OSCE Finals Revision Flashcards
1
Q
Sexual hx
A
Intro
- some questions sensitive, will include details about sex / sexual partners
- stress confidentiality
HPC
- explore sx
- discharge (urethral / vaginal/rectal)
- dysuria
- swellings/growths/ulcers
- pain (anogenital/pelvic/dyspareunia)
- PV bleeding, menstrual hx
- testicular pain/swelling, penile changes/itching/swelling
- fever, malaise, wt loss, rash, swelling/tenderness of joints, conjunctivitis
Partners
- ?sex with men/women/both
- last sexual encounter, type of sex, contraception use etc
- was this regular/casual partner
- if regular - how long been with
- any other partners in last 3mo (then ask same qs again)
- feel safe with partner? Any violence / unconsensual encounters? Any procedures to genitals like cutting/piercing?
BBV risk assessment
- partners from countries with high HIV/hep prevalence
- MSM
- needle sharing / injecting drugs
- sex work - paying/paid
- partners known HIV+
- chemsex
- tattoos / piercings
PMHx
- previous STIs, tests
- HIV / hep B/C status
- vaccinations, inc hep B, HPV
- previous obstetric/gynae issues
DHx
- meds, allergies
- contraception, adherance
- PrEP use
SHx
- alcohol, smoking, recreational drug use
- sexual problems, eg premature ejaculation
2
Q
Gynae hx
A
HPC
- SOCRATES, explore sx
- PV bleed (intermenstrual, post-coital, post-menopausal),
- abdo/pelvic pain
- PV discharge,
- dyspareunia,
- vulval itching/skin changes,
- infertility
- urinary sx
- bowel sx
- abdo distension
- fever, fatigue, wt loss
- chance of pregnancy
(4 Ps - PV bleed, PV discharge, pain, pregnancy)
PMHx
- menstrual hx
- obstetric hx
- sexual hx
- date last cervical smear, results
- surgical hx
- previous gynae issues
- previous STIs
DHx
- contraception, HRT
- meds, allergies
FHx
- breast, ovarian, endometrial cancer, diabetes, bleeding disorders
SHx
- wt change
- occupation, home, smoking, drinking, diet, exercise
3
Q
Menstrual hx
A
- length of cycle, ?regular
- duration of period
- volume of bleed - eg heavy
- dysmenorrhoea - more painful than usual
- LMP
- menarche
- date of menopause if post
4
Q
Obstetric hx
A
HPC
- N+V, fetal movts, PV bleed, abdo pain, PV discharge, headache/visual disturbance, oedema, pruritis, unilateral leg swelling, chest pain/SOB, fatigue/fever/wt loss
Previous obstetric hx
- gravidity, parity
- gestation at birth, mode of delivery, birth weight, complications, neonatal support, midwife/obstetric care, IVF etc
- current children - ages etc
- any previous miscarriages - causes
- previous TOP, type
- previous ectopics - site, management, cx
Current pregnancy
- LMP, when had +ve pregnancy test
- gestational age
- folate use
- estimated date of delivery - birth plans
- scans / screening results - eg 20 wk scan, Down’s
- any problems / admissions in this pregnancy
PMHx
- as per
DHx
- allergies, meds
- immunisations
FHx
- eg SCA, CF
SHx
- thoughts about pregnancy
- occupation, home, family, smoking/drinking
- domestic abuse
5
Q
Breast / breast lump Hx
A
6
Q
Fertility hx
A
“I understand you’ve been having some difficulty getting pregnant, can you tell me more about this please?”
General
- how long been trying - regular, unprotected sex
- previous Ix
- previous medical tx
- previous IVF
Sex
- frequency of sex
- difficulties with sex
- relation to fertile days?
