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neuroscience > OSCE systems: Gastrointestinal, cardiovascular and Endocrine > Flashcards

OSCE systems: Gastrointestinal, cardiovascular and Endocrine Flashcards

1
Q

Gastrointestinal examination. What do you want to know about abdominal pain?

A

location (epigastric, lower right quadrant, upper left quadrant, etc)

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2
Q

Gastrointestinal examination. What would vomiting or nausea indicate?

A

bowel obstruction. bacterial or viral infection. food poisoning. food intolerances

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3
Q

Gastrointestinal examination. What would difficulty swallowing indicate?

A

obstruction. neurological disease

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4
Q

Gastrointestinal examination. What would a change in stool indicate?

A

blood. Family history of bowel cancer. inflammatory bowel disease. irritable bowel syndrome

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5
Q

Gastrointestinal examination. What could telangiectases (spider veins) or spider angiomas in the cutaneous area indicate?

A

> 3 liver disease or increased estrogen effect of the pill or pregnancy

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6
Q

Gastrointestinal examination. What would examination of the sclera of the eyes show?

A

yellowing of sclera - jaundice

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7
Q

Gastrointestinal examination. What would examination of the corners of the lips show?

A

Stomatitis- systematic disease, infection, nutritional deficiencies, chemical or allergic irritation

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8
Q

Gastrointestinal examination. If an examination of the tongue showed what appears to be a bright pink surface what would that indicate?

A

Colour (yellow, cream, red, white)
▪ Texture (rough, smooth)
▪ Inferior surface
▪ Geographic tongue * A bright pink color on the tongue is most often due to a deficiency in iron, folic acid, or vitamin B-12. An allergic reaction to gluten can also cause this.

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9
Q

Gastrointestinal examination: What is the buccal mucosa? Why would you inspect it?

A

The buccal mucosa extends from the inside of your lips and cheeks to just behind your last teeth. It’s a soft, wet mucous membrane that’s made up of several layers of tissue. Its main function is to support your mouth when you’re eating and chewing. Inspection would show ulcers, bleeding, infection.

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10
Q

Gastrointestinal examination: What is Bruxism? Why would you inspect the teeth?

A

Staining, general hygiene, cavities, Bruxism. Teeth grinding (bruxism) is involuntary clenching, grinding, and gnashing of the teeth that usually happens during sleep. Causes can include stress, concentration, and use of illegal drugs.

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11
Q

Gastrointestinal examination: What is Terry Nails? What is koilonychia? What is clubbing?

A

Terry’s nails is a type of nail discoloration. The nailbeds look “washed out,” except for a thin reddish-brown strip near the tip. Often, Terry’s nails is a symptom of a chronic condition, such as liver failure or diabetes.
Koilonychia is a deformity of the nails where the central portion of the nail is depressed and the lateral aspects of the nail are elevated. This symptom can be a sign of an underlying disease process or a congenital process.
Nail clubbing is when your nails appear wider, spongelike or swollen, like an upside-down spoon. Clubbed nails are often a sign of a health condition that needs treatment, such as lung cancer.

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12
Q

Gastrointestinal examination: What is Erythema nodosum? What is palmer erythema?

A

Erythema nodosum is characterized by tender, red bumps, usually found symmetrically on the shins. Up to 55 percent of cases have no clear identifiable cause. Sometimes, erythema nodosum is not a separate disease. Rather, it is a sign of some other infection, disease, or of sensitivity to a drug. However, it is the most common skin sign of IBD. Can be caused by Chron’s disease Ulcerative Colitis- it is a form of panniculitis.

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13
Q

Gastrointestinal examination: What is palmer erythema?

A

palmer erythema is a Redness of palms (often heel of the hand) from dilated blood vessels. could be increased cardiac output/hyperdynamic circulation
Capillary dilation in the palms due to local factors
localized inflammation
High circulation estrogen levels- pregnancy, liver cirrhosis; rheumatoid arthritis

could be caused by liver disease or smoking

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14
Q

Gastrointestinal examination: What is Striae? Why would you inspect the abdomen?

