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OSCE Peer Teachings Flashcards

1
Q

What is MJ-THREADS

A 
MI
Jaundice
-
TB
HTN
Rheumatic fever
Epilepsy
Asthma and COPD
Diabetes
Stroke
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2
Q

Relevant things to ask about for FHx

A

Atopy, autoimmune, MI

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3
Q

What should you ask about in asthma

A

Pets

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4
Q

Cardiac presenting complaints

A 
Chest pain
SOB
Ankle swelling
Cough, sputum, haemoptysis
Dizziness
Syncope
Palpatations
Claudications
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5
Q

Cardiac causes of chest pain

A 
MI
Pericarditis
Angina
AF
Acute myocarditis
Aortic dissection
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6
Q

Musculoskeletal causes of chest pain

A

Costocondritis
Trauma
Muscle sprain

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7
Q

Gastrointestinal causes of chest pain

A

GORD
Peptic ulcer disease
Oesophageal stricture

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8
Q

Respiratory causes of chest pain

A

PE
Pneumonia, TB
Pneumothorax
Malignancy

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9
Q

Other causes of chest pain

A

Anxiety
Sickle cell crisis
Shingles

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10
Q

SOCRATES

A 
Site
Onset
Character
Radiation
Associated symptoms
Timing
Exacerbating/alleviating factors
Severity
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11
Q

MI SOCRATES

A

Central, crushing, radiates down left arm and jaw

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12
Q

Perciarditis SOCRATES

A

Central pain, bores through to the back, better if sat forward. Worse if lying down.

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13
Q

Angina SOCRATES

A

Central tightness or heaviness, radiates to arms and jaw. Exertional! Relieved by rest!

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14
Q

Acute myocarditis SOCRATES

A

Preceding flu symptoms

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15
Q

Aortic dissection SOCRATES

A

Tearing pain, central or abdominal

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16
Q

MI more likely to be silent in

A

Diabetics

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17
Q

Cardiac associated features

A

Syncope, epigastric pain, vomitting

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18
Q

What is a significant cardiac family history

A

MI <55yo 1st degree relative

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19
Q

What should you ask about PC

A

Whats your main concern? Which symptom is most problematic?

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20
Q

What medical conditions can cause angina

A

Anaemia, thyrotoxicosis, hyperlipidaemia and aortic stenosis.

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21
Q

How to distinguish between stable and acute angina

A

Stable=exertional
Quantify exertion
Cold, emotion, heavy meals.

How frequent? How is it affecting them? How do you stop the pain? New Dx?

Associated symptoms, lifestyle, PMH

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22
Q

What specific history questions might you want for angina

A

Statin?
GTN?
Aspirin?
Past MI?

