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MBChB Year 4 OSCE > OSCE Prep > Flashcards

OSCE Prep Flashcards

1
Q

Gastrointestinal System Exam: Inspection

Causes of abdominal distension

A 
Fat
Fluid (ascites)
Flatus
Faeces 
Fetus
Filthy big mass
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2
Q

Gastrointestinal System Exam: Palpation

DDx for Hepatomegaly (INCHIB)

A

Infection (Hepatitis, EBV, Malaria, Abscess)
Neoplastic (Myeloproliferative disease, HCC, metastasis)
Congestion (Venous) (RHF, TR, Budd-Chari Syndrome)
Haematological (Lymphoma/leukemia, Sickle cell or haemolytic anaemia)
Infiltrate (Sarcoidosis, Amyloidosis, fatty liver)
Biliary (PBC, PSC)

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3
Q

Gastrointestinal System Exam: Palpation

DDx for Splenomegaly

A

Massive (Malaria, Myeloproliferative disease [myelofibrosis or CML]
Moderate (Lymphoma, leukemia, Portal hypertension, haemolytic anaemia)
Mild (Glandular fever, Rheumatoid arthritis [Felty Syndrome], Infective endocarditis, Pernicious anaemia)

SLE

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4
Q

Gastrointestinal System Exam: Palpation

DDx for Hepato-splenomegaly

A

Hepatitis, EBV, Malaria, Lymphoma, Leukemia, Myelofibrosis, Sickle cell, haemolytic anaemia, sarcoidosis, amyloidosis

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5
Q

Gastrointestinal System Exam: Hands

DDx for clubbing (gastro causes)

A

Cirrhosis
IBD
GI lymphoma
Coeliac Disease

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6
Q

Cardiovascular System Exam: Hands

DDx of peripheral cyanosis

A

Peripheral vascular disease
Raynaud’s Syndrome
Heart failure
Shock

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7
Q

Cardiovascular System Exam: Mouth

DDx of central cyanosis

A

Hypoxic lung disease
Right-to-left shunt
Methaemoglobinaemia (drug or toxin induced)

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8
Q

Cardiovascular System Exam: Peripheral

DDx of irregular irregular pulse

A

Atrial Fibrillation
Atrial Flutter
Ventricular ectopic beats
Complete heart block with ventricular escape

To differentiate between AF and VEB without an ECG, exercise the patient, this will abolish VEBs but AF will remain.

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9
Q

Cardiovascular System Exam: Irregular Irregular Pulse

Causes of AF

A 
Ischemic Heart disease
Rheumatic Heart disease
Thyrotoxicosis
Pneumonia/PE/
Alcohol
Idiopathic
Fever
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10
Q

Cardiovascular System Exam: Heart Failure

Causes of Heart Failure

A

Pump Failure: IHD, Cardiomyopathy, Constrictive pericarditis, arrythmia or negative inotropes/chronotropes)
Excessive preload: MR or AR, Fluid excess (renal failure or IV fluids))
Excessive afterload (AS or hypertension)
Isolated RHF (Cor Pulmonale secondary to chronic lung disease or pulmonary hypertension (primary/due to MS))
High output cardiac failure (anaemia, pregnancy, metabolic)

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11
Q

Cardiovascular System Exam: Infective Endocarditis

List the stigmata of infective endocarditis

A 
Changing heart murmur
Clubbing
Splinter haemorrhages
Mild Splenomegaly
Microscopic haematuria
Oslers nodes
Janeway lesions
Roths spots (retina)
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12
Q

Peripheral Vascular Exam: Critical Limb Ischemia

6 signs of critical limb ischemia

A 
Pain 
Pallor
Pulseless
Paraesthesia
Perishingly cold
Paralysed
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13
Q

Peripheral Vascular Exam: Venous

Causes of chronic venous insufficiency

A

Valvular incompetance of deep veins (90%)

Obstruction of deep veins (10%)

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14
Q

Peripheral Vascular Exam

Causes of acute limb ischaemia

A

Thrombosis
Emboli (80% cardiac source eg AF, 10% non-cardiac source eg AAA or peripheral aneurysm, and 10 % unknown source)
Graft rejection/occlusion
Trauma

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15
Q

Peripheral Vascular Exam: ABPI

How is a ABPI done and what do the results show?

