Finals must know_ver_0.1_ppt

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Finals must know_ver_0.1_ppt

  1. 1. Cardiology Causes of chest pain? cardiac Arterial pulses Causes of raised JVP? Causes of AF? angina plateau AS RVF MI small volume AS pulmonary hypertension hypertension pulmonary stenosis mitral stenosis pericarditis shock aortic dissection AS, AR tricuspid stenosis lone atrial fibrillation anacrotic AS SVC obstruction cardiomyopathy PE pulsus alternans LVF pneumothorax GI bisferiens pleurisy respiratory pulsus paradoxus COPD idiopathic pulmonary fibrosis massive PE pericardial effusion obstructive sleep apnoea 1O pulmonary hypertension hyperthyroidism GORD constrictive pericarditis oesophagitis musculo-skeletal Causes of cor pulmonale? IHD severe asthma Causes of peripheral oedema? generalised (bilateral) fluid overload heart failure renal failure strain/trauma iatrogenic hypoproteinaemia Causes of Rt heart failure? IHD MI hypertension PS, TS, TR MI 1O pulmonary hypertension malabsorption Causes of Lt heart failure? 2O to Lt heart failure malnutrition AS, AR, MR chronic liver disease nephrotic syndrome medication obstruction localised (unilateral) calcium channel blocker pelvic tumour DVT 2O pulmonary hypertension (COPD) infection Causes of bradycardia? Causes of tachycardia? athletes pain DVT B-blocker fever anxiety recent surgery heart block thyrotoxicosis liver disease hypothermia B2-agonist renal disease hypovolaemia malignancy standing too long MI hypothyroidism cellulitis postural Causes of raised D-Dimer? ruptured Baker’s cyst Causes of pericarditis? infarction MI iatrogenic cardiac surgery inflammation SLE arrhythmia rheumatoid disease infection coxsachie virus bacterial
  2. 2. Cardiology Causes of cyanosis? central respiratory acute severe asthma COPD pulmonary oedema PE cardiac L-R shunt blood methaemoglobinaemia polycytheaemia peripheral as above vasoconstriction cold raynaud’s beta blocker poor circulation heart failure blockage arterial obstruction Aortic stenosis harsh crescendo-decrecendo systolic Mitral regurgitation pansystolic Aortic regurgitation early diastolic Mitral stenosis mid diastolic loudest in aortic area radiating to axilla LSE with expiration tapping apex beat radiating to carotid displaced, thrusting apex beat displaced, thrusting apex beat loud S1 sustained, heaving minimally displaced apex beat soft S1 collapsing (Corrigan) pulse slow rising pulse wide pulse pressure pistol shot noise over femorals Causes of Rt axis deviation? Rt ventricular hypertrophy cor pulmonale Causes of Lt axis deviation? Lt anterior fasicular block pulmonary stenosis Lt posterior fasicular block cardiomypoathy cardiomyopathy Rt sided infarction diffuse ischaemia/infarction Lt lateral infarction LAD artery ischaemia/infarction Lt ventricular hypertrophy
  3. 3. Cardiology Causes of Rt bundle branch block? hyperkalaemia Causes of Lt bundle branch block? PE hypertension cor pulmonale IHD IHD ECG changes dilated cardiomyopathy tall tented T waves widened QRS absent P waves rheumatic heart disease sine wave hypokalaemia flattened T waves MI <5min hyperacute T waves <20min ST elevation duration > 3 sq duration > 3 sq hrs terminal QRS changes slurred S wave lead I, V6 broad R waves lead I, V6 within days pathological Q waves RSR lead V1 broad S waves V1 variable time T wave inverts PE Rt BBB ECG changes? Infarct patters RBBB inferior lead II, III, aVF RV strain pattern ischaemia sinus tachycardia septal V1-V2 ST depression anterior V3-V4 T wave inversion LVH lead I, aVL, V5-V6 lateral S (V1 or V2) + R (V5 or V6) ≥ 35mm posterior any chest lead ≥ 45mm RVH Lt BBB ECG changes? tall R waves V1-V2 ST depression V1-V2 R wave ≥ 7sq V1 R:S ratio V1 or V2 ≥1 LVH strain pattern V1-V2 ST elevation deep S waves V5-V6 T wave inversion ST depression tall R waves RVH strain pattern depressed concave ST inverted assymetric T wave Causes of ST depression? Causes of ST elevation? ischaemia MI reciprocal changes in STEMI pericarditis LVH / RVH strain pattern benign early repolarisation BBB PE digoxin
