OSCE Flashcards
What are mnemonics for difficult direct laryngoscopy?
LEMONS
Look externally (gestalt)
Evalute 3-3-2
Mallampati = PUSH
Obstruction/Obesity
Neck mobility
Space (access to patient)/Skill
What is the mnemonic for difficult bag mask ventilation?
ROMAN
Radiation/Restriction (eg stiff lungs, COPD, cancer px)
Obstruction/Obesity/OSA
Mask seal/Male/Mallampati = male
Aged
No teeth = put an OS or gauze in part with the leak
What is the mnemonic for difficult extraglottic device?
RODS (for difficult airway alternatives)
Restriction (ie mouth opening, stiff lungs)
Obstruction/Obesity
Distorted Anatomy
Short thyromental distance
What is the mnemonic for difficult cricothyroidoctomy?
SMART
Surgery
Mass
Access/Anatomy
Radiation
Tumor
What should be evaluated in a px for inadequate ventilation due to poor inspiratory effect?
Chest walll movement
Respiratory rate
Pattern and depth of breathing
Use of accessory muscles
Abnormal sounds
Signs of injury
What is the diff betw partial airway and complete airway obstruction?
Partial obstruction = snoring, gurgling sounds
Complete osbutrction = accessory muscles, cyanosis, respiratory arrest
What are facial features to note in evaluationg anatomic airwya?
Small mouth
Facial hair/beard
High-arched palate = down syndrome
Short/long neck
Receeding chin
Protruding/buck teeth
What are the diff airway maneuvers?
Head tilt chin lift = if cervical spine injury is not a concern
Jaw thrust = if cervical spine injury is of concern
What are the diff basic airway adjuncts?
Oropharyngeal airway (OPA)
Nasophatyngeal airway
What do airway adjuncts do not do?
Pass the larynx
Protect the trachea from aspiration of secretions
Substitute for definitive airway
What are oropharyngeal airway adjuncts?
Curved, firm, hollow tube with a rectangular apertue
Used to maintain a conduit betw mouth and glottis to prevent obstriction by the px’s tongue and other soft tissue
What are indications of OPA?
Complete/partial obstruction of upper airway
Bite block in unconscious or intubated px
Adjunct for Oropharyngeal suctioning
What are C/Is for OPA?
Use with caution on awake, responsive px
Do not use on px with intact gag reflex
Should not be used in px with oral trauma
What are complications of OPA?
Soft tissue trauma
Vomiting
Exacerbation of airway obstruction
What are indications of nasopaharyngeal airway (NPA)?
Awake/semi-comatose px
Clenched teeth
Unable to lcoate OPA
Inadequate airway patency
What are C/Is for NPA?
Responsive px
Suspected fracture to the base of the skull or midface
What are the indications of bag mask ventilation?
Absent or inadequate spontaneou ventilation
Preliminary pre-oxygenation when intubation is planned
Short-term oxygenation when ventilation is temporarily compromised
What are the 3 critical errors in ventilation?
Excessive tidal volumes
Forcing air too quickly
Ventilating too rapidly
What are the adult ventilation rates?
Respiratory rate = 10-20/min
BLS/ACLS CPR Ratio compression: ventilation = 30:2 (2 breaths after every 30 chest compressions)
ACLS/CPR with advanced airway = 8-10/min (1 respiration every 6-8 secs, asynch with chest compression)
Respiratory Arrest = 10-12/min (1 respiration every 5-6 secs)
What rapid sequence induction and intubation is done with application of backward or downward pressure on the cricoid cartilage to occlude the esophagus?
Sellick’s maneuver/Cricoid pressure
= used to prevent aspiration of gastric events
What is the measurement of the bandage in the arms and legs?
3in = small limbs of children
4in = arms, forearm
6in = legs, thighs
What are indications of circular cast?
Fracture of distal femur
Fracture of proximia tibia
Fracture of tibial shaft
Goals: stabilize distal upper leg & lower leg
WHAT ARE THE diff methods of bandaging?