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23
Q

Non modifiable cardiac risk factors

A

Male, age, familly history of IHD

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24
Q

Modifiable risk factors

A

Smoking, hypertension, hyperlipidaemia, obesity, sedentary lifestyle

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25
Define acute angina
Chest pain at rest >20 minutes and associated symptoms
26
What are ACS
Acute angina and MI
27
Questions for SOB
``` Onset Pattern Affect on daily life? Quantify PMH DH Wheeze, weight loss, swelling ```
28
PMH questions for SOB
Asthma, malignancy, CV history, anaemia
29
Associated symptoms questions for SOB
Wheeze, weight loss, swelling
30
Differentials for SOB
Heart failure, PE, resp stuff
31
Symptoms fo LV failure
Dyspnoea, PND, Orthopnoea, poor exercise tolerance, fatigue, cough, wheeze
32
Define dyspnoea
Shortness of breathe
33
Define orthopnoea
SOB on lying flat
34
Define Paroxysmal Nocturnal Dyspnoea
SOB at night, waking from sleep
35
What classification is used for HF severity
New York Association Classification
36
SOB questions
What was normal before diagnosis? Quantify activity. Pillows at night? Stairs?
37
Grade I HF
No limitations, no symptoms on activity
38
Grade II HF
Rest fine, activity causes symptoms
39
Grade III HF
Marked limitation of physical activity
40
Grade IV HF
Symptoms at rest and any activity
41
What does peripheral swelling suggest
Right ventricular heart failure
42
Signs of RV heart failure
Pitting oedema, sacral oedema, ascites, nausea, facial engorgement, anorexia
43
What does cough with pink frothy sputum suggest
LV failure
44
RV failure = cough?
Lung disease a cause so possibly
45
What does nocturnal cough suggest
Asthma or heart failure
46
What does haemoptysis suggest
PE and malignancy
47
Questions for palpitations
``` Frequency Onset Duration 'Desribe it' Tap out rhythm Dizziness or LOC Anxiety Hx ```
48
Palpitations PMH
AF diagnosis On any blood thinners Stroke or mini stroke? History of valve disease?
49
What is CHADS2VASC for
Atrial fibrillation stroke risk
50
What does CHADS2VASC stand for
``` Congestive HF HTN Age (65-75-+) DM Stroke, tia Vascular disease Sex: female ```
51
What risk score is used for risk of bleeding on warfarin
``` HTN Abnormal liver or kidney Stroke Bleeding Labile INR Elderly Drugs or alcohol ```
52
Causes of syncope
Postural hypotension, vasovagal attack, severe aortic stenosis, AF
53
Syncope questions
``` When? How often? Blackouts? Associated symptoms? Systems review ```
54
Syncope associated symptoms
Palpitations, sweating, hyperventilation, chest pain, headache
55
Intermittent claudication questions
``` SOCRATES Where Quantify Risk factors Associated symptoms ```
56
Calf intermittent claudication artery
Femoral
57
Buttock intermittent claudication artery
Iliac
58
Intermittent claudication risk factors
Smoking, alcohol, diabetes, hypertension, hyperlipidaemia
59
Intermittent claudication associated symptoms
Gangrene, burning, foot pain, impotence
60
"Im hanging my foot off the bed at night"
Critical limb ischaemia.
61
Pacemaker v ICD
ICD can directly treat the arrythmia whereas a pacemaker just provides electrical stimuli
62
Describe aortic stenosis
Ejection systolic murmur heard loudest over aortic region. Can radiate to carotids. Loudest when sat forward in held expiration.
63
Describe mitral regurgitation
Pansystolic murmur loudest in axilla.
64
Causes of aortic stenosis
Old age calcification
65
Causes of mitral regurg
IV hypertrophy, IE, Valve calcification
66
Cough questions
``` Duration Dry or productive? Sputum Blood Time of day? Exacerbations ```
67
Cough: Sputum questions
Consistency Colour Odour
68
Cough: Blood questions
How much? Fresh or old? Bleeding elsewhere? DVT symptoms?
69
Cough: Exacerbation questions
``` Pets Pollen Dust Weather Occupation ```
70
Cough: other important symptoms
``` Wheeze Chest pain SOB FEVER, WEIGHT LOSS, NIGHT SWEATS feel unwell ```
71
Cough PMH
Acid reflux Asthma COPD TB
72
Cough DHx
ACE inhibitors Allergies Inhalers TB Jab
73
Cough FHx
Asthma, hayfever, eczema Pneumonia contacts TB contacts
74
Cough SHx
``` Occupation Pets Smoking Pollution Foreign travel ```
75
General respiratory PMH
``` TB Asthma PE Pneumonia GORD Allergies Rheumatoid ```
76
General respiratory FH
``` Cystic fibrosis TB Asthma Eczema Hayfever Emphysema ```
77
General respiratory SH
``` Crowded accomodation Damp Occupation Foreign travel Pets ```
78
SOB HPC
``` Describe Duration Constant or intermittent Activity limitation? Getting worse? Any exacerbations? Any relieving factors? ```
79
SOB Other symptoms
``` Chest pain Lie flat Pillows PND Ankle swelling Wheeze Cough Systemic illness Anxiety and pain attacks Fatigue ```
80
SOB PMH
``` Asthma COPD TB Cardiac Severe lung infections Blood clot ```
81
SOB DH
Inhalers | Allergies
82
SOB FH
Asthma | Cardiac disease
83
SOB SH
Smoking and ex smoking Occupation Stress and anxiety
84
Asthma assessment
``` Symptoms Waking at night Symptoms in morning Reliever use Activity limitation Allergies Social ```
85
Asthma symptoms
``` Wheeze Cough SOB Infections Diurnal variation ```
86
Asthma SHx
Coping with medications Smoking Occupation Pets
87
GTN side effects
Low blood pressure | Dizziness
88
Name the two open questions to ask first
Please could you tell me whats been troubling you? Can you tell me more about this?
89
Important questions about PC
SOCRATES Have you had this before? What do you think might have caused it?
90
Special question for dyspepsia
Can you describe the sensation of indigestion that you feel
91
Causes of dyspepsia
Peptic ulcer GORD Gastritis and duodenitis Non ulcer dyspepsia, medication induced and non GI
92
Which type of peptic ulcer is more common
Duodenal
93
Describe gastric ulcers
``` Less common Pain caused by meal Occurs 30mins-1hr after meal Bleeding- haematemesis Caused by delayed gastric emptying ```
94
Describe duodenal ulcers
``` More common Pain relieved by eating Occurs 2-3 hours after meal Bleeding- melaena Caused by increased gastric emptying ```
95
How to take a dyspepsia HPC
SOCRATES and ALARMS symptoms
96
Whatre you thinking about with the radiation of dyspepsia
Perforation? Pancreatitis? Chest pain- cardiac
97
Associated symptoms with dyspepsia
Bitter taste (GORD) Early satiety? Bloating ALARMS red flags
98
What are the ALARMS dyspepsia red flags
``` Anaemia (iron deficiency) Loss of weight Anorexia Recent onset/ progressive Malaena/ haematemesis Swallowing difficulty ```
99
If the dyspeptic patient has one of the ALARM symptoms or is over 55
Upper GI endoscopy
100
In addition to SOCRATES what should you ask a dyspepsia patient
Have you had these symptoms before? How does this episode compare? Do you know what may have caused these symptoms?
101
Vomitting and dyspepsia
Haematemesis, bleeding peptic ulcer, gastric cancer in the pyloric region
102
Malaena and dyspepsia
Due to erosion of mucosa due to gastric cancer or bleeding peptic ulcer
103
Dyspepsia and weight loss
How much? In how long? Suggests malignancy
104
Dyspepsia and tiredness/SOB
Chronic disease, leading to anaemia
105
Relevant Drug history for dyspepsia
NSAIDs/ Aspirin, steroids, SSRIs
106
What is dysphagia
Difficulty swallowing
107
What is odynophagia
Painful swallowing
108
What is globus
