OSCE Conditions Flashcards
What is Crohn’s Disease?
Inflammation of the GI tract
What is UC?
Inflammation of the colon and rectum
Give some symptoms of IBD
Diarrhoea- blood, mucous, pus Abdo pain Increased frequency of bowel movements Fatigue Weight loss
Explain why patients with IBD feel tired
Inflammation of the bowel leads to blood loss which leads to anaemia which causes tiredness
They may also not be able to absorb nutrients in their gut as well as they used to leading to malnutrition and tiredness.
Give some causes of IBD
Genetics
Western diet and environment
Smoking
Autoimmune destruction of gut flora
How is IBD diagnosed?
Blood tests- inflammation, anaemia, infections Stool sample Colonoscopy Barium enema CT/MRI
Give 3 ways IBD can be treated
Surgery- remove section of inflamed bowel (ileostomy)
Corticosteroids- prednisalone
Immunosuppressants
Biological therapies - infliximab
Give some complications of Crohn’s disease
Fistulas Bowel strictures Anaemia Osteoporosis Colorectal cancer
Give some complications of UC
Osteoporosis Poor growth Toxic megacolon Bowel cancer Primary sclerosing cholangitis
Explain how bowel strictures can occur in IBD
Chronic inflammation results in deposition of scar tissue. This builds up and narrows the bowel lumen causing strictures
Through what structures do fistulas form in Crohn’s disease?
Bowel and vagina, bladder or skin
What is cerebrovascular disease?
Diseases caused by poor blood flow to the brain
What are the 3 most common cerebrovascular diseases
Stroke
TIA
Vascular dementia
What is an ischaemic stroke?
Blockage of blood flow to the brain by a clot causing brain damage due to hypoxia
What is a haemorrhagic stroke?
Leakage of blood into the brain tissue
Give 3 symptoms of a stroke
Slurred speech
Drooping face
Loss of sensations in the arms
What is vascular dementia?
Loss of mental ability due to lack of perfusion to the brain
What is a TIA?
A transient ischaemic attack
Temporary disruption to the blood flow to the brain. Very similar to a stroke but resolves within 24 hours
Give 5 risk factors for cerebrovascular disease
Smoking Obesity Stress Atrial fibrillation Hypertension Poor diet Hypercholesteraemia Diabetes Excess alcohol
What are gallstones?
Aggregations of cholesterol in the gallbladder
When do gallstones become a problem?
When they become lodged in a duct
Give the main symptom of uncomplicated gallstones
Biliary colic- abdo pain which cannot be relieved, usually lasts a few hours
Give 4 symptoms of complicated gallstones
Biliary colic + Tachycardia Fever Diarrhoea Itchy skin Sweating Jaundice
Give the 2 main causes of gallstone formation
Hypercholesteraemia
Hyperbilirubinaemia
Give 4 risk factors for gallstones
Female Over 40 years old Obese IBS Genetics Taking ceftriaxone
What sign on examination would suggest gallstones?
Positive Murphy’s sign
Push on liver and ask patient to take deep breaths
If gallbladder is inflammed it will cause pain
What tests can be done to diagnose gallstones?
USS CT MRI Cholangiography Blood test- CRP, leukocytes
How are gallstones treated?
Painkillers
Control with low fat diet
Cholecystectomy
What can poorly managed gallstones lead to?
Acute pancreatitis Gallbladder cancer Jaundice Acute cholecystitis Acute cholangitis
What is acute kidney injury?
Sudden onset of kidney damage
Give 2 causes for pre-renal AKI
Hypertension
Liver failure
Give 2 causes for ATN
Infection
Ischaemia
Iatrogenic
Give 2 causes for post-renal AKI
Urinary stones
Enlarged prostate
Tumour
Give 3 medications which may precede AKI
ACE inhibitors
NSAIDs
Diuretics
Give 4 symptoms of AKI
Nausea Vomiting Abdo. pain Dehydration Confusion Increased blood pressure
Explain how an AKI can lead to increased blood pressure
An AKI will result in the kidney not functioning properly and therefore retaining electrolytes and water. This will increase the blood volume and therefore the blood pressure
How can an AKI be diagnosed?
eGFR
U+Es
Urine output
Blood creatinine
How can AKIs be treated?
Prevent dehydration
Find the underlying cause
Stop medications which may be causing kidney damage
What acid base balance change is likely to occur in AKI and why?
Metabolic acidosis- the kidney cannot excrete a range of acidic anions due to the lack of function leading to a decrease in pH in the blood
Why can AKI lead to pulmonary oedema?
