স্পেশাল বিসিএস (স্বাস্থ্য) - লং কোর্স

Dyspnea but chest is clear—pulmonary embolism, metabolic acidosis (diabeti ketoacidosis, renal failure, lactic acidosis salicylate poisoning), severe anemia, shock, pneumocystis jiroveci pneumonia, psychogenic.

Dyspnea with stridor (indicates upper airway obstruction)—foreign body or tumor, acute epiglottitis, anaphylactic reaction, laryngeal trauma, laryngeal fracture.

Lindsay’s nails
White/brown ‘half-and-half’ nails
Found in-  Chronic kidney disease

Macleod 14/box 3.4

Hypercarotenaemia occurs due to excessive ingestion of carotene-containing vegetables or in situations of impaired metabolism such as hypothyroidism or anorexia nervosa.

A yellowish discoloration is seen on the face, palms and soles but not the sclera or conjunctiva, and this distinguishes it from jaundice 


Macledo 14th/P-26

This product of haemoglobin breakdown is deposited in the skin of the lower legs following subcutaneous extravasation of blood due to venous insufficiency. Local deposition of haemosiderin (erythema ab igne or ‘granny’s tartan’) occurs with heat damage to the skin from sitting too close to a fire or from applying local heat, such as a hot water bottle, to the site of pain

The ‘a’ wave corresponds to right atrial contraction and occurs just before the first heart sound.
In atrial fibrillation the ‘a’ wave is absent.

Macleod 14th/52

Raynaud’s phenomenon is digital ischaemia induced by cold and emotion. It has three phases 
•     pallor: due to digital artery spasm and/or obstruction
•     cyanosis: due to deoxygenation of static venous blood
(this phase may be absent)
•    redness: due to reactive hyperaemia.

Dorsalis pedis pulse
Using the pads of your middle three fingers, feel at the origin of the first web space just lateral to the tendon of extensor hallucis longus 

Finger clubbing is due to overgrowth of soft tissue in the terminal phalanx, which increases the lateral and longitudinal curvature of the nail (see Fig. 3.8), raising the nail bed off the underlying bone. It is palpable as a boggy fluctuation of the nail when pressure is applied just proximal to the nail 

The most common respiratory causes of clubbing are chronic suppurative lung disease (such as bronchiectasis), lung cancer and pulmonary fibrosis. An additional rare complication of lung cancer is hypertrophic pulmonary osteoarthropathy, in which painful, tender swelling of
the wrists and ankles accompanies pronounced finger clubbing. X-rays of the distal forearm and lower legs show subperiosteal
new bone formation overlying the cortex of the long bones.
Other important signs of respiratory disease in the hands include:
•     cyanosis
•     tar staining of fingers from tobacco use (Fig. 5.8)
•     small-muscle wasting (see Fig. 13.22), which may indicate
T1 root damage by an apical lung tumour
•     rarely, yellow–brown discoloration of nails in yellow nail
syndrome

Clusters of symptoms are used to classify dyspepsia:
•     reflux-like dyspepsia (heartburn-predominant dyspepsia)
•     ulcer-like dyspepsia (epigastric pain relieved by food or antacids)
•     dysmotility-like dyspepsia (nausea, belching, bloating and premature satiety).

Left iliac fossa mass
• Sigmoid colon cancer
• Constipation
• Diverticular mass