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Year 6 > OSCE > Flashcards

OSCE Flashcards

1
Q

S1 noise represents

A

AV vlaves close

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2
Q

Soft S1

A

AV valves close with reduced velocity
- reduced contraction (severe heart failure)
- valves don’t close properly (MR)
- valves alreaedy partially closed at end of diastole as atrial relax occurs before LV contraction (prolonged PR interval)

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3
Q

S4/atrial gallop

A

(before S1)
Pressure overload: atrial contraction into stiff hypertrophied ventricle
- LV hypertrophy
- Hypertension
-Aortic stenosis

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4
Q

Loud S1

A

AV valves close with highger velocity as they are wide open at end of diastole
- high atrial pressure (MS, AF)
- short diastole (short PR interval, tachycardia)

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5
Q
A
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6
Q

Split S1

A

= asynchronous AV valve closure
- can be normal, but wide split may suggest RBBB or ASD

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7
Q

What is S2

A

Aortic/pulmonary vallves close

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8
Q

Soft S2

A

= reduced aortic/pulmonary valve motility
- AS
- PS

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9
Q

Loud S2

A

= valves close with higher velocity due to high upstram pressure
- pulonary hypertension
- systemic hypertension

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10
Q

Split S2 on inspiration

A

= physiological. Aortic valve closes first bcause pulm valve closure slightly delayed by increased blood return to right heart, due to negative intrathoracic pressure

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11
Q

Wide split S2

A

= exaggerated split, which increases during inspiration (aortic valve closing before pulmonary)
- RBBBB
- Increased resistance to RV ejection eg pulmonary hypertension or PS

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12
Q

Reverse split S2

A

= split which icnreases during expiration (pulmonary valve closes before aortic)
- LBBB
- incr resistance to LV ejection eg systemic hypertension or AS

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13
Q

S3/ventricular gallop

A

(after S2)
= volume overload: high volume blood from atrium rapidly fills ventricle during passive filling phase
- left ventricular failure
- hyperdynamic states, eg athlete, anaemia, fever, thyrotoxicosis

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14
Q

Causes of aortic stenosis

A

Age (senile calcification)
Bicuspid aortic valve (eg in Turner’s)
Congenital
Rheumatic heart diseease

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15
Q

Causes of mitral regurg

A

papillary muscle dysfunction (post MI)
Dilated cardiomyopathy
RHeumatic heart disease
infective endocarditis
congenital
connective tissue disorders- eg Marfan’s

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16
Q

Causes of mitral valve prolapse

A

Associated with:
connective tissue disease: Marfan’s, Ehler’s Danlos, osteogenesis imperfecta
Cardiac disease: congenital heart disease, congestive cardiomyopathy, HOCM, myocarditis
Other: SLE, muscular dystrophy, ADPKD

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17
Q

Mitral valve prolapse features

A

Mid-systolic clic, and/or late syystolic murmur (so normal S1 and GAP before murmur, unlike in mitral regurg)
As in ventricular systole, mitral valve leaflet prolapses to left atriium

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18
Q

Causes tricuspid regurgitation

A

Most commonly: RV dilation in pulmonary hypertension
rheymatic heart disease
Infective endocarditis (partic IVDU)
Ebstein’s abnormality (if split S1 and S2)

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19
Q

Causes mitral stenosis

A

Rheumatic heart disease

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20
Q

Causes aortic regurgitation

A

Acute: infective endocarditis, aortic dissection
Chronic: connective tissue disorders, rhematic heart disease, syphilis, congenital/bicuspid aortic valve, long standing hypertension

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21
Q

Heart failure signs

A

Tachypnoea/tachycardia
Cool peripheries
Raised JVP
Displaced apex
S3
Bibasal fine creps
Peripheral oedema

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22
Q

ASD signs

A

Soft, ejection systolic flow murmur (pulm area). Fixed, wide split S2. RV heaveAssociations: Down’s syndrome eg low set ears, flat nasal bridge etc
Watch out for cyanosis = Eisenmenger’s

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23
Q

VSD signs

A

pansystolic murmur (loudest left sternal edge) associated thrill, RV heave
If causing R heeart failure: raised JVP, peripheral oedema

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24
Q

signs of cor pulmonale

A

Plethoric facial appearance
central cyanosis
Raised JVP (large A waves)
Giant V waves and pansystolic murmur (if secondary to tricuspid regurg)
R ventricular heave
Palpable/loud S2
Ankle oedema

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25
Q

Signs tetralogy of fallot repair

A

Sternotomy scar
Latera

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26
Q

Nerve root hip flexion

A

L2/L3

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27
Q

Nerve root hip extension

A

L4/5

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28
Q

Nerve root jnee extension

A

L3/4

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29
Q

Nerve root knee flexion

A

L5/S1

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30
Q

Nerve root ankle dorsiflexion

A

L4/5

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31
Q

Nerve root ankle plantar flexion

A

S1/S2`

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32
Q

Nerve root big toe extension

A

Pure L5

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33
Q

How many beats of clonus indicates UMN lesion?

