Memorise For OSCE Flashcards
Diabetes and pre diabetes HbA1c?
Diabetes: > 48 mmol/L
Prediabetes: 42-47 mmol/L
What is QRISK2?
Risk if developing MI/stroke in next 10 years
Factors for QRISK2?
14 things
Age, males, ethnicity, smoking, diabetes, angina/MI in 1st degree relative <60, CKD 4 or 5, AF, BP treatment, RA, cholesterol/HDL, BP, BMI, UK postcode
When would someone be offered a statin who has not had CHD or a stroke?
If QRISK more than 10%
What lifestyle factors are important for heart health?
- healthy diet
- physical activity
- stopping smoking
What is the flow rate and percentage oxygen of nasal cannulae?
0.5-4L
24-36% O2
Considerations for nasal cannulae?
- Positive: speak, eat, drink, good claustrophobic/agitated/confused
- Negative: drying nasal mucosa/bleeding especially at higher flow rate, avoid oil creams
What is the flow rate & % oxygen for a Hudson mask/simple face mask?
30-40%
5-10L
What are considerations for simple face masks?
- Consider humidification for long term therapy
- latex allergies for all masks!
- Avoid over tightening of straps
- Do not allow tight control of FiO2
- Risk of aspiration if patient vomits
Straps under ears!
What % and flow rate of oxygen for non rebreathe mask?
70% and 10-15L
When and how is a non-rebreathe mask used?
Emergency therapy
Occlude valve to inflate reservoir bag before fitting on patient
What % and flow rate do the Venturi masks range?
2-15L/min
24-60%
What are the benefits and negatives of Venturi masks?
- Can change flow rate without altering %
- More accurate for long-standing lung disease
- Can be noisy
What does the tracheostomy mask and elephant tubing need?
Must be humidified and can be noisy
Chest X-ray steps?
- This is an erect chest X-ray!
- Patient ID, date, time, previous imaging
- RIPE: rotation, inspiration (5-6 ribs), projection, exposure (left hemidiaphragm visible to spine and vertebrae behind heart)
- Airway: trachea deviation, can see carina & bronchi?, hilar size and symmetry?, mediastinal shift
- Breathing: compare 3 zones - shadows and lung markings
- Cardiac: size and heart borders
- Diaphragm: air, costophrenic angles
- E: mediastinal contours (aortic knuckle & aortopulmonary window), bones, soft tissue, tubes, valves, pacemaker
- Review: lung apices, retro cardiac, behind diaphragm, peripheral lung, hilar
Causes of glucosurea?
- diabetes mellitus
- renal tubular disease
- SGLT2 inhibitors
What causes conjugated bilirubin in urine?
Increased serum levels
- post-hepatic: gallstones, head of pancreas cancer, cholangiocarcinoma, strictures
What cause ketourea?
Increased fatty acid metabolism in starvation and DKA
What is SG in urine analysis? What is normal range and what causes low and high?
Specific gravity
- normal is between 1.02-1.035mOsm/kg
- low: production of dilute urine = diabetes insipidus and acute tubular necrosis
- high: dehydration, glycosuria (DM), proteinuria (nephrotic syndrome)
What is normal pH of urine? What can cause it to change?
4.5-8
Low pH: starvation, DKA, metabolic acidosis (sepsis)
High pH: metabolic alkalosis (vomiting), medications (diuretics)
What is the blood strip in urinalysis testing for specifically? What does positive indicate?
Red blood cells, haemoglobin, myoglobin
UTI, renal stones, injury to renal tract, rhabdomyolysis, nephritic syndrome, malignant or urinary tract
What could cause proteinuria?
Nephrotic syndrome and CKD
What could the presence of nitrites in urine suggest?
E. Coli (+ other gram negative) breakdown product = UTI
What is the normal range of urobilinogen? What could high and low levels indicate?
Breakdown product of bilirubin (intestine)
- 0.2-1.0 mg/dL
- increased: haemolysis (haemolytic anaemia, malaria)
- decreased: biliary obstruction
