Being an FY1 Flashcards
What bacterial spores are resistant to alcohol gel
C. diff
How to use a bleep call?
Answer numbers as you go, and make a list of jobs if you can’t answer queries over the phone.
Prioritise this list
Ask nurses to get the equipment ready for you for when you arrive e.g. ECG, urine dipstick, obs, notes
The bleep should only be for sick and urgent patients! - any routine stuff can be made into a list and be made to wait.
Dealing with family of a patient you don’t know well
Be honest, say you dont know them well
Get patient consent
Try to arrange a place to talk
Address concerns
Involve seniors if necessary
Document - date, time and what was discussed
What are the factors of informed consent
What the procedure is
Purpose
Risks and side effects
How to incident report
Report anything that has harmed patient or delayed critical care. Even if near miss.
Get seniors involved early.
E.g. - wrong blood tube, allergy given as drug, failure to follow up bloods
First things to do as an FY in the morning before the ward round
Ask night team of any issues
Submit any missing requests - bloods, CXR, ECGs
Review any unwell patients
Jobs to do after ward round
Compare jobs lists between FYs based on urgency - radiology requests, speaking to other teams, discharge forms, taking blood
What jobs are done after the ward round
Review patients and liase with nurses
Review bloods and fix any issues
Chase outstanding requests
Submit blood requests for the following day
Re-write any kardex’s
What jobs are done before the end of the day
Review results and outstanding jobs with the team
Check all warfarin and insulin is written up
Prescribe sufficient fluids if need be
Get ready for handover - sickest patients, results needed
Patient info needed for handover
Name, CHI, DOB and exactly what you want them to do (e.g. check bloods for AKI)
Jobs to do before the weekend
Submit blood requests for those who really need them
Prescribe 3 days of warfarin if safe
Update all drug kardex’s that will run out
How to hand over
Mrs smith is a 64 year old female who came in 4 days ago with SOB, she has a background of asthma and DM2. Since admission she has had bloods and a CXR which showed XYZ and therefore we have started ABC to treat suspected pneumonia.
Important things to do when on call
Know info on the sickest patients
Know whos on call and how to contact
Keep an eye on bleep
Make a jobs list
Night shift pitfalls (5)
Poor handover
Failing to call for help early
Fluid prescribing (renal/heart failure, DM, electrolyte imbalance)
Warfarin prescriptions
Check you have right patient
7 things to include on a discharge form
Patient details - name, dob, chi, address
Admitting ward and consultant
Presenting complaint
Investigations and treatment with complications
GP instructions with med review if done/needed (any immediate instructions should be phone call)
Follow-up arrangements and who is responsible
Name, position and bleep no.
What do controlled drugs need on a discharge form
Name, dose, route and frequency and preparation in volume or weight in numbers and written.
How do fitness to work notes work
Patient can self certify for 7 days
Our responsibility not GP.
Up to 3 months.
What do you need before referring patient to another department
Reason
What you want team to do - advise, formal review, take over care, see in clinic, procedure/operation
Urgency or referral
Hospital notes, patient name, DOB, CHI, ward
Obs chart
Drug chart
Most recent results
REMEMBER TO WRITE OUTCOME IN NOTES.
What you need for a referral form
My name and contact
Patients info
Reason for referral
List diagnoses
Presenting complaint and management so far with latest meds and investigations and PMH
Finish referral with my name, grade and consultants name.
CC in other relevant staff.
REMEMBER TO PRINT SEVERAL COPIES AND SIGN THEM FOR THE NOTES.
What do you need for an investigation request
Patients details
Status (inpatient or out)
Location
Name of doctor
Date, test and reason for the test.
How to chase up results
Call if urgent
Cultures usually 2 days
How do you investigate a patient who complains of pain
Hx - SOCRATES, associated symptoms, PMH, D+A
Ex - General exam for source
Ix - based on findngs.
Use WHO pain ladder
What are the 4 steps of the who pain ladder
1 - paracetamol
2 - NSAID and paracetamol
3 - NSAID, paracetamol, weak opiod (codeine) (consider laxatives and anti-emetics PRN)
4 - NSAID, paracetamol, strong opioid (morphine) (consider laxatives and anti-emetics PRN)
Use paracetamol and codeine for discharge if needed as co-codamol/co-dydramol
How to prescribe long-term morphine
Once morphine requirments known with standard opioids.
