OSCE comms

Question 1

Key points advanced directive

Answer 1

Legally binding and generally a physical, signed document which is witnessed
Must be drawn up in absence of haste or duress
Existence and location should be easy to obtain by medical team
Allows patient to specify any interventions they do not wish to have
Once signed, can be redrafted if they change their mind, they can verbally over-ride it if have capacity at the time
If patients then lose capacity, relatives will not have ability to override advance directive

Question 2

Key points LPA

Answer 2

Legal document where appoint indicidual to take decisions for you
Only applicable when deemed to have lost capacity
Applied to devisions regarding what treatment you receive, discharge destinations
Can have separate one for property/finance
Any adult over 18 can be appointed to this role

Question 3

Process of coronary angiog

Answer 3

Thin tube inserted into artery at wrist or groin, then directed to the heart using xray images. Dye is injected so that coronary arteries show clearly on the xray

Question 4

minor complications coronary angiography

Answer 4

Bruising in 10%. removing can cause bleeding in 1/100. Fainting, development of abnormal heart rhythm

Question 5

major complications of coronary angiography

Answer 5

Allergic reaction to dye
Heart attack due to damage to coronary artery. damage to heart chamber walls. damage to radial or femoral artery.
Stroke

Question 6

Minor complications bronchoscopy

Answer 6

Sore throat and hoarse voice
nose bleed/soreness
Slightly blood stained phlegm
aching across lungs
Fever 6-12 hours after - goes away by itself or with paracetamol, if persists see GP

Question 7

Major complications bronchoscopy

Answer 7

Chest infection <1%
Puncture in lung wall (pneumothorax) can cause breathlessness and sharp pain. V unlikely but more like 1/10 if transbronchial biopsy, But 9/10 times resolves without further treatment
Occasionally more signif bleeding but uncommon

Question 8

Risks of pleural fluid aspiration

Answer 8

Pain: chest discomfort, or feel like coughing if larger volumes of air or fluid are taken off. This usually resolves on its own, but can have mild painkillers after.
rare infection may need antibiotics
Rare bleeding into pleural space
Small risk of damage to the lung, may possibly need chest drain after.

Question 9

Risks of chest drain

Answer 9

May fall out
Mild pain
1/100 infections
Rarely damage to vessels cause serious bleeding (1/500)

Question 10

Looking after chest drain

Answer 10

Keep drainage bottle below waist
If attached to suction then will need to stay close to this
Do not swing bottle by the tube
Be careful not to knock the bottle over
If you feel drain may have moved or is coming out, please tell your nurse

Question 11

Risks endoscopy

Answer 11

More common: risk of missed lesion 1/100, short term problems with breathing, heart rate and BP related to sedation 1/100
Bleedig where taken sample 1/100 usually stops on its own
More serious:
perforation of lining og bowel: 1/1000 higher risk if polyp removal
Damage to teeth: 1/2000
Heart attack or stroke related to sedation 1/5000

Question 12

Risks of ERCP

Answer 12

Pancreatitis 1/20
Cholangitis 1/50
- give 1L of fluids pre procedure to reduce risk
Bleeding 1/100 although more likely if cut in one of tubes to remove stones or insert a stent
Perforation 1/100
Very rarely are any of these lifethreatening
Damage to teeth 1/2000

Question 13

Risks with suprapubic catheter

Answer 13

Pain or discomfort when contrast injected (Rarely allergy)
Failure to get catheter in
Some pain around insertion site after
Some bleeding, should settle in 72h
low chance of infection
Damage to bowel: rare but serious complication

Question 14

Side effect cystoscopy

Answer 14

Stinging/burning on passing urine for 2-3 days
Blood in urine for a couple of days - drinking plenty of water will help
1/50 people will get UTI which requires antibiotics and should conact a doctor

Question 15

Side effects of shock wave lithotripsy

Answer 15

Common: blood for 72h, pain in kidney as fragments pass
UTI due to bacteria released as stone breaks up (keep eye out for symptoms)
Bruising/blistering of skin
Need for further lithotripsy
Failure to break stones-&raquo_space; alternative treatment
Rarely severe infection requiring IV abx, kidey damage or damage to pancreas/lungs by shockwaves

Question 16

Renal biopsy procedure

Answer 16

BP and urine checked
Cannula inserted
Lie on front, kidneys ultrasounded, local anaesthetic
Biopsy needle inserted. May need to hold breath for a few seconds whilst being taken. usually done twice then plaster over area.
takes approx 30 mins
Then need to stay in hospital for 4 hours, with 2 hours lying on bed
Nurse will examine urine for blood and check BP, if no problems can go home
return to driving once pain free, avoid strenuous exercise for a week
May need 2-3 days of work depending on job

Question 17

Risks kidney biopsy

Answer 17

Pain: paracetamol to take. avoid NSAIDs, and no aspirin
Minor bleeding 1/30: in urine or around kidney, most settles
<1/100 risk of severe bleeding requiring transfusion or other intervention
<1/100 sample of kidney is too small, may have to repeat boipsy
Damage to bowel and death extremely rare.

Question 18

Risks of injected varicose veins

Answer 18

○ Bruising usually disappears in approx 2 weeks
May still be lumpy/visible, will reduce over 3-6 months
Pale brown colour appears on skin where large veins injected. Normally will gradually fade but sometimes permanent
○ Sometimes painful lump after = thrombophlebitis. Can remove clot, but also pop some ibuprofen gel on
○ No guarantee that this will get rid of varicose veins or cure all leg symptoms
○ Rarely thrombosis can spread to deep veins
○ May get a migraine after especially if normally have migraines
Rare severe allergic to foam