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5th Year OSCE > Counselling > Flashcards

Counselling Flashcards

1
Q

Indications for induction of labour

A

Prolonged gestation which increases risk of still birth, LSCS etc

Prelabour rupture of membranes (>24 hrs before labour) which increases risk of infection

Maternal health conditions e.g. diabetes, hypertension or heart disease which can increase the risk of stillbirth and large baby

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2
Q

Disadvantages of induction of labour

A

Labour ward vs midwifery-led unit, no birth pool

May be more painful

Longer stay in hospital

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3
Q

Talk through the process of induction of labour

A

Most will get membrane sweep first (adjunct) to stimulate release of prostaglandins- increases chance of natural labour, can cause discomfort

Then depending on bishops score management is different:

<6 (unfavourable cervix) then PV prostaglandins or mechanical method e.g. balloon catheter is offered to increase favourability of cervix

> 6 (favourable cervix) then amniotomy +/- oxytocin infusion is recommended

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4
Q

Pros and cons of prostaglandin use in IOL

A

Hormones that mimic the ones in ur body that make contractions happen

Usually done when bishops <6 alongside ?balloon catheter

Reduces likelihood of needing mechanical methods

But can cause hyperstimulation

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5
Q

Pros and cons of amniotomy

A

Amnihook to artificially break the membranes to release prostaglandins

Must be done before oxytocin drip

But can be uncomfortable- pain relief can be provided

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6
Q

Alternative to OGD

A

Barium swallow

Non-invasive and doesnt require sedation

Shows motility problems in the oesophagus but can’t examine the mucosa or get a biopsy

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7
Q

What do you have to do before an OGD

A

Stop PPIs 2 weeks before

Not eat for 6 hours, clear fluids for 2 hours (same as surgery)

?stop anticoagulants also

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8
Q

2 options for anaesthesia during OGD

A

Throat spray- numbing back of throat, no gag reflex

IV sedation- relaxes patient but they stay awake, must be taken home

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9
Q

Side effects and risks of OGD

A

SE:
- gagging
- sore throat
- nausea/ abdominal pain
- minor bleeding

Risks:
- damage to teeth- mouthguard
- aspiration pneumonia
- perforation
- infection
- over-sedation

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10
Q

Alternative to colonoscopy

A

CT colonography (virtual colonoscopy)

Imaging test- air enema and then CT from different angle creates 3D model

Less invasive but not as detailed and no biopsies

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11
Q

How to prepare for colonoscopy

A

Bowel prep- low fibre diet for 2-3 days and increase fluids

Then take very strong laxative the day before -> diarrhoea

Eating 6 hrs, clear fluids 2 hrs

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12
Q

Pros and cons of the 2 types of dialysis

A

Haemodialysis and peritoneal dialysis (catheter into peritoneum- fluid changed either overnight or 4x a day )

Haemodialysis has a social aspect, performed by HCP, has dialysis-free days and can be done at home.
BUT diet and fluid intake are restricted, requires vascular access and can cause SE including infection, muscle cramps, itchy feeling

Peritoneal dialysis is more flexible and freeing, but is done every day, you have as permanent catheter in, and has risks e.g. hernia, infection, scarring

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13
Q

5 transfusion side effects and management

A

Anaphylaxis -> stop and IM adrenaline etc ABCDE

TACO -> stop and Tx as acute HF

TRALI -> stop and supportive care e.g. O2

Haemolytic reaction (ABO incompatibility) -> stop and supportive Mx

Febrile non-haemolytic transfusion reaction -> slow and paracetamol

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14
Q

How to differentiate between TRALI and TACO

A

Both present with SOB, hypoxaemia

TRALI more severe

TACO more likely in HF patients

TACO more of an overload picture, TRALi has CXR white out

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15
Q

How does acute haemolytic transfusion reaction present

A

Fever, hypotension, agitation, flushing, chest/ abdominal pain, DIC/ bleeding, AKI

Occurs in minutes of BT

If rigors consider bacterial contamination instead

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16
Q

What is UKMEC4 for COCP

A

<3wks p.p if not breastfeeding
<6wks p.p if breastfeeding

Breast cancer

> 35 and smoke >15 a day

VTE history
Recent immobilisation
Thrombogenic mutations
Antiphospholipid
AF

Migraine with aura

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17
Q

What percentage of women using the COCP get pregnant after a year

A

9%

Actually effectiveness is 99% but people dont use it right so it is 91% effective

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18
Q

What 2 cancers does COCP reduce chance of

A

Ovarian and endometrial

Increases cervical and breast cancer

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19
Q

Four risks of COCP

A

VTE

MI / stroke

Breast cancer

Cervical cancer

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20
Q

Common side effects of the POP

A

Irregular bleeding !!!!