Prescribe regular long-acting dose along with PRN fast acting for breakthrough (1/6 of daily) + laxatives.
Oral MST given every 12 hrs so half the total daily requirement
What is codeine and dihydrocodeine strength compared to oral morphine
10%
What is tramadol strength compared to oral morphine
20%
What is oxycodones strength compared to oral morphine
200%
What is subcut/IM/IV morphine strength compared to oral
200%
What is diamorphine SC strength compared to oral morphine
300%
What is fentanyl strength compared to morphine
1000% = ten times stronger
How to treat SOB in palliative care
Oxygen, open windows, fans, diamorphine, benzos, steroids, SC furosemide
How to treat constipation in palliative care
Check volume, check U and Es give laxatives
How to treat cough in palliative care
Saline nebs, antihistamines, codeine, morphine
How to treat dry mouth in palliative care
Chlorhexidine, ice, thrush? nystatin
How to treat hiccups in palliative are
Antacids, chlorpromazine
How to treat itching in palliative care
Antihistamines, cetrizine, ondansetron, colesrtyramine (jaundice)
What should be supported in palliative care
Fluids but not food or resus
Give 4 pallative care meds
Analgesia - diamorphine 2.5-5mg SC
Agitation - PRN levomepromazine or midazolam
N + V - Cyclizine or levomepromazine PRN
Secretions - sit up and glycopyrronium
How to confirm a death
Confirm cardiorespiratory arrest - listen to heart sounds in 2 places for a minute each, palpate over carotid for one minute, listen to breath sounds in 2 places for a minute each
(MAY HEAR GASTRO SOUNDS IF DEAD)
Confirm absence of motor response - no pupilary response to light, ansent corneal reflex, absent motor response to supra-orbital pressure
Document findings and time and date of death. Tell GP.
What to tell family of dead loved one
Get a nurse, read notes, identify self and identify family.
Ask if they have any questions and if they would like to see the body.
What to tell family of dead loved one
Get a nurse, read notes, identify self and identify family.
Ask if they have any questions and if they would like to see the body.
How to complete a certificate of death of cause
Seen patient within 14 days of death
Need - name, date of death, age, place of death, last seen alive by me date, outcome if theyre getting a post-mortem, cause of death (consultant) -
1A - what killed them
1B and 1C - sequence of events leading to A
2 - pathologies that likely contributed
Time of onset of these diseases needed from time of death.
What is needed for a cremation 4 form
Seen patient within 14 days of death and examine for an implant and talk to mortuary staff if present.
Get £70
Causes of death to refer to coroner
Unknown cause
Not seen by dr in last 14 days
Suspicious circumstances
MHA detainment
Abortion-linked
Industrial disease cause
Iatrogenic cause
Medical negligence
Within 24 hrs of admission
How to optomise nutrition in hospitals
Anti-emetics, fav foods, PPI and antacids, assisted feeding.
NG tube - get pharmacist input for what drugs can be given
Gastrotomy (PEG)
Parenteral feeding (Blood) - PN or TPN. Needs to be central as peripheral causes severe skin irritation. (Monitor U+Es).
What ion is important for refeeding syndrome
Phosphate
Things to ask patient if a colleage has a needle stick injury from them
IV drugs, transfusions, tattoos, piercings, unprotected sex in last 3 months, testing for Hep B,C and HIV.
Ask to take sample for Hep B,C and HIV.
What is the purpose of a pre-op assessment
Assess the problem
Assess their fitness for surgery
Check consent
Answer patients questions
Pre-op investigations
FBC, sickle cell (if FH), U+E, clotting, HbA1c, pregnancy test, ECG, ECHO if symptoms, ABG (possibly)
Group and save and maybe cross match - refer to unit request based on guidelines of op for number of units.
Who should go first on operating list
Diabetics
What type of patients should the anaesthetist be told about
Diabetics - go first
RA/alkalosing spondylitis - difficult to intubate
CVS - might need echo
What should happen to steroids pre-op
Increased and switched to IV
What happens with anticoagulants pre-op
Warfarin to be stopped at least 5 days pre-op
DOACs stopped 1 day before an op or 2 for high risk operations. Need to be stopped for double the length of time if patient has CKD.