Lack of water excretion by the kidney leads to an increased blood volume and blood pressure. The increased blood pressure from the body can put pressure on the left atrium. The blood backs up and it pushed out into the lungs to causes pulmonary oedema.
What is alcoholic liver disease?
Chronic liver damage due to excessive alcohol intake
What are the 3 severities of alcoholic liver disease?
Alcoholic fatty liver disease
Alcoholic hepatitis
Cirrhosis
Of the 3 stages of alcoholic liver disease, which are reversible?
Alcoholic fatty liver disease
Alcoholic hepatitis
Give 4 early symptoms of alcoholic liver disease
Nausea Vomiting Fatigue Abdo pain Loss of appetite Diarrhoea
Give 4 advanced symptoms of alcoholic liver disease
Ascites Fever Hair loss Weight loss Nosebleeds Clubbing Jaundice Vomiting blood
Give the 2 causes of alcoholic liver disease
Frequent binge drinking
Long term excessive drinking
Give 3 factors which as well as excessive alcohol intake, put patients at a greater risk of alcoholic liver disease
Obesity
Female
Pre-existing liver disease
Family history
How is alcoholic liver disease diagnosed?
LFTs MRI CT X-ray Liver biopsy Endoscopy
What is the main treatment of alcoholic liver disease?
Stop drinking alcohol
Give an intervention questionnaire which can be used to assess alcohol intake
CAGE
Cut down?
Annoyed by people commenting on your drinking?
Guilty about volume of alcohol?
Eye-opener? (Do you need alcohol in the morning?)
Give a pharmacological treatment of alcoholic liver disease
Corticosteroids
Give 4 complications of alcoholic liver disease
Liver cancer
Ascites leading to peritonitis
Portal hypertension
Oesophageal varices –> bleeding –> anaemia
What is the definition of anaemia?
Lack of haemoglobin in the blood causing poor oxygen transport and therefore hypoxia
Give 5 symptoms of anaemia
Pale Fatigue Feeling cold Lightheadedness Short of breath Palpatations
Give 3 causes of microcytic anaemia
Iron deficiency
Thalassaemias
Anaemia of chronic disease
Give 3 causes of normocytic anaemia
Sickle cell anaemia
Blood loss
Anaemia of chronic disease
Give 3 causes of macrocytic anaemia
Haemolytic anaemia
B12/folate deficiency
Bone marrow failure
Give 3 sources of iron in the diet
Spinach- green, leafy vegetables Fish Meat Lentils Eggs Nuts
How can anaemia be diagnosed?
Full blood count
Blood microscopy
Identify area of blood loss
Give 3 signs on examination of anaemia
Pale palmar creases
Pale conjunctiva
Angular stomatitis
Glossitis
How can anaemia be treated?
Treat underlying cause:
Eg. Prevent blood loss, Iron/B12 supplements
What is asthma?
Narrowing of the airways due to inflammation and excessive production of mucous
Give 4 triggers of an exacerbation of asthma
Cold air Chest infections Exercise Stress Allergies Night time
Why do asthmatics have worse symptoms at night?
Less cortisol (due to circadian rhythm) which is an anti-inflammatory Exposure to dust mites in bed clothes Lying flat- mucous drains along respiratory tract
Give 4 symptoms of asthma
Wheeze
Breathlessness
Tight chest
Coughing
What is the difference between a stridor and a wheeze?
A wheeze is heard on inspiration and a stridor is heard on expiration
What is an asthma attack?
A severe exacerbation of all the asthma symptoms plus tachycardia, confusion, drowsiness, central cyanosis, severe tight chest
Give 2 causes of asthma
Family history
Passive smoking as a child
Premature birth
How is asthma diagnosed?
Spirometry
Peak flow test
Allergy test
Which 2 conditions are strongly associated with asthma
Eczema
Hayfever
How can asthma be treated?
Step 1: Short-acting Beta-2 antagonist - Salbutamol
Step 2: Inhaled Corticosteroid
Step 3: Long-acting beta-2 antagonist- Salmeterol
Step 4: Inhaled corticosteroid and a long acting beta-2 antagonist
Step 5: Increase doses
Step 6: Add an oral corticosteroid
How do beta-2- antagonists work to treat asthma?
Bind to beta-2 adrenergic receptors in the airway to cause blocking of adrenaline which results in bronchodilation
What is atrial fibrillation?
The atria do not beat in a regular rhythm as they become independent of the pacemaker. The atria do not go into systole for long enough and therefore the heart fills less. The heart beats faster to compensate.