Headaches
Nausea
Mood changes
Breast tenderness

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21
Q

Missed pill times for types of POP

A

Desorgestrel= half Day= 12 hours ok

Levonorgestrel/ norethisterone= 3 hours

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22
Q

Indications for double dose of levonorgestrel

A

BMI>26
Weight >70kg
Enzyme-inducing meds

No double dosing for Ella-One

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23
Q

6 enzyme inducers

A

Carbemazepine (mood stabilizer, anticonvulsant)
Rifampicin (Abx)
Alcohol
Phenytoin (seizure prevention)

Griseofulvin (antifungal)
Phenobarbitone (seizure prevention)
Sulphonylureas (T2DM e.g. gliclazide)

They induce P450 which increases the amount of NAPQI which is hepatoxic which is relevant in paracetamol overdose

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24
Q

Inhibitors of P450 enzyme (9)

A

SSRIs
Omeprazole
Valproate
Acute Achilles
Antibiotics e.g. ciproflox, eryth
Amiodarone
Allopurinol
Isoniazid
Zoles e.g. ketoconazole

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25
Can you restart hormonal contraception after emergency
Yes if levonorgestrel No if EllaOne- wait for 5 days
26
UKMEC4 for contraceptive implant
Current breast cancer
27
Cons of contraceptive implant
Unpredictable bleeding that doesn’t necessarily get better Procedure to fit and remove Small increased risk of breast cancers
28
UKMEC 4 for copper coil
P.p sepsis PID active STI active Cervical/ endometrial cancer Pelvic TB a
29
Cons of copper coil
Heavier and more painful periods 1/20 risk of expulsion Ectopic pregnancy No protection vs PMS
30
When do you take methotrexate
Once a week Folic acid on the other days/ also once a week? But on different days FA helps to reduce side effects
31
Analgesia in copper coil insertion?
Yes! Take ibuprofen/ paracetamol 1/2 hours before Can have LA in the cervix, spray into cervix, gel into uterus or just simple analgesia
32
How does IUS work
3 ways: - thins endometrium to prevent implantation of egg - thickens cervical mucous to prevent sperm from entering uterus - can prevent ovulation sometimes
33
How does depot injection work contraception
3 ways: - thins lining of uterus - thickens cervical mucous - inhibits ovulation (Same as IUS as is progesterone, POP doesn’t seem to thin uterus lining like the other two do)
34
How often is depot injection given
Every 13 weeks (3 months)
35
What is chance of anaphylaxis in vaccinations
1 in 1 million in UK
36
Which vaccines are live
Measles Mumps Rotavirus Rubella
37
5 cautions for corticosteroid prescribing
Liver impairment Stomach ulcers Diabetes MH problems Pregnancy!! (Lower dose as affects growth)
38
What should be avoided in those taking immunosuppressive doses of steroid
Live vaccines! Polio, MMR, BCG
39
Missed pill rule for steroids
Take as soon as remember BUT Don’t take 2 doses at once to compensate
40
How do we monitor people on steroids
BP, body weight and BMI to check for weight gain i guess Eye exam for glaucoma/ catacts HBA1C 1 month after stating then every 3 months
41
Common short and long term side effects fo steroids
Short-term: Sleep disturbance/ insomnia Weight gain Mood changes long term: Cushings Osteroporosis HTN Muscle weakness Diatebetes Peptic ulcers Cataracts
42
What not to forget in steroid counselling
Steroid withdrawl-> adrenal insufficiency! Do not stop a suddenly Steroid emergency card Double dose (hydrocortisone) during illness
43
Do you stop metformin in low eGFR
Yes EGFR <30 As risk of lactic acidosis
44
Missed pill rule for metformin
Take next dose as normal, don’t take two together !
45
What do you monitor in metformin
Renal function As metformin is excreted by the kidneys so in bad renal function it could build up and cause lactic acidosis
46
2 serious risks of metformin
Lactic acidosis B12 deficiency-> neuro symptoms
47
Serious side effects of methotrexate
Liver toxicity -> jaundice Thrombocytopenia -> bleeding gums, bruising etc Serious infection -> fever, chills etc Stevens-Johnson syndrome -> severe skin rash/ blisters
48
Which drug do you not take with methotrexate
Trimethoprim (or co-trimoxazole) Increases risk of bone marrow suppression
49
4 serious side effects of clozapine
Agranulocytosis-> neutropenic sepsis Lowers seizure threshold Ileus/ bowel obstruction due to constipation Cardiac complications e.g. myocarditis/ cardiomyopathy due to potential persistent tachycardia
