OSCE RESIT Flashcards

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

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
Q

Abdominal bloating

A
Fat – obesity 
Flatus – paralytic ileus/obstruction
Faeces – constipation
Fluid – ascites 
Fetus – pregnancy
26
Q

Altered bowel habit

A

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
Q

Jaundice

A

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
Q

nausea and vomiting

A

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
Q

breathlessness investigations

A
  • 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
Q

ABPI

A

> 1.3 =abnormal vessel hardening from PVD

  1. 0-1.2 = normal
  2. 9-0.99 = acceptable
  3. 8-0.89 = some areterial disease
  4. 5-0.79 = moderate arterial disease

under 0.5 = severe arterial disease

31
Q

ECG settings

A

25mm/s

10mm/mv

32
Q

UMN vs LMN signs

A

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
Q

types of lung percussion

A

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
Q

where do you listen to murmurs

A

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
Q

Breast cancer risk factors

A
Age
Alcohol
Obesity
FHx
BRACA genes
personal history
white ethnicity
sex hormones
Contraception
HRT
menarchy/menopause
nulliparous
breastfeeding
36
Q

exclude acute limb ischaemia

A
Pain
Pallor
Perishingly cold
Pulselessness
Parastheisia
Paralysis
37
Q

Leg pain causes

A

Intermitent claudication
DVT
Spinal canal stnosis
MSK

38
Q

Umbilical pain differentials

A
early appendicitis
intestinal obstruction
acute gastritis
peptic ulcer disease
acute pancreatitis
ruptured AAA
mesenteric adenitis
gastroenteritis 
IBS
IBD
Constipaton
perforated viscus
39
Q

Right iliac fossa pain

A

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
Q

Raised JVP indicates

A
  • fluid overload
  • right ventricular failure
  • tricuspid regurgitation
41
Q

Different types of Apex Beat

A

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
Q

Blood pressure

A
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
Q

Abdo investigations

A
Abdo exam/ DRE
urine dip
pregnancy test
FBC
U &amp; 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
Q

Breast investigation

A

Tripple assessment;

  • History and examination (particularly breast and lymph node examination)
  • imaging = xray mammography or USS
  • sampling = fine needle aspiration or core biopsy
45
Q

Breast cancer risk factors

A
  • 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
Q

Diabetes values

A

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
Q

Systems review

A

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
Q

Chest Xray system

A
  • 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
Q

Pulmonary oedema xray

A

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
Q

What should you be looking for in the chest x ray

A
  • pneumonia
  • COPD
  • Pleural effusions
  • pulmonary oedema
  • pneumothorax
  • lobar collapse
51
Q

lobar collapse

A

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
Q

ECG interpretation

A
Rate
Rhythm
cardiac axis
P waves present?
PR interval (3-5) &amp; heartblock
QRS (2.5)
ST segment
T waves
53
Q

Diabetes symtpms

A

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
Q

Cranial nerves

A
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
Q

Large and small bowel obstruction differentials

A

Large;

  • malignancy
  • volvulus

Small;

  • adhesions
  • hernia
56
Q

abdominal xray process

A
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
Q

Obstructive pattern

A

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
Q

Restrictive Pattern

A
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