OSCE Study Set Flashcards
What clinical examinations MUST you ask for a chaperone in?
-rectal examination
-breast
-pregnancy abdominal
-cervical smear
-digitial vaginal examination
-male genitila
What is a normal MOCA score for assessing alzheimers?
normal MOCA >26
What symptoms must you ask for in a patient with memory loss/dementia?
-hallucinations- lewy body dementia
-impulsive behaviour- fronto-temporal dementia
-stepw-wise-vascular dementia
-depression, anyway passed away-pseudodemenia, pseudohallucinations
-changes in behaviour
-tremor
-medications- polypharmacy
-recent falls- sub-dural haemorrhage (fluctuating symptoms)
-forget words
-harder to understand instructions- broca’s or wernicke’s aphasia
-alcohol intake- delirium tremens
What types of dementia must you screen for in a memory loss comms?
-pseudodementia- depression
vascular dementia- IHD, Step wise decline
sub-dural haemorrhage- recent falls
-impulsive behaviour- fronto-temporal dementia
What are the before, middle and after screening questions for patient with a fall?
Before:
- *“What were you doing just before you fell?”
- “Talk me through what you were doing before you fell”
Middle:
- “How did you fall?”
- “Did you trip over, or did you just fall?”
- “Can you remember what direction you fell?”
- “Did anything break your fall?”
- “Did you hit your head or any other part of your body?”
- DID YOU LOSE CONSCIOUSNESS
After:
-did you lose in any memory
-who find you
-how long were you on floor
What types of delirium should screen for?
hypoactive
hyperactive
mixed
What are the ‘before’ questions for Suicide Risk Assessment?
Before
Was there aprecipitant?
- Examples may include an argument with a spouse or a recent bereavement.
- You mayestablish psychological, physical or social problems here, but youalso need to screen for these later.
Was the self-harmplanned, orimpulsive?
Did the patient carry out anyfinalacts?
- Write a SUICIDE NOTE! (*important)
- Leaving a will
- Terminating contracts (e.g. mobile phone, gas and electricity)
Were anyprecautionstaken against discovery?
- Closing curtains
- Locking doors
- Waiting until they knew everyone would be out of the house and not be back for several hours
- Going somewhere very remote
Wasalcoholused?
- Ask about the amount and type used
- Ask about previous alcohol use
medication- buying patterns
-was it bought gradually over weeks
-or all at once
What are the ‘during’ questions for Suicide Risk Assessment?
During
Whatmethodof self-harm was involved?
Was the patientalone?
Wherewere they when they self-harmed?
What wasgoing through their mindat the time?
Did they think their self-harm wouldend their life?
What did they do straightafterthe self-harm?
What are the ‘after’ questions for Suicide Risk Assessment?
After
Did the patientcallanyone? How did theyget toA&E?Whowere they found by?
How did they feelwhen help arrived?
How does the patient feel about the attemptnow? Do theyregretit?
What is the patient’scurrentmood?
Does the patient still feelsuicidal?
If the patient were togo hometoday,what would theydo? (make sure you cover the next few days)
If the patient were tofeel like this again, what might they dodifferently?
What does the patient think mightpreventthem from doing this again in the future?
Does the patient feel there isanything to live for? (i.e. protective factors)
Will the patientaccept treatment?
What questions should be asked to assess a patient that ‘cuts’
Whereare the cuts?
How manycuts are there?
How deepare the cuts?
How did the patientfeelwhilst they were cutting?
How did the patient feel when they sawblood?
What was the patient hoping the cutting woulddo?
What Red Flags should be asked in ALL psych questions?
RED FLAG:
-any issues with your eating
-bipolar- periods of low mood and high
-hallucinations
-delusions
-ever thought about ending your life
-ever SELF HARMED
What is the SCOFF screening tool used in anorexia?
Anorexia: SCOF
S-do you ever make yourself sick
C-los control over how much you eat
O-lost one stone last 3 months
F- do you think you are fat
F-do you feel that food dominates your life
Summarise words used for MSE screening tool?
(ASEPTIC)
-appropriatly dressed, eye contact
-speech- fast, slow, poverty of speech, pressured, rate, quantitiy, quality
-mood-blunted affect, angry, happy, sad, irritable,
thoughts- flight of ideas (Manic main symptom), insertion, blocking, echo, obsessions
perception- in life, hallucinations are they present
cognition- orientated to time and place, month
insight- are you aware of how you feel, why (wold you be willing to come to hospital for help)
What is the 4AT screening tool used in delirium?
