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OSCE > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What can cause chest discomfort?

A

MI

Angina

Pericarditis

Aortic dissection

Oesophageal spasm

Pneumothorax

MSK pain

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2
Q

What causes breathlessness

A

HF

Valvular disease

Angiona

PE

Pulomary hypertension

Respiratory disease

Anaemia

Obiestu

Anxiety

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3
Q

What causes palpitiations?

A

Tachyarrhythmias

Ectopic beats

Anxiety

Hyperthyroidism

Drugs

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4
Q

What causes syncope/presyncpe

A

Arrhytmias

Postural hypotension

Aortic stenosis

Hypertrophic cardiomyopathy

Atrial muxoma

Simple faints

Epilepsy

Anxiety

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5
Q

What causes oedema?

A

HF

Constrictive pericarditiiss

Venous stasis

Lymphoedema

Nephrotic syndrome

Liver disease

Drugs

Immobiliyy

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6
Q

What does chest pain due to MI feel like?

A

Dull discomfort

Tight or pressing band like sensation

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7
Q

What is stable angina?

A

Episodes of pain percipitated by exertion and may occur more readily when walking in cold or windy weather

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8
Q

What is unstable angina?

A

Abrupt onset of worsening chest pain

Minimal exertion or at rest

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9
Q

What are these for angina

A
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10
Q

What are these for MI?

A
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11
Q

What are these for aortic dissection

A
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12
Q

What are these for pericardial pain

A
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13
Q

What are these for oesophageal pain?

A
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14
Q

What causes reduced ventricular contractility (systolic dysfunction)?

A

MI

Dilated cardiomyopathy

Myocarditisi

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15
Q

What causes impaired ventricular filling (diastolic dysfunction)

A

Left ventricular hypertrophy

Constrictive pericarditis

Hypertrophic or restrictive cardiomyopathy

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16
Q

What causes increased metabolic and cardiac demand (rare)

A

Thyrotoxicosis

Atriovenous distulae

Paget’s disease

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17
Q

What are causes valvular or congenital lesions?

A

Mitral and/or aortic valve disease

Tricuspid and/or pulmonary valve disease

Ventricular septal defect

Patent ductus arteriosus

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18
Q

Whagt should be asked about in acute dysponea?

A

Durationof onset

Background symptoms of exertion dysponea and usual exercise tolerance

Associated symptoms: chest pain, syncope, palpitation or respiratory symptom

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19
Q

What is the SOCRATES for extrasystoles?

A
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20
Q

What is the SOCRATES for sinus tachycardia?

A
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21
Q

What is the SOCRATES for supraventricular tachycardia?

A
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22
Q

What is the SOCRATES for atrial fibrillation?

A
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23
Q

What is the SOCRATES for ventricular tachycardia?

A
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24
Q

What are ectioic beats?

A

Benign cause of palpiation at rest and are abolished by exercise

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25
Q

What does supraventricular tachycardia produce?

A

Sudden paroxysms of rapid, regular palpitation that can sometimes be terminated ith vagal stimulation using valsalva breathing manoeuvres or carotid sinus pressure

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26
Q

High risk features that increase the likelihood of life threatening arrhytmioa such as ventricul;ar tachycardoa include?

A

Previous MI or cardiac surgery

Associated syncope or severe chest pain

FH of sudden death

WPW syndrome

Signicianet heart disease such as hypertrophic cardiomyopathy or aortic stenosis

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27
Q

In patients with syncope ask about

A

Circumstances

Duration of LOC

Time to recovery

Driving status

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28
Q

What medication causes angina?

A

Aggravated by thyroixine or durg induced anaemia

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29
Q

What medication causes dysponea?

A

BB in patients with asthma

Exacerbation of HF with BB some Calcium channel antagonists

NSAIDS

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30
Q

What medication causes palpitation?

A

Tachycardia

Arrhytmia from thyroixne

Beta stimulants

Hypokalemia from diurectic

Tricyclic antidepressantsS

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31
Q

What medication causes syncope/presynctope?

A

Vasodilators

Brachycardia from rate limiting agents

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32
Q

What medication causes oedema?

A

Glucocorticoids, NSAIDS, calcium cha nnel antagondists

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33
Q

What is oedema?

A

Excess fluid in the intersitital space

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34
Q

What are the baseline symptoms, major events, investigations and procedures for ischemic heart disease?

A

Baseline symptoms- Exertional anaemia? If so ascertain functional limiations/response to GTN spray

Major events- Previous MI/ unstable angina

Investigations- Cornorary angiography, exercise electrocardiogram, exercise capacity

Procedures- PCI, coronary artery bypass graft surgery

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35
Q

What are the baseline symptoms, major events, investigations and procedures for heart failure?

A

Baseline symptoms- Dysponea, fatihue, ankle swelling, record usual functional status

Major events- Hospitalisation for decompensated HF, ventricular arrhytmias

Investigations- ECG, left ventricular sizem wall thickness and systolic function, valvular disease, RVF

Procedures- Implantable cardioverdefinbrillator, cardiac resynchronization therapy

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36
Q

What are the baseline symptoms, major events, investigations and procedures for ischemic valvular disease

A

Baseline symptoms- Often asymptomatic, exertuonal dysponea, chest pain or syncope

Major events- IE or previous rheumatic fever

Investigations- ECG: nature and severity of valve lesions, ventricular size and function

Procedures- Surgical valve repair or replacement, transcatheter valve procedures

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37
Q

What are Janeway lesions?

A

Painless, blanching red macules on the thenar/hypithenar eminences

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38
Q

What are osler nodes?

A

Painful raised erythematous lesions, typically on the pads of the fingerts

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39
Q

What is normal capillary refill time?

A

2 seconds or less

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40
Q

What do splinter haemorrhages be found?

A

IE

Some vasculitic disorders

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41
Q

What are petichial rash?

A

Most often present on the legs and conjunctivae is a transient finding in endocarditis and can be confused with the rash of meningococcal disease

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42
Q

What are tendon xanthomata are a sign of?

A

Sign of familial hypercholesterolaemia, a genetic disorder associated with severe elevations in serum cholesterol and premature coronary artery disease

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43
Q

What is xanthelmasta?

A

Creamy yellow plaques found periorbitally and on the medial aspect of the eyelids

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44
Q

What is corneal arcus?

A

Creamy yellow discolouration at the boundary of the iris and cornea

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45
Q

When taking a pulse asssess

A

Rate- number of pulses occuring per minute

Rhythm- The pattern of regularity of pulses

Volume- The perceived degree of pulsation

Character- AN impression of the pulse waveform shape

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46
Q

How to detect collapsing pulse?

A

Lift arm up vertically overhead. First ask if have any patin

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47
Q

What are sinus rhythm causes of fast rate?

A

Exercise

Pain

Excotement/anxiety

Fever

Hyperthyroidism

Medication

Sympathomimetics

Vasodilators

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48
Q

What are arrhytmia causes of fast rate?

A

AF

Atrial flutter

Supraventricular tachycardia

Ventricular tachycardia

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49
Q

What are sinus rhythm causes of slow rate?

