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OSCE Flashcards

1
Q

Criteria for adequacy on a CXR

A

RIPE
Rotation - med borders of clavicles equidistant from spinous process
Inspiration - at least 5-6 ant ribs visible above diaphragm
Picture area - lung apices, costodiaphragmatic recesses, scapula out of the way
Exposure - vertebral bodies should be just visible through the lower part of the cardiac shadow

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2
Q

CXR abnormalities in COPD

A 
Hyperinflation
Flattened hemi-diaphragm 
Dec lung markings
Black lesions (bulla)
Prominent hila
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3
Q

Structure for interpreting a MSK XR

A 
ABCS
Alignment - dislocation or subluxation
Bones - fractures
Cartilage - joint spaces
Soft tissue - swelling, disruption, foreign bodies
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4
Q

Structure for describing a fracture

A

SOD
Site - intra v extra-articular, position (prox/mid/distal third)
Obliquity - completeness, direction, open v closed, condition of bone (comminuted, segmental etc)
Displacement - angulation, translation, rotation

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5
Q

Structure for assessing the P wave. Common abnormalities?

A

Height <2 small squares (inc in RA hypertrophy - P HTN)

Morphology - bifid in MS, peaked in RA hypertrophy

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6
Q

Normal PR interval length. Common abnormalities?

A

3-5 small squares
Dec in accessory conduction pathways
Inc in HB

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7
Q

System for assessing the QRS complex

A

R wave progression
Length (rhythm strip) - <3 small squares
Height (V1, V5/6) - <4 small squares
Q waves

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8
Q

Causes of delayed R wave progression

A

RV enlargement (chronic LD)

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9
Q

What are pathological Q waves?

A

Abnormal large Q waves due to established/previous MI

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10
Q

Causes of saddle shaped ST segment

A

Pericarditis

Tamponade

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11
Q

In which leads would we accept T wave inversion?

A

III, aVR and V1

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12
Q

Normal QTc length. Causes of abnormalities?

A

<450ms

Inc predisposes to polymorphic VT

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13
Q

Most common organism causing IE?

A

Staph aureus

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14
Q

Most common organism causing IE on prosthetic valves?

A

Staph epidermidis

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15
Q

ABx for IE on native valve, or a prosthetic valve >1yr old

A

Ampicillin + fluclox + gent

Vanc + gent if pen allergy

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16
Q

ABx for IE on new prosthetic valve

A

Vanc + gent + rifampicin

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17
Q

What colour are gram +ve and -ve bacteria?

A 
\+ve = purple/blue
-ve = pink/red
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18
Q

How do penicillins work? Give 5 examples and when they’re used

A

Inhibit cell wall synthesis

  • Penicillin G -> gram +ve strep (chest, throat, endo)
  • ampicillin/amox -> URTI, sinusitis, chest, otitis media, UTI, H P
  • co-amox -> chest, pyelonephritis, cellulitis, bone
  • tazocin (piperacillin+tacobactam) -> broad spec (gram +ve and -ve
  • fluclox -> staph (skin, bone)
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19
Q

How do cephalosporins work? Give an example and when you’d use it

A

Inhibit cell wall synthesis

- ceftriaxone -> broad spec (CAP, HAP, UTIs, skin, bone, meningitis)

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20
Q

How do carbapenems work? Give an example and when you’d use it

A

Inhibit cell wall synthesis

- meropenem -> broad spec (+ve, -ve, aerobes, anaerobes)

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21
Q

How do lipopeptides work? Give 2 examples and when you’d use them

A

Inhibit cell wall synthesis
- Vanc
- Teicoplanin
Complicated +ve (incl MRSA), C Diff

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22
Q

How do aminoglycosides work? Give an example and when you’d use it

A

Inhibit protein synthesis

- gent -> -ve

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23
Q

How do macrolides work? Give 3 examples and when you’d use them

A

Inhibit protein synthesis
Azithromycin, erythromycin, clarithromycin
+ve cocci - chlamydia (not entero or staph)

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24
Q

How do tetracyclines work? Give an example and when you’d use it

A

Inhibit protein synthesis

Doxycycline - COPD exac, chlamydia, MRSA, malaria proph

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25
Q

How do folate synthesis inhibitors work? Give an example and when you’d use it

A

Inhibit nucleic acid synthesis

- trimethoprim -> -ve: UTI, prostatitis

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26
Q

How do fluoroquinolones work? Give an example and when you’d use it

A

Inhibit nucleic acid synthesis

- ciprofloxacin -> broad spec: UTI, prostatitis, HAP, infectious diarrhoea

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27
Q

How does metronidazole work? When would you use it?

