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OSCE > F+C (Part 2) > Flashcards

F+C (Part 2) Flashcards

1
Q

Name 5 differentials for a rash in children?

A

Meningitis (meningococcal septicaemia)
HSP (purpura on buttocks/ extensor limbs)
Measles (starts from head and moves down)
Chicken pox (macule>papule>vesicle>crust)
Herpes simplex (infection around mouth/skin/eyes)
Scarlet fever (preceeding throat infection, sandpaper like rash with strawberry tongue)
Kawasaki disease (conjunctival infection, strawberry tongue, lympadenopathy)

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2
Q

Name 5 symptoms of meningitis in a child?

A 
Fever
Prodromal illness (flu like)
Irritable and crying
Poor feeding
Rash 
Neck stiffness
Photophobia
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3
Q

When a baby is premature, how should you correct for this on a growth chart?

A

Correct for prematurity (before 36+6) up to 2 years

Correct by drawing an arrow backwards to corrected age. E.g. a child with born at 34 weeks who is now 6 months old would have their ‘dot’ on the growth chart at 6 months, but an arrow pointing back 6 weeks to 4.5mnths

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4
Q

What bacterial pathogen causes acute tonsilitis?

A

Group A strep

Viral is most commonly EBV/ herpes simplex/ cytomegalovirus

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5
Q

Name 5 differentials for a child for fever?

A 
Meningitis
Tonsilitis (later scarlet fever)
URTI/ bronchiolitis/ pneumonia 
UTI
Otitis Media 
Leukaemia 
Chicken pox
Kawasaki disease
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6
Q

What organism causes bronchiolitis?

A

Respiratory synctial virus (RSV)

Gets worse at D5 then starts to improve

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7
Q

What organism most commmonly causes croup?

A

Parainfluenza virus

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8
Q

How would you distinguish between croup and whooping cough in a history?

A

Croup = seal like cough, worse on expiration and with agitation
Whooping cough = whoop heard on inspiration, worse at night and expiration

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9
Q

What organism causes whooping cough, what is the management of whooping cough? (4)

A

Bordella pertussis (normally vaccinated against so now rarer)
Mx: Azithromycin (or other macrolide) if in first 21 days
- Send off nasal swab for proper diagnosis
- Keep off school for 2 days
- Notify public health england

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10
Q

What is the best full general history taking acronym to follow?

A

I PISS HI
I- Intro and open question
P- PC/ HPC (using SOCRATES)
I- ICE
S- Specific symptoms/ differentials/ red flags
S- Sub-history (PIDS for paeds, WIMPP for obgyn, MOSC for gynae)
H- History completion (PMHx, DHx, FHx, SHx)
I - ICE again and summarise

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11
Q

How should HSP be described to a patient?

A

Henoch Schonlein Purpura
A type of vasculitis (inflammation of the blood vessels), not normally serious infection, it doesn’t need any treatment, and most of the time doesn’t cause any problems, however we like to monitor you as in very small number of people it can cause some problems with the kidneys - so we keep an eye on things and if this is the case we can do something about it

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12
Q

How does HSP usually present?

A

Rash (raised red/ purple) - purpuric - doesn’t fade with glass test
On buttocks and extensor limbs

Can also have abdo pain, arthritis and renal failure if more established

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13
Q

How is HSP managed?

A

Supportive (hydration and paracetamol - no ibuprofen)
Self- resolves in around 3 weeks
Do FBC to rule out leukaemia and ITP
Monitor BP/ kidney function at D7/D14/1/3/6/12 mths
Can give steroids if renal disease develops (1%)

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14
Q

What are your differentials for a suspected HSP? (3)

A

ITP
Leukaemia
Meningococcal septicaemia

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15
Q

How would you describe testicular torsion to a patient? What age group does it most commonly affect?

A

Where the testicle twists back on itself and cuts off the blood supply
Young boys are most affected (7-12yrs)

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16
Q

How does testicular torsion usually present? How can it be distinguished from epididymitis?

A

Sudden onset pain in testicle or abdomen
May have previous transient episodes where testicle has corrected itself. Absent cremasteric reflex (100% sensitive)

When lifted pain is worse (in epididymitis when lifted the pain becomes better).

