C)#Clinical#diagnosis#-#head#of#symptoms#and#physical#findings#

#
Common#Symptoms#and#Physical#Findings#of#Cardiology:#
https://www.ncbi.nlm.nih.gov/books/NBK2213/#!!##
https://en.wikipedia.org/wiki/Cardiology_diagnostic_tests_and_proceduresAA
CommonASymptomsAofACardiologyADAHeartAandAvascularAdiseaseAA
D ChestApain,ASyncope,AMalaise,APalpitations,AFatigue,ADyspnoea/ADysnea,AOedema,A
ClaudicationAA
#
1. Cardiology#–#symptoms#and#physical#findings#in#left#heart#failure.##
a. Left#side#of#heart#-#AreceivesAbloodArichAinAO2AfromAlungsA&ApumpsAitAtoA
remainderAofAbody.AAbilityAtoApumpAbloodAforwardAfromAleftAsideAofAheartAisA
decreased,AremainderAofAbodyAdoesn’tAreceiveAenoughAO2AduringAexercising.A
ResultsAinAfatigue.AInAaddition,ApressureAinAveinsAofAlungAincreases,AwhichAcauseA
fluidAaccumulationAinAlung.AResultsAinAshortnessAofAbreathA&ApulmonaryA
oedema.ACausesAofAleftDsidedAfailureAinclude:ADrinkingAmuchAalcohol,AHeartA
attack,AHeartAmuscleAinfections,AHighAbloodApressure,AHypothyroidism,ALeakingA
orAnarrowAheartAvalves,AdiseaseAthatAdamagesAheartAmuscle,AinAchildren;A
causesAincludeAheartAbirthAdefectsAe.g.AabnormalAheartAvalves,AabnormalAbloodA
vesselAconnections,AorAviralAinfections.AA
i. Symptome:#LuftnotAbeiABelastung.AFeinblasige#RasselgeräuscheAüberA
denALungenfeldern.AÜberschreitetAderAPulmonalkapillardruckAca.A20–
25AmmHg,AkommtAesAzumALungenödem.AGrobblasigen#
RasselgeräuschenAundAblutig#schaumigem#SekretAbeimAHusten.A
AufgrundAeinesABronchialschleimhautödemsAkannAesAzuAeinerA
Bronchialobstruktion#kommenA(AsthmaAcardiale).AEineAzunehmendeA
LinksherzdilatationAkannAeineArelativeAMitralinsuffizienzAbedingen.AEinA
häufigerAZusatzbefundAinAallenAStadienAistAeinAPleuraerguss.A
ii. Symptoms#A
1. CoughA(frothyAorAbloodDtingedAmucus),ADecreasedAurineA
production,ADifficultyAlyingAdown;AneedAtoAsleepAwithAheadA
elevatedAtoAavoidAshortnessAofAbreath,AFatigue,Aweakness,A
faintness,AIrregularAorArapidApulse,ASensationAofAfeelingA
heartbeatA(palpitations),AShortnessAofAbreath,AwakingAupAdueAtoA
shortnessAofAbreathA(paroxysmalAnocturnalAdyspnoea),AWeightA
gainAfromAfluidAretention,ASymptomsAinAinfantsAmayAinclude:A
FailureAtoAthrive,APoorAfeeding,AWeightAlossA
iii. Physical#Findings/#Physical#examination#reveal:#
1. irregularAorArapidAheartbeatA&AincreasedAbreathingArateAA
2. abnormalAheartAmotionAwhenAtouchingAchestAwall.A
3. ListeningAtoAheartArevealAheartAmurmursAorAextraAheartAsoundsA
4. listeningAtoAlungsArevealAcracklesAorAdecreasedAbreathAsoundsAatA
bottom.A
5. lowerAlegsAbeAswollenA&AremainAdimpledAwhenApressed.A
6. TestsAinclude:ABloodAtest:AtoAevealuateAthyroid,AliverA&AkidneyA
function.AChestAXDRay,ACoronaryAangiography,AECG,AHeartAstressA
test,AUltrasoundAofAheartA(echocardiogram)AA
A
 A
A
2. Cardiology#–#symptoms#and#physical#findings#in#right#heart#failure.#
a. Right-sided#heart#failureA–ACoronaryAarteryAdiseaseAcommonAcauseAofAheartA
failure.ARHFA–ArightAventricleAlosesAitsApumping#functionA&AbloodAmayAbackAupA
intoAotherAareasAofAbody,AproducingAcongestion.ACongestionAaffects:Aliver,AGIT,A
limbs.AInAaddition,ArightAventricleAmayAbeAunableAtoApumpAbloodAefficientlyAtoA
lungsA&AtoAleftAventricle.ACausesA–AincludeAleftDsidedAheartAfailureA&AlungA
diseasesAe.g.AchronicAbronchitisA&Aemphysema.AOther:AcongenitalAheartA
disease,AclotsAinApulmonaryAarteries,ApulmonaryAHypertensionA&AheartAvalveA
disease.#
i. Symptoms##
1. ShortnessAofAbreath,AswellingAofAfeetA&Aankles,AUrinatingA
frequentlyAatAnight,APronouncedAneckAveins,APalpitationsA
(sensationAofAfeelingAheartAbeat),AIrregularAfastAheartbeat,A
Fatigue,AWeakness,AFainting,AFever,AInfections,AAnaemia,A
BlockageAinAcoronaryAarteries,AIrregularAheartbeatsA
(arrhythmias),AOveractiveAthyroidAglandA(hyperthyroidism),A
KidneyAdiseaseA
ii. Physical#Findings/#physical#examination#reveal:#
1. ElevatedAASTA(1D5Atimes),AIncreasedABloodAUreaANitrogen,A
increasedABDTypeANatriureticAPeptide,AincreasedACarbonADioxideA
ContentAinABlood,AdecreasedAcreatinineAclearance,AGammaD
GlutamylATranspeptidaseAelevatedA
2. ProteinABloodA(PROEDteenAblud)A(dipAstick;AuricAacid;AaminoA
acids;AurineAhydroxyproline)AdecreasedAA
 a. serumAproteinAtestAmeasuresAtotalAproteinAlevelAinA
blood.AMeasurementAofAalbumin,Aglobulin,A&A
albumin/globulinARatioA
3. SodiumA(SOEDdeeDuhm)A(Na):AElevatedAlevelsA(hypernatremia)A
4. BloodATest;AUricAAcid:AelevatedAlevelsAA
A
5. AbnormalAheartAsounds,Ae.g.Amurmur,AAbnormalAlungAsounds,A
AnkleAswelling,ADistendedAneckAveins,AEnlargedAliver,AIrregularA
orArapidAheartbeat,AWeightAgainA
6. Tests#include:AChestAxDray,AECG,AEchocardiogramA
7. Lab#tests:ABloodAchemistry,ABDtypeAnatriureticApeptideA(BNP),A
CompleteAbloodAcount,ALiverAfunctionAtests,AThyroidAfunctionA
tests,AUrinalysis,ACardiacAcatheterizationAmayAalsoAbeAdone.A

A
A
3. Cardiology#–#symptoms#and#physical#findings#in#rhythm-disorders,#pulse#deficit.##
a. Pulse#deficitA–ADifferenceAinAcountAbtw.AHeartArateA&AperipheralApulseArate.A
TooAweakAventricularAcontractionsAtoAopenAaorticAvalveAD>AAtrialAfibrillation,A
someAartificialApacemakers.ADifferentAcountAbtw.AAheartAbeatA(ApicalAbeatAorA
 HeartAsounds)A&AperipheralApulse.AHeartAisAcontracting,AbutApulseAisn’tA
reachingAperiphery.AA
1. AAtrialAfibrillation.A
2. VeryAearlyAdiastolicAventricularAectopicAbeatsA
3. InASomeApatientsAwithAPacemaker.A
b. Pulse#deficitA–AmayAindicateAunderlyingALVAdysfunction,ApacemakerA
malfunction.AA
c. Rhythm-disorders:AArrhythmiaA–AmeansAheartbeatAisAirregularD>Ait'sAoutAofAitsA
normalArhythm.AFeelingAofAskippedAbeat,AaddedAbeat,A"fluttering,"AorAisAbeatingA
tooAfastA(tachycardia)AorAtooAslowA(bradycardia)A
i. CausesAofAArrhythmiasA–!Heart&diseases,AwrongAbalanceAofAelectrolytesA
(sodiumAorApotassium)AinAblood,AChangesAinAheartAmuscle,AInjuryAfromA
heartAattack,AHealingAprocessAafterAheartAsurgeryA
ii. Symptoms#A
1. AAflutteringAinAchestA
2. RacingAheartbeatA(tachycardia),ASlowAheartbeatA(bradycardia)A
3. ChestApain,AShortnessAofAbreath,ALightAheadednessAorAdizzinessA
4. Sweating,AFaintingA(syncope)AorAnearAfaintingAA
iii. serious#signs#&#symptoms#include:#
1. Anxiety,AWeakness,Adizziness,AandAlightDheadednessA
2. FaintingAorAnearlyAfainting,ASweatingA
3. ShortnessAofAbreath,AChestApainA
iv. Physical#findings/#Physical#examination#A
1. ListenAto:ARateA&ArhythmAofAheartbeat,AheartAmurmurA(anAextraA
orAunusualAsoundAheardAduringAheartbeat)A
2. CheckApulse,ACheckAforAswellingAinAlegsAorAfeet,AwhichAcouldAbeAaA
signAofAenlargedAheartAorAheartAfailureAA
3. LookAforAsignsAofAotherAdiseases,AsuchAasAthyroidAdisease,AthatA
couldAbeAcausingAtheAproblemA
4. AspartateAAminotransferaseABloodATestA(AESDpahrDtaytAuhD
meeDnoeDTRAENSDf:rDays)A(serumAglutamicDoxaloaceticA
transaminase;ASGOT;AAST):AelevatedA1D5A
5. CalciumA(KAELDseeD:m)A(Ca2+;AtotalAserumAcalcium)ABloodATest:A
abnormalAlevelAA
6. ElectrodiagnosticAStudy:AAbnormalAtestAresultsAindicateAcardiacA
arrhythmiasA
7. HolterAMonitoring:AMonitorsAforAproarrhythmiaAduringA
initiationAofAcertainAantiarrhythmicAmedications.A
8. SignalDAveragedAElectrocardiographyA
9. StressAExerciseAA
A
4. Cardiology#–#symptoms#and#physical#findings#with#aortic#valve#diseases.#
a. StenosisAofAleftAarterialAostiumA(AORTIC#STENOSIS):AisolatedAaorticAstenosisAisA
oftenAcongenital.ALeftAventricleAmustAworkAagainstAresistanceAofAnarrowedA
aorticAostiumAduringAejectionAofAbloodAintoAaorta.ASystolicApressureAinAventricleA
isAmuchAhigherAthanAinAaorta,AcausingAventricleAtoAbeApressureAoverloaded.A
PressureAoverloadAisAcompensatedAforAbyAhypertrophyAofAventricularA
myocardium,AbutAvolumeAofAtheAventricleAremainsAnormal.A
b. InAtheAhypertrophicAventricleAtheAendADAdiastolicAfillingApressureAisAincreasedA
butAtheAmeanAatrialApressureAisAelevatedAonlyAslightly.AShortnessAofAbreatheAinA
theseApatientsAmayAbeAaArelativelyAlateAandAunreliableAsymptom.ATheAfirstA
symptomAofAaorticAstenosisAmayAbeAsyncopeAorAanginaApectoris.A
c. OnAinspectionAandApalpation:AweAfindAanAapicalAthrustAinsideAtheAmidclavicularA
lineAifAtheAleftAventricleAisAnotAorAonlyAslightlyAenlarged.AUsuallyAaAthrillAisAfoundA
intAheArightA2ndAinterspaceAparasternallyAorAoverAtheArightAcarotidAartery.A
UpstrokeAofAtheAcarotidApulseAisAslowAandAitsAmaximumAisAreachedAlate.A
d. Auscultation:AusuallyAthereAisAnoAmajorAchangeAinAtheA1stAHS.ATheAaorticA
componentAofAtheA2ndAHSAisAsoftAorAinaudible.AThereAisAaA4thAHSAbutAaA3rdAHSAisA
heardAonlyAexceptionallyAandAthenAonlyAinAventricularAfailure.AWeAcanAhearAaA
systolicAoverAtheAapex.AOverAtheAaortaAthereAisAaAtypicalAlongAejectionAmurmurA
withAaAdelayedAmaximumAandAwithAtransmissionAintoAtheAcarotidsAmoreAintoA
theAright.A
e. AAclearlyAaudibleAclickAisAdiagnosticAforAvalvularAstenosisAandAdistinguishesAitA
fromAsupravalvularAstenosisAandAtheAmajorityAofAsubvalvularAstenoses.A
f. IncompetenceAofAtheAleftAarterialAostiumA(AORTICAINSUFFICIENCY):ARheumaticA
heartAdisease,AwhichAcausesAaorticAinsufficiencyAinvolvesAtooAparticularlyAtheA
mitral.AIsolatedAaorticAinsufficiencyAmayAbeAcausedAbyAsymphilisA(mesaortitis)A
andAotherAdiseasesAifAtheAaorticAwallA(dissections)AorAbyAvalvularAdamageAdueAtoA
bacterialAendocarditis.A
g. LongADAstandingAsystemicAhypertensionAmayAcauseAaorticAinsufficiency.AAA
suddenAdevelopmentAofAaorticAinsufficiencyAisAindicativeAofAdissectionAofAtheA
ascendingAaortaAorAofAendocarditis.A
h. PartAofAtheAejectedAbloodAreturnsAtoAtheAleftAventricleAinAdiastoleAthroughAtheA
incompetentAvalve.AEnddiastolicAvolumeAofAtheAventricleAincreasesAandAalsoAistA
systolicAoutput.ALeftAventricularAvolumeAcontinuouslyAincrease.AFallAofAtheA
diastolicABPAinAtheAsystemicAcirculation.A
i. ByAisnpection:AweAmayAobserveAaAsystolicAbouncingAofAtheApatient'sAheadAandAaA
conspicuousAcarotidApulsation.A
j. ByApalpation:AweAfindAanAapicalAthrustAoftenAdisplacedAlaterallyAandAcaudadA
