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MEDICINE FOR FINALS

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PERCUSSION. AUSCULTATION. PLEURAL EFFUSION. LOOK FOR DECREASED MOVEMENT. TRACHEAL DEVIATION ... DECREASED PERCUSSION. BRONHIAL BREATHING. CREPS. CAUSES ... – PowerPoint PPT presentation

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Title: MEDICINE FOR FINALS


1
MEDICINE FOR FINALS
DR INDER MAINIE MAY 2002
2
CARDIOVASCULAR
  • INTRODUCTION
  • MAY I EXAMINE YOU?
  • 45 DEGREES
  • INSPECTION (SOB, SCARS, MALAR FLUSH, ANKLE
    OEDEMA)
  • ALWAYS LOOK AROUND THE BED, INHALERS, OXYGEN,
    DIET DRINKS ETC

3
EXAMINATION
  • LOOK AT THE HANDS
  • FINGER CLUBBING
  • CYANOSIS
  • SPLINTER HAEMORRAGES
  • PALE

4
PULSE
  • RATE
  • RHYTMN
  • CHARACTER BRACHIAL/CAROTID
  • VOLUME
  • COLLAPSING PULSE

5
CAUSES OF IRREGULAR IRREGULAR PULSE
  • ATRIAL FIBRILLATION, VES, ATRIAL FLUTTER WITH
    VAR BLOCK, CHB
  • CAUSES OF AF
  • ISCHAMIC HEART DISEASE
  • RHEUMATIC HEART DISEASE
  • THYROID
  • NO CAUSE
  • CARDIOMYOPATHY
  • WPW
  • INFECTION
  • ASD

6
COLLAPSING PULSE
  • AORTIC REGURG LOOK FOR CORRIGANS SIGN
  • PDA
  • PAGETS
  • PREGNANCY
  • RUPTURED ANEURYSM OF AORTIC SINUS
  • FEVER
  • ANAEMIA

7
RADIO-FEMORAL DELAY
  • COARCTATION OF THE AORTA
  • ASK WHILE EXAMINING THE PULSE CAN YOU CHECK FOR
    THIS

8
BLOOD PRESSURE
  • ALWAYS REMEMBER TO ASK IF YOU CAN CHECK THE BLOOD
    PRESSURE

9
JVP
  • INTERNAL JUGULAR
  • BETWEEN THE TWO HEADS
  • EQUAL TO PRESSURES IN THE RIGHT ATRIUM
  • a WAVE ATRAL CONTRACTION
  • v WAVE ATRIAL FILLING DURING VENTRICLAR
    SYSTOLE,TRICUSPID VALVE IS CLOSED

10
CAUSES OF A RAISED JVP
  • HEART FAILURE ELEVATION, SUSTAINED HJR
  • PE ELEVATED
  • PERICARDIAL EFFUSION-ELEVATED, PROMINENT Y
    DESCENT
  • CONSTRICTIVE PERICARDITIS-ELEVATED KUSSMAULS,
    PARADOXICAL RISE ON INSPIRATION
  • AF NO a WAVES
  • TRICUSPID STENOSIS- GIANT a WAVES
  • TRICUSPID REGURG- GIANT v WAVES
  • COMPLETE HEART BLOCK- CANNON WAVES

11
APEX BEAT
  • LOOK FOR STERNOTOMY SCARS
  • LOOK FOR THORACOTOMY SCARS
  • POSITION AND CHARACTER
  • CHECK FOR HEAVES OR THRILLS

12
HEART SOUNDS
  • PALPATE THE CAROTID SIMULTANEOUSLY
  • COMMENT ON I AND II OR ADDITIONAL
  • MURMURS

13
MURMURS
  • STENOSIS- APEX LEFT LATERAL USE THE BELL
  • REMEMBER CHANGES IN BREATHING
  • INSPIRATION RIGHT HEART MURMURS GET LOUDER
  • EXPIRATION LEFT SIDE MURMURS GET LOUDER
  • PANSYSTOLIC MURMUR APEX, AXILLA
  • EARLY DIASTOLIC AORTIC REGURG 3RD ICS SIT FORWARD
    ON EXP

