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2b > OSCE Peer Teachings > Flashcards

OSCE Peer Teachings Flashcards

1
Q

What is MJ-THREADS

A 
MI
Jaundice
-
TB
HTN
Rheumatic fever
Epilepsy
Asthma and COPD
Diabetes
Stroke
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2
Q

Relevant things to ask about for FHx

A

Atopy, autoimmune, MI

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3
Q

What should you ask about in asthma

A

Pets

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4
Q

Cardiac presenting complaints

A 
Chest pain
SOB
Ankle swelling
Cough, sputum, haemoptysis
Dizziness
Syncope
Palpatations
Claudications
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5
Q

Cardiac causes of chest pain

A 
MI
Pericarditis
Angina
AF
Acute myocarditis
Aortic dissection
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6
Q

Musculoskeletal causes of chest pain

A

Costocondritis
Trauma
Muscle sprain

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7
Q

Gastrointestinal causes of chest pain

A

GORD
Peptic ulcer disease
Oesophageal stricture

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8
Q

Respiratory causes of chest pain

A

PE
Pneumonia, TB
Pneumothorax
Malignancy

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9
Q

Other causes of chest pain

A

Anxiety
Sickle cell crisis
Shingles

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10
Q

SOCRATES

A 
Site
Onset
Character
Radiation
Associated symptoms
Timing
Exacerbating/alleviating factors
Severity
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11
Q

MI SOCRATES

A

Central, crushing, radiates down left arm and jaw

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12
Q

Perciarditis SOCRATES

A

Central pain, bores through to the back, better if sat forward. Worse if lying down.

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13
Q

Angina SOCRATES

A

Central tightness or heaviness, radiates to arms and jaw. Exertional! Relieved by rest!

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14
Q

Acute myocarditis SOCRATES

A

Preceding flu symptoms

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15
Q

Aortic dissection SOCRATES

A

Tearing pain, central or abdominal

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16
Q

MI more likely to be silent in

A

Diabetics

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17
Q

Cardiac associated features

A

Syncope, epigastric pain, vomitting

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18
Q

What is a significant cardiac family history

A

MI <55yo 1st degree relative

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19
Q

What should you ask about PC

A

Whats your main concern? Which symptom is most problematic?

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20
Q

What medical conditions can cause angina

A

Anaemia, thyrotoxicosis, hyperlipidaemia and aortic stenosis.

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21
Q

How to distinguish between stable and acute angina

A

Stable=exertional
Quantify exertion
Cold, emotion, heavy meals.

How frequent? How is it affecting them? How do you stop the pain? New Dx?

Associated symptoms, lifestyle, PMH

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22
Q

What specific history questions might you want for angina

A

Statin?
GTN?
Aspirin?
Past MI?

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23
Q

Non modifiable cardiac risk factors

A

Male, age, familly history of IHD

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24
Q

Modifiable risk factors

A

Smoking, hypertension, hyperlipidaemia, obesity, sedentary lifestyle

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25
Q

Define acute angina

A

Chest pain at rest >20 minutes and associated symptoms

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26
Q

What are ACS

A

Acute angina and MI

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27
Q

Questions for SOB

A 
Onset
Pattern
Affect on daily life?
Quantify
PMH
DH
Wheeze, weight loss, swelling
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28
Q

PMH questions for SOB

A

Asthma, malignancy, CV history, anaemia

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29
Q

Associated symptoms questions for SOB

A

Wheeze, weight loss, swelling

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30
Q

Differentials for SOB

A

Heart failure, PE, resp stuff

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31
Q

Symptoms fo LV failure

A

Dyspnoea, PND, Orthopnoea, poor exercise tolerance, fatigue, cough, wheeze

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32
Q

Define dyspnoea

A

Shortness of breathe

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33
Q

Define orthopnoea

A

SOB on lying flat

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34
Q

Define Paroxysmal Nocturnal Dyspnoea

A

SOB at night, waking from sleep

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35
Q

What classification is used for HF severity

A

New York Association Classification

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36
Q

SOB questions

A

What was normal before diagnosis? Quantify activity. Pillows at night? Stairs?

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37
Q

Grade I HF

A

No limitations, no symptoms on activity

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38
Q

Grade II HF

A

Rest fine, activity causes symptoms

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39
Q

Grade III HF

A

Marked limitation of physical activity

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40
Q

Grade IV HF

A

Symptoms at rest and any activity

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41
Q

What does peripheral swelling suggest

A

Right ventricular heart failure

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42
Q

Signs of RV heart failure

A

Pitting oedema, sacral oedema, ascites, nausea, facial engorgement, anorexia

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43
Q

What does cough with pink frothy sputum suggest

A

LV failure

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44
Q

RV failure = cough?

A

Lung disease a cause so possibly

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45
Q

What does nocturnal cough suggest

A

Asthma or heart failure

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46
Q

What does haemoptysis suggest

A

PE and malignancy

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47
Q

Questions for palpitations

A 
Frequency
Onset
Duration
'Desribe it'
Tap out rhythm
Dizziness or LOC
Anxiety Hx
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48
Q

Palpitations PMH

A

AF diagnosis
On any blood thinners
Stroke or mini stroke?
History of valve disease?

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49
Q

What is CHADS2VASC for

A

Atrial fibrillation stroke risk

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50
Q

What does CHADS2VASC stand for

A 
Congestive HF
HTN
Age (65-75-+)
DM
Stroke, tia
Vascular disease
Sex: female
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51
Q

What risk score is used for risk of bleeding on warfarin

A 
HTN
Abnormal liver or kidney
Stroke
Bleeding
Labile INR
Elderly
Drugs or alcohol
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52
Q

Causes of syncope

A

Postural hypotension, vasovagal attack, severe aortic stenosis, AF

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53
Q

Syncope questions

A 
When?
How often?
Blackouts?
Associated symptoms?
Systems review
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54
Q

Syncope associated symptoms

A

Palpitations, sweating, hyperventilation, chest pain, headache

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55
Q

Intermittent claudication questions

A 
SOCRATES
Where
Quantify
Risk factors
Associated symptoms
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56
Q

Calf intermittent claudication artery

A

Femoral

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57
Q

Buttock intermittent claudication artery

A

Iliac

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58
Q

Intermittent claudication risk factors

A

Smoking, alcohol, diabetes, hypertension, hyperlipidaemia

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59
Q

Intermittent claudication associated symptoms

A

Gangrene, burning, foot pain, impotence

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60
Q

“Im hanging my foot off the bed at night”

A

Critical limb ischaemia.

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61
Q

Pacemaker v ICD

A

ICD can directly treat the arrythmia whereas a pacemaker just provides electrical stimuli

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62
Q

Describe aortic stenosis

A

Ejection systolic murmur heard loudest over aortic region. Can radiate to carotids. Loudest when sat forward in held expiration.

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63
Q

Describe mitral regurgitation

A

Pansystolic murmur loudest in axilla.

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64
Q

Causes of aortic stenosis

A

Old age calcification

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65
Q

Causes of mitral regurg

A

IV hypertrophy, IE, Valve calcification

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66
Q

Cough questions

A 
Duration
Dry or productive?
Sputum 
Blood
Time of day?
Exacerbations
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67
Q

Cough: Sputum questions

A

Consistency
Colour
Odour

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68
Q

Cough: Blood questions

A

How much?
Fresh or old?
Bleeding elsewhere?
DVT symptoms?

