OSCE Flashcards
ICE format for Iron supplementation
Ideas
“Have you heard of iron supplements before?”
“Do you know why iron is important for health?”
“Have you ever been told that you have low iron before?”
Concerns
“Is there anything that worries you about taking iron?”
“Have you any concerns about your physical health at the moment?”
Expectations
“Do you understand the benefits of taking iron supplements?”
“What are you hoping iron supplements will do for you?”
What is the role of iron in the body?
- Transport of oxygen in red blood cells
- Providing oxygen to muscles, especially skeletal and cardiac muscle
- Acting as a co-factor for important enzymes
- Playing a role in immune response
When should you take iron supplements?
Iron is absorbed best if taken an hour before a meal.
Side effects of oral iron?
- Nausea
- Constipation
- Diarrhoea
- Dark-coloured stools
- Metallic taste
What foods are rich in iron?
- Red meat
- Leafy vegetables
- Dried fruit and nuts
What is the other vitamin important to consider when taking Iron supplements?
Vitamin C combines with iron to form an iron chelate complex which makes iron more soluble and results in increased uptake of iron in the small intestine
What are the benefits of blood transfusion?
- Can relieve symptoms caused by anaemia
- Can prevent damage caused to organs associated with anaemia
- Can allow earlier mobilisation and quicker recovery after an operation, acute illness or injury
What is the risk of a serious problem occuring with blood transfusion?
1 in 10,000
What are some of the possible risks of blood transfusion?
- Identification error (never event)
- Reactions
- Build-up of fluid
- Infection
- Formation of antibodies
- Iron overload
CAGE questions for alcohol dependency
- Ever felt you should cut down
- Been annoyed by people telling you to cut down
- Do you feel guilty about how much you drink
- Eye opener: ever had a drink first thing in the morning.
What special tests can you do in a hip examination and what are they looking for?
- Thomas’s test - used to assess for a fixed flexion deformity DO NOT PERFORM IN PATIENTS WITH HIP REPLACEMENT
- Trendelenburg’s test - used to screen for hip abductor weakness
What special tests can you do in a spinal examination and what are they looking for?
- Schober’s test - can be used to identify restricted flexion of the lumbar spine which may occur in Ankylosing Spondylitis
- Sciatic stretch test (a.k.a straight leg raise) - used to identify sciatic nerve irritation
- Femoral nerve stretch test - used to identify femoral nerve irritation
What are the cautions you should consider when prescribing steroids?
- Hepatic impairment
- Unhealed wounds
- Stomach ulcers
- Pre existing medical conditions
- MH problems
How to take steroids?
- Should be taken same time each day, usually in the morning
- Oral steroids should be taken with or soon after a meal
What should you do for a missed dose of steroids?
Should take it as soon as they remember but if it is the next day, they should not take two doses to compensate for the forgotten dose
What are the short term side effects of corticosteroids?
- Sleep disturbances and insomnia
- Weight gain: due to increased appetite and fluid retention
- Mood changes
What are some of the long term side effects of corticosteroids?
Cushing’s syndrome
Osteoporosis: increased risk of fractures
Proximal muscle weakness
Hypertension
Hyperglycaemia and diabetes
Increased risk of infection
Adrenal insufficiency (see below)
Peptic ulceration
Cataracts
Mental health problems: depression, psychosis, delirium or suicidal thoughts
What is Lithium?
It is a mood stabiliser. Used to treat a variety of mood disorders such as Bipolar and depression
What does lithium do?
“Lithium works by changing the way your brain processes signals to help stabilise your mood.”
How do you take Lithium?
- Tablet and Liquid form/
- Swallow the medication with lots of water
- Take at night at the same time every day
- Do NOT stop taking lithium suddenly or change dose without speaking to doctor first
- If you miss a dose do not take a double dose and instead take the next dose as normal
How often are you monitored on Lithium?
Bloods every week at the beginning of treatment
Once a month once more stable then
Every 3 months once stabilised on the drugs
Also require 6 months TFT, U&E and Calcium
What are the common side effects of Lithium?
- Increased thirst
- Increased volume and frequency of urination
- Tiredness
- Weight gain
- Fine tremor
When should you encourage a patient taking lithium to seek medical attention?
- Confusion
- Drowsiness
- Problems with vision
- Loss of appetite
- Difficulty speaking
- Seizures
- Excessive thirst and urination
What should you discuss when counselling about Lithium?
Pregnancy
Breast feeding
What facial signs would you see in Cushing’s syndrome?
- Facial fullness and rounding of the face
- Facial acne
- Hirsutism
- Butterfly rash
What should you do in a Cushings examination?
Mostly general inspection of face abdomen and legs
- Test for visual field defects
- Stand from sitting to show proximal myopathy
What should you do in an Acromegaly examination?
- Inspection of face, hands
- Palpate the hands for thickening of the skin
- Pulses and blood pressure
- Tinel’s and Phalen’s test for carpel tunnel syndrome
- Axillae for acanthosis Nigracans
- JVP
- Thyroid palpation
- Visual fields
- Proximal myopathy
What pulses can be felt in the feet?
Posterior tibial pulse
Dorsalis pedis pulse
What does a Bruit indicate?
Increased Vascularity
What is ‘infertility’
A couple is considered infertile if they have not conceived after a year of regular, unprotected intercourse.
What factors should you talk about in infertility counselling?
Pregnancy history
Menstrual history
Sexual history (STI Screen)
PMH
Allergies
DHx
FHx
SHx (smoking, alcohol, recreational drug use)
Partner history
What is Acne?
A problem with the hair follicles and their associated glands in the skin
What is psoriasis?
A chronic inflammatory skin condition characterised by clearly demarcated red scaly plaques
