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Finals OSCEs > OSCEs > Flashcards

OSCEs Flashcards

1
Q

Features of aortic coarctation

A
  • Radio-radio delay
  • Radio-femoral delay
  • Differing blood pressures in each limb
  • Ejection systolic murmur at L sternal border
  • Weak femoral pulse
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2
Q

On examination you find:

  • Radio-radio delay
  • Radio-femoral delay
  • Differing blood pressures in each limb
  • Ejection systolic murmur at L sternal border
  • Weak femoral pulse

What is your differential?

A

Aortic coarctation

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3
Q

Investigations and findings for aortic coarctation

A

ECG:
- Normal or RVH or LVH

CXR:

  • Normal
  • Posterior rib notching
  • 3 sign
  • Cardiomegaly

Echo:
- Narrowing in aorta

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4
Q

Aortic coarctation is associated with …

A
  • Genetic syndromes e.g. Turners

- Bicuspid aortic valve

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5
Q

Features of aortic regurgitation

A
  • Quincke’s sign (capillary nail bed pulsations)
  • Collapsing pulse
  • Bounding pulse
  • Wide pulse pressure
  • De Musset’s sign (head bobs with pulse)
  • Diastolic ‘blowing’ murmur
  • Laterally displaced apex beat
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6
Q

On examination you find…

  • Quincke’s sign (capillary nail bed pulsations)
  • Collapsing pulse
  • Bounding pulse
  • Wide pulse pressure
  • De Musset’s sign (head bobs with pulse)
  • Diastolic ‘blowing’ murmur
  • Laterally displaced apex beat

Differential?

A

Aortic regurgitation

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7
Q

Investigations and findings for aortic regurgitation

A

ECG:

  • ST-T changes
  • LVH and LAD
  • conduction abnormalities

CXR:
- Normal or cardiomegaly

Echo:
- regurgitation

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8
Q

Features of aortic stenosis

A
  • Slow rising pulse
  • Narrow pulse pressure
  • Ejection systolic murmur, radiating to carotids
  • Heaving apex beat
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9
Q

On examination you find:

  • Slow rising pulse
  • Narrow pulse pressure
  • Ejection systolic murmur, radiating to carotids
  • Heaving apex beat

Differential?

A

Aortic stenosis

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10
Q

Differentials for ejection systolic murmur

A
  • Aortic stenosis
  • Aortic sclerosis
  • Coarctation of the aorta
  • HOCM
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11
Q

Differentials for pansystolic murmur

A
  • Mitral regurgitation
  • Ventricular septal defect
  • Tricuspid regurgitation
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12
Q

Investigations and findings for aortic stenosis

A

ECG:
- LVH

CXR:
- Calcification of aortic valve +/- pulmonary oedema, cardiomegaly

Echo:
- Aortic stenosis

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13
Q

Causes of aortic stenosis

A
  • Calcification (elderly)

- Bicuspid valve (young)

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14
Q

Complications of aortic stenosis

A
  • Infective endocarditis
  • Embolic disease
  • Haemolytic anaemia
  • LV failure
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15
Q

Differentials for an irregular pulse

A
  • AF
  • Atrial flutter
  • Ventricular ectopics (disappear on exercise)
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16
Q

Causes of AF

A
  • Heart disease
  • Diabetes
  • Thyroid disease
  • Alcohol abuse
  • Smoking
  • Certain cancers
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17
Q

Features of heart failure

A
  • Shortness of breath
  • Orthopnoea
  • Peripheral cyanosis/pallor
  • Delayed cap refill time
  • Narrow pulse pressure
  • Raised JVP +/- hepatojugular reflux
  • Neck vein distention
  • Displaced apex beat
  • S3 gallop rhythm
  • Bibasal fine crackles
  • Sacral and peripheral oedema
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18
Q

On examination you find…

  • Shortness of breath
  • Orthopnoea
  • Peripheral cyanosis/pallor
  • Delayed cap refill time
  • Narrow pulse pressure
  • Raised JVP +/- hepatojugular reflux
  • Neck vein distention
  • Displaced apex beat
  • S3 gallop rhythm
  • Bibasal fine crackles
  • Sacral and peripheral oedema

Differential?