A

> 5

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34
Q

Patellar reflex nerve root

A

L3,4 (kick the door)

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35
Q

Ankle reflex nerve root

A

S1/2 (in the shoe)

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36
Q

Indications UMN lesion

A

Incr tone
Spasticity
Hyper-reflexia and upgoing plantar
weakness

37
Q

Indications LMN lesion

A

Wasting and fasciculation
Hypotonia
Weakness
Reduced reflexes

38
Q

Shoulder abduction nerve root

A

C5

39
Q

Elbow flexion nerve root

A

C6

40
Q

Elbow extension nerve root

A

C7

41
Q

Wrist extension nerve root

A

C7

42
Q

Finger extension nerve root

A

C7

43
Q

Finger flexion nerve root

A

C8

44
Q

Finger abduction nerve root

A

T1

45
Q

Causes bilateral UMN weakness

A

MS
Motor neuron disease
Myelopathy (due to cervical myelopathy, SOL, disc prolapse, paraspinal infection), trauma, trasnverse myelitis, syringomyelia
Others: brainstem stroke, cerebral palsy

46
Q

Abnormal sensation and LMN weakness distally

A

= sensorimotor polyneuropathy: ABCDE
Alcohol
B12/thiamine deficiency
Charcot-Marie-Tooth
Diabetes, Drugs (TB drugs, metronidazzole, cisplatin etc)
Every vasculitis

47
Q

Normal sensation and LMN weakness distally (chronic)

A

= distal motor neuropathy
CIDP
Myotonic dystrophy
Progressive muscular atrophy
Lead poisoning
Porphyria

48
Q

Acute flaccid paralysis

A

Guillain-Barre syndrome
some rare infections eg rabies, polio, West nile
Cauda equina (usually sensory deficits, often asymnetrical)
Acute transverse myelitis (although not technically LMN, presents with hypotonia and hyporeflexia acutely)

49
Q

Differentials proximal weakness and normal sensation

A

Dystrophies: Becker’s Duchenne;s
Endocrinological: Cushings. thyroid issues
Neuromuscular: MG, lambert-eaton
inflammatory: dermato/polymyositis

50
Q

Differentials cerebellar disease

A

MS
Alcohol
Thromboembolic/haemorrhage
Inherited: Friedreich’s, spinocerebellar ataxia, ataxia telangectasia
SOL

51
Q

Differentials mixed UMN +LMN signs

A

Motor neuron disease (nil sensory deficit)
Myeloradiculopathy
SACD of cord (symnetrical UMN signs with absent reflexes)

52
Q

Medical causes third nerve palsy

A

Diabetes
Migraine
MS

Classically pupil sparing

53
Q

Surgical causes third nerve palsy

A

Posterior communicating artery aneurysm
Cavernous sinus lesion
cancer

Classically involve pupil and painful

54
Q

Causes monocular vision loss

A

Ipsilateral retinal or optic nerve lesion
Retinal: central retinal artery/vein occlusion, retinal detachment
Optic nerve: optic neuritis, optic atrophy, glaucoma

55
Q

Causes bitemporal hemianopia

A

Optic chiasm lesion
Superior: pituitary tumour
Inferior: craniopharygoma

56
Q

Causes homonymous hemianopia

A

Lesion in contralateral optic tract (or whole optic radiation)
Eg MCA occlusion

57
Q

Causes homonymous inferior quadrantopia

A

Lesion in contralateral parietal optic radiation
Eg parietal tumour or superior branch of MCA occlusion

58
Q

Causes homonymous superior quadrantopia

A

Lesion in contralateral temporal optic radiation
Eg temporal tumour or inferion MCA branch occlusion

59
Q

Causes homonymous hemianopia with macular sparing

A

Contralateral occipital visual cortex lesion
Eg posterior cerebral artery occlusion

60
Q

Median nerve motor function

A

Thumb abduxtion
Pincer grip of thumb

61
Q

Median nerve sensory distribution

A

Index finger palm of hand

62
Q

Ulnar nerve motor function

A

Finger abduction

63
Q

Ulnar nerve sensory distribution

A

Little finger on palmar side

64
Q

Radiial nerve motor function

A

Wrist extensio

65
Q

Radial nerve sensory test

A

Anatomical snuff box (between thumb and index) on dorsal side of hand

66
Q

Differentials decreased air entry

A

Emphysema, pneumothorax, pleural effusion, collapse

67
Q

Differentials wheeze

A

Asthma, COPD, cardiac wheezeD

68
Q

Differentials coarse creps

A

Bronchiectasis, consolidation

69
Q

Differentials fine creps

A

Fine inspiratory: pulmonary oedema
Fine end inspiratory (like velcro): pulmonary fibrosis

70
Q

Differentials pleural rub (grating sound)

A

Pleurisy, pumonary infarction, pneumonia, pleural malignanct

71
Q

Examination findings pneumonia

A

Trachea central
Reduced expansion ipsilaterally
Decr percussion resonance
Bronchial breathing (harsh breath sounds) + coarse creps

