OSCE Flashcards
Causes of a midline sternotomy scar
- leg scar - CABG or valve replacement with CABG
- valve replacement
Causes of an elevated JVP
- RHF
- Volume overload
- PE
- Constrictive pericarditis
Causes of an elevated JVP with decreased BP
- Tension pneumothorax
- Cardiac tamponade
- Massive PE
- Severe asthma
Causes of a fixed elevated JVP
- SVC obstruction
Causes of cannon a waves
- Complete heart block
- Ventricular ectopic beats
- Ventricular tachycardia
Causes of giant V waves
- Tricuspid regurgitation
Causes of central cyanosis
- Hypoxic lung disease
- Right-to-left cardiac shunt e.g. cyanotic congenital heart disease, Eisenmenger’s syndrome
- Methaemoglobinaemia e.g. drugs, toxins
Causes of peripheral cyanosis
- Peripheral vascular disease
- Raynaud’s syndrome
- Heart failure
- Shock
Causes of an irregularly irregular pulse
- AF
- Ventricular ectopic beats
- Complete heart block with variable ventricular escape
Causes of an absent radial pulse
- Congenital heart disease (usually bilateral)
- Arterial embolism
- Atheroma
- Previous arterial line
- Previous coronary angiogram
- Cervical rib
- Coarctation of the aorta
6 causes of AF
- Rheumatic heart disease
- Ischaemic heart disease
- Thyrotoxicosis
- Pneumonia
- PE
- Alcohol
Causes of pulsus paradoxus
- Cardiac tamponade
- Constrictive pericarditis
- Restrictive cardiomyopathy
- Severe asthma/COPD
Causes of Kussmaul’s sign
- Cardiac tamponade
- Constrictive pericarditis
- Restrictive cardiomyopathy
Causes of a non-palpable apex beat
- Adipose tissue
- Pneumothorax
- Emphysema
- Pleural or pericardial effusion
- Displaced apex beat
- Dextrocardia
Causes of a heaving apex beat
- Aortic stenosis
- Hypertension
- Hypertrophic obstructive cardiomyopathy
- Coarctation of the aorta
Causes of pericarditis
- Viral (Coxsackie)
- Bacterial/fungal infection
- Post-MI
- Dressler’s syndrome
- SLE/RA/scleroderma
- Uraemia
- Malignancy
Causes of a 3rd heart sound
- May be normal in <30s
- CCF
- MR
- AR
- Large anterior MI
Causes of a 4th heart sound
- AS
- hypertension
- HOCM
- post-MI fibrosis
Causes of cardiac failure
- IHD
- Cardiomyopathy
- Constrictive pericarditis
- Arrhythmia
- Drugs (negative inotropes)
- MR
- AR
- Fluid overload e.g. renal failure, IV fluids
- VSD
- AS
- Hypertension
- Anaemia
- Pregnancy
- Hyperthyroidism
- Paget’s
- Cor pulmonale
- Primary pulmonary hypertension
Indications for lobectomy/pneumonectomy
- Bronchogenic cancer
- Bronchiectasis
- Trauma
- TB
Causes of interstitial lung disease/pulmonary fibrosis
- Cryptogenic fibrosing alveolitis
- Bird fancier’s lung
- Farmer’s lung
- ASbestosis
- Silicosis
- Coal miner’s pneumonoconiosis
- Systemic disease e.g. SLE, RA, Sarcoid, systemic sclerosis
- Drugs e.g. methotrexate, amiodarone, radiotherapy
Causes of Horner’s syndrome
- Stroke
- Tumour
- MS
- Syringobulbia
- Spondylosis
- Neurofibroma
- Pancoast tumour
- Cervical rib
- Trauma/birth injury (Klumpke’s)
- Carotid artery aneurysm
- Sympathectomy
- Cluster headache
Causes of fine bibasal crepitations
- Pulmonary oedema
- Interstitial lung disease
Causes of coarse bibasal crepitations
- Bronchiectasis
- CF
- Bibasal pneumonia
Causes of transudate pleural effusion
- Left ventricular failure
- Volume overload
- Hypoalbuminaemia
- Meig’s syndrome
Causes of exudative pleural effusion
- Pneumonia
- TB
- PE
- RA
- SLE
- Malignancy
Causes of transudative ascites
- CLD
- RHF
- Volume overload
- Hypoalbuminaemia
- Constrictive pericarditis
Causes of exudative ascites
- SBP
- TB
- Pancreatitis
- Malignancy
Causes of hepatomegaly
- Viral hepatitis
- EBV
- Malaria
- Hepatic abscess
- Sarcoid
- Amyloid
- NAFLD
- Haemochromatosis
- Lymphoma
- Leukaemia
- Myeloproliferative disease
- Haemolytic anaemia
- PBC
- PSC
- Primary HCC
- Metastatic deposits
- RHF
- Tricuspid regurgitation
- Budd-Chiari syndrome
Causes of hepatosplenomegaly
- Viral hepatitis
- EBV
- Malaria
- Sarcoid
- Amyloid
- Lymphoma
- Leukaemia
- Myeloproliferative disorders
- Haemolytic anaemia
Extra-intestinal manifestations of IBD
- Finger clubbing
- Mouth ulcers
- Episcleritis
- Conjunctivitis
- Erythema nudism
- Pyoderma gangrenosum
- Seronegative spondyloarthropathy
- PSC (especially UC)
- Amyloidosis (especially Crohn’s)
What would cause an apparent leg length shortening?
