Causes of chest pain?

cardiac

angina

​

MI

​

pericarditis

​

aortic dissection

respiratory

pleurisy

​

PE

​

pneumothorax

GI

GORD

​

oesophagitis

musculo-skeletal

strain/trauma

Arterial pulses

plateau

AS

small volume

AS

​

shock

bisferiens

AS, AR

anacrotic

AS

pulsus alternans

LVF

pulsus paradoxus

pericardial effusion

​

constrictive pericarditis

​

severe asthma

Causes of Rt heart failure?

Causes of Lt heart failure?

2^O to Lt heart failure

IHD

MI

hypertension

PS, TS, TR

MI

1^O pulmonary hypertension

AS, 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?

athletes

pain

B-blocker

fever

hypothyroidism

anxiety

heart block

thyrotoxicosis

hypothermia

B2-agonist

​

hypovolaemia

​

arrhythmia

Causes of peripheral oedema?

generalised (bilateral)

fluid overload

heart failure

​

​

renal failure

​

​

iatrogenic

​

hypoproteinaemia

malnutrition

​

​

malabsorption

​

​

chronic liver disease

​

​

nephrotic syndrome

​

medication

calcium channel blocker

localised (unilateral)

obstruction

pelvic tumour

​

​

DVT

​

infection

cellulitis

​

postural

standing too long

​

ruptured Baker’s cyst

​

Causes of pericarditis?

infarction

MI

iatrogenic

cardiac surgery

inflammation

SLE

​

rheumatoid disease

infection

coxsachie virus

​

bacterial

Causes of raised D-Dimer?

DVT

MI

recent surgery

liver disease

renal disease

malignancy

Causes of cyanosis?

​

central

respiratory

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

Mitral regurgitation

Aortic regurgitation

Mitral stenosis

harsh crescendo-decrecendo systolic

pansystolic

early diastolic

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?

Causes of Lt axis deviation?

Rt ventricular hypertrophy

cor pulmonale

Lt anterior fasicular block

LAD artery ischaemia/infarction

​

pulmonary stenosis

​

cardiomypoathy

Lt posterior fasicular block

cardiomyopathy

Rt sided infarction

​

​

diffuse ischaemia/infarction

Lt ventricular hypertrophy

​

Lt lateral infarction

​

​

​

Causes of Rt bundle branch block?

Causes of Lt bundle branch block?

PE

hypertension

cor pulmonale

IHD

IHD

dilated cardiomyopathy

​

rheumatic heart disease

ECG changes

hyperkalaemia

tall tented T waves

​

​

widened QRS

​

​

absent P waves

​

​

sine wave

​

hypokalaemia

flattened T waves

​

MI

<5min

hyperacute T waves

​

<20min

ST elevation

​

hrs

terminal QRS changes

​

within days

pathological Q waves

​

variable time

T wave inverts

PE

sinus tachycardia

​

​

RBBB

​

​

RV strain pattern

​

ischaemia

ST 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 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

​

Infarct patters

inferior

lead II, III, aVF

septal

V1-V2

anterior

V3-V4

lateral

lead I, aVL, V5-V6

​

posterior

tall 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

duration > 3 sq

slurred S wave lead I, V6

broad R waves lead I, V6

RSR lead V1

broad S waves V1

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 interval

3-5 sq

​

​

<3

WPW syndrome

​

>5

1^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 waves

lead 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

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?

sudden

inhaled foreign object

​

​

anaphylaxsis

​

gradual

tumour

pharynx

​

​

larynx

​

​

trachea

​

external compression of trachea

lymph nodes

​

​

goitre

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

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

LVF

​

central respiratory depression

Kussmaul

diabetes

​

uraemia

Causes of pleural effusion?

transudate

LVF

​

​

hepatic failure

​

​

nephrotic syndrome

​

exudate

bacterial pneumonia

​

​

malignancy

lung

​

​

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?

cardiac

cardiac failure

respiratory

asthma

​

bronchiectasis

​

COPD

​

pneumonia

​

pneumothorax

​

PE

​

pulmonary fibrosis

other

anaemia

​

overweight

Causes of wheeze?

asthma

COPD

bronchiectasis

large airway obstruction

Light criteria

1. pleural protein / serum protein >0.5

2. pleural LDH / serum LDH >0.6

3. pleural LDH > 2/3 normal upper serum limit

Causes of dysphagia?