14
GRADING OF MURMURS
  • 1. FAINT
  • 2. FAINT BUT EASILY DETECTED
  • 3. POMINENT BUT NOT LOUD
  • 4. LOUD THRILL
  • 5. VERY LOUD
  • 6. LOUD WITHOUT CONTACT

15
REMEMBER
  • LUNG BASES
  • SACRAL OEDEMA
  • HEPATOSPLENOMEGALY FAILURE
  • PERIPHERAL PULSES

16
MITRAL STENOSIS
  • MALAR FLUSH
  • PULSE- IRREGULR IRREGULAR
  • RAISED JVP
  • TAPPING APEX NOT DISPLACED
  • LEFT PARASTERNAL HEAVE(RIGHT VENTRICULAR
    ENLARGEMENT)
  • LOUD 1ST HS
  • OPENING SNAP

17
MITRAL STENOSIS
  • CAUSES- RHD
  • TAPPING APEX BEAT -DUE TO ACCENTUATED 1ST HS
  • OPENING SNAP OPENING OF A STENOSED VALVE
    PLIABLE, ABSENT IN DIFFUSELY CALCIFIED VALVE
  • LOUD 1ST VALVES ARE MOBILE
  • PRESYSTOLIC ACCENTUATION- SINUS RHYTMN DUE TO THE
    ATRIAL SYSTOLE WHICH INCREASES FLOW ACROSS A
    STENOTIC VALVE

18
COMLICATIONS
  • LEFT ATRIAL ENLARGEMENT
  • AF
  • PULMONARY HTN
  • TR
  • RHF

19
SEVERITY
  • NARROWER DISTANCE BETWEEN 2ND HS AND OS
  • LONGER THE DIASTOLIC MURMUR

20
MITRAL REGURG
  • PERIPHERAL PULSES- NORMAL JERKY DUE TO REDUCED
    SYSTOLIC EJECTION TIME SECONDARY TO A LARGE
    VOLUME OF BLOOD REGURG INTO LEFT ATRIUM
  • APEX BEAT- DISPLACED
  • 1ST HS SOFT
  • 3RD HS
  • PSM -gt AXILLA LOUDER ON EXP

21
CAUSES OF MR
  • MITRAL VALVE PROLAPSE
  • RHD
  • LEFT VENTRICLAR DILATATION
  • CORONARY DISEASE
  • ANNULAR CALCIFICATION
  • ENDOCARDITIS
  • PAPILLARY MUSCLE RUPTURE
  • CARDIOMYOPATHY
  • CONNECTIVE TISSUE DISORDER
  • TRAUMA
  • MYXOMATOUS DEGENERATION

22
CAUSES OF PSM
  • MR
  • TR
  • VSD
  • HOCM

23
AORTIC REGURG
  • PULSE- LARGE VOLUME, COLLAPSING
  • CORRIGANS
  • APEX DISPLACED OUTWARDS, FORCEFUL
  • EDM- LSE SIT FORWARD EXPIRATION

24
Aortic Regurgitation
  • WIDE PULSE PRESSURE
  • FEMORALS- PISTOL SHOTS(TRAUBES)
  • TO AND FRO MURMUR (DUROZIEZS)
  • CORRIGANS CAROTID PULSATION
  • QUINCKES
  • UVULA PULSATIONS (MULLERS)
  • ARGYLL ROBERTSON PUPIL
  • MARFANS
  • ANK SPOND, RA

25
Causes Of Aortic Regurgitation
  • RF
  • HTN
  • ATHEROSCLEROSIS
  • ENDOCARDITIS
  • SYPHILIS
  • MARFANS
  • RA
  • ANK SPOND
  • TRAUMA
  • AORTIC DISSECTION

