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OSCE prep > Diseases > Flashcards

Diseases Flashcards

1
Q

What is unstable angina?

A

Angina of recent onset or when symptoms frequently occur at rest, or increase in frequency or severity.

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2
Q

What are the key symptoms of angina?

A 
Chest pain (or discomfort)--> Worse on exertion and relieved by rest/ GTN spray
Pain that radiates to arms, neck or jaw
Dyspnoea (SOB)
Nausea
Sweating
Feeling faint/ dizzy
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3
Q

What key investigations would be done into angina?

A

ECG
CT coronary angiography
FBC

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4
Q

How is angina managed?

A

Modify risk factors
GTN spray, aspirin, statins, beta blockers, CCB
PCI or CABG if needed

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5
Q

Key presentation of MI?

A 
Chest pain/ burning/ squeezing
Breathlessness
Anxiety
Pale, clammy
Sweating
Nausea
Vomiting
Dyspnoea
Palpitations
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6
Q

How is a STEMI treated?

A

Primary PCI
Thrombolysis (if no PCI in 2 hours)
CABG

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7
Q

How is an NSTEMI treated?

A 
Beta blockers
Aspirin
Ticagrelor
Morphine
Anticoagulant
Nitrates
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8
Q

What are the causes of heart failure?

A 
Ischaemic heart disease
Cardiomyopathy
Valvular heart disease
Cor pulmonale
Hypertension
Alcohol excess
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9
Q

Key presentations of heart failure?

A

Shortness of breath
Fatigue
Peripheral oedema
Dyspnoea/ orthopnoea

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10
Q

Key investigation that indicates heart failure?

A

BNP (Brain natriuretic peptide= secreted by ventricles in response to increased myocardial wall stress)

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11
Q

Key presentations of mitral stenosis?

A

Progressive dyspnoea
Haemoptysis
Right heart failure

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12
Q

Key cause of mitral stenosis?

A

Rheumatic heart disease (secondary to rheumatic fever)

Infective endocarditis

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13
Q

Key presentation of aortic stenosis?

A 
ELDERLY
Chest pain
Exertional dyspnoea
Syncope
Angina
Heart failure
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14
Q

What does mitral stenosis sound like on auscultation?

A

Mid-diastolic, low pitched rumbling

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15
Q

What does mitral regurgitation sound like on auscultation?

A

High pitched pan systolic whistling

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16
Q

What does aortic stenosis sound like on auscultation?

A

Ejection systolic high pitched murmur with crescendo-decrescendo character.

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17
Q

What does aortic regurgitation sound like on auscultation?

A

Diastolic soft murmer

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18
Q

What are the risk factors for getting infective endocartidis?

A 
Elderly
Prosthetic valves
IV drug user
Congenital heart disease
Poor dental hygiene/ ental treatment
Pacemake/ cardiac surgery
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19
Q

What are the key symptoms of infective endocarditis?

A

(Flu-like) Fever, sepsis, embolic events, headache, malaise, confusion, night sweat, joint/ muscle pain

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20
Q

Key presentation of pericarditis?

A 
Chest pain ( severe, sharp, rapid onset, worse lying flat, radiates) 
Dyspnoea
Cough
Hiccups
Friction rub
Fever
Tachycardia
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21
Q

Key symptoms of atrial fibrillation?

A

Palpitations
Shortness of breath
Syncope

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22
Q

How is atrial fibrillation treated?

A

Rate control: Beta blocker, CCB, Digoxin
Cardioversion potentially
Anticoagulation

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23
Q

What are the symptoms of an unruptured AAA?

A

Pain in abdomen, back, loin or groin
Pulsatile abdominal swelling
(Often asymptomatic)

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24
Q

What are the symptoms of a ruptured AAA?

A 
Intermittent/ continueous abdominal pain
Pulsatile abdominal swelling
Collapse
Hypertension
Tachycardia
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25
Q

Key presentation of aortic dissection?

