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OSCE revision Flashcards

1
Q

What symptoms would you ask about in a urinary history taking

A 
Frequency
Urgency
Nocturia
Dysuria
Polyuria/Oliguria
Incontinence
Incomplete emptying of bladder
Retention
Abdominal Pain
Fever
Weight loss
Back pain
Nausea/V+
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2
Q

What does SOCRATES stand for

A 
Site
Onset
Character
Radiates
Associated Symptoms
Timing
Exacerbating/Relieving factors
Severity
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3
Q

What symptoms would you ask about in a cardio history taking

A 
Chest pain
Dyspnoea, at rest/exercise
Palpitations
Ankle Oedema
Varicose Veins
Claudication
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4
Q

What symptoms would you ask about in a respiratory history taking

A 
Cough
Sputum
Haemoptysis
Dyspnoea
Wheeze
Chest pain
Sinusitis symptoms, blocked nose, discharge, f pain, 
Earache
Sore throat
Change in taste (COVID)
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5
Q

What symptoms would you ask about in a neuro history taking

A 
Speech disturbance 
Cognitive impair (MSQ)
Headache
Fits/faints/LOC - tongue biting, jerking, incontinence 
Dizziness, vertigo
Balance
Vision - acuity, diplopia 
Hearing
Weakness
Numbness/tingling/paraesthesia
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6
Q

What symptoms would you ask about in an endocrine history taking

A 
Fatigue
Lethargy
Sleep quantity/quality
Sweating
Weight change/appetite
Thirst
itchy skin
bruising, neck lumps
hair loss/growth

CVS - tachycardia, palpitations, chest pain
Neuro - headache, dizzy, visual loss, confusion, blackout
GI - change in bowel habit, weight/appetite change
Urinary - polyuria/nocturia, erectile dysfunction, menstruated cycle, skin colour
Psych - low mood, depression, anxiety, personality change

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7
Q

What symptoms would you ask about in a alimentary history taking

A 
appetite/weight loss or change
mouth/teeth/tongue
dysphagia
dyspepsia/heartburn
nausea, v+
haematemesis 
Fat intolerance
Jaundice
Abdominal pain
abdominal distension (+ bloating)
Bowel habit: change/constipation/D+/blood/mucus/maleana 
faecal incontinence 
perianal symptoms, haemorrhoids, pain, itching
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8
Q

What symptoms would you ask about in a general history taking

A 
fatigue/malaise
fever/rigors
weight/appetite
skin: rashes/bruising/bleeding
sleep disturbances
thirst
pruritis
night sweats
neck swelling/lumps
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9
Q

What questions would you ask in a male sexual health history

A

Erectile dysfunction - how long, can they develop one at all? can they have sex. morning erections? affecting their relationship? have they discussed with their partner. any other changed with their body at the same time?

prem or delayed ejaculation
urinary symptoms - dysuria, frequency, dribbling, flow
penile discharge
testicular swelling, any pain
penile rashes, ulcers, lumps
infertility? how long trying
sexual history, partners?, how long together, protection?
high risk partners? gay, sex workers, iv drug users
any prev STIs?

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10
Q

What questions would you ask in a female sexual health history?

A

menstrual history - age periods started, intermenstrual or post coital bleeding
last menstrual period
dysmenorrhoea or menorrhagia
pelvic and sexual infections - discharge, pelvic pain, ulcers
smear history, when was last
menopause? any PMB?
obstetric history - parity and gravidity, terminations? miscarriages
infertility?
past and present use of contraception
incontinence, stress and urge?
sexual history, partner? type of sex, high risk partners?

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11
Q

What extra questions would you ask in a paediatric history?

A

Birth History
- gestation, mode of delivery, weight, mothers health, any labour problems, need any help delivering, neonatal care?
Immunisations
Development - milestones, smiling (6-8weeks) sitting (8mths), crawls (9mths) walking (by 18mths) first words (12mths)

Systemic: fever, feeding, lethargy, bowels, peeing, abd pain, cough, breathing, headache, vomiting. Pain anywhere?

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12
Q

What is part of the mental state exam

A

Appearance and Behaviour
Mood
Speech
Thought form - phobia, obsessions
Thought content - delusions
Abnormal perception - hallucinations
Insight - do you think there is something wrong?
Cognition - memory orientation

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13
Q

What is part of the mental state exam

A

Appearance and Behaviour
Mood
Speech
Thought form - phobia, obsessions
Thought content - delusions
Abnormal perception - hallucinations
Insight - do you think there is something wrong?
Cognition - memory orientation

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14
Q

How would you ask a patient about hallucinations

A

Do you ever hear things where you cant work out where they come from?
see things
feel things
smell things

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15
Q

How would you ask a patient about delusions

A

Do you have any beliefs that other people wouldn’t agree with?

