14/6

Question 1

Signs of opioid toxicity

Answer 1

MORP

Myoclonic jerks
Objectively drowsy or confused
Resp rate depression <8min
Pin-point pupils

Question 2

When prescribing opioids what is essesntial is written on prescription

Answer 2

• Name and form e.g. morphine sulphate oral solution
• Strength of medicine e.g. 10mg/5ml
• Dose
• Total quantity to be dispensed in words and figures e.g. 100ml, one hundred millilitres

And signature and date etc

Question 3

If placenta praevia is identified at the 20 wk scan then what are they offered after?

Answer 3

A further scan at 32 weeks to determine the lie
- if still low = repeat scans every 2 week s

Question 4

How are strangulated hernias managed?

Answer 4

Open repair

Question 5

Tolterodine

Answer 5

Muscarinic antagonist used similarly to ocybutynin

Question 6

How to remember link between far-sighted (hypermetropia) and near-sighted (myopia) and open and closed angle glucoma?

Answer 6

Far-sighted people plan ahead so will only be hit by suprises e.g. closed angle glucoma

Short-sighted people never plan and will be slowly hurt over time e.g. open angle gluacoma

Question 7

SAD for AS

Answer 7

Syncope
Anigina
Dysponea

Question 8

Quincke’s sign = ?

Answer 8

Nailbed pulsation

Question 9

How is ascietes managed?

Answer 9

Conservative
- Reduce Na+ in diet
- ~fluid restriction

Medical
- spironolcatone +/- loop
- prophylatic Abs - ciprofloxacin

Surgical
- drainage if tense ascietes (if large vol need albumin “cover” reduce the risk of paracentesis-induced circulatory dysfunction)
- ~TIPS is offered

Question 10

Go over how you would do a DNACPR OSCE

Answer 10

Opening
- safe space and no distractions - let pt know
- let them know today will be a serious conversation about what the medical team have decided for what will happen when the heart stops and are they in the headspace for that

CHeck in
- how have things been over the last while?
- what is your understanding of your condition?
- understanding of the treatment?
- understand that the body is getting weaker and unlike to recover?

Cardiac arrest
- “when the body is fighting off something as big as …, eventually it may get tired and the heart stop beating - this is called a cardiac arrest”

CPR
- today we are discussing what would happen if you were to suffer a cardiac arrest.
- in hospitals we sometimes do resusation or CPR.
- check pts understanding
- yes, it is the pushing down on the chest but we will also adminster drugs and sometimes shock the heart too
- there is a low survival rate, and in hospitals only 10% of people who get CPR recover enough to leave
- those who do survive are at risk of their heart stopping again as well as having rib fractures etc.
- it stops someone from being able to spend those last moments with peace and dignity surrounded by those they love

As a medical team we have discussed the best steps for you and don’t think it would be fair or correct for us to perform CPR on you. This is a medical decision and also means it’s one less thing for you and your loved ones to be thinking about

We can have the same convo with your wife.

It in no way means we are stopping treatment and will continually assess and manage your symptoms to keep you as comfortable as possible