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Year 5 > OSCE > Flashcards

OSCE Flashcards

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1
Q

Management of different intracranial haematomas/haemorraghe

A

Subdural
Medical
- ABCDE
- Analgesia and anti-emetics
- Anticonvulsants
- Refer to neurosurg

Surgical
- Burr hole

Extradural
- same as above but with mannitol to reduce ICP

Subarachnoid
- Nimodipine - reduce vasospasm
- Endovascular coiling

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2
Q

How to calculate HR in ECG

A

300/no. of big boxes between QRS
OR
no. of QRS in 30 big boxes x10

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3
Q

MI management

Including longer term plans

A

MMONA+T
Morphine
Metoclopramide
Oxygen (<94%)
Nitrates
Aspirin 300mg
Ticagrelor

<2hrs = PCI
>2hrs = thrombolyse

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4
Q

Causes of APH

A

<20wks - miscarriage
Os open = Incomplete or inevitable
Os closed = missed or complete or threatened

^TVUSS only way to truly know

> 20wks
- dark red -> woody and hard uterus and PAINFUL = placental abruption
- dark red -> not painful and ruptured mebranes = vasa praevia

  • bright red + not painful -> TVUS -> placental praevia or cervical ectropion
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5
Q

Where for pneumothorax management?

A

Wide bore cannula into 2nd intercostal space

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6
Q

Management of perforation

A

Conservative
- ABCDE
- Monitor fluid balance - catheter
- urgent referral
- nil-by-mouth

Medical
- IV PPI, fluids, ABx, anti-emetics, analgesia

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7
Q

Convert oral morphine 10mg into the following:
- oral codiene
- s/c morphine
- oral oxy
- IV/IM oxy

A
  1. 100mg (x10)
  2. 5mg (/2)
  3. 5mg (/2)
  4. 2.5mg (/4)
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8
Q

When is a seizure termed status epipletcus?

A

After 5mins

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9
Q

CURB-65 scoring
When to move to hospital

A

Confusion
Urea >7
R >30
B </= 90/ </=60
65

0-2 = mild/mod - should be ok in community
3-5 = need hospital and IV Abx

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10
Q

What scoring systems are used in upper GI bleeds

A

Glasgow-Blatchford
Rockall

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11
Q

How to manage upper GI bleed

A

Conservative
- ABCDE
- urgent senior advice

Medical
- IV abx
- IV fluid/blood
- Terlipressin

Surgical
- urgent surgical intervention

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12
Q

URINE SYMPTOMS INVX

A

Urine sample!!!
MSSU in men

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13
Q

Why important to check coag with obestretic emergencies?

A

For DIC - medical emergency
look for massively deranged coag.

  1. treat underlying
  2. replace clotting factors with plasma and platelet infusion
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14
Q

What is an isolated urea a sign of?

A

GI haemorraghe

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15
Q

What else can cause hyperthryroidism apart from Graves

A

Toxic multinodular goitre
Iodine excess
Amiodarone/levothyroxine
Viral infection
Postpartum thyrotoxicosis

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16
Q

Symptoms of hyper vs hypo thyroid

A

Hyper
- Intolerance to heat
- Loads of energy/irritable
- Increased appeite
- Palpiatations
- Weight loss
- Diarrhoea
- Oligomenorrhoea
- Weakness

Hypo
- Intolerance to cold
- Hair loss
- Low mood
- Weight gain
- Constipation
- Heavy periods
- Menorrhoeia

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17
Q

Management of hyperthyroidism

A

Beta-blocker
Carbimazole + contraception + warn about mouth ulcers (risk of agranulocytosis)

Surgery
- radioactive iodine
- surgeryW

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18
Q

What is used to assess the severity of acute pancreatitis?

A

Glasgow-Imrie score (PANCREAS)

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19
Q

How to address simple acute cholecystitis?

Study These Flashcards
A

Invx
Bedside
- Abdo exam
- Vitals

Bloods
- Baseline defos LFTs

Imaging
- USS abdo

Manage
Conservative
- reassess
- refer to surgical team

Medical
- IV fluids, analgesia and antiemetics
- IV abx

Surgical
- consider cholecystectomy

20
Q

Causes of macrocytic/microcytic/normocytic anaemia

Study These Flashcards
A

Macrocytic
- B12 deficency -> perncious anaemia, Crohns, TB, gastric bypass, diet
- Folate deficency -> poor diet and alcohol excess, pregnancy
- Hypothyrodism

Microcytic = TAILS
Thaelesemias
Anaemia of chronic disease
Iron deficent anaemia
Lead poisioning
Sidroblastic anaemia

Normocytic
- Acute blood loss
- Autoimmune haemolytic
- Hereditary spherocytosis

21
Q

What is replaced first B12 or folate?

Study These Flashcards
A

B12 - prevent subacute degeneration of the cord

22
Q

Who should be contacted in case of NAI

Study These Flashcards
A

SNP
Social worker
Nurse specialist in child protection
Paeds on-call consultant

23
Q

Pre-eclampsia
- What med is used prophalytically after 12 wks?
- What are the complications?
- How are seizures managed?
- What cut-off = hospital admission?
- What drugs are used to manage HTN?

Study These Flashcards
A

Aspirin 75mg
Eclampsia, HELLP syndrome, fetal complications -> IUGR, premature, heart failure, haemorraghe
- Magnesium sulphate IV
- >160/110
- 1. labetolol 2. nifedpine (if asthmatic)

24
Q

Who shouldn’t get beta-blockers?