intoAtheA6thD7thAinterspace.ATheAcarotidApulseAhasAaAsteepAandAfastAupstrokeA
withAanAearlyAmaximum.A
k. Auscultation:AtheA1stAHSAisAnormalAandAsoft.ATheAaorticAcomponentAofAtheA2ndA
HSAisAusuallyAclearlyAaudible.AAA3rdAHSAmayAbeAheardAsometimesAevenAinA
patientsAwithoutAheartAfailure.AAA4thAHSAisAexceptional.AMostAvaluableAforAtheA
diangosisAisAtheAlongAdiastolicAdecrescendoAmurmurAbeginningAimmediatelyA
afterAtheAaorticAcomponentAofAtheA2ndAHS.AOverAtheAauscultationAsiteAofAtheA
aorticAvalveAthereAmayAbeAaAsystolicAejectionAmurmurAfromArelativeAstenosis.A
TheAmurmurAisAbriefAandAreachesAistAmaximumAearly.A
l. AorticAinsufficiencyAisAconsideredAsevereAifAtheAleftAventricularAisAmarkedlyA
dialtedAandAhypertrophiedAandAifAthereAisAleftAventricularAstrainAonAtheAEKG.A
m. CombinedAaorticAstenosisAandAInsufficiency:AcanAbeAeitherAcongenitalAorAofA
rheumaticAorigin.ADiagnosisAisAmadeAofAtypicalAsystolicAejectionAmurmurAandAaA
diastolicAdecrescendoAmurmur.AInAcontrastAtoApureAaorticAinsufficiencyAitsA
combinationAwithAaorticAstenosisAdemonstratesAaAlongerAsystolicAmurmurAwithA
itsAmaximumAinAtheAsecondAhalfAofAsystole.AEvaluationAofAtheAseverityAisAsimilarA
toAtheAevaluationAofAaorticAstenosis,AorAinsufficiency.A
 n. Physical#FindingsAA
i. HomocysteineATest:AElevatedAhomocysteineAlevelsA
ii. CardiacANuclearAScan:AA
iii. CoronaryAUltrasonography:AA
A
5. Cardiology#–#symptoms#and#physical#findings#with#mitral#valve#diseases.A
a. StenosisAofAtheAleftAVenousAostiumA(MITRALASTENOSIS):AInAadultsAitAisAalwaysAofA
rheumaticAorigin.AInhibitsAtheAflowAofAbloodAfromAtheAleftAatriumAintoAtheA
ventricle.ACongestionAdevelopsAinAtheAleftAatriumAinAtheApulmonaryAveins,A
pulmonaryAcapillariesAandAinAtheApulmonaryAartery.AOnlyApassiveAhypertensionA
isApresentAinAtheApulmonaryAarteryAandAtheApressureAdifferenceAbetweenAtheA
leftAatriumAandAtheApulmonaryAarteryAremainsAnormalADAbelowA11mmAHg.A
ElevatedApressureAinAtheApulmonaryAcapillariesApromotesAtransductionAofA
bloodAplasmaAintoAtheAinteralveolarAseptaAandAalveoli,AimpedesAbreathingAandA
isAtheAcauseAofAbreathlessnessAalreadyAinAtheAearlyAstageAofAtheAdisease.A
b. On#Inspection:AweAmayAnoteAaAmitralAfacies.A
c. On#palpation:AofAtheAprecordiumAweAmayAfindAaAsystolicAthrustAofAtheAsternumA
(hypertrophyAofAtheAoverloadedArightAventricle).ASometimesAalsoAtheAtactileA
equivalentAofAanAaccentuatedA1stAHSAandArarelyAaAdiastolicAthrillAatAtheAapex.A
d. On#auscultation:AweAfindAanAaccentuatedA1stAHSAinAtheA2ndAleftAinterspaceA
parasternallyA(inApulmonaryAhypertension).ATheAmostAimportantAdiagnosticA
signAisAtheAopeningAsnapAofAtheAmitralAvalveAandAaAcoarse,AinflowADArelatedA
diastolicAmurmur.ASometimesAtheAopeningAsnapAisAbetterAheardAtoAtheAleftAofA
theAsternumAthanAatAtheAapex.ATheAdiastolicAmurmurAisAbestAauscultatesAinAtheA
leftAdecubitusApositionAandAhasAtoAbeAlookedAforAinAaArelativelyAwideAareaA
aroundAtheAapex.A
e. PulmonaryAveinsAbecomeAdistendedAinAtheAupperAlungAfields,ApulmonaryA
arteriesAareAdistendedAinAtheAhilarAregionsAandAareAnarrowedAinAtheAlowerAlungA
fields.AAAsoftAmurmurAdoesAnotAexcludeAsevereAstenosis.AAnAaccentuatedA1stA
HSAandAaAloudAhighADApitchedAopeningAsnapAspeaksAfroAstenosisAofAaAvalveAwithA
membranous,ApliableAleaflets.A
f. Incompetence#of#the#mitral#valveA(MITRALAINSUFFICIENCY):AitAcanAbeAacuteAosA
chronic.A
g. Acute#mitral#incompetence:AdevelopsAinAruptureAofAtheAchordaeAtendineaeAosA
inAischemicAdamageAtoAaApapillaryAmuscle,AparticularlyAinAinferiorAmyocardialA
infarcts.AItAleadsAtoAoverloadAofAtheAleftAventricleAandAatriumADAnotAbeingAableAtoA
dilateAfastAenough.AOnAphysicalAexaminationAweAnoteAaAsuddenAdevelopmentA
ofApulmonaryAcongestion,AmostAfrequentlyAaAsystolicAmurmurAatAtheAapexAandA
borderlineAorAlowAsystolicABP.A
h. Chronic#mitral#incompetence:AusuallyAcausedAbyAimpairementAofAtheAvalvularA
attachmentAinAchronicAdilatationAofAtheAleftAventricleAandAalsoAbyAimpairementA
ofApapillaryAmuscleAfunctionAfollowingAmyocardialAinfarction.AItAmayAdevelopAasA
aAconsequenceAofAdegenerativeAorArheumaticAlesionsAofAtheAvalve.AIsolatedA
mitralAincompetenceAwithoutAconcomitantAstenosisAorAinvolvementAofAtheA
otherAvalves.A
i. LeadsAtoAtheAvolumeAoverloadAofAtheAleftAventricleAwhichAejectsAaAlargerA
volumeAofAbloodAduringAsystole.A
 j. On#inspection#and#palpation:AweAobserveAanAapicalAthrustAshiftedAtoAtheAleftA
andAcaudalAasAtheAvolumeADAoverloadedAleftAventricleAenlarges.AAlsoAweAfindAaA
systolicAsternalAthrustAwhichAisAcausedAbyAaAjetAeffectAofAtheAregurgitantAbloodA
ejectedAfromAtheAleftAventricleAbackwardsAintoAtheAatrium.A
k. On#auscultation:AweAcanAdiagnoseAaA3rdAHSAinApatientsAwithoutAleftAventricularA
failure.AInAnonDrheumaticAmitralAinsufficiencyAwithAaAfunctionallyAintactAleftA
atriumAwhichAisAnotAtooAenlarged,AweAmayAhearAaA4thAHS.ADiagnosisAisAbasedAonA
theAregurgitateAsystolicAmurmur,AwhichAmayAhaveAaAdifferentAcharacterAfromA
caseAtoAcaseAbutAneverthelessAhasAitsAPMIAatAtheAapex,AtransmitsAtoAtheAaxilla,A
intensifiesAonAsquattingAandAweakensAinAtheAuprightAposition.A
l. EnlargedAleftAventricle,AsignsAofAheartAfailureAandAxDrayAchangesAshowA
pulmonaryAcongestion.A
m. Combined#Mitral#stenosis#and#incompetence:AalmostAalwaysAtheA
consequenceAofArheumaticAheartAdisease.AOnAphysicalAexaminationAweAcanA
findAevidenceAofAvalvularAstenosisAasAwellAasAofAincompetence.ATheApresenceAofA
anAopeningAsnapAandAtheAabsenceAofAaA3rdAandA4thAHSAindicateAanAorganicA
stenosisAofAtheAmitralAvalveAthatApreventsAaArapidAinflowAofAbloodAfromAtheA
atriumAintoAtheAventricle.A
n. Physical#Findings#A
i. LungAScan:AFalseApositivesAmayAbeAcausedAbyAmitralAstenosisA
A
6. Cardiology#–#symptoms#and#physical#findings#with#valve#diseases#of#the#right#heart#
a. Heart#valve#disordersADAaffectAanyAofAvalvesAinAheartA#
i. tricuspidAvalve;AlocatedAbtw.AtheArightAatriumA&ArightAventricle#
ii. pulmonaryAvalve;AlocatedAbtw.ArightAventricleA&ApulmonaryAartery#
iii. mitralAvalve,AlocatedAbtw.AleftAatriumAandAleftAventricle#
iv. aorticAvalve;AlocatedAbtw.AleftAventricleA&Aaorta#
b. HeartAvalveAdisorderAcausedAbyAaAleakageAofAblood,AcalledAregurgitation,AaA
narrowingAofAvalveAopening,AcalledAstenosis,AorAcombinationAofAregurgitationA
&Astenosis.APeopleAwithAheartAvalveAdisorderAmayAnotAhaveAanyAsymptoms,A
whileAothersAmayAexperienceAconditionsAlikeAstrokes,AheartAattacks,A&AbloodA
clotsAifAheartAvalveAdisorderAgoesAuntreated.#
c. Tricuspid#stenosis;AcausedAbyArheumaticAfever,ATricuspid#insufficiency;AdueAtoA
mitralAdeficiency,AcouldAbeAalsoAinheritedA(e.gAEbsteinDAbnormality).AMostAofA
timesATIAisAfunctionallyAinducedA(dilationA&AinsufficientAofArightAventricle).AA
d. Pulmonary#vavular#defect;AlessAcommon.AStenosisAoftenAinheritedA&A
combinedAwithAshunt.APulmonary#insufficiency;AoftenAfunctionalAnatureA
(pulmonaryAhypertonia)AA
e. Tricuspid#stenosis;ArightAatriumApressureAisAincreasedA&AdiastolicAflowAthroughA
valveAisAdiminishedD>AcardiacAoutputAisAdecreased.ADecreasedAcardiacAoutputA
restrictsAperformanceAability.AA
i. IncreasedAvenousApressure,AperipheralAoedema,AatrialAfibrillationAA
f. Tricuspid#insufficiency;AformationAofAoedemas.ASymptomsAarisesAwhenATIAisA
accompaniedAwithApulmonaryAhighApressureAorArightAheartAinsufficiency.A
g. Pulmonary#Insufficiency;AleadsAtoAvolumeAload.AAAPul.AIn.AisAmostlyAfromA
functionalAnatureD>ApulmonaryAhighApressureAdeterminesApatientsAfate.AA
h. Pulmonary#stenosis;AcompromisedAthroughAHypertrophy,AbutAphysicalAworkA
capacityAisArestrictedA&AtirednessA&AsyncopeA(lossAofAconsciousness)AariseAA
 i. Symptoms#DAofAtricuspidAvalveAregurgitationAmayAinclude:A
i. Fatigue,AdecliningAexerciseAcapacity,AswellingAinAabdomen,AlegsAorAveinsA
inAneck,AAbnormalAheartArhythms,APulsingAinAneck,AAnAenlargedAliver,A
ShortnessAofAbreathAwithAactivityA
j. SymptomsA–AofApulmonaryAvalveAdiseaseAA
i. noAearlyAsymptoms:AA
ii. SignsAdetectedAinAmedicalAexamAincludeAaAcertainAtypeAofAmurmurA
heardAwhenAheartAisAbtw.AheartAbeats.A
iii. lowerArightAchamberAofAheartAenlargedA
iv. moreAnoticeableAsymptoms;AchestApainAorAdiscomfort,Afatigue,AlightA
headednessAorAfainting.A
k. Physical#FindingsA
i. CoronaryAUltrasonographyA
A
7. Cardiology#–#symptoms#and#physical#findings#in#a#patient#with#myocarditis#and#
pericarditis.#
a. Myocarditis#-#inflammationA&AdamageAofAheartAmuscle.AExactAincidenceAofA
myocarditisAisn’tAknown.A#
i. CausesA–AviralAinfectionsA(mostAcommonAassociatedAwithAupperARTI),A
autoimmuneAdiseasesA(rheumatoidAarthritisAorAlupus),AenvironmentalA
toxins,A&AadverseAreactionsAtoAmedications.APrognosisAisAvariableAbutA
chronicAheartAfailureAisAmajorAlongAtermAcomplication.AA
ii. MostAmyocarditisAhasAno#symptomsA&AonlyAidentifiedAbyAanA
electrocardiogramAorAbyAblood#testsAthatAdetectAheartAinjury.AA
iii. SymptomA–shortnessAofAbreathAduringAexerciseAorAexertionD>AprogressA
intoAshortnessAofAbreathAatAnightD>AintoAsitAupAtoAbreathe.AOther#
symptomsA–Afatigue,AchestApainAorApressure,AswollenAleg,AsuddenAlossA
ofAconsciousness,AlightAheadedness,AacuteAdecompensationAofAheartA
failureA(e.g.Atachycardia,Agallop,AmitralAregurgitation,Aoedema)AA
iv. Physical#Findings#A
1. CreatineAKinaseABloodATest:ACPKDMBAisAelevatedA
2. Electrocardiogram,AChestAXDRay,AEchocardiogramA(abbreviatedA
echo),ACardiacAmagneticAresonanceAimagingA(MRI)Ascan,AheartA
biopsyAA
3. LaboratoryATestingA–ACompleteAbloodAcount,AErythrocyteA
sedimentationArateAlevelA(e.g.ACDreactiveAprotein),A
RheumatologicAscreening,ACardiacAenzymeAlevelsA(e.g.AcreatineA
kinaseAorAcardiacAtroponins),ASerumAviralAantibodyAtiters,AViralA
genomeAtestingAinAendomyocardialAbiopsy,AElectrocardiographyA
4. ImagingAstudiesA
a. AntimyosinAscintigraphy:AToAidentifyAmyocardialA
inflammationA
b. GadoliniumDenhancedAmagneticAresonanceAimaging:AToA
assessAextentAofAinflammationAandAcellularAoedema;A
nonspecificA
