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Year 3 OSCE > History Taking / Neuro / Glands > Flashcards

History Taking / Neuro / Glands Flashcards

1
Q

How do you introduce yourself in history taking?

A

Hi, my name is Kayleigh. I’m a student paramedic who is assessing you today.

I will start by taking a history, I will then move on to a general assessment and then I will do either a chest or abdominal exam depending on my findings.

Is this ok with you?

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2
Q

What does SOCRATES stand for?

A
  1. Site
  2. Onset
  3. Character
  4. Radiates
  5. Associated symptoms
  6. Time
  7. Exarbating/relieving
  8. Score
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3
Q

What does AMPLE CRENSON stand for?

A
  1. Allergies
  2. Medication
  3. Past/pertinent history
  4. Last oral intake / last bowel movement / last urinated
  5. Events leading up to
  6. Cardiac hx - MI, angina, hyper/hypotension
  7. Resp hx - Asthma, COPD
  8. Endocrine hx - Diabetes, thyroid, Addison’s
  9. Neuro hx - CVA, TIA, mental health
  10. Surgical - last GP visit, last surgery
    Social - live alone? family hx? mobility?
    smoke/drink?
  11. Occupation - exposure to things?
  12. Natal - pregnant? been pregnant recently?
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4
Q

What might you ask if someone said they have a medical condition?

A

Is it well controlled?
Are you medicated for this condition?
Have these conditions affected you day-to-day?

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5
Q

What might you ask if someone is breathless?

A
  1. Do you have a cough?
    If yes - what colour is it? Any blood? How
    long?
  2. Has the shortness of breath changed over
    time?
  3. Has the breathlessness affected your day-
    to-day life?
  4. If they have a cough: did the cough and
    breathlessness start at the same time?
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6
Q

What questions might you ask if someone has abdominal pain?

A
  1. Any vomiting?
  2. Going for a poo ok?
  3. Going for a wee ok?
  4. Where exactly is the pain - think about underlying organs
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7
Q

(1) Cranial Nerve I: _________
(2) How do you test it?

A

(1) Olfactory
(2) Smell

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8
Q

(1) Cranial Nerve II: _________
(2) Function?
(3) How do you test it?

A

(1) Optic
(2) Sight
(3) Visual acuity - Cover one eye, read
something 6ft away, or snellen test.

Visual fields test -
- Stand 1m away and have
arms outstretched - pt should not move eyes
or head. Wiggle fingers in periphery of
vision. Ask patient which fingers are
wiggling.
- Stand 1m away and pt covers right eye, you
cover your left eye. Bring finger from outside
the line of vision to periphery of vision and pt
tells you when they can see it. Test 4
positions on each eye.

- Fundoscopy
  Assessment of the fundus using an n 
  ophthalmoscope. Dim the lights, ask pt to 
  fixate on a distant target, approach patient 
  from the side, examine the optic nerve and 
  surrounding retina.
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9
Q

(1) Cranial Nerve III: _________
(2) Function?
(3) How do you test it?

A

(1) Oculomotor
(2) Muscle movement of the eye
(3)
Look: for Ptosis (drooping of the eyelid), for Palpebral fissures (gap between upper eyelid and lower eyelid).

Pupil reflexes (III)
- Constriction of pupils
- Check for consensual reflex

“H and +”
- + Up and down tests superior and inferior rectus. Left and right tests medial and lateral rectus.
- H Superior Oblique - pulls eye down and out
Inferior Oblique - pulls eye up and out
As well as testing other muscles in H test
Pause slightly at the end of each horizontal plane to test for nystagmus

Diplopia and Convergance
- Move your finger towards pt’s nose. Ask pt to follow it with their eye. Eyes should both fix on the finger all the way to the nose (convergance).
There should be no double vision (diplopia).

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10
Q

(1) Cranial Nerve IV: _________
(2) Function?
(3) How do you test it?

A

(1) Trochlear
(2) Muscle movement of the eye
(3)
Look: for Ptosis (drooping of the eyelid), for Palpebral fissures (gap between upper eyelid and lower eyelid).

Pupil reflexes (III)
- Constriction of pupils
- Check for consensual reflex

“H and +”
- + Up and down tests superior and inferior rectus. Left and right tests medial and lateral rectus.
- H Superior Oblique - pulls eye down and out
Inferior Oblique - pulls eye up and out
As well as testing other muscles in H test
Pause slightly at the end of each horizontal plane to test for nystagmus

Diplopia and Convergance
- Move your finger towards pt’s nose. Ask pt to follow it with their eye. Eyes should both fix on the finger all the way to the nose (convergance).
There should be no double vision (diplopia).

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11
Q

(1) Cranial Nerve V: _________
(2) Function?
(3) How do you test it?

A

(1) Trigeminal
(2) Motor/sensory sensations of the eyebrow/cheek/jaw
(3)
Sensation - Feel eyebrow, cheek and jaw (V1, V2, V3).
Muscles of mastication - Ask to clench teeth and palpate masseter and temporalis muscles
Jaw jerk.

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12
Q

(1) Cranial Nerve VI: _________
(2)
(3) How do you test it?

A

(1) Abducens
(2) Muscle movement of the eye
(3)
Look: for Ptosis (drooping of the eyelid), for Palpebral fissures (gap between upper eyelid and lower eyelid).