A

Inhibits nucleic acid synthesis

Anaerobic - intra-abdo, pelvic, oral, C. Diff

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28
Q

How does rifampicin work? When would you use it?

A

Inhibits nucleic acid synthesis

Mycobacteria (TB)

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29
Q

Surgical site infection organism and treatment

A 
Staph aureus (G +ve)
Flucloxacillin (+gent if severe)
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30
Q

Abx against staphlococcus

A

Penicillins

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31
Q

Abx against streptococcus

A

Penicillins

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32
Q

Most common cause of CAP. Therefore what ABx do you prescribe?

A

Strep pneumoniae, gram +ve -> Amoxicillin and/or clarithromycin (depending on CURB)

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33
Q

Abx for H Influenzae

A

Gram -ve -> cephalosporin eg cefuroxime

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34
Q

Abx for pseudomonas

A

Gram -ve -> ciprofloxacin

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35
Q

Most common cause of infectious GI disease

A

Norovirus

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36
Q

ABx in acute appendicitis

A

Tazocin (piperacillin/tazobactam

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37
Q

ABx in acute cholecystitis

A

Co-amoxiclav

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38
Q

ABx in ascending cholangitis

A

Tazocin (piperacillin/tazobactam)

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39
Q

ABx in acute abdomen (incl peritonitis)

A

Tazocin

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40
Q

Treatment of asymptomatic bacteriuria

A

Don’t use ABx in non-pregnant women, men and adults with catheters unless they have symptoms

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41
Q

Treatment of UTI in non-pregnant woman

A

3days nitrofurantoin if GFR>45, or trimethoprim

If this fails, culture urine

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42
Q

Treatment of an upper UTI in a non-pregnant woman

A

Culture

Broad spec ABx (e.g. Co-amoxiclav)

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43
Q

Treatment of UTI in men

A

7d nitrofurantoin if GFR>45, or trimethoprim

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44
Q

Treatment of septic arthritis

A

Aspirated and culture
Start empirical ABx whilst awaiting culture - follow local guidelines
Consider Flucloxacillin, vanc, cefuroxime
4-6wk total

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45
Q

Treatment of acute bronchitis

A

Amoxicillin 5d

Or doxycycline 5d

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46
Q

ABx in bronchiectasis

A

Amoxicillin 10d

Or clarithromycin 10d

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47
Q

ABx in acute diverticulitis

A

Co-amoxiclav 7d

Or ciprofloxacin + metronidazole 7d

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48
Q

Most common cause of osteomyelitis in adult?

A

Staph aureus

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49
Q

Main organisms in bronchiectasis

A

H influenzae
Strep pneumonia
Staph aureus
Pseudomonas

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50
Q

Common causes of septic arthritis

A

Staph aureus
Streptococci
Neisseria
Gram neg bacilli

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51
Q

Organism most likely responsible for COPD infective exac

A

H influenzae

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52
Q

Most likely cause of nephrotic syndrome in a 32yo male

A

FSGS

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53
Q

Most common cause of hepatocellular carcinoma in the UK

A

Hep C

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54
Q

Treatment of osteomyelitis

A

Vancomycin and cefotaxime

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55
Q

Symptoms to ask about in acromegaly

A 
Headaches
Change in appearance - hands, face, dental changes
Change in voice
Sleep apnoea
Carpal tunnel
Excessive sweating
Amenorrhoea
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56
Q

Outline of exam for acromegaly

A 
End of bed - height, size
Hands - size, skin fold thickness, OA, sweaty, carpal tunnel
Pulse and BP
Face - prominent, acne, macrognathia, visual fields (bitemp hemi), spaces between teeth
Neck - JVP (cardiomyopathy), goitre
Chest inspection
Heart sounds
Proximal myopathy
Gait
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57
Q

“To complete exam” in acromegaly

A

CV exam
Thyroid exam
Formally test visual fields

Further investigations:

  • Oral glucose tolerance test with GH measurements
  • blood and urine glucose - DM
  • MRI pit - adenoma
  • ECG - cardiomyopathy
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58
Q

