Makindo Medical Notes

Addison's disease

🟤 Diffuse hyperpigmentation (palmar creases, scars, mucosa) due to ↑ ACTH → primary adrenal failure.

Actinomyces

🦷 Chronic indurated cervicofacial infection with sinus tracts and “sulphur granules”.

Achenbach Syndrome

🩸 Sudden painful blue finger due to spontaneous venous bleeding — benign and self-limiting.

Acanthosis

⚫ Velvety hyperpigmentation of flexures — insulin resistance; sudden onset → consider malignancy.

Acne

🧴 Comedones, papules, pustules — androgen-driven pilosebaceous inflammation.

Acne Rosacea

🌹 Facial flushing, telangiectasia, papules; no comedones.

Acromegaly

🦴 Enlarged hands, jaw, coarse features — excess GH, usually pituitary adenoma.

Angioneurotic oedema

💥 Sudden non-pitting swelling of lips/tongue; ACE-I causes bradykinin-mediated disease.

Ameloblastoma

🦷 Slow-growing jaw tumour — locally aggressive, classically “soap-bubble” appearance.

Amiodarone

🔵 Blue-grey skin pigmentation and photosensitivity with long-term use.

Down syndrome

🧬 Trisomy 21 — upslanting palpebral fissures, hypotonia, single palmar crease.

Behcet syndrome

🔥 Recurrent oral and genital ulcers with uveitis — systemic vasculitis.

Neurofibromatosis

☕ Café-au-lait spots, neurofibromas; NF1 → optic glioma, NF2 → bilateral acoustic neuromas.

Monkey pox

🦠 Umbilicated vesiculopustular lesions with systemic symptoms.

Myotonic dystrophy

✋ Delayed muscle relaxation, frontal balding, cataracts.

Hurler syndrome

🧬 Gargoyle facies, corneal clouding, hepatosplenomegaly — MPS I.

EBV / Mononucleosis

💋 Fever, lymphadenopathy, exudative tonsillitis ± splenomegaly.

Penicillin + EBV rash

💊 Generalised maculopapular rash — not a true penicillin allergy.

Pressure Ulcers

🛏️ Non-blanching skin damage over pressure points.

Hereditary Haemorrhagic Telangiectasia

🩸 Telangiectasia + recurrent epistaxis → think AVMs.

Cutaneous Anthrax

⚫ Painless black eschar with surrounding oedema.

Lyme disease

🎯 Erythema migrans “bull’s-eye” rash.

Molluscum contagiosum

⚪ Umbilicated pearly papules — poxvirus.

Clubbing

🫁 Bulbous fingertips — chronic hypoxia or malignancy.

Cushing's syndrome

🌙 Moon face, truncal obesity, purple striae — cortisol excess.

Thyrotoxicosis

🔥 Key clinical clues: weight loss, heat intolerance, tremor, anxiety, diarrhoea, palpitations.
❤️ Exam: tachycardia/AF, warm sweaty skin, fine tremor, hyperreflexia; goitre ± bruit; Graves’ signs (lid lag, ophthalmopathy).
🧪 Tests: ↓TSH with ↑free T4/T3; check TSH receptor antibodies; consider thyroid uptake scan if unclear; baseline FBC/LFTs before carbimazole.
⚠️ Red flags: thyroid storm (fever, delirium, severe tachycardia), AF with fast rate, heart failure in older adults (often “apathetic hyperthyroidism”).
💊 Management: beta-blocker for symptoms; antithyroid drugs (carbimazole/PTU), radioiodine or surgery depending on cause and relapse risk.

Wilson Disease – Kayser–Fleischer Ring

👁️🟤 What you’re seeing: copper deposition in Descemet’s membrane causing a brown-green corneal ring.
🧠 Think Wilson if: young person with liver disease + neuropsychiatric symptoms (tremor, dystonia, dysarthria, personality change).
🧪 Tests: low caeruloplasmin, ↑24h urinary copper, liver copper on biopsy; slit-lamp exam confirms subtle rings.
⚠️ Pearl: haemolysis can occur (Coombs-negative) due to copper toxicity.
💊 Treatment: chelation (penicillamine or trientine) + zinc; transplant if fulminant liver failure.

Cutaneous Larva Migrans on Leg

🐛 Classic appearance: intensely itchy, serpiginous “creeping eruption” track advancing daily.
🏖️ Cause: hookworm larvae (often from dog/cat faeces in warm sandy soil) migrating within superficial skin layers.
🩺 Symptoms: marked pruritus; secondary bacterial infection from scratching is common.
🧪 Diagnosis: usually clinical; blood eosinophilia is variable and not required.
💊 Treatment: ivermectin (often single dose) or albendazole; antihistamines/topical steroids for itch; advise footwear and avoidance of contaminated sand.

Addison's disease

🟤 Diffuse hyperpigmentation (palmar creases, scars, mucosa) due to ↑ ACTH → primary adrenal failure.

