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OSCE 1 > History Buzzwords > Flashcards

History Buzzwords Flashcards

1
Q

Central crushing chest pain
Comes on when I walk
Goes away when I rest for a while

A

Stable angina

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2
Q

Central crushing chest pain
Comes on when I walk but also randomly, goes away by itself for a while
(or - goes away when I use my spray)

A

Unstable angina

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3
Q

Central crushing chest pain
It’s going down my jaw and left arm
I feel sick, sweaty, out of breath

A

ACS

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4
Q

I’ve been waking up at night really out of breath, I sleep with 4 pillows and my ankles are swollen

A

heart failure

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5
Q

I’ve started to get breathless when I walk, and I’m coughing up pink frothy stuff, and I get really breathless when I lie down

A

heart failure

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6
Q

I’m an elderly lady with angina, syncope and heart failure

A

aortic stenosis

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7
Q

Exclude this in any elderly patient with chest pain, exertional dyspnoea or syncope

A

aortic stenosis

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8
Q

central chest pain worse on inspiration and lying flat, relieved by leaning forward.
and I had an infection last week.

A

pericarditis

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9
Q

I’ve had spells of palpitations, to this irregularly irregular beat. They make me breathless and sometimes I feel faint or get pain in my chest.

A

Arrhythmias - AF is irregularly irregular and may be paroxysmal

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10
Q

I’ve had this sudden tearing pain in my chest, it’s going to my back.

A

Aortic dissection

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11
Q

I get this cramping pain in my leg when I walk for more than 300 yards. It goes away after I rest it for 10 mins.

A

Intermittent claudication

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12
Q

I wake up with a burning pain in my leg in the middle of the night, it only goes away if I sit up and hang my legs over the side of the bed.

A

Critical ischaemia

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13
Q

I’ve started to feel breathless when I walk up hills. I’ve got a bit of a cough, bringing up a bit of green sputum particularly in the mornings.
I’m 45 and smoke 20 a day.

A

COPD

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14
Q

Spirometry definition for COPD?

A

FEV1 <80% predicted

FEV1/FVC <0.7

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15
Q

I get really breathless and wheezy sometimes.
I wake up coughing at night, I bring up a bit of sputum.
The breathlessness comes on when I go running, it’s happening more now it’s winter.

A

Asthma

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16
Q

I keep coughing at night. Sometimes if it’s cold in the morning I get breathless.

A

Asthma

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17
Q

I’ve had this breathlessness that’s there basically all the time, it’s been getting worse. I’ve been losing weight. When I walk I get really out of breath.
I keep doves for a living.

A

chronic EAA
(pigeon-fanciers)

  • other causes = farmer’s/mushroom-worker’s lung, malt worker’s lung, sugar worker’s lung
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18
Q

a couple hours after I get home from work (on a farm) I get really out of breath, have a dry cough, achey muscles and a fever

A

EAA

4-6h after exposure - fever, rigors, myalgia, dry cough, dyspnoea

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19
Q

I’ve got a cough that brings up LOADS of sputum.

A couple of times there’s been blood in it.

A

Bronchiectasis.

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20
Q

I’ve got these weird tender red lumps on my shins, and my joints all ache

A

Acute sarcoidosis - erythema nodosum ± polyarthralgia

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21
Q

I’ve got a dry cough, I get breathless when I walk and I’m able to walk less and less distance all the time. Also, my eyes are really sore and dry.

A

Sarcoidosis
- dry cough, exertional dyspnoea, decreased exercise tolerance, chest pain.

Lymphadenopathy, hepatomegaly, splenomegaly, uveitis, conjunctivitis, keratoconjunctivitis sicca, erythema nodosum etc etc etc

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22
Q

I have a dry cough, I get breathless when I walk, and I’ve been really tired and lost a bit of weight.

A

idiopathic pulmonary fibrosis

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23
Q

I feel out of breath, and have a sharp pain in my chest when I breathe deeply

A

Pleural effusion, pneumothorax, PE

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24
Q

I’m a fit, skinny 22yo male - I’ve suddenly got really breathless and have this pain that’s worse when I breathe in and cough

A

Pneumothorax

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25
Q

I’m out of breath, have pain in my chest when I breathe in and this morning I coughed up a bit of blood

A

PE - may also have dizziness, syncope - could be any combo of these symptoms!

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26
Q

I’ve had a cough for the past 3 months, I’ve been coughing up blood, and I’ve started to feel really out of breath when I walk only a short way.
Yes, I suppose I have lost some weight, maybe 1.5 stone in the past 3 months.
I have a 40 pack year history of smoking.

A

Lung cancer

  • also, chest pain, lethargy, anorexia, recurrent pneumonia
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27
Q

I’ve been coughing up blood, and I’ve noticed there’s some in my wee too.

A

Goodpastures

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28
Q

I’ve had episodes of nosebleeds, and sinusitis. I’ve noticed there’s sometimes blood in my wee.
I’ve also coughed a lot, sometimes coughing up blood.

