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OSCE Conditions Flashcards

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1
Q

What is Crohn’s Disease?

A

Inflammation of the GI tract

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2
Q

What is UC?

A

Inflammation of the colon and rectum

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3
Q

Give some symptoms of IBD

A 
Diarrhoea- blood, mucous, pus
Abdo pain 
Increased frequency of bowel movements
Fatigue
Weight loss
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4
Q

Explain why patients with IBD feel tired

A

Inflammation of the bowel leads to blood loss which leads to anaemia which causes tiredness
They may also not be able to absorb nutrients in their gut as well as they used to leading to malnutrition and tiredness.

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5
Q

Give some causes of IBD

A

Genetics
Western diet and environment
Smoking
Autoimmune destruction of gut flora

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6
Q

How is IBD diagnosed?

A 
Blood tests- inflammation, anaemia, infections
Stool sample
Colonoscopy 
Barium enema
CT/MRI
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7
Q

Give 3 ways IBD can be treated

A

Surgery- remove section of inflamed bowel (ileostomy)
Corticosteroids- prednisalone
Immunosuppressants
Biological therapies - infliximab

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8
Q

Give some complications of Crohn’s disease

A 
Fistulas
Bowel strictures
Anaemia
Osteoporosis
Colorectal cancer
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9
Q

Give some complications of UC

A 
Osteoporosis
Poor growth 
Toxic megacolon 
Bowel cancer
Primary sclerosing cholangitis
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10
Q

Explain how bowel strictures can occur in IBD

A

Chronic inflammation results in deposition of scar tissue. This builds up and narrows the bowel lumen causing strictures

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11
Q

Through what structures do fistulas form in Crohn’s disease?

A

Bowel and vagina, bladder or skin

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12
Q

What is cerebrovascular disease?

A

Diseases caused by poor blood flow to the brain

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13
Q

What are the 3 most common cerebrovascular diseases

A

Stroke
TIA
Vascular dementia

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14
Q

What is an ischaemic stroke?

A

Blockage of blood flow to the brain by a clot causing brain damage due to hypoxia

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15
Q

What is a haemorrhagic stroke?

A

Leakage of blood into the brain tissue

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16
Q

Give 3 symptoms of a stroke

A

Slurred speech
Drooping face
Loss of sensations in the arms

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17
Q

What is vascular dementia?

A

Loss of mental ability due to lack of perfusion to the brain

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18
Q

What is a TIA?

A

A transient ischaemic attack

Temporary disruption to the blood flow to the brain. Very similar to a stroke but resolves within 24 hours

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19
Q

Give 5 risk factors for cerebrovascular disease

A 
Smoking
Obesity 
Stress
Atrial fibrillation 
Hypertension 
Poor diet 
Hypercholesteraemia 
Diabetes
Excess alcohol
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20
Q

What are gallstones?

A

Aggregations of cholesterol in the gallbladder

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21
Q

When do gallstones become a problem?

A

When they become lodged in a duct

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22
Q

Give the main symptom of uncomplicated gallstones

A

Biliary colic- abdo pain which cannot be relieved, usually lasts a few hours

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23
Q

Give 4 symptoms of complicated gallstones

A 
Biliary colic +
Tachycardia
Fever
Diarrhoea
Itchy skin 
Sweating
Jaundice
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24
Q

