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OSCE spec Flashcards

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1
Q

increased P wave

A

cor pulmonale

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2
Q

broad/notched/ bifid P wave

A

often most pronounced in lead II
a sign of left atrial enlargement, classically due to mitral stenosis

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3
Q

ST depression CX?

A

secondary to abnormal QRS (LVH, LBBB, RBBB)
ischaemia
digoxin
hypokalaemia
syndrome X

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4
Q

inverted T waves causes

A

myocardial ischaemia
digoxin toxicity
subarachnoid haemorrhage
arrhythmogenic right ventricular cardiomyopathy
pulmonary embolism (‘S1Q3T3’)
Brugada syndrome

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5
Q

FRAX QS?

A

FRAX
10-year risk of fragility fracture
40-90 years

assesses the following factors: age, sex, weight, height, previous fracture, parental fracture, current smoking, glucocorticoids, rheumatoid arthritis, secondary osteoporosis, alcohol intake

low: reassure
int: BMD
high: bone protection
reassess in 2 yrs or when RF change

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6
Q

reverse tick/ schooped out down sloping ST depression?

A

digoxin

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7
Q

digoxin features - ECG

A

down-sloping ST depression (‘reverse tick’, ‘scooped out’)
flattened/inverted T waves
short QT interval
arrhythmias e.g. AV block, bradycardia

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8
Q

Hypokalaemia ECG

A

U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT

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9
Q

reciprocal changed showing post mi?

A

Reciprocal changes of STEMI are typically seen v1-v3:
horizontal ST depression
tall, broad R waves
upright T waves
dominant R wave in V2

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10
Q

confirm post MI?

A

ST elevation and Q waves in posterior leads (V7-9)

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11
Q

posterio MI arteries?

A

Usually left circumflex, also right coronary

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12
Q

anterio lateral leads and arteries?

A

V4-6, I, aVL
Left anterior descending or left circumflex

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13
Q

osborne waves at end of QRS seen in?

A

hypothermia

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14
Q

hypothermia ecg?

A

bradycardia
‘J’ wave (Osborne waves) - small hump at the end of the QRS complex
first degree heart block
long QT interval
atrial and ventricular arrhythmias

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15
Q

WPW on ECG? also explain?

A

short PR interval
wide QRS complexes with a slurred upstroke - ‘delta wave’
left axis deviation if right-sided accessory pathway*
right axis deviation if left-sided accessory pathway*

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16
Q

ECG: LVH, deep Q waves, non spec ST and T abnormal with AF

A

HOCM AF freidrich;s and WPW
findings on echo:
MRSAMASH

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17
Q

ST elevation causes?

A

pericarditis/myocarditis
normal variant - ‘high take-off’
left ventricular aneurysm
Prinzmetal’s angina (coronary artery spasm)
Takotsubo cardiomyopathy
rare: subarachnoid haemorrhage

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18
Q

SVT stable patient MX?

A

vagal manouvers and adenosine
carotid sinus massage
CV
adenosine: causes brief brady/ asystole give in antecubitalfossa, cannula, large vein - 6, 12, 12,

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19
Q

AF with atrial flutter?

A

Hypertension
Ischaemic heart disease
Cardiomyopathy
Thyrotoxicosis

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20
Q

AF and WPW risk?

A

polymorphic VT. also caused by most antiarrhythmic meds. so these are contraindicated in WPW.
TX: radiofrequency ablation

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21
Q

LAD CX?

A

left anterior hemiblock
left bundle branch block
inferior myocardial infarction
Wolff-Parkinson-White syndrome* - right-sided accessory pathway
hyperkalaemia
congenital: ostium primum ASD, tricuspid atresia
minor LAD in obese people

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22
Q

RAD CX?

A

right ventricular hypertrophy
left posterior hemiblock
lateral myocardial infarction
chronic lung disease → cor pulmonale
pulmonary embolism
ostium secundum ASD
Wolff-Parkinson-White syndrome* - left-sided accessory pathway
normal in infant < 1 years old
minor RAD in tall people

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23
Q

prolonged PR CX?

