OSCE Flashcards
Causes of Mitral Regurgitation
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
Causes of Aortic Stenosis
CBA
- Calcification due to old age
- Bicuspid valve
- Acute rheumatic fever
What is the management of aortic stenosis?
Treat if asymptomatic:
- Valve replacement definitive
- Percutaneous balloon valvuplasty if unsuitable
Once symptomatic 2 year prognosis unless treated!
What options are available for valve replacement in aortic stenosis?
- Type of surgery
- Endovascular
- Open
- Type of valve
- Mechanical (lasts longer but need for warfarin)
- Tissue (only last 10-15 years but DON’T need warfarin)
Presentation of AF
- Irregular palpitations
- SOB
- Clinical consequences (stroke / peripheral ischaemia)
Dizziness, syncope, angina
Acute HF management
ABCDE and inform a senior
Sit upright and give O2 Furosemide IV (80mg)
Consider:
IV Nitrates
Morphine
Cardiac support
Management of chronic heart failure
BIOPSYCHOSOCIAL..
Conservative
- Reduce risk factors / Vaccinations
Medical
- Prognostic: Beta-blocker, ACEi and Spirolactone
- Symptomatic: Diuretics and Digoxin
Surgical
- ICD
- Cardiac resynchronisation therapy
What scoring system is used in AF?
CHA2DS2 VASc
What does 6/6 and 4/60 mean from a Snellen chart
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
In visual acuity what should you do if the patient can’t read the biggest letter at 6 meters.
- Move closer to chart 1 meter at a time
- Count fingers (CF)
- Hand movements (HM)
- Flashlight - perception of light (PL)
When would you use a pinhole occluder
If 6/6 is not achieved. Tests central vision.
An improvement indicates a refractive problem that may be correctable with glasses.
What would suggest background retinopathy
Microaneurysms, blot haemorrhages and hard exudates
What would suggest preproliferation retinopathy
Cotton wool spots.
Also large blot haemorrhages and gross venus abnormalities.
What would suggest proliferation retinopathy
New vessel formation
Causes of claudication without PVD
Spinal claudication, anaemia and beta-blockers
ABPI ranges
0.9-1.1 - normal
<0.3 - critical limb ischaemia
What changes might evident in a diabetic foot
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)
What is the approach to management for a diabetic foot?
Ulcer management:
- Clean
- Investigate for infection
- Dress
- Compress
- Elevate
- Patient education
If required:
- Manage any infection
- Vascular team involvement
Reasons for a Kocher incision
- Cholecystectomy
- Access to biliary tree and liver
Chevron or Mercedes expansion
- Oesophagus
- Stomach
- Kidney
- Liver
Causes of hepatomegaly
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
Causes of splenomegaly
Massive - CML, myelfibrosis or malaria
Smaller - IE or rheumatoid
Causes of hepatosplenomegaly
Blood disorder - leukaemia, lymphoma, myeloproliferative disorder and haemolytic disorder
Infiltration - sarcoidosis or amyloidosis
Infective - hepatitis, EBV and malaria
Causes of ascites
- transudative
- infective
- malignancy
Due to portal hypertension, reduced protein or excess fluid.
Causes of renal enlargement
More commonly unilateral
- Malignancy
- Simple cyst
More commonly bilateral:
- PCKD
- Hydronephrosis
- Amyloidosis
- Tubular sclerosis
Causes of dupytrons contractions
- Ideopathic
- Alcoholic liver disease
- Diabetes
- Epilepsy and phenytoin
- Vibrating tools
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)
How can you differentiate a spleen from another mass (e.g. Kidney)
- Can’t get above it
- Moves with respiration (down and across)
- Splenic notch palpable
- Dull to percuss
- CAN’T ballot
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
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
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
What is normal maintenance fluids
1L 0.9% sodium chloride
2L 5% dextrose
With 20mmol K in each
What are common complications of a misplaced NG tube
Aspiration of food - Pneumonia Empyema Pneumothorax No feed given
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