Give the 2 main causes of gallstone formation

A

Hypercholesteraemia

Hyperbilirubinaemia

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25
Give 4 risk factors for gallstones
``` Female Over 40 years old Obese IBS Genetics Taking ceftriaxone ```
26
What sign on examination would suggest gallstones?
Positive Murphy's sign Push on liver and ask patient to take deep breaths If gallbladder is inflammed it will cause pain
27
What tests can be done to diagnose gallstones?
``` USS CT MRI Cholangiography Blood test- CRP, leukocytes ```
28
How are gallstones treated?
Painkillers Control with low fat diet Cholecystectomy
29
What can poorly managed gallstones lead to?
``` Acute pancreatitis Gallbladder cancer Jaundice Acute cholecystitis Acute cholangitis ```
30
What is acute kidney injury?
Sudden onset of kidney damage
31
Give 2 causes for pre-renal AKI
Hypertension | Liver failure
32
Give 2 causes for ATN
Infection Ischaemia Iatrogenic
33
Give 2 causes for post-renal AKI
Urinary stones Enlarged prostate Tumour
34
Give 3 medications which may precede AKI
ACE inhibitors NSAIDs Diuretics
35
Give 4 symptoms of AKI
``` Nausea Vomiting Abdo. pain Dehydration Confusion Increased blood pressure ```
36
Explain how an AKI can lead to increased blood pressure
An AKI will result in the kidney not functioning properly and therefore retaining electrolytes and water. This will increase the blood volume and therefore the blood pressure
37
How can an AKI be diagnosed?
eGFR U+Es Urine output Blood creatinine
38
How can AKIs be treated?
Prevent dehydration Find the underlying cause Stop medications which may be causing kidney damage
39
What acid base balance change is likely to occur in AKI and why?
Metabolic acidosis- the kidney cannot excrete a range of acidic anions due to the lack of function leading to a decrease in pH in the blood
40
Why can AKI lead to pulmonary oedema?
Lack of water excretion by the kidney leads to an increased blood volume and blood pressure. The increased blood pressure from the body can put pressure on the left atrium. The blood backs up and it pushed out into the lungs to causes pulmonary oedema.
41
What is alcoholic liver disease?
Chronic liver damage due to excessive alcohol intake
42
What are the 3 severities of alcoholic liver disease?
Alcoholic fatty liver disease Alcoholic hepatitis Cirrhosis
43
Of the 3 stages of alcoholic liver disease, which are reversible?
Alcoholic fatty liver disease | Alcoholic hepatitis
44
Give 4 early symptoms of alcoholic liver disease
``` Nausea Vomiting Fatigue Abdo pain Loss of appetite Diarrhoea ```
45
Give 4 advanced symptoms of alcoholic liver disease
``` Ascites Fever Hair loss Weight loss Nosebleeds Clubbing Jaundice Vomiting blood ```
46
Give the 2 causes of alcoholic liver disease
Frequent binge drinking | Long term excessive drinking
47
Give 3 factors which as well as excessive alcohol intake, put patients at a greater risk of alcoholic liver disease
Obesity Female Pre-existing liver disease Family history
48
How is alcoholic liver disease diagnosed?
``` LFTs MRI CT X-ray Liver biopsy Endoscopy ```
49
What is the main treatment of alcoholic liver disease?
Stop drinking alcohol
50
Give an intervention questionnaire which can be used to assess alcohol intake
CAGE Cut down? Annoyed by people commenting on your drinking? Guilty about volume of alcohol? Eye-opener? (Do you need alcohol in the morning?)
51
Give a pharmacological treatment of alcoholic liver disease
Corticosteroids
52
Give 4 complications of alcoholic liver disease
Liver cancer Ascites leading to peritonitis Portal hypertension Oesophageal varices --> bleeding --> anaemia
53
What is the definition of anaemia?
Lack of haemoglobin in the blood causing poor oxygen transport and therefore hypoxia
54
Give 5 symptoms of anaemia
``` Pale Fatigue Feeling cold Lightheadedness Short of breath Palpatations ```
55
Give 3 causes of microcytic anaemia
Iron deficiency Thalassaemias Anaemia of chronic disease
56
Give 3 causes of normocytic anaemia