A

Wegener’s granulomatosis.

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29
Q

I’ve been feeling breathless and have a cough that’s bringing up green sputum. I’ve had some fevers, I’m off my food and I feel so tired and rubbish. I coughed up a bit of blood once, but I think it’s just because I’ve been coughing so much.

A

Pneumonia

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30
Q

I’ve got a productive cough, feel completely rubbish. I’ve also noticed some weight loss, and get really sweaty at night.

A

TB

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31
Q

I have this burning pain right at the bottom of the middle of my chest. It’s worse after meals and when I lie down. I also get this horrible sour taste at the back of my throat sometimes.

A

GORD

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32
Q

I’m a bulimic that throws up a lot, now I’m coughing up LOADS of blood

A

Mallory-Weiss tear

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33
Q

I get this pain at the top of my tummy, it gets worse after I eat

A

Gastric ulcer

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34
Q

I get this pain at the top of my tummy, it gets better after a meal or if I drink a glass of milk.

A

Duodenal ulcer

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35
Q

I’ve had difficulty swallowing. It’s always been solids and liquids together, and I sometimes regurgitate food a bit.

A

Achalasia

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36
Q

I’ve had difficulty swallowing. It started off just some foods, but now it’s all foods apart from yoghurt. I’ve lost quite a bit of weight as well.

A

Oesophageal cancer

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37
Q

I’ve been having this diarrhoea, it absolutely stinks and doesn’t flush down. I get crampy tummy pains and feel all bloated. I’ve got painful cracks in the corners of my mouth and feel so tired all the time. I’ve lost a bit of weight.

A

Coeliac disease

HLA-DQ2
villous atrophy + crypt hyperplasia, reversed on gluten-free diet.

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38
Q

I get diarrhoea 5-6 times a day, with blood and mucus in it sometimes. I get crampy abdo pain. No, I’ve not had any mouth ulcers.

A

UC.

Continual histology from rectum backwards. Inflammatory infiltrate, crypt abscesses, goblet cell depletion. Inflammation is NOT mucosal.

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39
Q

I get urgent diarrhoea, I have to get up in the middle of the night and then I’ll go 5 times in an hour.
I get tummy pain, and I’ve lost some weight. I have been getting lots of mouth ulcers. No, I haven’t seen any blood in my stool.

A

Crohn’s.

Skip lesions. Mouth to anus. Transmural granulomatous inflammation.

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40
Q

I get crampy abdominal pain that goes away when I defecate.
I sometimes get diarrhoea, sometimes it’s more formed.
I get bloating, mucous PR, and find when I need to go it’s quite urgent but then feels like I haven’t fully emptied my bowel.
It’s all worse when I’m stressed.

A

IBS

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41
Q

I’m constipated, vomiting, nauseous and off my food. I have colicky abdo pain too.

A

Intestinal obstruction

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42
Q

This bad pain came on around my belly button yesterday afternoon, and I’ve not been able to eat since. This morning I vomited twice and now the pains gone down to the bottom right hand side of my tummy.

A

Appendicitis

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43
Q

I’ve been passing blood from my bottom, it’s coating the outside of the stool. I’ve been going less frequently, and it never feels like I’ve finished when I do go.
I’ve lost some weight.

A

Bowel Ca

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44
Q

I’ve been having some indigestion, and I’ve noticed that I feel full after eating only small amounts of food.

A

Stomach Ca

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45
Q

I’ve got this AWFUL tummy pain, that’s come on today. It’s constant and right in the middle. I’ve no clinical signs but I’m REALLY ILL.

A

acute mesenteric ischaemia

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46
Q

I’ve got lower left sided abdominal pain and bloody diarrhoea. It’s been going on for a while, I have no other symptoms.

A

Ischaemic colitis

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47
Q

I’ve had some altered bowel habit, and colicky pain in my LIF, that’s relieved by defecation. I’m nauseous.
I go on to have a fever, and generalised peritonitis.

A

Diverticulitis

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48
Q

It’s REALLY painful when I poo. Sometimes there’s blood on the paper and in the pan.

A

Anal fissures.

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49
Q

I’ve got bright red rectal bleeding, it’s on the paper and drips into the pan. It’s never been painful, and has been getting more frequent. I’ve had no change in bowel habit.

A

Haemorrhoids.

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50
Q

I’ve got severe colicky RUQ pain that radiates to my back.

My pain is worse after I eat a fatty meal.

A

Biliary colic.

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51
Q

I’ve got severe colicky RUQ pain that radiates to my back and I’ve been feeling a bit feverish.
I’ve vomited twice from the pain.

A

Acute cholecystitis.

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52
Q

I’ve got severe colicky RUQ pain that radiates to my back and is worse after a takeaway. I’ve been feeling a bit feverish and my wife reckons my eyes have gone a weird yellow colour.

A

Cholangitis.

