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Cardiology Causes of chest pain? cardiac Arterial pulses GI musculo-skeletal Causes of AF? angina plateau AS RVF IHD MI small volume AS pulmonary hypertension hypertension pulmonary stenosis mitral stenosis pericarditis respiratory Causes of raised JVP? shock aortic dissection bisferiens AS, AR tricuspid stenosis lone atrial fibrillation pleurisy anacrotic AS SVC obstruction cardiomyopathy PE pulsus alternans LVF pneumothorax pulsus paradoxus pericardial effusion Causes of cor pulmonale? COPD idiopathic pulmonary fibrosis massive PE obstructive sleep apnoea 1O pulmonary hypertension hyperthyroidism GORD constrictive pericarditis oesophagitis severe asthma Causes of peripheral oedema? generalised (bilateral) fluid overload heart failure renal failure strain/trauma iatrogenic hypoproteinaemia Causes of Rt heart failure? Causes of Lt heart failure? 2O to Lt heart failure IHD MI hypertension PS, TS, TR MI 1O pulmonary hypertension AS, AR, MR malnutrition malabsorption chronic liver disease nephrotic syndrome localised (unilateral) medication calcium channel blocker obstruction pelvic tumour DVT 2O pulmonary hypertension (COPD) Causes of bradycardia? Causes of tachycardia? Causes of raised D-Dimer? athletes pain DVT B-blocker fever MI hypothyroidism anxiety recent surgery heart block thyrotoxicosis liver disease hypothermia B2-agonist renal disease hypovolaemia malignancy infection cellulitis postural standing too long ruptured Baker’s cyst Causes of pericarditis? infarction MI iatrogenic cardiac surgery inflammation SLE arrhythmia rheumatoid disease infection coxsachie virus bacterial 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 Mitral regurgitation Aortic regurgitation Mitral stenosis harsh crescendo-decrecendo systolic pansystolic early diastolic 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 cardiomypoathy pulmonary stenosis Lt posterior fasicular block Lt lateral infarction LAD artery ischaemia/infarction cardiomyopathy Rt sided infarction diffuse ischaemia/infarction Lt ventricular hypertrophy Cardiology ECG changes hyperkalaemia Causes of Rt bundle branch block? Causes of Lt bundle branch block? PE hypertension cor pulmonale IHD IHD 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 ischaemia sinus tachycardia Infarct patters RBBB inferior lead II, III, aVF RV strain pattern septal V1-V2 ST depression anterior V3-V4 T wave inversion LVH S (V1 or V2) + R (V5 or V6) 35mm Lt BBB ECG changes? lead I, aVL, V5-V6 lateral posterior any chest lead 45mm RVH Rt 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 Cardiology ECG P wave fever Rt atrial enlargement NAD on ECG, CXR, US anaemia bifid (P mitrale) Lt atrial enlargement NAD on physical exam pregnancy position dependent thyrotoxicosis <3 sq PR interval 3-5 sq grade 3 <3 WPW syndrome >5 1st degree HB QT interval if HR 60bpm < 0.44sec QTc used if HR not 60bpm Grading of murmur 1. very faint 2. soft QT/ (square of RR) short hyperCa2+ 3. heard all over praecordium long hypoCa2+ 4. loud with palpable thrill inverted ischaemia 5. loud heard with stethescope partially of chest MI 6. very loud, heard without stethescope SAH persistant juvenile pattern digoxin LVH strain pattern hypo K, Ca, Mg Q waves Causes of benign murmur? systolic tall (P pulmonale) >2.5 sq tall QRS T wave Features of benign murmur? <2.5sq wide lead II, III, aVF, V5-V6 normal > 1 sq wide & 2mm deep pathological Respiratory Causes of cough? Causes of haemoptysis? URTi bronchitis pneumonia pneumonia foreign body bronchiectasis post nasal drip lung CA asthma PE GORD spurious COPD TB acute chronic Causes of stridor? sudden inhaled foreign object 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 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 hypoventilation infection impaired diffusion cystic fibrosis abnormal V/P ratio bacterial pneumonia malignancy breast lymphoma PE TB bronchial CA SLE Causes of breathlessness? Causes of wheeze? asthma cardiac cardiac failure respiratory asthma COPD bronchiectasis bronchiectasis large airway obstruction 1. pleural protein / serum protein >0.5 pneumonia 2. pleural LDH / serum LDH >0.6 pneumothorax 3. pleural LDH > 2/3 normal upper serum limit pulmonary fibrosis other Light criteria COPD PE anaemia overweight lung 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 extrinsic compression tumour in neck stomach retrosternal goitre neurological stroke MND duodenum IBS CA infection gastric ulcer iflammation IBD acute gastritis cancer colon CA CA endocrine hyperthyroidism duodenal ulcer 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 sigmoid CA appendix abscess ovarian cyst ovary cyst Causes of Lt iliac fossa mass? sigmoid 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 Gastro Causes of splenomegaly? mild portal hypertension Causes of hepatomegaly? 