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Yr2 OSCE > Last minute facts > Flashcards

Last minute facts Flashcards

1
Q

Where does the oblique fissure of the lung run from and to?

A

From T3 to 6th costal cartilage anteriorly

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2
Q

Surface anatomy of the right horizontal fissure?

A

From sternum at the 4th costal cartilage to the oblique fissure

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3
Q

Where is the cardiac notch found?

A

Left side, 4th rib

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4
Q

What vertebral level does the trachea arise at?

A

C6

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5
Q

Surface marking of radial pulse?

A

lateral to flexor carpi radialis tendon

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6
Q

What murmurs do inspiration and expiration increase?

A

Inspiration = right side murmurs

Exp = Left side murmurs

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7
Q

How can you enhance an aortic regurgitation murmur?

A

Increase resistance: squat / place cuff on arm

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8
Q

What cardiac issues cause splinter haemorrhage?

A

Infective endocarditis due to small vegetations breaking off into systemic circulation and manifesting as visible lesions under the nail bed in capillaries

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9
Q

Approximate normal vital capacity?

A

Approximate normal vital capacity?

Can range from 3-5L depending on individual

(Women it is 3.1, men it is 4.8)

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10
Q

When do you get a dull lung? [1]
When do you get a stoney dull lung? [1]

A

Dull: tumour / pneumona / TB

Stoney dull: pleural effusion

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11
Q

When will fremitus be increased and when will it decrease?

A

Increase in areas of consolidation

Decrease in pleural effusion

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12
Q

What can decrease lung sounds?

A

COPD / Asthma

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13
Q

What would leukonychia indicate? [1]

A

Trauma
Chemotherapy
Heavy metal poisoning (lead)

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14
Q

Abdo eye signs? [2]

A

Jaundice in the sclera of eye

Kaiser-Fleischer rings

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15
Q

Describe what test can you do for ascites other than shifting dullness?

A

Fluid thrill. Ask someone to place their hand on the centre of the patients abdomen and then you flick the abdominal wall on one side. If there is ascites the impulse will be felt on the other side

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16
Q

Location of fundus of gall bladder? (surface anatomy)

A

T1 transpyloric plane at the mCL

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17
Q

What is McBurneys point?

A

1/3 of distance from ASIS to umbilicus, location of appendix

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18
Q

What causes palmar erythema that you should be aware of in abdo exam?

A

Increased oestrogen that is usually metabolised in liver, but wont be if liver function compromised

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19
Q

Vertebral level of transtubecular/intertubercular plane?

A

L5

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20
Q

What does the transpyloric plane cross? [4]

A

Pylorus of stomach
Fundus of gall bladder
Neck of pancreas hilium of L kidney and upper pole of R kidney

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21
Q

What part of trachea does the thyroid gland cover?

A

2nd and 3rd tracheal rings

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22
Q

What vertebral level is the thyroid gland?

A

C5-T1

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23
Q

What causes thyroid gland to move upwards upon swallowing?

A

It is embedded in pretracheal fascia

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24
Q

Why stick tongue out in thyroid exam?

A

Look in - lingual thyroid?

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25
Q

Why percuss in thyroid exam?

A

Retrosternal expansion of thyroid

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26
Q

What causes Dupuytren’s contracture? [1]

A

Thickening and shrinking of the palmar fascia
can indicate diabetes, liver disease or thyroid problems

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27
Q

What look for during fundoscopy in CVS exam? [1]

A

Roth spots

White-centered retinal hemorrhages, also known as Roth spots, are retinal hemorrhages that can be seen in a variety of medical conditions. Roth spots are most commonly associated with infective endocarditis and have been detected in 80 percent of cases of subacute bacterial endocarditis.

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28
Q

How does JVP differ from carotid pulse? [6]

A

MOPHAIR

Multi wave form: a and v waves
Occuladble - lightly pressing on it compresses on wave
Positional variation
Hepatojugular reflex
Fills from above
Impalpable
Resp changes

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29
Q

What is a heave? [1]
What is a thrill? [1]

A

Heave: palpable murmur
Thrill: palpable vibration caused by turbulent flow

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30
Q

Parasternal heaves are typically associated with ? [1]

A

Parasternal heaves are typically associated with right ventricular hypertrophy.

