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Jan Stuff > OSCE > Flashcards

OSCE Flashcards

1
Q

Standard History Template
(6 + 3 + 1)

A

1) Intro and offer painkillers if they are here for pain

2) Screen for presenting complaint
 What is wrong?
 Okay is there anything else that you have come in for

3) Information gathering
- Tell me a bit more
- SOCRATES
Now SUMMARISE back to them (So just to summarise…)

//////////////////////////////////////////////

4) RISK FACTORS and RED FLAGS
5) Systems Review for appropriate systems
Also CONSTITUTIONAL SYMPTOMS

/////////////////////////////////

6) ICEF
 What are you most hoping to get out of the doctors today?

/////////////////////////////////////////////

NOW finish the rest of the history
- PMH
- DH and ALLERGIES
- SH and FH

SAFETYNET

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2
Q

Obstetric History (Replaces Step 4 and 5)- before ICEF and after SOCRATES

4 PARTS- Systems Review, Questions About Current Pregnancy, Questions about Previous Pregnancy, Gynae History

A

HP 3 F PP 3
- Nausea and Vomiting/ Weight Loss- Hyperemesis Gravidarum
- Headache, Visual Symptoms, Epigastric Pain- Pre Eclampsia

  • Reduced Fetal Movement (felt after 16 weeks)- any change in baby’s movements?
  • Vaginal Bleeding (ask about latest ultrasound)
  • Vaginal Discharge
  • Abdominal Pain
  • Chest Pain/ Swollen Leg (PE/ DVT)
  • Pruritus- Obstetric Cholestasis
  • Fever (Chorioamnionitis), Fatigue (Anaemia), Weight loss (Hyperemesis Gravidarum)

//////////////////////////////////////////////////
Current Pregnancy (GSS IMO)

 Gestation Age
 Scan Results (Ask about Status of Fetus and Placenta)
 Screening- Ask about if they have opted for screening (HepB, HIV, Syphilis)
 Immunisations (Flu, Whooping Cough, Hepatitis B (if at risk only))
 Mental Health of Mother at the moment
 Other Details
* Single or Multiple Gestation
* Folic Acid
* Mode of Delivery
* Other Illnesses during Pregnancy
//////////////////////////////////////////////////////////////
Previous Obstetric History
- Gravidity and Parity
- Pregnancies that were >24 weeks
 Gestation at deliveries (preterm increases risk of subsequent preterm)
 Birth weight (LGA- Gestation diabetes?)
 Mode
 Complications
 Ask if IVF or assisted reproduction was used

  • Pregnancies that were <24 weeks
     Miscarriage- clarify trimester and if a CAUSE was identified
     Termination of Pregnancy- Clarify gestation and method of termination
     Ectopic- site and how it was managed

////////////////////////////////////////////////////////////////////

Quick Gynaecological History
- Cervical Screening (date of last screening)
- Previous Gynaecological conditions like STIs/ Malignancy/ Endometriosis

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3
Q

Gynae History- Ask G/P/ LMP EARLY

Gynae History, Menstrual History, Family Planning, Past Gynae History/ QUICK Obstetrics history (Current and Past Pregnancy)

A

Gynae Symptoms (Pain, PV bleeding, PV dscharge, Pregnancy)
- Abdominal Pain
- Vaginal Discharge
- Post coital bleeding- Cervical issues/ STI
- Intermenstrual bleeding- Contraception, STI, Fibroids, Cancers
- Post Menopausal Bleeding- Atrophic Vaginitis, HRT, Cancers (Endometrial mainly)

  • Dyspareunia (Endometriosis, STI, Atrophic Vaginitis)- ask about how deep the pain is

Systemic 3- Fever, Fatigue, Weight Loss

//////////////////////////

Menstrual History
- Duration and Frequency
- Ask about Menorrhagia
- Ask about Dysmenorrhoea
- Last Menstrual Period Date
- Menarche and Menopause date

///////////////////////////////

Contraception
- which contraception and what have they previously tried

Reproductive plans- are they considering having children?