Actinomyces

🦷 Chronic indurated cervicofacial infection with sinus tracts and “sulphur granules”.

Achenbach Syndrome

🩸 Sudden painful blue finger due to spontaneous venous bleeding — benign and self-limiting.

Acanthosis

⚫ Velvety hyperpigmentation of flexures — insulin resistance; sudden onset → consider malignancy.

Acne

🧴 Comedones, papules, pustules — androgen-driven pilosebaceous inflammation.

Acne Rosacea

🌹 Facial flushing, telangiectasia, papules; no comedones.

Acromegaly

🦴 Enlarged hands, jaw, coarse features — excess GH, usually pituitary adenoma.

Angioneurotic oedema

💥 Sudden non-pitting swelling of lips/tongue; ACE-I causes bradykinin-mediated disease.

Ameloblastoma

🦷 Slow-growing jaw tumour — locally aggressive, classically “soap-bubble” appearance.

Amiodarone

🔵 Blue-grey skin pigmentation and photosensitivity with long-term use.

Down syndrome

🧬 Trisomy 21 — upslanting palpebral fissures, hypotonia, single palmar crease.

Behcet syndrome

🔥 Recurrent oral and genital ulcers with uveitis — systemic vasculitis.

Neurofibromatosis

☕ Café-au-lait spots, neurofibromas; NF1 → optic glioma, NF2 → bilateral acoustic neuromas.

Monkey pox

🦠 Umbilicated vesiculopustular lesions with systemic symptoms.

Myotonic dystrophy

✋ Delayed muscle relaxation, frontal balding, cataracts.

Hurler syndrome

🧬 Gargoyle facies, corneal clouding, hepatosplenomegaly — MPS I.

EBV / Mononucleosis

💋 Fever, lymphadenopathy, exudative tonsillitis ± splenomegaly.

Penicillin + EBV rash

💊 Generalised maculopapular rash — not a true penicillin allergy.

Pressure Ulcers

🛏️ Non-blanching skin damage over pressure points.

Hereditary Haemorrhagic Telangiectasia

🩸 Telangiectasia + recurrent epistaxis → think AVMs.

Cutaneous Anthrax

⚫ Painless black eschar with surrounding oedema.

Lyme disease

🎯 Erythema migrans “bull’s-eye” rash.

Molluscum contagiosum

⚪ Umbilicated pearly papules — poxvirus.

Clubbing

🫁 Bulbous fingertips — chronic hypoxia or malignancy.

Cushing's syndrome

🌙 Moon face, truncal obesity, purple striae — cortisol excess.

Thyrotoxicosis

🔥 Key clinical clues: weight loss, heat intolerance, tremor, anxiety, diarrhoea, palpitations.
❤️ Exam: tachycardia/AF, warm sweaty skin, fine tremor, hyperreflexia; goitre ± bruit; Graves’ signs (lid lag, ophthalmopathy).
🧪 Tests: ↓TSH with ↑free T4/T3; check TSH receptor antibodies; consider thyroid uptake scan if unclear; baseline FBC/LFTs before carbimazole.
⚠️ Red flags: thyroid storm (fever, delirium, severe tachycardia), AF with fast rate, heart failure in older adults (often “apathetic hyperthyroidism”).
💊 Management: beta-blocker for symptoms; antithyroid drugs (carbimazole/PTU), radioiodine or surgery depending on cause and relapse risk.

Wilson Disease – Kayser–Fleischer Ring

👁️🟤 What you’re seeing: copper deposition in Descemet’s membrane causing a brown-green corneal ring.
🧠 Think Wilson if: young person with liver disease + neuropsychiatric symptoms (tremor, dystonia, dysarthria, personality change).
🧪 Tests: low caeruloplasmin, ↑24h urinary copper, liver copper on biopsy; slit-lamp exam confirms subtle rings.
⚠️ Pearl: haemolysis can occur (Coombs-negative) due to copper toxicity.
💊 Treatment: chelation (penicillamine or trientine) + zinc; transplant if fulminant liver failure.

Cutaneous Larva Migrans on Leg

🐛 Classic appearance: intensely itchy, serpiginous “creeping eruption” track advancing daily.
🏖️ Cause: hookworm larvae (often from dog/cat faeces in warm sandy soil) migrating within superficial skin layers.
🩺 Symptoms: marked pruritus; secondary bacterial infection from scratching is common.
🧪 Diagnosis: usually clinical; blood eosinophilia is variable and not required.
💊 Treatment: ivermectin (often single dose) or albendazole; antihistamines/topical steroids for itch; advise footwear and avoidance of contaminated sand.

Gorlin’s sign 👅

• Definition: ability to touch the tip of the nose with the tongue.
• Meaning: a supportive clue to generalised hypermobility / connective tissue laxity (e.g., hypermobility spectrum/EDS), but not diagnostic.
• Next step: assess Beighton score + symptoms (sprains/dislocations, chronic pain) + skin features + family history.

Urticaria