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year 3 OSCE > GI exam and history > Flashcards

GI exam and history Flashcards

1
Q

What are you looking for in general inspection?

A 
Sputum pots 
Sick bowels
Medication
Peg feed
Not jaundice--> colour of the patient
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2
Q

What are you looking for in the hand?

A 
Clubbing
Leuconychia
Koilonychias
Palmar erythema
Pale palmar creases
Spider naevi
Dupytren’s contracture
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3
Q

What does Leuconychia indicate?

A

Hypoalbuminaemia

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4
Q

What does Koilonychias indicate?

A

Iron deficiency anaemia

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5
Q

What does Palmar erythema indicate?

A

Chronic liver disease

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6
Q

What does Pale palmar creases indicate?

A

aneamia

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7
Q

What does spiner naevi indicate?

A

Liver disease

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8
Q

What does Dupytrens Contracture indicate?

A

Liver cirrhosis

Seen in alcoholics and in FHx

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9
Q

What is hepatic flap a indication of?

A

Liver failure

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10
Q

What does liver failure cause?

A

Hepatic encephalopathy–> confusion, altered consciousness and coma state

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11
Q

What does clubbing indicate?

A

Inflammatory bowel disease, Coeliac disease and cirrhosis

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12
Q

Do you do a pulse check in GI exam?

A

yes

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13
Q

What are the signs you are looking for around the eyes?

A

Jaundice
Conjuctive pallor
Xanthelasma

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14
Q

What do you look in the eye for jaundice and what does it indicate?

A

In the sclera

Cirrhosis and iarbily obstruction

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15
Q

What does Xanthelasma indicate?

A

Hyperlipidaemia

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16
Q

What does pale conjuctival indicate?

A

Anaemia

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17
Q

What are you looking for in the mouth?

A 
Angular stomatis
Oral candidas
Mouth ulcers
Glossitis
Odor
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18
Q

What does Glossitis indicate?

A

Smooth swelling of the tongue

Indication of B12/iron/folate deficiency

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19
Q

What does oral candidas indicate?

A

It is thrush

Indication of Iron deficiency/ immunodeficiency

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20
Q

What does mouth ulcers indicate?

A

Chrons or coeliac disease

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21
Q

What does angular stomatitis indicate?

A

B12/iron deficiency

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22
Q

What nodes do you palpate?

A

Supraclavicular, virchows, axilliary and femoral

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23
Q

What signs are you looking for on inspection of abdomen?

A 
Scars
Colles sign
Grey Turners Sign
Spider neavi
Gynaecomastia 
Hair loss
Pulsation
Striae
Stomas
Abdominal distention
Caput medusae
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24
Q

What scars would you see and what surgery does that indicate?

A

Midline–> laparotomy
RIF –> Appendectomy
Right inferior to subcostal–> Cholecystectomy

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25
Q

What is colles sign?

A

Bruising around the umbilicus

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26
Q

What is Grey Turners sign?

A

Bruising around the flanks

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27
Q

What does Colles and Grey Turners sign indicate?

A

Retro peritoneal beading causes by ruptured AAA or pancreatitis

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28
Q

Having 5 or more spider neavi can be a indication of?

A

Can be due to Chronic liver disease

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29
Q

What is the cause of gynaecomastia (over production of the mamillary gland)?

A

Sign of liver Cirrhosis
or
S/E of Digoxin or Spirolactone

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30
Q

What is caput meduase and what does it indicate?

A

Engorgement paraumbilical veins.

Indicates portal hypertension

31
Q

What does red pink striae indicate?

A

New abdominal distension

32
Q

What does silver white striae indicate?

A

Chronic abdominal distension

33
Q

What does hair loss in the abdomen indicate?

A

Malnourishment, iron deficiency anemia

34
Q

What is the first thing you ask before palpate the stomach?

A

Ask if they have any pain and where?

Then go to their last

35
Q

When palpating the abdomen what are you trying to identify? As well as looking at their face for signs of pain

A

Tenderness
Rebound tenderness –> peritonitis
Mass
Guarding

36
Q

When you have identified the mass what do you describe?

A 
Location
Size
Shape
Consistency
Mobility
Pulsatile
37
Q

What organs are you palpating for organomegaly?

A 
Aorta
Spleen
Liver
Kidney
Bladder
Gall bladder
38
Q

What causes pulsatile enlarged liver?

A

Tricuspid regurgitation

39
Q

What is the cause of a tender liver?

A

Hepatitis

40
Q

What two bruits do you try and identify in abdo examination?

A

Aorta and renal bruits

41
Q

What is the acronym used for end pieces?

A

SHRUGT

42
Q

What does SHRUGT stand for?

A 
Stool sample
Herniation inguinal
R--> Pr
Urinalysis and pregnancy test
Genitalia examination
Temperature
43
Q

What is shifting dullness trying to investigate?

A

Fluid in the abdomen (ascites)

44
Q

In a history of Altered Bowel habit.

What questions would you ask?