NB: Improving pain is not always a good sign as pain also decreases as the testis necroses and dies

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17
Q

How is testicular torsion treated? Name some counselling points (3)

A 
Emergency operation (done within 6-8hrs)
Small operation (GA, need to go NBM)
- Risks of testicle dying and needing removal
- This doesn't usually affect fertility 
- Can insert fake testicle if needed
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18
Q

What general advice around returning to activites following a surgical procedure with a wound is normally given?

A

No swimming etc until stitches out or 7-10days
Don’t bath/ shower for a few days
Avoid contact sports for 4 weeks

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19
Q

Name 3 risk factors for developing cerebral palsy

A 
Prem birth 
Congenital infections
Injury before birth 
Hypoxic event during labour 
Multiple births
Congenital malformations
Chorioamnionitis
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20
Q

What are your top differentials for a 20 year old female presenting with acute lower abdo pain on the R hand side?

A

Ectopic pregnancy
Ruptured cyst
Appendicitis
Ovarian torsion

PID (less acute)
Endometriosis
IBS/ IBD
Kidney pathology (urinary symptoms)

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21
Q

Name some key components of a post-natal depression history?

A

Intro
Gather information on symptoms (SAG CLASS)
Previous Hx of depression
Ask about bonding with baby, risk assess for any harm to baby
Ask about support at home, other children, partners etc. - do they have help?
Summarise and emphasise support

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22
Q

A woman presents with vaginal discharge, what investigations do you do?

A

Cultures- Charcoal high vaginal swab from posterior fornix (Gonorrhoea, TV, BV, candida)

NAAT- Endocervical swab from os - chlamydia and gonorrhoea

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23
Q

Name 3 risk factors for developing PID?

A 
New partner
Multiple partners
No condom use
IUD insertion 
Pregnancy termination
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24
Q

How is diagnosis of PID made?

A

Clinically (not from swab)

Lower abdo pain, with deep dysparenunia, vaginal bleed, discharge, fever - may see cervical excitation on examination

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25
Q

Name 5 differentials for PID?

A 
Endometriosis
STI (uncomplicated)
Ectopic pregnancy - often more acute
Appendicitis - often more acute 
FIbroids 
Cervical cancer
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26
Q

Name 3 investigations for suspected PID?

A

Pregnancy test - exclude ectopic!

Cervical swabs for chlamydia and gonorrhoea (+ve results supports diagnosis but -ve does not exclude)

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27
Q

How should PID be treated?

A

Ceftriazone IM single dose followed by oral doxycycline and metronidazole for 14 days

Avoid UPSI
Contact all partners in last 6 months

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28
Q

What general advice should be given regarding other partners when diagnosed with STI?

A

All other partners in last 6 months should be contacted and offered screening

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29
Q

Name 3 complications of PID?

A

Infertility (increase with number of episodes and severity)
Ectopic pregnancy
Chronic pelvic pain
Tubo-ovarian abscess

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30
Q

How do you distinguish between Crohns and UC?

A

UC is starts in rectum and moves up, crohns anywhere
UC more likely to be bloody
UC pain LLQ, Crohns RLQ
Weight loss more likely with Crohns

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31
Q

Name 5 differentials for a presentation of diarrhoea?

A 
Crohns/ UC
Gastroenteritis (travel?)
IBS
Diverticular disease
Colorectal cancer
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32
Q

Name 5 investigations you would do if suspecting IBS?

A 
FBC, CRP, U+E, LFT
B12/folate/iron 
Stool culture 
Faecal calprotectin (between IBS and IBD)
Endoscopy and biopsy
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33
Q

What is first line drug tx for both Crohns and UC?

A

Mesalazine

UC also need to induce remission with steroids

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34
Q

Name 5 key symptoms to ask about with a bowel change history?

A 
Abdominal pain
Bloating
Altered bowel habit
Blood or mucus in stools
Straining or pain going 
Urgency 
Incomplete evacuation 
Link to symptoms with eating
Nausea and vomiting 
Fever, weight loss
Recent travel
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35
Q

What are the diagnostic criteria for IBS?

A

6 months hx of abdominal pain with altered bowel habit or relived by defecation

+2 of (Bloating, straining, mucus in stool, aggravation by eating)

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36
Q

What are the three features which make up angina?

