Miscellaneous Short OSCE Items Flashcards
what pathogens are patients at risk from post-splenectomy
- pneumococcus
- haemophilus
- meningococcus
- capnocytophaga canimorsus; dog bites
what vaccinations are required for post-splenectomy patients
- haemophilus influenza b
- meningitis a and c
- annual influenza vaccination
- pneumococcal vaccination every 5 years
should be given 2 weeks pre-elective splenectomy is relevant
what antibiotic prophylaxis is recommended post-splenectomy
- penicillin v 500mg bd
- for at least 2 years or up to age 16
- often for life
- advise re malaria endemic regions
- unclear guidance
what blood film features are seen post-splenectomy
- howell-jolly bodies; cytoplasmic inclusions
- increased platelet count; may need anitplatelet medication
- target cells, reticulocytes and siderocytes
these changes are largely due to the absence of splenic clearance of defective cells
how is mrsa detected
- nasal swab
- dna based test
how is mrsa treated
- teicoplanin
- vancomycin
- linezolid as last resort
how is mrsa suppressed
- chlorhexidine body wash and shampoo
- mucopiricin nasal ointment
- no retest needed
what is clostridium difficile
- gram positive rod that produces an exotoxin that causes intestinal damage leading to pseudomembranous colitis
what are the features of a c diff infection
- diarrhoea
- abdominal pain
- raised wcc is characteristic
- severe toxic megacolon may develop
how is c diff infection comfirmed
- cdt stool toxin
how is c diff managed
- isolation
- barrier nursing
- metronidazole, then vancomycin
- both if severe
what are the sites for intramuscular injection
- ventrogluteal site
- dorsogluteal site
- deltoid site
- vastus lateralis site
what are the sites for subcutaneous injection
- Vascular areas around outer aspect of upper arms
- Abdomen from below costal margins to iliac crest
- Anterior aspect of thigh
lymph node examination
- cervical nodes
- axillary nodes; apex, lateral, medial, anterior, posterior
- epitrochlear
- inguinal
- popliteal
- hepatosplenomegaly
- complete
explaining a procedure format
- introduction
- concerns
- before
- during
- after
- check understanding
- complications
- recap and check understanding
- ending
explaining a diagnosis format
- introduction
- giving diagnosis with warning shot
- check understanding
- explain cause
- explain symptoms
- explain complications
- explain treatment
- address questions
- recap and check understanding
- ending
principles of fracture managment
- reduction
- immobilisation
- rehabilitation
open fracture management
- dr abcde; consider need for fluid replacement and/or blood transfusion
- history and examination when the patient is stable
- tetanus booster
- clean and inspect the wound
- lavage, debride, remove necrotic tissue
- surgery
- antibiotics; cefuroxime and metronidazole
- analgesia
early complications of fractures
- wound infection
- fat embolism
- compartment syndrome
- chest infection
- disseminated intravascular coagulation
late complications of fractures
- deformity
- osteoarthritis
- aseptic necrosis
- reflex sympathetic dystrophy
- pulmonary embolism
immediate post-operative complications
- anaesthetic complications; arrhythmia, hypo/hypertension, stroke/mi, damage from intubation, breathing problems, allergy, hyperthermia
- haemorrhage
early post-operative complications
- fluid depletion
- electrolyte imbalances
- fluid collection
- local infection
- systemic infection
- dvt/pe
- atelectasis
- wound breakdown
- anastamotic breakdown
- bed sores
post-operative complications; small and large bowel
- ileus
- intestinal obstruction
- anastamotic leaks
- stoma retraction
- intra-abdominal collections
- pre-sacral plexus damage
post-operative complications; cholecystectomy
- common bile duct injury
- bile leak