A

Sudden onset of severe central chest pain that radiates to back and down arms
Shock

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26
Q

Key symptoms of peripheral vascular disease?

A

MILD:
Intermittent claudication
Absent leg pulses
Cold feet

MODERATE: 
Nocturnal rest pain
Gangrene/ infection
Absent pulses
Cold, white legs
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27
Q

What are the key presentations of acute lower limb ishchaemia?

A 
Pain
Pallor
Perishingly cold
Pulseless
Paralysis
Parasthesia (pins and needles)
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28
Q

What are the key symptoms of GORD?

A 
Dyspepsia
Epigastric/ retrosternal pain/ discomfort/ burning--> worse when bending or lying down. 
Acid regurgitation (unpleasant taste in mouth)
Heartburn
Nocturnal cough
Hoarse voice
Hiccups
Bloating
Feeling sick
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29
Q

What can cause/ make GORD worse?

A 
Food and drink (coffee, alcohol, spicy foods, fatty foods, tomatoes, chocolate)
Overweight
Smoking
Pregnancy
Stress/ anxiety
NSAIDS
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30
Q

How can you ease GORD?

A

Smaller, more frequent meals
Raise end of the bed
Try to lose weight

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31
Q

What would be the red flags that would indicate it was cancer?

A

Weight loss
Blood in stool/ vomit
Dysphagia

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32
Q

What medication is used to treat GORD?

A

1: Acid neutralisation (renni/ gaviscon)
2: Reduce acid secretion (PPI
3: Ranitidine

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33
Q

Where is the most likely place for a peptic ulcer?

A

Duodenal more common than gastric

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34
Q

What are the causes of peptic ulcers?

A 
H. pylori
Drugs (NSAIDS)
Stress
Alcohol
Caffeine
Smoking
Spicy foods
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35
Q

What are the symptoms og a peptic ulcer?

A 
Recurrent burning epigastric discomfort/ pain
Haematemesis/ coffee ground vomit
Meleana
Nausea/ vomiting
Indigestion
Anaemia
Weight loss
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36
Q

What is a mallory-weiss tear and what are the main causes?

A

Tear at the oesophagastric junction, often followed by a bout of coughing or retching. (often linked to alcoholism or eating disorders)

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37
Q

What are the symptoms of a mallory-weiss tear?

A

Vomiting bright red blood
Diziness
Potentially melaena

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38
Q

Symptoms of bleeding gastro-oesophageal varices?

A

Vomiting large amounts of blood
Melaena
Signs of chronic liver damage

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39
Q

Symptoms of gastritis?

A 
Nausea/ upset stomach
Bloating
Epigastric pain
Vomiting
Indigestion
Haematemesis
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40
Q

What are the main causes of gastritis?

A 
H.pylori
Cocaine or alcohol smoke
NSAIDs
Stress
Autoimmune
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41
Q

Key symptoms of coeliac disease?

A 
Diarrhoea (Steatorrhoea) 
Pale stools
Stomach discomfort (bloating/ farting) 
Fatigue
Weight loss
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42
Q

What is Crohn’s disease (where)?

A

Intermittent inflammation anywhere along the GI tract (Transmural with skip lesions)

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43
Q

What is Ulcerative colitis (where?)

A

Continuous inflammation of the colon and rectum causing ulcers

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44
Q

In which IBD is smoking protective?

A

Ulcerative colitis

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45
Q

What are the key symptoms of ulcerative colitis?

A

Diarrhoea with blood and mucosa
Abdominal pain (lower left quadrant)
Weight loss
During flare up: Arthritis, mouth ulcers, skin conditions, irritated eyes

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46
Q

What are the key symptoms of Crohn’s?

A

Diarrhoea with urgency (may be blood)
Stomach pain (right lower quadrant)
Malaise
TTiredness

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47
Q

What are the common symptoms of IBD’s?

A

Diarrhoea with blood
Abdominal pain
Weight loss
Tiredness

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48
Q

Key symptoms of IBS?