A

Cardiac chest pain
Precipitated by exertion or emotion
Relived by rest/ GTN in 5 mins

Typical angina = all 3
Atypical = 2
Non-anginal = <2

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37
Q

What investigations should you perform in suspected angina?

A

ECG
Troponins - rule out MI
FBC - exclude anaemia
Fasting glucose/ cholesterol

38
Q

How do you manage angina (4)?

A

CVS risk advice + statin
Start aspirin if no CI
1) GTN spray for when symptoms occur
2) Beta blocker or CCB are first line preventives

39
Q

What are the three most common types of prolapse?

A

1- Cystourethrocele (prolapse of bladder and urethra)

2- Uterine prolapse (uterus into vagina)

3- Rectocele (rectum into vagina)

40
Q

Name 5 presenting symptoms of a prolapse?

A 
Sensation of pressure, fullness, heaviness 
Seeing a bulge
Difficulty retaining tampons 
Spotting 
Incontinence/ frequency/ urgency 
Dysparenunia 
Bowel symptoms
41
Q

What would you do to examine a vaginal prolapse? (2)

A

Examine standing and L lateral positions

Use speculate and ask patient to strain

42
Q

What are your first 3 management steps for treating a prolapse?

A

1) Conservative (weight loss, pelvic floor exercises, treat constipation)
2) Ring pessary (changed every 6-12 months- can be used if sexually active, effective in 60%)
3) Surgery

43
Q

Name 3 complications of a prolapse?

A

Infection or ulceration
Incontinence or retention
Recurrent UTI’s
Bowel dysfunction if rectocele

44
Q

What can you do to prevent a prolapse? (3)

A

Pelvic floor exercises (8x TDS for a few months)
Weight loss
Smoking cessation (reduce cough)

45
Q

Name 3 RF’s for a vaginal prolapse?

A 
Age
Vaginal delivery 
Increasing parity 
Obesity 
Previous hysterectomy
46
Q

Name 5 possible presenting symptoms of HIV?

A 
Raised temperature
Sore throat 
Body rash 
Joint pain
Fatigue
Muscle pain
Swollen LN's

(Short flu like illness for 2-6 weeks post infection then no symptoms for years)

47
Q

A healthcare worker has recently had a needlestick from a patient with HIV - what treatment should be offered?

A

Post exposure prophylaxis (PEP) - ideally start within 24 hrs

48
Q

When should HIV tests be repeated?

A

If done within 3 months of potential exposure ensure is repeated (negative)

49
Q

Name 3 things to counsel a patient to prevent HIV?

A 
Use a condom
Use PrEP (pre-exposure prophylaxis)
Don't share needles, spoons or swabs
50
Q

Name 7 counselling points for a caesarean section

A

1 in 5 births in UK
Done under spinal/ epidural anaesthetic so awake
Screen between you and whats going on
Small scar left below bikini line
Normally takes just under an hour
Need 3 days in hospital to recover, avoid driving etc for 6 weeks
Counsel on risks

Can still have vaginal delivery for next child

51
Q

Name 3 indications for caesarean

A 
Breech position 
Placenta praevia (low lying placenta)
Pre-eclampsia 
Non-progression labour 
Concerning CTG
52
Q

Name 3 risks of a caesarean section

A 
Infection of wound 
Blood clots
Excessive bleeding 
Damage to nearby areas such as bladder or ureter
Breathing difficulties in baby
Can give baby small cut
53
Q

Name 5 counselling points for group

A

Viral (parainfluenza virus)
Symptoms = barking cough, worse at night, hoarse voice, rasping sound breathing in - preceeded by coryza
Croup normally resolves by itself within 48 hours - sit upright, give fluids etc
DON’T give steam or cough/ cold medicines
Call NHS 111 if worried, child getting worse etc
Call 999 if struggling to breath, they look grey or blue or go quiet and still

54
Q

Name 5 counselling points for bronchiolitis

A

Most cases mild and settle without treatment within 2-3 weeks (2% need hospital)
Early symptoms are similar to common cold (runny nose and cough)
Later syx - fever, dry cough, difficulty feeding, wheezing
See GP if - worried, struggling to breath, feeds less than half, dry nappy >12hrs, irritable
Safetynet - dial 999 if (severe difficulty breathing, grey or blue)

1 in 3 children develop bronchiolitis at some point - caused by RSV

Tx: Paracetamol and fluids

55
Q

What are the 4 components of a developmental exam?

