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Final year useful tidbits for leeds medicine...

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HALLMARK FINDINGS Albumino-Cytologic Dissociation Antiplatelet Antibodies Arachnodactyly Autosplenectomy Bence Jones Protein Blue Bloater Boot-Shaped Heart Bouchard's Nodes Boutonniere's Deformity Brushfield Spots Chancre Chancroid Cheyne-Stokes Breathing Chocolate Cysts Clue Cells Cotton Wool Spots Currant-Jelly Sputum Depigmentation Of Substantia Nigra Fatty Liver Ghon Focus / Complex Gower's Maneuver Heberden's Nodes Heinz Bodies Hemorrhagic Urticaria Hypochromic Microcytic RBCs Kaussmaul Breathing Keyser-Fleischer Ring Koplik Spots Lewy Bodies McBurney's Sign Neuritic Plaques Neurofibrillary Tangles Painless Jaundice Philadelphia Chromosome Pick Bodies Pink Puffer Port-Wine Stain Pseudohypertrophy Punched-Out Bone Lesions Rash on Palms & Soles

Guillain-Barre (markedly increased protein in CSF with only modest increase in cell count) Idiopathic thrombocytopenic purpura Marfan's Sickle cell anemia Multiple myeloma free light chains (either kappa or lambda) Chronic Bronchitis Tetralogy of Fallot Osteoarthritis (PIP) Rheumatoid arthritis Down's Syphilis Haemophilus ducreyi Cerebral lesion Endometriosis Gardnerella vaginitis (BV) HTN Klebsiella Parkinson's Alcoholism and relatively normal with age and obesity Tuberculosis (1? & 2?, respectively) Duchenne's MD use of arms to stand Osteoarthritis (DIP) G6PDH Deficiency Henoch-Schonlein Iron-deficiency anemia Acidosis Wilson's Measles Parkinson's (eosinophilic inclusions in damaged substantia nigra cells) appendicitis (McBurney's Point is 2/3 of the way from the umbilicus to anterior superior iliac spine) Alzheimer's Alzheimer's Pancreatic CA (head) Note: Courvoisier's law CML and ALL Pick's Disease Emphysema Hemangioma. Sturge-Weber Syndrome Duchenne muscular dystrophy Multiple myeloma 2? Syphilis

Hodgkin's Disease L→R Shunt (VSD, PDA)

Reed-Sternberg Cells S3 Heart Sound

Mitral Regurg LV Failure Pulmonary Stenosis

S4 Heart Sound

Pulmonary HTN Thalassemia Familial Hypercholesterolemia gout Visceral ca, classically pancreatic (migratory thrombophlebitis)

Target Cells Tendinous Xanthomas Tophi Trousseau's Sign

Hypocalcemia (carpal spasm) These are two entirely different disease processes and different signs, but they unfortunately have the same name. Supraclavicular node enlargement by metastatic carcinoma of the stomach Spina Bifida

Virchow's Node - AFP in amniotic fluid or mother's serum

Anencephaly Gout

- Uric Acid

Lesch Nyhan Myeloproliferative Disorders Diuretics (Loop & Thiazides) COPD

FEV1/FVC

Symptoms/Signs Cheat Sheet Haematology Sign/Result/Symptom High Neutrophil Count High Lymphocyte Count Reed-Sternburg Cells Popcorn Cells Auer Rods Philadelphia Chromosome Hypercalcaemia Renal Failure Anaemia

Condition Suggests Bacterial Infection Suggests Viral Infection (or Leukemia) Classical Hodgkin’s Lymphoma Nodular Lymphocyte Predominant Hodgkin’s Lymphoma Acute Myeloid Leukemia Chronic Myeloid Leukemia

Bone Lesions Bense-Jones Proteins IgG +IgA Paraproteins M band Electrophoresis Apple Green Birefringence on Congo Red Stain under polarising light Frontal Bossing Hair on End Appearance on X-Ray Prominent Maxilla ‘Lemon Yellow’ Colour Peripheral Polyneuropathy Target Cells Pancytopenia Hypocellularity of Bone Marrow Microcytic Anaemia Normocytic Anaemia