A

idiopathic
ischaemic heart disease
digoxin toxicity
hypokalaemia*
rheumatic fever
aortic root pathology e.g. abscess secondary to endocarditis
Lyme disease
sarcoidosis
myotonic dystrophy
athletes

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24
Q

PE on ECG?

A

large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III

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25
TX bradys? SE of TX?
unstable/ mobitz type 2: atropine 500mvg IV repeat max 6 doses inotropes TC pacing SE: antimusc, inhibits parasymp, so pupil dilation, dry eyes constipation
26
Palpatations dD?
arrhythmias - SVT/ tachys/ flutter HF, structural problems, MVProlapse, anxietiy, thyroid, hypoglycaemis, caffiene, cocaine, heroine, ecstacy, anaemia, fever, phaechromocytoma, pregnancy, TCAs, macroglides, antipysh, terfenadine
27
macroglides?
clarithromycine and erythromycine, pregnancy sace. azithromycin - HL prolong QT
28
tetra cycline eg?
doxycycline, SE: teeth discolourisation, risk of ulcers, oesophagitis, take with water. phtosens, CI: 2 hrs of met acidosis
29
dysphagia DD:
Intrinsic (within oesophagus) — Reflux oesophagitis with stricture formation — Carcinoma of oesophagus or gastric cardia — Pharyngeal or oesophageal web — Pharyngeal pouch — Schatzki (lower oesophageal) ring — Foreign body Extrinsic (outside oesophagus) — Goitre with retrosternal extension — Mediastinal tumours, bronchial carcinoma, vascular compression (rare) Neuromuscular motility disorders (hints from the history: solids and liquids equally difficult, symptoms intermittent) Achalasia Diffuse oesophageal spasm Scleroderma Pharyngeal dysphagia (hints: aspiration, fluid regurgitation into the nose) Cricopharyngeal dysfunction – Zenker diverticulum Neurological diseases bulbar or pseudobulbar palsy myasthenia gravis polymyositis myotonic dystrophy Psychiatric
30
syncope DD? HEAD, HEART, VESSELS
CNS causes include HEAD: Hypoxia (hypoglycemia does not cause syncope) Epilepsy (not a true cause of syncope) Anxiety and hyperventilation Dysfunctional brain stem (basivertebral TIA) Cardiac causes are HEART: Heart attack (ACS) Embolism (PE) Aortic obstruction (IHSS, AS or myxoma) Rhythm disturbance, ventricular Tachycardia Vascular causes are VESSELS: Vasovagal (emotional reactions) or Valsalva (micturition, cough, straining etc) Ectopic (and other causes of hypovolemia) S ituational S ubclavian steal ENT (glossopharyngeal neuralgia) Low systemic vascular resistance autononic dysfunction: Addison’s, diabetic vascular neuropathy Drugs such as CCBs, beta-blockers, anti-hypertensives Sensitive carotid sinus
31
RUQ pain DD?
GORD, biliary colid, cholecystis, ASC chol, GI bleed, peptic ulcer, viral hep, budd chiari, hepatosplenomeg - lymphoma Pyelonephritis. Nephrolithiasis. Renal cancer. Other disease of the kidney or ureter, including hydronephrosis and obstruction of the urinary tract. Diabetic ketoacidosis. Addisonian crisis. Adrenal tuberculosis. Metastatic carcinoma. atypical? acute pancreatitis it is very high. Carcinoma of pancreas tends to produce an aching pain between the scapulae, eased on leaning forward. IBS, meckels, lobar pneumonia
32
LUQ pain DD?
thoracic: pneumona, endocardiits, angina, MI ABDO: AAA, splenic crisis, leukaemia, gastitis, ulcers, carcinomas, renal CX - loin pain colon: diverticular (splenic flexture), IBD, colitis, IBS, constipation epigastic: cancer panc, peptic ulcer, perfoated, peritonisis HSP, raised calcium, scepticaemia, DKA,
33
LIF fossa pain?
uro: torsion, uteretic colic, LUTS orchitis PID/ fibroid deg, ectopic, miscarriage,sigmoid volvulus, acute constipation diverticular disease common - sigmoid colon, GE - generalised
