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Lucy Knox - OSSE > Examination findings > Flashcards

Examination findings Flashcards

1
Q

What is the diagnosis?

A

Sub Conjunctival Haemorrhage

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2
Q

Name 3 factors that increase your risk of this happening

A

suddenly increase pressure – such as coughing, hypertension or Aspirin (as anti-platelet agent) will make this more likely as will trauma and increasing age.

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3
Q

This 30 year old felt the sensation of something in his eye since yesterday. His eye is watering and is uncomfortable. Why?

A

Small foriegn body (FB) can be seen when everting the eyelid

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4
Q

The FB is removed and the eye re-examined after insertion of a dye.

  1. What dye is it? What do you see?
  2. What is this called?
  3. Why has it occurred?
  4. What colour is the lamp used to examine in the above picture?
  5. What colour lamp is used to specifically look at blood vessels in the retina?
A
  1. Fluorescein – note uptake over cornea
  2. Corneal abrasion
  3. FB has rubbed epithelial surface of retina
  4. Blue light – fluorescein is orange therefore if uptake see as green
  5. Green light used to look at blood vessels.
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5
Q

This 23 year old man was involved in an altercation on Wind Street last night.

  1. What is the term given to the appearance of the eye above?
  2. What exactly is it?
A

a hyphema—a hemorrhage in the bottom of the anterior chamber of the eye.

The bleeding came from disruption of blood vessels at the iris root. It is a sign of severe ocular contusion. There may be other signs of ocular contusion: corneal and retinal swelling, bleeding in the vitreous cavity, dislocation of the lens, rupture of the iris, cornea, retina, or sclera.

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6
Q

This six year old is brought into surgery by his mother.

  1. What is the name of this sign?
  2. List 3 potential causes of this sign in THIS patient.
A
  1. Ptosis
  2. Myasthenia, Horner’s, Benign, Congenital, Traumatic (head injury), III nerve palsy

In this case, while Ca lung is a cause of horner’s and ptosis, it wouldn’t be expected in a 6 year old

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7
Q
  1. What part of the body is this a picture of?
  2. What are the features indicated by the arrows?
  3. What is the most common underlying disease which results in the features show?
A
  1. Retina – NOT eye
  2. Flame haemorrhages
  3. Hypertension
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8
Q
  1. What is indicated by A?
  2. What are the white areas indicated by the black arrow B?
  3. What are these white areas caused by?
  4. What is indicated by the yellow / green arrow C?
  5. What is the underlying disease?
A
  1. Optic Disc
  2. Hard Exudates
  3. Leakage of protein from blood vessels
  4. Flame haemorrhage
  5. Proliferative diabetic retinopathy
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9
Q
  1. What is …

A? B? C? D?

2.What is the underlying disease?

A

A Laser Scars

B Macula

C Retinal Vessel

D Microaneurism

2) Diabetic retinopathy (specifically diabetic macula oedema)

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10
Q
  1. What problem is visible?
  2. What symptoms may the patient have presented with?
  3. Name a very common underlying problem that would make this condition more likely.
A
  1. Retinal Detachment
  2. Deteriorating vision in curtain or flashing lights (remind them of history in year 1)
  3. Short sightedness
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11
Q

What feature is visible in the disc?

In this particular patient it may be due to:

  • Pulmonary embolism?
  • Multiple sclerosis?
  • chronic coughing?
  • Head injury ?
  • Malignant hypertension?
A

Papilloedema

Found in:

MS – (if optic neuritis)

Head injury (if raised ICP)

Malignant hypertension (not controlled)

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12
Q

What is seen in the picture?

What symptoms might this woman present with?

Which women are more likely to have this condition of the cervix?

A

Cervical ectropion (or cervical eversion)

  • central (endocervical) columnar epithelium protrudes out through the external os, undergoes squamous metaplasia, and transforms to stratified squamous epithelium

Symptoms = mucus discharge, post coital bleeding

Normal in younger women, pregnancy and those taking oestrogen OCP

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13
Q

What condition is this?

What virus causes it?

How is this usually transmitted?

What condition does this predispose to?

What should she be advised to do regularly in future?

Name one way of treating this

A

Genital warts

HPV

Sexual contact / skin to skin

Cancer

Wear a condom

Cream - podophyllotoxin

Cryotherapy

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14
Q

What is the metal object at the bottom?

What is the tube at the top?

What is the name given to this finding?

Name three reasons that might predispose to this?

Name three symptoms that this woman might have presented with.

A

Simms speculum

Catheter

Prolapse - Cystocoele

Vaginal deliveries, pregnancy, obesity, chronic cough

Dragging sensation, difficulty passing stools, urinary incontance/frequency

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15
Q
A

IUS - eg. merina coil

Checking threads

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16
Q

What 2 things does this show?

A

Threads from IUS

Cervical ectropion

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17
Q

What does this show?

A

Polp extending through the Os

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18
Q

This 36 year old woman has attended for her cervical screening and her cervix is pictured.

