Mcleaods Flashcards
1
Q
Gen obs
A
BMI Hydration Fever Distress, pain Musc wasting
2
Q
Hands
A
Clubbing
Koilonychia
Leukonychia
Palmar erythema
3
Q
Face
A
Pallor
Jaund
Spider naevi
Parotid swelling
4
Q
Mouth
A
Angular stomatitis
Glossitis
5
Q
Neck
A
Lymphadenopathy
6
Q
Abdo inspec
A
Scars
Swelling
Distended Vs
7
Q
Abdo palp
A
Hepatomeg Splenomeg Mass Kidn Bladder Tenderness
8
Q
Abdo percuss
A
Ascites
9
Q
Abdo ausc
A
Bowel sounds
Bruit
10
Q
Rectum
A
Skin tags
Haemorrhoids
Bleeding
Faecal occult blood
11
Q
Scrotum
A
Mass
Swelling
12
Q
Liver locat
A
Upper border 5th R ICS on full expirat
Lower costal margin mid clavic on full inspirat
13
Q
Panc locat
A
Neck at L1
Tail above and R
14
Q
Spleen locat
A
L ribs 9-11
Post to mid axillary line
15
Q
Kidn levels
A
-
16
Q
mouth pain
A
Aphthous ulcer Candiasis Dental sepsis HSV Coxsackie A Trauma Leukoplakia Drug allergy eg sulphonamide Iron, folate, vit B12, vit C defic Leucopenia, leukaemia Reactive arth IBD Coeliac Lichen planus
17
Q
GORD vs CP
A
Burning
Upward radiat
Occur when lie falt or bend forw
Waterbrash
18
Q
Dyspepsia- upper abdo discomfort
A
Reflux like- HB
Ulcer like- relieved by food, antacid
Dysmotility like- naus, belch, bloat, satiety
May be pointing sign or fat intol.
19
Q
Abdo pain
A
Visc pain- distens, traction, sm contrac. SNS splanchnic Ns.
Somatic pain- parietal perit and abdo wall, localised, IC spinal Ns.
20
Q
GU causes
A
Testic torsion Rupt ovarian cyst PID Endometriosis Ectopic preg
21
Q
Pain onset
A
Sudd severe, rap prog, becomes gen and const- hollow visus perf, rupt AAA, or mesent infarc.
Preceding constipat- CR CA or divertic as cause of perf.
Prior dyspepsia- rupt ulcer cause of perf.
COexist PVD, HTN, HF, AF- AAA or mesent isch cause.
Circ fail following pain- sepsis or bleed. Eg AAA, ecoptic preg.
Ovarian or testic torsion- sudd sev pai and naus.
Volvulus- sudd pain and assoc acute obstruc.
22
Q
Pain char
A
Acute- inflamm and obstruc.
Inflamm- const pain, worse on move or cough. Can persis hours.
Colicky pain- bowel obstruc, uterus contrac. Secs to mins. Moving or knees up can help.
Bil and renal colic- rap peaking pain, pesists sev hrs, then grad goes. Us relieved by analgesia.
Dull, vague and poorly loc us inflamm or low grade infec eg append, salpingitis, divertic.
23
Q
Peptic ulcer
A
Epig, grad onset, gnawing, into back. Remiss for weeks ot months. Worse nocturnal and when hungry. 30 mins to hrs durat. Exacerbated by spicy, alc, NSAID. Relieved by food, antacid, vom. Mild to mod sev.
24
Q
biliary colic
A
Epig and R hypochondrium, rapidly incr, constant, below R scap. Can count attacks Unpredictable 4-24hr Cant eat during pain Severe
25
Acute pancreatitis
```
Epig and L hypochondrium, sudd onset, const, into back.
Can count attacks
Heavy drinking worse
Over 24hr
Cant eat during pain
Eased by sit up
Severe
```
26
Renal colic
```
Loin, rapid incr, const, into genitalia and inner thigh.
Us a discrete episode
Worse after dehyd
4-24hr
Severe.
```
27
Radiating pain
Right hypoch to shoulder or interscap- diaph irrit eg cholecystitis.