26
SEVERITY
  • WIDE PULSE PRESSURE
  • SOFT 2ND HS
  • 3RD HS
  • AUSTIN FLINT MURMUR
  • LVF
  • LONGER LOUDER

27
AORTIC STENOSIS
  • LOW VOLUME SLOW RISING
  • APEX- HEAVING, NOT DISPLACED
  • SOFT 2ND
  • EJECTION CLICK
  • S4 MAY BE HEARD
  • ESM
  • NARROW PULSE PRESSURE
  • REVERSE SPLITTING

28
CAUSES OF AORTIC STENOSIS
  • RHEUMATIC
  • DEGENERATIVE CALCIFICATION OF A BICUSPID VALVE

29
OTHER CAUSES OF ESM
  • PULM STENOSIS
  • HOCM
  • SUPRAVALVULAR STENOSIS

30
SYMPTOMS
  • FATIGUE
  • ANGINA
  • DYSPNOEA
  • SYNCOPE
  • DEATH

31
INVESTIGATIONS
  • ECG
  • CXR
  • ECHO
  • CATH
  • EST BE CAREFUL IF SYMPTOMATIC

32
TRICUSPID REGURGITATION
  • CAUSES
  • FUNCTIONAL
  • PULMONARY HTN
  • CCF
  • RHD
  • ENDOCARDITIS DRUG ADDICTS

33
VSD
  • PSM AT LSE
  • LOUD P2 OF PULM HTN
  • MAY HAVE CCF
  • LOUDNESS DOES NOT MEAN SEVERE

34
CAUSES OF VSD
  • CONGENITAL
  • RUPTURE AFTER MI
  • 50 MAY CLOSE SPONTANEOUSLY
  • COMPLICATIONS ARE
  • CCF
  • AORTIC REGURG
  • SBE
  • PULM HTN

35
INFECTIVE ENDOCARDITIS
  • ANAEMIA
  • CLUBBING
  • SPLINTER HAEMORRAGES- EMBOLISM
  • OSLER NODES- INFLAMMATION OF EMBOLI
  • JANEWAY LESIONS
  • PETECHIAE
  • ROTH SPOTS
  • SPLENOMEGALY
  • HAEMATURIA
  • DENTAL
  • FBP- NORMOCYTIC NORMOCHROMIC
  • ESR
  • BLOOD CULTURES
  • ECHO/ TOE

36
COMLICATIONS OF SBE
  • CARDIAC FAILURE
  • RENAL PAIN
  • CEREBRAL ANEURYSMS
  • MYCOTIC ANEURYSMS
  • VALVE ABSCESS

37
HOCM
  • PULSE JERKY
  • DOUBLE APICAL- LEFT VENTRICULAR HEAVE WITH PROM
    PRESYSTOLIC PULSE
  • PSM- SOFTER ON SQUATTING
  • 4TH HS
  • FAMILY HISTORY

38
RESPIRATORY
  • INTRO
  • SITTING POSITION
  • SPUTUM CUP
  • BREATHLESS
  • WASTING
  • ASYMMETRICAL BREATHING
  • COUNT RESP

39
HANDS
  • CLUBBING
  • CYANOSIS
  • TAR
  • BOUNDING PULSE
  • ASTERIXIS
  • TONGUE CYANOSIS
  • EYES- PALLOR, HORNERS

40
EXAMINATION
  • LOOK FOR NECK VEINS
  • CERVICAL LYMPH
  • TRACHEA DEVIATION
  • PALPATE
  • MOVEMENTS OF BOTH SIDES
  • VOCAL FREMITUS
  • PERCUSSION
  • AUSCULTATION

41
PLEURAL EFFUSION
  • LOOK FOR DECREASED MOVEMENT
  • TRACHEAL DEVIATION
  • ASPIRATION MARKS
  • STONY DULL
  • DECREASED VOCAL RESONANCE
  • FIND THE UPPER LEVEL
  • BRONCIAL BREATHING
  • SIGNS OF RA, TAR, LYMPH NODES, RADIATION BURNS,
    MASTECTOMY

42
CAUSES OF DULLNESS
  • PLEURAL EFFUSION
  • PLEURAL THICKENING
  • CONSOLODATION
  • COLLAPSE
  • RAISED HEMIDIAPHRAGM

