OSCE Flashcards
Gynae:
* HxPC
* Gynae sx (4)
* Gynae history specifics - MOSCC (5) - adapt if necessary
* PMHx, DHx, FHx, ICE, SHx
- HxPC
- Gynae specific sx - 4 Ps
1. PV -bleeding (inter-menstrual, post-coital, post-menopausal; menorrhagia)
2. PV discharge
3. pelvic pain/dyspareunia
4. possibilty of pregnancy - Relevant systems review - gastro/uro
- Gynae specifics:
Menstrual hx
1. Cycle - Date of LMP, duration, regularity
2. Heaviness - meorrhagia
3. Age of menarche / menopause
Obstetric hx
1. GXPX?
2. Delivery - term, mode, antenatal/neonatal complications
3. Terminations/miscarriages - method
Sexual health
1. Sexually active?
2. Regular partner?
3. Up to date with STI checks / had one previously in past - screen, if sexually active and <25
Contraception + Cervical smear
1. Current method (and previous ones - RFs)
2. Last smear - date & ressults
Pelvic examination + speculum
- Explanation and consent
- speculum –> bimanual - Chaperone
- 2 important questions - pregnancy? empty bladder?
- Make patient comfortable; wash hands
- Abdominal palpation
- Speculum exam –> Lock –> ?swabs –> remove
- Bimanual palpation
- Close
PC:
SoB, cough, wheeze
resp
- Core Resp sx (cough, SOB, wheeze, chest pain, fever, coryza)
- Details: distance before SOB, episodic/constant, pleuritic etc, systemic features (sarcoid, ca)
- SR: cardiac, rheum
- RFs: smoking, pets, recent travel, occupational exposures, atopic triad, SE of drugs, vaccination hx
- Red flags: haemoptysis, W/L, fever, Horner’s
Differentials
- acute: PE, pneumothorax, pul edema, effusions, pneumonia, exacerbation asthma/COPD
- obstructive: asthma, COPD, occ. asthma, bronchiecstasis, asbestosis
- restrictive: NMD, skeletal - scoliosis/kyphosis, PF - amiodarone/methotrexate; idiopathic
- infective: TB, pneumonia,
- systemic: sarcoid, lung cancer (SC; NSCLC),
Investigations
Bedside: Obs (RR, O2), peak flow, ABG, sputum culture, PCR for TB
Bloods: VBG, CRP/ESR, BC, U&E
Imaging: CXR –> HRCT. CTPA.
Special tests: Bronchoscopy, Lung function tests (spirometry)
PC: chest pain/tightness, palpitations
cardiac
- Core cardiac sx: chest pain, palpitations, SOB, fatigue, syncope
- Details: coryza, episodic/constant, fever, AS triad (exertional sx),
- RFs: FHx of sudden cardiac death, PMHx, atherosclerotic RFs (diet, alcohol, smoking), hypercholesterolemia, DM, recent, travel, BE = IVDU,dental surgery), HTN, CTDs (Marfan’s, ED)
- Red flags: ?ca, syncope/LOC
- S/R: Resp, GI
Differentials
Acute: ACS, Pericarditis, arrythmia- fast AF, SVT, aortic dissection, PE, oesophageal spasm
Chronic:
- Ischemic: ACS - stable/unstable angina, valvular disease - AS, MR; heart failure - diastolic/systolic
- Non-ischemic: myocarditis/pericarditis, SVT - WPW
- Non-cardiac: GORD, resp
- Psych: anxiety, panic disorder, MUS
Ix
BS; Obs (PR, BP, RR), ECG
Bloods: FBC, trop, Hba1c, LFT, U&E
Imaging: TTE/TOE; 24-hr ecg monitoring (Zio/Bardy), myometrium biopsy, stress testing
“Tired all the time”
Key points in hx:
1. Daytime somnolence
2. Fatigue
3. Weakness
* Details of tiredness - fluctation/episodic, post-exertional
* S/R
* Psych/depression screen/risk assess
* Red flags - WL, systemic features, FND, spontaneous sleep when active
Differentials:
Primary sleep disorder - insomnia, OSA, parasomnias (night terrors, sleep paralysis), restless leg syndrome, narcolpesy
Other conditions:
Endo - diabetes, hypothyroid, adrenal insufficiency, hypoparathyroidism
Systemic - malignancy, RA, sarcoidosis, vasculitis, SLE
Cardioresp - heart failure, valvular disease
MSK - OA
Psych - depression, anxiety, fibromyalgia, dementia
Meds - Z-drugs, sedating antihistamines, Mirtazepine, opioids
Gynae - menopause, pregnancy, anaemia - menorrhagia
Infective - HIV, TB, long COVID
