OSCE revision- year 3 Flashcards
1
Q
name the 7 ‘symptoms’ of a clinical assessment for infection
A
- temperature
- tachycardia
- tachypnoea
- white cell count
- hypotension
- hyperglycaemia
- swollen lymph nodes
2
Q
what temperature is pyrexial?
A
over 38 degrees celsius
3
Q
what is hypertensive?
A
over 120/100
4
Q
what is hypotensive?
A
below 90/60
5
Q
define a normal neutrophil count
A
4-11
6
Q
define rigours
A
a sudden feeling of cold and shivering while feverish
7
Q
define tachypnoea
A
breathing rate of more than 20 per minute
8
Q
what is erythema?
A
redness of the skin
be careful as this may look different on different skin types - ie darker skin tone won’t look as red as paler skin tones
9
Q
define the SIRS criteria (systemic inflammatory response syndrome)
A
body temp- over 38, under 36
HR over 90
resp rate over 20
white cell count under 4
10
Q
define CURB 65
A
confusion
urea (over 7g/L)
respiratory rate over 20
blood pressure- high or low
over 65
11
Q
what is CURB 65 used for?
A
used to predict mortality in pneumonia
12
Q
what would be classified as a low respiratory rate?
A
under 12 per minute
13
Q
cellulitis treatment and dose
A
flucloxacillin 1g 4x/5 days
14
Q
cellulitis treatment and dose in penicillin allergic patient
A
clarithromycin 500mg 2x/5 days
15
Q
likely causative organism for cellulitis
A
staph aureus
16
Q
animal or human bite - treatment and dose
A
doxycycline 200mg immediately then 100mg OD for 2 days - total treatment 3 days
AND
metronidazole 400mg 3x/ 3 days
17
Q
bacterial tonsillitis treatment and dose
A
phenoxymethyl penicillin/ pen V
500mg 4x/ 5 days
18
Q
likely causative organism of bacterial tonsillitis
A
group A strep
19
Q
treatment and dose for COPD exacerbation (2 options)
A
doxycycline 200mg immediately then 100mg OD for 5 days
or
amoxicillin 500mg 3x/ 5 days
20
Q
c.diff infection give 2 possible treatments and doses
A
vancomycin capsules
125mg 4x/ 10 days
metronidazole
400mg 3x/ 10 days
21
Q
state one counselling point for metronidazole
A
no alcohol- severe sickness
22
Q
name 2 drugs which should be stopped (where possible) in a c.diff infection
A
PPI
laxative
23
Q
name 3 risk factors for developing a c. diff infection
A
over 60
4Cs (clindamycin, co-amoxiclav, cephalosporins, ciprofloxacin)
on PPI
24
Q
treatment for sepsis of unknown origin
A
piperacillin + tazobactam
AND
gentamicin
25
UTI- warning symptoms which require referral to GP/ hospital (3)
back pain
fever
generally feeling unwell
26
name 6 non drug self care points for UTI prevention and treatment
wipe front to back
drink plenty fluids
pee after sex
don't hold urine in too long
avoid caffeine and alcohol
avoid irritants such as perfumed wipes and washes in the area
27
treatment and dose for a women (not pregnant) with a UTI
trimethoprim
200mg 2x/ 3 days
28
treatment and dose for a man with a UTI
trimethoprim
200mg 2x/ 7 days
29
treatment and dose for a pregnant women with a UTI
nitrofurantoin
100mg MR tab 2x/ 7 days
if in last trimester- use trimethoprim- 200mg 2x/7days
30
impetigo treatment and dose (2 options)
fusidic acid cream
apply 3x/ 7 days
flucloxacillin
500mg 4x/ 7 days
31
likely causative organism (2) for impetigo and one characteristic symptom
Staph.aureus
Strep.pyogenes
yellow/ golden crust on face and hands
32
name 7 counselling points for doxycycline
- take on an empty stomach (1 hour before food or 2 hours after)
- take sitting up or standing (can cause irritation to the throat)
- complete the course
- no antacids - due to collation
- no milk - due to collation
- no zinc, iron etc - due to collation
- where suncream + cover up- increased photosensitivity
33
chickenpox treatment and appropriate time frame for this treatment
aciclovir
800mg 5x/ 7 days
within 72 hours of spot appearing
34
likely causative organism of nappy rash
E.coli
35
nappy rash treatment (2) and non drug advice
sudocreme (zinc oxide)
hydrocortisone 1% cream (once daily for max 7 days, must be at least one month old)
advise parents to keep area as clean as possible
wipe gently when changing and pat dry don't rub
36
shingles treatment, dose and appropriate time scale for giving treatment
aciclovir
800mg 5x/ 5 days
within 72 hours of rash appearing
37
painful unilateral rash with blisters has developed across upper torso over 48 hour period- diagnosis?
