Clinical Features

Question 1

HF

Answer 1

Left
SOB, Orthopnea, PND, Frothy Cough, Cardiomeg, Displaced Apex Beat, effusion

Right
Raised JVP, Peripheral Oed, Hepatomeg

Acute - N+V, Pain?

*ECG - LVH, ST elev, arrythmia, evidence past MI

Question 2

STEMI

Answer 2

Tight chest, 
N+V,
Pain radiating to arm, 
SOB, 
Sweaty, 
cool clammy peripheries
Hypotension

*ECG - ST el + Q waves + recipricol ST dep

Question 3

AF and Hypertension

Answer 3

AF
Palpitations, 
irregularly regular pulse
fatigue
>65

*5x risk of stroke / RF - HTN/CAD/DM/Smoking/Old

HTN
Retinal haem
Proteinuria
papilloedema
epistaxis
angina
LVH

Question 4

AS vs Mitral Regurg

Answer 4

AS
Slow Rising Pulse
Harsh, ejection systolic murmur
Radiating to carotids, heard in right aortic area
LVH, SOB, Chest Pain, Previous Syncope

MR
Pansystolic Murmur, radiating to axilla, heard in mitral area
Displaced apex beat
Pul Oedema
SOB on exertion
Hist I.E

Question 5

IE

Answer 5

Roth Spots
January Lesions
Splinter Haem
Oslers Nodes
MR

*DUKES staging

Question 6

Pericarditis

Answer 6

Better leaning forward
Sharp, Central Chest Pain, radiating to left shoulder
Worse on insp
fever
Pericardial rub

*ECG - Saddle shaped

Question 7

HyperThyroid

Answer 7

Heat Intolerance
Agitated
Weight Loss
Appetite Increase
Palpitation
Tremor
Goitre (with bruit if graves)
Exopthalmus
Lid Lag

*Must do ECG - AF

Question 8

HypoThyroid

Answer 8

Goitre
Cold Intolerance
Weight Gain
Thin Hair/ Loss
Ammenorhea
Lethargy
Constipation
Bradycardia
Depression

Question 9

Diabetes

Answer 9

Pear Drop Taste in mouth
Polydipsia, Polyuria
Weight Loss
Dizziness/ Drowsiness
2-6 weeks post infection

complications
Neuropathy/ Ulcers

Question 10

Cushings

Answer 10

Obese
Striae
Coarse Skin
Buffalo Hump
Moon Face
Gray Complexion
Decreased Libido
Impotent/ Amenorrhea
BP increase

Question 11

Addison’s

Answer 11

Bronze Colour
Weight Loss
Anorexia
Postural Hypotension
Hypotension
N+V
Fatigue
Hyperkalaemia - Arrythmias

Question 12

COPD vs Asthma

Answer 12

COPD
RESP DISTRESS - SOB, wheeze, Cough,Increased RR, Pursed lip breathing, Acces muscles, barrel chest,
INFECTION - Consolidation? Fever,decreased chest expansion
CO2 ret flap, drowsy

Asthma
Wheeze, cough, sob, atopy

Question 13

Pneumonia

Answer 13

Tachycard/dysp
Sputum cough (haemop)
Fever
Pain in area of infection
Decreased air entry
Coarse Crackles heard
Increased Tactile/Vocal Frem
Dull Percussion

*CURB 65 score

Question 14

PE

Answer 14

Pleuritic Pain
Worse on Insp
SOB
Risk Factors for PE
Haemoptysis
Periph Oedema
RR/HR increase and Infection signs

*ECG - S1 Q3 T3

Question 15

Tension Pneumo/ Effusion

Answer 15

TP
Increased HR/RR
Tracheal Deviation
Decreased air entry affected side
Pain

Effusion
Stony Dull Percusion
Bronchial Breathing
Decreased air entry/decrease tactile frem/breath sounds
Tracheal Deviation
SOB and Pain

*Exudate or transudative - 11.1 g/L

Question 16

Bronchiectasis

Answer 16

Lots of purulent sputum with cough
Persistant cough
Haemop
Coarse Insp Crackles
Finger Clubbing
wheeze

Question 17

Lung CA

Answer 17

HOARSE VOICE
Pain
Lymph Nodes - Sub Clav
Clubbing
Haemoptysis
Weight Loss
Appetite Loss
Perhaps bone issues
Cough
Other infections

Question 18

Sarcoidosis

Answer 18

Bilateral Lymphadenopathy
Erythema Nod
Polyarthralgia
SOB
Wheeze
cough

Question 19

Oes Ca

Answer 19

HOARSE VOICE
Dyspahgia
Weight Loss and appetite loss
retro-sternal Pain
cough?