- pain
Consider in partners (each)
- age
- occupation
- BMI
- previous children - same/different partner
- smoking / alcohol
- current meds
- PMHx
Woman’s gynae health
- gynae systems review
- PCOS sx - hirsutism, obesity, infrequent periods
- prolactinoma - galactorrhoea
- miscarriages, TOPs, any previous births (primary/secondary failure to conceive)
- menstrual hx
- obstetric hx
- sexual hx
- cervical smears, contraception hx
- vaccinations - eg MMR
PMHx
- abdo/pelvic ops, STIs/PID, previous subfertility
DHx
- folic acid, allergies, meds
FHx
- eg genetic problems, blood problems (SCA, thalassaemia)
- fhx of early menopause
SHx
- smoking, drinking, vaping, recreational drugs
- diet, exercise, occupation
7
Q
Paediatric hx
A
HPC
- SOCRATES, explore sx
- fever, activity/behaviour, rashes
- cough +/- sputum, runny nose, SOB, cyanosis
- vomiting, diarrhoea, abdo pain
- wet nappies, dysuria, frequency, haematuria
- seizures, fits, headaches, abnormal movts
- sore throat, ear pain
Birth
- any problems in pregnancy
- place of birth, gestation, weight, mode of delivery, complications, neonatal requirements
Growth
- weights - the Red Book
- puberty
Feeding
- eating / drinking, how much / how many bottles
- frequency of wet nappies / stools, consistency
Development
- any concerns
PMHx
- previous medical / surgical problems, previous hospital visits
DHx
- meds, allergies, immunisations
FHx
- as normal
SHx
- who’s at home, siblings/parents
- any smokers
- social services input
- housing, hobbies, school, pets
ICE
8
Q
Back pain hx idk
A
9
Q
Derm hx
A
HPC
- SOCRATES
- Where, when it appeared, how it’s changed
- Sx – itch, pain, rash, skin lesion, bleed, discharge, blisters, fever, malaise, wt loss, arthralgia
- Exacerbating / relieving factors
- Tx tried
- Recent contact, stress, illness, travel
- Hx of sunburn, use of tanning machines
- rheum system review
PMHx
- Atopy – asthma, allergic rhinitis, eczema
- Skin cancer, suspicious skin lesions
FHx
- Skin disease
SHx
- Occupation (inc skin contacts at work)
- Improvement of lesions when away from work
- alcohol, drugs, smoking
- home environment
- changes in diet
DHx
- Inc OTC
10
Q
Derm examination
A
Inspect
- general
- site, no of lesions
- pattern of distribution
Describe - SCAM
- Size, Shape
- colour
- Associated secondary change
- Morphology, Margin
Pigmented lesion - ABCDE
- Asymmetry
- irregular Border
- > 1 Colours
- Diameter >6mm
- Evolution - change in size/shape/colour
Palpate
- surface, consistency, mobility, tenderness, temp
Systemic
- nails, hair, mucous membranes, scalp
11
Q
ENT Hx
A
HPC
- SOCRATES
- general - fever, chills, wt change
- ear - tinnitus, vertigo, hearing loss, pain, discharge
- nose - congestion, rhinorrhoea, epistaxis, decreased smell
- throat - pain, dysphagia, odynophagia
- larynx - hoarse, voice change, noisy/difficulty breathing, pain speaking
- neck - swellings, pain, lumps
- face - sinus pain, pressure, swelling, numbness
PMHx
- previous surgery, eg head/neck
DHx
- meds, allergies
SHx
- smoker, alcohol
FHx
- anything in the family
12
Q
Ophthal hx
A
HPC
- SOCRATES, explore sx
- sudden vision loss
- change to vision - nature, onset, duration
- red eye
- eye discharge / watering
- gritty / dry eyes
- itchy eyes
- photophobia
- swelling / tenderness of eyes
- eye pain / pain on eye movt - SOCRATES
- double vision
- flashing lights
- headache/fever
- bleeding / trauma to eye - nature of injury, mechanism, FBs
- abnormal pupil reactions?
- temporal tenderness / jaw claudication
PMHx
- previous eye surgery, laser, trauma, contact lens/prescriptions
- chronic / autoimmune conditions
DHx
- eye drops?