-alertness
-acute onset
-AMT-cognition
-attention
What is the CAGE Screening tool used in alcohol misuse disorder?
c-cut down
a-annoyed when friends comment on your drinking
-guilty
-eye opener- do you ever drink in the morning to get rid of a hangover
What is the antibiotic management for Sepsis on Tayside Guidelines?
amoxicillin + metronidazole + gentamicin
What mask is used in a COPD patient if they need oxygen
Venturi mask
(do no give too much oxygen as risk of hypercapnia respiratory failure)
State the features of what I might forget in lower neuro exam
Babinski reflexes-descend ding tract
Tone-knee too
Inversion and eversion
-no need to use finger for reflex
-remeber power-inverion, eversion
State features which might forget in cerebellar examination
-intention tremor
-rebound phonon -press down arms and bounce up
Upper limb:
-remember pyramidal drift start- and pronator the way-START OF EXAM
What might I forget in vestibulocochlear nerve examination?
-vestibulocochlear- walk, heel toe and rombergs don’t forget
How should the bed be in GI examination?
Abdo/haem
FLATTTT-BED!!!!!
What investigations should you ask for in circulation?
Cardiovascular:
Bloods: FBC, U+E, CRP,
Lactate, glucose
blood culture, group +save
-UO- if sepsis
-ECG (as required)
-ketones
-pregnancy test
What investigations should you ask for in breathing and breathing?
ABG
O2 sats- I do
What MUST I say after SAMPLE??
airways are patent- as patient is clearly speaking to me
What do you ask at the start of ABCDE
-NAME AND DOB-IMPORTANT
-Symptoms
-Allergies
-Medical conditions
-Medication
-last eaten and had fluids
What are is insulin given?
Fixed rate IV insulin (0.1 units/hr/kg)
Woman with abdominal pain what test should be asked for?
HCG-pregancy
What is the management of anaphylaxis?
(give units)
IM Adrenaline 0.5ml
5 min wait
->no response give adrenaline again
If no response after 2 doses follow
What is the management of a STEMI/NSTEMI
MONA + T
Morphine
Oxygen
Nitrates
Aspirin
Clopidogrel/Tricagelor
PCI +/- thrombolysis
(*PCI= if within 2hr of hospital)
What is the management of Angina?
GTN spray
What is the management of a patient with eclampsia?
Eclampsia
->IV magnesium sulphate
(stop 24 hrs after last seizure)
What is the management of an asthma attack?
O SHIT MAN
“O SHIT MAN”
1) Oxygen
2) Salbutamol
3) IV Hydrocortisone
3) Ipratropium
4) Theophylline
5) Magnesium Sulfate
6) Anaesthist0- call of condition does n0t approve
7) Need second opinion
What does pronator (pyramidal) drift mean in UMN exam?
-pronator drift indicates a contralateral corticospinal tract lesion.
What does ‘SWIFT’ mean in a neuro exam?
-Scars
-Wasting
-Involuntary movements
-Fasiculations- MND
-Tremor
What do these types of tremor indicate
-intention tremor
-resting tremor
-essential
-intention-cerebellar disorder
-resting- if unilateral Parkinson’s, if bilateral drug induced
-essential - inherited- beta blockers
Spasticity and rigidity indicates
parkinsons
What does Hoffmans indicate?
fixed flexion and adduction- Cervical Degeneration of the spine
What is babinski reflex and what does it indicate?
loss of descending inhibition- babinski reflex
toes UPWARDS-abnormal (do not descend down)
What is the x3 criteria for depression?
X3 Criteria
-fatigue
-low mood
-loss of interest in things enjoy
> 2 weeks to be diagnosed with depression
After before, during and after in comms for depression what is asked next?
1) X3 Criteria
-fatigue
-low mood
-loss of interest in things enjoy
> 2 weeks to be diagnosed with depression
2) Red flags- happy and low, thought committing suicide, see things or hear things that others do not
What is the ADTP criteria for schizophrenia?
auditory hallucinations
delusions
thought disorders
passive phenomena