A

Performed using a pencil doppler machine and a standard blood pressure cuff. Bilateral brachial systolic pressures are recorded and then the highest reading is taken as the denominator for both legs.
In legs, take highest systolic reading from DP and PT to use as the numerator
>1.3 = Unreliable - vessels are calcified, commonly seen in diabetics
0.9-1.8 = Normal range
<0.8 = Evidence of peripheral arterial disease (claudication)
<0.5 = significant peripheral arterial disease - gangrene and ulceration

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16
Q

Cardiovascular System Exam: Murmur

Etiology of Aortic Stenosis

A

Rheumatic Heart disease
Calcified bicuspid aortic valve (50-60)
Calcified tricuspid aortic valve (70+)
Supravalvular stenosis

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17
Q

Cardiovascular System Exam: Murmur

Presentation of Symptomatic Aortic Stenosis

A

Dyspnoea/Decreased exercise tolerance
Syncope/dizziness
Angina pectoris

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18
Q

Cardiovascular System Exam: Murmur
Physical exam findings associated with Aortic Stenosis
What may you see on an ECG?

A

Low volume, slow rising pulse
Narrow pulse pressure
Ejection systolic murmur heard loudest over right 2nd intercostal space, radiating to carotids.
LVH with strain pattern, p mitralle, Left axis deviation

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19
Q

Cardiovascular System Exam: Murmur

DDx of Aortic Stenosis

A

Aortic Sclerosis
HOCM
Pulmonary stenosis (usually congenital)
Mitral regurgitation

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20
Q

Cardiovascular System Exam: Murmur

Etiology of Aortic Regurgitation

A

Acute: Endocarditis, Aortic dissection, Cusp rupture (congenital, traumatic), Iatrogenic

Chronic: Rheumatic heart disease, aortic root dilatation, congenital bicuspid aortic valve and calcific valve disease

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21
Q

Cardiovascular System Exam: Murmur

Presentation of Aortic Regurgitation

A

Often asymptomatic
May develop exertional dysnpnoea, angina and symptoms of Heart failure
Palpitations

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22
Q

Cardiovascular System Exam: Murmur
Physical exam findings associated with Aortic Regurgitation
What might you see on CXR

A

Quincke’s Sign: Pulsatile nailbeds
Corrigan’s Sign: Exaggerated carotid pulse
Wide pulse pressure.
Early diastolic murmur heard loudest over left sternal edge, increased on leaning forward and expiration
CXR: Cardiomegaly, CHF (ABCD)

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23
Q

Cardiovascular System Exam: Murmur

DDx of Aortic Regurgitation

A 
Pulmonary regurgitation
Graham Steel (PR secondary to pulmonary hypertension)
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24
Q

Cardiovascular System Exam: Murmur

Etiology of mitral regurgitation

A

IE, RHD, Calcification, mitral valve prolapse, ruptured chordae tendinae, papillary muscle rupture, connective tissue disorders (marfan’s)
Functional: LV dilation

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25
Q

Cardiovascular System Exam: Murmur

Presentation of Mitral Regurgitation

A 
SOB/Fatigue
Other LVF (orthopnea/PND)
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26
Q

Cardiovascular System Exam: Murmur

Physical exam findings associated with Mitral Regurgitation

A

Pansystolic murmur hear loudest in the mitral area.

