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NME Flashcards

1
Q

A patient presents with LUTS, what are voiding symptoms and what is the most likely cause?

A

Hesitancy, decreased flow, incomplete voiding, intermittent flow

Most likely caused by obstruction (prostate, stricture, retention)

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2
Q

A patient presents with LUTS, what are storage symptoms and what is the most likely cause?

A

Frequency, urgency, urge incontinence, nocturia

Most likely UTI (but could also be pregnancy, overactive bladder or tumor)

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3
Q

Name 4 red flags to ask about if a patient presents with LUTS?

A

Haematuria
Weight loss
Saddle anesthesia
Abdominal pain

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4
Q

On abdominal examination, what is suggested by a finding of: Palmar erythema?

A

Liver disease

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5
Q

On abdominal examination, what is suggested by a finding of: Dupuytren’s contracture

A

Alcohol excess

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6
Q

On abdominal examination, what is suggested by a finding of: Kolionychia (spoon nails)

A

Chronic iron deficiency

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7
Q

On abdominal examination, what is suggested by a finding of: Leukonychia

A

Hypoalbuminaemia

Liver failure

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8
Q

On abdominal examination, what is suggested by a finding of: Hepatic flap

A

Hepatic encephalopathy
Uremia
CO2 retention

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9
Q

On abdominal examination, what is suggested by a finding of: Petechiae

A

Low platelets

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10
Q

On abdominal examination, what is suggested by a finding of: Hair loss

A

IDA

Malnourishment

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11
Q

On abdominal examination, what is suggested by a finding of: Acanthosis nigricans

A

GI adenocarinoma

Obesity

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12
Q

On abdominal examination, what is suggested by a finding of: Xanthelasma

A

Hyperlipidaemia

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13
Q

On abdominal examination, what is suggested by a finding of: Angular stomatitis

A

IDA

B12 deficiency

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14
Q

On abdominal examination, what is suggested by a finding of: Mouth ulcers

A

Crohns

Coeliac

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15
Q

On abdominal examination, what is suggested by a finding of: Oral candidiasis

A

Immuniodeficiency
Steroid use
IDA

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16
Q

On abdominal examination, what is suggested by a finding of: Glossitis

A

IDA

B12 or folate deficiency

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17
Q

On abdominal examination, what is suggested by a finding of: Spider naevi

A

> 5 suggests chronic liver disease

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18
Q

On abdominal examination, what is suggested by a finding of: Gynaecomastia

A

Liver cirrhosis

Spironolactone/ digoxin

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19
Q

On abdominal examination, what is suggested by a finding of: Cullen’s sign (and what is it?)

A

Bruising around umblicus

Pancreatitis or ruptured AAA

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20
Q

On abdominal examination, what is suggested by a finding of: Grey turners sign (and what is it?)

A

Bruising in flanks

Pancreatitis or ruptured AAA

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21
Q

On abdominal examination, what is suggested by a finding of: Striae

A

Shows distension

22
Q

On abdominal examination, what is suggested by a finding of: Caput medusa

A

Portal hypertension

Chronic liver disease

23
Q

What is Murphy’s sign and how do you examine for it

A

Press at 9th costal margin, MC line
Ask patient to inspire
If they stop inspiration this is Murphy’s positive as pain from inflamed gallbladder has prevented further inspiration

24
Q

What are the management options for a patient with diverticulosis? (3)

A

High fibre diet,
Bulk forming laxatives
Paracetamol for pain

25
What are the consequences of UC which a patient should be counselled on?(3)
2x risk o CRC Risk of osteoporosis 25% lifetime surgery
26
What do you advise a patient with UC about colonoscopy follow up?
After 10 years have a colonoscopy every 1-3 years due to CRC risk
27
What do you advise a patient with Crohn's about colonoscopy follow up?
One colonoscopy 10 years after diagnosis
28
How long does carbimazole take to work?
4-8 weeks
29
How long is a patient likely to take carbimazole?
12-18months | 50% then cured
30
What checks are done when a patient is on carbimazole?
TFT's monthly
31
What are the common side effects of carbimazole?
Headache, sickness, taste change | Should pass in a few weeks
32
What is the important SE you must council on for carbimazole?
Agranulocytosis (Fever, rash, sore throat, mouth ulcers) Check WCC immediately
33
How long does a patient take levothyroxine for?
Lifelong
34
How should levothyroxine be taken?
``` Before breakfast (Iron or calcium can affect absorption) ```
35
How should a patient on levothyroxine be monitored?
Check TFT's after 1 month
36
What are the SE of levothyroxine?
Weight loss, diarrhoea, irritability, sweating etc
37
What should a patient on levothyroxine be counseled on regarding prescriptions?
Free for life
38
Name 3 bits of lifestyle advice for a patient with newly diagnosed diabetes?
Healthy diet Lose weight 30mins exercise 3x/ week Stop smoking/ control BP
39
What are the common SE's of metformin? (4)
Nausea, diarrhoea, change in taste, lack of appetite
40
What is the rare but important SE of metformin?
Lactic acidosis If very sick, very tired, very SOB let doctor know. - Normally occurs when already unwell - Alcohol can precipitate
41
What should a patient be warned about regarding hospital admissions with metformin?
Advise doctors (as can raise risk of AKI so is normally stopped) Can't have if having contrast
42
How should a patient be counselled to take their metformin?
Same time each day Take after food Swallow whole don't break or chew
43
What should a patient do if they forget a dose of metformin?
Take next dose as normal | Don't take two doses together
44
For a patient with newly diagnosed T2DM, how often should the HbA1c be checked?
3-monthly until stable | Then 6 monthly
45
Name 5 symptoms to council a patient on for a hypo?
Trembling, sweating, anxiety, tingling, blurred vision, confusion
46
What blood test should you do before starting a patient on metformin?
Kidney function
47
In a diabetic foot examination, what three pieces of equipment are needed?
Mono-filament Tuning fork Tendon hammer
48
What are the signs of PAD on inspection of the leg in a diabetic foot exam (3)?
Dry/shiny skin | Hair loss
49
What are the signs of venous disease in a peripheral vascular exam (2)?
Haemosiderin deposits | Eczema
50
What are the characteristics are arterial ulcers? (4)
Very painful Deep and punched out appearance With diabetes/ PAD
51
What are the characteristics of venous ulcers?(4)
Less pain Large and shallow Associated with venous disease
52
Name the components that should be checked in a lymph node examination.
Head and neck LN's (Inspect and palpate) Axiallary LN's (Ant, medial, post, lateral, apical) - Gloves Epitrochlear + popilteal LN's Inguinal (Horizontal and vertical chains) Palpate for hepato or splenomegaly

OSCE (6 decks)

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