A

Sleep

Athletic trainning

Hypothyroisism

BB

Digoxin

Verampamil, diltiazem

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50
Q

What are arrhytmias causes of fast rate?

A

Carotid sinus hypersensitivity

Sick sinus syndrome

Second degree heart block

Complete heart block

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51
Q

What are sinus rhythm causes of irregular pulse?

A

Sinus arrhytmia

Atrial extrasystoles

Ventricular extrasystoles

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52
Q

What are arrhytmias causes of irregular pulse?

A

Atrial fibrillation

Atrial flutter with variable response

Second degree heart block with variable response

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53
Q

What happens to pulse during inspiration?

A

Accelerates

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54
Q

What happens to pulse during expiration?

A

Slows

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55
Q

What haoppens to systolic blood pressure during inspiration?

A

Falls (up to 10mmHg)

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56
Q

What happens to systolic blood pressure during expiration?

A

Rises

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57
Q

What happens to jugular venous pressure during inspiration?

A

Falls

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58
Q

What happens to jugular venous pressure during expiration?

A

Rises

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59
Q

What happens to second heart sounds during inspiration?

A

Splits

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60
Q

What happens to second heart sound during expiration?

A

Fuses

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61
Q

When does a collapsing pulse occur?

A

Severe aortic reguargitation

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62
Q

What are the causes of widesprad vascular disease and renal bruit?

A

Renovascular disease, including renal artery stenosis

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63
Q

What are the causes of episodes of sweating, headache and palpitation?

A

Phaeochromocytoma

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64
Q

What are the causes of hypokalaemai?

A

Primary aldosteronism

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65
Q

What are the causes of cushinoid faces, central obseity, abdominal striae, proximal muscle weakness, chronic glucocorticoid use

A

Cushing’s syndrome

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66
Q

What are the causes of low bolume femoral pulses with radiofemoral delay?

A

Voarctation of thr aorta

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67
Q

What are the causes of bilateral palpable kindeys?

A

Adult polycystic kidney disease

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68
Q
A
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69
Q

What are the difference betwen the carotid and jugular pulsation?

A
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70
Q

What is the abnormality with heart failure?

A

Elevation, sustainaed abdomino-jugular reflux over 10 seconds

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71
Q

What is the abnormality with pulmonary embolism

A

Elevation

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72
Q

What is the abnormality with pericardial effusion

A

Elevation

Prominent Y descent

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73
Q

What is the abnormality with pericardial constructuo?

A

Elevation

Kussmaul’s sign

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74
Q

What is the abnormality with superior vena cava obstruction?

A

Evelation

Loss of pulsation

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75
Q

What is the abnormality with atrial fibrillatiob?

A

Absent A waves

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76
Q

What is the abnormality with tricuspid stenosis?

A

Giant a waves

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77
Q

What is the abnormality with tricuspid regurgitation?

A

Goant v or cv waves

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78
Q

What is the abnormality with common heart block?

A

Common waves

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79
Q

What are a waves?

A

Corresponds to right atrial contraction

Occurs just before the first heart sound

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80
Q

What are v waves?

A

Atrial filling during ventricular systole when the tricuspid valve is closed

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81
Q

What is Kussamaul’s sign?

A

Paradoxcal rise of JVP on inspiration that is seen in pericardial constriction, severe RVF and restrictive cardiomyopathy

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82
Q

What sounds are heard in the cardiac apex?

A

First heart sound

Third and fourth heart sounds

Mid diastolic murmur of mitral stenosis

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83
Q

What sounds are heard in the lower left sternal border?

A

Early diastolic murmurs of aortic and tricuspid reguargitation

Opening snap of mitral stenosis

Pansystolic murmur of ventricular septal defect

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84
Q

What sounds are heard in the upper left sternal border

A

Second heart sound

Pulmonary valve murmurs

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85
Q

What sounds are heard in the upper right sternal border?

A

Systoilic ejection murmurs

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86
Q

What sounds are heard in the left axilla?

A

Radiation of the pansystolic murmur of MR

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87
Q

What sounds are heard in the below left clavicle?

A

Continous machinery murmur of a persistent patent ductus arteriosus

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88
Q

What is pectus excavatum?

A

Posterior displacement of the lower sternum

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89
Q

What is pectus carinactum?

A

Displace the heart and affect palpatipn and auscultation

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90
Q

What does a midline sternotomy scar indicates?

A

Previous valve replacement or coronary artery bypass surgery

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91
Q

What is a left submammary scar?

A

Result of mitral valvotomy or transapical transcatheter aortic valve implantation

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92
Q

Whem are infraclavicular scars seen?

A

Seen after pacemaker of defribbator implanation and the bulge of the device may be obvious

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93
Q

What does a normal apical impusle do?

A

Briefly lifts your fingers and is localised

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94
Q

What is seen in detocardia with the cardiac apex?

A

Palpable om tje rigjt side but this is uncommon

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95
Q

What does left ventricular hypertrophy cause?

A

Forceful but undisplaced apical impusle

Imululses over left parasternal area indicates RVH

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96
Q

What is ther most common thrill?

A

Aortic stenosis

Usually palpable over the upper giht sternal border

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97
Q

What are the quiet abnormalities of the first heart sound?

A

Low cardiac output

Poor LVG

rheumatic mitral regurgitation

LOng P R interval

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98
Q

What are the loud abdnormalities of the first heart sound?

A

Increased CO

Large stroke volume

Mitral stenosis

Short PR interval

Atrial myxoma

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99
Q

What are the variable abnromalities of the intensity of the first heart sound?

A

Atrail fibrillation

Extrasystoles

Complete heart block

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100
Q

What are ejection clicks?

A

High pitched sounds

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101
Q

What is higher pitched aortic regurgitation or mitral stenosis?

A

Aortic regurgitation

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102
Q

What are the grades of instensity of murmurs?

A
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103
Q

What are examples of ejection systolic murmurs?

A

Increased flow through normal valves: Severe anaemia, feverem athletes, pregnancy, atrial septal defect, other causes of flow murmurs

Normal or reduced flow through a stenotic valve: AS and Pulmonary stenosis

Subvalvular obstruction: Hypertrophic obstructive cardiomyopathy

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104
Q

What are examples of pansystolic murmurs?

A

Mitral regurgitation

Tricuspid reguargitation

Ventricular septal defect

Leaking mitral or tricupid prothesios

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105
Q

What is the most common cause of continuous murmurs?

A

PDA

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106
Q

What is the medical rsearch council breathlessness scale?

A

Degree of breathlessness related to activities

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107
Q

What is stridor?

A

Haesh, granting respiratory sound is caused by the vibration of the walls on the trachea or major bronchi

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108
Q

What is excessive daytime sleepiness may be due?

A

Obstructive sleep aponea

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109
Q

What are some drugs that cause bronchoconstriction?

A

Beta blockers

Opiods

Non steroidal anti inflammatory drugs

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110
Q

What are some drugs that cause cough?

A

Angiotensin converting enzyme inhibitors

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111
Q

What are some drugs that cause bronchiolotitis obliterans

A

Penicillamine

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112
Q

What are some drugs that cause diffuse parencymal lung disease?

