1. Cardiology
Causes of chest pain?
Arterial pulses
Causes of raised JVP?
Causes of AF?
angina
plateau
AS
RVF
small volume
AS
pulmonary hypertension
hypertension
pulmonary stenosis
mitral stenosis
pericarditis
shock
aortic dissection
bisferiens
AS, AR
tricuspid stenosis
lone atrial fibrillation
pleurisy
anacrotic
AS
SVC obstruction
cardiomyopathy
PE
pulsus alternans
LVF
pneumothorax
respiratory
pulsus paradoxus
idiopathic pulmonary fibrosis
massive PE
pericardial effusion
constrictive pericarditis
oesophagitis
musculo-skeletal
COPD
obstructive sleep apnoea
1O pulmonary hypertension
hyperthyroidism
GORD
GI
Causes of cor pulmonale?
IHD
MI
cardiac
severe asthma
Causes of peripheral oedema?
generalised (bilateral)
fluid overload
heart failure
renal failure
strain/trauma
iatrogenic
hypoproteinaemia
Causes of Rt heart failure?
IHD
MI
hypertension
PS, TS, TR
MI
1O pulmonary hypertension
malabsorption
Causes of Lt heart failure?
2O to Lt heart failure
malnutrition
AS, AR, MR
chronic liver disease
nephrotic syndrome
medication
obstruction
localised (unilateral)
calcium channel blocker
pelvic tumour
DVT
2O pulmonary hypertension (COPD)
infection
Causes of bradycardia?
Causes of tachycardia?
athletes
pain
DVT
B-blocker
fever
anxiety
recent surgery
heart block
thyrotoxicosis
liver disease
hypothermia
B2-agonist
renal disease
hypovolaemia
malignancy
standing too long
MI
hypothyroidism
cellulitis
postural
Causes of raised D-Dimer?
ruptured Baker’s cyst
Causes of pericarditis?
infarction
MI
iatrogenic
cardiac surgery
inflammation
SLE
arrhythmia
rheumatoid disease
infection
coxsachie virus
bacterial
2. Cardiology
Causes of cyanosis?
respiratory
central
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
harsh crescendo-decrecendo systolic
Mitral regurgitation
pansystolic
Aortic regurgitation
early diastolic
Mitral stenosis
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
pulmonary stenosis
Lt posterior fasicular block
cardiomypoathy
cardiomyopathy
Rt sided infarction
diffuse ischaemia/infarction
Lt lateral infarction
LAD artery ischaemia/infarction
Lt ventricular hypertrophy
3. Cardiology
Causes of Rt bundle branch block?
hyperkalaemia
Causes of Lt bundle branch block?
PE
hypertension
cor pulmonale
IHD
IHD
ECG changes
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
Rt BBB ECG changes?
Infarct patters
RBBB
inferior
lead II, III, aVF
RV strain pattern
ischaemia
sinus tachycardia
septal
V1-V2
ST depression
anterior
V3-V4
T wave inversion
LVH
lead I, aVL, V5-V6
lateral
S (V1 or V2) + R (V5 or V6) ≥ 35mm
posterior
any chest lead ≥ 45mm
RVH
Lt 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
4. Cardiology
ECG
P wave
Features of benign murmur?
Causes of benign murmur?
systolic
fever
NAD on ECG, CXR, US
anaemia
NAD on physical exam
pregnancy
position dependent
thyrotoxicosis
<2.5sq wide
tall (P pulmonale) >2.5 sq tall
Rt atrial enlargement
bifid (P mitrale)
Lt atrial enlargement
QRS
<3 sq
PR interval
3-5 sq
grade ≤ 3
<3
WPW syndrome
>5
1st degree HB
QT interval
QTc
Grading of murmur
if HR 60bpm < 0.44sec
used if HR not 60bpm
1. very faint
2. soft
QT/ (square of RR)
short
3. heard all over praecordium
long
hypoCa2+
4. loud with palpable thrill
inverted
ischaemia
5. loud heard with stethescope partially of chest
MI
T wave
hyperCa2+
6. very loud, heard without stethescope
SAH
persistant juvenile pattern
digoxin
LVH strain pattern
hypo K, Ca, Mg
Q waves
lead II, III, aVF, V5-V6
normal
> 1 sq wide & 2mm deep
pathological
5. Respiratory
Causes of cough?