AF common

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27
Q

Cardiovascular System Exam: Murmur

DDx of Mitral Regurgitation

A

Ventricular septal defect
Tricuspid regurgitation
AS

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28
Q

Cardiovascular System Exam: Murmur

For Mitral Regurgitation, what may you see on ECG and CXR

A

ECG: AF common, VEB’s
CXR: Cardiomegaly or CHF

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29
Q

Cardiovascular System Exam: Murmur

Etiology of mitral stenosis

A

RHD (99%)

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30
Q

Cardiovascular System Exam: Murmur

Presentation of Mitral stenosis

A 
Dyspnoea 
Pulmonary oedema/haemoptysis
AF
RHF (late)
Really enlarged atria can compress recurrent laryngeal nerve - hoarseness
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31
Q

Cardiovascular System Exam: Murmur

Physical exam findings associated with Mitral stenosis

A

Mitral facies
Signs of RHF
AF
Mid-diastolic murmur loudest on LHS with expiration

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32
Q

Cardiovascular System Exam: Murmur

For Mitral stenosis, what may you see on ECG and CXR

A

ECG: AF or P mitrale (bifid P waves)

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33
Q

Cardiovascular System Exam: Murmur

DDx of Mitral stenosis

A 
Austin Flint (2ndary AR)
Carey Coombs (Rheumatic Fever)
Tricuspid Stenosis (RHD)
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34
Q

Gastrointestinal System Exam: Inspection

  1. Causes of Leukonychia
  2. Causes of Koilonychia
  3. Causes of xanthomata
A
  1. Hypoalbumininaemia
  2. Iron-deficiency anaemia
  3. Hyperlipidaemai
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35
Q

Gastrointestinal System Exam: Inspection

Causes of depuytren’s contracture

A

CLD, diabetes, heavy labour, phenytoin, trauma, familial

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36
Q

Gastrointestinal System Exam: Inspection

Causes of Palmar erythema

A

CLD, pregnancy, hyperthyroidism, rheumatoid arthritis

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37
Q

Gastrointestinal System Exam: Inspection

Why would someone have increased bruising?

A

CLD: THrombocytopenia , decreased clotting factors and falls
Jaundice: Biliary obstruction > reduced fat absorption > reduced absorption of fat soluble vitakne (A D E K) - reduced vitamin K means less synthesis of factors 10, 2 7 and 9.

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38
Q

Gastrointestinal System Exam: Inspection

Why would someone have a cushingnoid appearance of the face?

A

Alcoholic pseudocushings - hypercortisolaemia secondary to stress of repeated alcohol withdrawal

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39
Q

Respiratory Exam: Causes of wheeze

A

Asthma, COPD, Bronchiectasis, Fixed bronchial obstruction

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40
Q

Respiratory Exam: Causes of atelectasis

A

Intraluminal: Mucus, Foreign body, aspiration
Mural: Bronchial carcinoma
Extramural: ….

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41
Q

Respiratory Exam: DDx of haemoptysis

A 
Malingering
Pseudo-haemoptysis: GI source
Infection: TB, Pneumonia. Infective bronchitis, bronchiectasis
Infarction: PE
Pulmonary odema: LVH, MS
Vasculitis: SLE, Goodpastures
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42
Q

Respiratory Exam: DDx of pleural effusion

A

Transudate: HF, hypoalbuminuria, cirrhosis, nephrotic syndrome, hypothyroidism
Exudate: Infection, inflammation, neoplastic, pancreatitis

Empyema: Pus
Haemothorax: Blood
Chylothorax: Lymph

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43
Q 
Respiratory Exam: How does Consolidation present?
Mediastinal shift:
Chest wall movement:
Percussion:
Breath sounds:
Added sounds:
A 
Mediastinal shift: None
Chest wall movement: Decreased over affected area
Percussion: Dull
Breath sounds: Reduced (bronchial)
Added sounds: Crackles
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44
Q 
Respiratory Exam: How does Atelectasis present?
Mediastinal shift:
Chest wall movement:
Percussion:
Breath sounds:
Added sounds:
A

Mediastinal shift: Towards side of collapse
Chest wall movement: Decreased over affected area
Percussion: Dull
Breath sounds: Absent/reduced
Added sounds: None

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45
Q 
Respiratory Exam: How does Pleural effusion present?
Mediastinal shift:
Chest wall movement:
Percussion:
Breath sounds:
Added sounds:
A

