Index

Page numbers in italics denote fi gures, anion gap 263 Baker’s cyst 100, 104 those in bold denote tables. ankle swelling 195–8 bamboo spine 189 ankle-brachial pressure index 70–1 basal cell carcinoma 77 abdominal aortic aneurysm 145 ankylosing spondylitis 179, 189 basic life support 282–5 abdominal distension 143–7, 145 antalgic gait 25, 42, 94 Behçet’s disease 181 abdominal examination 10–19 anti-tuberculosis drugs 223 benign paroxysmal positional vertigo abdominal masses 17–18, 17 antiepileptics 223 173 abdominal pain 137–42 antihypertensives 223 benign prostatic hypertrophy 57 acute 138 anxiety berry aneurysm 33 chronic 139 faintness 175 biceps tendonitis 81 investigations 139–40 palpitations 120 bleeding diathesis 149 origin of 140–1, 141 tremor 169 blood gas analysis see arterial blood gas abducens nerve 34 aortic dissection 116 analysis abscess 193 aortic regurgitation 3 Boerhaave’s syndrome 149 breast 54 aortic stenosis 3 Bouchard’s nodes 90 perianal 57 aorto-enteric fi stula 149 bowel cancer see colorectal cancer acidosis apex beat 4 bowel obstruction 144, 146 metabolic 263, 265 Apley’s test 102 brachial plexus 85 respiratory 264 apologising 237 brain natriuretic peptide 6 acoustic neuroma 34, 175 appendicectomy 218 breaking bad news 208–10 acquired immunodefi ciency syndrome apraxic gait 25 SPIKES framework 209 see HIV/AIDS arterial blood gas analysis 262–6, 264–5 breast abscess 54 acromioclavicular joint arterial examination 68–72 breast examination 53–5 arthritis 81 arterial ulcer 70 description of lumps 55, 55 Scarf test 84, 84 arthritis patient welfare and dignity 54 activities of daily living (ADLs) 77, 107 osteoarthritis see osteoarthritis techniques 54–5, 55 acute abdomen 140 psoriatic 89, 181 breast malignancy 54 acute coronary syndrome 116 reactive 181 breast screening 55 adhesive capsulitis 81 rheumatoid see rheumatoid arthritis breathlessness 125–7 adrenaline septic see septic arthritis Broca’s expressive dysphasia 45 advanced life support 289 seronegative 100 bronchiectasis 8, 129 intramuscular injection 255 arthroscopy, shoulder 82 bronchoscopy 216 in local anaesthetics 279 ascites 145, 146, 146 Brudzinski’s sign 36 advanced life support 286–90 asthma 8 Buerger’s test 70 age-related macular degeneration 38 medication 220–1 bulbar palsy 30, 45 alcohol abuse, and diarrhoea 134 ataxic gait 42 bulge test 102 alcoholic liver disease 13 atrial fi brillation 119 bupivacaine 279 alkalosis ECG 272 bursitis metabolic 265 atropine hip 94 respiratory 264 COPYRIGHTEDadvanced life support 289 MATERIALknee 101, 104 Allen’s test 263 intramuscular injection 255 amiodarone 289 autoimmune hepatitis 13 caffeine-induced palpitations 119 amputation 69 avascular necrosis of hip 94 calcifi c tendonitis 81 anaemia 175 calcium chloride 289 anaesthesia 203 back pain 183–90 cancer 240 anal fi ssure 57, 154 red fl ags 187 breaking bad news 209 analgesia overuse headache 163 yellow fl ags 189 breast 55, 55 angry patients 236–8 see also specifi c conditions colorectal 134, 147, 153

OSCEs for Medical Finals, First Edition. Hamed Khan, Iqbal Khan, Akhil Gupta, Nazmul Hussain, and Sathiji Nageshwaran. © 2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd.

