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Resit OSCE Examination

Terms in this set (93)

What should be done to complete a cardiac examination?
ECG, CXR, Echo, Urinalysis
What are the causes of AF?
IHD
Thyrotoxicosis
Pneumonia / Urosepsis
What are the chest x-ray features of left heart failure?
Pulmonary oedema
Kerley B lines
Cardiomegaly
Upper lobe venous diversion
Pleural effusion
What are the causes of pericarditis?
- Viral (Coxsackie)
- Immediately post-MI
- Dressler's syndrome
What does a pansytolic murmur indicate?
- Mitral regurgitation
- VSD
What are the causes of mitral regurgitation?
- Infective endocarditis
- Valve prolapse
- Papillary muscle rupture
- Rheumatic heart disease
- Marfans
What does an ejection systolic murmur indicate?
- Aortic stenosis
- Pulmonary stenosis
What are the causes of aortic stenosis?
- Calcified valve
- Congenital bicuspid valve
What does a mid-diastolic murmur indicate?
Mitral stenosis
What is the cause of mitral stenosis?
Rheumatic heart disease
What does an early diastolic murmur indicate?
Aortic regurgitation
What are the causes of aortic regurgitation?
- IE
- Bicuspid valve
- Hypertension
What are the features on examination for infective endocarditis?
- Changing heart murmur
- Finger clubbing
- Splinter haemorrhages
- Microscopic haematuria
What are the complications of prosthetic valves?
- Structural valve failure
- Paravalvular leak
- Thrombosis and obstruction
- Infective endocarditis
What is aortic sclerosis
- Asymptomatic
- Does not radiate to the carotids
- No slow-rising pulse
- Normal pulse pressure
What are the indications for a bioprosthetic valve?
- Elderly
- Contraindication to Warfarin
- Patient choice
What are the indications for a pacemaker?
- 3rd degree heart block
- 2nd degree heart block type 2
- Asymptomatic bradycardia (sick sinus syndrome)
What are the features of SVT on an ECG?
- Sinus tachycardia (140 BPM)
- ST-segment depression
- P-waves may not be visible
What is the treatment of AF?
- Rate control = Atenolol
- Rhythm control = DC cardioversion or Flecanide
- Anticoagulation
You are the FY1 in general practice. Patient (60s) is complaining of breathlessness. Take a history from the patient in the view of making a diagnosis.
Basically, this patient had breathlessness on exertion, PND, ankle oedema.

What is your most likely diagnosis?
Heart failure leading to pulmonary oedema
How would you investigate a suspected heart failure patient?
CXR, ECG, bloods: FBC, U&Es, CRP, BNP
What would you expect to see on a CXR for heart failure?
Cardiomegaly
Interstitial shadowing
Prominent upper lobe vessels
How would you treat heart failure?
ACEi, Beta-blockers, spironolactone, nitrates, digoxin, furosemide
ECG shows AF, T wave inversion in lateral leads
How would you treat this patient assuming that there are no contra-indications?
Beta-blockers
What are the contra-indication of beta-blockers?
Asthma
You mention ACE inhibitors earlier on, what do you need to assess before starting treatment?
U&E's
What are the reasons for checking renal function?
Renal Artery Stenosis
What would you like to do to conclude a respiratory examination?
Peak flow
Spirometry
CXR
ABG
What are the chest features of consolidation?
- Dull percussion note
- Bronchial breath sounds
- Increased vocal resonance
What are the chest features of collapse?
- Mediastinal shift towards
- Percussion note dull
- Breath sounds reduced or absent
- Vocal resonance reduced or absent
What are the chest features of an effusion?
- Mediastinal shift away if big
- Percussion note stony dull
- Breath sounds reduced or absent
- Vocal resonance decreased or absent
What are the chest features of a pneumothorax
- Mediastinal shift away if tension
- Hyper-resonant on percussion
- Decreased or absent breath sounds
- Decreased vocal resonance
What are the chest features of pneumonectomy/
- Mediastinal shift towards
- Percussion note dull
- Breath sounds absent
- Vocal resonance absent
What are the features of hyperinflation?
- Reduced cricosternal distance +/- tracheal tug
- Intercostal indrawing (hoover's sign)
What are the differentials for interstitial lung disease (Pulmonary Fibrosis)?
- Bird fancier's lung
- Asbestosis
- Silicosis
- RA
- SLE
- Sarcoid
What are the features of bronchial breathing?
- Loud and blowing
- Length of inspiration = expiration
- Audible gap between inspiration and expiration
What are the causes of fine crepitations?
- Pulmonary oedema
- Interstitial lung disease
What are the causes of coarse crepitations?
- Bronchiectasis
- Cystic fibrosis
- Bibasal pneumonia
What are the different types of pleural effusion?
Transudate (protein <30 g/L)
- LVF
- Volume overload
- Hypoalbuminaemia