When should clopidogrel be stopped
7-10 days for clopidogrel
Aspirin is usually continued
What happens to HRT for surgery
Patients can stay on as long as there’s DVT prophylaxis.
What happens to contraception during surgery
POP can be continued
COCP should be stopped 4 weeks prior
Things to prescribe for all patients when coming in for surgery
Prophylactic anticoagulation
Antibiotics
Bowel prep and IV fluid review (clear fluids only for 24hrs)
Regular meds (the ones that can be continued)
TED stockings
Analgesia
Antiemetics
Other than prescribing meds, what other things need to be done by the FY pre-op
Consent forms signed
Seen by anaesthetist
Operation site marked by surgeon
Crossmatched blood
Patient has fasted
May have to put patient on theatre list ourselves
What is needed to book a theatre list
Theatre number, patient identifiers, surgeons name, special patient requirements, operation type, signed and leave bleep.
Put older patients with co-morbidities and more complex dirty operations first.
Parts of the post-op examination
ABCDE, pain, nausea, passed urine, NEWS, surgical site check, bowel movement, eating and drinking if allowed, mobilizing
Important forms required by patients
Med 3 note - fitness to work note for patients who are off for more than 7 days because patients can self-certify
Med 10 note - patients that require proof of security payments etc
Important post -op info for patients
No flying for 6 weeks
48 hrs after surgery for driving and showering
Date for removing sutures
Blood tests post-op
FBC for possible transfusion need
CRP U+Es for infection and fluid status
How to manage post-op hypotension
Check - fluid status, fluid chart, drugs, pain, sepsis screen examination
Management - hourly obs, lie patient flat, fluid bolus, bloods if sepsis suspected, senior review
How to manage post op pyrexia
Normal within 24hrs post-op but if proceeds after then abnormal
Check - infection symptoms, atelectasis, pain, temp, BP and HR
Management - full infection screen, routine bloods, imaging - CXR, USS, CT
Possible causes of post-op pyrexia
Day 1-2 - atelectasis (salbutamol, oxygen and physio)
Day 3-4 - pneumonia (abx, fluids)
Day 5-6 - anastomotic leak (theatre)
Day 7-8 - wound infection (open up wound and antibiotics)
How to manage SOB post-op
Check - Hx of long disease, previous PE, chest pain, ankle swelling, new onset cough
Look for - BP, HR, lung sounds, calf swelling (PE/fluid)
Management - sit up, O2, routine bloods and d-dimer, CXR, ECG
How to manage post-op wound infection
Swab, abx, discuss with senior
How to manage would dehiscence
Superficial (burst sutures and pink serious discharge) - senior review as might need packing and abx
Deep (bowel protrusion and haematoma) - urgent senior help, sterile swab in 0.9% saline over the bowel, analgesia, fluids and abx
Common stoma complications
Electrolyte imbalance
Ischaemia
Obstruction
Prolapse
Skin erosion
Psychosocial problems
Remember to check for what in resp exam
Tremors
Remember to check for what in cardio exam
Palpate chest
Inspect legs for swelling and peripheral vascular disease
When a patient comes in with diarrhoea what is important to ask about meds
Any recent C abxs
Causes of hepatomegaly
Alcohol, hepatitis, EBV, CMV, Liver mets, haemochromatosis, autoimmune hepatitis, amyloidosis, hyperexpanded chestMets
Causes of splenomegaly
Cirrhosis, thrombocytopenia, EBC, HIV, haemolytic anaemia, leukaemia, sickle cell, myelofibrosis, sarcoidosis, malaria, lymphoma
What is Brudzinski sign
Involuntary flexion of hips and knees when neck is flexed due to neck stiffness
What roots cover should abduction
C5
What roots cover shoulder adduction
C5-C7
What roots cover elbow flexion
C5-C6
What roots cover elbow extension
C7
What roots cover wrist flexion
C7-C8
What roots cover wrist extension
C7
What roots cover finger flexion
C8
What roots cover finger extension
C7
What roots cover finger abduction
T1
What roots cover the bicep reflex
C5 and C6
What roots cover the supinator reflex
C5-C6
What roots cover the tricep reflex
C7-C8
What roots cover the knee relfex
L3 and L4
What roots cover the ankle reflex
S1 and S2
