OSCE skills Flashcards
1
Q
SCOFF?
A
S – Do you make yourself Sick because you feel uncomfortably full?
C – Do you worry you have lost Control over how much you eat?
O – Have you recently lost more than One stone (6.35 kg) in a three-month period?
F – Do you believe yourself to be Fat when others say you are too thin?
F – Would you say Food dominates your life?
2
Q
causes of cushings CAPE
A
C – Cushing’s disease (a pituitary adenoma releasing excessive ACTH)
Cushing’s syndrome
A – Adrenal adenoma (an adrenal tumour secreting excess cortisol)
P – Paraneoplastic syndrome
E – Exogenous steroids (patients taking long-term corticosteroids)
3
Q
psoriasis description on examination
A
Patches of psoriasis are dry, flaky, scaly, faintly erythematous skin lesions that appear in raised and rough plaques, commonly over the extensor surfaces of the elbows and knees and on the scalp
4
Q
types of psoriasis
A
Plaque psoriasis
Guttate psoriasis
Pustular psoriasis
Erythrodermic psoriasis
5
Q
which type of psoriasis is secondary to what type of infection?
A
guttate and streptococcal throat infection
6
Q
Subdural Haemorrhage on CT
A
crescent
7
Q
Extradural Haemorrhage on CT
A
biconvex
8
Q
eye GCS
A
Eye-opening spontaneously 4 points
Eye-opening to sound 3 points
Eye-opening to pain 2 points
No response 1 point
Not testable NT
9
Q
speech GCS
A
Orientated 5 points
Confused conversation 4 points
Inappropriate words 3 points
Incomprehensible sounds 2 points
No response 1 point
Not testable NT
10
Q
motor GCS
A
Obeys command 6 points
Localises to pain 5 points
Withdraws to pain 4 points
Flexion decorticate posture 3 points
Abnormal extension decerebrate posture 2 points
No response 1 point
Not testable NT
11
Q
eye GCs 3
A
Eye-opening to sound 3 points
12
Q
speech GCS 3
A
Inappropriate words 3 points
13
Q
motor GCS 2
A
Abnormal extension decerebrate posture 2 points
14
Q
speech GCS 2
A
Incomprehensible sounds 2 points
15
Q
motor GCS 3
A
Flexion decorticate posture
16
Q
causes of peripheral neuropathy
A
A – Alcohol
B – B12 deficiency
C – Cancer and Chronic Kidney Disease
D – Diabetes and Drugs (e.g. isoniazid, amiodarone and cisplatin)
E – Every vasculitis
17
Q
High foot arches (pes cavus) differentials
A
Charcot-Marie-Tooth Disease
18
Q
skin coloured papules representing blocked pilosebaceous units
A
Comedomes
19
Q
Macules
A
flat marks on the skin
20
Q
antiemetics
A
cyclizine 50mg
Promethazine
Metoclopramide
Domperidone
Prochlorperazine 20mg
21
Q
Bulk-forming laxatives
A
ispaghula husk
22
Q
osmotic laxative
A
lactulose
23
Q
stimulant laxative
A
senna
24
Q
poo softener laxative
A
docusate
25
list of different type of laxatives and examples
ispaghula husk - Bulk-forming laxatives
lactulose - osmotic laxative
senna - stimulant laxative
docusate - poo softener
26
dihydrocodeine dose
30mg QDS
27
salter harris fractures SALTR
Type 1: Straight across
Type 2: Above
Type 3: BeLow
Type 4: Through
Type 5: CRush
28
requirement for an emergency detention certificate 72 hours
SIDMA
treatment available
insight?
Risk/danger
mental disorder suspected/exists
29
SIDMA?
significantly impaired decision making ability.
30
how to assess incapacity
incapable of:
acting
making decisions
communicating
understanding
retaining memory of decisions
31
why do you assess the spine in a newborn?
spina bifida
32
oxygen saturations in a new-born
pre-ductal and post-ductal
33
what is the ductus arteriosus?
