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FOUNDATION > qSkills > Flashcards

qSkills Flashcards

1
Q

Four Frames

A

Onset – When did the symptom start? / Was the onset acute or gradual?

Duration – Minutes / hours / days / weeks / months / years

Severity – i.e. If the symptom was frequency – how many times a day?

Course – Is the symptom worsening, improving, or continuing to fluctuate?

Intermittent or continuous? – Is the symptom always present or does it come and go?

Precipitating factors – Are there any obvious triggers for the symptom?

Relieving factors – Does anything appear to improve the symptoms?

Previous episodes – Has the patient experienced this symptom previously?

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3
Q

Systems R/V

A

Fits/Faints/Funny turns

Coughs/colds

SOB

N/V

Change in bowel habit

change in water works

Any pain anywhere

Have you lost any weight

hows your appetite been

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4
Q

Cardiovascular Red Flags

A

 Chest pain

 Palpitations (heart racing or thumping)

 Shortness of breath (dyspnoea): tolerance

 PND and Orthopnoea

 Peripheral oedema

 Pain in legs on walking, cold limbs (PVD)

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5
Q

Respiratory Red flags

A

Shortness of breath (dyspnoea): tolerance

 Cough: duration, haemoptysis

 Sputum: amount, character, blood, pink

 Chest pain on breathing (pleuritic pain)

 Wheeze, stridor, snoring

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6
Q

Gastro Red Flags

A

Difficulty/Pain chewing or swallowing, ulcers

 Nausea, vomiting, ? blood

 Indigestion or heartburn or abdo pain/mass

 Change in appetite, weight loss, weight gain

 Bowel habit: changes, blood, mucous, melaena, pale stools or floating (steatorrhoea)

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7
Q

Neurological and Psychiatric Red flags

A

Headache, fits, faints, dizzy, blackouts

 Numbness ( or any change in sensation), weakness or clumsiness in arms or legs

 Changes in vision, double vision, hearing (deafness, tinnitus), speech, taste, smell

 Change in mood, stress levels, thoughts

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8
Q

Genito-Urinary Red Flags

A

Pain or discomfort urination

Difficulty starting or stopping

Are you finding you’re going more often

Noticing you’re waking up at night to go to the loo

sudden urge to pee

any accidents

Fever/rigors

N&V

weight loss

Uraemic Symptoms

Dysuria: typically associated with urinary tract infection (UTI), including sexually transmitted infections (e.g. chlamydia, gonorrhoea).

Urinary frequency: commonly associated with UTIs.

Urinary urgency: may be associated with UTIs or detrusor instability.

Nocturia: associated with UTIs and prostate enlargement (e.g. benign prostatic hypertrophy).

Haematuria: associated with UTIs, trauma (e.g. catheter insertion) and renal tract cancers (e.g. bladder cancer, renal cancer).

Urinary hesitancy, terminal dribbling and poor urinary stream: associated with enlargement of the prostate (e.g. prostate cancer, benign prostatic hypertrophy).

Urinary incontinence: associated with a wide range of pathology including UTIs, detrusor instability and spinal cord compression (e.g. cauda equina syndrome).

Fevers and rigors: typically associated with pyelonephritis.

Nausea and vomiting: typically associated with pyelonephritis.

Weight loss: associated with malignancy and uraemia.

Uraemic symptoms: nausea, vomiting, fatigue, anorexia, weight loss, muscle cramps, pruritis and confusion.

Pain or difficulty passing urine, ? dribbling

 Day urination versus nocturia

 ? Amount ? need to drink fluids overnight

 Vaginal or penile discharge, lesions

 Periods: last one, changes, usual pattern,

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9
Q

Diabetes and Endocrinology Red flags

A

 Polyuria, polydipsia, weight loss/gain, , blurred vision, thrush

 Heat or cold intolerance, neck swelling.

