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OSCE > Last 2 Weeks > Flashcards

Last 2 Weeks Flashcards

1
Q

Response to a complaint

A 
Support 
Acknowledge 
Investigate 
Notify / document 
Respond 
Implement 
Communicate 
Evaluate
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2
Q

Open Disclosure

A 
Acknowledgement of event 
Expression of regret 
Factual explanation 
Further treatment 
Potential consequences 
Steps taken to manage / prevent recurrence
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3
Q

TV ultrasound - visible cardiac activity, CRL and expected BHCG

A

5.5 weeks, CRL 5 mm, BHCG 1500

Expect gestational sac at 1500

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4
Q

Criteria for pregnancy failure

A

Mean sac diameter > 25 mm and no foetal pole

CRL > 7 mm with no FHR

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5
Q

Steps to support impaired colleague

A 
Assure confidentiality 
Relieve of duty 
Support time off 
Seek cause 
Assist with NOK 
APHRA notification 
Notify director 
Documentation
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6
Q

Depression screening questions

A 
Mood? 
Sleep?
Activity enjoyment? 
Appetite? 
Concentration? 
Irritable / interpersonal conflict? 
Suicide / self harm?
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7
Q

Design of protocol

A

Plan: research, benchmark, stake holders

Do: draft.

  • Indications / Contraindications
  • Preparation & supervision
  • Description
  • Outcome
  • Complications

Study: input / feedback from stakeholders
Act: implement
Cycle: follow up and review

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8
Q

Disaster Management

A

Space - clear, allocate
Personelle - retain / call in / roster. Form teams. Brief teams. Other teams - surg / ortho
Equipment
Drugs
Organisation - media, exec, ED leadership, security

Post disaster - stand down, restocking, debriefing

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9
Q

Describe when to give epipen

A

If mild-moderate reaction (swelling of lips/face/eyes, hives, tingling of mouth) - locate epipen. Given antihistamine. Phone emerg contact.

If anaphylaxis:
- swelling of tongue / tightness of throat
- difficulty breathing, wheezing of persistent coughing. Hoarse voice.
- persistent dizziness or collapse (pale and floppy child)
Lie down, give adrenaline. Phone ambulance. Phone emerg contact. Repeat at 5 min.
CPR if not responsive and not breathing normally.

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10
Q

Calculate A-a gradient

A

PAO2 - PaO2
FiO2 (Patm - Pwv) - PaCO2 / 0.8
FiO2 (713) - PaCO2 x 1.25
150 - PaCO2 x 1.25

Normal < age/4 + 4

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11
Q

FiO2 2L & 4L min NP

A

0.28 & 0.36

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12
Q

FiO2 6L & 8L HM

A

0.4 & 0.6

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13
Q

FiO2 NRBM 15L min

A

0.9

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14
Q

Warfarin reversal

A 
INR > 1.5 critical bleeding 
Stop warfarin 
IV vitamin K 10 mg 
Prothrombin complex concentrate 50 IU/kg 
FFP 300 mls
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15
Q

Rivaroxaban / apixaban reversal

A

TXA 1g
PCC 50 IU / kg
Andexanet if available

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16
Q

Dabigatran reversal

A

Idarucizumab 5g

TXA 1g

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17
Q

VT vs SVT

A

NW axis
Very broad (>160 msec)
AV dissociation
Capture / fusion beats
Positive or negative concordance precordial leads
RSR’, taller left r wave ear
Brugada sign (onset R to nadir S) > 100 msec
Josephsons sign: notching / slurring near nadir of S
Initial R wave in aVR (Vereckei)

Age > 35, structural or ischaemic heart disease, IHD, FHx SCD.

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18
Q

Nexus criteria

A 
Normal alertness 
No intoxication 
No painful distracting injury 
No focal neurological deficit 
No midline tenderness

Alt: canadian C-spine rule.

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19
Q

Metabolic Alkalosis

A

H+ loss: vomiting, NGT drainage, renal diuretic - frusemide, or bartters synd.
HCO3 inc: citrate, admin HCO3, laxatives, milk alkali
Cushings: adrenal tumour, ectopic ACTH, steroids

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20
Q

PDA murmur

A

continuous, left infraclavicular

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21
Q

HCM murmur

A

midsystolic, inferior left sternal border, increase with valsalva / standing

22
Q

VSD murmur

A

pan systolic murmur, inferior left sternal border

23
Q

Diastolic murmur

A

Aortic regurgitation or mitral stenosis

24
Q

Anion gap

A

Na - Cl + HCO3 = 12 +/-4

25
Q

Corrected Na

A

Na + (glucose - 5) / 3

26
Q

Delta ratio

A 
Increase in AG / Dec in HCO3 
AG - 12 / 24 - HCO3 
0.4-0.8 = normal + HAGMA 
1-2 = pure HAGMA 
> 2 = HAGMA + resp acidosis / met alkalosis
27
Q

Expected HCO3 in respiratory acidosis

A

Acute = 1, chronic = 4

For every 10 increase in PaCO2, HCO3 goes up 1 / 4 depending if acute / chronic

28
Q

Expected HCO3 in respiratory alkalosis

A

Acute = 2, chronic = 5

For every 10 decrease in PaCO2, HCO3 goes down 2 / 5

29
Q

Urea: creatinine ratio

A

Urea : Creatinine (divided by 1000)
> 100 = prerenal
< 40 = renal

30
Q

Metabolic alkalosis, expected CO2

A

20 + 0.7 x HCO3 (+/- 5)