20 to cirrhosis cardiac heart failure cirrhosis infectious hepatitis moderate (4-8cm) massive (>8cm) tricuspid regurgitation infective hepatitis idiopathic thrombocytopenia brucellosis rheumatoid arthritis hydatid disease portal hypertension 20 to cirrhosis haematological lymphoma lymphoma leukaemia leukaemia myelofibrosis malaria haemolytic anaemia gaucher’s disease infiltrative Causes of paralytic ileus? abdominal surgery peritonitis amyloidosis mesenteric ischaemia black fever Causes of small bowel obstruction? Causes of large bowel obstruction? adhesion strictures tumour sigmoid volvulus Causes of hepatosplenomegaly? infective hepatitis brucellosis toxoplasmosis hernia colan CA volvulus 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 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 LLQ appendicitis renal colic sigmoid diverticulitis caecal perforation cystits sigmoid volvulus Meckles diverticulitis ectopic pregnancy mesenteric adenitis ovarian cyst GI gastritis inflammatory transudate exudate hepatitis metabolic uraemia heart failure pre hepatic haemolytic anemia chronic liver disease hepatic hepatitis nephrotic syndrome alcohol hypoproteaniemia primary biliary cirrhosis tuberculous peritonitis hypercalcaemia addison’s Causes of jaundice? intra-abdominal malignancy 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 neurogenic ↑ ICP pain vestibulocochlear disease medication cytotoxics opiods antibiotics Neurology Nerve palsies Causes of tremors? postural (physiological) eye is pointing down and out diabetes anxiety III dilated pupil MS Caffeine ptosis posterior communicating artery aneurysm eye pointing up trauma head is tilted diabetes salbutamol resting parkinsons intention cerebellar disease e.g.MS, cerebrovascular disease flapping respiratory failure (type II) IV MS VI eye pointing medially MS raised ICP hepatic encephalitis trauma V Signs of lesions UMN LMN ↑ tone ↓ tone ↑ reflexes ↓ reflexes clonus fasiclutaions extensor plantar muscle wasting sensory loss herpes zoster syringomyelia 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 Neurology Gait abnormalities antalgic (limp) myogenic trauma sensory ataxia peripheral neuropathy cerebral ataxia cerebrovascular disease MS hemiplegic Causes of ↑ ICP? Causes of ptosis? arthritis Horner’s syndrome intracranial mass “ infection III nerve palsy neurogenic tendon myasthenia gravis obstructed CSF flow myotonic dystrophy hypertensive encephalopathy involutional hypercapnia stroke scissor MS Causes of syncope? cerebal palsy neurally mediated situational MS foot drop vasovagal sneeze common peroneal palsy micturation L5 radiculopathy waddling proximal myopathy parkinsonian parkinsons disease cough carotid sinus hypersensitivity postural autonomic failure PD diabetes multiple system atrophy Bulbar IX, X, XII tongue LMN fasiculations GB syndrome wasting syringobulbia flaccid MND medication antihypertensives hypovolaemia haemorrhage diarrhoea post pradial cardiac arrhythmia ↓ movements Pseudobulbar sick sinus syndrome heart block dysphagia AF dysphonia long QT syndrome tongue UMN spastic MS AS ↓ movements bilateral internal capsule infarct HOCM MND acute aortic dissection dysphagia high pitch voice (Donald duck) respiratory PE psychogenic anxiety hyperventilation 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 Renal Causes of renal failure? acute pre-renal renal Causes of haematuria? hypoperfusion glomerulonephritis dehydration kidney renal artery obstruction infection ↓ cardiac output stones deposition of immune complexes trauma deposition of non-immune material nephritis immune mediated attack against endothelial cells of glomerular capillaries ureter hypoperfusion bladder contrast media interstial damage stones infection tumour prostate enlargement chronic glomerulonephritis diabetes anticholinergics post operatively BPH urethra trauma Causes of urinary frequency? ↑ fluid intake alcohol diabetes kidney disease diuretics diabetes Causes of urinary retention? BPH, CA detrusor instability hypertension congenital prostate NSAIDs antibiotics post-renal tumour infection NSAIDs aminoglycosides stones tumour immune mediated attack of basement membrane acute tubular necrosis tumours polycystic kidney disease 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 sideroblastic anaemia macrocytic B12 deficiency folate deficiency lymphoma leukaemia thalassaemia pernicious anaemia malignancy metastases systemic disease RA crohn’s disease SLE strict vegan 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 Haematology Causes of thrombocytosis? 1o 2o Causes of haemolytic anaemia? haematological disorder myeloproliferative disorders reactive infection congenital membrane deficit spheocytosis enzyme defect G6PD deficiency inflammation pyruvate kinase deficiency Hb defect malignancy sickle cell anaemia thalassaemia acquired Causes of thrombocytopenia? ↓ platelet production auto immune warm type (IgG mediated) infection autoimmune cold type (IgM mediated) medication medication leukaemia acute transfusion reaction non-immune myelodysplasia ↑ platelet destruction immune 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? viral infection chronic infection chronic lymphocytic leukaemia lymphoma TB Causes of eosinophilia? Causes of neutrophilia? allergic conditions infection eczema inflammation allergic bronchopulmonary aspergillosis malignancy parasitic infection myeloproliferative disorders necrosis Causes of neutropenia? post chemotherapy post radiotherapy medication carbimazole clozapine viral infection felty’s syndrome Biochem Causes of hyponatraemia? fluid depleted patient Causes of hypernatraemia? diuretics dehydration volume loss vomiting diabetes insipidus diarrhoea excess IV fluids burns normovolaemic patient hypoadrenalism Causes of hypokalaemia? SIADH medication diuretic hypothyroidism 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 1o hyperparathyroidism ↑ ↓ ↑ diabetic ketoacidosis 2o hyperparathyroidism ↔ ↑ ↑ 3o hyperparathyroidism ↑ ↓ ↑ potassium sparing diuretics potassium supplements addison’s disease 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
