Examination findings Flashcards by Lucy Knox

What is the diagnosis?

Sub Conjunctival Haemorrhage

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Name 3 factors that increase your risk of this happening

suddenly increase pressure – such as coughing, hypertension or Aspirin (as anti-platelet agent) will make this more likely as will trauma and increasing age.

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This 30 year old felt the sensation of something in his eye since yesterday. His eye is watering and is uncomfortable. Why?

Small foriegn body (FB) can be seen when everting the eyelid

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The FB is removed and the eye re-examined after insertion of a dye.

What dye is it? What do you see?
What is this called?
Why has it occurred?
What colour is the lamp used to examine in the above picture?
What colour lamp is used to specifically look at blood vessels in the retina?

Fluorescein – note uptake over cornea
Corneal abrasion
FB has rubbed epithelial surface of retina
Blue light – fluorescein is orange therefore if uptake see as green
Green light used to look at blood vessels.

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This 23 year old man was involved in an altercation on Wind Street last night.

What is the term given to the appearance of the eye above?
What exactly is it?

a hyphema—a hemorrhage in the bottom of the anterior chamber of the eye.

The bleeding came from disruption of blood vessels at the iris root. It is a sign of severe ocular contusion. There may be other signs of ocular contusion: corneal and retinal swelling, bleeding in the vitreous cavity, dislocation of the lens, rupture of the iris, cornea, retina, or sclera.

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This six year old is brought into surgery by his mother.

What is the name of this sign?
List 3 potential causes of this sign in THIS patient.

Ptosis
Myasthenia, Horner’s, Benign, Congenital, Traumatic (head injury), III nerve palsy

In this case, while Ca lung is a cause of horner’s and ptosis, it wouldn’t be expected in a 6 year old

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What part of the body is this a picture of?
What are the features indicated by the arrows?
What is the most common underlying disease which results in the features show?

Retina – NOT eye
Flame haemorrhages
Hypertension

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What is indicated by A?
What are the white areas indicated by the black arrow B?
What are these white areas caused by?
What is indicated by the yellow / green arrow C?
What is the underlying disease?

Optic Disc
Hard Exudates
Leakage of protein from blood vessels
Flame haemorrhage
Proliferative diabetic retinopathy

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What is …

A? B? C? D?

2.What is the underlying disease?

A Laser Scars

B Macula

C Retinal Vessel

D Microaneurism

2) Diabetic retinopathy (specifically diabetic macula oedema)

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What problem is visible?
What symptoms may the patient have presented with?
Name a very common underlying problem that would make this condition more likely.

Retinal Detachment
Deteriorating vision in curtain or flashing lights (remind them of history in year 1)
Short sightedness

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What feature is visible in the disc?

In this particular patient it may be due to:

Pulmonary embolism?
Multiple sclerosis?
chronic coughing?
Head injury ?
Malignant hypertension?

Papilloedema

Found in:

MS – (if optic neuritis)

Head injury (if raised ICP)

Malignant hypertension (not controlled)

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What is seen in the picture?

What symptoms might this woman present with?

Which women are more likely to have this condition of the cervix?

Cervical ectropion (or cervical eversion)

central (endocervical) columnar epithelium protrudes out through the external os, undergoes squamous metaplasia, and transforms to stratified squamous epithelium

Symptoms = mucus discharge, post coital bleeding

Normal in younger women, pregnancy and those taking oestrogen OCP

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What condition is this?

What virus causes it?

How is this usually transmitted?

What condition does this predispose to?

What should she be advised to do regularly in future?

Name one way of treating this

Genital warts

HPV

Sexual contact / skin to skin

Cancer

Wear a condom

Cream - podophyllotoxin

Cryotherapy

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What is the metal object at the bottom?

What is the tube at the top?

What is the name given to this finding?

Name three reasons that might predispose to this?

Name three symptoms that this woman might have presented with.

Simms speculum

Catheter

Prolapse - Cystocoele

Vaginal deliveries, pregnancy, obesity, chronic cough

Dragging sensation, difficulty passing stools, urinary incontance/frequency

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IUS - eg. merina coil

Checking threads

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What 2 things does this show?

Threads from IUS

Cervical ectropion

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What does this show?

Polp extending through the Os

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This 36 year old woman has attended for her cervical screening and her cervix is pictured.

Has this woman ever been pregnant?

Explain how you have derived your answer.

Yes

The os gets damaged/can form more of a slit after a vaginal delivery

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At present, how often are women normally and routinely offered cervical screening?

Every 3 years from 25-49

Every 5 years from 50-64

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How many times should the brush be rotated as part of the cervical screening process?

5 complete turns

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Where exactly should the cells be obtained from in a cervical smear?

The transitional zone

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What is the abnormality shown?

Name three factors that predispose to this?

What symptoms may the patient present with?

Anal fissure

Anything that stretches anal skin so straining at stool, diarrhoea, trauma, childbirth, Inflammatory bowel disease (crohn’s and UC), some STI’s (syphilis, chlmaydia, herpes)

Symptoms include – pain, bleeding – usually bright red on paper after wiping, constipation (largely due to pain and contraction of sphincter)

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What is the abnormality shown in the picture?

Name three predisposing factors.

Haemorrhoid

Chronic diarrhoea/constipation

Straining on toilet

Anal intercourse

Obesity

Sitting for long periods of time on toilet

Increasing age

Increased intra-abdominal pressure

Pregnancy

Chronic cough

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Name a complication of this.