50
Statins side effects
Generally well tolerated Myalgia (muscle pain) is common but not concerning, but muscle toxicity can be severe Also common is nausea, constipation, headache Can cause ILD
51
When to take Levothyroxine
At least 30 mins before breakfast as food etc can reduce absorption Also don’t suddenly stop taking it Also dont take two doses together if u miss one
52
How to describe levothyroxine side effects
Based on levels of drug So hypothyroid symptoms if too much dose Hyperthyroidism if too little Monitor levels at least yearly once stable
53
Who should not be taking PrEP
HIV positive people It wouldn’t work on them and increase drug resistance
54
2 options for taking PrEP
Daily dosing Event-based dosing- two tablets <24 hours before sex, 2 pills each day after
55
Common lithium side effects vs lithium toxicity
Common: - thirst - tiredness - weight gain - fine tremor Toxicity: - confusion - drowsy - difficulty speaking - seizures - vision problems
56
Common and serious side effects of bisphosphonates
Common: - Oesophageal irritation - advise not to take ibuprofen as can worsen - abdo pain, nausea Serious: - osteonecrosis of the jaw
57
5 A’s of smoking cessation
Ask about smoking history Assess their understanding of risks of smoking Advise on risk of smoking Assist: - Set a quit date - Tell family and friends - Anticipate challenges - Remove tobacco Arrange follow up appt
58
Pros of HRT
Reduction of vasomotor symptoms e.g. hot flushes Improved mood Improved dryness etc Reduces osteoporosis risk CV protection
59
Disadvantages of HRT
Depends on type, common includes breast tenderness, bloating, headaches RISKS: - VTE (combined and oestrogen only) - Stroke - Breast cancer (with combined- small risk only) - endometrial (oestrogen only is not prescribed in people with a womb)
60
How to counsel bleeding on warfarin
If small amount then ok e.g. long periods, cutting self, nosebleeds <10 mins, bleeding gums SERIOUS if nosebleed >10 mins, any blood in bodily fluid, cut that doesnt stop
61
How to do a pre-op assessment
History/ why getting surgery On the day- ?explain op and fasting period Previous anaesthetics- screen for MH (muscle contractions, high body temp) and sux apnoea (unable to move/ breathe) and anaphylaxis Meds- ask about anticoagulants, antiplatelet, antiHTN, painkillers PMH- resp, cardio, diabetes, kidneys, GI, neuro e.g. stroke, MSK e.g. arthritis FH social Hx- smoking, alcohol, diet, exercise, who will pick them up after, job
62
63
How does DOACs affect INR
Can prolong it due to prolonging PT (i.e takes longer to clot), however these effects are predictable and so we dont need to monitor clotting in DOACs too closely Baseline FBC, U+E, LFT, clotting and should recheck every 6 months
64
Reference ranges for ABG
pH: 7.35 – 7.45 pCO2: 4.6 – 6.4 kPa pO2: 11.0 – 14.4 kPa, Bicarbonate 22-29
65
How to interpret CURB65
0 / 1 -> treat as outpatient 2 -> treat as inpatient (potentially with IV abx) 3 or more -> treat as inpatient, consider ITU admission
66
How to interpret chadsvasc score
0 in males, 1 in females= no tx required, low risk of stroke 1 in males= moderate risk, consider oral anticoagulants treatment 2 or more in either gender= high risk, give oral anticoagulants
67
Driving rules after TIA
Can’t drive for 1 month after TIA Only tell the DVLA if you still have symptoms after a month, if not can go back to driving
68
Common OSCE station presentations that you need to notify urgently to UK Health Security Agency (7)
Hepatitis Encephalitis Meningitis Typhoid Haemolytic Uraemic Syndrome Legionella Measles Whooping cough
69
Is c diff notifiable
No
70
What are the spirometry findings in obstructive and restrictive lung disease
Obstructive: - reduced FEV1/FVC ration (<0.7) - FEV1 <80% of predicted - slightly reduced FVC Restrictive: - normal FEV1/FVC ration (>0.7) - both FEV1 and FVC reduced to <80% of normal
71
5 examples of restrictive lung disease
Pulmonary fibrosis Pulmonary oedema Lung tumour Neuromuscular disease e.g. MND, Guillan-Barre Obesity / pregnancy
72
How does digoxin work
Slows heart rate and increases myocardial contractility It has a narrow therapeutic index Can cause gynaecomastia, hypokalaemia, and interacts with lots of drugs
73
When is safe to discharge asthma patients