Sensation of having a lump in the throat
109
What is new onset dysphagia in middle age and elderly people
Cancer until proven otherwise
110
What is high dyphagia
Oropharyngeal and upper oesophageal
111
What is low dysphagia
Lower oesophageal
112
Character in dysphagia SOCRATES
Solids, liquids or both? has this changed?
113
Associated symptoms in dysphagia SOCRATES
Regurgitation? Neck lump? odynophagia?
114
Questions to ask about relieving factors in dysphagia SOCRATES
Does it get better after the first few swallows
115
Other questions to ask about dysphagia on top of SOCRATES
Have you had these symptoms before? How does this episode compare? Do you know what may have caused these symptoms?
116
Other PC to ask about in dyspepsia
``` Dysphagia Vomiting Abdo pain/ bloating Jaundice Constipation Blood in stool Weight loss Tiredness/ SOB ```
117
Other PC to ask about in dysphagia
``` Dyspepsia Vomiting Abdo pain Jaundice Change in bowel habit Blood in stool Weight loss ```
118
Young person diarrhoea causes
Infective diarrhoea Irritable bowel syndrome -coeliac, crohns, UC, medications, hyperthyroid
119
Old person diarrhoea causes
``` Neoplastic (colon or pancreatic) Diverticular disease Overflow Medications IBD ```
120
Which ages are most affected by IBD
15-25years and also 50-80years
121
Which patients are at risk of bacterial overgrowth
Diabetic patients
122
7 questions to ask about the character of
``` 1- frequency 2- colour 3- formed or watery 4- blood? paper? mixed? 5- float? flushable? 6- smelly? 7- mucus ```
123
What do stools which float, are difficult to flush and offensive smelling suggest
Steatorrhea
124
Causes of steatorrhoea
Chronic pancreatitis and malabsorption
125
What are gauges of severity in diarrhoea
Urgency to go to the toilet, incontinence
126
What should you always ask on top of SOCRATES
Have you had these symptoms before? How does this episode compare? Do you know what may have caused these symptoms
127
What does diarrhoea and vomitting suggest
Gastroenteritis
128
What GI associated symptoms should you ask about in diarrhoea
``` Vomiting Abdominal pain Jaundice Constipation Blood in the stool Weight loss Fever, tiredness, SOB -dyspepsia and dysphagia ```
129
What should you ask about if constipation and diarrhoea
Altered bowel habit? Tenesmus
130
What does weight loss and diarrhoea suggest
IBD, Carcinoma
131
What does fever, tiredness and SOB associating diarrhoea suggest
Chronic disease accompanying
132
Other presenting complaints to ask about in diarrhoea
Uveitis, scleritis, episcleritis Rashes Joint pain Thyroid symptoms (feel hot, palpitations, weight loss)
133
Risk factor questions for diarrhoea
``` Recent foreign travel Eaten anything unusual Unwell contacts with similar symptoms Stress? Diet? Changes to meds? ```
134
Diarrhoea- general examination
Jaundice, signs of dehydration, signs of anaemia
135
Diarrhoea- hand examination
Clubbing
136
GI/ diarrhoea causes of clubbing
IBD Hyperthryoid Coeliac
137
Diarrhoea- eye examination
Iritis, episcleritis,
138
How to distinguish episcleritis and scleritis
Episcleritis is more localised whereas scleritis can be blue
139
Diarrhoea- mouth examination
Mouth ulcers
140
Diarrhoea- lymph examiation
Virchows node
141
Diarrhoea- abdomen examination
Masses, tenderness, bowel sounds
142
Diarrhoea- leg examination
Rashes
143
In a history should you ask age or DOB first
Age
144
MSK presenting complaints
``` Pain Stiffness Swelling Erythema Weakness Extra-articular symptoms ```
145
Questions about an MSK presenting complaint
SOCRATES Have you ever had this before? What do you think might have caused it? Trauma?
146
Questions about other presenting complaints in an MSK history
Extra-articular features Risk factors for diseases PC of other systems
147
MSK- Site, queries
Arthralgia, myalgia, soft tissue? small or large joint? Mono, Oligo, Poly? Symmetrical, haphazard?
148
MSK- Onset, queries
Post trauma Gradual onset Acute onset
149
MSK- Post trauma onset
Haemarthrosis Tendon tear Tendonitis
150
MSK- Gradual onset
OA RA Chronic injury
151
MSK- Acute onset
Gout Vacular aetiology Trauma
152
OA joint distribution
``` Neck Spine Hip Distal fingers Knee ```
153
RA joint distribution
``` Neck Shoulder Elbow Wrist Every hand joint Hip Knee Ankle Every foot joint ```
154
Psoariatic arthritis joint distribution
``` Elbow Wrist Fingers Knee Ankle Toes ```
155
Ankylosing spondylitis joint distribution
Spine Pelvis Knee
156
MSK: Deep, boring pain esp at night
Osteomyelitis, osteonecrosis, bone mets
157
MSK: Diffuse pain
Osteomalacia | Fibromyalgia
158
MSK: Stiffness, poorly localised pain, worse on movement. Muscle pain
Polymyositis Dermatomyositis Partial muscle tears
159
MSK: Sharp pain worse on movement
Fracture pain
160
MSK: Shooting pain (peripheral nerve/root impingement)
Disc prolapse Sciatica
161
MSK: Widespread unremitting pain, poorly controlled
Fibromyalgia, complex pain syndrome
162
MSK: Exquisite pain but no apparent abnormality
Compartment syndrome
163
MSK: Wells criteria
``` Clinical signs of DVT PE more likely than alternative Immobilised 3 days Previous DVT or PE Haemoptysis Active malignancy ```
164
MSK: Nerve compression radiation
Radiates to the nerve distribution
165
MSK: Neck pain radiation
Radiates to the shoulder and over the top of the head
166
MSK: Low grade fever
SLE RA Giant cell arteritis
167
MSK: Spiking fever
Septic arthritis Bone TB Osteomyelitis
168
MSK: Spiking fever and pain which moves from joint to joint
Rheumatic fever | Gonococcal arthritis
169
MSK: Weight loss
Malignancy Bone METs Systemic (SLE, RA)
170
MSK: extra articular features
``` Rash Malaise Jaw claudication Headache Diarrhoea & GI Eye involvement ```
171
MSK: Timing questions
How often? For how long? Is there a pattern?
172
MSK: early morning stiffness and pain which lasts more than 30mins
Rheumatoid arthritis
173
MSK: end of the day aches and pains
Osteoarthritis
174
MSK: Stiffness which improves on exercise in younger patients
AnkSpond
175
MSK: Suggested exacerbating factors
``` Cold weather Physical exertion Infection Immobility Certain foods (alcohol) ```
176
MSK: Suggested alleviating factors
Warmth Exercise Resting NSAIDs
177
MSK: Very severe pain
Trauma Gout Septic arthritis Vascular
178
MSK: Severity questions
Scale 1-10 Stop you doing things? Affect social/work? Wake you up?
179
MSK: Stiffness questions
Restricted ROM? Difficulty moving but normal ROM? Painful movement? Particular joint or generalised movements?
180
MSK: Inflammatory stiffness
Early morning, more than 30mins, wears off with activity, responds well to NSAIDs
181
MSK: Non inflammatory stiffness
Mechanical, stiffness after rest but lasting less than 30mins. End of day stiffness and tiring
182
MSK: Polymyalgia rheumatica stiffness
Shoulder and pelvic areas. Temporal arteritis associated. Jaw claudication, temporal pain, vision symptoms. GIVE STEROIDS
183
MSK: AnkSpond stiffness
Back stiffness on waking up
184
MSK: Unilateral swelling
Local cause
185
MSK: Bilateral/symmetrical swelling
Systemic cause
186
MSK: Sudden onset swelling
Vascular, acute injury
187
MSK: Gradual onset swelling
Chronic injury or inflammation
188
MSK: swelling DHx
Anticoagulants? Bleeding disorder?
189
MSK: Erythema and warmth
Infective arthritis | Trauma
190
Foods which cause gout
