SBA buzzwords Flashcards by Izzi Raynaud

SOB on exertion
Wheeze
Chronic productive cough

COPD

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COPD investigation

Post-bronchodilator spirometry

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Fever
Chronic cough
Weight loss
Asian

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Red Ziehl-Nelson stain

Acid fast bacilli

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TB treatment

Rifampicin
Isoniazid
Pyrazinamide
Ethambutamol

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Rifampicin side effect

Orange tears

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Isoniazid side effect

Peripheral neuropathy

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Pyrazinamide side effect

Hepatitis

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Ethambutamol

Colour blindness

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Steatorrhoea, DM
Clubbing
Recurrent infections
Bronchiectasis
Sodium >60 mmol

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Shipyard/power station worker
End-inspiratory crackles
Non productive cough

Mesothelioma

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Exposure to mouldy hay

Farmer’s lung (hypersensitivity pneumonitis)

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Exposure to birds

Bird fancier’s lung (hypersensitivity pneumonitis)

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Exposure to silica
Nodular shadowing
Egg shell nodules

Hypersensitivity pneumonitis

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Horner’s syndrome

Arm pain

Pancoast tumour

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Hypercalcaemia
Ectopic PTH
Constipated, tired
Epithelial cells

Squamous cell carcinoma

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Lung cancer with:
Neuroendocrine symptoms
Paraneoplastic syndromes

Small cell carcinoma

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Small cell producing ACTH

Cushings

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Small cell producing ADH

SiADH

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Small cell producing Anti Ca abs

Lambert Eaton syndrome

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Lung cancer:
Of goblet cell origin
Non-smoker
Female

Adenocarcinoma

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Fever
SOB
Productive cough
Bronchial breath sounds
Coarse creps

Pneumonia

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Assessed with CURB65

Pneumonia

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CURB 65 components

CRP
Urea
RR
BP
Age >65 y/o

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Pneumonia treatment

IV clarithromycin, oral amoxicillin

Rusty sputum | Younger patient

S pneumonia

Small segmental infiltrates, sinusitis, pharyngitis, laryngitis

Chlamydia pneumonia

Adolescent (pneumonia) Erythema nodosum Pericarditis Haemolytic anaemia

Mycoplasma pneumonia

Pneumonia with abscesses

Staph aureus

Purulent dark sputum (pneumonia)

Klebsiella

Pneumonia in AIDS with widespread infiltrates and low O2 sats Normal CXR Dry cough and SOB

Pneumocystitis jiroveci

``` Pneumonia with: Low Na Low albumin SOB, muscle cramping Air conditioning exposure ```

Legionella pneumophila

``` Pneumonia with: Hepatosplenomegaly Conjunctivitis Arthralgia Lower lobe consolidation Bird exposure ```

Chlamydophila psittaci

Child coughing up blood

Inhaled foreign body

Night cough Intermittent wheeze Eczema/hayfever Diurnal variation

Stable asthma

Severe exacerbation of asthma treatment

60% O2 via facemask Back to back nebs Systemic steroids

Life threatening exacerbation of asthma treatment

IV magnesium sulphate, intubation

Silent chest, apparent improving O2, fatigue, bradycardia

Life-threatening exacerbation of asthma

Anacrotic pulse Breathlessness, syncope Angina on exertion

Aortic stenosis

Narrow pulse pressure, ejection systolic murmur radiating to carotids

Aortic stenosis

Pink frothy sputum | Post MI

Mitral regurgitation

Graham Steel murmur

Mitral regurgitation

Displaced apex beat, pan systolic murmur radiating to axilla

Mitral regurgitation

Late systolic murmur with mid-systolic click

Mitral prolapse

Murmur with Barlow syndrome

Mitral prolapse

Decrescendo diastolic murmur

Aortic regurgitation

Displaced apex beat with early diastolic murmur heard in expiration over left sternal edge

Aortic regurgitation

Pansystolic murmur at lower left sternal edge

Tricuspid regurgitation

Murmur associated with large V waves in JVP

Tricuspid regurgitation

Rumbling mid-diastolic murmur heard loudest at apex with tapping apex beat and loud first heart sound

Mitral stenosis

Muffled heart sounds following lupus/malignancy

Pericardial effusion

Positive valsalva manoeuvre Harsh ejection systolic murmur Sudden unconsciousness in young person

Hypertrophic Obstructive CardioMyopathy (HOCM)

Machine-line murmur with bounding pulse, wide pulse pressure and left supraclavicular thrill

