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OSCE III > Review OSCE 3 > Flashcards

Review OSCE 3 Flashcards

1
Q

Amsel criteria

A
  1. Homogenous thin white d.c
  2. pH > 4.5
    • whiff test after KOH
  4. Clue cells on wet mount (at least 75% adherent coccobacilli, at least 20% of epithelial cells on the slide)

Sens: 90%, Spec: 77%

Gold standard dx of BV: gram stain of vaginal discharge, but generally only performed in research studies.

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2
Q

Centor Criteria

Modified is one extra

A
  1. Tonsillar exudate
  2. Anterior cervical adenopathy
  3. Fever > 100.4 degrees F
  4. Absence of cough
  5. Modified
    -+1 age 3-14
    0 age 15-44
    -1 age >/= 45

1: 7% likelihood, no testing or abx
2: 21% likelihood, culture or RADT, abx for + culture only
3: 38% likelihood, culture or RADT, abx for + culture only
4: 57% likelihood, treat empirically

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3
Q

CHADS2

A
  1. CHF +1
  2. HTN +1
  3. Age >/= 75 +1
  4. DM +1
  5. Stroke/TIA +2
0 = aspirin 81
1 = aspirin 81-325 or warfarin
2 = warfarin 2-3 inr
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4
Q

CHADS-VASc

A
  1. CHF +1
  2. HTN +1
  3. Age >75 +2
    Age > 65 +1
  4. DM +1
  5. Stroke/TIA +2
  6. Vascular Disease (PAD) +1
  7. Female SEx +1
0 = no oral anticoagulant
1 = 1 Aspiring 81-325 mg QD or Coumadin (Warfarin)
2 = 2 Warfarin (INR 2-3, target 2.5)
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5
Q

CURB-65

A
  1. Confusion
  2. BUN > 19 mg/dl
  3. RR >/= 30
  4. BP
    - Systolic < 90 mmHg
    - Diastolic = 30 mmHg
  5. Age >/= 65

0-1 outpatient
2 Short inpatient hospitalization
3-4 severe pneumonia, consider intensive care if >4

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6
Q

PHQ-2

A
  1. Over the past two weeks, how often have you felt little interest or pleasure in doing things?
  2. Over the last two weeks, how often have you been feeling down, depressed, or hopeless?

If yes to either, use PHq-9

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7
Q

Well’s Criteria for DVT

A
  1. Calf swelling > 3 cm
  2. Superficial veins
  3. Entire leg swollen
  4. Tender along deep veins
  5. UL Pitting edema
  6. Active Cancer
  7. Bedridden >/= 3 days or minor surgery within 12 weeks
  8. Paralysis of lower extremity
  9. Previous DVT
    All +1
  10. Alternative diagnosis to DVT as likely -2

3-8 high probability DVT: diagnostic ultrasound with D-dimer for risk stratification
1-2 moderate probability DVT: D-dimer and compression ultrasound, repeat in one week
-2-0 low probability DVT: D-Dimer (if negative, rule out)

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8
Q

Well’s Criteria PE

A
  1. SSx DVT +3
  2. PE #1 Dx +3
  3. Tachycardia + 1.5
  4. Immobilization 3 d surgery 4 w + 1.5
  5. Previous dx DVT or PE +1.5
  6. Hemoptysis + 1
  7. Malignancy with treatment +1

> 6 high likelihood PE: CTA only
2-6 moderate likelihood PE: D-dimer and TA
<2 low likelihood PE: d-dimer

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9
Q

Rotterdam Criteria

A

2/3 required

  1. Oligo or anovulation
  2. Clinical/biochemical signs of hyperandrogenism
  3. Polycystic ovaries by US
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10
Q

ATP III Criteria for Metabolic Syndrome

A
  1. Waist circumference men >/= 102 cm women >/= 88 cm
  2. Serum TG >/= 150 or drugs for elevated TG
  3. Serum HDL < 40 in men or < 50 in women or drug tx
  4. BP >/= 130/85 mm Hg or drug for HTN
  5. FBG >/= 100 mg/dL or drugs for elevated blood glucose
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11
Q

CURB-65

A
  1. Confusion
  2. Urea (blood nitrogen) over 19 mg/dL
  3. RR >/= 30
  4. BP under 90/60 mmHg
  5. Age >/= 65

1-2 consider hospitalization
3-4 high risk of death, urgent hospitalization

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12
Q

LE Dermatomes

A 
L2: inguinal
L3: anterior
L4: patella
L5: lateral calf
S1: lateral foot
S2: medial malleolus
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13
Q