Macrocytic Anaemia

Dactylitis (Sore fingers) after cold Heinz Bodies Fava Bean Ingestion Howell-Jolly Body Increased APTT Increased PTT Prolonged APTT + Low levels FVIII/IX Prolonged APTT +low levels vWF Prolonged APTT + PTT Christmas Disease Telangiectasia and Nosebleeds Rheumatology Anti-dsDNA Antibodies Butterfly Rash ANCA positive vasculitis Non-ANCA positive vasculitis Rhinorrhoea Vasculitis Affecting Upper Respiratory Tract, Lungs and Kidneys Rhinitis & Asthma Vasculitis Affecting Lungs, Nerves & Skin Vasculitis Affecting Kidneys & Lungs

Myeloma

Thalassaemia (Cooley’s Anaemia in B Thalassaemia) Pernicious Anaemia (Severe B12 Deficiency) Non-megaloblastic Macrocytic Anaemias (no DNA replication problems) Aplastic Anaemia (Inherited =Fanconi’s) Chronic Iron Deficiency Thalassaemias Anaemia of Chronic Disease Acute Blood Loss Aplastic Anaemia (inherited=Fanconi) Vitamin B12 Deficiency (Pernicious Anaemia) Folate Deficiency (low intake/drugs) Sickle Cell Disease Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency Damaged Spleen (Trauma, Radiation etc) Intrinsic Pathway – Unfractionated Heparin Extrinsic Pathway – Warfarin Haemophilia Von Willebrand Disease Disseminated Intravascular Coagulopathy End Stage Liver Failure Factor V Leiden Another name for Haemophilia B Hereditary Haemorrhagic Telangiectasia (Osler-Webber-Rendu Disease)

Systemic Lupus Erythematosus Wegener’s granulomatosis (cANCA) Churg-Strauss Syndrome Microscopic Polyangiitis Henoch-Schonlein Purpura Cryoglobulinaemic vasculitis Wegener’s Granulomatosis

Churg-Strauss Syndrome Microscopic Polyangiitis

Haemoptysis HLA-B27 Genetic Defect Rheumatoid Factor Anti-Citrullinated Cyclic Peptide Antibodies Calcinosis of skin Raynaud’s Phenomenon Oesophageal Dysfunction Sclerodactyly Telangectasia (‘Beaking’ of Nose Pulmonary Fibrosis Renal Failure) Nail Pitting Acute Asymmetrical Arthritis Urethritis/Cervicitis Iritis (Circinate Balanitis, Keratoderma Blennorhagia) Follows Infection – STI, Dysentery Rheumatoid Arthritis Splenomegaly Neutropenia Rheumatoid Arthritis Pneumoconiosis Dryness of Eyes, Mouth, Skin, Vagina HLA-B8/DR3 Genetic Defect Renal Frank Haematuria (Red Blood) Painless Clots In Urine Painful Triad of proteinuria, hypoalbuminaemia and oedema

Haematuria Proteinuria Hypertension Uraemia Nephrotic Syndrome Child Nephrotic Syndrome Adult Nephrotic/Nephritic Syndrome SLE/Cerebral Shunt Nephritic Syndrome Post URTI Henoch-Schonlein Purpura Tonsilitis ~ 4 weeks previous ‘Smoky’ Brown Urine Antistrepsolysin O Antibodies Anti-GBM antibodies

Ankylosing Spondylitis Rheumatoid Arthritis

Systemic Sclerosis (CREST Syndrome)

Psoriasis

Reiter’s Syndrome/ Reactive Arthritis

Felty’s Syndrome Caplan’s Syndrome Sjogren’s Syndrome

Suggests Bladder Carcinoma Suggests Bladder Calculus Nephrotic Syndrome Bense-Jones Proteins (in urine if related to Myeloma)

