OSCE II Flashcards
What is SIG- E-Caps?
Screening for major depression/suicide screening
When is SIG-E-CAPS considered a positive screening?
At least 5 are positive
What are the questions corresponding to SIG-E-CAPS
- Any changes to sleep?
- Any changes in interest
- Guilt?
- Any changes in Energy level?
- Any changes in concentration?
- Any changes in your aptetive
- Psychomotor activity change?
- Any thoughts of suicide or homicide? If yes, do you have a plan/what is your plan?
What are the alcohol guidelines for low risk alcohol use?
Men: Max 2 drinks per day
Women: Max of 1 drink per day
How many grams of alcohol is 1 drink?
1 Drink = 14 g pure alcohol
What are the alcohol guidelines for heavy risk use?
- Men: more than 4 drinks on any day or 15 drinks/week for men
- Women: more than 3 drinks on any day or 8 drinks/week
Define binge drinking and the parameters for men and women.
- Binge drinking is a pattern of drinking that brings alcohol concentration to 0.08% or more
- Men: 5 drinks in 2 hours
- Women: 4 drinks in 2 hours
What is CAGE?
When do you use it?
- CAGE is an alcohol screening
- Used when alcohol is above low risk, > 1 drink for F or > 2 drink M per day
When is CAGE considered a positive screening?
- When more than 2 of questions are answered “yes”
What are the question of CAGE?
- Cut back: have you ever felt the need to cut down on drinking?
- Annoyed: have you ever felt annoyed by criticism of drinking
- Guilt: have you ever had guilty feelings about drinking?
- Eye opener: have you ever taken a drink first thing in the morning to steady your nerves or to get rid of a hangover?
How much nicotine is vaping compared to cigarettes?
- 15 puffs = 1 cigarette
What are the max acceptable levels of alcohol and caffeine per day for men?
- Alcohol: 2 drinks
- Caffeine: 400 mg
What are the max acceptable levels of alcohol and caffeine per day for women?
- Alcohol: 1 drink per day
- Caffeine: 400 mg per day
- Pregnant: max 200 mg caffeine per day
What is BATHE?
- Screening for Anxiety
- Background: “what’s going on in your life?”
- Affect: “How do you feel about that?”
- Trouble: “What troubles you most about this?”
- Handling: “How are you handling that?”
- Empathy
Where can you indicate “ + or -“ for symptoms on note documentation?
HPI for associated symptoms
Where can you not document “none” in a SOAP note?
What should be used instead?
- Cannot not list “none” in history documenting, or anywhere really
- Should use: “patient denies”
What is the very first portion listed in a SOAP note, subjective portion?
Name:
DOE:
DOB:
Age:
CC:
- “cc” meaning chief complaint
Describe the diagnosis portion of the SOAP note
1.) What you think the problem was, listed diagnosis
2.) Next likely cause
3.) Least likely of the top 3
4. & 5.) Social issue found or any other health problems affecting complaint. (If you find a somatic dysfunction)
Describe the plan portion of the SOAP note
- Need at least 3
1. When patient will return, usually within 2 weeks
2. Ask patient if they have any questions and ensure the verbalize understanding
How many questions and systems do you complete for ROS?
- Must ask 2 questions in at least 3 systems
What is AAOx3?
Where does it go in SOAP note?
Alert & oriented to person, place, time
Goes under: General-AAOx3, WNWD, Any physical distress visualized
What must be documented for Heart Exam in O portion of SOAP note/
- Rhythm
- Rate
- S1
- S2 hear sound
- Presence of murmur, gallops, rubs, clicks
- PMI location
How to document lung sounds on O portion of SOAP note?
List the spots that should be auscultated
- Any wheezes, rales, rhonchi. Any labored breathing?
- 4 anterior, 2 lateral, 6 posterior
For physical exam MSK portion, what must be checked?
Extremities: inspection, palpation, muscle strength, special tests of the appropriate joint affected and its complement
For PE portion, MSK, describe what must be done for spine exam and when it will be done
- Spine: inspect skin, palpate thoracic spinous process, check iliac crest heights
- Perform if there is not a complaint near a joint or joint is not named in HX
Describe the P portion of the SOAP note:
- Plan for you top assessment/top diagnosis
- Counseling on problem ,what you discussed/recommended
- Follow up: usually 2 weeks for recheck
- Pt verbalized understanding and ask again if any questions/concerns
- Sign name and Title, Emma Light OMS I
For P portion of SOAP note, indicate what is needed for the plan of top assessment/diagnosis
- Medication
- Supportive care
- Diagnostic test
- Labs
- Referrals to specialist
What are the signs of MI?
