OSCE Communication Skills Flashcards
Diabetes Risk Score
Age (older)
Gender (male)
Ethnicity (not white)
Waist (larger)
BMI (larger)
HTN
QRISK Risk Score
Info
Age
Sex
Ethnicity
BMI
Postcode
PMHx
CKD
AF
RA
DM
Migraines
SLE
Severe mental illness
Erectile dysfunction
DHx
Antihypertensives
Antipsychotics
Steroids
FHx
Angina / MI in 1st degree relative <60yo
SHx
Smoking
Measurements
Cholesterol/HDL ratio
Systolic BP
Std dev of last 2 SBP measurements
CHA2DS2VASC
CHF
HTN
Age (2 pts >75, 1 pt 65-75)
Diabetes
Stroke / TIA (2 pts)
Vascular disease
Sex category female
FRAX
Personal info
Age
Sex
Weight
Height
PMHx
RA
Previous fracture
Secondary osteoporosis (CKD, hyperthyroid, coeliac, T1DM, chronic liver disease, prem menopause)
Femoral neck bone mineral density
DHx
Glucocorticoids
Lithium
FHx
Parental fractured hip
SHx
Current smoker
Alcohol
ABCD2
Age >60 (1)
BP >140/90 (1)
Unilateral weakness (2) / Speech disturbance alone (1)
>60 mins (2) / 10-60 mins (1)
Diabetes (1)
DVT Wells Score
HPC
Paralysis / recent leg immobilisation
Local tenderness
Leg swollen
Calf swollen to >3cm than other leg
Pitting oedema
Non-varicose superficial veins present
PMHx
Bedridden >3d / major surgery <12wks ago
Active cancer
Previous DVT
Disease explanation
Intro
- intro, purpose
- check prior knowledge
- ICE
Explaining disease
- normal anatomy / physiology
- what disease is
- causes
- problems, complications
- management
- chunk/check, can use diagrams
Closure
- ICE
- check understanding, answer questions
- summarise discussion
- further consultations / leaflets / websites
Drug counselling
Intro
- intro, purpose, consent
- check understanding about condition
- check understanding about medication
- ICE
ATHLET(I)CS
- Action - indication, mechanism, diagrams
- Timeline (frequency) - when to take
- How to take (route) - eg oral/topical
- Length of tx
- Effects
- Tests (monitoring) - eg blood tests/ check effectiveness (HbA1c)
- Important side effects SEs- common/serious
- Contraindications
- Sick day rules/missed dose advice/ Supplementary advice - offer leaflet
Closure
- ICE
- double check understanding, answer questions
- confirm patient happy to take medication
- summarise info given
- offer follow up…
Corticosteroids counselling
- reduce inflammation + suppress immune system
- normally produced by adrenal gland
- tablet, OD, in morning same time (insomnia if taken later)
- take with meal
- may need long-term (goal is least amount of time)
- tale missed dose asap, but not 2 in one day
- sick day rules - double dose
Tests
- BP, BMI, eyes, HbA1c, lipids, K
- regular BP/BMI checks, lipids/K every 6-12mo, HbA1c every 3mo
S/Es
- insomnia
- wt gain
- mood changes
- long-term - Cushing’s, osteoporosis, proximal myopathy, HTN, high BMs, infections, adrenal insufficiency, peptic ulcers, cataracts, psychosis/depression
- never stop suddenly - risk of adrenal crisis - lethargy, weakness, N+V, abdo pain, diarrhoea, dizziness, wt loss, loss of appetite
- have steroid emergency card if on long-term
CIs / cautions
- acute systemic infections
- hepatic impairment
- unhealed wounds
- stomach ulcers
- HF, HTN, DM, epilepsy
- hx of mental health problems
- may be risky in breastfeeding/pregnancy
- avoid NSAIDs
Antipsychotics counselling
- schizophrenia - overactivity of chemical messengers in brain - antipsychotics block receptors (dopamine) that cause this
- tablet OD, or injection every few weeks
- start low dose, gradually build up, take long-term, takes a few weeks to start effect
S/Es
- weight gain, diabetes, stroke, heart attacks - healthy diet
- restless legs, muscle spasms, eye movt problems, tremor, stiffness
- constipation, dry eyes, dry mouth, trouble urinating
- drowsy/lightheaded
- hot / shakey + very stiff muscles - see doctor
- sore throat / fever (clozapine) - see doctor
Monitoring
- clozapine - weekly FBC for 18wks, then every 2 wks for first yr
- 3mo HbA1c, lipids, BMI, BP, ECG, prolactin
Cautions
- CVD, Parkinson’s, Lewy body, epilepsy, DM, MG, previous jaundice
- hepatic impairment, phaeo
Lithium counselling
- stabilises mood
- tablet OD, same time, continue long-term, takes a few weeks to take effect
S/Es
- damage to kidney, thyroid - bloods to check
- tremor, thirsty, polyuria, weight gain, swelling, drowsy, abdo pain
- teratogenicity in women
- OD is dangerous - D+V, coarse tremor, urinating lots, slurred speech, unsteady walking
Monitoring
- weekly lithium levels to start, then every 3mo once stable
- 6mo - U/E, TFTs, Ca
Contraindications
- 1st trim pregnancy
- breast feeding
- renal impairment / hypothyroid
- hyponatraemia (untreated)
- cardiac insufficiency / rhythm disorder
SSRI / SNRI counselling
SSRI / SNRI counselling
- depression imbalance of chemicals in brain - SSRIs re-adjust this (mainly serotonin)
- tablet OD, same time, usually morning (affects sleep)
- if working, continue for 6mo after sx resolve
- no effect for 4-6 wks, but keep going, may feel worse in wk 1-2 - follow up appt
S/Es
- anxious, jittery, suicidal - talk to us if this happens
- insomnia, headaches, wt gain/loss, D/V, loss of libido - see us if so
- don’t stop suddenly - withdrawal
Monitoring
- Nil, appt in 4-6 wks to follow up
CIs
- poorly controlled epilepsy
- manic phase
- suicidal risk
- don’t take MAOi / triptans
Bisphosphonates counselling
- osteoporosis is where bones become brittle as cells break them down
- bisphosphonates slow these breakdown cells, help bone become denser
- tablet once a week - first thing in morning, empty stomach, with full glass of water, sit upright for 30 mins (don’t eat)
S/Es
- acid reflux
- bloating, indigestion
- change in bowel movts - diarrhoea / constipation / abdo pain
- headache
- may cause damage to bone in jaw - have regular check ups with dentist - watch out for pain / loose teeth
- oesophagitis
Tests
- nil
CIs
- pregnancy, stomach ulcers
- renal impairment
Donepezil counselling
Warfarin counselling
- thins the blood (decreases levels of factors in blood that trigger formation of blood clots, blocks vit K)
- tablet, take in evening, same time each day
- start low dose, adjust based on blood results
- duration depends on indication - 3mo DVT, 6mo PE, lifelong AF
S/Es
- risk of bleeding
- avoid activities which risk injury/bleeding
- if big bruise / bleeding heavily / black stools - see doctor
- avoid ibuprofen/aspirin - stomach ulcer risk
- avoid lots of alcohol
- mention to drs you are on warfarin
- avoid grapefruit juice / spinach
Tests
- blood levels 2x a wk for 2wks, then every wk until stable
- then check every 6-8wks
- check more frequently if out of range
CIs
- teratogenicity in women
- active bleeding / risk, haemorrhagic stroke
- 48hrs post-partum
DOAC counselling
- thin blood, prevent clots
- block a protein involved in clot formation
- OD/BD tablet / capsule
- take with full glass of water sitting upright
- 3mo for DVT, 6mo for PE, lifelong for AF - but varies
S/Es
- bleeding - see doctor if head injury, bleeding, headaches, blood in urine/stool/vomit, black stool, bruising
- GI disturbance
Tests
- none regular
