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Specific OSCE stuff > typical presentations and things difficult to remember > Flashcards

typical presentations and things difficult to remember Flashcards

1
Q

classical phaeochromocytoma symptoms

A 
(labile or postural hypotension,
headache, 
palpitations, 
pallor 
sweating
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2
Q

Causes of gum hypertrophy

A
  1. Scurvy
  2. Pregnancy
  3. Acute polymelocytic leukaemia
  4. Drugs
    a. Phenytoin
    b. Nifedipine
    c. Ciclosporin
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3
Q

Drugs causing peripheral neuropathy:

A
  1. TCAs
  2. Amiodarone
  3. Metronidazole
  4. Nitrofurantoin
  5. AZT
  6. Isoniazid
  7. Phenytoin
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4
Q

Causes of finger Clubbing

A

Respiratory: malignancy, infection (abscess, empyema), bronchiectasis, fibrosing alveolitis, cystic fibrosis, TB, mesothelioma

Cardiac: congenital cyanotic heart disease (fallot’s tetralogy, transposition of the great arteries), acyanotic heart disease (PDA with reversal of shunt (clubbing in toes only), infective nedocarditis

Subclavian artery aneurysm (unilateral clubbing)

GIT disease (cirrhosis, PBC, IBD, malabsorptio, coelic, whipple’s disease)

Thyroid (hyper)
Familial

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5
Q

Causes of cyanosis

A

Cyanosis (non-oxygenated Hb >5g/dl)

Peripheral : shock (hypovolemic, cardiogenic, septic), cold weather (Rynaud’s), arterial/venous occlusion

Central: respiratory failure, congenital heart disease, hemoglobin abnormalities (methaemoglobinaemia, HbM disease, NADH diaphorase)

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6
Q

Weight gain ddx

A
  1. Pregnancy
  2. Excessive caloric intake
  3. Endocrine
    a. PCOS
    b. Cushing’s
    c. Hypothyroidism
    d. Hypothalamic disease
    e. Acromegaly
  4. Drugs
    a. Steroids
    b. OCP
    c. Antidepressants
    d. Anticonvulsants
  5. Depression
  6. Fluid:
    a. CCF
    b. Renal failure
    c. Cirrhosis
    d. Lymphatic
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7
Q

Absent radial pulse:

A
  1. Aoritc dissection with subclavian involvement
  2. Trauma/surgery/catheterisation
  3. Arterial embolism
  4. Takayasu’s arteritis
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8
Q

Impalpable apex beat:

A
  1. Obesity/thick chest wall
  2. Lung pathology: emphysema
  3. Pericardial effusion
  4. Dextrocardai
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9
Q

Bilaterally reduced expansion:

A
  1. Obesity
  2. Lung pathology (emphysema, bronchial athma, diffuse pulmoanry fibrosis)
  3. Chest cage pathology eg ankylosing spondylitis
  4. Neuromuscular pathology (GB syndrome, MS, MND etc)
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10
Q

INCREASED vocal femitus:

A

Consolidation, Cavitation, Collapse with patent main bronchus

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11
Q

DECREASED vocal fremitus:

A

pleural pathology (effusion, pneumothorax), collapse with obstructed main bronchus

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12
Q

Spider naevi

A

normal in women, OCP, prengancy, liver failure

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13
Q

causes of massive splenomegaly:

A
  1. Myelofibrosis
  2. Idiopathic tropical splenomegaly
  3. Chronic myeloid leukaemia
  4. Kala-azar
  5. Shistosomiaisis
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14
Q

other causes of moderate&mild splenomegaly

A
  1. Blood dyscrasias: leukaemia, haemolysis, polycythaemia rubra vera
  2. Lymphoma
  3. Infections: EBV, septicaemia, bacterial endocarditis, malaria
  4. Portal HTN
  5. Storage disease
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15
Q

causes of hepatomegaly:

A
  1. Tumours: either malignant or bening
  2. Cysts
  3. Hepatitis: infectious
  4. Other infections: EBV, bacterial
  5. Hepatic vein obstruction - budd chiari
  6. storage diseases: haemochromatosis, glycogen
  7. tricuspid regurgitation
  8. right heart failure
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16
Q

palpable liver without being enlarged:

A

riedel’s lobe
emphysema
gall bladder

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17
Q

DDx CHest pain

A
  1. Anginal (Stable)
  2. ACS
  3. Aortic dissection
  4. Pericarditis
    * ** GORD
  5. PE
  6. Pneumothorax
  7. Penumonia/ pleurisy
  8. Musculoskeletal
  9. Pre-herpes zoster
  10. trauma
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18
Q