The ductus arteriosus is located along the arch of the aorta and connects the aorta with the pulmonary artery. It normally stops functioning within 1 – 3 days of birth. It allows blood from the deoxygenated right sided circulation before the lungs to mix with the oxygenated left sided circulation after the lungs.
34
anaphylaxis algorithm
Sudden onset of Airway and/or Breathing and/or
Circulation problem + skin
-
HELP
-
remove trigger
lie flat
elevate legs
-
adrenaline
-
airway
high flow oxygen
ECG, oximetry, B.P.
-
I.V. bolus
repeat adrenaline after 5 minutes
35
anaphylaxis concentration for adrenaline
Use adrenaline at 1 mg/mL (1:1000) concentration
36
anaphylaxis adult adrenaline dose
500 micrograms IM (0.5 mL)
37
anaphylaxis adrenaline kid dose
150 micrograms IM (0.15 mL)
38
DKA treatment
F – Fluids – IV fluid resuscitation with normal saline (e.g., 1 litre in the first hour, followed by 1 litre every 2 hours)
I – Insulin – fixed rate insulin infusion (e.g., Actrapid at 0.1 units/kg/hour)
G – Glucose – closely monitor blood glucose and add a glucose infusion when it is less than 14 mmol/L
P – Potassium – add potassium to IV fluids and monitor closely (e.g., every hour initially)
I – Infection – treat underlying triggers such as infection
C – Chart fluid balance
K – Ketones – monitor blood ketones, pH and bicarbonate
39
cardiology
Position the patient on their left side on expiration for
mitral stenosis
40
cardiology
Position the patient sat up, leaning forward and holding exhalation for
mitral regurgitation
41
mitral regurgitation murmur
pansystolic
42
mitral regurgitation murmur best heard at
apex; loudest on expiration
radiates left axilla
43
tricuspid regurgitation
pan systolic
44
differentiation between tricuspid and mitral regurgitation murmur
tricuspid:
louder on inspiration because it’s on the right
Giant JVP
Non-displaced apex
45
aortic regurgitation murmur
Early diastolic (sounds like a breath)
46
mitral stenosis murmur
low rumbling mid-diastolic with opening snap
47
ECG interpretation
Rate and Rhythm
Axis
P wave
PR interval
QRS complex
ST segment
T wave
48
COCP mechanism
Preventing ovulation (this is the primary mechanism of action)
Progesterone thickens the cervical mucus
Progesterone inhibits proliferation of the endometrium, reducing the chance of successful implantation
49
COCP regimes
21 days on and 7 days off
63 days on (three packs) and 7 days off (“tricycling“)
Continuous use without a pill-free period
50
SE COCP
Unscheduled bleeding is common in the first three months and should then settle with time
Breast pain and tenderness
Mood changes and depression
Headaches
Hypertension
Venous thromboembolism (the risk is much lower for the pill than pregnancy)
Small increased risk of breast and cervical cancer, returning to normal ten years after stopping
Small increased risk of myocardial infarction and stroke
51
COCP benefits
Effective contraception
Rapid return of fertility after stopping
Improvement in premenstrual symptoms, menorrhagia (heavy periods) and dysmenorrhoea (painful periods)
Reduced risk of endometrial, ovarian and colon cancer
Reduced risk of benign ovarian cysts
52
CI COCP
Uncontrolled hypertension (particularly ≥160 / ≥100)
Migraine with aura (risk of stroke)
History of VTE
Aged over 35 and smoking more than 15 cigarettes per day
Major surgery with prolonged immobility
Vascular disease or stroke
Ischaemic heart disease, cardiomyopathy or atrial fibrillation
Liver cirrhosis and liver tumours
Systemic lupus erythematosus (SLE) and antiphospholipid syndrome
53
starting COCP
Starting after day 5 of the menstrual cycle requires extra contraception (i.e. condoms) for the first 7 days of consistent pill use before they are protected from pregnancy. Ensure the woman is not already pregnant before starting the pill (i.e. they have been using contraception reliably and consistently
54
COCP emergency contraception missed pill rule
>72 hours -> If day 1 – 7 of the packet they need emergency contraception if they have had unprotected sex
55
POP, injection, and implant mechanism
Inhibiting ovulation
Thickening the cervical mucus
Altering the endometrium
Reducing ciliary action in the fallopian tubes
56
POP starting
Starting the POP on day 1 to 5 of the menstrual cycle means the woman is protected immediately. otherwise 48hrs requiring extra protection
57
main side effect for progestogen contraceptives
the bleeding pattern that a woman will experience with progestogen-only contraception (the pill, implant or injection) is unpredictable.