shingles
38
athletes foot- treatment and dose
miconazole cream
2x daily
39
which antibiotic daily does this structure relate to?
cyclic amide fused to 5 membered ring with sulphur atom inside ring
penicillin
40
which antibiotic daily does this structure relate to?
cyclic amide fused to 6 membered ring with sulphur atom inside ring
cephalosporins
41
which antibiotic daily does this structure relate to?
cyclic amide fused to 5 membered ring with sulphur atom on the side of the ring
carbapenem
42
which antibiotic daily does this structure relate to?
cyclic amide alone- no ring present
monobactam
43
name 3 prednisone counselling points
- take all 6 tabs together in the morning (mimics natural cortisol levels, can keep patient awake if they take it at night)
- common side effects - GI upset, indigestion
- take after food to reduce likelihood of GI upset
44
max salbutamol dosing - pMDI?
8 puffs - 800mcg daily
45
max salbutamol dosing- accuhaler?
4 puffs (each puff is 200mcg not 100 like a pMDI)
max 800mcg
46
name 5 side effects associated with tiotropium
- dry mouth
- constipation
- blurred vision
- tachycardia
- urinary problems
47
describe how to use a pMDI inhaler
- cap off
- shake
- if it has a dose counter- check the inhaler isn’t empty
- sit upright or stand up
- breathe out as far is comfortable, facing away from your inhaler
- create a tight seal with your lips around the mouthpiece – no gaps
- breathe in slowly and steadily and press the top of the canister down fully
- breathe in until lungs feel full
- take the inhaler out – keep lips closed
- hold breath for 5-10 seconds
- if you take a second puff- wait 1 minute then repeat
- remember to put the cap back on
- rinse mouth if it is a steroid inhaler
48
describe how to use an accuhaler (DPI)
- slide open inhaler cover
- check the counter- is it got enough doses/puffs left?
- Hold inhaler horizontally
- push back the lever with your thumb until it clicks
- Sit or stand upright and breathe out as far as is comfortable, facing away from your inhaler
- create a tight seal with lips around the mouthpiece
- Breathe in quickly and deeply
- Take the inhaler out of your mouth and hold your breath for up to 10 seconds or as long as you can
- Then breathe out gently
- If you have been prescribed more than one puff- reset the inhaler by closing the cover over- wait 1 minute before taking another puff – repeat all steps
- If the inhaler contains steroids, rinse your mouth with water and spit it out
49
describe how to use a spiromax inhaler (DPI)
- Open the cap by pulling it down until it clicks
- Check the dose counter- is there enough left
- Hold the inhaler upright
- Sit or stand upright and breathe out as far as is comfortable
- Then create a tight seal with your lips around the mouthpiece
- Breathe in quickly and deeply
- Remove the inhaler from your mouth and hold your breathe for 5-10 seconds
- Then breathe out gently
- If a second puff has been prescribed- wait about 1 minute then reset the inhaler by closing the cap and starting the steps again
- (only comes as steroid) rinse your mouth with water and spit it out or brush teeth
50
describe how to use a Elipta inhaler (DPI)
- Slide open the cover until it clicks
- Check the dose counter
- Hold the inhaler horizontally
- Sit or stand upright
- Breathe out as far as is comfortable, facing away from the inhaler
- Create a tight seal with your lips around the inhaler mouthpiece
- Then breathe in quickly and deeply
- Remove the inhaler from your mouth and hold your breath for 5-10 seconds
- When finished close over the inhaler cover
- If the inhaler contained steroids then rinse your mouth with water and spit it out or brush teeth
51
describe how to use an NEXThaler (DPI)
- Hold the inhaler upright and open the cover until it clicks
- Check the dose counter
- Sit or stand upright
- Breathe out as far as is comfortable away from inhaler
- Create a tight seal around the inhaler mouthpiece with your lips
- Then breathe in quickly and deeply
- Remove the inhaler from your mouth and hold your breath for 5- 10 seconds
- Breath out slowly
- If a second puff has been prescribed then close the cover to reset the inhaler
- Wait about 1 minute between doses
- this inhaler contains steroids so rinse your mouth with water and spit it out, or brush teeth
52
describe how to use a spacer with an inhaler
- Hold inhaler upright, remove the cap and shake well
- If the spacer has a valve, make sure it is facing upwards
- Then put the inhaler into the hole at the back of the spacer