*OGD + biopsy / Barium Swallow

Question 20

Ulcers

Answer 20

Epigastric Pain (localised by pointing)
tenderness
heartburn
IF SEVERE - Weight Loss, anorexia

GU - worse when eating
DU - relieved by eating

*Think Complications for PC - haematem/melaena/anaemia

Question 21

Gallstones

Answer 21

Fat Forty Fertile Female Fam Hx

RUQ pain and Guarding
Jaundice
N+V
fever
Murphy’s Sign +ve

*ERCP/ MRCP major diagnostic if in bile duct

Question 22

Acute Panc vs Panc CA

Answer 22

LUQ radiating to back, Guarding and Tender
Better sitting forward
Fever and Vomiting?
Jaundice?
Pale, Fatty Stools

*Classified-PANCREAS / COMP= Renal Fail/Shock/Sepsis

Panc CA
Palpable mass gallbladder
Painless jaundice
HepatoSplenomegaly

Question 23

Colon CA L vs R

Answer 23

L
Tenesmus
Altered bowel Habit
Mucus/Blood Stool
PR Mass

R
Weight Loss
Blood in Stool/ Hb Decrease
Abdo Pain
Palp Mass

*RF - IBD/Neop Polyps/ Prev CA
I - FOB, Scopes

Question 24

Bowel Obs Sm vs L

Answer 24

Sm
Less distension
Nausea earlier
Constipation
Tinkling bowel sounds
Central Abdo, Colicky pain
L
More distension
Later Nausea
Constant Pain
Tympanic Percussion of Abdo

*Comp - Perforation (erect cxray), Sigmoid Volv, Sepsis

Question 25

Acute Appendix

Answer 25

``` Fever Increased HR/RR Anorexia Pain starts epigastric and moves RIF - Rosving sign +ve - Pain over McBurneys Point - Rebound Tenderness ``` *Do preg test if aprop/ 1st management = NBM

Question 26

Venous Disease

Answer 26

``` Ulcers - Anterior Tibial / medial malleolus - Not well circumscribed/ uneven edges - No Necrosis Varicose Veins Vascular Dermatitis Warm peripheries, Normal Colour Moderate Pain ankle oedema ``` *RF - DVT / Preg / Pill / Obesity

Question 27

Arterial Disease

Answer 27

``` Ulcers - Tips of toes and between toes - Black, necrosis - Well circumscribed Absent Pulses Cool peripheries BIG Pain on exertion, better at rest (unless crit limb isc) Cap Refill >2secs ``` *Bueger’s Sign / Brachial Ankle Pressure + Duplex US T - Stent/ Amputation/ Lifestyle/ Embolectomy?

Question 28

Breast Lumps

Answer 28

Cyst - fluid filled, mid age(perimeno), linked to HRT, mobile Fat Nec - trauma,skin change, firm, painless, irreg border FibroAd - young, mouselike, small, mobile, smooth Phyllodes - growing, defined, necrosis CA Asymmetry, hard, tethered, craggy, lymph nodes involved, skin changes, nipple changes (inversion, discharge, pagets) *Brown/Yellow Discharge = Duct Ectasia Red - CA or Intra-Duct Pap

Question 29

IBD

Answer 29

UC - Gradual Onset, Bloody diarr, >10 times per day, pain, smoker, Erythema Nod, pyoderma gang, LIF pain *Compl - Tox megacolon, Perf, CA, PSC? Crohns - RIF pain, crampy type, not as much bloody diarr, non-smoker, vomiting * Compl - Sm Bowel Obs/ Fistula/ Toxic Dilatation

Question 30

Hepatitis

Answer 30