b. PericarditisA–AAinflammationAofApericardium.ACauseAdueAtoAaAviralAinfection,A
bacterialAinfectionsAe.g.Atuberculosis,AuremicApericarditis,AheartAattack,Acancer,A
autoimmuneAdisorders,AandAchestAtrauma.AA
 i. SymptomsA–AsuddenAonsetAofAsharpAchestApain.APainAalsoAfeltAinA
shoulders,Aneck,AorAback.ABetterAsittingAupA&AworseAwithAlyingAdownAorA
breathingAdeep.AOther:Afever,Aweakness,ApalpitationsA&AshortnessAofA
breath.ASubsternalAorAleftAprecordialApleuriticAchestApainAwithAradiationA
toAtrapeziusAridge.ADryAcough,Afever,Afatigue,AandAanxiety.ADiaphoresisA
(excessiveAsweating)A
ii. DiagnosisA–AchestApain,AaApericardialArub,AspecificAelectrocardiogramA
changes,A&AfluidAaroundAheart.AA
iii. Physical#findings#A
a. AspartateAAminotransferaseABloodATest:ASlightAelevationA
b. ElectrocardiographyA
c. BodyAFluidAAnalysis,ACellACount:APericardialAfluidD>AelevatedARBC’s,A
elevatedAWBC’sAA
d. Paracentesis:AremoveAaccumulatedAexudativeAorAtransudativeAfluidA
fromAabdominalAcavityAA
e. FrictionArubAheardAwithAaAstethoscopeAonAlowerAleftAsternalAborderA

A
A
Common#Symptoms#and#Physical#Findings#in#Pneumology#
http://www.hopkinsmedicine.org/healthlibrary/test_procedures/pulmonary/AA
https://en.wikipedia.org/wiki/PulmonologyAA
https://www.hoag.org/specialtiesDservices/otherDprogramsDservices/respiratoryD
care/services/pulmonaryDlaboratoryDtesting/AA
http://www.inDcorpore.ch/services/pneumology/AA
D PulmonaryAandApleuralAdiseasesAA
o ChestApain,ACough,AExpectoration,AHaemoptysis,ADyspnoea,AVoiceAalterations,A
HiccupsAA
A
8. Cardiology-#Symptoms#and#physical#findings#in#patient#with#endocarditis#
a. ClassificationAofAendocarditisA
i. NONDINFECTIVEA
1. RheumaticAendocarditisA(dueAtoApreviousAinfectionD>AautoAAb’sA
attackAvalves)A
2. AtypicalAverrucousA(LibmanDSacks)AendocarditisA(dueAtoA
depostitionAofAimmnuneAcomplexesAinAsystemicAlupusA
erythematosusA(SLE)A)A
3. NonDbacterialAthromboticA(cachectic,Amarantic)AendocarditisA
ii. INFECTIVEA
1. BacterialAendocarditisA
a. AcuteA
b. SubacuteA
 2. OtherAinfectiveAtypesA(tuberculous,Asyphilitic,Afungal,Aviral,A
rickettsial)A
b. SYMPTOMS+ASIGNSA
i. UnspecificAsymptoms:AA
1. FeverA
2. SubfebrileAtemperaturesA
3. Anorexy,AWeightAlossA
4. NightAsweatsA
5. FatigueA
6. HeartAsounds,AtachycardiaA
ii. OftenAtheAfirstAsymptomsAareAalreadyAsignsAofAcomplicationsAlikeA
1. DyspnoeA(ApointingAtoAvalveAdestructionsA!AincreasedAvolumeA
load)A
2. SepticAemboliesAmayAcauseAneurologicAsymptomsA(Ae.g.A
hemiparesis)A
3. SepsisA
iii. VascularAandAimmunologicAsymptoms:A
1. OslerAnodesA(Asubcutaneous,AhemorrhagicAnodesAasAsignAofA
immunocomplexAvasculitisAorAsepticAembolism)A
2. SplinterAhemorrhagesA(AbleedingsAbelowAfingerAnails)A
3. JanewayDAlesionsA(AbleedingsAofApalmsAofAhandAandAfeetAdueAtoA
immunocomplexes)A
4. GlomerulonephritisAA
iv. LaboratoryAparameters:A
1. LeucocytosisA
2. IncreasedACRPA
3. IncreasedAsedimentationArateAA
4. AnAincreaseAofAserumAprocalcitoninA(moreAsensitiveAthanAotherA
parameters)A
v. BUTAallAthoseAparametersAareAnotAspecificAforAendocarditisA
c. InAcaseAofAanAinfectiveAendocarditisA(IE)AAitAisAimportantAtoAdetectAtheAcausativeA
agentAA
d. DukeAcriteriaA
i. Min.AtwoApositiveAbloodAculturesApreviousAtoAATBAtherapyA
ii. PositiveAEchoA(abscess,AnewAvalvularAinsufficiency)A
1. TTEDATransthoracicAechocardiographyA
2. TEEDATransesophagealAechocardiographyA
e. PrediposingAfactorsAforAendocarditis:AheartAvalveAprothesis,AIVAmedication/A
drugAabususA
A
9. Cardiology-#Symptoms#and#physical#findings#in#patient#with#pulmonary#embolism#
a. PulmonaryAembolismAoftenAisAnotAdiagnosedA
b. Symptoms:A
i. DyspnoeA/ATachypnoeA
ii. TachycardiaA
iii. CyanosisA
iv. ChestApainA
v. CoughA
 vi. HemoptysisA
vii. Vertigo/ADizzinessA
viii. SweatingA
c. AAgreaterApulmonaryAembolisationAoftenAoccursAafterAaAcoupleAofAclinicallyA
quietAembolisationsAwithArelativelyAunspecificAsymptomsAlikeAvertigo,A
tachycardiaAandAfeverA
i. ThereAmightAalsoAbeAanAincreaseAofADDAdimersAinAtheAbloodAsampleA
1. DDAdimerAisAproteinAwhichAisAdetectedAafterAdetachmentAofA
thrombusAD>AifApresentAthereAisAaAhighAriskAthatAaAembolusAisA
formedAA
ii. XDraysAandACTPAA(AcomputerisedAtomographyApulmonaryAangiography)A
mightAbeApositiveAA
iii. VentilationDAperfusionAscanA(AvisualizationAofAbloodAsupplyAtoAtheAlungs)A
mightAalsoAshowAabnormalitiesA
A
10. Pneumology-#Symptoms#and#physical#findings#in#patient#with#chronic#bronchitis,#
COPD,#asthma#bronchiale#
a. Chronic#bronchitis##
i. DifferentiationAfromAacuteAbronchitisAisAdurationAandArecurrenceA(Aacc.A
ToAWHOAdefinitionAchronicAbronchitisAwhen:AcoughAandAexpectorateA
persistAlongerAthanA3AmonthsAinAminimumA2AfollowingAyearsA)A
ii. DifferentiationAfromAchronicAobstructiveAbronchitisAisAmainlyAthatAitAisA
alsoAcharacterizedAbyAbreathlessnessAdueAtoAincreasedAdamageAofA
bronchioliAandAobstructionAofAairwaysA
1. ChronicAobstructiveAbronchitisAfollowsAchronicAbronchitisAA
iii. PermanentAinflammationAofAbronchialAmucosaA
1. CoughA
2. ExpectorateAA
3. HoarsenessA
4. FeverA
b. COPD#–#chronic#obstructive#pulmonary#disease#
i. ChronicAobstructiveAbronchitisAandApulmonaryAedemaAareAsummarizedA
asACOPDA
ii. CharacteristicAbesidesAcoughAandAexpectorateAisAdyspnoeAfollowingAaA
latentAorAmanifestedAbronchialAobstructionAwithAbreathlessnessA
1. WeakendAperipheralA(vesicular)AbreathAsoundsA(dueAtoA
bronchialAobstruction)AA
2. ForcedAexpiratoryAvolumeAinA1Asec.A(FEV1)AisAdecreasedAA
c. Asthma#bronchiale#
i. Symptoms:A
1. BreathlessnessA(AparoxysmalA–Aanfallsartig)A
2. ExpiratoryAsoundsA
a. LongerAexpirationA
b. Wheezing,Awhistle,AgrumbleAsoundsA
3. ChestAtightnessAA
4. CoughAA
5. TachypneaA
6. OrthopneaA
A
11. Pneumology-#Symptoms#and#physical#findings#in#patient#with#acute#bronchitis,#
pneumonia#
a. Acute#bronchitis#
i. CoughA
ii. ExpectorateA–AmightAbeAglassyDAclearAorAyellowishA(AmostlyAassociatedA
withAbacterialAinfection)A
iii. StridorAA
iv. FeverAA
b. Pneumonia#
i. DueAtoAinflammatoryAexudateAinAalveoliA!ArestrictionAofAlungAfunctionA
!AbreathlessnessA
ii. CoughA
1. InAalveolarApneumoniaAitAisAproductiveA
2. InAintersitialApneumoniaAitAisAaAdryAcoughA
iii. FeverAA
iv. TachypnoeaAA
v. CrackelAsoundAduringAauscultationA
vi. BronchialAbreathingAinAcaseAofAlobarApneumoniaAA
vii. DullnessAduringApercussionAoverAaffectedApartAofAtheAlungA
viii. FremitusAandAbronchophoniaAisAenhancedA
ix. InAcaseAofAadditionalAinflammationAofApleura,AtheApatientAmightAbeAinA
relievingApostureAtowardsAaffectedAsideAA
A
12. Pneumology-#Symptoms#and#physical#findings#in#patient#with#disease#of#upper#
respiratory#tract#
a. Symptoms#of#URTI’s:#
i. CoughA
ii. Sneezing,ANasalAdischarge,ANasalAcongestion,ARunnyAnoseA
iii. FeverA
iv. Scratchy/AsoreAthroatA
v. NasalAbreathingAA
vi. HeadacheAA
1. AlsoAdueAtoAsinusitisAD>AsensitiveAtoApressureA
A
13. Pneumology-#Symptoms#and#physical#findings#in#patient#with#tuberculosis,#lung#
carcinoma#
a. Tuberculosis#
i. LatentATBAcanAbeAsymptomlessA
ii. UnspecificAsymptomsAlike:A
1. fatigue,AA
2. lossAofAappetite,AlossAofAweight,AA
3. fever,AnightAsweatsAetc.AA
iii. ThereAalsoAmightAbeAA
1. hemoptysis,AA
2. anemiaAA
3. swollenAlymphnodesA
4. dyspnoeaA
 b. Lung#carcinoma#
i. CoughA
ii. chestApainAA
iii. whistlingAbreathAA
iv. breathlessnessA
v. hemoptysisA
vi. swellingAinAfaceAandAonAneckA
vii. weightAlossA
A

14. Pneumology#–#The#symptoms#and#physical#findings#in#a#patient#with#bronchiectasis,#
emphysema,#lung#abscess#and#pleuritis.#
a. BronchiectasisA–APermanentAdilationAofAbronchiAasAaAcauseAofAdestructionAofA
musclesA&AelasticAconnectiveAtissue.AMostAcommonlyAtheAdiseaseAstartsAwithAaA
narrowingAofAtheAbronchialAtreeAthroughAanAinfection,AwhichAtroughA
chronificationAleadsAtoAdestructionAofAtheAepithelium.ATheAdisturbanceAofA
mucusDciliaryAclearanceAresultsAinAaAsecretion,AwhichAisApredestinedAforAmoreA
infections.AA
i. SymptomsA–AchronicAcough,AproductionAofAmucus,AshortnessAofAbreath,A
Lethargy,AHaemoptysis,AcoughingAupAblood,A&Achest/AthoraxApain,A
weightAloss,Abronchospasm,Adyspnoea,AWheezingA&AnailAclubbing.A
PatientAaffectedAwithAtheAdiseaseAoftenAgetAlungAinfections.AA
ii. BronchiectasisAoccursAinAmostApatientsAwithAcysticAfibrosis.AA
iii. DiagnosisA–Abronchiectasis#isAdiagnosedAthroughAhighDresolutionA
computerDtomographyA(HRCT).AA
iv. ReasonsAofAbronchiectasis;#Post-infectious;AdifferentArespiratoryA
infectionsAcanAleadAtoAtheAdiseaseAe.g.Apertussis,AgramAnegativeA
bacteria’sA(PseudomonasAAeruginosa,AHaemophilusAInfluenza),AVirusesA
(HIV,AParamyxovirus,AAdenovirus,AInfluenza),ATuberculosis,AatypicalA
MycobacteriaAA
1. InfectionAwithAtheAMycobacteriumAaviumAcomplexAisAaAtypicallyA
findingAofALadyDWindermereDSyndrome.A
v. CongenitalAcauseA–AprimaryAciliaryAdyskinesiaA(PCD),AchronicA
obstructiveAlungAdiseaseA(COPD).AAA
vi. Physical#Findings##
1. Cytology,ASputum:AEvaluatesAmetaplasticAchangesAassociatedA
b. Emphysema#–#isAoneAofAdiseasesAthatAcomprisesACOPDA(chronicAobstructiveA
pulmonaryAdisease).AInvolvesAenlargementAofAairAsacsAinAtheAlungA&AgradualA
damageAofAlungAtissue,AspecificallyAthinningAandAdestructionAofAtheAalveoliAorA
airAsacs.AAlveoliAatAendAofAbronchiolesAofAlungAbecomeAenlargedAbecauseAofA
breakdownAofAtheirAwallsD>AreducedAsurfaceAareaAforAexchangeAofAO2AintoA
bloodA&AcarbonAdioxideAoutAofAit.ADamageAisApermanentADAnotAreversibleADA&AitA
causesAreducedArespiratoryAfunctionA&Abreathlessness.A
i. Symptoms#–#Shortness#of#breath#&#Cough.#AirAsacsAareAdestroyed,A
makingAitAprogressivelyAdifficultAtoAbreath.AE.AusuallyAaccompaniedAbyA
chronicAbronchitis,AwithAalmostDdailyAorAdailyAcoughAandAphlegm.A
CigaretteAsmokingAisAmajorAcauseAofAE.AShortnessAofAbreathAwithA
 activities.AItAisAnotAcurable,AbutAthereAareAtreatmentsAthatAcanAhelpAtoA
manageAdiseaseA
ii. Physical#Findings#A
1. Lung#function#testsA=ApulmonaryAfunctionAtestsD>AusedAtoA