A

How altered? For how long? Age of Patient?
Diarrhoea +/- vomiting – Onset? Contacts? Travel?
Blood –> old or new blood
Mixed or separate
Constipation ~( codeine)

45
Q

In a history of vomiting

What questions would you ask?

A

How long for? What do they vomit (blood?) Pregnant? Timing?
Type of blood fresh or coffee granules
Get any chest pain/acid reflux

46
Q

In a history of melena.

What questions would you ask?

A

Where in bowel motion? How much and how long? Associated symptoms (of anaemia?)

47
Q

What are the causes of melena?

A

Commonly due to acute or chronic peptic ulceration
Sometimes due to right sided colonic bleeding
Rarely due to small bowel bleeding
Iron tablets

48
Q

What questions would you ask in a Jaundice patient?

A

Urine and stools. Urine is dark and stools are pale
Any itching?
Associated symptoms? Consider Family and especially social histories (transfusions, alcohol, travel, sex, drugs).

49
Q

What questions would you ask in a dysphagia patient?

A

Continuous or intermittent? How long? Where does food stick? Solids, liquids or both? Acid reflux or dyspepsia? Consider risk factors for Ca.

50
Q

In a change weight history station

What questions would you ask?

A

How much over how long? Loss of appetite or interest in food? Dieting? Associated symptoms are important because there are lots of possible diagnoses (not just GI).

51
Q

What are the key past medical histories you should ask about?

A

Jaundice
Anemia
Diabetes

52
Q

What drugs should you inquire about?

A 
NSAIDS
Iron tablets
Abx
SSRIS
Opiates
Laxatives
53
Q

If a patient has gall bladder what examination would illicit the symptoms?

A

Murphy’s sign

54
Q

What is Murphy’s sign?

A

The patient is asked to inhale while the examiner’s fingers are hooked under the liver border at the bottom of the rib cage.
The inspiration causes the gallbladder to descend onto the fingers, producing pain if the gallbladder is inflamed.

55
Q

What is a sign of acute appendacitiesʔ

A

Pain at Mcburny’s point

56
Q

Where is Mcburny’s pointʔ

A

1/3rd between the ASɪS and umbilical

57
Q

ɪn general pain in the right hypochondriac is a indication of disease in what organʔ
ɢive example of disease

A

ʟiver

Cholangitis
ɢall bladder
ʟiver abscess
ʜepatitis

58
Q

ɪn general pain in the lefthypochondriac is a indication of disease in what organʔ
ɢive example of disease

A

Spleen

Spleen rupture, abscess
Acute splenomegaly

59
Q

ɪn general pain in the epigastrium is a indication of disease in what organʔ
ɢive example of disease

A 
Peptic ulcer
Esophagitis
Perforating ulcer
ɢOʀD
Pancreatitis
60
Q

ɪn general pain in the right and left lumbar is a indication of disease in what organʔ
ɢive example of disease

A

ʀenal

Pylenophritis
Ureteric colic

61
Q

ɪn general pain in the umbilical is a indication of disease in what organʔ
ɢive example of disease

A

Small bowel diseae
Merckel’s diverticulum
Early appendicitis

62
Q

ɪn general pain in the left iliac is a indication of disease in what organʔ
ɢive example of disease

A 
Diverticulitis
ʜernia
Ulcerative colitis 
Ovarian cyst
Constipation
63
Q

ɪn general pain in the hypograstic is a indication of disease in what organʔ
ɢive example of disease

A

Urinary retention
Cystitis
Testicular torsion

64
Q

ɪn general pain in the right iliac is a indication of disease in what organʔ
ɢive example of disease

A 
Ectopic pregnancy
ʜernia
Ovarian cyst
Ceacum obstruction
Chrons disease 
Appendicitis late
65
Q

What is the three abx are given for acute appendacitisʔ

A

AMɢ

Amoxicillin
ɢentamicin
Metronidazole

66
Q

What is the triad of symptoms for acute pyelonephritis?

A

Fever
Loin pain
Nausea and vomiting

67
Q

If the patient indicates there is blood in the urine?

What 4 questions should you ask?

A

How much blood is their in the urine?
What colour is the blood? ( dark or bright)
Do you ever wee just blood and no urine ?
Is there any clots in the blood?

68
Q

For a patient with UTI symptoms what questions relating to the urinating do you ask?

A

Frequency
Urgency
The colour and smell of the urine?
The flow of the urine (stream or dribbling)?

69
Q

When patient has UTI/renal tract problems you should ask about there bowels. What should you ask?

A

Are your bowels working?

Are you incontinent?

70
Q

What social history question is key in a UTI/renal tract infection history?

A

Sexual activity and for how long

71
Q

If a patient says they have vomited what should you ask?

A

What was the content of the vomit? (blood, food, mixture, bile etc)

72
Q

What is key to ask in a GORD history?

A

what makes it worse? (heavy faty food, spicy food, hot tea and alcohol).

73
Q

What should you ask/consider in every history?

A

Pain, Bowel Habits, Blood Loss, Distension, Vomiting, Appetite, Weight Changes and Continence (both).

year 3 OSCE (14 decks)

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