Mediastinal shift: Away from side of effusion in large effusions
Chest wall movement: Decreased over area affected
Percussion: Stony dull
Breath sounds: Absent over fluid, bronchial over upper border
Added sounds: nil

46
Q 
Respiratory Exam: How does Pneumothorax present?
Mediastinal shift:
Chest wall movement:
Percussion:
Breath sounds:
Added sounds:
A 
Mediastinal shift: Away from side fo Ptx
Chest wall movement: Decreased over affected area
Percussion: Hyperresonant
Breath sounds: Absent/reduced
Added sounds: nil
47
Q 
Respiratory Exam: How does ILD present?
Mediastinal shift:
Chest wall movement:
Percussion:
Breath sounds:
Added sounds:
A 
Mediastinal shift: Nil
Chest wall movement:Decreased Symmetrically
Percussion: Normal
Breath sounds: Normal
Added sounds: Crackles
48
Q

Respiratory Exam: What is type one respiratory faiure and what are the commonest causes?

A

Low PaO2 but normal/low PaCO2
V/Q mismatch, hypoventilation, abnormal diffusion, right to left cardiac shunts.
V/Q mismatch: Pneumonia, PE, pulmonary oedema, asthma, emphysema, pulmonary fibrosis, ARDS

49
Q

Respiratory Exam: What is type two respiratory failure and what are the commonest causes?

A

Low PaO2 and High PaCO2
Pulmonary problme: COPD, Pulmonary oedema, pneumonia
Mechanicl Problem: Chest wall trauma, muscular dystrophy, MND, Myasthenia gravis
Central: Opiate overdose, acute CNS disease

50
Q

Respiratory Exam: List causes of dullness on percussion

A 
Consolidation
Effusion
Atelectasis (presents same as lobectomy)
Lobectomy/Pneumonectomy
Raised hemidiaphragm
Pleural thickening
51
Q

Cranial Nerve Exam: Causes of opthalmoplegia

A 
Myasthenia gravis
Cranial Nerve Palsy
Graves Disease
Wernicke's Encephalopathy 
Progressive supranuclear palsy (vertical gaze)
52
Q

Cranial Nerve Exam: Where does the lesion occur in internuclear opthalmoplegia?

A

Medial longitudinal fasciculus

53
Q

Cranial Nerve Exam: What are the causes of Internuclear opthalmoplegia?

54
Q

Cranial Nerve Exam: General causes of any cranial nerve palsy

A 
Diabetes (microangiopathy of the vasa nervorum)
Stroke
MS
Tumours
Sarcoid
SLE
Vasculitis
55
Q

Cranial Nerve Exam: Specific Causes of Cranial Nerve 1 (olfactory) palsies

A

Trauma (shearing of olfactory bulbs through cribriform plate)
Alzheimer’s and Parkison’s
Frontal lobe tumour (meningioma)
Meningitis

56
Q

Cranial Nerve Exam: Specific Causes of Cranial Nerve 2 (optic) palsies

  1. Monocular
  2. Bitemporal hemianopia
  3. Homonymous hemianopia
A
  1. MS, GCA
  2. Lesion at optic chiasm: pituitary adenoma, suprasellar meningioma, craniopharyngioma
  3. Anything behind optic chiasm (stroke, tumour or abscess)
57
Q

Cranial Nerve Exam: Causes of Relative Afferent Pupilllary defect

A

Optic Nerve disorder: Optic ischaemic neuropathy, optic neuritis, Optic nerve compression, unilateral glaucoma
Retinal Disorders: Central retinal artery/veins occlusion, severe diabetic retinopathy, retinal detachment, Infection (CMV/HSV), tumours (retinoblastoma/melanoma)

58
Q

Cranial Nerve Exam: What would you see in a cranial nerve 3 palsy

A

Eye down and out position (unapposed lateral rectus and superior oblique)
Ptosis (levator palpebrae dysfunction)
Fixed Dilated pupil (parasympathetic nerve fibres from ciliary ganglion affected)
Do not always get all three signs. Often not all branches of the nerve affected

59
Q

Cranial Nerve Exam: Causes of unilateral ptosis?