A

Cytotoxic agents: Bleomcin, methotrexate

Anti inlfmamatory agents: Sulfasalazine, penicillamine gold salts and aspirin

Cardiovascular drugs: Amiodarone, hydralazine

Antibiotics: nitrofuratonin

IV drug misuse

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113
Q

What are some drugs that cause parenchymal thromboembolism?

A

Oestrogen

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114
Q

What are some drugs that cause pulmonary hypertension?

A

Oestrogens

Dexfenfluramine

Fenfluramine

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115
Q

What drugs causes pleural effusion?

A

Amiodarone

Nitrofuratonin

Phenytoin

Methotrexate

Pergolide

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116
Q

What are some drugs that cause respiratory depression?

A

Opiods

Benzodiazepines

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117
Q

When is jugular venous pressure raised?

A

In patients with pulmonary hypertension

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118
Q

What happens to the trachea in a tension pneumothorax?

A

Tracheal deviation away from the affected side

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119
Q

What are the suggestive features on history of infection?

A

Fever

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120
Q

What are the suggestive features on history of acute bronchitis?

A

Wheeze

Cough

Sputum

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121
Q

What are the suggestive features on history of exacerbation of chronic obstructive pulmonary disease

A

Acute on chronic dysponea

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122
Q

What are the suggestive features on history of pneumonia

A

Pleuritic pain, rusty sputum, righors

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123
Q

What are the suggestive features on history of malignancy?

A

Insidious onset, weight lossm, persisting pain or cough

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124
Q

What are the suggestive features on history of progressive fibrodis

A

Progressive dysponea

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125
Q

What are the suggestive features on history of pulmonary effusion?

A

Progressive dysponea

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126
Q

What are the suggestive features on history of large pulmonary embolism

A

Sudden

Severe dysponea

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127
Q

What are the suggestive features on history of medium PE

A

Epusodes of pleural pain

Haemoptysis

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128
Q

What are the suggestive features on history of multiple small PE

A

Progressive dysponea

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129
Q

What are the suggestive features on history of asthma?

A

Atopy

Hay fever

Pet ownership

Variable wheezw

Disturbance of sleep

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130
Q

What are suggestive features on examination for acute bronchitis

A

Wheee

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131
Q

What are suggestive features on examination for exacerbation of COPD

A

Hyperinflation

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132
Q

What are suggestive features on examination for pneumonia

A

If lobar, dull to percusion and bronchial breathing

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133
Q

What are suggestive features on examination for malignancy

A

Cervical lymphadenopathy

Clubbing

Signs of lobar/lung collapse and effusion

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134
Q

What are suggestive features on examination for pulmonary fibrosis?

A

Tachyponea

Inspiratory fine crackles at bases

Cyanosis

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135
Q

What are suggestive features on examination for pulmonary effusion?

A

Unilateral basal fullness and reduced breath sounds

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136
Q

What are suggestive features on examination for large PE

A

Normal breath sounds

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137
Q

What are suggestive features on examination for medium PE

A

Pleural rub, swollen leg if DVT, crackles if infarct

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138
Q

What are suggestive features on examination for multiple small PE

A

Raised jugular venous pressure, right ventricular heave

Loud pulmonary second sound

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139
Q

What are suggestive features on examination for asthma

A

Polyphhonic expiratory wheeze

Eczema

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140
Q

What is the position of the liver?

A

Upper border: fifth right intercosal space on full expiration

Lower border: At the costal margin in the mid clavicular line on full inspiration

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141
Q

What is the position of the spleen?

A

Underlies left ribs 9-11, posterior to the mid axillary line

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142
Q

What is the position of the gallbladder

A

At the intersection of the right lateral vertical plane and the costal margin

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143
Q

What is the position of the pancreas?

A

Neck of the pancreas lies at the level of L1

Head lies blow and right

Tail lies above and left

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144
Q

What is the position of the kidneys?

A

Upper poles lies deep to the 12th rib posteriorly

7cm from the midline

The right is 2-3cm lower than the left

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145
Q

What are causes of painful mouth?

A

Deficiencies, including iron, folate, vitmain B12 or C

Dermatological disorders, including lichen planus

Chemotherapy

Aphthous ulcers

Infective stomatitis

IBC and coelaic disease

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146
Q

What is the socrates of heartburn?

A

Chest pain is burning

Radiates upwards

Perciciptated by lying flat or bending foward

Associated symptoms: Waterbrash, taste of acid appearing in the mouth

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147
Q

What is used to classify dyspepsia?

A

Reflux like dyspepsia

Ulcer like dyspepsia

Dysmotility like dyspepsia

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148
Q

What is odynophagia?

A

Pain on swallowing

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149
Q

What is the SOCRATES for peptic ulcer?

A
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150
Q

What is the SOCRATES for biliary colic

A
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151
Q

What is the SOCRATES for acute pancreatitis

A

Site is the epigastrum/left hypochondrium

Onset is sudden

Character is constant

Radiation is into back

Associated sym,ptoms is non specific

Frequenct attacks can be enumerated

Special times- After heavy drinking

Duration is more than 24 hours

Exacervating- Alcohol and eating

Relieving is sitting upright

Severe

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152
Q

What is the SOCRATES for renal colic

A

S- Loin

O- Rapid increasing

C- Constant

R- Into genitalia and inner thigh

A- Non specific

Frequency- Usually a discrete period

Special times- Following periods of dehyration

T- 4-24 hours

E

S- Severe

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153
Q

What are the history symptoms of acute apendicitis?

A

Nausea

Vomiting

Abdominal pain that later shifts to right iliac fossa

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154
Q

What are the history symptoms of perforated pelvic ulcer with acute peritonitis?

A

Vomiting at onswt associated with severe acute onset abdominal pain

Previous history of dysphagia

Ulcer disease

NSAIDS

Glucocorticoid therapy

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155
Q

What are the history symptoms of acute pancreatitis

A

Anoreixa

Nausea

Vomiting

Constant severe epigastric pain

Previous alcojol abuse/choleithiasis

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156
Q

What are the history symptoms of ruptured aortic anyerusm

A

Sudden onset of severe tearing back/loin/abdominal pain

Hyoitension and past history if vascular disease

High BP

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157
Q

What are the history symptoms of acute mesenteric ischemia?

A

Anorexia

Nausea

Vomiting

Blood diarrhoea

Constant abdominal pain

Previous history of vasciaular disease

High BP

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158
Q

What are the history symptoms of intestinal obstruction

A

Colicky central abdominal pain

Nausea

Viomutunbg and constipation

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159
Q

What are the history symptoms of ruptured ectopic pregnancy?

A

Premenopausal female

Delayed or missed menstral period

Hypotension

Unilateral iliac fossa pain

Oleuritic shoulder tip pain

Prune juice like vaginal dischare

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160
Q

What are the history symptoms of pelvic inflammatory disease?

A

Sexually active young female

Previous history of SRI

Recent gynaecological procedure

Pregancny

Pregnancy

use of IUD

Dyspaneuria

Lower of central abdominal pain

Backache

Pleuritic chest pain

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161
Q

What are the examinations of the acute appendicitis?