Loin to groin and genit- renal colic.
Central abdo to back, relieved by sit forw- acute pancreatitis.
Central, later RIF- acute appendicitis
Sev back and abdo pain- rupt or dissec aorta
Ing canal- ureteric pain
28
Other abdo symps
```
Anorexia
NV
Sev painless vom- gastric outlet or SI obstruc.
Faeculent- late LI obstruc.
In peritonitis vom with retching and can cause MW tear or boerhaave.
Change bowel habit.
Ask about urinary symps
Wind and flatulence
Dysphagia
Distension
Bleeding
Jaundice
Reflux
```
29
Timing
Can be delay after perf before peritonitis
| In SI obstruc colic change to persis pain can sugg isch
30
Non GI causes of abdo pain
MI
Dissecting aneur- tearing interscap pai, hypot, asymm fem pulses.
Verteb collapse
Cord comp
Pleurisy- lat pain on cough, pleural rub.
Herpes zoster- hyperaesthesia, vesicles.
DKA- cramps, vom, air hungerm tachy, breath sweet
Salpingitis or ectopic- suprapubic and IF, NV, fever.
Gonad torsion- low abdo pain, NV.
31
Pain severity
V sev and not relieved by opiates- isch vasc event eg bowel infarc or rupt AAA.
Sev but responds to analgesia- pancreatitis or peritonitis.
32
Swallow
Globus and early satiety is not related
Neurologic dysphagia worse for liq- choke, nose regurg.
Neuromusc dysphagia or oes dysmotil- worse for solid.
Achalsia- LOS fail relax. Can cause aspirat. And CP.
mech dysphagia- CA if wl, no refluc. Stricture if no wl and heartburn.
Dysphagia causes- tonsillitis, bulbar palsy, CVA, achalasia, pharyng pouch, MG, dysmotil, CA, ext comp, benign stricture, oesophagitis.
Symps to ask- pain, progressive, time, HB, solid or liq, level that food sticks, regurg.
33
NV
Often assoc pallor, sweating, hyperventil.
Dyspepsia naud but no vom.
Gastric outlet obstruc- projectile, not bile stained.
Obstruc distal to pylorus bile stain.
Comm causes- gastroeneteritis, cholecystitis, pancreatitis, hepatitis, sev pain.
Non alimentary- RICP, migraine, meniere, drugs, DKA, renal fail, preg, ED.
Symps to ask- warning, pain, time of day, bile/blood/faeculent.
34
Distension
Ascites- Accum fluid in perit cav.
Functional bloating- flucs dur day, resolves at night. Us IBS.
Constipat rarely causes distension.
Painless in wom- ovarian pathol or preg.
Fat, flatus, faeces, fluid (ascites and bladder), fetus, functional (IBS).
35
Ascites
Exudate-inflamm or malig.
Transudate- hepatic cirrhosis with portal HTN, acute hepatic V occlus, hypoproteinaemia eg nephotic synd.
Constrictive pericarditis and RHF. Check JVP and ausc for rub.
TB peritonitis- low gluc
Pancreatitis- high amylase.
36
diarrhoea
Freq loose stool.
High vol over 1L per day.
Secretory- due to int inflamm eg infec, IBD. Contins if dont eat.
Osmotic- malabs, drug AE, motility prob. Osmotic stops if dont eat.
Steattorhoea.
Low vol eg IBS.
Bloody- IBD, colonic isch, infective gastroenteritis.
Acute causes- infec gastroenteritis eg C diff, drugs eg AB.
Chronic over 4 wk- IBS, IBD, parasite, CR CA, autonomic neuropathy eg DM, laxative abuse, hyperthyroid, overflow from faecal impaction, SI or right colon resection, malabs.
Symps to ask- time, urgency, tenesmus, contin, stool consis and vol, freq, blood/mucous/pus, sleep, travel, sex hx, alc, drugs, surg, IBD, fam hx, other symps.
37
IBS
```
Bloating, dyspepsia.
