/melasma

40
Q

Drugs causing melasma:

A
  • combined oral contraceptive pill
  • hydroxychloroquine (Plaquenil)
  • diphenylhydrazine
41
Q

Causes of Malar flush

A
  • Mitral stenosis
  • Pulmonary stenosis
  • Rosacea
  • SLE
  • Mesenteric adenitis
42
Q

Causes of Spider naevi

A
  • Pregnancy
  • Liver disease
  • Vitamin B deficiency in normal people
43
Q

Causes of enlarged tongue

A
  • Acromegaly
  • Hypothyroidism
  • Amyloidosis
  • Down syndrome
44
Q

Causes of cataracts

A
  • Senility
  • Corticosteroid therapy
  • Diabetes
  • Hypoparathyroidism
  • Dystrophia myotonia
  • Trauma
  • Ocular disease (e.g. glaucoma
45
Q

Causes of telengiactesia

A

Systemic sclerosis
• CREST syndrome
• Liver disease (e.g. alcoholism

46
Q

_____ is a bluish discolouration of the skin and
mucous membranes due to deoxygenated haemoglobin
concentrated in the superficial blood vessel

A

Cyanosis

47
Q

02 treshold for cyanosis

A

The
arterial oxygen saturation is 80–85% before it is clinically
apparent.

48
Q

Types of Cyanosis

A

It is classified as central or peripheral.

49
Q

Type of cyanosis:

Cyanosis is present in parts of the body with good
circulation, such as the lips and tongue

A

Central

50
Q

Causes of central cyanosis

A

The main causes are pulmonary disease,
pulmonary oedema, cyanotic congenital heart
disease (right to left shunt), respiratory depression,
polycythaemia

51
Q

Cyanosis is in the extremities, such as the outer surface

of the lips, nose and ears

A

Peripheral

52
Q

Causes of peripheral cyanosis

A

The main
causes are peripheral vascular disease, cardiac failure,
‘shock’, exposure to cold, left ventricular failure and
all causes of central cyanosis .

53
Q

Characteristics of clubbing

A 
• Loss of usual angle between base of nail and nail
fold
• Curvature in two planes
• Increased sponginess in base of nail
• Increased convexity of nail
54
Q

Usual etiology of clubbing:

A

respiratory diseases

55
Q

Common causes of inc pigmentation:

Increased melanocyte-stimulating
hormone (MSH)

A

Addison disease (see CHAPTER 23)
• Cushing syndrome
• Ectopic ACTH syndrome

56
Q

Common causes of inc pigmentation:

Metabolic

A
  • Hyperthyroidism
  • Haemochromatosis
  • Cirrhosis of the liver
  • Porphyria
  • Chronic kidney failure
  • Malnutrition/malabsorption
  • Pregnancy
57
Q

Drugs causing inc pigmentation:

A
  • Amiodarone
  • Antibiotics (busulphan, bleomycin, minocycline)
  • Antimalarials (chloroquine/hydroxychloroquine)
  • Arsenic, gold, silver
  • Chemotherapy
  • Dapsone
  • Oral contraceptive pill (OCP)
  • Phenothiazines
  • Photochemotherapy (PUVA)
  • Psoralens
  • Thiazides
58
Q

Tumors causing inc pigmentation:

A
  • Lymphomas
  • Acanthosis nigricans
  • Metastatic melanoma

MC (90 decks)

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