58
missed pill for POP is when?
>12hours
59
progestogen injection return to fertility
12 months
60
progestogen injection CI
Active breast cancer
Ischaemic heart disease and stroke
Unexplained vaginal bleeding
Severe liver cirrhosis
Liver cancer
61
progestogen injection duration
12-13 weeks
62
initiation for progestogen injection
Starting after day 5 of the menstrual cycle requires seven days of extra contraception
63
benefits of the implant
Effective and reliable contraception
It can improve dysmenorrhoea (painful menstruation)
It can make periods lighter or stop all together
No need to remember to take pills (just remember to change the device every three years)
It does not cause weight gain (unlike the depo injection)
No effect on bone mineral density (unlike the depo injection)
No increase in thrombosis risk (unlike the COCP)
No restrictions for use in obese patients (unlike the COCP)
64
risks with the implant
It requires a minor operation with a local anaesthetic to insert and remove the device
It can lead to worsening of acne
There is no protection against sexually transmitted infections
It can cause problematic bleeding
Implants can be bent or fractured
Implants can become impalpable or deeply implanted, leading to investigations and additional management
65
CI for Coils
Pelvic inflammatory disease or infection
Immunosuppression
Pregnancy
Unexplained bleeding
Pelvic cancer
Uterine cavity distortion (e.g. by fibroids)
66
review dates for coil insertion
6 weeks
67
copper coil duration
5-10 years
68
copper coil specific CI
wilsons disease
69
copper coil benefits
Reliable contraception
It can be inserted at any time in the menstrual cycle and is effective immediately
It contains no hormones, so it is safe for women at risk of VTE or with a history of hormone-related cancers
It may reduce the risk of endometrial and cervical cancer
70
copper coil risks
A procedure is required to insert and remove the coil, with associated risks
It can cause heavy or intermenstrual bleeding (this often settles)
Some women experience pelvic pain
It does not protect against sexually transmitted infections
Increased risk of ectopic pregnancies
Intrauterine devices can occasionally fall out (around 5%)
WILSOOONS DISEAAASE
71
IUS duration
5yrs
72
IUs benefits
It can make periods lighter or stop altogether
It may improve dysmenorrhoea or pelvic pain related to endometriosis
No effect on bone mineral density (unlike the depo injection)
No increase in thrombosis risk (unlike the COCP)
No restrictions for use in obese patients (unlike the COCP)
The Mirena has additional uses (i.e. HRT and menorrhagia)
73
IUS drawbacks
A procedure is required to insert and remove the coil, with associated risks
It can cause spotting or irregular bleeding
Some women experience pelvic pain
It does not protect against sexually transmitted infections
Increased risk of ectopic pregnancies
Increased incidence of ovarian cysts
There can be systemic absorption causing side effects of acne, headaches, or breast tenderness
Intrauterine devices can occasionally fall out (around 5%)
74
emergency contraception Levonorgestrel should be taken within
72 hours of UPSI
75
emergency contraception Ulipristal should be taken within
120 hours of UPSI
76
emergency contraception Copper coil can be inserted within
5 days of UPSI, or within 5 days of the estimated date of ovulation
77
Ulipristal should be avoided in patients with
asthma
78
common SE of ulipristal and levonorgestrel
nausea and vomiting
79
dermatology systematic review
location
shape
edge
elevation
colour
secondary features
80
CURB65
confusion
urea >7
RR >30
B.P. <90 systolic
65 age
81
neurofibromatosis diagnosis
C – Café-au-lait spots (6 or more) measuring ≥ 5mm in children or ≥ 15mm in adults
R – Relative with NF1
A – Axillary or inguinal freckles
BB – Bony dysplasia such as Bowing of a long bone or sphenoid wing dysplasia
I – Iris hamartomas (Lisch nodules) (2 or more) are yellow brown spots on the iris
N – Neurofibromas (2 or more) or 1 plexiform neurofibroma
G – Glioma of the optic nerve
82
type 1 neurofibromatosis differential
tuberous sclerosis
83
type 1 neurofibromatosis cause
chromosome 17. It codes for a protein called neurofibromin, which is a tumour suppressor protein. Inheritance of mutations in this gene is autosomal dominant.