LE Reflexes

A

L4: patellar
L5: hamstring
S1: achilles

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14
Q

LE Motor Testing

A 
L2: hip flexion
L3: knee etension
L4: foot dorsiflexion
L5: toe dorsiflexion
S1: foot plantarflexion
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15
Q

Back Pain Flow

A 
STANDING: 3
1. Gait
2. AROM
3. Belt Test
SEATED: 5
1. Valsalva 
2. MRS
3. Becterew: active knee extension
4. Slump Test
5. Kemp's
SUPINE: 3
1. SLR with Bragards, Secards
PRONE: 2
1. Static Palpation
2. Motion Palpation
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16
Q

Consider Imaging or LBP IF:

A

X-RAY of lumbar spine, then MRI follow up

  1. Motor weakness +3/5 or less
  2. 4-6 weeks without improvement
  3. RED FLAG SYMPTOMS: trauma, neurologic defecits
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17
Q

Chest Pain Hx Keys

A

Location, quality, severity, radiation, duration, context (exertional, postprandial, positional, cocaine use, trauma), associated symptoms (sweating, nausea, dyspnea, palpitation, sense of doom), exacerbating and alleviating factors (especially medicines);

PMHx:
prior history of similar symptoms; known heart or lung disease or history of diagnostic testing; cardiac risk factors (hypertension, hyperlipidemia, smoking, family history of early MI); pulmonary embolism risk factors (history of DVT, coagulopathy, malignancy, recent immobilization).

SHx:
tobacco, alcohol, drugs (cocaine, meth), diet, exercise

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18
Q

Palpitations Hx Keys

A

Gradual vs. acute onset/offset, context (exertion, caffeine, anxiety), associated symptoms (lightheadedness, chest pain, dyspnea);

  • hyperthyroid symptoms;
  • history of bleeding or anemia;

Pmhx: Hyperthyroid, heart disease, bleeding/anemia

Ddx: arrhythmia (CAD, MI) hypoglycemia, hyperthyroidism, anxiety, pheochromo,

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19
Q

Dysphagia Hx

A

Solids vs. both solids and liquids, ± progressive, constitutional symptoms (especially weight loss), drooling, regurgitation, odynophagia, GERD symptoms;

medications

PMHx: HIV risk factors, history of Raynaud’s phenomenon (CREST)

SHx: history of smoking,

Ddx: Achalasia, esophagitis, esophageal cancer, CREST, stricture, GERD

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20
Q

Nausea Hx

A

Acuity of onset, ± abdominal pain, relation to meals, sick contacts, possible food poisoning,

  • possible pregnancy;
  • neurologic symptoms (headache, stiff neck, vertigo, focal numbness or weakness), other associated symptoms (GI, chest pain), exacerbating and alleviating factors; medications.

Ddx: gastritis, pregnancy, gastroenteritis, acute abdomen (pancreatitis, pyelo, hepatitis, etc.)

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21
Q

Abdominal Pain Hx

A

Location, quality, intensity, duration, radiation, timing (relation to meals), associated symptoms (constitutional, GI, cardiac, pulmonary, renal, pelvic, other), exacerbating and alleviating factors; prior history of similar symptoms;

PMHx: history of abdominal surgeries, gallstones, renal stones, atherosclerotic vascular disease;

medications;

alcohol and drug use; domestic violence.

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22
Q

Abdominal Pain PE

A

Vital signs; heart and lung exams; abdominal exam, including guarding, rebound, Murphy’s sign, and CVA palpation; rectal exam; pelvic exam (women).

23
Q

Palpitations PE

A

PE: Vital signs; endocrine/thyroid exam, including exophthalmos, lid retraction, lid lag, gland size, bruit, and tremor; complete cardiovascular exam.

24
Q

Chest Pain PE

A

PE: Vital signs ± BP in both arms; complete cardiovascular exam (JVD, PMI, chest wall tenderness, heart sounds, pulses, edema); lung and abdominal exams.

25
Q

Diarrhea/Constipation Hx

A

Frequency and volume of stools, duration of change in bowel habits, associated symptoms (constitutional, abdominal pain, bloating, sense of incomplete evacuation, melena or hematochezia);

  • thyroid disease symptoms;
  • sick contacts, travel, camping,

history of abdominal surgeries, diabetes, pancreatitis; HIV risk factors;
family history of colon cancer.

medications (including recent antibiotics);

diet (especially fiber and fluid intake);
alcohol and drug use;

Ddx: colorectal cancer, low fiber diet, IBS, IBD, gastroenteritis (virus, bacteria, parasite), diverticulosis, Hyper-hypothyroid, celiac,

26
Q

Diarrhea/Constipation PE

A

Vital signs; relevant thyroid/endocrine exam; abdominal and rectal exams; ±female pelvic exam.