293 294 Index cancer (cont’d) communication skills 205–7 diabetic foot 69 gastrointestinal 149, 153, 240 angry patients 236–8 diabetic neuropathy 135 lung 129, 240 breaking bad news 208–10 diabetic retinopathy 38 oesophageal 149 counselling for HIV test 225–7 diabetic ulcer 77 prostate 57 cues and emotions 205–6 dialysis 14, 16 testicular 65 do not resuscitate orders 230–2 diarrhoea 132–6 cannula ethics and law 206–7 overfl ow 135 care of 259 explaining medication 211–14 diastolic murmurs 3–4 fl ow rates 259 explaining procedures 215–19 diclofenac 255 intravenous 257–9 handovers 239–41 Dieulafoy lesion 149 carcinoid 135 ICE mnemonic 205 diplopia 34 cardiac arrest rhythms 288, 288 inhalers and asthma medication directly observed therapy 224 cardiac catheterisation 217 220–1 disc protrusion 185 cardiac tamponade 274 non-compliance 222–4 dizziness 172–6 cardiopulmonary resuscitation 282–5, non-verbal communication 206 do not resuscitate orders 230–2 289 post mortem consent 228–9 dorsal column 26 cardiovascular examination 2–6 post-myocardial infarction drug fever 194 carotid sinus hypersensitivity 174 medications 233–5 Dukes staging 147 carpal tunnel syndrome 88 signposting 206 Dupuytren’s contracture 89 cataract 38 complaints 237–8 dysarthria 45 catheters computed tomography dysphagia 158–60 cardiac 217 abdomen 136 dysphasia 45 urinary 245–7 bowel obstruction 144 dysphonia 46 cauda equina syndrome 57, 58, 185, chest 159, 196 187, 189 gastrointestinal cancer 153 Eaton-Lambert syndrome 25 cavernous sinus 30 head 163, 217 ECG see electrocardiogram cellulitis 197 pulmonary angiogram 126, 166 ectopic pregnancy 140 central lines 216 conduction aphasia 45 electrocardiogram (ECG) 271–5, central nervous system examination confusion 47, 47 272–4 28–36 congestive cardiac failure 196 cardiac arrest 288, 288 central retinal artery occlusion 38 consolidation 8 encephalitis 193 central retinal vein occlusion 38 corneal arcus 5 end-stage renal failure 11, 14, 16 cerebellar ataxia 94 coronary artery bypass graft 5 with chronic liver disease 16 cerebellar disease 45, 169, 175 Corrigan’s pulsation 3 endocarditis 193 cerebellar examination 40–3 corticobasal syndrome 170 endoscopic retrograde cerebellopontine angle tumour 30 corticosteroids see steroids choleopancreatography (ERCP) chaperones costochondritis 116 217 breast examination 54 cough 122–4 epididymal cyst 65 hernia 61 cranial nerves 31, 31, 32–3, 35 epigastric hernia 62 rectal examination 58 crepitations 9 epilepsy 174 testicular examination 65 Crohn’s disease see infl ammatory bowel ethics and law 206–7 Charcot’s joint 181 disease examinations 1 chest compression 285 cruciate ligament tear 101 abdominal 10–19 chest pain 115–17 CT see computed tomography breast 53–5 Child-Pugh grading system 150, 151 cyclizine 255 cardiovascular 2–6 chlorpheniramine 255 cysts central nervous system 28–36 chronic liver disease 11, 13, 13, 196 Baker’s 100, 104 cerebellar 40–3 with end-stage renal failure 16 epididymal 65 hand 87–92 chronic obstructive pulmonary disease thyroglossal 49 hernia 60–3 (COPD) 8 hip 93–7 chronic venous insuffi ciency 74, 75 De Musset’s sign 3 knee 98–104 Clostridium diffi cile 134 De Quervain’s tenosynovitis 89 ophthalmoscopy 37–9 cluster headaches 163 death, confi rmation of 105–6 peripheral nervous system 20–7 co-amoxiclav 255 death certifi cates 291–2 rectal 56–9 coeliac disease 134 deep vein thrombosis 197 respiratory 7–9 colonoscopy 216 defi brillation 288–9, 289 shoulder 80–6 colorectal cancer 134, 153 dextrocardia 274 speech 44–7 Dukes staging 147 diabetes mellitus 110, 111, 209 testicular 64–7 colostomy 19 hypoglycaemia 120, 174 thyroid 48–52 Index 295