Circular bandage
Spiral bandage
Reverse spiral bandage
Figure of eight
RECURRENT bandage = stump or head injury, fingers & hand also
Ankle bandage
Where do u do figures of eight?
Joints
- knees, ankle, elbow and wrists
What should be observed in the px during orthoepdia exam?
GALS
Gait
Arms
Legs
Stance
What is the order of sequence of orthopedia exam?
Insoection
Palpation
Passive movement
Active movement
What device is used to measure angles?
Goniometer
Stationary arm = align with proximal line of reference point
Moving arm = place along moving arm in line with long bone
What are the important dermatomes of the upper ex?
C4 = deltoid/shoulder
C5 = biceps/flexion of elbow
C6 = wrist extensors
C7 = triceps/elbow extension
C8 = wrist flexors
T1 = finger abducction
What are the important dermatomes of the lower ex?
L2 = hip flexion
L3 = knee extension
L4 = ankle dorsiflexion
L5 = great toe extension
S1 = ankle plantarflexion
What are the diff neurological and vascular assessment?
Pulse and capillaryrefill time
Power
Reflexes
Sensations
Muscle tone
What are diff special tests/techniques?
Measuring hte length of the legs
Describing limited motion of a joint
What is the joint of the shoulders?
Glenohumeral joint
What are the diff special maneuvers of the shoulder?
Likelihood ratio
= probability of obtaining a giver test result in a diseased px divided by probability of obtaining a gievn test result in a non-diseased px
Pain provocation test
= painful arc test = has a positive LR of 3.7
= Neer test = Positive LR <2 (less diagnostic)
= Hawkins test = Positive LR is <2 (less diagnostic)
Strength tests
-> internal rotation lag test
-> external rotation lag test
-> drop arm test
-> positive LRs of 7.2, 5.6, and 3.3
What are other tests for the shoulders?
Laxity
Sulcus test = assess the glenohumeral joint for inferior stability
Apprehension
What are special maneuvers of the elbow?
Cozen test = lateral epicondylitis or “tennis elbow”
Mill test = passive stretching of wrist extensors
Maudsley test = resisted extension of middle finger with wrist extended
What are the maneuvers of the fingers and hands?
Test sensation for
Median nerve = pulp of index finger
Ulnar n = pulp of fifth finger
Radial n = dorsal web space of thumb & index finger
How long does a local anesthesia last? What should u prescribe for this?
2 hrs
After anesthesia:
- analgesic
- antibiotics
What is the sequence of donning & removing PPE?
Donning = Gown > Mask > Goggle/face shield > Gloves
Doffing = Gloves > Goggle/face shield > Gown > Mask
What are the agents used in routine hand wash, antiseptic hand wash, antiseptic hand rub, surgical antisepsis?
Routine hand wash = water & non-antimicrobial soap
Antiseptic hand wash = water & antimicrobial soap
Antiseptic hand rub = alcohol based hand rub
Surgical antisepsis = water & antimicrobial soap + alcohol based surgical hand scrub
What are the diff sterilization techniques?
1. Ethylene oxide sterilization: heat-sensitive instruments (plastic, suture material, lenses, and finely-shaped instruments)
2. Chemical sterilization (cold): bactericidal, fungicidal, virucidal, sporicidal
3. Radiation sterilization: prepacked surgical equipment
4. Filter sterilization: removal of microorganisms in fluids & gasses
5. Gas Plasma: heat & moisture-sensitive devices and surgical instruments
What are the result of rinne and webber test for conductive and sensorineural heairng loss?
Conductive hearing loss (bone)
Rinne: BC>AC
Weber: lateralizes on the affected ear (heard better here)
Sensorineural hearing loss (nerve)
Rinne: AC>BC
Weber: lateralizes on the normal ear (better hearing there)
What are the 2 tests for visual cuity?
