General clinical skills Flashcards
Steps when reporting any clinical test?
- W’s
- Who is the pt
- What is the test
- When was it done
- Where was it done
- Why was it done - Adequacy
- Is the test adequate - Point out the obvious abnormalities
- Systematically review the test
- Summary.
Aspects of a clinical summary?
- Intro:
- Patient details
- who are you writing to
- Your name and who you work for
- When it was written
- Urgency
- Why writing
- The clinical stuff:
- Hook e.g. what is the problem
- The patients story - Plan and info:
- My plan and actions
- Your plan and actions recommendations
- Other info
- Sign
BOXES mnemonic for investigations?
BOXES
B - Bloods & cannula, VBG, ABG, standard bloods, blood culture, amylase.
O - Orifice tests, e.g. urine dip, swab, sputum culture
X - Xray - AXR, CXR
E - ECG
S - special tests, e.g. FAST scan, CT, USS, LP
DANISH mnemonic for cerebellar signs?
Dysdiadokinesis (can’t do rapid altering movement)
Ataxia
Nystagmus
Intention tremor
Scanning dysarthria (words spoken as explosive syllables)
Hell shin test failure
On an ECG If leads 1 and 3 are positive what does this show?
Normal axis
On an ECG if leads 1 and 3 are facing away from each other what does this mean?
Leaving = L for Left
Left axis deviation
On an ECG if leads 1 and 3 are facing towards each other what does this mean?
Returning = R for Right
Right axis deviation
Urine dip interpretation?
pH High (alkalotic):
- Systemic alkalosis
- UTI
- Some drugs e.g. Carbonic anhydrase inhibitor, sodium bicarb
pH Low (acidic):
- Systemic acidosis
- PKU, Starvation, Diarrhoea, Diabetes
Protein high:
- Renal pathology, glomerularnephritis, nephrotic syndrome, pyelonephritis
- Drugs e.g. NSAIDS, Sulphonamides, Penicillins
- (false if excessively conc. urine or excessively dilute urine
Leukocytes
- pyuria - UTI
Nitrites
- UTI (Gram -ve bacteria produce them e.g. E.coli)
Blood
- Trauma, infection, inflammation (chronic infection)
- Ca.
- Clotting disorders
Ketones
- DKA
- Starvation
- Alcoholism
Glucose
- DM
- Some drugs
Bilirubin
- Jaundice
VITAMIN C surgical sieve?
Vascular Infection/inflammation Trauma Autoimmune Metabolic Idiopathic/iatrogenic Neoplastic
Congenital
In which leads on the ECG can the P wave be inverted?
aVR (and can be in V1)
On an ECG how long is a normal PR interval?
3-5 small squares
On an ECG how long can a QRS complex be?
3-5 small squares
Causes of bradycardia on an ECG?
Sinus bradycardia Sinoatrial node dysfunction Atrioventricular block (heart block) Junctional and ventricular escape rhythms Asystole
Indications for pacemaker in persistent bradycardia?
Complete heart block
Mobitz Type 2
Symptomatic Mobitz type 1
Most common cause of first degree heart block?
The most common cause is age related degeneration of the conduction fibres of the heart.