ulcer 76–9 haemorrhoids 57, 153 hydrocele 65 vascular haloperidol 255 hyperkalaemia 273 arterial 68–72 hand 87–92 hypertensive retinopathy 38 venous 73–5 handovers 239–41 hyperthyroidism 49, 169 external (superfi cial) ring 61 Hawkins-Kennedy test 83, 83 and diarrhoea 135 head CT 217 treatment 50 FABER test 95 headache 161–4 hypertrophic obstructive facial nerve 35 hearing 32, 32 cardiomyopathy 119 palsy 30, 33 heart block 273 hypoglossal nerve palsy 30 faintness 174–5 heart failure 6, 13 hypoglycaemia 120, 174 FAIR test 95–6 heart murmurs 3–4, 3 hypokalaemia 273 fat necrosis of breast 54 Heberden’s nodes 90 hypothermia 273 fatty liver 13 HELP mnemonic 1 hypothyroidism 46, 49, 51, 196 femoral aneurysm 61 hemiplegic gait 25 post-thyroidectomy 49 femoral canal 61 hepatitis 13, 193 hysterectomy 209 femoral fractures 101 autoimmune 13 femoral hernia 61, 62 hepatomegaly 13–14, 15, 145 ICE mnemonic 205 festinant gait 25, 42 hereditary neuropathies 24 ileostomy 19 fever hernia 60–3, 144 immobilisation of spinal patients 188 palpitations 120 types of 61, 62 immunosuppressives 223 pyrexia of unknown origin 191–4 high-stepping gait 25, 42 impingement tests 83–4, 84 fi broadenoma 54 hip infl ammatory bowel disease 11, 134, fi broadenosis 54 anatomy 95 154, 194 fi nger clubbing 9, 16, 90 examination 93–7 infraspinatus test 83, 83 Finkelstein’s test 91 fractures 96–7 inguinal canal 61 foot drop 94 hip replacement 97 inguinal hernia 61, 62, 65 forced expiratory volume 269 histories 107–8 repair 218 forced vital capacity 269 abdominal distension 143–7 inguinal ligament 61 fractures abdominal pain 137–42 inhalers 220–1 femoral neck 101 ankle swelling 195–8 insulin 223 hip 96–7 back pain 183–90 intention tremor 43 Friedreich’s ataxia 24 breathlessness 125–7 intermittent claudication 69 Froment’s sign 90–1 chest pain 115–17 internal (deep) ring 61 frozen shoulder 81 cough 122–4 internuclear ophthalmoplegia 34 diarrhoea 132–6 intracerebral haemorrhage 163 gait 25–6, 41–2, 94, 102 dizziness 172–6 intracranial pressure, raised 163 see also specifi c types dysphagia 158–60 intramuscular injection 254–6 Gallavardin’s phenomenon 3 haematemesis 148–51 sites for 255 gastric cancer 149 haemoptysis 128–31 intravenous cannulation 257–9 gastritis 116, 149 headache 161–4 indications and contraindications gastroenteritis 134 jaundice 155–7 258 gastrointestinal cancer 149, 153, joint pain 177–82 sites for 258 240 lethargy and tiredness 109–11 intravenous drug administration generalised anxiety disorder 120 loss of consciousness 165–7 260–1 giant cell arteritis 193 needlestick injury 199–200 irritable bowel syndrome 135, 145 global aphasia 45 palpitations 118–21 ischaemia, critical 69 globus hystericus 159 pyrexia of unknown origin 191–4 goitre 52 rectal bleeding 152–4 jaundice 155–7 multinodular 50 tremor 168–71 joint pain 177–82 Goodpasture’s syndrome 129 weight loss 