OSCE Examination

Question 1

when looking at a tremor in the hands, what are we looking for

Answer 1

Flapping tremor ==> Hepatic Encephalopathy + uraemia

Question 2

When looking at a px nails, what does:

Clubbing Represent

Answer 2

IBD

Coeliac Disease

Cirrhosis

Question 3

When looking at a px nails, what does:

Leukonychia Represent

Answer 3

Hypoalbuminanaemia ==> Liver cirrhosis // Enteropathy

**white dots on nails

Question 4

When looking at a px nails, what does:

Koilonychia Represent

Answer 4

Iron deficiency

**scooped nail => enough to drop liquid into it

Question 5

When looking at a px palms, what does:

Palmar erythema represent

Answer 5

increased oestrogen => inc. hyperdynamic circulation in liver disease / pregnancy

Question 6

When looking at a px palms, what does:

Dupuytren’s contracture represent

Answer 6

Alcoholism // Liver disease

Question 7

Overall when looking at the hands, what are all the conditions we are looking out for?

Answer 7

Hepatic Encephalopathy (F.tremor)
Cirrhosis + IBD + Coeliac (Clubbing)
Hypoalbumnaemia in cirrhosis (Leukonychia)

Iron Deficiency (Koilonychia)
Increased oestrogen (palmar erythema)
Alcoholism // Liver disease (Dupuytren's contracture)

Question 8

When looking at the px eyes, what does:

Jaundice in the Sclera represent?

Kayser-Fleischer rings represent?

Answer 8

liver disease

Wilson’s disease ==> Copper disease

Question 9

when looking at the px eyes, what does:

Conjunctival pallor represent

Answer 9

Anaemia*

GI bleeds, malabsorption

Question 10

When looking at the px eyes, what does:

periorbital xanthelasma represent?

Corneal Arcus represent?

Answer 10

Hyperlipidaemia in cholestasis

hypercholesterolaemia (if under 50)

Question 11

When looking at the px mouth, what does:

Glossitis // stomatitis represent

Answer 11

Iron / B12 deficiency

Question 12

when looking at the px mouth, what does:

Aphthous ulcers represent

Answer 12

IBD

Question 13

when looking at the px mouth, what does a:

Fruity smell indicate?

Feculent indicate?

Answer 13

Ketoacidosis

Obstruction

Question 14

overall when looking at the face, what are all the conditions we are looking out for?

Answer 14

Liver disease (sclera jaundice)
anaemia (Conjunctival pallor)
Hyperlipidaemia in cholestasis (Periorbital xanthelasma)

Iron/b12 def (glossitis / stomatitis)
IBD (Apthous ulcers)
Ketoacidosis (Fruity smell breath)
B.obstruction (Feculent breath)

Question 15

when examining the neck, what node are we interested in (left supraclavicular fossa)

what does this indicate

Answer 15

Virchow’s node

==> Gastric malignancy

Question 16

when examining the back + chest, what is significant if we find 5+ of these

Answer 16

Spider Naevi

Question 17

When examining the neck and back of px, what are we asking the patient to do?

Answer 17

lean forwards

Question 18

When examining the chest of the px, what are we asking the patient to do/

Answer 18

Ask px to sit back

Question 19

What does a loss of axilliary hair indicate when looking at the chest

Answer 19

Inc. in oestrogen levels ==> liver disease // pregnancy

IDA
Malnutrition

Question 20

When looking at the axillae, what does Acanthosis nigricans represent

Answer 20

darkening // hyperpigmentation

==> T2DM
==> GI Malignancy

Question 21

When looking at a px with distention, what are the 5 causes of it

Answer 21

5F’s

Fluid
Flatus
Fat
Fetus
Faeces

Question 22

What is the order of palpation of the abdomen

Answer 22

Superficial
Deep
Liver 
Spleen
Kidney
Aorta

Question 23

how to demonstrate the Rovsing’s sign

What does a positive sign produce

Answer 23

Palpate in LIF//Suprapubic area. Quickly release and pain should be felt in RIF

Positive ==> Appendicitis

Question 24

how to demonstrate the Murphy’s sign

What does a positive sign produce

Answer 24

Place 2 fingers under the coastal margin in RUQ on mid clavicular line

Ask px to inhale and px should be in pain from inhalation

Positive sign ==> Acute cholecystitis

Question 25

Hepatomegaly can be caused by what (5)

Answer 25

HCC

Hepatitis

RVF

Leukaemia // Lymphoma

fatty liver // Alcoholic liver disease