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53
Q

Causes of acute pancreatitis?

A

Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune (PAN)
Scorpion bite
Hyperlipidaemia, hypothermia, hypercalcaemia
ERCP and emboli
Drugs
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54
Q

I’ve got this awful pain right at the top middle of my tummy, it goes to my back but gets a bit better when I sit forward.
It’s been here since this morning, it’s really bad. I’ve been vomiting loads since it came on.

A

Acute pancreatitis

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55
Q

I’m an IVDU. I’ve started to go yellow and have been feeling feverish and generally rubbish, nauseous and off my food.

A

Viral hep (likely hep B)

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56
Q

I’m off my food, I’ve lost weight and I’ve had some funny fevers. Occasionally I get a weird dull ache in my RUQ.

A

liver metastases - jaundice appears late, except for in cholangiocarcinoma

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57
Q

I’ve lost my appetite, I’ve lost lots of weight, I have RUQ pain and I’ve gone yellow. My tummy is weirdly swollen all over, it’s HUGE.

A

HCC

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58
Q

My wife noticed a while ago that my eyes had gone a weird yellow colour, and now my skin has gone yellow too. I’m itchy all over and feel really nauseous.
No, I don’t have any tummy pain at all.
My stools are pale and my urine dark.

A

Ca head of pancreas

painless obstructive jaundice

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59
Q

I’ve got this pain right in the middle just below my ribs - it’s going to my back, but sitting forwards relieves it a bit.
I’ve lost lots of weight and I’m a bit off my food.

A

Ca body/tail of pancreas.

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60
Q

I’m really tired and have been a bit breathless lately. Sometimes I feel quite faint, and I’ve had weird palpitations sometimes too.

A

Anaemia - also, headache, tinnitus, anorexia.

Possibly also angina, if there’s pre-existing coronary artery disease.

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61
Q

I’m really tired, a bit breathless and have this weird lemon tinge to my skin.

A 
B12 deficiency (anaemia)
lemon tinge = pallor + mild jaundice
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62
Q

I’m always tired, I get breathless quite easily.
Also, I get episodes of severe pain in my hands and feet (sometimes elsewhere). I think it gets brought on by cold or dehydration.

A

Sickle cell anaemia - vaso-occlusive painful crises.

Can get - mesenteric ischaemia, stroke, avascular necrosis (e.g. of femoral head), leg ulcers, low-flow priapism.

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63
Q

I get really itchy after a hot bath. I get a burning sensation in my fingers and toes.

A

Polycythaemia rubra vera - malignant proliferation of red blood cells in the marrow.
Signs of hyperviscosity also - headaches, dizziness, tinnitus, visual disturbance.

64
Q

I’ve got a warm, red, swollen, tender calf. There’s some pitting oedema.

A

DVT

65
Q

Risk factors for a DVT?

A

age, pregnancy, oestrogen (pill, HRT), trauma, surgery, past DVT, cancer, obesity, immobility, thrombophilia

66
Q

I’m a child, I’ve been bleeding and bruising easily, I’m anaemic, and I’ve been getting lots of colds and other infections.
I’ve felt a small lump in my armpit and one in my neck.

A

Acute Lymphoblastic Leukaemia
- commonest cancer in children.
BLAST CELLS

67
Q

I’m 65, I’m anaemic, I’ve had lots of weird bruises without really hurting myself, lots of colds and I’ve weirdly noticed that my gums have got really swollen and sore.

A

Acute Myeloid Leukaemia
- commonest acute leukaemia in adults, increases with age.
(gum hypertrophy)
Auer rods!

68
Q

I am 40-60 years old. I’ve had weight loss, fever, tiredness, sweats over the past few months.
I’m anaemic, I’ve had some bruising, I’ve had a couple of episodes of gout.

A

Chronic Myeloid Leukaemia

gout due to increased purine breakdown.

Philadelphia chromosome! t(9;22), BCR-ABL fusion gene on chromosome 22.

69
Q

I am 89 years old. I’m a bit anaemic, and routine FBC has shown I have high lymphocytes. I’ve got a couple of rubbery lumps in my neck.

A

Chronic Lymphoblastic Leukaemia - often asymptomatic.
Commonest in elderly.
good prognosis - slow progression so they live for years.

70
Q

I’m 22 years old. I had glandular fever 6 months ago. I’ve had generalised itching for 2 weeks.
I’ve stopped drinking alcohol as it gives me weird pains in my neck when I do.
I have some painless rubbery lumps in my neck if I really feel for them.
I’ve lost some weight and had some sweating at night. I’ve been really tired lately.

A

Hodgkin’s lymphoma - young adult’s and the elderly!

risk increased by: affected sibling, EBV, SLE, obesity.

Reed-Sternberg cells.

A = no systemic symptoms, apart from pruritus.
B symptoms = gever, weight loss, night sweats.

71
Q

I’ve got a lump in my neck. It’s on the side, not in the middle.
I’ve lost weight recently, quite a lot, and have been getting fevers and night sweats.

