OSCE 2 Flashcards
(31 cards)
How is pericarditis pain improved/worsened?
Worse - lying flat
Improved - sitting forward
How to invx/manage pericarditis?
Bedside
- Cardio exam - pericardial rub, ~muffled heart sounds
- ECG - saddle ST elevation
Bloods - FBC, TROPONIN
Imaging
- Echo
- CXR
Manage
- usually viral/idiopathic
- just watch and wait - reduce exercise and NSAIDS and colchine
- admit if red flags e.g. increasing SOB, syncope, worsening pain
How to manage angina
RAMPS + AAAA
Refer to rapid access chest pain clinic
Advise/when to call 999
Med treatment - GTN + B-blocker/CCB
Procedure/surgery
Sndary prevention (AAAA)
AAAA
Aspirn 75mg
Atorvastatin 80mg
ACEi
Already on B-blocker/CCB
Changing QRS amplitudes on ECG?
Cardiac tamponade
Different heart blocks
- > 0.2s PR interval
2.1 = Increasing PR interval by drop
2.2 = Random P waves missing (needs paced)
3rd/complete = no assoc. of P waves and QRS (needs paced)
What can cause AF?
PIRATES
PE
Infection
Rheumatic heart disease
Alcohol/anaemia/age
Thyroid disease
Electrolyte abnormalities/exacerabation of CHF
Sepsis/sleep aponea/surgery
Management of renal stones
Conservative
<5mm - watch and wit
Review in ~4wks to make sure stone has passed
Medical
- Diclofenac
- IV fluids
- antiemetics
Surgical
If one of following interventional therapy needed
1. Irretractable pain despite good analgesia
2. AKI
3. Bilateral kidney obstruction
4. Infected- obstructed kidney (urgent)
Non-infected = ureteroscopy and laser stone fragmentation/ESWL
Infected = stent/nephrostomy
Causes of painful/painless red eye?
Causes of painful/painless sudden vision loss?
Painful red eye
GUTS
Glucoma
Ulcer/uveitis
Trauma
Scleritis
Painless
SEC
Subconjunctival haemorraghe
Episcleritis
Conjuntivitis
Painful sudden vision loss
Acute glucoma
Chemical/mechanical eye injuries
Painless sudden vision loss
Retinal detachement
CRAO
Vitreal haemorraghe
CRAO vs armarosis fugax
CRAO - Complete (stroke like)
Armarosis fugax - TIA like
Type of painful red eye assoc with autoimmune
Scleritis
Important things to ask in eye exams
Driving
Swelling
What med for trigeminal neuralgia?
Carbemazpine
How to approach a alcohol dependancy history?
How to manage?
- MUST PRACTICE AGAIN -
CAGE - integrate it
Cut down?
Annoyed by people criticizing?
Guilty about drinking?
Eye-opener - need 1st thing in AM to stave off hangover
Current use
- what - how much and what you drinking?
- where and when - “what does a day/week of drinking look like to you”
- who - social/alone
- Red flags for alcohol -> vomiting blood/coffee-ground like or black tarry stools
Hx of dependance
- when did you start drinking more?
- any trigger?
Previous absitence
- ever tried to stop - shaky/sweaty/mood changes
- support before?
- why unsuccessful?
Impact on life
- relationships
- work
- drive
- diet
- police
- gambling
- mood
Rest of normal hx
Manage
- Refer to drug and alcohol team and AA and social support
- advise around detoxing and that it can cause seizures so important to do this monitored
Medically
- parbinex - prevent WE
- reducing doses of chlordiazepoxide - reduce sx
- disulfiram - deterant -> makes sick
- acamprosate - AC = anti-craving
If someone presents with MSK trauma what is important to check?
5 Ps
Pallor - look more pale
Pulseless - feel for pulses and CRT
Pain - can you feel pain?
Parasthesia - feel distal to injury?
Paralysis - move distal to injury?
What invx for falls?
Bedside
- BP - standing and lying
- cardio and neuro exam
- 4AT
- vision
- CHECK MEDS
Bloods
- FBC, U+Es, LFTs, CK (if long lie)
- Inflam markers
Imaging
- ?head CT
- XR
Manage hip fracture and complications
Conservative
- MDT approach
- Rest then mobilise as soon after surgery
Medical
1. Paracetomol every 4hrs
2. Opioids and anti-emetic IV
3. Nerve block
Surgical
Intracapsular
- undisplaced - use a screw (unless unfit -> hemiarthroplasty)
- displaced -> replace (total in young and fit pts)
Extracapsular
- intertrochanteric -> dynamic hip screw
- subtrochanteric/femur -> intermedullary nail
Complications
BIP
Blood loss
Infection
Chronic pain
AVN
DVT
Non-union fracture healing
If red flags for GORD what do you urgently refer for?
DDx for GORD
2 wk urgent OGD
Gastric ulcers
Oesphageal ca
functional dyspesia
haitus hernia
How to manage GORD?
Conservative
- test for H.pylori
- weight loss, diet changes, stop smoking/vaping
- avoid late night eating
Medical
- antiacids
- PPI
- H.pylori +ve -> C/MAP 7 days BD -> re-test -> no success use C or M and AP for another 7 days BD -> no response = refer
Surgery
- anti-reflux surgery in refactory cases
Pt with difficulty swallowing both liquids and solids?
Most likely neurouscular motility -> manometry
How to explain febrile convulsions?
Gain a brief hx
- ICE
- Explain febrile convulsion
- NOT epilepsy
- it is a fit but caused by the brain when you are small not being able to manage the increase in temp
- v.common in 6mnth-5yrs - Gain info whilst explaining
- caused by fever - did he have one?
- <15mins - is that what happened?
- recover quickly <1hr - is that what happened? - Plan - monitor for next few hours in hospital
- Further plan
- 1 in 3 kids will have another episode
- stay with them, recovery position, don’t put anything in their mouth, make them comfy, and time - LONGER THAN 5 MINS = 999
- paracetomol won’t prevent but will make them more comfortable if they have a fever
- leaflets to take away with you
How to trigger the major haemorraghe protocol?
2222 - major haemorraghe - ward … - NW
33394 - blood bank - massive haemorraghe
How to tell difference between small and large bowel obstruction on AXR
Causes of both
Small
- central
- haustra whole way round
Large
- more peripheral
- no haustra
V
I
N - tumours in abdomen not necessarily bowel ca
D
I - adhesions post surgery/endometerosis
C
A - Crohns, hernia, gallstone ileus
T
E
Coffee-bean sign on AXR
Volvus
Important invx in small/large bowel obstruction etc
VBG - gives you a quick lactate