A

Cranial nerve III palsy
Horners syndrome
Congenital

60
Q

Cranial Nerve Exam: Causes of bilateral ptosis?

A 
Myasthenia gravis
Myotonic dystrophy
Bilateral Horners
Neurosyphilus
Congenital
61
Q

Cranial Nerve Exam: Causes of cranial nerve 3 palsy

A

Location dependent!
Diabetes - vascular neuropathy
Demyelination
Midbrain: Infarction, haemorhage, tumour
Subarachnoid space: PCA aneurysm (will be painful!)
Superior orbital fissure (tumour, ICA artery [would also affect nerves in cavernous sinus]
Orbit: Tumour/trauma

62
Q

Cranial Nerve Exam: Causes of cranial nerve 4 (trochlear) palsy

A

microvascular disease

Orbit trauma

63
Q

Cranial Nerve Exam: CN5

What are the afferent and efferent branches of the corneal reflex?

A

Afferent: Opthalmic branch of the trigeminal
Efferent: Facial Nerve

64
Q

Cranial Nerve Exam: CN7

What is the difference between an UMN and LMN 7th nerve lesion?

A

UMN: Sparing of the forehead due to bilateral facial representation at the level of the 7th nerve nuclei
LMN: All muscles of the face affect

65
Q

Cranial Nerve Exam: Causes of LMN CN7 palsy?

A

Pons: Infarction, tumour, MS
Cerebellopontine angle (CN 6, 7 and 8 affected): Tumour (meningioma or acoustic neuroma)
Base of skull/parotid: Bells Palsy, Maligannt parotid tumour/parotid pathology, Herpes Zoster (Ramsay Hunt)

66
Q

Cranial Nerve Exam: Causes of UMN CN7 palsy?

A

Stroke

Tumours

67
Q

Cranial Nerve Exam: Causes of Bilateral facial nerve LMN weakness

A

Guillain Barre syndrome. Sarcoidosis, Myasthenia gravis, myotinic dystrophy

68
Q

Cranial Nerve Exam: Features of bulbar palsy

A

Absent gag reflex
Wasted tongue + Fasciculations
Absent/normal Jaw Jerk
Nasal Speech

69
Q

Cranial Nerve Exam: Features of pseudobulbar palsy

A

Increased/normal gag reflex
Spastic tongue
Jaw jerk increased
Spastic dysarthria

70
Q

Cranial Nerve exam: Which way does the tongue deviate in a CNXII nerve lesion?

A

Toward the side of the lesion

71
Q

Cranial Nerve exam: Which way does the uvula deviate in a CNX nerve

A

Away from side of lesion

72
Q

Cranial Nerve Exam: Afferent and Efferent pathways of the gag reflex?

A

Afferent: Glossopharyngeal
Efferent: Vagus

73
Q

Median Nerve Palsy

  1. Inspection
  2. Power
  3. Sensation
  4. Special Tests
A
  1. Inspection: Thenar wasting, carpel tunnel decompression scar
  2. Power: Thumb abduction
  3. Sensation: Lateral side of index finger
  4. Special Tests: Phalen’s, Allens
74
Q

Radial Nerve Palsy

  1. Inspection
  2. Power
  3. Sensation
A
  1. Inspection: Forearm extensors and wrist drop
  2. Power: Wrist/MCP extension
  3. Sensation: Dorsal 1st interosseus space
75
Q

Ulna Nerve Palsy

  1. Inspection
  2. Power
  3. Sensation
  4. Special Tests
A
  1. Inspection: Hypothenar wasting, interosseus wasting, elbow trauma
  2. Power: Index finger abduction
  3. Sensation: Medial side of little finger
  4. Special Tests: Fromonth’s
76
Q