Causes of haemoptysis?
acute
bronchitis
pneumonia
pneumonia
foreign body
bronchiectasis
post nasal drip
lung CA
asthma
PE
GORD
spurious
COPD
chronic
URTi
Causes of stridor?
sudden
inhaled foreign object
TB
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
6. 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
impaired diffusion
cystic fibrosis
abnormal V/P ratio
malignancy
hypoventilation
infection
bacterial pneumonia
breast
lymphoma
PE
TB
bronchial CA
SLE
Causes of breathlessness?
Causes of wheeze?
asthma
cardiac
cardiac failure
respiratory
asthma
COPD
bronchiectasis
bronchiectasis
Light criteria
COPD
1. pleural protein / serum protein >0.5
pneumonia
2. pleural LDH / serum LDH >0.6
pneumothorax
large airway obstruction
3. pleural LDH > 2/3 normal upper serum limit
PE
pulmonary fibrosis
other
anaemia
overweight
lung
7. 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
CA
tumour in neck
stroke
MND
duodenum
IBD
cancer
colon CA
endocrine
hyperthyroidism
duodenal ulcer
retrosternal goitre
iflammation
acute gastritis
stomach
infection
gastric ulcer
CA
extrinsic compression
neurological
IBS
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
abscess
ovarian cyst
ovary
cyst
sigmoid
sigmoid CA
appendix
Causes of Lt iliac fossa mass?
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
8. Gastro
Causes of splenomegaly?
mild
Causes of hepatomegaly?
portal hypertension 2 to cirrhosis
0
heart failure
cardiac
cirrhosis
infectious hepatitis
tricuspid regurgitation
hepatitis
infective
idiopathic thrombocytopenia
rheumatoid arthritis
moderate (4-8cm)
brucellosis
hydatid disease
portal hypertension 20 to cirrhosis
lymphoma
haematological
lymphoma
leukaemia
massive (>8cm)
leukaemia
myelofibrosis
malaria
haemolytic anaemia
gaucher’s disease
infiltrative
Causes of paralytic ileus?
abdominal surgery
peritonitis
mesenteric ischaemia
amyloidosis
black fever
Causes of small bowel obstruction?
Causes of large bowel obstruction?
adhesion
strictures
tumour
sigmoid volvulus
Causes of hepatosplenomegaly?
infective
hepatitis
hernia
toxoplasmosis
colan CA
volvulus
brucellosis
intersusception
intersusception
CMV
haematological
myelofibrosis
Small and large bowel on Xray
lymphoma
small
central
Causes of rectal bleeding?
small intestine
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
9. 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
appendicitis
renal colic
sigmoid diverticulitis
caecal perforation
cystits
sigmoid volvulus
Meckles diverticulitis
ectopic pregnancy
mesenteric adenitis
GI
LLQ
ovarian cyst
gastritis
inflammatory
hepatitis
metabolic
uraemia
Causes of jaundice?
heart failure
pre hepatic
haemolytic anemia
hepatic
neurogenic
hepatitis
nephrotic syndrome
alcohol
hypoproteaniemia
exudate
primary biliary cirrhosis
intra-abdominal malignancy
tuberculous peritonitis
hypercalcaemia
addison’s
chronic liver disease
transudate
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
↑ ICP
pain
vestibulocochlear disease
medication
cytotoxics
opiods
antibiotics
10. Neurology
Nerve palsies
Causes of tremors?
eye is pointing down and out
diabetes
anxiety
dilated pupil
MS
Caffeine
postural (physiological)
ptosis
posterior communicating artery aneurysm
eye pointing up
trauma
head is tilted
diabetes
III
salbutamol
resting
intention
cerebellar disease
e.g.MS, cerebrovascular disease
flapping
respiratory failure (type II)
IV
parkinsons
MS
VI
eye pointing medially
MS
raised ICP
hepatic encephalitis
trauma
V
Signs of lesions
UMN
↓ tone
↑ reflexes
↓ reflexes
clonus
fasiclutaions
extensor plantar
herpes zoster
syringomyelia
LMN
↑ tone
sensory loss
muscle wasting
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
11. Neurology
Gait abnormalities
antalgic (limp)
Causes of ptosis?