SHx
- smoking
13
Q
Ophthalmic examination
A
Inspect
- face, eyebrows, asymmetry
- globe position, proptosis
- facial swelling/erythema/rashes
Vision
- acuity - Snellen’s / newspaper
- Ishihara plates
- visual fields
Eye movts
- ?diplopia, pain, nystagmus
Pupils
- shape
- direct / indirect reflexes
- RAPD
- accommodation
Lid/lashes
- lumps, swellings, erythema, cellulitis, ptosis
Conjunctiva
- red, discharge, purulent
Cornea
- eg abrasions, ?fluorescein stain
Anterior chamber
- hypopyon, hyphaema
Direct ophthalmoscopy
- red reflex, optic disc, retinal vessels, retina, macula
14
Q
Psych hx
A
HPC
- explore sx - nature, onset, tx, severity (functional impact), exacerbating/alleviating, duration/progression - impact on life
- psychosis - hallucinations, delusions, thought disorder - irrational thoughts, seeing/smelling things, feel targeted
- depression - low mood, anhedonia, sleep/energy, hopelessness…
- mania - periods of elation, out of character
- cognition - memory loss/forgetful
- anxiety, panic attacks, phobia
- unhappy about bodyweight / can’t control eating
- insight
Risk assessment
- intention to harm self, anyone else
- suicidal thoughts
- action on these thoughts
- risk of harm from anyone
PMHx
- psych issues - dx, tx
- past contact with mental health services
- previous self-harm/suicide attempts
- medical hx
DHx
- meds, allergies
- compliance
FHx
- psych issues, suicide
SHx
- alcohol, smoking, drugs
- current home, relationships, dependents/children, work, education
- forensic hx - police, jail, criminal record
- upbringing hx - childhood, school, inc child abuse
15
Q
Self-harm / suicide hx
A
HPC
- before - eg life events, depression
- planning - how long for / impulsive
- suicide note / tell anyone?
- precautions to avoid being found
- any alcohol/drugs
- truly intend to end life?
- when / where / how - eg specific OD details, self-harm injuries, where they got meds from etc
- how were they found / how did they get here
- feelings after the event - angry/regret
- current mood
- anything stopping them commit suicide?
- If they went home what would they do?
- any future plans for suicide
- happy to accept tx?
- depression screen - low mood, anhedonia, sleep/energy…
- psychosis - hallucinations, delusions…
- anorexia - problems with eating habits / body image
- safe at home? any risk from others?
PMHx
- conditions, inc psych
- past suicide attempts/self-harm - methods, help sought
DHx
- meds, inc allergies
FHx
- self-harm/suicide, psych conditions
SHx
- drug / alcohol, social stresses, relationship/family, jobs, living situation, hobbies
16
Q
Psychosis hx
A
17
Q
Depression hx
A
18
Q
Mania hx
A
19
Q
Eating disorders hx
A
20
Q
Psych risk assessment (self-harm/suicide)
A
- any thoughts of self-harm
- any thoughts of harming others
- any suicidal thoughts
- any harm from others?
- any attempts to self-harm / commit suicide
- what stops you acting on these thoughts
- made plans for suicide? What are they?
- how do you feel afterwards?
- take steps to ensure not found?
- support system at home
- any triggers for these feelings?
- any dependents?
21
Q
Capacity assessment
A
Requirements
- Any impairment of brain/mind - eg dementia, injury, intoxication - if NO then pt has capacity, if YES then follow point below
- can the patient understand, retain, weight up, communicate decision
- capacity is decision specific
- assume pt has capacity unless proven otherwise
- illogical decisions don’t mean pts don’t have capacity
Consultation
- intro, purpose, consent
- “can you tell me a bit about why you are in hospital”
- “do you understand what the options are for managing…”
- look for demonstration of requirements
- document clearly in notes
If pt lacks capacity
- find least restrictive option
- DoLS if decision infringes on pt’s ability to leave, or if they are controlled / supervised in any way they don’t consent to
- make decisions in best interests of pt - involve pt, take own beliefs into account
- ensure that ADRT / LPA are accounted for
22
Q
NAI / safeguarding
A
…
23
Q
Domestic abuse
A
Intro
- intro, purpose, consent
- build rapport
- emphasise privacy, safety, confidentiality
Approaching the issue
- general hx
- “how are things at home?”
