OSCE 2 Flashcards
Myocardial infarction signs and symptoms
Signs:
Pale
Sweaty/ cool skin (diaphoretic)
Hyper or hypotension
Symptoms:
Acute chest pain
Chest pressure
Left shoulder/ lower jaw pain
Shortness of breath (dyspnea)
Other:
Activity makes pain worse
Radiates to one or both arms
Radiates to lower jaw, neck, throat
Myocardial infarction treatment
Send to ER
If in ER- EKG & Cardiac Monitoring
Meds:
Oxygen
Aspirin 325mg chewed up
Nitroglycerin 0.4mcg every 5 min for pain- up to 3 pills
Chest x-ray
Refer to cardiologist
Pneumonia signs/ symptoms
Signs:
Tachypnea (rapid shallow breathing)
Increases work to breath
Hypoxia (O2 saturation < 95%)
Symptoms:
Cough- with or without sputum
Shortness of breath (dyspnea)
Pleuritic chest pain (pain worse w breathing in, coughing…)
Fever/chills
Fatigue
Pneumonia plan
- Amoxicillin 1 gram three times a day X 10 days or Z pak 250mg 2 tabs per day 1 then 1 tab per days 2-5
- (Supportive care idk)
- Chest x-ray
- Sputum culture & possible flu/covid testing
- Follow up in 10 weeks w/ repeated x-ray (if not improving day 7- call office)
Pneumonia treatment
Amoxicillin 1 gram three tabs per day X 10 days
Or
Z pak 250mg 2 tab day 1, 1 tab day 2-5
If O2 < 92%= hospitalized
Chest X-ray
Sputum culture/ possible flu or covid test
Plan aspects
- Wyd ab problem
-medication
-supportive care
-diagnostic tests
-labs
-referral to specialist - Counseling (alc or depression)
- F/U visit
- Patient verbalized understanding & questions answered
Pulmonary- embolism signs/symptoms
Symptoms
Shortness of breath (dyspnea)
Pain w breathing in coughing.. (pleuritic chest pain)
Coughing- non productive
Hemoptysis- BLOOD COUGH
Signs
Tachycardia
Hypoxemia- low O2
Hypotension- low bp
Pulmonary embolism treatment
Meds
- oxygen- 2L supplemental
- anticoagulation meds
Lab tests:
-CBC
-D-Dimer
Diagnostic tests
-CT pulmonary angiography
May need to transfer to ER
F/U couple days after discharge
Patient comes in w/ chest pain and looks pale with sweaty/cool skin.
Patient most likely has?
What meds, labs, diagnostic…
Myocardial infarction
Med
- aspirin 325mg chewable
- oxygen
- nitroglycerin .4 mg every 5 min for pain
Lab
-ekg
-cardiac monitoring
Diagnostic
-chest X-ray
Patient comes in with cough and tachypnea and shows positive egophony
Patient has pneumonia
Meds-
amoxicillin 1 mg three times a day for 10 days
Or
Z pak 250mg 2 1st day, 1 day 2-5
Labs-
Sputum culture
Posible flu/ Covid test
Of O2 < 92%= hospitalized
F/u in 10 weeks- call office if not better in 7 days
Deep vein thrombosis signs/symptoms
unilateral leg swell
leg/calf pain, especially with walking
warm & red skin area of pain
pain over course of major vein affected
special test DVT
perform MSK tests @ joints near suspected DVT in order to eliminate possible msk injury
treatment DVT
immediate labs/ultrasound
CBC
D-dimer
coagulation study (if genetic in history)
compression venous doppler of affected leg
follow up
if above knee be concern with PE (anticoag meds, may need transfer EMS)
below knee 5 days
patient present with calf pain after long flight what is it and how treat?
deep vein thrombosis
immediate labs/ultrasound
CBC
D-dimer
coagulation study (if genetic in history)
compression venous doppler of affected leg
follow up
if above knee be concern with PE (anticoag meds, may need transfer EMS)
below knee 5 days
Rotator cuff treatment
Rest
Nsaids (ibuprofen 800mg TID)
OMT- if partial tear
Suggest Physical Therapy
Xray: if trauma
Possible joint injection
MRI of joint if 8 weeks of OMT or PT does not help
Orthopedic referral greater than 6-12 month
rotator cuff special test - supraspinatus
empty can sign
rotator cuff special test - infraspinatus/teres mino
pt elbow flex 90
apply medial pressure & patient press against
rotator cuff special test - subscapularis
pt flex elbow 90
apply lateral pressure & patient resist
signs/symptoms meniscus injury
swelling if large tear
trauma with acute pain
knee lock/catch
complain knee gives out
no grinding
treatment acute meniscus
Get xray if needed (Ottawa)
>55 years old
tender @ patella or fibular head
can’t flex knee to 90
can;’t bear weight 4 steps
Medications: Diclofenac 50mg BID
Rest knee, Ice for 15 minutes every 4 hour Knee brace, elevate knee while icing knee.
Use knee every hour
Referral to Orthopedic surgeon if significant injury or swelling seen along with tests, ACL tear present
F/u in 1 week
when to use CAGE
alcohol screen
women >1 drink a day
men >2 drink a day
CAGE
Cut back (ever feel need to?)
Annoyed (felt annoyed by criticism drinking?)
Guilt (felt guilty about drinking?)
Eye opener (take drink first thing in morning?)
when to use SIGECAPS
if you think they have signs of major depression/suicide
is positive test if get at least 5 yes to the questions
SIGECAPS
Sleep changes
Interest changes
Guilt
Energy changes
Concentration changes
Appetite changes
Psychomotor changes
Suicide/Homicide thoughts, plans (homicide police call)
what must you do if use CAGE?
assign hw for patient to think about why inclinced to drink