- Sit or stand upright
- Breathe out as far as is comfortable away from the spacer and inhaler
- Create a tight seal with your lips around the mouthpiece of the spacer
- Press the canister on the inhaler to release the dose
- Breathe in and out normally about 5 times
- If a second puff has been prescribed wait 1 minute then shake the inhaler again and repeat the steps
- When finished replace the caps on both the inhaler and the spacer
- If the inhaler contained steroids- rinse your mouth with water and spit it out
53
describe how to use a turbohaler (DPI)
- Twist off the cover and hold it upright (coloured base at the bottom)
- Then check the dose counter
- Turn the coloured base as far as it will go in one direction then all the way back again- you should hear a click on one of the turns
- Sit or stand upright
- Breathe out as far as is comfortable, away from the inhaler
- Create a tight seal around the mouthpiece with your lips
- Then breathe in quickly and deeply
- Remove the inhaler from your mouth and hold your breath for 5-10 seconds
- Then breath out- if a second puff has been prescribed then repeat the steps after 1 minute
- When finished twist cap back on
- If the inhaler contained a steroid- rinse your mouth with water and spit it out
54
describe how to use an Easi-breathe inhaler
- Hold the inhaler upright and shake
- Open the cap
- Sit or stand upright and breathe out as far as is comfortable, away from the inhaler
- Create a tight seal around the mouthpiece with your lips
- Then breathe in slowly and steadily, continue to breathe in slowly once dose has been released
- Remove the inhaler from your mouth and hold your breath for 5-10 seconds then breathe out
- If a second puff has been prescribed, close the cap and wait 1 minute, shake the inhaler and repeat the steps
- When finished close the cap
- If the inhaler contains a steroid- rinse your mouth with water and spit it out or brush teeth
55
describe how to use a Respimat inhaler (side-mist inhaler)
- The first time you get this inhaler- you will receive a pack containing an empty inhaler and cartridge- your normal repeat prescription will only be for the cartridges, every 6 months you will get a new inhaler
- first ensure a cartridge is inserted, then hold the inhaler upright
- turn the base in the direction of the arrows until it clicks
- open mouthpiece until it snaps fully open
- breathe out as far as is comfortable away from the inhaler
- create a tight seal around mouthpiece with lips
- breathe in slowly and deeply- press the dose-release button while doing this
- remove inhaler and hold breath for about 5-10 seconds
- then breathe out slowly
- if a second puff has been prescribed close the mouthpiece and wait 1min, then repeat the steps
- (doesn't come in steroid)
56
describe how to use a Handihaler (DPI)
- First press on the green side button to release the cap and lift it open
- Next open the mouthpiece by pulling it upwards, then put a capsule into the inner chamber
- Close the mouthpiece until it clicks
- hold inhaler upright and press and release the green button fully to make a hole in the capsule
- Sit or stand upright
- Breathe out as far as is comfortable away from the inhaler
- Now create a tight seal around the mouthpiece using your lips
- Then breathe in quickly and deeply- you should hear a vibrating noise
- Remove the inhaler from your mouth and hold your breath for 5-10 seconds then breathe out
- to ensure the capsule is empty- repeat these steps
- when finished open the mouthpiece and tip out the used capsule into the bin, then close the mouthpiece and cover
(doesn't come in steroid)
57
describe how to use an autohaler
- hold upright and remove the cover by pulling down the lip at the back then shake well
- Flip the red lever on the top until it clicks into place
- Sit or stand upright
- Breathe out as far as is comfortable
- Create a tight seal with your lips around the mouthpiece of the inhaler
- Breathe in slowly and steadily- continue breathing in when you hear a click
- Remove the inhaler from your mouth and hold your breath for 5-10 seconds, then breathe out gently
- Lower the red lever on the top of the inhaler
- If a second puff has been prescribed – wait 1 minute then shake the inhaler again and repeat the steps
- When finished replace the cover and ensure the red lever is down
- If the inhaler contains steroids rinse your mouth with water and spit it out
58
how long must a POM record be kept in the pharmacy?