FEV1 >75% of best Salbutamol less than 4 hourly Symptoms no longer significant Discharge with asthma discharge plan- inhaler technique, GP follow up, written instructions on when to attend ED, ensure asthma meds
74
Which meds to stop in AKI
NSAIDS (apart from low dose aspirin 75mg) ACE inhibitors Angiotensin II receptor blockers Diuretics (unless overloaded in which case can give furosemide etc) Aminoglycosides e.g. gentamicin Consider stopping the following as they can increase the risk of toxicity: - metformin - lithium - digoxin
75
Which 3 medications can put you at risk of renal toxicity but dont worsen AKI
Metformin Lithium Digoxin So consider stopping
76
Venturi masks, required flow rate and FiO2 given
Blue= 2-4L/min, 24% White= 4-6L/min, 28% Yellow= 8-10L/min, 35% Red= 10-12L/min, 40% Green= 12-15L/min, 60%
77
UC management
Mild- moderate= mesalazine (an aminosalicylate) to maintain and induce remission, severe give IV hydrocortisone
78
Chrons management
Steroids to induce remission (oral pred or IV hydrocortisone) Maintain remission with azathioprine or mercaptopurine
79
How to interpret ABCD2 score in TIA management
If above 4 then do not discharge to TIA clinic, keep them in hospital as 1 in 9 chance of major stroke in 6 days
80
81
Management of GORD
LIFESTYLE: - lose weight - avoid trigger foods e.g. choc, spicy food, coffee - smaller meals - stop smoking - reduce alcohol - sleep with bed raised slightly (not more pillows) PRESCRIBE: - PPI
82
Which anti-epileptic should pregnant women be taking
Lamotrigine or levetiracetam
83
What causes a bitemporal hemianopia
Lesion to the optic chaism (where the nerves cross) Next to pituitary So caused by pituitary adenoma
84
What causes homonymous hemianopia
Contralateral optic tract lesion (before they cross) Caused by stroke/ neoplasm
85
What causes mono-ocular blindness
3 categories Ocular medial - corneal ulcer - ocular trauma Retinal - retinal detachment - CRAO, CRVO Neurological - ipsilateral optic nerve lesions e.g. optic neuritis
86
STEMI on V1-V2 what type and artery
Septal MI Proximal LAD
87
STEMI on V3-V4 which type and artery
True anterior LAD
88
STEMI on V5-V6 which type and artery
(Antero)Lateral Could be distal LAD, Left Circumflex or RCA
89
STEMI V5, V6, I, AvL which type and artery
Lateral Left circumflex is most likely
90
STEMI II, III, AvF which type and artery
Inferior STEMI 80% chance of RCA, LCx in 18%
91
What are the reciprocal leads for each type of stemi
Anterior (V1-V4)= inferior leads (II, III, AvF) Lateral (V5-6, I, AvL)= inferior leads (II, III, AvF) Inferior (II, III, AvF)= lateral leads (I, AvL) Posterior (V7,8,9)= anterior (V1-V4)
92
93
What is section 136
Police can detain person to a place of safety for up to 24 hours for assessment by medical practitioner From public place 135 is from house to place of safety
94
What is section 135
Allows police officers to enter a private property to take them to a place of safety if they: - have been neglected - unable to care for themselves Up to 24 hours
95
What section do you use if inpatient in hospital and thinks should be sectioned
5(2) if doctor- holds for 72 hours against their will for assessment 5(4) if nurse- holds for 6 hours against their will for assessment
96
How long do section 2 and 3 last for
2= 28 days 3= 6 months
97
Who needs to be involved in a section 2/3
AMHP AND Two doctors (one must be section 12 approved) q
98
AAA screening management
<3cm-> normal 3-4.5-> rescan yearly 4.5-5.5-> rescan 3 monthly >5,5-> refer 2nd to vascular surgery
99
4 ways to diagnose H Pylori
Urea breath test Stool test Blood test for antibodies vs H.pylori OGD biopsy (most accurate) Stop taking PPIs for 4 weeks before this
100
101
Antibodies for SLE
ANA is most sensitive Anti-dsDNA is most specific
102
Antibodies for systemic sclerosis
Limited (CREST)= Anti-centromere Diffuse= anti-Scl70
103
SJogren’s syndrome antibodies §
Anti-Ro and anti-La
104
Polymyositis/ dermatomyositis antibodies
Anti-Jo1
105
Glaucoma on fundoscopy
Increased cup:disk ratio !!! Cataracts would cause absent red light reflex
106
What causes AV nipping
Most commonly is HYPERTENSVIE RETINOPATHY
107
Most common cause of drusen
DIABETES
108
What commonly causes dot and blot haemorrhage
Retinal haemorrhage due to diabetic retinopathy Also get drusen
109

5th Year OSCE (13 decks)

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