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69
Q

Cough: Exacerbation questions

A 
Pets
Pollen
Dust
Weather
Occupation
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70
Q

Cough: other important symptoms

A 
Wheeze
Chest pain
SOB
FEVER, WEIGHT LOSS, NIGHT SWEATS
feel unwell
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71
Q

Cough PMH

A

Acid reflux
Asthma
COPD
TB

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72
Q

Cough DHx

A

ACE inhibitors
Allergies
Inhalers
TB Jab

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73
Q

Cough FHx

A

Asthma, hayfever, eczema
Pneumonia contacts
TB contacts

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74
Q

Cough SHx

A 
Occupation
Pets
Smoking
Pollution
Foreign travel
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75
Q

General respiratory PMH

A 
TB
Asthma
PE
Pneumonia
GORD
Allergies
Rheumatoid
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76
Q

General respiratory FH

A 
Cystic fibrosis
TB
Asthma
Eczema
Hayfever
Emphysema
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77
Q

General respiratory SH

A 
Crowded accomodation
Damp
Occupation
Foreign travel
Pets
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78
Q

SOB HPC

A 
Describe
Duration
Constant or intermittent
Activity limitation?
Getting worse?
Any exacerbations?
Any relieving factors?
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79
Q

SOB Other symptoms

A 
Chest pain
Lie flat
Pillows
PND
Ankle swelling
Wheeze
Cough
Systemic illness
Anxiety and pain attacks
Fatigue
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80
Q

SOB PMH

A 
Asthma
COPD
TB
Cardiac
Severe lung infections
Blood clot
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81
Q

SOB DH

A

Inhalers

Allergies

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82
Q

SOB FH

A

Asthma

Cardiac disease

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83
Q

SOB SH

A

Smoking and ex smoking
Occupation
Stress and anxiety

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84
Q

Asthma assessment

A 
Symptoms
Waking at night
Symptoms in morning
Reliever use
Activity limitation
Allergies 
Social
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85
Q

Asthma symptoms

A 
Wheeze
Cough
SOB
Infections
Diurnal variation
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86
Q

Asthma SHx

A

Coping with medications
Smoking
Occupation
Pets

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87
Q

GTN side effects

A

Low blood pressure

Dizziness

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88
Q

Name the two open questions to ask first

A

Please could you tell me whats been troubling you?

Can you tell me more about this?

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89
Q

Important questions about PC

A

SOCRATES
Have you had this before?
What do you think might have caused it?

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90
Q

Special question for dyspepsia

A

Can you describe the sensation of indigestion that you feel

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91
Q

Causes of dyspepsia

A

Peptic ulcer
GORD
Gastritis and duodenitis
Non ulcer dyspepsia, medication induced and non GI

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92
Q

Which type of peptic ulcer is more common

A

Duodenal

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93
Q

Describe gastric ulcers

A 
Less common
Pain caused by meal
Occurs 30mins-1hr after meal
Bleeding- haematemesis
Caused by delayed gastric emptying
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94
Q

Describe duodenal ulcers

A 
More common
Pain relieved by eating
Occurs 2-3 hours after meal
Bleeding- melaena
Caused by increased gastric emptying
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95
Q

How to take a dyspepsia HPC

A

SOCRATES and ALARMS symptoms

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96
Q

Whatre you thinking about with the radiation of dyspepsia

A

Perforation? Pancreatitis? Chest pain- cardiac

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97
Q

Associated symptoms with dyspepsia

A

Bitter taste (GORD)
Early satiety?
Bloating
ALARMS red flags

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98
Q

What are the ALARMS dyspepsia red flags

A 
Anaemia (iron deficiency)
Loss of weight
Anorexia
Recent onset/ progressive
Malaena/ haematemesis
Swallowing difficulty
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99
Q

If the dyspeptic patient has one of the ALARM symptoms or is over 55

A

Upper GI endoscopy

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100
Q

In addition to SOCRATES what should you ask a dyspepsia patient

A

Have you had these symptoms before? How does this episode compare? Do you know what may have caused these symptoms?

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101
Q

Vomitting and dyspepsia

A

Haematemesis, bleeding peptic ulcer, gastric cancer in the pyloric region

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102
Q

Malaena and dyspepsia

A

Due to erosion of mucosa due to gastric cancer or bleeding peptic ulcer

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103
Q

Dyspepsia and weight loss

A

How much? In how long? Suggests malignancy

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104
Q

Dyspepsia and tiredness/SOB

A

Chronic disease, leading to anaemia

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105
Q

Relevant Drug history for dyspepsia

A

NSAIDs/ Aspirin, steroids, SSRIs

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106
Q

What is dysphagia

A

Difficulty swallowing

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107
Q

What is odynophagia

A

Painful swallowing

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108
Q

What is globus

A

Sensation of having a lump in the throat

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109
Q

What is new onset dysphagia in middle age and elderly people

A

Cancer until proven otherwise

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110
Q

What is high dyphagia

A

Oropharyngeal and upper oesophageal

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111
Q

What is low dysphagia

A

Lower oesophageal

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112
Q

Character in dysphagia SOCRATES

A

Solids, liquids or both? has this changed?

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113
Q

Associated symptoms in dysphagia SOCRATES

A

Regurgitation? Neck lump? odynophagia?

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114
Q

Questions to ask about relieving factors in dysphagia SOCRATES

A

Does it get better after the first few swallows

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115
Q

Other questions to ask about dysphagia on top of SOCRATES

A

Have you had these symptoms before? How does this episode compare? Do you know what may have caused these symptoms?

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116
Q

Other PC to ask about in dyspepsia

A 
Dysphagia
Vomiting
Abdo pain/ bloating
Jaundice
Constipation
Blood in stool
Weight loss
Tiredness/ SOB
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117
Q

Other PC to ask about in dysphagia

A 
Dyspepsia
Vomiting 
Abdo pain
Jaundice
Change in bowel habit
Blood in stool
Weight loss
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118
Q

Young person diarrhoea causes

A

Infective diarrhoea
Irritable bowel syndrome
-coeliac, crohns, UC, medications, hyperthyroid

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119
Q

Old person diarrhoea causes

A 
Neoplastic (colon or pancreatic)
Diverticular disease
Overflow
Medications
IBD
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120
Q

Which ages are most affected by IBD

A

15-25years and also 50-80years

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121
Q

Which patients are at risk of bacterial overgrowth

A

Diabetic patients

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122
Q

7 questions to ask about the character of

A 
1- frequency
2- colour
3- formed or watery
4- blood? paper? mixed?
5- float? flushable?
6- smelly?
7- mucus
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123
Q

What do stools which float, are difficult to flush and offensive smelling suggest

A

Steatorrhea

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124
Q

Causes of steatorrhoea

A

Chronic pancreatitis and malabsorption

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125
Q

What are gauges of severity in diarrhoea

A

Urgency to go to the toilet, incontinence

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126
Q

What should you always ask on top of SOCRATES

A

Have you had these symptoms before? How does this episode compare? Do you know what may have caused these symptoms

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127
Q

What does diarrhoea and vomitting suggest

A

Gastroenteritis

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128
Q

What GI associated symptoms should you ask about in diarrhoea

A 
Vomiting
Abdominal pain
Jaundice
Constipation
Blood in the stool
Weight loss
Fever, tiredness, SOB
-dyspepsia and dysphagia
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129
Q

What should you ask about if constipation and diarrhoea

A

Altered bowel habit? Tenesmus

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130
Q

What does weight loss and diarrhoea suggest

A

IBD, Carcinoma

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131
Q

What does fever, tiredness and SOB associating diarrhoea suggest

A

Chronic disease accompanying

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132
Q

Other presenting complaints to ask about in diarrhoea

A

Uveitis, scleritis, episcleritis
Rashes
Joint pain
Thyroid symptoms (feel hot, palpitations, weight loss)

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133
Q

Risk factor questions for diarrhoea

A 
Recent foreign travel
Eaten anything unusual
Unwell contacts with similar symptoms
Stress?
Diet?
Changes to meds?
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134
Q

Diarrhoea- general examination

A

Jaundice, signs of dehydration, signs of anaemia

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135
Q

Diarrhoea- hand examination

A

Clubbing

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136
Q

GI/ diarrhoea causes of clubbing

A

IBD
Hyperthryoid
Coeliac

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137
Q

Diarrhoea- eye examination

A

Iritis, episcleritis,

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138
Q

How to distinguish episcleritis and scleritis

A

Episcleritis is more localised whereas scleritis can be blue

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139
Q

Diarrhoea- mouth examination

A

Mouth ulcers

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140
Q

Diarrhoea- lymph examiation

A

Virchows node

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141
Q

Diarrhoea- abdomen examination

A

Masses, tenderness, bowel sounds

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142
Q

Diarrhoea- leg examination

A

Rashes

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143
Q

In a history should you ask age or DOB first

A

Age

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144
Q

MSK presenting complaints

A 
Pain
Stiffness
Swelling
Erythema
Weakness
Extra-articular symptoms
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145
Q

Questions about an MSK presenting complaint

A

SOCRATES
Have you ever had this before?
What do you think might have caused it? Trauma?

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146
Q

Questions about other presenting complaints in an MSK history

A

Extra-articular features
Risk factors for diseases
PC of other systems

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147
Q

MSK- Site, queries

A

Arthralgia, myalgia, soft tissue?
small or large joint?
Mono, Oligo, Poly?
Symmetrical, haphazard?