Nephritic Syndrome

Minimal Change Disease Focal Segmental Glomerulosclerosis Membranous Glomerulonephritis (may be idiopathic) IgA nephropathy (Berger’s Disease)

Post Infectious Glomerulonephritis

Haemoptysis Nephritic Syndrome Nephritic Syndrome Hypocomplimentaemia High Specific Gravity (Urine Dipstick) Deletion of short arm of Chromosome 3 (Von Hippel-Lindau Disease) Working in Chemical, Cable and Rubber Industries (Benzidine exposure) Herbal Weight Loss Supplements (Aristolochic Acid) Apple Green Birefringence on Congo Red Stain under polarising light ELK Classification

Goodpasture’s Syndrome

Amyloid Plaques (Renal Amyloidosis) From Multiple Myeloma Wegener’s Granulomatosis

Nephritis and Hearing Loss Zebra/Myeloid Bodies on Ultrasound

Alport Syndrome Fabry’s Disease

Membranoproliferative Glomerulonephritis Pre-renal AKI Renal cell Carcinoma (bilateral) Urothelial (Bladder) Carcinoma

Gastrointestinal Clubbing

Virchow’s node (supraclavicular fossa) =Troisier’s Sign Weight Loss Sensation of Fullness Leukonychia Koilonychia Hepatic Fetor (Sweet Breath) Air under diaphragm (on Chest X-ray) Increased/Tinkling Bowel Sounds Epigastric pain worse at night/when hungry Crypt Hyperplasia Villous Atrophy Cobblestone Appearance of Bowel Apple Core Sign on Barium Enema Lead Pipe Sign on Barium Enema Flank/Periumbilical Bruising (Grey-Turner’s/Cullen’s signs) Elevated serum Amylase Exudative Ascites Exudative Pleural Effusion Jaundice Right Upper Quadrant Pain Fever Brown Pigmentation of Mouth and Tongue Elevated AST +ALT (relative to ALP) Elevated ALP (relative to AST +ALT) ⍺1Antitrypsin Deficiency

Crohn’s Disease Ulcerative Colitis Liver Cirrhosis Malabsorption Gastric Carcinoma

Hypoalbuminaemia Iron Deficiency Anaemia Portal Hypertension Bowel Perforation Bowel Obstruction Duodenal Ulcer (vs Gastric) Coeliac Disease Crohn’s Disease Colonic Carcinoma Chronic Ulcerative Colitis Ruptured Pancreatic Pseudocyst (Acute Pancreatitis) Acute Pancreatitis Ovarian Carcinoma (Meig’s Syndrome) Cholecystitis (Charcot’s Triad) Peutz-Jegher’s Syndrome (Hereditary Intestinal Polyposis) Suggests Hepatic Pathology Suggests Biliary Pathology Predisposes to Liver Cirrhosis & Non-smoking COPD

Elevated ⍺-Fetoprotein Anti-mitochondrial Antibodies Anti-nuclear cytoplasmic Antibodies (ANCA) HBsAg (s=Surface) Anti-HBs

Hepatocellular Carcinoma Primary Biliary Sclerosis (and other AI diseases) Primary Sclerosing Cholangitis (PSC)

Anti-HCV

Ongoing Hepatitis B Infection Marker of Previous Hepatitis B Vaccination Marker of previous natural Hepatitis B infection (+ve=has immunity) Marker of Hepatitis C infection

Hernia pointing down leg Hernia pointing towards groin

Femoral Hernia Inguinal Hernia

Anti-HBc IgM (c=Core)

Breast Pain varies with menstrual cycle Inflamed Breast Bloody Nipple Discharge

Fibrocystic Disease Breast Abscess Ductal Papilloma (rarely carcinoma)