confirmAaAdiagnosisAofAemphysemaD>AmeasureAcapacityAofAlungsA
toAexchangeArespiratoryAgasesA&AincludeAspirometry.A
2. Spirometry:#assessesAairflowAobstructionA&AisAmeasuredAperA
reductionAinAforcedAexpiratoryAvolumeAafterAbronchodilatorA
treatment.A
3. Cytology,#Sputum:ADetectsAbenign,AatypicalAchangesA
c. Lung#Abscess#DAtypeAofAliquefactiveAnecrosisAofAlungAtissueA&AformationAofA
cavitiesAcontainingAnecroticAdebrisAorAfluidAcausedAbyAmicrobialAinfection.AThisA
pusDfilledAcavityAcausedAbyAaspiration,AwhichAmayAoccurAduringAanaesthesia,A
sedation,AorAunconsciousnessAfromAinjury.AAlcoholismAisAmostAcommonA
conditionApredisposingAtoAlungAabscesses.ALungAabscessA–AconsideredAprimaryA
(60%)AwhenAitAresultsAfromAexistingAlungAparenchymalAprocessA&AsecondaryA
whenAitAcomplicatesAanotherAprocessAe.g.AvascularAemboliAorAfollowsAruptureA
ofAextraDpulmonaryAabscessAintoAlung.A
i. Symptoms#–ACoughA(productionAofAfoulAsmellingApurulentAmucusAorA
withAblood),AfeverAwithAshivering,A&AnightAsweats.AChestApain,A
shortnessAofAbreath,AlethargyAA
ii. Physical#FindingsA
1. raisedAinflammatoryAmarkersA(increasedAESR,ACRP),A
examinationAofAcoughedAmucus,AtransDtrachealAorAtransD
bronchialAculture.AA
2. XDray:ARoundAshadow,AoccupyingAfewAsegmentsAorAentireA
pulmonaryAlobe.AA
3. ChestARadiography:AA
d. Pleuritis#–AinflammationAofAmembranesA(pleurae)AthatAsurroundsAlungsA&AlineA
chestAcavity.ACausedAbyAviralAinfectionsAorApneumonia,ApulmonaryAembolism,A
autoimmuneAdisease,AlungAcancer,AheartAsurgery,Apancreatitis,AchestAtrauma,A
asbestosisAA
i. Symptoms#–AsharpAchestApainAwithAbreathing,AshortnessAofAbreath,A
rapid,AshallowAbreathing,AdryAcough,AfeverA&Achills,AweightAloss,A
tachycardia,AsoreAthoratAfollowedAbyApainA&AswellingAinAjointsAA
ii. Diagnosed#–AchestAXDRay,AelectrocardiogramA(ECG),AbloodAtestAA
iii. Physical#Findings#A
1. stethoscope:AbreathingD>AdetectsAanyAunusualAsounds;Arough,A
scratchyAsoundAasAtheyAlayersArubAagainstAeachAotherAduringA
breathingA=ApleuralAfrictionArub.AA
2. Chest#x-ray:AshowAairAorAfluidAinApleuralAspaceA&AcauseA(e.g.,A
pneumonia,AaAfracturedArib,AorAaAlungAtumour)AofApleurisy.A
3. Blood#tests:AdetectAbacterialAorAviralAinfections,Apneumonia,A
rheumaticAfever,ApulmonaryAembolism,AorAlupus.AA
4. Ultrasonography:#showsAlocationAofAfluidAinAchest,AshowsA
tumours,AdetectAfluidAaroundAlungsA(pleuralAeffusion).AA
5. CT#scan:AshowApocketsAofAfluid,AsignsAofApneumonia,AaAlungA
abscess,AorAaAtumour.AA
 6. Magnetic#resonance#imagingA(MRI):AshowApleuralAeffusionsA
andAtumours.AA
7. Thoracentesis:AlargeAnumberAofAleukocytesAindicatesAanAacuteA
inflammatoryAprocess,ApresenceAofAanAexcessAfluidAinApleuralA
cavity,AorApleuralAeffusion,AisAsuspectedA&AlocationAofAfluidAisA
confirmed,AaAsampleAofAfluidAcanAbeAremovedAforAtesting.AA
iv. Physical#ExaminationA–AdecreasedAorAabsentAtactileAfremitus,AdullnessA
toApercussion.ADiminishedAbreathAsoundsAoverAsiteAofAeffusion.A
BronchialAbreathAsoundsAareAfrequentApresentAimmediatelyAaboveA
effusion.AA
15. Angiology#–#symptoms#and#physical#findings#in#deep#vein#thrombosis,#chronic#
venous#insufficiency#and#lymphoedema.##
a. Deep#vein#Thrombosis#–AformationAofAaAbloodAclotA(thrombusAwithinAdeepA
vein,AcommonlyAlegs.AA
i. Symptoms#–ApainAorAtenderness,Aswelling,ArednessAorAdiscoloration,A
warmness,AengorgedAsuperficialAveins.ASymptomsAareAmoreAoftenAdueA
toAotherAcauses,Ae.g.Acellulitis,ABaker'sAcyst,AmusculoskeletalAinjury,AorA
lymphedema.AOtherAdiagnosesAincludeAhematoma,Atumours,AvenousAorA
arterialAaneurysms,AandAconnectiveAtissueAdisorders.AA
ii. Phlegmasia#cerulea#dolensADAlargeA&AdangerousAtypeAofADVT.A
CharacterizedAbyAacuteAandAtotalAvenousAocclusionAofAentireAextremityA
outflow,AincludingAiliacA&AfemoralAveins.ATheAlegAisApainful,AtingedAblueA
inAcolour,A&Aswollen,AwhichAmayAresultAinAvenousAgangrene.A
iii. Symptoms#A
1. swellingAinAfoot,Aankle,AorAlegAonAoneAsideA
2. crampingApainAinAaffectedAlegAA
3. sever,AunexplainedApainAinAfootA&AankleA
4. areaAofAskinAfeelsAwarmerAthanAskinAonAsurroundingAareasAA
5. skinAoverAaffectedAareaAturningApaleAorAreddishAorAbluishAcolourAA
6. CalfApainAonAdorsiflexionAofAfootA
7. DiscomfortAinAcalfAmusclesAonAforcedAdorsiflexionAofAfootA
iv. Physical#FindingsA
1. PlethysmographAA
2. Superficial#thrombophlebitisAcharacterizedAbyAfindingAofAaA
palpable,Aindurated,Acordlike,Atender,AsubcutaneousAvenousA
segment.AA
b. Chronic#venous#insufficiency#–AconditionAinAwhichAveinsAcannotApumpAenoughA
bloodAbackAtoAheart.ACVIAincludesAvaricoseAveinsA&AsuperficialAvenousAreflux.A
ValvesAinAveinsA(usuallyAinAlegAorAsometimesAarms)Adon'tAfunctionAproperly,A
causingAbloodAtoApoolAinAlegsA&AputtingAincreasedApressureAonAwallsAofAveins.A
DueAtoAvalveAdysfunctionA(usuallyAhereditary)AorAdueAtoAvalveAdestructionAafterA
aAdeepAveinAthrombosisA(DVT)AorAbloodAclot.A
i. Symptoms#DAmild,A&AnotAlimbDthreatening.AHeaviness,#swelling#&#pain:AA
heavinessAinAaffectedAlimb,AswellingA&Apain.ADarkeningAofAskin.AAnAopenA
soreAorAulcer,AusuallyAonAinsideAofAankle.AVaricose#Veins:AEnlargedA&A
twistedAveinsAcloseAtoAsurfaceAofAskinAareAsignAofAaAmilderAformAofA
venousAdisease.ABurning,Aaching,AheavinessAandApain.A
 1. Aching,Apain,Atightness,AskinAirritation,Apruritus,Aheaviness,A
tingling,AmuscleAcramps,AandAcosmeticallyAunsatisfyingAvaricoseA
veinsD>AsymptomsAworsenA&AwithAprolongedAstanding.ASevereA
insufficiencyApresent:Aoedema,AskinAchanges,AorAulceration.A
SeveralAclinicalAmimic:Aosteoarthritis,Asciatica,Aosteomyelitis,A
tendonitis,AligamentousAinjuries,Aarthritis,AperipheralA
neuropathy,A&AarterialAinsufficiency.A
ii. Physical#Findings#–ACEAPAclassification.AWeighAtreatmentAalternatives.A
GeneralAexaminationAinAadditionAtoAaAdetailedAexaminationAofAlowerA
extremities.AA
c. Lymphoedema#–AconditionAofAlocalizedAfluidAretentionA&AtissueAswellingA
causedAbyAaAcompromisedAlymphaticAsystem,AwhichAnormallyAreturnsA
interstitialAfluidAtoAthoracicAduct,AthenAtoAtheAbloodstream.ATheAconditionAcanA
beAinheritedAorAcausedAbyAaAbirthAdefect,AbutAfrequentlyAcausedAbyAcancerA
treatmentsAandAbyAparasiticAinfections.AThoughAincurableA&Aprogressive,AaAnr.A
ofAtreatmentsAcanAameliorateAsymptoms.ATissuesAwithAlymphedemaAareAatA
highAriskAofAinfection.A
i. Symptoms#–AfeelingAofAheavinessAorAfullness,Aoedema,A(occasionally)A
achingApainAinAaffectedAarea,ApresenceAofAskinAchanges:Adiscoloration,A
verrucousA(wartDlike)Ahyperplasia,AhyperkeratosisA&Apapillomatosis;A
deformityA(elephantiasis).AA
ii. Physical#Findings#A
1. Lymphangiography#&#Sensitel#Node#Studies#(Nuclear#Scan)#A
2. examineAskin:ADryness,AincreasedAthickness,AhyperkeratosisA
(scaling),AlymphangiomasA(blistersAcontainingAlymphAfluid),A
abnormallyAwarmAorAhotAtemperature,AunusuallyAdarkAskin,AandA
presenceAofAanyAnodulesAareAallAindicatorsAofAlymphedema.AA
3. Papillomatosis:AcobblestoneAappearanceAofAskin.AA
4. Kaposi-Stemmer's#sign:AinabilityAtoApinchAaAfoldAofAskinAatAbaseA
ofAsecondAtoeAbecauseAskinAisAsoAthickened.A
http://www.lymphedemapeople.com/medical/Diagnosing_Ly
mphedema_by_Physical_Examination.htmAA
16. Angiology#–#symptoms#and#physical#findings#in#a#patient#with#peripheral#artery#
disease#and#acute#arterial#occlusion.##
a. Peripheral#artery#disease#–#narrowingAofAperipheralAarteriesAtoAlegs,Astomach,A
armsA&AheadD>AmostAcommonlyAinAarteriesAofAlegsA#
i. Symptoms#–#cramping,ApainAtirednessAinAlegAorAhipAmusclesAwhileA
walkingAorAclimbingAstairs.APainAgoesAawayAduringArestA&AcomesAbackA
duringAwalking.ASkinAulcer,AbluishAskin,AcoldAskin,ApoorAnailAandAhairA
growth.A#
1. IntermittentAclaudication:ApainAinAmusclesAduringAwalking,A
relievedAduringArestAdueAtoAunmetAO2AdemandAinAmuscles.A
2. CriticalALimbAIschemia:ArestApainAinAsolesAofAfeetA(inAelevatedA
position),AtissueAlossA(arterialAinsufficiencyAulcer),Asores,A
wounds,AgangreneAA
ii. Physical#Findings#
1. inspection:AthickAshinyAskin,AhairAloss.AA
 2. ExposingAtheAskin:ABrittleANails,AcolourAchanges,AUlcer,AMuscleA
Wasting.AA
3. Palpation:ATemperature,APulseA(regularAetc.),ACapillaryARefill,A
Sensation/AMovement.AA
4. Auscultation:AFemoralABruits.AA
5. AnkleABrachialAIndexA(ABI):AsystolicABPAinAankle/ASystolicABPAinA
brachialAartery.AA
6. Buerger’sATest:AelevateAtheAlegAtoA45°D>AlookAforApallor,AplaceAlegA
inAdependentApositionA9ß°D>AlookAforAredAflushedAfootAbeforeA
returningAtoAnormal,APallorAatA<20°AsevereAPAD.AA
iii. Medical#Signs#–#changingAcolour:Ablueness,AorAinAtemperatureA
(coolness),A#
iv. ankle#brachial#pressure#index#(ABPI/ABI):#whenABPinAanklesAisAlowerA
thanAthatAinAarms,AblockagesAinAarteriesAwhichAprovideAbloodAfromA
heartAtoAankleAareAsuspected.A#
1. Normal#ABIArangeAofA1.00AtoA1.40.AWhenAtheAABIAisA≤A0.90,A
patientsAareAdiagnosedAwithAPAD.AValuesAofA0.91AtoA0.99A=A
‘‘borderline’’A&AvaluesA>1.40A=AnonDcompressibleAarteries.APADA
grad:AmildAtoAmoderateD>AABIAisAbtw.A0.41A&A0.90,AABIAlessAthanA
0.40AD>AAsuggestiveAofAsevereAPAD.A#
b. Acute#Arterial#OcclusionA–AsuddenAdecreaseAinAlimbAperfusionAthatAcausesAaA
potentialAthreatAtoAlimbAviability.AThreatenedAlimbAmayAmanifestAasAischemicA
restApainAorAtheAdevelopmentAofAtissueAlossA(ulcers,Agangrene).ADevelopsAoftenA
afterAPAD,AcanAdevelopAintoAchronicAlimbAischemia.AAAOAisAresultAofAanA
embolusAfromAaAproximalAsourceAlodgingAintoAdistalAvessel,AacuteAthrombosisA
ofAaApreviouslyApatentAartery,AacuteAthrombosisAofAaAstentAorAgraft,A&A
dissectionAofAanAarteryAorAdirectAtraumaAtoAanAartery.#
i. SymptomsA
1. intermittentAclaudication:AdefinedAasAmuscleApainAdueAtoA
ischemiaAuponAprolongedAuseAofAinvolvedAbodyApart,AlowerA
extremitiesAhurtAduringA&AafterAwalking.#A
2. 5x#P:##painA(absentAinAcompleteAischemia),APallorA(presentAinA
chronicAischemia),ApulselessnessA(presentAinAchronicAischemia),A
ParaesthesiaA(leadingAtoAanaesthesia),AParalysis.APerishingAcoldA
ii. Physical#Findings##
1. DigitalASubtraktionAAngiographieA
