Flashcards in OSCE Masterfile Deck (52):
General systemic enquiry
Weight loss, change in appetite, fever/night sweats, fatigue, pain
CVS systemic enquiry
Chest pain, palpitations, orthopnoea, peripheral oedema, claudication
Resp systemic enquiry
Breathlessness, wheeze, cough, hoarseness, haemoptysis
GI systemic enquiry
Dysphagia, reflux, N&V, change in bowel habit, blood/mucous in stool
GU systemic enquiry
Dysuria, frequency, urgency, nocturia, haematuria
CNS systemic enquiry
Fits/faints/falls/funny turns, numbness/tingling, weakness, headaches, visual changes
MSK systemic enquiry
Joint pain, muscle pain, swelling, stiffness, rashes
WIPE checklist before examination
Permission, Position, Pain
5 key signs of respiratory distress?
Noisy breathing (grunting, wheeze, stridor)
Accessory muscle use
Retractions (supracostal, suprasternal, intercostal, substernal, subcostal)
Body position (leaning forward, nose to air)
Head and neck in respiratory exam
Chest inspection in respiratory exam
Chest palpation in respiratory exam
Chest percussion and auscultation in respiratory exam
To complete a respiratory exam
The 3 key stages of describing breath sounds
What are the 5 key added sounds in respiratory examination?
Crackles, wheeze, rhonci, pleural rub, stridor
ENT systemic enquiry
Hearing loss, tinnitus, runny nose/bleeding, pain, voice changes
Periods, PV bleeding, PV discharge, Pain, Pregnancy
Repeat x3 (document highest)
Plot (age/height graph or previous best)
Repeat after 1 min
Normal ABG values?
pH 7.35 - 7.45
PaO2 11-13 (FiO2 - 10)
BE -2 - +2
Flow rate and FiO2 in nasal cannulae?
Flow rate and FiO2 in hudson mask/simple face mask?
Flow rate and FiO2 in non rebreather mask?
up to 15l/min
Flow rate and FiO2 in venturi mask?
Blue 2l/min 24%
White 4l/min 28%
Yellow 8l/min 35%
Red 10l/min 40%
Green 15/min 60%
Step by step guide of reading ABGs?
Oxygenation - is the patient hypoxic (PaO2 <10 hypoxemia, <8 severe hypoxemia (look at PaCO2 to determine type of respiratory failure)
Look at pH
Determine driving factor (ROME)
What are the two types of respiratory failure?
Type 1: PaO2 <8, PaCO2 <6
Type 2: PaO2 <8, PaCO2 >6 (hypercapnia)
What does BE indicate?
Amount of H+ ions needed to return pH of the blood to normal
What does a BE >+2 indicate?
Higher than normal HCO3- (metabolic acidosis or compensating respiratory alkalosis)
What does a BE of
Lower than normal HCO3- (metabolic alkalosis or compensating respiratory acidosis)
Spirometry results in obstructive and restrictive disease?
O: FEV1 <80%, FVC N/<80%, FEV1/FVC <0.7
R: FEV1 <80%, FVC <80%, FEV1/FVC N or >0.7
5 features of lipatodermatosclerosis?
Erythema, swelling, induration, hyperpigmentation, inverted champagne bottle
Arterial ulcer vs venous ulcer?
Arterial: Deep, small, punched out, well defined, pain
Venous: Irregular border, sloping edges, shallow, mild pain, larger
Where do you auscultate for each of the heart valves?
Bicuspid/mitral (5th ICS mid clavic)
Tricuspid (4th ICS LSE)
Pulmonary (2nd ICS LSE)
Aortic (2nd ICS RSE)
What makes S1 and S2?
S1 (lub): closure of the AV valves
S2 (dub): closure of the aortic and pulmonary valves
Systole between S1 and S2
Diastole between S2 and S1
What causes an S3 and who classically has it?
Rapid filling of the ventricles with large volumes (ventricullar gallop)
Kids and athletes
What causes and S4 and who classically has it?
Atrium contracting at the end of diastole forcing into high volumes (atrial gallop)
Risk of stroke in patients with AF
CHD, HF, Age >75 (2), Diabetes, Stroke (2), Vascular disease, Age 65-75, Sex (female)
0: no treatment
1: anticoagulate if male
>2: anticoagulate (warfarin, NOACS)
Warfarin INR target?
(vitamin K antagonist decreasing activation of clotting factors: 2, 7, 9, 10)
What are 2 common NOACs and MOA?
Dabigatron (direct thrombin inhibitor)
Rivaroxiban, apixapan (factor Xa inhibitor)
Wash hand, intros, explanation (inserting a flexible tube into the penis to reach the bladder, it may be painful but I will use some local anaesthetic to try and make you as comfortable as possible), consent, double check understanding, chaperone present
Equipment ready, double glove, apron, drape and pad patient, retract foreskin, wash area pushing away from meatus, inject LA/instagel (10mls male, 5mls female) double check no allergies, wait for 5 minutes, take off top gloves, insert catheter, inject 10mls to inflate balloon, retract to ensure in place, attach bag and place below patient.
NG tube insertion?
Wash hands, intro, explanation (insertion of a thin tube in your nose down to your stomach, may be a bit uncomfortable, allows us to take fluid out or put in nutrients), consent
Equipment ready, apron/gloves, measure ng tube size (nose to ear to 5cm below xyphisternum), more patent nostril, lubricate and insert, remind patient if it gets to painful to tap on your arm, take small sips of water and swallow as advancing tube. Aspirate for pH (<5.5), dont use until XRay confirmation (pass carina)
Setting and intro
Perception (what patient knows so far, what they know about investigation)
Invitation (how much does patient want to know, would they like a family member present)
Knowledge (give info) I'm afraid its not the results we were hoping for. pause. I'm afraid its cancer.
Summary, support, strategy
Decision should be discussed with patient and relatives but ultimately lies with medical team acting on best interest of the patient
Should discuss all decisions with patients and families asap
'have you thought about the future or resus options'
'providing all possible treatments to keep you comfortable and improve your condition' 'one of the things we're trying to avoid is causing you harm' 'one of the things that may cause harm would be trying to aggressively restart the heart if it stopped' 'we will continue to give you other treatments' 'this does not mean that care is being withdrawn'
4 stages of capacity?
10 features of lump assessment?
Site, size, shape
Colour, contour, consistency
Temperature, tenderness, tethering
Hallmarks of delirium?
Acute and fluctuating
Inattention or cognitive impairment
Disorganised thinking or altered level of consciousness
Management of acute distress in delirium?
Lorezapam if LB dementia/PD or alcohol withdrawal
Hallmarks of psychosis?
Delusions and hallucinations