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Year 3 OSCE > General Assessment > Flashcards

General Assessment Flashcards

1
Q

What do you say at the beginning of the general assessment?

A

I have washed my hands and donned the correct PPE.

“Hi, my name is Kayleigh from the ambulance service, what’s your name?”

Today, we are going to do a general examination, which involves me asking you some questions and generally looking at your overall health status.”

“This will lead me into doing a specific systems examination which might involve me looking at your chest or abdomen.”

“Does this sound ok with you?”

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2
Q

After introducing yourself and gaining consent, what do you do next in the general assessment?

A
  1. Observe the patient for any pain / discomfort / agitation / distress / guarding / anxiety / tripoding
  2. Alert? Conversing?
  3. Ask the patient to report any pain / pain score
  4. Record vital signs:
    - HR between 60-100bpm resting
    - RR between 12-20
    - SpO2 between 94-98%
    - Temp between 36.1 - 37.8
    - ECG to show NSR
    - BP preferably 120/80
    - HGT between 4-8mmol/L
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3
Q

What are you looking for in general appearance of a patient (general assessment)?

A
  1. Colour
  2. Dressed
  3. Weight
  4. Odours
  5. Posture
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4
Q

What could a pale or flushed complexion indicate?

A

Pale - shock, anaemia
Flushed - alcohol dependency
Yellow - jaundice - liver failure

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5
Q

What could being overdressed or underdressed indicate?

A

Overdressed - Hiding an ED, track marks, bruising, scarring, confusion
Underdressed - Confusion

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6
Q

What could being underweight or overweight indicate?

A

Underweight - malnourished, an eating disorder
Overweight - more risk for heart disease or diabetes

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7
Q

What are you looking for in terms of odours?

A
  1. Foul odours could indicate self neglect or confusion
  2. Ammonia or urine smells could indicate a UTI
  3. Alcohol and cigarette odours could tell you if someone has not been truthful in their history, and more risky for illnesses
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8
Q

How do you assess posture and what are you looking for?

A

Ask the patient to stand up and walk a short distance to assess their gait.

Any kyphosis or scoliosis?
Any Parkinson’s shuffle?
Any left or right sided weakness - CVA/TIA?

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9
Q

What is kyphosis and scoliosis?

A

Curves of the spine - kyphosis is leaning forward and scoliosis is leaning sideways

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10
Q

What are you looking for in the hand assessment?

A
  1. Condition - hydration (skin turgor test) / warm / cold
  2. Size - large hands (marfan’s syndrome)
  3. Palms - Reddening of the palms (Palmar erythema)
  4. Contractures - Dupuytren’s contracture
  5. Muscle wastage - Carpal tunnel syndrome
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11
Q

What is Marfan’s Syndrome?

A

A connective tissue disorder

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12
Q

What is Palmar Erythema?

A

A skin condition causing the reddening of the palms. Usually normal in pregnancy, however this could indicate liver disease

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13
Q

What is Dupuytren’s contracture?

A

When one or more fingers bend in towards the palm, can be caused by smoking, alcoholism, or diabetes.

Nodules form in the hand, causing the fingers to bend inwwards.

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14
Q

What are you assessing in the fingers and nails assessment?

A
  1. Finger staining (nicotine)
  2. Nails and nail beds
  3. Cyanosis
  4. Clubbing
  5. Deformities of fingers (arthritis)
  6. Heberden’s node (end) and Bouchard’s node (mid)
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15
Q

What are you looking for in the nails and nail beds?

A
  1. Splinter haemorrhage - blood spots under nail - occurs when capillaries along the nail bed are damaged due to trauma or due to bacterial endocarditis
  2. Spoon nails - iron deficiency anaemia
  3. Terry’s nails - white nails - liver failure or diabetes
  4. Clubbing
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16
Q

What does cyanosis mean?

A

Poor blood circulation

17
Q

What does clubbing of the fingernails mean?

A

CO2 retention, usually found in COPD patients

18
Q

What are heberden’s node and bouchard’s node?

A

Small swollen bumps on the joints of the fingers.
Bouchard’s - proximal interphalangeal joint
Heberden’s - distal interphalangeal joint
Indicative of osteoarthritis
Check on both hands

19
Q

What are you assessing in the forearm and wrists?

A
  1. Forearm nodes
  2. Tendonitis
  3. Xanthomas (lesions)
  4. Asterixis
  5. Tremors
  6. Skin condition
20
Q

What are the arm nodes called?

A

Cubital nodes

21
Q

How would you know if there was tendonitis (arm)?

A

Inflammation and pain around the elbow, wrist and hand

22
Q

What is asterixis and how do you test for it?

A

The flapping tremor

Ask patients to hold out hands as if stopping a bus, hands would be flapping back and forth

23
Q

How would you test for tremors and what does this indicate?

A

Ask patient to hold arms out straight, palms down, and look for a tremor

Indicative of Parkinson’s Disease

24
Q

What can asterixis indicate?

A

Impaired liver function, CO2 retention, electrolyte imbalance

25
Q

What are you looking at when looking at skin condition?

A
  1. Condition - sun damage / rashes / urticaria / bruising / mottling
  2. Sweat
  3. Dehydration
  4. Eczema/Psoriasis
  5. Skin lesions
  6. Hair distribution
26
Q

What do you look at during the mouth assessment?

A
  1. Lips - hydrated? cyanosed?
  2. Tongue - size? colour? hydration? thrush? smoothness?
  3. Teeth - decay? erosion? infection?
  4. Gums - condition? infection? ulcers?
  5. Buccal mucosa - hydration? ulcers?
  6. Tonsils - swollen? infected? intact?
  7. Odours - smoke? alcohol? pear drop? faecal?
27
Q

What are you looking for in the eyes and eye lid assesssment?

A
  1. Scelera - white? bloodshot? yellow (jaundice)?
  2. Conjunctiva - white? - anaemia
  3. Eye twitching / nystagmus / squinting
  4. Corneal arcus - hyperlipidaemia
  5. Xathalasma - hypercholesterolemia
  6. Eye lids - in turning? out-turning?
28
Q

What are splinter hemorrhages indicative of?

A

Splinter haemorrhages are small clots that break off and block/ settle in narrow vessels – seen in the nails, they are caused by bacterial endocarditis.

29
Q

What can cold hands or warm hands indicate?

A
  1. Cold hands - low cardiac output, Raynaud’s disease, poor peripheral circulation
  2. Warm hands - High cardiac output
30
Q

What can in-turning or out-turning eyelids indicate?

A
  1. In-turning = Entropion - ageing/muscle wastage
  2. Out-turning = Ectropion - ageing/muscle wastage
31
Q

Tachycardia could indicate…..

A

Pain, infection, AF, anxiety

32
Q

Bradycardia could indicate…..

A

Heart block, medication, athlete

33
Q

Bradypnoea (low RR) could indicate…..

A

Opioid usage, COPD, pneumonia

34
Q

Tachypnoea (high RR) could indicate…..

A

Anxiety attack, sepsis, DKA, asthma

35
Q

Systolic BP >140 could indicate…..

A

Atherosclerosis, obesity

36
Q

Low blood pressure could indicate……

A

Fluid loss (sepsis), dehydration

37
Q

Sats below 94% could indicate?

A

Hypoxemia - caused by COPD, asthma

38
Q

High temp could indicate?

A

Infection

39
Q

Low temp could indicate?

A

Hypothermia, cold environment

Year 3 OSCE (5 decks)

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