34
RIF pain CX?
crohns: temrinal ileum, appendic, mesenteric adenitis - viral/ infection, LN diverticular: distal colon more thn proximal or perforation meckels peptic ulcer - uq pain right inguinal hernia/femoral hernia PID/ ectopic/ miscarriage/ torsion/ mittelscherz, fibroid deg,
35
Emergency contraception options/ counselling?
IUD: must be inserted within 5 days of UPSI,/ if a woman presents after more than 5 days then an IUD may be fitted up to 5 days after the likely ovulation date ellaone/ ulipristal: 30mg no later than 120 hours after., reduce the effectiveness of hormonal contraception. Contraception with the pill, patch or ring should be started, or restarted, 5 days after having ulipristal. Barrier methods should be used during this periodcaution severe asthma.breastfeeding should be delayed for one week after taking ulipristal. 5 days after ovulation day. ask LMP, 28 cycle? levogestrel: 72 hours of unprotected sexual intercourse (UPSI)\* single dose of levonorgestrel 1.5mg (a progesterone) the dose should be doubled for those with a BMI \>26 or weight over 70kg 84% effective is used within 72 hours of UPSI
36
SMoking cessation counselling?
smoking history: precipitating, finances, personal relations affects, how much, what type, what situation, previous attempts? STAR - set, tell, anticipate, remove. stop date in 2-4W varenicline: dreams, NV, insomnia, start 1 week before SD, do 12 W course. caution in depression, suicide bupropion: NV, CI epilepsy, BF, pregnancy. 2 week before SD and 12 W course NRT: start 1 W before and CBT/ counselling/ follow up in 1-2 W and 4W
37
QRISK2 may underestimate CVD risk in the following population groups?
people treated for HIV people with serious mental health problems antipsychotics, corticosteroids or immunosuppressant drugs autoimmune disorders/systemic inflammatory disorders such as systemic lupus erythematosus
38
Statin counselling?
offered to Qrisk \> 10 yrs high, all over 85YO, T1DM wiht CVd RF or over 40YO, CKD monitor:3 months- full lipid profile if the non-HDL cholesterol has not fallen by at least 40% concordance and lifestyle changes should be discussed with the patient, up to 80mg dose. continue 3m before conception familial hypercholesterolaemia: total cholesterol level \> 7.5 mmol/L and/or there is a personal or FH of premature CVD. test children. O/E xanthoma
39
Chest drain insertion consent? risks?
risks:Failure of insertion -remove and resite., bleeds,Infection, Penetration of the lung, Re-expansion pulmonary oedema
40
CLinical signs of acute pulmonary oedema?
dysonpea, orthopnea, cough, reduced BS, hypoxia, tachy, peripheral oedema, dull to percuss, course crackles, peripheral eodema,
41
42
43
Conditions where HbA1c may not be used for diagnosis in t2DM?
haemoglobinopathies haemolytic anaemia untreated iron deficiency anaemia suspected gestational diabetes children HIV chronic kidney disease people taking medication that may cause hyperglycaemia (for example corticosteroids)
44
CX of type 2 mobitz 1. wencheback?
Drugs: beta-blockers, calcium channel blockers, digoxin, amiodarone Increased vagal tone (e.g. athletes) Inferior MI Myocarditis Following cardiac surgery (mitral valve repair, Tetralogy of Fallot repair)
45
CX of LBB?
notched, broad R in v6, deep pominent S in V1, LAD, poor R wave progression CX: IHD, AS, MI- ant, dilated CM, HTN, digoxin tox, hyperkalaemia
46
EXPL and CX of mobitx 2?
