OSCE clin skills Flashcards

Question

What does a physio do

Answer 1

Make sure muscles are strong allowing you to carry on normal daily life- for example getting from bed to chair. We dont want you to be falling again so theyre going to make sure your legs have good balance and can support you

Answer 2

Whos at home with you Do you have any neighbours, children and friends who can help you Do you live in a flat Are there any stairs/ is there a lift What does a normal day look like What are some things you like to do in a day

Answer 3

They increase insulin production

Answer 4

Wee out more glucose

Answer 5

It helps activate insulin and makes sure more of it acts as that door

Answer 6

``` BUCES Brief history Understanding of patient Concerns Explanation Summarise ```

Answer 7

``` Normally we can probably manage Normal physiology What disease is Causes Problems of it Management ```

Answer 8

``` Whats brought you in today? Have you had any symptoms? Feeling thirsty? Weeing out more water than usual? Tired? Infections of your genitals? Past medical history? What is your diet like? What is your daily activity like? What job do you do? ```

Answer 9

From what youve been told so far/What do you know about X?

Answer 10

So normally when we eat our body breaks it down into sugar and this enters the blood to go around the body for cells to use it as energy. However sugar cant just enter cells it needs a gateway into them so when we eat we also produce a hormone called insulin that goes into blood that acts as a door allowing the sugar into cells In type 2 diabetes that you have some of the insulin doesnt work so not all glucose can get into cells meaning that it builds up and damages some of our blood vessels Just to check that you understand would you be able to just run me through what you understand so far? In terms of what causes it, its often a mix of both sometimes people are born with faulty insulin so and as they get older waht they eat that contain lots of sugar it causes this insulin to be faulty and the cells dont respond Do you have any questions at this point So with diabetes it can lead to everyday symptoms such as feeling tired, going to toilet more or can often get infections on your penis which can be uncomfortable but the main problem with diabetes is that silently when youre totally unaware of it your all this sugar is damaging certain parts of your body and what that leads to In your eyes can lead to vision loss In your nerves can lead to not be able to feeling your hands and feet In your kidney causing kidney failure In your brain increasing risk of stroke In your heart leading to heart attacks So im sure at this point thats all sounding very scary but this can be managed and even in the early stages can be reversed through a variety of lifestyle modifications and medicines

Answer 11

Good afternoon my names owen vineall etc Can i just confirm your name and DOB please Ive been asked by the doctor today to come and explain to you how to take whats called a mid stream urine sample is that ok with you? Have you ever had this before? From what youve been told so far what do you uderstand about this procedure? Ok so what were doing is taking a sample of your urine and then its gonna go off to the lab who are going to look for an signs of infection and then youll get the results back in a few days the doctor will call you So whats important about this sample is that we dont get it contaminated with any of the germs on your skin so waht you do is so you take this cup to the toilet with you and before you start weeing take the cap off having it ready at the side taking special care to make sure you dont touch the inside of the lid and cup. So you start weeing with the cup in your hand or on the side then after a bit of weeing put the cup in front of your stream to catch some of it and before you finish weeing put the bottle on the side and finsh your wee then when youre done flush wash your hands and put the cap back on the cup making special care again not to touch inside of lid and cap. then its gonna go off to the lab who are going to look for an signs of infection and then youll get the results back in a few days the doctor will call you

Answer 12

Brief history for AF Have you ever had it before? SOB, chest pain, palpitations, fainting- when started Heart problems in the past Any illness in the past Any medications What lifestyle like active? Do you understand ICE Explain about irregular rythm, blood pools can form clumps of cells that cause stroke, fast want to reduce work on heart, rythm return will increqse CO helping activity Management start anticoagulation, depends on factors if start rate or rythm management

Answer 13

Symptoms at night Using reliever inhaler more than 3 times a week Symptoms interfering with daily activities Number of hospitilisations

Answer 14

Introduce self- explain why here How are you feeling- any chest pain or SOB What inhalers? Ask about understanding of inhalers Explain what inhalers are for Go through parts of inhaler with patient and check expiration date Explain procedure by demonstrating Mention washing out mouth if steroids Explain some potential side effects - salbutamol heart racing and tremor - steroids can get sore mouth so wash mouth Safety net about when to use in an excacerbation and if doesn't work after 10 call 999 Check if have any concerns Any questions?

Answer 15

Clean- clear from any marks and stains Aseptic- clear from any pathogens Sterile- free of all microorganisms

Answer 16

Burns area Limb damaged by stroke, hemiplegic Sited for surgical procedure Suspected fracture

Answer 17

Diagnostic levels Monitor drugs Sample for group and save Monitor treatment

Answer 18

FBC ESR Blood film Hba1c

Answer 19

INR Clotting D-dimer

Answer 20

``` U&Es LFTs Calcium Lipids Troponin TFTs Phosphate Magnesium ```

Answer 21

Glucose | Lactate

Answer 22

``` Systemic infection Syncope Allergic reaction Haematoma Air embolism ```

Answer 23

Introduce self Been asked by the doctor take your blood today is that ok? Ok great so this is to look at the levels of x which will help doctor have more of an idea of whats going on, this will involve just putting a small needle into your arm does that sound ok? Have you had your blood taken before? How are you with needles? Are you in any pain at the moment? Any recent surgeries? Any allergies? Any medications? Ok so im going to go and get my equipment ready I will see you in a minute Needle Cap Gauze Alcohol wiples gloves Blood bottles Tape Tourniquet REMEMBER TO HAVE GAUZE READY Ok so thats all done how was that? So try and keep that on for 30 mins and avoid any heavy lifting Some things to look out for around this site and redness and if it becomes hot so if that does happen seek medical assistance as soon as possible So now im going to write this all up it will go off to lab and the doctor will contact you with the results Thank you for your time today

Answer 24

``` Have you had your blood taken before? How are you with needles? Are you in any pain at the moment? Any allergies? Any medications? ```

Answer 25

Sodium fluoride

Answer 26

Purple- FBC etc

Answer 27

Sodium citrate

Answer 28

After collecting all equipment and returning to patient

Answer 29

If its hard as suggest phlebitis

Answer 30

Withdraw needle a little bit when have advanced tube a little bit

Answer 31

``` Introduce self Im just going to be putting a small plastic tube into your arm to deliver some fluids is that ok with you Have you had your blood taken before? How are you with needles? Are you in any pain at the moment? Any recent surgeries? Any allergies? Any medications? PREPARE AND DO PROCEDURE Ok so thats all done someone will come and change it in 2 days but if you think the site gets very hot, red and painful let a member of staff know and theyll come and change it Do you have any questions for me? ```

Answer 32

Introduce self Today ive been asked to come and stitch up your wound to close it and hopefully relieve some pain does that sound OK? Identity This will just involve me using a small needle to put some stitches in does that sound alright? How did the cut happen? Has someone been along to put some anaesthetic in? Do you have any allergies? Have you had your tetanus jab? Are you on any medication? DO PROCEDURE Ok so thats all done how was that? Ok so in terms of managing the wound now make sure you look out for any redness and discharge if this does happen go to one of our walk in clinics Try and keep it nice and dry so avoid swimming and when youre in the shower hold it away from water You can get your stitches removed in around x days if ask GP Any questions?

Answer 33

Must get booster

Answer 34

- Stitches inserted on the head can be removed in about 5 days. This is due to the good blood supply to this region of the body. - Stitches over joints must be present for 10-14 days. This is because these areas are usually under a lot of stress due to the continuous movements which stretch the skin. - Stitches on other body parts can be removed in in 7-10 days

Answer 35

``` Identity etc Time Reason Batch Size Site Number of attempts ```

Answer 36

Sitting at 45 degrees legs supported

Answer 37

V1- 4th intercostal space right sternal border V2- 4th intercostal space left sternal border V3- halfway between V2 and 4 V4- 5th ICS MCL V5- halfway between V4 and 6 V6- MAL horizontal to V4

Answer 38

Red- right arm Yellow- left arm Green- left foot Black- right foot

Answer 39

25mm/second | 10mm/mv sensitivity

Answer 40

Clean with paper Towel If required use alcohol wipes If hairy shave after gaining consent from patient

Answer 41

green or blue

Answer 42

For insulin in must be at 90 | Normal is at 45

Answer 43

Pull skin taut with thumb and forefiner of free hand

Answer 44

Get the signature of a supervisor

Answer 45

Big purple ones as have glass filters these will have big red sheath

Answer 46

Clean the top of it

Answer 47

Don’t have to depends on guidelines but in OSCE safe to do it

Answer 48

Gluteus maximus or shoulder

Answer 49

Intra dermal

Answer 50

Done intradermally | Go around the site in multiple areas pulling out whilst injecting- called continuous technique

Answer 51

Introduce self can i just check your name and DOB ive been asked today to come and set up a drip for you is that ok this will just involve me hooking up some fluids to your cannula there which will..... How are you doing today are you in any pain? Do you have any allergies examiner will act as my chaperone Check cannula site, for example date of cannula and VIP score Collect equipment and prescribing chart- note prescription and see if matches up to bag you have Remove fluid bag and check expiration date, drip factor and if any punctures etc Place fluid bag on side Remove infusion bag port and ensure roller clamp closed Remove cap from spike and infusion bag Insert into bag and hang up Open roller clamp ensuring fluid into collection chamber at least half full or up to drawing line while squeezing in Open end and see if fluid coming out then close roller clamp Now check cannula so clean it and flush to check primed Insert into octopus port Adjust drip rate to prescription- check correct with examiner Thank patient and let them know to let medical team if start feeling unwell

Answer 52

•Date and time,•Patient name, hospital no.•Your name and grade•Chaperone name and grade•Prescription/name of fluid•Batch number•Fluid checked against prescription, for expiry, leakages, clarity of solution. All clear.•Attached to cannula in [location] which was deemed appropriate. •Cannula to be changed on:•Time started, time to finish•Volume•Duration of infusion•Drip rate•Sign and print name•Chaperone sign and print name•Complete fluid balance char

Answer 53

Allergies | About cannula

Answer 54

``` Right time Right patient Right drug Right dose Right route ```

Answer 55

Work out ml/min then multiply by drop factor

Answer 56

Avoids abscesses and lipid hypertrophy

Answer 57

10-30 seconds

Answer 58

Introduce self State purpose and consent Gather equipment Draw up drug using filterless blunt needle for rubber bungs and filtered one for glass bottles CLEAN BUNG Take off drawing up needle and dispose of it Put on correct needle and administer When taking out the needle apply pressure Tell them what to look out for- red and discharge seek medical attention

Answer 59

``` Lateral part of arms Sides of back Anterior tummy area Thighs anteriorly Lower loins ```

Answer 60

Deltoid Ventrogluteal Dorsogluteal

Answer 61

``` Rotation- equidistant clavicle from spinous processes Inspiration- 6 ribs anteriorly and 10 posteriorly Penetrated- can you see spinous process behind cardiac shadow Exposure Airway - trachea central - bronchi changes (diversion mainly) Breathing - work from apices to base - opacity - lung volume Cardiac - cardiomegaly - aortic knuckle - mediastinal shift Diaphragm - flat? - air - costophrenic angles visible Everything else - bones - soft tissue such as breast - surgical emphysema - any tubes etc ```

Answer 62

Introduce self Ive been asked today to come and examine your eyes today does that sound ok Thats gonna involve me having a look in your eyes through this fundoscope which has a light and a window for me to look through. Im also going to have to dim the lights a bit to help me see better is that ok Can i ask do you use glasses or contacts Say to examiner id ideally use tropicamide eye drops to dilate the eyes Start by inspecting the eyes without fundoscope Do red reflex by asking patient to look into distance at a point I'm gonna put my hand on your shoulder to make sure we dont bump into eachother Examine right eye first using right hand for fundoscope and put other hand on shoulder Zoom in to a very high plus Start off looking at a vessel then follow up to optic disc Examine the rest of vessels coming off the optic disc Move on to examine macula Clean hands and thank patient Present to doctor

Answer 63

The colour, size and margins

Answer 64

Well defined margins yellow in appearance with paler center

Answer 65

Optic disc

Answer 66

Start on your prescription- ie -3

Answer 67

Turn part at bridge between grey and black part

Answer 68

Long sightedness

Answer 69

Short sightedness

Answer 70

Remove tourniquet | Get gauze ready

Answer 71

``` Warfarin bracelets Medications- diabetes eg Defib pads GTN spray Oxygen masks ```

Answer 72

Splinter haemorrhages Janeway lesions Clubbing Osler nodes

Answer 73

Non-painful flat lesions

Answer 74

Septic micro emboli

Answer 75

Drum sticking of fingers- thing phalangeals Curvature of nailbed Loss of angle between nail beds- luverbonds

Answer 76

``` Infective endocarditis Atrial myxoma Malignancy Congenital cyanotic heart disease Teratology of fallot ```

Answer 77

Painful raised nodes

Answer 78

Immunological reaction

Answer 79

Septic emboli

Answer 80

High cholesterolaemia

Answer 81

In CO2 retention is symmetrical | In asterixis is asymmetrical flapping

Answer 82

Can be related to difference with breathing

Answer 83

VSD | Persistent ductus arteriosus

Answer 84

Waterhammer pulse | Collpasing pusle

Answer 85

Feel the pulse properly bounding- dont have to just feel the pulse put hand around it

Answer 86

Difference in pulse strength depending on inspiration vs expiration

Answer 87

Pericardial effusion Constrictive pericarditis Anything affecting hearts ability to contract

Answer 88

In expiration as in inspiration when you reduce thoracic pressure more blood flows into right side of heart putting pressure on left ventricle which reduces its CO

Answer 89

``` Anything causing LVD Aortic stenosis Hypertension Dilated cardiomyopathy IHD ```

Answer 90

``` Malar flush Corneal arcus Xanthelasma Conjunctival pallor Central cyanosis High arch palate ```

Answer 91

Malar flush in mitral stenosis | Malar rash in SLE

Answer 92

Downs syndrome Ehlers Danlos Downs syndrome

Answer 93

Raised above 4cm

Answer 94

``` Fluid overload RHF Tamponade Constrictive pericarditis Tricuspid regurg ```

Answer 95

Should fall

Answer 96

Metabolic acidosis not just DKA

Answer 97

Cardiac tamponade Constrictive pericarditis Restrictive cardiomyopathy

Answer 98

JVP double wave form | Carotid single

Answer 99

A wave then followed by little c waves and finally second V wave

Answer 100

Atrial contractoin

Answer 101

Tricsupid bulge from ventricular constriction

Answer 102

Passive atrial filling

Answer 103

3rd degree HB

Answer 104

Tricuspid regurg

Answer 105

Tricuspid stenosis

Answer 106

Descent of V wave

Answer 107

SVC syndrome

Answer 108

Either on the front or back | Will be curve shaped

Answer 109

For example left anterior thoracotomy | Posterolateral

Answer 110

Lung transplant

Answer 111

Left subclavicular

Answer 112

``` Midline sternotomy Left/right anterior thoracotomy Lateral posterior thoracotomy Clam shell scar Left subclavicular ```

Answer 113

CABG | Valve replacements

Answer 114

Pacemakers Scars Chest deformities Angiomas

Answer 115

Joints just under fingers

Answer 116

Bottom of hands and so when feeling for heave make sure use that part of the hand

Answer 117

Right ventricle

Answer 118

4th ICS left sternal edge

Answer 119

Right ventricle hypertophy

Answer 120

Go over all locations using bottom of fingers

Answer 121

Mitral valve closure

Answer 122

Aortic valve closure

Answer 123

Turbulent ventricular filling

Answer 124

atria contracting against stiff ventricles

Answer 125

S3 is early diastole whereas S4 is late diastole

Answer 126

Stenosis radiates to carotids

Answer 127

Thickening of aortic valve

Answer 128

Crescendo decrescendo murmur heard best at 2nd ICS left sternal edge Radiates to carotid Louder on expiration

Answer 129

Decrescendo diastolic murmur heard best with patient leaning forward on expiration

Answer 130

Mid diastolic murmur Loud S1 Cresecendo decrescendo Heard best on expiration

Answer 131

Rheumatic fever Calcium deposits Congenital defect

Answer 132

IE Rheumatic fever MI Mitral valve prolapse

Answer 133

CAGB | Swelling

Answer 134

Today i performed a cardiovascular examination on a 22yo male On general inspection he was breathing comfortably on room air and was no medical paraphenalia around the bed indicative of cardiovascular disease There was no stigmata of cardiovascular disease in the hands or face and his HR was x RR was X BP X all within normal range His JVP was not riased and general inspection of the chest was ubremarkable The apex beat was palpated in the 5th ICS MCL with no heaves or thrills detected HS 1 and 2 were auscultated with no murmurs or added sounds The lung bases were clear and was no sacral or pedal oedema In summary this was a normal cardiovascular examination of a 22 yo male To complete my examination id like to take a full history do resp and vascular exam Do fundoscopy get a urine dip and an ECG

Answer 135

``` Inhalers Oxygen Mobility aids Extra pillows Central line How comfortably breathing the patient is Use of accessory muscles Cigarettes ```

Answer 136

``` Clubbing Tar stains Peripheral cyanosis Erythema Cap refill ```

Answer 137

3-5 seconds

Answer 138

Less than 2 seconds

Answer 139

``` Conjunctival pallor Miosis Anydrosis Ptosis Oral candidiasis Hydration status Central cyanosis ```

Answer 140

Cricosternal distacne

Answer 141

Over 3 fingers

Answer 142

Hyperinflated chest in COPD

Answer 143

Under 3 fingers

Answer 144

Chest wall defromities Scars Asymmetrical chest expansion Intercostal muscle use

Answer 145

Barrel chest Pectus excavatum Pectus carinatum

Answer 146

Marfans Rickets Scoliosis

Answer 147

Margans | Ehlers danlos

Answer 148

Do medially either side of spine- remember not to laterlally!!

Answer 149

COPD Asthma Bronchiecrasis

Answer 150

Subglottic stenosis

Answer 151

Pneumonia Pulmanonary infarct Mesothelioma

Answer 152

Throughout systole and diastole

Answer 153

Primary Massive PE Chronic lung disease

Answer 154

Today i performed a resp exam on x On general inspection there were no medical paraphenelia seen around the bed and the patient was breathing comfortably on room air There were no stigmata of respiratory disease noted on the face or hands and his pulse and RR was xxxx His JVP wasnt raised, trachea central chest expansion was full and symmetrical his apex beat was palpated in the 5th ICS MCL The chest was resonant on percussion and on auscultation there was good air entry bilaterally with vesicular breath sounds heard everwhere There was no evidence of pedal or sacral oedema In conclusion this was a normal examination To complete my examination id like to take a full history take his obs and do a cardiovascular examination id also like to take a sputum sample and peak flow

Answer 155

``` In any pain Scars distension Stomas Hernias Jaundice Hyperpigmentation ```

Answer 156

``` Clubbing Erythema Bruising Leukonychia Koilonycia Duputyrens contracture Xanthomata Hyperpigmentation ```

Answer 157

``` Track marks Tattoos Bruising AV fistula Acanthosis nigricans ```

Answer 158

Get to look up when pulling eyelids down as better see jaundice

Answer 159

``` Xanthelasma Jaundice Conjunctival pallor Kayser fleishcer rings Corneal arcus ```

Answer 160

``` Glossitis Angular cheilitis Ulcers Odour Oral candidiasis ```

Answer 161

Wilsons- blue lunalae

Answer 162

Gynaecomastia Hair loss Spider naevi

Answer 163

``` Scars Distension Caput medusa Striae Cullens and grey turner Hernias Stomas ```

Answer 164

``` Kochers- gall bladder surgery Lanz and gridiron- appendicectomy Mercedes benz- liver transplant Midline- laparotomy Hockey stick scar (rutherford morrison)- renal transplant Pfannenstiel- gyane procedure ```

Answer 165

When letting go after palpation hurts more than palpating that area to begin with

Answer 166

Just superior to umblicus

Answer 167

Today i carried out an abdominal examination of x he seemed comfortable at rest with no medical paraphenlia around the bed On examination of the hands and face there were no peripheral stigmata of abdominal disease His pulse was x, rr x and bp x His JVP wasnt raised On palpation of the abdomen it was soft non tender with no organomegaly the abdominal aorta was pulsatile and non expansive on auscultation there were no bruits and bowel sounds were present and normal In conclusion this was a normal abdominal examination To complete my examination id like to take a full history, examine the hernial orifices and external genitalia, do a DRE and get a urine dip

Answer 168

``` Medications Walking aids Slings Feeding status Facial droop ```

Answer 169

``` Wounds Scars Wasting Fasiculations Fibrillations Dyskinesia ```

Answer 170

LMN lesion | Cerebellar lesion

Answer 171

Lead pipe and cog wheel rigidity | UMN spasticity

Answer 172

Fasiculation

Answer 173

Move with gravity eliminated- eg move from side to side on bed

Answer 174

Able to move against gravity but not with resistance

Answer 175

Able to move weakly against gravity

Answer 176

Move up the finger and determine point at which senosry loss

Answer 177

Ulcers Fasicualtions Wasting Walking aids

Answer 178

Look at ankles and see if foot follows the leg exactly or is slightly delayed

Answer 179

Go from sole to big toe

Answer 180

``` L1- top part of leg anteriorly L2- middle of thigh anteriorly L3- on top of the knee L4- anteromedial leg L5- just above 3rd toe S1- lateral part of foot ```

Answer 181

``` Drinking Smoking Drugs Living situation Job Activity level ```

Answer 182

``` DM HTN High cholesterol Fhx Diet and exercise ```

Answer 183

``` Painful to touch? Eased by GTN spray? Eased by antacids? Worse when breathe in? Worse when eat? ```

Answer 184

``` Chest pain SOB How many pillows sleeping with at night? Ever wake up gasping for air? Fainted? Palpitations? Leg swelling or pain? ```

Answer 185

``` SOB? How many pillows at night? Ever wake up gasping for air? Cough? Wheeze? Chest pain? ```

Answer 186

``` Oral ulcer Dysphagia N&V Pain on eating Any tummy pain Discolouration of skin Itching Diarrhoea Constipation Change in colour of stool Change in habit Any blood in stool Problems with the water works Going more often Change in colour ```

Answer 187

``` Full cardio Full resp Nausea Sweating Pain worse after meals Pain worse lying down ```

Answer 188

``` Any lung problems in past or currently Recent travel Recent surgery Recent illness Leg swelling ```

Answer 189

``` Fever Tired Weight loss Appetitie Wake up in morning drenched in sweat Skin changes ```

Answer 190

``` Sob at rest or on exertion? Currently how far can walk without getting SOB on flat surface Before this started same thing Worse lying down? How many pillows do you sleep with? Exposure to anything make it worse Are you more tired ```

Answer 191

Go straight to flaws

Answer 192

``` Full cardio Full resp Coughed up any sputum Weakness in limbs Eye problems Blood in stool or urine THEN FLAWS if not tired ```

Answer 193

Lung illness TB Rheumatoid

Answer 194

Allergies to everything | Vaccinations

Answer 195

Allergies | Lung problems

Answer 196

Smoking Travel Occupation Pets

Answer 197

``` When start? Is it productive? Is it always there? Any blood? Does anything trigger it youve noticed such as animals What does it sound like? ```

Answer 198

How much? What colour? Ever blood?

Answer 199

Do you have a fever?

Answer 200

Full resp Full cardio Pain on eating FLAWSS

Answer 201

Pets Job Smoking

Answer 202

Pain to touch it Painful when breathe in or cough Have had it before

Answer 203

``` How long has it been going on How many times a day do you have it Since it started has there been a change to the consistency Is it painful What colour is the stool Ever black, pale or have blood in it Does it wake you up at night Does it come on urgently Does it flush easily Do you feel like you always empty your bowels Have you started any medications recently What is your diet like ```

Answer 204

Pain | Nausea and vomiting

Answer 205

``` When did it start Is it always there Is it getting worse Where have you noticed it Noticed change to colour of stools Noticed change to colour of urine Any itching Are you feeling tired or short of breath ```

Answer 206

``` How often does it happen How long do they last Does it feel regular or irregular Do you feel lightheaded when it happens Do you get chest pain or sob Do you feel anxious when happens Are you feeling more anxious than normal recently about something thats coming up Do you drink caffeine or alcohol This is an uncomfortable question but do you take any recreational drugs ```

Answer 207

``` Onset- did it come on suddenly Character- has this changed at all radiation- to jaw Timing- is it always there, worse in am Exacerbating factors- does coughing make it worse, combing hair or eating Severity- does it affect your daily life ```

Answer 208

Anything like it in the past Have you hit your head or noticed any bruising Before it starts do you have any warning its going to happen such as seeing things Anything trigger it like chocolate, cheese Nausea Neck stiffness How are you with bright lights Runny nose FLAWSS

Answer 209

``` Any fits Fainted LOC Dizziness Problems with vision Facial droop Problems with speech or swallowing Weakness in legs or arms Tingling or numbness Incontinence of any type ```

Answer 210

``` Ulcers in mouth Dysphagia Pain on eating Any tummy pain Jaundice Itching Swelling of tummy Constipation Diarrhoea Blood in stool Problems with weeing such as blood or going more often Changes to smell ```

Answer 211

Ablation | B blockers

Answer 212

Depends on severity, only if very severe do operate | Normally lifestyle

Answer 213

Exercise Leg elevation Compression stockings Lose weight

Answer 214

Introduce self Confirm name and DOB State going to ask a few questions then examine your breast which will involve me inspecting them and then placing my hands on it to assess the tissue is that alright For the purpose of the exam you will need to take off your bra, i understand this can be uncomfortable so the examiner will act as a chaperone Are you in any pain today Also for the purposes of the examination youll be required to be sat back at 45^ Whats brought you in today QUESTIONS ELSEWHERE Ok so now I'm going to move on to examine the breast so ill pop out of the room whilst you get unchanged thank you Inspect at rest Ask to put hands on head and lean forward Ask to push hands into waist Assess in circular motion starting from nipple and feel the axillary tissue too Go back to assess lump at end Squeeze nipple Do lymph nodes by lifting up arms and you taking all the weight Thank patient and let them get dressed

Answer 215

``` When did you first notice it Is it getting bigger Is it there all the time Where exactly is it Have you tried feeling it Is it painful+ to touch Any skin changes Any nipple discharge To the best of your knowledge are you pregnant ```

Answer 216

``` SOCRATES * ask about cyclical nature Any lumps Any skin changes Any discharge from the nipple To the best of your knowledge are you pregnant ```

Answer 217

``` Pregnancy When was your last period When was your first period Have you ever had children If so did you breastfeed them FLAWS Back pain, SOB, Headaches Smoking Family history of breast problems ICE!!!!! ```

Answer 218

Valvular disease

Answer 219

Short equals WPWS Long equals HB Pericarditis if depressed

Answer 220

This CXR is not rotated, taken in inspiration, adequate exposure and well penetrated The trachea isnt deviated, the lung fields appear clear with no pleural thickening, hilar region shows no abnormalities Looking at the heart it is not enlarged and located centrally with good visualisation of the left and right heart border. The aortic knuckle is visible with no enlargement of the mediastinum Costophrenic angles are visible and the diaphragm shows no pneumoperitoneum There is no obvious bony abnormality or soft tissue lesions To summarise these are my positive findings and my differentials are

Answer 221

What the procedure is Reason for it Before during and after Risks

Answer 222

Good morning ive been asked to come and have a chat with you to explain your colonsocopy thats coming up Do you know why you're in today What brought you to go to doctor in the first place What do you understand about a colonoscopy from what you've been told so far ICE What the procedure is - it involves passing a small flexible tube through your back side which has a camera in, this camera is the best way for your doctor to see whats going on then also can take a few cells to look at under microscope Reason for it - help find the reason for whats been going on- find a source of your.... that'll best allow the doctor to manage the problem*** match to why presented What goes on before - you'll recieve a leaflet letting you know that 2/3 days before can only eat plain food - 1 day before only clear fluids and laxatives to completely clear the bowel and make the insides very clear to the doctor - NBM a few hours before What goes on on day - can someone drive you? - this can be up to you on the day they can give you painkillers, gas or a sedative to help you relax - during the procedure some air will be passed through camera which may make you feel a bit bloated or like you need to go toilet - then the procedure should last about 30 mins it can give you some tummy pains but again there are pain killers to help you relax What about after - someone will have to drive you home - avoid alcohol or machinery - follow up will be arranged Risks very small risk of perforation- 1 in 1000 Can feel uncomfortable in tummy

Answer 223

Cancer Infective Gastro Endo

Answer 224

Endocarditis TB Hepatitis

Answer 225

``` Coeliac Peptic ulcer IBD Cancer NAFLD Chronic pancreatitis ```

Answer 226

Addisons DM Hyperthyroid

Answer 227

Weight loss - how much and for how long - any changes to lifestyle which could have contributed FLAWSS, joint pain, muscle aches, weakness and how has mood been recently Anything else you've noticed, any new pains? Then questions listed elsewhere

Answer 228

``` Tummy pain Diarrhoea Change to bowel habits Change in colour of stool, blood? Change to waterworks? Going more often Blood in urine Going more often Thirsty? FULL systems review ```

Answer 229

``` Establish if actually haemoptysis When started How many times has it happened Getting worse What did you bring up- streaked on sputum or frank blood? Colour How much do you think it was ```

Answer 230

``` Haemoptysis questions Blood in urine Cough at same time? Resp and cardio systems review DVT risk factors ```

Answer 231

``` PE TB Cancer Bronchiectasis Abscess- staph aureus, klebsiella, TB COPD Recent bronchoscopy ```

Answer 232

``` SOCRATES in particular - worse at any time in day - how does exercise affect it - walking uphill easier Then ask about - stiffness - recent trauma - any other joint pain Neuro systems review FLAWSS and recent ilnesses Risk factors - immuno suppression like steroids - history of cancer ```

Answer 233

``` Spinal canal stenosis Cancer mets, meyeloma Trauma Seronegative spondyloarthropathies Abdominal aortic aneurysm CES GBS Oesteomyelitis Muscular sprain ```

Answer 234

``` How are you feeling now, did you hurt yourself when fell Did someone witness it Have you hit your head recently Before - what were you doing at time - was there any warning symptoms palpitations, weird feelings During - how long did it last - can you remember it - did you shake, tongue biting, incontinent After - how long did it take for you to return to normal - confused - arm weakness - face flushing ICE Neuro and cardio systems review FLAWSS and recent illness ```

Answer 235

Transverse myelitis Osteomyelitis Abscess Potts disease

Answer 236

Where is it Clarify if actually weakness or pain/sensory How is it affecting your life/ to what extent (depending on onset) Anything happen before it When start Getting better or worse Is it always there Is it worse at any particular point in the day/ noticed anything particular times when its worse/ anything make it worse or better Ever noticed it before

Answer 237

``` Limb weakness questions Any headache, back or neck pain Trauma SOB Diabetic Neuro system review FLAWSS and recent illness ```

Answer 238

``` Stroke/TIA SOL MS MND Todds paresis Hypoglycaemia Migraine Radiculopathy ```

Answer 239

Migraine | SOL

Answer 240

``` MS MG MND Stroke Achalasia CREST Oesophageal spasm diffuse and nutcracker ```

Answer 241

``` Pharyngeal and oesophageal cancer Plummer vinson Zenckers diverticulum Benign stricture from GORD Lung cancer GOITRE Oesophagitis ```

Answer 242

When start Is it getting worse Is it there every meal Is it painful What do you mean by difficulty swallowing is it you feel gets stuck or trouble initiating that movement Is it to both liquids and solids or just to one of them Anything make it better or worse

Answer 243

``` Bring up food or vomit Change to voice or hiccups Bad taste in mouth Neck swelling Cough Pain on eating SOB/haemoptysis ```

Answer 244

Dysphagia questions(291) Extra dysphagia questions(292) Neuro and gastro systems review FLAWSS and recent illnesses

Answer 245

``` When first happen Ever happened before How many times What colour How much Is it mixed in/streaked or on wiping Painful Is it itchy Mass in anus or skin changes Tenesmus Diarrhoea Constipation Change in bowel habits Diet? ```

Answer 246

``` PR bleeding (294) Tenesmus Diarrhoea Constipation Change to habits ABDO REVIEW FLAWSS and recent illness ```

Answer 247

``` Vascular - inferior MI - AAA Pancreas - pancreatitis - cancer Stomach - GORD/Hiatus hernia/Barretts oesophagus - ulcer/gastritis - cancer - functional dyspepsia - boerhaves Biliary - cholecystitis/cholangitis ```

Answer 248

Pain related to eating Radiate to back? Relieved by ant acids?

Answer 249

``` SOCRATES Nausea and vomiting Sweating Lightheaded Bad taste in mouth SOB Cough Abdo systems review FLAWSS- recent illness ```

Answer 250

``` SOCRATES- mainly has pain always been there Diarrhoea Constipation Blood in stool Going to wee more often than not Nausea and vomiting If woman could be pregnant Abdo review and diet FLAWSS and recent illness ```

Answer 251

``` Colorectal cancer Diverticular disease UC Gastroenteritis Pseudomembranous colitis Sigmoid volvulus ```

Answer 252

``` Mesenteric adenitis Appendicitis Crohns Caecal volvulus Caecal cancer ```

Answer 253

``` Ectopic pregnancy AAA Ovarian cyst/fibroids UTI Stone ```

Answer 254

``` What mean by constipation(less often or hard to go) How long been going on for Getting worse Always there Consistency of stool Colour Ever any blood Passed wind Painful? ```

Answer 255

``` SOCRATES questions Tummy pain Diarrhoea Nausea and vomiting Going to toilet more often (wee) Back pain Feeling cold Weakness TIngling Balance Abdo review Diet- fibre and water? FLAWSS and recent illness ```

Answer 256

Obstruction Functional Dont want to push

Answer 257

Cancer Obstruction Diverticular disease

Answer 258

Haemorrhoids Fissure Abscess Fistula

Answer 259

``` Post op Metabolic- K, Ca, Mg Hypothyroid IBS Opiods ```

Answer 260

Metformin Colchicine Thiazides Abx

Answer 261

``` SOCRATES - have you had pain in tummy before - does it hurt to move Constipation Diarrhoea Wee more often Abdo review FLAWSS and recent illness ```

Answer 262

``` Meniers BPPV Vestibular neuronitis Stroke/TIA Migraine Cerebellar MS or cancer Acoustic neuroma ```

Answer 263

``` Tell me what you mean by vertigo When start Is it always there Is it getting better Does it come on when stand up or turn head Do you feel light headed ```

Answer 264

``` FOOTH Fullness in ear Nausea and vomiting Neuro systems review FLAWSS and recent illness ```

Answer 265

``` Facial weakness Otorrhoea Otalgia Tinnitus Hearing loss Dizziness ```

Answer 266

``` TIA Uveitis Papilloedema Optic neuritis GCA Migraine Acute glaucoma ```

Answer 267

``` Both eyes? How quickly did it come on Happened before Painful Vision loss Change in appearance or discharge ```

Answer 268

Modified socrates Headache Systems review FLAWSS and recent illness

Answer 269

``` Whole abdomen or one particular point? When start, getting worse? Anything like it before? What does it feel like? Painful? To touch? Skin changes? Swelling anywhere else? ```

Answer 270

``` Whole abdomen or one particular point? When start, getting worse? Anything like it before? What does it feel like? Painful? To touch? Skin changes? Swelling anywhere else? Bruising? History of liver, kidney or heart disease Pain on eating Chest pain SOB Abdo systems review FLAWSS and recent illness ```

Answer 271

``` Variceal bleed Mallory weiss tear Cancer of oesophagus Stomach cancer Ulcer thats bleeding Gastritis Oesophagitis ```

Answer 272

Ulcer | Oesophagitis

Answer 273

Oesophagitis | Oesophageal cancer

Answer 274

``` When first happen Ever happen Before How many times happen What colour Quantify What doing at the time Change to colour of stool ```

Answer 275

``` Liver disease history Pain on eating in past Bad taste in mouth Dysphagia Do you drink Other nausea and vomiting Abdo systems review FLAWSS and bad taste in mouth ```

Answer 276

``` When start How many times Happened before Getting worse? What bringing up- digested or undigested food, green or any blood Colour How much How long after eating Worse at any point in day Headache Dizziness SOB Headache Tummy or chest pain Abdo review FLAWSS and recent illness ```