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Final OSCEs > Abdo Histories > Flashcards

Abdo Histories Flashcards

1
Q

What are the red flags for a patient with dysphagia?

A 
Progressive dysphagia
Anaemia
Weight loss
Anorexia
Malaena/haematemesis
Age>55
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2
Q

What are the neuromuscular disorders that can cause dysphagia? (3)

A

Stroke
Myaesthenia Gravis
Motor neurone disease

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3
Q

What features in a dysphagia history might point to a stroke?

A

Other features: acute onset speech impairment/limb weakness
High risk of aspiration - gurgling voice after drinking
RFs: diabetes, obesity, hypertension, AF

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4
Q

What features in a dysphagia history might point to myasthenia gravis?

A

Autoimmune neuromuscular disorder
Muscle fatiguability
Difficulty initiating swallowing with subsequent cough due to aspiration
Other signs: weakness, ptosis, dysarthria, SoB, waddling gait

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5
Q

What features in a dysphagia history might point to motor neurone disease?

A

Age 50-70; Male
Progressive with UMN & LMN signs
Progressive bulbar palsy - quiet hoarse voice

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6
Q

What are the obstructive causes of dysphagia? (5)

A 
Oesophageal cancer
Benign oesophageal stricture
Oesophageal web
Oesophageal pouch
External compression
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7
Q

What features in a dysphagia history might point to oesophageal cancer?

A

Progressively worsening dysphagia
Initially solids, later liquids
Constitutional symptoms
RFs: older, male, smoking, alcohol, chronic GORD

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8
Q

What features in a dysphagia history might point to benign oesophageal stricture?

A

Associated with chronic GORD
Intermittent dysphagia for solids, gradually worsens
Hx of corrosive ingestion, radiation or trauma

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9
Q

What features in a dysphagia history might point to oesophageal web?

A

Associated with odynophagia (pain on swallowing)

Due to congenital or Plummer-Vinson syndome

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10
Q

What features in a dysphagia history might point to pharyngeal pouch?

A

Lump in throat

Halitosis (bad breath)

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11
Q

What oesophageal motility disorders cause dysphagia? (3)

A

Achalasia
Oesophageal spasm
Systemic sclerosis

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12
Q

What features in a dysphagia history might point to achalasia?

A

Difficulty relaxing oesophageal stricture
Long Hx of intermittent dysphagia (solids>liquids)
Retrosternal chest pain after meals + heart burn

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13
Q

What features in a dysphagia history might point to oesophageal spasm?

A

Spontaneous intermittent chest pain

Commonly misdiagnosed ACS

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14
Q

What features in a dysphagia history might point to systemic sclerosis?

A

Reflux symptoms
Right, thickened skin
Raynaud’s
Possible heart/lung involvement

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15
Q

What are the red flags for a patient with change in bowel habit?

A

Anaemia
Weight loss
Age >60
Rectal bleeding

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16
Q

What questions should you ask about change in bowel habit?

A 
Clarify - relation to normal
Frequency
Consistency
Colour - blood/melaena 
Exacerbating/relieving factors
Tenesmus - still need to go
17
Q

What factors may cause constipation?

A

Diet: lack of fibre, reduced water
Lack of exercise, immobility
Medications: opioids, Fe, amitriptyline
Anorectal disease

18
Q

What are the differentials for change in bowel habit?

A 
Colorectal cancer
IBD
IBS
Gastroenteritis
Diverticular disease
Malabsorption
19
Q

What features in a change in bowel habit history might point to colorectal cancer?

A

Age>55 unless FH
Red flags: cachexia, rectla bleeding, abdo mass, change in BH > 6w
Iron defiicency anaemia (all men, non-menstruating women)
Previous Hx of malignancy, IBD, coeliac disease

20
Q

What features in a change in bowel habit history might point to IBD?

A

Chronic diarrhoea with blood and mucus
Abdo pain
Fever, mouth ulcers, anorectal disease, extra-intestinal features

21
Q

What features in a change in bowel habit history might point to IBS?

A

Commoner in younger women, related to stress/anxiety
Associated with bloating, constipation/diarrhoea and crampy abdo pain
No blood in stools

22
Q

What features in a change in bowel habit history might point to gasteroenteritis?

A

Recent history of eating uncooked/poorly prepared food/foreign travel
Diarrhoea: may be watery/bloody
Vomiting
Household members with similar symptoms

23
Q

What features in a change in bowel habit history might point to diverticular disease?

A

Middle-age with bloody diarrhoea & LIF pain
Can lead to diverticulitis (fever, nausea, vomiting)
RF: obesity, low fibre diet

24
Q

What features in a change in bowel habit history might point to malabsorption?

A

Due to coeliac disease, chronic pancreatitis, thyroid disease, diabetes
Steatorrhoea, weight loss, general malaise

Final OSCEs (18 decks)

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