OSCEs Flashcards
Angina
Causes - atheroma, rarely anaemia
Types - stable which is induced by effort and relieved by rest and unstable which is of increasing frequency or severity that occurs on minimal exertion or at rest
Tests - ECG, usually normal, can show ST depression
Management - alteration of lifestyle factors, aspirin, beta blockers, calcium channel blockers, nitrates, statin
Acute Coronary Syndrome
Includes unstable angina and evolving MI. Share the same underlying pathology - plaque rupture, thrombosis and inflammation
Risk factors - age, male, family history of IHD, smoking, hypertension, DM, hyperlipidaemia, obesity, sedentary lifestyle
Symptoms - include acute central chest pain, associated with nausea, sweatiness, dyspnoea and palpitations
Tests - ECG, CXR, bloods to include FBC, U&E, glucose, lipids and cardiac enzymes
Management -
Initial - morphine, oxygen, nitrates, aspirin, clopidogrel, atorvastatin, beta-blocker, LMWH
Short term - STEMI use PCI and if not available thrombolyse, NSTEMI if high risk consider PCI, if not go home with medication
Long term - beta-blocker, ACE-i, GTN, aspirin, statin, clopidogrel, lifestyle
Arrhythmias
Causes - MI, CAD, LV aneurysm, cardiomyopathy, pericarditis, myocarditis, caffeine, smoking, alcohol, pneumonia, drugs
Presentation - palpitations, chest pain, syncope, hypotension, pulmonary oedema
Tests - FBC, U&E, glucose, calcium, magnesium, TSH, ECG, signs of IHD, AF, short PR interval, long QT, U waves, 24hr ECG monitoring, echo
Heart Failure
Cardiac output and BP are inadequate for the body’s requirements. Prognosis is poor
Causes - ischaemia, hypertension, valve disorders, pericarditis, mitral regurgitation, fluid overload, anaemia
Symptoms - LVF; dyspnoea, poor exercise tolerance, fatigue, orthopnoea, paroxysmal nocturnal dyspnoea, pink frothy white sputum, wheeze. RVF; peripheral oedema, abdominal distention, nausea, anorexia, increased JVP
Signs - look ill, cold peripheries, tachycardia, reduced BP, increased JVP, S3 gallop, tachypnoea, bibasal end-respiratory crackles, wheeze, pleural effusions
Investigations - FBC, U&E, BNP, CXR, ECG, echo
Management - treat the cause, diuretics, ACE-i, beta-blockers, spironolactone, digoxin, vasodilators
Hypertension
All patients with malignant hypertension or a sustained pressure should be treated.
Causes - essential (95%) and secondary. Secondary causes include renal disease, endocrine disease and pregnancy
Investigations - U&E, creatinine, cholesterol, glucose, ECG, urinalysis
Management - lifestyle changes, thiazide diuretics, beta blockers, ACE-i, calcium antagonists
Infective endocarditis
Fever and new murmur = endocarditis
Diagnosis - blood culture, blood tests and echocardiogram
Require prophylaxis in prosthetic valves, previous endocarditis, septal defects, mitral valve prolapse with regurgitation, acquired valve disease.
Pneumonia
Causes - community acquired pneumonia (strep, h.influenzae, mycoplasma, staph aureus), HAP, aspirations, immunocompromised patient
Symptoms - fevers, rigors, malaise, anorexia, dyspnoea, cough, purulent sputum, haemoptysis and pleuritic chest pain
Tests - CXR, O2sats, blood tests, sputum culture, consider bronchoscopy, CURB 65
Management - antibiotics, oxygen, fluids, analgesia
Complications - pleural effusion, empyema, lung abscess, respiratory failure, sepsis, pericarditis, brain abscess
Bronchiectasis
Pathology - chronic infection of bronchi and bronchioles leading to permanent dilatation of the airways
Causes - cystic fibrosis, post-infection, bronchial obstruction
Features - persistent cough, copious purulent sputum, intermittent haemoptysis, finger clubbing, coarse inspiratory crackles, wheeze
Investigations - sputum culture, CXR, bronchoscopy
Management - postural drainage twice a day, antibiotics, bronchodilator, corticosteroids
Cystic fibrosis
Caused by mutations in the CFTR gene leading to defective chloride secretion and increased sodium absorption across airway epithelium