A

Gross motor - ask to run, balance one leg etc
Fine motor - use pen, make with bricks, swap hands
Language and hearing - Ask to do colours
Social

Height/ weight and head circumference into red book

56
Q

Name 4 dietary and vitamin points pregnant women should be counselled on?

A

Folic acid 400mcg from pre-conception > 12 wks
Avoid vitamin A suppliments/ liver (tetratogenic)
Listeriosis: avoid unpasteurised milk, ripened soft cheeses (Camembert, Brie, blue-veined cheeses), pate or undercooked meat
Salmonella: avoid raw or partially cooked eggs and meat, especially poultry

57
Q

What treatment should be offered to a woman at 20weeks who has previously had group B strep infection before delivery of a previous child?

A

Intrapartum antibiotics

58
Q

What are the 4 risk factors for GBS infection?

A

Prematurity
Prolonged rupture of the membranes
Previous sibling GBS infection
Maternal pyrexia e.g. secondary to chorioamnionitis

59
Q

Name three indications for intrapartum antibiotics?

A

GBS infection
Previous baby with GBS infection
Preterm labour
Pyrexia during labour

(Benzylpenicillin)

60
Q

Name three counselling points for GBS screening?

A

Not routinely offered, can’t be requested

If swabs done do 3-5 weeks before delivery

61
Q

Name 5 differentials for bleeding in pregnancy?

A

Placenta praevia < not normal in early scans
Placental abruption < painful
Vasa previa
Bloody show < mucus in bleed
Non-obstetric (trauma, cervicitis, polyps)

62
Q

What are your top 5 differentials for diarrhoea?

A

Cancer < weight loss, age, pr bleed
Gastroenteritis < recent travel, fever, unwell
Lactose intolerance/ coeliac < Diet/ FHx
IBS < 6 months
IBD < Young, blood and mucus, weight loss
Hyperthyroid < Mood, periods, tremor, heat intolerance, sweating, swelling in neck

63
Q

Name 5 differentials for epigastric pain?

A 
GORD
Peptic ulcer 
Pancreatitis
MI 
Gallstones 
IBS
Hepatitis 
AAA needs ruling out! (pain in back)
64
Q

Name 5 general symptoms to ask about with any ?miscarriage?

A 
Blood (amount, spotting/ needing pads, colour, clots)
Abdo pain 
Discharge 
Bladder/ bowel changes
Dysuria 
How do you feel in yourself!
65
Q

What are the two types of cows milk protein allergy?

A

IgE mediated- immediate hypersensitivity (hives etc.)

Non IgE mediated - most common (slower onset, diarrhoea, vomitting etc)

66
Q

What acronym is used in the management of suspected paeds NAI?

A 
SMACK
S- Safety (admit to ward to observe)
M - Medical management (analgesia etc.)
A- Ask for senior help
- To decide on examination, photography 
- To decide on FBC/ clotting etc 
C- Contact social service 
K - Keep proper documents
67
Q

How do you prescribe oral suspension paracetamol on an FP10 prescription?

A

Paracetamol 120mg/5ml oral suspension
Take 240mg (10ml) every 4-6 hours as required
Maximum 4 doses in 24 hours
Provide 200ml

The above is for a 7 year old - see BNF

68
Q

How do you prescribe amoxicillin oral suspension on an FP10 prescription?

A 
Amoxicillin 250mg/5ml oral suspension 
Take 500mg (10ml) three times per day 
Supply 210ml (7 days)

The above is for a 7 year old - see BNF

69
Q

When taking a miscarriage history name 5 things you ask about?

A

Weeks, complications so far?

Blood (amount/ clots)
Pain
Rule out STI and UTI
Bladder or bowel symptoms

MOSC (minus M)
- Focus on previous pregnancies or miscarriages
PMHx
- Bleeding disorders

70
Q

What requirements must be met do to medical management of miscarriage?

