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Causes of chest pain? cardiacangina MI pericarditis aortic dissection respiratorypleurisy PE pneumothorax GIGORD oesophagitis musculo-skeletalstrain/trauma.

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Presentation on theme: "Causes of chest pain? cardiacangina MI pericarditis aortic dissection respiratorypleurisy PE pneumothorax GIGORD oesophagitis musculo-skeletalstrain/trauma."— Presentation transcript:

1 Causes of chest pain? cardiacangina MI pericarditis aortic dissection respiratorypleurisy PE pneumothorax GIGORD oesophagitis musculo-skeletalstrain/trauma Arterial pulses plateauAS small volumeAS shock bisferiensAS, AR anacroticAS pulsus alternansLVF pulsus paradoxuspericardial effusion constrictive pericarditis severe asthma Causes of Rt heart failure?Causes of Lt heart failure? 2 O to Lt heart failureIHD MIhypertension PS, TS, TRMI 1 O pulmonary hypertensionAS, AR, MR 2 O pulmonary hypertension (COPD) Causes of raised JVP? RVF pulmonary hypertension pulmonary stenosis tricuspid stenosis SVC obstruction Causes of cor pulmonale? COPD idiopathic pulmonary fibrosis massive PE obstructive sleep apnoea 1 O pulmonary hypertension Causes of AF? IHD hypertension mitral stenosis lone atrial fibrillation cardiomyopathy hyperthyroidism Causes of bradycardia?Causes of tachycardia? athletespain B-blockerfever hypothyroidismanxiety heart blockthyrotoxicosis hypothermia B2-agonist hypovolaemia arrhythmia Causes of peripheral oedema? generalised (bilateral)fluid overloadheart failure renal failure iatrogenic hypoproteinaemiamalnutrition malabsorption chronic liver disease nephrotic syndrome medication calcium channel blocker localised (unilateral)obstructionpelvic tumour DVT infectioncellulitis posturalstanding too long ruptured Baker’s cyst Causes of pericarditis? infarctionMI iatrogeniccardiac surgery inflammationSLE rheumatoid disease infectioncoxsachie virus bacterial Causes of raised D-Dimer? DVT MI recent surgery liver disease renal disease malignancy Cardiology

2 Causes of cyanosis? centralrespiratoryacute severe asthma COPD pulmonary oedema PE cardiacL-R shunt bloodmethaemoglobinaemia polycytheaemia peripheralas above vasoconstrictioncold raynaud’s beta blocker poor circulationheart failure blockagearterial obstruction Aortic stenosisMitral regurgitationAortic regurgitationMitral stenosis harsh crescendo-decrecendo systolicpansystolicearly diastolicmid diastolic loudest in aortic arearadiating to axillaLSE with expirationtapping apex beat radiating to carotiddisplaced, thrusting apex beat loud S1 sustained, heaving minimally displaced apex beatsoft S1collapsing (Corrigan) pulse slow rising pulsewide pulse pressure pistol shot noise over femorals Causes of Rt axis deviation?Causes of Lt axis deviation? Rt ventricular hypertrophycor pulmonaleLt anterior fasicular blockLAD artery ischaemia/infarction pulmonary stenosis cardiomypoathy Lt posterior fasicular blockcardiomyopathyRt sided infarction diffuse ischaemia/infarction Lt ventricular hypertrophy Lt lateral infarction Cardiology