A

Fever

Tenderness

Guarding or palpable mass in right iliac fossa

Pelvic peritonitis on rectal examination

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162
Q

What are the examinations of the perforated peptic ulcer with acute peritonitis?

A

Shallow breathing with minimal abdo,omal witrh movement

Abdomional tenderness and guarding board like rigitdity

Abdominal distenstion and absent bowel sounds

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163
Q

What are the examinations of the acute pancreatitis?

A

Fever

Periumbiliacal or loin bruising

Epigastric tenderness

Variable guaridng

Reduced or absent bowel sounds

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164
Q

What are the examinations of the rupture aortic aneurysm?

A

Shock and hypotemsion

Puslatile, tender, abdominal mass

Asymmetrical femoral pulses

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165
Q

What are the examinations of the acute mesenteric ischemia

A

AF

HF

Asymmetrical peropheral pulses

Absent bowel sounds

Variable tenderness an guarding

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166
Q

What are the examinations of the intestinal obstruction?

A

Surgical scars

Hernias

Mass

Distension

Visible peristalsis

Increased bowel sounds

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167
Q

What are the examinations of the ruptured ectopic pregnancy?

A

Suprapubic tenderness

Periumbilical brusing

Pain and tenderness on vaginal exmaintion

Swelling/fullness in fornix on vaginal examination

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168
Q

What are the examinations of the PID?

A

Fever

Vaginal discharge

Pelvic peritnonitis causing tenderness on rectal exmaintion

RUQ tenderness

Pain/tenderness on vaginal examination

Swlling/fullness in fornix on vaginal examination

169
Q

What drugs cause weight gain?

A

Oral glucocorticoids

170
Q

What drugs cause dyspepsia and GI bleeding?

A

Aspirtin

NSAIDS

171
Q

What drugs cause nausea?

A

Many drugs

Including SSRIs

172
Q

What drugs cause diarrhoea?

A

Antibiotics

PPIs

173
Q

What drugs cause concstipation?

A

Opioids

174
Q

What drugs cause jaundice hepatitis?

A

Paracetemol

Pyrazinamide

Rifampicin

Isoniazid

175
Q

What drugs cause jaundice cholesttic?

A

Flucloxacillin

Chloropromazine

Co-amoxiclav

176
Q

What drugs cause liver fibrosis?

A

Methotrextaee

177
Q

What is an indirect inguinal hernia?

A

Bulges through internal ring and follows course of inguinal canal

178
Q

What is a direct inguinal hernia?

A

At the sit of muscle weakness in posterior wall of inguinal canal

179
Q

What is the cause of abnomrally pale stool?

A

Biliary obstruction

180
Q

What is the cause of abnomrally pale and grassy stoool?

A

Steatorrhoea

181
Q

What is the cause of black and tarry

A

Bleeding from upper gi tract

182
Q

What is the cause of grey/black

A

Oral iron or bismuth therapy

183
Q

What is the cause of silver

A

Steatorrhoea pul upper gi bleeding

184
Q

What is the cause of fresh blood in or on stool

A

Large bowel, rectal or anal bleeding

185
Q

What is the cause of stool mixed with pus

A

Infective colitis or IBD

186
Q

What is the cause of rice water stool

A

Cholera

187
Q

What are the vasovagal syncope triggers, prodome, duration of unconciousness, convulsion, colour, injuries and revovery

A

Triggers- Tyoucally pain, illness, emotion

Prodome- Feeling faint/lightheaded, nausea, tinnitus, vision dimming

Duration of unconsioussness- Less then 60 seconds

Convulsions- May occyr but usually brief myoclonic jerks

Colour- Pale/grey

Injuries- Uncommon. Sometimes biting tip of tongue

Recovery- Rapid, no confusion

188
Q

What are the seizure triggers, prodome, duration of unconciousness, convulsion, colour, injuries and revovery

A

Triggers- Often none

Prodome- Focal onset

Duration of unconsioussness- 1-2 minutes

Convulsions- Usual tonic clinic. 1-2 minutes

Colour- Flushed/cyanosed, may be pale

Injuries-lateral tongue biting, headache, generalised myalgia, back pain

Recovery- Gradual over 30 minutes

189
Q

What are the clinical features of GCA

A

Painless loss of vision

More than 50 years

Weight loss

Loss of aptitie, fatigue

Jaw or tongue claudication

Temporal headach

Pale or swollen optic disc

RAPD

190
Q

What are the clinical features of vitreous haemorrhage?

A

Painless loss of vision

Risk in poligerative diabetic retinopathy

Hisotry of flashing lights or floaters may precede haemorrhage in posterior vitreous attachment

Poor fundus view on examination

Reduction or loss of red reflex

191
Q

What are the clinical features of central retinal vein occlusion?

A

Acute painless loss of vision

May have RAPD if severe

Greater risk if hypertensive

Haemorraheg exudates and tortuous retainal veins

192
Q

What are the clinical features of wet age related acular defeneration?

A

Sudden painless loss of central vision

Age more than 55

Increased risk in smokers

Haemorrhages at the macula

193
Q

What are the clinical features of retinal detachment?

A

Painless loss of vision

Associated with flashing lights or floaters

History of curtain coming across vision

Myopuv patients at greater risk

RAPD if macula is involved

Pale raised retiana usually with a retinal tear

194
Q

What are the clinical features of anterior ischemic optic neuropathy?

A

Painless loss of upper or lower visual field

Increaased risk of vasculopaths

Examination may reveal optic disc swelling

195
Q

What are the clinical features of central retinal arterial occlusion

A

Acute, painless loss of visin

Carotid bruit may be ehatd

Increased risk in vasculopaths

Examination: Pale retina with a cherry red spot at the fovea

196
Q

What are the clinical features of optic neuritis/retrobular neuritis

A

Visual reduction over hours

20-50

Pain exacerbated by eye movement

RAPD

Reduced colour sensitivity

Swollen optic disc in optic neuritis

197
Q

What are the clinical features of corneal disease

A

Usual association with pain

Foreign body sesnation

Corneal opacity may be visible

198
Q

What are the clinical features of amaurosis fungax?

A

Painless loss of vision for minutes

History of CVD

May have association AF or carotid bruit

Normal ocular examination

199
Q

What are the clinical features of refractive error

A

No associated symptoms

Normal ocular examination

Vision can be improved by pinhole

200
Q

What are the clinical features of glaucoma

A

Usually bilateral but asymmetrical los of visual feild

Cupped optic discs on examination

201
Q

What are the clinical features of cataract

A

Gradual clouding of vision

May be associated with glare

Seen in elderly

Examintion clouding of the pupil and altered red reflex

202
Q

What are the clinical features of diabetic maculopathy

A

Histroy of diabetes

Central vision reduced or distorted

Haemorrhages and exudates at the macula on examination

203
Q

What are the clinical features of compressive optic neuropathy

A

Gradual unilateral loss of vision

Pale optic disc

204
Q

What are the clinical features of retinitis pigmentosa

A

Gradual bilateral symmetrical loss of poeripheal visual field

Nuctalopia

FH

Bone spicule fundus, attenuated blood vessels and waxy optic disc

205
Q

What are the clinical features of dry age related macular degeneration

A

Gradual loss of central vision

Bilateral

Examintion: Drusen, atrophy and pigmentation of the macula

206
Q

What do flashers and floaters result from?

