SCP 2 RE

Question 1

In a diabetic foot exam, you notice that one of the patient’s feet is a reddish/purple colour, and the other is their normal skin colour. What could this indicate?

Answer 1

Unilateral discolouration is a sign of acute iscaemia

Question 2

Name some factors that contribute to the development of foot ulcers:

Answer 2

Sustained hyperglycaemia
Angiopathy (peripheral vascular disease)
Abnormal immunity
Neuropathy and loss of sensation
Foot deformity
Skin atrophy- dryness/cracks in the skin
Friction/footwear/calluses
Trauma- mechanical, chemical, or thermal

Question 3

“A break in the skin which is failing to heal”

Answer 3

ulcer

Question 4

What does the acronym “SINBAD” stand for?

Answer 4

Site
Ischaemia
Neuropathy
Bacterial infection
Area
Depth

Question 5

Most common site of foot ulcers?

Answer 5

the forefoot

Question 6

___________ is necrosis secondary to inadequate perfusion (can be wet or dry)

Answer 6

Gangrene

Question 7

Erythema of the foot could be due to infection or acute ________

Answer 7

ischaemia

Question 8

It’s important to remove dead tissue in foot ulcers in order to prevent _______

Answer 8

sepsis

Question 9

One sign of chronic lack of blood perfusion in the lower extremities is _____ loss.

Answer 9

hair

Question 10

Sudden onset unilateral warmth, redness and oedema over the foot/ankle, usually with a history of minor trauma

Answer 10

Charcot arthropathy

NB: 30% can present without pain or discomfort

Question 11

__________ sounds should heard in a Doppler ultrasound of the lower extremity . As the disease progresses, only _________ sounds are heard.

Answer 11

Triphasic, monophasic

Question 12

The ________ _______ pulse is palpable on the dorsum of the foot in the first intermetatarsal space just lateral to the extensor tendon of the great toe

Answer 12

dorsalis pedis

Question 13

Where would you palpate the posterior tibialis pulse?

Answer 13

Behind the medial malleolus

Question 14

Impaired sense of vibration and proprioception indicate an impairment in which area of the CNS?

Answer 14

the dorsal columns

Question 15

What are the sites on the foot at highest risk of peripheral neuropathy?

Answer 15

Toes and heads of the metatarsals

Question 16

What type of tool is used to test for peripheral neuropathy in the feet?

Answer 16

10g monofilament

Question 17

Where should you place a tuning fork to test a patient’s sense of vibration?

Answer 17

Start by placing the tuning fork on the patient’s sternum to test whether they can feel it, then move it to the interphalangeal joint of the 1st hallux. Move to proximal bony prominences if they cannot feel vibration distally.

Question 18

Which nerve root is associated with the “ankle jerk” reflex?

Answer 18

S1

Question 19

What is one of the first nerve roots affected in diabetic neuropathy (due to its long length?)

Answer 19

S1

Question 20

If someone has a “moderate” diabetic foot risk score, how often should they be screened, and by whom?

Answer 20

Annual screening by a podiatrist

Question 21

If someone has a “high” diabetic foot risk score, how often should they be screened, and by whom?

Answer 21

Annual screening by a specialist podiatrist

Question 22

What are the four components of a diabetic foot exam?

Answer 22

Inspection
Palpation
Sensation
Gait assessment

Question 23

Difficulty rising from a chair could potentially be a sign of what endocrine condition?

Answer 23

hypothyroidism (proximal muscle weakness)

Question 24

What is a major (lifestyle) risk factor for eye disease in Grave’s patients?

Answer 24

smoking

Question 25

A rare complication of autoimmune thyroid disease that presents with digital clubbing and swelling of digits and toes is known as

Answer 25

thyroid acropachy

Question 26

Oncholysis can be a sign of what endocrine condition?

Answer 26

Hyperthyroidism

Question 27

How might a patient's pulse be affected in underactive and overactive thyroid conditions?