Rheum Hand: DDx of symmetrical polyarthritis

A

Rheumatoid arthritis
Osteoarthritis
Systemic conditions: SLE, Sarcoidosis etc

77
Q

Rheum Hand: DDx of asymmetrical polyarthritis

A

Reactive arthritis
Psoriatic Arthritis
Systemic SLE, Sarcoid etc

78
Q

Rheum Hand: DDx of oligoarthritis

A 
Gout
CPPD
Psoriatic arthritis
Reactive arthritis
Ankylosing spondylitis 
OA
79
Q

Rheuma Hand: DDx of monoarthritis

A 
Septic arthritis 
Gout
CPPD
OA
Trauma
80
Q

XRay features of OA

A

Loss of joint space
Osteophytes
Subchrondral cysts
Subarticular sclerosis

81
Q

Stoma: Features of iliostomy stoma and types/indications for one?

A

Site: RIF
Contents: Soft faeces
Opening: Spout to protect skin from enzymes

End Iliostomy: UC, FAP or Hirsprungs
Loop: De-function distal bowel (obstruction due to malignancy, anus (Crohn’s) or new distal anastamoses

82
Q

Stoma: Features of colostomy stoma and types/indications for one?

A

Site: LIF
Contents: Hard faeces
Opening: Flush with skin

End: AP resection or hartmann’s
Loop: De-function distal bowel (obstruction due to malignancy, anus (Crohn’s) or new distal anastamoses

83
Q

Stoma: Early complications?

A 
High output ( dehydration, hypokalaemia)
Peristomal inflammation
Retraction
Obstruction
Ischaemia/Necrosis
84
Q

Stoma: Late Complications?

A

Parastomal hernia
Prolapse
Fistula formation
Dermatitis

85
Q

Cranial Nerve Exam: Presentation of a cranial nerve 4 lesion

A

Trochlear nerve palsies present

86
Q

Cranial Nerve Exam: Presentation of a cranial nerve 6 lesion

A

Abducens Nerve palsies present with inability to abduct affected eye

87
Q

Respiratory Exam: Causes of ILD

A

Idiopathic
Systemic disease: Rheumatoid arthritis, SLE, Sarcoidosis
Occupational exposure to asbestos
Drug toxicity: Amiodarone, methotrexate or radiotherapy

88
Q

Lower Limb Neurology: Approach to foot drop?
?location of lesion
?What lesion is

A

Think anterior horn, L5 nerve root, lumbosacral plexus, sciatic nerve palsy, Common peroneal nerve palsy, Muscle.

Common peroneal nerve palsy: Ankle reflex intact, sensory loss between 1st and 2nd toes.

Sciatic nerve lesions: weak knee flexion, no ankle jerk, widespread sensory loss

L5 lesion: skdjdbadkjl

89
Q

Neurological Exam: Signs of UMN lesion

A 
Increased tone: Spasticity
Decreased power
Impaired coordination 
Increased reflexes (clonus present)
Up-going plantars
90
Q

Neurological Exam: Signs of LMN lesion

A 
Muscle atropy, fasciculations
Decreased tone
Decreased power
Coordination not impaired unless weakness
Reduced or absent reflexes
91
Q

Neurological Exam: What Hz tuning fork is used for webers and rinnes?

A

256Hz or 512Hz

92
Q

Neurological Exam: What Hx tuning fork is used for vibration sensation

93
Q

Head and Neck: Describe the features of a neck lump you would comment on?

A 
Sizze
Shape
Symmetry
Surface
Consistency 
Edges
Fluctuance
Pulsation
Translumination
94
Q

Head and Neck: DDx for mid-line neck mass

A 
Thyroid 
THyroglossal cyst
Lymph node
Lipoma
Sebaceous cyst
Abscess
95
Q

Head and Neck: DDx for anterior triangle neck mass

A 
Thyroid, salivary gland, carotid artery aneurysm
Carotid body tumour
Branchial tumour
Lymph node
Lipoma
Sebaceous cyst
Abscess
96
Q

Head and Neck: DDx for posterior triangle mass

A

cystic hygroma, lymph node, subclavian artery aneurysm , lipoma, abscess, sebaceous cyst

97
Q

Head and Neck: DDx for a goitre

A 
Multinodular goitre
Hashimoto's thyroiditis
Grave's Disease
Iodine deficiency
Acute thyroiditis (de Quer) 
Tumours
Amyloid/sarcoid
98
Q

Head and Neck: What are the classes of thyroid cancers and what markers are useful in these malignancies?

