OSCE knowledge Flashcards

1
Q

What are the three reasons you do a DNACPR?

A

Resus unlikely to be successful

The pt does not want it

It may be successful but would result in a QOL that is not to the pts benefit

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2
Q

What percentage of hospital CPR is successful roughly?

A

20% - lower if significant co-morbidities

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3
Q

Causes of blood on urinalysis?

A

ONNIT

Obstruction
Neoplasm
Nephritic syndrome
Infection
Trauma

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4
Q

What three things are required for consent to a procedure to be valid?

A
  1. Consent must be informed
  2. Consent must be voluntary
  3. Patient must have capacity
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5
Q

What is involved in explaining a procedure for consent?

A

Explain what it is
Explain why we are doing it
Explain Before, during and after
Explain the risks and benefits
Explain any alternatives

Assess capacity

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6
Q

What are the fraser guidelines for contraceptive consent in children?

A

The child understands the advice
They cannot be persuaded to tell their parents
Likely to continue having sex
Physical/mental health may suffer without contraception
It is in their best interests

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7
Q

Warfarin counselling structure?

A

Check for contraindications
- Active bleeding, or risk of
- Pregnant

How treatment works
- Blocks vitamin K, which helps to stop your blood forming clots, thins the blood.

Treatment course and how taken
- Once daily (usually in the eve)
- 3 months DVT, 6 Months PE, lifelong for AF

S/Es
- Bleeding - safetynet for any significant blood loss
- Diarrhoea rash, hair loss, nausea
- Avoid alcohol binges, liver, spinach NSAIDS and aspirin.

Monitoring
- INR days 3, 4 and 5
- Regular checks in warfarin clinic
- Warfarin booklet

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8
Q

Methotrexate counselling structure and content?

A

Check for contraindications
- Pregnancy
- Immunodeficiency
- Breast-feeding
- Active infection
- Hepatic impairment

How the medication works
- Suppresses inflammation and the immune system
- Stops folic acid synthesis

Treatment course and how taken
- Once a week tablet
- Take folic acid on another day
- Dose is built up slowly
- Long term if effective
- Takes 3-12 weeks to work

S/Es
- Hair loss
- Headaches
- GI disturbances
- Myelosupporession - if infections, unexpected bruising seek medical help
- Liver and lung toxicity

Monitoring
- FBC, LFTs U&Es
- Before starting then every 2 weeks until established, then every 2 months

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9
Q

Insulin counselling structure and content?

A

Check for contraindications
- None

How it works
- Allows cells in your body to take up glucose and use it for energy
- Insulin reduces the sugar in the blood

Treatment course and how you take it
- depends on their regime
- 90 degree angle in suncut tissue
- Vary sites, abdomen, buttocks and thigh

S/Es
- Weight gain
- Sharps injuries
- Hypoglycaemia - management
- Lipodystrophy

Monitoring
- Cap glucose before each meal and before bed
- High or low sugar symptoms

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10
Q

Bisphosphonate counselling structure and content?

A

Contraindications
- Pregnancy
- Dysphagia
- Peptic ulcer
- Renal impairment
- Sit upright for 30 mins?

How it works
- Stops the bone bening broken down and strengthens new bone
- Lifestyle can also help

Treatment course and how it’s taken
- Either once a day or once a week
- Swallow with a full glass of water
- 30 mins before food (in the morning)
- Upright for 30 mins after taking it
- Long term course

S/Es
- Heartburn and indigestion
- Headaches
- Bowel habit
- Urgent advice for: UGIB, Dysphagia, Osteonecrosis of jaw

Monitoring
- Dental check ups

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11
Q

Two places you swab for MRSA?

A

Nasal and groin

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12
Q

General structure to a explaining disease station?

A
  1. Normal anatomy
  2. What the disease is and what causes it
  3. Risks/complications
    4 .Management
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13
Q

Immunisation schedule?

A

2, 3 4 months, 1 year, 3 years 4 months, girls 12-13, teens.

2 months
- 6 in one
- rotavirus
- pneumococcal
- meningitis B

3 months:
- 6 in 1
- rotavirus

4 months
- 6 in one
- pneumococcal
- Meningitis B

1 year
- MMR
- Pneumococcal
- Men B
- Hib B
- Men c

Preschool (3 y, 4 m)
- MMR
- 4 in one

Girls 12-13
- HPV

Teens
- 3 in 1
- Men ACWY

6 in 1
- Diptheria
- Polio
- Tetanus
- Pertussis
- Hib
- Hep B

4 in 1
- Diptheria
- Polio
- Tetanus
- Pertussis

3 in 1
- Diptheria
- Polio
- Tetanus

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14
Q

quick developmental review?

A

3 weeks
- Smiling

3 months
- Turn to sound

6 months
- Sitting up

18 months
- Walking

18 months
- first words

3 years
- Short sentences

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15
Q

Bronchoscopy counselling structure and content?

A

What it is

Why needed

Before, during after
- Before: 6 hours no food, 2 hours no fluid, stop anticoags, and do clotting

  • During: Midazolam and lidocaine spray for all
  • After: No eating or drinking for 2 hours, No driving, alcohol, or signing legal documents for 24 hours. Keep someone with you for 24 hours.

Risks
- Lung damage
- Infection
- Bleeding

Alternatives
- Imaging?

ICE

Capacity

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16
Q

Gastroscopy counselling structure and content?

A

What it is

Why needed

Before, during after
- Before: 6 hours no food, 2 hours no fluid, stop antiacid meds 2 weeks before

  • During: Midazolam or lidocaine spray
  • After: No eating or drinking for 2 hours (if throat spray), No driving, alcohol, or signing legal documents for 24 hours. Keep someone with you for 24 hours - if midaz.

Risks
- perforation
- Infection
- Bleeding

Alternatives
- Imaging?

ICE

Capacity

17
Q

Colonoscopy counselling structure and content?

A

What it is

Why needed

Before, during after
- Before: 1 day before only clear fluid, bowel prep afternoon before and morning of.

  • During: Midazolam
  • After: No driving, alcohol, or signing legal documents for 24 hours. Keep someone with you for 24 hours.

Risks
- perforation
- Infection
- Bleeding

Alternatives
- Imaging?

ICE

Capacity

18
Q

Structure and content for a counselling station about surgery?

A

WIPE

Confirm op
What they know so far, any questions they want to ask

What is, why needed

Before
- Pre operative assessment, mobility and independence assessment, history and examination
- Pre op investigations, including imaging, ECG, blood tests
- Consent taken by a surgeon
- (risks and benefits)
- fasting - 2/6

During
- Anaesthetic room with nurse
- Meet anaesthetist, insert cannula and give anaesthetic, fall asleep

After
- Wake up in recovery area
- May have tubes from the operation
- Pain control
- VTE prophylaxis
- Physio/OT

Risks
- Most are rare and we minimise the risk as much as possible.
- Anaesthetic reaction
- Bleeding
- Damage to nearby structures
- Infections of the wound or systemic
- VTE
- Pain
- Fluid collections

Alternatives

Ask for any questions, ICE