Explaining (OSCE prep) Flashcards
What is angina?
Angina is a pain in your chest that is caused by reduced blood flow to the heart because the plumbing system which supplies your heart is narrowed from build up of fatty patches..
Angina isn’t usually life-threatening, but it is a warning sign that you could be at risk of a heart attack or a stroke (check patient knows what these are)
Describe to a patient the lifestyle and medical treatments given for stable angina.
Lifestyle: important to stop smoking if you do - increases risk of heart disease. Cutting down on alcohol. Losing weight (if overweight). Improve diet (less fatty foods and more fruit, vegetables and fish)
GTN spray is given and is to be used at the time of pain, it widens the pipes to your heart so blood can get there easier. You take 1-2 sprays under your tongue when you start to feel the pain. Make sure you take it sitting down as it can cause you to feel a bit dizzy. It can also give you a bit of a headache but that should be relieved by paracetamol. If the pain is still there 5 mins after taking the spray, use another 1-2 sprays. If the pain is still there after another 5 mins - phone 999.
Also given a statin to lower blood fats level and ACEi to lower blood pressure. These will help lower your chances of a heart attack or stroke.
Describe to a patient what caused their acute coronary syndrome
The underlying problem is a sudden reduction in blood flow to part of the heart muscle.
It is usually caused by a clot forming and blocking one of the pipes which supplies your heart muscle - causing the severe pain you experienced.
Drugs after ACS are aspirin, clopidogrel, b-blocker, ACEi, statin
Describe heart failure to a patient who has been newly diagnosed and any relevant treatment.
Means the heart is unable to pump blood around the body properly. It usually happens because your heart has become too weak or stiff. It doesn’t mean your heart has stopped working, it just needs some support to help it work better
It is a long term condition that tends to get gradually worse overtime, it can’t usually be cured, but the symptoms can often be controlled for many years
Lifestyle factors which can help improve your symptoms and slow down the disease are things such as improving diet, stopping smoking and ensuring you get regular up to date vaccines. Exercise also can be beneficial - we have a cardiac rehabilitation programme which many patients find beneficial. ACEi is a drug given to relax and open the pipes that blood flows through. B-blockers slow your heart down. Diuretics are water tablets that will help with the swelling and breathlessness you are experiencing
Describe asthma to a patient who has been newly diagnosed.
It is a common condition where your airways are narrowed because of inflammation. This makes it harder to breathe and causes the symptoms you have been experiencing. The exact cause of asthma is unknown but you have swollen airways which can become narrow and clogged with a sticky mucus if you come into contact with certain triggers - things such as cold air, smoking, infections, pollen, dust mites and exercise. But there is treatment available to help prevent this.
A reliever inhaler is the most common medication given initially for asthma. You should take it if you ever experience any symptoms or you can take it if you known you are about to do some exercise. If you take this inhaler more than 3 times in a week contact the nurse so she can change your medication.
It is important with asthma to stay up to date with vaccinations to prevent any nasty infections which could worsen your asthma.
You will also receive a personal asthma action plan which will be written up by you and the specialist asthma nurse who you will keep in regular contact with.
I know this is alot of information but we shall schedule an appointment for you with the asthma specialist nurse so you can ask any more questions and she will go over this information with you again.
Explain COPD to a patient who has been newly diagnosed with the condition.
It is a long-term condition of the lungs where the flow of air to the lungs is restricted due to damage of the air sacs in the lungs and from your airways being swollen and inflamed.
The condition is most often caused by smoking and the most important treatment is to stop smoking. You are also more inclined to develop chest infections so it is important to stay up-to-date with vaccinations.
Inhalers can be used to help improve your symptoms, and different types can be given depending on how bad your symptoms are.
Explain to a patient their recent colonoscopy findings showing diverticular disease.
The tests show that there is no sign of cancer.
There are some weaknesses in the wall of the large bowel that have caused little outpouchings, or pockets to form. These pockets can trap stool and cause pain. They are called diverticulae, so the problem is called diverticular disease.
Treatment options include a high fibre diet to keep the bulk moving through the colon. Bulk forming laxatives (eg movicol) can help with this too. Painkillers can be used for any mild pain. Surgery may be used as a last resort but only if they repeatedly cause bad pain, or if they cause complications.
Complications of diverticulae can cause severe pain, fever, or vomiting. They should see a doctor straight away if they are likely to need hospital admission for a drip and antibiotics put straight into your blood.