Anchioves Fish Kidney, liver Yeast (beer)
191
Foods which prevent gout
``` Lemon Cherries Peppers Watercress Ginger Tumeric ```
192
What are gout crystals made out of
Uric acid crystals
193
What are pseudogout crystals made out of
Calcium pyrophosphate
194
Which gender gets more gout
Males
195
Which gender gets more pseudogout
Females
196
Gout on light microscopy
Negatively birefringent needles
197
Pseudogout on light microscopy
Positively birefringent rhomboids
198
Which joints are affected by gout
1st MTP, small joints of hand, wrist, ankle, elbow, knee
199
Which joints are affected by pseudogout
Knee, wrist and ankle
200
Which other changes are associated with gout
Purine rich foods, obesity, DM, crystal cellulitis, gout tophi, urate kidney stones
201
Which other changes are associated with pseudogout
Fever, chondrocalcinosis on XRay
202
MSK: Neurological causes of weakness
``` Spinal cord injury Nerve root entrapment Single nerve damage MND GBS Polio ```
203
MSK: Muscular causes of weakness
Myositis Myalgia Muscle atrophy
204
Causes of myositis
Injury Infection Autoimmune
205
Causes of muscle atrophy
``` Malnutrition Burns Muscular dystrophy Drug SEs LMN damage ```
206
Infective causes of myalgia
``` Coxsackie virus Cytomegalovirus Dengue fever Streptococcus Mycoplasma ```
207
Trauma causes of myalgia
Tears Haematoma Rhabdomyolysis
208
Inflammatory causes of myalgia
Polymyalgia rheumatica Dermatomyositis Polymyositis
209
Drugs causes of myalgia
Alcohol withdrawal Statins Triptans
210
Metabolic causes of myalgia
Hypo/hyperthyroid Addisons disease Low vitamin D
211
Myotoxic drugs
``` Colchicine Antimalarial Statins Corticosteroids Sulfonamides Zidovudine ```
212
MSK: Past medical history
Previous MSK TB Gout Risk Factors
213
MSK: PMH Risk Factors
``` DM Coeliac Steroid therapy Fractures or deformities Stroke ```
214
MSK: Gout PMH questions
Alcohol Renal disease Metabolic syndrome Aspirin, diuretics
215
MSK; Family history
``` Inflammatory arthritis (1stDegree) OA/osteoporosis HLA-B27 Charcot Marie Tooth Osteogenesis imperfecta Ehlers-Danlos, Marfans Muscular dystrophies ```
216
4 HLA-B27 seronegative conditions
``` PEAR Psoariatic arthritis Enteropathic arthritis Ank Spond Reactive arthritis ```
217
MSK: Drug history
``` Steroids Statins ACE-I Anti epileptics Immunosuppressants Quinolones ```
218
MSK: what do steroids cause
Osteoporosis Myopathy Osteonecrosis
219
MSK: what do statins cause
Myalgia, myositis, myopathy
220
MSK: what do ACE-I causee
Myalgia | Arthralgia
221
MSK: what do anti-epileptics cause
Osteomalacia | Arthralgia
222
MSK: what do immunosuppressants cause
Infections: Osteomyelitis
223
MSK: what do quinolones cause
Tendinopathy, tendon rupture
224
MSK: Social history
``` Occupation Ethnicity Sexual History Alcohol Smoking IVDU Diet ```
225
MSK: occupational diseases
Repetitive strain disorder Hand vibration syndrome Fatigue syndrome
226
MSK: Ethnicity diseases
African- sickle cell Asian- osteomalacia TB areas- bone TB
227
MSK: Sexual diseases
HIV- reactive arthritis, gonoccal arthritis Neurosyphilis Hep B
228
MSK: Alcohol diseases
``` Trauma Gout Myopathy Rhabdomyolysis Neuropathy ```
229
MSK: Smoking diseases
Lung cancer bone mets RA
230
MSK: IVDU diseases
Trauma Hep B HIV
231
MSK: Diet diseases
Vitamin deficiencies -rickets/osteomalacia -scurvy Osteoporosis
232
MSK: Extra-articular features
``` Brain Hair Eyes Mouth Face/skin Nail changes Skin rash Dry cough/ SOB Arrythmias Abdominal pain Aches/ weakness Hand deformities ```
233
MSK: brain signs
``` SLE= depression&migraines Fibromyalgia= tension ha GCA= throbbing ha + vision loss ```
234
MSK: hair signs
SLE= scarring allopecia | Dry? Brittle?
235
MSK eye signs
``` Sjogrens= red and dry Episcleritis= pain & tearing Uveitis= pain & floaters ```
236
MSK: mouth signs
``` Crohns&SLE= sores Sjogrens&RA= dry ```
237
MSK: face
``` Sarcoidosis= lupus pernio SLE= malar rash Sjogrens= big salivary glands ```
238
MSK: arrythmias
SLE= endocarditis | Scarring and cardiomyopathy
239
MSK: dry cough/sob
Sarcoidosis SLE Caplans
240
MSK: Aches and weakness
PMR Steroids Sjogrens Dermatomyositis
241
MSK: Abdominal pain
SLE= serositis Sarcoidosis= high Ca2+ Fibromyalgia= IBS Enteropathic A= IBD
242
MSK: Nail changes
Psoariatic arthritis= nail pitting
243
MSK: Skin rash
Erythema Nodosum TB, Sarcoidosis SLE= photophobia
244
Osteoarthritis XRay signs
``` LOSS Loss of joint space osteophytes Subchondral cysts Subarticular sclerosis ```
245
MSK: DIPJ
OA (Heberdens) Psoariatic Reactive
246
MSK: PIPJ
OA (Bouchards) SLE RA Psoariatic
247
MSK: MCP
RA Pseudogout Haemochromatosis
248
MSK: Base of thumb
OA
249
MSK: Wrist
``` RA Pseudogout JIA Carpal tunnel Gonococcal arthritis ```
250
HLA DR4
``` RA DM1 MS Coeliac SLE IgA nephropathy Systemic sclerosis PMR ```
251
HLA B27
P E A R
252
HLA DR2
``` Goodpastures SLE MS PBS AI Hepatitis ```
253
Vitiligo associations
``` Hashimotos Scleroderma RA DM1 Pernicious anaemia Addisons SLE ```
254
Signs of goodpastures syndrome
Haematuria and haemoptysis
255
Lower back pain red flags
Urinary retention Saddle anaesthesia Leg weakness Faecal incontinence
256
What does having all the lower back pain red flags point towards
Cauda equina syndrome
257
Lower back pain questions
``` Cancer Hx Coeliac IVDU Morning stiffness Pseudoclaudication Trauma Fever <35yo ```
258
Fibromyalgiadditional questions
``` Chronic widespread pain Shoulders, elbows and knees Tension headache Atypical chest pain IBS Dysmennorhoea Facial pain Sleep disturbance ```
259
AnkSpond Clinical picture
``` Younge male Stiff pack better with exercise Night pain Sacroiliac joint Bamboo spine Reduced chest expansion Syndesmophytes Ankylosis Schobers test Uveitis+costohondritis ```
260
Psoariatic arthritis clinical picture
``` DIP Arthritis mutilans penicl in cup deformity Nail changes Dactylitis Enthesitis ```
261
What is arthritis mutilans
Periarticular osteolysis and bone shortening seen in psoariatic A
262
What is dactylitis
Whole digit swelling
263
What is enthesitis
Tendon attachment inflammation
264
What nail changes are in psoariatic arthritis
Subungal hyperkeratosis Nail plate pitting Discolouration and ridging Onycholysis
265
Reactive arthritis develops after
UTI STI Dysentry (salmonella, shigella)
266
Reactive arthritis clinical picture
Conjunctivitis Arthritis Skin changes -keratoderma blennorrhagica
267
Reiters syndrome
Cant see Cant pee Cant climb a tree
268
Rheumatic fever criteria
Jones criteria
269
Jones criteria for rheumatic fever
``` Joint arthralgia CardiOmyopathy subcutaneous Nodules Erythema marginatum Sydenham chorea ```
270
Dermatomyositis blood tests
ANA CK Myoglobin
271
Dermatomyositis clinical picture
``` Heliotrope (eyelid) rash V neck rash Gottons papules Periungal erythema Calcinosis ```
272
Causes of peripheral neuropathy
``` DM Poliomyelitis Chronic alcoholism Leprosy Syphilis ```
273
Neck of femur fracture sign
Leg shortened and externally rotated
274
Symptoms to screen for in a neuro history
``` Headache/ facial pain Weakness Numbness Collapse Confusion Gait change Tremor Dizziness Visual change ```
275
thunderclap headache is suggestive OF
SAH
276
What can focal neurological signs suggest
Brain haemorrhage Stroke Abscess
277
What can a change in mental status suggest
Raised ICP | Encephalitis