25
When to urgently refer to breast ca pathway?
- Unexplained breast lump >30 - Unexplained axiallary lump >30 - Unilateral nipple changes >50yo - skin changes suggestive of breast ca
26
DD for breast cancer
Fat necrosis Breast cyst Fibrocystic changes Phyllodes tumour fibroadenoma Lipoma Fill out flow diagram
27
Management for following STIs - BV - thrush - gonorrhoea - chlyamdia - trichomoniasis - syphillis
- metronidazole - clotrimazole - 1g ceftriaxone - doxycycline - 7 day - metronidazole - IM benzylpencillin (remind of flu-like symtpoms 1-2hrs post injection - reassure + paracetomol)
28
Syphillis vs LGV
Painful lymphaedonpathy = LGV Painless = syphilis
29
Urinary incontience management
Conservative (all) - Avoid caffiene/fizzy drinks/alcohol - Avoid drinking too much - Pelvic floor exercises - PT Urge M. Bladder training M. Oxybutynin, solifenacin (warn of SE - can't SEE, can't PEE, can't SHIT, can't SPIT) M. Botox injections Stress M. Duloxetine (if surgery not option) S. Mid-urethral sling (aids in the closure of the urethra by compressing it)
30
What is buerger's test?
Test for peripheral circulation - Elevate both legs at 45 degrees adn hold for 1-2mins -> pale = ischaemia
31
How can you assess peripheral artery disease as a bedside test? How to manage?
Ankle brachial index - divide BP of ankle by BP of arm <0.9 = peripheral artery disease Exercise - at least 3 months Stop smoking Lifetsyle mods Antiplatelet - aspirin/clopidogrel 75mg Atorvastatin
32
What are some causes for acanthosis nigricans?
T2DM gastric malignancy cushing's PCOS Acromegaly Etc. etc
33
What kind of staining do you get with venous ulcers? Management
Haemosiderin Wound care + compression stockings Stop smoking, improve diabetic/hypertensive control
34
What is actinic keratosis? How can it be managed?
Pre-cancerous lesions - dry, scaly patches on sun-damaged skin Can precede SCC Emollient 5-flurouracil cream - prepare for irritated, red skin (apply 1-2 times per day for 3-4 weeks - thinly JUST to the affected area)
35
Corner of mouth name? What can cause angular chelitis?
Oral commissure Lip licking Infection Nutritional deficencys IBD Coeliac Isoteritonin
36
Psoriasis management
Important that unlikley to cure - just going to manage sx and treatments take several weeks to work so don't be disheartend Conservative - leaflet from BAD - stop smoking, reduce alcohol and manage stress Medical 1. Emollients 2. Topical steroid + vit D (calcipotriol) once a day - at different times ---reassess in 4wks--- if no imporvement - continue for another 4 weeks ----reassess in 4wks----- if no improvement - continue with just vit D alone BD for 4 weeks
37
Who gets started on biphosphonates?
>75 w/ fragility fracture DEXA <-2.5 On steroids >3months
38
What bloods would you see with pt eith osteomalcia?
Low Ca and Phosphate
39
Difference between croup and bronchiolitis?
Both - Increased WOB - Low grade fever - Corozyal sx Croup - 6month - 1yr - "Barking" cough - Hoarse voice Bronchiolitis <1yr Make sure to ask about aponeas!! Invx - Croup DO NOT look in mouth - incase diptheria Management Croup - single dose dexamethasone If severe/audible stridor = admit - O2 - nebulised budesonide and adrenaline Bronchiolitis - self-resolving - Admit if <3mths/PMH inc prem, aponeas/reduced feeds - ~NG/IV fluids - saline nasal drops and suction - O2
40
How to approach DNACPR convo
1. Intro 2. Assess BG situ 3. Invite to have convo about future planning -- summarise key PMH and "important to make plans for future if get more unwell and heart and lungs stop working" 4. Introduce idea of DNACPR 5. Establish understanding of DNACPR and explain 6. Explain that not that successful in people - "it is a very invasive process and in those with lots of other medical condition the harms associated with carrying out the process are significant and the QoL afterwards would be poor" "treat person with dignity" 7. Allow to process + stress medical decision "this is not giving up - we are still continuing all other treatments" + "not a pressure and decision you need to make" 8. Allow Qs and get to repeat to make sure understand
41
Haem cancer buzzwords - auer rods - Philadelphia chromosome - reed sternberg cells - smear cells - target cells - Heinz bodies and bite cells
Auer rods - AML Philadelphia chromosome - CML Reed-sternberg - lymphoma Smear cells - CLL Target cells - thalasemias Heinz bodies and bite cells - G6PD
42
Management of following electrolyte imbalances: - Hyperkalaemia - Hypercalcaemia - Hypokalaemia
Hyperkalaemia - IV insulin and dextrose - Calcium gluconate if ECG changes - nebulised salbutamol - refer to protocol Hypercalcemia - IV fluids - IV biphosphonates Hypokalaemia - Telemetry - IV K+ (make sure to check Mg+ is ok or won't rise)
43
Signs of resp distress in children
Cyanosis Head bobbing Nasal flaring Abnormal airway noises Tracheal tug Intercostal and subcostal recessions Use of accessory muscles Raised RR
44
DDx of croup/bronchilotis
VINDICATE V I - epiglottitis, pnuemonia, tonsilitis N - D - allergic reaction I - foreign body C - larygomalacia A - T E - hayfever, foreign body
45

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