A

contour
scars
swellings (fat, flatus, fluid, faeces, fibroids, foetus, fatal tumour
striae - pink purple may be due to Cushings Syndrome

Striae are a form of dermal scarring associated with stretching of the dermis. They often result from a rapid change in weight (gain and loss) or are associated with endogenous or exogenous corticosteroids.

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15
Q

Gastrointestinal examination: Auscultate abdomen. What are you listening for?

A

Bowel sounds (listen in all 4 quadrants for 2+ minutes)
o Frequency ▪ Normal
* 5-30 per minute
* Normally intermittent, low-pitched sounds
▪ Hypoactive
* Bowel obstruction
* Constipation
* Ischaemic bowel disease
▪ Hyperactive
* Bowel obstruction
* Infectious enteritis
* Malabsorption
* Gastrointestinal bleeding
o Character
▪ Gurgles, clicks, soft, strong

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16
Q

Gastrointestinal examination: Palpate the abdomen. What are you feeling for?

A

Observe for
o Masses
o Tenderness
o Guarding
o Rigidity
o Rebound tenderness

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17
Q

Gastrointestinal examination: What is an Abdominal Aortic Aneurysm - how would you detect it?

A

A periumbilical or upper abdominal mass with expansile pulsations 3cm or more wide suggests AAA.
Press firmly deep in the upper abdomen slightly to the left of the midline – identify aortic pulsations.
o In patients > 50yo press deeply on either side of the aorta.
Normal: not more than 3cm – allow for the thickness of the abdominal wall.
The ability to feel varies greatly with the thickness of the abdominal wall and the AP diameter of the abdomen

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18
Q

Gastrointestinal examination: Palpate the caecum, ileocaecal and sigmoid regions. What are you feeling for?

A

If there is currently pain in a specific location begin palpation away from the site of pain (such as the opposite side of the abdomen) and begin with gentle pressure.
o The ileocaecal valve may be palpable as a localised area of tightness in the vicinity of McBurney’s point (approximately 1/3 the distance of the way from ASIS to umbilicus).
o Feel for masses, increased peristaltic waves of intestinal obstruction (along with increased bowel sounds on auscultation), pulsing of the abdominal aorta.

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19
Q

Gastrointestinal examination: When assessing the sounds of percussion of the abdomen, what does a high-pitched, dull-quality sound indicate?

A

normal bone or muscle
abnormal collapsed lung, dense mass

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20
Q

Gastrointestinal examination: When assessing the sounds of percussion of the abdomen, what does a medium-pitched, thud like -quality sound indicate?

A

normal liver and organs
abnormal pleural effusion, ascites

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21
Q

Gastrointestinal examination: When assessing the sounds of percussion of the abdomen, what does a low-pitched, hollow-quality sound indicate?

A

normal lung

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22
Q

Gastrointestinal examination: When assessing the sounds of percussion of the abdomen, what does a very low-pitched, booming-quality sound indicate?

A

emphysema

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23
Q

Gastrointestinal examination: When assessing the sounds of percussion of the abdomen, what does a high-pitched, drum-like -quality sound indicate?

A

normal gastric bubble
abnormal air-distended abdomen

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24
Q

Gastrointestinal examination: Why do we palpate the liver?

A

hepatomegaly (enlarged liver) or tenderness

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25
Q

Gastrointestinal examination: What is McBurneys’s Point?

A

McBurney’s point refers to the point on the lower right quadrant of the abdomen at which tenderness is maximal in cases of acute appendicitis. Acute appendicitis is characterized by the inflammation, infection, or swelling of the appendix.

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26
Q

Gastrointestinal examination: What is Murphy’s Sign?

A

Murphy’s sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive

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27
Q

Gastrointestinal examination: What is Rebound Tenderness?

