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Year 6 > OSCE > Flashcards

OSCE Flashcards

1
Q

S1 noise represents

A

AV vlaves close

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2
Q

Soft S1

A

AV valves close with reduced velocity
- reduced contraction (severe heart failure)
- valves don’t close properly (MR)
- valves alreaedy partially closed at end of diastole as atrial relax occurs before LV contraction (prolonged PR interval)

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3
Q

S4/atrial gallop

A

(before S1)
Pressure overload: atrial contraction into stiff hypertrophied ventricle
- LV hypertrophy
- Hypertension
-Aortic stenosis

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4
Q

Loud S1

A

AV valves close with highger velocity as they are wide open at end of diastole
- high atrial pressure (MS, AF)
- short diastole (short PR interval, tachycardia)

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5
Q
A
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6
Q

Split S1

A

= asynchronous AV valve closure
- can be normal, but wide split may suggest RBBB or ASD

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7
Q

What is S2

A

Aortic/pulmonary vallves close

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8
Q

Soft S2

A

= reduced aortic/pulmonary valve motility
- AS
- PS

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9
Q

Loud S2

A

= valves close with higher velocity due to high upstram pressure
- pulonary hypertension
- systemic hypertension

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10
Q

Split S2 on inspiration

A

= physiological. Aortic valve closes first bcause pulm valve closure slightly delayed by increased blood return to right heart, due to negative intrathoracic pressure

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11
Q

Wide split S2

A

= exaggerated split, which increases during inspiration (aortic valve closing before pulmonary)
- RBBBB
- Increased resistance to RV ejection eg pulmonary hypertension or PS

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12
Q

Reverse split S2

A

= split which icnreases during expiration (pulmonary valve closes before aortic)
- LBBB
- incr resistance to LV ejection eg systemic hypertension or AS

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13
Q

S3/ventricular gallop

A

(after S2)
= volume overload: high volume blood from atrium rapidly fills ventricle during passive filling phase
- left ventricular failure
- hyperdynamic states, eg athlete, anaemia, fever, thyrotoxicosis

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14
Q

Causes of aortic stenosis

A

Age (senile calcification)
Bicuspid aortic valve (eg in Turner’s)
Congenital
Rheumatic heart diseease

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15
Q

Causes of mitral regurg

A

papillary muscle dysfunction (post MI)
Dilated cardiomyopathy
RHeumatic heart disease
infective endocarditis
congenital
connective tissue disorders- eg Marfan’s

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16
Q

Causes of mitral valve prolapse

A

Associated with:
connective tissue disease: Marfan’s, Ehler’s Danlos, osteogenesis imperfecta
Cardiac disease: congenital heart disease, congestive cardiomyopathy, HOCM, myocarditis
Other: SLE, muscular dystrophy, ADPKD

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17
Q

Mitral valve prolapse features

A

Mid-systolic clic, and/or late syystolic murmur (so normal S1 and GAP before murmur, unlike in mitral regurg)
As in ventricular systole, mitral valve leaflet prolapses to left atriium

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18
Q

Causes tricuspid regurgitation

A

Most commonly: RV dilation in pulmonary hypertension
rheymatic heart disease
Infective endocarditis (partic IVDU)
Ebstein’s abnormality (if split S1 and S2)

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19
Q

Causes mitral stenosis

A

Rheumatic heart disease

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20
Q

Causes aortic regurgitation

A

Acute: infective endocarditis, aortic dissection
Chronic: connective tissue disorders, rhematic heart disease, syphilis, congenital/bicuspid aortic valve, long standing hypertension

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21
Q

Heart failure signs

A

Tachypnoea/tachycardia
Cool peripheries
Raised JVP
Displaced apex
S3
Bibasal fine creps
Peripheral oedema

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22
Q

ASD signs

A

Soft, ejection systolic flow murmur (pulm area). Fixed, wide split S2. RV heaveAssociations: Down’s syndrome eg low set ears, flat nasal bridge etc
Watch out for cyanosis = Eisenmenger’s

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23
Q

VSD signs

A

pansystolic murmur (loudest left sternal edge) associated thrill, RV heave
If causing R heeart failure: raised JVP, peripheral oedema

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24
Q

signs of cor pulmonale

A

Plethoric facial appearance
central cyanosis
Raised JVP (large A waves)
Giant V waves and pansystolic murmur (if secondary to tricuspid regurg)
R ventricular heave
Palpable/loud S2
Ankle oedema

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25
Signs tetralogy of fallot repair
Sternotomy scar Latera
26
Nerve root hip flexion
L2/L3
27
Nerve root hip extension
L4/5
28
Nerve root jnee extension
L3/4
29
Nerve root knee flexion
L5/S1
30
Nerve root ankle dorsiflexion
L4/5
31
Nerve root ankle plantar flexion
S1/S2`
32
Nerve root big toe extension
Pure L5
33
How many beats of clonus indicates UMN lesion?
>5
34
Patellar reflex nerve root
L3,4 (kick the door)
35
Ankle reflex nerve root
S1/2 (in the shoe)
36
Indications UMN lesion
Incr tone Spasticity Hyper-reflexia and upgoing plantar weakness
37
Indications LMN lesion
Wasting and fasciculation Hypotonia Weakness Reduced reflexes
38
Shoulder abduction nerve root
C5
39
Elbow flexion nerve root
C6
40
Elbow extension nerve root
C7
41
Wrist extension nerve root
C7
42
Finger extension nerve root
C7
43
Finger flexion nerve root
C8
44
Finger abduction nerve root
T1
45
Causes bilateral UMN weakness
MS Motor neuron disease Myelopathy (due to cervical myelopathy, SOL, disc prolapse, paraspinal infection), trauma, trasnverse myelitis, syringomyelia Others: brainstem stroke, cerebral palsy
46
Abnormal sensation and LMN weakness distally
= sensorimotor polyneuropathy: ABCDE Alcohol B12/thiamine deficiency Charcot-Marie-Tooth Diabetes, Drugs (TB drugs, metronidazzole, cisplatin etc) Every vasculitis
47
Normal sensation and LMN weakness distally (chronic)
= distal motor neuropathy CIDP Myotonic dystrophy Progressive muscular atrophy Lead poisoning Porphyria
48
Acute flaccid paralysis
Guillain-Barre syndrome some rare infections eg rabies, polio, West nile Cauda equina (usually sensory deficits, often asymnetrical) Acute transverse myelitis (although not technically LMN, presents with hypotonia and hyporeflexia acutely)
49
Differentials proximal weakness and normal sensation
Dystrophies: Becker's Duchenne;s Endocrinological: Cushings. thyroid issues Neuromuscular: MG, lambert-eaton inflammatory: dermato/polymyositis
50
Differentials cerebellar disease
MS Alcohol Thromboembolic/haemorrhage Inherited: Friedreich's, spinocerebellar ataxia, ataxia telangectasia SOL
51
Differentials mixed UMN +LMN signs
Motor neuron disease (nil sensory deficit) Myeloradiculopathy SACD of cord (symnetrical UMN signs with absent reflexes)
52
Medical causes third nerve palsy
Diabetes Migraine MS Classically pupil sparing
53
Surgical causes third nerve palsy
Posterior communicating artery aneurysm Cavernous sinus lesion cancer Classically involve pupil and painful
54
Causes monocular vision loss
Ipsilateral retinal or optic nerve lesion Retinal: central retinal artery/vein occlusion, retinal detachment Optic nerve: optic neuritis, optic atrophy, glaucoma
55
Causes bitemporal hemianopia
Optic chiasm lesion Superior: pituitary tumour Inferior: craniopharygoma
56
Causes homonymous hemianopia
Lesion in contralateral optic tract (or whole optic radiation) Eg MCA occlusion
57
Causes homonymous inferior quadrantopia
Lesion in contralateral parietal optic radiation Eg parietal tumour or superior branch of MCA occlusion
58
Causes homonymous superior quadrantopia
Lesion in contralateral temporal optic radiation Eg temporal tumour or inferion MCA branch occlusion
59
Causes homonymous hemianopia with macular sparing
Contralateral occipital visual cortex lesion Eg posterior cerebral artery occlusion
60
Median nerve motor function
Thumb abduxtion Pincer grip of thumb
61
Median nerve sensory distribution
Index finger palm of hand
62
Ulnar nerve motor function
Finger abduction
63
Ulnar nerve sensory distribution
Little finger on palmar side
64
Radiial nerve motor function
Wrist extensio
65
Radial nerve sensory test
Anatomical snuff box (between thumb and index) on dorsal side of hand
66
Differentials decreased air entry
Emphysema, pneumothorax, pleural effusion, collapse
67
Differentials wheeze
Asthma, COPD, cardiac wheezeD
68
Differentials coarse creps
Bronchiectasis, consolidation
69
Differentials fine creps
Fine inspiratory: pulmonary oedema Fine end inspiratory (like velcro): pulmonary fibrosis
70
Differentials pleural rub (grating sound)
Pleurisy, pumonary infarction, pneumonia, pleural malignanct
71
Examination findings pneumonia
Trachea central Reduced expansion ipsilaterally Decr percussion resonance Bronchial breathing (harsh breath sounds) + coarse creps
72
Examination findings pleural effusion
Trachea defiated away if large Reduced expansion ipsilaterally Stony dull percussion Reduced/absent breath sounds Reduced tactile fremitus and vocal resonance Signs of aetiology: clubbing/radiation marks/lymphadenopathy = mesothelioma/lung malignancy Signs of chronic liver disease = cirrhosis pulmonary/peripheral oedema = heart failure
73
Examination findings lung collapse
Tracheal deviation towards collapse Reduced expansion ipsilaterally decreased percussion resonance reduced/absent breath sounds
74
signs bronchiectasis
Productive cough Inspiratory clicks Clubbing Coarse, late expiratory creps + signs of aetiology - young and thin = CF - lymphadeoma = malignancy - dextrocardia = Kartagener's
75
Signs of lung cancer
Cachexia Clubbing Tar-stained fingers Hard, irregular lymphadenopathy Radiation burns Signs of complications - ptosis/meiosis/anhydrosis = Horner's - paraneoplastic syndromes
76
Signs of pulmonary fibrosis
Oxygen therapy Dry cough Tachypnoea reduced expansion Fine end inspiratory creps Signs of aetiology: - hand deformity = RA - clubbing = idiopathic lung fibrosis - sclerodactyly/telangiectasia/microstomia = systemic sclerosis - butterfly rash = SLE - kyphosis = ank spond - erythema nodosum = sarcoid
77
Signs of COPD
Bedside inhalers/nebs Accessory muscle use Tar stained fingers Tachypnoea Lip pursing Reduced cricosternal distance (<3 fingers) Tracheal tug Indrawing of lower intercostal muscles on ispiration Hyper resonance (obliterated cardiac and hepatic dullness( Quiet breath sounds/wheeze/prolonged expiratory phase
78
venous leg inspection
Swelling venous eczema Haemosiderin deopsition Lipodermatosclerosis -> inverted champagne bottle leg venous ulcers Atrophie blanche
79
Percussing varicosities
tap distally and feel impulse proximally = normal Tap proximally and feel impulse distally = incompetent valves
80
Tourniquet test
If varicosities present helps establish level Lift patient leg high and milk leg to empty veins Then apply tourniquet (quite high up leg) Ask patient to stand with tourniquet done up Rapid filling of varicosities = suggests incompetent perforating veins lie below the level of tournique Redo moving tourniquet down 3cm at a time. when varicosities do not refill, incompetent perforator is above the tourniquet, but below where previously applied.
81
Top causes of hepatomegaly
Mets HCC Hepatitis Right ventricle failure Leukaemia/lymphoma Fatty liver alcoholic liver disease
82
Top causes splenomeg
Lymphoma/leukaemia Myelofibrosis Myeloproliferative disrders Portal hypertension Extravascular haemolysis Malaria EBV
83
Signs chronic liver disease
Clubbing Leukonychia Palmar erythema Dupuytren's contracture Jaundice Spider naevi Gynaecomastia Loss of axillary Hair Caput medusae and splenomeg *(if portal hypertension) Hepatomegaly AScites
84
Transplanted kidney signs
old AV fistula Hockey stick (Rutherford Morrison scar) usually RIF SMooth mass of transplanted kidney underlying scar Signs of aetiology - fingertip glucose monitoring mars = diabetes - hearing aid = Alport syndrome - collapsed nasal bridge = Wegener's - flank masses = APKD Functionality? - flap/excoriations = uraemia - active marks in AV fistula - Pale confunctiva = anaemia - fluid retention Complicaitons of immunosuppression - tremor (calcineurin inhibitor) - cushingoid from steroids - skin lesiosn/excisions
85
Polycystic kidneys signs
AV fistula Hypertension Pale conjunctiva Flank scar if either kidney removed Bilateral ballotable flank masses Hepatomegaly (hepatic cysts)
86
Liver transplant signs
Signs of chronic liver disease (but most do resolve) Mercedes benz scar poss some signs of aetiology Complications of immunosuppressants - tremor (calcineurin inhibitor) - cushingoid/bruising (steroids) - skin lesions/excisions (immunosuppress -> SCC)
87
Combined kidney-pancreas transplant
LIF scar + RIF scar. With smooth mass underlying LIF which is transplanted kidney Signs of diabetic complications - visual aids from retinopathy - Charcot joints - toe ulcers/amputations - neuropathy Renal graf functionality Pancreas graft functionality - fingertip CBG monitoring, insulin injection marks Signs previous renal replacement theraapy Complications of immunosuppression
88
Signs PBC
Middle age female Jaundice Skin hyperpigmentation Excoriations Xanthelasma Hepatomegaly

Year 6 (9 decks)

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