Exudate (protein >30 g/L)
- Pneumonia
- TB
- PE
- RA
- Maliganncy (bronchogenic / mesothelioma)
Clubbing + bilateral bi-basal inspiratory crackles?
Interstital lung disease / pulmonary fibrosis
Explain spirometry readings
Obstructive
- Reduction in airflow (air will remain in the lung after expiration)
- COPD / asthma / bronchiectasis

Restrictive
- Reduction in lung volume (due to stiffness inside the lung tissue or chest wall cavity)
- Interstitial lung disease / scoliosis
How do you treat a pnuemothorax?
Tension
- Immediate decompression (2nd intercostal space, mid-clavicular line)

Simple
- ABCDE approach
- <2 cm = obervation + supportive measures
- >2cm = aspiration, if that fails chest drain
What would you like to do to conclude a GI examination?
- Examine groins, genetalia & perform a PR exam
What are the causes of ascites?
Transudate (<30 g/L)
- Chronic liver disease
- RHF
- Hypoalbuminaemia

Exudate (>30 g/L)
- Infection
- Malignancy
What are the causes of hepatomegaly?
- Viral hepatitis
- Ebstein Barr Virus
- Malaria
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
- Primary hepatocellular carcinoma
- Right heart failure
What are the extra-intestinal manifestations of IBD?
- Finger clubbing
- Mouth ulcers
- Episcleritis, conjunctivitis
- Skin = erythema nodosum, pyoderma gangrenosum
- Seronegative spondyloarthropathy
What are the causes of a massive spleen?
- Malaria
- Myelofibrosis
- Chronic myeloid leukemia
What are the differentials for a LIF mass?
- Renal transplant
- Loaded colon
- Diverticular disease
- Colorectal carcinoma
- Ovarian mass / cyst
What are the differentials for a RIF mass?
- Renal transplant
- Appendix mass
- Crohn's disease (inflamed, matted small intestine)
What are the causes of bilateral enlarged kidneys?
- Polycystic kidney disease
- Bilateral hydronephrosis
What are the causes of a unilateral enlarged kidney?
- Hydronephrosis
- Renal cancer
- Renal cyst
What are the indications for dialysis?
- Progressive decline in renal function
- Renal bone disease
- Pericarditis
- Volume overload despite despite fluid restriction and diuretics
- Hyperkalaemia despite treatment
What would you like to do to complete your Hip Examination?
I would like to examine the knee and the lumbar spine
Ix i would like to do = x-rays, CT hip, joint aspiration
What are the indications of a total hip replacement?
- Osteoarthritis
- Displaced intracapsular NOF fracture in young patients
What are the complications of a total hip replacement?
- Perioperative (anaesthetic-related, haemorrhage, infection)
- Acute dislocation
- Chronic infection
What is the typical surgery for neck of femur fracture?
Displaced
- Young / active = total hip replacement
- Old / inactive = hemiarthroplasty