31
Q

Consent

A

Informed
Specific to procedure / treatment
No coersion
Have capacity

32
Q

Capacity

A

Understand facts
Weight up consequences
Communicate choice

33
Q

Triage in disaster

A 
RR, SBP and GCS 
each aspect given a score of 0-4 
Score < 10 - priority 1, resus 
Score 11 - priority 2, monitored bed 
Score 12 - priority 3 - observed area
34
Q

Phone call for external emergency

A 
Major disaster declared? 
Exact location?
Type of incident? 
Hazards
Access 
No of casualties 
Emerg services present / needed
35
Q

Requirements for transfer

A

Patient with monitoring
Equipment and drugs, anticipation of complications
Staff with appropriate skills set
Department safe

36
Q

Thrombolysis in CVA

A

IV tPA/alteplase 0.9mg/kg to 90 mg, 10% initial bolus and then remaining over 60 min

37
Q

Thrombolysis in PE

A

Massive PE (arrest, SBP < 90 15 min)
tPA / Alteplase IV 90 mg over 2 hrs
Arrest - 50 mg bolus

38
Q

Thrombolysis in STEMI

A

Suggestive Hx, ECG diagnosis, Chest pain > 30 min < 12 hrs, no PCI within 90 min

Tenecteplase IV 1000 units / kg to 10,000 units.

39
Q

Contraindications to thrombolysis

A

HTN > 180/110
Active bleeding / coagulopathy / anticoagulation
CNS: ICH, CVA, CNS tumour, AVM
Major surgery < 1 month
GI / GU bleeding < 1 month
Life limiting illness: advanced liver disease, dementia

40
Q

DDx right heart strain

A 
Pulmonary hypertension 
Pulmonary embolism 
Chronic lung disease 
Mitral stenosis 
Congenital heart disease (PS or TOF) 
ARVD
41
Q

Signs of PE on ECG

A 
Sinus tachycardia 
Anterior (V1-v3) TWI 
Right axis deviation 
Right bundle branch block 
S wave I 
Q wave and TWI in III
42
Q

Causes of LBBB

A 
Ischaemic heart disease 
Anterior MI 
HTN 
Aortic stenosis 
Cardiomyopathy 
Myocarditis 
Hyperkalaemia
43
Q

Causes of LAD

A 
LAFB 
LBBB
LVH
Inferior MI 
WPW 
Pacing / VEs
44
Q

Causes of RBBB

A 
RVH 
Pulmonary embolism 
Ischaemic heart disease 
Congenital heart disease (ASD) 
Myocarditis 
Cardiomyopathy
45
Q

Causes of RAD

A 
LPFB
RVH
Lateral MI 
Lung disease / PE 
VT 
Hyperkalaemia 
Sodium channel blockade
46
Q

How to give urinary alkalinisation

A

1-2 mEq/kg Sodium bicarbonate
150 mmol NaHCO3 in 950 mls 5% glucose at 250 mls/hr, add 20 mmol/KCL
Target urine pH > 7.5

47
Q

ECG findings in TCA poisoning

A 
IVCD - QRS > 100 msec 
RAD 
RS Ratio > 0.7 in aVR
Sinus tachy (muscarinic)
Prolonged QT
48
Q

Causes of high osmolar gap

A 
Tox 
 -ethanol, ethylene glycol, methanol 
- polypropylene glycol 
- mannitol 
Non-tox 
- ketoacidosis - alcoholic, DKA 
- renal failure 
- hyperlipidaemia and hyperproteinaemia 
- Severe lactic acidosis, trauma, burns
49
Q

Examination elements in cerebellar disease

A

Vital signs - fever, hypotension
Speech - staccato, slurred
Gait - wide based, ataxia. normal rhombergs.
CnNv - associated abn, nygstagmus, ophthalmoplegia, RAPD, facial weakness
Limb neuro - hypotonia, cooridnation - disdiadochokinesis, intention tremor, pendular reflexes
Ear - HZV lesions
Eye - papilloedema
CVS - PR & rhythm, postural hypotension, murmurs, carotid bruits, pulses

Disdiadochokinesis, Ataxia, Nystagmus, Intention tremor, Slurred/staccato speech, Hypotonia

50
Q

Examination elements in vertigo

A

Vital signs
Speech - slurred / staccato
Gait - ataxia, normal rhombergs
Nystagmus
Head impulse
Test of skew
CnNv - specifically opthalmoplegia, RAPD, facial weakness, hearing loss
PNS - hypotonia, coordination - disdiadochokinesis / intention tremor, pendular reflexes
Ear - obstruction canal, cholesteatoma, HZV
CVS - postural BP, HR and rhythm, pulses, murmurs, carotid bruits

BPPV - dix hallpike / epley

51
Q

Causes of complete heart block

A

AMI - inferior / anterior
Hyperkalaemia
Drug toxicity - ca / b-blocker
Inflammatory - myocarditis, rheumatic fever
Infiltrative - sarcoid, haemochromatosis
Autoimmune - SLE
Idiopathic fibrosis

OSCE (3 decks)

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