278
What is the triad of meningism
Photophobia Neck stiffness Headache
279
What can cause meningism
Meningitis Abscess affecting meninges SAH
280
What goes red eye suggest
acute closed angle glaucoma
281
What does worse on lying down suggest in a neuro patient
Raised ICP
282
What are causes of raised ICP
Space occupying lesion | Haemorrhage
283
What are red flags in neuro
``` Thunderclap headache Focal neurological signs Change in mental status Meningism Worse on lying down ```
284
Primary headaches
Tension Migraine Cluster
285
Secondary headaches
Intracranial infections Intracranial bleeds Raised ICP GCA
286
Signs of tension headache in a history
Band like Stressed Towards end of day
287
Signs of a migraine headache in history
``` Unilateral Throbbing/ pulsating Aura Photophobia Phonophobia (Quiet dark room) ```
288
What is the most common aura in migraines
Scintillating scotoma (spot of flickering light)
289
Signs of a cluster headache in a history
Unilateral red eye Autonomic features Seasonal clusters
290
What are extra features of a cluster headache
Lid swelling Lacrimation Rinorrhoea
291
Questions to differentiate secondary headaches
Fever Head injury/fall Speed of onset
292
Meningitis symptoms
``` Neck stiffness Headache Photophone Fever N+V Non blanching rash ```
293
Diagnosis of meningitis
Blood cultures | Lumbar puncture
294
Treatment of meningitis in GP
IM BenPen
295
Treatment of meningitis in hospital
IV Cefotaxime
296
Specific signs for inflammation of lining of brain
Kernigs and Brudzinskis
297
Triad of encephalitis
Fever Headache Change in mental state
298
How to differentiate encephalitis and meningitis
Encephalitis has more predominant symptoms of confusion and altered consciousness
299
What is meningitis (layman)
Inflammation of lining of brain
300
What is encephalitis
Inflammation of brain parenchyma itself (Normally herpes, simplex bad)
301
Diagnosis of encephalitis
Lumbar puncture
302
Treatment of encephalitis
IV acyclovir
303
SAH symptoms
``` Thunderclap headache Raised ICP -headache -N&V -visual disturbance -fixed dilated pupil ```
304
SAH history
Usually spontaneous | Sentinel headaches
305
SAH PMH
PKD | Ehlers Danlos
306
SAH investigations
CT
307
SAH treatment
Endovascular coil, surgical clip
308
SDH history
Elderly Alcholic Recent major trauma Within hours
309
Question to rule out brain tumour
Weight loss
310
Question to rule out brain abscess
Fever
311
Question to rule of intracranial bleed
Trauma
312
Symptoms of raised intracranial pressure
Headahce worse lying down/coughing Weakness N&V Confusion
313
Describe what happens in GCA
Inflammation of branches of external carotid artery. Granulomatous thickening and reduced blood supply to distal muscles causes claudication
314
Signs of PMR
Shoulder and pelvic girdle pain and stiffness
315
Specific question in PMH for GCA
Polymyalgoa rheumatica
316
Specific questions for GCA
Hurt when comb hair? Hurt when eat? Vision problems? Chest pain to back?
317
Symptoms of GCA
Jaw and tongue claudication Tender scalp/ occiput Sudden painless unilateral LOV Aorta dissection risk
318
Investigation of GCA
Temporal artery biopsy
319
Treatment of GCA
High dose steroids
320
Differential diagnosis of visual disturbance
``` Migraine MS GCA Raised ICP Myasthenia gravis ```
321
Visual disturbance HPC questions
Describe what problem is Onset Ever had before Associated symptoms
322
Possible descriptions of visual disturbance
Spot of flickering light in centre of vision which enlarges Loss of central colour vision Vision is blurry Seeing double
323
Recurring visual problems suggests
MS | Migraines
324
Visual disturbance associated symptoms
Weakness Numbness Headache
325
MS investigations
LP- Oligoclonal bands VEP- Optic neuritis MRI
326
MS Treatment
Relapses- prednisolone | DMAs- beta interferon
327
What is often first presentation of MS
Optic neuritis
328
What does optic neuritis present as
Pain on eye movement Reduction in central vision Reduction in colour vision
329
Questions for MS
``` Disseminated in space and time Weakness? Sensory disturbance? Ever had before? Where? Fatigue? Worse in bath? ```
330
What is the pathophysiology of trigeminal neuralgia
Artery compressing trigeminal nerve and its branches
331
Questions to ask for trigeminal neuralgia
SOCRATES | Triggers- chewing, contact, breeze
332
Treatment for trigeminal neuralgia
Carbamazepine
333
Triggers of trigeminal neuralgia
Chewing, any contact, a breeze
334
Questions to ask about weakness
``` Site and distribution Onset Duration Triggers Timing and progression Associated symptoms Happened before? ```
335
Associated symptoms for weakness
Visual, speech and sensory disturbance. Bladder bowel, ED, saddle anaesthesia
336
Weakness PMH
Cardiovascular events | AI disease
337
Sudden onset weakness questions- currently?
``` Facial weakness? sensation? Visual disturbance? Weakness or sensory distribution elsewhere? Eating, drinking, swallowing problems? Speech disturbance? Dizziness/balance problems? Confusion? ```
338
Sudden onset weakness questions- in the past?
Head trauma LOC Illness Anything similar
339
Bells palsy symptoms
``` Cant wrinkle brow Drooping eyelid Cant puff cheeks Drooping mouth Loud noises (stapedius) ```
340
Which cranial nerve is affected in Bells Palsy
CN VII Facial
341
What is the treatment for Bells Palsy
Prednisolone
342
Stroke- face, arm or leg symptoms
Numbness or weakness | Trouble walking
343
Stroke- brain symptoms
Confusion Aphasia Dizziness Headache
344
Stroke- eye symptoms
Trouble seeing
345
Stroke- stomach symptoms
Nausea or vomiting
346
Is a stroke painful
No
347
Stroke history
Neuro and CVS Hx CVS risk factors Previous TIA
348
Stroke, CVS risk factors
HTN DM Cholesterol AF
349
Stroke drug history
Anticoagulants
350
Stroke investiagtions
CT head
351
Stroke treatment
Streptokinase <4.5hrs | Aspririn >4.5hrs
352
Is weakness present in upper or lower motor neurone lesions
Both
353
Is atrophy present in upper or lower motor neurone lesions
Lower
354
Are reflexes and tone increased or decreased in UMN lesions
Increased
355
Are reflexes and tone increased or decreased in LMN lesions
Descreased
356
Are fasciculations present in UMN or LMN lesions
Lower
357
Is Babinski present in UMN or LMN lesions
Upper
358
Brain UMN lesions
Stroke Space occupying lesion Multiple sclerosis
359
Spinal cord UMN lesions
Multiple sclerosis | Spinal cord compression
360
LMN lesions
Radiculopathies Peripheral neuropathies Myasthenia Gravis Guillain Barre Syndrome
361
Both Upper and Lower lesions
Motor neurone disease
362
Lesions disseminated in time and space
Multiple sclerosis
363
Symptoms made worse by hot baths
Motor neurone disease
364
What is a radiculopathy
Nerve root neuropathy
365
Causes of radiculopathy
``` Prolapsed disk Spinal stenosis Tumours Trauma Infection Spondylolithesis ```
366
What is the main cause of radiculopathy
Prolapsed disk
367
What is radicular pain
Pain along a dermatome
368
What is the general presentation of a radiculopathy
Sciatica LMN weakness and altered sensation Absent reflex Bladder, bowel, ED, saddle anaesthesia
369
What is myelopathy
Spinal cord compression
370
What is the most common cause of myelopathy
Metastasis
371
What are the causes of myelopathy
Metastasis, infection, trauma, disk prolapse
372