A
  • Heart failure
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19
Q

Features of hyperlipidaemia

A
  • Xanthomata
  • Corneal arcus
  • Xanthelasma
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20
Q

Causes/risk factors for hyperlipiademia

A
  • Lifestyle factors e.g. diet
  • Kidney disease
  • Diabetes
  • PCOS
  • Pregnancy
  • Hypothyroidism
  • Familial hypercholesterolaemia
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21
Q

Features of infective endocarditis

A
  • Fever
  • Finger clubbing
  • Splint haemorrhages
  • Janeway lesions
  • Osler’s nodes
  • Poor dental hygiene
  • New murmur
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22
Q

On examination you find:

  • Fever
  • Finger clubbing
  • Splint haemorrhages
  • Janeway lesions
  • Osler’s nodes
  • Poor dental hygiene
  • New murmur

Differential?

A

Infective endocarditis

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23
Q

Features of mitral regurgitation

A
  • Associated AF
  • Pansystolic ‘blowing’ murmur at apex, radiates to axilla
  • Thrusting, displaced apex beat
  • Pitting oedema
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24
Q

On examination you find…

  • Associated AF
  • Pansystolic ‘blowing’ murmur at apex, radiates to axilla
  • Thrusting, displaced apex beat
  • Pitting oedema

Differential?

A

Mitral regurgitation

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25
Q

Causes of mitral regurgitation

A
  • IE
  • Post-MI
  • Ischaemic injury to left ventricle
  • Rheumatic heart disease
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26
Q

Features of mitral stenosis

A
  • Malar flush
  • Neck vein distention
  • Diastolic ‘low pitched rumbling’ murmur at apex
  • Opening ‘snap’
  • Tapping apex
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27
Q

On examination you find:

  • Malar flush
  • Neck vein distention
  • Diastolic ‘low pitched rumbling’ murmur at apex
  • Opening ‘snap’
  • Tapping apex

Differential?

A

Mitral stenosis

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28
Q

Features of tricuspid regurgitation

A
  • Raised JVP with prominent V wave
  • Parasternal pansystolic murmur over LLSE, no radiation
  • Carvallo’s sign (increased murmur on inspiration)
  • Pulsatile hepatomegaly
  • Peripheral oedema
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29
Q

On examination you find:

  • Raised JVP with prominent V wave
  • Parasternal pansystolic murmur over LLSE, no radiation
  • Carvallo’s sign (increased murmur on inspiration)
  • Pulsatile hepatomegaly
  • Peripheral oedema

Differential?

A

Tricuspid regurgitation

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30
Q

Factors to consider when deciding on valve replacement

A
  • Patient preference
  • Symptom burden
  • Any decompensation e.g. heart failure
  • Severity of valve dysfunction on ECHO
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31
Q

Complications of prosthetic valve replacement

A
  • Paravalvular leak
  • Obstruction (thrombus)
  • Subacute bacterial IE
  • Haemolysis (due to turbulence)
  • Valve failure
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32
Q

Pros and cons to mechanical heart valves

A
  • Longer lifespan

- Requires anticoagulation

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33
Q

Pros and cons to biological heart valves

A
  • Does not require anticoagulation
  • Preferred in women of child-bearing age
  • Less durable, shorter life span
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34
Q

Causes of left sided heart failure

A
  • IHD

- Mitral or aortic valve disease

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35
Q

Causes of right-sided heart failure

A
  • Left sided heart failure
  • Tricuspid or pulmonary valve disease
  • Cor pulmonale e.g. COPD, fibrosis, PE, OSA
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36
Q

Causes of finger clubbing

A

General:

  • Malignancy
  • Grave’s disease

Cardiac:
- IE

Respiratory:

  • CF
  • Bronchiectasis
  • Interstitial lung disease
  • Lung cancer

GI:

  • IBD
  • Liver cirrhosis
  • Lymphoma
  • Coeliac disease
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37
Q

Features of asthma on examination

A

ACUTE FLARE:

  • Use of accessory muscles
  • Intercostal recession
  • difficulty speaking
  • tachycardia
  • tachypnoea
  • reduced chest expansion
  • hyper-resonant percussion
  • reduced air entry
  • prolonged expiration
  • widespread polyphonic wheeze

CHRONIC DISEASE:
- examination may be normal

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38
Q

On examination you find:

  • Use of accessory muscles
  • Intercostal recession
  • difficulty speaking
  • tachycardia
  • tachypnoea
  • reduced chest expansion
  • hyper-resonant percussion
  • reduced air entry
  • prolonged expiration
  • widespread polyphonic wheeze

Differential?

A

Acute asthma

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39
Q

Investigations to consider in asthma

A
  • Spirometry
  • PEF
  • ABG
  • Sputum culture
  • CXR
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40
Q

Management of asthma

A
  • SABA PRN
  • ICS BD
  • switch to combi ICS LABA
  • LTRA
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41
Q

Features of COPD on examination

A
  • Hyper-inflated chest
  • Use of accessory muscles
  • Agitation
  • Drowsiness
  • Tachypnoea
  • Tachycardia
  • Central cyanosis
  • Pursed lip breathing
  • Raised JVP
  • Tracheal tug
  • Reduced cricosternal distance
  • Decreased breath sounds
  • Decreased chest expansion
  • Wheeze on expiration
  • Inspiratory crackles
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42
Q

On examination you find:

  • Hyper-inflated chest
  • Use of accessory muscles
  • Agitation
  • Drowsiness
  • Tachypnoea
  • Tachycardia
  • Central cyanosis
  • Pursed lip breathing
  • Raised JVP
  • Tracheal tug
  • Reduced cricosternal distance
  • Decreased breath sounds
  • Decreased chest expansion
  • Wheeze on expiration
  • Inspiratory crackles

Differential?

A

COPD

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43
Q

Investigations for COPD

A
  • Sputum culture
  • CXR
  • Spirometry (obstructive pattern)
  • ABG
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44
Q

Management of COPD

A
  • Smoking cessation
  • Pulmonary rehab
  • Immunisations
  • SABA/SAMA PRN
  • If asthmatic features: Add LABA and ICS
  • No asthmatic features: Add LABA and LAMA
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45
Q

Features of bronchiectasis on examination

A
  • Productive cough
  • Finger clubbing
  • Coarse crackles which change on coughing
46
Q

On examination you find:

  • Productive cough
  • Finger clubbing
  • Coarse crackles which change on coughing

Differential?

A

Bronchiectasis

47
Q

Investigations for bronchiectasis

A
  • Sputum culture
  • CXR
  • CT thorax: signet ring
  • Spirometry: obstructive
48
Q

Management of bronchiectasis

A
  • Pulmonary rehab
  • Immunisations
  • Bronchodilators +/- ICS
  • Long term azithromycin
  • Mucolytics
  • Surgery
49
Q

Features of pneumonia on examination

A
  • Confusion
  • Pyrexia
  • Accessory muscle use
  • Tachypnoea
  • Hypotension
  • Central cyanosis
  • Productive cough
  • Pleuritic chest pain
  • Dull percussion
  • Reduced breath sounds
  • Coarse crackles
  • Bronchial breathing
  • Pleural rub
50
Q

On examination you find:

  • Confusion
  • Pyrexia
  • Accessory muscle use
  • Tachypnoea
  • Hypotension
  • Central cyanosis
  • Productive cough
  • Pleuritic chest pain
  • Dull percussion
  • Reduced breath sounds
  • Coarse crackles
  • Bronchial breathing
  • Pleural rub

Differential?