A

Non-Hodgkin’s lymphoma.
B symptoms LESS common than in Hodgkin’s.
Risk factors - FHx, ataxia, H pylori infection, EBV, HIV, immunosuppression.

72
Q

I’m anaemic, have bony pain, back pain (vertebral crush), and have been getting hypercalcaemic symptoms.

A

Myeloma

Bence-Jones protein in urine, pepper pot skull.

73
Q

I’ve had a headache for a couple of days, feel really rubbish, and had achey muscles and joints. Today I woke up with shivering and feeling really cold, but then after an hour or so I went really hot and flushed, and felt nauseous. I don’t feel hot now but still feel a bit sweaty.
I flew back from the Amazon jungle last week.

A

Falciparum malaria.

74
Q

I’m 15 years old, and have loads of spots, whiteheads and blackheads across my face, chest and back. My skin always feels really greasy and oily, and it’s all really getting me down.

A

Acne vulgaris.

75
Q

I’ve got this itchy dry rash in the crooks of my elbows, and behind my knees. The itching gets worse when it’s cold outside and when I get sweaty.

A

Eczema.

76
Q

I’ve got this red itchy rash covering my whole hands. I’ve never had this before, and don’t suffer from hayfever, eczema or asthma. I’ve not got the rash anywhere else, and it ends sharply about 3 inches up my wrist from my hands.

A

Contact dermatitis - chemical irritant or type IV hypersensitivity reaction to something that has come in contact with the skin.

E.g. here bleach diluted in warm water in a bucket, hands dunked in to soak a sponge to wipe surfaces etc.

clear cut demarcation, unusual pattern of rash and odd-shaped areas.

77
Q

I’ve got these silvery red itchy rashes on the backs of my elbows and across my knees.

A

Psoriasis

78
Q

I cut my leg last week on a trowel whilst gardening. Over the weekend the area has got really red and swollen, and is really hot to the touch. It’s really painful.
Today I have noticed I’ve had some episodes where I go all hot and cold and shivery.

A

Cellulitis

79
Q

I have noticed this mole on my neck that’s started to get bigger and has changed shape and got darker. It bleeds every now and then too.

A

Malignant melanoma.

80
Q

I have this horrible ulcerated mole thing on my forearm that didn’t used to be there. I work as a gardener so my arms are out in the sun all day.

A

SCC

81
Q

I have a pearly nodule on my nose.

A

BCC

82
Q

I’ve got a fever, feel really rubbish, sore throat and achey muscles. Two weeks ago I had unprotected sex with a prostitute.

A

HIV seroconversion.

83
Q

I am 28 years old and have noticed a lump in my left breast. It’s firm, smooth and mobile. It’s painless.
There’s no history of breast Ca in my family, and I have two children that I have finished breast feeding, and I’ve never taken the Pill.

A

Fibroadenoma.

Usually <30, always pre-menopause.

84
Q

I am 51 years old. I have a lump in my left breast that feels like it’s filled with fluid. It’s round and not fixed to the surrounding tissue.

A

Breast cyst.

Common >35, esp. perimenopausal.

85
Q

I’ve had this weird bloody nipple discharge, and my nipples have retracted. I’m 53 years old and am going through the menopause. I’m very worried about breast cancer as my friend has just been diagnosed with it, but there’s no history of it in my family.

A

Duct ectasia.

86
Q

I am 68 years old. I’ve noticed a mobile lump in my right breast, and I think there might be another one in my right armpit. My aunt had breast Ca aged 42 so I am really worried. I took HRT for the menopause. I’ve never had children.

A

Breast cancer.

Stage 2.

87
Q

I have EXCRUTIATING pain going ‘loin to groin’ in spasms. It’s so bad I feel really nauseous and have thrown up twice.

A

Renal colic, secondary to urinary tract stones

acute upper tract obstruction

88
Q

I’ve got severe loin to groin pain that’s been there since yesterday. Today when I woke up I felt really nauseous and just sat by the toilet all morning being sick from the pain. I felt all hot and cold and was really violently shaking.

A

Pyelonephritis

89
Q

I have severe pain really low down in the middle of my tummy, just above the bottom of my pelvis really. I’ve been really struggling to go to the toilet - frequency, urgency, hesitancy, terminal dribbling etc.

A

lower urinary tract obstruction - suprapubic pain present in an acute setting, may be absent if more chronic e.g. BPH
causes include stones, tumour (luminal or extra-mural), strictures, or post op.

90
Q

I am a 79 year old man. I’ve started having to get up at night to go to the toilet, and I’m going almost twice as often each day as I used to. It doesn’t hurt. When I go it takes a while to get started, and then I have a poor stream once I do start. I also get lots of dribbling at the end, and feel like I haven’t finished even though I can’t squeeze anything else out.

A

Benign prostatic hyperplasia or prostatic carcinoma.