A 
Bloating
Constipation/ diarrhoea
Stomach pain
Gas
Fluctuating bowel habits
Symptoms worse after eating and improved by opening bowels
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49
Q

Key symptoms of small bowel obstruction?

A

Pain (colicky followed by diffuse)
Vomiting following pain
Nausea/ anorexia
Constipation with no wind (occurs later)

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50
Q

Key symptoms of large bowel obstruction?

A 
Constant abdominal pain
Distension
Palpable mass
Late stage faecal like vomiting
Constipation
Fullness/ bloating/ nausea
(Symptoms present slower and later than SBO)
51
Q

Symptoms of diverticulitis?

A

Abdominal pain (lower left side)
Constipation or diarrhoea
Blood in stools/ rectal bleeding

52
Q

Symptoms of appendicitis?

A

Pain that localises to right sided umbilical region (McBurney’s point)
Guarding
Fever
Anorexia/ nausea/ vomiting

53
Q

At what point is diarrhoea classified as chronic?

A

After 14 days

54
Q

What are the different types of causes of diarrhoea?

A

Infective: Non bloody, bloody (dysentry)

Non-infective: Neoplasm, IBD, IBS, Hormonal, Radiation, Chemical, Antibiotics

55
Q

Key presentation of colorectal cancer?

A 
Change in bowel habit
Unexplained weight loss
Rectal bleeding
Abdominal pain
Tiredness (anaemia)
56
Q

Key presentation of oesophageal cancer?

A 
Progressive dysphagia
Weight loss
Anorexia
Chest pain 
Cough/ hoarse voice
Nausea/ vomiting
Heartburn/ acid reflux
57
Q

Risk factors for oesophageal cancer?

A

Barrets oesophagus (long term GORD)
Excess alcohol
Smoking
Obesity

58
Q

Symptoms of bowel ischaemia?

A

Acute severe abdominal pain

Signs of shock

59
Q

Symptoms of haemorrhoids?

A 
Bright red rectal bleeding (streaks in stools/ drips into toilet) 
Mucus 
Itchy bum 
anaemia
weight loss
change in bowel habits
60
Q

Symptoms of an anal fistula?

A

Pain
Discharge
Itchy bum

61
Q

Symptoms of an anal fissure?

A

Extreme pain on defecation

Bleeding

62
Q

Symptoms of perianal abscess?

A

Painful swelling
Tender
Discharge (pus)

63
Q

What is cholecystitis?

A

Gallbladder inflammation

64
Q

What is cholangitis?

A

Bile duct inflammation

65
Q

What are the risk factors for gallstones?

A

Female
Fertile
Fourty
Fat

66
Q

Symptoms of biliary colic?

A

Sudden intense pain with crescendo pattern.
Most common evening- early morning and may radiate to right shoulder.
May be triggered by eating fatty foods.

67
Q

Symptoms of acute cholecystitis?

A

Persistent sudden sharp pain in upper right quadrant. May spread to right shoulder.
Breathing may make it worse. May get fever

68
Q

Symptoms of acute cholangitis?

A

Fever
Jaundice (dark urine, pale stools, itching)
Right upper quadrant pain

69
Q

What is primary biliary cirrhosis/ cholangitis?

A

Autoimmune disorder that attacks the bile ducts and leads to cirrhosis of the liver

70
Q

What are the symptoms of primary biliary cirrhosis?

A 
Bone and joint aches
Fatigue
Itchy skin
Dry eyes and mouth
Upper right quadrant pain
71
Q

What is primary sclerosing cholangitis?

A

Condition where the intrahepatic or extrahepatic ducts become inflamed, leading them to be strictured and fibrotic, obstructing the flow of bile.

72
Q

What is the cause of primary sclerosing cholangitis?

A

Unknown (whereas PBC is autoimmune)

73
Q

What is primary sclerosing cholangitis associated with?

A

Ulcerative colitis

74
Q

How does primary sclerosing cholangitis present?