A

Pneumonia

51
Q

Components of CURB65 score

A
  • Confusion
  • Urea >7
  • RR >30
  • BP <90/60
  • Age >65
52
Q

Investigations for pneumonia

A
  • ABG
  • Sputum culture
  • CXR
53
Q

Management of pneumonia

A
  • CURB 0-1: 10 days PO amoxicillin OR doxycycline
  • CURB 2:10 days PO amoxicillin OR clarithromycin
  • Curb >3: 10 days co-amoxiclav + clarithromycin
54
Q

Most common causative agents of pneumonia

A
  • Adults: strep pneumoniae

- Elderly/associated lung disease: H. Influenzae

55
Q

Features of pleural effusion on examination

A
  • Dyspnoea
  • Signs of associated causative disease
  • Tracheal and mediastinal shift
  • Reduced chest expansion
  • Stony dull percussion
  • Diminished breath sounds
  • Decreased vocal resonance
  • Bronchial breathing
56
Q

On examination you find:

  • Dyspnoea
  • Signs of associated causative disease
  • Tracheal and mediastinal shift
  • Reduced chest expansion
  • Stony dull percussion
  • Diminished breath sounds
  • Decreased vocal resonance
  • Bronchial breathing

Differential?

A

Pleural effusion

57
Q

Investigations for pleural effusion

A
  • Pleuritic aspiration for biochemistry and culture:
  • Protein >30: exudate e.g. infection, cancer, inflammation
  • Protein <35: transudate e.g. fluid overload, organ failure
  • Empyema: low glucose, low pH
  • CXR
58
Q

Management of pleural effusion

A
  • Small: diuretics
  • Moderate: aspiration
  • Large: chest drain
  • Recurrent: pleurodesis
59
Q

Features of pneumothorax on examination

A
  • Tall, skinny males
  • Hyperinflation
  • Tachycardia
  • Dyspnoea
  • Reduced chest expansion
  • Hyper-resonant percussion
  • Decreased/absent breath sounds
  • Decreased vocal resonance
  • Subcutaneous emphysema
60
Q

On examination you find:

  • Tall, skinny males
  • Hyperinflation
  • Tachycardia
  • Dyspnoea
  • Reduced chest expansion
  • Hyper-resonant percussion
  • Decreased/absent breath sounds
  • Decreased vocal resonance
  • Subcutaneous emphysema

Differential?

A

Pneumothorax

61
Q

Investigations for pneumothorax

A
  • CXR
62
Q

Management of pneumothorax

A

Depending on size and if it is primary/secondary:

  • Watch and wait with outpatient review
  • Aspiration
  • Chest drain insertion
63
Q

Features of TB on examination

A
  • Pyrexia/night sweats
  • Evidence of weight loss
  • Hoarse voice
  • Cough
  • Sputum
  • Tachycardia
  • Displaced trachea
  • Enlarged lymph nodes
  • Decreased chest expansion
  • Decreased breath sounds
  • Bronchial breathing
  • Extra-pulmonary signs
64
Q

On examination you find:

  • Pyrexia/night sweats
  • Evidence of weight loss
  • Hoarse voice
  • Cough
  • Sputum
  • Tachycardia
  • Displaced trachea
  • Enlarged lymph nodes
  • Decreased chest expansion
  • Decreased breath sounds
  • Bronchial breathing
  • Extra-pulmonary signs

Differential?

A

TB

65
Q

Investigations for TB

A
  • CXR

- Sputum culture, including acid fast bacilli (3 cultures including 1 early morning sample)

66
Q

Management of TB

A

2 months:

  • Rifampicin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol

Further 4 months:

  • Rifampicin
  • Isoniazid
67
Q

Examination findings for interstitial lung disease

A
  • Laboured breathing
  • Dyspnoea
  • Dry cough
  • Finger clubbing
  • Central cyanosis
  • Reduced chest expansion
  • Dull percussion
  • Fine inspiratory bibasal crackles
  • Oedema
68
Q

On examination you find:

  • Laboured breathing
  • Dyspnoea
  • Dry cough
  • Finger clubbing
  • Central cyanosis
  • Reduced chest expansion
  • Dull percussion
  • Fine inspiratory bibasal crackles
  • Oedema

Differential?