2 years from the last entry
59
state 2 POMs meds which don't need to be recorded in the POM register
oral contraceptives
schedule 2 CDs- because these will already be in the CD register
60
state the details which must be recorded in the POM resigner (10)
- supply date
- prescription date
- medicine details (name, quantity, formulation, strength)
- prescriber details (name and address)
- patient details (name and address)
61
what are the rules on dental prescribing- can they prescribe anything?
dentists can technically prescribe any POM- however professional judgement is required here, is this suitable, why?
however on an NHS dental Rx- they can only prescribe from the dental formulary
62
state the details required on a prescription (7)(non CD)
- patient details (name and address, age if under 12 years old)
- date (only valid for 6 months)
- prescriber details (name and address)
- prescriber signature in indelible ink
63
state the details required on a prescription for a schedule 2 or 3 CD (12)
- patient details (name, address, age if under 12)
- prescriber details (name and address)
- prescribers signature - in indelible ink
- date (only valid for 28 days)
- drug details (name, form, strength, dose, total quantity- in words and figures)
64
what units should liquid preparations of schedule 2 or 3 controlled drugs be given on the Rx (for total quantity) ?
milliliters not milligrams
65
if an Rx is missing the total quantity how much can the pharmacist legally give?
up to 5 days or minimum pack size possible
66
state the details required on the label of a dispensed medicine (7)
- name of patient
- name and address of pharmacy making supply
- date of dispensing
- name of medication (no other details legally require although is good practice)
- directions for use
- precautions ie 'for external use only'
67
what is the maximum period of time the responsible pharmacist can be absent from the premises?
2 hours
68
what is the likely causative organism of community acquired pneumonia? (2)
strep pneumoniae
haemophillus influenzae
69
what CURB-65 score would signify a 'non-severe' case of CAP?
0 or 1
70
treatment option and dose for non-severe or moderate CAP (2)
- amoxicillin (500mg 3x/ 5 days)
- doxycycline (200mg immediately then 100mg for 4 further days- total 5 days treatment)
71
what CURB-65 score would signify a moderate CAP infection?
2 (and no sepsis syndrome)
72
what CURB-65 score would signify a severe CAP infection?
3 or more
or any CURB score with sepsis syndrome
73
treatment option, route and dose for severe CAP infection (3 options)
co-amoxiclav 1.2g every 8 hours via IV
clarithromycin 500mg 2x daily via IV or orally(5 days)
review IV therapy daily for swap to oral
74
describe the difference between CAP and HAP
within 4 days of hospital admission- CAP
within 7 days of discharge or 5 days after admission- HAP
75
treatment and dose option for HAP with a CURB score of 2 or less (2)
co amoxiclav 500/125mg 3x/ 5 days then review
or
doxycycline 200mg immediately then 100mg OD for 4 days (5 days total treatment)
76
treatment and dose option for HAP with a CURB score of 3 or more
co amoxiclav 1.2g every 8 hours- IV
and
gentamicin - IV
77
name an antibiotic group statins interact with and give 3 specific examples
macrolides
Azithromycin, clarithromycin, and erythromycin
78
name one drug and one food interaction with warfarin
miconazole
pomegranate juice
79
explain why a patient cannot take a PPI within 2 hours of having an antacid?
PPI is gastro resistant and only begins working when pH increases (normally intestine but after having an antacid the stomach pH will be increased)
80
How long does the prescriber have to provide you with a prescription when suppling an emergency supply- is this the same for CDs?
normal- 72 hours
CD- 24 hours
81
pKa for carboxylic acid?
4
82
pKa for amine?
9
83
pKa for phenol
10
84
does a low pKa mean stronger or weaker acid?
stronger
85
what is the difference between log p and log d?
log d accounts for both ionised and unionised forms of the drug
86
when pKa = pH what % is ionised?
