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Medicine > OSCE stations > Flashcards

OSCE stations Flashcards

0
Q

Additional stuff to ask in change in bowel habit history taking

A

Urgency? (Suggests proctitis)
Uncontrollable bowel motions (proctitis or overflow)
Nocturnal bowel passage (suggests organic disease)
Pain? Relieved by defaecation (IBS)
Diarrhoea:
- large volume, medium volume, made better with FASTING? - fasting makes better suggests OSMOTIC diarrhoea rather than SECRETORY

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1
Q

Investigations in acromegaly

A

ECG, visual fields and acuity
Bloods: Ca, PO4 (both increase), glucose. OGTT - look for decrease in GH in normal patients.
Imaging: MRI pituitary, CXR for cardiomegaly

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2
Q

Causes of palmar erythema

A

“CRaP Peter Ho”

Cirrhosis
Rheumatoid arthritis
Polycythaemia
Pregnancy
Hyperthyroidism
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3
Q

Causes of gynaecomastia

A 
Physiological (puberty and senility)
Cirrhosis
Drugs (spironolactone, digoxin)
Testicular tumour/orchidectomy
Endocrinopathy (thyroid problems)
Klinefelter
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4
Q

Causes of massive splenomegaly (and definition of M. Splenomegaly)

A

Definition: >8cm, (?pass the umbilicus)

Myelofibrosis
CML
Tropical diseases (leishmaniasis, malaria, kala-azar)

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5
Q

Definition of and causes of Moderate splenomegaly

A

Definition: 4-8cm

Causes:
Myelo/lymphoproliferative disorders, and all causes of massive splenomegaly
Infiltrative conditions (Gaucher’s, Amyloidosis, ?rheumatoid)

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6
Q

Mild splenomegaly definition and causes

A

Definition: as above
Portal hypertension by various causes
Infectious: infective mononucleosis, infective endocarditis, infective hepatitis
Haemolytic anaemia

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7
Q

Splenectomy indications

A

Trauma

Hereditary haem conditions: ITP and Spherocytosis

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8
Q

Causes of UNILATERAL enlarged kidney

A

Simple cyst
RCC
PCKD (w/ unilateral nephrectomy…)
Hydronephrosis

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9
Q

Causes of BILATERAL enlarged kidney

A

PCKD
bilateral hydronephrosis
Amyloidosis
RCC

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10
Q

Indications for surgery in Crohn’s disease

A

Obstruction from STRICTURES
Fistulae complications
Perianal disease…
Failure to respond to medical therapy

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11
Q

Indications of surgery in UC

A

Chronic disease
Prophylaxis against cancer or colonic dysphasia
Emergency for refractory colitis

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12
Q

Crohn’s disease complications

A 
"FOAMA"
Fistula
Obstruction
Anaemia
Malabsorption 
Abscess
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13
Q

Complications of Ulcerative Colitis

A

“PACT”

Perforation
Anaemia
Carcinoma
Toxic megacolon

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14
Q

Cyclophosphamide side effects

A

“HIT”

Haem and haemorrhaged cystitis
Infertility
Teratogenicity…

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15
Q

Management of systemic sclerosis

A 
Calcinosis: may fall off...surgically resect them
Raynauds:
Warm gloves etc.
CCB
(ACEI)
Iloprost (prostacyclin infusion)

Esophageal dysmotility:
PPIs for reflux

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16
Q

Indications for surgery in Mitral Stenosis

A
  1. Pulmonary HTN & haemoptysis on minimal exertion..
  2. Valve area <1.5cm^2
  3. Recurrent thromboembolic events even with anticoagulation
17
Q
  1. Surgery indications for Mitral regurgitation
  2. When is valve repair less likely to be successful
  3. When does MR murmur radiate to the carotid?
A
  1. Symptomatic, with good LV function…
  2. Ischaemic, infectious, rheumatic, significant calcification, when prolapse is bileaflet or anterior
  3. When posterior leaflet is defective, and regurgitant stream hits the LA close to the adjacent aortic root.
18
Q

What is Gallavardin phenomenon

A

High frequency components of ESM radiates to the axils, and can mimic MR

19
Q

Indications for surgery in AS

A

Symptomatic (ie. LVF)
Valvular pressure gradient >50mmHg
Valvular area <0.5cm^2

20
Q

Aortic stenosis severity grading

A

Mild: valvular pressure gradient 50mmHg, area <0.5cm^2

21
Q

Valve replacement complications

A

Surgery: GA complications, bleeding, infection etc.

Valve itself:
Thromboembolic (especially with artificial valves)
Valve dysfunction: valve leakage, dehiscence, obstruction (thrombi & clogging)
Haemolysis at valve
Endocarditis
Structural dysfunctions (mainly bio valve): calcification, cuts pal tear etc.
Non-structural dysfunctions: paravalvular leak, suture/tissue entrapment

22
Q

Aortic regurgitation eponyms:

Quinke
Corrigan
De musset
Miller
Becker
Rosenback
Gerhard
Langolfi
A 
Dilatation of capillary nail bed
Wide pulse pressure
Head nodding
Uvula systolic pulsations
Retinal artery visible pulsations
Liver pulsations
Spleen pulsations
Pupil dilates and constricts
23
Q

Complications of bronchiectasis

A 
Recurrent pneumonias
Haemoptysis (can be life-threatening)
Brain abscesses
Pneumothorax, pleural effusions, pleurisy etc.
Amyloidosis
24
Q

Examination features of Charcot-Marie tooth

A

Champagne bottle legs - wasting of small muscles DISTALLY (c/w MND where there is globalised muscle wasting)

Pes cavus, or pes planus, foot drop. Thickened calluses, hammer toe.