- if pt asks about surgery and colostomy explain that a small no of people who have surgery for diverticular disease do need a colostomy bag but by no means everyone. Sometimes it is possible to join the ends of the cut bowel together.
Explain a diagnosis of gallstones
The liver makes a substance called bile which helps to break down fatty food. This bile is stored in a bag in your body called the gallbladder and released into you gut when you eat fatty food. Sometimes stones can form in your gallbladder. Sometimes they cause no problems and can be left alone but they can cause pain if they block the opening. They can irritate the gall bladder and cause infection. Avoiding fatty foods may help with the pain as it stops the gallbladder releasing any bile. Because of the risk of infection, doctors usually recommend surgery to avoid future complications.
- removal is usually done by keyhole surgery, which means patients don’t need to be in hospital for more than a day or two
Describe endoscopy procedure so that you can gain consent from a patient.
The camera is in a flexible thin tube - about the size of your little finger.
The back of your throat will be sprayed with local anaesthetic to numb it a little, so that swallowing the camera doesn’t hurt - it will feel like swallowing something that you haven’t chewed properly
The procedure will only take about 20 mins and you can usually watch what is being seen on a video screen.
The endoscopist may take some tissue biopsies and you shall have another appointment to discuss these results.
You must be awake to swallow the tube but you can have some sedative to make you sleepy if you wish. If you have a sedative you may have to stay in hospital for a few hours and will need someone to take you home. Also you should not drive, operate heavy machinery for 24hrs
Minor common complications = the procedure is pretty safe, you may have a slight sore throat afterwards.
Other side effects are rare but you must see a doctor if you get abdominal pain, a temperature or breathing problems afterwards
Explain a diagnosis of hyperthyroidism
Hyperthyroidism means an overactive thyroid - which is a gland in your neck. When your thyroid gland is overactive it makes too much of a chemical called thyroxine. The extra thyroxine causes many of your body’s functions to speed up.
In Graves’ this happens because the body is attacking itself, specifically the thyroid gland, making it overactive.
There are many different treatment options;
- tablet called carbimazole. It slows the thyroid down and is taken for 12-18months, during which time you will need regular blood tests. If pregnant take PTU. Mention risk of agranulocytosis.
- Radioiodine is given as a drink in hospital, the effect of radiation only acts on the thyroid
- Surgery can be performed to remove the thyroid, but this means you shall need to take a thyroxine replacement for the rest of your life
What do you reply to a patient who mentions that warfarin is rat poison?
Yes warfarin like drugs are used as rat poison. Rats are given a very high dose of warfarin so that they bleed internally. This is one of the main reasons we ensure you take the right dose at the same time every day, and attend regularly for blood tests.
Too much can cause bleeding, and too little can increase the chances of a clot forming
Explain a diagnosis of B12 deficient anaemia.
You have lower than normal amounts of b12 which has caused you to develop anaemia. Anaemia is a condition where you have fewer RBC than you normally should.
B12 is found in meat, eggs and dairy products, but some people - like yourself - cannot absorb it properly
CHUNK + CHECK
It is treated with injections of b12, they are initially given twice weekly for 4 weeks to build up supplies. After that injections are given every three months for life
Bloods shall be checked in a few weeks to check that your body is responding to the b12
Describe a beta blocker to a patient who has just been commenced on the drug.
It slows down the speed of the heart and can help lower your blood pressure.
Side effects = tiredness, cold extremities, headache and nausea.
Warn patients with heart failure about risk of initial deterioration in their symptoms.
Describe ACE inhibitors to a patient who has just been commenced on the drug.
It lowers blood pressure by relaxing the walls of your pipes and allowing the blood to flow at a lower pressure Side effects include dizzyness - so it is important to take your first dose at night incase this occurs. Also common to have a persistent dry cough, if this occurs contact your GP and they can switch you to another class of drug which does not cause the cough. You will also need to be monitored with blood tests as this drug can affect your kidneys
Describe steroids to a patient who has just been commenced on the drug.
They reduce inflammation and reduces your body’s natural defence against illness and infection.
Side effects - increased risk of infections. Can also affect your mood and your sleep. It can cause weight gain, weakening of your bones and can cause you to have a higher chance of developing diabetes.
It is important not to stop taking them suddenly. Best to take steroids in the morning. If ever you start to feel unwell contact your doctor as the dose needs to be increased. it is also important to carry a steroid card at all times
