OSCE stations Flashcards
Additional stuff to ask in change in bowel habit history taking
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
Investigations in acromegaly
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
Causes of palmar erythema
“CRaP Peter Ho”
Cirrhosis Rheumatoid arthritis Polycythaemia Pregnancy Hyperthyroidism
Causes of gynaecomastia
Physiological (puberty and senility) Cirrhosis Drugs (spironolactone, digoxin) Testicular tumour/orchidectomy Endocrinopathy (thyroid problems) Klinefelter
Causes of massive splenomegaly (and definition of M. Splenomegaly)
Definition: >8cm, (?pass the umbilicus)
Myelofibrosis
CML
Tropical diseases (leishmaniasis, malaria, kala-azar)
Definition of and causes of Moderate splenomegaly
Definition: 4-8cm
Causes:
Myelo/lymphoproliferative disorders, and all causes of massive splenomegaly
Infiltrative conditions (Gaucher’s, Amyloidosis, ?rheumatoid)
Mild splenomegaly definition and causes
Definition: as above
Portal hypertension by various causes
Infectious: infective mononucleosis, infective endocarditis, infective hepatitis
Haemolytic anaemia
Splenectomy indications
Trauma
Hereditary haem conditions: ITP and Spherocytosis
Causes of UNILATERAL enlarged kidney
Simple cyst
RCC
PCKD (w/ unilateral nephrectomy…)
Hydronephrosis
Causes of BILATERAL enlarged kidney
PCKD
bilateral hydronephrosis
Amyloidosis
RCC
Indications for surgery in Crohn’s disease
Obstruction from STRICTURES
Fistulae complications
Perianal disease…
Failure to respond to medical therapy
Indications of surgery in UC
Chronic disease
Prophylaxis against cancer or colonic dysphasia
Emergency for refractory colitis
Crohn’s disease complications
"FOAMA" Fistula Obstruction Anaemia Malabsorption Abscess
Complications of Ulcerative Colitis
“PACT”
Perforation
Anaemia
Carcinoma
Toxic megacolon
Cyclophosphamide side effects
“HIT”
Haem and haemorrhaged cystitis
Infertility
Teratogenicity…
Management of systemic sclerosis
Calcinosis: may fall off...surgically resect them Raynauds: Warm gloves etc. CCB (ACEI) Iloprost (prostacyclin infusion)
Esophageal dysmotility:
PPIs for reflux
Indications for surgery in Mitral Stenosis
- Pulmonary HTN & haemoptysis on minimal exertion..
- Valve area <1.5cm^2
- Recurrent thromboembolic events even with anticoagulation
- Surgery indications for Mitral regurgitation
- When is valve repair less likely to be successful
- When does MR murmur radiate to the carotid?
- Symptomatic, with good LV function…
- Ischaemic, infectious, rheumatic, significant calcification, when prolapse is bileaflet or anterior
- When posterior leaflet is defective, and regurgitant stream hits the LA close to the adjacent aortic root.
What is Gallavardin phenomenon
High frequency components of ESM radiates to the axils, and can mimic MR
Indications for surgery in AS
Symptomatic (ie. LVF)
Valvular pressure gradient >50mmHg
Valvular area <0.5cm^2
Aortic stenosis severity grading
Mild: valvular pressure gradient 50mmHg, area <0.5cm^2
Valve replacement complications
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
Aortic regurgitation eponyms:
Quinke Corrigan De musset Miller Becker Rosenback Gerhard Langolfi
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
Complications of bronchiectasis
Recurrent pneumonias Haemoptysis (can be life-threatening) Brain abscesses Pneumothorax, pleural effusions, pleurisy etc. Amyloidosis
Examination features of Charcot-Marie tooth
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
Other uncommon features CMT is associated with
“ROP” SPOARP
Retinitis Pigmentosa
Optic atrophy
Spastic paraparesis
Places where lacunar infarcts can occur and aetiology
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.
Posterior circulation syndrome
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
Lacunar syndromes
- Pure motor
- Pure sensory
- Ataxic
- Sensorimotor
- Unilateral, pure motor deficit
Clearly involving 2/3 areas (face, arms, legs)
Whole limb being involved - Unilateral pure sensory symptoms
2/3 areas
Whole limb involved - Ipsilateral cerebellar and corticospinal tract signs
+/- dysarthria
No higher cerebral dysfunction or visual field defect - Pure motor and pure sensory stroke combined, without higher cortical dysfunction or visual field defect
Treatments of pleural effusions
- Treat underlying cause
- Chest drains for large pleural effusions
- Pleurodesis (eg. With doxycycline, talc, bleomycin etc) for recurrent effusions.
Pleural drain - can lead to the outside or inside..(pleuroperitoneal shunt)
Remove the pleura
Causes of hydropneumothorax
Iatrogenic
Gas-forming organisms
Trauma
Main complications of total hip replacement (THR)
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)
Causes of positive trendelenberg test
Hip dislocation
Greater trochanter fracture
SUFE
Proximal myopathy etc and nerve damages leading to abductor weakness
Any painful hip disorder which causes gluteal inhibition…
Causes of generalised papulosquamous eruptions on trunk
(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
Management of Crohn’s disease
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
Extra-bowel manifestations of Crohn’s disease
Eyes: anterior uveitis, episcleritis
Skin: pyoderma gangrenosum, nodosum
Joints: arthritis (reactive), sacroilitis
Organs:
Extra-bowel manifestations of UC
Eyes: anterior uveitis, episcleritis
Skin: pyoderma gangrenosum, nodosum
Joints: arthritis, sacroilitis
Organs: increased cancer in bowel, PSC
Causes of anaemia in Rheumatoid arthritis
Chronic disease
Drugs and marrow suppression (gold penicillamines, MTX etc)
Folate deficiency
Felty syndrome
Causes of INO
Demyelinating diseases - MS Vascular diseases Pontine glioma Inflammatory lesions of the brainstem Drugs - phenytoin, carbamazepine
What is Fisher’s one and a half syndrome?
Lesion in MLF and PPRF (and 6th nerve nucleus?) on same side.
Therefore cannot move eyes horizontally at all except abduct the opposite eye
Other associated abnormalities of neurofibromas
Lung cysts Retinal hamartomas Skeletal lesions: erosive bony defects, and intraosseous cystic lesions, skull dysplasia Aqueductal stenosis Sarcomatous changes
Stuff to look for in NF1
>6 cafe-au lait spots Axillary freckling Lisch nodules >2 neurofibromas Plexiform neurofibromas Optic gliomas (treat with radiation - papilloedema on fundoscopy)