mechanical

GORD induced oesopheal stricture

​

​

foreign body

​

​

oesophageal carcinoma

​

​

plummer-vinson syndrome

​

​

extrinsic compression

tumour in neck

​

​

retrosternal goitre

neurological

stroke

​

​

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?

oesophagus

oesophagitis

​

Mallory-Weiss tear

​

varicies

​

CA

stomach

gastric ulcer

​

acute gastritis

​

CA

duodenum

duodenal ulcer

Causes of Rt iliac fossa mass?

caecum

CA

​

crohns

appendix

abscess

ovary

cyst

​

CA

external iliac artery

aneurysm

psoas muscle

abscess

kidney transplant

​

Causes of constipation?

idiopathic

dietary

opioids

diverticular disease

colorectal cancer

hypothyroidism

hypercalcaemia

Causes of diarrhoea?

diet

curry

stress

exams

​

IBS

infection

​

iflammation

IBD

cancer

colon CA

endocrine

hyperthyroidism

medication

antibiotics

Causes of hypogastric mass?

enlarged bladder

sigmoid CA

ovarian cyst

uterine fibroids

Causes of Lt iliac fossa mass?

sigmoid

diverticular abscess

​

CA

ovary

cyst

​

CA

external iliac artery

aneurysm

psoas muscle

abscess

kidney transplant

​

Causes of paralytic ileus?

abdominal surgery

peritonitis

mesenteric ischaemia

Causes of hepatomegaly?

cardiac

heart failure

​

tricuspid regurgitation

infective

hepatitis

​

brucellosis

​

hydatid disease

haematological

lymphoma

​

leukaemia

​

myelofibrosis

​

haemolytic anaemia

infiltrative

amyloidosis

Causes of splenomegaly?

mild

portal hypertension 2⁰ to cirrhosis

​

cirrhosis

​

infectious hepatitis

​

idiopathic thrombocytopenia

​

rheumatoid arthritis

moderate (4-8cm)

portal hypertension 2⁰ 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 intestine

Meckel’s diverticulum

​

enteritis

colon

IBD

​

angiodysplasia

​

CA

​

diverticula disease

​

polyp

rectum

CA

anus

haemorrhoids

​

fissure

Causes of large bowel obstruction?

strictures

sigmoid volvulus

colan CA

intersusception

Small and large bowel on Xray

small

central

​

valvulae conniventes

​

cross entire lumen

​

upto 3cm diameter

large

circumferentail

​

haustrae

​

up to 6cm (caucum 9cm)

Causes of hepatosplenomegaly?

infective

hepatitis

​

brucellosis

​

toxoplasmosis

​

CMV

haematological

myelofibrosis

​

lymphoma

​

portal hypertension 2⁰ to chronic liver disease

​

sarcoidosis

​

amyloidosis

Causes of acute abdomen?

Causes of ascities?

transudate

heart failure

​

chronic liver disease

​

nephrotic syndrome

​

hypoproteaniemia

exudate

intra-abdominal malignancy

​

tuberculous peritonitis

Causes of jaundice?

pre hepatic

haemolytic anemia

hepatic

hepatitis

​

alcohol

​

primary biliary cirrhosis

post hepatic

gall stones in CBD

​

bile duct stricture

​

sclerosing cholangitis

​

CA head of pancreas

​

chronic pancreatitis

Causes of vomiting?

GI

obstruction

​

gastritis

inflammatory

cholecystitis

​

pancreatitis

​

hepatitis

metabolic

hypercalcaemia

​

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

Causes of tremors?

postural (physiological)

anxiety

​

Caffeine

​

salbutamol

resting

parkinsons

intention

cerebellar disease

e.g.MS, cerebrovascular disease

flapping

respiratory failure (type II)

​

hepatic encephalitis

Signs of lesions

UMN

LMN

↑ tone

↓ tone

↑ reflexes

↓ reflexes

clonus

fasiclutaions

extensor plantar

muscle wasting

Nerve palsies

​

III

eye is pointing down and out

diabetes

​

dilated pupil

MS

​

ptosis

posterior communicating artery aneurysm

IV

eye pointing up

trauma

​

head is tilted

diabetes

​

​

MS

VI

eye pointing medially

MS

​

​

raised ICP

​

​

trauma

V

sensory loss

herpes zoster

​

​

syringomyelia

​

motor loss

myotonic dystrophy

​

​

MND

VII

UMN (forehead spared)