50%
87
name 4 drugs that can cause vitamin b12 deficiency
PPIs
H2 antagonists
oral contraceptives
metformin
88
name 6 symptoms of hyperthyroidism
o Anxiety
o Irritability
o Sweating/ heat intolerance
o Tachycardia
o Weight loss
o Sexual dysfunction
89
name one treatment option for hyperthyroidism
carbimazole
90
is graves disease associated with hypo or hyperthyroidism ?
hyperthyroidism
91
is TSH and T3/T4 high or low in primary hyperthyroidism?
low TSH
high T3/T4
92
is TSH and T3/T4 high or low in secondary hyperthyroidism?
both high
93
is Hashimoto's thyroiditis associated with hypo or hyperthyroidism >
hypothyroidism
94
name 7 symptoms of hypothyroidism
Weight gain
Fatigue
Dry skin
Course hair
Hair loss
Constipation
Heavy/ irregular periods
95
is TSH and T3/T4 high or low in primary hypothyroidism?
high TSH
low T3/T4
96
is TSH and T3/T4 high or low in secondary hypothyroidism?
low TSH
low T3/T4
97
what system/ criteria is used as a marker of inflammation?
SIRS criteria
98
which antibiotics cannot be used in under 12s?
tetracyclines
99
what is FEVERPAIN used for?
to determine if tonsillitis requires antibiotics
100
what is the FEVERPAIN criteria? (5)
fever in the last 24h
purulence (pus)
attend rapidly (<3days)
inflamed tonsils
no cough
101
lactulose dose and counselling
adult- 15ml 2x/day
drink plenty water
102
what does a positive log P indicate?
the molecule is lipophilic and will be absorbed
103
what does a negative log D indicate?
molecule is ionised and therefore will no absorb
104
what route do we need to give B12 if the patent is also taking omeprazole (or another PPI) - why is this?
parenterally- pepsin is required for the uptake of B12 via GIT since the PPI stops acid secretion there is little pepsin and so the B12 will not be absorbed
105
if an ACE inhibitor is causing a cough- what would we do?
swap to ARB like losartan
106
name 3 drugs that hypertensive patents need to avoid and why?
soluble tabs - high sodium content
antacids - high sodium content
NSAIDS - causes sodium retention
107
name one class of drug which is contraindicted in asthmatic patients and why?
beta blockers - increases risk of bronchospasm
108
name 5 signs of digoxin toxicity
nausea
vomiting
confusion
irregular pulse
visual disturbances
109
give 2 examples of a short acting B2 agonist
salbutamol
terbutaline
110
Give 2 examples of long acting B2 agonist
salmeterol
formoterol
111
give 2 examples of ICS
beclometasone
fluticasone
112
give 3 examples of long acting muscarinic antagonists
tiotropium, aclidinium, umeclidinium
113
which drugs are in fostair (name and type)
beclomatasone and formoterol
ICS and LABA
114
what treatment is most appropriate for a 40 year old white male who is hypertensive- give drug family as well as an example with dose and frequency
ace inhibitor
ramipril 2.5mg OD- measure BP in 4 weeks - increase dose if no improvement
115
ACE inhibitor counselling (3)
- take first dose at night (due to first dose hypotension) , then continue taking normal dose in the morning
- side effects- dry cough
- patient should avoid using NSAIDs
116
what treatment is most appropriate for a 60 year old, type 2 diabetic, white female who is hypertensive- give drug family as well as an example with dose and frequency
ACE inhibitor
ramipril 2.5mg OD - review in 4 weeks- if no improvement increase dose
117
what treatment is most appropriate for a 65 year old white male who is hypertensive- give drug family as well as an example with dose and frequency
CCB
amlodipine 5mg OD- review in 4 weeks- if no improvement then increase dose
118
what treatment is most appropriate for a 40 year old afro male who is hypertensive- give drug family as well as an example with dose and frequency
CCB
amlodipine 5mg OD- review after 4 weeks- can increase to 10mg OD if no improvement in BP
119
name a common side effect of amlodipine
ankle oedema
120
when should patients take their first dose of amlodipine ?
in the morning- first dose hypertension is not an issue with this drug
121
levothyroxine counselling (when)
- take at least 30 mins before any food or caffeinated drinks in the morning
122
when should thyroid function tests be carried out (3- different situations)
2-3 weeks after commencing treatment
2-3 months after changing doses/ until levels are stable
annually once levels are stable
