Penile lesions are common. They can interfere with quality of life and affect sexual intercourse. The majority of surgical conditions of the penis relate to problems with the foreskin and glans. Carcinoma of the penis and Peyronie’s disease are rare. Causes Foreskin and glans ● Penile lumps (pearly penile papules, molluscum contagiosam, fordyce spots) ● Phimosis ● Paraphimosis ● Balanoposthitis ● Balanitis xerotica obliterans ● Herpes…

Palpitation is an awareness of the heartbeat. Although benign in the vast majority, palpitations are occasionally a manifestation of a life-threatening disorder. Causes Sinus tachycardia ● Anxiety/emotional stress ● Caffeine ● Nicotine ● Alcohol ● Infection ● Hyperthyroidism ● Electrolyte disturbances Cardiac arrhythmia ● Premature ventricular contractions (ventricular ectopic beats) * ● Premature atrial contractions (atrial ectopic beats) * ● Atrial fibrillation * ( Fig. 47…

Oliguria is the passage of less than 400 mL of urine in 24 hours. Anuria is defined as the failure to pass urine (less than 100 mL in 24 hours). Oliguria is an important feature of acute renal failure. Causes Renal circulatory insufficiency ● Dehydration, e.g. vomiting, diarrhoea ● Shock, e.g. haemorrhage, burns Renal ● Nephrotoxins ● Acute tubular necrosis ● Acute cortical necrosis ● Acute…

This is a common problem and can be embarrassing for the patient, as discharge may leak through and stain clothing. Bloodstained nipple discharge may be due to an underlying carcinoma. We have classified below according to consistency. Causes Serous ● Early pregnancy ● Fibroadenosis ● Medication (e.g. antipsychotics, antidepressants) Milky ● Late pregnancy ● Lactation ● Lactorrhoea of the newborn (witch’s milk) ● Puberty ● Prolactinoma…

Neck pain is a common presenting complaint. The majority of cases are due to poor posture or cervical spondylosis. If there has been a history of trauma, extreme care must be taken in examination of the neck and any X-rays must be strictly supervised. Causes Congenital ● Torticollis ● Klippel–Feil syndrome Acquired Traumatic ● Fractures ● Dislocations ● Whiplash injury Inflammatory ● Rheumatoid arthritis Infective ●…

A lump in the neck is a common problem. It is necessary to be able to distinguish the different causes, which may vary from a simple benign swelling to part of a generalised malignant condition. Causes Superficial ● Sebaceous cyst ● Lipoma ● Lymph nodes ● Abscess ● Dermoid cyst Deep ● Lymph nodes Anterior triangle Move on swallowing ● Thyroid ● Thyroglossal cyst ( Fig.…

Nasal discharges are common. The most frequent causes are the common cold and allergic rhinitis, however persistent bloodstained nasal discharge is a serious symptom requiring urgent investigation. Causes Congenital ● Choanal atresia ● Cystic fibrosis Acquired Infective ● Common cold (coryza) ● Chronic rhinitis ● Sinusitis (acute or chronic) ● Adenoiditis (large adenoids) ● Viral infections ● Bacterial infections (e.g. whooping cough) ● Fungal infections ●…

Nail abnormalities are common and can give invaluable clues to underlying systemic illness. Clubbing is dealt with in a separate section (p. 56). Causes Congenital ● Epidermolysis bullosa ● Anonychia congenita Acquired Infections ● Fungal infection (onychomycosis) ● Paronychia Traumatic ● Nail biting ● Nailbed trauma Systemic illness ● Severe systemic illness (Beau’s lines) ● Iron deficiency anaemia (koilonychia) ● Chronic liver disease (leuconychia) ● Diabetes…

Muscle weakness and wasting may be caused by a variety of conditions both systemic and those confined to the muscles only. Causes Localised ● Peripheral nerve lesions ● Peripheral nerve compression ● Motor neuropathy ● Peripheral nerve transection ● Disuse atrophy ● Anterior horn cell lesions ● Previous poliomyelitis • (common in developing countries) Generalised Nutritional deficiency ● Vitamin D deficiency Systemic disease ● Malignancy ●…