A

Press steadily into the abdomen and then suddenly release.
Pain is a positive result
o Suggests peritoneal irritation (such as if appendicitis has progressed to cause peritonitis)

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28
Q

Gastrointestinal examination: What is the Psoas Sign?

A

Place a hand above the right knee, and ask the patient to flex the hip against the resistance from your hand.
Pain with engagement of hip flexion is a positive result
indicating potential appendicitis due to pressure from the underlying psoas

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29
Q

Gastrointestinal examination: What is a common oral finding of IBD?

A

mouth ulcers

30
Q

Gastrointestinal examination: Name two signs of colon cancer.

A

weight loss; change in bowel habits; bleeding in stool; constipation, ribbon like stools; flatulence; tenesmus, fatigue, light headed

31
Q

Gastrointestinal examination: What might a person find if they were experiencing bleeding in the upper part of the intestine

A

melena- sticky tarry black/dark stools

32
Q

Gastrointestinal examination: What causes koilonychia?

A

nutritional (particularly Fe) deficiencies (interrupted oxygen supplies to nail bed)

33
Q

Gastrointestinal examination: What causes jaundice?

A

disrupted bilirubin metabolism

34
Q

Gastrointestinal examination: where might a person experience referred pain from the liver or gall bladder?

A

right shoulder blade

35
Q

Gastrointestinal examination: What is the typical percussive sound of the liver?

A

Dull

36
Q

Gastrointestinal examination: What is the typical percussive sound of the intestines?

A

Tympanic

37
Q

Cardiovascular examination: Initial observation… what are you looking for?

A

Anxiety
o Tachycardia, bradycardia, palpitations?
- Pain
o Chest, neck, arm, shoulder, abdomen?
- Colour of the skin
o Erythema, pallor, cyanosis
- Respiration
o Dyspnoea (shortness of breath), orthopnoea breathlessness in the recumbent position), paroxysmal nocturnal dyspnoea (sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position.)
- Fatigue

38
Q

Cardiovascular examination: eye observation… what are you looking for?

A

Pallor
- erythema or cyanosis
Arcus Senilis
White, grey, or blue ring in the margin of the cornea
o May indicate altered lipid metabolism
o Common in elderly
Xanthelasma
o Yellowish deposits of fat under the skin, often near the eyes
o May be genetic or due to hypercholesterolemia

39
Q

Cardiovascular examination: hand observation… what are you looking for?

A

Clubbing of nails
o Thickening of the connective tissue in the distal phalanges o Common in cardiovascular and respiratory conditions
o Ask the patient to bring the dorsal aspect of matching left and right fingers together at the distal phalange.
Observe for a small window between the nail bed and nail of the two fingers
Osler’s nodes
o Painful red/brown lesions on the hands and feet
o Small (pinhead size)
o Common in bacterial endocarditis (infective infarcts)
Splinter haemorrhages
o Small, linear blood clots under the nails
▪ May be related to trauma or benign
▪ May be present in bacterial endocarditis
Nicotine staining (smoker?)
- Observe palmar creases
(they should have a pink colour to them and not be pale)
- Observe for cuts, grazes, bruises, swelling, or inflammatory signs - Note any tenderness on palpation of the hand
- Observe for atrophy of the hand
- Assess the health of the nail, nail bed, cuticle, and skin around the nail
- Note any skin markings, moles, warts, blisters etc.

40
Q

Cardiovascular examination: blood pressure at carotid pulse… what are you looking for?

A

Auscultate the carotid pulse using the diaphragm of the stethoscope o
Observe for a bruit. A bruit is a sound alike a murmur, which may indicate turbulent arterial blood flow.
The presence of a bruit at the site of the carotid artery may indicate atherosclerosis.

41
Q

Cardiovascular examination: Auscultate the heart in the 2nd intercostal space right sternal Border.. what are you looking for?

A

S2: Aortic (& pulmonary) valves snapping shut

42
Q

Cardiovascular examination: Examine the retina … what are you looking for?