A

Interstitial lung disease

69
Q

Causes of interstitial lung disease

A
  • Idiopathic pulmonary fibrosis
  • Drug-induced e.g. methotrexate, amiodarone
  • Associated with systemic disease e.g. sarcoid, connective tissue disease, ankylosing spondylitis, RA, SLE
  • Associated with occupational hazards e.g. asbestosis, pigeon fanciers, silicosis, coal workers
70
Q

Investigations for ILD

A
  • Spirometry: restrictive
  • CXR: reticular opacities
  • HRCT: honeycomb lung
  • Bronchiolar lavage

Investigation of causes:

  • Urine dipstick: haematuria and proteinuria in vasculitis
  • Antibodies e.g. Anti-CCP, ANA
71
Q

Management of ILD

A
  • Avoid triggers
  • Smoking cessation
  • Pulmonary rehab
  • Consider anti-fibrotics e.g. nintedanib or pirfenidone
  • Consider LTOT
  • Consider corticosteroids
72
Q

Examination features of PE

A
  • Pyrexia
  • Tachycardia
  • Hypotension
  • Tachypnoea
  • Central cyanosis
  • Raised JVP
  • Potential causes e.g. scars from previous surgery

(Examination may be normal)

73
Q

On examination you find:

  • Pyrexia
  • Tachycardia
  • Hypotension
  • Tachypnoea
  • Central cyanosis
  • Raised JVP
  • Potential causes e.g. scars from previous surgery

(Examination may be normal)

Differential?

A

PE

74
Q

Investigation of PE

A
  • Well’s score
  • D-dimer
  • CTPA
75
Q

Management of PE

A
  • Apixaban PO for 3 months
76
Q

Features of lung cancer on examination

A
  • Cachexia
  • Pallor
  • Koilonychia
  • Finger clubbing
  • Tar staining
  • Reduced chest expansion
  • Pleural effusion
  • Hepatomegaly
  • Endocrinology signs

Examination may be normal

77
Q

On examination you find:

  • Cachexia
  • Pallor
  • Koilonychia
  • Finger clubbing
  • Tar staining
  • Reduced chest expansion
  • Pleural effusion
  • Hepatomegaly
  • Endocrinology signs

Examination may be normal

Differential?

A

Lung cancer

78
Q

Investigations for lung cancer

A
  • Bloods including Ca
  • CXR
  • CT CAP
  • Bronchoscopy and biopsy
  • PET-CT
79
Q

Indications for lobectomy

A
  • Malignancy
  • COPD
  • Chronic lung disease
  • TB
  • Bronchiectasis
80
Q

On examination you find:

  • Normal tone
  • Moderately reduced power in proximal upper limbs
  • Normal reflexes
  • Normal sensation
  • Normal coordination

Differentials?

A

Proximal myopathy:

  • Dermatomyositis/polymyositis
  • Muscular dystrophy e.g. DMD, Becker’s muscular dystrophy
  • Cushing’s
  • Glycogen storage disorders
  • Mitochondrial disorders
  • Thyroid disease
  • Acromegaly
  • Drugs e.g. statins
81
Q

Features of proximal myopathy on examination

A
  • Normal tone
  • Moderately reduced power in proximal upper limbs
  • Normal reflexes
  • Normal sensation
  • Normal coordination
82
Q

Investigations for proximal myopathy

A
  • Lower limb neuro exam
  • TFTs
  • Antibodies (Anti-M2, Anti-Jo)
  • CK
  • Muscle biopsy
83
Q

Features of myotonic dystrophy on examination

A
  • Ptosis

- Distal limb weakness

84
Q

On examination you find:

  • Ptosis
  • Distal limb weakness

Differential?

A

Myotonic dystrophy

85
Q

Investigations for myotonic dystrophy

A
  • EMG: myotonia

- Genetic testing: mutations in CNBP and DMPK

86
Q

Features of myasthenia gravis on examination

A
  • Female
  • Middle-age
  • Unilateral ptosis
  • Normal cranial nerve examination
87
Q

On examination you find:

  • Female
  • Middle-age
  • Unilateral ptosis
  • Normal cranial nerve examination

Differential?