Far visoin = 20ft with snellen chart
Near vision = 14 in with pocket chart
What CNs are responsible for gag reflex?
CN IX & X
What aer the 2 lymph nodes checked during breast exam?
Axillary nodes
Supraclavicular nodes
What is the Grey turner sign and Cullen sign?
Grey turner sign = ecchymosis of the flank & groin seen in hemorrhagic pancreatitis
Cullen sign= periumbilical ecchymosis from retroperitoneal hemorrhage or intra-abdominal hemorrhage
What are the normal bowel sounds, rate?
Normal rate = 2-5clicks/min
Normal bowel sounds = low pitched and gurgling
What is the normal liver span?
6-12cm in the R midclavicular line
4-8cm in midsternal line
What is the Castell’s point?
Most inferior interspace on the L anterior axillary line (spleen area)
What are the indications of catheterization?
*Chronic urinary retention
*Cystography = way to check if thre is perforation of bladder or UB injury
What are C/Is of cathetization?
Acute prostatitis
Urethral injury in trauma px with blood noted per meatus
What are the measurements of French catheters?
1 Fr = 0.33m
24 Fr = 8mm
What aer the diff types of catheter and for what condition do u use it?
*Indwelling catheter = long period of time & accurate output monitoring
- temporaory or permanent drainage for urinary/bladder outlet patho
*intermittent catheter = removed once the bladder is completely emptied
What aer the diff parts of the catheter and its use?
Drainage eye**: where urine flows in
**Balloon anchor: enables catheter to be indwelling and avoid slipping our of the px’s bladder
Catheter shaft**: longest part of the catheter
**Inflation funnel: insertion of sterile water to inflate the balloon anchor
*Irrigation funnel: not seen in 2 way catheter
What are the 3 types of catheter and its use?
single lumen catheter**: 1 lumen for drainage (intermettent catheterization)
**2-way catheter: most common (1 drainage, 1 balloon inflation
*3-way catheter: continously irrigate the urinary bladder with sterile saline (1 drainage, 1 balloon, 1 irrigation fluid)
What is the most preferred material for catheter?
Silicone = avoids microbial growth
What are the measurements of FOley catheter/other catheter used in practice?
*French 16 2-way catheter = readily available
*French 24 3-way catheter
*Robinson’s catheter = 1 lumen for intermittent catheter
What are the positions of the patient in catheterization?
Males: supine
Females: Lithotomy or frog leg
How long can u use a latex catheter and silicone catheter?
*Latex catheter = 14 days
*Silicone catheter = 4-6wks
What are C/Is of DRE?
*thronbosed hemorrhoids
*Imperforate anus
*abdomino-perineal reaction surgery
*acute prostatitis
*recent cardiac event (MI)
What is the proper position of the px during DRE?
Lateral decubitus position or standin gposition
What are the outer diameters of 18, 24, & 30Fr urethral catheter?
18Fr = 6mm
24 Fr = 8mm
30 Fr = 10mm
What are indications of NGT?
*enteral feeding
*decompression of stomach and its contents in case of bowel obstruction
*obtain specimen of gastric contents
*drainage and lavage in drug overdose or poisoning
What aer C/Is of NGT insertion?
Severe facial trauma (cribriform plate disruption
What is used to remove fluid from the surgical site?
Bulb drains
What aer the natural and synthetic absorbable sutures?
Natural
*Plain gut
*chromic gut
Synthetic
*Vicryl rapide
*Vicryl plus
PSD II
*Monocryl
How long is wound support and mass absorption in plain gut and chromic gut?