3 Causes of Rt bundle branch block?Causes of Lt bundle branch block? PEhypertension cor pulmonaleIHD dilated cardiomyopathy rheumatic heart disease ECG changes hyperkalaemiatall tented T waves widened QRS absent P waves sine wave hypokalaemiaflattened T waves MI <5minhyperacute T waves <20minST elevation hrsterminal QRS changes within dayspathological Q waves variable timeT wave inverts PE sinus tachycardia RBBB RV strain pattern ischaemiaST depression T wave inversion LVH S (V1 or V2) + R (V5 or V6)  35mm any chest lead  45mm RVH R wave  7sq V1 R:S ratio V1 or V2  1 LVH strain patternV1-V2 ST elevation deep S waves V5-V6T wave inversion ST depression tall R waves RVH strain patterndepressed concave ST inverted assymetric T wave Infarct patters inferiorlead II, III, aVF septalV1-V2 anteriorV3-V4 lateral lead I, aVL, V5-V6 posteriortall R waves V1-V2 ST depression V1-V2 Causes of ST depression? ischaemia reciprocal changes in STEMI LVH / RVH strain pattern BBB PE digoxin Causes of ST elevation? MI pericarditis benign early repolarisation Rt BBB ECG changes?Lt BBB ECG changes? duration > 3 sq slurred S wave lead I, V6broad R waves lead I, V6 RSR lead V1broad S waves V1 Cardiology

4 ECG P wave <2.5sq wide tall (P pulmonale) >2.5 sq tall Rt atrial enlargement bifid (P mitrale) Lt atrial enlargement QRS<3 sq PR interval3-5 sq <3WPW syndrome >51 st degree HB QT interval if HR 60bpm < 0.44sec QTc used if HR not 60bpm QT/ (square of RR) short hyperCa2+ long hypoCa2+ T wave inverted ischaemia MI SAH persistant juvenile pattern digoxin LVH strain pattern hypo K, Ca, Mg Q waveslead II, III, aVF, V5-V6 normal > 1 sq wide & 2mm deep pathological Features of benign murmur? systolic NAD on ECG, CXR, US NAD on physical exam position dependent grade  3 Causes of benign murmur? fever anaemia pregnancy thyrotoxicosis Grading of murmur 1. very faint 2. soft 3. heard all over praecordium 4. loud with palpable thrill 5. loud heard with stethescope partially of chest 6. very loud, heard without stethescope Cardiology

5 Causes of cough? acute URTi pneumonia foreign body chronic post nasal drip asthma GORD COPD smokers cough lung CA ACEi Causes of haemoptysis? bronchitis pneumonia bronchiectasis lung CA PE spurious TB Causes of stridor? suddeninhaled foreign object anaphylaxsis gradualtumour pharynx larynx trachea external compression of trachea lymph nodes goitre Features of lung diseases consolidation-↓ chest expansiondull percussion↑ VT +TVFbronchial BS with coarse crackles lobar collapsetrachea pulled towards↓ chest expansion↔ or dull↓ VT +TVF↓ BS unilateral fibrosistrachea pulled towards↓ chest expansion↔↑ VT +TVFfine crackles interstitial fibrosis-↓ chest expansionresonant↑ VT +TVFfine crackles pleural effusiontrachea pushed away↓ chest expansionstony dull↓ VT +TVF↓ BS pneumothorax-↓ chest expansionhyper resonant↓ VT +TVF↓ BS tension pneumothoraxtrachea pushed away↓ chest expansionhyper resonant↓ VT +TVFabsent Causes of clubbing? respiratoryidiopathic pulmonary fibrosis bronchiectasis lung CA asbestosis lung abscess mesothelioma cardiaccyanotic congenital heart disease infective endocarditis GIIBD celiac disease cirrhosis Causes of pneumothorax? traumatic iatrogenic spontaneousemphysema asthma lung abscess subpleural bulla ??bleb Respiratory

6 Causes of respiratory failure? Type IType II pulmonary oedemaCOPD pulmonary fibrosissevere asthma pneumoniarespiratory centre depressionopioids pneumothoraxrespiratory muscle weaknessmyasthenia gravis PE COPD Breathing patterns Cheyne-StokesLVF central respiratory depression Kussmauldiabetes uraemia Causes of pleural effusion? transudateLVF hepatic failure nephrotic syndrome exudatebacterial pneumonia malignancylung breast lymphoma PE TB SLE Causes of bronchiectasis? idiopathic infection cystic fibrosis bronchial CA Causes of hypoxia? hypoventilation impaired diffusion abnormal V/P ratio Causes of breathlessness? cardiaccardiac failure respiratoryasthma bronchiectasis COPD pneumonia pneumothorax PE pulmonary fibrosis otheranaemia overweight Causes of wheeze? asthma COPD bronchiectasis large airway obstruction Light criteria 1. pleural protein / serum protein > pleural LDH / serum LDH > pleural LDH > 2/3 normal upper serum limit Respiratory