Patent Ductus Arteriosus

Dyspnoea, orthopnoea | Fine inspiratory crepitations

Heart failure

Increased BNP

Heart failure

Gold standard investigation for heart failure

Transoesophageal echo

Heart failure CXR signs

``` Alveolar oedema Kerley B lines Cardiomegaly Diversion of upper lobes Effusion ```

Petechiae, microvascular haematuria, Janeway lesion, splinter haemorrhages

Infective endocarditis

Scoring for infective endocarditis

Modified Duke Criteria

Irregularly irregular pulse

Atrial fibrillation

ECG shows absent P waves

Atrial fibrillation

Palpitations, SOB, fatigue, syncope in elderly person

Atrial fibrillation

Narrow complex tachycardia with rate >150 bpm and 2:1 block

Atrial flutter

Saw-tooth appearance of ECG

Atrial flutter

Broad complex on ECG of individual with previous MI

Ventricular tachycardia

Pulseless patient needing cardioversion

Ventricular fibrillation

Delta wave (slurred upstroke on ST)

Wolff-Parkinson White syndrome

ECG with: | Broad QRS, uniform P waves with random QRS, cannon waves on JVP

Complete heart block

Collapse when running Tearing pain to back Connective tissue disorder

Dissected aortic aneurysm

Friction rub on cardiac auscultation

Pericarditis

Male, post-MI | Chest pain worse on lying down

Pericarditis

Central crushing chest pain radiating to jaw/Left arm

Myocardial infarction

Initial MI intervention

``` Morphine Oxygen Nitrates Aspirin Reperfusion (thrombolysis/PCI) Clopidogrel Heparin ``` Beta blocker ACEi Risk factors Statin

Sharp, pleuritic chest pain Haemoptysis OCP/long haul travel

Pulmonary embolism

PE scoring system

Wells

Anxiety, paroxysmal hypertension

Phaeochromocytoma

Interscapular murmur Decreased femoral pulses Turner's syndrome Radio-radial delay

Aortic coarctation

HTN, polymyalgia, polyuria, polydipsia Increased Na, reduced K Normal renal function Increased aldosterone, decreased renin

Conn's syndrome

ANCA positive, micro aneurysms and MI

Polyarteritis MI

ST depression and T wave inversion on exertion | Normal resting ECG

Stable angina

Exertion chest pain, radiating to jaw

Stable angina

Episodic chest pain on rest

Unstable angina

ST elevation at rest in cycles

Prinzmetal angina

ST depression on ECG with normal angiogram

Syndrome X

Chest pain waking patient up at night, lying down

Decubitus angina

Pleuritic chest pain, low grade fever and pericarditis a few weeks post-MI

Dressler's syndrome

Right heart failure, pulmonary hypertension | Large A waves in JVP

Cor pulmonale

Pulmonary hypertension, heart failure, shunt reversal

Ventricular septal defect

Harsh pan systolic murmur at left sternal edge with a left parasternal heave

Ventricular septal defect

Wide, fixed, split second heart sound | Ejection systolic murmur in ICS2/3

Atrial septal defect

Anterior leads

V1-V4

Anterior artery on ECG

Left anterior descending

Inferior leads

II, III, aVF

Inferior artery on ECG

Right coronary

Lateral leads

I, V5-V6

Lateral artery on ECG

Circumflex

Raised and fixed JVP

SVC obstruction

Increased JVP on inspiration

Cardiac tamponade | Constrictive pericarditis

Saddle shaped ST elevation on ECG

Acute constrictive pericarditis

S1, QIII, TIII on ECG

Pulmonary embolism

Tall tented T waves on ECG with wide QRS

Hyperkalaemia

Flattened T waves on ECG with prominent U waves

Hypokalaemia

Long QT interval on ECG

Hypocalcaemia

Stroke with receptive aphasia

L temporoparietal

Receptive aphasia

Wernicke's

Stroke with expressive aphasia

L frontal

Expressive aphasia

Broca's

Stroke with face/arms involvement >legs

Middle cerebral artery

Stoke with legs involvement> face/arms

Anterior cerebral artery

Stroke with visual involvement

Posterior cerebral artery

Acute vertigo, cerebellar signs, Horner's

Lateral medullary syndrome

Confusion Dizziness Anxiety Loss of consciousness

Hypoglycaemia

Uni/bilateral headache, pulsating Nausea and vomiting Photophobia Aura

Migraine

Headache like tight band around head | Stress

Tension headache

Jaw claudication, severe headache Fatigue, weight loss, sore throat Red face, scalp tenderness

Temporal arteritis

Multinucleated giant cells on artery biopsy

Temporal arteritis

Shooting pains when touching face

Trigeminal neuralgia

Head trauma followed by loss of consciousness, then lucid period

Extradural haemorrhage

Progressively developing head pain and loss of consciousness

Subdural haemorrhage

Severe orbital/temporal pain, occurring in clusters

Cluster headache

Progressive worsening headache Worse on coughing, sneezing, bending Headaches in morning