Give 3 cardiac causes of atrial fibrillation
Hypertension Atherosclerosis Mitral stenosis Congenital HF Pericarditis
Give 3 respiratory causes of atrial fibrillation
COPD Asthma CO poisoning Pneumonia PE
GIve 3 triggers for an exacerbation of atrial fibrillation
Excess of alcohol Obesity Caffeine excess Smoking Drugs
How is atrial fibrillation diagnosed?
ECG
Echocardiogram
Pulse rate
Blood test- anaemia/thyroid levels
What ECG changes would be seen on a patient with atrial fibrillation?
Absent P waves
Irregular R-R intervals
Irregular baseline
What is the difference between atrial fibrillation and atrial flutter?
Atrial fibrillation is irregularly irregular
Atrial flutter is regularly irregular
Give 2 complications of atrial fibrillation
Heart failure
Stroke
Give 5 symptoms of atrial fibrillation
Breathlessness Palpitations Chest pain Dizzy Tired
How can atrial fibrillation be treated pharmacologically?
Restore rhythm–> Amiodarone, Sotalol, Flecanide
Control rate –> Verapamil, Digoxin
Reduce stroke risk –> Warfarin, Edoxaban
How can atrial fibrillation be treated non-pharmacologically?
Cardioversion- controlled electric shock
Catheter ablation- destroy diseases area of the heart
Pacemaker
Define COPD
Respiratory condition resulting in obstruction of the airways. Chronic condition which cannot be cured
Which 2 main conditions are encompassed by COPD
Emphysema
Chronic bronchitis
Describe emphysema
Loss of the elastic recoil in the alveoli resulting in a loss of surface area in the alveoli so less gas exchange can occur. The volume of dead space is increased
Describe bronchitis
Excessive mucous production in the airway
Give 5 symptoms of COPD
Breathlessness Wheeze Fatigue Cough- with sputum Tachycardia Nausea Chest infections
Give 3 causes of COPD
Smoking! Genetics Passive smoking Air pollution Occupational hazards- fumes/dust
How is COPD diagnosed?
O2 stats Full blood count- anaemia Peak flow Spirometry Sputum culture X-ray Respiratory exam
How can COPD be managed pharmacologically?
Inhalers
Steroids
Mucolytic agent
Antibiotics to treat infections
How can COPD be managed non-pharmacologically?
Lung transplant
Nebuliser
Long-term O2 therapy
Stop smoking
What is Type I diabetes?
Autoimmune destruction of the beta cells in the pancreas resulting in a loss of insulin. This means patients will have an intolerance to glucose
What is Type II diabetes?
Increased resistance to glucose by the cells so glucose cannot enter cells and remains in the blood. The beta cells which produce insulin are also damaged over time.
Give 3 classic symptoms of diabetes
Polyuria Polydipsia Weight loss Increased appetite Fatigue
Give a complication that only occurs in Type I diabetics
Ketoacidosis leading to a diabetic coma
Explain why Type I diabetics have a fruity breath
As glucose cannot enter the cells, the body breaks down fatty acids instead which have a side product of ketones. These ketones have a fruity smell
Give 4 complications of uncontrolled Type II diabetes
Heart disease Stroke Peripheral neuropathy Renal disease Retinopathy Sexual dysfunction
How is diabetes diagnosed?
HbA1c- glycosylated haemoglobin
Glucose fasting test
Urine dipstick
ABG- may show ketoacidosis
How is Type I diabetes treated?
Varying, length-acting, synthetic insulins
Eg. rapid, short, intermediate, long, very-long
How must insulin be administered?
Intramuscularly
Why may some patients not like injecting insulin?
Stigma
Painful
Lipohypertrophy
Give 3 symptoms of a hypoglycaemic attack
Shaking Sweating Nausea Vomiting Hunger Weakness Confusion
What is the first way of treating newly diagnosed Type II diabetes?
Diet and Exercise
Reduce alcohol
Stop smoking
What is the gold standard drug for treating Type II diabetes?
Metformin- Biguanide
Give the mechanism of action of metformin
Enters mitochondria to increase AMP levels
This increases AMPK levels to increase the sensitivity of the skeletal muscle and adipose tissue to insulin and reduce fatty acid synthesis
Give an example of a sulphonylurea
Gliclaside
What is epilepsy?
Long-term condition causing excessive, synchronised firing of excitatory neurons in the brain. This results in a seizure.
Explain the difference between a partial and generalised seizure
Partial- only affects 1 hemisphere of the brain
Generalised- affects both hemispheres of the brain
What is primary epilepsy?
Epilepsy with an unknown cause
What is secondary epilepsy?