112–14 see also specifi c conditions gout 179 HIV/AIDS 193 jugular foramen 30 Graves’ disease 52, 169 antenatal testing 227 groin lumps 61 breaking bad news 209 keratoacanthoma 77 Guillain-Barré syndrome 25, 46 non-disclosure to partner 227 Kernig’s sign 36 pretest counselling 225–7 ketoprofen 255 haematemesis 148–51 Holmes-Adie syndrome 31 kidney 16–17, 17 haemochromatosis 13 Horner’s syndrome 30, 31, 31 ballotable/enlarged 16 haemoptysis 128–31 human immunodefi ciency virus see Kings College Hospital criteria for liver diagnosis 130 HIV/AIDS transplantation 151 296 Index knee metabolic acidosis 263, 265 optic atrophy 38 examination 98–104 metabolic alkalosis 265 Osgood-Schlatter syndrome 101, 103–4 ligament lesions 101, 103 metformin 213 Osler-Weber-Rendu disease 149 meniscal lesions 100, 103 methotrexate 213 osteoarthritis 178 replacement 100, 102 metoclopramide 255 hip 94 swollen 103 migraine 162 knee 100 and oral contraceptive pill 163 osteomyelitis 193 labyrinthitis 173 mitral regurgitation 3 ototoxicity 174, 176 lactate 265 mitral stenosis 3 overfl ow diarrhoea 135 laparoscopic cholecystectomy 218 mononeuritis multiplex 24, 25, 26 lateral instability 175–6 morphine 255 pacemakers 5 laxative abuse 134 motor neurone disease 24 ECG 274 lethargy 109–11 mouth to mouth resuscitation 285 failure of 120 leukaemia 193, 209 multi-infarct dementia 170 Paget’s disease 100, 104 levothyroxine 51 multiple sclerosis 24, 209 pain Lewy body dementia 170 multisystem atrophy 27, 170 abdominal 137–42 lidocaine 279 muscle power, grading of 26, 26 chest 115–17 life support musculocutaneous nerve injury 85 movement limitation 26 advanced 286–90 myasthenia gravis 30, 46 palpitations 118–21 basic 282–5 mydriasis 33 pancreatitis, chronic 134 limb length 95 myocardial infarction papilloedema 38 lipoma 61 non-ST segment elevation 272 paresis 26, 27 lithium toxicity 171 posterior infarct 272 Parkinson-plus syndromes 27, 170–1 liver disease ST segment elevation 272 parkinsonian gait 94 alcoholic 13 myxoedema 51 Parkinson’s disease 169 chronic see chronic liver disease patellar dislocation 101, 103 see also specifi c conditions nasogastric tube insertion 248–51, 249 patellar tap test 102 liver transplantation, Kings College complications 250 peak expiratory fl ow rate 267–70, 269, Hospital criteria 151 confi rmation of placement 250–1 270 load shift sign 84 technique 250 interpretation 268, 268 lobectomy 8–9, 8, 9 needle phobias 224 uses of 268 local anaesthetics 279 needles 224 pelvic mass 145, 197 long thoracic nerve injury 85 needlestick injury 199–200 penile ulcer 65 loss of consciousness 165–7 Neer’s impingement test 84, 84 peptic ulcer 116, 149 lower limb nephrostomy 19 perianal abscess 57 arterial examination 68–72 nephrotic syndrome 196 perianal haematoma 57 arterial tree 71 nerve root compression 185 pericarditis 116 venous examination 73–5 nerve root lesions 24, 25 ECG 274 lower motor neurone disease 24, 25–6, neurogenic shock 188 peripheral nervous system examination 31 neuropathy 20–7 lumbar puncture 217 diabetic 135 peripheral neuropathy 24, 26 lung cancer 129, 240 hereditary 24 peripheral pulses 70 lymph nodes 61 nodal osteoarthritis 89 peritoneal pain 141, 141 lymphoedema nominal dysphasia 45 pethidine 255 hereditary 197 non-alcoholic