Cardiovascular Clubbing Pain in calf on dorsiflexion Splinter Haemorrhage Janeway Lesions Osler Nodes Roth Spots (Fundoscopy) Radio-radial Delay Turner’s Syndrome Malar Flush Tapping Apex Beat Pulmonary Hypertension Atrial Fibrillation Polycystic Kidney Disease Down’s Syndrome Sydenham’s Chorea Pulsus Alternans (Alternating Pulse) Pulmonary Stenosis Overriding Aorta Ventricular Septal Defect Right Ventricular Hypertrophy Collapsing Pulse Wide Pulse Pressure Marfan’s Syndrome Rheumatological Disease Hyperthyroidism Alcoholic Pulsus Paradoxus (Weaker on Inspiration) Xanthelasma Corneal Arcus Narrow Pulse Pressure

Congenital Cyanotic Heart Disease Subacute Bacterial Endocarditis Atrial Myxoma (=Homan’s Sign +ve) DVT Infective Endocarditis

Coarctation of the Aorta

Mitral Stenosis

Mitral Regurgitation Atrial/Ventricular Septal Defect Rheumatic Fever Severe Myocardial Failure Fallot’s Tetralogy

Aortic Regurgitation

Atrial Fibrillation Dilated Cardiomyopathy Cardiac Tamponade/Restrictive Pericarditis Hyperlipidaemia Aortic Stenosis

Syncope on Exertion Cannon A Waves of JVP Giant V Waves of JVP Steep Y Descent of JVP Chest Pain and Raised D-Dimer with High 12-hour Troponin Chest Pain and Raised D-Dimer with Low 12-hour Troponin ECG Leads I and III Leaving (pointing away from each other) Leads I and III Returning (pointing towards each other) Long PR interval – greater than one large square Consistent PR interval, one P not followed by QRS Progressive Lengthening of PR interval, One P not followed by QRS Two P waves per QRS No relationship between P waves and QRS complexes ‘RSR’ wave in V1 (mostly above baseline) M pattern in V6 (Mostly above baseline) No P waves Sawtooth Baseline Peaked P waves Broad & bifid P waves Delta Waves and widened QRS complex (especially in V3 and V4) Clockwise Rotation (Seen in Leads V1 to V 6) Tall tented T waves Q waves ST elevation ST depression T wave inversion Downward sloping ST segement Pulseless Electrical Activity

Third Degree Heart Block Tricuspid Regurgitation Constrictive Pericarditis/Tricuspid Incompitence Myocardial Infarction Pulmonary Embolism (CTPA to confirm)

Left Axis Deviation Right Axis Deviation First degree heart block Second Degree Heart Block (Mobitz Type 2) Second Degree Heart Block (Wenckebach Type) Second Degree Heart Block (2:1 Type) Third Degree Heart Block (Complete Heart Block) Right Bundle Branch Block Left Bundle Branch Block Atrial Fibrillation Atrial Flutter Right Atrial Hypertrophy Left Atrial Hypertrophy Wolff-Parkinson-White Syndrome Suggests Pulmonary Embolism Hyperkalaemia Myocardial Infarction (not necessarily acute) Acute Myocardial Infarction (STEMI) Ischaemia Ischaemia, Ventricular Hypertrophy, Bundle Branch Block, Digoxin Treatment Digoxin Toxicity 4H’s and 4T’s Hypotension Hypothermia Hypoxaemia Hyper/hypokalaemia Tamponade Tension Pneumothorax Thrombolytic Toxicity

Respiratory

Clubbing

Horner’s Syndrome Stony Dull to Percussion Low FEV1, Normal FVC – Decreased Ratio Normal FEV1, Low FVC – Increased Ratio Rusty Coloured Sputum AIDS Patient with Symptoms of Pneumonia Recent History of Flu Symptoms of Pneumonia Cough Bilateral Lymphadenopathy Asbestos Exposure

