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, VE’S, 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 CORRIGAN’S 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 -> 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 CORRIGAN’S
APEX DISPLACED OUTWARDS, FORCEFUL
EDM- LSE SIT FORWARD EXPIRATION

24. Aortic Regurgitation WIDE PULSE PRESSURE
FEMORALS- PISTOL SHOTS(TRAUBE’S)
TO AND FRO MURMUR (DUROZIEZ’S)
CORRIGANS – CAROTID PULSATION
QUINCKE’S
UVULA PULSATIONS (MULLER’S)
ARGYLL ROBERTSON PUPIL
MARFANS
ANK SPOND, RA

25. Causes Of Aortic RegurgitationRF
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 tug
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 OEDEMA PR

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 CAN’T 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 - WERNICKE’S SUPERIOR TEMPORAL

110. PARKINSONS EXPRESSIONLESS- HYPERMYMIA DROOLING PILL ROLLING
BRADYKINESIA
TONE- COG WHEEL
GLABELLAR TAP - CONTINUE MYERSON’S 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 !