 Change in appearance, sweating, hirsutism, periods, energy, libido, ED

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10
Q

Surgical Sieve

A
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11
Q

GCS

A

Glasgow coma scale (GCS) scores are generally expressed in the following format ‘GCS = 13, M5 V4 E4 at 21:30’.7

Intubate if GCS <8 (eg cuffed endotracheal tube)

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12
Q

Musco-skeletal and derm Red Flags

A

Pain, stiffness in joints ? circadian rhythm

 Pain, stiffness in muscles

 Tingling/weakness in hand eg CTS

 Falls, difficulty walking or dressing or ADL

 Any skin lesions: rash, ulcer, blisters, heat bruising, itching, bleeding, colour change

Rash specific: itching/pain

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15
Q

Notes Mneumonic

A

REDCOAT

Resus Status

EDD

Drugs Chart r/v

Cannula

Oxygen

Abx

Thrombolytis

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16
Q

Post Operative Assessment

A

IMPOTENCE

Introduction

  • What surgery & when?*
  • How many days post op? Anaesthetic type? +/- sedation*
  • Intra-operative complications?*

Mental State

Alert & orientated? GCS/AVPU? Consider AMT10

Pain

Where is the pain?- SOCRATES Is analgesia effective?

PONV - antiemetic Laxatives

Observations

EWS - BP/HR/SPOZ/RESPS/TEMP

+/- CVS/RESP EXAM +/- glucose measurement

Thromboprophylaxis

Calves soft & non-tender?-DVT Compression stockings Foot pumps LMWH

Consider chest - PE Mobile ASAP

Eating and Drinking

Diet & fluids

IV fluids / oral input fluid chart

PU/catheter - why catheterised? Colour/amount?

Bowels open?

Passed flatus/bowel sounds/Abdo SNT

Neurovascular

Check distal neurovascular status & document - take into consideration, surgical positioning/anaesthetic /surgery

Cut

Surgical wound site - is it clean dry & intact? Why has the dressing been changed? Any drains?

Exercise

Has the patient been up & mobilising? Walking aids used?

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17
Q

Heart Rate

A

6

12

18

24

30

36

42

48

54

60

66

72

78

84

90

96

102

108

114

120

126

142

148

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18
Q

Hand Measurements

A

Thumb edge : 4.5cm

Index to thumb base: 12cm

Index inside edge: 8cm

Pinky to wrist: 15cm

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19
Q

FBC range

A

HaemoglobinMen: 135-180 g/l Women: 115-160 g/l

Mean cell volume82-100 fl

Platelets150-400 * 109/l

White blood cells4.0-11.0 * 109/l

Neutrophils2.0-7.0 * 109/l

Lymphocytes1.0-3.0 * 109/l

20
Q

U&Es range

A

Sodium135-145 mmol/l

Potassium3.5 - 5.0 mmol/l

Urea2.0-7 mmol/l

Creatinine55-120 umol/l

Bicarbonate22-28 mmol/l

Chloride95-105 mmol/l

21
Q

LFTs range

A

Bilirubin3-17 umol/l

Alanine transferase (ALT)3-40 iu/l

Aspartate transaminase (AST)3-30 iu/l

Alkaline phosphatase (ALP)30-100 umol/l

Gamma glutamyl transferase (yGT)8-60 u/l

Total protein60-80 g/l

22
Q

ISBAR

A

Introduce

This is Luke an FY1 calling from ED. Who am I talking to?

Situation (reason)

Current problem

I am calling about Mr Brown who was admitted with severe pneumonia, he has sats of 90% despite high flow oxygen and I am very worried about him.

“The problem appears to be cardiac/respiratory/neurological/sepsis”

“I’m not sure what the problem is but the patient is deteriorating”

“The patient is unstable, getting worse and I need help”

Background (Story)

reason for admission and past medical hx

“He is 55 and previously fit and well. He has a 2 day hx of cough and fever and arrived an hour ago by ambulance”

Assessment (vital signs)

go through ABCDE approach

He looks very unwell and is tiring. Airway: . . . .. . Breathing . . . .. .