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148
Q

MSK- Onset, queries

A

Post trauma
Gradual onset
Acute onset

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149
Q

MSK- Post trauma onset

A

Haemarthrosis
Tendon tear
Tendonitis

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150
Q

MSK- Gradual onset

A

OA
RA
Chronic injury

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151
Q

MSK- Acute onset

A

Gout
Vacular aetiology
Trauma

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152
Q

OA joint distribution

A 
Neck
Spine
Hip
Distal fingers
Knee
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153
Q

RA joint distribution

A 
Neck
Shoulder
Elbow
Wrist
Every hand joint
Hip
Knee
Ankle
Every foot joint
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154
Q

Psoariatic arthritis joint distribution

A 
Elbow
Wrist
Fingers
Knee
Ankle
Toes
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155
Q

Ankylosing spondylitis joint distribution

A

Spine
Pelvis
Knee

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156
Q

MSK: Deep, boring pain esp at night

A

Osteomyelitis, osteonecrosis, bone mets

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157
Q

MSK: Diffuse pain

A

Osteomalacia

Fibromyalgia

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158
Q

MSK: Stiffness, poorly localised pain, worse on movement. Muscle pain

A

Polymyositis
Dermatomyositis
Partial muscle tears

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159
Q

MSK: Sharp pain worse on movement

A

Fracture pain

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160
Q

MSK: Shooting pain (peripheral nerve/root impingement)

A

Disc prolapse

Sciatica

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161
Q

MSK: Widespread unremitting pain, poorly controlled

A

Fibromyalgia, complex pain syndrome

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162
Q

MSK: Exquisite pain but no apparent abnormality

A

Compartment syndrome

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163
Q

MSK: Wells criteria

A 
Clinical signs of DVT
PE more likely than alternative
Immobilised 3 days
Previous DVT or PE
Haemoptysis
Active malignancy
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164
Q

MSK: Nerve compression radiation

A

Radiates to the nerve distribution

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165
Q

MSK: Neck pain radiation

A

Radiates to the shoulder and over the top of the head

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166
Q

MSK: Low grade fever

A

SLE
RA
Giant cell arteritis

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167
Q

MSK: Spiking fever

A

Septic arthritis
Bone TB
Osteomyelitis

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168
Q

MSK: Spiking fever and pain which moves from joint to joint

A

Rheumatic fever

Gonococcal arthritis

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169
Q

MSK: Weight loss

A

Malignancy
Bone METs
Systemic (SLE, RA)

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170
Q

MSK: extra articular features

A 
Rash
Malaise
Jaw claudication
Headache
Diarrhoea &amp; GI
Eye involvement
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171
Q

MSK: Timing questions

A

How often?
For how long?
Is there a pattern?

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172
Q

MSK: early morning stiffness and pain which lasts more than 30mins

A

Rheumatoid arthritis

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173
Q

MSK: end of the day aches and pains

A

Osteoarthritis

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174
Q

MSK: Stiffness which improves on exercise in younger patients

A

AnkSpond

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175
Q

MSK: Suggested exacerbating factors

A 
Cold weather
Physical exertion
Infection
Immobility
Certain foods (alcohol)
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176
Q

MSK: Suggested alleviating factors

A

Warmth
Exercise
Resting
NSAIDs

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177
Q

MSK: Very severe pain

A

Trauma
Gout
Septic arthritis
Vascular

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178
Q

MSK: Severity questions

A

Scale 1-10
Stop you doing things?
Affect social/work?
Wake you up?

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179
Q

MSK: Stiffness questions

A

Restricted ROM?
Difficulty moving but normal ROM?
Painful movement? Particular joint or generalised movements?

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180
Q

MSK: Inflammatory stiffness

A

Early morning, more than 30mins, wears off with activity, responds well to NSAIDs

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181
Q

MSK: Non inflammatory stiffness

A

Mechanical, stiffness after rest but lasting less than 30mins. End of day stiffness and tiring

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182
Q

MSK: Polymyalgia rheumatica stiffness

A

Shoulder and pelvic areas. Temporal arteritis associated. Jaw claudication, temporal pain, vision symptoms. GIVE STEROIDS

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183
Q

MSK: AnkSpond stiffness

A

Back stiffness on waking up

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184
Q

MSK: Unilateral swelling

A

Local cause

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185
Q

MSK: Bilateral/symmetrical swelling

A

Systemic cause

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186
Q

MSK: Sudden onset swelling

A

Vascular, acute injury

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187
Q

MSK: Gradual onset swelling

A

Chronic injury or inflammation

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188
Q

MSK: swelling DHx

A

Anticoagulants? Bleeding disorder?

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189
Q

MSK: Erythema and warmth

A

Infective arthritis

Trauma

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190
Q

Foods which cause gout

A

Anchioves
Fish
Kidney, liver
Yeast (beer)

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191
Q

Foods which prevent gout

A 
Lemon
Cherries
Peppers
Watercress
Ginger
Tumeric
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192
Q

What are gout crystals made out of

A

Uric acid crystals

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193
Q

What are pseudogout crystals made out of

A

Calcium pyrophosphate

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194
Q

Which gender gets more gout

A

Males

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195
Q

Which gender gets more pseudogout

A

Females

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196
Q

Gout on light microscopy

A

Negatively birefringent needles

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197
Q

Pseudogout on light microscopy

A

Positively birefringent rhomboids

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198
Q

Which joints are affected by gout

A

1st MTP, small joints of hand, wrist, ankle, elbow, knee

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199
Q

Which joints are affected by pseudogout

A

Knee, wrist and ankle

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200
Q

Which other changes are associated with gout

A

Purine rich foods, obesity, DM, crystal cellulitis, gout tophi, urate kidney stones

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201
Q

Which other changes are associated with pseudogout

A

Fever, chondrocalcinosis on XRay

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202
Q

MSK: Neurological causes of weakness

A 
Spinal cord injury
Nerve root entrapment
Single nerve damage
MND
GBS
Polio
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203
Q

MSK: Muscular causes of weakness

A

Myositis
Myalgia
Muscle atrophy

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204
Q

Causes of myositis

A

Injury
Infection
Autoimmune

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205
Q

Causes of muscle atrophy

A 
Malnutrition
Burns
Muscular dystrophy
Drug SEs
LMN damage
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206
Q

Infective causes of myalgia

A 
Coxsackie virus
Cytomegalovirus
Dengue fever
Streptococcus
Mycoplasma
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207
Q

Trauma causes of myalgia

A

Tears
Haematoma
Rhabdomyolysis

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208
Q

Inflammatory causes of myalgia

A

Polymyalgia rheumatica
Dermatomyositis
Polymyositis

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209
Q

Drugs causes of myalgia

A

Alcohol withdrawal
Statins
Triptans

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210
Q

Metabolic causes of myalgia

A

Hypo/hyperthyroid
Addisons disease
Low vitamin D

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211
Q

Myotoxic drugs

A 
Colchicine
Antimalarial
Statins
Corticosteroids
Sulfonamides
Zidovudine
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212
Q

MSK: Past medical history

A

Previous MSK
TB
Gout
Risk Factors

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213
Q

MSK: PMH Risk Factors

A 
DM
Coeliac
Steroid therapy
Fractures or deformities
Stroke
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214
Q

MSK: Gout PMH questions

A

Alcohol
Renal disease
Metabolic syndrome
Aspirin, diuretics

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215
Q

MSK; Family history

A 
Inflammatory arthritis (1stDegree)
OA/osteoporosis
HLA-B27
Charcot Marie Tooth
Osteogenesis imperfecta
Ehlers-Danlos, Marfans
Muscular dystrophies
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216
Q

4 HLA-B27 seronegative conditions

A 
PEAR
Psoariatic arthritis
Enteropathic arthritis
Ank Spond
Reactive arthritis
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217
Q

MSK: Drug history

A 
Steroids
Statins
ACE-I
Anti epileptics
Immunosuppressants
Quinolones
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218
Q

MSK: what do steroids cause

A

Osteoporosis
Myopathy
Osteonecrosis

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219
Q

MSK: what do statins cause

A

Myalgia, myositis, myopathy

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220
Q

MSK: what do ACE-I causee

A

Myalgia

Arthralgia

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221
Q

MSK: what do anti-epileptics cause

A

Osteomalacia

Arthralgia

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222
Q

MSK: what do immunosuppressants cause

A

Infections: Osteomyelitis

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223
Q

MSK: what do quinolones cause

A

Tendinopathy, tendon rupture

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224
Q

MSK: Social history

A 
Occupation
Ethnicity
Sexual History
Alcohol
Smoking
IVDU
Diet
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225
Q