CVA

​

​

demyelination

​

​

pseudobulbar palsy

​

​

MND

​

LMN (forehead involved)

Bell’s palsy

​

​

cerebelloponting angle lesion

​

​

GB syndrome

​

​

myasthenia gravis

VIII

conductive

wax

​

​

otitis media with effusion

​

​

perforated ear drum

​

​

pagets disease

​

​

otosclerosis

​

sensory

presbycusis

​

​

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

Bulbar IX, X, XII

tongue

fasiculations

GB syndrome

LMN

​

wasting

syringobulbia

​

​

flaccid

MND

​

​

↓ movements

​

​

dysphagia

​

​

dysphonia

​

Pseudobulbar

tongue

spastic

MS

UMN

​

↓ movements

bilateral internal capsule infarct

​

dysphagia

MND

​

high pitch voice (Donald duck)

​

Gait abnormalities

antalgic (limp)

arthritis

​

trauma

sensory ataxia

peripheral neuropathy

cerebral ataxia

cerebrovascular disease

​

MS

hemiplegic

stroke

​

MS

scissor

cerebal palsy

​

MS

foot drop

common peroneal palsy

​

L5 radiculopathy

waddling

proximal myopathy

parkinsonian

parkinsons disease

Causes of ptosis?

myogenic

Horner’s syndrome

​

III nerve palsy

neurogenic

myasthenia gravis

​

myotonic dystrophy

tendon

involutional

Causes of syncope?

​

neurally mediated

vasovagal

​

​

situational

cough

​

​

sneeze

​

​

micturation

​

carotid sinus hypersensitivity

​

postural

autonomic failure

PD

​

​

diabetes

​

​

multiple system atrophy

​

medication

antihypertensives

​

hypovolaemia

haemorrhage

​

​

diarrhoea

​

post pradial

​

cardiac

arrhythmia

sick sinus syndrome

​

​

heart block

​

​

AF

​

​

long QT syndrome

​

AS

​

​

HOCM

​

​

acute aortic dissection

​

respiratory

PE

​

psychogenic

anxiety

​

​

hyperventilation

​

Causes of ↑ ICP?

intracranial mass

“ infection

obstructed CSF flow

hypertensive encephalopathy

hypercapnia

Causes of neuropathy?

​

single nerve

mononeuropathy

carpal tunnel syndrome

​

more than one single nerve

mononeuritis multiplex

​

​

multiple peripheral nerves

polyneuropathy

alcohol

​

​

​

B vitamin deficiency

​

​

​

diabetes

​

​

​

drugs

isoniazid

​

​

endocrine

hypothyroidism

​

​

guillian barre syndrome

​

​

hemisensory loss

stroke

​

spinal root lesions

radiculopathy

​

​

spinal cord lesion

​

​

​

Causes of renal failure?

acute

pre-renal

hypoperfusion

dehydration

​

​

​

renal artery obstruction

​

​

​

↓ cardiac output

​

renal

glomerulonephritis

deposition 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 necrosis

hypoperfusion

​

​

​

NSAIDs

​

​

​

aminoglycosides

​

​

​

contrast media

​

​

interstial damage

NSAIDs

​

​

​

antibiotics

​

post-renal

stones

​

​

​

infection

​

​

​

tumour

​

​

​

prostate enlargement

​

chronic

hypertension

​

​

​

diabetes

​

​

​

glomerulonephritis

​

​

​

congenital

polycystic 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

Causes of anaemia?

microcytic

Fe deficiency

blood loss

menorrhagia

​

​

​

GI bleeding

​

​

↓ dietary intake

​

​

​

malabsorption

coeliac disease

​

thalassaemia

​

​

​

sideroblastic anaemia

​

​

macrocytic

B12 deficiency

pernicious anaemia

​

​

​

crohn’s disease

​

​

​

strict vegan

​

​

folate deficiency

↓ dietary intake

​

​

​

pregnancy

​

​

​

antifolate medication

anticonvulsants

​

↑ alcohol

​

​

​

myeloma

​

​

​

myeloproliferative disorders

​

​

​

myelodysplasia

​

​

normocytic

anaemia of chronic disease

​

​

​

haemolysis

​

​

​

acute blood loss

​

​

​

bone marrow failure

​

​

​

renal failure

​

​

​

pregnancy

​

​

Causes of lymphadenopathy?