Pleural Plaques on Xray Coal dust exposure Ground glass appearance on Xray

Lung Cancer (especially non-Small Cell) Interstitial Lung Disease Tuberculosis Suppurative Disease (Abscess, empyema, bronchiectasis) Cystic Fibrosis Mesothelioma Pancoast Tumour Pleural Effusion Obstructive Disease (e.g. Asthma, COPD) Restrictive Disease (e.g. Pulmonary Fibrosis) Strep Pneumoniae Pneumonia Pneumocystis Carinii Pneumonia Staph Aureus Pneumonia Sarcoid Most commonly causes Bronchial Adenocarcinoma or Mesothelioma Asbestos Exposure Pneumoconiosis Pulmonary Fibrosis

Endocrine ‘Woody’ Thyroid Yellow Tinge to skin (Tanned) Central Obesity Malignant Hypertension Age 2 indicates risk of DVT Wells (PE) - Score >4 indicates risk of PE TIMI - Assess the risk of death and ischemic events in patients experiencing UA/NSTEMI CHA2DS2-VASc - Risk of stroke in patients with AF (>1 consider OAC)

HAS BLED - 1 year risk of major haemorrhage for patients with AF on anticoagulation (>2 indicates caution or regular review required) ABCD2 - Risk of stroke in patients who have had a TIA QRISK2 - 10 year risk of CVD (a score above 10% = start statin) ECOG - Fitness for chemo; >2 (spends >50% time in a chair) indicates not fit for chemo RECIST - Tumour response to therapy MASCC Score - Home or hospital treatment for neutropenic sepsis Rotterdam Checklist - Measuring QOL in cancer patients Gleason Score - Grading prostate cancer Dukes Staging - Staging of colorectal cancer (>stage B requires adjunct chemo) Royal Marsden Staging System - Grading of testicular cancer CURB-65 - Treatment required for CAP (1=low risk, 2=admit, 3=ICU) Centor Criteria - Prescribing of antibiotics in sore throat Garden Classification - Femoral neck fractures Wilson's Score - Factors influencing difficult intubation Calder Test - Degree to which mandible is protrusible Bishops Score - Use to determine whether induction of labour is needed (8 indicates spontaneous labour likely) Glasgow Scoring System - Risk of death from pancreatitis CHA2DS2-VASc - Risk of stroke in patients with AF (>1 consider OAC) Congestive cardiac failure (1 point) Hypertension (1 point) Age >75 years (2 points) Diabetes (1 point) Previous Stroke/TIA (2 points) Vascular disease (1 point) Age >65 (1 point) Sex female (1 point) CURB-65 - Treatment required for CAP (1=low risk use oral amoxicillin, 2=admit use oral/I.V coamoxiclav, 3=ICU I.V co-amoxiclav + clarithromycin) Confusion (AMTS 7mmol RR >30 BP systolic T-cell deficiency & hypoparathyroidism Caused by a microdeletion on chromosome 22 Bacterial disease caused by Klebsiella granulomatis. Characterised by destructive ulcerative genital lesions.

Inguinale/Venereum) Down's Syndrome Dressler Syndrome (post myocardial infarction syndrome) Dubin-Johnson Syndrome Duchenne Muscular Dystrophy Ebstein’s Anomaly

Edwards' Syndrome Ehlers-Danlos Syndrome Eisenmenger's Syndrome Ekbom’s Syndrome Erb's Palsy Ewing Sarcoma Fitz-Hugh Curtis Syndrome Fregoli Delusion Gilbert's Syndrome

Commonly misdiagnosed as syphilis Trisomy 21 Secondary form of pericarditis secondary to injury to the heart or pericardium (consists of fever, pleuritic pain, pericarditis and/or a pericardial effusion). Rare, benign disorder causing an isolated increase in bilirubin in the serum. Causes a black liver. (pseudohypertrophy), appears early, skeletal or heart abnormalities are common (deficiency in dystrophin protein). Congenital malformation in which the leaflets of the tricuspid valve are displaced towards the apex. Caused by lithium therapy during pregnancy. Trisomy 18 Defective collagen Reversing of left to right shunt in patients with ASD, VSD, patent ductus arteriosus resulting in cyanosis. Delusional parasitosis Trauma to superior trunk of brachial plexus. Waiter's Tip deformity Undifferentiated round cell tumour of bone RUQ pain from perihepatitis following the transabdominal spread of infection from pelvic inflammatory disease (PID). Delusional belief that different people are a single person who changes appearance or is in disguise Congenital hyperbilirubinemia Defect in glucuronidation & hepatic uptake of bilirubin. Bilirubin increases by fasting & phenobarbitone (unconjugated). Appears in young adults, prognosis is excellent.