MSK: occupational diseases

A

Repetitive strain disorder
Hand vibration syndrome
Fatigue syndrome

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226
Q

MSK: Ethnicity diseases

A

African- sickle cell
Asian- osteomalacia
TB areas- bone TB

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227
Q

MSK: Sexual diseases

A

HIV- reactive arthritis, gonoccal arthritis
Neurosyphilis
Hep B

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228
Q

MSK: Alcohol diseases

A 
Trauma
Gout 
Myopathy
Rhabdomyolysis
Neuropathy
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229
Q

MSK: Smoking diseases

A

Lung cancer bone mets

RA

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230
Q

MSK: IVDU diseases

A

Trauma
Hep B
HIV

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231
Q

MSK: Diet diseases

A

Vitamin deficiencies
-rickets/osteomalacia
-scurvy
Osteoporosis

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232
Q

MSK: Extra-articular features

A 
Brain
Hair
Eyes
Mouth
Face/skin
Nail changes
Skin rash
Dry cough/ SOB
Arrythmias
Abdominal pain
Aches/ weakness
Hand deformities
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233
Q

MSK: brain signs

A 
SLE= depression&amp;migraines
Fibromyalgia= tension ha
GCA= throbbing ha + vision loss
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234
Q

MSK: hair signs

A

SLE= scarring allopecia

Dry? Brittle?

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235
Q

MSK eye signs

A 
Sjogrens= red and dry
Episcleritis= pain &amp; tearing
Uveitis= pain &amp; floaters
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236
Q

MSK: mouth signs

A 
Crohns&amp;SLE= sores
Sjogrens&amp;RA= dry
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237
Q

MSK: face

A 
Sarcoidosis= lupus pernio
SLE= malar rash
Sjogrens= big salivary glands
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238
Q

MSK: arrythmias

A

SLE= endocarditis

Scarring and cardiomyopathy

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239
Q

MSK: dry cough/sob

A

Sarcoidosis
SLE
Caplans

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240
Q

MSK: Aches and weakness

A

PMR
Steroids
Sjogrens
Dermatomyositis

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241
Q

MSK: Abdominal pain

A

SLE= serositis
Sarcoidosis= high Ca2+
Fibromyalgia= IBS
Enteropathic A= IBD

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242
Q

MSK: Nail changes

A

Psoariatic arthritis= nail pitting

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243
Q

MSK: Skin rash

A

Erythema Nodosum
TB, Sarcoidosis
SLE= photophobia

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244
Q

Osteoarthritis XRay signs

A 
LOSS
Loss of joint space
osteophytes
Subchondral cysts
Subarticular sclerosis
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245
Q

MSK: DIPJ

A

OA (Heberdens)
Psoariatic
Reactive

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246
Q

MSK: PIPJ

A

OA (Bouchards)
SLE
RA
Psoariatic

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247
Q

MSK: MCP

A

RA
Pseudogout
Haemochromatosis

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248
Q

MSK: Base of thumb

A

OA

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249
Q

MSK: Wrist

A 
RA
Pseudogout
JIA
Carpal tunnel
Gonococcal arthritis
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250
Q

HLA DR4

A 
RA
DM1
MS
Coeliac
SLE
IgA nephropathy
Systemic sclerosis
PMR
251
Q

HLA B27

252
Q

HLA DR2

A 
Goodpastures
SLE
MS
PBS
AI Hepatitis
253
Q

Vitiligo associations

A 
Hashimotos
Scleroderma
RA
DM1
Pernicious anaemia
Addisons 
SLE
254
Q

Signs of goodpastures syndrome

A

Haematuria and haemoptysis

255
Q

Lower back pain red flags

A

Urinary retention
Saddle anaesthesia
Leg weakness
Faecal incontinence

256
Q

What does having all the lower back pain red flags point towards

A

Cauda equina syndrome

257
Q

Lower back pain questions

A 
Cancer Hx
Coeliac
IVDU
Morning stiffness
Pseudoclaudication
Trauma 
Fever
<35yo
258
Q

Fibromyalgiadditional questions

A 
Chronic widespread pain
Shoulders, elbows and knees
Tension headache
Atypical chest pain
IBS
Dysmennorhoea
Facial pain
Sleep disturbance
259
Q

AnkSpond Clinical picture

A 
Younge male
Stiff pack better with exercise
Night pain
Sacroiliac joint
Bamboo spine
Reduced chest expansion
Syndesmophytes
Ankylosis
Schobers test
Uveitis+costohondritis
260
Q

Psoariatic arthritis clinical picture

A 
DIP
Arthritis mutilans
penicl in cup deformity
Nail changes
Dactylitis
Enthesitis
261
Q

What is arthritis mutilans

A

Periarticular osteolysis and bone shortening seen in psoariatic A

262
Q

What is dactylitis

A

Whole digit swelling

263
Q

What is enthesitis

A

Tendon attachment inflammation

264
Q

What nail changes are in psoariatic arthritis

A

Subungal hyperkeratosis
Nail plate pitting
Discolouration and ridging
Onycholysis

265
Q

Reactive arthritis develops after

A

UTI
STI
Dysentry (salmonella, shigella)

266
Q

Reactive arthritis clinical picture

A

Conjunctivitis
Arthritis
Skin changes
-keratoderma blennorrhagica

267
Q

Reiters syndrome

A

Cant see
Cant pee
Cant climb a tree

268
Q

Rheumatic fever criteria

A

Jones criteria

269
Q

Jones criteria for rheumatic fever

A 
Joint arthralgia
CardiOmyopathy
subcutaneous Nodules
Erythema marginatum
Sydenham chorea
270
Q

Dermatomyositis blood tests

A

ANA
CK
Myoglobin

271
Q

Dermatomyositis clinical picture

A 
Heliotrope (eyelid) rash
V neck rash
Gottons papules
Periungal erythema
Calcinosis
272
Q

Causes of peripheral neuropathy

A 
DM
Poliomyelitis
Chronic alcoholism
Leprosy
Syphilis
273
Q

Neck of femur fracture sign

A

Leg shortened and externally rotated

274
Q

Symptoms to screen for in a neuro history

A 
Headache/ facial pain
Weakness
Numbness
Collapse
Confusion
Gait change
Tremor
Dizziness
Visual change
275
Q

thunderclap headache is suggestive OF

276
Q

What can focal neurological signs suggest

A

Brain haemorrhage
Stroke
Abscess

277
Q

What can a change in mental status suggest

A

Raised ICP

Encephalitis

278
Q

What is the triad of meningism

A

Photophobia
Neck stiffness
Headache

279
Q

What can cause meningism

A

Meningitis
Abscess affecting meninges
SAH

280
Q

What goes red eye suggest

A

acute closed angle glaucoma

281
Q

What does worse on lying down suggest in a neuro patient

A

Raised ICP

282
Q

What are causes of raised ICP

A

Space occupying lesion

Haemorrhage

283
Q

What are red flags in neuro

A 
Thunderclap headache
Focal neurological signs
Change in mental status
Meningism
Worse on lying down
284
Q

Primary headaches

A

Tension
Migraine
Cluster

285
Q

Secondary headaches

A

Intracranial infections
Intracranial bleeds
Raised ICP
GCA

286
Q

Signs of tension headache in a history

A

Band like
Stressed
Towards end of day

287
Q

Signs of a migraine headache in history

A 
Unilateral
Throbbing/ pulsating
Aura
Photophobia
Phonophobia 
(Quiet dark room)
288
Q

What is the most common aura in migraines

A

Scintillating scotoma (spot of flickering light)

289
Q

Signs of a cluster headache in a history

A

Unilateral red eye
Autonomic features
Seasonal clusters

290
Q

What are extra features of a cluster headache

A

Lid swelling
Lacrimation
Rinorrhoea

291
Q

Questions to differentiate secondary headaches

A

Fever
Head injury/fall
Speed of onset

292
Q

Meningitis symptoms

A 
Neck stiffness
Headache
Photophone
Fever
N+V
Non blanching rash
293
Q

Diagnosis of meningitis

A

Blood cultures

Lumbar puncture

294
Q

Treatment of meningitis in GP

295
Q

Treatment of meningitis in hospital

A

IV Cefotaxime

296
Q

Specific signs for inflammation of lining of brain

A

Kernigs and Brudzinskis

297
Q

Triad of encephalitis

A

Fever
Headache
Change in mental state

298
Q

How to differentiate encephalitis and meningitis

A

Encephalitis has more predominant symptoms of confusion and altered consciousness