  4. 4. Cardiology ECG P wave Features of benign murmur? <2.5sq wide systolic Rt atrial enlargement bifid (P mitrale) Lt atrial enlargement anaemia NAD on physical exam pregnancy thyrotoxicosis <3 sq PR interval fever NAD on ECG, CXR, US position dependent tall (P pulmonale) >2.5 sq tall QRS Causes of benign murmur? 3-5 sq grade ≤ 3 <3 WPW syndrome >5 1st degree HB QT interval QTc Grading of murmur if HR 60bpm < 0.44sec used if HR not 60bpm 1. very faint 2. soft QT/ (square of RR) short 3. heard all over praecordium long hypoCa2+ 4. loud with palpable thrill inverted ischaemia 5. loud heard with stethescope partially of chest MI T wave hyperCa2+ 6. very loud, heard without stethescope SAH persistant juvenile pattern digoxin LVH strain pattern hypo K, Ca, Mg Q waves lead II, III, aVF, V5-V6 normal > 1 sq wide & 2mm deep pathological
  5. 5. Respiratory Causes of cough? Causes of haemoptysis? acute bronchitis pneumonia pneumonia foreign body bronchiectasis post nasal drip lung CA asthma PE GORD spurious COPD chronic URTi Causes of stridor? sudden inhaled foreign object TB anaphylaxsis gradual pharynx tumour larynx trachea external compression of trachea lymph nodes goitre smokers cough lung CA ACEi Features of lung diseases consolidation - ↓ chest expansion dull percussion ↑ VT +TVF bronchial BS with coarse crackles lobar collapse trachea pulled towards ↓ chest expansion ↔ or dull ↓ VT +TVF ↓ BS unilateral fibrosis trachea pulled towards ↓ chest expansion ↔ ↑ VT +TVF fine crackles interstitial fibrosis - ↓ chest expansion resonant ↑ VT +TVF fine crackles pleural effusion trachea pushed away ↓ chest expansion stony dull ↓ VT +TVF ↓ BS pneumothorax - ↓ chest expansion hyper resonant ↓ VT +TVF ↓ BS tension pneumothorax trachea pushed away ↓ chest expansion hyper resonant ↓ VT +TVF absent Causes of clubbing? respiratory idiopathic pulmonary fibrosis bronchiectasis lung CA asbestosis lung abscess mesothelioma cardiac cyanotic congenital heart disease infective endocarditis GI IBD celiac disease cirrhosis Causes of pneumothorax? traumatic iatrogenic spontaneous emphysema asthma lung abscess subpleural bulla ??bleb
  6. 6. Respiratory Causes of respiratory failure? Type I Type II pulmonary oedema COPD pulmonary fibrosis severe asthma pneumonia respiratory centre depression opioids pneumothorax respiratory muscle weakness myasthenia gravis PE COPD Breathing patterns Cheyne-Stokes Causes of pleural effusion? LVF transudate central respiratory depression Kussmaul LVF hepatic failure diabetes nephrotic syndrome uraemia exudate Causes of bronchiectasis? Causes of hypoxia? idiopathic impaired diffusion cystic fibrosis abnormal V/P ratio malignancy hypoventilation infection bacterial pneumonia breast lymphoma PE TB bronchial CA SLE Causes of breathlessness? Causes of wheeze? asthma cardiac cardiac failure respiratory asthma COPD bronchiectasis bronchiectasis Light criteria COPD 1. pleural protein / serum protein >0.5 pneumonia 2. pleural LDH / serum LDH >0.6 pneumothorax large airway obstruction 3. pleural LDH > 2/3 normal upper serum limit PE pulmonary fibrosis other anaemia overweight lung