2. comparisonAtoAcontralateralAextremities,A“FiveAPs”:APain,APallor,A
Paraesthesia,AparalysisA(proprioreceptiveA&AlightAtouchAlostA
first),APulselessness.AA
3. SurgicalAthromboembolectomyAandAbypassAgraftingAA
4. thrombolyticAtherapyAandApercutaneousAtransluminalA
angioplastyA

Common#symptoms#of#digestive#tract#diseases:ALossAofAapetite,AAnorexia,ABulimia,A
Dysphagia/odynophagia,ARegurgitation,APyrosis,ANausea,AVomiting,AHaematemesis,A
Melaena/hematochezia,AConstipation,ADiarrhea,AJaundiceA
Common#Physical#Findings#of#digestive#Tract#Diseases:A
http://www.merckmanuals.com/home/digestiveDdisorders/diagnosisDofDdigestiveD
disorders/acidDrelatedDandDrefluxDrelatedDtestsAA
http://www.thehealthsite.com/diseasesDconditions/whatDareDtheDdiagnosticDtestsDforD
gastrointestinalDdisordersDf915/A!!!A

17. Gastroenterology#–#symptoms#and#physical#findings#in#peptic#ulcer#disease#and#
oesophageal#reflux#disease.##
a. Peptic#Ulcer#DiseaseA–AchronicAdisease,AulcerationsAinAupperApartAofAGIAtractA
(stomach,AfirstApartAofAsmallAintestine,AlowerAoesophagus).AUlcerationsAoccurA
especiallyAinAproximalApartAofAduodenumA&AinAstomach.ATheApathogenesisAisA
basedAonAeffectAofA2AcommonAfactors:AhydrochloricAacidAandApepsin.AItAisA
causedAbyAexcessiveAproductionAofAgastrinAbyAgastrinDsecretingAisletAcellA
tumoursA(gastrinoma)AlocatedAmostAinAheadAofApancreas.AGastrinomasAalsoA
haveAbeenAlocatedAlessAcommonlyAinAduodenum,Aantrum.A
i. Symptoms#–AwakingAatAnightAwithAupperAabdominalApainAorAupperA
abdominalApainAthatAimprovesAwithAeating.APain:AburningAorAdullAache.A
Other:Abelching,Avomiting,AweightAloss,AorApoorAappetite.AAboutA1/3AofA
peopleAhaveAnoAsymptoms.A
1. abdominalApain:AepigastricAstronglyAcorrelatedAtoAmealtimes.AInA
duodenalAulcers:ApainAappearsAaboutA3AhoursAafterAtakingAaA
mealA
2. bloatingA&AabdominalAfullness,AwaterbrashA(rushAofAsaliva)AA
3. copiousAvomiting,AhematemesisA(vomitingAblood)A
4. melenaA(foulDsmellingAfaecesAdueAtoApresenceAofAoxidizedAironA
fromAhaemoglobin)AA
ii. Physical#FindingsA–Aclinical#findings:Ableeding,Aanaemia,AearlyAsatiety,A
ProgressiveAdysphagiaAorAodynophagia,ArecurrentAvomiting,AandAfamilyA
historyAofAGIAcancer.APatientsAwithAperforatedAPUDAhaveAsuddenAonsetA
ofAsevere,AsharpAabdominalApain.#A
1. Inspection:AunexplainedAweightAloss,Apale,AcoatingAofAtongue.A
2. Palpation:AleftAorAepigastricAtenderness,ApainAradiation,A
Vasilenko’sAsign.A
3. Percussion:AMendel’sAsign..A
4. GastricAAcidAStimulation:AFluidAAnalysisAA
5. LaboratoryAtestsAareAnotAhelpful;Ainstead,AdocumentationAofA
PUDAdependsAonAradiographicAandAendoscopicAconfirmationA
6. TestingAforAH.ApyloriAinfectionA
7. RapidAureaseAtests.AOfAnonDinvasiveAtests,AfecalAantigenAtestingA
moreAaccurateAthanAantibodyAtestingA&AlessAexpensiveAthanA
ureaAbreathAtests.AA
8. FastingAserumAgastrinAlevelAshouldAbeAobtainedAinAcertainAcasesA
toAscreenAforAZollingerDEllisonAsyndrome.A
b. Oesophageal#Reflux#DiseaseA–AacidAreflux,AlongAtermAconditionAwhereA
stomachAcontentsAcomeAbackAupAintoAtheAoesophagus.AGERDAmayAleadAtoA
Barrett'sAoesophagus,AaAtypeAofAintestinalAmetaplasiaAwhichAisAinAturnAaA
precursorAconditionAforAoesophagealAcancer.A
 i. Symptoms#–AtasteAofAacidAinAbackAofAmouth,Aheartburn,AbadAbreath,A
chestApain,Avomiting,AbreathingAproblems,A&AwearingAawayAofAteethA
1. Adults:AadultsAareAheartburn,AanAacidicAtasteAinAmouth,A&A
regurgitation.ALessDcommon:ApainAwithAswallowing/soreAthroat,A
increasedAsalivationA(waterAbrash),Anausea,AchestApain,A&A
coughing.A
2. Children:ArepeatedAvomiting,AeffortlessAspittingAup,Acoughing,A&A
respiratoryAproblemsAe.g.Awheezing.A
ii. Physical#FindingsA
1. esophagogastroduodenoscopyA(EGD)couldAshow:AOedemaA&A
basalAhyperplasia,ALymphocytic,ANeutrophilicA&AEosinophilicA
inflammationA(presenceAofAincreasedAnumbers),AGobletAcellA
intestinalAmetaplasiaAorABarrett'sAoesophagus,AElongationAofA
theApapillae,AthinningAofAsquamousAlayerAcellAlayer,Adysplasia,A
Carcinoma.AA
2. Oesophageal#pH#monitoringA
18. Gastroenterology#–#symptoms#and#physical#findings#in#a#patient#with#gallstones,#
choledocholithiasis,#cholecystitis,#cholangitis.##
a. GallstonesA–AstoneAformedAwithinAgallbladderAoutAofAbileAcomponents.TheA
termAcholelithiasisAreferAtoApresenceAofAstonesAinAgallbladderAorAtoAdiseasesA
causedAbyAgallstones.A
i. Symptoms#–AMostApeopleAwithAgallstonesA(80%)AneverAhaveA
symptoms.A
1. InA1–4%AofAthoseAwithAgallstones:AcrampyApainAinArightAupperA
partAofAabdomen,AknownAasAbiliaryAcolic.AA
2. sudden,AsevereAabdominalApainAlastsAaboutA5AhoursAA
3. painAfeltAinAtheAcentreAofAabdomen,AunderAtheAribsAonAtheArightD
handsideD>AmayAspreadAtoAshoulderAbladeAA
4. constantApain,AnoAreliveAduringAdefecation,AexcessiveAsweat,A
feelingAsickA&AvomitingA
5. seriousAproblemsAleadAto:AhighAtemperatureAabouveA38°C,A
persistentApain,ArapidAheartbeat,AyellowingAofAskinA&AwhitesAofA
eyes,AitchyAskin,Adiarrhoea,Achills,Aconfusion,AlossAofAapatiteAA
6. Torsion,ASpams,AContinuous,AParoxysmalAaggravation,AVeryA
strongARapidlyAprogressiveAHours,AnightAA
7. A
ii. Physical#FindingsAA
1. CholecystographyA
2. LaboratoryAdiagnosis:AbloodAtesting:AincreasedAbilirubinD
concentrationAinAblood,AincreasedAvaluesAofAgammaDglutamylD
transferaseA(gammaDGT)A&AalkalineAphosphataseAenzymesAA
3. Ultrasonography:AgallstonesAinAtheAsizeAofA2mmAareAdetectableAA
b. CholedocholithiasisA–ApresenceAofAgallstonesAinAcommonAbileAduct.AThisA
conditionAcausesAjaundiceA&AliverAcellAdamage.AA
i. Symptoms#–AmayAnotAcauseAsymptomsAforAmonthsAorAevenAyears.AButAifA
aAstoneAbecomesAlodgedAinAductAandAobstructsAit,AitAcauses:A
1. abdominalApainAinArightAupperAorAmiddleAupperAabdomenA
2. fever,AjaundiceA(yellowingAofAtheAskinAandAeyes)A
 3. lossAofAappetite,AnauseaAandAvomiting,AclayDcoloredAstoolsA
4. sporadicApain,AorAlingerApain,AmayAbeAmildApainAatAtime,AthenA
suddenlyAsevereA
ii. Physical#Findings#–ABloodAtest:AcompleteAbloodAcount,Abilirubin,A
pancreaticAenzymes,AliverAfunctionAtest.AA
c. CholecystitisA–AAcuteAinflammationAofAgallbladderAdevelopsAmostAfrequentlyAinA
consequenceAofAcholelithiasisA(calculousAcholecystitis).ATheAbileAstoneAcanvbeA
stuckAinAdrainingApartAofAgallbladderAorAinAcysticAductAwhichAdisablesAtheAfreeA
drainingAofAbileA&AcausesAchemicalAirritationA&Ainflammation.A
i. ChemicalAinflammationAisAcausedAbyAtheAreleaseAofAlysolecithinAwhichAisA
toxicAforAtheAmucosa.AInflammatoryAprocessAinAmucosaA&AwallAofAtheA
gallbladderAisAenhancedAbyAprostaglandins.AA
ii. SymptomsA–ApainAinAupperArightAabdomenAwithAradiatingApainAtoAtheA
shoulder,Anausea,Avomiting,Apaleness,AexcessiveAsweating,AfeverAA
iii. Physical#FindingsAA
1. Gallbladder#Scan#
2. Lipase#Blood#Test:AElevatedAlevelsA
3. Bile#Fluid#ExaminationAofAHepatobiliaryAsystem:AelevatedAlevelsAA
4. Laboratory:ABloodATest:AAincreasedAvalueAofAgammaDglutamylD
transferaseA&AalkalineAphosphatase,AincreaseAvalueAofACD
reactiveAproteinA&AbloodAsedimentationArate.AA
5. Ultrasonography:AdetectionAofAenlargedAgallbladder,AswellingA
ofAgallbladderAwallA
d. CholangitisA–AinfectionAofAbileAduct/AbiliaryAtract,AcausedAbyAbacteriaAascendingA
fromAitsAjunctionAwithAduodenum.ATendsAtoAoccurAifAtheAbileAductAisAalreadyA
partiallyAobstructedAbyAgallstones.AA
i. Symptoms#–ApainAinAepigastriumA(betweenAripAcageA&Aumbilicus),A
IcterusA(yellowishAcolourAofAtheAskin,AmucusAmembranesA&AinternalA
organsAasAaAconsequenceAofAhyperbilirubinemia),AfeverA&AchillsAA
ii. Physical#FindingsA
1. blood#test:AshowsAacuteAinflammationA(raisedAWBC’sAcountA&A
elevatedACDreactiveAprotein)A&AabnormalAliverAfunctionAtestA
(raisedAbilirubin,AalkalineAphosphataseA&AgammaDglutamylD
transpeptidase),ALiverAcellsAtest:AelevationAinAalanineA
transaminaseA&AaspartateAtransaminase.#A
2. Blood#Culture:AidentifyAcausingAagent.AA
3. Bile#culturing:AmostAcommonAbacteria;AgramAnegativeAbacilli:AE.A
Coli,AKlebsiella,AEnterobacter.AA
4. EndoscopicARetrogradeAcholangiopancreatographyA(ERCP):AuseA
ofAendoscopyA(passingAthroughAmouthAintoAoesophagus,A
stomachA&AtoAduodenum)AtoApassAaAsmallAcannulaAintoAbileA
duct.AEndoscopicAimageAofAampulla.AA
19. Gastroenterology#–#symptoms#and#physical#findings#in#acute#and#chronic#
pancreatitis.##
a. Acute#pancreatitisA–AinflammatoryAimpairmentAofApancreasAassociatedAwithA
oedema,AvariousAstagesAofAautodigestion,AnecrosisAandAhaemorrhageAinAitsA
parts.AThisAimpairmentAisAdueAtoAintrapancreaticAactivationAofAproteases.A
 i. SymptomsA–ApainAprojectsAfromAepigastricAareaAintoAback.AItAvariesA
fromAmoderateAdiscomfortAtoAsevereAdebilitatingApainAbadlyAtoleratedA
byApatient.ATheApainAisAevokedAbyAoedema,AdistensionAofApancreaticA
ductsAandAacini,AchemicalAirritationAandAperitonitis,AorAbyAobstructionAofA
biliaryApathways.AA
1. nauseaA&AvomitingAwithAintestinalAhypermotility,AorAevenA
paralyticAileusAinAconsequenceAofAperitonealAirritationA
2. meteorism,Afever,Ashock.AA
ii. Physical#FindingsA
1. EndoscopicARetrogradeAcholangiopancreatographyA(ERCP)A
2. BileAFluidAExamination:AelevatedAlevelsAA
3. BodyAFluidAAnalysis,ACellAcountA
a. PleuralAFluid:AelevatedARBC’s,AelevatedAWBC’sAA
4. Palpation:AfirmDelasticAmuscularAdefence.APeristaticAsounds:A
spare,ArevealAparalyticAIleus.AA
5. Lab.A3timesAIncreaseAofApancreaticAlipaseA&AalphaAamylase.A
CholestasisDparameterAareAincreased:AgammaDGT,AAP,A&A
bilirubin.AIncreasedAvaluesAofACRPA&ALDHA(lactateA
dehydrogenase)D>AleadsAtoAnecrotisingApancreatitisAA
a. ElevatedAserumAamylaseAandAlipaseAlevels,AinA
combinationAwithAsevereAabdominalApain,AoftenAtriggerA
initialAdiagnosisAofAacuteApancreatitis.AA
b. SerumAlipaseArisesA4AtoA8AhoursAfromAonsetAofAsymptomsA
&AnormalizesAwithinA7AtoA14AdaysAafterAtreatment.A
c. SerumAamylaseAmayAbeAnormalA(10%AofAcases)AforAcasesA
ofAacuteAorAchronicApancreatitisA(depletedAacinarAcellA
mass)AandAhypertriglyceridemia.A
