Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 OSCE > learning > Flashcards

learning Flashcards

1
Q

CHADS2 score

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

MMSE score

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

GAD-7

(7)

A

Feeling nervous, anxious or on edge?

Not being able to stop or control worrying?

Worrying too much about different things?

Trouble relaxing?

Being so restless that it is hard to sit still?

Becoming easily annoyed or irritable?

Feeling afraid as if something awful might happen?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Fraser Guidelines (5)

A

With regards to the provision of contraceptives to patients under 16 years of age the Fraser Guidelines state that all the following requirements should be fulfilled:

the young person understands the professional’s advice

the young person cannot be persuaded to inform their parents

the young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment

unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer

the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Depression: switching antidepressants

Switching from citalopram, escitalopram, sertraline, or paroxetine to another SSRI

Switching from fluoxetine to another SSRI

Switching from citalopram, escitalopram, sertraline, or paroxetine to venlafaxine

Switching from fluoxetine to venlafaxine

A

Switching from citalopram, escitalopram, sertraline, or paroxetine to another SSRI

  • the first SSRI should be withdrawn* before the alternative SSRI is started

Switching from fluoxetine to another SSRI

  • withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low-dose of the alternative SSRI

Switching from a SSRI to a tricyclic antidepressant (TCA)

  • cross-tapering is recommend (the current drug dose is reduced slowly, whilst the dose of the new drug is increased slowly)
  • an exception is fluoxetine which should be withdrawn prior to TCAs being started

Switching from citalopram, escitalopram, sertraline, or paroxetine to venlafaxine

  • cross-taper cautiously. Start venlafaxine 37.5 mg daily and increase very slowly

Switching from fluoxetine to venlafaxine

  • withdraw and then start venlafaxine at 37.5 mg each day and increase very slowly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

he Royal College of Obstetricians and Gynaecologists (RCOG) recommend that the following triad is present before diagnosis hyperemesis gravidarum:

A

5% pre-pregnancy weight loss

dehydration

electrolyte imbalance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

NIPE exam vital signs

A

Respiratory rate = 30-60

Heart rate = 90-160

Blood pressure - not recorded unless unwell

Pulse Ox - n/a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Disadvantages of combined oral contraceptive pill

(6)

A

people may forget to take it

offers no protection against sexually transmitted infections

increased risk of venous thromboembolic disease

increased risk of breast and cervical cancer

increased risk of stroke and ischaemic heart disease (especially in smokers)

temporary side-effects such as headache, nausea, breast tenderness may be seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Advantages of combined oral contraceptive pill

(8)

A

highly effective (failure rate < 1 per 100 woman years)

doesn’t interfere with sex

contraceptive effects reversible upon stopping

usually makes periods regular, lighter and less painful

reduced risk of ovarian, endometrial - this effect may last for several decades after cessation

reduced risk of colorectal cancer

may protect against pelvic inflammatory disease

may reduce ovarian cysts, benign breast disease, acne vulgaris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of Alcohol withdrawal

(4)

A

patients with a history of complex withdrawals from alcohol (i.e. delirium tremens, seizures, blackouts) should be admitted to hospital for monitoring until withdrawals stabilised

first-line: long-acting benzodiazepines e.g. chlordiazepoxide or diazepam. Lorazepam may be preferable in patients with hepatic failure. Typically given as part of a reducing dose protocol

carbamazepine also effective in treatment of alcohol withdrawal

phenytoin is said not to be as effective in the treatment of alcohol withdrawal seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Types of nappy rash

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Nappy rash counselling

A

disposable nappies are preferable to towel nappies

expose napkin area to air when possible

apply barrier cream (e.g. Zinc and castor oil)

mild steroid cream (e.g. 1% hydrocortisone) in severe cases

management of suspected candidal nappy rash is with a topical imidazole. Cease the use of a barrier cream until the candida has settled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Management of PPH

A

ABC including two peripheral cannulae, 14 gauge

IV syntocinon (oxytocin) 10 units or IV ergometrine 500 micrograms

IM carboprost

if medical options failure to control the bleeding then surgical options will need to be urgently considered

the RCOG state that the intrauterine balloon tamponade is an appropriate first-line ‘surgical’ intervention for most women where uterine atony is the only or main cause of haemorrhage

other options include: B-Lynch suture, ligation of the uterine arteries or internal iliac arteries

if severe, uncontrolled haemorrhage then a hysterectomy is sometimes performed as a life-saving procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which score assesses severity of anxiety and depression symptoms in hospital?