7 Causes of dysphagia? mechanicalGORD induced oesopheal stricture foreign body oesophageal carcinoma plummer-vinson syndrome extrinsic compressiontumour in neck retrosternal goitre neurologicalstroke MND MS PD achalasia Causes of epigastric mass? stomach CA plyloric stenosis liver enlarged left lobe pancreas pancreas cyst CA head of pancreas gallbladder mucocoele Causes of haematemesis? oesophagusoesophagitis Mallory-Weiss tear varicies CA stomachgastric ulcer acute gastritis CA duodenumduodenal ulcer Causes of Rt iliac fossa mass? caecumCA crohns appendixabscess ovarycyst CA external iliac arteryaneurysm psoas muscleabscess kidney transplant Causes of constipation? idiopathic dietary opioids diverticular disease colorectal cancer hypothyroidism hypercalcaemia Causes of diarrhoea? dietcurry stressexams IBS infection iflammationIBD cancercolon CA endocrinehyperthyroidism medicationantibiotics Causes of hypogastric mass? enlarged bladder sigmoid CA ovarian cyst uterine fibroids Causes of Lt iliac fossa mass? sigmoiddiverticular abscess CA ovarycyst CA external iliac arteryaneurysm psoas muscleabscess kidney transplant Gastro

8 Causes of paralytic ileus? abdominal surgery peritonitis mesenteric ischaemia Causes of hepatomegaly? cardiacheart failure tricuspid regurgitation infectivehepatitis brucellosis hydatid disease haematologicallymphoma leukaemia myelofibrosis haemolytic anaemia infiltrativeamyloidosis Causes of splenomegaly? mildportal hypertension 2 0 to cirrhosis cirrhosis infectious hepatitis idiopathic thrombocytopenia rheumatoid arthritis moderate (4-8cm)portal hypertension 2 0 to cirrhosis lymphoma leukaemia massive (>8cm)malaria gaucher’s disease black fever Causes of small bowel obstruction? adhesion tumour hernia volvulus intersusception Causes of rectal bleeding? small intestineMeckel’s diverticulum enteritis colonIBD angiodysplasia CA diverticula disease polyp rectumCA anushaemorrhoids fissure Causes of large bowel obstruction? strictures sigmoid volvulus colan CA intersusception Small and large bowel on Xray smallcentral valvulae conniventes cross entire lumen upto 3cm diameter largecircumferentail haustrae up to 6cm (caucum 9cm) Causes of hepatosplenomegaly? infectivehepatitis brucellosis toxoplasmosis CMV haematologicalmyelofibrosis lymphoma portal hypertension 2 0 to chronic liver disease sarcoidosis amyloidosis Gastro

9 Causes of acute abdomen? Causes of ascities? transudateheart failure chronic liver disease nephrotic syndrome hypoproteaniemia exudateintra-abdominal malignancy tuberculous peritonitis Causes of jaundice? pre hepatichaemolytic anemia hepatichepatitis alcohol primary biliary cirrhosis post hepaticgall stones in CBD bile duct stricture sclerosing cholangitis CA head of pancreas chronic pancreatitis Causes of vomiting? GIobstruction gastritis inflammatory cholecystitis pancreatitis hepatitis metabolichypercalcaemia addison’s uraemia neurogenic ↑ ICP pain vestibulocochlear disease medication cytotoxics opiods antibiotics Diffuse intestinal obstruction DKA gastroenteritis mesenteric ischaemia RUQ cholecystitis biliary colic hepatitis LUQ gastritis splenic infarct RLQ appendicitis caecal perforation Meckles diverticulitis mesenteric adenitis RUQ + LUQ pancreatitis perforated duodenal ulcer lower lobe pneumonia LLQ sigmoid diverticulitis sigmoid volvulus RLQ + LLQ renal colic cystits ectopic pregnancy ovarian cyst pelvic inflammatory disease Gastro

