Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MBBS - Year 1 > Clinical skills - Secondary care > Flashcards

Clinical skills - Secondary care Flashcards

1
Q

Absorption of subcutaneous injections

A

Sustained and slow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How much fluid can you inject subcutaneously

A

1-2 ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is an example of a medicine given subcutaneously

A

Insulin as subcut is suitable for freq injections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Sites for subcutaneous injections

A

Lateral aspect of upper arms and thigh

Below umbilicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What angle are s/c injections administered

A

45 degrees to optimise entry into s/c tissue

90 degrees if using shorter needles (5,6,8 mm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Procedure of giving a s/c injection

A

Pinch the skin to elevate tissue from muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why do we not aspirate with s/c injection

A

May form a haemotoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is skin cleaning pre-administration necessary for s/c injections

A

No unless the skin is visibly dirty

These injections usually have a lower chance of infection due to smaller needles used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Consideration for s/c injections

A

Rotation of sites of freq. injections

Avoid bruised, tender and scar tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Complications of s/c injections

A 
Infection 
Incorrect location 
Bruising 
Pain 
Anaphylaxis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Absorption of intramuscular injections

A

Rapid and systemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Volume of fluid given in IM injections

A

Up to 5ml in well perfused muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sites for IM injections

A 
Vastus Lateralis (Thigh)
Deltoids (2mls)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Giving dorsogluteal injections

A

Map out an imaginary 2x2 grid over the gluteal area and and in the upper outer quadrant do the same and inject that spot
Upper outer, upper outer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Giving thigh injections

A

Land mark one palm from hip and one palm up from the knee

Divide the thigh in half and inject towards the outer edge of the lateral half

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Note about giving dorsogluteal injections

A

High risk due to sciatic nerve; absorption hindered in obese patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Giving ventrogluteal injections

A

Use opposite hand to leg being injected
Place hand and over greater trochanter and spread ring and middle finger
Inject at point in between two fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Giving deltoid injections

A

Place little finger on acromion
Split middle and ring finger
Inject at point in between two fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Procedure of giving IM injections

A

Z track

Pull skin taut with your opposite hand 
Open safety lock 
Inject pt with needle no more than 2/3 its length 
Aspirate 
Release skin whilst removing injection 
Close safety lock and dispose of needle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why do we use the z track to give IM injections

A

Prevents escape of medicine by closing the point of needle entry on withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why do we aspirate when giving IM injections

A

To make sure the needle hasn’t reached the blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why can’t needles for IM injections be pushed all the way in

A

This makes removal easier in case of device failure/ breakage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Needle size and pain

A

Larger needles are less painful and smaller needles result in higher pressure –> discomfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Note about pre-filled syringes

A

Some have an air bubble built into them to cover needle length ensuring pt receives full dose
DO NOT dispel this air

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Do IM injections require skin cleaning

A

Yes as well-perfused muscle is being entered

Use every part of the clinell wipe, cleaning in diff directions and let dry for 30 secs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Procedure for loading syringes (plastic ampoules)

A

Open packet for syringe and blunt fill needle
Remove syringe and attach blunt fill needle before placing in blue box
Use clinell wipe to clean top of ampoule and twist open the top
Wait 30s for the ampoule to dry
Pick up syringe, remove cap from blunt fill needle and draw up desired volume of fluid
Ensure there are no air bubbles in the syringe
Open packet for needle w/ safety lock and swap needles, disposing of the blunt fill needle
Ensure you hear a click

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Loading syringes using glass ampoules

A

Use blunt fill needle WITH a filter

Open ampoule by placing thumb on blue dot and fingers on other side, snapping the ampoule open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Procedure when approaching an unwell pt

A

Take brief history
ABCDE
Don’t move on without intervening if necessary
Handover to senior member of staff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Airway assessment for an unwell pt

A

Is the patient alert & speaking?
Any extra noises e.g. stridor, secretions?
Is the pt unconscious with an at-risk airway?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Airway management for an unwell pt

A

Consider airway manoevres
Do you need a definitive airway (and therefore an anaesthetist)
Is there anything you can see to suction or remove?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Breathing assessment for unwell pt

A 
Measure respiratory rate
Pulse oximetry (oxygen sats)
‘Work of Breathing’
Examine the chest
Listen to the lungs in 3 diff positions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Breathing management for an unwell pt

A

Sit up
Give oxygen if sats <94% via a reservoir mask
Treat any underlying cause eg. in asthma give inhaler

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Circulation assessment for an unwell pt

A 
Heart rate (HS I + II + 0)
Blood pressure
Capillary refill time
Feel pulses
Listen to the heart
Fluid balance
Place a cannula & take bloods
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Cause of arrhythmia - circulation in an unwell pt