27
Q

Upper GI Bleed Hx

A

Amount, duration, context (after severe vomiting, alcohol ingestion, nosebleed), associated symptoms (constitutional, nausea, abdominal pain, dyspepsia);

medications (especially warfarin, NSAIDs);

PMHx: history of peptic ulcer disease, liver disease, abdominal aortic aneurysm repair, easy bleeding.

Ddx: PUD, gastritis, esophageal varices, Mallory-Weiss tear

28
Q

Upper GI Bleed PE

A

Vital signs, including orthostatics; ENT, heart, lung, abdominal, and rectal exams.

29
Q

Lower GI bleed (blood in stool)

A

Melena vs. bright blood; amount, duration, associated symptoms (constitutional, abdominal or rectal pain, tenesmus, constipation/diarrhea); trauma;

PMhx: prior history of similar symptoms; prior colonoscopy;

medications (especially warfarin); history of easy bleeding or atherosclerotic vascular disease.

Ddx: colorectal cancer, anal fissures, hemorrhoids, IBD, Diverticulosis, ischemic bowel disease, upper GI bleed, Proctitis, gastroenteritis

30
Q

Lower GI Bleed PE

A

Vital signs ±orthostatics; abdominal and rectal exams.

31
Q

Hematuria Hx

A

Amount, duration, ± clots, associated symptoms (constitutional, renal colic, dysuria, irritative voiding symptoms); medications;
*history of vigorous exercise, trauma,

PMHx: smoking, stones, cancer, or easy bleeding.

Ddx: renal cancer, bladder cancer, nephrolithiasis, prostate cancer, glomerulonephritis, UTI, pyelonephritis

32
Q

Hematuria PE

A

Vital signs; lymph nodes; abdominal exam; genitourinary and rectal exams; extremities.

33
Q

Urinary Symptoms Hx

A

Duration, obstructive symptoms (hesitancy, diminished stream, sense of incomplete bladder emptying, straining, postvoid dribbling), irritative symptoms (urgency, frequency, nocturia),

  • constitutional symptoms;
  • bone pain; medications;

PMhx: history of UTIs, urethral stricture, or urinary tract instrumentation; stones, diabetes, alcoholism.

34
Q

Amenorrhea Hx

A

Primary vs. secondary, duration, possible pregnancy, associated symptoms (headache, decreased peripheral vision, galactorrhea, hirsutism, virilization, hot flushes, vaginal dryness, symptoms of thyroid disease);

PMHx: history of anorexia nervosa, excessive dieting, vigorous exercise, pregnancies, D&Cs, uterine infections; drug use; medications.

Ddx: pregnancy, anovulatory cycle, hyperprolactinemia, PCOS, menopause, premature ovarian failure, anorexia, anxiety

35
Q

Vaginal Bleed

A

Pre- vs. postmenopausal, duration, amount; menstrual history and relation to last menstrual period; associated discharge, pelvic or abdominal pain, or urinary symptoms; trauma;
medications (especially warfarin, contraceptives);

PMHx: history of easy bleeding or bruising; history of abnormal Pap smears.

Ddx: DUB, coagulation d/o, cervical cancer, endometrial cancer, atrophic vaginitis, trauma, spontaneous abortion, PID, ruptured cyst

36
Q

Vaginal Discharge

A

Amount, color, consistency, odor, duration; associated vaginal burning, pain, or pruritus; recent sexual activity; onset of last menstrual period;

SxHx: use of contraceptives, tampons, and douches;

PMhx: history of similar symptoms; history of STD.

Ddx: BV, trich, candida, GC/CT,

37
Q

Dyspareunia

A

Duration, timing, associated symptoms (vaginal discharge, rash, painful menses, GI symptoms, hot flushes), adequacy of lubrication; libido;

sexual history; history of sexual trauma or domestic violence;

Pmhx: history of endometriosis, PID, or prior abdominal/pelvic surgeries.

Ddx: atrophic vaginitis, endometriosis, cervicitis, vaginismus, vulvodynia, PID

38
Q

Joint pain Hx

A

Location, quality, intensity, duration, pattern (small vs. large joints, number involved; swelling, redness, warmth), associated symptoms (constitutional, red eye, oral or genital ulceration, diarrhea, dysuria, rash, focal numbness/weakness), exacerbating and alleviating factors; trauma (including vigorous exercise);

medications;

PMHx: DVT risk factors; alcohol and drug use;
family history of rheumatic disease.

