Finger lesions form part of the wider subject of hand deformity. (See hand deformity chapter.) Lesions of the fingers are those which can result in hand function impairment. Painful finger lesions are dealt with on p. 147. Causes Congenital See chapter on hand deformity Acquired Traumatic/degenerative ● Dupuytren’s contracture ● Trigger finger ● Implantation dermoid ● Pyogenic granuloma ● Mallet finger ● Swan-neck deformity ● Boutonnière…

Faecal incontinence implies loss of voluntary control of passage of faeces from the anus. Any disease process that interferes with rectal sensation or affects function of the anorectal musculature may produce incontinence. However, incontinence may still occur with normal sphincters and pelvic floor, for example in severe diarrhoea. Causes Normal sphincters and pelvic floor ● Severe diarrhoea, e.g. infection, irritable bowel syndrome, inflammatory bowel disease ●…

Most facial ulcers are serious. Malignant facial ulcers are common in patients who work outdoors and are exposed to ultraviolet light. Lesions of the lips have been dealt with elsewhere (p. 293) and will not be included here. Causes Traumatic ● Physical ● Chemical ● Irradiation ● Dermatitis artefacta ● Bites Neoplastic ● Basal cell carcinoma (rodent ulcer) ( Fig. 20 ) • (rare in tropical…

Facial swelling is a common presenting complaint. It may be generalised or localised. Many cases are due to trauma or infection, but it may be a sign of systemic disease. Causes Traumatic ● Insect bites ● Facial fractures Infective ● Dental infection (e.g. abscesses) ● Sinusitis ● Parotitis (bilateral: mumps) ● Cellulitis/Erysipelas ● Actinomycosis Neoplastic ● Sinuses ● Parotid ( Fig. 19 ) ● Jaw ●…

Most patients are able to distinguish between pain arising from the cranium, which is termed headache, and that of the face, which is covered here under the heading of facial pain. Causes Local Sinus ● Sinusitis ● Carcinoma Ear ● Otitis media ● Otitis externa Eye ● Optic neuritis Mastoid ● Mastoiditis You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy…

Erectile dysfunction is failure in the adult male to sustain an adequate erection. Erectile dysfunction leads to and can be caused by psychological problems, often with relationship breakdown. Psychological causes of impotence are common, but the most common organic disease is diabetes mellitus. Causes Endocrine ● Diabetes mellitus ● Hyperlipidaemia ● Hypogonadism ● Hypothyroidism ● Cushing’s syndrome ● Metabolic syndrome ● Addison’s disease Vascular ● Diabetic…

Most eye disorders tend to present as ‘red eye’. It is the most common ophthalmic complaint encountered by general practitioners. Causes Eyelids ● Stye (hordeolum internum/externum) ( Fig. 17 ) ● Xanthelasma ● Blepharitis ● Meibomian cyst (chalazion) ● Entropion (in-turning of the eyelid) ● Ectropion (out-turning of the eyelid) Eye Surface ● Trauma ● Foreign body Conjunctiva ● Subconjunctival haemorrhage ● Conjunctivitis ● Bacterial ●…

Ear disorders are common in general, with earache being a frequent complaint. It may represent ear disease or referred pain from the oral cavity or pharynx. Causes of deafness are dealt with on p. 86, with many differentials overlapping. Causes Local External ear ● Trauma ● Boils ● Dermoid/epidermoid cyst ● Malignancy (e.g. basal cell carcinoma, squamous cell carcinoma) External auditory meatus ● Otitis externa ●…

Dyspnoea is the subjective awareness of breathing discomfort. Causes Sudden (seconds to minutes) ● Pneumothorax ( Fig. 15 ) ● Chest trauma ● Aspiration ● Pulmonary oedema ● Pulmonary embolism ● Anaphylaxis Acute (hours to days) ● Asthma ● Respiratory tract infection ● Pleural effusion ● Lung tumours ● Metabolic acidosis Chronic (months to years) ● Chronic airflow limitation (COPD) ● Anaemia ● Arrhythmia ● Valvular…

Dysphagia means difficulty in swallowing and should be distinguished from pain on swallowing. Dysphagia may be associated with ingestion of solids or liquids, or both. Pain on swallowing is odynophagia, which in itself does not interfere with the act of swallowing. Causes Congenital ● Oesophageal atresia Acquired In the lumen ● Food bolus ● Foreign body In the wall ● Gastro-oesophageal reflux ● Carcinoma ( Fig.…

Spatial disorientation may be expressed by the patient as dizziness, vertigo or feeling ‘light-headed’. True vertigo, however, is not experienced as a sensation of movement but as tilting or sloping of the environment, often characterised as the room spinning around them. Causes Episodic ● Ménière’s disease * ● Benign paroxysmal positional vertigo (BPPV) ● Arrhythmia ● Postural hypotension ● Migraine/Vestibular migraine ● Hyperventilation ● Drugs (antihypertensives,…

