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Jan Stuff > OSCE > Flashcards

OSCE Flashcards

(57 cards)

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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?

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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?

Study These Flashcards
A

Wait until their next period at the very least before removing

24
Q

When should the implantable contraceptive be inserted?

Study These Flashcards
A

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

25
What are the 2 side effects of the implantable contraceptive?
Irregular/ Heavy Bleeding- give COCP alongside to prevent this Progestogen effects- Headache Nausea Breast Pain
26
What does the implantable contraceptive interact with?
Enzyme INDUCERS so SWITCH to a method unaffected by enzyme inducers for ONE MONTH after stopping
27
What are the causes of hypoglycaemia?
Exogenous drugs (typically sulfonylureas or insulin) Pituitary insufficiency Liver failure Addison's disease Islet cell tumours (insulinomas) Non-pancreatic neoplasms
28
How long until Mirena can be relied upon as a contraceptive method?
7 days
29
What is the Acute management of heart Failure?
Oxygen and Loop ofc NITRATES (vasodilators) if AR, MR/ MI, HTN if HYPOTENSION- Inotropes (dobutamine) and Vasopressors (norepinephrine)
30
What is the chronic management of heart failure?
AB/ SS/ 3 The 3 extra managements - LEF<35- Sacubitril Valsartan - LEF<35 and HR>75- Ivabradine - Wide QRS- Cardiac Resynchronisation
31
How is Huntington's managed?
Tetrabenazine, Atypical Antipsychotics and SSRIs
32
Which arteries do LACI and PACI affecte?
LACI- Perforating PACI- Vertebrobasilar
33
A patient with a history of VTE is pregnant, what should you give them?
LMWH until 6 weeks of pregnancy
34
How is Cirrhosis Definitively Diagnosed?
LIVER BIOPSY, but transient elastography is first line
35
What is the Prophylactic and Acute management of Peritonitis?
Prophylaxis=if Neutr>250- Ciproflox and Oflox (Quinolones for the Peritonitis) Acute- CEFTRIAXONE
36
What are the main complications of Crohns?
Small bowel Cancer more common than Colon Cancer Osteoporosis
37
What are the cranial and nephrogenic causes of Diabetes Insipidus?
Cranial- Sickle Cell and Sarcoidosis Nephrogenic- Lithium, Hypercalcaemia and Hyperglycaemia
38
What is the management of DKA and HHS?
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
What is the management of Thyrotoxicosis and Myxoedema Coma
thyrotoxicosis- - IV Propanolol - NG Propylthiouracil - IV Steroids - Lugol's Iodine Myxoedema coma - IV Thyroid Replacement - IV Fluids - IV Steroids
40
What can cause Addison's?
A metastatic Melignancy
41
What are the causes of Delayed Puberty?
BRAIN (low Gonadotrophin)- - Hypothyroidism - Coeliac, CF - Pituitary Disease (and Kallman) GONADs (High Gonadotrophin) - Klinefelters (Tall) - Turners - Noonans - Prader Willi - _CAH_ and Hypogonadism
42
Management of DDH and Perthes
DDH- Pavlik if Young, Surgery if Old Perthes- Cast and Surgery if > 6yo
43
What do you look out for in NIPE in the face?
Upslanting Palpebral Fissures, flattened nasal bridge, Low set ears- Downs Syndrome Epicanthal Folds, Smooth Philtrum, Low Nasal Bridge- Foetal Alcohol Syndrome
44
Management of HIE
Oxygen Antiepileptics INOTROPES Controlled Hypothermia
45
What are the Rf for Pseudogout
haemochromatosis hyperparathyroidism low magnesium, low phosphate acromegaly, Wilson's disease
46
Psychiatric History
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
Subfertility History
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
Delirium/ Dementia
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
Paediatric Soiling/ Enuresis
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
Paediatric Low Weight
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
Paediatric Weight Gain
Input Use Output DIFFERENTIALS - Cushing's - Hypothyroidism - Prader Willi
52
Paediatric Walking/ Sitting Delay
Ask about: Mobility Hand Dominance Balance Issues Behaviour Issues NEUROLOGICAL ISSUES
53
Paediatric Speech Delay
Ask About: Senses- Hearing, Speech Communication- Non-verbal Communication, Comprehension, Social Responses (how does he act in new situations)
54
Paediatric Issues with Puberty/ Amenorrhoea
Ask about Puberty signs ICP (Headaches, Visual Changes) Familial Puberty/ Height Cystic Fibrosis Thyroid Disease Anorexia Crohn's
55
Paediatric Behaviour Issues
ADHD- poor concentration/ hyperactive Conduct- aggressive/ cruel/ hostile Autism- Poor social interaction/ restricted interests/ repetitive behaviours/ difficulties recognising emotions
56
Paediatric Allergies
Ask about Triggers What the Reaction is ANAPHYLAXIS Atopy history in child and family Ask about HOME and SMOKING
57
Dermatology History taking
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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