Stridor is a high-pitched inspiratory sound produced by upper airway obstruction. Causes Congenital ● Laryngomalacia (congenital flaccid larynx) Acquired ● Foreign body ● Infection ● Epiglottitis (green in countries without universal Hib vaccination) ● Retropharyngeal abscess ● Iatrogenic ● Post-tracheostomy stenosis ● Post-intubation stenosis ● Post-radiotherapy stenosis ● Post-thyroid surgery ● Goitre ● Laryngeal oedema ● Anaphylaxis ● Inhalational injury ● Cricoarytenoid rheumatoid arthritis ● Relapsing…

Steatorrhoea refers to the passing of excessive amounts of fat in the faeces. Causes Lipase deficiency ● Impaired secretion – chronic pancreatitis ● Inactivation – excess gastric acid Bile deficiency ● Underproduction – liver disease ● Obstruction – obstructive jaundice Mucosal disease ● Coeliac disease ● Ileal resection ● Crohn’s disease You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited…

The spleen must be enlarged to about three times its normal size before it becomes clinically palpable. The lower margin may feel notched on palpation. The spleen may become so massive in size that it is palpable in the right iliac fossa. Massive splenomegaly in the UK is likely to be due to chronic myeloid leukaemia, myelofibrosis or lymphoma. Splenomegaly may lead to hypersplenism, i.e. pancytopenia…

Shock is an abnormality of the circulation that results in inadequate organ perfusion and tissue oxygenation. Causes (all causes of shock require emergency assessment) Hypovolaemic ● Haemorrhage ● Burns ● Gastrointestinal losses Cardiogenic ● Myocardial infarction ● Acute valvular damage ● Arrhythmia Distributive ● Sepsis ● Anaphylaxis ● Neurogenic shock (spinal injury) Obstructive ● Massive pulmonary embolism ● Tension pneumothorax ● Cardiac tamponade You’re Reading a…

Scrotal swellings are a common presenting complaint in the outpatient clinic. It is also important to distinguish between those swellings that have underlying serious pathology (testicular tumour) and those that are simple and benign (epididymal cysts). Causes ● Sebaceous cyst ● Indirect inguinal hernia ● Hydrocele ● Epididymal cyst (spermatocele) ( Fig. 54 ) ● Epididymo-orchitis ● Testicular torsion ● Testicular tumour ● Varicocele ● Haematocele…

This may be due to lesions on the scrotal skin, within the scrotum, or may, rarely, be due to referred pain. It is important to make rapid diagnosis of emergencies, such as torsion and gangrene, and swiftly referred for surgery. Causes Skin ● Infected sebaceous cyst ● Irritation (urine/faeces in the incontinent) ● Dermatitis ● Herpes simplex ● Behçet’s disease ● Fournier’s gangrene ( Fig. 53…

Lesions on the scalp are common; the most common are sebaceous cysts, which are often multiple. Causes Traumatic ● Haematoma ● Cephalhaematoma Cystic ● Sebaceous cysts (epidermal cysts) ( Fig. 52 ) Neoplastic Benign ● Ivory osteoma Malignant Primary ● Basal cell carcinoma ● Squamous cell carcinoma ● Malignant melanoma ● Leukaemia ● Myeloma You’re Reading a Preview Become a Clinical Tree membership for Full access…

Rectal bleeding is a common symptom. The majority of patients with rectal bleeding have a simple condition such as haemorrhoids, but the symptoms should always be taken seriously and investigated. Rectal bleeding with a change in bowel habit or weight loss should be regarded as due to colorectal cancer until proved otherwise. Causes Anus ● Haemorrhoids ● Fissure-in-ano ● Carcinoma ● Trauma Colon and rectum ●…

Most pyrexias result from a clearly defined illness, e.g. acute pyelonephritis or acute appendicitis, or from self-limiting viral infections, e.g. common cold. Pyrexia of unknown origin is defined as a temperature >38.3°C on several occasions, accompanied by more than three weeks of illness and failure to reach a diagnosis after one week of inpatient investigation. Most cases of pyrexia of unknown origin are unusual presentations of…

Pruritus ani is itching around the anal canal. It is a common symptom and in approximately half of the cases, no cause can be found. Causes Anal discharge ● Haemorrhoids ● Fistula-in-ano ● Skin tags ● Warts ( Fig. 50 ) ● Carcinoma ● Polyps ● Gonococcal proctitis Faecal soiling ● Incontinence ● Poor hygiene ● Diarrhoea Skin disease ● Candidiasis ● Tinea cruris ● Lichen…

Pruritus is itching of the skin. There are a vast number of dermatological causes of pruritus, which are usually visible on inspection. However, the following are causes of generalised pruritus in the absence of skin disease. Causes ● Obstructive jaundice ● Chronic renal failure ● Liver disease ● Stroke Haematological disease ● Iron deficiency ● Polycythaemia ruba vera Internal malignancy ● Bronchial carcinoma ● Hodgkin’s lymphoma…

Popliteal swellings are common. The majority are easily diagnosed on clinical examination alone. Causes Superficial ● Sebaceous cyst ● Lipoma ● Varix of the short saphenous vein Deep ● Lymphadenopathy ● Semi-membranosus bursa ● Baker’s cyst ● Popliteal artery aneurysm ( Fig. 49 ) Bony ● Exostoses ● Osteogenic sarcoma History Superficial Sebaceous cyst A sebaceous cyst will present as a firm swelling in the skin,…

The volume of urine produced per day varies in each individual and is affected by the amount of fluid intake, physiological requirements and insensible losses. Polyuria is arbitrarily defined as urine output of more than three litres in 24 hours. Causes Diuretics Therapeutic ● Loop – e.g. furosemide, bumetanide ● Thiazide – e.g. bendroflumethiazide, metolazone, indapamide ● Amiloride Osmotic ● Hyperglycaemia ● Hypercalcaemia ● Mannitol ●…

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 ●…