Rome III criteria- recurr abdo pain at least 6 mnth, assoc with 2 or more of-
Impr with defecation
Onset assoc with chnage in stool freq
Onset assoc with change in stool form
```
38
Constipation
Reduc colon mobil, reduc rectal sensat, anorectal dysfunc.
Anismus- impaired evac process.
Tenesmus- rectal inflamm or tum.
Obstruc- absol ocnstip, vom, distens.
Causes- diet, IBS, obstruc, CA, drugs, hypothyr, hyperCa, immboil eg stroke and parkinsons.
Symps to ask- time, freq, how long straining, pain, bleed, stool shape, meds.
39
Coffee ground vom
Pepsin degradation of blood.
40
Malaena
Tarry shiny black, specif smell.
Diff from black stool seen in iron or bismut therap.
UGI bleed causes- ulcer, MW tear, oesophagitis, gastritis, varices, CA, vasc malformat.
Symps to ask fro haematemesis and malaena- GI hx, alc, NSAID, CS, type blood, retching, blood in first vomit.
41
jaund
Skin, sclerae, mucous mems.
Seen when over 50umol/L.
Causes- haemolysis, gilberts, hepatitis, cirrhosis, drugs, gallst, panc CA, cholangiocarcinoma.
Qs- appet, wl, abdo pain, bowel habit, bleed, dark urine, fever, drugs, alc, pmh, prev jaund or hep, blood transfus, fam hx, sex hx, tattoo, pruritis.
Charcots triad fever, pain, jaund- asc cholangitis.
Painless- CA.
42
rectal bleed
```
Haemorrhoid
Fissure
CR polyp or CA
IBD
Isch colitis
Diverticular dis
Vasc malformat
```
43
GI affects of drugs
```
Oral CS- weight gain
NSAID- dyspepsia, UGI bleed
SSRI- naus
ABs, PPI- diarr
Opioids- constipat
Paracetamol and TB drugs- jaund, hep
Fluclox and co amox- jaund, cholestatic
Methorexate- liver fibrosis
```
44
GI alarm feats
```
Persis vom
Dysphagia
Fever
Wl
Bleed
Anaemia
Painless, watery, high vol diarr
Nocturnal symps
```
45
Viral hep RFs
```
IV drugs
Tattoo
Travel
Transfus
Sex RFs
```
46
Hands
Clubbing
Koilonychia spoon
Leukonychia liver dis
Palmar eryth liver dis
47
Mouth
Angular chellitis iron defic
Atrophic glossitis iron defic
Aphthous ulcer gluten enteropathy and IBD
48
LNs
Troisiers sign- L supraclavic LN enlargem due to gastric or panc CA.
Widesp LNs with hepatosplenomegaly- lymphoma.
49
Chronic liver dis signs
```
Jaund
Spider naevi due to excess oestrogen due to reduced hepatic breakd.
Plamar eryth due to excess oestrogen
Ascites
Gynaecomastia
Testic atrophy
Leukonychia hypoalb
Clubbing cirrhosis, IBD, malabs.
Asterixis hepat enceph
Fetor hepaticus breath portosys shunt
Dupuytrens alc, fam hx, DM, smok, chol, HIV
```
50
liver fail signs
Fetor hepaticus
Flapping tremor
Variable mental state
Lat neuro- spasticity and limb ext, extensor plantar resp.
51
Caput medusa
Recanal of umb V along faliform lig
| Prods distended Vs drainign away from umb.
52
distension
```
Obese- sunken umb
Ascites- umn flat or everted.
Scars
Asymm
Masses
Gen or loc
```
53
Pain
Pain in sev areas on light palp- peritonitis, or anx
Vol gurading- vol abdo musc contrac due to pain
Invol- reflex contrac when parietal inflamm
Thoracic breathign with rigid abdo- gen perotnitis
RIF pain- append or corhns ileitis
Rebound tend not necess peritonitis- pain after deep palp
Bowel sounds
Visible peristalsis
54
Palpat
Epig mass- panc or gastric CA, AAA
Hepatomeg
Gen distens- Fs
RIF mass- caecal CA, crihns, append
LUQ mass- spleen cant get above, kidn can get above
LIF mass- sigm CA, constipat, divert mass.
