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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
QRISK3 personal information
Age Sex Ethnicity BMI
26
QRISK3 PMH
CHARD - CKD (stage 4/5)/ cholesterol - Hypertension - AF - Rheumatoid arthritis - Diabetic status + ED, severe mental illness (atypical antipsychotic use), SLE, migraines
27
Medication for QRISK3
Antihypertensives, Steroids
28
Fx for QRISK3
Angina/ MI in first degree relative under 60years old
29
Social Hx
Smoking
30
Measurements
Cholesterol/ HDL ratio BP
31
Subjects involved in QRISK3
Personal details PMH Medications Fx Sx Direct measurements
32
What is CHA2DS2VASc
Stroke risk in persons with AF Determines need for anticoagulation therapy
33
What do the letters in CHA2DS2VASc stand for
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
Scoring for CHADVASc
0 = no action taken 1 = consider anticoagulant e.g., DOAC 2 = Anti-coagulate
35
What does FRAX measure
10 year probability of fracture in spine, hip, wrist, or shoulder for people aged 40-90
36
FRAX personal details
Sex Ethnicity Weight Height
37
PMH for FRAX
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
Other points to take in FRAX
Fx - Parental hip fracture Sx - Smoking and alcoholic intake (more than 2/3 units a day Dx - Glucocorticoids/ lithium or oestrogen/HRT
39
What does ABCD2 measure
Risk of stroke following a TIA
40
What do ABCD2 stand for
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
Management for TIA
Lifestyle 300mg stat aspirin followed by 75mg OD Clopidogrel 75mg Control HTN and statins
42
What does Well's measure
Likelihood of a patient having a DVT
43
Things to ask in Wells assessment
HPC PMH Sx Differentials
44
HPC in a Wells score
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
PMH in Wells
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
Sx for WELLs
Occupational Smoking Long haul flights HRT/ OCP
47
Alternatives for DVT in WELLs
Cellulitis Musculoskeletal injury

2b OSCE (1 decks)

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