72
Q

Examination findings pleural effusion

A

Trachea defiated away if large
Reduced expansion ipsilaterally
Stony dull percussion
Reduced/absent breath sounds
Reduced tactile fremitus and vocal resonance
Signs of aetiology: clubbing/radiation marks/lymphadenopathy = mesothelioma/lung malignancy
Signs of chronic liver disease = cirrhosis
pulmonary/peripheral oedema = heart failure

73
Q

Examination findings lung collapse

A

Tracheal deviation towards collapse
Reduced expansion ipsilaterally
decreased percussion resonance
reduced/absent breath sounds

74
Q

signs bronchiectasis

A

Productive cough
Inspiratory clicks
Clubbing
Coarse, late expiratory creps
+ signs of aetiology
- young and thin = CF
- lymphadeoma = malignancy
- dextrocardia = Kartagener’s

75
Q

Signs of lung cancer

A

Cachexia
Clubbing
Tar-stained fingers
Hard, irregular lymphadenopathy
Radiation burns

Signs of complications
- ptosis/meiosis/anhydrosis = Horner’s
- paraneoplastic syndromes

76
Q

Signs of pulmonary fibrosis

A

Oxygen therapy
Dry cough
Tachypnoea
reduced expansion
Fine end inspiratory creps

Signs of aetiology:
- hand deformity = RA
- clubbing = idiopathic lung fibrosis
- sclerodactyly/telangiectasia/microstomia = systemic sclerosis
- butterfly rash = SLE
- kyphosis = ank spond
- erythema nodosum = sarcoid

77
Q

Signs of COPD

A

Bedside inhalers/nebs
Accessory muscle use
Tar stained fingers
Tachypnoea
Lip pursing
Reduced cricosternal distance (<3 fingers)
Tracheal tug
Indrawing of lower intercostal muscles on ispiration
Hyper resonance (obliterated cardiac and hepatic dullness(
Quiet breath sounds/wheeze/prolonged expiratory phase

78
Q

venous leg inspection

A

Swelling
venous eczema
Haemosiderin deopsition
Lipodermatosclerosis -> inverted champagne bottle leg
venous ulcers
Atrophie blanche

79
Q

Percussing varicosities

A

tap distally and feel impulse proximally = normal
Tap proximally and feel impulse distally = incompetent valves

80
Q

Tourniquet test

A

If varicosities present helps establish level
Lift patient leg high and milk leg to empty veins
Then apply tourniquet (quite high up leg)
Ask patient to stand with tourniquet done up
Rapid filling of varicosities = suggests incompetent perforating veins lie below the level of tournique
Redo moving tourniquet down 3cm at a time. when varicosities do not refill, incompetent perforator is above the tourniquet, but below where previously applied.

81
Q

Top causes of hepatomegaly

A

Mets
HCC
Hepatitis
Right ventricle failure
Leukaemia/lymphoma
Fatty liver
alcoholic liver disease

82
Q

Top causes splenomeg

A

Lymphoma/leukaemia
Myelofibrosis
Myeloproliferative disrders
Portal hypertension
Extravascular haemolysis
Malaria
EBV

83
Q

Signs chronic liver disease

A

Clubbing
Leukonychia
Palmar erythema
Dupuytren’s contracture
Jaundice
Spider naevi
Gynaecomastia
Loss of axillary Hair
Caput medusae and splenomeg *(if portal hypertension)
Hepatomegaly
AScites

84
Q

Transplanted kidney signs

A

old AV fistula
Hockey stick (Rutherford Morrison scar) usually RIF
SMooth mass of transplanted kidney underlying scar
Signs of aetiology
- fingertip glucose monitoring mars = diabetes
- hearing aid = Alport syndrome
- collapsed nasal bridge = Wegener’s
- flank masses = APKD
Functionality?
- flap/excoriations = uraemia
- active marks in AV fistula
- Pale confunctiva = anaemia
- fluid retention
Complicaitons of immunosuppression
- tremor (calcineurin inhibitor)
- cushingoid from steroids
- skin lesiosn/excisions

85
Q

Polycystic kidneys signs

A

AV fistula
Hypertension
Pale conjunctiva
Flank scar if either kidney removed
Bilateral ballotable flank masses
Hepatomegaly (hepatic cysts)

86
Q

Liver transplant signs

A

Signs of chronic liver disease (but most do resolve)
Mercedes benz scar
poss some signs of aetiology
Complications of immunosuppressants
- tremor (calcineurin inhibitor)
- cushingoid/bruising (steroids)
- skin lesions/excisions (immunosuppress -> SCC)

87
Q

Combined kidney-pancreas transplant

A

LIF scar + RIF scar. With smooth mass underlying LIF which is transplanted kidney
Signs of diabetic complications
- visual aids from retinopathy
- Charcot joints
- toe ulcers/amputations
- neuropathy
Renal graf functionality
Pancreas graft functionality
- fingertip CBG monitoring, insulin injection marks
Signs previous renal replacement theraapy
Complications of immunosuppression

88
Q

Signs PBC

A

Middle age female
Jaundice
Skin hyperpigmentation
Excoriations
Xanthelasma
Hepatomegaly

Year 6 (9 decks)

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