Cox & Roper: Clinical Skills

Chapter 14 - Spot Diagnosis

Instructions: Each group of extended matching questions consists of lettered options followed by a list of numbered problems/questions. For each numbered problem/question select the one lettered option that most closely answers the question. You can use the lettered options once, more than once, or not at all.

Options:

1. Acromegaly
2. Pagets Disease of Bone
3. Goitre
4. Addison's Disease
5. Horner's syndrome
6. Exophthalmos
7. Jaundice
8. Cushing's Syndrome
9. Hypothyroidism
10. Spider Naevi
11. Systemic Lupus Erythmatosus
12. Parkinson's Disease
13. Hereditary Haemorrhagic Telangiectasia
14. Systemic Sclerosis
15. Facial Nerve Palsy

You take every available opportunity to practice your skill at Spot Diagnosis. Choose the correct response from the following scenarios.

1

Scenario 1 a) An elderly man goes to his GP complaining of declining mobility and generally slowing down. His face is impassive and expressionless and you notice him drooling. Also there is a short lived tremor of his right hand. Choose... Acromegaly Pagets Disease of Bone Goitre Addison's Disease Horner's syndrome Exophthalmos Jaundice Cushing's Syndrome Hypothyroidism Spider Naevi Systemic Lupus Erythmatosus Parkinson's Disease Hereditary Haemorrhagic Telangiectasia Systemic Sclerosis Facial Nerve Palsy Correct. A face with a poverty of expression is typical of Parkinson's Disease. Drooling is another feature along with difficulties mobilising. The tremor gives a final clue and will be pill-rolling in nature. See pages 400, 219, 241.Incorrect. See pages 400, 219, 241.Your answer has been saved.

2

Scenario 2 a) A 42 year old woman goes to outpatients clinic complaining of feeling tired all the time and constipation. She is wearing several layers of clothing despite the warm temperature and looks apathetic. Her hair is coarse and thinning. Choose... Acromegaly Pagets Disease of Bone Goitre Addison's Disease Horner's syndrome Exophthalmos Jaundice Cushing's Syndrome Hypothyroidism Spider Naevi Systemic Lupus Erythmatosus Parkinson's Disease Hereditary Haemorrhagic Telangiectasia Systemic Sclerosis Facial Nerve Palsy Correct. The symptom of feeling tired all the time is non-specific. However wearing several layers of clothing in warm conditions suggests cold intolerance. Along with constipation and coarse thinning hair this strongly suggests hypothyroidism. See pages 403-404.Incorrect. See pages 403-404.Your answer has been saved.

3

Scenario 3 a) A 56 year old woman has gone to her GP complaining of intermittent right hypochondrial pain and dyspepsia. When seen at the surgery she is pain-free. However at the consultation you notice that her eyes and skin look yellow. Choose... Acromegaly Pagets Disease of Bone Goitre Addison's Disease Horner's syndrome Exophthalmos Jaundice Cushing's Syndrome Hypothyroidism Spider Naevi Systemic Lupus Erythmatosus Parkinson's Disease Hereditary Haemorrhagic Telangiectasia Systemic Sclerosis Facial Nerve Palsy Correct. The eyes and skin looking yellow are the crucial signs. If the sclerae are yellow this indicates jaundice. Intermittent right hypochondrial pain radiating around to the back or shoulder tip may suggest gallstones as a cause of jaundice. See pages 411-412, 136-138, 150-151, 177-178.Incorrect. See pages 411-412, 136-138, 150-151, 177-178.Your answer has been saved.

4

Scenario 4 a) A 32 year old man has been admitted to a general medical ward. He has been falling a lot and admits to drinking heavily over the years. He is covered in bruises and It is noticeable that there are red blebs on his face, neck, and upper chest. You wonder what the red blebs are. Choose... Acromegaly Pagets Disease of Bone Goitre Addison's Disease Horner's syndrome Exophthalmos Jaundice Cushing's Syndrome Hypothyroidism Spider Naevi Systemic Lupus Erythmatosus Parkinson's Disease Hereditary Haemorrhagic Telangiectasia Systemic Sclerosis Facial Nerve Palsy Correct. The big clue here is that the patient is an alcoholic. Bruising could reflect a number of accidents or liver dysfunction affecting his clotting (or both). The red blebs are in the distribution of the superior vena cava and are likely to be spider naevi. See pages 147-8, 150, 154.Incorrect. See pages 147-8, 150, 154.Your answer has been saved.

5

Scenario 5 a) A young woman who appears anxious is seen in clinic with loose stools and weight loss. Even though she is anxious her eyes seem to have a greater staring quality than would be expected. Choose... Acromegaly Pagets Disease of Bone Goitre Addison's Disease Horner's syndrome Exophthalmos Jaundice Cushing's Syndrome Hypothyroidism Spider Naevi Systemic Lupus Erythmatosus Parkinson's Disease Hereditary Haemorrhagic Telangiectasia Systemic Sclerosis Facial Nerve Palsy Correct. The staring quality of the eyes is probably due to exophthalmos and the loose stools and weight loss strongly suggest thyrotoxicosis. These features are diagnostic of Grave's disease. See pages 401-2.Incorrect. See pages 401-2.Your answer has been saved.

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