Other cases - symptoms + signs Flashcards
Cataracts signs and symptoms
• Subjective decrease in vision
o Classic presentation: gradual decrease in vision over many years that the patient may be very slow to recognise until there is some visual impairment
• Reduced visual acuity (cannot be corrected by refractive correction)
• Decreased contrast sensitivity/Washed-out colour vision
• Blurred or cloudy vision
- Glare
- Halos around lights
- Defects in red reflex
• Painless
Loss of vision in glaucoma
Damage to optic disc leads to progressive peripheral visual loss initially and then progresses more centrally as pressure increases
Open angle glaucoma symptoms + signs
- BILATERAL
- Frequently present asymptomatically
- Initial visual loss is to peripheral vision - patient don’t notice visual loss until severe + permanent damage has occurred impacting on central (foveal)
- May be identified on routine ophthalmic examination
- Elevated IOP (>21mmHg)
Closed angle glaucoma symptoms + signs
• UNILATERAL
• Acute angle-closure glaucoma – urgent o Painful red eye (aching eye or brow pain, redness is more marked around the periphery of the cornea) o Blurring of vision o Reduced visual acuity o Halos around eyes o Corneal oedema o Cloudy cornea o Fixed DILATED pupil (iris ischaemia) o Headache o N+V
• Elevated IOP (>21mmHg)
Anterior uveitis signs + symptoms
- Unilateral, autoimmune
- Progressive – occurs over a few hours/days
- Pain (worse when trying to read)
- Headache
- Photophobia
- Eye redness
- Tearing – watery eyes without purulent discharge
- CONSTRICTED or non-reactive pupil
- Decreased visual acuity
- Decreased IOP
- Corneal oedema
• Flare – hallmark of anterior uveitis
o Leukocytes floating in the aqueous humour of the anterior chamber – aqueous humour looks cloudy
o Hypopyon – highly suggestive of diseases associated with HLA-B27 + Bechet’s
• Keratic precipitates
o Inflammatory cells (lymphocyte aggregates) clumped together on the posterior part of the cornea as little white spots
- Ciliary flush – violaceous ring around the cornea, suggests intraocular inflammation
- Synechiae – iris adherence to cornea or lens from acute inflammation
Posterior uveitis signs + symptoms
- Bilateral, infective
- Painless
- Decreased vision – blurred vision, decreased acuity, decrease in visual fields
- Floaters + scotomata
• Optic disc swelling, oedema, optic nerve oedema, macular oedema
- Retinal exudates, Retinal vasculitis, Retina haemorrhages
- Retinal vascular sheathing = accumulation of inflammatory cells along the vessel walls
- Inflammatory lesions may be seen on the retina or choroid (yellow when fresh, white if older)
Conjunctivitis signs + symptoms
- Painless
- “foreign body” sensation
- Crust + discharge
- No photophobia, no change in visual acuity
- Conjunctival hyperaemia – pink eye
- Chemosis – oedema of the eyelid
Viral vs bacterial vs allergic conjunctivitis
Viral • Bilateral • Water discharge • Eyelids stuck together in morning • Normal vision • o/e Tender, pre-auricular lymphadenopathy • o/e Follicles – round collections of lymphocytes most prominent on the lower tarsal conjunctiva • Hx of URI, sore throat, fever
Bacterial • Unilateral • Purulent discharge (dead neutrophils) • Painful • Eyelids stuck together in morning • Reduced vision • o/e Follicles – round collections of lymphocytes most prominent on the lower tarsal conjunctiva • might have a Hx of STD so urethritis/vaginal discharge?