d. lipaseAlevelAisAaboutA2.5AtoA3AtimesAthatAofAamylase,AitAisA
anAindicationAofApancreatitisAdueAtoAalcoholD>AdecreasedA
serumAcalcium,AglycosuriaAA
iii. CT,AMRI,AEndoscopicAUltrasoundAforAdiagnosticsAA
b. Chronic#PancreatitisA–AprogressiveAdestructionAofAglandularAparenchymaAwithA
gradualAextinguishmentAofAacinarAcells,AfibrosisAandAtissueAatrophy.A
ImpairmentsAofApancreaticAexocrineAfunction;AimpairmentAofAendocrineA
functionAoccursAlater.AAppearsAasAaAconsequenceAofAautoimmuneAdiseases.AA
i. Symptoms#–Astrong,AnonDcolicApain,AbilateralAradiation.AMaldigestionA
(weightAloss,AfattyAstoolA(steatorrhoea),Aflatulence,Adiarrhoea).AIcterusAA
ii. Physical#Findings#–Ahypocalcaemia,AincreasedAtumourDmarkers,A
decreasedAcomplementAvaluesA(C3,AC4),AdiabeticAmetabolismA
(decreasedAinsulin).AA
1. TestsAonApancreaticAstructureA&Afunction:ASerumAamylaseAandA
lipaseAbeAmoderatelyAelevated,AamylaseAandAlipaseAareAnearlyA
alwaysAfoundAelevated.A
2. Palpation:AgummyDlikeAabdomenAdueAtoAincreasedAairAinAtheA
intestineD>AdueAtoAbottlingAofAgasesAA
20. Gastroenterology#–#symptoms#and#physical#findings#in#appendicitis#and#
diverticulosis.##
 a. AppendicitisA–inflammationAofAappendix.ACausedAbyAaAblockageAofAhollowA
portionAofAappendix.AThisAisAcommonlyAbyAaAcalcifiedA"stone"AmadeAofAfaeces.A
InflamedAlymphoidAtissueAfromAaAviralAinfection,Aparasites,Agallstone,AorA
tumoursAalsoAcauseAblockage.A
i. SymptomsA–rightAlowerAabdominalApain,Anausea,Avomiting,A&A
decreasedAappetite.A40%AofApeopleAdon’tAhaveAtypicalAsymptoms.A
SevereAcomplicationsAofAaArupturedAappendixAincludeAwidespread,A
painfulAinflammationAofAinnerAliningAofAtheAabdominalAwallA&Asepsis.A
1. TypicalAappendicitisADAseveralAhoursAofAgeneralizedAabdominalA
painAthatAbeginsAaroundAumbilicusAwithAassociatedAanorexia,A
nausea,AorAvomiting.ATheApainA"localizes"AintoArightAlowerA
quadrantAwhereAtendernessAincreasesAinAintensity.AA
2. AtypicalADAlackAtypicalAprogressionAandAhaveApainAinArightAlowerA
quadrantAasAinitialAsymptom.AIrritationAofAperitoneumAleadAtoA
increasedApainAonAmovement,AorAjolting.AA
ii. Physical#FindingsA–ALab.AelevationAofAneutrophilicAwhiteAbloodAcellsA
1. CompleteAbloodAcountA(CBC)A–A70D90ApercentAofApeopleAhaveAanA
elevatedAwhiteAbloodAcellA(WBC)Acount.AA
2. UrinalysisADArulingAoutAaAUTAinfectionAasAcauseAofAabdominalA
pain.ATheApresenceAofAmoreAthanA20AWBCAperAfieldAinAurineAisA
moreAsuggestiveAofAaAUTAdisorder.A
3. Ultrasound#–AshowAfreeAfluidAcollectionAinArightAiliacAfossa,A
alongAwithAaAvisibleAappendixAwithAincreasedAbloodAflowAwhenA
usingAcolourADoppler,A&AnonDcompressibilityAofAappendix.AA
b. DiverticulosisA–ApouchesAinAformAofAsmallAsacksAwhichAmaintainAcomponentsAofA
intestinalAwall.ADiverticulaAdevelopAmostAfrequentlyAinAsiteAofAentranceAofA
arterioleAintoAintestinalAwall.AMajorityAofAdiverticulaAdevelopAinAsigmoidAcolon.A
DiverticulitisA–AinfectionAdevelopsAinsideA&AaroundAdiverticula.ASuchAstateAcanA
resultAinAdiverticularAmicroDAorAmacroAperforation.AInflammationAisAincurredAbyA
colonicAbacteria.AA
DiverticulosisA–AconditionAofAhavingAdiverticulaAinAcolonAthatAareAnotAinflamed.A
i. SymptomsA–Acramping,Abloating,Aflatulence,AirregularAdefecation,AnoA
clearAsymptoms.ADiverticularAdiseaseAwasAfoundAassociateAwithAhighA
riskAofAleftAsidedAcolonAcancer.AA
1. Bleeding.APainlessArectalAbleeding.ACommonAcauseAofAacuteA
lowerAgastrointestinalAbleeding.AA
ii. Physical#FindingsA–AnoAbloodAtestAforAdiverculosis.AA
1. PlainAabdominalAXDrayA–AsignsAofAaAthickenedAwall,Aileus,A
constipation,AsmallAbowelAobstructionAorAfreeAairAinAcaseAofA
perforation.A
21. Gastroenterology#–#symptoms#and#physical#findings#in#IBD#and#malabsorption#
a. Inflammatory#Bowel#Disease#(IBD)#–#Morbus#Crohn#and#Ulcerative#Colitis##
i. LeadingASymptoms:AA
1. DiarrheaAA
2. inAulcerativeAcoltitisAalsoAperanalAbleedingsA
3. AbdominalApainAA A A
ii. OtherAsymptoms:A
1. FeverAA
 2. WeightAlossA
3. FatigueA
4. JointApain,AImpairedAgrowingAA A A
iii. PhysicalAfindings:A
1. AnemiaAA
2. ThrombocytosisAA
3. IncreasedACalprotectinA(unspecificAneutrophilicAproteinAinAGITA
inflammations)A
4. Vit.ABD12AdeprivationA
iv. MorbusACrohnAcanAaffectAtheAwholeAGITAtransmurallyA
v. UlcerativeAcolitisAmostlyAaffectsAmucosaAofAcolonA
vi. MostAoftenAinAyoungAadultsA
b. Malabsorption#
i. Symptoms:A
1. WeightAlossA
2. DiarrheaA
3. EdemaA(AdueAtoAlossAofAwaterAandAelectrolytes)A
4. FlatulencesAA
5. FattyAstoolAA
6. LactoseAintoleranceAA
7. OsteoporosisA
8. EcchymosisA(A↓AprothrombinA!AbleedingsAofAcapillariesAandA
smallerAvessels,AlargerAthanApetechialArashAA
ii. PhysicalAfindings:A
1. DecreasedAelectrolytesA(Ca2+,AMg2+)A
2. DecreasedAalbuminAA
3. DecreasedAVit.AB12A
22. Hepatology#–#symptoms#and#physical#findings#in#acute#hepatitis#and#acute#liver#
failure#
a. AcuteAhepatitis#
i. SymptomsA+AphysicalAfindings:A
1. JaundiceAA
2. ALTA>A1000AIU/AmlA
3. FatigueA
4. IncreasedAbilirubinA
5. FeverA
b. Acute#liver#failure#
i. SymptomsA
1. Triad:AJaundice,ACoagulopathy,ADisturbancesAofAconsciousnessA
2. FoetorAhepaticusA
3. FlappingAtremorA
4. EncephalopathyA(fromAdisturbancesAtoAcoma)A
5. ArterialAhypotensionAA
6. HyperventilationA(dueAtoAammoniaAdeposition)A
7. PruritusA(AitchingAbileAfluid,ApredominantelyAatAfeet)A
ii. PhysicalAfindingsA
1. ↑AAST,AALT,ABilirubin,ABicarbonateA
 2. ↓AQuickA(prothrombinAtime),Athrombocytes,APotassium,A
Glucose,AUreaA
23. Hepatology#–#symptoms#and#physical#findings#in#liver#cirrhosis#and#portal#
hypertension#
a. Liver#cirrhosis#
i. GeneralAsymptomsA
1. FatigueA
2. PressureAinArightAepigastricAregionA
3. MeteorismAA
4. NauseaA
5. WeightAlossA
ii. SkinAsymptomsA
1. JaundiceA
2. SpiderAangiomaA(AdilatationAofAarterialAskinAvessels)A
3. Palmar+AplantarAerythemaA
4. PrurigoAsimplexA(dermatosisAappearingAasAitchingArash)A
5. RhagadesAinAlabialAanglesA(AlacerationAintoAepidermalAlayersA)A
6. SkinAatrophiesA
7. TeleangiectasisA(AmacroscopicallyAvisibleAdilatationsAofA
superficiallyAlayingAcapillariesAfromAskinAandAmucosa)A
8. CaputAmedusaeA(AdueAtoAportalAhypertensionA!AformationAofA
variciousAveinsAinAnavelAregionA
iii. SymptomsAdueAtoAimpairedAendocrineAfunctionA
1. cirrhosisAcausesAactivationAofAreninDAangiotensinDAaldosteroneDA
systemA(RAAS)A
2. DegradationAofAestrogensAisAimpaired!AviaAhypophysisAisA
prolactinAlevelAincreasesA
iv. SymptomsAinAmaleApatientsA
1. LossAofAsecondaryAhairA
2. LossAofAlibidoA
3. VirilityAdisordersAD>AimpotenceA
4. AtrophyAofAtestesA
v. SymptomsAinAfemaleApatientsA
1. MenstruationAdisturbancesAD>AsecondaryAamenorrheaA
vi. OtherAsymptomsA
1. SplenomegalyA(AaboutA75%AofAcases)A
2. AscitesAA
3. FoetorAhepaticusA
24. Endocrinology#–#symptoms#and#physical#findings#in#hypothyroidism#
a. GeneralAsymptoms:A
i. FatigueAA
ii. LossAofAappetiteA
iii. WeightAgainA
iv. DryAskin,AColdAintoleranceA
v. AlopeciaA
vi. BradycardiaA
vii. OpstipationA
viii. FatAmetabolismAdisordersA
 ix. InAmanyApatientsAthereAisAaAriskAofAearlyAatherosclerosisA
x. InAlongAlastingAhypothyroidismAaAheartAinsufficiencyAisApossibleA
xi. LifeAthreateningAmyxoedemaAcomaAcanAoccurA
b. PhysicalAfinding:A
i. TSHAisAinArangeA10DA12AmU/lA
ii. SubclinicalAvalueAstartsAfromAserumATSHA>4mU/lA
25. Endocrinology#–#symptoms#and#physical#findings#in#hyperthyroidism##
a. Symptoms:A
i. Tension,Aarousal,AhyperactivityA
ii. InsomniaA
iii. SweatingA
iv. Arrythmias,Ae.g.AsinusAtachycardiaAandAatrialAfibrillationA
v. ArterialAhypertension,AincreasedARRDAamplitudeA
vi. WeightAlossA
vii. MuscleAweaknessA
viii. DiarrheaA
ix. MenstrualAdisturbancesA
x. AlopeciaAA
b. PhysicalAfindings:A
i. SerumAconcentrationAofAT3AandAT4A
ii. TSHAdecreasedA
iii. ThyriodAantibodiesA(TRAK,ATPODAk.ATgDAk)A
26. Endocrinology#–#symptoms#and#physical#findings#in#hypogonadism.#
a. FetalAdevelopmentA
i. ImpairedAgrowthAofAexternalAsexAorgansA
b. PubertyA
i. MaleAsymptomsA
1. DelayApubertyAorAcauseAincompleteAorAlackAofAnormalA
developmentA
2. DecreasedAdevelopmentAofAmuscleAmassA
3. LackAofAdeepeningAofAtheAvoiceA
4. ImpairedAgrowthAofAbodyAhairA
5. ImpairedAgrowthAofAtheApenisAandAtesticlesA
6. ExcessiveAgrowthAofAtheAarmsAandAlegsAinArelationAtoAtheAtrunkA
ofAtheAbodyA
7. DevelopmentAofAbreastAtissueA(gynecomastia)A
c. AdulthoodA
i. MaleAsymptomsA
1. AlterAmasculineAphysicalAcharacteristicsA+AimpairAofAnormalA
reproductiveAfunctionA
2. ErectileAdysfunctionA
3. InfertilityA
4. ↓AbeardAandAbodyAhairAgrowthA
5. ↓AmuscleAmassA
6. DecreaseAinAmuscleAmassA
7. DevelopmentAofAbreastAtissueA(gynecomastia)A
8. LossAofAboneAmassA(osteoporosis)A
9. CanAalsoAcauseAmentalAandAemotionalAchangesA
 10. AsAtestosteroneAdecreases,AsomeAmenAmayAexperienceA
symptomsAsimilarAtoAthoseAofAmenopauseAinAwomenA
a. FatigueA
b. ↓AsexAdriveA
c. DifficultiesAinAconcentrationA
d. HotAflashesA
ii. FemaleAsymptomsA
1. LackAofAmenstruationA
2. SlowAorAabsentAbreastAgrowthA
3. HotAflashedA
4. LossAofAbodyAhairA
5. LowAorAabsentAsexAdriveA
6. MilkyAdischargeAfromAbreastsA

26.#Endocrinology#–#symptoms,#physical#findings#in#hypogonadism.#
>AHypogonadism:AloweredAfunctionAofAtheAgonadsA
>A InA men:A ThereA areA twoA typesA ofA hypogonadism.A PrimaryA andA secondary.A A PrimaryA
(hypergonadotrophicA Hypogonadism)A affectsA mostlyA theA testes.A ItA canA beA causedA byA
inflammationA(e.g.Amumps),Achemotherapy,AfailureAofAtestisAdescendingAtoAscrotum,AabsenceA
ofA testes,A KlinefelterA syndrome,A tumors,A autoimmuneA disorder.A SecondaryA resultsA fromA
conditionsA affectingA hypothalamus/pituitaryA Gland.A ItsA causedA byA e.g.A pituitaryA tumors,A
Kallmann’sAsyndrome,AuseAofAanabolicAsteroids,Aobesity,APraderA–AWilliAsyndrome,AheadAinjury.AA
Symptoms:A DependsAonAstageAofApatientAinArelationAtoAsexualAmaturity.A
" ADelayedApubertyA(noAtestesAdevelopment,AnoApenisAdevelopment,AlackAofAA
pubicAandAfacialAhair,AfailureAofAvoiceAbreak,AnoAspermAproduction,Ainfertility)A
" DelayedAboneAageA