Has this woman ever been pregnant?

Explain how you have derived your answer.

A

Yes

  • The os gets damaged/can form more of a slit after a vaginal delivery
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19
Q

At present, how often are women normally and routinely offered cervical screening?

A

Every 3 years from 25-49

Every 5 years from 50-64

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20
Q

How many times should the brush be rotated as part of the cervical screening process?

A

5 complete turns

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21
Q

Where exactly should the cells be obtained from in a cervical smear?

A

The transitional zone

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22
Q

What is the abnormality shown?

Name three factors that predispose to this?

What symptoms may the patient present with?

A

Anal fissure

Anything that stretches anal skin so straining at stool, diarrhoea, trauma, childbirth, Inflammatory bowel disease (crohn’s and UC), some STI’s (syphilis, chlmaydia, herpes)

Symptoms include – pain, bleeding – usually bright red on paper after wiping, constipation (largely due to pain and contraction of sphincter)

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23
Q

What is the abnormality shown in the picture?

Name three predisposing factors.

A

Haemorrhoid

Chronic diarrhoea/constipation

Straining on toilet

Anal intercourse

Obesity

Sitting for long periods of time on toilet

Increasing age

Increased intra-abdominal pressure

Pregnancy

Chronic cough

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24
Q

Name a complication of this.

Name three different types of treatment

A

Complications are rare but include anaemia from chronic blood loss, strangulation (pain and gangrene)

Treatment:

Conservative – laxatives to avoid straining, analgesia

Creams – to shrink - little evidence of benefit

Rubber band ligation

Sclerotherapy

Cautery

Haemorrhoidectomy

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25
Q

What is the diagnosis?

How may this present?

A

Pilonidal sinus / abscess

Usually pain may be found and be asymptomatic

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26
Q

What does this show?

A

Pilonidal sinus

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27
Q
  1. What is the diagnosis?
  2. What is the causative agent?
  3. How did the patient acquire these?
A

Anal / Genital warts

Usually HPV wart virus

Usually sexually transmitted – note men need not necessarily have participated in anal sex to have these on anus

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28
Q

What is this?

Name three possible presenting symptoms of this condition.

What’s the usual underlying cause for this condition?

A

Rectal prolapse

The symptoms are identical to advanced hemorrhoidal disease,[13]and include:

Sensation of mass or something “coming down”

Fecal leakage

Rectal bleeding

Mucous rectal discharge

Rectal pain

Pruritis ani

Due to excessive straining at stool (note NOT associated with childbirth etc)

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29
Q

Percussion of the chest - what causes it to be:

Dull

A

Airless - consolidation, collapse, fibrosis

? pleural thickening

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30
Q

Percussion of the chest - what causes it to be:

Stoney dull

A

Pleural effusion - lung separated from chest wall

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31
Q

Percussion of the chest - what causes it to be:

Hyperresonant

A

Pneumothorax

Emphysema? - if large pulmonary cavity

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32
Q

What are normal breath sounds described as?

A

Vesicular

Insp - intensity steadily increases

Expiration - quickly fades

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33
Q

What may cause diminished vesicular breath sounds?

A

Airflow limitation

insulation - obesity, small pleural effusion, shallow pneumothorax

34
Q

What may be the cause of no breath sounds?

A

No airflow

Large pneumothorax

35
Q

What may cause bronchial breath sounds?

A

Fibrosis

Consolidation - pneumonia

36
Q

If you can hear vocal ressonance loudly what does it suggest?

A

Firm/solid underluing lung tissue

  • Consolidation
  • Fibrosis
  • Collapse
37
Q

What is usually said about the crackles you may hear in interstitial lung disease?

A

End-inspiratory creps

38
Q

What are crepetations?

A

Non musical sounds - crackles

Explosive re-opening of small airways which have occluded during expiration

39
Q

What are Ronchi heard when auscultating breath sounds?

A

Rhonchi are continuous low pitched, rattling lung sounds that often resemble snoring.

40
Q

What may cause you to hear ronchi?

A

Bronchial asthma

Tumour

Foreign body

41
Q

What is stridor? What may cause it?

A

An inspiratory noise, not a breath sound

Obstructed upper airway

eppiglotitis, angio-oedema of anaphylaxis

42
Q

What is seen in horner’s syndrome?

A

Interruption of sympathetic fibres to one eye

eg. due to bronchogenic Ca

symptoms:

  • Unilateral pupillary constriction
  • Partial ptosis
  • Enopthalmos
  • Loss of sweating on same side of face
43
Q

What is suppurative gingivitis in a resp exam associated with?

A

Lunh abcess

44
Q

Name 2 reasons for a rasied JVP

A

Right heart failure

Raised intrathoracic pressure

45
Q

What may cause a barrel chest?

A

Asthma

Bronchitis

Emphysema

46
Q

What is pectus carinatum?