  7. 7. Gastro Causes of dysphagia? Causes of haematemesis? Causes of diarrhoea? mechanical oesophagus oesophagitis diet curry foreign body Mallory-Weiss tear stress exams oesophageal carcinoma varicies GORD induced oesopheal stricture plummer-vinson syndrome CA tumour in neck stroke MND duodenum IBD cancer colon CA endocrine hyperthyroidism duodenal ulcer retrosternal goitre iflammation acute gastritis stomach infection gastric ulcer CA extrinsic compression neurological IBS medication antibiotics MS PD achalasia Causes of epigastric mass? stomach Causes of constipation? CA plyloric stenosis idiopathic dietary liver enlarged left lobe opioids pancreas pancreas cyst CA head of pancreas diverticular disease gallbladder colorectal cancer mucocoele hypothyroidism hypercalcaemia Causes of Rt iliac fossa mass? caecum CA Causes of hypogastric mass? enlarged bladder crohns abscess ovarian cyst ovary cyst sigmoid sigmoid CA appendix Causes of Lt iliac fossa mass? diverticular abscess CA ovary uterine fibroids cyst CA CA external iliac artery aneurysm external iliac artery aneurysm psoas muscle abscess psoas muscle abscess kidney transplant kidney transplant
  8. 8. Gastro Causes of splenomegaly? mild Causes of hepatomegaly? portal hypertension 2 to cirrhosis 0 cardiac heart failure cirrhosis infectious hepatitis tricuspid regurgitation infective hepatitis idiopathic thrombocytopenia moderate (4-8cm) brucellosis rheumatoid arthritis hydatid disease portal hypertension 20 to cirrhosis haematological lymphoma lymphoma leukaemia massive (>8cm) myelofibrosis malaria Causes of paralytic ileus? leukaemia haemolytic anaemia gaucher’s disease infiltrative abdominal surgery peritonitis mesenteric ischaemia amyloidosis black fever Causes of small bowel obstruction? Causes of large bowel obstruction? adhesion strictures tumour sigmoid volvulus Causes of hepatosplenomegaly? infective hepatitis hernia toxoplasmosis colan CA volvulus brucellosis intersusception intersusception CMV haematological myelofibrosis Small and large bowel on Xray Causes of rectal bleeding? lymphoma small small intestine central Meckel’s diverticulum portal hypertension 20 to chronic liver disease valvulae conniventes sarcoidosis cross entire lumen amyloidosis upto 3cm diameter angiodysplasia circumferentail CA haustrae diverticula disease up to 6cm (caucum 9cm) polyp large enteritis colon IBD rectum CA anus haemorrhoids fissure
  9. 9. Gastro Causes of acute abdomen? Diffuse intestinal obstruction DKA gastroenteritis mesenteric ischaemia RUQ RUQ + LUQ LUQ cholecystitis pancreatitis gastritis biliary colic perforated duodenal ulcer splenic infarct hepatitis lower lobe pneumonia Causes of vomiting? RLQ RLQ + LLQ appendicitis renal colic sigmoid diverticulitis caecal perforation cystits sigmoid volvulus Meckles diverticulitis ectopic pregnancy mesenteric adenitis GI LLQ ovarian cyst gastritis inflammatory transudate hepatitis metabolic uraemia Causes of jaundice? heart failure pre hepatic haemolytic anemia hepatic neurogenic hepatitis nephrotic syndrome alcohol hypoproteaniemia primary biliary cirrhosis intra-abdominal malignancy tuberculous peritonitis hypercalcaemia addison’s chronic liver disease exudate cholecystitis pancreatitis pelvic inflammatory disease Causes of ascities? obstruction post hepatic gall stones in CBD bile duct stricture sclerosing cholangitis CA head of pancreas chronic pancreatitis ↑ ICP pain vestibulocochlear disease medication cytotoxics opiods antibiotics
