OSCE Flashcards
describing chest X-ray quality
Rotation = look at spinous processes/clavicular heads Inspiration = 7 ribs anteriorly Penetration = vertebrae behind heart Exposure = good definition
describing an abnormality on XR
1) . number: single, multiple
2) . shape/size: round, lobulated
3) . composition: radiolucent/opaque, fluid level
4) . location
5) . margin: well circumscribed?
6) . associated features
colostomy vs ileostomy
colostomy = flat, formed stool, left sided ileostomy = spouted, liquid stool, right sided
nephrostomy bag would be central and collecting urine
SPIKES
Setting Perception Invitation Knowledge = chunk and check, diagram? Empathy Summarise and strategise = questions? treatment plan, teams involved, leaflet, specialist nurse, follow up appt
chronic disease review
- current symptoms
- compliance with therapy
- red flags/complications
- functional state
- disease knowledge: sick days, rescue packs
- ICE
ATHLETICS
Action Timeline How to take Length of treatment Effects (time taken to act) Tests (monitoring) Important SEs Complications Supplementary advice
fasting rule
usually 2-6 rule:
nil by mouth for 2 hrs before procedure
clear fluids only from 6 hrs before surgery to 2 hrs
post-operative
wake up in recovery area
- may be tubes (catheter, drains)
- pain control methods
- may be limitations, eg. mobility, food and drink
- VTE prophylaxis
- physio/OT
general potential complications of surgery
- anaesthetic (sore throat, arrhythmia, breathing problems, MI, stroke)
- bleeding
- damage to neary organs
- infection (local/systemic)
- VTE
- pain
ATHLETICS SSRI
A = affect NT serotonin T = once daily H = tablet L = may stop 3-6mo after feeling better (tapered off) E = ~month to take effect T = n/a I = tummy upset, appetite, weight, drowsiness, sexual dysfunction, suicide risk C = suicide risk S = www.mind.org.uk /headspace
ATHLETICS methotrexate
A = DMARD, reduces inflammation and immune response T = once weekly with folic acid on other days H = tablet L = long term E = ~month to take effect T = FBC, LFT, U+Es before starting then every 2 weeks until stable, then every 3 mo I = alopecia, myeosuppression (A+E if infection signs), bleeding/bruising/anaemia C = myelosuppression, liver disease, lung disease, pregnancy (inc male if trying) S = no NSAIDs/aspirin, versusarthritis.org.uk
ATHLETICS lithium
A = mood stabiliser
T = once or twice daily
H = tablet
L = lifelong if effective (regular psychiatrist review)
E = 2 weeks
T =
> before starting: FBC, U+Es, TFTs, BhCG, ECG
> Check Li level weekly until stable then every 3 mo
> Check TFTs, U+Es, Ca2+ every 6 mo
I = tremor, water symptoms, GI, metallic taste, toxicity (GI, neuromuscular, drowsiness)
C = pregnancy 1st trimester, renal toxicity, nephrogenic diabetes insipidus, hypothyroid
S = www.bipolaruk.org
ATHLETICS atypical antipsychotics
A = tones down overactivity of NTs T = once daily H = tablet or depot every 4 wks L = long term E = days-wks T = LFTs, FBC for agranulocytosis, ECG for clozapine I = anti-dop = movement disorders, anti-cho = constipation, anti-hist = weight, drowsiness, anti-adren = hypotension C = liver failure, epilepsy, parkinsons, pregnancy S = www.rethink.org.uk
ATHLETICS levodopa
A = replaces dopamine brain cannot make T = 3-4x daily with food H = tablet L = as long as is effective (effect wears off usually after 5 yrs) E = fast-acting T = n/a I = psychosis, GI, dyskinesia C = glaucoma S = parkinsons.org.uk
ATHLETICS bisphosphonates
A = helps rebuild bone and reduce bone loss, lifestyle factors further help T = weekly (or smaller daily dose) H = swallow on empty stomach with full glass of water, be upright for 30 mins after L = long term E = n/a T = dental check ups regularly (BRONJ) I = indigestion, GI, headache C = BRONJ, pregnancy, dysphagia, stomach ulcer S = theros.org.uk
ATHLETICS warfarin
A = thins the blood, vit K T = daily H = tablet L = DVT = 3mo, PE = 6mo, lifelong for AF E = 2 days T = regular INR monitoring I = bleeding, GI C = pregnancy, bleeding risk S = avoid liver, spinach, cranberry juice, alcohol binges. no NSAIDs/aspirin
ATHLETICS levothyroxine
A = synthetic thyroid hormone T = daily before breakfast H = tablet L = lifelong E = few weeks T = TFTs 2 weeks after start dose then every 2 months until stable, then annual I = possible hyperthyroid symptoms or continued hypothyroid symptoms if too low dose C = n/a S = free prescriptions for everything
ATHLETICS statin
A = stops liver making cholesterol T = daily in evening H = tablet L = lifelong E = decreases risk over years T = LFTs before starting, at 3 mo then at 12 mo. review in 4wks then 6 monthly I = muscle pains, GI C = pregnancy S = avoid grapefruit, www.bhf.org.uk
ATHLETICS metformin
A = increases effect of insulin T = daily with breakfast H = tablet with meal at same time each day L = lifelong if effective E = n/a T = U+Es before starting, then annually I = GI C = lactic acidosis, renal impairment S = if miss a dose, take ASAP unless nearer to next dose time, diabetes.org.uk
ATHLETICS iron tablets
A = replace iron, used for RBCs T = 1-3x daily H = tablet L = usually ~4mo E = month T = FBC - Hb in month I = GI, dark stools, taste bad C = n/a S = leaflet
rotator cuff pathology
- supraspinatus = initiates abduction, first 15
degrees - deltoid abducts up to 90 degrees
- trapezius and serratus anterior cause scapular rotation for abduction beyond 90 degrees
- infraspinatus and teres minor responsible for external rotation
- subscapularis is responsible for lift off test (internal rotation)
- impingement = empty can test
acromio-clavicular joint pathology
scarf test
note tenderness over ACJ
MRC grading for power
No contraction = 0
Flicker or trace of contraction = 1
Active movement, with gravity eliminated = 2
Active movement against gravity = 3
Active movement against gravity and resistance = 4
Normal movement = 5
myotomes
C4: shoulder shrugs C5: shoulder abduction and external rotation; elbow flexion C6: wrist extension C7: elbow extension and wrist flexion C8: thumb extension and finger flexion T1: finger abduction L2: hip flexion L3: knee extension L4: ankle dorsiflexion L5: big toe extension S1: ankle plantarflexion S4: bladder and rectum motor supply
describing a dermatological lesion
Asymmetry Border irregular? Colours Diameter (7mm+ = concerning) Elevation/everything else
describing a rash
Distribution - where it is
Configuration - grouping of rash eg. linear/clustered
Morphology - type of lesions
ask everyone…
fevers, night sweats, ∆ weight
communication: disease review
Treat it like a history:
- Current symptoms
- Compliance with therapy
- Red flags/Complications
- Functional state
- Disease knowledge: sick days, rescue packs
- ICE
COCP missed pill rules
- if just one missed, take next one immediately (even if this means taking 2 in one day) and continue as normal
- if missed 2, us a condom for 7 days
- 7 day condoms if D/V or enzyme inducers
- emergency conttraception if intercourse in pill free week or 1st week packet
POP missed pill rules
- important to take at same time each day
- if over 3 hrs missed (12 hrs cerazette) then take ASAP (even if this means taking 2 in one day) and use condoms for 2 days
- consider emergency contraception if intercourse in 3 days before missed pill or intercourse since