A

Tachycardia or bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Cause of hypotension- circulation in an unwell pt

A

Could be fluid depletion, sepsis, blood loss

Low bp causes tachycardia, prolonged CRT & weak pulses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Initial treatment for circulation in an unwell pt

A

Cannulate
Give 500ml of normal saline as a fluid challenge, monitor pt. Give 250ml in pt w/ heart failure
Further boluses can be given if the pt responds
Blood loss ideally replaced w/ blood
Escalate to ITU if you’ve given >2L fluids or pt is overloaded

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Normal saline soution %

A

0.9%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Fluids that can be given via cannula

A

Saline - salty
Hartmans - more balanced ions
Dextrose
Blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Disability assessment for an unwell pt

A 
DEFG
GCS
Temp
Neuro assessment
PEARL
Pain
AVPU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

DEFG

A

Don’t ever forget glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Neuro assessment

A

Asking pt to raise both arms and legs and wriggle toes and fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

PEARL

A

Pupils equal and reacting to light

Shining a bright light into the pupils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

AVPU

A

Alert - awake and aware of environment
Verbal - responds to verbal stimuli
Pain - responds to a pain stimulus
Unresponsive - unresponsive to any stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Disability management for an unwell pt

A

Correct low blood sugars with buccal/ oral / IV glucose
Check for DKA if blood glucose is high
If temperature is raised, consider infection and treat
Consider causes for altered neurology (e.g. stroke)
Manage pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Everything else assessment for an unwell pt

A

Expose and assess for injuries, rashes, oedema
Examine other systems (abdomen, ENT, neurological MSK)
Manage other abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Handing over an unwell pt after treating initially

A

SBAR

Situation - brief history
Background - PMH, DH, HPC
Assessment - findings and interventions
Recommendation - what you’d like the member of staff to do next

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Describing X-rays

A 
Say name, dob, hosp no and date X-ray taken 
Say where it is 
Describe view e/g lateral, posterior 
Describe displacement 
Mention any artefacts 
Translation 
STAR 
Extra-articular or intra-articular
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Describing displacement on a X-ray

A

Undisplaced
Mildly
Severely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

100% translation on an X-ray

A

Diameter has moved fully

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

STAR on X-rays

A

Shortening (offended)
Translation (measured in %)
Angulation
Rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Taking a drug hx

A

Routes
Dosage, freq, indication, compliance, side effects, day of the week taken, monitoring e.g. blood tests
How long they’ve been taking it for
OTC, illicit drugs and herbal remedies
Allergies and adverse reaction, intolerance - incl description

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

For pt’s who forgot drug hx

A

At least 2 other sources

Summary of care record 
Next of kin 
Dusset box
MAR chart 
Calling GP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Main investigations used during blood tests

A 
FBC 
Infl markers 
Renal function tets 
Liver function tests 
Bne profile 
Muscle enzymes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What does FBC incl

A

RBC
WBC (neutrophils, lymphocytes, eosinophils, monocytes, basophils)
Platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What to check after identifying low Fe

A

MCV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Types of anaemia

A

Microcytic and hypochromic

Macrocytic and hyper chromic

57
Q

Biggest source of iron in body

A

RBCs as iron is recycled from old RBC’s back in into bone marrow

58
Q

Fe deficiency causing microcytic anaemia

A

Bleeding e.g. menstruation

Bowel - peptic ulcers, Crohn’s, ulcerative colitis, cancer

59
Q

Peptic ulcers

A

Stomach or duodenal ulcers

Can be caused by NSAIDs

60
Q

Endoscopy vs colonoscopy

A

Endoscopy is for upper GI tract and colonoscopy is for lower GI

61
Q

Causes of increased MCV

A

Low B12 or folic acid

62
Q

When do we see normocytic anaemia

A

Anaemia of chronic disease

Acute bleeding e.g. stab wounds

63
Q

When do we see neutrophilia

A

Infl e.g. gout

Phagocytosis for bacterial infection

64
Q

Neutropenia

A

Low levels of neutrophil

65
Q

Lymphocytosis

A

High level of lymphocytes

66
Q

Lymphopenia

A

Low levels of lymphocytes

Seen in viral infections e.g. infectious mononucleosis

67
Q

When do we see eosinphils

A

Allergies
Hay fever
Parasitic infections
Asthma

68
Q

Function of liver

A 
Clears toxins 
Bile products 
Production of proteins e.g. albumin, globulins, clotting factors 
Metabolism of sugar and fat 
Conversion from harm to bilirubin
69
Q

