Adult Health - Clinical Presentations

Front 1

What is atopy?

Back 1

The triad of symptoms eczema, allergic rhinitis and asthma

Front 2

What are the most common triggers of atopic asthma?

Back 2

House dust mite, Pollen, Animal dander, moulds, cockroach droppings

Front 3

How does a patient with Asthma present and how would you treat them?

Back 3

Wheezing: Expiratory

Periodic SOB

Hyperinflation

Prolonged expiration

Symptoms worsen at night

Frequent cough (can be nocturnal)

Precipitated by wide range of triggers

Silent chest

Use of accessory muscles

Pulsus paradoxus = very severe

Front 4

How do you treat acute asthma exacerbation?

Back 4

Salbutamol and ipratropium

Front 5

How do you diagnose COPD?

Back 5

Hx: cough, sputum, occasional SOB, usually at night

Ausc: Prolonged expiration, adventitious continuous and discontinuous expiratory breath sounds, wheeze, barrel chest

Front 6

What is pulsus paradoxus?

Back 6

Inspiratory fall in systole BP exceeding 10mmHg

Front 7

What are the most common causes of COPD?

Back 7

Smoking and exposure to airway irritants

Front 8

What is occupational asthma?

Back 8

Asthma induced by hypersensitivity toan agent inhaled at work

Front 9

Where is the pathology if a patient presents with an inspiratory wheeze?

Back 9

Trachea or larynx

Front 10

What is cor pulmonale and how does it present?

Back 10

Alteration to RV structure due to pulmonary disease

Ascites

Chest pain (angina)

Distended neck veins

Tachypnoea

Exertional dyspnoea

Cough

Cyanosis

Wheezes or crackles

Raised JVP (with prominent a wave)

Loud P2 and RV parasternal heave

Syncope

If caused by pul embolism: pleuritic chest pain and haemoptysis

Front 11

What is lobar pneumonia and how does it present?

Back 11

What is lobar pneumonia and how does it present?

Sudden onset malaise, chest pain, dypnoea and fever

Productive cough

Cyanosis

Hyperventilation and tachycardia

Use of accessory muscles

Bronchial breath sounds

Dullness on certain areas of percussion

Reduced lung expansion on affected side

Vocal resonance and fremitus

CXR: Homogenous opacificaion in lobar patter

Front 12

What is bronchiectasis and how does it present?

Back 12

condition in which an area of the bronchial tubes is permanently and abnormally widened

Productive cough (foul smelling sputum)

consititutional symptoms

Clubbing

Hyperventilation

Pyrexia

Displaced trachea if severe fibrosis (towards)

Coarse inspiratory crackles

CXR: tram track opacities

Front 13

What is lung abcess and how does it present?

Back 13

Liquefactive necrosis of the lung tissue and formation of cavities containing necrotic debris or fluid caused by microbial infection.

Foul smelling, bad tasting sputum

Fever, night sweats, anorexia

Clubbing

Pyrexia

Gingivitis

Dullness on percission

Bronchial breath sounds

Coarse inspiratory crackles

Decreased breath sounds

CXR: Air/fluid cavity

Front 14

How does TB present?

Back 14

Night sweats, malaise, LOW

Lymphadenopathy

Pyrexia

Dullness on percussion

Stridor

CXR: Infiltrates an hilar lymphadenopathy

Front 15

How does lung cancer present?

Back 15

Haemoptysis

Weight loss

Clubbing

Hyperventilation

Fixed inspiratory wheeze

Front 16

What is interstitial lung disease and how does it present?

Back 16

A group of lung diseases affecting the interstitium (the tissue and space around the air sacs of the lungs

Dry cough

Cyanosis

Clubbing

Reduced chest expansion

Crackles (inspiratory, fine)

Front 17

What are vocal resonance and vocalfremitus and what pathology is present is these signs are positive?

Back 17

V Res: Palpable vibration felt by examiner’s hands when pt speaks.Pathological when feels different on different sides.

V Frem: Consolidated lung takes on a ‘bleating’ quality. (e sounds likea)

Condition = pneumonia

Front 18

What are the most important causes of heart failure in south africa?