  10. 10. Neurology Nerve palsies Causes of tremors? eye is pointing down and out diabetes anxiety dilated pupil MS Caffeine postural (physiological) III ptosis posterior communicating artery aneurysm eye pointing up trauma head is tilted diabetes salbutamol resting intention cerebellar disease e.g.MS, cerebrovascular disease flapping respiratory failure (type II) IV parkinsons MS VI eye pointing medially MS raised ICP hepatic encephalitis trauma V Signs of lesions UMN ↓ tone ↑ reflexes ↓ reflexes clonus fasiclutaions extensor plantar herpes zoster syringomyelia LMN ↑ tone sensory loss muscle wasting motor loss myotonic dystrophy MND VII UMN (forehead spared) CVA demyelination pseudobulbar palsy MND Causes of papilloedema? LMN (forehead involved) malignant hypertension cerebelloponting angle lesion ↑ ICP GB syndrome retinal venous obstruction myasthenia gravis VIII conductive perforated ear drum retinal detachment pagets disease acute glaucoma otosclerosis vitreous haemorrhage occular migraine wax otitis media with effusion Causes of sudden blindness? retinal artery/vein thrombosis Bell’s palsy sensory presbycusis noise-induced furosemide acoustic neuroma
  11. 11. Neurology Gait abnormalities antalgic (limp) Causes of ptosis? arthritis myogenic trauma sensory ataxia peripheral neuropathy cerebral ataxia hemiplegic Horner’s syndrome intracranial mass III nerve palsy cerebrovascular disease MS Causes of ↑ ICP? neurogenic “ infection obstructed CSF flow myotonic dystrophy tendon myasthenia gravis hypertensive encephalopathy involutional hypercapnia stroke MS Causes of syncope? cerebal palsy scissor neurally mediated situational MS foot drop vasovagal sneeze common peroneal palsy micturation L5 radiculopathy waddling parkinsons disease carotid sinus hypersensitivity proximal myopathy parkinsonian cough postural autonomic failure PD diabetes multiple system atrophy medication hypovolaemia Bulbar IX, X, XII tongue syringobulbia flaccid MND haemorrhage GB syndrome wasting LMN fasiculations antihypertensives diarrhoea post pradial cardiac arrhythmia ↓ movements sick sinus syndrome heart block dysphagia dysphonia Pseudobulbar AF long QT syndrome UMN spastic MS AS ↓ movements tongue bilateral internal capsule infarct HOCM MND acute aortic dissection dysphagia high pitch voice (Donald duck) respiratory PE psychogenic anxiety hyperventilation
  12. 12. Neurology Causes of neuropathy? single nerve mononeuropathy more than one single nerve mononeuritis multiplex multiple peripheral nerves polyneuropathy carpal tunnel syndrome alcohol B vitamin deficiency diabetes drugs isoniazid endocrine hypothyroidism guillian barre syndrome hemisensory loss spinal root lesions spinal cord lesion radiculopathy stroke
  13. 13. Renal Causes of renal failure? acute pre-renal Causes of haematuria? hypoperfusion dehydration kidney tumours renal artery obstruction ↓ cardiac output glomerulonephritis stones deposition of immune complexes trauma deposition of non-immune material renal infection nephritis immune mediated attack against endothelial cells of glomerular capillaries immune mediated attack of basement membrane acute tubular necrosis hypoperfusion NSAIDs aminoglycosides contrast media interstial damage stones infection tumour prostate enlargement chronic glomerulonephritis diabetes anticholinergics post operatively BPH bladder tumour infection prostate BPH, CA urethra trauma Causes of urinary frequency? ↑ fluid intake alcohol diabetes kidney disease diuretics diabetes Causes of urinary retention? tumour detrusor instability hypertension congenital stones NSAIDs antibiotics post-renal ureter polycystic kidney disease