A 
Fatigue
Jaundice
Pruritis
RUQ pain
Hepatomegaly
Cirrhosis
75
Q

Which types of hepatitis are acute?

A

Hep A
Hep E
(Hep B, C and D can be)

76
Q

Which types of hepatitis can become chronic?

A

Hep C (B and D)
Alcoholic
Autoimmune

77
Q

Symptoms of hepatitis?

A 
Abdominal pain
Fatigue
Jaundice
Nausea/ vomiting
Fever
78
Q

What questions should be asked if you suspect hepatitis?

A

Travel history
Unprotected sex
IVDU
Contact with infected person

79
Q

Symptoms of liver failure?

A

Abnormal bleeding
Ascites/ oedema
Jaundice (pale stools, dark urine, itching)
Hepatic encephalopathy (confusion, coma, liver flap)
Nausea/ anorexia

80
Q

Symptoms of pancreatitis?

A

Severe epigastric pain that radiates to back
Nausea/ Vomiting
Systemic symptoms–> Fever, tachycardia

81
Q

Causes of pancreatitis?

A 
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion sting
Hyperlipidaemia
ERCP
Drugs
82
Q

What is haemachromatosis?

A

Genetic metabolic liver disease that results in excessive body iron that is deposited in tissues

83
Q

Symptoms of haemachromatosis?

A 
Chronic tiredness
Joint pain
Pigmentation
Hair loss
Erectile dysfunction
Amenorrhoea
Organ failure
84
Q

What is Wilson’s disease?

A

Excessive accumulation of copper in the tiddues

85
Q

Key presentations of Wilson’s disease?

A 
Hepatic problems (hepatitis, cirrhosis)
Neurological problems (Concentration/ coordination problems e.t.c.)
Psychiatric problems
86
Q

What is Alpha-1- antitrypsin deficiency?

A

Inherited disorder causing an abnormality in the production of alpha-1-antitrypsin (inhibits elastase enzyme which breaks down connective tissues)

87
Q

Key presentation of alpha-1-antitrypsin deficiency?

A

Emphysema (S.O.B)

Cirrhosis (Jaundice e.t.c)

88
Q

Key presentations of peritonitis?

A

Sudden onset acute severe abdominal pain (followed by collapse and shock)

89
Q

Symptoms of liver cancer?

A 
(Mainly asymptomatic)
Weight loss
abdominal pain
Anorexia
Nausea/ vomiting
Jaundice
Pruritis
90
Q

What tumour marker indicates hepatocellular carcinoma?

A

Alpha-fetoprotein

91
Q

Symptoms of pancreatic cancer?

A 
Anorexia
Weight loss
Diabetes
Acute pancreatitis
Jaundice
92
Q

Causes of hernias?

A 
Chronic cough
Urinary obstruction
Constipation
Heavy lifting
Past abdominal surgery
93
Q

Symptoms of hiatus hernia?

A 
Dyspepsia
Heartburn
Acid refluc
Burping
Bloating
Bad breath
94
Q

What are the causes of microcytic anaemia?

A

Iron deficiency

Thalassaemia

95
Q

What are the causes of normocytic anaemia?

A

Acute blood loss
Aplastic
Haemolytic
Hypothyroidism

96
Q

What are the causes of macrocytic anaemia?

A

Alcohol

B12 and Folate deficiency

97
Q

Symptoms of anaemia?

A 
Fatigue
SOB
Headaches
Dizziness
Palpitations
98
Q

Causes of iron deficiency anaemia?

A 
Increased requirements (pregnancy, growth)
Insufficient dietary intake 
Blood loss (GI bleed, menorrhagia, hookworm)
Inadequate absorption (Medications- PPI), Inflammation (coeliac/ crohns)
99
Q

What extra anaemia symptoms come with iron deficiency anaemia?

A

Rica (dietary cravings for abnormal things like ice and dirt)
Hair loss

100
Q

What is pernicious anaemia (what cells involved?)