``` RUQ pain, jaundice (and itch) N+V confusion and lethargy Fever Hepatomegaly ``` dark Urine *if Paracetamol OD - N-acetyl cysteine

Question 31

Haemachrom (AR)

Answer 31

Slate gray, can be bronze if diabetic Sign of Chronic Liver Disease Fatigue Arthrlagia *Treated with Venesection

Question 32

Alfa 1 antitryp (AR)

Answer 32

Affects Lungs, Liver and … Lung - Productive Cough, SOB on exertion Liver - Hepatomeg, Ascites, Jaundice

Question 33

Wilsons (AR)

Answer 33

Aged 10-40 Hepatitis Cirrhosis Hepatic Decomp Copper buildup, around iris? *linked to Parkinson's

Question 34

PBC vs PSC

Answer 34

PBC - women Granulomatous inflam in Bile Duct —> obstruction xanthelasma, jaundice, hepato/splenomeg, itch *Anti-Mitochond AB’s // Both Need Transplant!!! PSC - men Inflammation of Med/L Bile ducts —> fibrosis —> stasis Hx of UC (80%) Jaundice, Itch, Fatigue —> fever + cholangitis

Question 35

Cirrhosis

Answer 35

Signs of Chronic Liver Disease!!! Spider Naevi, Liver Flap, Dupytrens, Caput Medusae, Plmer erythema Bleeding and Bruising Jaundice, itch Haematemesis Portal Hypertension - Ascites, Varices, Enceph *T of Ascites - Decrease Na, LVP, Duretic, Transplant

Question 36

Coeliacs

Answer 36

``` Diarr Anaemic - decreased B12, Folate and Iron Anorexia, Weight Loss Stinking Poo! - Dermatitis Herpetiformis ``` *Crypt Hyperplasia and Sub-total villous atrophy // TTG/IgA

Question 37

HCC

Answer 37

Jaundice Upper Abdo Pain Weight Loss, pallor Signs of Chronic Liver Failure… + varies/ascites *RF - Schistisomis/ Steroids/ Fam Hx/ Cirrhosis Tumor marker - alfa fetoprotein

Question 38

Anaemia

Answer 38

IDA SOB, fainting, palpitations, Tachycardia, pale palmer crease, pallor, pale conjunctiva, leukonychia, koilonychia, angular stomatitis, Rectal Bleeding, heavy periods Folate/B12 SOB, diarr, headache, glossitis, fatigue, anorexia, pale palmer crease, pallor, pale conjunctiva Aplastic Anaemia + Infection + Bleeding Pernicious Loss of IF because of parietal cell gastritis —> atrophy or gastrectomy

Question 39

Leukaemia

Answer 39

``` Acute Bleeding, Bruising, infections, anaemia, splenomegaly, bone pain AML - gum hypertrophy ALL - Tyrokin Inhib *Allopurinol in both! ``` Chronic Weight loss, tiredness, fever, night sweats (asympt?) Lymphadenopathy. Massive Splenomegaly! CML - Tyrosine Kin Inh

Question 40

Lymphoma

Answer 40

B symptoms - night sweats, fever, weight loss Painless Lymphadenopathy SOB Infections, Bruising, Bleeding *Hodgkins defined by Reed-Sternburg Cell

Question 41

Myeloma

Answer 41

Ca up Renal dysfunction Anaemia Bone Pain *Treat Each symptom separately

Question 42

Eczema

Answer 42

Atopic/ Contact/ Sebhorric/ Vasculitic Flexor Surfaces Erythema Scratch Marks Acute Lesions - weepy *Topical Emolients + Topical CorticoSteroids(hydrocort) + UV therapy +/- ABx’s and Antihistamine

Question 43

Psoriasis

Answer 43

Classic Plaque/ Guttate/ Erythrodermic/ Pustular Red raised plaque, with salmon pink encircling, silver scales on top. Erythema Extensor Surfaces Scratch Marks Auspitz Sign - removal of plaque = capillary bleeding Nail Changes - Pitting/ Discolour/ Onycholysis/ Sub ungal Hyperkeratosis *Topical - Emolients + Vit D3 ana + Topical Ster + Coal Tar Next - Phototherapy Systemic - acretin / methotrexate / infliximab