In BPH = inner (transitional) zone enlargement
In prostatic Ca = peripheral layer enlargement

91
Q

painless haematuria

A

= BLADDER CA until proven otherwise (>90% = transitional cell carcinoma)

92
Q

I’ve noticed the odd bit of blood in my wee, and I’ve got pain in my loin. I’m off my food, and have lost a lot of weight.

A

RCC

93
Q

I’ve got a fluid filled lump in my scrotum, that’s separate from the testis

A

epididymal cysts

94
Q

I’ve got a fluid filled lump in my scrotum, that seems to be part of or attached to my testis.

A

Hydrocele - fluid in the tunica vaginalis

95
Q

My scrotum is really tender and swollen, it came on quite suddenly. Weeing is painful and I’ve been having fevers.

A

Epididymo-orchitis

96
Q

I have a dull ache in one testicle. It feels like a bad of worms.

A

varicocele - dilated veins of the pampiniform plexus

97
Q

I noticed a lump in one of my testicles, it doesn’t hurt.

A

testicular tumour

98
Q

I’ve got this really severe pain in one testis, it came on really suddenly. It’s making it so difficult to walk, and the pain goes up to my tummy. It’s SUCH a bad pain, I feel really nauseous and I’ve thrown up twice from it.

A

Testicular torsion

DDx - epidiymo-orchitis

99
Q

I’ve noticed some blood in my urine.
It’s painless.

I had a sore throat a couple of weeks ago.

A

Post-streptococcal glomerulonephritis

100
Q

what makes up nephritic syndrome?

A

haematuria
mod-severely raised BP
mod-severely reduced GFR

101
Q

what makes up nephrotic syndrome?

A

proteinuria
normal-mildly raised BP
normal-mildly reduced GFR

102
Q

I am a 24yo man. I get these episodes where I have blood in my wee - it’ll happen a few times over a couple of days and then completely stop and not happen again for a while.

A

IgA nephropathy

typically a young male.
Renal biopsy shows mesangial proliferation.
Immunofluorescence shows IgA and C3 deposits.

103
Q

I have a rash over my knees and shins. I’ve noticed some blood in my wee.

A

Henoch-Scholein purpura - systemic version of IgA nephropathy, leading to small vessel vasculitis.

Purpuric rash on extensor surfaces, flitting polyarthritis, abdo pain and nephritis.

104
Q

I’ve got a burning sensation when I wee, I’m having to go more often, occasionally it looks like there might be some blood in it and I have suprapubic pain.

A

cystitis

105
Q

I’m 14 years old. Recently I’ve been really really thirsty, and have to go for a wee CONSTANTLY. I’ve also lost quite a bit of weight recently.

A

Type 1 DM

106
Q

I’ve been having diarrhoea, palpitations, lost weight even though if anything I’m eating more.
I’m sweaty, hate being too hot, and I’ve noticed a tremor.
I’me also really irritable and my periods have got really light and irregular.

A

Hyperthyroidism

if + eye disease - poss Graves
e.g. my eyes feel gritty, they’re tearing up, I’m seeing double, photophobia etc

107
Q

I’ve been really sleepy and low in mood. I hate being cold. I’ve gained loads of weight even though I’m not really eating much. I’m constipated, have really heavy periods and my voice has gone hoarse. Also I feel like I’ve gone really weak.

A

Hypothyroidism.

108
Q

I’ve been gaining weight recently, it seems to all have gone onto my belly. I’ve got stretch marks on my belly too. I’ve felt really down and lethargic and irritable.
I’m really struggling to get out of chairs, wash my hair and go up and down stairs as I feel too weak.
My face has gone all puffy and I’ve developed acne.

A

Cushing’s syndrome (glucocorticoid excess).
Proximal weakness = hair, chairs and stairs.
Also sexual dysfunction, hirsutism, irregular periods.

Lemon on sticks - central obesity. Moon face. Buffalo hump (supraclavicular fat). bruises, purple abdo striae. osteoporosis.

109
Q

I am lean, tanned, tired and tearful.

I am totally exhausted all the time, I can’t do anything anymore. I’m really low in mood. I’ve lost some weight.
Buccal mucos pigmentation and palmar creases.
Also I’m weak, I’m off my food.
GI symptoms etc.

A

Addison’s - adrenal insufficiency.
Addison’s disease = destruction of adrenal cortex leading to glucocorticoid and mineralocorticoid deficiency.

80% of adrenal insufficiency in UK = autoimmune.

110
Q

I’m weak, I have been getting lots of muscle cramps, and I have weird tingling sensations in my hands. I’ve been weeing a lot and feel more thirsty than usual.