infection

sepsis

​

TB

​

infectious mononucleosis

haematological

lymphoma

​

leukaemia

malignancy

metastases

systemic disease

RA

​

SLE

​

sarcoidosis

Causes of polycythaemia?

true

primary

polycythaemia vera

​

​

​

secondary

hypoxia

cyanotic heart disease

​

​

​

pulmonary disease

​

​

​

chronic smoking

​

​

​

high altitude

​

​

excess erythropoietin

renal cell carcinoma

​

​

​

polycystic kidney disease

​

​

​

adrenal tumour

​

​

​

hepatocellular carcinoma

apparent

dehydration

​

​

​

Gaissbock’s syndrome

​

​

Causes of thrombocytosis?

1^o haematological disorder

myeloproliferative disorders

2^o reactive

infection

​

inflammation

​

malignancy

Causes of haemolytic anaemia?

​

congenital

membrane deficit

spheocytosis

​

​

enzyme defect

G6PD deficiency

​

​

​

pyruvate kinase deficiency

​

​

Hb defect

sickle cell anaemia

​

​

​

thalassaemia

​

acquired

immune

auto immune warm type (IgG mediated)

​

​

​

autoimmune cold type (IgM mediated)

​

​

​

medication

penicillin

​

​

acute transfusion reaction

​

​

non-immune

infection

malaria

​

​

microangiopathic anaemia

​

​

​

mechanical heart valve

​

​

​

paroxysmal nocturnal haemoglobinuria

​

Causes of thrombocytopenia?

↓ platelet production

infection

​

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

​

medication

carbimazole

​

clozapine

viral infection

​

felty’s syndrome

​

Causes of lymphocytosis?

viral infection

​

chronic infection

TB

​

​

chronic lymphocytic leukaemia

​

lymphoma

​

Causes of eosinophilia?

allergic conditions

eczema

allergic bronchopulmonary aspergillosis

parasitic infection

Causes of hyponatraemia?

fluid depleted patient

diuretics

​

​

volume loss

vomiting

​

​

diarrhoea

​

​

burns

​

hypoadrenalism

​

normovolaemic patient

SIADH

​

​

hypothyroidism

​

​

psychogenic polydipsia

​

fluid overloaded patient

cardiac failure

​

​

liver failure

​

​

renal failure

​

​

hypoalbuminaemia

​

Causes of hypernatraemia?

dehydration

diabetes insipidus

excess IV fluids

Causes of hypokalaemia?

medication

diuretic

intestinal loss

excess vomiting

​

profuse diarrhoea

renal tubular disease

medication induced damage

endocrine

cushing’s syndrome

​

conn’s syndrome

metabolic alkalosis

​

Causes of hyperkalaemia?

renal failure

​

artefact

​

medication

potassium sparing diuretics

​

potassium supplements

rhabdomyolysis

​

endocrine

addison’s disease

diabetic ketoacidosis

​

Bone profile

​

​

​

Ca2+

phosphate

ALP

osteoporosis

↔

↔

↔

osteomalacia

↔/↓

↓

↑

pagets disease

↔

↔

↑

bony metastases

↔/↑

↔/↑

↑

1o hyperparathyroidism

↑

↓

↑

2o hyperparathyroidism

↔

↑

↑

3o hyperparathyroidism

↑

↓

↑

Causes of Cushing’s syndrome?

1o adrenal disease

adrenal tumour

2o ACTH excess

glucocorticoid medication

​

pituitary gland (Cushing’s disease)

​

ACTH secreting tumour

Causes of SIADH?

intracranial

infection

​

tumour

​

head injury

intrathoracic

infection

​

lung cancer

medication

carbamazepine

​

antipsychotics

Causes of hyperprolactinaemia ?

physiological

pregnancy

​

lactation

tumour

prolactin secreting pituitary tumour

medication

metoclopramide

​

domperidone

​

phenothiazine antipsychotics

endocrine

PCOS