Answer 27

Hypothyroid- bradycardia | Hyperthyroid- tachycardia and/or AF

Question 28

Medical term for protrusion specific to the eyes

Answer 28

Exopthalmos

Question 29

Name eye signs that could be seen in hyperthyroid (Graves disease) patients

Answer 29

``` Exopthalmos/proptosis Chemosis (conjunctival injection) Corneal inflammation Lid retraction Lid lag (with downward eye movement) Pain with eye movements Double vision ```

Question 30

Inflammation of orbital tissue, retrobulbar pain, diplopia, lid-lag, chemosis, and proptosis/exopthalmos are signs of?

Answer 30

Thyroid eye disease. | NB: The higher the TSH receptor antibody levels, the more likely it is that the eyes are going to be affected

Question 31

What are NOSPECS classification or EUGOGO activity scores used to determine?

Answer 31

How quickly a patient with signs of thyroid eye disease should be referred to an opthalmologist

Question 32

What abnormality presents as a painless, firm, midline neck mass that elevates with swallowing and tongue protrusion?

Answer 32

A thyroglossal duct cyst

Question 33

How would you differentiate a thyroglossal duct cyst from a thyroid nodule on physical exam?

Answer 33

While both thyroglossal duct cysts and thyroid nodules move up with swallowing, only the thyroglossal cyst moves up with tongue protrusion

Question 34

"Retrosternal extension," or dullness to percussion over the sternum, can be a sign of a

Answer 34

goitre

Question 35

infiltrative skin condition caused by circulating Ab. (Can be caused by either TPO Ab or TSH receptor Ab)

Answer 35

Pre-tibial myxedema

Question 36

What is the gold standard imaging technique used for assessing thyroid nodules?

Answer 36

Ultrasound +/- fine needle aspiration

Question 37

Peau d'orange is a RED FLAG sign of?

Answer 37

Breast cancer

Question 38

Name 6 important characteristics to note/document when palpating a breast lump

Answer 38

``` Location Size Shape Consistency Whether it is mobile Overlying skin (puckering, etc) ```

Question 39

Which lymph nodes do breast cancers spread to first?

Answer 39

Axillary lymph nodes

Question 40

What further imaging is recommended for women after finding a breast lump? Younger/older women?

Answer 40

Ultrasound for younger women | Mammogram for older women

Question 41

List some of the circumstances in which patient data can be shared without their consent

Answer 41

- If there is concern about the safety of someone <18, or a vulnerable adult - A contact is at risk of serious harm, where the patient has not informed them, and can't be persuaded to do so - An order is received from a judge or a court to disclose information

Question 42

How are GUM clinic services different from general medical services?

Answer 42

``` Anonymous Self-referral Direct access Free Confidential ```

Question 43

List some clinical features of female GU disease

Answer 43

``` Vaginal discharge Abnormal bleeding Abdominal pain/dyspareunia Dysuria Itching/soreness Ulceration (can be painful or painless) Lumps Systemic symptoms Can be asymptomatic ```