A 
Hypokalaemia
- hyperaldosteronism e.g. Conn's (aldosterone producing adenoma), bilateral adrenocortical hyperplasia
- diuretics
- D+V
etc
111
Q

I’ve got tingling in my hands and feet, a headache, I’m sweaty. I’ve gained weight and my face seems to have changed, got coarser, my nose is wide and my brow is really prominent. I’ve got acne. I just don’t look like myself.
I’ve been bumping into things/had a car crash (bitemporal hemianopia)

A

Acromegaly

112
Q

I am so so thirsty. I am just constantly drinking. I need to wee ALL THE TIME. I feel really dehydrated and tired, but I’ve not lost weight.

A

Diabetes insipidus, but exclude DM (hard to tell from a history!)

113
Q

I’m really tired and thirsty. I feel weak, irritable and confused.

A

Hypernatraemia
- fluid loss w/o water replacement e.g. D+V, burns
- DI
etc

114
Q

I’m off my food, nauseous and feeling rubbish.

Then I get a headache, irritable, confused and weak.

A

Hyponatraemia
LOADS of causes
one of them is SIADH - malignancy (SCLC, pancreas, prostate, thymus, lymphoma), loads of other causes too.

115
Q

what is needed for a diagnosis of SIADH secretion?

A

concentrated urine, in presence of hyponatraemia and low plasma osmolality in the absence of hypovolaemia, oedema or diuretics.

116
Q

I’m getting palpitations, chest pain, I feel weak and light headed.

A

hyperkalaemia
- oliguric renal failure, K sparing diuretics, rhabdomyolysis (e.g. after crush injury), Addison’s disease, burns, drugs etc

117
Q

I’ve got abdo pain, vomiting, constipation, I’m weeing a lot, I’m depressed, I’m off my food, I’m losing weight, I’ve got kidney stones, bony pain etc etc

A

Hypercalcaemia
“Bones, stones, groans, thrones and psychic moans”
Bone pain, kidney stones, groans = abdo pain, lethargy, fatigue, thrones = polyuria (can’t get off the ‘throne’), psychic moans = depression, irritability etc

causes - malignancy (bony mets, myeloma, squamous cell lung cancer secreting PTH), primary HYPERPARATHYROIDISM

118
Q

I’ve got muscle cramps, the area around my month is numb, I’ve got spasms (Troussaeu’s sign), I’m anxious and irritable, colic/wheeze/dysphagia etc

A

Hypocalcaemia e.g. hypoparathyroidism
SPASMODIC
spasms - carpopedal spasm on inflating BP cuff (Trousseau’s sign)
Perioral paraesthesiae
Anxious, irritable, irrational
Seizures
Muscle tone increased in smooth muscle (colic, wheeze, dysphagia etc)
Orientation impaired and confusion
Dermatitis
Impetigo herpetiformis
Chvostek’s sign (mouth twitch when tap facial nerve over the parotid), cataract, cardiomyopathy

119
Q

I’ve got bony pain, pathological fractures hypercalcaemic symptoms and hypertension

A

primary hyperparathyroidism

120
Q

I had this funny episode this morning where my left arms and legs went completely weak. They had a funny tingling and numbness up and down them too. It lasted for maybe around half an hour then started getting better. I was completely back to normal within an hour.

A

TIA

121
Q

I’ve started slurring my words, and my face is drooping on the right hand side. My right arm and leg are numb and weak. It’s been like this since yesterday, although has got a lot better. It’s still not back to normal though.

A

Stroke

122
Q

I’ve started to lose my sight in one eye, it’s like there’s a curtain coming down over my field of view

A

Amaurosis fugax - emboli in the retinal artery

123
Q

I’ve got this awful headache. It started really suddenly, like I’d been kicked in the head, and seemed to come from the back of my head but now it’s everywhere. It’s AWFUL. I’ve been vomiting. I have a bit of a stiff neck.

A

SAH

124
Q

I don’t think I’ve hit my head, but I have a bit of a headache. Actually maybe I did bump my head on a cupboard last week. The problem is my consciousness has been fluctuating, and I feel really sleepy and unsteady.

A

Subdural haemorrhage.

bleeding from bridging veins between cortex and venous sinus

125
Q

I was in a car crash this morning. I was completely fine to start off with but now my consciousness is deteriorating. I have a headache that’s just getting worse and worse.

A

Extradural haemorrhage - lucid interval is classic

126
Q

I was sat at my kitchen table doing work when next thing I knew I was on the floor. I don’t remember what happened but my housemate said I was jerking my limbs and shaking and stuff. I wet myself, and my tongue is sore.
When I woke up I was really confused and tired, and my muscles ached all over.

A

Tonic-clonic epilepsy.

ask about absence seizures!

127
Q

I’ve developed this annoying tremor in my hands when I’m not going anything, and I really struggle to get myself going when I walk. Also, weirdly, my sense of smell has got worse. Embarrassingly, I’ve started dribbling which I hate.

A

Parkinsons

128
Q

I’ve started getting pain in my right eye when I move it, and my vision has gone a bit funny too. It’s been going on for about a week, but it’s never happened before.

I didn’t think much of it, but yeah I suppose 6 months ago I had some problems with my legs, they were kind of numb? I don’t know, but I was really struggling to coordinate them when I went running. It lasted maybe a month then went away.