" InAmenAthatAreachedAsexualAmaturity:AinadequateAerection,AlossAofAlibido,A
poorAsexualAperformance,Atiredness,AlossAofAmotivationAandAconcentration,A
lossA ofA pubicA &A facialA hair,A decreasedA spermA count,A softA &A smallA testes,A
increasedA bodyA fat,A growthA ofA breastA tissue,A thinningA ofA bone,A reducedA
musclesA&AphysicalAstrength,AwrinkledAskinA
A
Diagnosis:A detailedAmedicalAhistoryAandAphysicalAexaminationA
" NonAdescendedAtestesA
" SizeAandApositionAofAtestesAinAscrotumA
" BiochemicalAtestAforAtestosteroneAlevelsAinAbloodAA
" BoneAdensitometryA
" SemenAanalysisA
A
>AInAwomen:ACanAalsoAbeAdistinguishedAintoA2Atypes.ACausesAforAprimaryAHGAareAautoimmuneA
disordersA geneticA (TurnerA A &A Kallmann’sA syndrome)A orA developmentalA disorders,A
Infection,A liverA andA kidneyA disease,A radiation,A surgeryA (removal).A SecondaryA HGA canA beA
 causedA byA anorexiaA nervosa,A bleedingA inA pituitaryA area,A medicationA (A glucocorticoids,A
opiates),A anabolicA steroids,A geneticA problems,A infections,A nutritionalA deficiencies,A ionA
excess,Aradiation,AsignificantAweightAloss,Asurgery,Atrauma,Atumors.A
Symptoms:AA IsAalsoAdependentAonAsexualAmaturationAstateA
" Children:A LackA ofA developmentA atA pubertyA (A lateA orA incomplete),A lackA ofA
breastsA andA menstrualA periods,A inabilityA toA smell,A shortA statue,A earlyA
menopause,AlowAboneAdensity,AlowAselfAesteemA
" Adults:A lossA ofA libido,A lossA ofA menstruationA (Amenorrhea),A decreasedA
energyAandAinterestAinAactivity,AweightAgain,AmoodAchanges,Ainfertility,AlossA
ofAbodyAhair,AhotAflashesA
Diagnosis:A AdetailedAmedicalAhistoryAandAphysicalAexaminationA
" BloodAtestA(FSH,ALH,ATSH,Aoestrogen,AironAlevels)A
" LHAresponseAtoAGnRHA
" GeneticAtestingA
A
27.#Endocrinology#–#symptoms#and#physical#findings#in#hypopituitarism#
A
1. AnteriorAPituitaryA
# Symptoms:AA A
" ALH/FSH:AA inAwomen:AStopAorAabsenceAofAmenstruation,A
Infertility,A decreasedA libido,A sexualA dysfunction,A lowA boneA
densityA
A A InAmen:ALossAofAbodyAhair,AlowAmuscleAmassAandAphysicalA
Strength,AlowAsexualAactivity,AerectileAdysfunction,AlowAboneA
densityA A
" GrowthH:AdecreasedAmuscleAmassAandAphysicalAactivity,Aobesity,AimpairedA
memoryAandAconcentration,AgrowthAretardationA
" ACTH:# Tiredness,AweightAloss,Avomiting,AdelayedApuberty,A
Hypoglycaemia,AanaemiaA
" TSH:AA HypothyroidismA(seeAQ24)A
SensitivityAtoAcoldAorAdifficultiesAtoAstayAwarmA
" Prolactin:ANoAbreastfeedingApossibleA
# PhysicalAFindings:AA
" LH/FSH:A missingAmenstruation,Ainfertility,AanaemiaA(men),AlowAlibido,A
sexualAdysfunction,AosteoporosisA
" GH:A decreasedAmuscleAmass,AcentralAobesity,AgrowthAretardationA
 " ACTH:AA lackAofAglucocorticoidsA(cortisol),Ahypoglycaemia,A
HyperpigmentationAofAskinA
" TSH:AA tiredness,Acoldness,Aconstipation,AweightAgain,AhairAloss,A
concentrationAproblems,AslowedAheartArate,AlowABPA
" Prolactin:AAinabilityAtoAbreastfeedA
A
A
2. PosteriorAPituitaryA
# Symptoms:AA
" ADH:A syndromeAofAdiabetesAinsipidusA(lossAofAabilityAtoAconcentrateA
urine,A polyuriaA lowA inA solutes,A dehydration,A polydipsiaA
(AextremeA
thirst),AhypernatremiaA
" Oxytocin:# generallyAfewAsymptomsAorAasymptomatic#
# PhysicalAFindings:A
" ADH:AA LowAspecificAgravityAofAurine,AHypernatremiaAinAbloodA
" Oxytocin:AAA
A
28.#Endocrinology#–#symptoms#and#physical#findings#in#growth#hormone#deficiency#
Symptoms:AA
# InAchildren:AA shorterAthanAotherAkids,AyoungerA&ArounderAfaces,AcentralA
obesityA withA normalA bodyA proportions,A ifA damageA occursA laterA
inAA
child’sAlifeAsexualAdevelopmentAmayAbeAhalteredA
# InATeens:AA A lowAselfDesteemAdueAtoAdevelopmentAdelays,AshortAstatue,AslowAA
Maturation,AnoAbreastAdevelopmentA(female),AnoAvoiceAbreakAA
(men)A
# InAadults:AA A reducedAboneAstrength,Atiredness,AsensitivityAtoAhotAandAcoldAA
Temperatures,Adepression,AlackAofAconcentration,AhighAlevelsAofAA
Fat,AgreaterAriskAofAdiabetesA&AheartAdiseases.A
PhysicalAFindings:AA
# InAblood:AA A GrowthAHormoneAConcentrationA
# InAchildren:A GrowthAplatesAareAdevelopingAtissueAatAendAofAarmsAandAlegs,AA
TheyAfuseAinAadulthood,AsoAXDraysAofAhandAtoAestimateAlevelAofAA
BoneAgrowthAA
 A
29.#Diabetology#–#symptoms#and#physical#findings#in#type#1#diabetes#
>ADiabetesATypeA1:ATheAbody’sAinabilityAtoAproduceAInsulinAinAadequateAamountsA
>ASymptoms:AA Polyuria,ApolydipsiaA(extremeAthirst),ApolyphagiaA(extremeAappetite),Afatigue,A
weightAloss,AalterationAofAvision,AdiabeticAketoacidosis,Adepression,AdryAmouthA
>APhysicalAfindings:AA hyperglycaemia,AglycatedAhaemoglobin,AincreasedAketoneAbodies,A
autoimmuneAcellsAagainstAbetaAcellsAofApancreasA
30.#Diabetology#–#symptoms#and#physical#findings#in#type#2#diabetes#
>AADiabetesATypeA2:AA TheA bodiesA inabilityA toA produceA sufficientA amountsA orA aA developedA
resistanceAtoAinsulinA
>ASymptoms:AA polyuria,ApolydipsiaA(ext.Athirst),ApolyphagiaA(Aext.Ahunger),Aoverweight,A
hypertension,AvaginalAinfections,AweightAloss,AfatigueA
>APhysicalAfindings:AA Hyperglycaemia,A glycatedA haemoglobin,A normalA orA increasedA levelA ofA
CDAPeptideA
A
31.# Diabetology# –# symptoms# and# physical# findings# in# diabetic# complications#
(#hypoglycaemia,#hyperglycaemia)##
1.AHypoglycaemiaA
>ASymptoms:AA Anxiety,A Palpitation,A Tachycardia,A sweating,A paleness,A coldness,A
mydriasis,Ahunger,Anausea,Avomiting,AabdominalAdiscomfort,Aheadache,A
impairedAjudgement,AchangeAinApersonality,Atiredness,Alethargy,Acoma,A
seizuresA
>APhysicalAfindings:A LowAbloodAsugar,AincreasedAamountAofAketoneAbodiesA
A
2.AHyperglycaemiaA
>ASymptoms:AA Polydipsia,A polyuria,A polyphagia,A blurredA visions,A fatigue,A weightA loss,A
dryA mouth,A itchyA skin,A erectileA dysfunction,A poorA woundA healing,A
recurrentAinfections,AcardiacAarrhythmias,Acoma,AseizureA
>APhysicalAfindings:A IncreasedAbloodAsugarA
A KetoacidosisA
A
31.# Nephrology# –# symptoms,# physical# findings# and# other# biochemical# abnormalities# in#
acute#renal#failure#
A
# Symptoms:AA Fatigue,AlossAofAappetite,Aheadache,Anausea,Avomiting,AcardiacA
Arrhythmia,ApainAinAflanks,Adehydration,AthirstA
# PhysicalAFindings:AA
 " InA blood:A increasedA ureaA &A creatinine,A increasedA potassium,A hepatitisA
virus,AincreasedAneutrophilAgelatinaseAassociatedAlipocalinA
" InA ultrasound:A stretchingA ofA capsule,A hydronephrosis,A possibleA renalA
obstructionA
" InAurine:AlowAurea,AoxalateAcrystals,Areddish/brownishAcolour,Aproteinuria,A
presenceAofAbloodAcellsA(erys/leukos),ApresenceAofAuricAacidAcrystalsA
" InAAngiography:ArenalAarterialAstenosis/AatherosclerosisA

A
33.# Nephrology# –# symptoms,# physical# findings# and# other# biochemical# abnormalities# in#
chronic#renal#failure#(#chronic#kidney#disease)##
ChronicArenalAfailure:AContinuedAandAprogressiveAlossAofArenalAfunctionA
# Symptoms:A Hypertension,A cardiacA arrhythmias,A oedema,A metabolicA
acidosis,AA
Atherosclerosis,AsexualAdysfunction,AdysmenorrheaA
(Menstruationsbeschwerden),AweightAloss,AimpairedAcognitiveA
functionA
A
# PhysicalAfindings:A D>Ain#blood:A↑AcreatinineA&Aurea,A↑potassiumA&Aphosphate,A
↓calciumA&Airon,Aanaemia,AtoxicAsubstancesA
 D>A others:A fluidA imbalance,A insulinA resistance,A immuneA
problemsA
D>Ain#urine:AProteinuria,AAlbuminuriaA
D>A in# ultrasound:# smallA kidneyA size,A structuralA abnormalities,A
hydronephrosisA
D>Ain#CT:ArenalAmasses,AcystsA
D>Ain#MRI:ArenalAveinAthrombosisA

A
A
34.# Nephrology# –# symptoms,# physical# findings# and# laboratory# findings# in# nephritic# and#
nephrotic#syndrome#
A
1. NephriticASyndromeA
# Symptoms:AHypertension,AblurredAvision,AoliguriaA
# PhysicalAfindings:A D>Ain#urine:AHaematuria,AProteinuriaA
D>A A in# blood:# ↑urea,A streptococciA (postDA streptococcalA
glomerulonephritis)A
A
2. NephroticASyndrome:AA
# Symptoms:AOedemaAformationAofAlabiaA&AfacialAskinA&AlowerAlegAascites,A
AHypertension,ArashA
# PhysicalAfindings:AAD>Ain#blood:#Hypoalbuminemia,Ahyperlipidaemia,Ahyponatremia,A
↑AthrombocyteAcount,A↑erythrocytesAsedimentationArate,A
↑creatinineA&Aurea,A↑LDLA&AVLDLAA
A A A A A D>Ain#urine:#proteinuria,AlipiduriaA
A A A A A D>Ain#biopsy:#possibleAglomerulonephritisA
#

##
#
#
35.# Nephrology# –# symptoms,# physical# findings# and# laboratory# findings# in# urine# tract#
infections#&#pyelonephritis#
A
1. UrinaryAtractAinfections:AA
# Symptoms:A BurningApainAduringAurination,AfrequentAurinationAofAsmallA
amountsAofAurine,AcontinuousAurgeAtoAurinate,AabsenceAofAA
vaginalAdischarge,ApainAaboveApubicAboneAandAbackA
A
# PhysicalAfindings:A D>Ain#urine:Aleukocytes,Aproteinuria,Ahaematuria,AbacterialA
coloniesAcausingAinfectionAA
A
2. Pyelonephritis:AUpperAurinaryAtractAinfectionA(Akidney,Acalyces,ArenalApelvis)A A
# Symptoms:AA FlankApain,Afever,Anausea,Avomiting,ApainAduringAurination,AA
AbdominalApain,AweightAloss,AdecreasedAappetiteA
# PhysicalAfindings:AAD>Ain#urine:#bloodA&Apus,AleukocytesA&Anitrite,AbacterialAcoloniesA
CausingAinfectionsA
D>Ain#blood:#increasedAcountAofAneutrophilsA
D>Ain#CT:#possibleAkidneyAstoneA
A
A
36.#Haematology#–#symptoms#and#physical#findings#in#patients#with#anaemia#and#anaemic#
syndrome#
A
1. Anaemia:AA
# Symptoms:AA Weakness,AshortnessAofAbreath,Apalpitation,Aangina,AheartA
failure,Apaleness,Asyncope,Acoldness,AjaundiceA(inAhaemolysis),A
tachycardiaA
# PhysicalAfindings:A D>Ain#blood:A↓countAofAery’s,A↓haemoglobin,A↓sizeAofAerys,A
↓haematocrit,A↓ironA&AB12A&AfolicAacid,A↓ferritinA&AtransferrinA
D>Ain#bone#marrow#test:#↓numberAofAreticulocytesA
A
2. AnaemicAsyndrome:AA CombinedAsymptomsAoccurringAinAanaemiaA
# Symptoms:AA Weakness,AshortnessAofAbreath,Apalpitation,Aangina,AheartA
Failure,Apaleness,Asyncope,Acoldness,Adizziness,AfaintingA
# PhysicalAfindings:A InApatientsAwith,A
D>AdeficienciesAofAB12,AfolicAacidAorAironA
D>AanaemiaAinAchronicAdiseasesAincludingAcancerA
D>A anaemiaA inA diseasesA affectingA theA boneA marrowA (e.g.A