43
INVESTIGATIONS
  • CXR
  • TAP
  • SEND FOR PROTEIN, LDH, GLUCOSE, BACTERIOLOGY,
    CYTOLOGY
  • PH IF EMPYEMA
  • AMYLASE IN NG, PANCREATITIS, OESOPHAGEAL RUPTURE
  • RHEUMATOID FACTOR

44
TRANSUDATE
  • NEPHROTIC SYNDROME
  • CARDIAC FAILURE
  • LIVER FAILURE
  • HYPOTHYROID
  • CONSTRICTIVE PERICARDITIS
  • MEIGS

45
EXUDATE
  • CA
  • SECONDARIES
  • PNEUMONIA
  • PE
  • TB
  • RA
  • SLE
  • LYMPHOMA
  • MESOTHELIOMA

46
PROGNOSIS
  • POOR IN NG PEURAL FLUID
  • LOW GLUCOSE
  • LOW pH

47
HAEMORRAGIC FLUID
  • PE
  • NG
  • TB

48
REMEMBER OCCUPATION
EG SHIP BUILDING
49
BRONCHIECTASIS
  • LOOK FOR SPUTUM CUP
  • FINGER CLUBBING
  • BILATERAL COARSE CREPS
  • LATE INSP CREPS

50
BRONCHIECTASIS
  • DEF - CHRONIC NECROTIZING INFECTION OF THE
    BRONCHI AND BRONCHIOLES LEADING TO ABNORMAL,
    PERMANENT DILATATION OF THE AIRWAYS

51
CAUSES
  • PNEUMONIA
  • MEASLES
  • PERTUSSIS
  • TB
  • MECHANICAL OBSTRUCTION
  • ASPERGILLOSIS
  • KARTAGENERS
  • CYSTIC FIBROSIS
  • IDIOPATHIC

52
INVESTIGATION
  • FBP
  • SPUTUM
  • CXR
  • CT

53
COMPLICATIONS
  • PNEUMONIA
  • PLEURAL EFFUSION
  • PNEUMOTHORAX
  • SINUSITIS
  • HAEMOPTYSIS
  • BRAIN ABSCESS
  • AMYLOIDOSIS

54
TREATMENT
  • POSTURAL DRAINAGE
  • ANTIBIOTICS
  • NEBS
  • SURGERY

55
CONSOLIDATION
  • SPUTUM
  • TACHYNOEA
  • REDUCED MOVEMENT ON AFFECTED SIDE
  • TRACHEAL CENTRAL
  • DECREASED PERCUSSION
  • BRONHIAL BREATHING
  • CREPS

56
CAUSES
  • PNEUMONIA
  • CARCINOMA
  • PE

57
FIBROSING ALVEOLITIS
  • TACHYNOEA
  • CLUBBING
  • CENTRAL CYANOSIS
  • BILATERAL BASAL FINE END INSP CREPS
  • DO NOT DISAPPEAR ON COUGHING

58
SIGNS
  • HANDS - RA, SYSTEMIC SCLEROSIS
  • FACE - RASH OF SLE
  • MOUTH - DRY OF SJOGRENS
  • PULMONARY HTN - a WAVE IN JVP, LEFT PARASTERNAL
    HEAVE AND P2
  • LOOK FOR CAUSES - DRUGS EG AMIODARONE

59
PROGNOSIS
  • 50 SURVIVAL AFTER 5 YEARS
  • INCREASE RISK OF CA

60
ABDOMEN
61
EXAMINATION
  • LYING FLAT
  • DO NOT EXPOSE GENITALIA
  • COMFORTABLE
  • LOOK AROUND THE BED

62
HANDS
  • CLUBBING
  • LEUCONYCIA
  • PALMAR ERYTHEMA
  • DUPUTRYENS
  • HEPATIC FLAP
  • PIGMENTATION
  • SCRATCH MARKS

