25 OSCE revision questions

1. 25 OSCE revision questions Conor Gillespie 15/05/19

2. 3 pictures- Cardio Clubbing Splinter haemorrhages Cardiomegaly Cardiothoracic ratio >0.5

3. Causes of clubbing • Cardio: • ACE- Atrial myxoma (benign atrial tumour), cyanotic heart disease, subacute infective endocarditis • Respiratory- Bronchial carcinoma, ILD, Bronchiectasis • GI: IBD, Coeliac, Liver Cirrhosis, GI lymphoma

4. CXR anatomy Aortic knuckle SVC Pulmonary trunk Left ventricle Right atrium Left cardio-phrenic angle Left costo-phrenic angle

5. CXR anatomy part 2 Would recommend learning this! (came up in sequence 2 last year)

6. Bacteria questions • Most common bacterial cause of pneumonia: • Strep. Pneumoniae • Most common cause of UTI: • E.coli • Most common cause of meningitis • N. meningitides • Most common cause of cellulitis/wound infection • S.aureus/s.pyogenes • Most common cause of endocarditis: • Strep. Viridans

7. Signs of endocarditis • 1. A changing heart murmur • 2. Clubbing if subacute • 3. Splinter haemorrhages • 4. Microscopic haematuria (almost all) • 5. Roth spots • 6. Janeway Lesions • 7. Oslers nodes

8. Urinalysis- • Presence of nitrites on dipstick indicates: • UTI • Glucose: • Diabetes, pregnancy • Ketones: • DKA, starvation • Leucocytes: • Pyuria (pus in urine)- non-specific • Blood: • Lots of things! (ureteric stones, bladder malignancy, schistosomiasis UTI, urethral trauma, be creative!)

9. 3 bacteria that cause urinary tract infections (UTI) • E.Coli (most common) • Proteus miriballis • Staphylococcus saprophyticus • Klebsiellapneumoniae

10. 3 bacteria that cause pneumonia • S. Pneumoniae • H. Influenzae • Legionella, mycoplasma, etc.

11. 3 indications for a rectal exam • Rectal Bleeding • As part of an abdominal examination • To assess prostate i.e. as part of BPH/suspected malignancy • Suspected spinal cord pathology/cauda equine to assess anal tone • Change in bowel habit ?colon cancer

12. To complete a GI exam fully you must do the following… • Examine the external genitalia • Examine the hernial orifices/groins • Do a PR (rectal) exam

13. Difference between guarding, rigidity and rebound tenderness • Guarding:Persons abdomen contracts only when you attempt to palpate it superficially, • Rigidity: persons abdomen is rigid on inspection with abdominal muscles contracted without you palpating it • Rebound tenderness: upon removal of palpating hand causes pain • All indicate: peritonitis/peritoneal irritation • Causes: perforated abdo viscus (perforated peptic ulcer, perforated bowel, appendicitis, diverticulitis)

14. Causes of hepatomegaly • Remembered as ‘2Is, 2Bs, and 2Cs’ • 2Is • Infection- EBV, Malaria, Hepatitis • Infiltration- Sarcoid/NAFLD/Amyloid • 2Bs • Blood- Leukaemia/malaria • Biliary- Primary biliary cirrhosis and PSC • 2Cs • Cancer- Primary HCC or metastases (more common) • Congestion- Heart failure, Budd-Chiairi

15. Indications for ophthalmoscopy • Routine as part of a diabetic eye test • Loss of vision • As part of a cranial nerve exam • Eye trauma etc.

16. Features that suggest a hydrocele/groin swellings • 1. Transilluminates • 2. Painless (mostly) • ‘bag of worms’ on palpation= • Varicocele • Has a cough impulse= • Probably a hernia • Disappears when patient stands up= • Varicocele or hernia

17. Features that suggest testicular cancer • Can get above the mass • Is continuous with the testes • Doesn’t transilluminate

18. Features of an upper motor neuron lesion (UMN) • Spasticity • Increased muscle tone (hypertonia) • Brisk/exaggerated reflexes • Extensor plantar response (aka upgoingplantars/+ve Babinski sign) • Clonus • Pyramidal weakness pattern (i.e extensors weaker in arms and flexors weaker in legs) • Weakness

19. Features of a lower motor neuron lesion (LMN) • Muscle weakness • Muscle wasting • Fasciculation's • Reduced tone (hypertonia) • Reduced or absent reflexes • Flexor plantar response (down going plantars/negative Babinski sign)

20. Causes of a non-palpable apex beat • All caused by something blocking your hand from feeling the heart • Caused by: • 1. Fluid (e.g. pericardial effusion) • 2. Fat (obesity) • 3. Gas (emphysema/tension pneumothorax)

21. Microvascular and Macrovascular complications of diabetes (important) • Microvascular: • Diabetic neuropathy, • Diabetic nephropathy, • Diabetic retinopathy, • Erectile dysfunction • Macrovascular: • Cardiovascular disease (MI/IHD/Angina) • Cerebrovascular disease (i.e stroke) • Peripheral vascular disease

22. 5 Symptoms of hypothyroidism • Tiredness/fatigue • Weight gain • Hair loss • Constipation • Menorrhagia (heavy periods) • Feel cold all the time • Probably more out there

23. 5 Symptoms of hyperthyroidism • Anxious/irritable • Excess sweating • Palpitations • Weight loss despite increase in appetite • Increased frequency of bowel movements • Oligomennorhoea • Not all of them but the ones I remember

24. 3 reasons to stop giving chest compressions • When the patient is responding and recovering consciousness • What to do then: • Place in recovery position • When senior help has arrived and instructed you to stop for whatever reason (either they may take over or decide not to carry on) • When you are unable to due to physical exhaustion

25. ‘Name 5 members of the Multi-disciplinary team (MDT) that could be involved in patient X’s care’ • Scenario may vary but there are a few core ones that will always get marks: • 1. ‘condition x’ specialist nurse- easy mark and there is a specialist nurse for most chronic conditions now i.e. diabetes specialist nurse, COPD/asthma specialist nurse etc. • 2. In the community this would be a district nurse • 3. Pharmacist- can be applied to multiple scenarios, will handle medication dispensing for when patients go home • 4. Physiotherapist- can assess mobility and provide aids for both inpatients and outpatients • 5. Occupational therapist (OT)- Say ‘to assess how well the patient is able to cope at home after hospital and assess ability to carry out activities of daily living (ADLs) • 6. GP • 7. Social Worker • Many more but having these in your head will make it much easier!

26. Good luck!