A

Changes that occur in hypertensive retinopathy
Blood pressure rises
2) Body wants to maintain consistent flow to tissues – vessels narrow to regulate flow
3) Vessels narrow by contraction in their muscular walls (vasospasm) 4) Like any muscle that contracts, over time it becomes thicker and stiffer creating a thicker vessel wall
5) Over time the vessel wall also scleroses (hardens) and becomes more opaque
6) Initially this presents as a diffusing of the normal red into a red-brown (or copper) colour and later when completely scleroses it becomes totally opaque (can’t see any blood in vessel) ☞ white or silver colour

43
Q

Endocrine examination: What are the signs and symptoms of hypothyroidism?

A
  • Fatigue/ lethargy
  • cold Intolerance
  • Dry, coarse, thick skin
  • brittle and coarse hair
  • bradycardia
  • hyporeflexia
44
Q

Endocrine examination: What are the signs and symptoms of hyperthyroidism?

A
  • irritability
  • heat intolerance
  • increased appetite
  • tachycardia
  • weight loss
  • hyperreflexia
45
Q

Endocrine examination: What are the signs and symptoms of diabetes Mellitus?

A
  • Reduced visual acuity
  • peripheral paraesthesia
  • Increased thirst and appetite
  • increased urination frequency
  • poor wound healing
46
Q

Endocrine examination: looking at the skin colour, what would patchy “bronzing” be symptomatic of?

A

Addison’s Disease

47
Q

Endocrine examination: looking at the skin colour, what is Acanthosis Nigricans and what would it be symptomatic of?

A

Acanthosis nigricans is a velvety, darkening of the skin that usually occurs in intertriginous areas. This hyperpigmentation has poorly defined borders, usually occurs in skin fold areas, such as the back of the neck, axilla, and groin, and may include thickening of the skin.
Diabetes Mellitus

48
Q

Endocrine examination: looking at the skin colour, What is Lipoidica Diabeticorum. What would it be symptomatic of?

A

Necrobiosis lipoidica diabeticorum (NLD) refers to a skin rash that most commonly affects the shins and is seen more often in women
Diabetes Mellitus

49
Q

Endocrine examination: looking at the skin colour, What is the condition Purple Striae. What would it be symptomatic of?

A

Dark blue/purplish stretch marks (also applicable to those with darker complexions
Cushing’s Disease

50
Q

Endocrine examination: looking at the skin, What is the condition Hirsutism. What would it be symptomatic of?

A

a condition in women that results in excessive growth of dark or coarse hair in a male-like pattern — face, chest and back.
symptomatic of Cushing’s disease; polycystic ovarian syndrome; insulin resistance; obesity

51
Q

Endocrine examination: looking at the facial expression, What is the condition Exopthalmic stare. What would it be symptomatic of?

A

Bulging or protruding eyes (proptosis or exophthalmos). Graves Disease

52
Q

Endocrine examination: Looking at the hands, What is the condition Thyroid acropachy? What would it be symptomatic of?

A

nail clubbing, swelling of digits and toes, Grave’s Disease

53
Q

Endocrine examination: Looking at the hands, What is the condition of Onycholysis? What would it be symptomatic of?

A

Separation of nails from the nail bed.
Could be indicative of Hyperthyroidism, iron deficiency
reaction to chemicals, fungal infection,

54
Q

Endocrine examination: Looking at the hands, What is the condition of Acromegaly? What would it be symptomatic of?

A

Acromegaly causes body tissues and bones to grow more quickly. Over time, this leads to abnormally large hands and feet, and a wide range of other symptoms
Hyperthyroidism; Cushing’s

55
Q

Endocrine examination: Looking at the respiration, What is the normal rate for an adult? What is Bradypnea? What would it be symptomatic of?

A

12-20 breaths per minute; slow rate of breathing; could be caused by hypothyroidism, head injuries or opioid or heavy alcohol use.

