A Malay teenager, thin-built, presented with pallor of hands, hepatomegaly 5cm below costal margin and splenomegaly. No stigmata of chronic liver disease.
1. How would you like to complete your examination with?
I would like to examine genitalia (for testicular atrophy) and per rectal examination.
2. Causes of hepatosplenomegaly?
- Myeloproliferative - Myelofibrosis, CML, PCV, Essential thrombocytosis
- Lymphoproliferative - ALL, CLL, lymphoma, myeloma
- Haemolytic anaemia
- Infective hepatitis
- Infective mononucleosis
A middle-aged cachexic Malay man, looked tachypneic and in respiratory distress, presented with finger clubbing and bilateral lung crepitations.
1. Clinical features of bronchiectasis?
- Chronic cough with copious, purulent sputum
- Recurrent haemoptysis
- Recurrent lung infection
2. Causes of bronchiectasis?
- Bronchial adenoma
- Bronchial carcinoma
- Kartagener's syndrome
3. Complications of bronchiectasis?
- Cerebral abscess
4. Investigations in bronchiectasis?
- Sputum AFB / fungal culture
- Sputum C&S - H. influenzae, P. aeruginosa, Str. pneumoniae
- CXR - Ring-like shadows, tram lines, focal opacities
- High-resolution CT - detects airway dilatation not visible on CXR