Sickle cell anaemia Blood loss Anaemia of chronic disease
57
Give 3 causes of macrocytic anaemia
Haemolytic anaemia B12/folate deficiency Bone marrow failure
58
Give 3 sources of iron in the diet
``` Spinach- green, leafy vegetables Fish Meat Lentils Eggs Nuts ```
59
How can anaemia be diagnosed?
Full blood count Blood microscopy Identify area of blood loss
60
Give 3 signs on examination of anaemia
Pale palmar creases Pale conjunctiva Angular stomatitis Glossitis
61
How can anaemia be treated?
Treat underlying cause: | Eg. Prevent blood loss, Iron/B12 supplements
62
What is asthma?
Narrowing of the airways due to inflammation and excessive production of mucous
63
Give 4 triggers of an exacerbation of asthma
``` Cold air Chest infections Exercise Stress Allergies Night time ```
64
Why do asthmatics have worse symptoms at night?
``` Less cortisol (due to circadian rhythm) which is an anti-inflammatory Exposure to dust mites in bed clothes Lying flat- mucous drains along respiratory tract ```
65
Give 4 symptoms of asthma
Wheeze Breathlessness Tight chest Coughing
66
What is the difference between a stridor and a wheeze?
A wheeze is heard on inspiration and a stridor is heard on expiration
67
What is an asthma attack?
A severe exacerbation of all the asthma symptoms plus tachycardia, confusion, drowsiness, central cyanosis, severe tight chest
68
Give 2 causes of asthma
Family history Passive smoking as a child Premature birth
69
How is asthma diagnosed?
Spirometry Peak flow test Allergy test
70
Which 2 conditions are strongly associated with asthma
Eczema | Hayfever
71
How can asthma be treated?
Step 1: Short-acting Beta-2 antagonist - Salbutamol Step 2: Inhaled Corticosteroid Step 3: Long-acting beta-2 antagonist- Salmeterol Step 4: Inhaled corticosteroid and a long acting beta-2 antagonist Step 5: Increase doses Step 6: Add an oral corticosteroid
72
How do beta-2- antagonists work to treat asthma?
Bind to beta-2 adrenergic receptors in the airway to cause blocking of adrenaline which results in bronchodilation
73
What is atrial fibrillation?
The atria do not beat in a regular rhythm as they become independent of the pacemaker. The atria do not go into systole for long enough and therefore the heart fills less. The heart beats faster to compensate.
74
Give 3 cardiac causes of atrial fibrillation
``` Hypertension Atherosclerosis Mitral stenosis Congenital HF Pericarditis ```
75
Give 3 respiratory causes of atrial fibrillation
``` COPD Asthma CO poisoning Pneumonia PE ```
76
GIve 3 triggers for an exacerbation of atrial fibrillation
``` Excess of alcohol Obesity Caffeine excess Smoking Drugs ```
77
How is atrial fibrillation diagnosed?
ECG Echocardiogram Pulse rate Blood test- anaemia/thyroid levels
78
What ECG changes would be seen on a patient with atrial fibrillation?
Absent P waves Irregular R-R intervals Irregular baseline
79
What is the difference between atrial fibrillation and atrial flutter?
Atrial fibrillation is irregularly irregular | Atrial flutter is regularly irregular
80
Give 2 complications of atrial fibrillation
Heart failure | Stroke
81
Give 5 symptoms of atrial fibrillation
``` Breathlessness Palpitations Chest pain Dizzy Tired ```
82
How can atrial fibrillation be treated pharmacologically?
Restore rhythm--> Amiodarone, Sotalol, Flecanide Control rate --> Verapamil, Digoxin Reduce stroke risk --> Warfarin, Edoxaban
83
How can atrial fibrillation be treated non-pharmacologically?
Cardioversion- controlled electric shock Catheter ablation- destroy diseases area of the heart Pacemaker
84
Define COPD
Respiratory condition resulting in obstruction of the airways. Chronic condition which cannot be cured
85
Which 2 main conditions are encompassed by COPD
Emphysema | Chronic bronchitis
86
Describe emphysema
Loss of the elastic recoil in the alveoli resulting in a loss of surface area in the alveoli so less gas exchange can occur. The volume of dead space is increased
87
Describe bronchitis
Excessive mucous production in the airway
