OSCE - Danger Elim. Flashcards
Mouth Ulcers danger elimination
Lasting longer than 3 weeks More than 5-10 at one time More than 1cm in size Failed treatment No pain Unexplained weight loss Under tongue Rash Diarrhoea
Oral Thrush danger elimination
Failed medication Recurrence Painless lesions Pain/difficulty swallowing Diabetic
Heartburn danger elimination
Recurrence Difficulty swallowing Regurgitation Pain radiating to arms Failed medication Long duration Increasing severity Caused by medication
Nausea and Vomiting danger elimination
Lasting more than 48 hours
Children less than 2 years
Blood in vomit/stools
Chronic
Motion Sickness danger elimination
Continues after journey Persistent vomiting Chest pain Headache Difficulty hearing
Constipation danger elimination
Change in bowel habits for 2 weeks or longer
Weight loss
Blood in stools
Abdominal pain
OTC medication used for more than 1 week with no effect
Caused by prescribed medication
Vomiting
Diarrhoea danger elimination
>24 hours in children <1yr >48 hours in children <3yrs or elderly >72 hours in older children and adults After antibiotics And vomiting Fever, high temp. Food poisoning outbreak Recent travel abroad Pregnancy Reaction to medication Blood or mucus in stools Accompanied by fever/ringing in ear
IBS danger elimination
Children or pregnant women Unexplained weight loss Failed treatment Blood in stools Signs of bowel obstruction First time in elderly Patients over 55 with changed bowel habits
Threadworms danger elimination
Suspected other infection Recent travel abroad Medication failure Children under 2 years Pregnancy and breastfeeding
Haemorrhoids danger elimination
Lasts longer than 3 weeks Change in bowel habits Severe pain with bleeding Bleeding from back passage Abdominal pain/vomiting Weight loss, malaise Fever
Cold and Flu danger elimination
Earache doesn't settle with medication Very young children Elderly Heart or lung disease, compromised immune system Persisting fever and productive cough Delirium Pleuritic-type chest pain Asthma
Coughs danger elimination
Longer than 2-3 weeks Yellow, green, blood-stained sputum Croup, whooping cough Difficulty breathing/shortness of breath Persistent nocturnal cough in children Significant fever, malaise Elderly (distressing cough) Comorbidities Chest pain ADR Failed medication
Sore Throat danger elimination
Longer than 1 week Recurrent infection Hoarseness for 3 weeks or more Difficulty swallowing Coloured sputum Failed medication Temperature
Allergic Rhinitis danger elimination
Unclear diagnosis Wheezing and shortness of breath Tight chest Painful ear or sinuses Purulent conjunctivitis Severe symptoms not fully resolved by OTC treatment Failed medication
Headache danger elimination
Severe, lasting more than 4 hours In children <12 years Previous head injury/trauma N&V Frequently recurring Location and type of pain - Across back of head Neck stiffness High temperature ADR Worse in morning then improves Drowsiness, unsteadiness, visual disturbances
Migraines danger elimination
Frequent episodes >5 times a month Pain uncontrolled by OTC analgesics Sudden blinding pain Stroke symptoms Headache with stiff neck and rash Contraceptives
Sprains and Strains danger elimination
Falls/bruising from ADRs Swelling, floppy Not able to put weight on it Severe pain Medication failure Recurrent falls Suspected arthritis
Muscle Pain danger elimination
Severe back pain with pins and needles Severe swelling/redness Occurs after taking statins Pain in middle/upper back Extreme muscle weakness Doesn't improve with self care
Repetitive Strain Disorder danger elimination
Swollen, inflamed tissue
Persistent symptoms
Changing routine doesn’t help
Vaginal Thrush danger elimination
Unusual bleeding
Common recurrence - more than twice in 6 months
Under 16 years or over 60 years
Pregnancy or suspected - clear before delivery
First occurrence
Hypersensitivity to vaginal antifungals
Previous STD exposure/recent exposure
Abnormal bleeding
Blood-stained discharge
Vulval or vaginal sores, ulcers or blisters
Abdominal pain
Adverse effects of treatment