Space occupying lesion

Stepwise deterioration in cognitive function | Cardiovascular risk factors

Vascular dementia

Gradual memory loss, impaired speech

Alzheimers dementia

Disinhibition, personality changes, inappropriate behaviour Normal memory <65 years

Pick's disease (frontotemporal dementia)

Myoclonus, memory loss, hallucinations | Rapid progression

CJD

Parkinsonism Vivid visual hallucinations Sleep disturbance

Lewy body dementia

Loss of consciousness precipitated by emotion/pain/fear/prolonged standing Nausea Pallor Clonic jerking, no stiffness

Vaso-vagal syncope

Loss of consciousness after reduced cardiac output Arrhythmia Pale, slow/absent pulse Flushing afterwards

Stokes-Adams attack

Head turning --> dizziness and syncope

Carotid sinus syndrome

Tonic-clonic sequence Tongue biting Incontinence Post-ictal confusion

Epilepsy

No loss of consciousness/amnesia/confusion | Pause

Simple partial seizure

No loss of confusion Aura Automatisms

Complex partial seizure

Seizure lasting more than 30 mins

Status epileptius

Status epilepticus treatment

IV lorazepam + 50% glucose, IV phenytoin

UMN lesion signs

Spasticity Hyperreflexia Babinski +ve

LMN lesion signs

Floppy paralysis Wasting Fasciculations

Muscular weakness improving with exercise

Lambert-Eaton syndrome

Lambert-Eaton syndrome antibodies

Pre-synaptic Ca channel

Muscular weakness worse with exercise

Myasthenia gravis

MG antibodies

Anti-ACH

Transient loss of vision, paraesthesia, paralysis, worse in heat Episodes separate in space and time