Chronic subacute spinal cord compression presentation
Spastic paraparesis Radicular pain at level Sensory loss below level
373
What would the radicular pain be if you had spinal cord compression at T4
Band of pain around nipples, worse on coughing or straining
374
What would the sensory symptoms be in spinal cord compression
Numbness starts in the feet and then rises to level of compression
375
What does spastic paraparesis show as
Retention of urine and constipation develops
376
Does cauda equina syndrome show UMN or LMN signs
LMN
377
Red flags for cauda equina syndrome
``` Sever lower back pain Sciatica Bladder/bowel dysfunction, urinary retention Saddle anaesthesia Sexual dysfunction Neurological deficit in lower limb ```
378
Motor neurone disease signs
UMN/LMN signs, no sensory loss
379
MND History hints
Weakened grip, dropping things Shoulder weakness Tripping up Dysarthria (bulbar onset)
380
How does myasthenia gravis work
Autoantibodies against post synaptic ACh receptor at the NMJ
381
Age and gender of myasthenia gravis
20-40, women more than men
382
What are classic signs of MG
Eye muscle weakness, fatigueability
383
What is the progression of MG
Eye, bulbar (dysphagia, swallowing, chewing, dysarthria) then proximal limb muscles
384
Questions to ask in MG history
Symptoms get worse as day goes on? | Exacerbated by exertion?
385
Numbness and tingling red flags
``` Weakness Incontinence Saddle anaesthesia Numbness after trauma Confusion Drowsiness ```
386
What does incontinence suggest when accompanying numbness
Cauda equina
387
What does saddle anaesthesia suggest when accompanying numbeness
Cauda equina
388
What does numbness after head, neck or back injury suggest
Spinal injury - cord compression - cauda equina - nerve root compression from prolapsed disk
389
What does confusion and numbness/tingling suggest
Stroke/something else affecting the brain
390
Numbness and tingling sites
``` Dermatomal Non dermatomal Sensory level One side of the body Hands and feet ```
391
What dos dermatomal distribution suggest
Peripheral nerve or nerve root lesion
392
What does a sensory level distribution suggest
Spinal cord lesion
393
What does a one side of the body distribution suggest
Stroke or other brain lesion
394
What does a glove and stocking distribution suggest
Peripheral neuropathy
395
Which nerve controls biceps muscle
C6
396
Which nerve controls big toe extension
L5
397
Radiculopathy specific questions
What were you doing at the time
398
Carpal tunnel syndrome tell tale sign
Thumb weakness
399
Carpal tunnel syndrome risk factors
Rheumatoid arthritis | Hypothyroidism
400
Ulnar nerve compression questions
Trauma to elbow | Weakness of hand muscles
401
Radial nerve compression question
Cannot open first
402
Median nerve muscles
``` LLOAF Lateral 2 lumbricals Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis ```
403
Ulnar nerve muscles
Muscles in hand apart from LLOAF
404
Radial nerve muscles
Extensor muscles in forearm
405
Spinal cord lesions specific questions
Preceding trauma | PMH: Osteoporosis
406
Stroke 5 problems | WAPES
``` Weakness Aphasia Problems with higher functioning Emotional disturbance Sensory disturbance ```
407
Stroke in which lobe causes weakness
Frontal
408
Stroke in which lobe causes sensory disturbance
Parietal
409
Stroke in which area causes receptive aphasia
Wernickes, temporal
410
Stroke in which area causes expressive aphasia
Brocas
411
Stroke in which area causes disinhibition and impulsivity
Frontal
412
Stroke in which area causes emotional disturbance
Hippocampus- temporal
413
Why do you get glove and stocking distribution
Disease of the axon, so the longest axons will be the first to be affected
414
Whats the difference between distal axonopathies and GBS
GBS has weakness as the main symptom
415
What causes a distal axonopathy
Response of neurones to metabolic or toxic disturbances
416
Distal axonopathy questions
Gradual? Diabetes? Alcohol abuse, kidney failure? Vit deficiency? B1 and B12
417
Malabsorption symptoms
Diarrhoea, foul smelling stools that are hard to flush, weight loss
418
Which vitamins cause distal axonopathies
B1 and B12
419
Signs of GBS
Symmetrical, ascending weakness and numbness over weeks
420
What should you ask about in GBS
Preceding infection? | Respiratory involvement?
421
What is a red flag in GBS
Respiratory involvement
422
Which infective agent can cause GBS
EBV
423
Collapse questions
When did it happen? What were they doing at the time? How many times has this occurred? LOC?
424
Precollapse symptoms questions
Aura? | Light headed?
425
During collapse symptoms questions
Tongue biting Foaming Incontinence
426
Post collapse symptoms questions
Rapid recovery | Fatigue
427
Generalised seizures precipitating events
Usually none, can occur during sleep
428
Syncope precipitating events
Stress, exercise, excitment
429
Generalised seizures signs preceding the episodes
Signs related to the prodrome and aura phases
430
Syncope signs preceding the episodes
Usually none. Sometimes ataxia, vocalisation, urination or defecation
431
Generalised seizures: during
Motor activity such as tonic clonic, jaw and facial movements. Urination or defecation, drooling. LOC
432
Syncope: during
Usually flacid collapse. LOC, urination etc more rare
433
Duration of generalised seizures
Longer than a minute
434
Duration of syncope
Usually shorter than a minute
435
After the event: generalized seziures
Signs related to post ictal phase, slow recovery
436
Signs following the event: Syncope
Rapid recovery
437
What does NEAD have that epilepsy doesnt
``` More than 2mins Gradual onset Closed eyes Side to side head moves Tip of tongue biting Fluctuating course May talk during seizure ```
438
Differentials of tremor
``` Parkinsons Benign essential tremor drug induced tremor Alcohol withdrawal Hypoglycaemia Thyrotoxicosis ```
439
Tremor HPC questions
``` Resting or action SOCRATES Gait change? Balance and coordination? Gradual onset=disease ```
440
Tremor DHx
Antipsychotics
441
Tremor SHx
Amphetamines
442
Tremor FHx
Essential tremor
443
Three parkinsons signs on examination
Resting tremor Rigidity Bradykinesia Assymetrical onset
444
Neurological parkinsons symptoms
``` Anosmia Postural instability Reduced dexterity Micrographia Decreased arm swing Blank face Dysphagia Neuropathy ```
445
Autonomic parkinsons symptoms
``` Constipation Sexual dysfunction Sweating Incontinence Drooling Dizziness ```
446
Psychiatric parkinsons symtoms
``` Depression Insomnia Amnesia Emotional volatility Poverty of thought Visual hallucinations ```
447
Parkinsons diagnosis
Clinical | SPECT scanning
448
Good things to ask in endocrine histories
``` Fatigue/tiredness Weakness Weight loss Weight gain Hirsuitism ```
449
Fatigue, tiredness, neck lump questions
``` Infection Night seats Neck lump not in midline -anaemia, DM, lymphoma, infective AI PMH ```
450
Neck lump differentials
Thyroid swellings Reactive neck lymphadenopathy Malignant neck node
451
Examples of thyroid swellings
Multinodular goitre, solitary thyroid nodule
452
Examples of reactive neck lymphadenopathy
Tonsilitis Glandular fever HIV
453
Examples of malignant neck nodes
Carinoma metastases, lymphoma
454
Key hypothyroidism symptoms
Weight gain Poor memory Intolerance to cold Feeling of tiredness
455