39
Q

Low back pain Hx

A

Location, quality, intensity, radiation, context (moving furniture, bending/twisting, trauma), timing (disturbs sleep), associated symptoms (especially constitutional, incontinence), exacerbating and alleviating factors;

PMHx: history of cancer, recurrent UTIs, diabetes, renal stones, IV drug use, smoking.

40
Q

Headache Hx

A

Location (especially unilateral vs. bilateral), quality, intensity, duration, timing (does it disturb sleep?); presence of associated neurologic symptoms, nausea, jaw claudication; recent trauma, dental surgery, sinusitis symptoms; exacerbating (stress, fatigue, menses, exercise) and alleviating factors (rest, medicines);

past history of headache; family history of migraines.

Ddx: migraine, cluster, tension, sinusitis, trigeminal neuralgia, temporal arteritis, meningitis

41
Q

Confusion Hx

A

Must include history from family members/caregivers. Detailed time course of cognitive deficits, associated symptoms (constitutional, incontinence, ataxia, hypothyroid symptoms, depression); screen for delirium (waxing/waning level of alertness); ADL/IADL status, falls,
medications (and recent medication changes);
history of stroke or other atherosclerotic vascular disease, syphilis, HIV risk factors, alcohol use, or vitamin B12 deficiency;
family history of Alzheimer’s disease.

Ddx: vascular dementia, Alzheimer’s, normal pressure hydrocephalus, tumor, depression, delirium, hypothyroid,

42
Q

Dizziness Hx

A

Lightheadedness vs. vertigo, ± auditory symptoms (hearing loss, tinnitus), duration of episodes, context (occurs with positioning, following head trauma), other associated symptoms (visual disturbance, URI, nausea); neck pain or injury; medications; history of atherosclerotic vascular disease.

Ddx: Meniere, Vestibular neuronitis, Labyrinthitis, BPPV, acoustic neuromas,

43
Q

35 yo F presents with intermittent episodes of vertigo, tinnitus, nausea, and hearing loss over the past week. Episodic attacks with intervening dread, fluctuating SN hearing loss (UL)

A

Meniere’s Disease, rule out TIA

44
Q

55 yo F c/o dizziness for the past day. She feels faint and has severe diarrhea that started two days ago. She takes furosemide for her hypertension.

A

Orthostatic Hypotension

45
Q

44 yo F c/o dizziness on moving her head to the left. She feels that the room is spinning around her head. Tilt test results in nystagmus and nausea

A

Benign positional vertigo.

46
Q

55 yo F c/o dizziness that started this morning. She is nauseated and has vomited once in the past day. She had a URI two days ago and has experienced no hearing loss. Following URI infection, frequent vertigo with NO HEARING LOSS OR TINNITUS

A

Vestibular neuronitis

47
Q

55 yo F c/o dizziness that started this morning and of “not hearing well.” She feels nauseated and has vomited once in the past day. She had a URI two days ago. Sudden UL loss of hearing, balance, acute onset severe vertigo with n/v, often concurrent with acute URI.

A

Labyrinthitis

48
Q

Slowly progressive UL hearing loss, tinnitus

A

Acoustic Neuroma

Dx: Refer for MRI of interior auditory canal with gadolinium contrast.

49
Q

Numbness/Weakness HX

A

Distribution (unilateral, bilateral, proximal, distal), duration, ± progressive, pain (especially headache, neck or back pain); constitutional symptoms, other neurologic symptoms;

history of diabetes, alcoholism, atherosclerotic vascular disease.

DDx: TIA, stroke, MS, MG, guillane-barre, diabetic peripheral neuropathy, B12 deficiency,

50
Q

33 yo F presents with ascending loss of strength in her lower legs over the past two weeks. She had a recent URI

A

Guillane Barre

51
Q

30 yo F presents with weakness, loss of sensation, and tingling in her left leg that started this morning. She is also experiencing right eye pain, decreased vision, and double vision. She reports feeling “electric shocks” down her spine upon flexing her head.

A

MS (brain MRI)

52
Q

40 yo F presents with occasional double vision and droopy eyelids at night with normalization by morning.

A

MG (Tensilon test, Ach antibodies)

53
Q

Fatigue Hx

A

Duration; sleep hygiene, snoring, waking up choking/gasping, witnessed apnea; overexertion; stress, depression, or other emotional problems; diet; weight changes; other constitutional symptoms;
*symptoms of thyroid disease;
history of bleeding or anemia; medications; alcohol and drug use.

Ddx: depression, hypothyroid, anemia, malignancy, mono, OSA, CFS, DM

OSCE III (3 decks)

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