Back 18

Rheumatic Fever

Dilated cardiomyopathy

Hypertensive disorder

Coronary artery disease

cor pulmonale

Front 19

How does dilated cardiomyopathy present?

Back 19

Pitting oedema

Tachycardia

Hypertension

Thrusting/dyskinetic apex

S3/4

Crackles

Heptosplenomegaly ascites

May have irregularly irregular pulse due to AFib

Front 20

How does Leftventricular hypertrophy with diastolic dysfunction present?

Back 20

Tachycardia

Hypertension

Displaced apex

may have s3 or s4

crackles

hepatomegaly and ascites

Front 21

How does pulmonary hypertension present?

Back 21

Pitting oedema

small volume pulse

RV heave, palpable p2

S4, Loud P2 and systolic ejection click

Hepatomegaly and ascites

Front 22

What causes non-pitting oedema?

Back 22

Hypothyroidism

Lymphoedema

Front 23

What is Beri beri and what can it result in?

Back 23

adisease causing inflammation of the nerves and heart failure, ascribed to adeficiency of vitamin B1

pitting oedema

Front 24

What is Intravascular fluid overload?

and sign is present in it?

Back 24

Fluid volume excess in the intravascular compartment occurs due to an increase in total body sodium content and a consequent increase in extracellular body water

Raised JVP

Front 25

Describe JVP waveform

Back 25

Front 26

What causes:

Large cv waves

Rapid xy descents

Cannon a waves (and what are they)

Back 26

a) tricuspid regurg

b) constrictive percarditis

c) complete heart block, ventricular tachycardia (occurs when atria close over completely closed tricuspid valve

Front 27

What are the signs of pulmonary oedema?

Back 27

Haemoptysis

Orthopnoea

PND

Grunting, gurgling or wheezinig

Dyspnoea

Rales

Front 28

What are rales?

Back 28

abnormal rattling sound in lungs

Front 29

What are the characteristics of Atrial stenosis?

Back 29

Small volume and slow rising pulse

Sustained and obvious apex

Ejection mid systolic murmur

Narrowly split or reversed S2

Front 30

What are the characteristics of aortic regurg?

Back 30

Pounding or collapsing pulse. Bisferense pulse

Displaced, hyperkinetic apex

Ejection systolic murmur

High pitched early diastolic murmur

Soft A2

Front 31

What are the characteristics of mitral stenosis?

Back 31

Tapping apex

Loud 1

Low pitched rumbling diastolic murmur

Front 32

What are the characteristics of mitral regurg?

Back 32

Displaced, diffuse apex

soft or absent s1

pansystolic murmur

LV S3

Front 33

What are the characteristics of tricuspid regurg?

Back 33

RV heave

Pansystolic murmur

Front 34

What are the risk factors for atherosclerosis?

Back 34

Hyperlipidaemia, stress, smoking, sex(male), age, DM, HPT,obesity, physical inactivity, erectile dysfunction, post-menopause

Front 35

What are the symptoms of stableangina?

Back 35

Onset with physical exertion Moderate pain or discomfort. Feeling of tightness, pressure. Relief on rest No associated symptoms

Front 36

Whatis an acute coronary syndrome?

Back 36

A spectrum of presentations where blood supply is cut off to the heart

Front 37

Give Ddx for chest pain

Back 37

Radiates to neck, arm, shoulder: IHD

Sharp/stabbing. Worse on inspiration = Pleuritic

Sharp/stabbing = pericardial

GERD = Retrosternal burning. Radiates to throat

Well localised = musculoskeletal

Very severe, tearing. Radiates to back = Dissection of thoracic aorta

Front 38

What are the signs of dyslipidaemia and familialhypercholesterolaemia?

Back 38

Tendon xanthomata, palmar xanthomata, tuboeruptive xanthomata,xanthelesmata (around the eyes)

Front 39

What are the signs of PVD and atherosclerosis or carotid arteries?

Back 39

Ulcers,erythema, discolouration, hair lossDecreasedperipheral temperature and capillary refill time.Odema, weak peripheralpulses.

Front 40

What factors contribute to Hpt?