55
murphys sign
Breathe in
Palp RUQ mid clavic
As liver descends inflamed gb hits finger- pain and sudd arrest of inspiration
Acute cholecystitis if RUQ pain too
56
gb
If jaund and palpab gb- extrahepat obstruc eg panc CA or gallst (courvoisier)
57
hepatomegaly causes
```
ALD
Steatosis
AI hep
Viral hep
Prim bil cirhosis
HCC
Mets CA
RHF
Lymphoma, leuk
Amyloidosis, sarcoidosis
```
58
splenomegaly causes
Has to triple to be palp
Us ribs 9-11 mid ax
```
Lymphoma, leuk
Myeloprolif disorders
Haemolytic anaemia
Glandular fever
Malaria
Bact endocarditis
TB
Rheum arth
SLE
Sarcoidosis, amyloidosis
```
59
ascites causes
| Shifting dulln
```
Malig
Chronic liver dis
Sev HF
Nephrotic synd
Hypoprot
```
60
Hepatosplenomegaly causes
```
Lymphoma
Myeloprolif dis
Cirrhosis with portal HTN
Amyloidosis
Sarcoidosis
Glycogen storage dis
```
61
Ascites px
Weight gain
Incr girth
Shifting dullness
62
Ausculatation
R of umb, 2 mins
Above umb for aorta and bruits
2-3cm lat to umb for renal bruit
Liver bruits
Absence- paralytic ileus or peritonitis
Incr freq and vol, high pitch tinkling- obstruc
Bruits- atheroma or aneur or SMA sten
Friction rub- peri hepatitis or splenitis
Splash over 4hr after eat- delayed gastric emp eg pyloric sten
63
Hernias
External- abn protrusion bowel or omentum from abdo cav.
Internal- through mesent defects or into retroperit sp, not visible.
Cough impulse.
64
Ing hernia
Ing canal- pubic tubercle to ASIS.
| Ing hernias are above and medial to pubic tubercle.
65
Femoral hernia
Fem canal- below ing lig and lat to pubic tubercle.
66
groin swell causes
```
Ing or fem hernia
LN
Lipoma, cyst
Hydrocoele
Undesc testis
Psoas abcess
Femoral aneur
```
67
Groin hernia px
```
Dull dragging discomfort
Exacerbated by straining
Groin swelling or lump
Symps us worse at end day and after activ
Might be reducible
```
68
Strangulated hernia
```
Tense
Tender
No cough impulse
Bowel obstruc
Later sepsis and shock
Surgical emerg- risk infarc and peritonitis.
```
69
indications for DRE
```
Susp append, pelvic ancess, peritonitis, low abdo pain.
Diarr, constip, tenesmus, anorectal pain.
Rectal bleed, iron defic anaem.
Unexpl wl.
Lower abdo mass.
Prostate symps.
Dysuria, freq, haematuria.
Abdo, spinal or pelvic trauma.
```
70
DRE
Prostate ant, 2 lobes and median groove.
In fem vagina and cervic ant. Puborectalis musc is upper end anal canal.
If susp fissure then give LA suppository 10 mins bef to reduce ext sphinct spasm.
Haemorrhoids only palpab if thromosed.
Rectal CA.
Lateralised tenderness suggs pelvic peritonitis.
Gynae malig can cause frozen pelvis.
BPH- symm enlargem.
Prostate CA- hard, irreg, asymm, no median groove.
Prostatitis or abcess- change in consis and tenderness.
Hypogonadism- small prostate.
71
Abn stool appearance
Pale- biliary obstruc
Pale and greasy- steatorrhoea
Black tarry- UGI bleed malaena
Grey/black- oral iron or bismuth therap
Silvery- steat plus UGI bleed eg pancreatic CA
Fresh blood in or on stool- LI, rectal or anal bleed
Stool mixed with pus- infective colitis or IBD
Ricewater- cholera.
72
proctoscopy
```
Do DRE first
Flex siggy instead if examining mucosa.
Haemorrhoid
Fissure
Rectal prolapse
```