63
EXAMINATION
  • NODES
  • TONGUE
  • EYES - JAUNDICE, XANTHELASMA ANAEMIA
  • SPIDER NAEVIA
  • ACANTHOSIS NIGRICANS
  • GYNAECOMASTIA

64
EXAMINATION OF ABDOMEN
  • MOVEMENTS
  • MASS
  • VEINS
  • PERISTALSIS
  • HERNIA

65
ASK IF THERE IS ANY PAIN
66
PALPATION
  • KNEEL DOWN
  • ALWAYS LOOK AT THE PATIENT
  • SUPERFICIAL THEN DEEP
  • ALL QUADRANTS

67
PALPATE
  • MASS - CHARACTERISTICS
  • LIVER - PERCUSSION
  • SPLEEN
  • KIDNEYS
  • LYMPH NODES
  • HERNIAL ORFICES
  • TESTICULAR ATROPHY

68
PERCUSSION
  • SHIFTING DULLNESS

69
AUSCULTATE
  • LIVER BRUIT
  • BOWEL SOUNDS
  • RENAL BRUIT

70
LEG OEDEMAPR
71
HEPATOMEGALY
  • SIZE
  • TENDERNESS- CHF OR ACUTE HEPATITIS
  • SURFACE - SMOOTH OR IRREGULAR
  • PERCUSS
  • AUSULTATE- ALCOHOLIC HEPATITIS OR CA FOR BRUIT

72
CAUSES
  • CHF
  • CIRRHOSIS
  • SECONDARIES
  • INFECTIVE HEPATITIS
  • MYELOPROLIFERATIVE DISORDERS
  • SARCOID
  • HAEMACHROMATOSIS
  • PBC
  • AMYLOID
  • TUMOURS

73
CAUSES OF HEPATIC ENCEPHALOPATHY
  • INFECTION
  • DIURETICS, ELECTROLYTE IMBALANCE
  • DIARROHEA AND VOMITING
  • SEDATIVES
  • GI BLEED
  • ABDOMINAL PARACENTESIS
  • SURGERY

74
CAUSE OF ASCITES
  • LIVER FAILURE PORTAL HTN
  • SECONDARY HYPERALDOSTERONISM
  • DECREASED METABOLISM OF ALDOSTERONE BY LIVER
  • DECREASED METABOLISM OF ADH
  • LOW ALBUMIN
  • LYMPHATIC OBSTRUCTION

75
HAEMACHROMATOSIS
  • MALE
  • PIGMENTED
  • PALMAR ERYTHEMA AND SPIDER ANAEMIA
  • JAUNDICE
  • ASCITES
  • HEPATOMEGALY
  • LOSS OF SEXUAL HAIR
  • TESTICULAR ATROPHY
  • JOINT PAIN- PSEUDOGOUT
  • CARDIOMYOPATHY
  • DIABETES

76
INVESTIGATIONS
  • AUTOSOMAL RECESSIVE
  • MOSTLY HLA-A3
  • CHROMOSOME 6
  • TRANSFERRIN INCREASED
  • SERUM FERRITIN RAISED
  • GENE TESTING
  • LIVER BIOPSY

77
TREATMENT
  • VENESECTION

78
RISK
  • X200 RISK OF HEP CA

79
PBC
  • MIDDLE-AGED WOMEN
  • CLUBBING
  • PIGMENTED
  • XANTHELASMA
  • ICTERUS
  • SCRATCH
  • HEPATOSPLENOMEGALY

80
PBC
  • XANTHOMATA- JOINTS
  • - SKIN FOLDS
  • - AREA OF TRAUMA
  • LOOK FOR OTHER AUTOIMMUNE DISEASES
  • PROXIMAL MUSCLE WEAKNESS OSTEOMALACIA
  • PERIPHERAL NEUROPHATHY
  • AMA M2
  • OBSTRUCTIVE PICTURE
  • LIVER TRANSPLANTATION

