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OSCEs > GI > Flashcards

GI Flashcards

1
Q

Position of patient

A

General exam: sat upright

Close exam: supine

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2
Q

General Inspection

A 
Bedside treatment
Patients appearance
Body habitus (obese etc.)
Scars
Jaundice
Anaemia
Abdo distention
Masses
Dressings
Needle track marks
Excoriations
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3
Q

Jaundice indicates..

A

cirrhosis/hepatitis

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4
Q

Anaemia indicates..

A

pallor > GI bleeding

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5
Q

Abdo distention indicates..

A

ascites/bowel obstruction/large masses

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6
Q

Masses indicate..

A

malignancy / organomegaly

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7
Q

Excoriations indicate..

A

pruritus, which is a sign of cholestasis

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8
Q

Signs on hands

A 
clubbing
koilonychia
leukonychia
palmar erythema
Dupuytren's contracture
Hepatic flap
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9
Q

Clubbing indicates..

A

IBD, cirrhosis, coeliac disease

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10
Q

Koilonychia indicates..

A

spooning of nails > chronic iron deficiency

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11
Q

leukonychia indicates..

A

whitened nail bed > hypoalbuminemia (liver failure)

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12
Q

palmar erythema indicates..

A

reddening of palms > liver disease, pregnancy

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13
Q

Dupuytren’s contracture indicates..

A

thickening of palmar fascia > alcohol excess, or family history

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14
Q

Hepatic flap

A

hold hands dorsiflexed for 15 seconds
+ve test= hands will flap irregularly
Causes= hepatic encephalopathy, uraemia, CO2 retention

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15
Q

Signs on arms and what they represent

A

Bruising: abnormal coagulation, secondary to liver failure
Petechiae: low platelets e.g. splenomegaly
Excoriations: cholestasis
Track marks: IV drug use > hepatitis/HIV

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16
Q

Signs in axillae and what they represent

A

Lymphadenopathy: malignancy/infection
Hair loss: malnourishment / iron deficiency anaemia
Acanthosis nigricans: GI adenocarcinoma / obesity

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17
Q

Signs in eyes

A

Jaundice
Conjunctival pallor
Xanthelasma

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18
Q

What does jaundice suggest?

A

haemolysis, hepatitis, cirrhosis, biliary obstruction

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19
Q

Conjunctival pallor

A

anaemia

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20
Q

xanthelasma

A

raised yellow deposits surrounding eyes > hyperlipidaemia

21
Q

Signs around the mouth

A

angular stomatitis
oral candidiasis
mouth ulcers
glossitis

22
Q

Angular stomatitis

A

inflamed red areas at the corners of the mouth: iron / B12 deficiency

23
Q

oral candidiasis

A

white slough on oral mucous membranes: iron deficiency/immunodeficiency

24
Q

mouth ulcers

A

crohn’s or coeliac

25
Q

glossitis

A

smooth swelling of tongue with associated erythema: iron/B12/folate deficiency

26
Q

Virchows nodes

A

left supraclavicular fossa suggest gastric malignancy

27
Q

Chest signs

A

Spider naevi
Gynaecomastia
Hair loss

28
Q

Spider naevi

A

central red spot with reddish extensions (>5 suggest chronic liver disease)

29
Q

Causes of gynaecomastia

A

liver cirrhosis, digoxin, spironolactone

30
Q

Pulsation on abdo inspection suggests

A

AAA

31
Q

Cullen’s sign

A

bruising around umbilicus > retroperitoneal bleed e.g. pancreatitis or ruptured AAA

32
Q

Grey-Turners sign

A

bruising in flanks > retroperitoneal bleed e.g. pancreatitis or ruptured AAA

33
Q

Abdominal distention

A

5 F’s:

Fat, fluid, faeces, fetus, flatus

34
Q

Striae indicate

A

abdominal distention

35
Q

caput medusae

A

engorged paraumbilical veins > portal hypertension

36
Q

Setting up for palpation

A

Ask if the patient is in pain
Kneel so you are level with the patient
Observe patients face when palpating

37
Q

Rebound tenderness

A

pain is worse when releasing pressure - peritonitis

38
Q

Guarding

A

involuntary tension in the abdo muscles

39
Q

Assessing masses

A

Location
Size
Shape
Consistency- smooth, soft, hard, irregular
Mobility- attached to superficial/underlying tissues
Pulsatility

40
Q

+ve Murphy’s sign =

A

cholecystitis

41
Q

Spleen is palpable when..

A

it is at least 3 times the normal size

42
Q

Steps for palpation

A 
Light palpation
Deep palpation
Liver
Spleen 
Ballot the kidneys
43
Q

Palpation of the organs the patient must…

A

take deep breathes in and out, and you palpate when they breathe in

44
Q

Steps for percussion

A

Liver, spleen, shifting dullness

45
Q

Key for shifting dullness

A

If fluid is present, the area that was previously dull (when supine) will now be resonant (when lying on side)

46
Q

Auscultation

A

Bowel sounds

47
Q

Tinkling bowel sounds

A

bowel obstruction

48
Q

Absent bowel sounds

A

ileus/peritonitis

49
Q

Suggest further assessments

A

Check for hernias
PR exam
External genitalia - if appropriate

OSCEs (26 decks)

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