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31
Q

Causes of radio-radial delay include? [3]

A

Subclavian artery stenosis (e.g. compression by a cervical rib)
Aortic dissection
Aortic coarctation

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32
Q

Describe 4 type of pulse character and what theyre associated with

A

Normal
Slow-rising (associated with aortic stenosis)
Bounding (associated with aortic regurgitation as well as CO2 retention)
Thready (associated with intravascular hypovolaemia in conditions such as sepsis)

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33
Q

Hypotension is indicated by? [1]

A

Hypotension: blood pressure of less than 90/60 mmHg

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34
Q

What would a difference of blood pressure between two arms indicate? [1]

A

Difference between arms: more than 20 mmHg difference in blood pressure between each arm is abnormal and may suggest aortic dissection

35
Q

What is the position of the larnyx? [1]

A

The carotid pulse can be located between the larynx and the anterior border of the sternocleidomastoid muscle.

36
Q

Names for shape of chests?

A

Pectus excavatum: a caved-in or sunken appearance of the chest.
Pectus carinatum: protrusion of the sternum and ribs.

37
Q

Displacement of the apex beat from its usual location can occur due to? [1]

A

Displacement of the apex beat from its usual location can occur due to ventricular hypertrophy.

38
Q

How do you test for heaves and thrills?

A

Heave:
* Place the heel of your hand parallel to the left sternal edge (fingers vertical) to palpate for heaves.

Thrill:
* horizontally across the chest wall, with the flats of your fingers and palm over the valve to be assessed.

39
Q

What lung ascultation would indicate pulmonary oedema? [1]

A

Coarse crackles are suggestive of pulmonary oedema (associated with left ventricular failure).

40
Q

What would suggest pleural effusion on ascultation of lung fields?

A

Absent air entry and stony dullness on percussion are suggestive of an underlying pleural effusion (associated with left ventricular failure).

41
Q

What assessing for in eyes of resp exam? [1]

A

Horners syndrome: due to lung cancer at apex of lung

42
Q

Lymph nodes?

A

Submental, submandibular, pre- auricular/parotid, posterior auricular/mastoid, occipital, ant. cervical, post cervical, deep cervical, supraclavicular

43
Q

When might you see changes in inspiratory / exp phase of inhalation [2]

A

the expiratory phase is often prolonged in asthma exacerbations and in patients with COPD).

44
Q

Things looking for when assessing mouth in resp?

A

Central cyanosis: bluish discolouration of the lips and/or the tongue associated with hypoxaemia.

Oral candidiasis: a fungal infection commonly associated with steroid inhaler use (due to local immunosuppression). It is characterised by pseudomembranous white slough which can be easily wiped away to reveal underlying erythematous mucosa.

45
Q

Reasons for symmetrical reduced chest expansion? [3]

Reasons for asymmetrical reduced chest expansion? [3]

A

Symmetrical: pulmonary fibrosis reduces lung elasticity, restricting overall chest expansion.

Asymmetrical: pneumothorax, pneumonia and pleural effusion would all cause ipsilateral reduced chest expansion.

46
Q

When assessing breath sounds, how would you describe:

Quality of breath sounds? [2]
Volume of breath sounds? [1]
Added sounds? [4]

A
47
Q

Why can second heart sound split?

A

The difference in timing between the closure of the aortic and pulmonary valves
physiological: during inspiration intrathoracic pressure increases, increases venous return, pulmonary valve closes slightly later.
pathological: LBBB and aortic stenosis cause the aortic valve closure to be delayed

48
Q

reasons for a pulse deficit?

A

difference between the apical and radial pulse rates
due to eg. atrial fibrillation

49
Q

where do you find posterior tibial pulse

A

posterior and inferior to medial malleolus

50
Q

resp causes of wasting of small hand muscles?

A

lung cancer involving the brachial plexus

51
Q

What is this sign? [1]

A

Xanthomata are raised yellow cholesterol-rich deposits that are often noted on the palm, tendons of the wrist and elbow.

Xanthomata are associated with hyperlipidaemia (typically familial hypercholesterolaemia), an important risk factor for cardiovascular disease.

52
Q

Reasons for Dupuytren’s contracture? [4]

A

Excessive alcohol intake
Manual work: especially involving vibrational machinery
Smoking: smokers are 3 times more likely to develop the condition
Diabetes mellitus: 1 in 5 diabetic patients develop the condition
70% of patients have a hereditary component

53
Q

horizontal fissure location?

A

horizontal line from 4th ICS anteriorly to oblique fissure

54
Q

inferior border of lungs?