81
LOOK FOR
  • AUTOIMMUNE CONDITIONS
  • PROXIMAL MUSCLE WEAKNESS DUE TO OSTEOMALACIA
  • PERIPHERAL NEUROPATHY

82
PBC
  • ANTI-MITOCHONDRIAL ABS
  • CURE IS TRANSPLANTATION

83
SPLENOMEGALY
  • DIFF FROM KIDNEY
  • KIDNEY BALLOTABLE
  • NOTCH
  • CANT GET ABOVE
  • DULL TO PERCUSSION
  • MOVES WITH RESP

84
LOOK FOR
  • LYMPH NODES
  • ANAEMIA
  • JAUNDICE
  • PLETHORIC (PRV)
  • SPLINTER HAEMORRAGES
  • RHEUMATOID

85
CAUSES
  • CML
  • MALARIA
  • KALA-AZAR
  • PRV
  • MYELOFIBROSIS
  • PORTAL HTN
  • SARCOID
  • AMYLOID
  • ENDOCARDITIS
  • INFECTIOUS MONONUCLEOSIS
  • FELTYS
  • CLL
  • ITP

86
KIDNEYS
  • LOOK FOR AV FISTULA
  • LOOK FOR TRANSPLANTED KIDNEY
  • 3RD NERVE PALSY ASSOC WITH POLYCYSTIC KIDNEY
    (BERRY)
  • BP
  • FHX
  • ANAEMIA

87
ABDOMINAL MASSES
  • EPIGASRTIC -CA STOMACH
  • -CA PANCREAS
  • -AAA
  • -RETROPERITONEAL LYMPHADENOPATHY

88
ABDOMINAL MASSES
  • RT ILIAC FOSSA- CROHNS
  • CA CAECUM
  • LYMPH NODES
  • TRANSPLANTED KID
  • APPENDIX ABSCESS
  • OVARIAN NG
  • CARCINOID
  • AMOEBIAS

89
CAUSES OF PTOSIS
  • UNILATERAL
  • 3RD NERVE PALSY
  • HORNERS
  • MYASTHENIA
  • CONGENITAL
  • IDIOPATHIC
  • BILATERAL
  • MYASTHENIA
  • DYSTROPHIA
  • OCULAR MYOPATHY
  • SYPHILIS
  • CONGENITAL
  • BILATERAL HORNERS IN SYRINGOMYELIA

90
HORNERS
  • MIOSIS
  • PARTIAL PTOSIS
  • ENOPTHALMOS
  • ANHYDROSIS

91
CAUSES
  • PANCOAST TUMOUR
  • CERVICAL SYMPATHECTOMY
  • CAROTID ANERUYSMS
  • SYRINGOMYELIA
  • LESION OF BRAINSTEM
  • TRAUMA

92
HOLMES- ADIE
  • YOUNG WOMAN
  • DILATED PUPIL
  • PUPIL REACTS SLOWLY
  • DECREASED REFLEXES
  • BENIGN

93
DILATED PUPIL
  • EYE DROPS
  • 3RD NERVE
  • HOLMES ADIE
  • LENS IMPLANT
  • DEATH
  • SYMPATHETIC OVERACTIVITY

94
SMALL PUPIL
  • OLD AGE
  • EYE DROPS
  • HORNERS
  • ARGYLL ROB
  • PONTINE
  • NARCOTICS

95
DIABETIC EYES
  • BACKGROUND RETINOPATHY
  • PREPROLIFERATIVE
  • PROLIFERATIVE

96
PAPILLOEDEMA
  • SOL
  • HTN RETINOPATHY
  • BIH
  • INCREASED ICP
  • HEAD INJURY CAUSING CEREBRAL OEDEMA
  • CO RETENTION
  • THYROID
  • VIT A INTOXICATION
  • CENTRAL RETINAL VEIN THRMBOSIS
  • MUTIPLE MYELOMA

97
OPTIC ATROPHY
  • MS
  • OPTIC NERVE COMPRESSION
  • GLAUCOMA
  • TOXINS
  • ISCHAEMIA
  • HEREDITARY
  • PAGETS
  • VIT B12 DEF