A

Parietal cells produce intrinsic factor which is essential for the absorption of B12 in the ileum. Pernicious anaemia= autoimmune condition where antibodies form against parietal cells or intrinsic factor

101
Q

What are the extra symptoms of pernicious anaemia?

A

Peripheral neuropathy,

Numbness, Parasthesia, loss of vibration sense/ proprioception, visual, mood/ cognitive changes

102
Q

What is haemolytic anaemia?

A

When the premature destruction of RBCs leads to anaemia

103
Q

What are the different types of inherited haemolytic anaemia?

A 
Hereditary spherocytosis
Hereditary elliptocytosis
Thalassaemia
Sickle cell anaemia
G6PD deficiency
104
Q

What are the different types of acquired haemolytic anaemia?

A

Autoimmune
Alloimue
Paroxysmal nocturnal

105
Q

What investigations would be done for haemolytic anaemia?

A

Full blood count
Blood film
Direct Coombs test
Family history

106
Q

What is thalassemiea?

A

Genetic mutation in either alpha or beta chains that make up haemoglobin

107
Q

Treatment of thalassemia?

A

Monitor and blood transfusions

108
Q

What is sickle cell anaemia?

A

Autosomal recessive anaemia where patients have an abnormal haemaglobin variant (HbS) that causes RBCs to sickle

109
Q

Symptoms of sickle cell anaemia?

A

Anaemia
Sickle cell crises: Painful episodes in particular parts of the body (when blood vessels become blocked)
Increased infections

110
Q

What is polycythaemia?

A

When there is a high concentration of red blood cells making it thicker and less able to travel through blood vessels and organs

111
Q

What can cause polycythaemia?

A

Absolute (increase in RBC mass): polycythaemia vera, hypoxia (high altitude, COPD e.t.c)
Relative (decreased plasma volume but normal RBC mass): Apparent polycythamia, dehydration

112
Q

Symptoms of polycythaemia?

A 
Vague/ may be asymptomatic:
Headaches
Blurred vision
Erythema
Tiredness
High BP
DIzinnes
Confusion
Stomach problems
Bleeding problems
Itchy skin
GOut
113
Q

How is polycythaemia treated?

A 
Venesection
Chemotherapy to slow production of RBCs
Aspirin to prevent clots
Treat underlying cause
Lifestyle changes
114
Q

How is a DVT treated?

A

Initially LMWH given
Then Warfarin/ NOAC/DOAC/ LMWH for 3 months if reversible cause, >3 months if cause unclear and >6 months in active cancer

115
Q

What is the normal presentation of leukaemi?

A 
Fatigue
Fever
Failure to thrive 
Pallor (amaemia)
Abnormal bruising (thrombocytopenia)
Abnormal bleeding
116
Q

What are the differentials for bruising?

A 
Thrombocytopenia (low platelets): LEUKAEMIA
Meningococcal septicamiea
Vasculitis
HSP
ITP
Injury
117
Q

How is leukaemia diagnosed?

A

Full blood count
Blood film
Lactate dehydrogenase
Bone marrow biopsy

118
Q

What is unique about ALL?

A

Most common in children, associated with philadelphia chromosome and Downs syndrome

119
Q

What are the symptoms of CLL and what can it turn into?

A

Often asymptomatic, but may be infections, anaemia, bleeding and weight loss
Can turn into high grade lymphoma

120
Q

How does CLL appear on blood film?

A

Smear or smudge cells

121
Q

What chromosome is CML associated with?

A

Philadelphia chromosome

122
Q

What phases does CML go through?

A

Chronic, accelerated and blast phase

123
Q

What happens in each phase of CML?

A

Chronic- 5 years of asymptomatic
Accelerated- More symptomatic, anaemia and thrombocytopenia, compromised immune system
Blast phase- Severe symptoms and pancytopenia

124
Q

What is seen on a blood film of AML?

A

Blast cells with Auer rods

OSCE prep (3 decks)

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