299
Q

What is meningitis (layman)

A

Inflammation of lining of brain

300
Q

What is encephalitis

A

Inflammation of brain parenchyma itself (Normally herpes, simplex bad)

301
Q

Diagnosis of encephalitis

A

Lumbar puncture

302
Q

Treatment of encephalitis

A

IV acyclovir

303
Q

SAH symptoms

A 
Thunderclap headache
Raised ICP
-headache
-N&amp;V
-visual disturbance
-fixed dilated pupil
304
Q

SAH history

A

Usually spontaneous

Sentinel headaches

305
Q

SAH PMH

A

PKD

Ehlers Danlos

306
Q

SAH investigations

307
Q

SAH treatment

A

Endovascular coil, surgical clip

308
Q

SDH history

A

Elderly
Alcholic
Recent major trauma
Within hours

309
Q

Question to rule out brain tumour

A

Weight loss

310
Q

Question to rule out brain abscess

311
Q

Question to rule of intracranial bleed

312
Q

Symptoms of raised intracranial pressure

A

Headahce worse lying down/coughing
Weakness
N&V
Confusion

313
Q

Describe what happens in GCA

A

Inflammation of branches of external carotid artery. Granulomatous thickening and reduced blood supply to distal muscles causes claudication

314
Q

Signs of PMR

A

Shoulder and pelvic girdle pain and stiffness

315
Q

Specific question in PMH for GCA

A

Polymyalgoa rheumatica

316
Q

Specific questions for GCA

A

Hurt when comb hair?
Hurt when eat?
Vision problems?
Chest pain to back?

317
Q

Symptoms of GCA

A

Jaw and tongue claudication
Tender scalp/ occiput
Sudden painless unilateral LOV
Aorta dissection risk

318
Q

Investigation of GCA

A

Temporal artery biopsy

319
Q

Treatment of GCA

A

High dose steroids

320
Q

Differential diagnosis of visual disturbance

A 
Migraine
MS
GCA
Raised ICP
Myasthenia gravis
321
Q

Visual disturbance HPC questions

A

Describe what problem is
Onset
Ever had before
Associated symptoms

322
Q

Possible descriptions of visual disturbance

A

Spot of flickering light in centre of vision which enlarges
Loss of central colour vision
Vision is blurry
Seeing double

323
Q

Recurring visual problems suggests

A

MS

Migraines

324
Q

Visual disturbance associated symptoms

A

Weakness
Numbness
Headache

325
Q

MS investigations

A

LP- Oligoclonal bands
VEP- Optic neuritis
MRI

326
Q

MS Treatment

A

Relapses- prednisolone

DMAs- beta interferon

327
Q

What is often first presentation of MS

A

Optic neuritis

328
Q

What does optic neuritis present as

A

Pain on eye movement
Reduction in central vision
Reduction in colour vision

329
Q

Questions for MS

A 
Disseminated in space and time
Weakness? Sensory disturbance?
Ever had before? Where?
Fatigue?
Worse in bath?
330
Q

What is the pathophysiology of trigeminal neuralgia

A

Artery compressing trigeminal nerve and its branches

331
Q

Questions to ask for trigeminal neuralgia

A

SOCRATES

Triggers- chewing, contact, breeze

332
Q

Treatment for trigeminal neuralgia

A

Carbamazepine

333
Q

Triggers of trigeminal neuralgia

A

Chewing, any contact, a breeze

334
Q

Questions to ask about weakness

A 
Site and distribution
Onset
Duration
Triggers
Timing and progression
Associated symptoms
Happened before?
335
Q

Associated symptoms for weakness

A

Visual, speech and sensory disturbance. Bladder bowel, ED, saddle anaesthesia

336
Q

Weakness PMH

A

Cardiovascular events

AI disease

337
Q

Sudden onset weakness questions- currently?

A 
Facial weakness? sensation?
Visual disturbance?
Weakness or sensory distribution elsewhere?
Eating, drinking, swallowing problems?
Speech disturbance?
Dizziness/balance problems?
Confusion?
338
Q

Sudden onset weakness questions- in the past?

A

Head trauma
LOC
Illness
Anything similar

339
Q

Bells palsy symptoms

A 
Cant wrinkle brow
Drooping eyelid
Cant puff cheeks
Drooping mouth
Loud noises (stapedius)
340
Q

Which cranial nerve is affected in Bells Palsy

A

CN VII Facial

341
Q

What is the treatment for Bells Palsy

A

Prednisolone

342
Q

Stroke- face, arm or leg symptoms

A

Numbness or weakness

Trouble walking

343
Q

Stroke- brain symptoms

A

Confusion
Aphasia
Dizziness
Headache

344
Q

Stroke- eye symptoms

A

Trouble seeing

345
Q

Stroke- stomach symptoms

A

Nausea or vomiting

346
Q

Is a stroke painful

347
Q

Stroke history

A

Neuro and CVS Hx
CVS risk factors
Previous TIA

348
Q

Stroke, CVS risk factors

A

HTN
DM
Cholesterol
AF

349
Q

Stroke drug history

A

Anticoagulants

350
Q

Stroke investiagtions

351
Q

Stroke treatment

A

Streptokinase <4.5hrs

Aspririn >4.5hrs

352
Q

Is weakness present in upper or lower motor neurone lesions

353
Q

Is atrophy present in upper or lower motor neurone lesions

354
Q

Are reflexes and tone increased or decreased in UMN lesions

355
Q

Are reflexes and tone increased or decreased in LMN lesions

A

Descreased

356
Q

Are fasciculations present in UMN or LMN lesions

357
Q

Is Babinski present in UMN or LMN lesions

358
Q

Brain UMN lesions

A

Stroke
Space occupying lesion
Multiple sclerosis

359
Q

Spinal cord UMN lesions

A

Multiple sclerosis

Spinal cord compression

360
Q

LMN lesions

A

Radiculopathies
Peripheral neuropathies
Myasthenia Gravis
Guillain Barre Syndrome

361
Q

Both Upper and Lower lesions

A

Motor neurone disease

362
Q

Lesions disseminated in time and space

A

Multiple sclerosis

363
Q

Symptoms made worse by hot baths

A

Motor neurone disease

364
Q

What is a radiculopathy

A

Nerve root neuropathy

365
Q

Causes of radiculopathy

A 
Prolapsed disk
Spinal stenosis
Tumours
Trauma
Infection
Spondylolithesis
366
Q

What is the main cause of radiculopathy

A

Prolapsed disk

367
Q

What is radicular pain

A

Pain along a dermatome

368
Q

What is the general presentation of a radiculopathy

A

Sciatica
LMN weakness and altered sensation
Absent reflex
Bladder, bowel, ED, saddle anaesthesia

369
Q

What is myelopathy

A

Spinal cord compression

370
Q

What is the most common cause of myelopathy

A

Metastasis

371
Q

What are the causes of myelopathy

A

Metastasis, infection, trauma, disk prolapse

372
Q

Chronic subacute spinal cord compression presentation

A

Spastic paraparesis
Radicular pain at level
Sensory loss below level

373
Q

What would the radicular pain be if you had spinal cord compression at T4

A

Band of pain around nipples, worse on coughing or straining

374
Q

What would the sensory symptoms be in spinal cord compression

A

Numbness starts in the feet and then rises to level of compression

375
Q

What does spastic paraparesis show as

A

Retention of urine and constipation develops

376
Q

Does cauda equina syndrome show UMN or LMN signs

377
Q

Red flags for cauda equina syndrome

A 
Sever lower back pain
Sciatica
Bladder/bowel dysfunction, urinary retention
Saddle anaesthesia
Sexual dysfunction
Neurological deficit in lower limb
378
Q

Motor neurone disease signs

A

UMN/LMN signs, no sensory loss

379
Q

MND History hints

A

Weakened grip, dropping things
Shoulder weakness
Tripping up
Dysarthria (bulbar onset)

380
Q

How does myasthenia gravis work

A

Autoantibodies against post synaptic ACh receptor at the NMJ

381
Q

Age and gender of myasthenia gravis

A

20-40, women more than men

382
Q

What are classic signs of MG

A

Eye muscle weakness, fatigueability

383
Q

What is the progression of MG

A

Eye, bulbar (dysphagia, swallowing, chewing, dysarthria) then proximal limb muscles

384
Q

Questions to ask in MG history

A

Symptoms get worse as day goes on?