Recommendation (Plan)

State explicitally what you want to caller to do - WHAT AND WHEN

I have given him IV abx that you presecribed and he has had 1 litre of IV saline. I am worried he is getting worse. I need help, please can you come and see him right away?

“I am going to start the following tx, is there anything else that you suggest?”

“I am going to do the following ix, is there anything else you can suggest?”

“If they do not improve when would you like to be called?”

“I don’t think I can do any more: I would like you to see the patient urgently”

23
Q

ECG red flags

A
24
Q

Other Haem Range

A

Erythrocyte sedimentation rate (ESR)Men: < (age / 2) mm/hr Women: < ((age + 10) / 2) mm/hr

Prothrombin time (PT)10-14 secs

Activated partial thromboplastin time (APTT)25-35 secs

Ferritin20-230 ng/ml

Vitamin B12200-900 ng/l

Folate3.0 nmol/l

Reticulocytes0.5-1.5%

D-Dimer< 400 ng/ml

25
Q

Other Biochemistry Ranges

A

Calcium2.1-2.6 mmol/l

Phosphate0.8-1.4 mmol/l

CRP< 10 mg/l

Thyroid stimulating hormone (TSH)0.5-5.5 mu/l

Free thyroxine (T4)9-18 pmol/l

Total thyroxine (T4)70-140 nmol/l

Amylase70-300 u/l

Uric acid0.18-0.48 mmol/l

Creatine kinase35-250 u/l

26
Q

Innervation

A

Upper limb Motor

 Shoulder Abduction (C5, C6) and Adduction (C6, C7, C8)

 Elbow Flexion (C5, C6) and Extension (C7, C8)

 Wrist Extension (dorsiflexion, C5, C6, C7) and Flexion (palmar flexion, C6, C7, C8)

 Grip: use your index and middle finger (C8, T1)

 Fingers out straight, “stop me bending them” C7 Radial N.

Upper Limb Sensation

o C4 = shoulder tip

o C5 = deltoid

C6 = Thumb

o C7 = middle finger

o C8 = little finger

o T1 = elbow

Upper limb reflexes

 Test biceps (C5, C6) ? Jendrassik Manoeuvre to re-inforce

 Supinator (C5,6)

 Triceps (C7,8) also finger jerk (C8,T1)

Lower limb Motor

  • Hip Flexion (L1, L2) and Extension (L5, S1)
  • Hip Adduction (L2, L3, L4) and Abduction (L4, L5, S1)
  • Knee Extension (L3, L4) and Flexion (S1)
  • Dorsiflexion of Foot (L4, L5), Plantarflexion (S1, S2)
  • Inversion of foot (L4, L5) and Eversion (L5, S1)
  • Toe Extension (L5) and Flexion (S1)

Lower Limb Sensation

 Light touch: L1 = hip L2 = outer thigh L3 = Inner Thigh L4 = big toe L5 = middle toe or outer calf, s1 = little toe or outer foot

29
Q

Paeds Red Flags

A

Have they been eating and drinkning normaly?

Have they been having the normal amount of wet and dirty nappies for them?

Any nausea or vommitting?

Any Fevers?

Any Rahes?

Any coughs or runny noses?

any changes in weight?

Any pain?

Have you felt they’ve not been their normal self in any other way?

Dietary intake: clarify what the child’s baseline dietary intake is and, if relevant, how this has changed recently.

Fluid intake: calculate the child’s fluid intake over the last 24 hours.

Urine output: ask if there has been any change in the child’s urine output (in younger children, ask if there has been a change in the number of wet nappies).

Stool: ask about the recent frequency and form of the child’s stools.

Vomiting: if the child has been vomiting, determine the frequency, volume and consistency of the vomit (e.g. bilious, haematemesis). Ask specifically about projectile vomiting if considering pyloric stenosis as an underlying diagnosis.