Mouth ulceration is common but it is important to be able to distinguish between simple benign ulcers (e.g. traumatic or aphthous) and those that are malignant. Tongue disorders are dealt with on p. 431. Causes ● Traumatic ● Aphthous ( Fig. 44 ) Inflammatory ● Inflammatory bowel disease Infective Bacterial ● Acute ulcerative gingivitis (Vincent’s angina) ● Syphilis ● TB Viral ● Herpes simplex ● Herpes…

Melaena is the passage of altered blood per rectum (PR). A melaena stool is black and tarry and has a characteristic smell. The blood is degraded by hydrochloric acid and intestinal enzymes high in the gastrointestinal tract. Melaena is unlikely to occur if bleeding comes from lower than the jejunum, although occasionally melaena may result from a bleeding Meckel’s diverticulum. Causes Swallowed blood ● Epistaxis ●…

Lymphadenopathy is a common presenting condition. It may be localised or generalised. The causes are multiple but a careful history and clinical examination will often simplify the diagnosis. Lymphadenopathy, especially cervical, is extremely common in children who are otherwise healthy. Painful tender nodes are usually associated with infection. Firm or hard, painless nodes are commonly the seat of malignancy. Only the more common causes, which the…

Lip lesions are common. They may be extremely painful and interfere with speech and feeding. There is often a social stigma attached for the patient that leads to embarrassment. In the elderly, carcinoma is a common cause of a lump on the lip, especially in those with outdoor occupations and non-healing ulcers. Causes Congenital ● Cleft lip Acquired Flat lesions ● Junctional naevus ● Telangiectasia (hereditary…

An ulcer is a discontinuity of an epithelial surface. Leg ulcers are common and the site of an ulcer on the leg may provide a clue to its aetiology. Causes Infective ● Syphilis ● TB • (common where TB is endemic) Neoplastic ● Squamous cell carcinoma ● Malignant melanoma ● Basal cell carcinoma Vascular ● Venous ulcers ( Fig. 42 ) ● Arterial (ischaemic) ulcers ●…

Swelling of the lower limb may be unilateral or bilateral. Bilateral swellings are usually due to medical conditions such as cardiac, renal or hepatic failure. Unilateral swellings are commonly due to trauma, venous disease or lymphatic disease. Causes Local 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

This section deals with causes of pain arising from local lesions within the leg, or referred into the leg. Pain in the leg is a common complaint and the majority of cases are of vascular or orthopaedic origin. Joint problems are dealt with in the section on Joint disorders (p. 247). Causes Traumatic ● Fractures ● Dislocations ● Crush injuries Inflammatory ● Rheumatoid arthritis ● Reiter’s…

Kidney swellings are common. They may present silently or may be associated with haematuria, urinary tract infections and pyrexia. Causes Congenital ● Polycystic kidney Acquired Infective ● Perinephric abscess ● TB • (common where TB is endemic) 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

Disorders of joints are common problems. They may be acute, as in gout or rheumatic fever, or chronic, as in osteoarthritis. Some acute disorders go on to become chronic, e.g. rheumatoid arthritis. The first part of this section deals with general causes of arthropathy and the second part deals with specific joint disorders. Causes Congenital ● Achondroplasia (dwarfism) ● Ehlers–Danlos syndrome ● Marfan’s syndrome ● Osteogenesis…

Pain or swelling of the jaw results most commonly from dental conditions. In the upper jaw, pain may also result from infection of the paranasal sinuses which is considered under Facial swellings (p. 129). Causes Traumatic Infective ● Dental abscess ● Tonsilitis ● Mumps (increasing incidence in UK) ● Pericoronitis ● Acute osteomyelitis ● Actinomycosis Temporomandibular joint ● Temporomandibular joint disorder ● Rheumatoid arthritis ● Osteoarthritis…

Jaundice is yellow discoloration of the tissues, noticed especially in the skin and sclera ( Figs 27 and 36 ), due to accumulation of bilirubin. Jaundice may be prehepatic (due to haemolysis), hepatic (due to intrinsic liver disease) or cholestatic (due to either intrahepatic cholestasis or post-hepatic biliary tract obstruction). Open full size image Figure 36 Jaundiced sclera in a patient with hepatitis . Mild jaundice…