steatohepatitis 13 Peutz-Jegher syndrome 149 secondary 197 non-compliance 222–4 phaeochromocytoma 119 lymphoma 66, 193 non-verbal communication 206 Phalen’s test 88, 90 phlebotomy 252–3 McMurray’s test 102 obturator hernia 62 piriformis syndrome 94 magnesium sulphate 289 occupation-associated illness 194 plegia 26, 27 Mallory-Weiss tear 149 oculomotor nerve palsy 30 pleural effusion 8 malnutrition 160 oesophageal cancer 149 pneumonectomy 8–9, 8 mammary duct ectasia 54 oesophageal rupture 116 pneumonia 116, 129, 193 marche à petits pas 94 oesophageal varices 149 pneumothorax 8, 9, 116 median nerve 90 oesophagitis 149 polymyalgia rheumatica 193 medication 211–14 oesophago-gastro-duodenoscopy 216 polymyositis/dermatomyositis 180 post-myocardial infarction 233–5 olanzapine 255 post mortem consent 228–9 melaena 57, 154 ondansetron 255 postoperative review 202–3 Ménière’s disease 173 ophthalmoplegia 34 postural hypotension 175 meningitis 162, 193 ophthalmoscopy 37–9 pre-eclampsia 197 Index 297 prednisolone 212 rectal bleeding 152–4 muscle groups 82 pregnancy 145 rectal examination 56–9 nerve supply 85 ankle swelling 197 rectal tumour 57 referred pain 85 ectopic 140 red fl ags 107 scars 82 pregnancy test 140 back pain 187 signifi cant event analysis 238 premedication 202 diarrhoea 136 signposting 206 preoperative assessment 201–2 refl exes 26, 26 sinusitis 163 ASA classifi cation 202, 202 relapsing polychondritis 180 Sjögren’s syndrome 159 investigations 202 renal cell carcinoma 145 SOCRATES mnemonic 107, 182 Prescription Payment Certifi cates 223 renal disease 11 spastic gait 25, 42 pressure ulcer 77 end-stage renal failure 11, 14, 16 speech 44–7 primary biliary cirrhosis 13 renal failure 196 spigelian hernia 62 primary sclerosing cholangitis 13 respiratory acidosis 264 SPIKES framework 209 procedures 243–4 respiratory alkalosis 264 spinal cord advanced life support 286–90 respiratory examination 7–9 lesions 24 arterial blood gas analysis 262–6, respiratory failure 264 subacute combined degeneration 24 264–5 retinitis pigmentosa 38 spinal infection 185 basic life support 282–5 rheumatoid arthritis 178–9 spinal shock 188 death certifi cates 291–2 breaking bad news 209 spinal stenosis 185 ECG 271–5, 272–4 hand 88, 91 spinothalamic tract 26 explaining 215–19 hip 94 spirometry 268–70, 269, 270 intramuscular injection 254–6 knee 100 spleen 16–17, 17 intravenous cannulation 257–9 pyrexia 193 splenomegaly 13–14, 18, 145 intravenous drug administration Rinne test 32, 32 causes 15 260–1 Rockall score 150–1, 151 spondyloarthropathies 94 nasogastric tube insertion 248–51 rodent ulcer 77 stamping gait 25, 42 peak expiratory fl ow rate 267–70 Romberg’s test 22, 41 statins 213 scrubbing up 276–7 rotator cuff non-compliance 223 suturing 278–81, 280 impingement 81 steroids 212 urinary catheterisation 245–6 tendonitis 81 non-compliance 223 venepuncture/phlebotomy 252–3 test 83, 83 Still’s disease 193 progressive supranuclear palsy 27, 170 Stokes-Adams attacks 175 pronator drift 26 salbutamol overuse 169 stomas 18, 18, 19 prostate saphena varix 61, 74 Streptococcus bovis 4 benign prostatic hypertrophy 57 SBAR framework 241 stroke 24 carcinoma 57 scapular winging 85 subarachnoid haemorrhage 35–6, 163, transurethral resection (TURP) 218 Scarf