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…

Chest pain is a common presenting symptom of disorders that can range from trivial to life-threatening. Causes Cardiovascular ● Angina ● Myocardial infarction ● Pericarditis/myocarditis ● Acute aortic dissection Gastrointestinal ● Gastro-oesophageal reflux disease ● Peptic ulcer disease ● Oesophageal spasm Pulmonary ● Pneumonia ● Pneumothorax ● Pulmonary embolism Musculoskeletal ● Chest wall trauma ● Herpes zoster ● Costochondritis ● Secondary tumours of the rib Miscellaneous…

Pain in the breast is a common symptom in general surgical practice. Most cases are benign and due to cyclical mastalgia, but occasionally pain may be the presenting symptom of carcinoma. Causes ● Cyclical mastalgia (fibroadenosis, cystic mastitis) ● Noncyclical mastalgia ● Duct ectasia ● Breast abscess ( Fig. 8 ) ● Pregnancy ● Lactation ● Carcinoma (15% of lumps are painful) ● Fat necrosis ●…

A lump in the breast is a common clinical presentation. In every case of a breast lump, in both males and females, carcinoma must be excluded. Causes Discrete lumps Malignant ● Carcinoma ( Fig. 7 ) ● Phyllodes tumour (some behave in benign fashion) Benign ● Fibroadenoma ● Cyst (in cystic mastitis) ● Duct ectasia ● Sebaceous cyst ● Galactocele ● Fat necrosis ● Lipoma ●…

Backache is one of the most common complaints seen in general practice and orthopaedic clinics. Most causes are either traumatic or degenerative, but other causes are numerous and may occur as a result of pathology in almost any system of the body. Causes Congenital ● Kyphoscoliosis ● Spina bifida ● Spondylolisthesis Acquired Traumatic ● Vertebral fractures ● Ligamentous injury ● Joint strain ● Muscle tears Infective…

The great majority of axillary swellings are enlarged lymph nodes. Axillary nodes can be enlarged due to secondary deposits from carcinoma of the breast. Most axillary swellings are easily diagnosed from clinical examination alone. Causes Superficial ● Acute abscess ● Sebaceous cyst ● Lipoma ● Viral or bacterial infections ● Hidradenitis suppurativa Deep ● Lymphadenopathy (e.g. lymphoma, leukaemia, lupus) ● Benign or malignant breast lump (arising…

Ascites is the accumulation of excess free fluid in the peritoneal cavity ( Fig. 5 ). Open full size image Figure 5 CT scan of ascites . There is free fluid throughout the peritoneal cavity (arrows) . Causes Hepatic ● Cirrhosis ● Hepatic tumours Malignant disease ● Peritoneal metastases ● Abdominal/pelvic tumour (primary or secondary) ● Pseudomyxoma peritonei ● Primary mesothelioma Cardiac ● Cardiac failure ●…

Swelling may be localised or generalised. Localised swellings may be related to joints or fractures. Localised swellings around joints are covered in the section on Joint Disorders (p. 247). This section includes only those conditions that may cause generalised swelling of the arm. Causes ● Trauma ● Infection, e.g. cellulitis, lymphangitis, phlebitis ● Acquired lymphoedema ● Venous thoracic outlet syndrome ● Venous thrombosis ● Congenital lymphoedema…