OSCE year 1 Flashcards
1
Q
What questions would you ask a patient during a cranial nerve exam, for nerves CN2 CN3 CN4 and CN6.
A
- any changes in vision
- any concerns over their eyesight
- do they normally where anything to correct their eyesight?
-any pain
2
Q
What tasks would be involved for a cranial nerve test of nerves CN2, CN3, CN4 and CN6?
A
- Acuity = Snellen chart (one eye covered repeat for both eyes, what is the smallest line they can read)
- Pupil reflexes, shade and look in both eyes, swinging light reflex (ask patient to look forward at a fixed point)
- accommodation reflex
- inattention - which finger-moving test
- peripheral vision ( four quadrant test - ask patient to cover one eye and look at your eye)
-eye movement by the h test - ask if any double vision
3
Q
what must you do at the start and end of each clinical skills station?
A
Wash your hands
4
Q
What questions would you ask for a cranial nerve exam of nerves 5 and 7?
A
-any facial drooping
- any changes in facial expression
- any pain at all
- any changes in hearing
- any changes in taste
- dry mouth/eyes (not routine)
5
Q
what tests would you do for a cranial nerve exam of nerves 5 and 7?
A
- inspect the face
- sensation of dermatomes in the face with cotton wool and neurotip, ask if it felt the same on both sides
- clench jaw and palpate the mandible and temporal muscles
- raise eyebrows against resistance
- scrunch up eyes against resistance
- wide smile
-pout lips as if whistling - puff up cheeks against resistance
- open chin against resistance
- chin jerk reflex
6
Q
What questions would you ask for a cranial nerve exam CN9,10,11,12?
A
- heart palpitations
- gut motility problems
- any changes in taste
- a dry mouth
- any problems with swallowing or coughing
7
Q
What exams would you perform for a cranial nerve exam 9,10,11,12?
A
-ahhhh light in the throat to look at the tongue and back of the mouth
- stick tongue out hold for few seconds, move to left and right
- sip of water
-cough for me
- stick tongue into sides of cheeks, against resistance
- shrug shoulders up against resistance
- turn neck left and right against resistance
- yellow lorry and baby hippopotamus
8
Q
What is the function of cranial nerve 1?
A
Olfactory - sense of smell
9
Q
What is the function of cranial nerve 2?
A
Optic - sense of vision
Acuity, reflexes, inattention, visual fields
10
Q
What is the function of cranial nerve 3?
A
Oculomotor
Motor to extrocular eye muscles (inferior oblique, inferior rectus, superior rectus and medial rectus and lavtor palpebrae superioris
Autonomic - pupillar reflexes
11
Q
What is the function of cranial nerve 4?
A
Trochlear - superior oblique
12
Q
What is the function of cranial nerve 5?
A
Trigeminal - motor innervation to muscles of mastification/jaw
Sensory innervation - light touch and pain to the face
13
Q
What is the function of cranial nerve 6?
A
Abducens - eye movement lateral rectus
14
Q
What is the function of cranial nerve 7?
A
Facial -
sensory is taste 2/3 tongue
Motor - muscles of facial expression
Autonomic - dry mouth/eyes
15
Q
What is the function of cranial nerve 8?
A
vestibulocochlear - sense of hearing
balance
16
Q
What is the function of cranial nerve 9?
A
Glassopharangeal -
Sensory - taste to posterior 1/3 of tongue
Motor to stylopharnygeus
Autonomic - parotid gland (dry ness in mouth)
17
Q
What is the function of cranial nerve 10?
A
Vagus - parasympathetic innervation
-motor to soft palate, speech, cough and swallowing
18
Q
What is the function of cranial nerve 11?
A
Accessory -
motor to trapezius and sternocalcomastoid
19
Q
What is the function of cranial nerve 12?
A
Hypoglossal -
Motor to tongue - can be responsible for wasting of fasiculations, strength of tongue and movement
20
Q
Which cranial nerves have parasympathetic routes?
A
Oculomotor
Facial
Glassopharangeal
Vagus
21
Q
How do you test cranial nerve eight?
A
Mask or cover one ear and whisper in the other, ask patient to repeat - often use a double barreled number
Balance - close eyes and march on the spot
22
Q
What is the rate and depth of chest compression in an adult?
A
100 to 120 bpm
5-6cm depth
23
Q
What is the ratio of chest compressions to rescue breaths in an adult?
A
30 compression
2 rescue breaths
24
Q
What is the ratio of rescue breaths to compressions in a baby?
A
5 original rescue breaths
15 chest compressions
2 rescue breaths and repeat
25
What is the ratio of chest compression to rescue breaths in a child?
5 original rescue breaths
15 chest compressions
2 rescue breaths
26
What is the depth and method of chest compressions in a child?
5 cm
One handed lower sternum
27
What is the depth and method of chest compressions in a baby?
4 cm
Thumbs or two fingers in the lower sternum
28
What is the order of events before commencing with CPR?
