OSCE style longer Q and As

Question 1

GUM-

How would you manage a patient who requires HIV PEPSI?

Answer 1

1. Take a full medical and sexual history
2. Discuss PEPSI, risks and benefits (Truvada and Raltegravir)
3. Offer PEPSI if needed and encourage to commence within 72 hours of exposure (ideally within 24 hrs)
4. Screen for STIs
5. HIV and HEPB blood test- Give Hepatitis B vaccine if needed
6. Encourage partner notification and for them to be HIV tested
7. Offer emergency contraception if needed
8. Take baseline bloods with UEs and LFTs
9. Arrange follow up in 2 weeks for STI screen results, and 2 months after finishing PEPSI for repeat HIV screen
10. Encourage to use protection until definitive negative HIV test
11. Encourage to take full course of PEPSI (4 weeks)

Question 2

Respiratory-

What investigations could you do for a patient presenting with symptoms of pneumonia?

Answer 2

1. Bloods- FBC, U&E, LFTs, HIV
2. CXR- look for consolidation
3. Blood cultures
4. Sputum culture
5. ABG- if their sats are below 92% or pre-existing respiratory disease
6. Urine antigen testing- Legionella, Pneumococcus
7. CRP point of care testing if available