98
LOWER 7TH
  • LOOK IN THE YEARS
  • PAROTID GLAND ENLARGEMENT
  • TASTE (INVOLVING CHORDA TYMPANI)
  • HEARING (HYPERACUUSIS DUE TO STAPEDIUS)
  • URINE - DIABETES

99
CAUSES OF BILATERAL
  • GUILLAN BARRE
  • SARCOIDOSIS
  • MYASTHENIA MAY MIMIC

100
UNILATERAL PALSY
  • LLS
  • HERPES
  • CEREBELLOPONTINE TUMOURS
  • POLIO
  • OTITIS MEDIA
  • SKULL FRACTURE

101
DYSTROPHICA MYOTONICA
  • SHAKING HANDS
  • FRONTAL BALDNESS
  • PTOSIS
  • CATARACTS
  • EXPRESSIONLESS

102
DYSTROP MYOTON
  • TEST POWER
  • DECREASED REFLEXES
  • ASK ABOUT SWALLOWING
  • URINE - GLUCOSE
  • LOW IQ
  • GYNAECOMASTIA
  • TESTICULAR ATROPHY

103
DYSTROP MYOTONICA
  • A D
  • CARDIOMYOPATHY
  • CHEST INFECTION

104
PROXIMAL MYOPATHY
  • DIABETES
  • CUSHINGS
  • THYROID
  • POLYMYOSITIS
  • DRUG
  • CARCINOMA
  • OSTEOMALACIA
  • HEREDITARY

105
WASTING SMALL MUSCLES OF THE HAND
  • RHEUMATOID
  • OLD AGE
  • CERVICAL SPONDYLOSIS
  • BILATERAL CERVICAL RIBS
  • MND
  • SYRINGOMYELIA
  • CHARCOT
  • GUILLAN
  • NERVE PALSIES
  • PANCOASTS

106
NEUROFIBROMATOSIS
  • AXILLA FOR FRECKLES
  • VISUAL ACUITY - GLIOMA
  • ACOSTIS NEUROMA
  • IRIS FOR LISCH NODULES
  • KYPOSCOLIOSIS
  • BLOOD PRESSURE

107
LOOK FOR
  • 6 OR MORE CAFÉ AU LAIT
  • 2 OR MORE NEUROFIBROMAS
  • AXILLA FRECKLING
  • OPTIC GLIOMA

108
SPEECH
  • COMPREHENSION
  • PUT OUT TONGUE
  • SHUT YOUR EYES
  • ORIENTATION
  • TIME , DATE

109
SPEECH
  • NAME FAMILIAR OBJECTS
  • ARTICULATION
  • MENTAL SCORE
  • EXPRESSIVE - BROCA FRONTOPARIETAL
  • RECEPTIVE - WERNICKES SUPERIOR TEMPORAL

110
PARKINSONS
  • EXPRESSIONLESS- HYPERMYMIA
  • DROOLING
  • PILL ROLLING
  • BRADYKINESIA
  • TONE- COG WHEEL
  • GLABELLAR TAP - CONTINUE MYERSONS SIGN
  • WALK
  • MICRGRAPHIA

111
RHEUMATOID
  • SUBLUXATION OF MCP
  • SWAN NECK
  • BOUTONNIERES
  • Z DEFORMITY
  • SUBLUX AT WRIST
  • NAIL FOLD INFARCTS
  • PALMAR ERYTHEMA

112
RHEUMATOID ARTHRITIS
  • MUST CHECK FOR NODULES SEROPOSITIVE AGGRESSIVE
  • PERFORM SIMPLE TASKS
  • EXAMINE OTHER JOINTS

113
ANAEMIA
  • CHRONIC DISEASE
  • PERNICIOUS ANAEMIA
  • FELTYS
  • NSAIDS

114
PULMONARY
  • NODULES
  • EFFUSION
  • FIBROSIS
  • CAPLANS
  • BRONCHIOLITIS OBLITERANS

115
EYES
  • EPISCLERITIS
  • SCLERITIS
  • SCLEROMALACIA
  • SICCA
  • SJOGRENS

116
ANK SPOND
  • ? MARK POSTURE
  • PROTUBERANT ABDOMEN
  • ASK HIM TO TURN WHOLE BODY TURNS
  • STAND AGAINST A WALL
  • SCHOBERS TEST