88
Give 5 symptoms of COPD
``` Breathlessness Wheeze Fatigue Cough- with sputum Tachycardia Nausea Chest infections ```
89
Give 3 causes of COPD
``` Smoking! Genetics Passive smoking Air pollution Occupational hazards- fumes/dust ```
90
How is COPD diagnosed?
``` O2 stats Full blood count- anaemia Peak flow Spirometry Sputum culture X-ray Respiratory exam ```
91
How can COPD be managed pharmacologically?
Inhalers Steroids Mucolytic agent Antibiotics to treat infections
92
How can COPD be managed non-pharmacologically?
Lung transplant Nebuliser Long-term O2 therapy Stop smoking
93
What is Type I diabetes?
Autoimmune destruction of the beta cells in the pancreas resulting in a loss of insulin. This means patients will have an intolerance to glucose
94
What is Type II diabetes?
Increased resistance to glucose by the cells so glucose cannot enter cells and remains in the blood. The beta cells which produce insulin are also damaged over time.
95
Give 3 classic symptoms of diabetes
``` Polyuria Polydipsia Weight loss Increased appetite Fatigue ```
96
Give a complication that only occurs in Type I diabetics
Ketoacidosis leading to a diabetic coma
97
Explain why Type I diabetics have a fruity breath
As glucose cannot enter the cells, the body breaks down fatty acids instead which have a side product of ketones. These ketones have a fruity smell
98
Give 4 complications of uncontrolled Type II diabetes
``` Heart disease Stroke Peripheral neuropathy Renal disease Retinopathy Sexual dysfunction ```
99
How is diabetes diagnosed?
HbA1c- glycosylated haemoglobin Glucose fasting test Urine dipstick ABG- may show ketoacidosis
100
How is Type I diabetes treated?
Varying, length-acting, synthetic insulins | Eg. rapid, short, intermediate, long, very-long
101
How must insulin be administered?
Intramuscularly
102
Why may some patients not like injecting insulin?
Stigma Painful Lipohypertrophy
103
Give 3 symptoms of a hypoglycaemic attack
``` Shaking Sweating Nausea Vomiting Hunger Weakness Confusion ```
104
What is the first way of treating newly diagnosed Type II diabetes?
Diet and Exercise Reduce alcohol Stop smoking
105
What is the gold standard drug for treating Type II diabetes?
Metformin- Biguanide
106
Give the mechanism of action of metformin
Enters mitochondria to increase AMP levels This increases AMPK levels to increase the sensitivity of the skeletal muscle and adipose tissue to insulin and reduce fatty acid synthesis
107
Give an example of a sulphonylurea
Gliclaside
108
What is epilepsy?
Long-term condition causing excessive, synchronised firing of excitatory neurons in the brain. This results in a seizure.
109
Explain the difference between a partial and generalised seizure
Partial- only affects 1 hemisphere of the brain | Generalised- affects both hemispheres of the brain
110
What is primary epilepsy?
Epilepsy with an unknown cause
111
What is secondary epilepsy?
Epilepsy which is secondary to a known cause such as a stroke or meningitis
112
What is status epilepticus?
A seizure for >30 minutes OR | Lots of small seizures without gaining consciousness in between
113
What is the treatment for status epilepticus?
Diazepam | Midazolam
114
Give 4 factors which can trigger a seizure in an epileptic
``` Excess alcohol Flashing lights Stress Lack of sleep Menstruation ```
115
Give 3 ways epilepsy can be diagnosed
Full history with eye-witness report of the seizure MRI- look for underlying cause EEG- looks at brain electrical activity
116
Give an example of 3 anti-epileptic drugs
Sodium valproate Carbamazepine Ethosuximide Lamotrigine
117
Give 3 ADRs which are very common in anti-epileptic drugs
``` Drowsiness Headaches Hair loss Rashes Agitation Tremor ```
118
What is the definition of hypertension?
Pressure in the blood vessels is too high | Chronically over 140/90
119
Give 5 modifiable risk factors for hypertension
``` Obesity Smoking Lack of exercise Lack of sleep Stress High salt diet ```
120
Give 3 non-modifiable risk factors for hypertension
