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CP1 as you go > OSCE RESIT > Flashcards

OSCE RESIT Flashcards

(58 cards)

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1
Q

Cardiovascular

A
  • Chest pain
  • Palpitations
  • Dyspnoea
  • Syncope
  • Orthopnoea
  • Peripheral oedema
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2
Q

Respiratory

A
  • Dyspnoea
  • Cough
  • Sputum
  • Wheeze
  • Haemoptysis
  • Chest pain
  • upper RTIs
  • weight loss
  • night sweats
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3
Q

GI

A

ALARMS 55

  • anaemia
  • loss weight
  • appetite
  • recurrent symptoms
  • melaena (or haematemesis)
  • swallowing difficulty
  • > 55yrs
  • Nausea
  • Vomiting
  • Indigestion
  • Abdominal pain
  • Bowel habit
  • night sweats
  • jaundice
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4
Q

Urinary

A
  • Volume of urine passed
  • Frequency
  • Dysuria
  • Urgency
  • Incontinence
  • weight loss/ night sweats
  • nocturia
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5
Q

CNS

A
  • Vision
  • Headache
  • Motor or sensory disturbance
  • Loss of consciousness
  • menigism
  • Confusion
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6
Q

MSK

A
  • Bone and Joint pain

- Muscular pain

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7
Q

Dermatology

A
  • Rashes
  • Skin breaks
  • Ulcers
  • Lesions
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8
Q

History taking format

A
  • 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
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9
Q

Urinalysis Results

A

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

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10
Q

Urine colour

A

Straw coloured – normal
Dark concentrated urine – dehydration
Red – macroscopic haematuria / rifampicin / porphyria / beetroot
Brown – bile pigments / myoglobin / antimalarials

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11
Q

urine clarity

A

Clear – normal
Cloudy / debris – urinary tract infection (UTI)
Frothy – nephrotic syndrome

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12
Q

Urine Smell

A

Offensive urine – UTI

Sweet – glycosuria

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13
Q

Cardiac chest pain causes

A 
Unstable angina
NSTEMI
STEMI
Aortic dissection
PE 
Pneumonia
Pneumothorax
GORD
Peptic ulcer
Hiatus hernia
oesophageal spas,
chest wall injuries
rib fracture
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14
Q

cardiovascular investigations

A 
FBC 
U and E
thyroid function
glucose
troponin (within 12 hours)

Chest x ray

serial ECGs

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15
Q

cardiovascular risk factors

A 
age 
male 
family history
previous CVD
smoking and drinking
hypercholesterolemia
obesity
hypertension
diabetes
sedentary lifestlye
poor compliance with medication 
stress
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16
Q

further DRE investigations

A 
Full abdominal examination
Bloods – e.g. FBC / haematinics (anaemia)
Faecal occult blood
Abdominal X-ray – constipation
Flexible sigmoidoscopy / colonoscopy 
CT Abdomen / pelvis
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17
Q

How to examine a breast lump

A
  • position
  • size and shape
  • consistency
  • overlying skin changes
  • mobility
  • fluctuance
  • nipple changes
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18
Q

vascular leg inspection

A

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

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19
Q

peripheral vascular further investigations

A

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

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20
Q

Perineum observations

A

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)

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21
Q

LOC causes

A
  • Cardio (arrhythmias, wolf-parkinson white)
  • Seizure (epilepsy)
  • Vaso-vagal syncope (drop in B.P, MI)
  • Hypoglycaemia (diabetes)
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22
Q

LOC questions

A 
•	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?

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23
Q

LOC investigations

A
  • ECG
  • BP (lying and standing)
  • HR
  • CT (check for haemorrhage)
  • bloods (FBC, U&E,TFT)
  • glucose
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24
Q

Breathlessness questions

Study These Flashcards
A

When did the shortness of breath start?
Did it coincide with the chest pain?
Are you short of breath at rest or only during exertion?
Have you ever experienced shortness of breath in the past?
Have you had a cough or fevers in the last few weeks?
Is the chest pain associated with breathing in?
Have you noticed any wheezing?
Any contact with others who are unwell recently?
Any recent long haul travel, surgery or prolonged periods of immobility?

PMH - cardio, resp ?
DH- Contraceptive pill or HRT? anticoags?
SH- smoking/pets/travel/work?

