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…

Mechanical obstruction of the bowel may be simple (one-point obstruction) or closed loop (obstruction at two points enclosing a segment of bowel). If the bowel is viable, the obstruction is termed non-strangulating. If the arterial blood supply is compromised, strangulating obstruction occurs with subsequent infarction of the bowel. Intestinal obstruction is a common surgical emergency. Causes Small bowel In the lumen ● Gallstone ileus ● Food…

Hypertension is the persistent elevation of blood pressure. An individual is classified as hypertensive when there is a sustained rise in blood pressure to more than 140/90 mmHg. Most patients have essential hypertension with contributory factors such as aging, obesity, alcohol and salt intake. An underlying cause is identified in less than 10% of patients. The causes of secondary hypertension are considered below. Causes Renal ●…

Hirsutism is the presence of male-pattern (androgen dependent) hair growth in women. This is not the same as virilism, which, in addition to hirsutism, is associated with the development of male secondary sexual characteristics in women. Whilst hypertrichosis refers to the excessive growth of hair occuring in either sex (i.e. androgen independent). Causes Physiological ● Senility ● Familial (varies with ethnicity) Pathological Drugs ● Ciclosporin ●…

Hiccups (hiccoughs) are the characteristic sounds produced by the involuntary contractions of the diaphragm terminated by sudden closure of the glottis. In the majority of patients, it is a self-limiting condition. The most common cause of hiccups is thought to be gastric distension after rapid ingestion of food, fluid or air. The causes of intractable persistent hiccups are listed below, with aetiology characterised by the hiccup…

Hepatomegaly is enlargement of the liver. The most common causes in the UK are cirrhosis, cardiac failure and secondary malignancy. Causes Hepatitis/infection Acute ● Alcohol ● Viruses (Hep A/B/C, EBV) ● Bacteria (Leptospirosis, actinomycosis, pyogenic abscess) ● Protozoans (malaria, amoeba) ● Parasites (hydatid cyst, liver fluke) Chronic ● Chronic active hepatitis Congestion ● Congestive cardiac failure ● Constrictive pericarditis ● Budd–Chiari syndrome Infiltration ● Fatty liver…

Hemiparesis is weakness or paralysis of one side of the body; it usually arises from unilateral lesions above the midcervical spinal cord. Causes (all causes of acute hemiparesis require urgent assessment) Vascular ● Cerebrovascular ischaemia ● Cerebral or spinal infarction ● Intracerebral haemorrhage ● Paradoxical embolus ● Cerebral vasculitis Traumatic ● Subdural haematoma ● Extradural haematoma You’re Reading a Preview Become a Clinical Tree membership for…

When assessing a patient with headache, it is important to exclude life-threatening causes first. Causes Acute headache ● Trauma ● Cerebrovascular ● Subarachnoid haemorrhage ( Fig. 33 ) ● Intracranial haemorrhage/infarction ● Systemic infection ● Meningitis ● Acute angle-closure glaucoma Chronic or recurrent headache ● Tension headache ● Migraine (important to also consider in acute headache as may be first presentation) ● Medication overuse headache ●…