Pupil reflexes (III)
- Constriction of pupils
- Check for consensual reflex

“H and +”
- + Up and down tests superior and inferior rectus. Left and right tests medial and lateral rectus.
- H Superior Oblique - pulls eye down and out
Inferior Oblique - pulls eye up and out
As well as testing other muscles in H test
Pause slightly at the end of each horizontal plane to test for nystagmus

Diplopia and Convergance
- Move your finger towards pt’s nose. Ask pt to follow it with their eye. Eyes should both fix on the finger all the way to the nose (convergance).
There should be no double vision (diplopia).

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13
Q

(1) Cranial Nerve VII: _________
(2) Function?
(2) How do you test it?

A

(1) Facial
(2) Movement of facial muscles
(3)
Motor - Ask patient to:
- Pretend to blow a trumpet
- Show their teeth/smile
- Frown
- Whistle
- Close their eyes and don’t let you open them
Sensory
- Salty or sweet drink (difficult in practice)

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14
Q

(1) Cranial Nerve VIII: _________
(2) Function?
(3) How do you test it?

A

(1) Auditory/Vestibulocochlear
(2) Hearing
(3) Auriscopic exam - Inspection of patient’s ear canal and tympanic membrane. Inspect for wax, cone of light (5oclock and 7oclock), handle of malleus, colour (pink is normal, red is inflamed), bulging is abnormal

Auditory acuity - Stand behind the pt and whisper a number or word of at least 2 syllables, ask the patient to repeat. Do in both ears (different word)

Weber test - Apply the vibrating tuning fork to the centre of forehead - ask the patient where they hear it (on one side or both sides?). Hearing more in one ear could indicate conductive or sensoineural loss

Rinne’s test - Compares air conduction and bone conduction. Strike the tuning fork and put it behind the ear on the mastoid process. When the pt can’t hear the sound anymore, put the fork by the ear, should still be able to hear it. Abnormal = conductive hearing loss

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15
Q

(1) Cranial Nerve IX: _________
(2) Function?
(3) How do you test it?

A

(1) Glossopharyngeal
(2) Swallowing muscles
(2) Ask to swallow

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16
Q

(1) Cranial Nerve X: _________
(2) Function?
(2) How do you test it?

A

(1) Vagus
(2) Muscles to roof of mouth and uvula
(3) Say “aahh” and check uvula rises centrally

17
Q

(1) Cranial Nerve XI: _________
(2) Function?
(3) How do you test it?

A

(1) Accessory
(2) Movement of the sternocleidomastoid muscles and trapezius
(3) Shrug shoulders and move head side to side against resistance

18
Q

(1) Cranial Nerve XII: _________
(2) Function?
(3) How do you test it?

A

(1) Hypoglossal
(2) Movement of the tongue
(3) Stick tongue out and wiggle it side to side. Poke tongue into each cheek.

19
Q

Where are the pre-auricular lymph nodes and what do they indicate if swollen?

A

In front of your ears.

Indicates ear infection, eye infection or tooth infection

20
Q

What do lymph nodes do?

A

Lymph vessels take excess fluid from the body’s tissues and direct it toward nearby lymph nodes. The lymph nodes contain immune cells that detect and destroy bacteria, viruses, and damaged cells in the fluid.

21
Q

Where are the posterior auricular lymph nodes and what do they indicate if swollen?

A

Behind the ears, superficial to the mastoid process.

Upper respiratory infection/scalp infection/ear infection

22
Q

On a cranial nerve test, why would you pause during the H and + test at the horizontal planes?

A

To draw out any potential nystagmus (quivering of the eye).

Horizontal quivering of the eye can be normal in vertigo but vertical quivering is not and can be a sign of posterior stroke.

23
Q

Corneal arcus often indicates a patient has a high level of what?

A

Cholesterol

24
Q

How does corneal arcus cause the white ring around the iris?

A

Arcus senilis is a gray or white arc visible above and below the outer part of the cornea — the clear, domelike covering over the front of the eye. Eventually, the arc may become a complete ring around the colored portion (iris) of your eye.

Usually an age-related condition that creates a deposit of cholesterol, phospholipids, and triglycerides in an “arc” on either the top or bottom side of the iris, inside the cornea. Over time, the arc can grow to encircle the entire iris, creating a white, gray, blue, or yellowish “outline.”

25
Q

Why are the axillary nodes important in the chest examination?

A

The axillary nodes are the drainage point for the thorax and chest - which is why it can be especially important in females due to the risk of breast maligancy.

26
Q

Why are the left clavicular nodes significant in the abdominal exam?

A

The lymph from the abdominal cavity drains to the left supraclavicular nodes, which is why these nodes are significant in an abdominal exam.

27
Q

What areas do the infraclavicular lymph nodes drain?

A

Thoracic and abdominal

28
Q

How do you test mental state?

A
  1. New Memory
    - Give 3 new words and ask them to repeat
    these words to you and come back to them
    later to repeat again.
  2. Recent Memory
    - What was the weather like this morning?
  3. Remote Memory
    - Who is the prime minister?
    - Who is the president?
  4. Orientation
    - Time: What day is it?
    - Place: Where are you?
    - Person: Who is this?
29
Q

What are the salivary glands and where are they situated?

A
  1. Parotid - situated in front of the ears
  2. Submandibular - under angle of jaw
  3. Sublingual - floor of mouth
30
Q

What are the normal BMI ranges?

A

Females - 19-24
Males - 20-25

31
Q

What is the difference between a gland and a lymph node?

A
  1. Gland - organ in the body that produces chemical substances for the body to use or get rid of
  2. Lymph node - bean shaped masses of tissue that help protect against infection by killing bacteria and neutralising toxins - drainage system

Year 3 OSCE (5 decks)

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