Diarrhoea is an increased frequency of abnormally loose motions. The diagnosis of diarrhoea must be related to the patient’s normal bowel habit. Causes Intestinal Infective enteritis Non-specific, bacterial ● Campylobacter spp • (rare in tropical Africa) ● Salmonella spp • (rare in tropical Africa) ● Escherichia coli ● Clostridium difficile ● Staphylococci ● Shigella spp ● Vibrio cholerae ● Yersinia enterocolitica • (common in the Indian…

Deafness is loss of hearing and may be divided into ‘conductive’ and ‘sensorineural’. Causes Conductive deafness Acquired ● Ear wax ● Otitis externa ● Otitis media (including glue ear) ● Labyrinthitis ● Otosclerosis ● Foreign body ● Perforation of the tympanic membrane (TM) ● Barotrauma ● Cholesteatoma Congenital ● Atresia of the meatus Sensorineural deafness Acquired ● Presbyacusis (age-related sensorineural hearing loss) ● Noise-induced trauma ●…

Cyanosis is the abnormal blue discoloration of the skin and mucous membranes, resulting from the presence of reduced oxygenated haemoglobin in the blood. It is not synonymous with hypoxaemia, which may be present (e.g. anaemia) without cyanosis. Causes Central cyanosis Decreased oxygen saturation ● Severe respiratory disease ● Pulmonary oedema ● Pulmonary embolism ● Congenital cyanotic heart disease Abnormal haemoglobin ● Methaemoglobinaemia ● Sulphaemoglobinaemia Peripheral cyanosis…

Cough is a reflex explosive expiration that prevents aspiration and promotes the removal of secretions and foreign particles from the lung. Causes Acute ● Inhaled foreign body ● Respiratory tract infection Chronic Productive ● COPD (mucoid/purulent) ● TB (bloodstained) • (common where TB is endemic) ● Bronchiectasis (purulent) ● Pulmonary oedema (pink, frothy) ● Lung cancer (bloodstained) ( Fig. 12 ) ● Pulmonary embolism (bloodstained) Non-productive…

A convulsion is a series of involuntary violent contractions of voluntary muscles. Causes Neurological ● Epilepsy ● Febrile convulsions Traumatic ● Head injuries Metabolic ● Hypoxia ● Hypo and hyperglycaemia ● Electrolyte abnormalities, e.g. calcium, sodium ● Uraemia Vascular ● Ischaemic stroke ● Subarachnoid haemorrhage ● Intracranial haemorrhage Infective ● Meningitis ● Encephalitis ● Cerebral abscess You’re Reading a Preview Become a Clinical Tree membership for…

Constipation is a common complaint that results from decreased frequency of abnormally firm motions. It must be considered relative to the patient’s normal bowel habit. Absolute constipation in the absence of both bowel motions and flatus. Acute constipation due to acute intestinal obstruction (p. 232) may require admission to hospital, whereas changes in bowel habit may be investigated in the outpatient setting. Causes Congenital ● Hirschsprung’s…

Confusion is a behavioural state of reduced mental clarity, coherence, comprehension and reasoning. The causes may be organic or psychiatric. The organic causes are listed below. Causes (all causes of acute confusion require urgent assessment) Toxins/drugs ● Alcohol intoxication/withdrawal ● Drug intoxication Hypoxia ● Respiratory disorders ● Cardiac failure Metabolic disorder ● Hyperglycaemia/hypoglycaemia ● Electrolyte imbalance, e.g. sodium, calcium ● Thiamine (vitamin B 1 ) deficiency…

Coma can be defined as a state of prolonged unconsciousness from which a person cannot be roused, or numerically categorised as a GCS score of <8. Causes (all causes of coma require emergency assessment) Trauma ● Head injury (diffuse axonal injury) ● Extradural haemorrhage ( Fig. 11 ) ● Subdural haemorrhage Metabolic ● Diabetic ketoacidosis ● Hypoglycaemia ● Hypothermia ● Hyperglycaemia ● Hyponatraemia ● Hypernatraemia Organ…

Clubbing is the selective bulbous enlargement of the distal segments of fingers or toes due to proliferation of connective tissues ( Fig. 10 ). Open full size image Figure 10 Clubbing . Note the exaggerated longitudinal curvature and the loss of angle between the nail and the nailbed . Causes Respiratory Bronchial carcinoma Chronic suppurative lung disease Bronchiectasis Lung abscess Empyema Cystic fibrosis ● Interstitial lung…