Toe (and finger clawing)

Lateral popliteal nerve thickening, and greater auric ulnar nerve thickening
Scoliosis

May get some sensory changes

25
Q

Other uncommon features CMT is associated with

A

“ROP” SPOARP

Retinitis Pigmentosa
Optic atrophy
Spastic paraparesis

26
Q

Places where lacunar infarcts can occur and aetiology

A

Internal capsule
Pons (ataxia, partial hemispheresis)
Basal ganglia (hemiballismus)
Thalamus (mainly sensory)

Hypertension, rupture of Charcot-Bouchard micro aneurysms causing lacunae haematomas that leave small area of infarct.

27
Q

Posterior circulation syndrome

A

Bilateral motor or sensory signs, not secondary to brainstem compression by a large supratentorial lesion

Cerebellar signs, unaccompanied by ipsilaterally motor deficits (would be ataxic hemiparesis)

Diplopia

Crossed signs (ie. ipsilateral face and contralatetal limb)

Hemianopia alone, or with above signs

28
Q

Lacunar syndromes

  1. Pure motor
  2. Pure sensory
  3. Ataxic
  4. Sensorimotor
A
  1. Unilateral, pure motor deficit
    Clearly involving 2/3 areas (face, arms, legs)
    Whole limb being involved
  2. Unilateral pure sensory symptoms
    2/3 areas
    Whole limb involved
  3. Ipsilateral cerebellar and corticospinal tract signs
    +/- dysarthria
    No higher cerebral dysfunction or visual field defect
  4. Pure motor and pure sensory stroke combined, without higher cortical dysfunction or visual field defect
29
Q

Treatments of pleural effusions

A
  1. Treat underlying cause
  2. Chest drains for large pleural effusions
  3. Pleurodesis (eg. With doxycycline, talc, bleomycin etc) for recurrent effusions.
    Pleural drain - can lead to the outside or inside..(pleuroperitoneal shunt)
    Remove the pleura
30
Q

Causes of hydropneumothorax

A

Iatrogenic
Gas-forming organisms
Trauma

31
Q

Main complications of total hip replacement (THR)

A

Deep infection
DVT
Dislocation (esp. when sit down or squat etc)
Nerve damage (sciatic with posterior approach causing foot drop, anterolateral approach can damage superior gluteal nerve -> trendelenberg gait from weak abductors)

32
Q

Causes of positive trendelenberg test

A

Hip dislocation
Greater trochanter fracture
SUFE

Proximal myopathy etc and nerve damages leading to abductor weakness

Any painful hip disorder which causes gluteal inhibition…

33
Q

Causes of generalised papulosquamous eruptions on trunk

A

(2x pityriasis; 2x infectious; 2 x “D’s”; 2 x “P’s”

Pityriasis rosea
Pityriasis versicolor
Generalised pustular psoriasis
Pemphigus
Secondary syphilis
Chickenpox
Chronic superficial Dermatitis
Drug eruptions
34
Q

Management of Crohn’s disease

A

Conservative: MDT etc. dietary advice…
Medical: 5-ASA: azathioprine, steroids, anti-TNFs (infliximab & adalimumab), acute flare up: may need to treat underlying infections (metronidazole)
Surgical: proctopancolectomy

35
Q

Extra-bowel manifestations of Crohn’s disease

A

Eyes: anterior uveitis, episcleritis

Skin: pyoderma gangrenosum, nodosum

Joints: arthritis (reactive), sacroilitis

Organs:

36
Q

Extra-bowel manifestations of UC

A

Eyes: anterior uveitis, episcleritis

Skin: pyoderma gangrenosum, nodosum

Joints: arthritis, sacroilitis

Organs: increased cancer in bowel, PSC

37
Q

Causes of anaemia in Rheumatoid arthritis

A

Chronic disease
Drugs and marrow suppression (gold penicillamines, MTX etc)
Folate deficiency
Felty syndrome

38
Q

Causes of INO

A 
Demyelinating diseases - MS
Vascular diseases
Pontine glioma
Inflammatory lesions of the brainstem
Drugs - phenytoin, carbamazepine
39
Q

What is Fisher’s one and a half syndrome?

A

Lesion in MLF and PPRF (and 6th nerve nucleus?) on same side.

Therefore cannot move eyes horizontally at all except abduct the opposite eye

40
Q

Other associated abnormalities of neurofibromas

A 
Lung cysts
Retinal hamartomas
Skeletal lesions: erosive bony defects, and intraosseous cystic lesions, skull dysplasia
Aqueductal stenosis
Sarcomatous changes
41
Q

Stuff to look for in NF1

A 
>6 cafe-au lait spots
Axillary freckling
Lisch nodules
>2 neurofibromas
Plexiform neurofibromas
Optic gliomas (treat with radiation - papilloedema on fundoscopy)

Medicine (20 decks)

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