Palpitations DDx and Qs

A
  1. Frequency and if paroxysmal
  2. FHx (WPW, RVAH)
  3. THyrotoxicosis
    4, ? Infective endocarditis
  4. Stimulant use: coffee, energy drinks, tea, amphetamines
  5. Anaemia
  6. Anxiety
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19
Q

Vertigo DDx

A
  1. BPPV - lasts seconds, provokes by head movements
  2. Meniere’s disease - can last hours, tinnitus, hearing loss, sense of fullness in the ear
  3. Labyrinthytis - almost constant, previous infection, discharge
  4. Trauma
  5. DRUGS
    —-Vestibular:
    Aminoglycosides (gentamicin)
    Furosemide
    Quinine
    Salicylate
    — Cerebellar:
    Phenytoin
    EtOH
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20
Q

Acute single episode of headache :

A 
SAH
Idiopathic cranial HN
Cerebral vein thrombosis
Acute Meningitis, encephalitis
Acute carotid dissection
\+/- GCA
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21
Q

Subacute progressive headache

A

Raise ICP (tumour, abscess, Idiopathic intracranial HTN)
Infections - meningitis, encephalitis
Temporal arteritis

22
Q

Recurrent headaches

A

Migraine
Tension headache
Cluster headache
Drugs: nitrates, dipyridamole

TRIGEMINAL NEURALGIA

23
Q

chronic headache

A

Chronic daily headache syndrome
Hronic migraine
Medication overuse
Cervicogenic

24
Q

DDx Acute painful and prolonged visual disturbance/LOSS

A
  1. Acute angle closure glaucoma
  2. GCA
  3. Optic neuritis
  4. Anterior uveitis
  5. Endophthalmitis
  6. Orbital ecellulitis
25
Q

DDx acute painless and prolonged visual disturbance/loss

A
  1. Central or branch retinal vein occlusion
  2. Central or branch retinal artery occlusion
  3. Anterior ischaemic optic neuropathy
  4. Retinal detachment or vitreous haemorrhage
  5. Macular haemorrhage
26
Q

DDx acute painless and fleeting visual loss

A
  1. Amaurosis fugax

2. Raised ICP

27
Q

Gradual visual loss DDx

A
  1. Cataracts
  2. Diabetic retinopathy
  3. Age related macular degeneration
  4. Chronic glaucoma
28
Q

acute +/- progressive LIMB WEAKNESS DDx

A
  1. GBS - prior viral/diarrhoeal illness
  2. Stroke -speech, LOC, face, RISK FACTORS, AF
  3. TIA - speech, resolved completely, risk factors
  4. SPINAL CORD COMPRESSION - ? malignancy OR trauma, sphincter disturbance, pain
29
Q

subacute limb weakness ddx

A
  1. MS - episodes where weakness paritally/completely resoved
  2. SOL - raised ICP sx
  3. Myasthenia gravis - fatiguing
  4. Lambert-Eaton - malignancy
  5. MND - NO sensory Sx
  6. Peripheral neuropathies -sensory Sx burning tingling, anaemia, vegan
30
Q

DDx chronic cough

A 
GORD
Asthma
Post-viral
Rhinitis/sinusitis
Drugs, eg ACEi
Lung tumour
TB
Interstitial disaese
Bronchiectasis
31
Q

HAEMOPTYTSIS ddx

A

DDx
Infective: TB, bronchitis, pneumonia
Neoplastic: primary or metastatic
Vascular: PE, LVF & pulmonary oedema, AVM
Inflammatory: Wegener;s, Goodpasture, SLE
Traumatic & iatrogenic
Drugs: warafin, cocaine

32
Q

Dyspnoea Progression and onset

Minutes

A 
PE
Pneumothorax
Asthma
Ihaled foreign body
Acute LVF
33
Q

dyspnoea onset over hours- days

A

Pneumonia
Athma
IECOPD

34
Q

dyspnoea onset/progression over weeks - years

A

Anaemia
Pleural effusion
Neuromuscular disorder
AS

Months-years:
COPD
Fibrosis
TB
Pulmonary HTN
35
Q

Weight loss wiht preserved appetite

A

Malabsorption: Diarrhoea, constipation, abdo pain, comiting, mouth ulcers

Diabetes: Polydipsia, polyuria, fatigue, infections

Hyperthyroid: Anxiety, fast heart rate, tremor, heat intolerance, increased appetite, eye symptoms, diarrhoea

