OSCE conditions

Question 1

Bronchiectasis CX?

Answer 1

Post-infectious (most common cause):
Recurrent childhood lower respiratory tract infections (e.g. influenza, pertussis and measles)
Pulmonary tuberculosis
Allergic bronchopulmonary aspergillosis (ABPA)

Pulmonary disease:
Chronic obstructive pulmonary disease
Asthma (especially in patients with frequent exacerbations and neutrophilic asthma)5

Congenital:
Cystic fibrosis
Primary ciliary dyskinesia
Alpha-1 antitrypsin deficiency (also causes emphysema)
Connective tissue disease:

Rheumatoid arthritis
Systemic lupus erythematosus (SLE)
Sarcoidosis
Idiopathic (40% of bronchiectasis)6

Question 2

Bronchiectasis complications?

Answer 2

Respiratory failure: due to failure of gas exchange in the lungs
Massive haemoptysis (>250ml per day): often due to rupture of a bronchial artery into a bronchus21
Anxiety and depression: due to impaired quality-of-life

Treatment-related complications of bronchiectasis include:
Macrolides: long QT syndrome, tinnitus and hearing loss
Lung transplant: immediate complications (e.g. blood loss), early complications (e.g. transplant rejection) and late complications (e.g. post-transplantation lymphoproliferative disorder)

Question 3

IX for respiratory conditions?

findings on bronchiectasis?

Answer 3

Relevant bedside investigations include:

Pulse oximetry:
Sputum culture:
Pseudomonas aeruginosa and Haemophilus influenza. - bronchiectasis
Lung function tests: obstructive?
Echocardiogram: bronchiectasis may impair ventricular function and lead to pulmonary hypertension

Full blood count: WCC, neutrophilia, CRP:
Autoimmune : anti-CCP, ANA and ANCA
Specific IgE to Aspergillus fumigatus: if suspecting ABPA
Genetic testing (done in specialist units): cystic fibrosis and primary ciliary dyskinesia

Chest X-ray: tram lines and ring shadows.
High-resolution CT chest :gold-standard imaging test. Shows bronchial dilation, with or without airway thickening.
Bronchoscopy: localised disease/ FB

Question 4

IX for COPD?

Answer 4

Chest xray to exclude other pathology such as lung cancer.
Full blood count for polycythaemia or anaemia. Polycythaemia (raised haemoglobin) is a response to chronic hypoxia.
Body mass index (BMI)
Sputum culture - pseudomonas.
ECG and echocardiogram to assess heart function.
CT thorax for alternative diagnoses such as fibrosis, cancer or bronchiectasis.
Serum alpha-1 antitrypsin (early, young)
Transfer factor for carbon monoxide (TLCO) is decreased in COPD.
FEV1 for severity

Question 5

cervical cancer RF?

Answer 5

Smoking
HIV (patients with HIV are offered yearly smear tests)
Combined contraceptive pill use for more than five years
Increased number of full-term pregnancies
Family history
Exposure to diethylstilbestrol during fetal development (this was previously used to prevent miscarriages before 1971)
HPV 16 and 18

Question 6

endometrial CA RF?

how to protect PCOS women for endometrial cancer?

Answer 6

Increased age
Earlier onset of menstruation
Late menopause
Oestrogen only hormone replacement therapy
No or fewer pregnancies
Obesity
Polycystic ovarian syndrome -give COCOP, Mirena coil)Cyclical progestogens to induce a withdrawal bleed.

Tamoxifen
unopposed oestrogen
lynch syndrome,
T2DM

Question 7

IX for endometrial cancer?

Answer 7

Transvaginal ultrasound for endometrial thickness (normal is less than 4mm post-menopause)
Pipelle biopsy, which is highly sensitive for endometrial cancer making it useful for excluding cancer
Hysteroscopy with endometrial biopsy

Question 8

conservative measures for menopause?

Answer 8

Lifestyle changes such as improving the diet, exercise, weight loss, smoking cessation, reducing alcohol, reducing caffeine and reducing stress
Cognitive behavioural therapy (CBT)
Clonidine, which is an agonist of alpha-adrenergic and imidazoline receptors
SSRI antidepressants (e.g. fluoxetine)
Venlafaxine, which is a selective serotonin-norepinephrine reuptake inhibitor (SNRI)
Gabapentin

Question 9

CI to HRT?

Answer 9

Undiagnosed abnormal bleeding
Endometrial hyperplasia or cancer
Breast cancer
Uncontrolled hypertension
Venous thromboembolism
Liver disease
Active angina or myocardial infarction
Pregnancy

Question 10

risks of HRT?

Answer 10

Increased risk of breast cancer (particularly combined HRT – oestrogen-only HRT has a lower risk)
Increased risk of endometrial cancer
Increased risk of venous thromboembolism (2 – 3 times the background risk)
Increased risk of stroke and coronary artery disease with long term use in older women
VTE reduced with patch

Question 11

MEng 0-3m CX?

Answer 11

Group B Streptococcus (most common cause in neonates)
E. coli
Listeria monocytogenes

Question 12

meng 3m - 6yrs CX?

Answer 12

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae

Question 13

6yrs-60yrs meng cx

Answer 13

Neisseria meningitidis

Streptococcus pneumoniae

Question 14

60YR + CX meng?

Answer 14

Streptococcus pneumoniae
Neisseria meningitidis
Listeria monocytogenes