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FY1 > Being an FY1 > Flashcards

Being an FY1 Flashcards

1
Q

What bacterial spores are resistant to alcohol gel

A

C. diff

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2
Q

How to use a bleep call?

A

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.

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3
Q

Dealing with family of a patient you don’t know well

A

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

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4
Q

What are the factors of informed consent

A

What the procedure is
Purpose
Risks and side effects

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5
Q

How to incident report

A

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

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6
Q

First things to do as an FY in the morning before the ward round

A

Ask night team of any issues
Submit any missing requests - bloods, CXR, ECGs
Review any unwell patients

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7
Q

Jobs to do after ward round

A

Compare jobs lists between FYs based on urgency - radiology requests, speaking to other teams, discharge forms, taking blood

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8
Q

What jobs are done after the ward round

A

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

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9
Q

What jobs are done before the end of the day

A

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

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10
Q

Patient info needed for handover

A

Name, CHI, DOB and exactly what you want them to do (e.g. check bloods for AKI)

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11
Q

Jobs to do before the weekend

A

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

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12
Q

How to hand over

A

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.

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13
Q

Important things to do when on call

A

Know info on the sickest patients
Know whos on call and how to contact
Keep an eye on bleep
Make a jobs list

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14
Q

Night shift pitfalls (5)

A

Poor handover
Failing to call for help early
Fluid prescribing (renal/heart failure, DM, electrolyte imbalance)
Warfarin prescriptions
Check you have right patient

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15
Q

7 things to include on a discharge form

A

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.

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16
Q

What do controlled drugs need on a discharge form

A

Name, dose, route and frequency and preparation in volume or weight in numbers and written.

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17
Q

How do fitness to work notes work

A

Patient can self certify for 7 days
Our responsibility not GP.
Up to 3 months.

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18
Q

What do you need before referring patient to another department

A

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.

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19
Q

What you need for a referral form

A

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.

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20
Q

What do you need for an investigation request

A

Patients details
Status (inpatient or out)
Location
Name of doctor
Date, test and reason for the test.

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21
Q

How to chase up results

A

Call if urgent
Cultures usually 2 days

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22
Q

How do you investigate a patient who complains of pain

A

Hx - SOCRATES, associated symptoms, PMH, D+A
Ex - General exam for source
Ix - based on findngs.
Use WHO pain ladder

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23
Q

What are the 4 steps of the who pain ladder

A

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

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24
Q

How to prescribe long-term morphine

A

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

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25
Q

What is codeine and dihydrocodeine strength compared to oral morphine

A

10%

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26
Q

What is tramadol strength compared to oral morphine

A

20%

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27
Q

What is oxycodones strength compared to oral morphine

A

200%

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28
Q

What is subcut/IM/IV morphine strength compared to oral

A

200%

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29
Q

What is diamorphine SC strength compared to oral morphine

A

300%

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30
Q

What is fentanyl strength compared to morphine

A

1000% = ten times stronger

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31
Q

How to treat SOB in palliative care

A

Oxygen, open windows, fans, diamorphine, benzos, steroids, SC furosemide

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32
Q

How to treat constipation in palliative care

A

Check volume, check U and Es give laxatives

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33
Q

How to treat cough in palliative care

A

Saline nebs, antihistamines, codeine, morphine

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34
Q

How to treat dry mouth in palliative care

A

Chlorhexidine, ice, thrush? nystatin

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35
Q

How to treat hiccups in palliative are

A

Antacids, chlorpromazine

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36
Q

How to treat itching in palliative care

A

Antihistamines, cetrizine, ondansetron, colesrtyramine (jaundice)

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37
Q

What should be supported in palliative care

A

Fluids but not food or resus

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38
Q

Give 4 pallative care meds

A

Analgesia - diamorphine 2.5-5mg SC
Agitation - PRN levomepromazine or midazolam
N + V - Cyclizine or levomepromazine PRN
Secretions - sit up and glycopyrronium

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39
Q

How to confirm a death

A

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.

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40
Q

What to tell family of dead loved one

A

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.

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41
Q

What to tell family of dead loved one

A

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.

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42
Q

How to complete a certificate of death of cause

A

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.

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43
Q

What is needed for a cremation 4 form

A

Seen patient within 14 days of death and examine for an implant and talk to mortuary staff if present.
Get £70

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44
Q

Causes of death to refer to coroner

A

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

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45
Q

How to optomise nutrition in hospitals

A

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).

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46
Q

What ion is important for refeeding syndrome

A

Phosphate

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47
Q

Things to ask patient if a colleage has a needle stick injury from them

A

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.

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48
Q

What is the purpose of a pre-op assessment

A

Assess the problem
Assess their fitness for surgery
Check consent
Answer patients questions

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49
Q

Pre-op investigations

A

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.

50
Q

Who should go first on operating list

A

Diabetics

51
Q

What type of patients should the anaesthetist be told about

A

Diabetics - go first
RA/alkalosing spondylitis - difficult to intubate
CVS - might need echo

52
Q

What should happen to steroids pre-op

A

Increased and switched to IV

53
Q

What happens with anticoagulants pre-op

A

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.

54
Q

When should clopidogrel be stopped

A

7-10 days for clopidogrel
Aspirin is usually continued

55
Q

What happens to HRT for surgery

A

Patients can stay on as long as there’s DVT prophylaxis.

56
Q

What happens to contraception during surgery

A

POP can be continued
COCP should be stopped 4 weeks prior

57
Q

Things to prescribe for all patients when coming in for surgery

A

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

58
Q

Other than prescribing meds, what other things need to be done by the FY pre-op

A

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

59
Q

What is needed to book a theatre list

A

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.