25
Abdominal bloating
``` Fat – obesity Flatus – paralytic ileus/obstruction Faeces – constipation Fluid – ascites Fetus – pregnancy ```
26
Altered bowel habit
Diarrhoea - Consistency – how formed is it? (Bristol stool chart) - Mucous – Inflammatory bowel disease (IBD) / Irritable bowel syndrome (IBS) - Blood – Fresh red blood (anal fissure/haemorrhoids/IBD). Melaena (upper gastrointestinal bleed) - Urgency– IBD/IBS/gastroenteritis - Recent antibiotics? – C. Difficile - Recent suspect food? – food poisoning - Laxative use? Constipation - Duration of constipation - Absolute constipation? – not passing flatus – obstruction Colour of the stool - Black (Melaena) – peptic ulcer / duodenal ulcer / malignancy - Fresh red blood – anal fissure / haemorrhoids / IBD / polyp / lower GI malignancy - Pale (steatorrhoea) – biliary obstruction (gallstones / malignancy)
27
Jaundice
Yellowing of the skin and sclera & Dark urine Could be; Infectious – hepatitis B and C / malaria Malignancy – pancreatic cancer / cholangiocarcinoma Alcoholic liver disease Autoimmune – autoimmune hepatitis / primary sclerosing cholangitis Congenital – Gilbert’s syndrome (benign)
28
nausea and vomiting
Frequency and volume – high frequency and volume increases risk of dehydration Projectile vomiting – obstruction What does the vomit look like? Undigested food – pharyngeal pouch / achalasia / oesophageal stricture Non-bilious vomit – pyloric obstruction (i.e. pyloric stenosis) Bilious vomit/ faecal matter – lower GI obstruction (i.e. severe constipation)
29
breathlessness investigations
- resp + cardiac exam - obs - O2, HR, RR - Bloods - CXR - ECG - blood gases - FBC and U&E - Sputum sample (culture, microscopy, sensitivity) - Peak flow - spirometry - bronchoscopy
30
ABPI
>1.3 =abnormal vessel hardening from PVD 1. 0-1.2 = normal 0. 9-0.99 = acceptable 0. 8-0.89 = some areterial disease 0. 5-0.79 = moderate arterial disease under 0.5 = severe arterial disease
31
ECG settings
25mm/s | 10mm/mv
32
UMN vs LMN signs
UMN - no fasciculation or significant wasting - possible pronator drift - hypertonic +/- ankle clonus - extensors weaker than flexors in arms and vice versa in legs - hyperreflexia - babinski positive LMN - wasting and fasciculation - no pronator drift - hypotonic - weakness depending where the damange is - hyporeflexia - normal downgoing reflex or mute
33
types of lung percussion
Resonant – this is a normal finding Dullness – this suggests increased tissue density – consolidation / fluid / tumour / collapse Stony dullness – this suggests the presence of a pleural effusion Hyper-resonance – the opposite of dullness, suggestive of decreased tissue density – e.g. pneumothorax
34
where do you listen to murmurs
mitral regurgitation or stenosis over the mitral area (bell and lie to left side) aortic stenosis over aortic area aortic regurgitation over 3rd intercostal space on the left side
35
Breast cancer risk factors
``` Age Alcohol Obesity FHx BRACA genes personal history white ethnicity sex hormones Contraception HRT menarchy/menopause nulliparous breastfeeding ```
36
exclude acute limb ischaemia
``` Pain Pallor Perishingly cold Pulselessness Parastheisia Paralysis ```
37
Leg pain causes
Intermitent claudication DVT Spinal canal stnosis MSK
38
Umbilical pain differentials
``` early appendicitis intestinal obstruction acute gastritis peptic ulcer disease acute pancreatitis ruptured AAA mesenteric adenitis gastroenteritis IBS IBD Constipaton perforated viscus ```
39
Right iliac fossa pain
GI - appendicitis - diverticulitis - IBD - intestinal obstruction - Meckel's diverticulitis - perforated viscera - obstructed or incarcertated inguinal or femoral hernia Gynae - Ruptured oarian cyst - Torsion of ovarian cyst - Pelvic inflammatory disease - ectopic pregnancy Urinary - UTI - Renal calculi Other - testicular torsion - MSK
40
Raised JVP indicates
- fluid overload - right ventricular failure - tricuspid regurgitation
41
Different types of Apex Beat
thrusting displaced apex beat is caused by volume overload: an active large stroke volume ventricle eg aortic or mitral regurgitation or left to right shunts. sustained apex beat is caused by pressure overload eg aortic stenosis, gross hypertension. tapping apex beat - mitral stenosis.