//////////////////////////////

Past Gynae History and Cervical Smear

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4
Q

Paeds History Taking

Establish name of who they have brought in the room with them

Say it is my usual practice to speak with the parent first and then the child

Systems Review is different

Also Extra bit for PMH and SH

A

Systems Review (Especially if YOUNG) (3,2,2,3)

  • Diet and Water intake
  • Urine Output and Stool
  • Vomiting
  • Cough and Coryza
  • Short of breath
  • Behaviour
  • Movements (Seizures)
  • Pain
  • Weight Loss
  • Fever
  • Rash

////////////////////
Under PMH- (3 birth, 3 current)
- Birth (Antenatal, Natal and Post Natal)- When and How were they born
- Immunisations
- Nutrition- Feeding (How many meals a day?)
- Development and Growth - Prenatal- any abnormal scans or screening (Height and Weight)

////////////////////////////
Under SH
HEEADSSS

  • Home- who is at home, who do you get on with at home, who do you turn to when you are down
  • Education and Employment- ask about that and friends at school/ how they are doing at school/ how their work is going
  • Eating- worried about body shape? on a diet
  • Activities and Hobbies
  • Drugs/ Alcohol/ Tobacco
  • Sex and Relationships, Are you in a relationship at the moment? Boy or girl? Young people are often starting to develop intimate relationships, how have you handled that part of the relationship
  • Self-harm, depression and self-image
  • Safety and Abuse- Do you feel safe at home and school, is anyone harming you/ making you do things you do not want to

Make sure to always ask about Family Life

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5
Q

Complications of Gastrectomy

A

Small intestine bacteria growth
Peptic Ulcer
Anastomotic Ulcer
Malabsorption

Dumping Syndrome
Bloating

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6
Q

Complications of bowel surgery

A

Ileus
Anastomotic Leak
Intestinal Obstruction/ Adhesions

Damage to other organs

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7
Q

Complications of cholecystectomy

A

CBD Injury/ bile leak (abdo pain/ fever and nausea)

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8
Q

Complications of biliary operation

A

CBD Injury/ bile leak
Anastomotic Leak
PANCREATITIS

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9
Q

Complications of CABG

A

Reperfusion Arrythmia
Post-operative ACS
Inotropes are needed after operation- may REDUCE OTHER ORGAN PERFUSION

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10
Q

Complications of vascular stents/ grafts

A

Haemorrhage
Organ Ischaemia
Contrast Complications (renal injury/ anaphylaxis)

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11
Q

Thyroidectomy

A

Hypocalcaemia
Laryngeal Nerve Damage
AIRWAY OBSTRUCTION- open wound asap

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12
Q

Parathyroidectomy

A

FACIAL NERVE DAMAGE

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13
Q

Orthopaedic Operation

A

Infection
Neurovascular Injury
Compartment Syndrome- due to increased pressure within the limb (usually leg)

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14
Q

TURBT/ Cystoscopy

A

UTI
Impotence and retrograde ejaculation
External SPhincter Damage and therefore INCONTINENCE

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15
Q

what can cause Jugular Foramen Syndrome (9-11)

A

GCA
VZV
Trauma and Neoplasm

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16
Q

what can cause Cn3-6 issues

A

Cavernous Sinus and Miller Fischer

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17
Q

What can cause chorea?

A

Stroke
huntingtons
sydenhams chorea

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18
Q

what can cause athetosis?

A

Cerebral Palsy and Neonatal Jaundice

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19
Q

How is Cor Pulmonale managed?

A

Loop Diuretic and LTOT

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20
Q

When should admission be considered in COPD?

A

O2 < 90
Confusion
Cyanosis
Comorbidity is significant (Cardiac disease)

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21
Q

In angina, in addition to B+C, what other drugs should be given?

A

Aspirin and Statin

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22
Q

What drug does the injectable contraceptive contain?

A

Medroxyprogesterone Acetate

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23
Q

When can an IUD be removed?

A

Wait until their next period at the very least before removing

24
Q

When should the implantable contraceptive be inserted?

A

Within the first 5 days of the period, otherwise 1 week of contraception needed

25
Q

What are the 2 side effects of the implantable contraceptive?

A

Irregular/ Heavy Bleeding- give COCP alongside to prevent this

Progestogen effects- Headache Nausea Breast Pain

26
Q

What does the implantable contraceptive interact with?