117
LOOK FOR
  • IRITIS
  • ANTERIOR UVEITIS
  • AORTIC REGURG
  • APICAL FIBROSIS
  • ACHILLES TENDINITIS

118
GENETIC
  • HLA-B27
  • 40 SEVERE DISEASE

119
SCLERODERMA
  • TIGHTENING OF HANDS
  • TELANGICTASIA
  • PSEUDOCLUBBING
  • VITILIGO
  • JOINT FOR ARTHRITIS
  • PINCHED NOSE
  • DIFF OPENING MOUTH

120
ASK ABOUT
  • DYSPHAGIA
  • RAYNAUDS
  • DRY EYES
  • SWALLOWING
  • BREATHING - FIBROSIS

121
GOUT
  • ASYMMETRICAL
  • LOOK AT 1ST MTP , HELICES, OLECRANON, ACHILLES
  • NEGATIVE BIFRINGENT
  • DISORDER OF PURINE METABOLISM

122
THYROID
  • HANDS - SWEATING, TREMOR, WARM
  • SCARS
  • PALMAR ERYTHEMA
  • PULSE
  • NODES
  • GOITRE
  • SEAT UPRIGHT
  • EXOPTHALMOS
  • PALPATE ,WATER

123
EXAMINE FOR
  • SIZE
  • MOBILITY
  • TEXTURE
  • TENDERNESS
  • PEMBERTONS SIGN - RAISE ARMS FOR COMPRESSION
  • PERCUSS FOR RETROSTERNAL
  • BRUITS - GRAVES

124
EYES
  • LID LAG VON GRAEF SIGN
  • EXOPTHALMOS
  • LID RETRACTION DALRYMPLES SIGN
  • EXTRAOCCULAR MOVEMENTS
  • CORNEAL INVOLVEMENT
  • PROXIMAL MUSCLES
  • SKIN PRETIB MYXOEDEMA

125
CUSHINGS
  • MOON FACE
  • BRUISES
  • HIRSUTISM
  • PLETHORIC
  • BUFFALO HUMP
  • STRIAE
  • PROXIMAL MUSCLE WEAKNESS

126
ASK ABOUT
  • STEROIDS
  • DIABETES
  • BP
  • LOOK FOR RA , ASTHMA
  • VISUAL FIELDS

127
CAUSES
  • STEROIDS
  • PITUITARY ADENOMA- PIT DISEASE
  • ADRENAL CA
  • ADRENAL ADENOMA
  • ECTOPIC CA

128
ACROMEGALY
  • FACE
  • SWEATING
  • LARGE HANDS
  • CARPAL TUNNEL
  • PROM SUPRAORBITAL RIDGES
  • LARGE NOSE AND LIPS
  • PROTRUSION OF LOWER JAW
  • WIDE TEETH

129
LOOK FOR
  • MACROGLOSSIA
  • VISUAL FIELDS
  • ACANTOSIS NIGRICANS
  • ORGANOMEGALY
  • JOINTS- CHONDROCALCINOSIS
  • KYPHOSIS
  • BP
  • DIABETES
  • OLD PHOTOGRAPHS

130
HYPERTENSIVE FUNDUS
  • GRADE 1 SILVER WIRING
  • GRADE 2 AV NIPPING
  • GRADE 3 HAEMORRAGES (FLAME) EXUDATES
  • GRADE 4 - PAPILLOEDEMA

131
DIABETIC EYES
  • BACKGROUND/PREPROLIFERATIVE HAEMORRAGES
    (MICROANEURYSMS) EXUDATES
  • PROLIFERATIVE MALIGNANT RETINOPHATY
  • NEOVASCULARISATION NEW VESSELS

132
GOOD LUCK !
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