Symptoms to ask about in Addisons

A 
Fatigue, weakness
Anorexia, W/L
N+V, diarrhoea or constipation
Abdo pain
Syncope and dizziness
Darkened skin
59
Q

Outline of Addison’s exam

A

General insp - cushingoid (LT steroid -> adrenal sup)
Hands - hyperpigmentation, BM marks,
Arm - pulse, BP
Face - hyperpigmented lips/buccal mucosa
Neck - goitre
Inspect chest and abdo - scars, deformities
Auscultate - HS, lungs

60
Q

To complete exam in Addisons

A

Cap glucose
BP sitting and standing
Formally assess visual fields

Investigations:

  • U+Es
  • Cortisol and ACTH
  • Plasma renin:aldosterone
  • Short synacthen test
61
Q

Questions to ask in Cushing’s Hx

A 
Weight gain
Weakness
Bruising
Swollen ankles
Irregular menses
Polydipsia, polyuria
62
Q

Outline Cushing’s exam

A

End of bed - central obesity, muscle wasting
Hands - dec skin fold thickness, BM marks, pigmentation (Cushing’s disease)
Pulse and BP
Face - Cushingoid (facial mooning), acne, rash (SLE), buccal pig (Cushing’s disease), visual fields (bitemp hemi)
Chest and back - gynae, interscapular fat pad
Abdo - striae, central obesity
Prox myopathy

63
Q

To complete Cushing’s exam

A

BP, urine dip gluc, formally assess visual fields

Investigations:

  • Dex supp test
  • 24h urinary cortisol
  • blood test = U+Es (hypokal), glucose
  • Bone scan (osteoporosis)
64
Q

Questions to ask in a CVS Hx

A 
Pain
SOB
Palpitation
Coughs
Syncope
Oedema
Systemic - fever, W/L
65
Q

Outline CVS exam

A

End of bed
Hands -
- perfusion -> temp, CR, peri cyanosis
- nails -> clubbing (cyanotic CHD, IE), splinter haem (IE), Quincke’s sign (AR)
- palms -> Osler’s, Janeway (IE) (Janeway tender)
Pulse - rate, rhyth, delay, collapse (AR - 1st few are stronger)
BP
Neck - JVP and carotid
Face - malar flush (MS), corneal arcus, conjunctiva, central cyanosis
Inspect
Palpate
Ausculatate
- M -> listen in M area, roll, listen in axilla, listen with bell on exp
- T + P
- A -> listen in A area, sit forward + listen in P in exp (AR), RCA (AS)
Lung bases
Ankle oedema

66
Q

To complete CVS exam

A 
Feel for hepatomegaly (RF)
Peripheral vascular exam
Obs chart
Urine dip (haematuria in IE)
ECG, CXR, echo
67
Q

Symptoms to ask in Resp Hx

A 
SOB
Cough
Sputum
Haemoptysis
Chest pain
Wheeze
Systemic - fever, night sweats, WL
68
Q

Outline resp exam

A

End of bed - acc muscle (COPD, pleural ef, pneumothorax, asthma), distress, stridor, cachexic (Ca, emphysema), Cushingoid
Hands - cyanosis, CR, temp, tar, clubbing (idio pul fib, Ca, CF, bronch, sarcoid/TB), koil (iron def)
Wrist - flapping vs fine tremor, RR, pulse
BP
Face - horners, central cyan, Cushingoid, plethoric (CO2 ret), facial rashes (SLE, SS)
Neck - JVP, pulse, lymph nodes, tracheal deviation
Chest inspect - chest wall (scars, skin etc), movements, breathing
Palpate - expansion
Percuss
Ausculate - breath and vocal
Calves - oedema (cor pul), DVT

69
Q

To complete resp exam

A 
Sputum sample
Obs chart
Peak flow
CXR
ABG
70
Q

Symptoms to ask about in GI Hx

A 
Dysphagia, reflux
N+V, change bowel habit
Reduced appetite/WL
Pain
Distension
Jaundice
Systemic symptoms - fevers, night sweats
71
Q

Outline GI exam

A

End of bed - tubes, general
Hands - clubbing (cirrhosis, IBD, coeliacs), koil (iron def), leuk (hypoalb), parmar erythema (inc oestrogen in LD), dupuy (fam, LD)
Wrist - flap (hep enceph), pulse
Arms - IVDU, BP
Face/eyes - cushing, xanthelasma, conjunct (anaem), jaundice,
Mouth - glossitis/stomatitis (iron/b12 def anaem), ulcers (IBD)
Neck - lymph nodes
Chest - spider, gynae + loss of ax hair (inc oestrogen in LD)
Abdo inspect - distension, hernia, scars, striae, spider etc
Palpate - 9 areas (s+d), liver, spleen, kidneys, AAA
Percuss - liver, spleen, bladder, shifting dull
Ausc - bowel sounds, bruit
Ankle oedema (hypoalb)

72
Q

To complete GI exam

A

Examine hernial orifices and genitalia
Perform DRE
Obs chart

73
Q

Symptoms to ask in renal Hx

A 
Dysuria
Frequency, urgency incontinence
Nocturia
Haematuria
Hesitancy
Fevers, rigors, N+V
74
Q

Outline renal exam

A

End of bed - catheter, PD
Hands - palmar creases, skin turgor, cap refill, temp, leuk (hypoalb in nephrotic), koil (iron def in nephritic)
Wrist - flap (uraemia), pulse
Arm - BP, fistulae (palp+aus)
Face - yellow tinge (uraemia), rashes (SLE), collapsed nasal bridge (Wegeners)
Eye - periorbital oedema, conj pallor (dec EPO), arcus (hyperlip in nephrotic)
Neck - JVP (FO in nephrotic)
Chest - inspect (spider, gynae), heart sounds (uraemic pericard), lung bases (pul oed in nephrotic)
Abdo inspect - distension, scars, bruising
Palpate abdo - 9 areas, bladder, kidneys
Percuss
Ausc - renal bruit
Peripheral oedema

75
Q

To complete renal exam

A 
Obs chart
BP - lying and standing
DRE - assess prostate
Urine dipstick
Fundoscopy
76
Q

Symptoms to ask in hyperthyroid Hx

A 
Weight loss
Irritability
Weakness
Diarrhoea
Sweating
Tremor
Heat intolerance
77
Q

Symptoms to ask in hypothyroid Hx

A 
Tiredness
Intolerance to cold
Dry skin, hair loss
Difficulty concentrating
Constipation
Dec appetite
78
Q

Outline a thyroid exam

A

End of bed
Hands - temp, colour (erythema in thyrotoxicosis)
Pulse
Face - lid lag, ‘H’ test (ophthalmoplegia in Grave’s)
Inspect thyroid - front and sides, swallow, stick out tongue
Palpate - behind with both hands, size/shape/symmetry, edge, swallow + stick out tongue
Lymph nodes
Percuss from xiphisternum
Ausc both sides of lump
Tinel/Phalen test
Proximal myopathy
Reflexes
Pretibial myxoedema

79
Q

To complete thyroid exam

A

I would assess thyroid status - TFTs and USS

Fine needle aspiration

80
Q

Questions to ask in diabetic exam

A 
T1 vs T2 - test freq, control
Stroke/TIA
MI
Claudication
Eye
Kidney
Ulcers
81
Q

Outline diabetic exam

A 
End of bed - weight
Hands - testing sites
Pulse and BP
Face - xanthelasma/cataract
Abdo - injection sites
Ausc - heart sounds, carotid bruits
Inspect feet - shoes, skin (fissures, infections, ulcers, calluses), nails (dystrophic), web spaces, deformity (collapse of med arch - Charcot’s)
Arteriopathy - temp, pulse, cap refill
Neuropathy - soft, sharp, vibration, proprioception, ankle reflex
Gait - unsteadiness, foot drop
82
Q

To complete diabetic exam

A 
Fundoscopy (retinopathy)
Full neuro exam
BMI calculation
ABPI measurements
HbA1c and cap gluc
Lipid profile
Renal function
Urinalysis
83
Q

Symptoms to ask about in ank spond Hx

A 
Inflammatory back pain
Peripheral enthesitis
Peripheral arthritis
Skin rashes
Bowel problems
84
Q

Outline spinal exam

A

Look - gait, posture, muscles, kyphosis, lordosis, scoliosis
Feel - spinous processes, SI joints, paraspinals, chest expansion (dec in ank spond)
Move - cervical (lat flex, flex, extend, rotate), lumbar (flex, lat flex), thoracic (rotate)
Schober’s
Straight leg raise

If time:
- neurovascular assessment of lower limb

85
Q

To complete spine exam

A

Examine rest of MSK system
Full neuro assessment of lower limbs
Perform PR if indicated
XR, MRI

86
Q

Symptoms to ask in rheum Hx

A 
Pain, stiffness and swelling
Rashes, skin and nail changes
Fingertips change colour in cold
Difficulty swallowing
Night sweats, weight changes
SOB, blood in urine
Painful eyes
87
Q

Outline hand exam

A

End of bed
Inspect:
- nails -> pitting + onch (PA), clubbing, leuk or koil
- fingers -> swelling, scars, swan-neck (RA), boutonniere (RA), herberdens (DIPJ - OA), Bouchard’s (PIPJ - OA)
- MCP -> swelling, ulnar dev (RA)
- palm -> erythema (RA), scars, Duy cont
- wrists -> swelling, sublux
- praying position
- make fists -> loss of gutters (RA)
- arms/elbow -> rheum nodules, psoriatic plaques
Feel:
- each joint
- contractures
- thenar/hypo mass
- temp
- elbows
- sensation -> Ulnar (palmar 5th), median (palmar index), radial (anat snuff)
Move (active + passive) - wrists, MCPs, small joints
Hand function - squeeze, pinch, piano
UL function - elbow, pro and sup, hands behind head and up back
Tinel and Phalen

88
Q

To complete hand exam

A

Examine the rest of the MSK system
Listen to heart sounds and lungs
XR, ESR, CRP, RF, CCP etc
Joint aspiration

89
Q

Outline hip exam

A 
Observe gait
Inspect standing - symm, muscle
Trendelenburgs
Lie down
Look - wasting, scars, redness
Feel - temp, ASIS, ant joint line, greater trochanter
Move
Special test - Thomas
NV - dorsum and sole, pulses
90
Q

To complete hip exam

A

Examine other hip
Rest of MSK system (esp knee and spine)
XR, CT hip, joint aspiration

91
Q

Outline knee exam

A

Observe gait
Inspect standing
Lie down
Look - symmetry, muscle, scars etc
Bend to 90
Feel - temp, joint lines, patellar insertion
Straighten
Feel - patellar border, pop fossa, pat tap
Move
Special test - post sag, ant draw, collateral stress, pat apprehension
NV

92
Q

To complete knee exam

A

Examine other knee
Rest of MSK system - esp hip and ankle
XR, MRI, joint aspiration

93
Q

Outline shoulder exam

A

Look - all way round and axilla
Feel - temp, bones
Move - active (side - flex, extend, ext rotation, behind - AB, AD, int rotate), passive
Function - behind head, mouth, bottom
1) Shoulder instability - AB90, F elbow 90, ext rotate, force further ext rotate
2) Impingement - F90, F elbow 90, int rotate, force int rotation
3) Supraspinatus - AB90, thumb to floor, maintain against AD res
4) Subscap - dorsums against back, push out hand against res
5) Teres minor and inf - elbow F90, ext rotate against res
NV - sensation at regimental badge, lat index, med little finger, dorsal 1st IO
Pulses

94
Q

Outline a foot/ankle exam

A 
Gait
Look - symmetry, toes, bunion, scar, arches, achilles tendon
Lie down
Feel - temp, pulses, joints and bones
Move - active (plant, dors, toe flex and extend, inv and ev), passive
Pt kneels on bed
Palpate achilles, squeeze each calf
Quick check of sensation
95
Q

To complete foot/ankle exam

A

Examine other foot
Full NV exam
Examine rest of MSK - esp knee
XR, MRI

96
Q

Outline lower limb neuro exam

A

Inspect - symmetry, muscle wasting, fasiculations
Tone
Power - hip flex, hip extend, knee flex, knee extend, ankle dorsi, big toe extend, ankle plant
Reflexes - knee and ankle, plant
Co-ord - heel-shin
Sensation - soft, sharp, prop, vibration
Romberg’s - balance with eyes closed

97
Q

Outline PAD exam

A

Look - colour, oedema, hair loss, fungal infection, ulcers, scars
Palpation - temp, cap refill
Pulses - fem, pop, tib and dors
Straight leg raise - look at what point leg becomes pale

98
Q

Completing PAD exam

A

Measure BP
ABPI measurements
Doppler USS

99
Q

Outline varicose veins exam

A

Inspect - varicosity, oedema, haemosiderosis, champagne bottle legs, ulcer
Palpation - skin texture, tenderness, temp of veins
Tourniquet test - lie flat, put leg on your shoulder and milk leg, apply tourn on upper thigh, pt stand up