Name three different types of treatment

Complications are rare but include anaemia from chronic blood loss, strangulation (pain and gangrene)

Treatment:

Conservative – laxatives to avoid straining, analgesia

Creams – to shrink - little evidence of benefit

Rubber band ligation

Sclerotherapy

Cautery

Haemorrhoidectomy

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What is the diagnosis? How may this present?

Pilonidal sinus / abscess Usually pain may be found and be asymptomatic

What does this show?

Pilonidal sinus

1. What is the diagnosis? 2. What is the causative agent? 3. How did the patient acquire these?

Anal / Genital warts Usually HPV wart virus Usually sexually transmitted – note men need not necessarily have participated in anal sex to have these on anus

What is this? Name three possible presenting symptoms of this condition. What’s the usual underlying cause for this condition?

**Rectal prolapse** The symptoms are identical to advanced hemorrhoidal disease,[13]and include: Sensation of mass or something “coming down” Fecal leakage Rectal bleeding Mucous rectal discharge Rectal pain Pruritis ani Due to excessive straining at stool (note NOT associated with childbirth etc)

Percussion of the chest - what causes it to be: Dull

Airless - consolidation, collapse, fibrosis ? pleural thickening

Percussion of the chest - what causes it to be: Stoney dull

Pleural effusion - lung separated from chest wall

Percussion of the chest - what causes it to be: Hyperresonant

Pneumothorax Emphysema? - if large pulmonary cavity

What are normal breath sounds described as?

Vesicular Insp - intensity steadily increases Expiration - quickly fades

What may cause diminished vesicular breath sounds?

Airflow limitation insulation - obesity, small pleural effusion, shallow pneumothorax

What may be the cause of no breath sounds?

No airflow Large pneumothorax

What may cause bronchial breath sounds?

Fibrosis Consolidation - pneumonia

If you can hear vocal ressonance loudly what does it suggest?

Firm/solid underluing lung tissue - Consolidation - Fibrosis - Collapse

What is usually said about the crackles you may hear in interstitial lung disease?

End-inspiratory creps

What are crepetations?

Non musical sounds - crackles Explosive re-opening of small airways which have occluded during expiration

What are Ronchi heard when auscultating breath sounds?

Rhonchi are continuous low pitched, rattling lung sounds that often resemble snoring.

What may cause you to hear ronchi?

Bronchial asthma Tumour Foreign body

What is stridor? What may cause it?

An inspiratory noise, not a breath sound Obstructed upper airway eppiglotitis, angio-oedema of anaphylaxis

What is seen in horner's syndrome?

Interruption of sympathetic fibres to one eye eg. due to bronchogenic Ca symptoms: - Unilateral pupillary constriction - Partial ptosis - Enopthalmos - Loss of sweating on same side of face

What is suppurative gingivitis in a resp exam associated with?

Lunh abcess

Name 2 reasons for a rasied JVP

Right heart failure Raised intrathoracic pressure

What may cause a barrel chest?

Asthma Bronchitis Emphysema

What is pectus carinatum?

Pigeon chest - Stenal prominence, indrawing of ribs to form horrizontal grooves "harrison's sulci" Due to chronic respiratory disease in childhood + rickets

What abnormalities can be seen? What causes this?

Cotton wool spots Hard exudates Papilloedema Silver wiring AV nipping = Hypertensive retinopathy

What abnormalities are only seen in hypertensive retinopaty on fundoscopy?

Silver wiring AV nipping

List abnormalities you would seen in diabetic retinopathy

Dot and blot haemorrhages Exudates Neovascularisation Cotton wool spots

What is the mechanism of making flame heamorrhages?

Rupture of superficial pre-capillary arterioles, small veins

What can cause flame haemorrhages?

systemic hypertension

What are early signs seen in diabetic retinopathy?

Dot and blot haemorrhages Microaneurysms

As diabetic retinopathy progresses what later signs are seen on fundoscopy?

Signs of retinal ischaemia: Cotton wool spots Venous dilatation Neovascularisation

List 4 causes of retinal haemorrhages

Diabetes Hypertension Trauma SAH Retinal vein occlusion Sickle cell disease Anti-coags

Name 3 causes for papilloedema

Increased intracranial pressure Cerebral oedema Malignant hypertension Optic nerve tumours Papillitis

What changes can you see with optic atrophy?

Pale disc usually assoc. decreases vision

What are soft exudates in the eye due to?

Swelling of the nerve fibre layer axons

What are hard exudates caused by?

Lipoproteins leaking out of an abnormally permiable blood vessel

What TFT levels would you expect to see with this sign?

Graves disease T3/T4 - high TSH - low

What condition causes this sign?

Graves disease

What does this show?

Pretibial Myxodema

Are these symptoms of thyroid disease seen in hyper, hypo or both? * Depression * Heat Intolerance * Tremor * Lethargy * Weight Loss * Hyporeflexia

* Depression - Both * Heat Intolerance - Hyper * Tremor - Hyper * Lethargy - Both * Weight Loss - Hyper * Hyporeflexia - Hypo

Where is the pathology causing this?

Optic chiasm

What pathology woulc commonly cause this defect?

Pituitary tumour (adenoma ) commonly found in acromegaly

What is this visual field defect?