- Establish abuse types - physical / sexual / emotional
- “has your partner ever hurt you”, “does your partner make you do sexual things you don’t want to?”, “how does your partner make you feel?”
- who is it, nature of relationship
- pattern - when it occurs, how long it’s been occurring, any escalation
- any alcohol/drugs involved
- coping? anything to try to stop it?
- who else lives at home?
- any weapons in the house?
- construct emergency safety plan - call police
Risk assessment
- currently feel in danger?
- mood? self-harm / suicide?
- children / vulnerable adults at risk?
- any previous psych hx, alcohol/drug use, previous divorce….
Closure / management
- ICE
- establish support - friends/family
- counselling support - eg national domestic violence helpline, WomensAid.org.uk - give leaflet
- refuge
- referrals - police, local domestic abuse services, counselling/support services, social services (if at risk children/adults)
- offer follow up
24
Q
CAGE / alcohol hx
A
HPC
- current use - what, how much, type, when, where (pub/home), why, who with
- anything happen in past?
- tried to cut down?
- treatments / detoxes
- relapse reasons
- ?tolerance
- any tremors, sweating, N+V, palpitations
- agitation, headache, hallucinations, seizures, insomnia
- affect on mood - assess risk of self harm / suicide / harming others
- how important is drinking to you?
CAGE
- felt the need to cut down?
- feel annoyed by people complaining about your drinking?
- feel guilty about drinking?
- ever drink an eye opener in morning?
SHx
- effect on self - injuries/medical conditions
- effect on family/friends, work, finances, police, driving, crime
- given up on hobbies/friends?
- recreational drug use, smoking
- family/living/working situation
- gambling?
FHx
- family alcohol use
DHx
- allergies, meds
PMHx
- eg ALD, UGIB, memory loss, PUD
- anxiety / depression
25
Q
Smoking cessation counselling
A
- (smoking causes CV disease, stroke, lung cancer, PVD)
- intro etc
- ICE about smoking / cessation
Smoking hx
- how long, how much
- what type - tobacco/nicotine
- where
- how does it make you feel, any effect on relationships
- how do they finance, how much would they save if stopping
- previously tried to quit? Relapses and why?
- withdrawal sx - craving, dizziness, low mood, fatigue, insomnia
PMHx
- COPD, asthma, pulm fibrosis, CVD / RFs
DHx
- any nicotine replacement now/before
FHx
- eg malignancy
SHx
- alcohol, drugs
- stressful life?
- employment
5 A’s approach
Ask
- ask + record smoking status
Advise
- risks of smoking, long-term effects
- advise to quit
Assess
- assess understanding of consequences of smoking with their own health
- explore pt’s views on cessation, if they feel motivated
- quantify motivation 1-10
- use stages of change model to guide assessment - precontemplation/contemplation/preparation/action maintenance/relapse
Assist - STAR
- Set quit date (2-4wks)
- Tell family + friends
- Anticipate challenges + how to overcome
- remove all tobacco products - recommend counselling / pharmacological therapies
Pharmacological therapies
- Nicotine replacement therapy - patches, spray
- Bupropion
- Varenicline
- all reduce cravings
Non-pharmacological therapies
- brief intervention (face-to-face therapy)
- individual counselling
- group counselling
- telephone counselling
Arrange
- follow up in 1-2 wks
- reassure about relapses - part of process
Closure
- check understanding, chunk + check
- any qs/concerns
- direct to leaflets / websites - NHS SmokeFree National Campaign