56
Q

Endocrine examination: Looking at the face: What is lid lag and what is it a symptom of?

A

upper eyelid remains higher than normal while eye is in downward gaze.
Hyperthyroidism.

57
Q

Endocrine examination: Looking at the face: What is Von Graefe’s Sign and what is it a symptom of?

A

Delay in the ability of the eyelid to follow the changing direction of the eyes. Hyperthyroidism

58
Q

Endocrine examination: Looking at the throat: What is Hashimoto’s Thyroiditis? what are its signs and symptoms?

A

Hashimoto’s disease is a common cause of hypothyroidism (underactive thyroid). Hashimoto’s disease is an autoimmune condition – immune system cells attack the thyroid gland, and the resulting inflammation and destruction of thyroid tissue reduces the thyroid’s ability to make hormones.
Symptoms include: Fatigue and sluggishness
Increased sensitivity to cold
Increased sleepiness
Constipation
Muscle aches, tenderness and stiffness
Joint pain and stiffness, Brittle nails
Irregular or excessive menstrual bleeding
Depression and Problems with memory or concentration
A puffy face, swelling of the thyroid (goiter) Enlargement of the tongue and hair loss

59
Q

Gastrointestinal examination. If an examination of the tongue showed what appears to be a furry or hairy surface what would that indicate?

A

If the tongue appears to be furry or hairy, it’s most likely caused by a course of antibiotics. Radiation to the head or neck can also lead to this symptom. It can also develop if you consume too much of an irritating substance, such as coffee or mouthwash, or if you smoke.

60
Q

Gastrointestinal examination. If an examination of the tongue showed what appears to be a white surface what would that indicate?

A
  • A white tongue is usually a result of smoking, drinking alcohol or poor oral hygiene. White lines or bumps may be an inflammation called oral lichen planus. People think this occurs due to an abnormal immune response that may occur from an underlying condition, such as hepatitis C or allergies.
61
Q

Gastrointestinal examination. If an examination of the tongue showed signs of swelling what would that indicate?

A

May be a symptom of disease or medical condition such as Downs syndrome, tongue cancer, overactive thyroid, leukemia, step throat, anaemia

62
Q

Cardiovascular examination: Auscultate the heart in the 2nd intercostal space left sternal Border.. what are you looking for?

A

o Pulmonic valve closing

63
Q

Cardiovascular examination: Auscultate the heart in the 5th intercostal space left sternal Border.. what are you looking for?

A

o Tricuspid valve- 5th intercostal space, mid-clavicularline

64
Q

Cardiovascular examination: Auscultate the heart in the area fifth intercostal space on mid clavicular line .. what are you looking for?

A

The apex of the heart
o S1: Mitral valves snapping shut

65
Q

Cardiovascular examination: when using the ophthalmoscope, name 2 retinal findings in hypertension.

A

copper / silver wire appearance; AV snipping and nicking; flame haemorrhages; cotton wool spots; papilledema

66
Q

Cardiovascular examination: Auscultate the heart at Erbs point .. why? what are you looking for?

A

left sternal third intercostal space- the best area to hear all heart sounds.

67
Q

Cardiovascular examination: what condition is indicated by the presence of splinter hemorrhages and Osler’s nodes?

A

Bacterial Endocarditis

68
Q

Cardiovascular examination: what systolic pressure indicates moderately high blood pressure

A

moderate 160-179

69
Q

Cardiovascular Examination: name an examination finding associated with right-sided heart failure.

A

pitting eodema; swelling in hands, feet, abdomen

70
Q

Cardiovascular examination: In what way do kidneys influence blood pressure?

A

Sodium and water pressure regulation.

71
Q

Cardiovascular: what are the causes of dyspnoea

A

The causes of dyspnea include cardiac and pulmonary disease (congestive heart failure, acute coronary syndrome; pneumonia, chronic obstructive pulmonary disease) and many other conditions (anemia, mental disorders)

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