Multiple sclerosis

Tremor after alcohol withdrawal | Confusion, crawling sensation

Delirium tremens

Cerebellar signs

``` Dysdiadocokinesa Ataxia Nystagmus Intention tremor Slurred speech Hyperreflexia ```

Peripheral neuropathy in alcoholics

B12/folate deficiency

Peripheral neuropathy with glove and stocking distribution

Diabetes

Confusion, ataxia and ophthalmoplegia in alcoholic patient

Wernicke's encephalopathy

Wernicke's encephalopathy treatment

IV pabrinex

Anterograde amnesia, confabulation in alcoholic

Korsakoff's

Cafe au lait spots, axillary freckling, neurofibromas

Neurofibromatosis I

Bilateral acoustic neuroma

Neurofibromatosis II

Telangiectasia, epistaxis, vascular disorder

Osler-Weber-Rendu

Wasting of thenar eminence and weakness in abductor pollicis brevis

Median nerve

Loss of sensation in lateral palmar serve of 3 and a half digits

Median nerve

Median nerve distribution

C6-T1

Wasting of hypothenar eminence and weakness in abductor digiti minimi, claw hand

Ulnar nerve

Sensory loss over medial one and a half digits

Ulnar nerve

Ulnar nerve distribution

C8-T1

Weakness in wrist extension, wrist drop

Radial nerve

Anaesthesia over first dorsal interosseous muscle

Radial nerve

Radial nerve distribution

C5-T1

Paralysis of intrinsic muscles of hand Loss of sensation in ulnar distribution Horner's syndrome may be present

Klumpke's palsy

Loss of shoulder abduction and elbow flexion Arm held internally rotated Waiters tip sign

Erb's palsy

Weakness in dorsiflexion and eversion of foot Sensory loss over dorm of foot Hit inside of knee

Common peroneal nerve

Common perineal nerve distribution

L4-S1

Inability to invert foot or stand on tip toe | Sensory loss on sole of foot

Tibial nerve

Tibial nerve distribution

L4-S3

Shuffling gait

Parkinsons

High stepping gait

Sensory ataxia

Wide based gait

Cerebellar lesion

Gastroenteritis with vomiting shortly after eating food

Staph aureus

Gastroenteritis after eating reheated rice

Bacillus cereus

Haematemesis after sepsis, organ failure

Cushing's ulcer

Haematemesis after burns

Curling's ulcer

Recurrent ulceration and high serum gastrin

Zollinger Ellison syndrome

Massive haematemesis, microcytic anaemia and history of alcoholism

Oesophageal varices

Short history of change in bowel habit | Tenesmus and mucus

Rectal carcinoma

History of broad spectrum antibiotics | Green diarrhoea

Clostridium difficile

Pale stool, burping, foul flatus, watery diarrhoea after visiting eastern europe

Giardia

Bloody diarrhoea + intense abdo pain

Ischaemic colitis

Loos stool associated with weight loss, hyperpigmentation and onycholysis

Thyrotixicosis

Epigastric pain worse with meals/alcohol

Chronic pancreatitis

Rapidly progressive dysphagia (solids, then liquids), weight loss, hypoproteinaemia

Oesophageal carcinoma

Apple core lesion on barium swallow

Oesophageal carcinoma

Progressive difficulty with speech and swallowing | Weak facial muscles, absent jaw jerk

Bulbar palsy

Weight loss + anorexia + Iron deficiency | Signet ring cells

Adenocarcinoma

Generalised ulceration of oesophagus on background of immunosuppression

Oesophageal candidiasis

Purple, plaque like lesions of proliferating spindle cells

Kaposi's sarcoma

Beading of intrahepatic ducts Associated with ulcerative colitis Cholestatic jaundice with raised ALP

Sclerosing cholangitis

Deep necrotic ulceration of shin associated with IBD, vasculitis and haematological malignancy

Pyoderma gangrenosum

Raised bilirubin - jaundice when stressed/acutely ill

Gilbert's syndrome

Jaundice, diarrhoea and fever after eating infectious food

Hepatitis A

Thrombus in hepatic portal vein secondary to thrombogenic disorders

Budd-Chiari syndrome

Chronic liver disease + jaundice related to antimitochondrial antibodies

Primary biliary cirrhosis

Faecal oral RNA virus leading to jaundice, diarrhoea and fever

Hepatitis A

Infectious dsDNA virus leading to infection and chronic carriage after fluid transmission

Hepatitis C

Iron overload - haemosiderin within hepatocytes leading to bronzed skin and raised transaminase

Genetic haemochromatosis

Copper accumulation leading to Kaiser-Fleischer rings, neuro and liver changes

Wilson's disease

Pre-hepatic causes of jaundice

Haemolysis

Hepatic causes of jaundice

Autoimmunity, drugs, infection, malignancy

Post-hepatic causes of jaundice

Obstruction via gallstone, tumour, infection, inflammation

Fever, right upper quadrant pain, nausea, icteric sclera worse on fatty foods Female, fat, forty, fertile

Biliary colic

Charcot's triad leading to fever, rigours and jaundice

Ascending cholangitis

Unexplained dyspepsia, dysphasia, malaena, anaemia and anorexia Acanthosis Nigricans Virchow's node

Gastric carcinoma

Abdo pain after meals | CLO test positive

Peptic ulcer

Metaplasia of distal oesophagus from squamous to columnar epithelium Related to GORD

Barrett's oesophagus

Abdo pain improving with meals, worse with hunger and at night

Duodenal ulcer

Proportion of GIT ulcers which are duodenal

80%

Small haematemesis following repeated retching and vomiting

Mallory Weiss tear

Fullness, epigastric pain, nausea Radiates to back Hypokalaemia + anaemia

Acute pancreatitis

Acute pancreatitis score

Modified Glasgow score

Hypoglycaemia upon fasting/exercise | Palpitations, dizziness, syncope, diplopia

Insulinoma

Painless progressive jaundice with mass Diabetes, smoking, alcohol Dark urine, pale stools ALP>AST

Pancreatic adenocarcinoma

Pancreatic cancer marker

Ca19-9

Severe, acute onset abdominal pain | Expansile mass, tachycardia, hypotension

Abdominal aortic aneurysm

Shock, epigastric pain History of dyspepsia Rigid abdomen, absent bowel sounds

Perforated peptic ulcer

Pain, nausea, vomiting and bloody diarrhoea Febrile, tachycardia, distension >6cm Coffee bean sign

Toxic megacolon

Umbilical to right iliac fossa pain Nausea and vomiting Tender over McBurney's point Rosving's sign positive

Appendicitis

Pain, vomiting, altered blood per rectum | Pale, tachycardia, shock

Mesenteric ischaemia

Beak sign on barium swallow | Chest pain and regurgitation of solids and liquids

Achalasia

Decreased calcium, decreased calcitriol, increased phosphate, increased bone resorption, increased ALP Osteoporosis on DEXA Due to chronic renal failure

Renal osteodystrophy

Autonomous PTH secretion Parahyroid adenoma/MEN 1 Increased PTH, increased Ca

Primary hyperparathyroidism

Physiological reaction to low calcium or high phosphate | High PTH

Secondary hyperparathyroidism

Autonomous parathyroid function | After transplant

Tertiary hyperparathyroidism

Hypertension, diabetes, glomerulonephritis Fatigue, anorexia, pruritus, bone pain, oedema Increased urea, increased creatinine, increased phosphate, decrease calcium, increase potassium Normocytic, normochromic anaemia

Chronic renal failure

Terminal haematuria Following travel to Middle East/Africa Fevers, malaise, eosinophilia Squamous cell carcinoma

Schistosomiasis

Acute renal failure | Granular/muddy brown cell casts

Acute tubular necrosis

Multiple aneurysms, irregular constrictions

Polyarteritis nodosa

Acute renal failure | White cell casts

Acute pyelonephritis

Hypoalbuminaemia Oedema Lipid abs Proteinuria Thromboembolism, hyperlipidaemia, increased infection risk

Nephrotic syndrome

