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Hypoglycaemia is defined as a plasma glucose <2.5 mmol The actual glucose level at which symptoms develop varies markedly. Causes Drugs ● Insulin ● Sulfonylurea ● Alcohol ● Beta blockers ● Quinolones ● Pentamidine ● Quinine You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Hyperglycaemia is defined as a plasma glucose >7.0 mmol By far the most common cause is diabetes mellitus. Causes Endocrine ● Diabetes mellitus (types 1 and 2) You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Unintentional weight loss is often a manifestation of significant underlying disease and should never be ignored. Causes Systemic disease ● Malignancy ● Cardiac failure ● Chronic respiratory disease ● Renal failure ● Liver failure ● Malabsorption ● Connective tissue disease (e.g. SLE, rheumatoid arthritis) Endocrine ● Diabetes mellitus ● Hyperthyroidism ● Addison’s disease Infective ● TB • (very common in the developing world and on the…

Weight gain is extremely common and the most frequent cause is simple obesity. Excessive weight gain itself has deleterious effects on general health. With the exception of simple obesity and pregnancy, other conditions only account for ,1% of patients presenting with weight gain. Causes Increased fat ● Simple obesity ● Hypothyroidism ● Cushing’s syndrome ( Fig. 64 ) ● Polycystic ovarian syndrome ● Hypothalamic disease Increased…

Vomiting is the forceful ejection of gastric contents through the mouth. It occurs when the vomiting centre in the medulla oblongata is stimulated. This may be due to direct stimulation of the centre (central vomiting) or via afferent fibres (reflex vomiting). Haematemesis (vomiting blood) is dealt with in a separate chapter on p. 185. Causes Central vomiting ● Drugs, e.g. narcotic analgesics, chemotherapeutic agents ● Acute…

Voice disorders can be caused by a number of conditions. Change in the quality of the voice ranges from mild hoarseness to aphonia. It is important to exclude laryngeal carcinoma, which is easily treated in the early stages but has a poor prognosis once metastatic spread has occurred. Causes Infective ● Laryngitis Traumatic ● Blunt trauma ● Excessive vocal use Neoplastic ● Laryngeal papilloma (due to…

Patients who present with visual disturbance are often very distressed, with their quality of life affected, including their ability to drive. Below is a list of common conditions that may give rise to visual problems, grouped according to symptoms. Causes Visual disturbances (flashing lights or floaters) ● Migraine ● Retinal detachment ● Vitreous haemorrhage ● Age-related macular degeneration ● Vitreous detachment Blurring of vision ● Refractive…

Vaginal discharge can occur at any age but is usually a symptom of reproductive years. Causes ● Candidiasis ● Bacterial vaginosis ● Trichomonas vaginosis ( Fig. 60 ) ● Cervicitis, e.g. gonorrhoea, Chlamydia , herpes ● Excessive normal secretions ● Retained foreign body, e.g. tampon, pessary ● Intrauterine contraceptive device ● Salpingitis ● Infection of Bartholin’s glands ● Neoplasm, e.g. vagina, vulva ● Pyometra ● Colovaginal…

Retention of urine may be acute, chronic or acute-on-chronic. Patients with acute retention present as surgical emergencies. Acute retention is the sudden inability to pass urine, with the presence of painful bladder. Chronic retention is the presence of an enlarged, painless bladder with or without difficulty in micturition, which may be accompanied by overflow. Causes Local Urethral lumen or bladder neck ● Stones ● Blood clot…

Urinary incontinence is the involuntary loss of urine from the bladder. This has profound implications for patients quality of life including at times and places which are inconvenient, inappropriate and socially embarrassing. Stress incontinence is loss of urine during coughing or straining. Urge incontinence is the inability to maintain urinary continence in the presence of frequent and persistent urges to void. Overflow incontinence occurs when the…