Fever: ask if the child has had a fever recently and if this was confirmed with a thermometer.

Rash: ask if the child currently has a rash, including its location, whether it appears to be spreading and if it appears to be itchy.

Coryzal symptoms: ask if the child has recently had a runny nose, or sounded ‘sniffly’.

Cough: ask if the child has a cough and if they are bringing up any sputum with it. Gain further details about the frequency of the cough, including associations with particular triggers or times of the day (e.g. nocturnal cough).

Work of breathing: ask if the child’s breathing has appeared more laboured recently.

Weight change: ask if the child appears to be gaining weight at an appropriate rate and review growth charts if available.

Behaviour: ask if the child appears to be their usual self, including their level of activity, mood and social interaction.

Pain: ask if the child appears to be in pain and further explore this using the SOCRATES acronym.

30
Q

Lipid Levels

A

Total cholesterol< 5 mmol/l

Triglycerides< 2 mmol/l

HDL cholesterol> 1 mmol/l

LDL cholesterol< 3 mmol/l

31
Q

Blood Pressure

A

Home BP S1 = 135/85 mmHg

Home BP S2 = >= 150/95 mmHg

Clinic BP severe = >180/110

32
Q

Sepsis

A
33
Q

Common ECG patterns

A
34
Q

Developmental Red Flags

A
  • No smile by 8 weeks
  • No eye contact by 3 months
  • Not reaching for objects by 5 months
  • Not sitting at 9 months
  • Not walking at 18 months
  • No speech at 18 months
  • Hand preference below 12-18 months
  • No 2-3 word sentences at 2½
35
Q

Opthal Red Flags

A

vision changes/ double vision

Flashes/Floaters

Photophobia

Eye pain

Jaw/Temporal Pain

Headache/neuro changes

Trauma/Wear Contacts

36
Q

LFT table

A

ALT 3-40 iu/l

AST 3-30 iu/l

ALP 30-100 umol/l

GGT 8-60 u/l

Bilirubin 3-17 umol/l

Albumin 35-50 g/l

PT 10-14 s/ 1

ALT>AST = chronic liver disease

AST>ALT = alcoholic hepatitis or cirhosis

37
Q

ENT Red Flags

A

Ears

Hearing changes? Muffled? Uni/Bi?

Titinis

Discharge (ottorhea/purulent)

Blood per ear

Pain? - where? pulling/swallowing?

Vertigo

facial weakness

NOSE (unilateral things worse!)

Discharge? clear/purulent

Blood?

Breathing problems? snoring?

Pain/ Headaches(sinisitis)

Facial Pain

Buccal Swelling

Visual disturbances (cancer growth

Throat (ALARMS 55)

Anaemia

Loss of weight

Anorexia

Recent onset/rapid progression

Malaena

Swallowing difficulty

>55

38
Q

AMT

A

Abbreviated Mental Test

AMT-4: (<4 = abnormal cognition)

Age

DoB

Place

Year

AMT-10 (7-8 cut off to ix further for dementia)

Age

Time (nearest hour)

Address to recall later (42 west street)

Year

Name of this place

Identification of two persons (eg doctor/nurse)

Date Of Birth

Year of First world war ended

Name of The Monarch

Count backwards from 20 -1

Recall the address

39
Q

Anti-Muscarinic Side Effects

A

drowsiness

dry mouth

blurred vision

constipation

urinary retention

lengthening of QT interval

40
Q

Musco-skeletal and derm Red Flags

A

Pain, stiffness in joints ? circadian rhythm

 Pain, stiffness in muscles

 Tingling/weakness in hand eg CTS

 Falls, difficulty walking or dressing or ADL

 Any skin lesions: rash, ulcer, blisters, heat bruising, itching, bleeding, colour change

Rash specific: itching/pain

41
Q

Hand Measurements

A

Thumb edge : 4.5cm

Index to thumb base: 12cm

Index inside edge: 8cm

Pinky to wrist: 15cm

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