Enzymes in the liver

A

ALT

ALP

70
Q

Where is ALT found

A

Produced in hepatocytes

71
Q

When is ALT increased

A

Liver damage from hepatitis
Infection
Cirrhosis
Drugs

72
Q

Where is ALP found

A

Biliary epithelium

73
Q

When is ALP increased

A

Infl
Sepsis
Bone disorders

74
Q

Hepatic jaundice

A

High ALT

Normal ALP

75
Q

Obstructive jaundice

A

High ALP
Normal ALT
Caused by pancreatitis or gallstones

76
Q

Function of albumin

A

Increases osmotic pressure so when dc teases fluid leaves blood vessels and causes swelling

77
Q

Albumin as a -ve acute reactant

A

Decreases in infection and infl due to higher levels of globulins

78
Q

Renal blood tests

A

U&E’s

Urea and creatinine
Sodium, potassium

79
Q

Hepcidin

A

+ve aceite phase reactant

80
Q

How does fibrinogen affect ESR

A

Leads to increase

81
Q

Causes of +ve RhF

A 
Bacterial endocarditis 
Osteomyelitis 
TB 
Syphilis 
Hepatitis 
Mononucleosis
Diffuse interstitial pulmonary fibrosis 
Liver cirrhosis 
Sarcoidosis
82
Q

Investigation results seen in MM

A 
Anaemia 
Lytic lesions 
High globulin 
Renal failure 
High infl marker
83
Q

Causes of high globulins

A 
Chronic in sections e.g. HIV, TB 
Liver disease (billiard cirrhosis, obstructive jaundice)
RhA
Ulcerative colitis 
MM, leukaemias, macroglobulinemia 
Autoimmunity (lupus, Sjorgen's)
Kidney dysfunction
84
Q

Serum levels in osteoporosis

A

No change ion phosphate and calcium levels

High ALP when fracture occurs

85
Q

Treatment of uric acid levels during gout attack

A

Wait until attack has subsided as uric acid levels usually normal

86
Q

Malignancy and calcium

A

Malignancy pushes up Ca level

87
Q

When do we see thrombocytosis

A

In infl conditions like vasculitis

88
Q

Look in examinations

A

Deformity
Scars/ redness
Swelling
Muscle wasting

89
Q

Feel in examination

A

Bony landmarks
Effusion
Swelling
Temp (back of hand)

90
Q

Move in examination

A

All possible movements at joint:
Active
Passive
Resisted

91
Q

Bony landmarks in hip

A

ASIS
Iliac crest
SI joint
Greater trochanter

92
Q

Indentifying SI joint

A

Dimples of Venus

93
Q

Abnormal Trendelenburg test result

A 
Gluteus medius (abductor) weakness 
Superior gluteal nerve weakness
94
Q

Testing resisted flexion of hip

A

Place hand near hip and ask pt to bring knees close to chest

95
Q

Testing abduction of hip

A

Hold ASIS tp stabilise pelvis

96
Q

External rotation of hip

A

For move in

97
Q

Pain when internally rotating

A

OA

98
Q

Why do we ask the pt to fully flex during the Thomas test

A

Removes lumbar lordosis

99
Q

Bony landmarks of knee

A 
Patella 
Patella tendon 
Tibial tuberosity 
Joint margin 
Femoral condyles 
Head of fibula
100
Q

Feel in knee exams

A

BPEST

Bony landmarks arks 
Popliteal fossa/ pulse 
Effusion
Swelling (bursa)
Temp
101
Q

What is Baker’s cyst a sign of

A

OA

102
Q

Testing effusion in knee exam

A

Patellar tap (testing for bounce)

103
Q

What is key in both anterior and posterior drawer test

A

Making sure the hamstring is relaxed

104
Q

What to do if you find leukocytes and nitrates in urine

A

Microscopy and culture to identify pathogenic organism

105
Q

What to do if you find glucose in urine

A

Capillary blood glucose and serum HBA1C

106
Q

What to do if you find glucose, ketones and low pH in urine

A

Admission (diabetic ketoacidosis)

107
Q

What to do if you find raised SG and proteinuria in urine

A

U&Es and microscopy & culture (nephrotic syndrome and UTI)

108
Q

What to do if you find blood in urine

A

FBC, U&Es

109
Q

Adequacy of film

A

Views - minimum 2 views required
Image joint above and below
Rotation
Penetration

110
Q

ABCS of radiographs

A

A - alignments and joint space
B - bone texture
C - cortices
S - soft tissues

111
Q

What can cause thrombocytosis

A

Infl

112
Q

Cervical spine exam - look

A

Do whole exam seated

Deformity - lordosis
Scars
Swelling
Muscle wasting

113
Q

Cervical spine exam - feel

A

Bony landmarks - C7 and count up, parapsinal muscles, trapezius, deltoid
Swelling
Temp - compare w/ shoulder