``` Proteinuria Haematuria Azotemia Red cell casts Oliguria HTN ``` Inflammatory process, increased urea, increased creatinine

Nephritic syndrome

Multiple large bilateral cysts in kidneys UTIs, haematuria, hypertension PKD 1/2 mutation High risk of Berry aneurysm, mitral valve prolapse

Autosomal dominant polycystic kidney disease

Renal failure in childhood | Hypertension, portal hypertension, congenital hepatic fibrosis

Autosomal recessive polycystic kidney disease

Middle aged patient Haemoptysis Haematuria and hypertension Linear immunofluorescence on renal biopsy T4 glomerular basement membrane antibodies

Goodpasture's syndrome

Wegener's granulomatosis antibodies

cANCA

Upper respiratory tract infection, lower respiratory tract infection, renal effects (haematuria, RBC casts)

Wegener's granulomatosis | Granulomatosis with polyangiitis

Glomerulonephritis in children post-upper respiratory tract infection/immunisation/allergy

Minimal change disease

Obstructive urinary symptoms Back pain Craggy, nodular prostate Loss of midline sulcus

Prostate cancer

Transitional zone hyperplasia of the prostate Obstructive urinary symptoms Smoothly enlarged prostate

Benign prostatic hyperplasia

Male patients 60-70 years old Painless haematuria lacking casts Relating to azo dyes

Transitional Cell Carcinoma

Diarrhoea, vomiting, increased urea/creatinine Thrombocytopenia E coli 0157

Haemolytic Uraemia Syndrome

Post-renal failure Confusion, abdominal pain Large, palpable bladder

Urinary retention

Loin to groin pain Vomiting Writhing in agony Haematuria

Renal colic

Urine dip with nitrates, blood, leukocytes | Increased frequency

Urinary tract infection

``` Weight loss, nigh sweats Loin pain, dysuria Blood, leukocytes, -ve nitrates Sterile pyruia Positive mantoux ```

WBC casts

Tubulointerstitial nephritis

RC casts

Glomerulonephritis

Centripetal obesity, bruises, darkened palmar creases, recent onset diabetes

Cushing's syndrome

Pituitary adenoma secreting ACTH

Cushing's disease

Polyuria, polydipsia, pituitary tumour, trauma

Central diabetes insipidus

Polyuria, polydipsia | Hereditary, hypercalcaemia, lithium, thiazide diuretic

Nephrogenic diabetes insipidus

Polyuria, polydipsia Associated with schizophrenia Urine osmolality same with fluid deprivation and after desmopressin

Psychogenic polydipsia

Generalised weakness, hyporeflexia, ataxia, lethargy, confusion Hyponatraemia, high urine osmolality, hypoosmolality

Syndrome of inappropriate ADH

Coarse features, widely spaced teeth, slanting forehead, protruding jaw Growth hormone secreting pituitary tumour

Acromegaly

Adrenal insufficiency GI disturbance, weight loss, postural hypertension High potassium, low sodium

Addison's disease

Aldosterone producing adenoma Low potassium, high sodium, high bicarb High aldosterone, low renin Metabolic alkalosis

Conn's syndrome

Parathyroid tumour Pituitary adenoma Pancreatic tumour (Zollinger-Ellison syndrome)

Multiple Endocrine Neoplasia 1

Phaeochromocytoma Amyloid-producing thyroid tumour Primary hyperparathyroidism

Multiple Endocrine Neoplasia 2a

Phaeochromocytoma Amyloid-producing tumour Marfan's syndrome Organ fibrosis

Multiple Endocrine Neoplasia 2b

Insomnia, palpitations, weight loss, increased appetite

Hyperthyroidism

Exophthalmos, pretibial myxoedema | Autoimmune stimulation of TSH-receptor

Grave's disease

Weight gain, lethargy, constipation Diffusely enlarged thyroid Anti-thyroglobulin, anti-microsomal, anti-thyroid peroxidase, anti-TSH-receptor antibodies

Hashimoto's thyroiditis

Flu like illness --> inflammation and T3/4 release Hyperthyroid --> hypothyroid --> euthyroid Pain worse with swallowing, fever Increased ESR

De Quervain's thyroiditis

Slow growing, hard, immobile, enlarged thyroid Fibrotic tissue on biopsy Difficulty breathing and swallowing

Riedel's thyroiditis

Rare thyroid cancer in elderly Hard, rapidly enlarging Fixed to skin

Anaplastic carcinoma

Thyroid cancer in adolescents and young adults Orphan Annie eyes, psammoma bodies Lymphadenopathy

Papillary carcinoma

Thyroid cancer in middle aged | Spread to lung/bone

Follicular carcinoma

Thyroid cancer with calcitonin tumour marker | MEN2

Medullary carcinoma

Lumpy, irregular thyroid Plummer's syndrome Autonomous hyperfunctionign nodules

Toxic multi nodular goitre

Enlarged thyroid due to iodine decifiency, pregnancy, puberty

Simple colloid goitre

Bones, stones, moans, groans Polyuria, polydipsia Increased PTH

Primary hyperparathyroidism

Bones, stones, moans, groans Trousseau's sign Chvostek's sign

Hypercalcaemia

Convulsions Arrhythmias Tetany Paraesthesia

Hypocalcaemia

Hypocalcaemia causes

Chronic kidney disease Parathyroid failure Post-thyroidectomy Hypomagnesaemia

Low calcium and high PTH

Pseudohypoparathyroidism

Hypercalcaemia causes

Hyperparathyroidism, malignancy, vitamin D intoxication, sarcoidosis

Lung cancer secreting ectopic PTH | Hypercalcaemia + bone breakdown

PTHRP secretion

Ischaemic necrosis of pituiary Post-partum haemorrhage Hypopituitarism - amenorrhoea

Sheehan's syndrome

Cushings --> bilateral adenalectomy

Nelson's syndrome

Weight loss, fatigue, polyuria, polydipsia

Type 1 diabetes mellitus

Hyperglycaemia, ketoacidosis, ketonuria, dehydration, confusion, abdo pain Kussmal breathing, pear drop breath

Diabetic ketoacidosis

Neuroglycopaenia | Irritable, tired, drowsy

Hypoglycaemia

Breast cancer marker

Ca15-3

Colorectal cancer marker

CEA

Carcinogen risk for hepatocellular cancer

Aflatoxin B1

Carcinogen risk for mesothelioma

Asbestos

Carcinogen risk for prostate cancer

Cadmium

Carcinogen risk for bladder cancer

Aniline dyes/rubber industry

Carcinogen risk for endometrial cancer

Oestrogen

Carcinogen risk for GI lymphoma

Coeliac

Carcinogen risk for gastric cancer

Pernicious anaemia

Carcinogen risk for cervical cancer

Unprotected sex with multiple partners

Carcinogen risk for lymphoma

EBV

Painless punctum attached to skin

Sebaceous cyst

Nodule on extensor surface Firm and painless History of rheumatoid arthritis

Rheumatoid nodule

Lump on a scar, solid and itchy

Keloid

Lump on dorsal of foot/hand Herniation of tendon sheath Transilluminates

Ganglion

Lump in anterior triangle Slow growing Young patient Cholesterol crystals on FNA

Branchial cyst

Lump in anterior triangle | Lateral mobility

Carotid body aneurysm

Pulsatile lump in neck Lateral mobility Pulsatile, bruit Pressure --> dizziness

Carotid body tumour

Lump with uneven borders Slightly fluctuant Not fixed to skin/deep structures

Lipoma

Lump in neck Fever, lethargy, appetite change, weight loss, sweats Painful after alcohol Reed-Sternberg cells

Hodgkin's lymphoma

Lump in posterior triangle Regurgitation/difficulty swallowing Gurgling, bad breath

Pharyngeal pouch

Rubbery lump | Tingling on pressure

Neurofibroma

Large skin abscess made of several boils

Carbuncle

Infection of hair follicle

Furuncle

Low grade tumour from hair follicle | Skin coloured with black central core

Keratoacanthoma

Benign lump Smooth, hard, mobile <30y/o

Fibroadenoma

Fibrocystic changes Multiple cysts and nodules Oestrogen induced hyperplasia

Fibroadenosis

Large, hot painful lump in breast | Associated with breast feeding

Acute mastitis

Large, hot painful lump in breast Inability to sleep Continuous pain

Breast abscess

Painful, erythamtous sub areolar mass Abscess and inflammation Smoking = risk factor

Periductal mastitis

Peri-areolar mass Dilatation and blockage --> inflammation and fibrosis White discharge 50-60 years old

Duct ectasia