Symptoms of hypothyroidism
``` Hair thin and loss Puffy face Enlarged thyroid Dry and coarse skin Slow heart beat Constipation Heavy menstruation Poor appeitite Carpal tunnel ```
456
Signs of hypothyroidism
``` Oedema Vocal hoarseness Goitre Delayed relaxation of reflexes Paraesthesia ```
457
Key hyperthyroidisim symptoms
``` Irritability Hyperactivity High blood sugar Intolerance to heat Low cholesterol ```
458
Breathless, dysphagia, neck pressure suggests
Large toxic multinodular goitre
459
Symptoms of hyperthryoidism
``` Fine brittle hair Bulging eyes Increased sweating Enlarged thyroid Enlarged liver Arrythmias Increased appetite N, V and D Hand tremors Loss of libido Amenorrhea ```
460
Hyperthyroidism signs
``` Agitation, fine tremor, erythema Tachycardia, AF, heart failure, oedema Eye signs Goitre Fine tremor Alopecia Urticaria, pruritus Brisk reflexes Proximal myopathy ```
461
What does a tender irregular thyroid gland suggest
Subacute thyroiditis
462
What is graves disease signs
``` Lid retraction Exopthalmos Opthalmoplegia Lid lag Pretibial myxoedema ```
463
What is exopthalmos
Protrusion of the eye ball, specific to graves
464
What is opthalmoplegia
Paralysis of the extra ocular muscles which cause diplopia
465
Risk factors for thyroid eye disease
Smoking | Female
466
Describe T1 DM
Autoimmune destruction of beta islet cells
467
Describe T2 DM
Combination of insulin resistance and then islet cell destruction
468
Acute triad of T1DM
Polyuria Polydipsia Weight loss (tiredness)
469
Acute triad of T2DM
Polyuria Polydipsia Obesity (tiredness)
470
Diabetes HPC
Vision problems Numbness/ tingling Sexual dysfunction Skin infections
471
Diabetes PMH
Stroke Heart disease PVD Kidney problems
472
T2DM DH
Steroids
473
T2DM SH
Smoking Alcohol Exercise Diet
474
T2DM FH
T2DM
475
T1DM Treatment
Insulin and education | Chronic disease management
476
T2DM Treatment
1) Lifestyle advice, statin, Ramipril 2) Metformin Chronic disease management
477
Cardiac PMH
Hospital/ A&E visits, GP visits | Previous stents
478
Cardiac FH
M1 <55years 1st degree relative
479
Cardiac SH
``` Smoking Alcohol Diet and lifestyle Occupation Home- carers? ADLs? ```
480
Respiratory FH
Cystic fibrosis | Asthma, eczema, hayfever
481
Respiratory PMH
ACE-I Inhalers Immunisations
482
Respiratory SH
``` Foreign travel Pets Occupation Living conditions Hobbies Long haul flights ```
483
Respiratory PMH
``` Asthma TB PE Allergies Pneumonia Home oxygen Inhalers ```
484
CV common presenting complaints
``` Chest pain Palpitations Ankle swelling Leg pain SOB Syncope and presyncope ```
485
Respiratory common HPCs
``` Cough SOB Asthma COPD Pulmonary fibrosis ```
486
Cardiac causes of chest pain
ACS Pericarditis Aortic stenosis Aortic dissection
487
Aortic stenosis triad
Chest pain Syncope Heart failure
488
Respiratory causes of chest pain
Pulmonary embolism Pneumonia Pneumothorax
489
GI causes of chest pain
GORD | Peptic ulcer disease
490
Other causes of chest pain
Costochondritis | Rib injuries
491
Cardiac pain which goes to the trapezius and shoulders
Pericarditis
492
Cardiac chest pain associated symptoms
SOB, N&V, sweating, palpitations, ankle swelling, syncope, calf swelling, haemoptysis, sputum or trauma
493
Palpitations questions
``` TAP OUT BEAT how often, for how long Associations Sweating or SOB Syncope, Chest pain? Associated with exercise? Family history of CVD? ```
494
Palpitations red flags
Chest pain | Palpitations associated with exercise
495
Cardiac causes of palpitations
Cardiac arrhythmias Valve pathology Heart failure Congenital heart disease
496
Non cardiac causes of palpitations
Psychosomatic, hyperthyroid, anaemia, medication, recreational drugs, caffeine
497
Left ventricular failure symptoms
``` Exertional SOB PND Orthopnoea Cough Pink frothy sputum ```
498
Right ventricular failure symptoms
``` Ankle and sacral oedema Cough Ascites JVP Bibasal crackles ```
499
What does pink frothy sputum suggest
Left ventricular heart failure
500
What are the three cardinal signs of heart failure
Exertional SOB, ankle swelling and fatigue
501
Heart failure questions
``` How many pillows Sleeping in chair Can they climb stairs Exercise tolerance What was normal for them before ```
502
Leg pain symptoms
Leg swelling Increase in skin temperature Change in skin colour
503
Leg pain risk assessment questions
``` Recent surgery Long haul flight History of malignancy Immobility Previous VTE Family history of VTE ```
504
Intermittent claudication questions
``` How far can walk before pain CVS risk factors Associated symptoms -gangrene, burning, foot pain (hanging foot off bed=critical ischaemia) -impotence ```
505
How do you measure intermittent claudication
ABPI
506
Chronic causes of SOB
COPD Pulmonary fibrosis Heart failure
507
Acute causes of SOB
PE Asthma attack Pneumonia Pneumonothorax
508
Acute/chronic causes of SOB
Carcinoma of the lung Pleural effusion TB
509
SOB HPC
When How long does it last Associated features What makes it better or worse
510
Associated features of SOB
Chest pain, palpitations, orthopnoea/PNS, nausea or vomiting, cough, oedema, pain
511
SOB PMH
Asthma, COPD, VTE | RF for heart disease
512
SOB DH
Inhalers, drugs, allergies
513
SOB SH
Smoking | Occupation
514
SOB FH
Asthma | Cardiac disease
515
SOB Important extras
SWAFF | Risk factors for VTE
516
Syncope causes
Vasovagal syncope, postural hypotension, aortic stenosis, cardiac arrhythmias
517
Syncope questions
``` Onset, duration Situation Previous episodes How frequently Associated symptoms ```
518
Syncope associated symptoms
Palpitations, sweating, chest pain, headache
519
Things to look out for in CVS examinations
``` Pacemakers Murmurs AF GTN spray CABG scars on legs ```
520
Things to look out for in resp examinations
Sputum pots, oxygen tanks and inhalers Tar staining on fingers Walking stick
521
Prehospital treatment of MI
Morphine Oxygen gtN Aspirin
522
Kidney transplant signs
Lump and scar
523
LOC before questions
What were you doing | How did you feel
524
LOC during questions
``` LOC Duration Injuries Bite your tongue Incontinent ```
525
LOC after questions
How did you feel Confused How long was recovery
526
Epilepsy before
Flashing lights aura Metallic taste Altered behaviour Can be in sleep
527
Epilepsy during
2-3mins LOC Stiffness then shaking Incontinence Bite side of tongue Symmetrical
528
Epilepsy after
Confusion | Tiredness for days
529
Sycope before
Standing, stress, emotion, eating, coughing, turning head | Palpitations and nausea
530
Syncope during
``` Flaccid collapse Multifocal shaking- assymetrical Scream out Random limb movements Less than one minute ```
531
Syncope after
Rapid recovery | No marked confusion
532
Non epileptic attack disorder ebfore
Emotions Traumatic experiences Bodily sensations
533
NEAD during
``` Fluctuating course eyes tightly shut talking Moving head side to side Longer than 5 minutes ```
534
Headaches red flags
``` Thunderclap headache Altered mental state Focal neurological signs Meningisms Worse on lying down ```
535
Tension headaches symptoms
Tight band pain across whole head Associated with stress Analgesia induced
536
Tension headache questions
Do you feel stressed? Are you taking pain relief? How much?
537
Migraine symptoms
Severe throbbing pain on one side of the head. Photo and phonophobia Aura Associated numbness and tingling