Question 44

ACNE

Answer 44

Vulgaris/ Rosacea/ Folliculitis/ Keritosis ``` Erythema, Pustules, Comedones Papules Hirtuism Greasy Skin Scarring ``` *1st - Topical Retinoids + The Pill + Topical ABx’s 2nd - Oral Retinoids + The Pill + refer to dermo

Question 45

CA

Answer 45

ABCDE BCC - Pearly white, small nodule SCC - Not shiney, more keratotic MM - Colour change, growing, bleeding, sunburnt, asym, irreg borders *Breslows and Clarks and TNM RF - Sunbeds/ Bad sunburn/ Fair skin/ Moles/ Fam Hx

Question 46

Cellulitis

Answer 46

``` Red/Blue Swollen Tender Hot Unilateral Site of Infection ``` *Staph Aur or Strep pyogenes T - Mark with pen the borders

Question 47

Osteo Arthritis

Answer 47

``` Joint Crepitus Decreased ROM Joint Tenderness, Joint Instability Heberdens Nodes Musc Wasting ``` ``` *xray Loss of Joint space Peri-articular sclerosis Sub Chondral cysts Osteophytes ```

Question 48

Rheumatoid Arthritis

Answer 48

DIP and PCP + wrist joints Rheumatoid Nodules Ulnar Deviation at MCP Swann-Neck, Z-shaped thumb, Boutinerres Deform ``` *xray Palmer Subluxation at MCP Decreased Joint Space Soft Tissue Swelling Periarticular osteoporosis ```

Question 49

Septic Artritis

Answer 49

Fever, Hot swollen Joint Pain Hx of Infection/trauma or Prosthetic Joint *Blood Culture - Staph/Strep pyogen Joint aspirate and washout for treating

Question 50

Psoriatic Arthritis

Answer 50

``` DIP and Sacro-Iliac Unilateral Dactylitis *Psoriasis present Pencil-in Cup on xray ```

Question 51

Ank Spond

Answer 51

Back Pain - stiff in morning made better with exercise Eye Pain Leg Pain Worse with Straight Leg raise

Question 52

Hypo Nat

Answer 52

N+V Anorexia Malaise Confusion HypoNat Enceph = Seizures / Coma *If Acute or Dehydrated - cautious rehydr + frusemide If Chronic/asymp - Fluid restric + ADH antagonist

Question 53

HyperKal

Answer 53

Worrying = Arrhythmias , Chest Pain, Weakness, irreg pulse *T - Calcium Gluc - cardiac memb protection Insulin (actrapid) - push K+ into cells Calcium Resonium - Increase K+ absorption in Gut

Question 54

HypoKal

Answer 54

``` Musc weakness hypotonia hyporeflexia palpitation constipation ``` *Oral Sando-K

Question 55

HyperCalcaemia

Answer 55

``` Bones - pain/ path fracture Thrones - constip/ polyuria Groans - abdo pain Moans - depression Stones - renal or gallstones ``` *Bisphosphonates

Question 56

HypoCalcaemia

Answer 56

SCAMS ``` Seizure confused Anxious Spasms musc tone increased ``` *CKD/ Vit D def // Osteomalacia/ acute panc

Question 57

Stroke

Answer 57

``` Speech facial Droop Hemiplegia Hemiparesis Visual Disturbance - homon hemi Headache Unconscious ```

Question 58

SAH

Answer 58

Sudden onset, worst ever headache, behind eyes Unconscious Photophobia N+V *LP done >12 hours to allow xanthyecroma

Question 59

MS

Answer 59

Diplopia, painful eye, RAPD Facial Palsy Hearing/Balance problems Depression Weak painful legs Lethargic * i —> LP - oligoclonal AB’s / Spinal Cord MRI - Gadolinium labelling