100
Q

Completing varicose veins exam

A

Examine lower limb arterial system

Doppler USS

101
Q

Outline a stoma exam

A

Inspect - site, number of lumens, spout, hard or soft stool, surrounding skin quality, complications
Ausc - bowel sounds

102
Q

Completing a stoma exam

A

Stoma output chart

Full GI examination

103
Q

Outline a hernia exam

A 
Pt supine
Inspect - scars, "loud cough"
Palpation - size, tension, temp, tender, cough impulse
Reduction - ask pt, try yourself
Ausc over lump
Repeat with pt standing
104
Q

Completing a hernia exam

A

Full abdo exam, causes of a raised intra-abdo pressure

Abdo wall USS, CT abdo

105
Q

Treatment of C Diff

A

mild/mod - Metronidazole

severe - Vanc

106
Q

Treatment of H Pylori

A

PPI
Clarithromycin
Amoxicillin

107
Q

Treatment of prosthetic infections

A

Vanc

Cefuroxime

108
Q

Questions to ask in a depression Hx

A 
Low mood
Little interest
Low energy
Difficulty concentrating
Low self-esteem/guilt
Sleep and appetite problems
109
Q

Questions to ask in a mania Hx

A

Have you had more energy than normal
Able to focus
Depression in the past

110
Q

Questions to ask in psychosis

A

Any odd or unusual things happening?
Thoughts being interfered with/controlled?
Auditory hallucinations?
Visual hallucinations?

111
Q

Questions to ask in anxiety?

A

Ask symptoms
Ask triggers
Problems sleeping etc

112
Q

Outline MSE

A 
ASMPTCIR
Appearance and behaviour
Speech
Mood
Perception
Thought
Cognition
Insight
Risk
113
Q

Acronym for explaining drugs

A 
ATHLETICS
Action
Timeline
How to take
Length
Effects - time before
Tests needed
Important side effects
Complications and C/I
Supplementary advise
114
Q

Explain SSRIs

A 
A - alter balance of brain chemicals
T - OD
H - tablet
L - can stop 3-6m after feeling better (taper off)
E - 4-6w to work
I - GI, headache, may feel worse in first 2w
C - suicide risk
S - mind.org.uk
115
Q

Explain methotrexate

A

A - DM medicine that dec inflam and sup immune
T - once a week with folic acid at another time
H - usually tablet, can be injection
L - long term
E - 4-6m to get full effect
T - blood tests to monitor liver, kidneys and white blood cells (baseline, 2wkly, then 2-3m)
I - alopecia, headaches, GI
C - myelosuppression (go to A+E), liver problems (avoid alc)
C/I - avoid pregnancy
S - no NSAIDs, get flu jab

116
Q

Explain lithium

A 
A - mood stabiliser, unknown mechanism
T - OD or BD
H - tablet, capsule or syrup
L - lifelong usually
E - 1-2wk before effect fully
T - baseline bloods, 5d, wkly then every 3m
I - GI, water symptoms
C - kidney problems, underactive thyroid, avoid pregnancy
S - bipolaruk.org.uk
117
Q

Explain atypical anti-psychotics

A

A - blocking NTs that are overactive in schizophrenia
T - tablet every day or injection every 2-4wk
H - tablet or injection
L - long term (keeps symptoms from returning)
E - 1-2wks for effect to start
T - occasional blood test for liver
I - tremor, movement problems, constipation, dry mouth, weight gain, dizziness, low BP
C - high fever, liver problems
S - rethink.org

118
Q

Explain levodopa

A 
A - replaces dopamine in the brain
T - 3-4 times a day with food
H - tablet
L - long-term, often begins to be less effective after 5yrs
E - fast-acting
T - none
I - psychosis, N+V, postural hypotension (can be given other tablets to counteract these)
C - C/I in glaucoma
S - parkinsons.org.uk
119
Q

Explain bisphosphonates

A 
A - prevents bone being broken down
T - once a week or daily
H - swallow with full glass of water 30mins before food, sit upright for 30mins
L - long-term
E - /
T - dental checkups (can affect jaw)
I - headache, heartburn, bloating, indigestion
C - can cause jaw problems
S - nos.org.uk
120
Q