10 Causes of tremors? postural (physiological)anxiety Caffeine salbutamol restingparkinsons intention cerebellar disease e.g.MS, cerebrovascular disease flappingrespiratory failure (type II) hepatic encephalitis Signs of lesions UMNLMN ↑ tone↓ tone ↑ reflexes↓ reflexes clonusfasiclutaions extensor plantarmuscle wasting Nerve palsies IIIeye is pointing down and outdiabetes dilated pupilMS ptosisposterior communicating artery aneurysm IVeye pointing uptrauma head is tilteddiabetes MS VIeye pointing mediallyMS raised ICP trauma Vsensory lossherpes zoster syringomyelia motor lossmyotonic dystrophy MND VIIUMN (forehead spared)CVA demyelination pseudobulbar palsy MND LMN (forehead involved)Bell’s palsy cerebelloponting angle lesion GB syndrome myasthenia gravis VIIIconductivewax otitis media with effusion perforated ear drum pagets disease otosclerosis sensorypresbycusis noise-induced furosemide acoustic neuroma Causes of papilloedema? malignant hypertension ↑ ICP retinal venous obstruction Causes of sudden blindness? retinal detachment acute glaucoma vitreous haemorrhage retinal artery/vein thrombosis occular migraine Neurology

11 Bulbar IX, X, XIItonguefasiculationsGB syndrome LMN wastingsyringobulbia flaccidMND ↓ movements dysphagia dysphonia PseudobulbartonguespasticMS UMN ↓ movementsbilateral internal capsule infarct dysphagiaMND high pitch voice (Donald duck) Gait abnormalities antalgic (limp)arthritis trauma sensory ataxiaperipheral neuropathy cerebral ataxiacerebrovascular disease MS hemiplegicstroke MS scissorcerebal palsy MS foot dropcommon peroneal palsy L5 radiculopathy waddlingproximal myopathy parkinsonianparkinsons disease Causes of ptosis? myogenicHorner’s syndrome III nerve palsy neurogenicmyasthenia gravis myotonic dystrophy tendoninvolutional Causes of syncope? neurally mediatedvasovagal situationalcough sneeze micturation carotid sinus hypersensitivity posturalautonomic failurePD diabetes multiple system atrophy medicationantihypertensives hypovolaemiahaemorrhage diarrhoea post pradial cardiacarrhythmiasick sinus syndrome heart block AF long QT syndrome AS HOCM acute aortic dissection respiratoryPE psychogenicanxiety hyperventilation Causes of ↑ ICP? intracranial mass “ infection obstructed CSF flow hypertensive encephalopathy hypercapnia Neurology

12 Causes of neuropathy? single nervemononeuropathycarpal tunnel syndrome more than one single nervemononeuritis multiplex multiple peripheral nervespolyneuropathyalcohol B vitamin deficiency diabetes drugsisoniazid endocrinehypothyroidism guillian barre syndrome hemisensory loss stroke spinal root lesionsradiculopathy spinal cord lesion Neurology

13 Causes of renal failure? acutepre-renalhypoperfusiondehydration renal artery obstruction ↓ cardiac output renalglomerulonephritisdeposition of immune complexes deposition of non-immune material immune mediated attack against endothelial cells of glomerular capillaries immune mediated attack of basement membrane acute tubular necrosishypoperfusion NSAIDs aminoglycosides contrast media interstial damageNSAIDs antibiotics post-renalstones infection tumour prostate enlargement chronichypertension diabetes glomerulonephritis congenitalpolycystic kidney disease Causes of urinary retention? diabetes anticholinergics post operatively BPH Causes of urinary frequency? ↑ fluid intake alcohol diabetes kidney disease detrusor instability diuretics Causes of haematuria? kidney tumours infection stones trauma nephritis ureter stones tumour bladder tumour infection prostate BPH, CA urethra trauma Renal

14 Causes of anaemia? microcyticFe deficiencyblood lossmenorrhagia GI bleeding ↓ dietary intake malabsorptioncoeliac disease thalassaemia sideroblastic anaemia macrocyticB12 deficiencypernicious anaemia crohn’s disease strict vegan folate deficiency↓ dietary intake pregnancy antifolate medicationanticonvulsants ↑ alcohol myeloma myeloproliferative disorders myelodysplasia normocyticanaemia of chronic disease haemolysis acute blood loss bone marrow failure renal failure pregnancy Causes of lymphadenopathy? infectionsepsis TB infectious mononucleosis haematologicallymphoma leukaemia malignancymetastases systemic diseaseRA SLE sarcoidosis Causes of polycythaemia? trueprimary polycythaemia vera secondaryhypoxia cyanotic heart disease pulmonary disease chronic smoking high altitude excess erythropoietin renal cell carcinoma polycystic kidney disease adrenal tumour hepatocellular carcinoma apparentdehydration Gaissbock’s syndrome Haematology

15 Causes of thrombocytosis? 1 o haematological disordermyeloproliferative disorders 2 o reactiveinfection inflammation malignancy Causes of haemolytic anaemia? congenitalmembrane deficitspheocytosis enzyme defectG6PD deficiency pyruvate kinase deficiency Hb defectsickle cell anaemia thalassaemia acquiredimmuneauto immune warm type (IgG mediated) autoimmune cold type (IgM mediated) medicationpenicillin acute transfusion reaction non-immuneinfectionmalaria microangiopathic anaemia mechanical heart valve paroxysmal nocturnal haemoglobinuria Causes of thrombocytopenia? ↓ platelet productioninfection medication leukaemia myelodysplasia ↑ platelet destruction autoimmune idiopathic thrombocytopenia purpura heparin induced thrombocytopenia thrombotic thrombocytopenic purpura DIC Causes of neutrophilia? infection inflammation malignancy myeloproliferative disorders necrosis Causes of neutropenia? post chemotherapy post radiotherapy medicationcarbimazole clozapine viral infection felty’s syndrome Causes of lymphocytosis? viral infection chronic infectionTB chronic lymphocytic leukaemia lymphoma Causes of eosinophilia? allergic conditions eczema allergic bronchopulmonary aspergillosis parasitic infection Haematology

16 Causes of hyponatraemia? fluid depleted patientdiuretics volume lossvomiting diarrhoea burns hypoadrenalism normovolaemic patientSIADH hypothyroidism psychogenic polydipsia fluid overloaded patientcardiac failure liver failure renal failure hypoalbuminaemia Causes of hypernatraemia? dehydration diabetes insipidus excess IV fluids Causes of hypokalaemia? medicationdiuretic intestinal lossexcess vomiting profuse diarrhoea renal tubular diseasemedication induced damage endocrinecushing’s syndrome conn’s syndrome metabolic alkalosis Causes of hyperkalaemia? renal failure artefact medicationpotassium sparing diuretics potassium supplements rhabdomyolysis endocrineaddison’s disease diabetic ketoacidosis Bone profile Ca2+phosphateALP osteoporosis↔↔↔ osteomalacia↔/↓↓↑ pagets disease↔↔↑ bony metastases↔/↑ ↑ 1o hyperparathyroidism↑↓↑ 2o hyperparathyroidism↔↑↑ 3o hyperparathyroidism↑↓↑ Biochem

17 Causes of Cushing’s syndrome? 1o adrenal diseaseadrenal tumour 2o ACTH excess glucocorticoid medication pituitary gland (Cushing’s disease) ACTH secreting tumour Causes of SIADH? intracranialinfection tumour head injury intrathoracicinfection lung cancer medicationcarbamazepine antipsychotics Causes of hyperprolactinaemia ? physiologicalpregnancy lactation tumour prolactin secreting pituitary tumour medicationmetoclopramide domperidone phenothiazine antipsychotics endocrinePCOS Endocrinology


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