OSCE Flashcards
Paediatric BLS
DRSABCDE
D - danger R - response - stimulate (not shake) S - Shout for help A - head in Neutral position B - look/listen/feel 10s --> 5 rescue breaths C - Chest compressions, 1 finger above xiphi
15:2
–> go get help after 1 min CPR
Differences between adult and child:
1) PBLS: 5 rescue breaths before circulation
2) CPR 1 min before leaving
3) Different airway position (neutral)
4) 15:2 , not 30:2
5) Chest compression different
6) In adults check breathing/circulation at same time
DR ABCDE CROUP
DRS
A - look in airway without distressing child
B - look listen feel - signs of resp distress
measure (02/RR), treat : 02, CXR?
C
D
E
Tx:
- Single dose oral dex 0.15mg/kg
- Nebulised budesonide 2mg
- Nebulised adrenaline up to 5ml 1:1000
- Call ITU
- Write in notes
- Monitor O2 + HR
Ethics + Law : Paediatric refusal of treatment
- Find out why tx refused
- Find out if parents want tx or not
LAW (Gillick vs HA 1985)
- Children
Headache hx
SOCRATES
Aura? Visual/auditory/sensory/speech
Associated (N+V, photo/phonophobia)
Aggravating factors: light, routine activity, tiggers (chocolate, cheese, caffeine, alcohol, anxiety)
Red flags:
- Fever, neck stiffness, rash
- Fits
- Reduced consciousness
- Traumatic injury
- Travel abroad (malaria)
- Scalp tenderness (TA)
- Loss/change in vision
- Loss of power/sensation in limbs
Ddx:
- Stress/tension/cluster/migraine
- Chronic raised ICP
- Medication misuse
- Sinusitis/otitis media
- TIA
- Meningitis
- Encephalitis
- SAH/ head injury
- Glaucoma
- TA
OCP for 15 yr/old
Brief Sexual & Menstrual history: partner age, consensual, previous contraception, exchanging money. Possibility of current pregnancy?
PMH/SH:
- FH of breast/ovarian cancer/ clots
Gillick competence to fraser guidelines:
- Understands advice
- Cannot be persuaded to tell parents/allow doctors to
- Likely to continue having unprotected sex without
- Physical/mental health liekly to suffer unless receives contraceptive advice
Will you tell her parents:
- No law imposing duty on doctors to disclose information young person wants to keep confidential
EXCEPT in cases where child at risk of neglect/abuse - Children act 1989 - duty to disclose to child protection service.
Meningococcal sepsis medication dose?
Ceftriaxone IV 80mg/Kg
Psoriasis station:
1) What is psoriasis
2) Can it be cured?
3) treatments available
4) What happens if worsen/other tx?
1) Common, hereditary Inflammatory T cell mediated disorder characterised by thickening (hyperproliferation) of the top layer of skin (epidermis).
Results in itchy, scaly red plaques
Often one xtensor surfaces and scalp
- Non infectious
Triggers; stress, infection, trauma, drugs, Alcohol
Associated features:
- Nails: pitting, onycholysis
- Psoriatic arthropathy
2) Lifelong relapsing-remitting condition with no current cure, but can be managed very effectively
3) Tx:
1) Emolliants/bath oils/soap substitutes
2) Topical treatments:
- Vit D
- Coal Tar
- Dithranol
- Topical steroids
3) Phototherapy:
pUVA
UVB
4) Systemic:
- Retinoids
- Fumaric Acid
- Hydroxycarbamide
- Immunosuppressants:
- -> Methotrexate
- -> Ciclosporin
5) Biologics
- Anti-TNF Eg. Etanercept
- Anti IL-12/23
Paed wheeze Resp Hx:
SOCRATES eg. for Wheeze. Intermittant/constant Associated symptoms (cough, pyrexia, coryza, poor freeding, weight loss, rashes, sweating with feeds - Previous episodes
PMH:
- Atopy
- FH
Neonatal period
Developmental hx
Immunisation Hx
Wheeze Ddx:
- VIW/ Asthma
- Bronchiolitis (RSV/adenovirus)
- GORD/aspiration
- Chronic lung disease of prematurity
- CF
- Atypical pneumonia (mycoplasma)
- HF : Cardiac wheeze
Ritalin communication station;
What is it?
Why is it used?
What are the SE?
How will you monitor George?