Age Genetic risk Diseases- diabetes, ATN, acromegaly, lupus, cushings
121
Give examples of 3 commonly prescribed drug types which may cause hypertension
NSAIDs Steroids Anti-depressants Combined pill
122
Give 4 complications of unmanaged hypertension
``` Stroke MI Aortic aneurysm Kidney disease Oedema Heart disease ```
123
Give 4 lifestyle change treatments of hypertension
``` Stop smoking Reduce alcohol Lose weight Healthy diet Stop caffeine ```
124
How is a patient with hypertension under the age of 55 treated?
ACE inhibitor
125
How is a patient with hypertension over the age of 55 or black treated?
Ca2+ channel blocker OR Thiazide diuretic
126
Explain how hypertension can be treated with a diuretic
Pressure in the circulatory system can be relieved if the volume is reduced by losing the excess water. A diuretic causes more urine to be produced
127
Where is aortic stenosis heard best?
Right carotid on inspiration
128
In what part of the cardiac cycle is an aortic stenosis murmur heard?
Ejection systolic
129
Where is aortic regurgitation heard best?
Patient sat forward on expiration | Left sternal edge, 4th intercostal space
130
In what part of the cardiac cycle is an aortic regurgitation murmur heard?
Early diastolic
131
Where is mitral stenosis heard best?
Mid-clavicular line, 5th intercostal space Patient rolled to left- on expiration Use bell
132
In what part of the cardiac cycle is an mitral stenosis murmur heard?
Mid-diastolic
133
Where is mitral regurgitation heard best?
Axilla, 5th intercostal space
134
In what part of the cardiac cycle is an mitral regurgitation murmur heard?
Pan-systolic
135
What is peptic ulcer disease?
Ulcers most commonly found in the stomach, lower oesophagus and small intestine
136
Give 5 symptoms of peptic ulcer disease
``` Nausea Burning pain Indigestion Weight loss Reduced appetite Vomiting ```
137
Give 2 symptoms of advanced peptic ulcer disease
Vomiting blood | Melaena
138
Give 3 causes of peptic ulcer disease
Excess alcohol H pylori infection NSAIDs Stress
139
How is peptic ulcer disease diagnosed?
H. pylori confirmation- urea breath test, stool antigen test, blood test Gastroscopy
140
Give 3 complications of peptic ulcer disease
Internal bleeding Perforation of the bowel Gastric obstruction
141
How can peptic ulcer disease be treated?
PPI H2 antagonist Antacids Anti-biotic
142
What is osteoarthritis?
Pain in large joints due to a loss of cartilage
143
Give 3 causes of osteoarthritis
``` Joint injury Age Obesity Gout Rheumatoid arthritis ```
144
Give 3 symptoms of osteoarthritis
``` Pain Stiffness Cracking of joints Tenderness Loss of function ```
145
What is the main way of diagnosing osteoarthritis?
Taking a thorough history
146
How is osteoarthritis treated?
``` Painkiller NSAID Opioids Joint replacement Corticosteroid injections ```
147
Define heart failure
Heart cannot adequately pump blood around the body
148
Give 4 symptoms of heart failure
``` Shortness of breath Dizziness Oedema Tachycardia Chest pain Fatigue Exercise intolerance ```
149
Give 4 causes of heart failure
Hypertension Smoking Diabetes Congenital
150
How is heart failure diagnosed?
``` ECG Echocardiogram FBC Spirometry X-ray ```
151
How is heart failure treated non-pharmacologically?
``` Stop smoking Lose weight Good diet Exercise Reduce alcohol ```
152
Describe the steps of treating heart failure
Step 1: ACE inhibitor and beta blocker Step 2: add a ARB and an aldosterone antagonist Step 3: add digoxin
153
What complications can occur from heart failure?
``` Oedema MI Stroke Thromboembolism PND ```
154
What is ischaemic heart disease?
Lack of blood flow to the coronary arteries causing damage to the heart muscles
155
Give 2 differences between angina and an MI
Angina is reversible, MI is not | MI symptoms are more severe than angina
156
Give 4 symptoms of ischaemic heart disease
``` Chest pain Breathlessness Palpitations Exercise intolerance Cough ```
157
Give 4 symptoms of an MI
``` Sweating Crushing chest pain Lightheadedness Nausea Breathless ```