- Pale
- Diaphoretic
- Either hypertension or hypotension
What are the symptoms for MI?
- Acute chest pain-all over chest (non-focal)
- Chest pressure
- Left shoulder/jaw pain
- Dyspnea (esp. females)
What are the PE exam components performed for MI?
- Inspect: general, skin, lips, capillary refill
- Palpate: ribs, PMI, pulses
- Auscultate: heart and lungs
What is the treatment for MI?
- Send to ER
- If in ER: EKG & cardiac monitoring, Admin medications: O2, Aspirin 325 mg chewed, Nitro 0.4 mg every 5 minutes with a maximum of 3 pills, diagnostic imaging-chest xray, consult cardio
What accessory information might be found for MI?
- Activity makes pain/discomfort worse
- Radiates into either both arms
- Radiates into lower jaw, neck, or throat
Why does cigarette smoking put patients at risk for MI?
Higher clotting factor and the presence of more plaques
Why does meth use place patients at risk for MI
Increases HR
What are the symptoms of pneumonia community acquired?
- Cough: both productive and non productive
- Dyspnea: SOA
- Pleuritic chest pain, chest wall or rib
- Fever or chills
- Fatigue
- Several causes sepsis including hypotension, altered mental status
What are the signs of pneumonia-community acquired?
- Tachypnea
- Increased work to breathe
- Hypoxia, O2 says, >95%
What are the physical exam for pneumonia-community acquired?
- Inspect: general, skin, lips, extremities
- Capillary refill
- Palpate: ribs, percussion-dullness, + Tactile fremitus
- Auscultation: heart, lungs, +egophony?
What is the treatment for CA Pneumonia?
- Chest xr
- Sputum culture
- If vitals stable treat with ABX at home
- O2 <92 refer for hospitalization
- F/u in 10 days and get repeat XR, if not improving call office
What antibiotics are prescribed for CA Pneumonia typically?
- Amoxicillin 1 gram three times each day for 10 days
- If allergic, Azithromycin pack 250 mg 2 tablets day 1, then 1 tablet per day for days 2-5
What are the symptoms of PE-acute?
- SOA
- Pleuritic chest pain
- Cough-non productive
- Hemoptysis-blood cough
What are the signs for PE-Acute?
- Unstable PE will give hypotension
- Hypoxemia
- Tachycardia
What physical exam components are necessary for suspected acute PE?
- Check vitals
- O2 saturation
- Inspection: skin color, lip color, extremitites
- Palpate: ribs, extremities, spine
- Labored breathing? Abnormal positioning?
- Auscultation?
What is the tx for PE-acute?
Lab tests:
- CBC, D dimer, CT Pulmonary angiography
Meds: O2 @ 2 LPM, Anticoagulation
If in ER findings determine if in hospital. If in office may need to transfer to EMS to ER for additional work up
- F/U is few days after discharge
What are some common causes of PE?
- Cancer
- Acute stroke-ischemic
- Hospitalized patient
What are the symptoms of rotator cuff injury
- Pain at night especially laying on affected shoulder
- Pain with lifting or lowering arm
- Gradual worsening of pain if chronic or over-use is the cause
- Sudden if due to trauma
What are the signs for rotator cuff injury?
Shoulder somatic dysfunction or TTC
Describe the physical exam component of rotator cuff injury
- Inspect: skin color
- Palpate: joint affected & other side, palpate for edema, dislocation etc.
- Muscle strength
- Pulses
- ROM
- MSK special tests
- Heart & Lung Sounds
What is the treatment for rotator cuff injury?
- Rest
- NSAIDS (Ibuprofen 800 mg TID)
- OMT: if partial tear
- PT
- XR: if trauma
- Possible joint injection
- MRI of joint if 8 wk of OMT or PT does not help
- Orthopedic referral if greater than 6-12 mo
What are 2 special notes about rotator cuff injury?
- Tends not to radiate
- Tends to be a chronic pain from repetitive use or chronic. lifting overhead, unless there is a sudden injury to cause a tear
What are the symptoms of meniscus injury?