Danger - check for danger, 'no sharps, no trip hazards, no threats so it is safe to approach the patient'
Response - speak to patient, touch and gently shake shoulder assure there is no response
S - shout for help, call 999
A - airway - head chin lift (fingers on bony of chin), look for visible obstructions
B - listen for breathing with ear to mouth looking down at exposed chest
- if not breathing commence CPR
29
How to deal with choking in an adult?
Are you choking
Encourage to cough
Five back slaps - check between each slap if the blockage is removed
Five abdominal thrusts - check between each thrust if the blockage is removed
Repeat - if falls unconscious start CPR immediately.
30
How to deal with choking in an infant?
Child coking as unable to cough, unable to cry, going blue at the edges
Lay over knee or over the elbow
Five back slaps
Flip over - five chest thrusts (two fingers in line with armpits)
31
What korotokoff sounds are used during blood pressure?
1st korotokoff - systolic blood pressure
5th korotokoff - diastolic blood pressure
32
When might standing blood pressure be used?
Take after standing for one minute, then against after standing for three minutes
Normally expect to decrease originally then stabilise or increase towards original
- taken for concerns over orthostatic hypertension, elevated blood pressure when standing may indicate an increased risk of heart attack.
33
When might a lying down blood pressure be used?
Often taken if patients are hospitalized and unable to sit up
Expect blood pressure to decrease then stabilise
34
In what scenarios may an oxygen saturation reading meter nat be accurate?
In small fingers
In cold fingers
If nail polish on
In more pigmented skin
35
What boxes should be filled in when communicating with a patient in news chart?
Name
DOB
Date and time of appointment
All fields on a patient sheet (except second oxygenation box)
36
When might the SpO2 scale on a news chart be used?
For a patient on oxygen such as a COPD patient.
37
How should blood pressure be marked and scores on a news chart?
Mark on systolic and diastolic - join with a line
Score based on systolic only.
38
What do the different news scores mean?
An individual score of three in any section requires an urgent ward based response
A combined score of 3 is a low to medium risk - requires a ward based response
A combined score of 5 is a medium risk requires an urgent ward based response
A combined score of 7 is a high risk and requires an urgent escalated response
Highest possible score in 20
39
What are the two different categories of spinal comatic reflexes?
stretch reflexes
Flexor reflexes
40
What are stretch reflexes?
Maintenance of tone and mathiching force of contraction to load e,g knee jerk
41
What are flexor reflexes?
Protective reflexes
All flexor reflexes are activated in the limb e.g withdrawl reflex
42
What sources can build up the the neurological picture of the environment leading to posture and movement reflexivly?
Conventional proprioceptors
Cutaneous receptors
Vestibular information
Cerebellum
43
What is the optimal method for testing reflexes?
Tell the patient to relax
Optimal tension is half paw between contracted and relaxed by passive manipulation
Tap tendon briskly using the tendon of the rubber
44
What is a dermatome?
An area of skin supplied by a specfic spinal nerve
45
What is a myotome?
A group of muscles which are innervated by a singal spinal nerve root
46
What are the dermatomes in the upper limb?
47
What are the dermatomes in the lower limb?
48
Spirometry - how do you calculate pressure in the lungs?
Pressure (Pa) = Force (N) divided by area (m2)
49
Spirometry - how do you calculate compliance?
Change in volume dividied by change in pressure
50
Spirometry what is boyles law?
That pressure is inversly proportional to volume
51
How to read a spirogram?
Upward wave deflection is inspiration
Downward wave deflection is expiration
52
What is the basic concept of a spirometer test?
Enter patient details into machine
Maximal inspiration normally (bacterial valve closet to patient mouth)
Maximal expiration through the spirometer often pinch nose
Repeat three times
53
Define tidal volume. What is its normal value?
Tidal volume is the volume of air expired at rest, this is equal to the air inspired.
0.5L
54
What is inspiratory reserve volume?
What is the normal value?
The maximum valume inspired above tidal volume
Normally 3L
55
What is expiratory reserve volume?
What is its normal value?
Maximum air that can be expired below tidal volume
This is normally 1.5L
56
What is residual volume?
What is its normal value?
Remaining volume of air in the lungs after a complete expiration
Normally 1.2L
57
What is inspiratory capacity?
Mamximum air breathed in after a normal expiration
TV plus IRV
58
What is expiratory capacity?
Volume of air maximal expired after a normal inspiration
TV plus ERV
59
What is functional residual volume?
The volume of air remaining in the lungs after a normal expiration
ERV plus RV
60
What is the vital capacity of the lungs?
The Maximum volume of air that can be expired from the lungs after a maximal inspiration
IRV + TV + ERV
61
What is total lung capacity?
The total volume of air in the lungs at rest after mamximal inspiration
IRV, TV, ERV and RV
62
What is FVC and how is it calculated?
Forced vital capacity
The maximum volume of air that can be forcibly expired after a maximal inspiration
Adjusted for gender, age and ethnicity
63
What is FEV1?
The maxmimum volume of air a person can exhale in one second after a maximal inspiration
64
What safety chest should be asked before a spirometer?
Do you have a cough?
Do you have respiratory conditions?
Chest or abdominal surgery?
Problem on eyes requiring surgery?
Ever had a lung collapse?
Do you smoke?