Any inflammatory condition within the urethra may cause a discharge. It is important to diagnose sexually transmitted diseases so that appropriate treatment is given, not only to the patient but also to sexual contacts via contract tracing. Causes ● Prostatitis ● Non-gonococcal urethritis ● Chlamydia trachmatis ● UTI ● HSV ● Adenovirus ● Trichomonas vaginalis ● Mycoplasma genitalium ● Gonococcal urethritis ● Rare causes ● Coliforms…

A tremor is an involuntary rhythmic oscillation of a body part and usually refers to the movements around the small joints of the hands. Causes Resting tremor ● Parkinsonian tremor Action tremor ● Idiopathic ● Benign essential tremor ● Physiological ● Anxiety ● Exercise ● Chronic respiratory disease ● Thyrotoxicosis You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles…

Tongue disorders are extremely common, ranging from minor furring of the tongue to extensive inflammation and even malignancy. Tongue disorders can also be a manifestation of systemic disease. Causes Furring ● Gastrointestinal disease ● Dehydration ● Smokers ● Antibiotics Colour change ● White patches, e.g. leucoplakia, thrush ● Pallor (anaemia) ● Blue (central cyanosis) ● Red (pernicious anaemia, vitamin deficiency) ● Black (black hairy tongue) ●…

Lesions of the toes are extremely common. They are caused by a variety of conditions ranging from simple ingrowing toenails to severe pain and ulceration caused by ischaemia. Deformities of the toes are also exceptionally common, particularly in the elderly. Causes Toenails ● Ingrowing toenail ( Fig. 57 ) ● Subungual haematoma ● Warts/verrucas ● Subungual melanoma ● Subungual exostosis ● Onychogryphosis ● Onychomycosis Deformities ●…

Tiredness or physical fatigue with no obvious cause is a very common complaint. It is normal to feel tired at times, e.g. after working long hours, unaccustomed exertion or sleepless nights. However, it is important to differentiate between tiredness due to excessive normal activities and tiredness due to disease. Causes Post-viral fatigue syndromes Acute ● Infectious mononucleosis ● Viral hepatitis Chronic ● Chronic post-viral fatigue syndrome…

A sore throat is an extremely common symptom, especially in children and young adults. Persistent sore throat in an elderly patient is a cause for concern, as it may indicate the presence of neoplasia. Causes Infective ● Tonsillitis ( Fig. 56 ) ● Bacterial, e.g. streptococcus , gonococcus ● Viral, e.g. glandular fever (infectious mononucleosis) ● Pharyngitis/laryngitis ● Viral ● Fungal ● Quinsy (peritonsillar abscess) ●…

Thirst as a symptom, is usually associated with two other symptoms, i.e. drinking excessive amounts of water (polydipsia) and excessive urination (polyuria). Causes Inadequate fluid intake ● General debility/frailty ● Neurological disease ● Anorexia Excessive fluid loss ● Vomiting ● Fever ● Diarrhoea ● Bleeding (i.e. loss of blood volume) ● Excessive sweating ● Burns You’re Reading a Preview Become a Clinical Tree membership for Full…

Syncope is the transient loss of consciousness due to impaired cerebral blood flow. Causes Cardiovascular ● Myocardial infarction (when complicated by arrhythmia or cardiogenic shock) ● Pulmonary embolism ● Aortic stenosis ● Carotid sinus hypersensitivity ● Hypertrophic obstructive cardiomyopathy Vasovagal syncope ● Situational syncope ● Micturition syncope ● Cough syncope Orthostatic hypotension ● Prolonged bedrest ● Drug-induced ● Hypovolaemic ● Autonomic failure You’re Reading a Preview…

Excessive sweating is often brought to the attention of the physician when it becomes socially unacceptable. The underlying cause ranging from trivial to serious. Causes Excessive sweating ● Primary hyperhidrosis ● Hypoglycaemia Infections ● Any systemic infection Malignancy ● Brain tumours ● Hodgkin’s lymphoma You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a…