Epilepsy which is secondary to a known cause such as a stroke or meningitis
What is status epilepticus?
A seizure for >30 minutes OR
Lots of small seizures without gaining consciousness in between
What is the treatment for status epilepticus?
Diazepam
Midazolam
Give 4 factors which can trigger a seizure in an epileptic
Excess alcohol Flashing lights Stress Lack of sleep Menstruation
Give 3 ways epilepsy can be diagnosed
Full history with eye-witness report of the seizure
MRI- look for underlying cause
EEG- looks at brain electrical activity
Give an example of 3 anti-epileptic drugs
Sodium valproate
Carbamazepine
Ethosuximide
Lamotrigine
Give 3 ADRs which are very common in anti-epileptic drugs
Drowsiness Headaches Hair loss Rashes Agitation Tremor
What is the definition of hypertension?
Pressure in the blood vessels is too high
Chronically over 140/90
Give 5 modifiable risk factors for hypertension
Obesity Smoking Lack of exercise Lack of sleep Stress High salt diet
Give 3 non-modifiable risk factors for hypertension
Age
Genetic risk
Diseases- diabetes, ATN, acromegaly, lupus, cushings
Give examples of 3 commonly prescribed drug types which may cause hypertension
NSAIDs
Steroids
Anti-depressants
Combined pill
Give 4 complications of unmanaged hypertension
Stroke MI Aortic aneurysm Kidney disease Oedema Heart disease
Give 4 lifestyle change treatments of hypertension
Stop smoking Reduce alcohol Lose weight Healthy diet Stop caffeine
How is a patient with hypertension under the age of 55 treated?
ACE inhibitor
How is a patient with hypertension over the age of 55 or black treated?
Ca2+ channel blocker OR Thiazide diuretic
Explain how hypertension can be treated with a diuretic
Pressure in the circulatory system can be relieved if the volume is reduced by losing the excess water. A diuretic causes more urine to be produced
Where is aortic stenosis heard best?
Right carotid on inspiration
In what part of the cardiac cycle is an aortic stenosis murmur heard?
Ejection systolic
Where is aortic regurgitation heard best?
Patient sat forward on expiration
Left sternal edge, 4th intercostal space
In what part of the cardiac cycle is an aortic regurgitation murmur heard?
Early diastolic
Where is mitral stenosis heard best?
Mid-clavicular line, 5th intercostal space
Patient rolled to left- on expiration
Use bell
In what part of the cardiac cycle is an mitral stenosis murmur heard?
Mid-diastolic
Where is mitral regurgitation heard best?
Axilla, 5th intercostal space
In what part of the cardiac cycle is an mitral regurgitation murmur heard?
Pan-systolic
What is peptic ulcer disease?
Ulcers most commonly found in the stomach, lower oesophagus and small intestine
Give 5 symptoms of peptic ulcer disease
Nausea Burning pain Indigestion Weight loss Reduced appetite Vomiting
Give 2 symptoms of advanced peptic ulcer disease
Vomiting blood
Melaena
Give 3 causes of peptic ulcer disease
Excess alcohol
H pylori infection
NSAIDs
Stress
How is peptic ulcer disease diagnosed?
H. pylori confirmation- urea breath test, stool antigen test, blood test
Gastroscopy
Give 3 complications of peptic ulcer disease
Internal bleeding
Perforation of the bowel
Gastric obstruction
How can peptic ulcer disease be treated?
PPI
H2 antagonist
Antacids
Anti-biotic
What is osteoarthritis?
Pain in large joints due to a loss of cartilage
Give 3 causes of osteoarthritis
Joint injury Age Obesity Gout Rheumatoid arthritis
Give 3 symptoms of osteoarthritis
Pain Stiffness Cracking of joints Tenderness Loss of function
What is the main way of diagnosing osteoarthritis?
Taking a thorough history
How is osteoarthritis treated?
Painkiller NSAID Opioids Joint replacement Corticosteroid injections
Define heart failure
Heart cannot adequately pump blood around the body
Give 4 symptoms of heart failure
Shortness of breath Dizziness Oedema Tachycardia Chest pain Fatigue Exercise intolerance
Give 4 causes of heart failure
Hypertension
Smoking
Diabetes
Congenital
How is heart failure diagnosed?
ECG Echocardiogram FBC Spirometry X-ray
How is heart failure treated non-pharmacologically?
Stop smoking Lose weight Good diet Exercise Reduce alcohol
Describe the steps of treating heart failure
Step 1: ACE inhibitor and beta blocker
Step 2: add a ARB and an aldosterone antagonist
Step 3: add digoxin
What complications can occur from heart failure?
