Mod 4 OSCE Flashcards
1
Q
Order of ECG interpretation
A
- This is a 12 lead ECG of (Name, DOB, Hospital No.)
- Taken on ___
- Speed is 25mm/sec, ECG is calibrated
- Axis Deviation
- Rate
- Rhythm strip - Regularity, P-waves (followed by QRS? Shape?), QRS, T waves, PR intervals, QT
- Rest of the leads - same? R-wave progression? Poor due to prev MI or obesity. Flutter waves?
- Summarise and suggest diagnosis
2
Q
In normal cardiac axis
A
- Lead I is normal
- Lead II is normal (maybe taller than I)
- Lead III is neutral
3
Q
P wave too tall
A
RA abnormality
(congenital heart disease, pulmonary disease)
4
Q
How long should a PR interval be?
A
3 - 5 small squares
5
Q
QT interval is?
A
Time taken for ventricles to depolarise then repolarise
6
Q
QRS too wide?
A
Supraventricular - BBB, Brugada, pre-excitation
Ventricular - Ectopic, pacemaker
7
Q
ST segment elevation
A
STEMI, Pericarditis
8
Q
T wave represents
A
Ventricular repolarisation
9
Q
In which leads would you see changes for lateral heart damage?
A
- I
- AVL
- V5
- V6
10
Q
How wide should a QRS complex be?
A
< 3 small squares
11
Q
In right axis deviation
A
- Lead I is small, neutral, negative
- Lead II is normal
- Lead III is normal, maybe taller than II
12
Q
PR interval too long?
A
1st or 2nd degree heart block
13
Q
P wave too broad?
A
- Valve disease, HTN, Cardiomyopathy, Coronary Heart Disease
14
Q
QRS too tall?
A
Ventricular hypertrophy
15
Q
In left axis deviation
A
- Lead I is positive, small
- Lead II is negative
- Lead III is negative, taller than II
16
Q
T wave - too tall?
A
Hyperkalaemia
17
Q
The anterior surface of the heart is supplied by the?
A
Right Coronary Artery (RCA)
18
Q
Which leads would you see changes in for septal damage?
A
- V1
- V2
19
Q
Q wave?
A
Previous MI
20
Q
What should you screen for after RAV and ICE?
A
- SOB
- Chest pain
- Palpitations
- Syncope/dizziness
21
Q
The inferior heart is supplied by?
A
Right coronary artery
22
Q
ABPI ranges?
A
23
Q
What view is this?
A
Axial
24
Q
Questions in Hx of collapse?
A
3 PS:
- Prodromal symptoms (how did you feel before collapse? Dizziness/blurred vission/nausea)
- Post Event Phenomena (how quickly did you recover? Confusion/Nausea?)
- Precipitant - where were you, what were you doing?
25
PR interval
Time for conduction through atria and purkinjie fibres (via AVN and Bundle of His)
26
Questions for ACS patient after open questions?
Full SOCRATES
27
Questions for post stroke/TIA patient
1. Weakness
2. Sensation
3. Visual changes
4. Speech changes?
5. Facial Droop?
6. Onset/duration and frequency?
28
Specific questions for PMHx?
Risk factors:
- HTN
- DM
- High cholesterol
- Heart attack
- Stroke/TIA
29
History for suspected PVD?
1. Maximum walking distance? Uphill + on flat
2. Screen for 6Ps (pain, pallor, paraesthesia, paralysis..)
3. Any ulcers? Gangrene? Rest pain? --\> Critical Limb Ischaemia
30
How do you calculate the Rate on ECG?
- **300 ÷** no. of large squares from R-R
- If irregular, count the no. of QRS complexes **x 6**
31
haemorrhage shows up on CT as?
Bright white areas - hyperattenuation
32
QRS = ?
Ventricular depolarisation
(atrial repolarisation occurs now but is masked)
33
Putting on ECGs - Procedure?
- Intro - name, DOB, Hospital no,
- Explain procedure
- Ever had done before? Allergies?
- Expose patient
- Attach stickies - Ride Your Green Bike (rt hand, clockwise etc)
- "Lie completely still for me please"
- Check on screen, capture, print
34
What does this show?
intracerebral haemorrhage
35
Ishaemia shows up as
dark areas - hypoattenuation
36
What does this show?
Loss of Insular ribbon
37
Questions for AF? (5 things)
1. Palpitations? Tap it out
2. When do they occur?
3. Any trigger?
4. How often do they occur?
5. How long do they last?
38
Which leads would you see changes in if damage had happened to the anterior heart?
- V3
- V4
39
Questions for FHx
- Any death due to MI \<65?
- Any sudden/unexpected/unexplained death?
40
Septum of the heart is supplied by the?
Left Anterior Descending artery (LAD)
41
What does this show?
Midline shift
42
What view is this?
Coronal
43
What does this show?
hyperdense MCA sign
44
ST segment represents?
Time between depolarisation and repolarisation of ventricles (start of repolarisation)
45
What does this show?
extradural haemorrhage (biconvex)
46
P wave
Atrial depolarisation
47
ST segment depression?
Angina, NSTEMI
48
T wave - QT interval too short/too long \*\*\*
Ventricular arrhythmia
49
T wave - inverted?
Ischaemia, ventricular hypertrophy, BBB
50
What does this show?
subarachnoid haemorrhage
51
Small square = ?
Big square = ?
Small square = 0.04s
Big square = 0.2s
52
Which leads would you see changes in if there was damage to the inferior heart?
- II
- III
- AVF
53
PR interval too short?
Accessory pathway e.g. WPW
54
P wave absent?
AF, Flutter, AVRT, AVNRT
55
How do you present a radiology image?
1. Patient details - Name, DOB, Hospital No
2. Date Taken
3. Method of Imaging and view
4. Most obvious abnormality with correct description (attenuation for CT, signal for MRI)
5. Any other abnormalities, possible negative findings
6. Differentials
7. Working Diagnosis
56
The lateral heart is supplied by the?
Circumflex Artery
57
What does this show?
subdural haemorrhage (crescent shape)
58
What view is thiss?
Saggital
59