Exacerbated by exertion?

385
Q

Numbness and tingling red flags

A 
Weakness
Incontinence
Saddle anaesthesia
Numbness after trauma
Confusion
Drowsiness
386
Q

What does incontinence suggest when accompanying numbness

A

Cauda equina

387
Q

What does saddle anaesthesia suggest when accompanying numbeness

A

Cauda equina

388
Q

What does numbness after head, neck or back injury suggest

A

Spinal injury

  • cord compression
  • cauda equina
  • nerve root compression from prolapsed disk
389
Q

What does confusion and numbness/tingling suggest

A

Stroke/something else affecting the brain

390
Q

Numbness and tingling sites

A 
Dermatomal
Non dermatomal
Sensory level
One side of the body
Hands and feet
391
Q

What dos dermatomal distribution suggest

A

Peripheral nerve or nerve root lesion

392
Q

What does a sensory level distribution suggest

A

Spinal cord lesion

393
Q

What does a one side of the body distribution suggest

A

Stroke or other brain lesion

394
Q

What does a glove and stocking distribution suggest

A

Peripheral neuropathy

395
Q

Which nerve controls biceps muscle

396
Q

Which nerve controls big toe extension

397
Q

Radiculopathy specific questions

A

What were you doing at the time

398
Q

Carpal tunnel syndrome tell tale sign

A

Thumb weakness

399
Q

Carpal tunnel syndrome risk factors

A

Rheumatoid arthritis

Hypothyroidism

400
Q

Ulnar nerve compression questions

A

Trauma to elbow

Weakness of hand muscles

401
Q

Radial nerve compression question

A

Cannot open first

402
Q

Median nerve muscles

A 
LLOAF
Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
403
Q

Ulnar nerve muscles

A

Muscles in hand apart from LLOAF

404
Q

Radial nerve muscles

A

Extensor muscles in forearm

405
Q

Spinal cord lesions specific questions

A

Preceding trauma

PMH: Osteoporosis

406
Q

Stroke 5 problems

WAPES

A 
Weakness
Aphasia
Problems with higher functioning
Emotional disturbance
Sensory disturbance
407
Q

Stroke in which lobe causes weakness

408
Q

Stroke in which lobe causes sensory disturbance

409
Q

Stroke in which area causes receptive aphasia

A

Wernickes, temporal

410
Q

Stroke in which area causes expressive aphasia

411
Q

Stroke in which area causes disinhibition and impulsivity

412
Q

Stroke in which area causes emotional disturbance

A

Hippocampus- temporal

413
Q

Why do you get glove and stocking distribution

A

Disease of the axon, so the longest axons will be the first to be affected

414
Q

Whats the difference between distal axonopathies and GBS

A

GBS has weakness as the main symptom

415
Q

What causes a distal axonopathy

A

Response of neurones to metabolic or toxic disturbances

416
Q

Distal axonopathy questions

A

Gradual?
Diabetes?
Alcohol abuse, kidney failure?
Vit deficiency? B1 and B12

417
Q

Malabsorption symptoms

A

Diarrhoea, foul smelling stools that are hard to flush, weight loss

418
Q

Which vitamins cause distal axonopathies

A

B1 and B12

419
Q

Signs of GBS

A

Symmetrical, ascending weakness and numbness over weeks

420
Q

What should you ask about in GBS

A

Preceding infection?

Respiratory involvement?

421
Q

What is a red flag in GBS

A

Respiratory involvement

422
Q

Which infective agent can cause GBS

423
Q

Collapse questions

A

When did it happen? What were they doing at the time? How many times has this occurred? LOC?

424
Q

Precollapse symptoms questions

A

Aura?

Light headed?

425
Q

During collapse symptoms questions

A

Tongue biting
Foaming
Incontinence

426
Q

Post collapse symptoms questions

A

Rapid recovery

Fatigue

427
Q

Generalised seizures precipitating events

A

Usually none, can occur during sleep

428
Q

Syncope precipitating events

A

Stress, exercise, excitment

429
Q

Generalised seizures signs preceding the episodes

A

Signs related to the prodrome and aura phases

430
Q

Syncope signs preceding the episodes

A

Usually none. Sometimes ataxia, vocalisation, urination or defecation

431
Q

Generalised seizures: during

A

Motor activity such as tonic clonic, jaw and facial movements. Urination or defecation, drooling. LOC

432
Q

Syncope: during

A

Usually flacid collapse. LOC, urination etc more rare

433
Q

Duration of generalised seizures

A

Longer than a minute

434
Q

Duration of syncope

A

Usually shorter than a minute

435
Q

After the event: generalized seziures

A

Signs related to post ictal phase, slow recovery

436
Q

Signs following the event: Syncope

A

Rapid recovery

437
Q

What does NEAD have that epilepsy doesnt

A 
More than 2mins
Gradual onset
Closed eyes
Side to side head moves
Tip of tongue biting
Fluctuating course
May talk during seizure
438
Q

Differentials of tremor

A 
Parkinsons
Benign essential tremor 
drug induced tremor
Alcohol withdrawal
Hypoglycaemia
Thyrotoxicosis
439
Q

Tremor HPC questions

A 
Resting or action
SOCRATES
Gait change?
Balance and coordination?
Gradual onset=disease
440
Q

Tremor DHx

A

Antipsychotics

441
Q

Tremor SHx

A

Amphetamines

442
Q

Tremor FHx

A

Essential tremor

443
Q

Three parkinsons signs on examination

A

Resting tremor
Rigidity
Bradykinesia
Assymetrical onset

444
Q

Neurological parkinsons symptoms

A 
Anosmia
Postural instability
Reduced dexterity
Micrographia
Decreased arm swing
Blank face
Dysphagia
Neuropathy
445
Q

Autonomic parkinsons symptoms

A 
Constipation
Sexual dysfunction
Sweating
Incontinence
Drooling
Dizziness
446
Q

Psychiatric parkinsons symtoms

A 
Depression
Insomnia
Amnesia
Emotional volatility
Poverty of thought
Visual hallucinations
447
Q

Parkinsons diagnosis

A

Clinical

SPECT scanning

448
Q

Good things to ask in endocrine histories

A 
Fatigue/tiredness
Weakness
Weight loss
Weight gain
Hirsuitism
449
Q

Fatigue, tiredness, neck lump questions

A 
Infection
Night seats
Neck lump not in midline
-anaemia, DM, lymphoma, infective
AI PMH
450
Q

Neck lump differentials

A

Thyroid swellings
Reactive neck lymphadenopathy
Malignant neck node

451
Q

Examples of thyroid swellings

A

Multinodular goitre, solitary thyroid nodule

452
Q

Examples of reactive neck lymphadenopathy

A

Tonsilitis
Glandular fever
HIV

453
Q

Examples of malignant neck nodes

A

Carinoma metastases, lymphoma

454
Q

Key hypothyroidism symptoms

A

Weight gain
Poor memory
Intolerance to cold
Feeling of tiredness

455
Q

Symptoms of hypothyroidism

A 
Hair thin and loss
Puffy face
Enlarged thyroid
Dry and coarse skin
Slow heart beat
Constipation
Heavy menstruation
Poor appeitite
Carpal tunnel
456
Q

Signs of hypothyroidism

A 
Oedema
Vocal hoarseness
Goitre
Delayed relaxation of reflexes
Paraesthesia
457
Q

Key hyperthyroidisim symptoms

A 
Irritability
Hyperactivity
High blood sugar
Intolerance to heat
Low cholesterol
458
Q

Breathless, dysphagia, neck pressure suggests

A

Large toxic multinodular goitre

459
Q

Symptoms of hyperthryoidism

A 
Fine brittle hair
Bulging eyes
Increased sweating
Enlarged thyroid
Enlarged liver
Arrythmias
Increased appetite
N, V and D
Hand tremors
Loss of libido
Amenorrhea
460
Q

Hyperthyroidism signs

A 
Agitation, fine tremor, erythema
Tachycardia, AF, heart failure, oedema
Eye signs
Goitre
Fine tremor
Alopecia
Urticaria, pruritus
Brisk reflexes
Proximal myopathy
461
Q