``` Irregular, hard lump, tethered Nipple inversion, puckering Bloody discharge Ulceration, swelling Peau d'orange ```

Invasive carcinoma

Itchiness and discharge from nipple | No palpable lump

Ductal carcinoma in situ

Itchy, erythamous, scaly skin over nipple | Erosion and nipple discharge

Paget's disease

Increase in size of breast Tear drop appearance Fibroadenoma appearance

Phyllodes tumour

Milk production without pregnancy

Prolactinoma

Trauma to breast More common in obese women Overlying bruising Hard, irregular lump

Fat necrosis

Ulceration in gaiter region with haemosiderin deposition and lipodermatosclerosis Oedema and brown discolouration of skin Common in women after middle age

Venous ulcer

``` Punched out ulcers Atherosclerosis/vasculitis Low ABPI Absent pulses Shiny, hairless limb ```

Arterial ulcer

``` Absent/reduced sensation Found in pressure areas Well perfused, deep penetrating skin Loss of reflexes Diabetes ```

Neuropathic ulcer

Squamous cell carcinoma from previous scar/burn/ulcer | Irregular, raised edge, blood-stained discharge, painless

Marjolin's ulcer

Pale, pulseless, painful, perishingly cold, paraesthesia, paralysis

Acute limb ischaemia

Risky ABPI

<0.3

Causes for amputation

Paraethstia, paralysis

Atherogenic emboli to retinala artery | Black curtain over eye

Amaurosis fugax

Distended superficial veins due to venous insufficiency

Varicose veins

Site of local trauma + tissue infection Swelling, erythema, vesicle and bullae formation over skin Fever +/- diarrhoea and vomiting

Necrotising fasciitis

Digital ischaemia - reflex vasospasm Pallor --> cyanosis --> reactive hyperaemia Associated with rheumatoid conditions, beta blockers

Raynaud's syndrome

Tired, SOB, conjunctival pallor Tachycardia Flow murmur Coeliac/Crohn's/GI bleed/menorrhagia

Anaemia

Microcytic anaemia Hepatospenlomegaly Jaw protrusion

Thallasaemia

Microcytic anaemia + neuro signs

Phenytoin toxicity

Microcytic anaemia associated with B12 deficiency | Coeliac/alcohol/drugs

Pernicious anaemia

Anaemia with hyperhsegmented neutrophils and erythroblasts

Megaloblastic anaemia

Jaundice and anaemia

Haemolytic anaemia

Anaemia in Adro-Caribbean patients | Symptoms at altitude

Sickle cell disease

Anaemia Splenomegaly Spherocytes on film Osmotic fragility test +ve

Hereditary spherocytosis

Anaemia with jaundice X linked recessive Triggers - fava beans, anti-malarial, infection, moth balls Heinz bodies

G6Pd deficiency

Anaemia - Coomb's test positive

Autoimmune haemolytic anaemia

Cold-activated anaemia association

Mycoplasma

Warm-activated anaemia association

CML/lymphoma/SLE

Clots, low platelets, rash

Thrombotic Thrombocytopenia Purpura

Petechia with low fibrinogen and clots | Sepsis/vascular insult

Disseminated Intravascular Coagulation

Normocytic anaemia causes

Chronic disease Liver disease Blood loss

Pancytopaenia Hypocellular basement membrane Absent reticulocytes

Aplastic anaemia

Uncontrolled red blood cell proliferation Headaches, dizziness, stroke Mast cells --> pruritus after hot baths Gout, splenomegaly, plethora

Polycythaemia rubra vera

Excessive red blood cell production due to other disease (COPD/EPO secreting tumour)