A

Disturbance of the vitreous and the reinsa, occurring most commonly in posterior vitreous detachment

207
Q

What are the clinical features of blocked gland on lid?

A

Pain on lid

Tenderness to touch

Occular examination: redness and swelling of lid

208
Q

What are the clinical features of corneal foreign body

A

Foreign body sensation

Watery eye

Photpphobia

Ocular examination

209
Q

What are the clinical features of corneal infection

A

Foreign body sensation

Photophobia

Red eye

Ulcer on cornea which can be highlighted with fluorescien stainning

Ocular examination: white infiltrate may be visible

210
Q

What are the clinical features of scleritis

A

Severe pain that keeps the patient awake at night

Soreness of the eye to touch

Association with recent infection, surgery or rheumatic disease

Ocular examination: sclera injection

211
Q

What are the clinical features of angle closure glaucoma

A

Constant pain around eye

Acute reduction in vision

Possibly haloes seen around lighyd

Asssociated with nausea and vomiting

Ocular examination: fixed mid dilated pupil, hazy cornea and usually a cataract

212
Q

What are the clinical features of conjunctivitis?

A

increased clear or purulent discharge

Ocular examination: red eye

Vision is usually unaffected

213
Q

What are the clinical features of uveitis

A

Floaters

Blurry vision

Photophobia

Ocular examination: ciliary flush

214
Q

What are the clinical features of optic neuritis?

A

Reduction in vision

Reduction in colour sensitivity

Constant pain worsened by eye movement

Ocular examination: swolen disc in optic neuritis

Normal disc in retrobulbar neutiritds

215
Q

What are the clinical features of orbital cellulitis

A

Constant ache around the eyes

Reduced vision

Double vision

Associated with a recent viral infection

Ocular examintion- conjunctival chemosis and injection, restrictive eye movement in severe cases visual reduction with RAPD

216
Q

What are the clinical features of thyroid eye disease?

A

Symptoms of hyperthyrodisim

Sore, gritty eyes

Double vision

Ocular eamointion: lid retraction, proptosis, restricted eye movements and conjunctival injection, conjunctival chemosis

217
Q

What are monocular causes of double vision?

A

High astigmatism

Cornal opacity

Abnormal lens

Iris defect

218
Q

What are binocular causes of double vision?

A

Myaesthenia gravis

VI, IV, III nerve palsy

Internuclerar opthalmoplegoa

Thyroid eye disease

Complex or combined palsy

Severe orbital cellulitis or orbital inflammation

219
Q

What are causes of increased discharge from the eyes?

A

Bacterial conjunctiitis

Viral conjunctivitis

Blocked tear duct

Foreign body

Allergic conjunctivitis

Blepharitis

Poor tear film/dry eyes

220
Q

What are the common causes of periorbital swelling?

A

Infective

Inflammatory

Neoplastic

Systemic

Vascular

Pseudoproptosis

221
Q

What are the associated distinguishing features of horner’s syndrome?

A

Ptosis

Miosis

Eye movement spared

222
Q

What are the associated distinguishing features of cranial nerve III palsy

A

Dilated pupil

Eye movement affected

223
Q

What are the associated distinguishing features of myotonic dystrophy?

A

Frontal balding, sustained handgrip

224
Q

What are the associated distinguishing features of chronic progressive external opthalmoplegia

A

Bilateral ptosis and impairment of eye movements

Often without diplopia

Sparing of pupil reflexes

225
Q

What are the associated distinguishing features of oculopharyngeal dystrophy?

A

History of swallowing abnormalities

226
Q

What are the associated distinguishing features of myasthenia gravis?

A

History of variable muscular failure

227
Q

What are the associated distinguishing features of eyelid tumour?

A

Evident on inspecrion

228
Q

What are the associated distinguishing features of eyelid inflammation/infection

A

Evident on inspection

229
Q

What are the associated distinguishing features of trauma of eyelid?

A

Scarring/history of trauma

230
Q

What are the associated distinguishing features of levator aponeuorisis degeneration?

A

Often unilateral, eye mvoement normal

231
Q

What are the associated distinguishing features of long term contact lens wear

A

History of contact lens use

232
Q

What are the causes of dilated pupil?

A

Cranial nerve III pa;sy

Physiological

Pharmacological treatment with a dilating agent

Post surgival

Adie’s tonic pupil

233
Q

What are some causes of constricted pupil?

A

Horner’s syndrome

Mechnaical

Physiological

Late stage Adie’s tonic pipil

Pharmacological treatment with a constricting agent

234
Q

What are the causes of the unilateral optic disc swelling??

A

Optic neuritis

Anterior ischemic optic neuropathy

Syphilis

Lyme disease

Bartonella

Sarcoidosis

Leukemia

Optic nerve glioma

Secondary metastases

235
Q

What are the causes of the bilateral optic disc swelling

A

Papilloeema

Pseudopapilloedemia in hypermetropes

Optic disc drusen

Diabetic papillitis

Hypersensitve papillopathy

236
Q

What are the differential diagnosis of optic disc pallor?

A

Inherited- congenital optic atrophy including leber’s and behr’s

End stage glaucoma

Trauma

Compressive- Orbital neoplasm, Thyroid eye disease and Orbital cellulitis

Neurological- End stage papilloedema, devic’s disease

Metabolic- Nutritional deficiency, ethambutol, dm

Vascular- Central retianl artery occlusion, GCA

Inflammatory- Meningitis, post optic neuritis

237
Q

What are the clinical features of acute otitis external?

A

Pain worse on touching outer ear, tragus

Swelling of ear canal

Purulent discharge and itching

238
Q

What are the clinical features of acute otitis media?

A

Severe pain, red, bulging tympaninic membrane, purulent discharge if tympanic membernae perforation preset

239
Q

What are the clinical features of perichondritis

A

Erythmeanous, swollen pinna

240
Q

What are the clinical features of trauma fo the ear?

A

Pinna haematoma, pinna laceration, haemotympanum, CSF leak of facial nerve pasly may be present

241
Q

What are the clinical features of herpes zoster?

A

Vesicles in ear canal, facialn nerve palsy may be present, vertigo in common

242
Q

What are the clinical features of ear malignancy?

A

Mass in ear canal or on pinna

243
Q

What are the clinical features of tonsillitis and peritonsillar abscesses

A

Sore throat, tonsil inflammation

Trismus, soft palate swelling in peritonisllar abscess

244
Q

What are the clinical features of tmj dysfunction?

A

Tenderness

Clicking of joint on jaw opening

245
Q

What are the clinical features of dental disease?

A

Toothache

246
Q

What are the clinical features of cervical spine disease?

A

Neck pain/tenderness

247
Q

What are the clinical features of cancer of the pharynx or larynx

A

Associated sore throat, hoarseness, dysphagia, weight loss and neck lump

248
Q

What are causes of conductive hearing loss?

A

Wax

Otitis externa

Middle ear effusion

Trauma to the tympanic membrane/ossicles

Otosclerosis

Chronic middle ear infection

Tumours of the middle ear

249
Q

What are the clinical features of sensorineural hearing loss?