What does a tender irregular thyroid gland suggest

A

Subacute thyroiditis

462
Q

What is graves disease signs

A 
Lid retraction
Exopthalmos
Opthalmoplegia
Lid lag
Pretibial myxoedema
463
Q

What is exopthalmos

A

Protrusion of the eye ball, specific to graves

464
Q

What is opthalmoplegia

A

Paralysis of the extra ocular muscles which cause diplopia

465
Q

Risk factors for thyroid eye disease

A

Smoking

Female

466
Q

Describe T1 DM

A

Autoimmune destruction of beta islet cells

467
Q

Describe T2 DM

A

Combination of insulin resistance and then islet cell destruction

468
Q

Acute triad of T1DM

A

Polyuria
Polydipsia
Weight loss
(tiredness)

469
Q

Acute triad of T2DM

A

Polyuria
Polydipsia
Obesity
(tiredness)

470
Q

Diabetes HPC

A

Vision problems
Numbness/ tingling
Sexual dysfunction
Skin infections

471
Q

Diabetes PMH

A

Stroke
Heart disease
PVD
Kidney problems

472
Q

T2DM DH

473
Q

T2DM SH

A

Smoking
Alcohol
Exercise
Diet

474
Q

T2DM FH

475
Q

T1DM Treatment

A

Insulin and education

Chronic disease management

476
Q

T2DM Treatment

A

1) Lifestyle advice, statin, Ramipril
2) Metformin
Chronic disease management

477
Q

Cardiac PMH

A

Hospital/ A&E visits, GP visits

Previous stents

478
Q

Cardiac FH

A

M1 <55years 1st degree relative

479
Q

Cardiac SH

A 
Smoking
Alcohol
Diet and lifestyle
Occupation
Home- carers? ADLs?
480
Q

Respiratory FH

A

Cystic fibrosis

Asthma, eczema, hayfever

481
Q

Respiratory PMH

A

ACE-I
Inhalers
Immunisations

482
Q

Respiratory SH

A 
Foreign travel
Pets
Occupation
Living conditions
Hobbies
Long haul flights
483
Q

Respiratory PMH

A 
Asthma
TB
PE
Allergies
Pneumonia
Home oxygen
Inhalers
484
Q

CV common presenting complaints

A 
Chest pain
Palpitations
Ankle swelling
Leg pain
SOB
Syncope and presyncope
485
Q

Respiratory common HPCs

A 
Cough 
SOB
Asthma
COPD
Pulmonary fibrosis
486
Q

Cardiac causes of chest pain

A

ACS
Pericarditis
Aortic stenosis
Aortic dissection

487
Q

Aortic stenosis triad

A

Chest pain
Syncope
Heart failure

488
Q

Respiratory causes of chest pain

A

Pulmonary embolism
Pneumonia
Pneumothorax

489
Q

GI causes of chest pain

A

GORD

Peptic ulcer disease

490
Q

Other causes of chest pain

A

Costochondritis

Rib injuries

491
Q

Cardiac pain which goes to the trapezius and shoulders

A

Pericarditis

492
Q

Cardiac chest pain associated symptoms

A

SOB, N&V, sweating, palpitations, ankle swelling, syncope, calf swelling, haemoptysis, sputum or trauma

493
Q

Palpitations questions

A 
TAP OUT BEAT
how often, for how long
Associations
Sweating or SOB
Syncope, Chest pain?
Associated with exercise?
Family history of CVD?
494
Q

Palpitations red flags

A

Chest pain

Palpitations associated with exercise

495
Q

Cardiac causes of palpitations

A

Cardiac arrhythmias
Valve pathology
Heart failure
Congenital heart disease

496
Q

Non cardiac causes of palpitations

A

Psychosomatic, hyperthyroid, anaemia, medication, recreational drugs, caffeine

497
Q

Left ventricular failure symptoms

A 
Exertional SOB
PND
Orthopnoea
Cough
Pink frothy sputum
498
Q

Right ventricular failure symptoms

A 
Ankle and sacral oedema
Cough
Ascites
JVP
Bibasal crackles
499
Q

What does pink frothy sputum suggest

A

Left ventricular heart failure

500
Q

What are the three cardinal signs of heart failure

A

Exertional SOB, ankle swelling and fatigue

501
Q

Heart failure questions

A 
How many pillows
Sleeping in chair
Can they climb stairs
Exercise tolerance
What was normal for them before
502
Q

Leg pain symptoms

A

Leg swelling
Increase in skin temperature
Change in skin colour

503
Q

Leg pain risk assessment questions

A 
Recent surgery
Long haul flight
History of malignancy
Immobility
Previous VTE
Family history of VTE
504
Q

Intermittent claudication questions

A 
How far can walk before pain
CVS risk factors
Associated symptoms
-gangrene, burning, foot pain (hanging foot off bed=critical ischaemia)
-impotence
505
Q

How do you measure intermittent claudication

506
Q

Chronic causes of SOB

A

COPD
Pulmonary fibrosis
Heart failure

507
Q

Acute causes of SOB

A

PE
Asthma attack
Pneumonia
Pneumonothorax

508
Q

Acute/chronic causes of SOB

A

Carcinoma of the lung
Pleural effusion
TB

509
Q

SOB HPC

A

When
How long does it last
Associated features
What makes it better or worse

510
Q

Associated features of SOB

A

Chest pain, palpitations, orthopnoea/PNS, nausea or vomiting, cough, oedema, pain

511
Q

SOB PMH

A

Asthma, COPD, VTE

RF for heart disease

512
Q

SOB DH

A

Inhalers, drugs, allergies

513
Q

SOB SH

A

Smoking

Occupation

514
Q

SOB FH

A

Asthma

Cardiac disease

515
Q

SOB Important extras

A

SWAFF

Risk factors for VTE

516
Q

Syncope causes

A

Vasovagal syncope, postural hypotension, aortic stenosis, cardiac arrhythmias

517
Q

Syncope questions

A 
Onset, duration
Situation
Previous episodes
How frequently
Associated symptoms
518
Q

Syncope associated symptoms

A

Palpitations, sweating, chest pain, headache

519
Q

Things to look out for in CVS examinations

A 
Pacemakers
Murmurs
AF
GTN spray
CABG scars on legs
520
Q

Things to look out for in resp examinations

A

Sputum pots, oxygen tanks and inhalers
Tar staining on fingers
Walking stick

521
Q

Prehospital treatment of MI

A

Morphine
Oxygen
gtN
Aspirin

522
Q

Kidney transplant signs

A

Lump and scar

523
Q

LOC before questions

A

What were you doing

How did you feel

524
Q

LOC during questions

A 
LOC
Duration
Injuries
Bite your tongue
Incontinent
525
Q

LOC after questions

A

How did you feel
Confused
How long was recovery

526
Q

Epilepsy before

A

Flashing lights aura
Metallic taste
Altered behaviour
Can be in sleep

527
Q

Epilepsy during

A

2-3mins LOC
Stiffness then shaking
Incontinence
Bite side of tongue

Symmetrical

528
Q

Epilepsy after

A

Confusion

Tiredness for days

529
Q

Sycope before

A

Standing, stress, emotion, eating, coughing, turning head

Palpitations and nausea

530
Q

Syncope during

A 
Flaccid collapse
Multifocal shaking- assymetrical
Scream out
Random limb movements
Less than one minute
531
Q

Syncope after

A

Rapid recovery

No marked confusion

532
Q

Non epileptic attack disorder ebfore

A

Emotions
Traumatic experiences
Bodily sensations

533
Q

NEAD during

A 
Fluctuating course
eyes tightly shut
talking
Moving head side to side
Longer than 5 minutes
534
Q

Headaches red flags

A 
Thunderclap headache
Altered mental state
Focal neurological signs
Meningisms
Worse on lying down
535
Q

Tension headaches symptoms

A

Tight band pain across whole head
Associated with stress
Analgesia induced

536
Q

Tension headache questions

A

Do you feel stressed?
Are you taking pain relief?
How much?