65
What are the five moments of hand hygiene?
Before touching a patient
After touching a patient
After touching a patient environment
If there is a fluid exposure risk
If there is a sterile procedure or an invasive device
66
How should you wash your hands?
Wet hands
Soap
Palms together and between fingers
Palm to back of hand and between fingers
Around thumbs
Around wrists
Swirl in centre of hand
Nails in finger creases
67
What occurs in an upper limb neurological exam?
Inspection – injury, bruising, wasting, tremors.
Tone – move arms along all movement axis
Power – chicken wings up/down, boxer – in/out, zombie – wrist up and down, fingers pointed – up/down, fingers spread – digits in/out, palms and thumb up – push thumbs down
Reflexes – biceps (with finger), triceps , supinator (with finger)
Co-ordination – close eyes and hold hands out spread 10 seconds, flip flop test fast as possible on either side, your finger to your nose to my finger
Sensation – dermatomes, cotton wool, sharp v blunt, vibration with the tuning folk on the thumb, proprioception on thumb, ask if same on both sides
68
What happens in a lower limb neurological exam?
Inspection – walking aids, wasting, tremors, injuries
Tone – leg roll, pick up and drop, ankle clonus
Power – leg up into hand, push leg down into hand, push thigh outwards, push thigh inwards, kick football outwards, heel towards bum, leg straight (hold just above ankle) plantarflexion, dorsiflexion, inversion, eversion, hallux flexion and extension
Reflexes – knee jerk, calcaneal tend, on slightly flexed foot, plantar reflex with a neurotip
Co-ordination – march on spot with eyes closed. Heal to knee to toe loop, tap feet to hands as fast as you can
Sensation – cotton wool, blunt v sharp, vibration, proprioception on big toe, ask if the same on both sides
69
How should PPE be put on?
Apron on
wash hands
Eye protection on
Gloves on
70
How should PPE be taken off?
Gloves off
WAsh hands
Apron off
Eye protection off
71
What rubbish goes into a black bin?
General waste
72
What rubbish goes into a white bin bag?
REcycling
73
What rubbish goes into an orange bin?
Biologically infectious waste
74
What waste goes into a yellow bine?
Chemically infectious waste
75
What waste goes into a yellow bag with a purple stripe?
Cytotoxic waste
76
What waste goes into a yellow bag with a black stripe?
Offensive waste
77
What must remember before begining an upper or lower neurological limb exam?
Upper - ask patient to remove their top
Lower - ask patient to roll up shorts
78
Where are the electrodes placed in a three lead ECG?
AvR - on right wrist - red
AvL - on left wrist - yellow
AvF - on left ankle - green
79
Where are the electrodes placed on a 12 lead ECG?
v1 - fourth intercostal space right of sternum - red
v2 - fourth ICS left of sternum - yellow
V3 - midway between V2 and V4 - green
V4 - Fifth intercostal space at the midclavicular line - blue
V5 - V4 level at the anterior axillary line - orange
V6 - level with V5 at midaxillary line - purple
LA - black
LL - red
RA - white
RL - green
80
What is the difference between a segment and an interval on an ECG?
Segment contains no waves
An interval contains waves
81
Draw and label einthovens triangle
82
How to set up a power lab for an EMG?
Bioamp in bioamp slot
Plug in cables - linked by colour
Plug in the simulatoed bar electored (red and black)
Plug in the wrist strap to green earth cable
Sellotape the pulse producer to the table and plug into input 1
83
Where do you place the elctrodes for an EMG?
Gently remove jewelry
Put small crosses on skin and abrade gently with gell and wipe clean
Place electrodes linked to bioamp over the abductor minimi muscle (below little finger on plamar surface)
Place electrode cream over metal pads on bar
Place over the ulnar nerve (medial side) at elbow (may leter change to distal wrist ulnar bone - pinky side)
Position arm in relaxed place with finger over pulse transducer
If able to distinguish red should be placed more proximal
84
What muscle route and nerve area being tested in the biceps reflex?
C5 and C6
Biceps muscle
Musculocutaneous nerve
85
What nerve, root and muscle are being tested in the triceps jerk?
Radial nerve
Triceps muscle
C6 7 8
86
What nerve, root and muscle are being tested in the supinator reflex?
Brachioradialis
C5 6
Radial nerve
87
In the knee jerk reflex which muscle, nerve and nerve roots are being tested?
Quadriceps femoris tendon
Level L2 3 4
Femoral nerve
88
How is the knee jerk tested potenitation?
Ask to clench jaw at the same time
Or ask to clasp hands and pull them apart at the same time
89
How is the knee jerk testesed suppression?
Ask the subject to oppose the reflex by voluntary flexing the knee joint
90
What nerve, nerve route and muscle are being tested in the ankle jerk?
Gastrocnemius and Soleus muscle
Level S1 and S2
Tibial nerve
91
For the plantar reflex which nerve p, nerve root and muscle are being tested?
Socks should be taken off
L5 S1 and S2
92
What is the babinski response?
Plantar réflex - normal to flex toes inwards
Pathological in a corticospinal lesión to extend the hallucis