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16
Q

What extra things do you ask in a psychiatric history

A

After presenting complaint
- Past psychiatric history - prev illnesses? treatment, duration
Past medical history
Drug and allergies
Family history
- Personal history - early development, childhood, education, occupation, relationships
Social - drugs and alc, any dependancies?
- Forensic - have you ever had any trouble with the police?
- Pre-Morbid personality - what were you like before this happened

Mental state exam
ask about delusions, hallucinations
elated mood?
memory disturbance?
suicidal thoughts? harming others?

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17
Q

Cerebellar exam pneumonic?

A

DANISH
disdiadochokinesis
Ataxia
Nystagmus
Intention tremor
slurred speech
hypotonia, heel shin

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18
Q

What should be assessed in cerebellar examination

A
  • general inspection
  • gait (broad based ataxic gait), turn, heel toe
  • Romberg’s test (sensory ataxia)
  • Speech - ataxic dysarthria, slurred
  • Eyes - nystagmus, H
  • Upper limbs - dysd, finger nose, tremor, tone (hypotonia)
  • Lower limbs - leg roll, knee lift for tone, knee reflex (hyporeflex), heel shin test
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19
Q

Side effects of corticosteroids

A

dizzines, headache, ankle swelling, weight gain.
GI upset - indigestion, rarer stomach ulcers
Mood disorder - depression, mania

Osteoporosis
Increased risk of infection
Thinning of skin
Cushings syndrome, round face
Diabetes
Hypertension
Glaucoma
Muscle weakness

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20
Q

Explaining diagnosis checklist

A

normal anatomy physiology
what disease is
what causes it
complications
management
monitoring

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21
Q

Explain procedure checklist

A

What it is
Why they need it
Before the procedure, during and after procedure info
Risks and benefits

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22
Q

Explain drug checklist

A

check p’s understanding of condition
what drug is and what it does
how to take tx
side effects
monitoring
check for contraindications

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23
Q

HRT benefits

A

reduction vasomotor symptoms
inc mood
CVS protection
reduced risk of osteoporosis