A

Hospital Anxiety and Depression (HAD) scale - assesses severity of anxiety and depression symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which score is used to determine the need to anticoagulate a patient in atrial fibrillation?

A

CHADS2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Heart failure severity scale score

A

NYHA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

A scoring system used to assess the severity of liver cirrhosis

A

Child-Pugh classification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Score which helps estimate the risk of a patient having a deep vein thrombosis

A

Wells score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Score used to assess cognitive impairment

A

Mini-mental state examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Patient Health Questionnaire - assesses severity of depression symptoms

A

PHQ-9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Used as a screening tool and severity measure for generalised anxiety disorder

A

GAD-7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Used to screen for postnatal depression

A

Edinburgh Postnatal Depression Score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Questionnaire used to detect eating disorders and aid treatment

A

SCOFF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Alcohol screening tools

A

AUDIT

CAGE

FAST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Score used to assess the prognosis of a patient with pneumonia

A

CURB-65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Used in the assessment of suspected obstructive sleep apnoea

A

Epworth Sleepiness Scale

28
Q

International prostate symptom score

A

IPSS

29
Q

Indicates prognosis in prostate cancer

A

Gleason score

30
Q

Assesses the health of a newborn immediately after birth

A

APGAR

31
Q

Used to help assess the whether induction of labour will be required

A

Bishop score

32
Q

Assesses the risk of a patient developing a pressure sore

A

Waterlow score

33
Q

Risk assessment tool developed by WHO which calculates a patients 10-year risk of developing an osteoporosis related fracture

A

FRAX

34
Q

Acute pancreatitis score

A

Ranson criteria

35
Q

Malnutrition score

A

MUST

36
Q

Score which stratifies upper GI bleeding patients who are ‘low-risk’ and candidates for outpatient management.

A

The Glasgow-Blatchford Bleeding Score (GBS) stratifies upper GI bleeding patients who are ‘low-risk’ and candidates for outpatient management.

37
Q

Indications foir induction of labour

A

prolonged pregnancy, e.g. 1-2 weeks after the estimated date of delivery

prelabour premature rupture of the membranes, where labour does not start

diabetic mother > 38 weeks

pre-eclampsia

rhesus incompatibility

38
Q

Management of cord prolapse

A

cord prolapse is an obstetric emergency

the presenting part of the fetus may be pushed back into the uterus to avoid compression

if the cord is past the level of the introitus, there should be minimal handling and it should be kept warm and moist to avoid vasospasm

the patient is asked to go on ‘all fours’ until preparations for an immediate caesarian section have been carried out

the left lateral position is an alternative

tocolytics may be used to reduce uterine contractions

retrofilling the bladder with 500-700ml of saline may be helpful as it gently elevates the presenting part

although caesarian section is the usual first-line method of delivery, an instrumental vaginal delivery is possible if the cervix is fully dilated and the head is low.

39
Q

mMSE

A

A - appearance and behaviour

S - speech (how they are speaking, rather than what they are saying, which comes under thought content)

E - emotion (mood and affect; how the patient says they feel compared with how they appear to you)

P - perceptions (any unusual experiences/ hallucinations etc)

T - thought (form and content)

Thought form - this is where you describe if the patient shows any evidence of formal thought disorder

Thought content - this is where you describe if the patient is very fixated on one particular idea, or if there is a general tone or theme to their thoughts

I - insight

C - cognition

40
Q

dehydration red flags

A

tachypnoea

tachycardia

sunken eyes

reduced skin turgor

41
Q

Systems review

(7)

A

Ask about respiratory symptoms (breathlessness, cough, chest tightness)

Ask about cardiovascular symptoms (chest pain, palpitations, leg swelling)

