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OSCE Flashcards

1
Q

Causes of a midline sternotomy scar

A
    • leg scar - CABG or valve replacement with CABG

- valve replacement

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2
Q

Causes of an elevated JVP

A
  • RHF
  • Volume overload
  • PE
  • Constrictive pericarditis
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3
Q

Causes of an elevated JVP with decreased BP

A
  • Tension pneumothorax
  • Cardiac tamponade
  • Massive PE
  • Severe asthma
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4
Q

Causes of a fixed elevated JVP

A
  • SVC obstruction
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5
Q

Causes of cannon a waves

A
  • Complete heart block
  • Ventricular ectopic beats
  • Ventricular tachycardia
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6
Q

Causes of giant V waves

A
  • Tricuspid regurgitation
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7
Q

Causes of central cyanosis

A
  • Hypoxic lung disease
  • Right-to-left cardiac shunt e.g. cyanotic congenital heart disease, Eisenmenger’s syndrome
  • Methaemoglobinaemia e.g. drugs, toxins
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8
Q

Causes of peripheral cyanosis

A
  • Peripheral vascular disease
  • Raynaud’s syndrome
  • Heart failure
  • Shock
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9
Q

Causes of an irregularly irregular pulse

A
  • AF
  • Ventricular ectopic beats
  • Complete heart block with variable ventricular escape
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10
Q

Causes of an absent radial pulse

A
  • Congenital heart disease (usually bilateral)
  • Arterial embolism
  • Atheroma
  • Previous arterial line
  • Previous coronary angiogram
  • Cervical rib
  • Coarctation of the aorta
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11
Q

6 causes of AF

A
  • Rheumatic heart disease
  • Ischaemic heart disease
  • Thyrotoxicosis
  • Pneumonia
  • PE
  • Alcohol
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12
Q

Causes of pulsus paradoxus

A
  • Cardiac tamponade
  • Constrictive pericarditis
  • Restrictive cardiomyopathy
  • Severe asthma/COPD
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13
Q

Causes of Kussmaul’s sign

A
  • Cardiac tamponade
  • Constrictive pericarditis
  • Restrictive cardiomyopathy
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14
Q

Causes of a non-palpable apex beat

A
  • Adipose tissue
  • Pneumothorax
  • Emphysema
  • Pleural or pericardial effusion
  • Displaced apex beat
  • Dextrocardia
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15
Q

Causes of a heaving apex beat

A
  • Aortic stenosis
  • Hypertension
  • Hypertrophic obstructive cardiomyopathy
  • Coarctation of the aorta
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16
Q

Causes of pericarditis

A
  • Viral (Coxsackie)
  • Bacterial/fungal infection
  • Post-MI
  • Dressler’s syndrome
  • SLE/RA/scleroderma
  • Uraemia
  • Malignancy
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17
Q

Causes of a 3rd heart sound

A
  • May be normal in <30s
  • CCF
  • MR
  • AR
  • Large anterior MI
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18
Q

Causes of a 4th heart sound

A
  • AS
  • hypertension
  • HOCM
  • post-MI fibrosis
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19
Q

Causes of cardiac failure

A
  • 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
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20
Q

Indications for lobectomy/pneumonectomy

A
  • Bronchogenic cancer
  • Bronchiectasis
  • Trauma
  • TB
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21
Q

Causes of interstitial lung disease/pulmonary fibrosis

A
  • 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
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22
Q

Causes of Horner’s syndrome

A
  • Stroke
  • Tumour
  • MS
  • Syringobulbia
  • Spondylosis
  • Neurofibroma
  • Pancoast tumour
  • Cervical rib
  • Trauma/birth injury (Klumpke’s)
  • Carotid artery aneurysm
  • Sympathectomy
  • Cluster headache
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23
Q