A

Myasthenia Gravis

88
Q

Investigations for myasthenia gravis

A
  • Ice pack test (ptosis should improve)
  • Antibodies: Anti-AchR and Anti-MuSK
  • CT chest: associated with thymoma
  • EMG: decreased amplitude with repetitive stimulation
  • Consider screening for autoimmune disease
89
Q

Features of hemiplegia on examination

A
  • Unilateral facial droop
  • Ipsilateral flexed upper limb
  • Increased tone, clonus, reduced power, hyperreflexia in ipsilateral leg
  • Contralateral leg normal
90
Q

UMN lesion signs

A

Lesion in brain, brainstem or spinal cord:

  • Hypertonia: rigidity and spasticity
  • Pronator drift
  • Ankle clonus
  • Hyperreflexia
  • Positive Babinskis sign
  • Weakness - usually affects arm flexors and leg extensors
  • Decreased sensation
  • Abonormal gait
  • Coordination reduced in cerebellar lesions
91
Q

On examination you find:

  • Unilateral facial droop
  • Ipsilateral flexed upper limb
  • Increased tone, clonus, reduced power, hyperreflexia in ipsilateral leg
  • Contralateral leg normal

Differentials?

A

Hemiplegia:

  • Ischaemic stroke or TIA
  • Haemorrhagic stroke
  • Space occupying lesion
  • Demyelinating process e.g. MS
92
Q

Investigations in hemiplegia

A
  • Complete neuro exam
  • CT head
  • MRI brain/spine
93
Q

Examination findings in peripheral neuropathy

A
  • Sensory loss in hands
  • Reduced power on distal leg movements
  • Sensory loss from feet to knees
  • Normal tone, reflexes and coordination in legs
94
Q

On examination you find:

  • Sensory loss in hands
  • Reduced power on distal leg movements
  • Sensory loss from feet to knees
  • Normal tone, reflexes and coordination in legs

Differential?

A

Peripheral neuropathy

95
Q

Causes of peripheral neuropathy

A

Mostly sensory (ABCDE):

  • Alcohol and diabetes (most common)
  • B12/folate deficiency
  • Chronic renal failure
  • Cancer (paraneoplastic syndrome)
  • Drugs e.g. isoniazid
  • Diabetes
  • Everything else e.g. vasculitides (SLE)

Mostly motor:

  • Charcot-Marie-Tooth (hereditary sensory and motor neuropathy)
  • Guillain-Barre syndrome
  • Chronic inflammatory demyelinating polyneuropathy e.g. MS
96
Q

Examination findings for MS

A
  • Young adult females
  • Lhermitte’s sign
  • Urthoff’s phenomenon
  • Autonomic signs e.g. urinary incontinence
  • Internuclear ophthalmoplegia
  • Optic neuritis
  • Sensory disturbances in upper limbs
  • Increased tone and ankle clonus
  • Reduced leg power
  • Hyperreflexia in legs
  • Impaired heel-shin coordination
  • Impaired proprioception and light touch
  • Foot drop
97
Q

On examination you find:

  • Young adult females
  • Lhermitte’s sign
  • Urthoff’s phenomenon
  • Autonomic signs e.g. urinary incontinence
  • Internuclear ophthalmoplegia
  • Optic neuritis
  • Sensory disturbances in upper limbs
  • Increased tone and ankle clonus
  • Reduced leg power
  • Hyperreflexia in legs
  • Impaired heel-shin coordination
  • Impaired proprioception and light touch
  • Foot drop

Differential?