1) Ritalin (methylphenidate) - stimulant that works as an indirect sympathomimetic to increase the release of DA and NA
- -> NOT a cure, only modifies behaviour
2) Benefits:
- Control difficult behaviours by increasing conc + attention and reducing impulsivity
- effective in 70% individuals
3) Like having too much coffee: Decreased appetite, anxiety, GI disturbance, insomnia, tics, hypertension, seizures, growth suppression
- -> Drug holidays required - long term use may lead to growth suppression
4) Investigations before treatment:
- Height, weight, blood pressure, LFTs
Regular monitoring by specialist:
- Height every 6 months
- Weight at 3 months, then every 6 months
- HR + BP every 3 months
–> med stopped if no response after 1/12
- Suspend med every 1-2 yrs to assess condition
Stopping drug:
- not addictive if correct dose taken
- Avoid abrupt withdrawal to prevent SE
Other treatments:
1) Cognitive behavioural therapy
2) Parent management training
3) family therapy
4) Educational intervention
LEAFLET
Child with UTI in GP
1) Clarify symptoms: dysuria, frequency, urgency, loin pain, haematuria, fever
2) PMH, DH, allergies, FHx
–> Ask risk factors for diabetes, pregnant, problems with water works as a child
Advice about how caught:
a) 20-40% of women will get during life
b) close proximity of anus and urethra
c) Urinary stasis
d) Sexual intercourse
Mx:
eg. Trimethoprim 200mg BD for 3 days
- Increase fluid intake
How to prevent: A) Urinate frequently - Double void b) increase fluid intake c) Void after intercourse d) Wipe from front to back
LEAFLET
Paediatric vomiting Hx
Vomit: Timing, freq, volume, contents, colour, odour, bile/blood, projectile? Hungry after?
Associated fever, cough, diarrhoea?
Signs of dehydration: Wet nappies, soiled nappies, dry tears, sunken eyes
Neonatal/developmental/immunisations
FH: Childhood vomiting?
DDx: Pyloric stenosis, GORD, Gastroenteritis, Intersusception, Overfeeding, Milk allergy, UTI
OSCE: High Cholesterol Councelling in GP
Set Agenda
What do they know
2 types: HDL (Good) & LDL (Bad)
Risks: Heart disease, Brain (stroke) & Kidney
Pt risk factors:
- FH
- PMH: HTN/Diabetes?
- Smoking/alcohol
- Diet & Exercise
- Current Wt
Secondary causes of hypercholestrolaemia:
- Alcohol
- Nephritic syndrome
- Hypoth
General hx: Pmh, FH, SH
Mx:
- Diet/ Lifestyle
1) Exercise/lose weight
2) Reduce animal fats (Sat) and increase plant (unsat) - -> try little things first eg. margarine –> butter
- add salad
- Reduce fried food content (Baked instead)
3) Medical; - Statins - protects vessels & lowers cholesterol
- Only when absolute QRISK >20% in 10yrs
F/U in 1 mo, monitor HDL/LDL, Leaflet
OSCE: Woman at GP with UTI, explain Diagnosis & Mx to her
Quick history: Dysuria, frequency, urgency, loin pain, haematuria, fever
Find out what she knows
Explain UTI + how you get (common, anus, stasis, sex)
Check Risk factors: diabetes, pregnancy, problems with waterworks as a child
Explain Mx (check allergies/previous tries) - Trimethoprim 200mg BD for 3 days - Ask about pill
Tips on prevention
- Drink lots
- double void
- Wipe front to back
- Urinate after sex
Pt.co.uk Leaflet
OSCE: Smoking cessation at GP
Current smoking habits
Why quit?
- -> Motivation
- -> Confidence
What have you tried before
What worked/didn’t work
Suggestions? - Cold turkey vs nicotine replacement: - Patch Gum Inhalator Nasal spray
Meds:
Buproprion
- Antidepressant - stops enjoyment of cigarettes
SE: GI, Taste change, dry mouth, insomnia, tremors
CI
GP OSCE: parent wants Abx for childs sore throat
Agenda
ICE
History:
- Exudates
- Cough
- Temperature
- Lymphadenopathy
- Watery eyes
- Runny nose
Mx; If centor less than 3, no abx
Most likely viral - we don’t have drugs that can kill viruses like abx
Don’t want to give you abx just in case:
- may upset stomach
- interact with other drugs
- Make our natural body bugs resistance
Self-care recommendations
- Analgesia - ibuprofen/Paracetamol + Difflam gargle (Local anesthetic/NSAID)
- Fluids + rest + salt gargle
- Don’t whisper
SAFETY NET:
- sx not better in 1/52, come back
- if fever worsens >38.5, neck swelling making it hard to swallow liquids or breathe, call us urgently
