CMS OSCE Flashcards
what sections of the trigeminal nerve can be tested?
corneal
facial
motor
jaw jerk
how to test the corneal aspect of the trigeminal nerve?
look up/away
tough wool on each side of cornea
look for blink
how to test the facial aspect of trigeminal nerve?
sharp object at forehead/cheek/jaw
repeat with a dull instrument
if anything is abnormal try with temperature or light touch
how to test the facial nerve?
look for droop and asymmetry
wrinkle face - feel strength by pushing down
shut eyes tight - bilateral?
grin - check nasolabial grooves
how to test glossopharyngeal and vagus nerves?
if voice is hoarse or nasal swallow/cough palate - ulvuar displacement when pt says ah - symmetrical soft palate is gag reflex normal
how to test the hypoglossal nerve?
articulation of speech
tongue wasting
what is parkinsons disease?
degeneration of dopaminergic neurones in the basal ganglia
what are some signs of parkinsons?
bradykinesia = mask like face and festination
rigidity
resting tremor
shuffling gait and falls
what are some signs of a previous stroke?
intention tremor
hemiplegia
spasticity - because muscle stiffness
what is cerebellar ataxia?
loss of co ordination
cerebellar gait
intention tremor
what is intention tremor?
low frequency oscillation
increased amplitude of tremor as near end point of voluntary visually guided movement
what is resting tremor?
not associated with voluntary movement
pin rolling action of hand
seen in parkinsons
what is essential tremor?
voluntary contraction of muscles and no association with any neurological disorder
what is bradykinesea?
increased tone of basal ganglia = slowness of action
tremor
what is ABCDE?
airway breathing circulation disability exposure
what is A?
look listen feel
high flow oxygen 15litres/min
suction and airway adjuncts
what is B?
resp rate look listen feel inspection of chest efficacy/effort/cyanosis palpation - rise/fall listen - wheeze sats high flow o2
what is C?
assess - pulses/blood pressure/peripheries colour/temp/CRT
shock - signs of shock, control any bleeding, elevate legs, keep warm
what is D?
disability
asses CNS
AVPU
BM level
what is E?
expose and undress - rashes/clinical signs
temp control measures
signs of anaphylaxis?
collapse angioedema flushing/pallor resp distress hypotension tachycardia itching
treatment of anaphylaxis?
ABCDE
999
15litres/min O2
500mg adrenaline IM - 5 min intervals
child adrenaline doses?
12 = 500mg
what are symptoms of severe asthma?
cant complete sentences
resp >25
pulse>110
peak flow = 33-50% expected best
what are the symptoms of life threatening asthma?
silent chest, feeble resp effort, cyanosis, exhaustion, hypotension
pulse
how to treat asthma?
ABCDE
sit up
2 puffs salbutamol 100mg per puff
additional doses through spacer if not responding
signs of an MI?
severe, crushing central chest pain, pallor and sweating, nausea and vomiting, breathless, weak pulse, low bp
how to treat cardiac emergency?
ABCDE
999
GTN 1-2 sprays
300mg oral aspirin
phases of a seizure?
sudden collapse and loss of consciousness
tonic phase - 30 secs. rigidity and cyanosis
clonic phase - few mins - jerking movements
post ictal confusion
how to treat an epileptic seizure?
ABCDE prevent injury oxygen 15l/min check bp/glucose recovery position when comes around buccal midazolam 10mg
signs of hypoglycaemia?
shaking sweat palpitations headache speech slurring confusion convulsions and unconscious
treatment of hypoglycaemia?
ABCDE oxygen 10-20 g glucose drink 3 x glucose tablets 1mg IM glucagon
what to ask an asthmatic pt in a medical history?
is it well controlled?
frequency of attacks?