A

Enzyme INDUCERS

so SWITCH to a method unaffected by enzyme inducers for ONE MONTH after stopping

27
Q

What are the causes of hypoglycaemia?

A

Exogenous drugs (typically sulfonylureas or insulin)
Pituitary insufficiency
Liver failure
Addison’s disease
Islet cell tumours (insulinomas)
Non-pancreatic neoplasms

28
Q

How long until Mirena can be relied upon as a contraceptive method?

A

7 days

29
Q

What is the Acute management of heart Failure?

A

Oxygen and Loop ofc

NITRATES (vasodilators) if AR, MR/ MI, HTN

if HYPOTENSION- Inotropes (dobutamine) and Vasopressors (norepinephrine)

30
Q

What is the chronic management of heart failure?

A

AB/ SS/ 3

The 3 extra managements
- LEF<35- Sacubitril Valsartan
- LEF<35 and HR>75- Ivabradine
- Wide QRS- Cardiac Resynchronisation

31
Q

How is Huntington’s managed?

A

Tetrabenazine, Atypical Antipsychotics and SSRIs

32
Q

Which arteries do LACI and PACI affecte?

A

LACI- Perforating

PACI- Vertebrobasilar

33
Q

A patient with a history of VTE is pregnant, what should you give them?

A

LMWH until 6 weeks of pregnancy

34
Q

How is Cirrhosis Definitively Diagnosed?

A

LIVER BIOPSY, but transient elastography is first line

35
Q

What is the Prophylactic and Acute management of Peritonitis?

A

Prophylaxis=if Neutr>250- Ciproflox and Oflox (Quinolones for the Peritonitis)

Acute- CEFTRIAXONE

36
Q

What are the main complications of Crohns?

A

Small bowel Cancer more common than Colon Cancer

Osteoporosis

37
Q

What are the cranial and nephrogenic causes of Diabetes Insipidus?

A

Cranial- Sickle Cell and Sarcoidosis

Nephrogenic- Lithium, Hypercalcaemia and Hyperglycaemia

38
Q

What is the management of DKA and HHS?

A

DKA
- IV Fluids
- 0.1 Insulin (stop short acting)
- DEXTROSE if Glucose <14
- Potassium if not Hypokalaemic (40mmol)

HHS
- IV fluids and Potassium
- 0.05 Insulin (ONLY if Glucose isnt falling)- otherwise CPM

39
Q

What is the management of Thyrotoxicosis and Myxoedema Coma

A

thyrotoxicosis-
- IV Propanolol
- NG Propylthiouracil
- IV Steroids
- Lugol’s Iodine

Myxoedema coma
- IV Thyroid Replacement
- IV Fluids
- IV Steroids

40
Q

What can cause Addison’s?

A

A metastatic Melignancy

41
Q

What are the causes of Delayed Puberty?

A

BRAIN (low Gonadotrophin)-
- Hypothyroidism
- Coeliac, CF
- Pituitary Disease
(and Kallman)

GONADs (High Gonadotrophin)
- Klinefelters (Tall)
- Turners
- Noonans
- Prader Willi
- CAH and Hypogonadism

42
Q

Management of DDH and Perthes

A

DDH- Pavlik if Young, Surgery if Old
Perthes- Cast and Surgery if > 6yo

43
Q

What do you look out for in NIPE in the face?

A

Upslanting Palpebral Fissures, flattened nasal bridge, Low set ears- Downs Syndrome

Epicanthal Folds, Smooth Philtrum, Low Nasal Bridge- Foetal Alcohol Syndrome

44
Q

Management of HIE

A

Oxygen
Antiepileptics
INOTROPES
Controlled Hypothermia

45
Q

What are the Rf for Pseudogout

A

haemochromatosis
hyperparathyroidism
low magnesium, low phosphate
acromegaly, Wilson’s disease

46
Q

Psychiatric History

A

Presenting Complaint and WHO PROMPTED them to come in

HPC- Ask about TRIGGERS and TIMEFRAME

Systems Review for Psych
- Psychosis
- Depression
- Memory
- RISK

PMH- (previous psych and SUICIDE ATTEMPTS)

Drug History- Check COMPLIANCE

Family History of SUICIDE as well

SOCIAL History
- SOCIAL CIRCUMSTANCES-
Friends, Family, Finances, Relationships
EDUCATION
FORENSICS HISTORY

Childhood and Upbringing- any child abuse?
Pre-morbid Personality

47
Q

Subfertility History

A

How long have they been trying/ Any previous investigations/ management?