  14. 14. Haematology Causes of anaemia? microcytic Fe deficiency Causes of lymphadenopathy? blood loss menorrhagia infection sepsis GI bleeding TB ↓ dietary intake malabsorption infectious mononucleosis coeliac disease haematological thalassaemia leukaemia sideroblastic anaemia macrocytic B12 deficiency lymphoma malignancy systemic disease pernicious anaemia metastases RA crohn’s disease strict vegan folate deficiency SLE sarcoidosis ↓ dietary intake Causes of polycythaemia? pregnancy antifolate medication anticonvulsants true ↑ alcohol primary secondary polycythaemia vera hypoxia myeloma pulmonary disease myeloproliferative disorders chronic smoking myelodysplasia normocytic cyanotic heart disease high altitude anaemia of chronic disease excess erythropoietin haemolysis renal cell carcinoma acute blood loss polycystic kidney disease bone marrow failure adrenal tumour renal failure hepatocellular carcinoma pregnancy apparent dehydration Gaissbock’s syndrome
  15. 15. Haematology Causes of thrombocytosis? Causes of haemolytic anaemia? 1 haematological disorder myeloproliferative disorders 2o reactive infection o congenital membrane deficit spheocytosis enzyme defect G6PD deficiency inflammation pyruvate kinase deficiency malignancy Hb defect sickle cell anaemia thalassaemia acquired Causes of thrombocytopenia? immune auto immune warm type (IgG mediated) infection autoimmune cold type (IgM mediated) medication medication leukaemia ↓ platelet production acute transfusion reaction non-immune myelodysplasia ↑ platelet destruction autoimmune idiopathic thrombocytopenia purpura penicillin infection malaria microangiopathic anaemia mechanical heart valve heparin induced thrombocytopenia paroxysmal nocturnal haemoglobinuria thrombotic thrombocytopenic purpura DIC Causes of lymphocytosis? Causes of eosinophilia? allergic conditions viral infection chronic infection infection lymphoma eczema inflammation allergic bronchopulmonary aspergillosis chronic lymphocytic leukaemia TB Causes of neutrophilia? malignancy parasitic infection Causes of neutropenia? post chemotherapy myeloproliferative disorders necrosis post radiotherapy medication carbimazole clozapine viral infection felty’s syndrome
  16. 16. Biochem Causes of hyponatraemia? fluid depleted patient Causes of hypernatraemia? diuretics dehydration volume loss vomiting diabetes insipidus diarrhoea excess IV fluids burns hypoadrenalism Causes of hypokalaemia? SIADH medication diuretic hypothyroidism normovolaemic patient intestinal loss excess vomiting psychogenic polydipsia fluid overloaded patient profuse diarrhoea cardiac failure renal tubular disease medication induced damage liver failure endocrine cushing’s syndrome renal failure conn’s syndrome hypoalbuminaemia metabolic alkalosis Causes of hyperkalaemia? renal failure Bone profile Ca2+ phosphate ALP artefact osteoporosis ↔ ↔ ↔ medication osteomalacia ↔/↓ ↓ ↑ pagets disease ↔ ↔ ↑ rhabdomyolysis bony metastases ↔/↑ ↔/↑ ↑ endocrine diabetic ketoacidosis 1o hyperparathyroidism ↑ ↓ ↑ 2o hyperparathyroidism ↔ ↑ ↑ 3o hyperparathyroidism ↑ ↓ ↑ potassium sparing diuretics potassium supplements addison’s disease
  17. 17. Endocrinology Causes of Cushing’s syndrome? Causes of hyperprolactinaemia ? 1o adrenal disease adrenal tumour physiological 2o ACTH excess glucocorticoid medication pregnancy lactation pituitary gland (Cushing’s disease) tumour prolactin secreting pituitary tumour ACTH secreting tumour medication metoclopramide domperidone phenothiazine antipsychotics Causes of SIADH? intracranial endocrine infection tumour head injury intrathoracic infection lung cancer medication carbamazepine antipsychotics PCOS

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