Ask about gastrointestinal symptoms (nausea, vomiting, diarrhoea, constipation, anorexia)

Ask about urogenital symptoms (urinary frequency, dysuria, genital itch, genital pain, dyspareunia)

Ask about dermatological symptoms (rash, pruritus)

Ask about neurological symptoms (headache, visual disturbance, weakness, paraesthesia, dizziness, syncope)

Ask about systemic symptoms (fever, weight loss)

42
Q

Obstetric history

A

Ascertain gravidity and parity

  1. Gravidity is the number of times a person has been pregnant, regardless of outcome, so in this case she is gravida 3
  2. Parity is the number of times a person has delivered a foetus/baby of at least 24 weeks gestation, regardless of mode of delivery or live/stillborn, in this case she is para 0

Ask gestation

  • A question such as “Do you know how far along you are in the pregnancy?” may prompt the patient to tell you

Ask specifically about the last menstrual cycle (LMP)

Calculate approximate gestation

Ask about any problems in pregnancy

  • May be useful to ask if she has attended any extra appointments or clinics, and if she’s attended the GP for anything else

Ask about ultrasound scans

  • Remember a normal schedule for ultrasound scans is a “dating” scan at 10-14 weeks and a foetal anomaly scan at 20 weeks. Additional scans are dictated by clinical picture

Ask if any other investigations during pregnancy

Ask about foetal movements

  • Foetal movements are usually not felt until 16-20 weeks gestation, so if she’s feeling movements, this suggests she is a later gestation than we think!

It’s important to tell the patient it’s NORMAL not to feel movements at this gestation!

Ask about uterine activity

E.g. hardening of stomach or cramping

Ask about vaginal losses

E.g. discharge, fluid, mucous plug, tissue, ??foetus

Ask about symptoms of pre-eclampsia if you haven’t already (headache, visual disturbance, epigastric pain, oedema)

Ask about history of sexually transmitted/pelvic infections

43
Q

Urge incontinence

Cause (2)

Investigations (4)

Management (4)

A

Cause

  • overactive bladder (OAB)/urge incontinence
  • due to detrusor overactivity

Investigations

  • bladder diaries should be completed for a minimum of 3 days
  • vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)
  • urine dipstick and culture
  • urodynamic studies

Management

  • bladder retraining (lasts for a minimum of 6 weeks, the idea is to gradually increase the intervals between voiding)
  • bladder stabilising drugs: antimuscarinics are first-line - NICE recommend oxybutynin (immediate release), tolterodine (immediate release) or darifenacin (once daily preparation)
  • Immediate release oxybutynin should, however, be avoided in ‘frail older women’
  • mirabegron (a beta-3 agonist) may be useful if there is concern about anticholinergic side-effects in frail elderly patients
44
Q

Pharmacological management of nocturesis

A

Desmopressin-sublingual/tablet form

  • 1-2hrs before Bed time
  • Warn about excessive drinking and illness
  • Not used when there is only day time symptoms

Anticholinergic(oxybutynin)

  • overactive bladder(detrusor instability)
  • used with desmopressin used in bedwetting + day time symptom

Tricyclics(imipramine)

  • second line
  • Used in enuresis clinics
  • More side effects Toxicity in overdose a concern
45
Q

Stress incontinence

Cause (1)

Investigations (4)

Management (4)

A

Cause (1)

  • leaking small amounts when coughing or laughing

Investigations (4)

  • bladder diaries should be completed for a minimum of 3 days
  • vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)
  • urine dipstick and culture
  • urodynamic studies

Management (4)

  • pelvic floor muscle training - NICE recommend at least 8 contractions performed 3 times per day for a minimum of 3 months
  • surgical procedures: e.g. retropubic mid-urethral tape procedures
  • duloxetine may be offered to women if they decline surgical procedures
  • a combined noradrenaline and serotonin reuptake inhibitor
  • mechanism of action: increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced
46
Q

Nocturesis treatment pathway

A

Management

  • look for possible underlying causes/triggers
  • constipation
  • diabetes mellitus
  • UTI if recent onset
  • emotional trauma

general advice

  • fluid intake
  • toileting patterns: encourage to empty bladder regularly during the day and before sleep
  • lifting and waking

reward systems (e.g. Star charts)

