OSCE Flashcards
Abdominal Peripheral
Hands - pallor, palmar erythema, koilonychia, leukonychia, Dupuytrens, finger clubbing, temperature, radial pulse
Arms:
Acanthothosis nigricans
Hair loss
track marks
Eyes + Mouth:
Keyser Fleischer rings
Pallor
Angular cheilitis
Corneal arcus
Oral apthous ulcers
Neck LN -> Virchow’s
Ab -> Cullen’s, Grey-Turner, distension, stoma, hernia, masses, striae
Palpate gallbladder, aorta, bladder
Pedal Oedema
Neuro Upper
Finger extension and grip
Shoulder MSK
Scapula palpation
Renal
Hands:
Asterixis
Pallor
Skin turgor
Arm:
Bruising
AV fistula
Pulse and BP
Face:
Uraemia frost
Uraemic fetor
Gingival hypertrophy
Neck:
JVP
Dialysis catheter
Chest:
HS
Lung bases for crackles
Percussion
Abdominal:
Palpate 9
Ballot kidneys
Auscultate bruits
Pitting oedema
COPD Management
A-E assessment
Call for senior
Nebulised salbutamol
Nebulised ipratropium
Oral prednisolone 30mg 5 days
Venturi 24-28 -> 88-92%
PO antibiotics -> amoxicillin, clarithromycin, doxycycline
Persistent -> BiPap
XR
Rotation
Inspiration -> anterior 5-6 ribs visible, both costophrenic angles and lateral rib edges
Assume PA if no label
Exposure -> left hemidiaphragm visible
CXR:
Airways - Trachea (deviation), carina, bronchi and hilar structures
Breathing - lungs and pleura
Cardiac - heart size and borders
Diaphragm - costophrenic angles
Everything else - mediastinal contours, bones, soft tissue, tubes, valves, pacemakers, aortic knuckle
Area of body xrayed
Bowel and organs:
Dilatation
Gas
Size
Organomegaly
Bones:
Alignment and joint space
Bone - texture
Cortices
Soft tissue - swelling, effusion
Calcification
Coffee bean on AXR -> diagnosis
Sigmoid volvulus
LL Neuro
Coordination, Romberg’s, Gait, plantars, stand up from chair without using arms
Give 3
Hand MSK
Hand on pillow
Radial pulse
Palpate thenar and hypothenar bulk
MCP squeeze
Palpate snuffbox
Power and sensation of ulnar (little volar, medial 2 lumbricals), radial (1st dorsal webspace, wrist extension/finger extension) and median (index and thenar eminence, thumb abduction)
Function -> power grip, pincer grip, small object
Tinel and Phalens
Uraemia + microcytic anaemia -> differential?
Upper GI Bleed
Management immediately + SOB
Bloods, ECG, CXR, ABG
Aortic dissection -> investigations?
ECG, CT angiogram
Breast exam
Clavicular LN, sub-mammary fold
UMN
Pronator drift, proprioception, vibration, finger extension, thumb abduction,
Which investigations can be used for stroke?
CT head urgent to rule out haemorrhage and SoLs
Carotid doppler to determine stenosis
Give an investigation for cardio in a ?stroke
ECG
Holter for AF
Give some stigmata of IE
Clubbing
Splinter haemorrhage
Janeway (brown lesions, painless)
Oslers nodes (red circles on bulk of hands, tender)
What to listen for when hearing crackles to differentiate bronchiectasis and fibrosis?
Coarse crackles changing on cough and productive -> bronchiectasis
Fine, end inspiratory with dry cough -> fibrosis
Give some signs of decompensated resp + cardio disease
Resp -> CO2 retention flap, cor pulmonale
Cardio -> peripheral or pulmonary oedema
Give the murmurs found in aortic stenosis
Slow rising pulse, reverse S2 splitting
Give a facial sign in mitral stenosis + P murmur
Loud P2
Mitral stenosis
Both from pulmonary hypertension
Which muscle is atrophies the earliest?
Vastus medialis
What is the most common direction that a TKR might dislocate?
Posterior
PCL sometimes cut in TKR
Define HS S3 + S4
S3 = overcompliance of ventricles -> seen in dilated cardiomyopathy, systolic HF,
S4 = filling into non-compliant ventricles -> hypertrophy, severe aortic stenosis or diastolic heart failure (always pathological)
What is Kussmaul’s sign indicative of?
Constrictive pericarditis (impaired RV filling) -> increase in JVP with inspiration
Give 3 complication groups in transplants
Rejection, recurrence, immunosuppressant side effects
Give 3 causes of hyperthyroidism
Graves, toxic multi nodular goitre (iodine deficiency), toxic adenoma
Define Pemberton’s test
Ask patient to raise arms above head -> check for flushing due to compression of SVC from goitre
Give 2 signs to distinguish Graves
Thyroid acropachy
Pretibial myxoedema
Why ask about trauma in breast history taking?
Fat necrosis
Which murmur is associated with bisferiens pulse?
AR
What to ask before explaining a procedure?
Indication -> tailor counselling
Give 2 red flags for same day assessment in paediatric GORD
Vomiting blood
Melaena
How to tell difference between AP and PA in CXR?
Look at scapulae within chest wall = AP
What type of crackles are heard in pulmonary oedema?
Coarse crackles
Reduced breath sounds
Give some notes for contraceptive implant (years, mechanism of hormone -3, onset of effect, side effects, red flags)
3 years
Progestogen -> prevents ovulation, thickens cervical mucus, thins endometrium
Days 1-5 of menstrual cycle -> immediate
Over 5 days -> wear barrier protection for 7 days
Irregular bleeds, some have usual pattern, tends to improve over time, some don’t have any
Interactions with medications -> consult with doctor
Make sure you are able to feel it, if not, then book appointment to check position
Systemically unwell, persistent pain and redness
Give 3 side effects of clozapine + monitoring
Agranulocytosis -> first 18 weeks, monitor FBC weekly
Cardiac -> ECG + safety net for chest pain, palpitations, leg swelling
Constipation -> bowel obstruction
Give the weeks for pre-term, very pre-term and severe?
37, 32, 28
What should be monitored in cephalohaematoma?
Bilirubin
Hair on end, Howell Jolly body, target cell -> diagnosis?
beta-thalassaemia
How less should pO2 be compared to % O2?
10 less (e.g. 21 room air -> target 11)
What else should you consider in perceptions along with auditory (talking to them or about them, how many voices) and visual hallucinations?
Depersonalisation
Derealisation
What to ask in current situation for MSE?
Eating, cleaning, work
Which anaemia is associated with choriocarcinoma?
alpha-thalasaemia
Diabetes
1) Insulin role, high sugar -> low insulin, decreased sensitivity
2) Acute -> UTIs
3) chronic -> sugar in vessels cause damage -> microvascular (eyes, kidneys, hands and feet)
Macro -> heart and brain
4) Weight loss, diet, alcohol, smoking, HbA1c every 3-6 months, drug therapies, vaccinations, diabetes nurse follow up