Undisplaced
- Cannulated screw

Extra-capsular fracture
- Dynamic hip screw
What investigations would you like for a knee?
X-rays
MRI
Aspiration effusion
What does a painful arch between 60 to 120 degrees indicate?
Impingement syndrome (supraspinatus tendonitis)
What is frozen shoulder also called?
Adhesive capsulitis
What is the treatment of frozen shoulder?
- Physiotherapy
- Naproxen
- Intra-articular corticosteroid injection
What are the differentials for lumbar back pain?
- Muscular
- Disc prolapse
- Osteoarthritis
- Osteoporotic wedge fracture
- Ankylosing spondylitis
What are the causes of Carpal Tunnel Syndrome?
- Pregnancy
- RA
- Hypothyroidism
- Diabetes
- Acromegaly
What should be covered in a upper limb neurology examination?
- Tone
- Power
- Reflexes
- Co-ordination
- Sensation
What would you like to do to conclude your upper limb neurology exam?
- Nerve conduction studies
- Imaging (CT / MRI)
What should be done to conclude a lower limb neurology examination?
- I would now like to assess gait then complete a full neurological examination
- Spastic paraparesis = examine for sensory level on the thorax
- Flaccid paraparesis = perform PR and check or saddle anaesthesia
What investigations would you like to do for a lower limb neurology examination?
- Nerve conduction studies
- CT Head / MRI Spine
What are the differentials for acute paraparesis?
- Acute spinal cord compression
- Cauda equina syndrome
- Guillian-barre syndrome
- Cord compression
What are the differentials for bilateral leg weakness?
- Stroke
- Tumour
- MS
What are the differentials for peripheral neuropathy?
Alcohol
B12
Chronic kidney disease
Diabetes
What does a 3rd nerve palsy look like?
Down and out
What does a 4th nerve palsy look like?
Up and in
What does a 6th nerve palsy look like?
Just in medially
What are the causes of parkinsonism?
- Idiopathic parkinsons disease
- Drug induced parkinsonism (metaclopramide)
- Parkinson-plus syndrome
What are the causes of cerebellar disease?
- Stroke
- Tumour
- MS
- Alcohol abuse
What are the classic signs of cerebellar lesion?
DANISH
- Dysdiadochokinesis
- Ataxia
- Nystagmus
- Intention tremor
- Speech (slurred, staccato)
- Hypotonia
What investigations would you like to do to conclude a lower limb arterial examination?
Doppler USS, CT Angiogram, ABPI
What are the causes of claudication in the presence of normal peripheral pulses?
- Neurogenic claudication (spinal stenosis)
- Anaemia
- Beta-blockers
What are the 6 P's of a critically ischaemic limb?
- Pain
- Pallor
- Pulseless
- Perishingly cold
- Paraesthesia
- Paralysis
What are the different values of ABPI
> 1 = normal
0.5 - 1 = intermittent claudication
0.3 - 0.5 = rest pain / critical limb ischaemia
< 0.3 = ganfrene + ulceration
What is the management of intermittent claudication?
Conservative
- Stop smoking
- BP control
- Simvastatin

Surgical
- Angioplasty
- Stent
- Bypass graft
- Amputation
What are the causes of a midline neck swelling?
- Goitre
- Thyroglossal cyst
What are the classic features of Graves disease?
- Goitre
- Thyrotoxicosis
- Eye disease (exophthalmos, opthalmoplegia)
What should be done for investigation if a breast lump is found on examination?
Triple assessment
- Full history and examination
- Mammography, uss breast
- Fine needle aspiration
What are the features of a tumour?
- Firm mass
- Continuous with testis
What are the features of a hydrocoele?
- Soft and smooth
- Continuous with testis
- Transilluminable
What are the features of a epididymal cyst?
- Soft and smooth
- Separate
- Transluminable
What are the features of a varicocoele
- Feels like a bag of worms
- Separate to the testis
- Examine patient standing (disappears when laying flat)
- More common on the left
What investigations should be done for scrotal swelling?
- USS
- Tumour markers (alpha-fetoprotein, beta-HCG)
In a rectal examination, what are the different pathologies?
- Polyp = lump, smooth
- Ulcer = try to get above it
What are the pathologies of examination of the prostate?
- Normal = central sulcus
- BPH = smooth + rubbery
- Prostate cancer = unilateral / bilaterally craggy
What are the indications for a digital rectal examination?
- Prostate assessment
- Rectal bleeding
- Altered bowel habit
- Urinary or faecal incontinence
What are the risk factors for colorectal cancer?
- Personal history of colon cancer
- Polyps
- Increasing age
- IBD
- Hereditary non-polyposis colon cancer
- Obesity
- Smoking
What is the sepsis 6?
- Blood cultures
- Lactate
- Urine output
- IV fluids
- Broad-spectrum antibiotics
- High flow O2
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