A

upper border of 8th rib
(back T10)

55
Q

leuconychia sign of? [3]

A

Nailbed trauma
Hypoalbuminaemia (e.g. end-stage liver disease, protein-losing enteropathy)
Chemotherapy

56
Q

GI causes of clubbing? [3]

A

GI lymphoma, IBD, coeliac disease

57
Q

GI causes of course, irregular tremor?

A

liver failure

58
Q

GI causes of Kaiser-Fleischer rings?

A

Wilson’s disease, copper deposition in iris

59
Q

Abdo exam - mouth

A

angular stomatitis
glossitis
ulcers
distinct breath odor

60
Q

Cause of rebound tenderness? [1]

A

peritonitis

61
Q

Questions for end of abdomen exam? [3]

A

Pregnancy test
Hernias - any lumps: cough impulse

62
Q

name for what assessing when shining light in eyes? [2]

A

direct and consensual pupillary reflex
swinging light reflex

63
Q

Antalgic gait?

A

Limping, gait that can develop to avoid pain while walking

64
Q

foot drop gait causes?

A

L5 weakness, foot drops in swing phase, use hip/leg to compensate
common fibular nerve

65
Q

Scissor gait

A

legs cross midline upon advancement
spastic cerebral palsy or other UMN lesion

66
Q

Nerve roots for:

o Shoulder abduction
o Elbow flexion
o Elbow extension
o Wrist flexion/extension
o Finger flexion/extension
o Finger adduction

A

o Shoulder abduction (C5) o Elbow flexion (C5/6)
o Elbow extension (C7/8)
o Wrist flexion/extension (C6/7) o Finger flexion/extension (C7/8) o Finger adduction (T1)

67
Q

Supinator reflex is testing which nerve roots?

A

(C5,6)

68
Q

What does clonus indicate? [1]

A

Gently roll each ankle then briskly dorsiflex the foot
o Beats of clonus (repetitive muscle contractions) = UMN lesion

69
Q

patellar tendon reflex roots?

A

L3-4

70
Q

achilles tendon reflex? [1]

A

(S1/2)

71
Q

Normal and abnormal Babinski reflex? [1]

A

Their big toe should plantarflex. Dorsiflexion = UMN lesion (or normal in babies who are not yet
bipedal)

72
Q

Proprioception? [1]

A

DCML

73
Q

Vibration? [1]

A

dorsal column

Using a 128Hz tuning fork, hit it against a firm surface to start it vibrating

74
Q

How to use a Snellen chart?

A
  • Ask if using glasses / contacts
  • Stand 6m away from chart
  • Cover one eye
  • Read as far down as possible
  • Repeat with other eye
  • Visual acuity is chart distance (numerator) / number of lowet line read (denominator)
  • If patient gets more than 2 letters wrong then previous line should be recorded as acuity
  • If 2 wrong, record as 6/6 (-2)
75
Q

How to use a Snellen chart?

A
  • Ask if using glasses / contacts
  • Stand 6m away from chart
  • Cover one eye
  • Read as far down as possible
  • Repeat with other eye
  • Visual acuity is chart distance (numerator) / number of lowet line read (denominator)
  • If patient gets more than 2 letters wrong then previous line should be recorded as acuity
  • If 2 wrong, record as 6/6 (-2)
76
Q

Nerve roots for:

o Hip Flexion
o Hip Extension
o Knee Flexion
o Knee Extension
o Ankle Dorsiflexion
o Ankle Plantarflexion
o Big toe extension

A

o Hip Flexion (L2/3)
o Hip Extension (L4/5)
o Knee Flexion (L5/S1)
o Knee Extension (L3/4)
o Ankle Dorsiflexion (L4/5)
o Ankle Plantarflexion (S1/2) o Big toe extension (L5 only)

77
Q

normal carrying angle in women?

Name for increased / decreased carrying angle? [2]

A

5-15

Greater: cubitus valgus
Lesser: Cubitus varus

78
Q

Myotomes and reflexes for upper and lower limb?

A
79
Q

muscles attaching to medial epicondyle?

A

pronator teres
flexors of anterior forearm (pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis, and flexor carpi ulnaris muscles)

80
Q

muscles attaching to lateral epicondyle?

A

supinator
common extensors of elbow and wrist

81
Q

Resisted external rotation tests which muscles in shoulder exam? [2]

A

infraspinatus, teres minor

82
Q

Resisted internal rotation tests which muscles?

A

subscapularis, teres major

83
Q

What is the name for the test of acriomiocalvicular joint in shoulder?

A

Neers test

Yr2 OSCE (1 decks)

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