failure of conduction at the level of the His-Purkinje system (i.e. below the AV node) not PR prolongation. constant P waves regular, may or may not conduct the QRS. CX: Anterior MI (due to septal infarction with necrosis of the bundle branches) Idiopathic fibrosis of the conducting system (Lenègre-Lev disease) Cardiac surgery, especially surgery occurring close to the septum e.g. mitral valve repair Inflammatory conditions (rheumatic fever, myocarditis, Lyme disease) Autoimmune (SLE, systemic sclerosis) Infiltrative myocardial disease (amyloidosis, haemochromatosis, sarcoidosis) Hyperkalaemia Drugs: beta-blockers, calcium channel blockers, digoxin, amiodarone
47
48
Severe prolonged bradycardia in a CTG defined as?
(less than 80 bpm for more than 3 minutes) CX: Prolonged cord compression Cord prolapse Epidural and spinal anaesthesia Maternal seizures Rapid fetal descent
49
non reassuring variability? in CTG
less than 5 bpm for between 30-50 minutes more than 25 bpm for 15-25 minutes
50
abnormal varibaility ctg?
less than 5 bpm for more than 50 minutes more than 25 bpm for more than 25 minutes sinusoidal
51
CX of reduced variability?
Fetal sleeping: this should last no longer than 40 minutes (this is the most common cause) Fetal acidosis (due to hypoxia): more likely if late decelerations are also present Fetal tachycardia Drugs: opiates, benzodiazepines, methyldopa and magnesium sulphate Prematurity: variability is reduced at earlier gestation (\<28 weeks) Congenital heart abnormalities
52
CTG - accelleration def?
baseline fetal heart rate of greater than 15 bpm for greater than 15 seconds.1
53
Corneal N reflex?
afferent V1 and effernet CN7
54
Jaw jerk reflex?
mandibular N V3
55
gag reflex n? and carotid sinus reflex?
glossopharyngeal 9 afferent and vagus is efferent
56
pupillary light?
CN2 is afferent, CN3 is efferent
57
lacrimation reflex?
opthalmic V1 afferent and facial N efferent
58
vagus N lesion?
Lesions may result in; ## Footnote uvula deviates away from site of lesion loss of gag reflex (efferent)
59
XII (Hypoglossal) lesion?
Tongue deviates towards side of lesion
60
Lacunar infarcts (LACI, c. 25%) definition? which vessels? presenting?
Lacunar infarcts (LACI, c. 25%) ## Footnote involves perforating arteries around the internal capsule, thalamus and basal ganglia presents with 1 of the following: 1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three. 2. pure sensory stroke. 3. ataxic hemiparesis
61
Posterior circulation infarcts (POCI, c. 25%) stroke SX? vessel?
Posterior circulation infarcts (POCI, c. 25%) ## Footnote involves vertebrobasilar arteries presents with 1 of the following: 1. cerebellar or brainstem syndromes 2. loss of consciousness 3. isolated homonymous hemianopia
62
Lateral medullary syndrome (posterior inferior cerebellar artery) ## Footnote aka Wallenberg's syndrome? SX?
ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner's contralateral: limb sensory loss
63
Weber's syndrome?
ipsilateral III palsy contralateral weakness
64
hydrocephalus is a sign of?
dilated temporal lobe
65
udden onset headache in keeping with a vascular cause and associated hemiplegia. She is also at an increased risk as she suffers migraines and is on the COCP. suggests? investigations?
MR venogram is the gold standard test for diagnosing venous sinus thrombosis DD: migraine with aura, stroke and venous thrombosis. An intracranial haemorrhage is also possible, IX: non-contrast CT head is normal in around 70% of patients D-dimer levels may be elevated
66
MI ECG signs?
inverted T waves ST elevation ST depression a prolonged PR interval peaked T waves right bundle branch block a long QT interval left bundle branch block
67

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