42
Blood pressure
``` Normal - <120/80 elevated 120-129/80 high S1 = 130-139/80-89 High S2 = >140/90 Hypertensive crisis = >180/120 ``` large difference between two arms good suggest aortic aneurysm
43
Abdo investigations
``` Abdo exam/ DRE urine dip pregnancy test FBC U & E CRP LFT LDH Glucose Amylase Group and Save blood cultures Helicobacter pylori ABG US Abdo Xray Erect chest x ray Endoscopy for bleed ```
44
Breast investigation
Tripple assessment; - History and examination (particularly breast and lymph node examination) - imaging = xray mammography or USS - sampling = fine needle aspiration or core biopsy
45
Breast cancer risk factors
- previous breast cancer - smoking - early menarche - late menopause - nulliparity - family history of breast/ovarian cancer . . . age at diagnosis .. . . . first or second degree relatives - breast feeding is PROTECTIVE
46
Diabetes values
diabetes = fasting >6.1 and 2 hrs >11.1 impaired glucose tolerance = fasting <6.1 and 2 hrs > 7.8 IFG= 5.6-6.1 2hrs <7.8 HBA1C pre diabetes =42-47 (6-6.4%) and diabetes = >47 (6.4&)
47
Systems review
Fain'ts fits or funny turns? Chest pain, SOB, sweating or palpitations? Tummy pain? change in bowel habit, change in passing water? Any skin changes?
48
Chest Xray system
- AP/PA - Patient details - Technical quality (rotation, inspiration, penetration) - Obvious abnormalities (which lung, shape, density, texture) - Systemic ABCD review (airway, breathing, -cardiac/mediastinum, diaphram, delicates) - Review areas (apices, hila, behind the heart, costophrenic angles and behind the diaphragm) - Summarise
49
Pulmonary oedema xray
ABCDEF - Alveolar and interstitial shadowing - Kerley B lines - Cardiomegally - Diversion of upper lobe venous blood (prominant upper compared to lower) - Effusions - Fluid in the horizontal fissure
50
What should you be looking for in the chest x ray
- pneumonia - COPD - Pleural effusions - pulmonary oedema - pneumothorax - lobar collapse
51
lobar collapse
left uppper lobe - veil sign left lower lobe- sail sign right upper lobe - increased upper opacification right middle lobe - look for depression of horizontal fissure right lower lobe- sail sign -genereally look for tracheal and diaphragm shifts
52
ECG interpretation
``` Rate Rhythm cardiac axis P waves present? PR interval (3-5) & heartblock QRS (2.5) ST segment T waves ```
53
Diabetes symtpms
Excessive thirst and hunger Frequent urination (from urinary tract infections or kidney problems) Weight loss or gain Fatigue Irritability Blurred vision Slow-healing wounds Nausea Skin infections Darkening of skin in areas of body creases (acanthosis nigricans) Breath odor that is fruity, sweet, or an acetone odor Tingling or numbness in the hands or feet
54
Cranial nerves
``` the olfactory nerve (I) the optic nerve (II) oculomotor nerve (III) trochlear nerve (IV) trigeminal nerve (V) abducens nerve (VI) facial nerve (VII) vestibulocochlear nerve (VIII) glossopharyngeal nerve (IX) vagus nerve (X) accessory nerve (XI) hypoglossal nerve (XII). ```
55
Large and small bowel obstruction differentials
Large; - malignancy - volvulus Small; - adhesions - hernia
56
abdominal xray process
``` AP/PA Patient details Technical Adequacy obvious abnormality (obstruction) large bowel small bowel obstruction extraluminal gas thumbprinting of wall liver,spleen, gallbladder, kidneys and pancreas abdominal aorta Bones foreign bodies ```
57
Obstructive pattern
FEV1 reduced (<80% of the predicted normal) FVC reduced, but to a lesser extent than FEV1 FEV1/FVC ratio reduced (<0.7) COPD Asthma Emphysema Bronchiectasis / Cystic fibrosis
58
Restrictive Pattern
``` FEV1 reduced (<80% of the predicted normal) FVC reduced (<80% of the predicted normal) FEV1/FVC ratio normal (>0.7) ``` ``` Pulmonary fibrosis Pneumoconiosis Pulmonary oedema Lobectomy/pneumonectomy Parenchymal lung tumours Skeletal abnormalities (e.g. kyphoscoliosis) Neuromuscular diseases (e.g. motor neuron disease, myasthenia gravis, Guillan-Barre) Connective tissue diseases Obesity or pregnancy ```

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