Wound support
*Plain gut: 7-10 days
*chromic gut: 17-21 days
Mass absorption
*plain gut: 60-90 days
*chromic gut: 90-110 days
A patient who complains of “loose” shoulder. One of the tests will not be helpful in confirming this.
a. Anterior - posterior stress test
b. Sulcus test
c. Apprehension test
d. Jobe’s test
Answer: D = a composite
test for the shoulder testing for supraspinatus
rotator cuff tear
A, B & C = special test
for instability of the shoulder
A patient has weakness of wrist flexion. Where is the lesion?
a. T1
b. C7
c. C6
d. C8
Answer: C6
Upper Extremities
■ C4: Deltoid / Shoulder
■ C5: Biceps / Flexion of elbow
■ C6: Wrist extensors
■ C7: Triceps / Elbow extension
■ C8: Wrist flexors
■ T1: Finger abduction
○ Lower Extremities
■ L2: Hip flexion
■ L3: Knee extension
■ L4: Ankle dorsiflexion
■ L5: Great toe extension
■ S1: Ankle plantar flexion
As a general physician you are expected after taking the Hx and PE, when confronted with diabetic foot ulcers of the following except one?
a. Amputation of a single toe as an emergency procedure
of those with sepsis
b. Reliance on a single test such as Doppler pressure
c. Hospital based referral for ulceration and tissue
necrosis
d. The assessment of the vascular status of the foot
Answer: B
in the management of diabetic foot
ulcers it is important not to rely on a single
finding such as the doppler pressure as this may
be misleading
In diabetic patients, deformity of the foot results generally from which of the following?
a. Impairment of motor function
b. Clawing of toes
c. Impairment of sensory function
d. Muscle imbalance
Answer: C
- Deformity of the foot is not addressed early
on because of lack of sensory function
For a patient who has sustained an overuse injury to the abductor pollicis longus and extensor pollicis brevis tendon, what finding can give you a confirmation of this:
a. Finkelstein test is present
b. pain on range of motion of wrist
c. Tenderness at the anatomical snuffbox
d. Madelung’s deformity
Answer: A
- Injury to the abductor pollicis longus and
extensor pollicis brevis tendon (tendons on the
thumb side of the wrist) indicate de Quervain
tenosynovitis, confirmed by a positive (+)
Finkelstein test
The following items can be used for emergency immobilization except:
a. Popsicle stick and scotch tape
b. Nylon rope and cloth
c. Elastic bandage and wooden board
d. Newspaper rolls and duct tape
Answer: B
If one will use nylon rope and cloth, material
for holding the immobilization in place (i.e. tape)
will be lacking
Among the choices below, the first layer that is nearest the skin during a CASTING procedure is the:
a. Plaster of Paris
b. Cast padding
c. Waddling sheet
d. Fiberglass roll
e. Stockinette
Answer: E = - Closest to the skin to prevent skin irritation; optional
A, C - Options for casting material; outermost for
setting
B, D- Cushion bony prominences; placed after
stockinette
The best technique for wrapping joints with a bandage is:
a. Figure of 8 roll
b. Circular roll
c. Semi-circular roll
d. Spiral roll
Answer:A = used over joints or
bandaging around a joint which is a junction of 2
axes (e.g. the shoulder is the junction between
the appendicular axis and the axial axis)
B = circular roll is indicated as a usual
technique in injured limbs, used over a tubular
area like the arm or leg
D - Spiral (or reverse spiral) bandage is a
technique used for application of compression
bandaging
A patient who has an injury of the proximal interphalangeal joint on her ring finger from a basketball game will benefit with:
a. Short arm splint
b. Long arm splint
c. Ulnar gutter splint
d. Buddy Taping
Answer: D = immobilizing the
fingers; this type is less rigid and will permit
some motion in flexion and extension. It will need the adjacent LONGER DIGIT as its buddy
A - Short-arm splint: Spans from the knuckles and distal palmar crease distally up to 4 cms. from the cubital fossa proximally
**B **- Long-arm splint: Spans from the **knuckles and distal palmar **crease distally up to 4 cms. below the axilla proximally
**C **- Ulnar gutter splint: flexible splint that is used to
support, stabilize, and immobilize injuries,
dislocations and fractures of the hands, fingers, or
wrists (not mentioned in lecture)
