Osce Flashcards
Inhaler Technique counselling (7)
1- Introduce, Check understanding,
2- Ask about pain or SoB
3- Gen Overview of inhaler
4- Types of Inhaler-saba laba ics etc
5- Show technique -shake, 10s hold in mouth, 30s between next dose
6- Assess patient technique
7- Spacer device technique
Downs Syndrome
screening counsel (7)
1- What is downs (random genetic trisomy, learning
disabilities+health problems, shorter life expectancy, reduced independence)
2- Risks (prev downs, high maternal age, screening detects those at risk)
3- Screening (Non-invasive, done at 10-14 weeks gestation)
4- Blood test
+ultrasound.BHCG, PAPP-A, nuchal translucency.
5- Diagnostic=Amniocentesis/CVS-invasive+miscarriage risk
7- if downs abortion choice next step
Rhesus status in pregnancy (11)
1- what is rhesus (blood group), 15% of females are Rh-ve
2- Partner rhesus, prev pregnancies (ectopics,miscarriages,terminations), Bleeding in current pregnancy?
3- Trauma/procedures risk contamination
4- R+ baby mum Immune will fight
those blood cells-danger in 2nd pregnancy
5- causes Haemolytic disease of the newborn
6- MANAGEMENT: Not needed if baby Rh- or father is Rh-
7- given Anti-D
8- Rh-mum given at 28+34 weeks
9- no risk to baby
10- allergy risk to mother so monitored
Death confirmation (5)
1- Confirm details
2- Assess verbal response
3-Central pulse, heart sounds, respiratory sounds, signs of life-all 5 mins each
4- pupil/corneal reflexes, trap squeeze
5- Document
CBT counsel (7)
1-Talking therapy with psychs confidential
2- 12 weeks
3- for chronic faitgue, depression,anxiety
4- CBT explores thoughts/behaviours
5- helps coping mechanisms
6- talk about life and past
7-Self-help available while you wait
8-explores past and can often make patients feel worse
9-self driven so need to be in good place to take it on/flourish on course
Spacer device (6
1- Asthma understanding
2- Benefits-less waste+less side effects-thrush
3- multi breath-breathe in and out of inhaler 5 times
4- Second is single-hold for 10s
5- online vids
6- Clean weekly, repace 6-12 months
Renal failure (7)
1- PMH
2- prev consults
3- diet+fluids
4- diet (low protein,K, Na,sugar,volume)
6- Risks-Nausea, Itching, Paralysis
7- Refer to dietician
Diabetes control importance and risks
1- PMH
2- Hospital-DKA,hypo
3- Macro-BP,Cardio
Micro-Eyes,Kidney,Neuro
4- Attendance to clinic
5- Monitoring
6- Lifestyle changes-drinking, smoking, diet
7-Sick day rules (don’t stop taking insulin, increase dose if ill, sugary drinks
8- Poor control-explore why?
Osteoporosis diagnosis (7)
1- Introduce and PMH
2-Why DEXA scan done
3- What is DEXA
4- Explain results-weak bones
5- Why-Post-menopausal-low oestrogen, Steroid, Diet, FamHist
6- Cant reverse, can slow progression
(Calcium,exercise, quit smoking/alcohol,prevent falls
7- Explain bisphosponates
SSRI
Action-serotonin balance
Once daily tablet
3-6 months
Wait 1 month to see impact
SEs- GI upset, +/- weight
Contras-suicide risk
Risks-Serotonin Sydrome-High temp,tremor,sweating
Methotrexate
Action-DMARD-suppresses immmune system
Once weekly tablet or injection+ once weekly folic acid on different day
Long term
Effects- 4-6 months
Tests : FBC, LFT, U+E before starting, every 2 weeks until stabilised then
every 2-3 months
SEs-Alopecia, headaches, GI upset
Major comps-Myelosuppresion, Liver toxicity (careful of alcohol)
Contras-pregnancy, conception-6 months prior, Liver disease
Advise-Annual flu jab, avoid NSAIDs/Aspirin
Lithium
Action : Mood stabiliser
once or twice daily tablet/syrup
Lifelong
Effects : 1-2 weeks
Tests : before starting (FBC, U+Es, TFTs. BHCG, ECG)
Check lithium level weekly until stable,then every 3 months
check TFTs,U+Es and Ca2+ every 6 months
SEs- GI upset, metallic taste, fine tremor, water symptoms
Lithium toxicity-GI,dysarthria,tremor
Complications : Renal toxicity, Nephrogenic diabetes insipidus, hypothyroidism
Contras-1st trimester pregnancy, breast feeding, cardiac
disease, Addison’s
Atypical
antipsychotics-eg Risperidone, Quetiapine,Olanzapine, Clozapine
Action-stops over-activity of chemicals in brain
Daily tablet or injection 2-4 weekly
Titrate dose
Longterm
Effects: Several days to weeks
Tests: lfts
Ses-tardive dyskinesia constipation+dry mouth,weight
gain
Neuroleptic malignant syndrome (high fever,
muscle rigidity),
Agranulocytosis,
Lower seizure threshold
Levodopa
Action: replaces dopamine
Given with carbidopa
Every 3-4 daily tablet with food
Lifelong
Effect: fast-acting
Important side effects: Psychosis, N+V, Dyskinesia, Postural hypotension
Comps-End dose deterioration on-off effects
Contras-Glaucoma
Warfarin
Action: thins the blood, blocks vitamin K clotting
Once daily tablet in EVENING
3 months DVT
6 months PE
Lifelong AF/Valve
replacement
Effects: 2-3 days
Titrate dose
Check-INR
SEs-Bleeding,diarrhoea,rash
Interactions senzyme inducers (carbamazepine, rifampicin)
enzyme inhibitors (Metronidazole, erythromycin)
Contras-Pregnancy,stroke,bleeding,falls
Avoid high vitK foods(Liver, spinach)
no NSAIDs/aspirin