A

Need to be able to return for follow up
No abdominal pain
HcG < 1500 and mass <35mm
No intrauterine pregnancy

71
Q

Name the SOCRATES and other questions done in an antepartum haemorrhage history?

A 
S- Sure its from vagina?
O - Onset, duration, number of episodes, still bleeding?
C- Character (red/ brown, clots, mucus)
R - 
A - N+V, fevers, well in self
T- Ever happened before?
ES
WIMPP
PMHx - Bleeding disorders
72
Q

What acronym should be used for travel histories?

A 
WAFAPP 
W- Where (city/ country)
A- Accommodation 
F- Food and drink
A- Activities (fresh swim, injuries, animals, sex)
P- Purpose of trip
P- Prophylaxis and vaccinations
73
Q

What maintenance fluid is given in paeds? How do you calculate the volume

A

Maintain:
Bag: 0.9% saline, 5% dextrose and 10mmol potassium in 500ml bag

First 10kg: 100ml/kg
Second 10kg: 50ml/kg
After: 20ml/kg

74
Q

How do you replace fluids in a dehydrated child?

A

Assess how dehydrated they are (clinically) and decide how much they’ve lost:
Mild: Replace orally
Moderate (dry mucus membranes, low skin turgor) or severe:
- Fluid bolus IV stat (20ml/kg) - give one if moderate, if severe may need several

75
Q

How do you prescribe morphine in palliative care?

A

Calculate what amount of morphine they were on previously (table in BNF)
- Calculate amount morphine in 24hrs

Convert that into modified release morphine tablets (BD) and then add oromorph PRN at 1/6 of total daily dose every 2-4 hours as required

Add metoclopramide for sickness and lactulose for constipation

76
Q

Do all children with meningitis get an LP?

A

Ideally yes - but don’t let it delay antibiotics!

Give ab’s and steroids, then do LP

77
Q

When is a heel prick test performed and what does it test for?

A

5 days

Sickle cell, congenital thyroid, CF
+ lots of metabolic disease

78
Q

How should women with T1 or T2DM be counselled regarding birth timing?

A 
Deliver all (vag or c-section) a little bit early 
- Make sure seen by diabetic specialist consultant
79
Q

Name 5 differentials of abdominal pain in later pregnancy?

A 
Pre-term labour
Placental abruption
Uterine rupture
Chorioaminionitis (fever, discharge)
Pre-eclampsia or HELLP syndrome

(Non-obstetric)

80
Q

Name 3 RF’s for placenta praevia

A 
Previous PP
Previous caesrean 
Increasing age
Multiparity 
Smoking or drug use
IVF
81
Q

How do you manage placenta praevia?

A

Don’t do vag exam - TVUS only

Follow up scans (@20wks there is 90% chance resolve, @32weeks on 10% chance)
Minor (>2cm from os) can still do vag
Major - need c-section, don’t have intercourse, aim to deliver at 38 weeis

82
Q

Name 3 RF’s for placenta abruption

A 
Previous abruption
Multiple pregnancy 
Pre-eclampsia 
Multiparity 
Previous caesarean 
Smoking
Thrombophillia
83
Q

How do you manage a placental abruption?

A

ABCDE (mothers life takes priority)
Put in L lateral position
Give 2L fluids then blood
Cesarean once mum is stable

84
Q

At what age should a child be able to scrible with a pen?

A

18mths

85
Q

At what age should a child be able to say a single word?

A

9mths

86
Q

At what age should a child be able to obey instructions?

A

2yrs

87
Q

At what age should a child (a) drink using a cup and (b) use a fork and spoon?

A

a) 1 yr

b) 2yrs

88
Q

At what age should a child a) stand and b) walk and c) run/ do stairs

A

a) 9mths
b) 15 months (refer at 18)
c) 2yrs

89
Q

Name 5 differentials for a breast lump?

A 
Fibroadenoma
Breast cyst
Cancer
Papilloma
Fat necrosis
Phyllodes tumour

Paget’s (eczema on nipple)
Inflammatory breast cancer (mammogram may be normal)

90
Q

How does fibroadenosis present?

A

Young woman complaining of lumpy breasts, worse during her period

91
Q

How do you treat cyclical breast pain?

A

Trial topical NSAIDS
- Swap if on COCP
Get well fitting bra, diet and lifestyle

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