leukaemia)A
D>AautoimmuneAhaemolyticAdiseasesA
D>AsickleDAcellAanaemiaA
D>AinApatientsAwithAchronicAorAacuteAbloodAlossA
A
#
#
#
#
#
37.# Haematology# –# symptoms# and# physical# findings# in# patients# with# disorder# of# white#
blood#cells#
A
1. Leukopenia:AdecreasedAcountA
Neutropenia:AdecreasedAcountAinANeutrophilsA
# Symptoms:AA Fever,AgingivalApain,ApainfulAswallowing,AskinAabscesses,Aotitis,A
Hypotension,A ulcers,A rashes,A woundsA thatA takeA aA lotA timeA toA
healAA
# PhysicalAfindings:AAD>Ain#blood:#decreasedAcountAofAneutrophilsA
D>A in# patients# with:A infection,A nutritionalA deficiencies,A
Leukaemia,A afterA radiationA therapy,A tuberculosis,A HIV,A viralA
hepatitis,A Lupus,A causedA byA Antibiotics,A psychiatricA &A epilepticA
&AbloodApressureAmedicationA
A
A A Lymphocytopenia:AA DecreaseAcountAofALymphocytesA(T/B/NK)A
# Symptoms:AA EnlargedAlymphAnodesA&AenlargedAspleenAinAcancer,AHIV,Acough,A
runnyAnose,Afever,ArespiratoryAviralAinfections,AsmallAtonsilsA&AA
smallAlymphAnodesAinAevtl.AImmuneAsystemAdisorder,ApainfulAA
swollenAjointsAandArashAinAsuggestedArheumatoidAarthritisAorA
systemicAlupusA
# PhysicalAfindings:A D>Ain#blood:AdecreasedAcountAofAlymphocytesA(AallAT/B/NK)A
D>A in# patients# with:# certainA viralA infection,A fasting,A severeA
stress,A thatA useA corticosteroids,A chemotherapy,A HIV/AIDS,A
lupus,A rheumatoidA arthritis,A tuberculosis,A leukaemia,A
lymphomas,AHodgkinALymphoma,AimmunodeficiencyAdisordersA
A
2. Leukocytosis:AIncreasedAcountAofAleukocytesA
NeutrophiliaA
# Symptoms:AA SymptomsAareApresentAasAaAresultAtoAanAunderlyingAdisease,A
SuchA asA infectionA asA inflammatoryA response,A bleedingA leadingA
toAA
Hypotension,AtachycardiaAandAmostlyAsepsis,AhypothermiaAorAA
decreasedAbodyAtemperature,AtachypneaAandAdyspnoeaA
# PhysicalAfinding:AA D>Ain#blood:AincreasedAcountAinAneutrophilsA
 D>A in# patients# with:A acuteA infection,A inflammation,A metabolicA
troublesA (diabeticA ketoacidosis,A preeclampsiaA etc.),A
haemorrhage,Asepsis,AcigaretteAsmoking,Astress,Adrugs,AcancersA
D>Abone#marrow#aspiration:#toAdiagnoseAleukaemiaAA
A A A
A A Eosinophilia:A
# Symptoms:AA SymptomsAofAeosinophiliaAareAdueAtoAtheAunderlyingAcondition,AA
e.g.AinAasthmaAmayAincludeAbreathlessness.AParasiticAinfectionsAA
mayAleadAtoAabdominalApain,Afever,AdiarrhoeaAetc.AMedicationAA
reactionAoftenAgiveAskinArashes,AsymptomsAcanAalsoAincludeAA
weightAloss,AnightAsweat,AlymphAnodeAenlargement,AnumbnessAA
andAtinglingAdueAtoAnerveAdamage.A
InAexcessAincreasedAeosinophilia,AheartAfailure,AankleAswelling,AA
enlargementAofAspleenAandAliver,AabdominalAswellingAcanAoccur.A
A
# PhysicalAfindings:A D>Ain#blood:AeosinophilAcountA
D>Askin#biopsy#
->#in#patients#with:#asthma,AhayAfever,Avasculitis,AsomeAtumor,A
liverAcirrhosis,AsomeAantibodyAdeficiencies,ArareAskinAdiseaseA
#
38.# Haematology# –# symptoms# and# physical# findings# in# patients# with# platelet# and#
coagulation#disorder#
A
1. PlateletAdisorderA
ThrombocytopeniaA
# Symptoms:AA BleedingAofAgum/nose,AredAbleedingAspotsAonAskinA(Purpura),A
PetechiaeAonAlegsAandAfeet,Abruises,AHematoma,AbloodAinAurineA
orAstoolA
# PhysicalAfindings:A D>Ain#blood:AbleedingAtimeAbyAduke,AdecreasedAcountAofA
A A A thrombocytesA
D>A in# patients# with:A infectionA (helicobacterA pylori,A sepsis,A
hepatitisAC,AHIV,AcertainAmedicationA(AheartAproblems,Aseizures,A
heparin,A chemotherapy),A bypassA surgery,A radiationA therapy,A
cancer,A VitaminA B12A deficiency,A pregnancy,A enlargedA spleen,A
autoimmuneAdiseaseA
ThrombocytosisA
# Symptoms:AA mostApatientsAdoAnotAexperienceAanyAotherAsymptomAthanAtheA
 symptomsA ofA theA conditionA leadingA toA thrombocytosis,A
howeverAA
symptomsA canA be,A skinA bruises,A bleedingA fromA variousA sitesA
suchAA
asAnose,Amouth,Agum,AstomachAandAGIT.AAbnormalAbloodAA
clottingAcanAalsoAoccurAleadingAtoAstrokeA&AheartAattackA
# PhysicalAfindings:AAD>Ain#blood:AthrombocytesAcount,AbloodAtestAforAgeneAJAK2A
-># bone# marrow# aspiration:A increasedA rateA ofA thrombocyteA
productionA
D>A in# patients# with:# anaemiaA dueA toA ironA deficiency,A cancer,A
inflammationAorAinfection,AsurgeryA(especiallyAinAsplenectomy)A
A
2. CoagulationAdisorderA
VonA–AWillebrandAdisease:A
# Symptoms:AA UnexplainedAandAeasyAbruising,AheavyAmenstrualAbleeding,A
frequentAnosebleed,AexcessiveAbleedingAfromAsmallAcutsAorAA
injuries,AbleedingAintoAjointsA
# PhysicalAfinding:AA D>Ain#blood:AincreasedAbleedingAtimeAbyAduke,AlackAofAvWAfactor,A
IncreasedAprothrombinAtime,AwhiteAandAredAbloodAcellAcountA
A
A A HaemophiliaAAAA&ABA
# Symptoms:AA internalAandAexternalAbleedingAepisodesA
# PhysicalAfindings:A D>Ain#blood:AincreasedAprothrombinAtime,AincreasedAbleedingA
timeAbyAduke,AlackAofAcertainAcoagulationAfactorsA
D>Agene#testing:#presenceAofAallelesAcarryingAdiseaseA
A
A A FactorsAII,AV,AVII,AX,AXIIAdeficienciesA
A
" CheckA forA aA lowA redA bloodA cellA count,A vitaminA KA deficienciesA andA sideA
effectsAfromAcertainAmedicationsAifAanyAsuspicionAofAcoagulationAdiseaseAisA
suggestedA
A
39.# Rheumatology# –# symptoms# and# physical# finding# in# inflammatory# and# degenerative#
disease#of#joints#and#spine#
A
1. InflammatoryAdiseaseAofAjointAandAspineA
 AnkylosingASpondylitisA(arthritisAofAjointAandAspine)A
# Symptoms:AA swellingAofAjoints,AjointAstiffness,AgeneralAdiscomfort,Atiredness,A
weightAloss,ApoorAsleep,AmuscleAache,Apain,AdifficultiesAmovingAA
joint,AmuscleAweakness,AlossAofAflexibilityA
# PhysicalAfindings:A D>Ain#blood:ApossibleArheumatoidAfactor,AantinuclearAfactorA
(autoimmunity),AextractableAantigenA(antiACCP),AspecificAA
antibodies,ACRP,AHLAAantigenAforAHLAAB27,AuricAacidA
D>#in#urine:#uricAacidA(gout)A
D>Aothers:#AthyroidAfunctionAtest,AaspirationAofAjointAfluidAforAcellA
countA
D>A in# rheumatic# arthritis:A systemicA diseaseA ofA joints,A wrists,A
fingers,A knees,A feet,A anklesA (morningA stiffness,A pain,A lossA inA
motility)A
D>Ain#osteoarthritis:ApainA&Astiffness,ApainAworseAafterAexercise,A
cracklingAsoundsAwhenAjointAisAinAmovement,AmorningAstiffness,A
sleepAdisturbanceAdueAtoApainA
D>A Juvenile# arthritis:A swollen,A red,A warmA joint,A limping,A highA
fever,A rash,A stiffness,A pain,A limitedA movement,A paleA skin,A
swollenAlymphs,AredAeyesA
D>A septic# arthritisA pseudoparalysis,A intenseA jointA pain,A jointA
swelling,AjointAredness,AfeverA
D>AGout:AmostlyAbigAtoe,AkneeAorAankleAjoint,AsuddenApain,AoftenA
duringA night,A warm,A redA andA swollenA joint,A mayA comeA withA
feverA
D>A Lupus:A redA rashA onA faceA (butterflyA shape),A painfulA swollenA
joints,A unexplainedA fever,A chestA painA withA deepA breathing,A
swollenA glands,A extremeA fatigue,A unusualA hairA loss,A paleA orA
purpleA fingersA orA toesA fromA stress,A sensitivityA toA theA sun,A lowA
bloodAcount,AdepressionA
A
2. DegenerativeAdiseaseAofAjointsAandAspineA
OsteoarthritisA
# Symptoms:A Pain,Astiffness,AmuscleAspasm,AformationAofAbonyAenlargement,A
jointAeffusionA
# PhysicalAfinding:A JointAspaceAnarrowing,AincreasedAboneAformationAaroundAjoint,A
subchondralAcystAformation,AdamagedAcartilageA
A
A A OsteoporosisA
 # Symptoms:A OftenAstartsAsilently,Apain,AheightAloss,AthinnedAbones,AdeformedA
bones,AbonesAfractureAmoreAeasily,AstoppedApostureA
# PhysicalAfindings:A OftenAinApatientsAwithAoldAage,AmoreAfemalesAthanAmen,AmoreA
white/AsianApeopleAthanAothers,AfamilyAhistoryAofAosteoporosis,AA
smallerA peopleA moreA likelyA thanA tallA becauseA theyA haveA lessA
boneAA
mass,AhyperthyroidismAcausesAboneAloss,AloweredAsexAA
hormones,AlowAcalciumAintake,AeatingAdisordersA(underweight),AA
steroids,AmedicationAagainstAseizures,AgastricAreflux,Acancer,AA
alcoholics,AsmokerA
" Diagnostic:AXDray,AmeasurementAofAboneAdensity,AmineralAlevelAofAbone,AonA
MRIAdeepAveinAthrombosisAorApulmonaryAembolismA
A
A
40.#Rheumatology#–#symptoms#and#physical#findings#in#systemic#connective#tissue#disease#
an#osteoporosis#
A
1. SystemicAconnectiveAtissueAdiseaseA
MarfanASyndromeA
# Symptoms:A longAlimbs,AprotrusionAofAsternum,AflatAfeet,AhammerAtoes,AlensA
DislocationA(blurredAvision),Afatigue,AshortnessAofAbreath,AA
palpitation,Aangina,AaorticAaneurysm,AspontaneousAA
pneumothorax,Apneumonia,AweakeningAofADuralAsacA
A
# PhysicalAfindings:AAD>Ain#X#ray:AboneAdeformationA
D>Ain#MRI:#aorticAdissection,Aaneurysm,Adilation,ApneumoniaA
A
A A AlportAsyndromeA
# Symptoms:AA hearingAloss,AeyeAchangesA
# PhysicalAfinding:AA D>Ain#urine:Ahaematuria,AproteinuriaA
D>Ain#MRI:AaorticAdissection,AtumorsAofAsmoothAmusclesA
A
A A OsteogenesisAimperfectA
# Symptoms:A blue/greyAtintAofAwhitesAofAeye,AthinAskin,AcurvedAspine,A
breathingAproblems,AhearingAloss,AteethAbreakAeasilyA
 # PhysicalAfindings:A FindAmutationAforAgeneAresponsibleAforAcollagenAtypeA1A
GenerationA
A
A A SystemicAlupusAerythematosusA
# Symptoms:AA butterflyAshapedArash,AsunlightAsensitivity,AmouthAulcers,AhairA
loss,AfluidAaroundAheart/lung,AkidneyAproblems,Aanaemia,AA
problemsAwithAmemoryAandAconcentrationA
A
" SieheA auchA rheumaticA arthritisA (Q39),A vasculitis,A EhlersDA DanlosA Syndrom,A
EpidermolysisAbullosaA
A
OsteoporosisA
# Symptoms:A OftenAstartsAsilently,Apain,AheightAloss,AthinnedAbones,AdeformedA
bones,AbonesAfractureAmoreAeasily,AstoppedApostureA
# PhysicalAfindings:A OftenAinApatientsAwithAoldAage,AmoreAfemalesAthanAmen,AmoreA
white/AsianApeopleAthanAothers,AfamilyAhistoryAofAosteoporosis,AA
smallerA peopleA moreA likelyA thanA tallA becauseA theyA haveA lessA
boneAA
mass,AhyperthyroidismAcausesAboneAloss,AloweredAsexAA
hormones,AlowAcalciumAintake,AeatingAdisordersA(underweight),AA
steroids,AmedicationAagainstAseizures,AgastricAreflux,Acancer,AA
alcoholics,AsmokerA
" Diagnostic:AXDray,AmeasurementAofAboneAdensity,AmineralAlevelAofAbone,AonA
MRIAdeepAveinAthrombosisAorApulmonaryAembolismA