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24
Q

HRT SE

A

breast tenderness, nausea, bloating

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25
HRT risks
inc risks of clots, stroke, breast cancer, endometrial cancer (prog protects)
26
Heart failure chest x ray signs
Alveolar oedema Kerley b lines Cardiology Dilated upper lobe vessels Pleural effusion
27
first line investigation for prostate cancer and other ix
multiparametric MRI Biopsy, TRUS
28
Investigations for testicular cancer
Beta HCG AFP LDH Trans-scrotal ultrasound CT w contrast
29
MX testicular cancer
radical inguinal orchidectomy
30
Differentials for dementia
Depression Delirium
31
3rd nerve palsy signs
eye down and out pupil dilated
32
4th nerve palsy sign
up and out vertical diplopia
33
6th nerve palsy
Inwards
34
What is rockall score for
Severity of upper GI bleed
35
What is glasgow blatchford score for
likelihood of patients needing medical or surgical intervention for upper GI bleed
36
Emergency contraception types?
Copper IUD Ullipristal tablet Levongesterol tablet
37
Pericarditis ecg changes
PR depression ST elevation in limb leads I, II, III AND pre cordial leads V2-6 Reciprocal ST depression and PR elevation in lead aVR
38
When can you use Copper IUD for emergency contraception
up to 5 days after UPSI can cause heavy periods should take preg test 3 weeks after
39
When can you use ullipristal for emergency contraception
5 days
40
How does ullipristal work and who cannot take it?
delays ovulation not recommended in patients with severe asthma taking oral glucocorticoid
41
When can you use levonogesterol for emergency contraception
3 days synthetic progestogen inhibits ovulation
42
What should be done 3 weeks after UPSI and emergency contraception
pregnancy test
43
what are risks of COCP
breast and cervical cancer clots in legs and lungs small increased risk of heart attack and stroke
44
contraindications to COCP
migraine w aura history of clots age >35 smoking CVS, hypertension <6wks postpartum and breastfeeding BMI>35
45
how does COCP work
prevents ovulation cervical mucus thickening thins lining of womb
46
what to do if miss 1 pill cocp
take missed pill asap No additional contraceptive measures required
47
what to do if miss 1 pill cocp in first week
consider emergency contraception if unprotected sexual intercourse take pill asap Use additional contraceptive measures (condoms) or abstain from sex until pills have been taken for 7 consecutive days
48
what to do if miss 1 pill cocp in week 2-3
take pill asap 2 or more pills are missed in the 7 days prior to a scheduled hormone free interval, the HFI should be missed (go straight to a new packet) additional contraceptive measures (condoms) or abstain from sex until pills have been taken for 7 days
49
how does POP work
Thickening the cervical mucus (to prevent sperm from entering the uterus) Suppression of ovulation.
50
POP starting info
Starting a POP at any other time will require forty-eight hours of extra contraceptive precautions.
51
Missed POP info?
take it as soon as they remember if V+ or D+ within 2hrs, take asap additional contraceptive precautions, such as condoms, should be used for the next two days advice on emergency contraception if unprotected sexual intercourse has occurred after the missed pill and within 48 hours of restarting the POP
52
Methotrexate SE
headahces, stomach upset mucositis - oral ulcers - myelosuppression - infections be aware - pneumonitis - Pulm fibrosis - restrictive - liver fibrosis - folate deficiency - macrocytic anaemia
53
what is RAPD
swinging light test and one eye when tested does not respond to light shone in, does not constrict dysfunction of optic nerve
54
DVLA guidelines for stroke/TIA
stop driving for 1 month then re-assess
55
DVLA guidelines for stroke/TIA for bus/lorry driver
stop for 1 year
56
DVLA guidelines for confirmed Epilepsy dx
license taken away, can't drive for 1 year
57
DVLA guidelines for seizure due to meds changes or dose changed
reapply 6mths
58
DVLA guidelines for first seizure
no seizure for 6 months
59
DVLA guidelines for bus/lorry driver with epilepsy
seizure free for 10 years without being on medication
60
DVLA guidelines for bus/lorry driver with first seizure
no seizure for 5 years no anti-epilepsy medication for 5 years
61
Chlamydia tx
doxycycline preg - azithromycin
62
Neisseria Gonorrhoea tx
IM ceftriaxone
63
Genital herpes tx
oral aciclovir analgesia saline baths
64
bacterial vaginosis tx
metronidazole
65
trichomonas tx
metronidazole
66
HIV tx
early initiation anti-retroviral therapy
67
HIV symptoms
glandular fever type illness sore throat myalgia lymphadenopathy D+ maculopapular rash, non itchy, erythematous occurs 3-12wks after
68
causes of painful loss of vision
Acute angle closure glaucoma Anterior uveitis Corneal Abrasion Scleritis Herpes zoster opthalmicus Optic neuritis - no red eye
69
causes of painless loss of vision
Retinal detachment Retinal vein occlusion Central retinal artery occlusion Age related macular degeneration Diabetic retinopathy Hypertensive retinopathy Open angle glaucoma
70
Physiological causes of neonatal jaundice
Breastfeeding Physiological
71
Pathological neonatal jaundice, <24hrs
Rhesus disease Blood group incompatibility G6PD Sepsis
72
medial epicondylitis fts
flexion and pronation painful, elbow 90 deg
73
lateral epicondylitis fts
extension and supination painful
74
Ectopic pregnancy ix?
urine pregnancy test, urinalysis, vaginal swabs bloods - coag, serum hcg, group and save transvaginal US most accurate
75
mx for ectopic
expectant methotrexate depending on criteria surgical - laparascopic salpingectomy
76
examination findings for appendicitis
Murphy's triad - nausea and vomiting, low grade fever and right iliac fossa pain Rovsing's sign - palpation of LIF causes RIF pain Psoas stretch sign Mcburney's point - between belly button and ASIS generalised pain due to T10 - umbilical pain then moves to RIF
77
exam findings for ascending cholangitis
Charcot's triad - jaundice - fever - RUQ pain
78
Finding for acute cholecystitis
Murphy's sign - palpating RUQ while p inspiring - cause inspiratory catch due to pain US IV AB laparascopic cholecystectomy
79
pancreatitis causes
Alcohol Gallstones Malignancy Idiopathic Drugs - steroids, diuretics Viruses - CMV Hypercalcaemia
80
delirium causes
Infection - UTI, sepsis Constipation Retention Toxins, Drugs Hypoxia Pain Sleeplessness Environment changes
81
Treatment of Crohn's disease
Steroids for flares ASA - sulfasalazine second line Maintaining remission - Azathioprine - Mercaptopurine - Biologics
82
Tx for UC
Flares - ASA - topical or oral mesalazine or sulfasalazine - oral steroids Maintain - Topical ASA - oral ASA
83
Crohns systemic effects or complics
inc risk of bowel cancer gallstones Episcleritis Arthritis
84
UC SE
primary sclerosing cholangitis Uveitis Arthritis

FINALS (7 decks)

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