538
Migraine questions
Do you see anything before it happens
539
Cluster symptoms
Severe ocular pain Autonomic features Multiple a day for weeks, years apart with no warning (clusters)
540
Cluster questions
Has it happened before
541
Subdural haemorrhage risk factors
Elderly Epileptic Alcoholic recent head trauma
542
Extradural haemorrhage symptoms
Head injury LOC Period of regaining consciousness V, dizziness, confusion, headaches, LOC
543
Secondary headaches
``` EDH SDH SAH Meningitis Encephalitis Raised ICP Temporal arteritis ```
544
Subarrachnoid haemorrhage symptoms
Thunderclap headaches- spontaneous, peaks within 5s | Sentinel headaches
545
SAH PMH
PKD | Ehlers danlos
546
SAH Ix
CT head, don't LP
547
SAH Tx
Surgical coiling/clipping
548
Meningitis symptoms
``` Fever Stiff neck Altered conscious state Headache Non blanching purpuric rash Photophobia Vomiting ```
549
How do encephalitis symptoms differ from meningitis
Confusion and altered mental state are more prominent
550
3 things which increase ICP
Brain tumour Brain abscess Intracranial bleed
551
Question for a) tumour b) abscess c) bleed
Weight loss Fever Trauma
552
Temporal arteritis symptoms
Headache, hurts when I eat or brush hair | Painless loss of vision
553
Temporal arteritis treatment
High dose prednisolone
554
Temporal arteritis investigations
Temporal artery biopsy
555
Visual disturbances questions
``` Do you wear glasses? One eye or both Describe it Triggers or trauma Pain ```
556
Amaurosis Fugax desribe
TIA | Curtain coming down over vision
557
TIA PMHx
HTN Stroke AF DM
558
Retinal detachment questions
``` Always painless Many floaters Flashes of light Blurred vision Then curtain like loss of vision ```
559
Myasthenia gravis questions
``` Symptoms worse with use Double vision Ptosis Myasthenic snarl Swallowing problems ```
560
Symptoms arising from the thyroid swelling
``` Duration and change in size Cosmetic symptoms Odynophagia, dysphagia Dyspnoea Hoarseness ```
561
Thyroid PMH
Eye symptoms Previous thyroid operations Drug history Radio-iodine therapy for Graves
562
Breast lump history
``` SOCRATES Pain Nipple changes Discharge Skin changes Before? Radiation or surgery ```
563
Breast cancer risk factors
``` Early menarche Late menopause 1st pregnnacy >30yo Nulliparty HRT FHx ```
564
What to look for for breast cancer
``` Lump in armpit Lump in breast Dimpled, depressed skin Swelling Nipple changes Breast pain Skin irritation Bloody discharge ```
565
Smooth breast lump that moves under skin
Fibroadenoma
566
Breast lumpiness, thickening and swelling associated with periods
Fibrocystic changes
567
Red tender breast swelling associated with fever
Mastitis
568
Breast bruise with lump
Breast trauma
569
Neuro red flags
LOC, dizziness, headache, visual or speech disturbance, swallowing, sensory changes, bowel and bladder incontinence, meningism, weakness, hearing changes, tremors, N/V, weight loss
570
Stroke PMH
Arrythmias, MI, HTN, angina, high cholesterol, diabetes
571
Leg motor gone, which artery was affected
Anterior cerebral artery
572
Arms, face motor gone. Which artery was affected
middle cerebral artery
573
Which artery is blocked in amaurosis fugax
Opthalmic artery
574
Two causes of face paralysis
Stroke or Bells palsy
575
How can you tell between stroke and bells palsy
Forehead spared in stroke
576
Face paralysis questions
``` Drooling difficulty speaking Dry eyes hypersensitive to sound decrease in taste Recent illness? ```
577
Treatment for bells palsy
Prednisolone within 72hours
578
Change classic to MG
Fatigueability
579
Change classic to MS
Sensory or sphincter loss
580
Change classic to MND
Upper and lower motor neurone changes
581
Are fasciculations a sign of upper or lower MN problem
Lower
582
Is babinskis reflex a sign of upper or lower MN problem
Upper
583
What is the first change in MG
Eye signs
584
Numbness and tingling differential diagnosis
``` Peripheral neuropathy Stroke Nerve root lesion Spinal cord lesion Cauda equina MS ```
585
Radiculopathy describe
Back pain and altered sensation along a dermatome. LMN signs. Myotome weakness ?What were you doing at the time
586
What is the most common cause of radiculopathy
Slipped disc
587
Myelopathy describe
Back pain, sensory loss and pain. UMN signs
588
What is radiculopathy
Nerve root lesions
589
What is myelopathy
Spinal cord lesions
590
Specific questions for myelopathy (spinal cord lesions)
Preceding trauma Osteoporosis Red flags
591
Cauda equina symptoms
``` Severe lower back pain Sciatica Bladder, bowel dysfunction Saddle anaesthesia Sexual dysfunction Neurological deficit ```
592
5 possible stroke problems
``` Weakness Sensory disturbance Aphasia Higher function Emotional disturbance ```
593
Where is the lesion if they get weakness
Frontal
594
Where is the lesion if they get sensory disturbance
Parietal
595
Where is the problem if they get receptive aphasia
Wernickes- temporal
596
Where is the problem if they get expressive aphasia
Brocas
597
Where is the problem if they have problems with higher function
Frontal
598
Where is the problem if they have emotional disturbance
Temporal- hippocampus
599
Signs of capral tunnel syndrome
Thumb weakness | RFs: RA, hypothyroid
600
Signs of. ulnar nerve compression
Trauma to elbow | Weak muscles of hand
601
Signs of radial nerve compression
Cannot open fist
602
Classic first symptom of MS
Optic neuritis
603
Classic sign of MS
Gets worse with heat (stress and illness)
604
1st line therapy for MS
A happy stress free life
605
Diabetes questions
``` Thirst Toilet Tired Infections Eyesigh Tingling ED ```
606
Diabetes family history
Diabetes Stroke Cardiovascular disease
607
Diabetes Drug History
Steroids (= hyperglycaemia)
608
Diabetes Social history
Alcohol
609
B12 neuropathy pathophysiology
Weakness due to B12 deficiency leading to subacute degeneration of the cord
610
Cuses of B12 deficiency
Pernicious anaemia, malabsorption, dietary
611
B12 Questions
AI (Addisons), UC or Crohns Vegan SWAFF
612
Why does low b12 lead to subacute degeneration of the cord
Patchy losses of myelin
613
Signs and symptoms of subacute degeneration of the cord
Weakness and tingling that progressively worsens Visual and mental changes Spastic paresis
614
Causes of microcytic anaemia
Iron deficiency Thalassaemia Haemoglobinopathies
615
Causes of normocytic anaemia
``` Acute blood loss Haemolysis Renal failure Chronic disease Cancer ```
616
Causes of macrocytic anaemia
``` B12 deficiency Folate deficiency Alcohol excess Liver/thyroid disease Methotrexate and trimethoprim ```
617
General infection questions
Sexual history Recreational drugs Holiday Bitten
618
Cushings symptoms
``` Acne Weight gain Gonadal dysfunction Proximal weakness Mood change ```
619
Signs of. cushings
``` Fat distribution Skin changes Osteoporosis HTN Hyperglycaemia, infection prone ```
620
Fat distribution changes in cushings
Central obesity Moon face Buffalo neck Supraclavicular fat distribution
621
Skin changes in cushings
Skin and muscle atrophy Bruises Purples abdominal striae
622
Mood changes in cushings
Depression, lethargy, irritbaility, psychosis
623
Gonadal dysfunction in cushings
Irregular menses, hirsuitism, ED, virilsation

2b (28 decks)

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