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
Backache Danger Eliminations
Medication failure
Severe back pain
Pins and needles radiating to leg
Middle/upper back pain
Repetitive strain injuries Danger Eliminations
Medication failures
Suspected fractures
Vaginal Thrush Danger Eliminations Questions
OTC med failure Diabetics <16 >60 First occurance More than 2 attacks in the last 6 months Pregnancy/suspected pregnancy Blood stained/strong smelling discharge
Cystitis Danger Eliminations Questions
Failed medications Diabetes Men and children Fever, nausea and vomiting Loin pain/tenderness Haematuria Pregnancy Recurrent
Dysmenorrhoea Danger Eliminations Questions
Abnormal discharge or bleeding
Severe intermenstrual pain
Medication failure
Presence of fever
Insomnia Danger Eliminations Questions
Suspected depression
Lasting >3 weeks
Children < 16 years
Medication failure
Mouth Ulcer referral time
1 week
Oral thrush referral time
1 week
Dyspepsia referral time
1 week
Nausea and vomiting referral time
48 hrs adults
Refer for child <2
Constipation referral time
1 week with OTC
2 weeks with dietary advice
Diarrhoea referral time
1 day in children, otherwise 2 days
IBS referral time
1 week
Threadworms referral time
2-3 weeks
Haemorrhoids referral time
1 week
Colds and flu referral time
10-14 days
Sore throat referral time
1 week
Coughs referral time
2 weeks
Hayfever referral time
5 days
Perennial Rhinitis referral time
5 days
Tension Headache referral time
1 day
Migraine referral time
1 day
Sprains and strains referral time
5 days
Backache referral time
5 days
Repetitive strain injury referral time
5 days
Vaginal thrush referral time
7 days
Cystitis referral time
2 days
Dysmenorrhoea referral time
2 cycles
Insomnia referral time
1 week
