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0
Q

Causes of Mitral Regurgitation

A

Ischaemic cardiomyopathy
Valvula - infective endocarditis / rheumatic fever
- connective tissue disorders (EDS, margins, SLE)
Papillary muscle dysfunction - post-MI
Functional - cardiac wall dysfunction
- dilated cardiomyopathy / ventricular aneurysm
Congenital
Atrial myxoma
Trauma and iatrogenic post surgery

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1
Q

Causes of Aortic Stenosis

A

CBA

  1. Calcification due to old age
  2. Bicuspid valve
  3. Acute rheumatic fever
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2
Q

What is the management of aortic stenosis?

A

Treat if asymptomatic:

  • Valve replacement definitive
  • Percutaneous balloon valvuplasty if unsuitable

Once symptomatic 2 year prognosis unless treated!

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3
Q

What options are available for valve replacement in aortic stenosis?

A
  1. Type of surgery
    • Endovascular
    • Open
  2. Type of valve
    • Mechanical (lasts longer but need for warfarin)
    • Tissue (only last 10-15 years but DON’T need warfarin)
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4
Q

Presentation of AF

A
  1. Irregular palpitations
  2. SOB
  3. Clinical consequences (stroke / peripheral ischaemia)

Dizziness, syncope, angina

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5
Q

Acute HF management

A

ABCDE and inform a senior

Sit upright and give O2
Furosemide IV (80mg)

Consider:
IV Nitrates
Morphine
Cardiac support

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6
Q

Management of chronic heart failure

A

BIOPSYCHOSOCIAL..

Conservative
- Reduce risk factors / Vaccinations

Medical

  • Prognostic: Beta-blocker, ACEi and Spirolactone
  • Symptomatic: Diuretics and Digoxin

Surgical

  • ICD
  • Cardiac resynchronisation therapy
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7
Q

What scoring system is used in AF?

A

CHA2DS2 VASc

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8
Q

What does 6/6 and 4/60 mean from a Snellen chart

A

6/18 what the patient can read at 6 meters can be read by someone with no impairment at 18 meters

4/60 what the patient can read at 4 meters can be read by someone with no impairment at 40 meters

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9
Q

In visual acuity what should you do if the patient can’t read the biggest letter at 6 meters.

A
  1. Move closer to chart 1 meter at a time
  2. Count fingers (CF)
  3. Hand movements (HM)
  4. Flashlight - perception of light (PL)
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10
Q

When would you use a pinhole occluder

A

If 6/6 is not achieved. Tests central vision.

An improvement indicates a refractive problem that may be correctable with glasses.

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11
Q

What would suggest background retinopathy

A

Microaneurysms, blot haemorrhages and hard exudates

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12
Q

What would suggest preproliferation retinopathy

A

Cotton wool spots.

Also large blot haemorrhages and gross venus abnormalities.

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13
Q

What would suggest proliferation retinopathy

A

New vessel formation

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14
Q

Causes of claudication without PVD

A

Spinal claudication, anaemia and beta-blockers

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15
Q

ABPI ranges

A

0.9-1.1 - normal

<0.3 - critical limb ischaemia

16
Q

What changes might evident in a diabetic foot

A

Chronic:

  • Vascular (pale or erythematous with absent pulses)
  • Neurological (dry, cracked, atrophied skin and hair loss)
  • Musculoskeletal (hammer toes, high arch and charcots joint)

Acute:

  • Ulcers
  • Infection (cellulitis and osteomyelitis)
  • Critical limb ischaemia (gangrene and amputation)
17
Q

What is the approach to management for a diabetic foot?

A

Ulcer management:

  • Clean
  • Investigate for infection
  • Dress
  • Compress
  • Elevate
  • Patient education

If required:

  • Manage any infection
  • Vascular team involvement
18
Q

Reasons for a Kocher incision

A
  • Cholecystectomy
  • Access to biliary tree and liver

Chevron or Mercedes expansion

  • Oesophagus
  • Stomach
  • Kidney
  • Liver
19
Q

Causes of hepatomegaly

A

Cancer - HCC or mets
- Lymphoma, leukaemia or myloproliferative disorders
Congestion - HF or Budd-Chiari
Infection - Hepatitis, EBV mononucleosis or malaria
Infiltration - Fatty liver, haemachromatosis, amyloidosis or sarcoidosis
Immunological - Autoimmune hepatitis, PBC or PSC

20
Q

Causes of splenomegaly

A

Massive - CML, myelfibrosis or malaria

Smaller - IE or rheumatoid

21
Q

Causes of hepatosplenomegaly

A

Blood disorder - leukaemia, lymphoma, myeloproliferative disorder and haemolytic disorder
Infiltration - sarcoidosis or amyloidosis
Infective - hepatitis, EBV and malaria

22
Q

Causes of ascites

A
  • transudative
  • infective
  • malignancy

Due to portal hypertension, reduced protein or excess fluid.

23
Q

Causes of renal enlargement

A

More commonly unilateral

  • Malignancy
  • Simple cyst

More commonly bilateral:

  • PCKD
  • Hydronephrosis
  • Amyloidosis
  • Tubular sclerosis
24
Causes of dupytrons contractions
1. Ideopathic 2. Alcoholic liver disease 3. Diabetes 4. Epilepsy and phenytoin 5. Vibrating tools
25
Causes of gynecomastia
Physiological: - neonates - puberty - old age (dx of exclusion!) Pathological: - spironolactone, digoxin, cimetidine and izoniazide - opiates and cannibis - excess oestrogen (liver disease, thyrotoxicosis and lung, testicular and adrenal cancer) - reduced testosterone (orchitis, trauma and kleinfelters)
26
How can you differentiate a spleen from another mass (e.g. Kidney)
1. Can't get above it 2. Moves with respiration (down and across) 3. Splenic notch palpable 4. Dull to percuss 5. CAN'T ballot
27
Causes of AF
``` Idiopathic Cardiovascular: - valvular (in particular mitral) - chronic hypertension - ischaemic heart disease or heart failure Systemic - alcohol - sepsis - hyperthyroid - some medications e.g. Theophylline Pulmonary - COPD and emphysema - pneumonia - PE ```
28
What blood tests would be involved in a 'liver screen'
LFT, U&E (renal function and urea), FBC, BM!, Clotting ?crossmatch or group and save - viral load - copper - ferritin - autoantibodies (anti-smooth muscle / mitochondrial / pANCA) - alpha fetaprotein
29
What is the child-Pugh score
Prognosis of chronic liver disease 5-6 A 7-9 B 10+ C - encephalopathy - ascites - bilirubin (34 and 51 (multipuls of 17...)) - albumin - INR
30
What is normal maintenance fluids
1L 0.9% sodium chloride 2L 5% dextrose With 20mmol K in each
31
What are common complications of a misplaced NG tube
``` Aspiration of food - Pneumonia Empyema Pneumothorax No feed given ```
32
When should an NG tube be checked with a p strip
When it's first put in If suspicious it may have moved for any reason Before feeds Everyday when on continuous feeds

OSCE Questions (1 decks)

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