Oedema MI Stroke Thromboembolism PND
What is ischaemic heart disease?
Lack of blood flow to the coronary arteries causing damage to the heart muscles
Give 2 differences between angina and an MI
Angina is reversible, MI is not
MI symptoms are more severe than angina
Give 4 symptoms of ischaemic heart disease
Chest pain Breathlessness Palpitations Exercise intolerance Cough
Give 4 symptoms of an MI
Sweating Crushing chest pain Lightheadedness Nausea Breathless
Give 5 causes of IHD
Obesity Atherosclerosis Thrombosis Hypercholesterolaemia Diabetes Hypertension
How is IHD diagnosed?
Exercise stress test Angiography ECG Echocardiogram X-ray MRI CT
How is IHD treated pharmacologically?
Anti-platelet drug
Statin
Beta blocker
ACE inhibitor
How can IHD be treated surgically?
Coronary angioplasty
Coronary artery bypass graft
What is rheumatoid arthritis?
Long-term condition causing pain, swelling and stiffness in the joints, usually in the hands and feet
Give 5 symptoms of rheumatoid arthritis
Joint pain Weight loss Tired Warmth in the joints Swelling Stiffness Redness Sweating
What is the cause of rheumatoid arthritis?
Autoimmune destruction of the joint lining leading to inflammed synovium. This causes bone, cartilage, tendon and ligament damage
Give 3 risk factors of rheumatoid arthritis
Smoking
Hormones
Family history
How is rheumatoid arthritis diagnosed?
Joint imaging- USS, X-rayk, MRI
History
Blood test- ESR, FBC, CRP
Give an example of a DMARD
Methotrexate
Give 3 ways rheumatoid arthritis can be treated
DMARDs Infliximab NSAIDs Painkillers Corticosteroid injections Physio
Give 3 complications of chronic rheumatoid arthritis
Carpal tunnel Widespread inflammation Joint damage Cervical myelopathy CV disease
What is carpal tunnel disease?
Median nerve is compressed as it passes through the wrist causing severe pain, especially on flexion
What is hyperthyroidism?
Excessive production of thyroid hormone
Give 3 causes of hyperthyroidism
Autoimmune
Pituitary adenoma
Thyroid tumour
Amiodarone side effect
Give 4 symptoms of hyperthyroidism
Weight loss Hot flushes Palpitations Mood swings Muscle weakness Hair loss Anxiety
What test diagnoses thyroid disease?
Levels of T3/T4 in the blood
How is hyperthyroid disease treated?
Thionamines= carbimazole
Radioiodine treatment
Surgery- thyroidectomy
What is a thyroid storm?
Exacerbation of hyperthyroidism
Tachycardia, fever, confusion, jaundice, loss of conciousness
What is hypothyroidism?
Underproduction of thyroid hormone
Give 4 symptoms of hypothyroidism
Weight gain Feeling cold Muscle cramp Tired Depression Constipation
Give 4 causes of hypothyroidism
Autoimmune destruction Gene mutation Congenital- malformation Lack of iodine Previous thyroid treatment
How is hypothyroidism treated?
Levothyroxine
What is a goitre?
Lack swelling in the neck due to thyroid disease
What is thrombo-embolic disease?
Formation of a clot in a blood vessel which can move to block a smaller vessel
Give 4 conditions which are classes as thrombo-embolic diseases
Stroke
DVT
PE
MI
Give 3 risk factors for thromboembolic disease
COCP Prolonged immobility Diabetes Post-surgery High cholesterol
Give the 3 factors in Virchow’s triad
Damage to vessel lining
Change in blood constituents
Turbulent/stagnant flow
How is thromboembolic disease treated?
Anticoagulants- warfarin, heparin, aspirin
How can thromboembolic diseases be diagnosed?
Imaging Blood tests D Dimer Physical examination History
What is a vasovagal faint?
Sudden temporary loss of consciousness, usually resulting in a fall
Give 4 warning symptoms that may be present before a vasovagal faint
Nausea Lightheadedness Sweaty Yawning Tachycardia Confusion Blurred vision
Describe how the patient may feel after a vasovagal faint
Weak, tired and have some memory loss of the event
What is the pathological cause of a vasovagal faint?
Temporary reduction in blood flow to the brain
Give some causes of vasovagal faints
Slow heart rate
Dehydration
Medication ADRs
Low blood pressure
How are vasovagal faints treated?
Treat underlying cause
Warning signs –> lie down, head between legs, drink water
After faint –> recovery position
