OSCE Finals Revision Flashcards

Question

Smoking cessation counselling

Answer 1

- (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

Answer 2

Appearance/behaviour - build, dress, hygiene, self-neglect - engagement, eye contact, anxious, disinhibited, gait/posture Speech - rate (eg pressured), rhythm, tone (eg monotonous), volume Emotion (Mood/Affect) - subjective - pt's view of own mood - objective - your assessment of their mood - affect - their outward expression of their emotions Perceptions - illusions - hallucinations - auditory, visual, tactile, gustatory, olfactory - derealisation/depersonalisation Thoughts - stream - pressure, poverty, blocking - form - flight of ideas, loosening of associations, perseveration - content - delusions, obsessions, over-valued ideas - self-harm / suicide Insight - aware of own mental illness? - willing to comply with treatment? Cognition - MMSE / AMT

Answer 3

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

Answer 4

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 / SEs - esp common/serious - Tests (monitoring) - eg blood tests - Contraindications - Supplementary advice - offer leaflet Closure - ICE - double check understanding, answer questions - summarise info given - offer follow up...

Answer 5

- 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

Answer 6

- 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

Answer 7

- 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

Answer 8

- 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

Answer 9

- 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 Tests - nil CIs - pregnancy, stomach ulcers - renal impairment

Answer 10

- 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

Answer 11

- 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

Answer 12

- 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

Answer 13

- 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

Answer 14

- 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

Answer 15

- 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

Answer 16

- 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

Answer 17

- 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

Answer 18

- 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

Answer 19

Intro - intro, purpose, consent - focused hx if needed - check understanding of condition / procedure - ICE Procedure explanation - what it is - reason for it - details - before, during, after - risks / benefits - alternative treatments - if consenting - ensure pt has capacity - understand/retain/weigh up/communicate Closure - summarise - check understanding, answer questions - offer leaflet, follow up, eg specialist nurse

Answer 20

Setting - confidential room, comfortable, tissues to hand, sat down - family with if they want - turn off bleep Perception - what do they know already Invitation - check what they want to know - "I have the result here today, would you like me to explain it to you now?" Knowledge - build up to result, give warning shot - be direct, use plain language - chunk and check - wait for them to respond after delivering news - slow pace, respectful tone, give pt time to react after news Emotions / empathy - acknowledge their emotions - eg "I can see this news is a big shock" - respond to non-verbal cues - am I going to die - "I can't answer that at the moment....we're still gathering information...I want to stress that you're in the best possible hands..." Strategy/Summary - check understanding of everything, any questions - plan, when to meet again, next steps - ?refer to specialist - leaflet, Macmillan nurses, websites etc - offer to contact family to inform them - any religious preferences, eg chaplain

Answer 21

Background info - DNAR is a medical decision - <20% survive in hospital cardiac arrests, 10% survive to discharge, rates lower if co-morbidities / frail - take a SPIKES approach Consultation - "here today to talk about your health, perhaps some plans for the future" - focused history - check prior understanding of illness / prognosis - "any thoughts about if things were to get worse / patient's heart stops beating" - check understanding about resuscitation, what it involves - "any thoughts about how you want to spend the final moments of your life?" - check understanding about RESEPECT form / DNAR - explain procedure, low success rates, reasons for DNAR (CPR likely futile, poor outcomes, reduced quality of life afterwards) - allow for more natural death, maintain quality of life - not giving up on patient (DNAR is only relevant if heart stops) - focus on alleviating symptoms, prioritising comfort - eg pain, nausea, agitation.... - chunk/check Closing - check understanding, answer questions - if disagree - give time to mull over, come back later with senior - offer leaflet, offer further discussions - spiritual support? Organ donation / post-mortem / brain-stem death / invasive procedures

Answer 22

intro - introduce self, consent, calm manner - private location, position self close to door - clear boundaries if pt aggressive/rude Dealing with pt - allow to vent feelings uninterrupted - validate feelings, apologise early, don't collude - "I'm sorry to hear you feel that way" - focus on pt - explore concerns, acknowledge them Explaining to pt - try to give some info - reassure you'll look into the matter, escalate to senior colleagues - stress complaint is being taken seriously - make clear, realistic plan - follow-up - inform of right to complain - practice manager at GP, PALS at hospital

Answer 23

Stabilisation - make sure pt is safe - A-E - escalate care as required Post-incident - SPIKES approach - inform patient + relatives - apologise - explain how error occurred - document well in notes - inform seniors - Fill out Datix - reflect + learn from error - offer chance for complaint - PALS - summarise + plan Near miss - report, even if no harm (could have potentially led to harm)