- Fixed flexion deformity of the hip
- Fixed abduction e.g. OA
What would cause a true leg length deformity?
- Previous femur fracture
- Previous tibia fracture
- Growth disturbances
- NOF
- OA
- Hip dislocation
Indications for a total hip replacement
- OA
- RA
- DDH
- Displaced intra-capulse NOF in a young patient
Extra-articular features of RA
- Malaise
- Lethargy
- Low grade fever
- Weight loss
- Pericarditis
- Pericardial effusion
- Pleural effusion
- Pulmonary fibrosis
- Pneumoconiosis
- Renal amyloid
- Polyneuropathy
- Mononeuritis monoplex
- Carpal tunnel
- Atlanto-axial subluxation
- Scleritis
- Episcleritis
- Keratoconjunctivitis sicca
- Sjogren’s syndrome
- Anaemia
- Thrombocytosis
- Decreased WCC
Features of RA on x-ray
- Loss of joint space
- Bony erosion
- Periarticular osteoporosis
- Deformity
- Soft tissue swelling
Features of OA on x-ray
- Loss of joint space
- Osteophytes
- Subchondral sclerosis
- Bone cysts
Key side effects of all DMARDs
- Bone marrow suppression
- Hepatotoxicity
- Rash
- GI upset
Signs of an LMN lesion
- Normal or reduced tone
- Reduced power
- Reduced reflexes
- Downward plantars
- Normal coordination
- Wasting
- Fasciculations
Signs of an UMN lesion
- Increased tone
- Reduced power
- Brisk reflexes
- Upward plantars
- Reduced downward
- Clonus
Signs of an extra-pyramidal lesion
- Rigidity
- Normal power
- Normal reflexes
- Downward plantars
- Reduced coordination
- Resting tremor
- Bradykinesia
- Postural instbaility
Signs of a cerebellar lesion
- Reduced tone
- Normal power
- Normal reflexes
- Downward plantars
- No coordination
- Intention tremor
- Nystagmus
- Cerebellar speech
Causes of an olfactory nerve palsy
- Trauma
- Frontal lobe tumour
- Meningitis
Causes of an optic nerve palsy
Monocular blindness
- MS
- GCA
Bitemporal hemianopia
- Pituitary adenoma
- Internal carotid artery aneurysm
Homonymous hemianopia
- Anything behind chiasm e.g. stroke, tumour, abscess
Causes of an oculomotor nerve palsy
- Diabetes (partial, pupils spared)
- PCA aneurysm
- Raised ICP with tentorial herniation
Causes of a trochlear nerve palsy
- Orbit trauma
Causes of a trigeminal nerve palsy
- Idiopathic - trigeminal neuralgia
- Acoustic neuroma
- Herpes zoster
Causes of an abducens nerve palsy
- Skull fracture involving petrous temporal bone
- Nasopharyngeal carcinoma
- Raised ICP (false localising sign)
Causes of a facial nerve palsy
- Bell’s palsy
- Malignant parotid tumour
- Ramsay Hunt sundrome
- Sarcoid (often bilateral)
- Stroke/tumour (forehead spared)
Causes of a vestibulocochlear nerve palsy
- Excessive noise levels
- Meniere’s disease
- Furosemide
- Aminoglycoside antibitoics (genatmicin)
Causes of a bulbar nerve palsy (9-12)
- MND
- Diphtheria
- Polio
- MG
- GBS
- Syringobulbia
- Bilateral stroke
- MS
Cause of a nerve palsy of cranial nerves V, VII, VIII, (and sometimes IX, X)
- Cerebellopontine angle tumour (acoustic neuroma or meningioma)
Cause of a nerve palsy of cranial nerves V, VII and VIII
- Paget’s disease of the bone
Cause of a nerve palsy of cranial nerves III, IV & VI
- Cavernous sinus thrombosis
Causes of ptosis
- CN III palsy
- Horner’s syndrome
- Congenital
- MG
- Myotonic dystrophy