Explain warfarin

A 
A - thins the blood, blocks vitamin K
T - OD
H - tablets
L - 3m for DVT, 6m for PE, life for AF
E - 2-3d to start working
T - regular INR checks
I - risk bleeding
C - avoid liver, spinach, cranberry, alcohol, NSAIDS
S - given anticoag book
121
Q

Explain levothyroxine

A 
A - medicine version of normal thyroid hormone
T - OD before breakfast
H - tablet
L - lifelong
E - few wks
T - review 2m then annually
I - SEs are rare
C - /
S - free prescription for everything
122
Q

Explain statins

A 
A - stop liver making cholesterol
T - OD in evening
H - tablet
L - lifelong
E - dec risk over many years
T - blood test for liver at start, 3m and 12m
I - muscle pains, itching, GI
C - rhabdomyolysis
S - avoid grapefruit
123
Q

Explain metformin

A 
A - inc sensitivity to insulin
T - OD with breakfast, may be inc to BD
H - take at same time each day
L - lifelong if it works
E - /
T - kidney blood test annually
I - GI, abdo pain
C - lactic acidosis
S - if you miss a dose, take it as soon as you remember unless it's close to next dose time
124
Q

Explain iron tablets

A 
A - replaces body's store of iron
T - 1-3 times daily
H - tablet (take with food to stop stomach irritation)
L - around 4m
E - 3-4wk
T - Hb in 4wk
I - GI, darkened stools
C - /
S - /
125
Q

To complete ank spond exam

A

Full neurovascular exam of limbs
Auscultate HS + lung sounds

Investigations:

  • bedside = ECG
  • bloods = HLA B27, FBC, ESR, CRP
  • imaging = MRI spine
126
Q

Outline the SLE/SS exam

A 
General inspection - SOB
Hands/arms:
- SSc = sclerodactyly, telangiectasia, prayer sign
- SLE = discoid rash
- either = Raynaud’s, joint/muscle pain
Sensation - SLE neuropathy
Face:
- malar rash (SLE)
- alopecia (SLE)
- oral ulcers (SLE)
- microstomia (SSc)
Chest - palpate (dec exp - SSc or SLE), auscultate (pericardial rub = SLE, fibrosis = both)
Abdo - HSM (SLE)
Legs - erythema nodosum (SLE)
127
Q

To complete SLE/SSc exam

A

Bedside = BP + urinalysis (SLE + SSc nephritis), ECG
Bloods = FBC, CRP, ESR, U+Es, LFTs
- SLE = ANA, anti-dsDNA, anti-Sm, anti-Ro
- SSc = ACA (lc), anti-scl (dc)
Imaging = CXR

128
Q

Outline a cranial nerve exam

A

I Olf -> “any change in your sense of smell”
II Optic -> “do you usually wear glasses?”
- inspect = pupil size + symmetry
- acuity = Snellen chart (one eye at a time), near vision
- fields
- reflexes = accommodation, direct + consensual, swinging
- fundoscopy
III, IV, VI (Oculomotor, Trochlear, Abducens) -> “any double vision?”
- inspect = strabismus, ptosis (partial = Horner’s, complete CNIII lesion)
- H test = nystagmus (cerebellar), fatiguability (MG)
V Trigeminal -> “any pins and needles? Any weakness of jaw?”
- sensory
- motor = clench jaw and palp masseter, open jaw against resistance
- others = “consider corneal reflex”
VII Facial
- motor = raise eyebrows, scrunch eyes, puff out cheeks, show teeth
VIII Vestibulocochlear
- crude hearing
- Weber’s + Rinne’s
- others = walking on spot, Dix-Hallpike
IX + X (glossopharyngeal, vagus)
- inspect = palate symmetry (9) and uvula deviation (10) (devs away)
- motor = cough and swallow
- others = consider gag reflex
XI accessory
- inspect = SCM/trap wasting
- motor = turn head + shrug shoulders against resistance
XII hypoglossal
- inspect = tongue for wasting and fasciculations (LMN)
- motor = stick out tongue (dev towards), test power in cheek

129
Q

Outline a lower limb neuro exam

A

General inspection
Gait - normal, heel to toe (ataxia), stand on heels then toes, Romberg’s (sensory ataxia)
Local inspection - tremors, wasting, fasciculations, skin
Tone - roll leg, pull up knee, clonus
Power - hip flex, hip ext, hip aB, hip aD, knee ext, knee flex, ank dorsi, ank plantar, big toe ext
Reflexes
Co-ordination
Sensation - pain, light touch, proprioception, vibration, temp

