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Flashcards in CMS OSCE Deck (33):
1

what sections of the trigeminal nerve can be tested?

corneal
facial
motor
jaw jerk

2

how to test the corneal aspect of the trigeminal nerve?

look up/away
tough wool on each side of cornea
look for blink

3

how to test the facial aspect of trigeminal nerve?

sharp object at forehead/cheek/jaw
repeat with a dull instrument
if anything is abnormal try with temperature or light touch

4

how to test the facial nerve?

look for droop and asymmetry
wrinkle face - feel strength by pushing down
shut eyes tight - bilateral?
grin - check nasolabial grooves

5

how to test glossopharyngeal and vagus nerves?

if voice is hoarse or nasal
swallow/cough
palate - ulvuar displacement
when pt says ah - symmetrical soft palate
is gag reflex normal

6

how to test the hypoglossal nerve?

articulation of speech
tongue wasting

7

what is parkinsons disease?

degeneration of dopaminergic neurones in the basal ganglia

8

what are some signs of parkinsons?

bradykinesia = mask like face and festination
rigidity
resting tremor
shuffling gait and falls

9

what are some signs of a previous stroke?

intention tremor
hemiplegia
spasticity - because muscle stiffness

10

what is cerebellar ataxia?

loss of co ordination
cerebellar gait
intention tremor

11

what is intention tremor?

low frequency oscillation
increased amplitude of tremor as near end point of voluntary visually guided movement

12

what is resting tremor?

not associated with voluntary movement
pin rolling action of hand
seen in parkinsons

13

what is essential tremor?

voluntary contraction of muscles and no association with any neurological disorder

14

what is bradykinesea?

increased tone of basal ganglia = slowness of action
tremor

15

what is ABCDE?

airway
breathing
circulation
disability
exposure

16

what is A?

look listen feel
high flow oxygen 15litres/min
suction and airway adjuncts

17

what is B?

resp rate look listen feel
inspection of chest efficacy/effort/cyanosis
palpation - rise/fall
listen - wheeze
sats
high flow o2

18

what is C?

assess - pulses/blood pressure/peripheries colour/temp/CRT
shock - signs of shock, control any bleeding, elevate legs, keep warm

19

what is D?

disability
asses CNS
AVPU
BM level

20

what is E?

expose and undress - rashes/clinical signs
temp control measures

21

signs of anaphylaxis?

collapse
angioedema
flushing/pallor
resp distress
hypotension
tachycardia
itching

22

treatment of anaphylaxis?

ABCDE
999
15litres/min O2
500mg adrenaline IM - 5 min intervals

23

child adrenaline doses?

12 = 500mg

24

what are symptoms of severe asthma?

cant complete sentences
resp >25
pulse>110
peak flow = 33-50% expected best

25

what are the symptoms of life threatening asthma?

silent chest, feeble resp effort, cyanosis, exhaustion, hypotension
pulse

26

how to treat asthma?

ABCDE
sit up
2 puffs salbutamol 100mg per puff
additional doses through spacer if not responding

27

signs of an MI?

severe, crushing central chest pain, pallor and sweating, nausea and vomiting, breathless, weak pulse, low bp

28

how to treat cardiac emergency?

ABCDE
999
GTN 1-2 sprays
300mg oral aspirin

29

phases of a seizure?

sudden collapse and loss of consciousness
tonic phase - 30 secs. rigidity and cyanosis
clonic phase - few mins - jerking movements
post ictal confusion

30

how to treat an epileptic seizure?

ABCDE
prevent injury
oxygen 15l/min
check bp/glucose
recovery position when comes around
buccal midazolam 10mg

31

signs of hypoglycaemia?

shaking sweat palpitations
headache
speech slurring
confusion
convulsions and unconscious

32

treatment of hypoglycaemia?

ABCDE
oxygen
10-20 g glucose drink
3 x glucose tablets
1mg IM glucagon

33

what to ask an asthmatic pt in a medical history?

is it well controlled?
frequency of attacks?