  • NICE recommend these ‘should be given for agreed behaviour rather than dry nights’ e.g. Using the toilet to pass urine before sleep

enuresis alarm

  • generally first-line for children
  • have sensor pads that sense wetness
  • high success rate

desmopressin

  • particularly if short-term control is needed (e.g. for sleepovers) or an enuresis alarm has been ineffective/is not acceptable to the family
47
Q

AKI Scoring

A
48
Q

Explaining Statins

A

Briefly explains about hypercholesterolaemia

Explains the potential complications

Explains how statins work

Explains that statins are a daily medication

Advises the patient to take the medication in the evening

Explains that the treatment is lifelong

Explains that statins decrease a patient’s risk profile over many years

Statin prescriptions require regular monitoring. Lipids and LFTs should be performed prior to starting treatment. LFTs should be repeated after three months. Further monitoring is then done yearly.

Talks about common side effects

Important side effects include rhabdomyolysis, hepatic disorders, and pancreatitisAdvises the patient to let their clinician know about any side effects that they experience

Asks the patient to consult with their clinician if they are about to start any new medications

Explains to the patient that some types of statin can interact with grapefruit juice

Checks for any allergies

Asks about current drug history

49
Q

Explain lithium

A

Explains the mechanism of action of lithium

  • Mood stabiliser - balances the patient’s mood in between depression and mania, exact mechanism is unknown. Thought to interfere with neurotransmitter release in the brain.

Explains how the patient should take the medication

  • Tablet, to be taken once daily

Explains the duration of treatment

  • Usually lifelong, with regular reviews by a psychiatrist

Explains how long it takes for the medication to work

  • Takes 1-2 weeks to work

Explains appropriate monitoring tests before initiation:

  • FBC
  • U&Es
  • TFTs
  • b-HCG (pregnancy test)
  • ECG

During treatment:

  • Li levels after 5 days, then every week until stable for 4 weeks, them 3-monthly
  • TFTs, U&Es, Ca should be monitored 6-monthly

Explains some of the important side effects

  • Water symptoms: thirst, polyuria, impaired urinary concentration, weight gain, oedema

GI side effects:

  • abdominal pain, nausea
  • Metallic taste
  • Fine tremor

Explains some of the symptoms of lithium toxicity

  • anorexia
  • diarrhoea
  • vomiting
  • dysarthria
  • dizziness
  • muscle twitching
  • tremor
  • Drowsiness
  • Apathy
  • Restlessness

Provides supplementary advice to the patient for further help (e.g. Bipolar UK charity)

Checks the patient understanding, using “chunk and check” method

Asks if the patient has any remaining questions

50
Q

Explaining steroids

A

Explains what Addison’s disease is to the patient

Explains that without treatment he could become seriously ill

Explains the need for him to wear a medical emergency identification bracelet

Explains that he will also need a steroid card

Explains that these are different steroids to anabolic steroids, and he will not gain muscle mass

Explains that he will not experience testicular shrinking

Reassures the patient that although steroids do have many potential side effects fertility issues are not considered to be likely

Talks briefly through how steroids work with the patient

Explains how often he needs to take the steroids

Explains that steroids are taken orally as a tablet

Discusses the length of treatment

Discusses ongoing monitoring requirements

Tells the candidate the potential common side effects of steroids

Tells the candidate the potential serious side effects of steroids

Emphasises the importance of not missing steroid doses

Explains to the patient that he should not stop taking the steroids abruptly

Talks to the patient about sick day rules for steroids (Patient should take double the dose of steroids if they feel unwell)

Explains to the patient that they will need to double their dose of medication if they feel unwell

Emphasises that the patient should seek medical help if they are so unwell they cannot take medication orally

Gives the patient advice for travelling, for example, they should carry extra medication and an emergency intramuscular injection

Advises the patient to let their clinician know about any side effects they experience

Ask the patient to consult with their clinician if they are about to start any new medication whilst taking steroids

Explains the need for concurrent prescription of alendronate to prevent steroid-induced osteoporosis