130
Q

To complete lower limb neuro exam

A

Examine cranial nerves and perform upper limb neuro exam

131
Q

Outline an upper limb neuro exam

A

General inspection
Local inspection - tremors, wasting, fasciculations, skin
Pronator drift (palm up and close eye) -> +ve + distal flex = pyramidal weakness, upward drift = cerebellar
Tone
Power - shoulder aB, elbow flex, elbow ext, wrist ext, finger ext, finger flex, finger aB, thumb aB
Reflexes - biceps, supinator, triceps
Co-ordination - finger-nose (past-pointing = cerebellar), dysdiado
Sensation - pain, light touch, proprioception, vibration, temp

132
Q

Outline a breast exam

A

-> chaperone!
General inspection - cachexia
Inspection in 4 positions -> arms relaxed, hands on thigh, hands pressed on hip, hands behind head
Palpate with pt lying (hand behind head) in systematic way
Lymph nodes - axillary and supraclavicular

133
Q

To complete breast exam

A

Complete triple assessment:

  • imaging (<35 US, >35 mam)
  • tissue sampling (FNA if cystic, core biopsy if solid)
134
Q

How would you describe lumps?

A 
SSSCCCTTT
Site
Size
Shape
Consistency
Contours
Colour
Tenderness
Temp
Transilluminates
135
Q

Outline a hernia exam

A

Ask pt to stand
Inspect - size, shape, position, scrotal extension, cough impulse
Palpating:
- scrotal contents
- inguinal area -> feel from side with hand on pt back, describe lump (SSSCCCTTT)
- cough impulse -> compress lump firmly and ask to cough
- reducibility -> locate DIR (midway between ASIS and pubic tubercle), press on lump and lift it up and reduce, maintain pressure on DIR, ask to cough, if reappears = direct, release and watch reappear

136
Q

To complete a hernia exam

A

Full abdo exam

Cardio resp exam and assessment to determine fitness for surgery

137
Q

Outline a haematology/lymphoreticular exam

A

General inspection - cachexia, rashes, bleeding/bruising
Cervical lymph nodes
Axillary lymph nodes - lie at 30/45’, inspect, take weight of arm and palpate with other hand, feel 4 sides of axilla
Epitrochlear lymph nodes - hold olecrannon with fingers and feel with thumb
Inguinal lymph nodes
Abdo exam

138
Q

To complete haematology/lymphoreticular exam

A

If lymph mets suspected, examine relevant primary organ (e.g. if axillary lymphadenopathy examine breast)

Investigations:

  • bloods -> FBC, blood film
  • imaging -> CXR, US, CT
  • biopsy
139
Q

Outline a varicose vein exam

A

General inspection
Leg inspection -> standing, gait, then lying
- skin (colour + changes)
- ankle swelling (DVT, HF)
- venous insufficiency (eczema, haemosiderin, ulcers)
- superficial venous dilatation and tortuosity -> distribution, colour, prominence
Palpation:
- varicosities
- elevate limp to 15’ and note rate of emptying
- tourniquet test -> lift leg as high as comfortable to empty vein, place tourniquet over saphenofemoral junction (2/3cm below and 2-3cm lat to pubic tubercle), ask pt to stand, rapid filling indicates incompetent perforator vein lies below the SFJ, repeat moving tourniquet 3cm down
- calf tenderness (DVT)
Percuss -> tap distally and feel prox impulse (normal), vice versa is incompetent valve
Auscultate -> turbulent flow
Pitting oedema
Pulses

140
Q

To complete varicose vein exam

A

Full abdo exam and pelvic exam for potential masses causing IVC obstruction
US varicosities

141
Q

Paediatric red flags

A 
Pale, mottled, ashen, blue
Doesn’t stay awake when roused
Dec consciousness (not engaging, apathy, coma)
Dec skin turgor
GRUNTING signs
142
Q

Paediatric amber signs

A 
Taking <1/2 feeds
Pale
Not responding to social cues
Hard to wake
Dec activity
No smiling
Tachypnoea
Sats <95%
Crepitations
Nasal flaring if <1yo
CR >3s
143
Q

Paediatric green signs

A 
Taking most feeds ok
Normal colour
Responds to social cues
Alert/wakens quickly
Lusty cry
Playing
Breathing calmly

Finals (25 decks)

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