84
non-shockable rhythm
Pulseless electrical activity
asystole
85
shockable rhythm
VT
VF
86
resus adrenaline dose
Adrenaline 1mg IV (10ml of 1:10,000)
87
when to give adrenaline in resus
after third shock
88
amiodarone dose in resus and when to give
Amiodarone 300mg IV: if shockable rhythm only. Give after 3rd shock (during CPR). Repeat 150mg IV after 5th shock if ongoing.
89
cycle for resus is
2 minutes of CPR (6 rounds of 30:2) then rhythm check. shock. then CPR +/- delivery of drugs.
90
salbutomal neb dose for asthma
2.5mg
91
ipratropium neb dose for asthma
500 mcg
92
hydrocortisone dose for asthma
100mg or 40mg prednisolone
93
H and T's of resus
hypoxia
hypovolaemia
hyper/hypo potassium, glucose
hypo/hyperthermia
Toxins
Tension pneumothorax
tamponade
thromboembolus (MI)
94
thyroid acropachy refers too and is seen with what condition
hand swelling, finger clubbing, graves disease
95
bulbar cranial nerve examination includes
glossopharyngeal (9), vagus (10), accessory (11), and hypoglossal (12)
96
bulbar palsy signs
tongue wasting and fasciculations
absent gag reflex
flaccid speech with nasal twang
97
pseudobulbar palsy signs
spastic tongue
increased gag reflex
spastic high pitch speech
98
jugular foramen effects which nerves and cause
CN 9,10,11 and tumour
99
RA hand signs
Z shaped deformity to the thumb
Swan neck deformity (hyperextended PIP with flexed DIP)
Boutonnieres deformity (hyperextended DIP with flexed PIP)
Ulnar deviation of the fingers at the knuckle (MCP joints)
100
spine normal description (lordosis/kyphosis)
cervical lordosis
thoracic kyphosis
lumbar lordosis
101
Medial epicondylitis is often called
golfer’s elbow.
102
Lateral epicondylitis is often called
tennis elbow.
103
venturi masks for COPD
Venturi masks deliver 24% (blue), 28% (white)
104
UMN
increased tone
spasticity
weakness
brisk reflexes
upgoing plantars
105
LMN
wasting and fasciculations
hypotonia
weakness
reduced reflexes.
106
four main ligaments of the foot
deltoid, anterior talofibular, calcaneofibular, posterior talofibular.
107
ligaments of the elbow
annular and the radial collateral and ulnar collateral
108
risk factor for adhesive capsulitis
diabetes
109
three phases of adhesive capsulitis
painful phase
stiff phase
thawing phase
110
fracture of neck of femur signs
shortened and externally rotated leg, soft tissue swelling and bruising with reduced movement and pain on palpation
111
early sign of hip OA
loss of internal rotation of the hip
112
lateral rectus palsy is due to which CN
6
113
4 causes of CN 6 palsy
raised ICP
microvascular ischaemia
SOL trauma
114
schizophrenia first rank symptoms
auditory hallucinations
thought interference
thought broadcasting
somatic hallucinations
delusional perception
feelings or experiences manipulated by someone else