114
Q

Cervical spine exam - move

A

Explain in layman’s terms to pt, medical to examiner
Only do active movements

Flexion - touch neck w/ chin
Extension - look up
Rotation - look to the left/ right
Lateral flexion - bring ear to chest without moving neck

115
Q

Neurological part of spine exam

A

Sensation on dermatomes - cotton tip, neurotip (do both limbs)
Reflexes
Myotomes - resisted movement’s

116
Q

Cervical spine exam - reflexes

A

Ask pt to rest arm on knee
C5 - place 2 fingers over biceps tuberosity then hit fingers (biceps)
C6 - hit radial styloid processes (bracxhioradialis)
C7 - hit olecranon (triceps)

117
Q

Testing reflexes in spine exam

A

Wait for response, hit at enthesis (max 2x)

Hit tendon at perpendicular angle

118
Q

Cervical spine dermatomes

A 
C5 - deltoid 
C6 - thumb 
C7 - middle finger
C8 - pinky 
C1 - axilla
119
Q

Thoracic spine dermatomes

A

T4 - nipple
T8 - diploid
T10 - umbilicus
T12 - symphysis

120
Q

Testing myotomes in spinal exam

A

Only do resisted movements - testing muscle power
Place hand close to joint
Finish all movements at joint before moving on
Ask examiner whether or not to do both sides

121
Q

Cervical myotomes

A

C5 - shoulder abduction (deltoid)
C6 - elbow flexion (biceps), wrist extension
C7 - elbow extension (triceps), wrist flexion, finger extension
C8 - finger flexion
T1 - finger abduction

122
Q

Most common injury in spine

A

Slipped disc esp at (L4/5 or L5/S1)
Rarely happens at cervical spine (C6/C7)
Never happens in thoracic spine

123
Q

Lumbar spine - Look

A

Deformity - scoliosis, lordosis, kyphosis
Swelling
Scars
Muscle wasting

124
Q

Lumbar spine - feel

A

Bony landmarks - start at ASIS, round iliac wings, L5 and count up, lat doors, posterior iliac crest (level with L4), SI joint
Swelling
Temp

125
Q

Lumbar spine - move

A

Flexion - touch toes
Extension - lean back (stand behind pt)
Lateral flexion - hand down leg

Schober test - use fingers

126
Q

What does Schober test look for

A

AS

127
Q

Neurological aspect of lumbar spine exam

A

Do lying down

```
Straight leg raise/ sciatic stretch
Dermatomes
Reflexes
Myotomes
Femoral nerve test
~~~

128
Q

Straight leg raise test

A

Raise leg until painful and note approx angle
Drop leg slowly until pain is gone
Dorsiflex foot and abs for pain

Pain should be in back

129
Q

Lumbar dermatomes

A 
L1 - upper thigh 
L2 - middle thigh 
L3 - lower thigh 
L4 - knee joint and big toe 
L5 - middle toe 
S1 - pinky toe
130
Q

Lumbar reflexes

A

Knee jerk - L3/4 - place arm under both knees, make sure quads are relaxed, flex nee slightly, hit just above tibial tuberosity
Ankle - S1 - flex knee and turn out, use hand to dorsiflex for, hit Achilles’ tendon before insertion in Os-Calcis

131
Q

Lumbar myotomes

A 
L2 - hip flexion 
L3/4 - knee extension 
L4 - nakle dorsiflexion 
L5 - hallux extension 
S1 - hip extension, ankle plantar flexion, hallux flexion
S2 - knee flexion
132
Q

Testing lumbar myotomes

A

Hip - push hand down into bed and up
Knee - push hand back and forward
Ankle - “ “
Hallux - “ “

133
Q

Shoulder exam - look

A

Deformity (asymmetry/ winging)
Swelling
Scarrs
Muscle wasting

134
Q

Shoulder exam - feel

A

SCJ, clavicle, ACJ, acromion, spine of scapula, medial border, tip of scapula, lateral border, greater tubeoritu, coracoid process
Effusion
Swelling
Temp

135
Q

Posterior shoulder dislocation

A

V rare
Caused by electrocution or electric seizure
See lightbulb sign in X-ray

136
Q

Anterior shoulder dislocation

A

Common
Caused by trauma
Head of humerus not in glenoid fossa

137
Q

Detcting AC OA during shoulder exam

A

Tenderness of ACJ

Pain in high arc

138
Q

Injury hx

A

Mechanism of injury
Dominant hand
Occupation/ hobbies
Any previous injuries

MBBS - Year 1 (93 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions