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OSCE Counselling > OSCE counselling > Flashcards

OSCE counselling Flashcards

1
Q

HPI for woman who got PAP results with moderate dyskaryosis

A

last pap and results

vaginal discharge/bleeding, itching, redness, abdo pain

menarche, regularity, length of cycle/menses, irregular bleeding

sexual activity, sexual debut, number of partners presently/past/currently, men/women/both, oral/vaginal/anal sex

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2
Q

meds to ask for woman who got PAP results with moderate dyskaryosis

A

contraception

condoms

HPV vaccine

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3
Q

pmhx to ask for woman who got PAP results with moderate dyskaryosis

A

STIs, HIV, PID, warts, cancer

gyne procedures, pregnancy, abortions

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4
Q

social hx to ask for woman who got PAP results with moderate dyskaryosis

A

smoking

etoh

ivdu

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5
Q

how should you start counselling for woman who got PAP results with moderate dyskaryosis

A

there are many types of HPV, some cause warts, some cause cancer, some you can have and never know you have it at all

HPV infection with high risk types cause over 99% of cervical cancers

most HPV infections go away without treatment

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6
Q

can HPV be transmitted thru non penetrative sex

A

yes, due to contact with anogenital region

viral shedding

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7
Q

what are the high risk HPV types

A

16 and 18

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8
Q

will HPV always be found on PAP

A

no because may be latent

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9
Q

what types of HPV does guardasil protect against

A

16 and 18–cancer

6 and 11–warts

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10
Q

when should PAP screening begin

A

start at age 25 and screen every 3 years

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11
Q

when should you increase frequency of paps

A

HSIL, AIS, cervical cancer or immunosuppression

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12
Q

how should you follow up ASC-US and LSIL

A

every 6 months for one year… if continue to be abnormal then refer for colposcopy

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13
Q

how should you follow up ASC-H, HSIL, AGC, AIS

A

colposcopy

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14
Q

how should you follow up SCC, adenocarcinoma

A

consult

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15
Q

how to prevent HPV

A

reduce sexual partners

avoid concurrent partners

use condoms

HPV vaccine

stop smoking

get regular PAPs

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16
Q

OCP absolute contraindications

A

previous PE/CVA/DVT

CAD

HTN above 160/90

severe hypercholesterolemia (also C/I for progesterone only pill)

thrombophilia/family hx

valvular heart dz

smoker older than 35

breast or endometrial cancer

abnormal vaginal bleeding

abnormal liver function

pregnancy

migraine with aura

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17
Q

what should you ask about in a sexual history

A

previous use, current knowledge, personal preference

LMP, pregnancy

vag discharge, bleeding, pain, itching, redness, abdo pain

menarche, regularity, length of cycle/menses, irregular bleeding

sexual activity, debut, number of partners, men/women/both, oral/vaginal/anal, current relationship, age of partner

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18
Q

what to ask about on pmhx for 16 year old girl coming in for birth control

A

HTN

CAD

DVT, PE

liver or gallbladder disease

cancer, clotting disorder, migraine with aura

gyne procedures, pregnancy, abortions

past PAP results, last PAP, STIs

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19
Q

meds to ask for 16 year old girl coming in for birth control

A

antibiotics

anticonvulsants

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20
Q

social hx to ask for 16 year old girl coming in for birth control

A

smoking, etoh, ivdu

HEADSS

childbearing goals? what would you do if you got pregnant?

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21
Q

what is the effectiveness of the OCP

A

99% when used correctly

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22
Q

what is the effectiveness of the IUD

A

99%, lasts 5 years

STU check before and check for string monthly

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23
Q

pros of the combined OCP

A

regulates periods

decreases risk of endometrial/ovarian/GI cancers

helps with acne

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24
Q

cons of the combined OCP

A

compliance issues

must be taken at same time each day

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25
Q

IUD pros

A

simple, long lasting

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26
Q

IUD cons

A

risk of uterine perforation

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27
Q

what should you discuss with for 16 year old girl coming in for birth control

A

surgical sterilization is an option

30% regret rate

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28
Q

how long does it take to get pregnant after stopping pills

A

most women get pregnant 3 mo after stopping

may take up to a year

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29
Q

causes of superficial dyspareunia

A

vaginal atrophy

vagina spasm

vestibulodynia

candidiasis

chlamydia

UTI

vaginal cancer

rectal cancer

endometriosis

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30
Q

causes of deep dyspareunia

A

PID

cervicitis

endometriosis

adenomyosis

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31
Q

when discussing dyspareunia/sensitive matters, what should you do first

A

obtain consent and stress confidentiality

“sexual difficulties are quite common in otherwise healthy people”

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32
Q

HPI for dyspareunia

A

onset (during/after coitus)

duration (lifelong, other relationships)

quality (burning, aching, itching)

entry vs deep

frequency of intercourse

provoking/palliating factors (lubrication, position)

itching, redness, sores

fever, chills, night sweats, abdo pain/pelvic

LMP, fatigue, hot flashes, mood, energy, appetite, wt loss, sleep

dysuria, constipation

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33
Q

meds to ask for dyspareunia

A

viagara, HRT

SSRIs, beta blockers

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34
Q

pmhx to ask for dyspareunia

A

DM

eczema

fibroids, endometriosis

PID

PAP smear

infertility

pregnancy, lacerations, episiotomies, trauma

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35
Q

social hx for dyspareunia

A

smoking, etoh, ivdu

sexual debut, partners etc…

how would they feel about their partner being involved, are they able to discuss their concerns with their partner, are they happy in the relationship

“because sexual violence is an enormous problem in our society, and can affect a person’s health and wellbeing, I now ask all my patients about sexual health and safety”

arguments, tensions, forced to have sex, sexually assaulted

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36
Q

what causes atrophic vaginitis

A

lack of estrogen

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37
Q

first line tx for atrophic vaginitis

A

estrogen repalcement

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38
Q

contraindications for estrogen replacement

A

breast, endometrial cancer

end stage liver failure

past history of estrogen related thromboembolism

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39
Q

adverse events associated with estrogen replacement

A

breast tenderness

vaginal bleeding

slight increase in breast, endometrial cancer risk

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40
Q

routes of administration for estrogen

A

oral, cream, transdermal

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41
Q

pros and cons of oral estrogen replacement

A

prevents bone loss and alleviates hot flashes

doesnt alleviate vag dryness in 25% of patients

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42
Q

pros and cons of transvaginal cream

A

very effective for vag dryness

decreases UTI risk

has lower hormone amount

increases risk of endometrial cancer

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43
Q

what else can be used to help vag dryness

A

moisturizers and lubricants

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44
Q

what should you do if a parent brings their kid into see you?

A

speak to them together then ask to speak to the kid alone

stress to the kid that things are confidential unless danger to self or others

HEADSS

for STD screens, say that certain diseases are reportable but confidential still

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45
Q

asthma counseling: what causes asthma

A

airways are very sensitive and can cause narrowing and difficulty breathing

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46
Q

asthma counseling: asthma etiology

A

family history and environmetnal factors

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47
Q

asthma counseling: triggers for asthma

A

URTI

allergens

smoking

NSAIDs

emotional stress

cold air

exercise

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48
Q

asthma counseling: treatment/management

A

treatment is to manage it is not a cure

but most kids grow out of it, though can be lifelong

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49
Q

symptoms of asthma

A

night time coughing

difficulty breathing

wheezing

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50
Q

asthma counseling: lifestyle changes

A

exercise

avoid allergens like pet dander

avoid infections

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51
Q

asthma counseling: what do puffers do

A

one type are reliever medications–> dilate airways, are short acting

one type are controller medications–> are inhaled steroids and can help prevent attacks

*steroids not absorbed systemically so side effects are not as much of a concern

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52
Q

asthma counseling: signs of an attack

A

difficulty breathing

pale/blue

fatigue

cant speak

wheeze

change in mental status

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53
Q

asthma counseling: what to do during an attack

A

give puffers and come to ER if not improved

54
Q

asthma counseling: ventolin use and dosing

A

used for acute treatment

TID for one week then PRN

55
Q

asthma counseling: ventolin side effects

A 
nausea, vomiting
muscle aches
fine motor tremor
palpitations
restlessness 
throat irritation
56
Q

asthma counseling: fluticasone use and dosing

A

for prevention

BID every day

57
Q

asthma counseling: fluticasone side effects

A

nausea, vomiting

abdo pain

diarrhea

headaches

dizziness

nasal irritation, bleeding

58
Q

asthma counseling: prednisone use and dosing

A

decreases inflammation

once daily for two days for attacks

59
Q

prednisone side effects

A

nausea and vomiting

mood changes

candidiasis

avacular necrosis of the femoral head

60
Q

what should you do at the end of an asthma counseling session

A

offer pamphlets and support groups

book f/u to do PFTs

instruct mother about a follow up

61
Q

what can cause breast lumps

A

cyst

fibroadenoma

fibrocystic changes

breast cancer

infection

62
Q

what are the guidelines for mammography screening

A

start at 5 years q2 years

for those with strong family history start at 40 or 10years prior to earliest diagnosis

63
Q

what is the “triple assessment” for breast cancer

A

clinical exam, biopsy, imaging

64
Q

is a breast FNA diagnostic?

A

NO

if non bloody and lump disappears then it was benign cystic disease

if bloody, send for pathology

65
Q

what imaging you do consider in a breast lump

A

diagnostic mammography

breast u/s (for cysts)

guided core bx

MRI maybe for difficult lesions

66
Q

what genetic tests do you consider for a breast lump

A

BRCA 1/2 if family hx

Her-2 and hormone receptor testing if mass is cancer

67
Q

management of early stage breast cancer

A

lumpectomy or mastectomy with or without RT then adjuvant therapy may be offered mased on size, grade, lymph nodes, genetic testing

68
Q

what is breast conserving therapy for breast ca

A

lumpectomy with RT

must preclude multicentric disease, large tumour size relative to breast, diffuse malignant appearing calcifications on imaging, prior hx of chest wall RT, pregnancy, persistent positive margins

69
Q

how long does WHO recommend breastfeeding

A

6 mo

70
Q

how often should you breastfeed

A

every 2 hours for premature

every 4 hours for term baby

every 5 hours at night until 4/5 kgs or 2-3 months old

71
Q

benefits of breastfeeding (mnemonic)

A

ALLERGIC conditions reduced

BEST food for infants

CLOSE bond

DEVELOPMENT of IQ/jaw/mouth

ECONOMICAL

FITNESS of mom (return to normal weight)

GUARD against breast, ovarian, uterine cancer

HEMORRHAGE reduction

**risk of HIV transfer

72
Q

contraindications for breastfeeding

A

HIV/AIDS/active TB/herpes in breast

heavy EtOH or illicit drug use

chemo/rad compounds

diazepam, metronidazole, lithium, tetracycline, mrocopriptine, ergots, gold, cyclophosphamide

73
Q

are mastitis, OCP, CMV or hepatitis contraindications to breastfeeding

A

no

74
Q

complications associated with breastfeeding

A

sore/cracked nipples

engorgement

mastitis

poor weight gain

oral candidiasis

breast feeding jaundice

breast milk jaundice

75
Q

what should you ask about in a teen who, after HEADSS, admits they’re an alcoholic

A

mood, suicide

CAGE

amount/week, types, drinking more, drinking with friends

effects on family, friends, trouble with police

withdrawal symptoms–mood, sweating, hallucinations

76
Q

what should do you do etoh counseling in a teen

A

would they like to reduce the amount?

benefits–> reduced risk of disease, improved mood, improvement in function

groups available–> refer to etoh team

detox in the community–> chlordiazepoxide over 1 week, reduces symptoms vs in hospital

77
Q

BC reportable illnesses

A 
gonorrhea
syphilis
chlamydia
HIV
hep a/b/c
TB

HCP also needs to notify sexual partners

78
Q

what is the SPIKES mnemonic for counseling bad news (i.e positive TB in homeless person or positive HIV in married person)

A

setting
perception–> is it okay to share important news, do you want someone here, their knowledge of the test
invitation–> would you like all information or more focus on treatment plan?
knowledge–>unfortunately ive got some bad news, test came back +
emphathy–>I can see how this is upsetting to you
summarize

79
Q

TB counselling: what is TB

A

infects lungs and causes cough and hemoptysis

ask about htese sx

80
Q

TB counselling: how do you get it

A

homeless
etoh dependent
immunosuppressed are at risk

81
Q

TB counselling: treatment

A

there is a cure

6 months of meds

initial phase 2 mo, then AFB smears, then another 4 months

82
Q

TB counselling: risks of treatment

A

liver damage
vision
rash
drug fever

83
Q

TB counselling: housing for treatment

A

can get long term hospitalization or portland hotel society

84
Q

TB counselling: importnat points

A

reportable, confidential

85
Q

HIV counseling: what is it

A

viral infection that attacks immune system and causes you to have other infections

HPI

86
Q

HIV counseling: how did they get it

A

sexual activity, sharing needles

ask patient if they know how they got it (IVDU, MSM, paying for sex)

87
Q

HIV counseling: treatment

A

no cure

treatment keeps illness under control

88
Q

HIV counseling: important points

A

reportable, confidential

inform partner, offer to help, partner should be tested

89
Q

mnemonic for DNR discussion

A

SPIKE

what do you know about your disease
what do you expect of your medical care
what are your goals for your care
can we talk about CPR
do you know what CPR is
–chest compressions
–usually doesnt work
if you were to die suddenly would you want CPR
what is a reasonable quality of life that you would like to live with
what are your feelings around this topic
dont need to decide now, make decision later
DNR status does not mean withdraw care, we would like to make you as comfortable as possible

90
Q

what are the geriatric giants

A 
drugs
delirium
dementia
falls
sleep
constipation
urinary retention
vision/hearing 
supports
functionality
91
Q

ADLs

A

feeding, grooming, washroom

92
Q

IADLs

A

cooking, groceries, shopping, bills, driving

93
Q

risk factors for heart disease

A 
males above 45
females above 55
DM
HTN
high cholesterol
obesity
smoking family hx under age 60
inflammatory biomarkers
94
Q

physical signs of hyperlipidemia

A

atheromata
xanthoma
tendinous xanthoma
corneal arcus

95
Q

lifestyle changes for hypercholestrolemia

A

3 month trial

decraese SAFA
increase fibre
exercise
weight loss
smoking cessation
moderation of alcohol
96
Q

management of hyperlipidemia

A

treat HTN and DM

lab tests for DM and end organ function

97
Q

what are statins

A

slow cholesterol formation

98
Q

dose of atorvastatin

A

10-80 mg po daily

99
Q

side effects of statins

A

less than 5% get myalgias

some hepatotoxicity

100
Q

monitoring for statins

A

ALT, AST, CK at baseline then 6 weeks then every 6 months

101
Q

follow up for hypercholesterolemia

A

every 3 months

102
Q

waht does systolic BP represent

A

pressures of the contracting heart (versus relaxing heart in dBP)

103
Q

define HTN

A

above 140/90 (cutoffs different for DM and renal disease)

104
Q

what are the most likely causes of hTN

A

artery hardening (but not known for sure)

secondary causes:
cushings
pheo
aldosteromism
hyperthyroid
cocaine
aortic coarctation
renal artery stenosis
105
Q

risk factors for htn

A 
age
obesity
sedentary lifestyle
stress
smoking
alcohol 
high salt
family history
106
Q

complications of htn

A

stroke
blindness
heart attack
kidney failure

107
Q

ask about OSA in htn assessment

A

lalala

108
Q

management of HTN

A

lifestyle changes trial for 3 mo
–exercise, salt, smoking, alcohol, stress reduction

labs
–HbA1c, creatinine, GFR, lipids, UA, urine ACR, ECG

first line
–HCTZ or ACEi

109
Q

what are HCTZ/ACEi

A

diuretics that prevent the body from retianing too much salt and thus water

110
Q

side effects of diuretics

A

urination
dizziness
may increase BG

111
Q

follow up for HTN

A

3 mo

112
Q

risk factors for diabetes

A 
first degree relative
high risk population
hx IGT, GDM
vascular disease
overweight
HTN
dLP
PCOS
acanthosis nigricans
113
Q

management of diabetes

A

lifestyle for 3 month then meds

114
Q

first line antihyperglycemic agents

A

metformin, sulphonylurea, aalpha-glucosidase inhibitor

115
Q

what do antihyperglycemic agents do

A

make cells more sensitive to insulin

taken once or twice daily

116
Q

side effects of antihyperglycemic agents

A 
nausea
diarrhea
abdo pain
weight loss
lactic acidosis
117
Q

contraindications to antihyperglycemic agents

A

kidney disease

low BMI

118
Q

compliations of diabetes

A

neuropathy (impotence, constipation, diarrhea, gastroparesis, orthostatic hypotension, paresthesias in feet)

retinopathy

nephropathy

CVS

foot ulcers

hospitalizations (DKA etc)

119
Q

screening guidelines for diabetes

A

every 3 years once over 40 if no risk factors

120
Q

how do you diagnose diabetes

A

symptoms plus random glucose above 11.1

-or-

fasting blood glucose above 7

or-

HbA1c above 6.5%

121
Q

why should you vaccinate kids

A

prevents serious illness

safe

majority of babies get it

prevents spread of disease i.e smallpox

122
Q

adverse events with injections

A

crying, irritable, low grade fever, local reaction

can treat with tylenol and fluids

rare 1/1000 high grade fever, seizure, call 911

1/500 000 anaphylaxis

“disease is more serious than the complication, thus we vaccinate”

123
Q

what to watch out for with vaccines

A

if large swelling, or swelling around lips or mouth, rash, call doctor

124
Q

what are the links between autism and MMR

A

none

paper from 1990s has since been disredicted

study very small and outcomes biased

several large scale epidemiological studies found no evidence

125
Q

what are the 4 As of alzheimers

A

amnesia
aphasia
apraxia
agnosia

126
Q

what is alzheimers

A

form of memory loss, form of dementia

memory loss, confusion, word finding difficulties, concentration, problems with paying bills, getting lost etc

later changes can include behavioral changes (sometimes aggressive, sometimes passive), hallucinations, needing help with eating, bathing, dressing, incontinence, driving and cooking will become dangerous

127
Q

how does someone get alzheiemrs

A

unknown mechanism

deposits in the brain

risks are age and family history

128
Q

how do you manage alzheimers

A

no cure

medications improve memory and slow progression for more than 10 years sometimes

meds trialled for 8 weeks, monitor for SEs

can treat other sx like depression with SSRIs

129
Q

does alzheimers kill you

A

death is from other illnesses like pna or falls

130
Q

what should you advise patients to do after an alzheimer’s diagnosis

A

get financial affairs in order

advise to draw up advanced care directives

support groups

follow up in 3 months

OSCE Counselling (1 decks)

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