No improvement within 7 days of treatment
Immunocompromised
Cystitis danger elimination
Lasting longer than 3 days Blood in urine Pain in side, tenderness Fever, N&V Male Recurrent cystitis Pregnancy Children Abnormal vaginal discharge Failed medication
Dysmenorrhoea (Period Pain) danger elimination
Irregular periods Thick or odorous discharge Normal pattern of periods changes Heavy period or severe pain Pain during sex Pain with late period Severe intermenstrual pain and bleeding Fever Medication failure
Insomnia danger elimination
Suspected depression Chronic problem (longer than 4 weeks) Children under 16 years Snoring, sleep apnoea, restless legs Associated physical conditions Suspected alcohol problems/dependency Recreational drug dependence
Atopic Eczema danger elimination
Evidence of infection (weeping, crusting, spreading)
Severe eczema
Failed medication
No identifiable cause (unless already diagnosed)
No improvement after 1 week with topical corticosteroids
Acne danger elimination
Large, hard lumps Affecting self-esteem Severe acne Pregnancy First time in adult life Signs of infection Side effects of medication Persistent Red, inflamed, pustular spots
Athlete’s Foot danger elimination
Failed treatment Red, hot painful feet Immunocompromised Recurrent episodes Diabetic Not just affecting toes Signs of bacterial infection Fungal toenails Not treated after 2 weeks
Cold Sores danger elimination
Lasting longer than 2 weeks Pregnancy Very large or painful Immunocompromised Babies or young children Failure to resolve Worsening sore Frequent cold sores Painless Eczema Affects eyes Uncertain diagnosis
Warts and Verrucas danger elimination
Worried about a growth Very large or painful On face or genitals Recurrence Bleeding/change in appearance Itching Immunocompromised
Scabies danger elimination
Lasting longer than 4 weeks Babies and young children Crusting Outbreak in schools/homes Through sexual contact Infected skin Treatment failure Unclear diagnosis
Dandruff danger elimination
Other areas of skin red and scaly - psoriasis Severe dandruff Scalp is red or swollen Anti-dandruff shampoos not worked after 1 month Severe itching Immunocompromised Infection signs Treatment does not work
Hair Loss danger elimination
Sudden hair loss Bald patches Affecting wellbeing Hair loss in large clumps Itching/burning skin Anaemia, hyperthyroidism Caused by drugs
Psoriasis danger elimination
Severe flare ups Joint stiffness/pain Bleeding from psoriatic plaques Pustular plaques Extensive Affects nails No improvement of flare up within 4 weeks Less than 50% reduction in 12 weeks
Nappy Rash danger elimination
Broken skin and severe rash Unwell baby Signs of infection Affects other body areas Persistent rash Does not resolve within a month
Childhood Rashes danger elimination
Signs of meningitis - Stiff neck, glass test Red-brown rash Pink-red rash with sandpaper texture Recurrent raised, itchy spots Flu-like symptoms Vomiting Headache Spots or bruises or rashes that do not blanch when pressed
Allergic Conjunctivitis danger elimination
Purulent discharge
Pain in the eye
Eyes sticking when waking
Vision affected
Infective Conjunctivitis danger elimination
Painful eyes Discomfort to light Lasts longer than 1 week Problems with vision Marked redness
Earwax danger elimination
History of perforated tympanic membrane
Severe hearing problems
No previous diagnosis
Otitis Media danger elimination
Children under 2 years Pain lasts more than a few days Restlessness Discharge from the ear High fever Vomiting
Colic danger elimination
Vomiting High temperature Abnormal cry Abnormal responses Blood in nappy Abnormal breathing Rash Grey skin
Teething danger elimination
Check for signs of other illness before determining symptoms are teething
Head Lice danger elimination
Eczema
Redness on scalp
Other symptoms of more serious infection (high temp., rash)
Indigestion danger elimination
>55years Unexplained weight loss Difficulty swallowing Persistent or recurrent N&V Anaemia Lump in stomach Blood in stools or vomit Abdominal pain H2 antagonist/PPI treatment failed Associated with NSAIDs Children
