OSCE Finals Flashcards
Type 1 respiratory failure on ABG?
Hypoxia withOUT hypercapnia
pCO2 normal or low
Type 2 respiratory failure on ABG?
Hypoxia AND hypercapnia
pCO2 high
Type 1 and 2 respiratory failure general cause?
Type 1 - failure of oxygenation
Type 2 - failure of respiration (pump)
What is FEV1?
Forced expiratory volume in 1 sec
Volume of air pt can expire forcibly in 1 second
What is FVC?
Forced vital capacity
The total volume of air a pt can expire in 1 breath
Spirometry pattern of COPD?
FEV1 < 80% predicted
FEV1/FVC < 0.7 (70%)
Spirometry pattern of restrictive lung disease?
FEV1 - reduced
FVC - reduced
FEV1/FVC - normal
Causes of restrictive pattern on spirometry?
Pulmonary fibrosis
Pulmonary oedema
Lobectomy/pneumectomy
Pneumoconiosis
Skeletal abnormalities
Neuromuscular disorders
Connective tissue disorders
Pregnancy or obesity
Method for interpreting CXR?
Name, date, type (PA or AP; erect; mobile)
RIPE
(Rotation, inspiration, penetration, exposure)
A - airway: trachea, carina, bronchii
B - breathing: lung fields, markings, vasculature
C - Cardiac: heart size, heart borders
D - Diaphragm: costophrenic angles; flattened; pneumoperitoneum
E - Everything else: BONES, apices, behind heart.
Method for interpreting AXR?
Name, date, type.
RIPE
A - air (bowel air) - air in bowel, type of bowel seen, faecal loading
B - Bones - lower ribs, vertebrae, pelvis
C - calcification - in bones/pancreas/liver/KUB
S - soft tissue - organs, liver, pancreas, stomach, kidneys
Method for interpreting an ECG?
Name, time, date.
Rate Rhythm Cardiac axis P waves PR interval (3-5 squares; 120-200ms) QRS complex (<120ms) ST segment T and U waves
Left axis deviation?
Lead I most positive
Lead II and III are negative
Right axis deviation?
Lead III most positive
Lead I negative
Normal cardiac axis?
Lead II most positive deflection compared to other leads
Gross motor milestones?
2 mo - head control 6 mo - sits without support 9-12 mo - pulls to standing 12-15 mo - walking 18 mo - running 2 yrs - Walks upstairs 2 feet each step 3 yrs - hops on one foot
Fine motor/vision milestones?
2 mo - tracks objects/face 5 mo - palmar grasp 6 mo - hand to hand transfer 12 mo - pincer grip and 2 brick tower 2 yr - draw vertical line 3 yr - draw circle 3.5 yr - draw cross 4 yr - draw square
Language milestones?
0-6 mo - babbling, turning to voice etc 9 mo - mama and dada (specific); waves bye bye 12 mo - 1-3 words with meaning 18 mo - 3 body parts 2 yrs - 2 word phrases 3 yrs - 3-4 word phrases
Social/emotional milestones?
6 weeks - social smile 6 mo - objects to mouth 9 mo - separation anxiety 1 yr - hand clapping, drinks from beaker, waves 18 mo - imitates everyday activities 2.5 yrs - Spoon eating accomplished
Key GI symptoms (history)?
Dysphagia/odynophagia Nausea/vomiting (haematemesis) Reduced appetite/weight loss Reflux Abdo pain Abdo distention Bowel habit change (ask about blood) Systemic symptoms - fever, jaundice, malaise, fatigue
Key Urological symptoms (history)?
Dysuria Frequency Urgency Nocturia Haematuria Hesitancy/dribbling Poor stream Incontinence Fever/rigors Nausea/vomiting
Key headache symptoms (history)?
Nausea/vomiting Visual disturbance Photophobia Neck stiffness Rash Fever Weight loss Sleep disturbance Temporal region distribution Neurological deficit
Key depression symptoms (history)?
Main 3: Persistent low mood Loss of interests or pleasure Fatigue Also ask: Sleep disturbance Appetite change Concentration Low confidence Suicidal Agitation Slow movements Guilt
Key gynae symptoms (history)?
Pelvic/abdo pain Post coital bleeding Intermenstrual bleeding Post-menopausal bleeding Abnormal discharge Dyspareunia Vulval changes and itching Urinary symptoms Bowel changes Weight loss
Key CVS symptoms (history)?
Chest pain Dyspnoea Palpitations Syncope/dizziness Oedema Claudication Systemic symptoms (fatigue, fever, weight loss)
Key respiratory symptoms (history)?
Dyspnoea Cough Wheeze Haemoptysis Chest pain Systemic symptoms (fever, weight loss, night sweats)
Treatment of anaphylaxis?
Adrenaline 1:1000 500mcg (0.5ml)
Chlorphenamine 10mg
Hydrocortisone 200mg
Fluid challenge
Treatment of NSTEMI?
Aspirin 300mg
Clopidogrel 300mg
GTN sublingual
Morphine 2-5mg IV
Oxygen if SpO2 < 90%
Beta blocker
Treatment of STEMI?
Aspirin 300mg
Morphine 2-4mg IV
GTN sublingual
Oxygen if SpO2 < 90%
AND PCI ASAP!!
Acute asthma exacerbation treatment? (moderate/severe/life threatening)
Nebulised Salbutamol 5mg Prednisolone 40-80mg Nebulised Ipratropium 500mcg (given with salbutamol) Magnesium 2g IV (over 20 mins) ITU admission if severe
Risks of bronchoscopy?
Sore throat/nose Infection Bleeding (haemoptysis) Lung collapse Failure Pain
Risks of endoscopy?
Perforation Bleeding (haematemesis, melaena) Aspiration (pneumonia) Infection Sore throat Cardio-respiratory arrest (elderly) Failure
Risks of colonoscopy and flexible sigmoidoscopy?
Perforation Bleeding (PR) Pain Infection Abdominal discomfort (esp with colonoscopy) Failure
LFTs:
Raised ALP and GGT?
Cholestasis
LFTs:
Raised ALT and AST?
Hepatocellular damage
Confusion screen?
Obs - (Temp, BP, HR) Bloods: FBC U&E LFT INR TFT Calcium B12/Folate Glucose Cultures
Other:
CXR
Urine dip
Consider CT
Review Meds
Causes of metabolic alkalosis?
Vomiting/diarrhoea
Diuretics
Causes of metabolic acidosis?
DKA
Lactic acidosis
Diarrhoea/colostomy
Renal tubular acidosis
Causes of respiratory acidosis?
Asthma
COPD
Respiratory depression (opiates)
Guillain Barre
Causes of respiratory alkalosis?
Anxiety PE Pain Hypoxia Pneumothorax