A

Genetic

Prenatal infeciton

Birth injury

Infection

Trauma

Menieres disease

Degenerative

Occuptation

Acousitc neuroma

Idiopathic

250
Q

What are the duration, hearing loss, tinnotis, aural fullness, episodic triggers of benign paroxysmal positional vertigo

A

duration- Seconds

hearing loss- no

tinnotis- no

aural fullness- no

episodic- yes

triggers- lying on affected ear

251
Q

What are the duration, hearing loss, tinnotis, aural fullness, episodic triggers of vestibular neuritis

A

duration- days

hearing loss- no

tinnotis- np

aural fullness- no

episodic- rarely

triggers- possible presence of upper respiratory symptoms

252
Q

What are the duration, hearing loss, tinnotis, aural fullness, episodic triggers of menieres disease

A

duration- hours

hearing loss0 yes

tinnotis- yes

aural fullness- yes

episodic- Recurrent vertigo, persistent tinnitus and progressive sensorineural deafness

triggers- None

253
Q

What are the duration, hearing loss, tinnotis, aural fullness, episodic triggers of central vertigo

A

duration- Hours- migrane. Days and weeks- MS. Long term- cerebrovascular accident

hearing loss- No

tinnotis- no

aural fullness- no

episodic- migrane- recurs. CNS demage- usually some recovery but often persistent

triggers- drugs

254
Q

What is nystagmus?

A

Involuntaru rhytmic oscillation of the eyes

255
Q

What are the clinical pathology and characteristics of peripheral nystagmus

A

Clinical- SSC, vestibular nerve

Unidirectional

Not suppressed by optic fixation

Patient too dizzy to walk

Dix halpike fatigue on repetition

Away from affected side

256
Q

What are the clinical pathology and characteristics of central nystagmus?

A

Brainstem, cerebellum are affected

Bidirectional

Suppressed by optic fixation

Patient can walk

Dix hallpike persists

To either side is nyastmus

257
Q

What are the clinical pathology and characteristics of dysconjugate nystagmus

A

Interconnectons of III, IV and VI nerves are affected

Typically affects the abducting eye

Maximal on looking to either side

258
Q

What are the clinical pathology and characteristics of pendular nystagmus type?

A

Eyes are effect

No fast phase

Looks straight ahead

259
Q

What are the features of congenital abnormalities of dysphonia?

A

Larynfomalacia

More common in preterm neonates

Associated stridor due to immature larynx folding in on indpsiration

260
Q

What are the features of neurological disorder in dyshonia

A

Vocal cord palsy

Unilareral causing weak

Breathy cry

Bilateral may cause stridor and airway obstruction

261
Q

What are the features of croup?

A

Barking cough

Stridor

Hoarse voice

262
Q

What are the features of laryngitis?

A

Bacterial or viral

263
Q

What are the features of voice abuse?

A

History of voice abuse

264
Q

What are the features of upper respiratory tract infection and laryngitis?

A

Associated features of upper respiratory tract infection

265
Q

What are the features of trauma of dysphonia?

A

Mechanical or chemical injury

Cigarette smoking

GORD

266
Q

What are the features of dysphonia in lung cancer?

A

Vocal cord paralysis

Breatrhy voice

267
Q

What are the features of dysphonia in vocal cord nodules

A

Prologned vocal straon

Rough voice

Reduced vocal range

Vocal fatigue

268
Q

What are the features of dysphonia in neurological disorder?

A

Weak, wet or dysarthric voice

269
Q

What are the features of dysphonia in cancer of the larynx

A

Rough voice

Constant progressive often affects smokers

Associated with dysphagia, odynophagia and otalgia

270
Q

What are the clinical features of a thyroglossal cyst

A

Smooth, round, cystic lymp that moves when patient sticks out tongue

271
Q

What are the clinical features of a submental lymph nodes?

A

Associated infectipn of lower lip, floor of mouth, tip of tongue or cheek skin

272
Q

What are the clinical features of a thyroid isthmus swelling

A

Lump moves on swallowing

273
Q

What are the clinical features of a dermoid cyst

A

Small, non tender, mobile subcutanous lump

274
Q

What are the clinical features of a thyroid lobe swelling

A

Lump moves with swallowing but not on tongue protrusion

275
Q

What are the clinical features of a submandibular gland swelling?

A

Swelling below the angle of the mandible

Can be felt bimanually

276
Q

What are the clinical features of a parotid gland swelling

A

Swelling in the preauricular area or just below the ear

277
Q

What are the clinical features of a parotid gland mass

A

Hard, fixed mass with facial nerve weakness suggests a malignant tumour of the parotid gland

278
Q

What are the clinical features of a brachial cyst

A

Smooth, non tender, fluctuant mass

Not translucent

Slowly enlarging may increase after URTI

279
Q

What are the clinical features of a malignant lymph nodes?

A

Large

Hard

Fixed

Matted

Painless mass suggests malignancy

280
Q

What are the clinical features of lymph nodes during infection?

A

Lymph nodes can be reactive to infectio and are usually smooth, firmly, mobile and tender

281
Q

What are the clinical features of carotid body tumour?

A

Firm, rubbery, pulsatile neck mass, fixed verticully due to attachment to bifurcation of common carotid

Bruit may be predent

282
Q

What are the clinical features of carotid artery aneurysm?

A

Rare, present as pulsatile neck mass

283
Q

What are the clinical features of cystic hygroma

A

Soft, fluctuant, compressible and transilluminable mass, usually seen in children

284
Q

What are the clinical features of cervical ribs

A

Hard, bony mass

285
Q

What are the clinical features of supraclavicular lymphadenopathy?

A

Left supraclavicular node may suggest gastric malignancy

286
Q

What is the differential diagnosis of tiredness

A

Hypothyroidism

Hyperthyrodism

DM

Hypopituitarism

287
Q

What is the differential diagnosis of weight gain

A

Hypothyroidism

PCOS

Cushings syndrome

288
Q

What is the differential diagnosis of weight loss

A

Hyperthyrodisim

DM

Adrenal insufficiaency

289
Q

What is the differential diagnosis of diarrhoea

A

Hyperthryodism

Gastrin producing tumour

Carcinoid

290
Q

What is the differential diagnosis of diffuse neck swelling

A

Simple goitre

Graves disease

Hashimotos thyroiditis

291
Q

What is the differential diagnosis of polyuria?

A

DM

DI

Hyperparathyroisidm

Conn’s syndrome

292
Q

What is the differential diagnosis of hirsutism

A

Idiopathic

PCOS

Congenital adreanl hyperplasia

Cushings syndrome

293
Q

What is the differential diagnosis of funny turns or spells

A

Hypoglucemia

Phaeochromocytoma

Neuroendocrine tumour

294
Q

What is the differential diagnosis of sweating

A

Hyperthryodism

Hypogonadism

Acromegaly

Phaeochromocytoma

295
Q

What is the differential diagnosis of flushing

A

Hypogonadism

Carcinoid syndromes

296
Q

What is the differential diagnosis of resistant hypertension

A

Conns syndrome

Cushings syndrome

Phaeochromocytoma

Acromegaly

297
Q

What is the differential diagnosis of amenorrhoea/oligomenorrhea

A

PCOS

Hyperprolactinaemia

Thyroid dysfunction

298
Q

What is the differential diagnosis of erectile dysfunction

A

Primary or secondary hypogonadism

DM

Non endocrine systemic disease

Medication induced

299
Q

What is the differential diagnosis of muscle weakness

A

Cushings syndrome

Hyperthyrodism

Hyperparathyrodisms

Osteomalacia

300
Q

What is the differential diagnosis of bone fragility and fractures?