537
Q

Migraine symptoms

A

Severe throbbing pain on one side of the head.
Photo and phonophobia
Aura
Associated numbness and tingling

538
Q

Migraine questions

A

Do you see anything before it happens

539
Q

Cluster symptoms

A

Severe ocular pain
Autonomic features
Multiple a day for weeks, years apart with no warning (clusters)

540
Q

Cluster questions

A

Has it happened before

541
Q

Subdural haemorrhage risk factors

A

Elderly
Epileptic
Alcoholic
recent head trauma

542
Q

Extradural haemorrhage symptoms

A

Head injury
LOC
Period of regaining consciousness
V, dizziness, confusion, headaches, LOC

543
Q

Secondary headaches

A 
EDH
SDH
SAH
Meningitis
Encephalitis
Raised ICP
Temporal arteritis
544
Q

Subarrachnoid haemorrhage symptoms

A

Thunderclap headaches- spontaneous, peaks within 5s

Sentinel headaches

545
Q

SAH PMH

A

PKD

Ehlers danlos

546
Q

SAH Ix

A

CT head, don’t LP

547
Q

SAH Tx

A

Surgical coiling/clipping

548
Q

Meningitis symptoms

A 
Fever
Stiff neck
Altered conscious state
Headache
Non blanching purpuric rash
Photophobia
Vomiting
549
Q

How do encephalitis symptoms differ from meningitis

A

Confusion and altered mental state are more prominent

550
Q

3 things which increase ICP

A

Brain tumour
Brain abscess
Intracranial bleed

551
Q

Question for

a) tumour
b) abscess
c) bleed

A

Weight loss
Fever
Trauma

552
Q

Temporal arteritis symptoms

A

Headache, hurts when I eat or brush hair

Painless loss of vision

553
Q

Temporal arteritis treatment

A

High dose prednisolone

554
Q

Temporal arteritis investigations

A

Temporal artery biopsy

555
Q

Visual disturbances questions

A 
Do you wear glasses?
One eye or both
Describe it
Triggers or trauma
Pain
556
Q

Amaurosis Fugax desribe

A

TIA

Curtain coming down over vision

557
Q

TIA PMHx

A

HTN
Stroke
AF
DM

558
Q

Retinal detachment questions

A 
Always painless
Many floaters
Flashes of light
Blurred vision
Then curtain like loss of vision
559
Q

Myasthenia gravis questions

A 
Symptoms worse with use
Double vision 
Ptosis
Myasthenic snarl
Swallowing problems
560
Q

Symptoms arising from the thyroid swelling

A 
Duration and change in size
Cosmetic symptoms
Odynophagia, dysphagia
Dyspnoea
Hoarseness
561
Q

Thyroid PMH

A

Eye symptoms
Previous thyroid operations
Drug history
Radio-iodine therapy for Graves

562
Q

Breast lump history

A 
SOCRATES
Pain
Nipple changes
Discharge
Skin changes
Before?
Radiation or surgery
563
Q

Breast cancer risk factors

A 
Early menarche
Late menopause
1st pregnnacy >30yo
Nulliparty
HRT
FHx
564
Q

What to look for for breast cancer

A 
Lump in armpit
Lump in breast
Dimpled, depressed skin
Swelling
Nipple changes
Breast pain
Skin irritation
Bloody discharge
565
Q

Smooth breast lump that moves under skin

A

Fibroadenoma

566
Q

Breast lumpiness, thickening and swelling associated with periods

A

Fibrocystic changes

567
Q

Red tender breast swelling associated with fever

568
Q

Breast bruise with lump

A

Breast trauma

569
Q

Neuro red flags

A

LOC, dizziness, headache, visual or speech disturbance, swallowing, sensory changes, bowel and bladder incontinence, meningism, weakness, hearing changes, tremors, N/V, weight loss

570
Q

Stroke PMH

A

Arrythmias, MI, HTN, angina, high cholesterol, diabetes

571
Q

Leg motor gone, which artery was affected

A

Anterior cerebral artery

572
Q

Arms, face motor gone. Which artery was affected

A

middle cerebral artery

573
Q

Which artery is blocked in amaurosis fugax

A

Opthalmic artery

574
Q

Two causes of face paralysis

A

Stroke or Bells palsy

575
Q

How can you tell between stroke and bells palsy

A

Forehead spared in stroke

576
Q

Face paralysis questions

A 
Drooling
difficulty speaking
Dry eyes
hypersensitive to sound
decrease in taste
Recent illness?
577
Q

Treatment for bells palsy

A

Prednisolone within 72hours

578
Q

Change classic to MG

A

Fatigueability

579
Q

Change classic to MS

A

Sensory or sphincter loss

580
Q

Change classic to MND

A

Upper and lower motor neurone changes

581
Q

Are fasciculations a sign of upper or lower MN problem

582
Q

Is babinskis reflex a sign of upper or lower MN problem

583
Q

What is the first change in MG

584
Q

Numbness and tingling differential diagnosis

A 
Peripheral neuropathy
Stroke
Nerve root lesion
Spinal cord lesion
Cauda equina
MS
585
Q

Radiculopathy describe

A

Back pain and altered sensation along a dermatome. LMN signs.
Myotome weakness
?What were you doing at the time

586
Q

What is the most common cause of radiculopathy

A

Slipped disc

587
Q

Myelopathy describe

A

Back pain, sensory loss and pain. UMN signs

588
Q

What is radiculopathy

A

Nerve root lesions

589
Q

What is myelopathy

A

Spinal cord lesions

590
Q

Specific questions for myelopathy (spinal cord lesions)

A

Preceding trauma
Osteoporosis
Red flags

591
Q

Cauda equina symptoms

A 
Severe lower back pain
Sciatica 
Bladder, bowel dysfunction
Saddle anaesthesia
Sexual dysfunction
Neurological deficit
592
Q

5 possible stroke problems

A 
Weakness
Sensory disturbance
Aphasia
Higher function
Emotional disturbance
593
Q

Where is the lesion if they get weakness

594
Q

Where is the lesion if they get sensory disturbance

595
Q

Where is the problem if they get receptive aphasia

A

Wernickes- temporal

596
Q

Where is the problem if they get expressive aphasia

597
Q

Where is the problem if they have problems with higher function

598
Q

Where is the problem if they have emotional disturbance

A

Temporal- hippocampus

599
Q

Signs of capral tunnel syndrome

A

Thumb weakness

RFs: RA, hypothyroid

600
Q

Signs of. ulnar nerve compression

A

Trauma to elbow

Weak muscles of hand

601
Q

Signs of radial nerve compression

A

Cannot open fist

602
Q

Classic first symptom of MS

A

Optic neuritis

603
Q

Classic sign of MS

A

Gets worse with heat (stress and illness)

604
Q

1st line therapy for MS

A

A happy stress free life

605
Q

Diabetes questions

A 
Thirst
Toilet
Tired
Infections
Eyesigh
Tingling
ED
606
Q

Diabetes family history

A

Diabetes
Stroke
Cardiovascular disease

607
Q

Diabetes Drug History

A

Steroids (= hyperglycaemia)

608
Q

Diabetes Social history

609
Q

B12 neuropathy pathophysiology

A

Weakness due to B12 deficiency leading to subacute degeneration of the cord

610
Q

Cuses of B12 deficiency

A

Pernicious anaemia, malabsorption, dietary

611
Q

B12 Questions

A

AI (Addisons), UC or Crohns
Vegan
SWAFF

612
Q

Why does low b12 lead to subacute degeneration of the cord

A

Patchy losses of myelin

613
Q

Signs and symptoms of subacute degeneration of the cord

A

Weakness and tingling that progressively worsens
Visual and mental changes
Spastic paresis

614
Q

Causes of microcytic anaemia

A

Iron deficiency
Thalassaemia
Haemoglobinopathies

615
Q

Causes of normocytic anaemia

A 
Acute blood loss
Haemolysis
Renal failure
Chronic disease
Cancer
616
Q

Causes of macrocytic anaemia

A 
B12 deficiency
Folate deficiency
Alcohol excess
Liver/thyroid disease
Methotrexate and trimethoprim
617
Q

General infection questions

A

Sexual history
Recreational drugs
Holiday
Bitten

618
Q

Cushings symptoms

A 
Acne
Weight gain
Gonadal dysfunction
Proximal weakness
Mood change
619
Q

Signs of. cushings

A 
Fat distribution
Skin changes
Osteoporosis
HTN
Hyperglycaemia, infection prone
620
Q

Fat distribution changes in cushings

A

Central obesity
Moon face
Buffalo neck
Supraclavicular fat distribution

621
Q

Skin changes in cushings

A

Skin and muscle atrophy
Bruises
Purples abdominal striae

622
Q

Mood changes in cushings

A

Depression, lethargy, irritbaility, psychosis

623
Q

Gonadal dysfunction in cushings

A

Irregular menses, hirsuitism, ED, virilsation

2b (28 decks)

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