- Effusions-large tears
What are the signs of a meniscus injury?
- Trauma-causing acute knee pain
- Pain to knee-especially sudden onset with in the next 24 hours
- May experience locking, or catching sensation
- Can complain that knee “gives out”
- No grinding senstation
- Swelling within 24 hours
What are the physical exam components of a meniscus injury?
- Heart and lung
- Inspect skin: discoloration, rash
- Palpate: joint for tenderness, bone tenderness, warmth, and effusion bilaterally
- Pulses of lower extremities
- Active ROM bilaterally
- Muscle strength bilaterally
- Special tests for affected joint
What is the treatment for Meniscus injury?
- Check Ottaway knee rules: if one or more is positive get XR
- Medication: Diclofenac 50 mg BID
- Rest knee, Ice for 15 minutes every hour, Knee brae, elevate knee while icing
- Use knee every hour
- Refer to Ortho surgeon if significant injury or swelling seen along with tests, ACL tear present
- F/U 1 week
What are some common causes for Acute meniscus injury?
- Jumping, landing, cutting, squatting, slipping or sprinting
- Forceful injury involving twisting o the knee while foot is planted
- Rare in kids below 10 yr
- Overuse from older patients with minimal twisting or stress as a cause
List 4 special tips associated with acute meniscus injury
- How were legs positioned at time of injury
- Any snap or pop heard-think ligament tear or acute meniscal tear at time of injury if acute
- Check to make sure no fever/chills, night sweats, fatigue, rash to rule out joint infection
- Acute-worsening with twisting or pivoting
What does Jobe’s/Empty Cans MSK test?
Supraspinatous tendon compression
What does Hawkin’s MSK test?
Rotator Cuff Tendon Impingement
During upper extremity testing, when the patient actively externally rotates, what muscles are being tested?
Infraspinatus and Teres Minor
During upper extremity testing, when patient actively internally rotates, what muscles is being tested?
Subscapularis
What does Neer impingement test for?
AC Impingement
What are some differential diagnosis for DVT?
Enlarged lymph node compressing vein
Cellulitis
What are some differential diagnosis for Rotator Cuff injury?
Cervical spondylitis radiating to shoulder
Frozen shoulder
Osteoarthritis
What are some differential diagnosis for Meniscus injury?
Patellofemoral syndrome
Arthritis
What are some differential diagnosis for MI?
Chostochondritis
GERD
What are some differential diagnosis for Pneumonia?
Influenza
RSV
Endocarditis
What are some differential diagnosis for PE?
Acute heart filaure
COPD
Cardiac tamponade
What are some ROS questions for CV?
Any palpitations?
Any SOA?
Orthopnea?
PND? (Paroxysmal nocturnal dyspnea)
Edema
What are some ROS questions for GI?
- Any nausea?
- Any vomiting or diarrhea?
- Any trouble swallowing?
- Any heartburn?
- Loss of appetite?
- Any change in stools or blood in stools?
- Any jaundice?
What are ROS questions for GU?
- Any dysuria, hematuria, or polyuria?
- Any hesitancy or dribble?
- Any hesitancy or dribble?
- Any urgency?
- Any incontinence?
- F: Any vaginal discharge? Pain with intercourse? Timing and heaviness of periods?
What are some ROS questions for vascular?
- Leg cramps?
- Varicose veins?
- Past clots?
- Edema?
What are some ROS questions for MSK?
- Muscle or joint?
- Muscle weakness?
What are some ROS questions for psych?
- Any depression?
- Any anxious?
- Any insomnia?
- Any mood changes?
- SI/HI idealizations?
What are some ROS questions for Neuro?
- Any changes in mood or attention or speech?
- Changes in orientation?
- Memory?
- Headache, dizziness or vertigo?
What are some ROS questions for Hematologic?
- Any anemia?
- Easy bruising?
- Bleeding?
What are some ROS questions for Endocrine?
- Heat or cold intolerance?
- Excessive sweating?
- Polyuria? Polyphagia & polydipsia?
- Change in hat, glove or shoe size?
What are the Ottowa knee rules?
- Cannot bear weight for more than 3 steps
- <55 YOA
- Cannot flex to 90 degrees
- There is tenderness at the head of the fibula
- There is isolated tenderness of the patella