A

Hypogonadism

Hyperthyrodism

Cushings syndrome

Primary hyperparathyrodism

301
Q

What is the SOCRATES of uterine pain

A

S- Midline

O- Builds up before periods

C- Cramping

R- Lower back and upper thighs

A- Bleeding from vagina

T- With menstration

E

S- Variable in spasms

302
Q

What is the SOCRATES of ovarian pain

A

S- Left or right iliac fossa

O- Sudden, intermittent

C- Gripping

R- Groin, if free fluid to shoulder

A- Known cyst, pregnancy, irregular cycle

T- May be cyclical

E- Positional

S- Intense

303
Q

What is the SOCRATES of adhesions or pelvic infection

A

S- Generalised lower abdomen. More on one side

O- Builds up, acute on chronic

C- Shooting, gripping

R- None

A- Discharge, fever, past surgery

T- Acute, may be cyclical

E- Movement, examination

S- Intense in waves

304
Q

What is the SOCRATES of endometriosis

A

S- Variable

O- Builds up, sudden

C- Shooting, cramping

R- None

A- Infertility

T- Builds up during period

E- Intercourse, cyclical

S- Variable

305
Q

What is dyspanunia?

A

Pain during intercourse

306
Q

What should you ask about dyspanunia?

A

Is it around vaginal entrance or deep

307
Q

What is vaginismus?

A

Pain due to involuntary spasm of muscles at the vaginal entrance

308
Q

When does stress incontinence occur?

A

Occurs on excretion, coughing, laughing or sneezing

309
Q

What is urge incontience?

A

Overwhelming desire to urinate when the bladder is not full due to detrusor muscle dysfunction

310
Q

What is tamoxifen?

A

Has oestrogenic effects in postmenopausal women

311
Q

What is the routine examination sequence for a pregnancy checkup

A

Calculate MI

MSSU

BP

Physical exam

312
Q

When should an MSSU be done and what does it do?

A

Booking. always sent

Detects asymptomatic bacteruria

313
Q

When should an urinalysis be done and what does it do?

A

Every visit

Trace or proteinuria: Send MSU, ask about symptoms or UTI

Lots of proteinuria. Consider pre-eclampsia or, rarely underlying renal disorder

Glycosuria: Consider random blood glucose or glucose tolerance test

314
Q

When should an FBC be done and what does it do?

A

Booking, 28 weeks, 36 weeks

If haemoglobin is less than 105, treat; consider checking haematinic

315
Q

When should an haemoglobin electrophoresis be done and what does it do?

A

Booking. To check for sickle cell disease and thalaseemia

316
Q

When should a blood group and antibody screen be done and what does it do?

A

Bookig, 28 weeks

More often if advised by labratory

317
Q

When should an hep B be done and what does it do?

A

Booking

If the patient is a previous intravenous drug absuer or is known to be HIV or hep B positive also carry out hep C screening

318
Q

When should an HIV screening be done and what does it do?

A

Booking

Unless the patient opts out

319
Q

When should an syphilis screening be done and what does it do?

A

Booking

320
Q

When should an plasma glucose screening be done and what does it do?

A

Booking

321
Q

When should an carbon monoxide level screening be done and what does it do?

A

Every visit for smpkers

Advice and referral for cessation, growth scans

322
Q

When should a combined biochewmical screening and nuchal translucency measurement for trisomy 21 be done and what does it do?

A

11-14 weeks

Detects 80-90% of affected pregnancies

323
Q

When should an first trimester US screening be done and what does it do?

A

6-13 weeks

Viability, gestational age more or less than 7 days

Fetal number

Some major anomalies

324
Q

When should an detailed US scan be done and what does it do?

A

18-22 weeks

Detects 90% of major congenital abnormalities and placental site

325
Q

When should a placental site check be done and what does it do?

A

If low at 20 weeks, recheck later at 34 weeks

If there is an anterior placenta in a woman who has had a previous C section, recheck the scan at 28 weeks to consider the risk of placenta acreta

326
Q

When should a growth scan be done and what does it do?

A

After 24 weeks; can be as often as 2-4 weekly

Previous growth restricted baby. other risk factors, measurement of a small for dates baby, reduced fetal movements

327
Q

When should an presentation scan be done and what does it do?

A

After 36 weeks

If there is concern that presentation is not cephalic

328
Q

When should an amniocentesis be done and what does it do?

A

15 weeks onwards

For fetal karyotype; 0.5-1% risk of miscarriage

329
Q

When should an free fetal DNA maternal test be done and what does it do?

A

End of first triemster

To detect trisomy: current guidance advocates use of screening test only

330
Q

What happens to the size of the uterus during pregnancy?

A

Increases

At 20 weeks the uterine fundus is at the umbilicus

By 36 weeks it reaches the xiphisternum

331
Q

When should vaginal examination not be done?

A

In pregnancy unless there is a specific indication. Never perform a vaginal examination after 20 weeks unless the placental location is known not to be low

332
Q

What do diuretics cause?

A

Contribute to urinary symptoms

333
Q

What can alpha blockers cause?

A

Retrograde ejaculation

334
Q

What can antihypertensive agents cause?

A

Erectile dysfunction

335
Q

What can vasoactive agents cause?

A

Such as alprostadil, may result in a prolonged erection

336
Q

What can antidepressants or antipsychotics cause?

A

May affect sexual function

337
Q

What is variocele?

A

Dilation of the veins of the pampiniform plexus and feels like a bag of worms

338
Q

What is a hydrocele?

A

Swelling caused by fluid in the tunica vaginalis.

Usually idiopathic but may be secondary to inflammatory conditions or tumours

339
Q

What is epididymal cysts?

A

Swelling of the epididymis that are felt to be completely separate from the body of the testis are epididymal cysts

Transilluminate and are never malignant

340
Q

What are testicular tumours?

A

Painless, hard swelling of the body of the testis

341
Q

What are epididymitis?

A

Inflammation of the epididymis produces painful epidiymal swellig, most often caused by an STI in young men, or a coliform urinary infection in the eldarly

342
Q

What is testicular torsion?

A

Retracted or high lying testicle, accompanies by acute pain and swelling

Occurs in testicular torsion

343
Q

What are the extra articular signs of rheumatoid arthritis?