Question 60

Parkinsons

Answer 60

``` Bradykinesia, Tremor and Rigidity. Festinant gait Blank face Micropathic writing Postural Instability ``` *L-dopa and dopa decarboxylase inhibitor +/- MOAB-I Drug Induced P - Anti-emetic / neuro-leptics (haloper)

Question 61

MG and Dementia

Answer 61

AI muscle fatigue after exercise without any wasting and normal tone/reflexs. Diplopia Dementia Memory loss/ behavioural change/ agitation/ depression/ agnosia

Question 62

Motor Neuron Dis

Answer 62

``` Dysphagia Fasciculations Brisk Reflexs Musc weakness Speech decrease Breathing difficulties No sensory loss/sphincter loss ``` *Upper and Lower Motor Lesion SIGNS!!

Question 63

Neuropathies

Answer 63

Ulnar - claw hand / wasting / sens loss Medial - Carpal Tunnel // Tinnels and Phalens Radial - Wrist drop / weakness / loss sens Peroneal - foot drop / decrease dorsiflexion / numb dorsum Medial - C5-8 Radial - C6-8 Ulnar - C8-T1

Question 64

Sepsis

Answer 64

Mottled Skin, fever, confused/GCS down, RR/HR increase, BP drop, Clammy cool peripheries, N+V, oliguria

Question 65

HIV

Answer 65

Night Sweats, Weight Loss, fever Infections - candida/ ulcers/ TB Diarr Skin Rashes

Question 66

Returning Traveller (Malaria)

Answer 66

Malaria Delayed onset of symptoms (3-6 weeks) Fever, Rigors, Tachycardia, Sweating *Chloraquin Typhoid Salmonella - Fever, Headache, Abdo Pain *Ceftriaxone Dengue Mosquitos - Fever and rash + Fatigue

Question 67

Meningitis

Answer 67

``` Photophob Neck Stiffness Headache Confused Fever HR/RR up Kernels Sign +ve N+V ```

Question 68

TB

Answer 68

``` Abdo Pain Anorexia/Weight Loss Fever Night Sweats Cough SOB Wheeze Haemop ```

Question 69

Herpes

Answer 69

Sores. Flu-like prodrome then ulcers appear +/- Dysuria +/- Discharge Chicken Pox —> shingles *PCR Testing is Diagnostic

Question 70

PUO

Answer 70

Sarcoid/ Lymphoma/ SLE/ Malignancy/ TB Fever >38 for >3 weeks

Question 71

Mono

Answer 71

Cervical Lymph fever Pharyngitis Splenomegaly *EBV AB’s or PCR

Question 72

AKI

Answer 72

``` Oliguria/ Haematuria Palpable kidneys Pain Vomiting JVP up, BP up, Oedema ``` *Careful of HyperKal

Question 73

Nephritic and Nephrotic

Answer 73

``` Nephrotic Hypoalbuminaemia Hypercholesterolaemia Oedema Proteinuria ``` Nephritic Haematuria Hypertension Proteinuria

Question 74

UTI L vs U

Answer 74

L Urinary Symp - dysuria, oliguria Supra-Pubic Pain Haematuria U Loin to Groin pain Infection symptoms (Fever) N+V *E-Coli!!!

Question 75

Renal Stone vs PCK

Answer 75

``` Stone Loin to groin pain, colic, can’t lie still Haematuria/ Urgency /Freq up Fever Tachycardia *NSAID treatment ``` ``` PCK Irregular Palpable Kidney Acute Loin Pain Hypertension Hepatomegaly ```

Question 76

Renal CA and Bladder CA and Prostate CA

Answer 76

Renal Abdo Mass + Flank/Loin Pain + Weight Loss + Haematuria Bladder Painless Haematuria + recurrent UTI’s + weight loss + Urinary symptoms (Polyuria,hesitancy) Prostate Tender bladder, Poor flow, nocturia, freq, hesitancy + weight loss + post Void dribbling

Question 77

Anti-phospholipid Syndrome

Answer 77

``` Venous Thrombosis (DVT, PE) Arterial Thrombosis (cerebral ischaemia - stroke/TIA) Fetal Complications (Spontaneous abortion, premature births) Thrombocytopenia (not overly severe) ```