A

Differentiated: Papillary (85%) Follicular (12%)
Thyroglobulin proportional to amount of thyroid tissues so helpful in monitoring cancer burden and recurrence

Undifferentiated: ANaplastic

Medullary: Parafollicular (C) cells - CALCITONIN

99
Q 
Lower Limb Neuro: Causes of Bilateral leg weakness (paraparesis)?
Acute:
Spastic:
Flaccid:
Mixed UMN/LMN:
A

Acute: Acute cord compression, Cauda equina, Guillain-barre syndrome
Spastic: Sagital sinus lesion (meningioma), bilateral strokes, cord trauma, cord compression (epidural abscess, disc prolapse, spondylosis), intrinsic cord disease (tumour, Vascular myelopathy, MS, transverse myelitis)
Flaccid: Polio, Guillain-barre, lead poisening
Mixed: CMT

100
Q

Lower Limb Neuro: Causes of Unilateral leg weakness?

Upper vs Lower motor neuron

A

UMN: Stroke, tumour, MS
LMN: Root lesion, Nerve lesion

101
Q

Lower Limb Neuro: If on exam you find a spastic paraparesis, what should be included in the exam?

A

Assess for a sensory level on the thorax

102
Q

Lower Limb Neuro, If on exam you find a flaccid paraparesis, what should you include on exam?

A

PR assessing for peri-anal sensation and sphincter tone

103
Q

Peripheral Neurological exam: Causes of glove/stocking distribution sensory loss

A 
Diabetes Mellitus
Alcohol
B12/folate deficiency
Paraneoplastic syndrome
Medications e.g. isoniazid
104
Q

Neuro: What does a positive romberg’s test tell you?

A

Person has sensory ataxia

Can be due to dorsal column loss (B12/folate deficiency or MS) or sensory peripheral neuropathy

105
Q

Diabetic Foot Exam: What are the key exam findings in assessing a diabetic foot? hat complications arise in diabetic feet?

A 
Peripheral arterial disease
Diabetic neuropathy (fine touch, vibration, joint-position sensation) + autonomic neuropathy

Ulcers and infections!

106
Q

Cerebellar exam: Causes of cerebellar disease

A 
Stroke
Tumour
MS
Friedreich's Ataxia
Alcohol abuse
Thiamine deficiency (Wernicke's Encephalopathy)
Anti-epileptic medication
107
Q

Cerebellar exam: Classic signs of cerebellar lesion (DANISH)

A 
Dysdiodochokinesis
Ataxia (limb/trunk)
Nystagmus
Intention tremor
Speech (slurred, staccato)
Hypotonia
108
Q

Cerebellar exam: Causes of cerebellar lesions

A 
Stroke
Tumour
MS
Congenital
Friedreich's ataxia
ALcohol abuse
Thiamine deficiency
Anti-epileptic medication
109
Q

Extrapyramidal Exam: Causes of Parkinsonism

A 
Idiopathic Parkinsons Disease
Drug induced (Metacloperamide, lithium)
Parkinsons plus syndromes (Progressive supranuclear palsy, corticobasilar degeneration, Multiple System atrophy)
Vascular Parkinsons
Lewy Body Dementia
110
Q

Neuro Examination: Differential diagnosis of dysarthria, plus what features would you look for to confirm each?

A

Facial nerve palsy (facial muscle weakness)
Bulbar palsy (flaccid, wasted fasciculating tongue)
Pseudobulbar palsy (spastic, contracted tongue)
Myasthenia gravis
Cerebellar disease

MBChB Year 4 OSCE (1 decks)

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