A

MS

98
Q

Investigations for MS

A
  • MRI brain/spinal cord: demyelinating lesions
  • LP: oligoclonal bands

Diagnosed using McDonald criteria: must have multiple lesions separated in space and time

99
Q

Management of MS

A
  • Physiotherapy
  • Baclofenac for spasticity
  • Analgesia for neuropathic pain
  • IV methylprednisolone for flares
  • Dimethyl fumarate/Interferon beta and alemtuzumab for maintenance if >2 relapses in last 2 years
100
Q

Examination findings for Parkinsonism

A
  • Myerson’s sign on glabella tap
  • Reduced facial expression
  • Slow monotonous speech
  • Resting tremor in upper limbs
  • Increased tone with cog-wheeling
  • Bradykinesia
  • Micrographia
  • Normal power, reflexes, sensation and coordination in arms
  • Increased tone in legs
  • Normal power, reflexes, sensation and coordination in legs
  • Gait: difficulty initiating walking, shuffling gait, reduced arm swing, multiple steps to turn around
101
Q

Management of Parkinson’s disease

A
  • Physiotherapy
  • Support groups
  • Dopamine agonists e.g. bromocriptine
  • L-DOPA with peripheral dopa decarboxylase inhibitor
102
Q

On examination you find:

  • Myerson’s sign on glabella tap
  • Reduced facial expression
  • Slow monotonous speech
  • Resting tremor in upper limbs
  • Increased tone with cog-wheeling
  • Bradykinesia
  • Micrographia
  • Normal power, reflexes, sensation and coordination in arms
  • Increased tone in legs
  • Normal power, reflexes, sensation and coordination in legs
  • Gait: difficulty initiating walking, shuffling gait, reduced arm swing, multiple steps to turn around

Differential?

A

Parkinsonism

103
Q

Causes of Parkinsonism

A

Parkinson’s disease (usually asymmetrical signs): idiopathic destruction of the substantia nigra

Parkinson’s plus syndromes (usually symmetrical signs):

  • Multi-system atrophy: Parkinsonism plus postural hypotension, cerebellar signs
  • Progressive supra-nuclear palsy: vertical gaze palsy
  • Corticobasal degeneration: apraxia, alien hand

Drug induced Parkinsonism e.g. antipsychotics

Lewy Body Dementia: dementia precedes Parkinsonism features

104
Q

Features of MND on examination

A
  • Age >40
  • Strained, slow speech
  • Head drop
  • Stooped posture
  • Weakness
  • Painful muscle spasms
  • Muscle atrophy
  • Hyperreflexia
  • Spastic, unsteady gait
  • Foot drop
  • Sensation intact
105
Q

On examination you find:

  • Age >40
  • Strained, slow speech
  • Head drop
  • Stooped posture
  • Weakness
  • Painful muscle spasms
  • Muscle atrophy
  • Hyperreflexia
  • Spastic, unsteady gait
  • Foot drop
  • Sensation intact

Differential/

A

MND

106
Q

Management of MND

A
  • Riluzole BD: prolongs survival

- Symptomatic relief e.g. nutritional support

107
Q

Differentials for ptosis

A
  • Large lid lesion e.g. tumour, oedema
  • Myotonic dystrophy
  • Myasthenia gravis
  • 3rd nerve palsy
  • Horner’s syndrome (damage to sympathetic pathway)
108
Q

LMN lesion signs

A

Lesion in grey matter of spinal cord at level of synapse or injury to axons leaving spinal cord

  • Hyporeflexia
  • Hypotonia: flaccid paralysis
  • Fasciculations
  • Muscle wasting
  • Weakness: usually more focal, follows nerve root or peripheral nerve distribution
  • Normal coordination
  • Decreased sensation
109
Q

Features of cerebellar disease on examination

A
  • Dysdiadochokinesia
  • Ataxia
  • Nystagmus
  • Intention tremor
  • Slurred speech
  • Hypotonia and hyporeflexia
  • Past-pointing
110
Q

On examination you find:

  • Dysdiadochokinesia
  • Ataxia
  • Nystagmus
  • Intention tremor
  • Slurred speech
  • Hypotonia and hyporeflexia
  • Past-pointing

Differential?

A

Cerebellar disease e.g. stroke

Finals OSCEs (1 decks)

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