What roots cover hip flexion
L1 and L2
What roots cover hip adduction
L2 and L3
What roots cover hip extension
L5-S1
What roots cover knee flexion
L5-S1
What roots cover knee extension
L3-L4
What roots cover ankle dorsiflexion
L4
What roots cover ankle plantarflexion
S1-S2
What roots cover the big toe
L5
What is an antalgic gait
Limp
What is an apraxic gait
cant lift legs despite normal power (hydrocephalus/frontal lobe)
What is an ataxic gait
Uncoordinated and wide base
What is a hemiplegic gait
Knee extended, hip circumducts and drags leg, elbow may be flexed (stroke)
What is a myopathic gait
Leaning back with abdomen sticking out and waddling - proximal myopathy
What is a shuffling gait
Short, shuffled steps no arm swing (parkinsons)
What is a sastic gait
Like wadding through water (pyramidal e.g. MS)
What is a high stepping gait
Peripheral neuropathy
Features of an endocrine examination
General inspection - body size, fat pad on neck, facial shape, striae, brusing, muscle waisting, goitre, skin coarseness, jaw and brow ridge size, hirsutism, vitiligo, acne, pre-tibial myxodema, acanthosis nigricans
Hands - temp, sweating, size and tremor
Eyes - lid lag, proptosis, bitemporal haemiopia, CN eye palsy, fundoscopy
Neck - goitre or lumps
Cardioresp - HR, BP, pulse regularity, oedema
Neuro - palsys, peripheral neuropathy and reflexes
Tests - routine bloods, fundoscopy, morning cortisol, TFTs, short synthacten test
Questions to ask about skin rashes
Pain, bleeding, timeline, burning, systemic symptoms (sore throat, headache, fatigue, weightloss, diarrhoeal, travel history ), drugs
What drugs to ask about in a breast exam
HRT and COCP
Questions to ask when taking an ophthalmic Hx
visual changes, pain, grittiness, discharge, tearing, photophobia, diplopia, floaters, flashing lights, sudden onset, PMH - RA, SLE, thyroid eye disease MS
What infective disease are important to ask about in septic arthritis
TB, strep, gonorrhoea, STI, cellulitis - strep and staph
What is an important spine MSK test to do
Straight leg raise
Shobers test (should be >5cm)
What to check in wrist MSK exam
Radial, median and ulnar nerve distributions
Important sex hx questions
No. of partners in last 3 months
gender, where they were from, protection or not, type of intercourse, sex worker?
Questions for a female history
LMP, Length of cycle, pain and associated symptoms, pain with sex, bleeding, amount of pads/tampons, vaginal discharge, clots, amount of blood, last smear, kids and miscarriages, use of contraception, foreign sex, STIs, urinary issues, lumps
Questions for an obstetric history
Number of previous pregnancies and how they went, what week they are in, any issues, any pain, any movements, any bleeding, discharge, headache, urinary symptoms, fatigue, GORD, vomiting, specifically asking about pre-eclampsia, previous pregnancies and diabetes
Method of delivery, length of labour, any tears, baby’s health when born
PMH for obstetrics
Psych conditions, DM, pre-eclampsia, DVT, post-partum bleed, PE, STIs
What are the parts of a mental state exam
Appearance, behaviour, speech, mood, thought form, perception, cognition, risk and insight
Parts of a neonate exam
Done within 72hrs of birth
Check notes for type of birth and maternal health
Ask if parents have any concerns and if baby has passed urine and faeces
General appearance - colour, breathing pattern
Neuro - tone
Head - fontanelle check for sinking or buldging, head circumference, red light reflex, ear shape and position, palate with little finger, suck reflex
Hands/arms - fingers (number/shape colour), palmar crease number, symmetrical arm movement
Chest - palpate apex, RR and HR, clavicles for fractures
Abdo - palpate organs for megaly, femoral pulses, patent anes, enlarged clitoris and descended testes
Hips and feet - symmetrical hip creases, barlow test, ortolani test, ankles club foot, toes (same as fingers)
Turn baby over - spine, spina bifida, posterior hip creases
Record in red book
Important things to ask in paeds Hx
Age, milestones reached, how school is, build rapport, how theyre eating and drinking, infective symptoms, birth issues and immunisations
