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2b OSCE > 2B Osce > Flashcards

2B Osce Flashcards

1
Q

What can you be asked for chronic disease management

A

INR
HBA1C
Peak Flow
Spirometry
Inflammatory Markers
LFTs

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2
Q

What can you be asked in risk assessment

A

FRAX
Well’s
QRISK3
CHADSVASC
ABCD2
HASBLED

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3
Q

How would you describe INR ?

A

INR provides information on how long it takes blood to clot. High INR = longer time to clot

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4
Q

Normal INR range (and on warfarin)

A

Normal = 1
Warfarin = 2-3

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5
Q

How often should INR be done?

A

Every 3-4 days the once readings are constant every 12 weeks

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6
Q

What is warfarin? What does it prevent?

A

Vit K antagonist
DVT, PE, Stroke in AF, Clots with prosthetic valves

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7
Q

Too high INR symptoms

A

Bleeding
- Headache
- Stomachache
- Bruising
- Cuts bleed longer
- Haematuria

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8
Q

Too low INR symptoms

A

Clots
- Stroke
- DVT/PE

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9
Q

Questions to ask for drug history in chronic disease management?

A
  • Do you know how many times you should be taking…
  • How and when do you take it
  • Have you missed any doses, do you double the doses ever?
  • Are you managing medication regime
  • Any other medications over the counter or herbal remedies
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10
Q

Sx for INR

A
  • Diet changes e.g., leafy greens have vit K
  • Alcohol and smoking (or sudden alcohol withdrawal)
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11
Q

Explain HBA1C

A

Average blood glucose level over 2-3 months as sugar sticks to blood cells

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12
Q

Why should HBA1C be kept low

A

Reduces risk of nephropathy, neuropathy, and retinopathy
General reduced risk of cataracts, heart failure and amputation

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13
Q

General HBA1C structure

A

How are they feeling now
- Any recent infections
- Any recent hospital admissions e.g., DKA
- Any symptoms e.g., polyuria, polydipsia, weight loss, vision changes, neuropathy, tiredness, mood changes, itchy genitals
- Heart disease
Exercise and diet
Smoking and alcohol
Drug and Sx

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14
Q

Explain peak flow and spirometry

A

Peak flow - measures how fast you can breathe out i.e., how well lungs are working
Spirometry - Measures lung function, specifically volume and speed of inhalation

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15
Q

Dx in asthma

A

Which inhalers do you use
How and when - how often do you need to use blue
When was technique last reviewed
Missed doses
Managing okay?
How well does it control condition

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16
Q

Sx in asthma

A

Pets
Travel
Housing
Hay fever
Smoking
Alcohol
Occupation
Impact on social, mood, occupation, sleep etc

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17
Q

Inflammatory markers explanation

A

CRP = substance made by liver that raises in inflammation
ESR is another inflammation marker

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18
Q

What to ask about in LFTs

A

Mostly social history (alcohol, drugs and smoking) but also ask about events e.g., gallstones, IBD, surgery, previous diagnoses

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19
Q

What are LFTs?

A

Different measures of products that give an indication of how the liver is functioning

20
Q

Non-modifiable risk factors for diabetes

A

Age
Sex
Ethnicity
Relative with diabetes

21
Q

Modifiable

A

Waist measurement
Weight
HTN
BMI

22
Q

5Ts in diabetes

A

Toilet (polyuria)
Thirsty (polydipsia)
Tiredness
Thrush (genital infection secondary to increased infection risk)
Thinner (weight loss)

23
Q

Lifestyle advice in patients with diabetes

A

Regular meals/ portion sizes and be balances
Alcohol and smoking reduction
Weight loss

24
Q

What is QRISK3

A

Risk of person developing CVD in the next 10 years for 35-74 year olds

25
Q

QRISK3 personal information

A

Age
Sex
Ethnicity
BMI

26
Q

QRISK3 PMH

A

CHARD
- CKD (stage 4/5)/ cholesterol
- Hypertension
- AF
- Rheumatoid arthritis
- Diabetic status

+ ED, severe mental illness (atypical antipsychotic use), SLE, migraines

27
Q

Medication for QRISK3

A

Antihypertensives, Steroids

28
Q

Fx for QRISK3

A

Angina/ MI in first degree relative under 60years old

29
Q

Social Hx

A

Smoking

30
Q

Measurements

A

Cholesterol/ HDL ratio
BP

31
Q

Subjects involved in QRISK3

A

Personal details
PMH
Medications
Fx
Sx
Direct measurements

32
Q

What is CHA2DS2VASc

A

Stroke risk in persons with AF
Determines need for anticoagulation therapy

33
Q

What do the letters in CHA2DS2VASc stand for

A

C - Congestive heart failure
H - HTN
A - Age (75+ = 2 point)
D - Diabetes diagnosis
S - Stroke/ TIA/ thromboembolism (2 points)
V = Vascular disease (PVD, MI, aortic plaque)
A - Age (65-74 = 1 point)
S - Sex (female)

34
Q

Scoring for CHADVASc

A

0 = no action taken
1 = consider anticoagulant e.g., DOAC
2 = Anti-coagulate

35
Q

What does FRAX measure

A

10 year probability of fracture in spine, hip, wrist, or shoulder for people aged 40-90

36
Q

FRAX personal details

A

Sex
Ethnicity
Weight
Height

37
Q

PMH for FRAX

A

Rheumatoid arthritis
Previous fracture
Femoral neck BMD from previous DEXA scan
Secondary osteoporosis
- Kidney failure, hyperthryoidism, coeliac, T1DM, CLD
- Premature menopause, chronic malnutrition, malabsorption

38
Q

Other points to take in FRAX

A

Fx - Parental hip fracture
Sx - Smoking and alcoholic intake (more than 2/3 units a day
Dx - Glucocorticoids/ lithium or oestrogen/HRT

39
Q

What does ABCD2 measure

A

Risk of stroke following a TIA

40
Q

What do ABCD2 stand for

A

A - Age
B - BP
C - Clinical features (1 point for speech disturbance, 2 points for unilateral weakness)
D - duration (60+ mins = 2 points, 10-60 mins = 1 point)
D - Diabetes

41
Q

Management for TIA

A

Lifestyle
300mg stat aspirin followed by 75mg OD
Clopidogrel 75mg
Control HTN and statins

42
Q

What does Well’s measure

A

Likelihood of a patient having a DVT

43
Q

Things to ask in Wells assessment

A

HPC
PMH
Sx
Differentials

44
Q

HPC in a Wells score

A

Localised tenderness along deep venous system
Entire leg swollen
Calf swelling (>3cm compared to other leg)
Unilateral pitting oedema
Non-varicose superficial veins present
Neuro symptoms
SOB

45
Q

PMH in Wells

A

Paralysis/ paresis or recent immobilisation of leg
Bedridden recently or major surgery within 12 weeks
Active cancer within 6 months
Previous DVT
Hyper coagulability disorder

46
Q

Sx for WELLs

A

Occupational
Smoking
Long haul flights
HRT/ OCP

47
Q

Alternatives for DVT in WELLs

A

Cellulitis
Musculoskeletal injury

2b OSCE (1 decks)

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