Back 40

Age, Obesity, Fam Hx, Race, High sodium Diet, excessive alcohol consumption, physical inactivity, diabetes and dyslipidaemia

Front 41

What are the five most important causes of secondary hypertension?

Back 41

Kidney disease

Sleep apnoea

Primary hyperaldosteronism

Coarctation of aorta

Pregnancy

Front 42

Whatis the pathophysiology of type I diabetes?

Back 42

Autoimmune disease resulting in the destruction of pancreaticbeta cells (insulin secreting) by autoreactive CD4 and CD8 cells. Geneticpredisposition> environmental trigger/infectious agent> loss ofsuppression of immunity> clinical phase.

Front 43

What is the pathophysiology of typeII diabetes?

Back 43

Genetic defects + risk factors (obesity, physical inactivity, unhealthy life style)= over secretion of insulin by beta cells> insensitivity of tissue to insulin= relative insulin deficiency

Front 44

What is the metabolic syndrome and what are the signs on general examination?

Back 44

Obesity, BMI>28, waist circumference, HPT, Dyslipidaemia, insulin resistance, hyperuricaemia.

Front 45

What are the symptoms of hyperglycaemia?

Back 45

Increased thirst, increased urinary frequency, headaches, fatigue

Front 46

What are the symptoms of hypoglycaemia?

Back 46

Shakiness, anxiety, clamminess, dizziness, sweating, tachycardia.

Front 47

What is diabetic ketoacidosis and howdo patients present?

Back 47

Hyperglycaemia, hyperosmolarity, low pH, ketonaemia, ketonuria.

Present: distressed,dehydrated, polyuria, nausea, vomiting, hypotension, tachycardia, kussmaul’sbreathing (deep and laboured), acetone on breath

Front 48

What are the most common causes of Hepatitis and what are their methods of transmission

Back 48

Hepatits A-E

A: Faecal-oral

B: Exposure to infected body fluid

C: Infected blood

E: waterborn

Front 49

Give overview of antibodies in Hepatitis and when they will be present

Back 49

Front 50

Whatare the symptoms and signs of a patient with acute viral hepatitis?

Back 50

Poor appetite, nausea, vomiting,fever, pain in the upper right part of the abdomen, and jaundice.

Front 51

Whatare the five most important causes of chronic liver disease/ cirrhosis?

Back 51

Alcohol abuse

Viral Hepatitis B and C

Autoimmune hepatitis

Primary and secondary biliarycirrhosis

Front 52

What are the signs of liver disease?

Back 52

Clubbing, Palmar erythema, Spider naevi, Gynaecomastia/Feminising hair distribution/Testicular atrophy

Small, irregular shrunken liver, Anaemia and caput medusa

Front 53

What is the normal liver span?

Back 53

6cmto 15 cm but generally is considered as less than 12 cm

Front 54

What organisms commonly cause UTI?

Back 54

E. Coli

Front 55

What are the symptoms and signs ofUTI and pyelonephritis?

Back 55

Dysuria, fever, flank and back pain, increased frequency,rigors, loin pain when pubic angle is ballotted.

Front 56

What are the signs of chronic renalfailure?

Back 56

Maliase, fatigue, anorexia (uraemia) Dehydration, nocturia (inability to concentrate urine)

HPT (failure to excrete Na) or hypotension (excessive loss ofNa)

Metabolic acidosis - Normocytic normochromic anaemia (failure to secrete EPO)

Front 57

Whatare the symptoms and signs of severe uraemia?

Back 57

Hicuppping, uraemic fetor, uraemic tinge, uraemic frost

Front 58

How does nephrotic syndrome present?

Back 58

Oedema (due to hypoalbuminaemia)

Protein +++ in urine

Causes:

Membranous glomerulonephritisSystemic disease (DM, SLE)

Front 59

How does nephritic syndrome present?

Back 59

Blood +++ and Protein + in urine

RBC Casts

Front 60

How does pyelonephritis present?

Back 60

Leucocytes +++ and Nitrite ++ in urine

White blood cell casts

Causes:

Ascending UTI

Cystitis

Front 61

How does Acute tubular necrosis present?

Back 61

No Hypertension

Granular casts