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OSCE FINAL > OSCE skills > Flashcards

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?

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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)

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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

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4
Q

types of psoriasis

A

Plaque psoriasis
Guttate psoriasis
Pustular psoriasis
Erythrodermic psoriasis

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5
Q

which type of psoriasis is secondary to what type of infection?

A

guttate and streptococcal throat infection

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6
Q

Subdural Haemorrhage on CT

A

crescent

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7
Q

Extradural Haemorrhage on CT

A

biconvex

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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

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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

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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

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11
Q

eye GCs 3

A

Eye-opening to sound 3 points

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12
Q

speech GCS 3

A

Inappropriate words 3 points

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13
Q

motor GCS 2

A

Abnormal extension decerebrate posture 2 points

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14
Q

speech GCS 2

A

Incomprehensible sounds 2 points

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15
Q

motor GCS 3

A

Flexion decorticate posture

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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

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17
Q

High foot arches (pes cavus) differentials

A

Charcot-Marie-Tooth Disease

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18
Q

skin coloured papules representing blocked pilosebaceous units

A

Comedomes

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19
Q

Macules

A

flat marks on the skin

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20
Q

antiemetics

A

cyclizine 50mg
Promethazine
Metoclopramide
Domperidone
Prochlorperazine 20mg

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21
Q

Bulk-forming laxatives

A

ispaghula husk

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22
Q

osmotic laxative

A

lactulose

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23
Q

stimulant laxative

A

senna

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24
Q

poo softener laxative

A

docusate

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25
Q

list of different type of laxatives and examples

A

ispaghula husk - Bulk-forming laxatives
lactulose - osmotic laxative
senna - stimulant laxative
docusate - poo softener

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26
Q

dihydrocodeine dose

A

30mg QDS

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27
Q

salter harris fractures SALTR

A

Type 1: Straight across
Type 2: Above
Type 3: BeLow
Type 4: Through
Type 5: CRush

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28
Q

requirement for an emergency detention certificate 72 hours

A

SIDMA
treatment available
insight?
Risk/danger
mental disorder suspected/exists

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29
Q

SIDMA?

A

significantly impaired decision making ability.

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30
Q

how to assess incapacity

A

incapable of:
acting
making decisions
communicating
understanding
retaining memory of decisions

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31
Q

why do you assess the spine in a newborn?

A

spina bifida

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32
Q

oxygen saturations in a new-born

A

pre-ductal and post-ductal

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33
Q

what is the ductus arteriosus?

A

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.

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34
Q

anaphylaxis algorithm

A

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

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35
Q

anaphylaxis concentration for adrenaline

A

Use adrenaline at 1 mg/mL (1:1000) concentration

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36
Q

anaphylaxis adult adrenaline dose

A

500 micrograms IM (0.5 mL)

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37
Q

anaphylaxis adrenaline kid dose

A

150 micrograms IM (0.15 mL)

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38
Q

DKA treatment

A

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

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39
Q

cardiology
Position the patient on their left side on expiration for

A

mitral stenosis

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40
Q

cardiology
Position the patient sat up, leaning forward and holding exhalation for

A

mitral regurgitation

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41
Q

mitral regurgitation murmur

A

pansystolic

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42
Q

mitral regurgitation murmur best heard at

A

apex; loudest on expiration
radiates left axilla

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43
Q

tricuspid regurgitation

A

pan systolic

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44
Q

differentiation between tricuspid and mitral regurgitation murmur

A

tricuspid:
louder on inspiration because it’s on the right
Giant JVP
Non-displaced apex

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45
Q

aortic regurgitation murmur

A

Early diastolic (sounds like a breath)

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46
Q

mitral stenosis murmur

A

low rumbling mid-diastolic with opening snap

47
Q

ECG interpretation

A

Rate and Rhythm
Axis
P wave
PR interval
QRS complex
ST segment
T wave

48
Q

COCP mechanism

A

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
Q

COCP regimes

A

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
Q

SE COCP

A

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
Q

COCP benefits

A

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
Q

CI COCP

A

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
Q

starting COCP

A

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
Q

COCP emergency contraception missed pill rule

A

> 72 hours -> If day 1 – 7 of the packet they need emergency contraception if they have had unprotected sex

55
Q

POP, injection, and implant mechanism

A

Inhibiting ovulation
Thickening the cervical mucus
Altering the endometrium
Reducing ciliary action in the fallopian tubes

56
Q

POP starting

A

Starting the POP on day 1 to 5 of the menstrual cycle means the woman is protected immediately. otherwise 48hrs requiring extra protection

57
Q

main side effect for progestogen contraceptives

A

the bleeding pattern that a woman will experience with progestogen-only contraception (the pill, implant or injection) is unpredictable.

58
Q

missed pill for POP is when?