test 84, 84 164 proximal myopathy 24 scars sulcus sign 84 pseudobulbar palsy 30, 45 abdominal 17, 17 suprascapular nerve injury 85 pseudoclubbing 16 cardiovascular 4, 5 supraventricular tachycardia 119 pseudogout 179 nephrectomy 16 ECG 272 psoriatic arthritis 89, 181 respiratory 8 suturing 278–81, 280 ptosis 33 shoulder 82 indications and contraindications pulmonary embolism 116, 129, 194 vertebrectomy 188 279 ECG 274 scissor gait 25, 42, 94 local anaesthetic 279 pulmonary fi brosis 8 SCOFF questionnaire 114 technique 279–81, 280 pulmonary hypertension 196 scrubbing up 276–7 types of suture 279, 279 pulmonary oedema 129 self-control 237 systemic lupus erythematosus 180 pupillary defects 31, 31 seminoma 66 pyrexia 193 pyrexia of unknown origin 191–4 sensory ataxia 94 systemic sclerosis 89, 179 septic arthritis 181 systolic murmurs 3–4 Quincke’s sign 3 hip 94 knee 101 temporal arteritis 163 radial nerve 90 seronegative arthritis 100 tension headache 162 palsy 88 shingles 116 teratoma 66 radiation enteritis/colitis 135 short bowel syndrome 134 teres minor test 83, 83 radioiodine 50 shoulder Terry’s nails 19 Ramsay Hunt syndrome 174 dislocation 81 testes 61 reactive arthritis 181 examination 80–6 examination 64–7 recovery position 285 instability 84, 84 tumour 65 298 Index tetanus prophylaxis 281, 281 ulcers ventricular ectopics 120 Thomas test 96 arterial 70 ventricular fi brillation 272 thoracic outlet syndrome 85–6 diabetic 77 ventricular tachycardia 119 thyroglossal cyst 49 edges of 77 ECG 272 thyroid autoantibodies 50 examination 76–9 vertebrectomy 188 thyroid examination 48–52 penile 65 vertigo 173–4 thyroid function tests 50 peptic 116, 149 vestibular neuronitis 173 thyroid-stimulating hormone receptor pressure-induced 77 VIPoma 135 antibody 50 rodent 77 visceral pain 140–1, 141 thyroidectomy 50 venous 74, 78 visual fi eld defects 32, 32 thyrotoxicosis 119 ulnar nerve 90 VITAMIN CDE mnemonic 182 Tinel’s test 88, 90 palsy 88 tiredness 109–11 umbilical hernia 62 waddling gait 25, 42, 94 torsade des pointes 289 upper motor neurone disease 24, 25, 31 warfarin 212 tramadol 255 increased tone 26 non-compliance 223 transurethral resection of prostate urinary catheterisation 245–7 weakness 23 (TURP) 218 types of catheter 247 asymmetrical 25 trauma urinary tract infection 193 distal symmetrical 26 back pain 186 urostomy 19 grading of muscle power 26, 26 joint pain 181 proximal symmetrical 25 tremor 168–71 vagal nerve palsy 46 Weber test 32, 32 benign essential 169 vagus nerve palsy 30 Wegener’s granulomatosis 129, 181 cause 170 valve replacement 4 weight loss 110, 112–14 intention 43 valvular lesions 3–4, 3 Wernicke’s receptive dysphasia 45 Trendelenburg gait 25, 42, 94 varicocele 65 Whipple’s disease 135 Trendelenburg test 95 varicose veins 74 Wilson’s disease 13 tricuspid regurgitation 3, 4 vascular examination Wolff-Parkinson-White syndrome 273 trifascicular block 273 arterial 68–72 trigeminal neuralgia 162 venous 73–5 xanthelasma 5 trigger fi nger 89 vasovagal syncope 174 xanthochromia 164 tuberculosis 129, 193 venepuncture 252–3 xerostomia 159 venous examination 73–5 ulcerative colitis see infl ammatory bowel venous insuffi ciency 196 yellow fl ags in back pain 189 disease venous ulcers 74, 78 yellow nail syndrome 124, 127