OSCEs Flashcards
Core symptoms and other symptoms of depression
Mild- 2 core + 2 other symptoms
Moderate- 2 core + 3/4 others
Severe- 3 core + 5 others (e.g. sleep disturbance, anorexia, suicidal thoughts, memory problems, loss of libido)
Features of bipolar depression (manic depression)
Mania- severe functional impairment or psychotic symptoms for 7 days or more e.g. delusions of grandeur, auditory hallucinations.
- Reduced need for sleep
- Inability to concentrate
- Poor insight
Features of hypomania
- Lasts for < 7 days, typically 3-4 days. Can be high functioning and does not impair functional capacity in social or work setting
- Features of mania but to a lesser degree, does not affect social functioning
First rank symptoms of schizophrenia
Need to have at least one of:
- Thought disorder- echo/insertion/broadcasting/withdrawal
- Auditory hallucinations- running commentary, voices discussing patient in 3rd person
- Passivity phenomena- thoughts, actions are being controlled by someone else
- Delusional perception- persistent delusions
Negative symptoms of schizophrenia
- Incongruity/blunting of affect
- Anhedonia
- Self-neglect
- Poverty of speech (alogia)
Structure of a psychiatric history
ASEPTIC
PC/HPCx
Psych Ros
- Depression screen (low mood, anhedonia, anergia)
- Psychosis screen (3rd person auditory hallucinations, running commentoary, thought disorder, passivity)
- Mania (increased energy)
RISK ASSESSMENT- risk to self and to others. what is stopping you. Thoughts of harming self or others
Insight- do you feel like you need treatment/there is a problem
Past Psych history- any previous diagnosis, how many episodes + admissions- voluntary or involuntary. orevious episodes of self harm or suicide attempts
PMHx
MHx- on any psych medications
FHx- family history of suicides, mental health disoders
SHx- alcohol and drug use
social circumstances- housing, relationships, dependents, home- need support, finances, coping with activiites of daily living
forensic history- ever been arrested? prison? any convictions, longest prison sentence? what type of crimes
Personal upbringing- how would you describe childhood, school/work/employment
Pre-morbid personality- before diagnosis how would people have described you
Assessing capacity in a patient
Does patient have disturbance/impairment of brain function?
I know this might sound patronising but could you please tell me who I am, where we are, what today’s date is
If yes, need to see if they are unable to make a decision as a result- must be able to:
- Understand information relevant to the decision (consequences, risks, benefits)
- Retain the information long enough to make a decision
- Weigh up/use information to make a decision (pros and cons)
- Communicate the decision (by any means)
If they can do all of this then they have capacity
If they lose capacity, must act in best interests of the patient:
- Try to involve them
- Take into account any known beliefs, views- look for advanced statement of wishes
- Check for lasting power of attorney
Investigations and differentials of falls
Investigations:
- Full cardiovascular and neurological examination
- Assess gait, balance and vision
- Want to do lying and standing BP- drop of >20/10mmHg is postural hypotension
Counselling on syringe drivers
What is a syringe driver:
- Small, battery-powered pump that delivered medication at a constant rate throughout the night and day
- Medicines put in a syringe and driver pushes them through a small plastic tube and into your body
- Tube is inserted using a thin needle, which is then removed. It is usually inserted just under the skin on your arm, leg, abdomen
- Sometimes it is called a continuous subcutaneous infusion
Why are they used:
- Difficult to swallow tablets or liquids
- If symptoms cannot be managed with tablets or injections
- Vomiting and being sick
- Need more than 2 injections of medications within 24 hours
- If body cannot absorb medicine properly
They are often used in last few weeks and days of life but they are not only used at this stage
Can be useful for managing symptoms at any stage
Types of medicines in syringe drivers
Medicines to treat symptoms:
- Pain- morphine
- Nausea and vomiting- Cyclizine, haloperidol, metoclopramide, levomepromazine
- Agitation- midazolam
- Too much fluid in the throat and lungs (respiratory secretions)- hyoscine hydrobromide, hyoscine butylbromide, glycopyrronium
- Breathlessness- morphine
Common worries:
- Means that they will die soon- not necessarily true, syringe drivers can be used at any stage. Some people just use them for a short time to manage symptoms. Often used at end of life as person is unable to swallow medicines, or body stops being able to absorb them properly- syringe driver is often best way to give medicines
- Makes them die sooner- no evidence for this. They are used often at end of life because easiest ways to give someone medicines they need to feel comfortable
2WW for oesophageal cancer
Urgent upper gastrointestinal endoscopy for those:
- with dysphagia or
-
aged 55 and over with weight loss and:
- Upper abdo pain
- Reflux
- Dyspepsia
2WW for pancreatic cancer
Urgent CT scan for those:
60 and over with weight loss and:
- Diarrhoea
- Back pain
- Abdominal pain
- Nausea
- Vomiting
- Constipation
- New-onset diabetes
2WW for stomach cancer
Urgent direct upper GI endoscopy for those:
With dysphagia or
- Aged 55 and over with weight loss and any of the following:
- Upper abdominal pain
- Dyspepsia
Red signs for fever in children <5 years
- Colour- Pale/mottled/ashen/blue
- Activity- no response to cues, appears ill, does not wake or if roused does not stay awake, high-pitched cry or continous cry
- Respiratory- grunting, RR>60 breaths/min, moderate or severe chest wall recession
- Circulation and hydration- reduced skin turgor
Age <3 months, temperature >38C, non-blancing rash, bulging fontanelle, neck stiffness, status epilepticus, focal neurological signs, focal seizures
Management of sepsis in a child in GP then Hospital
Urgently refer child to paediatric specialist in hospital
In hospital:
- A-E assessment
- Start Sepsis 6 pathway
- BUFALO:
- Bloods and blood cultures
- Urine dipstick- for cutlure and sensitivities
- IV Fluids
- Broad-spectrum antibiotics according to trust policy
- ABG- for lactate and acidosis
- Oxygen if sats <94%
Determine the source of infection:
CXR- if pneumonia is suspected
- Urinalysis
- Abdominal and pelvic USS
- Lumbar puncture- if meningitis suspected and no contraindications
- Meningococcal PCR blood test- if meningococacl disease suspected
2WW referral for ovarian cancer
- Physical examination identifies ascites and/or pelvic or abdominal mass which is obviously not uterine fibroids