Allergic
• Bilateral
• Watery with mucus
• Itching
• Sneezing
• o/e Papillae – cobblestone appearance of flattened nodules most prominent on the upper tarsal conjunctiva
• Hx - Seasonal element – they had similar symptoms at the same time last year
Rheumatic fever signs + symptoms
• Fever, malaise, anorexia
• 5 major manifestations
o Carditis (pancarditis – pericardium, myocardium, endocardium affected) – chest pain, SOB, palpitations, heart murmur (most commonly MR), pericarditis, cardiomegaly, signs of HF
o Arthritis – swollen, hot, tender joints, restricted movement (wrists, elbows, hips, knees, ankles)
Joint pain is extreme + if the lower limbs are affected the patient often cannot walk
o Chorea – rapid, involuntary irregular movements with flowing or dancing quality, F>M
o Erythema marginatum – transient erythematous rash with raised edges on the trunk and proximal limbs but never on the face, exacerbated by heat and fades when the patient is cool
o Subcutaneous nodules – extensor surfaces, firm, painless
• Heart murmurs (mitral>aortic>tricuspid)
o Carey Coomb’s murmur
Mitral valvulitis due to vegetations on the mitral valve
o Austin flint murmur
Aortic regurgitation
Result of a) mitral valve leaflet displacement + b) turbulent mixing of anterograde mitral flow and retrograde aortic flow [better explanation on the “other cases” document]
HSV1 infection symptoms + signs
- Herpes labialis Gingivostomatitis - children Pharyngitis - adults Cold sores Prodrome of pain, burning, tingling Vesicles form (48h), ulcerate, crust + heal in about 10 days
- Ocular herpes
Keratoconjuctivitis
Cornea - blurry vision, branching dendritic lesion
Conjunctiva - pain, redness, tearing, sensitivity to light
Systemic infection - fever, sore throat, lymphadenopathy, pneumonitis, hepatitis
Herpes simplex meningitis, encephalitis - fever, fits, headaches, odd behaviour
Eczema herpeticum
Herpetic whitlow - vesicle in finger
• Classical clinical presentation – tingling sensation > vesicles > painful ulcers > crusted lesions
HSV2 infection symptoms and signs
- Genital herpes
- Flu like prodrome (5-7 days, myalgia + fever)
- Tender inguinal lymph nodes
- tingling neuropthic pain in genital area/buttocks/legs
- Vesicles/papules aroudn genitals + anus (vulva, perineum, shaft of penis)
- Shallow ulcers
- Urethral discharge
- Dysuria
- Systemic symptoms - fever, malaise
• Classical clinical presentation – tingling sensation > vesicles > painful ulcers > crusted lesions
VZV symptoms and signs - primary infection
Primary infection – varicella/ chicken pox
• Systemic symptoms/Flu prodrome - Fever, headache, malaise
• Pruritic, vesicular rash - Skin lesions on scalp, face, trunk
o Macules > papules > fluid filled vesicles > scubs
o Lesions are continuously forming every 3-5 days
o Typical appearance – macules, papules, vesicles, scabs all at the same time
o Contagious from 48h before the rash until all the vesicles have crusted over (within 7-10 days)
• Painful sores on mucosal surfaces
VZV symptoms and signs - secondary infection
Secondary infection - Herpes zoster/Shingles
• Pain, itching, tingling in the area before the rash develops
• Followed by painful skin lesions
• Single stripe of vesicles around either the L or R side of the body or on one side of the face
• Appears only on one side of the body (ipsilateral side of affected trigeminal ganglion)
• Affects branches of the trigeminal nerve
o If ophthalmic division is affected conjunctivitis, keratitis, iridocyclitis
• Takes 4 weeks for the rash to disappear
• Postherpetic neuralgia – pain in the affected dermatome that lasts >90 days
o Virus also infects sensory neurones in the skin – travels retrogradely through the nerve to the dorsal root ganglion or the trigeminal ganglion (if it’s on the face) where it remains dormant for many years
o Immune system weakens - virus reactivated
o The virus can then travel anterogradely through the nerve from the ganglion to the skin + cause an infection in the innervated dermatome - herpes zoster (shingles)
EBV infectious mononucleosis glandular fever symptoms + signs
- Fever
- Pharyngitis (exudative or non-exudative)
- Lymphadenopathy (most commonly posterior cervical chain that drains the tonsils)
- Sore throat
- Tonsillar enlargement
- Malaise
- Hepatosplenomegaly (jaundice)
- Fine macular non-pruritic rash (which rapidly disappears)
HIV symptoms + signs
- FLAWS
- Generalized painless lymphadenopathy
• Oral ulcers, angular cheilitis, oral thrush, oral hairy leukoplakia
• HIV wasting syndrome (AIDS defining illness, WHO stage 4)
o Unexplained weight loss/Wasting
o Unexplained fever lasting >1 month
o Unexplained chronic diarrhoea lasting >1 month
• AIDS defining conditions
o Recurrent bacterial pneumonia
o Pneumocystis jirovecii pneumonia – Bilateral pulmonary interstitial infiltrates – buzzword for PCP
o Fungal infections (candidiasis of oesophagus)
o Kaposi sarcoma– pink/violaceous patch on the skin or in the mouth, caused by HHV8
o Squamous cell carcinoma – particularly cervical or anal due to HPV
o Primary lymphoma of the brain
• Infections from
o Bacteria – Mycobacteria (pulmonary + extrapulmonary TB), staphylococci, salmonella, capsulated organisms
o Viral – CMV, HSV (encephalitis), VZV (recurrent shingles), HPV (warts), papovavirus (progressive multifocal leukoencephalopathy), EBV (oral hairy leucoplakia)
-Hairy leucoplakia – irregular, white, painless palques on lateral tongue that cannot be scraped off – EBV mediated, occurs in HIV +ve patients, organ transplant patients
(contrast with thrush (scrapable), leukoplakia (precancerous)
o Fungal – pneumocystis pneumonia (PCP), cryptococcus (meningitis), candida, invasive aspergillosis
o Protozoal – toxoplasmosis, cryptopsporidia, microsporidia (diarrhoea)
Tonsilitis symptoms + signs
- Sudden onset of sore throat, cough, runny nose
- Pain on swallowing
- Fever (>38)
- Tonsillar exudate, tonsillar erythema, tonsillar enlargement
- Enlarged anterior cervical lymph nodes
- Headache
- Abdominal pain, N+V
- No cough or coryza
- Classical streptococcal tonsillitis – acute onset, headache, abdominal pain, dysphagia
Centor criteria demonstrate Group A beta-haemolyic streptococcus (GABS) infection :
o Tonsillar exudate
o Tender anterior cervical lymphadenopathy or lymphadenitis
o History of fever over 38
o Absence of cough
Alcohol withdrawal - when do the symptoms begin?