A

Pigeon chest

  • Stenal prominence, indrawing of ribs to form horrizontal grooves “harrison’s sulci”

Due to chronic respiratory disease in childhood + rickets

47
Q

What abnormalities can be seen?

What causes this?

A

Cotton wool spots

Hard exudates

Papilloedema

Silver wiring

AV nipping

= Hypertensive retinopathy

48
Q

What abnormalities are only seen in hypertensive retinopaty on fundoscopy?

A

Silver wiring

AV nipping

49
Q

List abnormalities you would seen in diabetic retinopathy

A

Dot and blot haemorrhages

Exudates

Neovascularisation

Cotton wool spots

50
Q

What is the mechanism of making flame heamorrhages?

A

Rupture of superficial pre-capillary arterioles, small veins

51
Q

What can cause flame haemorrhages?

A

systemic hypertension

52
Q

What are early signs seen in diabetic retinopathy?

A

Dot and blot haemorrhages

Microaneurysms

53
Q

As diabetic retinopathy progresses what later signs are seen on fundoscopy?

A

Signs of retinal ischaemia:

Cotton wool spots

Venous dilatation

Neovascularisation

54
Q

List 4 causes of retinal haemorrhages

A

Diabetes

Hypertension

Trauma

SAH

Retinal vein occlusion

Sickle cell disease

Anti-coags

55
Q

Name 3 causes for papilloedema

A

Increased intracranial pressure

Cerebral oedema

Malignant hypertension

Optic nerve tumours

Papillitis

56
Q

What changes can you see with optic atrophy?

A

Pale disc

usually assoc. decreases vision

57
Q

What are soft exudates in the eye due to?

A

Swelling of the nerve fibre layer axons

58
Q

What are hard exudates caused by?

A

Lipoproteins leaking out of an abnormally permiable blood vessel

59
Q

What TFT levels would you expect to see with this sign?

A

Graves disease

T3/T4 - high

TSH - low

60
Q

What condition causes this sign?

A

Graves disease

61
Q

What does this show?

A

Pretibial Myxodema

62
Q

Are these symptoms of thyroid disease seen in hyper, hypo or both?

  • Depression
  • Heat Intolerance
  • Tremor
  • Lethargy
  • Weight Loss
  • Hyporeflexia
A
  • Depression - Both
  • Heat Intolerance - Hyper
  • Tremor - Hyper
  • Lethargy - Both
  • Weight Loss - Hyper
  • Hyporeflexia - Hypo
63
Q

Where is the pathology causing this?

A

Optic chiasm

64
Q

What pathology woulc commonly cause this defect?

A

Pituitary tumour (adenoma ) commonly found in acromegaly

65
Q

What is this visual field defect?

A

bitemporal hemianopia

66
Q

What test would you do to confirm acromegaly?

A

Glucose Tollerance Test

67
Q

What is this sign?

What causes it?

A

Koilonychia

Iron deficiency anaemia

68
Q

What is this sign?

What causes it?

A

Xanthelasma

Hyperlipideamia

69
Q

What is this sign?

What causes it?

A

Splinter haemorrhage

Infective Endocarditis

70
Q

What is this sign?

What causes it?

A

Grey Turner’s sign

retroperitoneal haemorrhage (takes 24–48 hours to develop, can predict a severe attack of acute pancreatitis)

71
Q

What is this sign?

What causes it?

A

Cullen’s sign

Pancreatitis

72
Q

What is this sign?

What causes it?

A

Malar flush

Mitral stenosis

  • CO2 retention leading to vasodilation
73
Q

What is this sign?

What causes it?

A

Butterfly rash

SLE / Lupus

74
Q

What is this sign?

What causes it?

When is it significant?

A

Spider naevi

liver disease

3 or more = significant

(get them in pregnancy)

75
Q

Tenderness upon deep palpation of 1 suggests what?

A

Acute appendicitis

Shows involvement of the peritoneum - localises the pain

76
Q

What does 1 indicate?

What is it measured from (2 + 3)

A

1) McBurney’s point - Location of the appendix
2) umbilicus
3) ASIS
- 1/3 from ASIS towards umbilicis

77
Q

What does E show?

What pathology causes it?

A

left homonymous hemianopia with macular/ central vision sparring

Lesion in R occipital lobe

Why? Stroke of posterior circulation

78
Q

What does D show?

What pathology causes it?

A

Left upper homonymous quadrantanopia

lesion at the right optic radiation

Why? Stroke or space occupying lesion

79
Q

What does C show?

What pathology causes it?

A

Left homonymous hemianopia

Lesion at R optic tract - after chiasm

Why? vascular disease, head injury, cerebral tumour

80
Q

What does b show?

What pathology causes it?

A

Bitemporal hemianopia

Lesion at optic chiasm

Why?

pituitary tumour, craniopharyngioma, suprasellar meningioma

81
Q

What does A show?

What pathology causes it?

A

Total blindness in 1 eye = monocular loss

Ipsilateral optic nerve damage

Why? Trauma, MS

Lucy Knox - OSSE (9 decks)

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