158
Give 5 causes of IHD
``` Obesity Atherosclerosis Thrombosis Hypercholesterolaemia Diabetes Hypertension ```
159
How is IHD diagnosed?
``` Exercise stress test Angiography ECG Echocardiogram X-ray MRI CT ```
160
How is IHD treated pharmacologically?
Anti-platelet drug Statin Beta blocker ACE inhibitor
161
How can IHD be treated surgically?
Coronary angioplasty | Coronary artery bypass graft
162
What is rheumatoid arthritis?
Long-term condition causing pain, swelling and stiffness in the joints, usually in the hands and feet
163
Give 5 symptoms of rheumatoid arthritis
``` Joint pain Weight loss Tired Warmth in the joints Swelling Stiffness Redness Sweating ```
164
What is the cause of rheumatoid arthritis?
Autoimmune destruction of the joint lining leading to inflammed synovium. This causes bone, cartilage, tendon and ligament damage
165
Give 3 risk factors of rheumatoid arthritis
Smoking Hormones Family history
166
How is rheumatoid arthritis diagnosed?
Joint imaging- USS, X-rayk, MRI History Blood test- ESR, FBC, CRP
167
Give an example of a DMARD
Methotrexate
168
Give 3 ways rheumatoid arthritis can be treated
``` DMARDs Infliximab NSAIDs Painkillers Corticosteroid injections Physio ```
169
Give 3 complications of chronic rheumatoid arthritis
``` Carpal tunnel Widespread inflammation Joint damage Cervical myelopathy CV disease ```
170
What is carpal tunnel disease?
Median nerve is compressed as it passes through the wrist causing severe pain, especially on flexion
171
What is hyperthyroidism?
Excessive production of thyroid hormone
172
Give 3 causes of hyperthyroidism
Autoimmune Pituitary adenoma Thyroid tumour Amiodarone side effect
173
Give 4 symptoms of hyperthyroidism
``` Weight loss Hot flushes Palpitations Mood swings Muscle weakness Hair loss Anxiety ```
174
What test diagnoses thyroid disease?
Levels of T3/T4 in the blood
175
How is hyperthyroid disease treated?
Thionamines= carbimazole Radioiodine treatment Surgery- thyroidectomy
176
What is a thyroid storm?
Exacerbation of hyperthyroidism | Tachycardia, fever, confusion, jaundice, loss of conciousness
177
What is hypothyroidism?
Underproduction of thyroid hormone
178
Give 4 symptoms of hypothyroidism
``` Weight gain Feeling cold Muscle cramp Tired Depression Constipation ```
179
Give 4 causes of hypothyroidism
``` Autoimmune destruction Gene mutation Congenital- malformation Lack of iodine Previous thyroid treatment ```
180
How is hypothyroidism treated?
Levothyroxine
181
What is a goitre?
Lack swelling in the neck due to thyroid disease
182
What is thrombo-embolic disease?
Formation of a clot in a blood vessel which can move to block a smaller vessel
183
Give 4 conditions which are classes as thrombo-embolic diseases
Stroke DVT PE MI
184
Give 3 risk factors for thromboembolic disease
``` COCP Prolonged immobility Diabetes Post-surgery High cholesterol ```
185
Give the 3 factors in Virchow's triad
Damage to vessel lining Change in blood constituents Turbulent/stagnant flow
186
How is thromboembolic disease treated?
Anticoagulants- warfarin, heparin, aspirin
187
How can thromboembolic diseases be diagnosed?
``` Imaging Blood tests D Dimer Physical examination History ```
188
What is a vasovagal faint?
Sudden temporary loss of consciousness, usually resulting in a fall
189
Give 4 warning symptoms that may be present before a vasovagal faint
``` Nausea Lightheadedness Sweaty Yawning Tachycardia Confusion Blurred vision ```
190
Describe how the patient may feel after a vasovagal faint
Weak, tired and have some memory loss of the event
191
What is the pathological cause of a vasovagal faint?
Temporary reduction in blood flow to the brain
192
Give some causes of vasovagal faints
Slow heart rate Dehydration Medication ADRs Low blood pressure
193
How are vasovagal faints treated?
Treat underlying cause Warning signs --> lie down, head between legs, drink water After faint --> recovery position

PPE OSCE Questions (3 decks)

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