36
Q

Weight loss with norexia

A

?Addisons Weakness, dizziness, excessive sweating, skin PIGMENTATION

Pancreatit Assess EtOH, gallstones

Depression How has your mood been lately? Early-morning wakening, reduced appetite, anergia, anhedonia

?Infection Night sweats, fever, rigors, malaise, cough, sputum, rashes, SOB

?Malignant PR bleeding, changes in bowel habit, cough, haemoptysis, bruising (haematological)

37
Q

DDx painful swollen leg

A 
DDx
DVT
Cellulitis
Ruptured Baker’s cyst
Neuropathy

Neurological: muscle weaknes, wasting, ssensory, back pain
Bladder or bowel problems&raquo_space; CAUDA EQUINA
PE: Haemoptysis, SOB, pleurtic chest pain?

38
Q

Causes of lymphadenopathy

A

L – Lymphoma and leukaemia
I – Infection (see below)
S – Sarcoidosis
T – Tumours (primary/secondary)

39
Q

Abnormal LFTs ddx

A 
•	EtOH
•	Viral hepatitis
•	PBC, AIH
Gilberts
•	Drugs
•	Obstructive causes: gallstones, pancreatic ca, liver mets
•	Haemochromatosis
•	Wilsons
40
Q

Epigastric pain ddx

A 
GORD
Peptic ulcer
Upper GI cancer
Depression
Cardiac
Pancreatitis
Gallstones
41
Q 
Jaundice 
Acute onset (days)
A

Gall stones
Acute hepatitis
Budd-Chiari
Haemolysis

42
Q

Jaundice RECURRENT

A

Gallstones

Congenital (Gilbert’s syndrome)

43
Q

Jaundice onset subacute

A

Pancreatic, hepatobilairy malignancy
Intrahepatic cholestasis: drugs, autoimmune,infiltrate
Right-sided heart failure

44
Q

DDx diarrhoea

A
  • Coeliac
  • Chron’s
  • Chronic pancreatitis - alcohol
  • Thyrotoxicosis
  • Laxative abuse
  • Carcinoid
  • Colorectal cancer
  • Whipple’s disease
  • Bacterial overgrowth
  • Tropical sprue
  • Lactose intolerance
45
Q

Blood PR + pain

A

Blood mixed with stool – source proximal to sigmoid colon: Colitis

Blood streaked on stool – sigmoid or anorectal: Anal tumour

Blood separate from stool: Colitis

Blood on toilet paper: Anal fissure

46
Q

Painless PR blood

A

Mixed with stool: Colonic tumour

On the stool: Rectal tumour

Separate from stool: Haemorrhoids
Diverticular disease – arterial blood
Angiodysplasia – venous blood
CRCa

Blood on toilet paper: Haemorrhoids - unless thrombosed

47
Q

Upper GI bleed

A 
Bleeding dueodenal/gastric (peptic) ulcer
Gastro-oesophageal varices
Erosive oeophagogastritis
Mallory-Weiss tear
Drug related:
NSAIDs
Anticoagulants
Steroids
Alcohol
Oesophageal/gastric tumours - benign or malignangt
48
Q

Causes of hematuria:

A
  • Cancer: bladder (TCC,SCC), kidney(adenocarcinoma), renal pelvis/ ureter (TCC), prostate
  • Stones: kidney, ureteric, bladder
  • Infection: bacterial (&TB), parasitic(schistosomiasis), infective urethritis
  • Inflammation: cyclophosphamide cystitis, interstitial cystitis
  • Trauma: kidney, bladder, urethra (e.g. traumatic catheterization), pelvic fracture causing urethral rupture
  • Renal cystic disease (e.g. medullary sponge kidney)
49
Q

Mass in RLQ

A
  1. appendicular mass/abscess
  2. carcinoid tumour
  3. crohn’s grnauloma
  4. Carcinoma
  5. volvulus
  6. trnasplanted kidney
50
Q

DIfferentiation between CML and myelofibrosis

A

Massive splenomegaly with very high WCC is in BOTH

BLood film in CML: numerous granulocytes at varying stages of maturation. In myelofibrosis - teardrop cells due to haemopoeisis not in bone marrow

Marrow biopsy in CML: numerous granulocytes at varying stages of maturation. In myelofibrosis - firbosis

Specific OSCE stuff (7 decks)

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