CMS OSCE

Question 1

what sections of the trigeminal nerve can be tested?

Answer 1

corneal
facial
motor
jaw jerk

Question 2

how to test the corneal aspect of the trigeminal nerve?

Answer 2

look up/away
tough wool on each side of cornea
look for blink

Question 3

how to test the facial aspect of trigeminal nerve?

Answer 3

sharp object at forehead/cheek/jaw
repeat with a dull instrument
if anything is abnormal try with temperature or light touch

Question 4

how to test the facial nerve?

Answer 4

look for droop and asymmetry
wrinkle face - feel strength by pushing down
shut eyes tight - bilateral?
grin - check nasolabial grooves

Question 5

how to test glossopharyngeal and vagus nerves?

Answer 5

if voice is hoarse or nasal
swallow/cough
palate - ulvuar displacement
when pt says ah - symmetrical soft palate
is gag reflex normal

Question 6

how to test the hypoglossal nerve?

Answer 6

articulation of speech

tongue wasting

Question 7

what is parkinsons disease?

Answer 7

degeneration of dopaminergic neurones in the basal ganglia

Question 8

what are some signs of parkinsons?

Answer 8

bradykinesia = mask like face and festination
rigidity
resting tremor
shuffling gait and falls

Question 9

what are some signs of a previous stroke?

Answer 9

intention tremor
hemiplegia
spasticity - because muscle stiffness

Question 10

what is cerebellar ataxia?

Answer 10

loss of co ordination
cerebellar gait
intention tremor

Question 11

what is intention tremor?

Answer 11

low frequency oscillation

increased amplitude of tremor as near end point of voluntary visually guided movement

Question 12

what is resting tremor?

Answer 12

not associated with voluntary movement
pin rolling action of hand
seen in parkinsons

Question 13

what is essential tremor?

Answer 13

voluntary contraction of muscles and no association with any neurological disorder

Question 14

what is bradykinesea?

Answer 14

increased tone of basal ganglia = slowness of action

tremor

Question 15

what is ABCDE?

Answer 15

airway
breathing
circulation
disability
exposure

Question 16

what is A?

Answer 16

look listen feel
high flow oxygen 15litres/min
suction and airway adjuncts

Question 17

what is B?

Answer 17

resp rate look listen feel
inspection of chest efficacy/effort/cyanosis
palpation - rise/fall
listen - wheeze
sats 
high flow o2

Question 18

what is C?

Answer 18

assess - pulses/blood pressure/peripheries colour/temp/CRT

shock - signs of shock, control any bleeding, elevate legs, keep warm

Question 19

what is D?

Answer 19

disability
asses CNS
AVPU
BM level

Question 20

what is E?

Answer 20

expose and undress - rashes/clinical signs

temp control measures

Question 21

signs of anaphylaxis?

Answer 21

collapse
angioedema
flushing/pallor
resp distress
hypotension
tachycardia
itching

Question 22

treatment of anaphylaxis?

Answer 22

ABCDE
999
15litres/min O2
500mg adrenaline IM - 5 min intervals

Question 23

child adrenaline doses?

Answer 23

12 = 500mg

Question 24

what are symptoms of severe asthma?

Answer 24

cant complete sentences
resp >25
pulse>110
peak flow = 33-50% expected best

Question 25

what are the symptoms of life threatening asthma?

Answer 25

silent chest, feeble resp effort, cyanosis, exhaustion, hypotension pulse

Question 26

how to treat asthma?

Answer 26

ABCDE sit up 2 puffs salbutamol 100mg per puff additional doses through spacer if not responding

Question 27

signs of an MI?

Answer 27

severe, crushing central chest pain, pallor and sweating, nausea and vomiting, breathless, weak pulse, low bp

Question 28

how to treat cardiac emergency?

Answer 28

ABCDE 999 GTN 1-2 sprays 300mg oral aspirin

Question 29

phases of a seizure?

Answer 29

sudden collapse and loss of consciousness tonic phase - 30 secs. rigidity and cyanosis clonic phase - few mins - jerking movements post ictal confusion

Question 30

how to treat an epileptic seizure?

Answer 30

``` ABCDE prevent injury oxygen 15l/min check bp/glucose recovery position when comes around buccal midazolam 10mg ```

Question 31

signs of hypoglycaemia?

Answer 31

``` shaking sweat palpitations headache speech slurring confusion convulsions and unconscious ```

Question 32

treatment of hypoglycaemia?

Answer 32

``` ABCDE oxygen 10-20 g glucose drink 3 x glucose tablets 1mg IM glucagon ```

Question 33

what to ask an asthmatic pt in a medical history?

Answer 33

is it well controlled? | frequency of attacks?