arthritis
myogenic
trauma
sensory ataxia
peripheral neuropathy
cerebral ataxia
Horner’s syndrome
intracranial mass
III nerve palsy
cerebrovascular disease
MS
Causes of ↑ ICP?
neurogenic
“ infection
obstructed CSF flow
myotonic dystrophy
tendon
myasthenia gravis
hypertensive encephalopathy
involutional
hypercapnia
stroke
hemiplegic
MS
Causes of syncope?
cerebal palsy
scissor
neurally mediated
vasovagal
situational
MS
sneeze
common peroneal palsy
foot drop
micturation
L5 radiculopathy
waddling
parkinsons disease
carotid sinus hypersensitivity
proximal myopathy
parkinsonian
cough
postural
autonomic failure
PD
diabetes
multiple system atrophy
medication
hypovolaemia
tongue
syringobulbia
MND
haemorrhage
GB syndrome
wasting
LMN
fasiculations
flaccid
Bulbar IX, X, XII
antihypertensives
diarrhoea
post pradial
cardiac
arrhythmia
↓ movements
sick sinus syndrome
heart block
dysphagia
dysphonia
Pseudobulbar
AF
long QT syndrome
UMN
spastic
MS
AS
↓ movements
tongue
bilateral internal capsule infarct
HOCM
MND
acute aortic dissection
dysphagia
high pitch voice (Donald duck)
respiratory
PE
psychogenic
anxiety
hyperventilation
12. 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
13. Renal
Causes of renal failure?
acute
pre-renal
Causes of haematuria?
hypoperfusion
dehydration
kidney
tumours
renal artery obstruction
↓ cardiac output
glomerulonephritis
stones
deposition of immune complexes
trauma
deposition of non-immune material
renal
infection
nephritis
immune mediated attack against endothelial cells
of glomerular capillaries
immune mediated attack of basement membrane
acute tubular necrosis
hypoperfusion
NSAIDs
aminoglycosides
contrast media
interstial damage
stones
infection
tumour
prostate enlargement
chronic
glomerulonephritis
diabetes
anticholinergics
post operatively
BPH
bladder
tumour
infection
prostate
BPH, CA
urethra
trauma
Causes of urinary frequency?
↑ fluid intake
alcohol
diabetes
kidney disease
diuretics
diabetes
Causes of urinary retention?
tumour
detrusor instability
hypertension
congenital
stones
NSAIDs
antibiotics
post-renal
ureter
polycystic kidney disease
14. 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
thalassaemia
leukaemia
sideroblastic anaemia
macrocytic
B12 deficiency
lymphoma
malignancy
systemic disease
pernicious anaemia
metastases
RA
crohn’s disease
strict vegan
folate deficiency
SLE
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
15. Haematology
Causes of thrombocytosis?
Causes of haemolytic anaemia?
1 haematological disorder
myeloproliferative disorders
2o reactive
infection
o
congenital
membrane deficit
spheocytosis
enzyme defect
G6PD deficiency
inflammation
pyruvate kinase deficiency
malignancy
Hb defect
sickle cell anaemia
thalassaemia
acquired
Causes of thrombocytopenia?
immune
auto immune warm type (IgG mediated)
infection
autoimmune cold type (IgM mediated)
medication
medication
leukaemia
↓ platelet production
acute transfusion reaction
non-immune
myelodysplasia
↑ platelet destruction
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?
Causes of eosinophilia?
allergic conditions
viral infection
chronic infection
infection
lymphoma
eczema
inflammation
allergic bronchopulmonary
aspergillosis
chronic lymphocytic leukaemia
TB
Causes of neutrophilia?
malignancy
parasitic infection
Causes of neutropenia?
post chemotherapy
myeloproliferative disorders
necrosis
post radiotherapy
medication
carbimazole
clozapine
viral infection
felty’s syndrome