A

Optic neuritis, as a second clinical episode of demyelination in MS.

129
Q

I am 51 years old, and have started walking funny. My legs seem really stiff, and I stumble a lot. I also struggle to pick my feet up properly. I’m struggling to wash my hair, and feel like there’s something wrong with my hands, like I can’t turn door handles anymore.

A

MND - stumbling, spastic gait, foot drop, proximal myopathy, weak grip (door handles don’t turn), shoulder abduction (hair washing)
UMN signs and LMN signs - spasticity, brisk reflexes, upgoing plantars, and wasting, fasciculation of tongue, abdo, back and thigh.
bulbar signs - speech and swallow.

130
Q

I’ve started to feel like my eyes get tired really easily, over the last couple of months or so. Recently I’ve had to eat smaller meals as I get so tired chewing all the food. Towards the end of the meals I sometimes have problems swallowing as well. And then this week apparently my smile has gone a bit weird, I find it hard to smile properly.
Also if I talk for a long time I find my voice gets quieter and quieter.

A

Myasthenia gravis.

increasing muscular fatigue due to antibodies against nAChRs - there’s less of them, so get ‘full’ faster = fatigue.

extra-ocular, bulbar, face, neck, limb girdle, trunk.

ptosis, diplopia, myasthenic smile.
on counting to 50, voice fades.

131
Q

I’m 45. I’ve been a bit down and irritable over the past few months. Then the past two weeks I’ve started having these weird jerks in my muscles, like my shoulder will just randomly jerk for no reason.
My dad had the same thing when he was about my age.

A

Huntington’s.

132
Q

I’m 15 years old. A few weeks ago I had glandular fever. And then this morning I just couldn’t get out of bed. I guess I maybe felt like my muscles were a bit weak yesterday but I honestly can’t get out of bed now.

A

Guillain-Barre syndrome.

triggers - C jejuni, CMV, mycoplasma, zoster, HIV, EBV.
Progressive weakness over up to 4 weeks, can advance quickly and paralyse. Then gets better - most make a complete recovery.
Trunk, respiratory and cranial nerve muscles - watch for respiratory issues closely!

133
Q

I get these headaches, they’re focused around my left eye. My eye gets all red and watery, and my whole face blushes and my nose runs. It lasts for like 20 minutes at a time and is just horrendous. I get them a couple of times a day when I’m having an episode, usually at night. Last time I got them this went on for maybe a month, but that was a year ago now.

A

Cluster headaches

134
Q

I’ve been getting the odd headache, maybe a couple of days a week for the last month. It’s generalised and non-pulsatile. I’m not sensitive to light or movement. It’s maybe a 5/10 severity. I’ve been going through a divorce.

A

Tension headaches

135
Q

I’ve had this headache for two days, it’s worse first thing in the morning, but goes away once I’ve got up and start walking round the house. It’s still there though, and is worse whenever I cough, or if I bend down to pick something up. Then today I’ve vomited a couple of times.

A

SOL

136
Q

I get this stabbing pain along the left side of my face, over my cheek and along my jaw. It lasts a few seconds at a time but is really bad when it’s there. It makes me screw my face up with pain.
It comes on when I shave, and when I’m eating or talking.

A

Trigeminal neuralgia - affecting here the mandibular division.

137
Q

I’ve had this AWFUL headache for 3 hours now. Its all along the left side of my head and throbbing. It’s 10/10 painful, I feel really sick from the pain. Moving around and lights make it worse, I just want to lie in a dark silent room.
Maybe 20 minutes before the pain came on I had these weird wiggly lines and flashing lights in my vision.

A

Migraine with visual aura

138
Q

I’ve got this headache, it’s sort of here to the right side of my forehead. I’ve started to get blurry vision. The headache gets worse when I brush/wash my hair, and my whole scalp seems really tender. I’m 59 years old. When I’m eating a big meal I noticed some pain in my jaw.

A

Temporal arteritis/GCA

139
Q

I’ve got weakness in both legs. I’ve had weird tingling sensations down my legs, and a bit of pain too. I’ve not gone for a wee for about a day now, but it isn’t painful. I suppose I might have noticed some numbness around my bottom.

A

cauda equina

140
Q

I’ve had a headache for two days, and have started to get a really stiff neck. My flatmates say I’ve been a bit confused, and I just feel really ill. I’ve had some episodes where I’ve been going all hot and cold. I really don’t like how bright it is in here, can you turn the lights off?

A

meningitis - ask about rash!

141
Q

what are the red flags for back pain?