Goodpasture Syndrome

Grave's Disease Guillain-Barre Syndrome Hashimoto's Thyroiditis Hashitoxicosis Hansen’s Disease Henoch-Schonlein purpura

Autoimmune disease in which the basement membranes of the lungs and kidneys are attacked. Leads to bleeding from the lungs and kidney failure Autoimmune hyperthyroidism (TSI) Idiopathic polyneuritis (ascending muscle weakness & paralysis; usually self-limiting) Autoimmune hypothyroidism Initial hyperthyroidism in Hashimoto's Thyroiditis that precedes hypothyroidism Leprosy IgA vasculitis Haemorrhagic urticaria (with fever, arthralgias, GI & renal involvement) Associated with upper respiratory infections

Hirschsprung's Disease Hodgkin’s Lymphoma Horner's Syndrome

Aganglionic megacolon Lymphoma in which cancer originates from lymphocytes. Risk may be increased by infection with Epstein-Barr virus Ptosis, miosis, anhidrosis (lesion of cervical sympathetic nerves often 2? to a Pancoast tumour)

Huntington's Disease Jacksonian Seizures

Kaposi Sarcoma Kartagener's Syndrome (Primary Ciliary Dyskinesia) Kasabach-Merritt Syndrome Kawasaki Disease Klinefelter's Syndrome Li-Fraumeni syndrome (SBLA syndrome) Lou Gehrig's Lynch’s Syndrome Mallory-Weiss Syndrome Marfan's Syndrome McCune-Albright Syndrome Meckel's Diverticulum

Progressive degeneration of caudate nucleus, putamen & frontal cortex; AD Epileptic events originating in the primary motor cortex (area 4) Jacksonian march Malignant vascular tumour (HHV 8 in homosexual men) Autosomal Recessive. Defect in dynein arms leading to immotile cilia this in turn leads to sterility and is associated with situs inversus Haemangioma with thrombocytopenia. Vascular tumour leads to decreased platelet counts Mucocutaneous lymph node syndrome (lips, oral mucosa) 47, XXY Autosomal dominant cancer predisposition syndrome, with multiple cancers in an individual and their family. p53 mutation. Amyotrophic Lateral Sclerosis degeneration of upper & lower motor neurons (motor neurone disease) Hereditary non-polypoidal colorectal cancer (HNPCC) Bleeding from oesophagogastric lacerations 2? to retching (alcoholics) Connective tissue defect Bone and ovarian cysts Cafe au lait spots Precocious puberty rule of 2's: 2 inches long, 2 feet from the ileocecum, in 2% of the population embryonic duct origin; may contain ectopic tissue (gastric, pancreatic, etc.)

Meig’s Syndrome

Meniere’s Syndrome Munchausen Syndrome Osgood-Schlatter Disease Osler-Webber-Rendu Disease Paget's Disease of Bone Paget’s Disease of Breast Paget’s Disease of Vulva/Penis Pancoast Tumour Parkinson's Patau Syndrome Perthe’s Disease (Legg-Calve-Perthe’s

Small ovarian fibroma Pleural effusion (usually right sided) Ascites Inner ear disorder characterised by vertigo, tinnitus and hearing loss Factitious disorder (consciously creates symptoms, but doesn't know why) Inflammation of patellar ligament at tibial tuberosity. Common in adolescents who play sport. Hereditary Haemorrhagic Telangiectasia Abnormal bo...