Checks for any allergies

Asks about current drug history

51
Q

Normal electrolyte ranges

A
52
Q

TDP management

A

magnesium sulfate 4g

53
Q

DKA Main principles of management

A

fluid replacement

  • most patients with DKA are deplete around 5-8 litres
  • isotonic saline is used initially, even if the patient is severely acidotic
  • please see an example fluid regime below.

insulin

  • an intravenous infusion should be started at 0.1 unit/kg/hour
  • once blood glucose is < 15 mmol/l an infusion of 5% dextrose should be started

correction of electrolyte disturbance

  • serum potassium is often high on admission despite total body potassium being low
  • this often falls quickly following treatment with insulin resulting in hypokalaemia
  • potassium may therefore need to be added to the replacement fluids
  • if the rate of potassium infusion is greater than 20 mmol/hour then cardiac monitoring may be required

long-acting insulin should be continued, short-acting insulin should be stopped

54
Q

Osteoporosis explanation to the patient

A

Establishes patient’s current understanding

Offers detailed explanation of osteoporosis as a condition

Explains possible causes of osteoporosis

Discusses lifestyle modifications that can be of benefit

Discusses weight bearing exercise

Discusses quitting smoking

Discusses limiting alcohol

Discusses reducing the risk of future falls by addressing high risk activities/ modifying high risk areas of the home e.g. by installing shower rails

Recommends calcium and vitamin D supplements for healthy bones

55
Q

Bisphosphonates explanation

A

Asks specifically about any previous gastric/ duodenal ulcers

Asks about alcohol intake

Establishes current medication regime

Asks about patient functioning to establish ability to comply with administration requirements

Confirms suitability for bisphosphonate therapy

Explains action of drug

Explains how to take bisphosphonates

Explains that it is taken weekly, on the same day each week

Explains that it should be taken with a glass of water a minimum of 30 minutes before food

Explains that they will need to sit upright for a minimum of 30 minutes following administration

Explains that bisphosphonates are a long term medication but do not need to be taken lifelong

Explains they would be taken for a minimum 3 years to get the most benefit

Explains potential side effects and complications

Explains minor side effects of indigestion/ general gastro-intestinal irritation (oesophagitis, diarrhoea, abdominal pain)

Explains major potential side effect of osteonecrosis of jaw (rare but serious)

Explains need for dental check before starting therapy and to continue with regular dental checks throughout treatment

Explains that GI side effects are significantly reduced if administration instructions are followed carefully

Explains that if patient is experiencing side effects they should come back to see their GP

Explains that in cases where patient’s do not tolerate the drug orally there are alternative therapies that can be considered

56
Q

DOAC explanation

A

Checks patient understanding at this stage

Explains the risks associated with atrial fibrillation - clot formaiton

Explains the indication for rivaroxaban - stroke prevention

Clarifies drug as rivaroxaban 20mg once daily

Explains that treatment will be life long, or until a decision is made to stop

Explains it should be taken at the same time each day

Explains that if a dose is missed this can be taken up to 12 hours late

Explains not to double dose or take a dose more than 12 hours late (wait until next dose due)

Explains if takes a double dose by mistake to speak to a pharmacist, contact his GP or call 111

Reiterates importance of good compliance

Explains risks of poor compliance in terms of thrombosis risk

Explains side effects and possible complications of therapy

Unexplained bruising

Bleeding - minor (nosebleeds, increased bruising, small cuts taking longer to stop bleeding) versus major bleeding (intracranial bleeds , intra-abdominal bleeds)

Explains appropriate management of self-terminating bleeding episode - advises patient to speak to pharmacist or GP

Explains appropriate management of ongoing bleeding, severe bleeding, recurrent episodes of bleeding, rectal bleeding, haematuria or head injury / other major injury - advises patient to go to the Emergency Department for assessment

Explains that rivaroxaban can be reversed in the event of significant bleeding or trauma

Explains the need to tell dentists/ doctors in the future that he is on this medication due to blood thinning effects