A

Rheumatoid nodules

Palmar erythema

Episcleitis

Dry eyes

Intertsitial lung disease

Pleural witjh or withoput perciardial effusion

SMall vessel vasculitis

Raynud’s phenomenon

Low grade fever

Weight loss

Lymphadenopathy

Splenomegaly

Leg ulcers

344
Q

What are the extra articular signs of psoriatic arthrisi

A

Psoriasis

Nail pitting

Onycholysis

Enthesititis

Dactylitis

345
Q

What are the extra articular signs of reactive arthritis

A

Urethritis

Mtuh and or genital ulcers

Conjuncittis

Iritis

Enthesitis

346
Q

What are the extra articular signs of axial spondyloartheitis

A

IBD

psoriasis

Enthesititis

Iritis

Aortic regurgitiation

Apical intersittial fibrosis

347
Q

What are the extra articular signs of septic arthtitis

A

Fever

Malaise

Source of sepsis

348
Q

What are the extra articular signs of gout

A

Tphi

Signs of renal failure of alcoholic liver disease

349
Q

What are the extra articular signs of sjorgrens syndrome

A

Dry eyes

Xerostomia

Salivery gland enlargement

Raynaud’s phenomenon

Neuropathy

350
Q

What are the extra articular signs of SLE

A

Photosenstivie rash

Mucucotaneous ulcers

Alopecia

Fever

Pleural with or without pericardial effusion

Diaphragmatic paralysis

Pulmonary fiboris

Raynaud’s phenomenon

Lymphopenia

351
Q

What are the extra articular signs of systemic sclerosis?

A

Skin tightening

Telangievtasia

Raynaud’s phenomonenon

Calcifiec deposits in fingers

Dilated nail-fold capullaries

Pulmonary fibrosis

352
Q

What are the extra articular signs of adult- onsent Still’s disease?

A

Rash, fever, hepatomegaly, splenomegaly

353
Q

What are the adverse musculoskeletal effects of glucocricoids

A

Osteoporosis

Myopathy

Osteonecrosis

Infection

354
Q

What are the adverse musculoskeletal effects of statins?

A

Myalgia

Myositis

Myopahty

355
Q

What are the adverse musculoskeletal effects of ACEI

A

Myalgia, arthralgia, postivie antinuclear antibody

356
Q

What are the adverse musculoskeletal effects of antiepilaptoics

A

Osteomalacia

Arthraliia

357
Q

What are the adverse musculoskeletal effects of immunosuppressants

A

Infections

358
Q

What are the adverse musculoskeletal effects of quinolones

A

Tendinopathy

Tendon rupture

359
Q

What is the defenition of abscess

A

A collection of pus, often associatied with signs and symptoms of inlammation

360
Q

What is the defenition of angioedema

A

Deep swelling (oedema) of the dermis and subcutis

361
Q

What is the defenition of annular?

A

Ring like

362
Q

What is the defenition of arcurate

A

Curved

363
Q

What is the defenition of atrophy

A

Thinning of on eor more layers of the skin

364
Q

What is the defenition of blister

A

A liquid filled lesion

365
Q

What is the defenition of bulla

A

Large blister

366
Q

What is the defenition of burrow

A

Track left by burrowing scabies mite

367
Q

What is the defenition of callus

A

Thicekened area of skin that is a response to repeated friction or pressure

368
Q

What is the defenition of circinate

A

Circular

369
Q

What is the defenition of comedo

A

Blackhead

370
Q

What is the defenition of crust

A

A hard, adherent suface change caused by leakage and drying of blood, serum or pus

371
Q

What is the defenition of cyst?

A

Fluid filled papular lesion that fluctanes and transillumionates

372
Q

What is the defenition of discoid

A

Disc like

373
Q

What is the defenition of ecchymosis

A

Deep bleed in skin

374
Q

What is the defenition of erosion

A

Superficial loss of skin, involving the epidermis, scarring is not normally a result

375
Q

What is the defenition of erythma

A

Redness of the skin that blanches on pressure

376
Q

What is the defenition of erythroderma

A

Any inflammatory sjkin disease thart affects more than 80% if the body surface

377
Q

What is the defenition of exanthem

A

Rash

378
Q

What is the defenition of excoriation

A

Scratch mark

379
Q

What is the defenition of fissure

A

A split, usually extending from the skin surface through the epidermis to the dermis

380
Q

What is the defenition of freckle

A

An area of hyperpigmentation that increases in the summer months and. decreases during winter

381
Q

What is the defenition of furuncle

A

A boil

382
Q

What is the defenition of gyrate

A

Wave like

383
Q

What is the defenition of haematoma

A

Swelling caused by a collection of blood

384
Q

What is the defenition of horn

A

Hyperkeratotic projection from the skin surface

385
Q

What is the defenition of hyperkeratosis

A

Thickening of the stratum corneum

386
Q

What is the defenition of ichthyosis

A

Very dry skin

387
Q

What is the defenition of keratosis

A

Lesion characterised by hyperkeratosis

388
Q

What is the defenition of lentigo

A

Area of fixed hyperpigmentation

389
Q

What is the defenition of lichenification

A

Thickening of the epidermis, resulting in accentuation of skin markings. Usually indicative of a chronic eczematous process

390
Q

What is the defenition of macule

A

Flat colour change

391
Q

What is the defenition of millium

A

Keratin cyst

392
Q

What is the defenition of naevus

A

Localised development defect

393
Q

What is the defenition of nodule

A

Large papule

394
Q

What is the defenition of nummular

A

Coin shaped

395
Q

What is the defenition of onycholysis

A

Seperation of the nail plate from the nail bed

396
Q

What is the defenition of papilloma

A

Benign growth projecting from the skin surface

397
Q

What is the defenition of papule

A

Elevated lesion, arbitrarily less than 0.5 cm in diameter

398
Q

What is the defenition of patch

A

Large macule

399
Q

What is the defenition of pedunculate

A

Having a stalk

400
Q

What is the defenition of petechiae

A

Pin head sized macular purpura

401
Q

What is the defenition of pigmnetation

A

Change in skin colour

402
Q

What is the defenition of plaque

A

A papule or nodule that in cross sectional profile is plateau shaped

403
Q

What is the defenition of poikiloderma

A

A combination of atrophy, hyperpigmentation and telangiectasia

404
Q

What is the defenition of purpura

A

Non blachable redness

405
Q

What is the defenition of pustule

A

A papular lesion containing turbid purulent material

406
Q

What is the defenition of reticulate

A

Net like

407
Q

What is the defenition of scale

A

A flake on the skin surface, composed of stratum corneum cells, shed together rather than individually

408
Q

What is the defenition of scar

A

The fibrous tissue resulting from the healing of a wound, ulcer or certain inflammatory conditions

409
Q

What is the defenition of serpiginous

A

Snake like

410
Q

What is the defenition of striae

A

A strethc mark

411
Q

What is the defenition of targetoid

A

Target like

412
Q

What is the defenition of telangiectasia

A

Dilated blood vessels

413
Q

What is the defenition of ulcer

A

A deep loss of skin, extending into the dermis or deeper, usually results in scarring

414
Q

What is the defenition of umbilication

A

Depression at the centre of a lesion

415
Q

What is the defenition of verrucous

A

Wart like

416
Q

What is the defenition of vesicle

A

Small blister

417
Q

What is the defenition of wheal

A

A transient, itchym elevated area of skin resulting from dermal oedema that characrises urticaria

418
Q

What is the defenition of xerosis

A

Mild/moderate dryness of the skin

OSCE (45 decks)

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