- renal function before, annually
CIs
- renal impairment
- risk of bleed / active bleed
Levothyroxine counselling
- synthetic version of thyroxine - hormone from thyroid gland - works to bring thyroid activity back to normal
- tablet OD before breakfast
- 4-6wks for effect, take long term
Tests
- TSH every 2-3mo until stable, then annually
S/Es
- when stable, S/Es rare
- hyperthyroid - D+V, headache, palpitations, heat intolerance if too high
- Hypothyroid - cold intolerance, constipation if too low
CIs
- none
Statin counselling
- decreases level of bad cholesterol in blood - reduce risk of heart attacks/strokes
- tablet OD, in evening
- take for long period of time
S/Es
- muscle aches / pain - usually mild, fade with time
- severe muscle pain, urine dark - see doctor
- headache, tummy upset
Tests
- LFTs at start, 3mo, 1yr
- cholesterol levels every 6mo
CIs
- pregnancy
- avoid grapefruit
- macrolides interact
Methotrexate counselling
- dampens immune system, stopping it attacking our own cells, also reduces inflammation
- tablet, once a week
- take same day every week
- folic acid tablet other day
- effect in 3-12wks, continue for long term
S/Es
- hair loss, headaches, stomach upset
- serious (rare) - bone marrow suppression - bruising/bleeding, tired/breathless/fever - see doctor (avoid aspirin/ibuprofen)
- liver damage - avoid excessive alcohol
- lung damage - breathless/cough - see doctor
Tests
- FBC, U/E, LFT every 2wks until dose stable, then every 3mo
CIs
- if trying to get pregnant - tell us, med is damaging to baby, will need swapping
- breastfeeding
- active infection, immunodeficiency
- ascites, pleural effusion
- hepatic impairment
Levodopa counselling
- replaces dopamine in brain (lacking in parkinson’s)
- helps to reduce sx, eg rigidity, slow movts
- tablet 3-4/day, take with food (reduce nausea)
- give with carbidopa
- see effects quickly, continue for long term, may have to add other meds later
- never stop taking / miss dose - worsens sx
Tests
- none
S/Es
- tell dr if you have any S/Es
- tummy upset, light headed, vivid dreams, nightmares
- seeing/hearing things
- dry mouth
- involuntary movts - on-off effect, end of dose, dyskinesias
CIs
- glaucoma
Insulin counselling
- allows cells to take up glucose from blood, reducing blood glucose level
- various regimens
- inject wit injection pen at 90 degree angle
- rotate injection sites
S/Es
- weight gain
- sharp injuries
- hypoglycaemia
- lipodystrophy
Tests
- BMs before each meal and before bed
- check if sx of high/low blood sugar
CIs
- none
Metformin counselling
- decreases blood sugar by increasing amount of sugars taken up/stored by liver, also increases insulin response (so cells take up more glucose)
- tablet, OD, gradually increase dose
- take in morning with food, same time each day
- continue for long term
S/Es
- if troublesome - tell us - can change type
- diarrhoea, wt loss, tummy pain, nausea
- rarely - increase acid levels in blood - if feel unwell - see doctor urgently
Tests
- U/E every year - just to check we can still give it
- HbA1c every 3-6mo until stable, them 6mo at diabetic check ups
CIs
- acute metabolic acidosis
- eGFR<30 / Cr>150
- low BMI
Iron tablets counselling
- replace body’s store of iron - needed to make RBCs
- tablet 1-3 times/day, or syrup
- take without food
- 3-4mo for Hb to normalise, then 3mo to replenish stores
Tests
- Hb in 3-4 wks to assess response
S/Es
- nausea, sickness, diarrhoea, constipation, abdo pain
- black/green stools
- metallic taste
CIs
- none