Secondary polycythaemia

Randomly high red blood cells | Risk of AML

Idiopathic erythrocytosis

Platelets >600 Hypercoagulable Nosebleeds/GI/gum bleeding

Essential thrombocytaemia

Menorrhagia + nosebleeds + purpura

Idiopathic thrombocytopenic purpura

``` Bone marrow failure Child Lymphadenopathy Incrased infections Anaemia Blast cells ```

Acute Lymphoblastic Leukaemia

Bone marrow failure Adults RARA-PML protein Auer rods

Acute Myeloid Leukaemia

Bone marrow failure Increased white cell count Smear cells

Chronic Lymphocytic Leukaemia

Bone marrow failure 25-40 years Philadelphia chromosome

Chronic myeloid Leukaemia

X linked factor 8 deficiency

Haemophilia A

X linked factor 9 deficiency

Haemophilia B

History of excessive bleeding

Von Willebrand disease

Liver disease and pancreatic insuffiency

Vitamin K deficiency

Multiple miscarriage | Arterial and venous thromosis

Antiphospholipid syndrome

Spinning sensation Increased volume of endolymph Unilateral tinnitus, unilateral sensorineural hearing loss

Meniere's disease

Fluid from knee effusion forms popliteal cyst | Rupture --> compartment syndrome

Baker's cyst

Systemic vasculitis associated with HLA B51 Recurrent oral/genital ulceration Ocular inflammation

Behcet's disease

Peroneal muscular atrophy (high arched feet) Inherited neuropathy (starts in puberty) Weak legs and foot drop Inverted champagne bottle apprearance

Charcot-Marie-Tooth

Late onset asthma Eosinophilia Granulomatous small vessel vasculitis pANCA +ve

Churg-Strauss syndrome

Small vessel vasculitis Purpura on buttocks and extensor surfaces Joint involvement and abdominal pain

Henoch Schonlein Purpur

Ptosis Miosis Anhydrosis

Horner's syndrome

Mucocutaneous freckles on mucosa/soles/pams | GI polyps --> obstruction/bleed

Peutx-Jegher's syndrome

Uveitis Urethritis Arthritis

Reiter's syndrome

AI inflammatory disorder Exocrine gland dysfunction Xerostomia, keratoconjunctivitis Parotid swelling

Sjogren's syndrome

Erythema multiforme Toxic epidermal necrolysis Hypersensitivity reaction

Stevens-Johnson syndrome

Bilateral renal cell cancer Retinal and cerebellar haemangioblastoma Phaeochromocytoma

Von Hippel Lindau syndrome

Idiopathic costochrondritis

Tietze's syndrome

Lesions to multiple CNS nuclei Posterior/inferior cerebellar artery occlusion Dysphagia/dysarthrita/vertigo/horners

Lateral medullary syndrome

OD = tachycardia, bradycardia

Digoxin

OD = hepatic failure

Paracetamol

OD = drowsiness, respiratory depression

Benzodiazepine

OD = respiratory depression, pinpoint pupils

Opiates

OD = tinnitus, vertigo, hyperventilation, metabolic acidosis

Salicylates

OD = salivation, lacrimation, urination, diarrhoea

Organophosphates

OD = bleeding

Warfarin

OD = severe bradycardia/hypotension

Beta blocker

OD = normal blood gas with low sats

Carbon monoxide

Electrolyte imbalance | Anorexia, nausea, malaise, headache, irritability, confusion, weakness, seizures, oedema

Hyponatraemia

Electrolyte imbalance | Lethargy, thirst, weakness, irritability, confusion, coma, fits, dehydration

Hypernatramia

Hyponatramia causes

``` Water loss in excess of sodium loss Diarrhoea, vomiting, burns Excess saline Diabetes insipidus Osmotic diuresis Primary aldosteronism ```

Dehydrated causes of hyponatramia

``` Addison's Renal failure Diuretic excess Osmolar diuresis Diarrhoea, vomiting, burns ```

Non-dehydrated causes of hyponatraemia

Oedematous - nephrotic syndrome, cardiac failure, cirrhosis, renal failure No oedema - water overload, severe hypothyroidism, glucocorticoid insufficiency, SIADH

Normal values for Na

135-145

Normal values for K

3.5-4.5

Electrolyte imbalance | Muscle weakness, hypotonia, hyporeflexia, cramps, tetany, palpitations, arrhytmia

Hypokalaemia

Hypokalaemia causes

``` Diuretics Diarrhoea and vomiting Cushings/steroids Conns syndrome Alkalosis Bulimia Renal tubular failure ```

Electrolyte imbalance | Fast irregular pulse, chest pain, weakness, palpitations, light headedness

Hyperkalaemia

Hyperkalaemia causes

``` Oliguric renal failure K sparing diuretics Rhabdomyolysis Metabolic acidosis Addison's Burns ACEi ```

``` Electrolyte imbalance Spasm Perioribital paraesthesia Anxiety, irritability Seizures Increased smooth muscle tone Confusion Chvostek's sign ```

Hypocalcaemia

``` Electrolyte imbalance Abdo pain, vomitting Constipation Polyuria, polydipsia Depression Anorexia, weight loss Tiredness HTN Confusion Renal stones/failure ```

Hypercalcaemia

Cause of raised phosphate

``` CKD Hypoparathyroidism Pseudohypoparathyroidism Acute rhabdomyolysis Hypomagnesaemia ```

Causes of low phosphate

Osteomalacia, acute pancreatitis, over hydration and respiratory alkalosis

Causes of hypercalcaemia

Malignancy, primary hyperparathyroidism, renal failure, Addison's, TB, fit D overdose, muscles tumours

Marker of renal function

Creatinine

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