• Symptoms typically begin 6-12h after the patient’s last alcoholic drink
Alcohol withdrawal symptoms + signs
6-12h after the pt last alcoholic drink
12-24h
36h
48-72h
6-12h - sympathetic arousal Restlessness Headache Anorexia Depression
12-24h - mind becomes overactive
Psychiatric disturbance – agitation, hallucinations
Normal mental status
36h - body becomes overactive
Seizures – short, generalised, tonic-clonic seizures
48-72h - system becomes overactive
DELIRIUM TREMENS
Symptoms are rapid in onset + difficult to control
Psychiatric disturbance – agitation, hallucinations, altered cognition
Profound confusion/delirium – fluctuating in nature, pt disorientated to time, person, place, clouding of consciousness
Hyperalert state – Visual, auditory, tactile hallucinations, frightening delusions – pt responding to unseen stimuli
Pins + needles, burning, numbness
Coarse tremor
Features of clinical instability – tachycardia, fever, ketoacidosis, circulatory collapse
Hypertension > hypotension
Fever>Hypothermia
Anaphylaxis symptoms + signs
• Airway
o Wheezing
o Inspiratory stridor
o Angio-oedema (= manifestation of immediate hypersensitivity with a circumscribed swelling of any part of the body, incl the airway, throat, tongue, pharynx, larynx) – throat/tongue swelling
• Breathing
o SOB, Increased RR, decreased O2
• Circulation
o Hypotension (widespread vasodilation)
o Tachycardia becoming bradycardia just before cardiac arrest
o Decreased consciousness
• Skin o Urticaria o Angio-oedema o Skin rash o Pale, clammy skin o Flashing
• Abdominal cramps, vomiting, diarrhoea
Symptoms commonly peak within 30 mins
Aspirin overdose symptoms + signs
Early presentation o N+V o Lethargy o Tinnitus o Dizziness o Hyperventilation, Kussmaul’s respiration - respiratory alkalosis o Confusion o Dehydration o Restlessness o Fever, Sweating
Late/Severe presentation o Low GCS o Hallucinations o Seizures o Coma o Cerebral oedema o Pulmonary oedema o Warm extremities with bounding pulses o Deafness o Low bp + heart block
Tinnitus, deafness, dizziness (aspiringing)
Hyperpnoea (rasp-irin)
N&V, diarrhoea (most poisonings)
[+ hyperthermia, sweating] Per-spirin-g
Paracetamol overdose signs + symptoms
• First 24h
o Patients often asymptomatic
o May have mild GI symptoms at initial presentation – nausea, vomiting, abdominal pain
• After 24h
o Hepatic necrosis - Increased transaminases, RUQ pain, jaundice, hepatomegaly
o Hepatotoxicity after paracetamol overdose – serum [AST] >1000 IU/L
• >72h
o Can progress to acute liver failure
• Massive overdose may initially present with coma + severe metabolic acidosis
Opiate overdose signs + symptoms
• CNS and respiratory depression
- Miosis - pinpoint pupils
- Bradypnea <12 breaths/min
- Altered mental status – drowsiness, sleepiness
- Apnoea
- Hypotension
- Increased GI motility
• Dramatic response to naloxone – diagnostic of opioid overdose
IV naltrexone + IV methadone - used to wean someone off opioids/used to manage opioid dependence
Describe the lesion in squamous cell carcinoma
o Well-circumscribed, rolled edges
o Hyperkeratotic
o Red elevations with scaly plaques
o Sometimes ulcerate
o Bleed easily
o Non-healing
• Keratin horn present – shows that SCC is well differentiated as keratinocytes still have the ability to produce keratin
o Lump/No keratin horn - lost their ability to make keratin - poorly differentiated - more likely to metastasise
Can metastasise
Cancer of keratnocytes in the epidermis
Describe the lesion in basal cell carcinoma
- Well-circumscribed
- Pearly/Waxy/shiny
- Rolled borders
- Elevation of the skin
- Telangiectasias
- Small crusts
- Non-healing wounds
- Can also be ulcerated + pigmented
Do not typically metastasise
Cancer of keratnocytes in the epidermis (in stratum basale)
