OSCE Flashcards
Mouth Ulcer Danger Eliminations
Duration of longer than 3 weeks ADRs (aspirin, NSAID’s,cytotoxic, nicorandil, beta-blockers) Failed Treatment Ulcers bigger than 1cm More than 5-10 ulcers present Painless ulcers (should be painful) Unexplained Weight Loss Bleeding – ulcers don’t usually bleed Other symptoms
Nausea and Vomiting Danger Eliminations
> 48 hours in adults
Children <2 years
Blood
Chin to chest/neck stiffness
Motion Sickness Danger Eliminations
Glaucoma -pressure in the eye (medication may be a problem – may be antimuscarinic side effects)
Failed treatment (may have been a wrong diagnosis)
Hyoscine/Buscopan used before?
Pregnant and breast-feeding women
Children under 8
Those taking other medication
Drivers who suffer from motion sickness
Heartburn Danger Elimination Questions
Persistant >7 days ADR's Treatment failed >45 and first time symptoms Pain radiating down arm on exertion Weight loss Bleeding Anaemia Vomiting Pain/difficulty swallowing Breathlessness >twice a week
Indigestion Danger Elimination Questions
Persistent >5 days ADR's (NSAID's) Treatment failed >45 and first time Blood in vomit or stools Unintentional weight loss Pain worsens on effort Severe pain Pain radiating to arms/neck Difficulty swallowing Regurgitation Children
Oral thrush Danger Eliminations
Failed medication
Diabetics
Painless lesions
Recurrent infection
Constipation Danger Eliminations
Change in bowel habit of 2 weeks or longer Failure of OTC medications ADRs Blood in stools Presence of abdominal pain/vomiting
Diarrhoea Danger Eliminations
>1 day in children under 1 year >2 days in children under 3 and elderly >3 days in older children and adults Recent travel abroad Presence of blood or mucus in stools Pregnancy Antibiotic use
Haemorrhoids Danger Eliminations
Longer than 3 weeks
ADRs
Blood in stools
Persistent change in bowel habit
IBS Danger Eliminations
Diagnosed before? Unexplained weight and appetite loss Child <16 years Blood in stools No previous history and no factors Failed treatment Travelled abroad N&V
Threadworms Danger Eliminations
Medication failure
Signs of bacterial infection
Recent travel abroad
<2 years old
Cold and Flu Danger Eliminations
Persistent high temperature
Difficulty breathing/wheezing
Coughs Danger Eliminations
Long duration (2-3 weeks) Difficulty breathing Coloured sputum Persistent nocturnal cough in children Croup/whooping cough Chest pain Lumps in neck
Sore throat Danger Eliminations
Long duration (2-3 weeks) ADRs (agranulocytosis) - carbimazole, immunosuprressants Unable to swallow White exudate on tonsils Recurrent infection neck stiffness
Hayfever Danger Eliminations
Failed medications
Wheezing/shortness of breath
Tightness of chest
Headache Danger Eliminations
Steady, dull pain, deep seated and aggregated by laying down Severe and >4 hrs ADRs Children < 12 Head injury/trauma Location and type of pain N&V Neck stiffness/rash that doesnt fade under glass Frequently recurring
Migraine Danger Eliminations
Severe and >4 hrs ADRs Children <12 Head injury/ trauma Location and type of pain Neck stiffness Frequently occurring
Sprians and strains Danger Eliminations
ADRs (drowsiness, diuretics, BP meds)
Medication failure
Suspected fracture
