OSCE RESIT Flashcards
Cardiovascular
- Chest pain
- Palpitations
- Dyspnoea
- Syncope
- Orthopnoea
- Peripheral oedema
Respiratory
- Dyspnoea
- Cough
- Sputum
- Wheeze
- Haemoptysis
- Chest pain
- upper RTIs
- weight loss
- night sweats
GI
ALARMS 55
- anaemia
- loss weight
- appetite
- recurrent symptoms
- melaena (or haematemesis)
- swallowing difficulty
- > 55yrs
- Nausea
- Vomiting
- Indigestion
- Abdominal pain
- Bowel habit
- night sweats
- jaundice
Urinary
- Volume of urine passed
- Frequency
- Dysuria
- Urgency
- Incontinence
- weight loss/ night sweats
- nocturia
CNS
- Vision
- Headache
- Motor or sensory disturbance
- Loss of consciousness
- menigism
- Confusion
MSK
- Bone and Joint pain
- Muscular pain
Dermatology
- Rashes
- Skin breaks
- Ulcers
- Lesions
History taking format
- Intro/ consent and all
- presenting complaint
- history of presenting complaint
- past medical history
- drug history
- family history
- social history
- Review of systems
- summarise history
- ICE
- Possible presentation of findings
Urinalysis Results
Specific gravity – indicates amount of solute dissolved in urine – ↓ in diabetes insipidus
Blood – indicates number of red blood cells in urine – ↑ in haematuria
Protein – indicates level of protein in the urine – ↑ nephrotic syndrome
Leukocyte esterase – enzyme produced by neutrophils (WCC in urine) – ↑ in UTI
Nitrites – breakdown products caused by Gram -ve organisms – Gram -ve UTI e.g. Ecoli
Ketones – breakdown product of fatty acid metabolism – ↑ starvation / ↑DKA
Glucose – ↑ hyperglycaemia e.g. poorly controlled diabetes
Bilirubin – Indicates ↑ conjugated bilirubin (water soluble) – ↑ biliary tract obstruction
Urobilinogen – if raised indicates ↑ bilirubin turnover – ↑malaria / ↑haemolytic anaemia
Urine colour
Straw coloured – normal
Dark concentrated urine – dehydration
Red – macroscopic haematuria / rifampicin / porphyria / beetroot
Brown – bile pigments / myoglobin / antimalarials
urine clarity
Clear – normal
Cloudy / debris – urinary tract infection (UTI)
Frothy – nephrotic syndrome
Urine Smell
Offensive urine – UTI
Sweet – glycosuria
Cardiac chest pain causes
Unstable angina NSTEMI STEMI Aortic dissection PE Pneumonia Pneumothorax GORD Peptic ulcer Hiatus hernia oesophageal spas, chest wall injuries rib fracture
cardiovascular investigations
FBC U and E thyroid function glucose troponin (within 12 hours)
Chest x ray
serial ECGs
cardiovascular risk factors
age male family history previous CVD smoking and drinking hypercholesterolemia obesity hypertension diabetes sedentary lifestlye poor compliance with medication stress
further DRE investigations
Full abdominal examination Bloods – e.g. FBC / haematinics (anaemia) Faecal occult blood Abdominal X-ray – constipation Flexible sigmoidoscopy / colonoscopy CT Abdomen / pelvis
How to examine a breast lump
- position
- size and shape
- consistency
- overlying skin changes
- mobility
- fluctuance
- nipple changes
vascular leg inspection
Scars – bypass surgery / vein harvest sites
Hair loss – PVD
Discolouration – e.g. necrosis
Pallor – suggests poor vascular perfusion
Missing limbs / toes – previous amputation
Ulcers – venous vs arterial – look between toes and lift feet up
Muscle wasting – may indicate PVD
Ask patient to wiggle their toes – gross motor assessment
peripheral vascular further investigations
Cardiovascular examination
Ankle-brachial pressure index (ABPI) measurement
Lower limb neurological examination
Doppler can be used if pulse is not palpable
Buergers test - if suspect critical ischaemia
Perineum observations
Skin excoriation (sphincter dysfunction/incontinence)
Skin tags
Rashes (don’t forget STIs)
Haemorrhoids (are they thrombosed?)
Anal fissures (majority are located posteriorly in the midline)
External bleeding (e.g. brisk GI bleeding or anal pathology such as squamous cell anal cancer)
Fistulae and abscesses (e.g. perianal Crohn’s disease)
LOC causes
- Cardio (arrhythmias, wolf-parkinson white)
- Seizure (epilepsy)
- Vaso-vagal syncope (drop in B.P, MI)
- Hypoglycaemia (diabetes)
LOC questions
• Before: o auras? Epilepsy? o Headache? SAH? o Back pain/abdo pain? AAA? o Chest pain, sweaty? MI? o Palpitations? Arrhythmia? o Light headed, tunnel vision, altered sound? Faint? o Weakness? Stroke? o Loss of consciousness? o During exercise? Cardiac o Temperature?
• During:
o duration?
o Anyone witnessed?
o Stiffness, jerking, incontinence, tongue biting?
• After:
o Recovery (quick with cardiac and syncope, long with seizure)?
o Confusion?
LOC investigations
- ECG
- BP (lying and standing)
- HR
- CT (check for haemorrhage)
- bloods (FBC, U&E,TFT)
- glucose