A
  • aged <20 or >55
  • acute onset in elderly people
  • constant or progressive pain
  • nocturnal pain
  • worse pain on being supine
  • fever, night sweats, weight loss
  • history of malignancy
  • abdominal mass
  • thoracic back pain
  • morning stiffness
  • bilateral/alternating leg pain
  • neurological disturbance
  • sphincter disturbance
  • current/recent infection
  • immunosuppression
  • leg claudication, exercise related leg weakness/numbness (spinal stenosis)
142
Q

I’m a 78 year old woman. I’ve been getting pain and stiffness in the joints of my fingers, and my right hip, it’s been getting gradually worse for maybe 6 months now. The pain is there all the time, but worse at the end of the day. They get stiff if I don’t use them for half an hour or so. I can’t move them as much as I used to be able to.

A

Osteoarthritis

143
Q

I’m a 49 year old woman. Over the last month or so I’ve noticed that the joints in my hands are really sore, swollen and stiff. Yes, it’s symmetrical and has been since it started. It’s worse in the mornings definitely.

A

Rheumatoid arthritis

exclude psoriatic

144
Q

I’ve come into A&E because I have this really swollen and painful knee. It came on yesterday, and is now really hot and swollen and hurts a lot. I’m diabetic. I have not had any recent trauma to my knee. What diagnosis must you exclude?

A

septic arthritis - consider in any acutely inflamed joint, as it can destroy a joint in under 24h

145
Q

My big toe joint on my right foot is ridiculously painful. I eat a fatty diet, high in alcohol and got started on a diuretic for my heart failure earlier this week.

A

Gout
monosodium urate crystals
negatively birefringent urate crystals (polarized light microscopy)

146
Q

I have a really painful wrist. It’s come on really suddenly, and is a big swollen but not stiff. This is the first time this has happened. I’ve not had any cuts or trauma to the area.

A

Pseudogout

calcium pyrophosphate deposition
weakly positively birefringent crystals

147
Q

I am a 27 year old man, and I’ve recently had this gradually worsening lower back pain. It started out just in my lower spine, and now affects my hips and pelvis. It’s worse at night and my back is really stiff in the morning, but seems to get better towards the end of the day.

A

Ankylosing spondylitis

148
Q

My eyes are really red, itchy and sore. I’ve got really sore and stiff knees but not had any trauma to them. I have had unprotected sex a few times but never got checked.

A 
Reiters syndrome (reactive arthritis) - can't see, can't pee, can't climb a tree.
chlamydia, campylobacter (dysentery)
149
Q

I’ve got Raynaud’s syndrome, swallowing difficulties, swollen and tight fingers and these weird spidery veins on my chest

A 
CREST syndrome
- Calcinosis of subcut tissues
- Raynaud's
- oEsophageal/gut dysmotility
- Sclerodactyly
- Telangiectasia
(limited cutaneous systemic sclerosis)
150
Q

I’ve been really tired recently, had some fevers, general muscle aches. I’ve lost a bit of weight and started getting migraines. Sometimes I have this weird rash across my cheeks and nose, and I’ve been getting loads of mouth ulcers. I recently went on holiday to Spain and it seemed to get a lot worse whilst I was there. I started getting joint pains this week too.

A 
LUPUS - soap brain md
Serositis - pleuritis, pericarditis
Oral ulcers
Arthritis
Photosensitivity

Blood - everything’s low (anaemia, leukopaenia, thrombocytopaenia)
Renal - proteinuria
ANA positive
Immunological - anti-dsDNA ab, Anti-Sm ab, antiphospholipid ab
Neurologic - seizures, migraines, psychological

Malar rash
Discoid rash

151
Q

I am 58 years old. Over the last fortnight or so I’ve had bilateral aching, tenderness and morning stiffness in my shoulders and upper arms. I’m not weak, just a bit sore and stiff.

A

Polymyalgia rheumatica - associated with temporal arteritis!

152
Q

What is polyarteritis nodosa?

A

necrotizing vasculitis causing aneurysms and thrombosis in medium sized arteries, leading to infarction in affected organs.

usually - systemic features, plus rash/ulcers, renal, cardiac, GI and GU involvement.

153
Q

I’ve had this pain in all these different joints and muscles for over 3/12 now. It seems to be completely random areas of pain, but it’s lots of them and all over. There’s no swelling or redness or any other signs of inflammation. I feel really stiff in the morning and just so so exhausted all the time. I’m losing concentration and have a lot of difficulty sleeping.

A

fibromyalgia

154
Q

what are the ‘yellow flags’ of chronic pain (psychosocial risk factors for developing persisting chronic pain and long-term disability)

A
  • believing pain and activity are harmful
  • sickness behaviours e.g. extended rest
  • social withdrawal
  • emotional problems e.g. low mood, anxiety, stress
  • problems at work
  • problems with claims for compensation or time off work
  • overprotective family or lack of support
  • inappropriate expectations of treatment
155
Q

When I get cold or stressed my hands get really painful and go like pale, then blue, then red.

A

Raynaud’s

156
Q

I’ve got really dry eyes, and a dry mouth that’s making it hard to swallow. I’ve also got painful joints.

A

Sjogren’s syndrome

OSCE 1 (3 decks)

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