60
Q

Parts of the post-op examination

A

ABCDE, pain, nausea, passed urine, NEWS, surgical site check, bowel movement, eating and drinking if allowed, mobilizing

61
Q

Important forms required by patients

A

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

62
Q

Important post -op info for patients

A

No flying for 6 weeks
48 hrs after surgery for driving and showering
Date for removing sutures

63
Q

Blood tests post-op

A

FBC for possible transfusion need
CRP U+Es for infection and fluid status

64
Q

How to manage post-op hypotension

A

Check - fluid status, fluid chart, drugs, pain, sepsis screen examination
Management - hourly obs, lie patient flat, fluid bolus, bloods if sepsis suspected, senior review

65
Q

How to manage post op pyrexia

A

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

66
Q

Possible causes of post-op pyrexia

A

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)

67
Q

How to manage SOB post-op

A

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

68
Q

How to manage post-op wound infection

A

Swab, abx, discuss with senior

69
Q

How to manage would dehiscence

A

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

70
Q

Common stoma complications

A

Electrolyte imbalance
Ischaemia
Obstruction
Prolapse
Skin erosion
Psychosocial problems

71
Q

Remember to check for what in resp exam

A

Tremors

72
Q

Remember to check for what in cardio exam

A

Palpate chest
Inspect legs for swelling and peripheral vascular disease

73
Q

When a patient comes in with diarrhoea what is important to ask about meds

A

Any recent C abxs

74
Q

Causes of hepatomegaly

A

Alcohol, hepatitis, EBV, CMV, Liver mets, haemochromatosis, autoimmune hepatitis, amyloidosis, hyperexpanded chestMets

75
Q

Causes of splenomegaly

A

Cirrhosis, thrombocytopenia, EBC, HIV, haemolytic anaemia, leukaemia, sickle cell, myelofibrosis, sarcoidosis, malaria, lymphoma

76
Q

What is Brudzinski sign

A

Involuntary flexion of hips and knees when neck is flexed due to neck stiffness

77
Q

What roots cover should abduction

A

C5

78
Q

What roots cover shoulder adduction

A

C5-C7

79
Q

What roots cover elbow flexion

A

C5-C6

80
Q

What roots cover elbow extension

A

C7

81
Q

What roots cover wrist flexion

A

C7-C8

82
Q

What roots cover wrist extension

A

C7

83
Q

What roots cover finger flexion

A

C8

84
Q

What roots cover finger extension

A

C7

85
Q

What roots cover finger abduction

A

T1

86
Q

What roots cover the bicep reflex

A

C5 and C6

87
Q

What roots cover the supinator reflex

A

C5-C6

88
Q

What roots cover the tricep reflex

A

C7-C8

89
Q

What roots cover the knee relfex

A

L3 and L4

90
Q

What roots cover the ankle reflex

A

S1 and S2

91
Q

What roots cover hip flexion

A

L1 and L2

92
Q

What roots cover hip adduction

A

L2 and L3

93
Q

What roots cover hip extension

A

L5-S1

94
Q

What roots cover knee flexion

A

L5-S1

95
Q

What roots cover knee extension

A

L3-L4

96
Q

What roots cover ankle dorsiflexion

A

L4

97
Q

What roots cover ankle plantarflexion

A

S1-S2

98
Q

What roots cover the big toe

A

L5

99
Q

What is an antalgic gait

A

Limp

100
Q

What is an apraxic gait

A

cant lift legs despite normal power (hydrocephalus/frontal lobe)

101
Q

What is an ataxic gait

A

Uncoordinated and wide base

102
Q

What is a hemiplegic gait

A

Knee extended, hip circumducts and drags leg, elbow may be flexed (stroke)

103
Q

What is a myopathic gait

A

Leaning back with abdomen sticking out and waddling - proximal myopathy

104
Q

What is a shuffling gait

A

Short, shuffled steps no arm swing (parkinsons)

105
Q

What is a sastic gait

A

Like wadding through water (pyramidal e.g. MS)

106
Q

What is a high stepping gait

A

Peripheral neuropathy

107
Q

Features of an endocrine examination

A

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

108
Q

Questions to ask about skin rashes

A

Pain, bleeding, timeline, burning, systemic symptoms (sore throat, headache, fatigue, weightloss, diarrhoeal, travel history ), drugs

109
Q

What drugs to ask about in a breast exam

A

HRT and COCP

110
Q

Questions to ask when taking an ophthalmic Hx

A

visual changes, pain, grittiness, discharge, tearing, photophobia, diplopia, floaters, flashing lights, sudden onset, PMH - RA, SLE, thyroid eye disease MS

111
Q

What infective disease are important to ask about in septic arthritis

A

TB, strep, gonorrhoea, STI, cellulitis - strep and staph

112
Q

What is an important spine MSK test to do

A

Straight leg raise
Shobers test (should be >5cm)

113
Q

What to check in wrist MSK exam

A

Radial, median and ulnar nerve distributions

114
Q

Important sex hx questions

A

No. of partners in last 3 months
gender, where they were from, protection or not, type of intercourse, sex worker?

115
Q

Questions for a female history

A

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

116
Q

Questions for an obstetric history

A

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

117
Q

PMH for obstetrics

A

Psych conditions, DM, pre-eclampsia, DVT, post-partum bleed, PE, STIs

118
Q

What are the parts of a mental state exam

A

Appearance, behaviour, speech, mood, thought form, perception, cognition, risk and insight

119
Q

Parts of a neonate exam

A

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

120
Q

Important things to ask in paeds Hx

A

Age, milestones reached, how school is, build rapport, how theyre eating and drinking, infective symptoms, birth issues and immunisations

FY1 (6 decks)

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