Lifestyle - alcohol, drugs, CO poisoning
CFS/ME - 6 weeks of debilitating fatigue
Weakness - MND, MG, osteomalacia, Cushing’s syndrome
Dizziness
Distinguish peripheral/central cause of vertigo
* Clarify true vertigo vs non-vertiginoius dizziness (x sense of movement)
* Core symptoms: vertigo, hearing loss, tinnitus, nausea/vomiting, headache, neck pain, gait disturbance, diplopia/nystagmus
* Red flags: raised ICP (positional headache, seizures, vomiting)
* RFs: PMHx neuro/ENT, FHx, surgery (ear), infections, vascular risk factors
* Red flags: onset (hyper-acute), unilateral ear symptoms
Differentials
Central: posterior circulation stroke , vertebrobasilar insufficiency, MS, SOL- tumour, vestibular migraine
Peripheral: vestibular neuronitis (no HL), Meniere’s, labrynthitis, BPPV, tympanic membrane perf, med SEs,functional neurologcial disorder, alcohol/susbstance misuse
Not true vertigo –> cardiac (HF, MI, PE, postural hypotension, vasovagal syndrome, POTS) neurological cause (normal pressure hydrocephalus) psych (anxiety
Seizure
- before (?syncope - cardiogenic, orthostatic, postural. Aura - abnormal sensations/weakness. Headache)
- during (Core sx: abnormal movements of limbs, incontinence, tongue-biting/jaw ache, LoC, fever)
- after (post-ictal confusion, sequalae), timing of event, ?drugs
- distinguish true seizure from syncope
RFs: structural CNS abnormalities, autoimmune, chronic infections, Alzheimer’s, dialysis, I/S –> infections manifesting as seizures
Key parts of history not to forget - DRIVING, FAMILY PLANNING
Neuro
Motor sx -
Sensory sx -
Cerebellar -
Parkinsons -
FND - CNs
General
Bladder
Bowel
Swallow
Social
Driving
Occupation
Scrotal lump
- pain - ?elevation
- description of lump
- sexual hx - sexually active, previous/current STI
- Urinary - dysuria, LUTS
- Skin changes
- Red flags - night sweats, haematuria
RFs: previous abdominal surgery, history of undescended testes (testicular ca?), trauma, STIs, FHx (testicular ca)
Ix: Urine dip (WCC, RC?), urethral swab
Bloods: FBC, U7E, CRP, tumour marker (bHCG/LDH/AFP?)
Imaging: US Scrotum
DX
Acute: testicular torsion
Benign: epididymo-orchitis, varicocele (bag of worms), hydrocele, epidydmal cyst, hernia
Malignant: testicular cancer, lymphoma,
DIFFERENTIALS
KNEE PAIN
Septic arthritis
Gout
Pseudogout
Reactive arthritis
Housemaid’s knee - pre patellar bursitis
Ostearthritis
Rheumatoid arthritis
ACL/PCL/collateral tear/Meniscal tear/loose body
Paeds - Osgood schlatters, patellar tendonitis
Differentials
Shoulder pain
- Rotator cuff tear -supraspinatus (+ve empty can test, abduction), infra spinatus/teres minor (+ve pain on external rotation), subscapularis (+ve lift off test: internal rotation)
- Impingement “painful arc syndrome” - pain between 80-120degrees abduction
- Adhesive capsulitis - DM, pain, stiffness, episodic
- Referred pain from elbow, back or internal organs (shoulder tip - ruptured ectopic)
- Nerve entrapment
OA, RA
Elbow pain
- Medial epicondylitis (golfers elbow)
- lateral epicondylitis (tennis elbow)
- # radial/ulnar
- Cubital tunnal syndrome (ACF)
- Carpal tunnel syndrome (Wrist pain –> elbow)
- olecranon bursitis
Wrist pain
- Carpal tunnel syndrome
- # - FOOSH, posterior fall
- RA, OA
- Nerve entrapment
- De Quervain’s tenosynovitis
Hip pain
- Trochanteric bursitis
- # NOF, hip dislocation (anterior/posterior), pubic ramus
- OA, RA
- Superior gluteal neuropathy
- CTD
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Ankle/foot pain
- # , muscular strain
- metatarsal stress #
- lisfranc injury
- achilles tendon rupture/achilles tendinopathy
- ulcer - diabetic, venous, neuropathic
- plantar fascitis - heel pain
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