Impairment of hand function can lead to severe disability and is a common presentation. Causes Congenital Failure of formation ● Absent digit ● Finger and thumb hypoplasia ● Radial club hand ● Macrodactyly Failure of separation ● Syndactyly (fusion of digits) ● Camptodactyly Duplication ● Polydactlyl Primary muscle contractures ● Arthrogryposis multiplex congenita Acquired ● Dupuytren’s contracture ● Rheumatoid arthritis ( Fig. 32 ) ● Osteoarthritis…

An hallucination is an apparent sensory perception of an external object when no such object is present. They may be auditory, visual, tactile, olfactory or gustatory in nature. It is to be differentiated from an illusion, which is a real perception that is misinterpreted. Causes ● Fever (especially children and the elderly) ● Drugs (and drug withdrawal) ■ Marijuana ■ Cocaine ■ LSD ■ Ecstasy ■…

Haemoptysis is the expectoration of blood or bloodstained sputum. With massive haemoptysis, the main priorities are to secure the airway and initiate emergency resuscitative measures before establishing a diagnosis. Causes Respiratory ● Bronchial carcinoma ● Pneumonia ● TB (worldwide) ( Fig. 30 ) ● Chronic obstructive pulmonary disease (COPD) ● Bronchiectasis ● Pulmonary oedema ● Goodpasture’s syndrome ● Granulomatosis with polyangiitis (GPA – formerly Wegener’s granulomatosis)…

Haematuria is the passage of red blood cells in the urine. Care must be taken to distinguish it from other causes of discoloration of urine. All patients with haematuria must be fully investigated. If haematuria has initially been diagnosed on dipstick testing, it must always be confirmed by microscopy. Causes Kidney ● Glomerular disease ● Carcinoma ● Stone ● Infection – pyelonephritis ● Trauma (including renal…

Haematemesis is the vomiting of blood. This may be frank blood or blood altered by the action of gastric acid and digestive enzymes, i.e. ‘coffee grounds’. Haematemesis is usually caused by lesions proximal to the duodenojejunal junction. Causes (all patients with significant haematemesis should be urgently assessed) Swallowed blood ● Epistaxis ● Haemoptysis Oesophagus ● Reflux oesophagitis ● Oesophageal varices ( Fig. 28 ) ● Oesophageal…

Gynaecomastia is enlargement of the male breast. There is an increase in the ductal and connective tissue elements of the breast. The condition should not be confused with fat in the mammary region, which may occur in obese patients and in old age with weight loss. In most cases, gynaecomastia is a result of an increase in the oestrogen–androgen ratio. In many cases, the actual mechanism…

These are common clinical problems, especially hernias. They are therefore common in clinical examinations. Causes Above the inguinal ligament ● Sebaceous cyst/abscess ● Lipoma ● Direct inguinal hernia ● Indirect inguinal hernia ( Fig. 26 ) ● Imperfectly descended testis ● Hydrocele of the cord/canal of Nuck Below the inguinal ligament ● Sebaceous cyst/abscess ● Lipoma ● Femoral hernia ● Lymph nodes ● Saphena varix ●…

A goitre is an enlargement of the thyroid gland ( Fig. 25 ). It can result from physiological causes such as puberty (due to increased demand for thyroid hormone) which require no treatment, to frank malignant disease requiring urgent diagnosis and treatment. Open full size image Figure 25 Endemic goitre . This condition, caused by iodine deficiency, is extremely common in isolated mountainous regions. The thyroid…

Disorders of gait may be structural or neurological. When assessing gait, it is important to observe the whole patient and not merely the feet. Causes Structural ● Pain – antalgic gait ● Length discrepancies – short leg gait ● Weak hip abductors – Trendelenburg or waddling gait ● Femoral anteversion – intoe gait Neurological ● Stroke – hemiplegic gait ● Parkinson’s disease – festinant gait ●…

Ulcers on the feet are common. The majority of them are of vascular or neuropathic origin. Causes Vascular Large vessel disease ● Arteriosclerosis ● Embolism Small vessel disease ● Diabetes ● Raynaud’s disease ● Embolism ● Vasculitis, e.g. SLE, rheumatoid arthritis, scleroderma ● Buerger’s disease Neuropathic Peripheral nerve lesions ● Diabetes ( Fig. 24 ) ● Peripheral nerve injuries ● Leprosy • (in endemic areas) ●…

Pain in the foot is a common presenting complaint. The majority of causes are related to injury, overuse or conditions causing inflammation. Causes Traumatic ● Fractures ● March fracture Infective ● Cellulitis – esp if suspected necrotising fascitis ● Osteomyelitis ● Pyogenic arthritis Inflammatory ● Rheumatoid arthritis ● Plantar fasciitis ● Reiter’s disease ● Osteochondritis of the navicular bone (Köhler’s disease) ● Osteochondritis of the metatarsal…

The deformity will often be apparent at birth but occasionally does not present until the child starts walking. A deformity of the foot and ankle is normally referred to as ‘talipes’. Other terms may qualify the word talipes, e.g. varus (inverted heel), valgus (everted heel) and equinus (foot plantar-flexed). Deformities of the toes are dealt with under toe lesions (p. 426). Causes Congenital ● Talipes congenital…

A painful finger is a common presenting symptom. This may vary from an obvious local lesion to part of a generalised disease, e.g. rheumatoid arthritis. Impairment of the function of even a single finger may grossly impair the overall function of the hand. Causes Traumatic ● Subungual haematoma ● Fractures Inflammatory/infective ● Paronychia ● Pulp space infection ● Tendon sheath infection – especially if open Neoplastic…

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 ●…