Explains that some medications can interact with rivaroxaban

Patient should avoid NSAIDs such as ibuprofen

Patient should always check with a doctor before starting a new medication

Chunks information and regularly checks patient understanding throughout

57
Q

Indications for warfarin over DOACs

A

mechanical heart valves

  • target INR depends on the valve type and location
  • mitral valves generally require a higher INR than aortic valves.

second-line after DOACs:

  • venous thromboembolism: target INR = 2.5, if recurrent 3.5
  • atrial fibrillation, target INR = 2.5
58
Q

Before starting antipsychotics

A
59
Q

Lithium: side effects

A
60
Q

Counselling DOACs

A

Counselling DOACs specifically:

Rrivaroxaban is a “blood thinner” and helps reduce the risk of blood clot formation and by extension, the risk of stroke.

It is taken once daily as a tablet, the duration of which is lifelong.

It doesn’t require regular monitoring with blood tests, unlike older medications including warfarin.

It will require a one off test of kidney function before starting the medication.

It does carry a small risk of serious bleeding events.

There are no specific dietary or lifestyle alterations needed.

Seeking medical advice is recommended if any unexpected bleeding occurs.

Seeking medical advice is recommended if any injuries to the head are sustained, or following any significant falls, as scans will be required to evaluate for internal bleeds.

61
Q

Explaining Atrial Fibrillation specifically:

A

The regular heartbeat we all have is regulated by a certain parts of your heart called the pacemakers. They also ensure that the heart beats in a co-ordinated manner and hence pumps out blood effectively.

In atrial fibrillation, one of the pacemakers has lost its ability to provide control and this results in an irregular heart beat which can affect the heart’s effectiveness in pumping blood. This can leave you with palpitations, feeling lightheaded, and dangerously low blood pressure if left unchecked.

Often the underlying trigger for this condition cannot be pinpointed.

The diagnosis is made by looking at your heart rhythm trace and the unsuccessful attempts at reverting your heart back to normal rhythm.

If left untreated, it carries a risk of blood clot formation which itself can lead to stroke.

It can also be worsened by alcohol, infections, caffeine.

A long term (lifetime) treatment will be required as attempts to reverse the heart rhythm to its normal state have failed.

Early initiation of treatment is highly recommended to minimise the long term risk of stroke.

62
Q

NICE recommend a step-wise approach for chronic plaque psoriasis

A

regular emollients may help to reduce scale loss and reduce pruritus

first-line: NICE recommend:

  • a potent corticosteroid applied once daily plus vitamin D analogue applied once daily
  • should be applied separately, one in the morning and the other in the evening)
  • for up to 4 weeks as initial treatment

second-line: if no improvement after 8 weeks then offer:

  • a vitamin D analogue twice daily

third-line: if no improvement after 8-12 weeks then offer either:

  • a potent corticosteroid applied twice daily for up to 4 weeks, or
  • a coal tar preparation applied once or twice daily
  • short-acting dithranol can also be used
63
Q

Score used in adult patients with atrial fibrillation, to assess risk of major bleeding with anticoagulation.

A

ORBIT

64
Q

Management of rosecea

A

Management

topical metronidazole may be used for mild symptoms (i.e. Limited number of papules and pustules, no plaques)

topical brimonidine gel may be considered for patients with predominant flushing but limited telangiectasia

more severe disease is treated with systemic antibiotics e.g. Oxytetracycline

recommend daily application of a high-factor sunscreen

camouflage creams may help conceal redness

laser therapy may be appropriate for patients with prominent telangiectasia

patients with a rhinophyma should be referred to dermatology

65
Q

Management of eczema

A
  • avoid irritants
  • simple emollients
  • large quantities should be prescribed (e.g. 250g / week), roughly in a ratio of with topical steroids of 10:1
  • if a topical steroid is also being used the emollient should be applied first followed by waiting at least 30 minutes before applying the topical steroid
  • creams soak into the skin faster than ointments
  • emollients can become contaminated with bacteria - fingers should not be inserted into pots (many brands have pump dispensers)
  • topical steroids
  • wet wrapping
  • large amounts of emollient (and sometimes topical steroids) applied under wet bandages
  • in severe cases, oral ciclosporin may be used
66
Q

COPD treatment pathway

A
67
Q
A

Year 4 OSCE (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions