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GP Conditions > OSCE > Flashcards

OSCE Flashcards

1
Q

Abdominal Peripheral

A

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

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2
Q

Neuro Upper

A

Finger extension and grip

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3
Q

Shoulder MSK

A

Scapula palpation

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4
Q

Renal

A

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

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5
Q

COPD Management

A

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

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6
Q

XR

A

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

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7
Q

Coffee bean on AXR -> diagnosis

A

Sigmoid volvulus

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8
Q

LL Neuro

A

Coordination, Romberg’s, Gait, plantars, stand up from chair without using arms

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9
Q

Give 3

A
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10
Q

Hand MSK

A

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

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11
Q

Uraemia + microcytic anaemia -> differential?

A

Upper GI Bleed

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12
Q

Management immediately + SOB

A

Bloods, ECG, CXR, ABG

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13
Q

Aortic dissection -> investigations?

A

ECG, CT angiogram

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14
Q

Breast exam

A

Clavicular LN, sub-mammary fold

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15
Q

UMN

A

Pronator drift, proprioception, vibration, finger extension, thumb abduction,

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16
Q

Which investigations can be used for stroke?

A

CT head urgent to rule out haemorrhage and SoLs
Carotid doppler to determine stenosis

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17
Q

Give an investigation for cardio in a ?stroke

A

ECG
Holter for AF

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18
Q

Give some stigmata of IE

A

Clubbing
Splinter haemorrhage
Janeway (brown lesions, painless)
Oslers nodes (red circles on bulk of hands, tender)

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19
Q

What to listen for when hearing crackles to differentiate bronchiectasis and fibrosis?

A

Coarse crackles changing on cough and productive -> bronchiectasis

Fine, end inspiratory with dry cough -> fibrosis

20
Q

Give some signs of decompensated resp + cardio disease

A

Resp -> CO2 retention flap, cor pulmonale
Cardio -> peripheral or pulmonary oedema

21
Q

Give the murmurs found in aortic stenosis

A

Slow rising pulse, reverse S2 splitting

22
Q

Give a facial sign in mitral stenosis + P murmur

A

Loud P2
Mitral stenosis
Both from pulmonary hypertension

23
Q

Which muscle is atrophies the earliest?

A

Vastus medialis

24
Q

What is the most common direction that a TKR might dislocate?

A

Posterior
PCL sometimes cut in TKR

25
Q

Define HS S3 + S4

A

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)

26
Q

What is Kussmaul’s sign indicative of?

A

Constrictive pericarditis (impaired RV filling) -> increase in JVP with inspiration

27
Q

Give 3 complication groups in transplants

A

Rejection, recurrence, immunosuppressant side effects

28
Q

Give 3 causes of hyperthyroidism

A

Graves, toxic multi nodular goitre (iodine deficiency), toxic adenoma

29
Q

Define Pemberton’s test

A

Ask patient to raise arms above head -> check for flushing due to compression of SVC from goitre

30
Q

Give 2 signs to distinguish Graves

A

Thyroid acropachy
Pretibial myxoedema

31
Q

Why ask about trauma in breast history taking?

A

Fat necrosis

32
Q

Which murmur is associated with bisferiens pulse?

A

AR

33
Q

What to ask before explaining a procedure?

A

Indication -> tailor counselling

34
Q

Give 2 red flags for same day assessment in paediatric GORD

A

Vomiting blood
Melaena

35
Q

How to tell difference between AP and PA in CXR?

A

Look at scapulae within chest wall = AP

36
Q

What type of crackles are heard in pulmonary oedema?

A

Coarse crackles
Reduced breath sounds

37
Q

Give some notes for contraceptive implant (years, mechanism of hormone -3, onset of effect, side effects, red flags)

A

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

38
Q

Give 3 side effects of clozapine + monitoring

A

Agranulocytosis -> first 18 weeks, monitor FBC weekly

Cardiac -> ECG + safety net for chest pain, palpitations, leg swelling

Constipation -> bowel obstruction

39
Q

Give the weeks for pre-term, very pre-term and severe?

A

37, 32, 28

40
Q

What should be monitored in cephalohaematoma?

A

Bilirubin

41
Q

Hair on end, Howell Jolly body, target cell -> diagnosis?

A

beta-thalassaemia

42
Q

How less should pO2 be compared to % O2?

A

10 less (e.g. 21 room air -> target 11)

43
Q

What else should you consider in perceptions along with auditory (talking to them or about them, how many voices) and visual hallucinations?

A

Depersonalisation
Derealisation

44
Q

What to ask in current situation for MSE?

A

Eating, cleaning, work

45
Q

Which anaemia is associated with choriocarcinoma?

A

alpha-thalasaemia

46
Q

Diabetes

A

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

GP Conditions (5 decks)

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