Causes of fine bibasal crepitations

A
  • Pulmonary oedema

- Interstitial lung disease

24
Q

Causes of coarse bibasal crepitations

A
  • Bronchiectasis
  • CF
  • Bibasal pneumonia
25
Causes of transudate pleural effusion
- Left ventricular failure - Volume overload - Hypoalbuminaemia - Meig's syndrome
26
Causes of exudative pleural effusion
- Pneumonia - TB - PE - RA - SLE - Malignancy
27
Causes of transudative ascites
- CLD - RHF - Volume overload - Hypoalbuminaemia - Constrictive pericarditis
28
Causes of exudative ascites
- SBP - TB - Pancreatitis - Malignancy
29
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
30
Causes of hepatosplenomegaly
- Viral hepatitis - EBV - Malaria - Sarcoid - Amyloid - Lymphoma - Leukaemia - Myeloproliferative disorders - Haemolytic anaemia
31
Extra-intestinal manifestations of IBD
- Finger clubbing - Mouth ulcers - Episcleritis - Conjunctivitis - Erythema nudism - Pyoderma gangrenosum - Seronegative spondyloarthropathy - PSC (especially UC) - Amyloidosis (especially Crohn's)
32
What would cause an apparent leg length shortening?
- Fixed flexion deformity of the hip | - Fixed abduction e.g. OA
33
What would cause a true leg length deformity?
- Previous femur fracture - Previous tibia fracture - Growth disturbances - NOF - OA - Hip dislocation
34
Indications for a total hip replacement
- OA - RA - DDH - Displaced intra-capulse NOF in a young patient
35
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
36
Features of RA on x-ray
- Loss of joint space - Bony erosion - Periarticular osteoporosis - Deformity - Soft tissue swelling
37
Features of OA on x-ray
- Loss of joint space - Osteophytes - Subchondral sclerosis - Bone cysts
38
Key side effects of all DMARDs
- Bone marrow suppression - Hepatotoxicity - Rash - GI upset
39
Signs of an LMN lesion
- Normal or reduced tone - Reduced power - Reduced reflexes - Downward plantars - Normal coordination - Wasting - Fasciculations
40
Signs of an UMN lesion
- Increased tone - Reduced power - Brisk reflexes - Upward plantars - Reduced downward - Clonus
41
Signs of an extra-pyramidal lesion
- Rigidity - Normal power - Normal reflexes - Downward plantars - Reduced coordination - Resting tremor - Bradykinesia - Postural instbaility
42
Signs of a cerebellar lesion
- Reduced tone - Normal power - Normal reflexes - Downward plantars - No coordination - Intention tremor - Nystagmus - Cerebellar speech
43
Causes of an olfactory nerve palsy
- Trauma - Frontal lobe tumour - Meningitis
44
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
45
Causes of an oculomotor nerve palsy
- Diabetes (partial, pupils spared) - PCA aneurysm - Raised ICP with tentorial herniation
46
Causes of a trochlear nerve palsy
- Orbit trauma
47
Causes of a trigeminal nerve palsy
- Idiopathic - trigeminal neuralgia - Acoustic neuroma - Herpes zoster
48
Causes of an abducens nerve palsy
- Skull fracture involving petrous temporal bone - Nasopharyngeal carcinoma - Raised ICP (false localising sign)
49
Causes of a facial nerve palsy
- Bell's palsy - Malignant parotid tumour - Ramsay Hunt sundrome - Sarcoid (often bilateral) - Stroke/tumour (forehead spared)
50
Causes of a vestibulocochlear nerve palsy
- Excessive noise levels - Meniere's disease - Furosemide - Aminoglycoside antibitoics (genatmicin)
51
Causes of a bulbar nerve palsy (9-12)
- MND - Diphtheria - Polio - MG - GBS - Syringobulbia - Bilateral stroke - MS
52
Cause of a nerve palsy of cranial nerves V, VII, VIII, (and sometimes IX, X)
- Cerebellopontine angle tumour (acoustic neuroma or meningioma)
53
Cause of a nerve palsy of cranial nerves V, VII and VIII
- Paget's disease of the bone
54
Cause of a nerve palsy of cranial nerves III, IV & VI
- Cavernous sinus thrombosis
55
Causes of ptosis
- CN III palsy - Horner's syndrome - Congenital - MG - Myotonic dystrophy

Year 4 (11 decks)

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