COITUS
- Frequency
- Any difficulties/ Pain
- Relating it to FERTILE DAYS

Partners (ask about both
- Age/ Occupation
- BMI
- PMH/ DH
- Smoking/ Alcohol
- Previous Children

Women’s Gynaecological Health
- also look for PCOS and Prolactinoma

///////////////

Due to:

Hypergonadotrophic Hypogonadism/ Hypogonadotrophic Hypogonadism
Any Gynae Symptoms
Mechanical/ Timing
ED/ Ejaculation

48
Q

Delirium/ Dementia

A

SOCRATES

Gradual confusion- Alzheimer’s, Step Wise= Vascular

Associated Symptoms-
- Psychiatry
- Changes in Behaviour (Aggression/ Calling Out)
- Sleeping (awake at night= Alzheimers), fluctuating consciousness (DELIRIUM)

ICEF

PMH- Vascular Diseases, Head Injuries, Infection, Parkinson’s (PHIV)

Drug History

FMH

SH (Home, Walking, Working, Effect, Carer)- (HWWEC)
- Living situation
- MOBILITY and WALKING AIDs
- Working/ Driving
- Effect on LIFE
- If Talking to Carer ask about THEIR NEEDS

Also RISK

49
Q

Paediatric Soiling/ Enuresis

A

Toilet Training
School Toilet Behaviour
Ask about life at home

Soiling- Diarrhoea/ Constipation? and any Pain?
Enuresis- Have they ever had a dry night?

DIFFERENTIALS
- Primary
- NEUROLOGICAL conditions
- Urinary/ GI infection

50
Q

Paediatric Low Weight

A

Ask about Growth Chart

LOW Input- ask DETAILS about diet
Use- Activity Level
Output- Ask about Wet nappies/ stools

DIFFERENTIALS
- Cystic Fibrosis
- Cardiac Cause if Sweating when breathing
- Primary Ciliary Dyskinesia or other Genetic Cause

51
Q

Paediatric Weight Gain

A

Input
Use
Output

DIFFERENTIALS
- Cushing’s
- Hypothyroidism
- Prader Willi

52
Q

Paediatric Walking/ Sitting Delay

A

Ask about:

Mobility
Hand Dominance
Balance Issues
Behaviour Issues
NEUROLOGICAL ISSUES

53
Q

Paediatric Speech Delay

A

Ask About:

Senses- Hearing, Speech
Communication- Non-verbal Communication, Comprehension, Social Responses (how does he act in new situations)

54
Q

Paediatric Issues with Puberty/ Amenorrhoea

A

Ask about Puberty signs
ICP (Headaches, Visual Changes)
Familial Puberty/ Height

Cystic Fibrosis
Thyroid Disease
Anorexia
Crohn’s

55
Q

Paediatric Behaviour Issues

A

ADHD- poor concentration/ hyperactive
Conduct- aggressive/ cruel/ hostile
Autism- Poor social interaction/ restricted interests/ repetitive behaviours/ difficulties recognising emotions

56
Q

Paediatric Allergies

A

Ask about

Triggers
What the Reaction is
ANAPHYLAXIS
Atopy history in child and family
Ask about HOME and SMOKING

57
Q

Dermatology History taking

A

PC
HPC

Derm Symptoms (Bleeding, Itchiness, Pain, Blisters, CONSTITUTIONAL and JOINT PAIN)
Systems Review (Resp, GI, Peripheral Oedema, Confusion (for Meningococcal Sepsis))

ICE

PMH (including CONTACT HISTORY and DERM HISTORY and WHAT TREATMENTS they have tried)

DH

SH (Travel History and Sun exposure)
Also remember Occupation

Jan Stuff (6 decks)

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