Osce Questions

Question 1

2 signs that might indicate obstructed airway?

Answer 1

OBSTRUCTED AIRWAY
Use of accessory muscles;
Paradoxical breathing (see-saw);
Silence - total obstruction;
Noises such as snoring, choking, gurgling, wheezing.

Question 2

Name 2 airway adjuncts that you could use to maintain a patient’s airway.

Answer 2

AIRWAY ADJUNCTS
Oropharyngeal such as Guedel airway;
Nasopharyngeal airway.

Question 3

Name 2 actions you can do to maintain patient’s airway.

Answer 3

MAINTAIN AIRWAY
Head tilt/chin lift.
Jaw thrust.
Insert airway adjunct.

Question 4

Why is respiration rate most important observation?

Answer 4

RESPIRATION RATE MOST IMPORTANT VITAL SIGN
First indication of deterioration. Evidence that tachypnoea (increased RR) is most significant predictor of critical illness.

Question 5

Name 2 causes of lowered respiratory rate?

Answer 5

CAUSES OF LOWERED RESPIRATORY RATE
Exhaustion following period of respiratory distress.
Opiates which can depress respiration. E.g morphine, oxycodone, alfentanil. Treat with artificial ventilation or naloxone.
Hypothyroidism - low production of thyroid hormone - controls RR, HR

Question 6

Name 2 causes of increased respiratory rate.

Answer 6

CAUSES OF INCREASED RESPIRATORY RATE
Asthma
Pneumonia
Pain or anxiety
Heart failure

Question 7

What does haemoptysis mean?

Answer 7

HAEMOPTYSIS?

Coughing up blood or blood stained sputum.

Question 8

What does pink or white frothy sputum indicate?

Answer 8

PINK OR WHITE FROTHY SPUTUM INDICATES?

Pulmonary oedema

Question 9

What is meant by purulent sputum?

Answer 9

PURULENT SPUTUM?

Often thick and sticky, yellow or green colour, contains white blood cells, dead tissue, serous fluid, mucous.

Question 10

Name accessory muscles of ventilation?

Answer 10

ACCESSORY MUSCLES OF VENTILATION?

Muscles in shoulders and neck - scalene and sternocleidomastoid muscles and internal and abdominal intercostal muscles.

Question 11

Name normal muscles of ventilation

Answer 11

NORMAL MUSCLES OF VENTILATION?

Diaphragm and intercostal muscles

Question 12

Name 3 causes that may make pulse oximetry less reliable

Answer 12

3 CAUSES OF UNRELIABLE PULSE OXIMETRY?
Patient may have poor peripheral perfusion;
Ambient light shining on sensor;
Patient may be cold or vasoconstrictor;
Carbon monoxide which binds to haemoglobin and gives false readings.

Question 13

Name 2 causes of tachycardia.

Answer 13

CAUSES OF TACHYCARDIA?
Heart related condition such as hypertension.
Exercise.
Poor blood supply to heart muscle due to heart failure or atherosclerosis.
Emotional stress or drinking large amounts of caffeine or alcohol.

Question 14

Name 2 causes of bradycardia.

Answer 14

CAUSES OF BRADYCARDIA?
Medication to treat heart problems like beta blockers e.g. Bisoprolol, labetalol, atenolol.
Electrolyte imbalance such as hyperkalaemia (too much potassium).
Disease damaging heart’s electrical system, e.g. MI or coronary artery disease.
Also athletes or the very fit.

Question 15

2 conditions that might cause heart to be weak and thready.

Answer 15

CAUSE HR TO BE WEAK AND THREADY?
Cardiogenic shock - when heart can’t pump as much blood as body needs;
DKA - diabetic ketoacidosis.
Hyperkalaemia - high potassium in blood.
Hypovolaemic shock - when blood volume isn’t enough.

Question 16

What is normal capillary refill time and identify one thing that may cause it to be prolonged.

Answer 16

CAPILLARY REFILL TIME? WHY PROLONGED?
Usually 2 seconds.
Cause of delay - poor perfusion, dehydration.

Question 17

What is the Portsmouth sign and when might it be present?

Answer 17

PORTSMOUTH SIGN? WHEN PRESENT?

When patients systolic is lower than heart rate. Usually indicates onset of shock.

Question 18

Name 3 causes of hypotension

Answer 18

CAUSES OF HYPOTENSION?
Loss of blood.
Sepsis.
Severe dehydration.
Anaphylactic shock

Question 19

Name 3 signs of dehydration

Answer 19

SIGNS OF DETERIORATION?
Increased thirst.
Dry mouth, eyes and mucous membranes.
Decreased urine output, and dark in colour as concentrated.
Headache.

Question 20

Name 3 signs of fluid overload.

Answer 20

SIGNS OF FLUID OVERLOAD?
Oedema in hands, arms and feet, legs.
Coughing and difficulty breathing.
Sudden weight gain.

Question 21

Name 2 of red flag sepsis signs.

Answer 21

RED FLAG SEPSIS SIGNS?
Heart rate over 130 bpm.
Respiratory rate over 25.
Oxygen saturations less than 91%.
Systolic BP less than 90.

Question 22

What does acronym AVPU stand for?

Answer 22

WHAT DOES AVPU STAND FOR?
Alert
Responds to voice, pain and unresponsive

Question 23

What 3 components make up the GCS?

Answer 23

GCS COMPONENTS?

Eye response, verbal response, motor response.

Question 24

Name 2 reasons why you need to record GCS rather than AVPU.

Answer 24

WHY RECORD GCS RATHER THAN AVPU?
Assess level of consciousness after head injury.
If patient response is VPU then need to do more in depth assessment using GCS.
Gives a baseline in cases of neurological injury.

Question 25

Name 2 causes of changes in level of consciousness.

Answer 25

``` CAUSES OF CHANGES IN LEVEL OF CONSCIOUSNESS? Head injury. Seizures. Hypoglycaemia. Hypotension. ```

Question 26

Name 2 causes that might make pupils appear bigger than usual.

Answer 26

CAUSES OF DILATED PUPILS? Multiple sclerosis. Eye injury damaging nerves to iris or pupil. Recreational drug use - cocaine, LSD, ecstasy. Brain injury in mid brain area where nerves responsible for pupil size are. E.g. Tumour or stroke.

Question 27

Name 2 causes that could cause low blood glucose.

Answer 27

CAUSES OF LOW BLOOD GLUCOSE? Taking too much insulin for needs. Skipping meals or eating less than normal with same diabetic medication such as insulin. Exercising more than normal. Alcohol abuse - liver can stop releasing glucose into bloodstream.

Question 28

Name 2 causes of high blood glucose.

Answer 28

``` CAUSES OF HIGH BLOOD GLUCOSE? Missing insulin dose if diabetic. Dehydration. Pancreatic cancer or pancreatitis. Hyperthyroidism. ```

Question 29

Name 3 checks you would make when you assess pain?

Answer 29

NAME CHECKS TO ASSESS PAIN? Ask when the pain started and how long they've had it? Ask where it's located and does radiate? Ask about intensity, using Use a 1-3 or 1-10 pain scale so patient can self report. Ask does anything make it better or worse. Ask if it causes any other symptoms. Observational checks if person can't report pain - facial expressions, guarding, restlessness, groaning, restlessness, grimacing.

Question 30

Name 3 checks you make when you expose a patient.

Answer 30

CHECKS TO MAKE WHEN EXPOSING PATIENT? Check for bleeding and check any drains. Check limbs for signs of VTE - one limb is red, swollen, tender, hot. Check for any signs of infection such as infected wounds or cellulitis. Check for fluid overload - oedema in peripheries.