Question 44

List some clinical features of male GU disease

Answer 44

``` Urethral discharge Testicular pain Dysuria Itching/soreness Ulceration (can be painful or painless) Lumps Systemic symptoms Can be asymptomatic ```

Question 45

What are the "Three C's" of an intimate examination?

Answer 45

Consent Communication Chaperone

Question 46

Sexual symptom that can be experienced by men with diabetes or heart disease

Answer 46

erectile dysfunction, low libido

Question 47

Cyst that can form within the vulva, which can become infected and swollen

Answer 47

Bartholin's cyst

Question 48

What is the most common type of speculum used for a female pelvic exam?

Answer 48

Cuscoe (bivalve) speculum

Question 49

Mucous-filled cervical cyst

Answer 49

Nabothian cyst

Question 50

red appearance to the centre part of the central cervix externally- often d/t hormonal changes, but it can happen when the glandular cells from inside the cervix come down onto the external part of the cervix

Answer 50

Ectropion

Question 51

What would be the concern if a cervix appeared "macerated" and irregular when visualised during the speculum exam?

Answer 51

Cervical cancer

Question 52

When would it be most appropriate to use a Sims speculum?

Answer 52

To assess for prolapse

Question 53

What is another name for a prolapsed bladder?

Answer 53

Cystocele

Question 54

In about 15% of women, the position of the uterus is

Answer 54

retroverted

Question 55

How can adnexal masses be palpated in a bimanual examination?

Answer 55

With fingers pressed into the lateral fornices of the vagina, with other hand pressing on top of the lower abdomen

Question 56

Describe the correct procedure for inserting a bivalve/Cuscoe speculum

Answer 56

Ensure correct size is used +/- lubricant/water Gently part labia with left hand Insert bivalve speculum, with blads vertical Rotate 90 degrees so handles point anteriorly and blades are now horizontal Slowly open blades to see cervix between them If cervix cannot be seen, reinsert speculum at a more downward angle as cervix may be behind the posterior blade

Question 57

Protrusions of bowel or fat through the musculature of the abdomen

Answer 57

hernias

Question 58

Collection of fluid within the tunica vaginalis of the testicle

Answer 58

hydrocele

Question 59

Dilation of the testicular veins within the spermatic cord

Answer 59

varicocele

Question 60

What are the two attachment sites of the inguinal ligament?

Answer 60

the ASIS and pubic tubercles

Question 61

Site of origin of an indirect inguinal hernia

Answer 61

Deep inguinal ring

Question 62

This type of hernia does not pierce the posterior wall. The abdominal contents pass through the deep inguinal ring, passing through the inguinal canal and exiting via the superficial ring.

Answer 62

Indirect inguinal hernia

Question 63

This type of hernia is caused by a weakness in the posterior wall of the inguinal canal. The abdominal contents (usually just fatty tissue, sometimes with bowel) are forced through this defect and enter the inguinal canal. This means that the contents emerge in the canal medial to the deep ring

Answer 63

Direct inguinal hernia

Question 64

Bladder enlargement can be felt above the

Answer 64

symphysis pubis

Question 65

Congenital hernia that can form if the two folds of tunica vaginalis fail to fuse

Answer 65

Patent process vaginalis (congenital hernia seen in children)

Question 66

Which type of hernia is due to muscle weakness, and therefore occurs more commonly in older men?

Answer 66

Direct inguinal hernia

Question 67

External spermatic fascia is derived from

Answer 67

external oblique muscles

Question 68

Cremaster muscle is derived from

Answer 68

Internal oblique

Question 69

Internal spermatic fascia is derived from

Answer 69

Transversalis fascia

Question 70

Where does lymph from the testicles drain to?

Answer 70

The common iliac and para-aortic lymph nodes

Question 71

Where does lymph from the penis, the scrotum, and lower limb drain into?

Answer 71

Superficial inguinal lymph nodes

Question 72

What are three important landmarks to identify towards the beginning of a male pelvic exam?

Answer 72

ASIS's Pubic tubercles Pubic symphysis

Question 73

How can you differentiate between a solid testicular lump and a cystic testicular lump on physical examination?

Answer 73

cystic lumps will transilluminate

Question 74

Scarring in the tunica albinguinea of the corpus cavernosum can indicate?

Answer 74

Peyronie's disease

Question 75

Varicoceles become more obvious to spot when patients are in what position?

Answer 75

standing

Question 76

If the fingers can "get above" a testicular mass, this indicates

Answer 76

A scrotal swelling

Question 77

If the fingers CANNOT "get above" a testicular mass, this indicates

Answer 77

Hernia

Question 78

If a swelling feels separate from the testicle, the lesion is likely in the

Answer 78

Epidiymus

Question 79

3 key questions for differentiating common scrotal pathologies:

Answer 79

Can you get above it? Is it separate from the testicle? Does it transilluminate (cystic or solid?)

Question 80

Abrupt haemorrhage or infarction of the pituitary gland

Answer 80

Pituitary apoplexy (Sheehan's syndrome)

Question 81

complete loss of outer (peripheral) visual fields

Answer 81

bi-temporal hemianopia | Associated with lesions of the optic chiasm, such as tumours of the pituitary gland