A

> 12hours

59
Q

progestogen injection return to fertility

A

12 months

60
Q

progestogen injection CI

A

Active breast cancer
Ischaemic heart disease and stroke
Unexplained vaginal bleeding
Severe liver cirrhosis
Liver cancer

61
Q

progestogen injection duration

A

12-13 weeks

62
Q

initiation for progestogen injection

A

Starting after day 5 of the menstrual cycle requires seven days of extra contraception

63
Q

benefits of the implant

A

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
Q

risks with the implant

A

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
Q

CI for Coils

A

Pelvic inflammatory disease or infection
Immunosuppression
Pregnancy
Unexplained bleeding
Pelvic cancer
Uterine cavity distortion (e.g. by fibroids)

66
Q

review dates for coil insertion

A

6 weeks

67
Q

copper coil duration

A

5-10 years

68
Q

copper coil specific CI

A

wilsons disease

69
Q

copper coil benefits

A

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
Q

copper coil risks

A

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
Q

IUS duration

A

5yrs

72
Q

IUs benefits

A

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
Q

IUS drawbacks

A

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
Q

emergency contraception Levonorgestrel should be taken within

A

72 hours of UPSI

75
Q

emergency contraception Ulipristal should be taken within

A

120 hours of UPSI

76
Q

emergency contraception Copper coil can be inserted within

A

5 days of UPSI, or within 5 days of the estimated date of ovulation

77
Q

Ulipristal should be avoided in patients with

A

asthma

78
Q

common SE of ulipristal and levonorgestrel

A

nausea and vomiting

79
Q

dermatology systematic review

A

location
shape
edge
elevation
colour
secondary features

80
Q

CURB65

A

confusion
urea >7
RR >30
B.P. <90 systolic
65 age

81
Q

neurofibromatosis diagnosis

A

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
Q

type 1 neurofibromatosis differential

A

tuberous sclerosis

83
Q

type 1 neurofibromatosis cause

A

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
Q

non-shockable rhythm

A

Pulseless electrical activity
asystole

85
Q

shockable rhythm

A

VT
VF

86
Q

resus adrenaline dose

A

Adrenaline 1mg IV (10ml of 1:10,000)

87
Q

when to give adrenaline in resus

A

after third shock

88
Q

amiodarone dose in resus and when to give

A

Amiodarone 300mg IV: if shockable rhythm only. Give after 3rd shock (during CPR). Repeat 150mg IV after 5th shock if ongoing.

89
Q

cycle for resus is

A

2 minutes of CPR (6 rounds of 30:2) then rhythm check. shock. then CPR +/- delivery of drugs.

90
Q

salbutomal neb dose for asthma

A

2.5mg

91
Q

ipratropium neb dose for asthma

A

500 mcg

92
Q

hydrocortisone dose for asthma

A

100mg or 40mg prednisolone

93
Q

H and T’s of resus

A

hypoxia
hypovolaemia
hyper/hypo potassium, glucose
hypo/hyperthermia

Toxins
Tension pneumothorax
tamponade
thromboembolus (MI)

94
Q

thyroid acropachy refers too and is seen with what condition

A

hand swelling, finger clubbing, graves disease

95
Q

bulbar cranial nerve examination includes

A

glossopharyngeal (9), vagus (10), accessory (11), and hypoglossal (12)

96
Q

bulbar palsy signs

A

tongue wasting and fasciculations
absent gag reflex
flaccid speech with nasal twang

97
Q

pseudobulbar palsy signs

A

spastic tongue
increased gag reflex
spastic high pitch speech

98
Q

jugular foramen effects which nerves and cause

A

CN 9,10,11 and tumour

99
Q

RA hand signs

A

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
Q

spine normal description (lordosis/kyphosis)

A

cervical lordosis
thoracic kyphosis
lumbar lordosis

101
Q

Medial epicondylitis is often called

A

golfer’s elbow.

102
Q

Lateral epicondylitis is often called

A

tennis elbow.

103
Q

venturi masks for COPD

A

Venturi masks deliver 24% (blue), 28% (white)

104
Q

UMN

A

increased tone
spasticity
weakness
brisk reflexes
upgoing plantars

105
Q

LMN

A

wasting and fasciculations
hypotonia
weakness
reduced reflexes.

106
Q

four main ligaments of the foot

A

deltoid, anterior talofibular, calcaneofibular, posterior talofibular.

107
Q

ligaments of the elbow

A

annular and the radial collateral and ulnar collateral

108
Q

risk factor for adhesive capsulitis

A

diabetes

109
Q

three phases of adhesive capsulitis

A

painful phase
stiff phase
thawing phase

110
Q

fracture of neck of femur signs

A

shortened and externally rotated leg, soft tissue swelling and bruising with reduced movement and pain on palpation

111
Q

early sign of hip OA

A

loss of internal rotation of the hip

112
Q

lateral rectus palsy is due to which CN

A

6

113
Q

4 causes of CN 6 palsy

A

raised ICP
microvascular ischaemia
SOL trauma

114
Q

schizophrenia first rank symptoms

A

auditory hallucinations
thought interference
thought broadcasting
somatic hallucinations
delusional perception
feelings or experiences manipulated by someone else

OSCE FINAL (1 decks)

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