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OSCE

Consultation

Scenario Description Worsening (See GP) Red flags (111 or 999) Lifestyle
Infection Bacterial infection of area Symptoms not resolving in 2-3 days Sepsis- temp > 38, increased SOB, fever, rigors, confusion, unable to pass urine, ?Practice good hygiene
Anticoagulation Blood thinning in response to AF/DVT/PE/Valve SOB
Limb pain, swelling, reddening
Minor bleeds increased bruising
Stroke Face Arm Speech Time
Major Bleeding - urine, bowels, vomit, cough, nose not resolved in 10 mins
Head injury
Accident
Hydration
Mobility - no prolonged sitting/crossing legs
Travel advice
Healthy weight
Reduce alcohol
Stop smoking
Hypertension Raised blood pressure Headache
BP >150/95
BP > 180/120
Visual disturbance
Nausea and Vomiting
Chest pain
Stroke FAST
Reduce salt intake
Balanced low-fat diet
Exercise
Drink less EToH and Caffeine
Stop smoking
Diabetes Reduced response to insulin, so high blood sugar concentration, this can cause complications/damage to organs Tingling or numbness in limbs
Eyes blurred vision, floaters
Hypoglycaemia - drowsy, irritable
If unwell sick day rules for in event of poor eating and drinking > Gliclazide risk of Hypos/Metformin Lactic Acidosis
Hypoglycaemia - loss of conciousness, aggressive, seizures Balanced diet, less sugar, fat, salt
Regular meals - don't skip
2-3 hours of activity per week
Lose weight BMI

Respiratory Conditions

Condition Description Inspection Trachea Palpation Percussion Auscultation Tactile vocal fremitus, bronchophony, egophony and whispered pectoriloquy
Consolidation Likely infection within the lung. It is due to material, usually purulent, filling the alveoli Increased SOB and resp rate Central Decreased expansion Dull Crackles/Rhonchi Increased
Pneumothorax Air in the pleural cavity. This occurs when there is a breach of the lung surface or chest wall which allows air to enter the pleural cavity and consequently cause the lung to collapse. Increased SOB and resp rate Shifts away from affected side Decreased expansion Hyper resonant Reduced/Absent breath sounds Decreased/Absent
Pulmonary Oedema Abnormal accumulation of fluid in the extravascular compartments of the lung parenchyma Increased SOB and resp rate Central Equal expansion/may be reduced Resonant ?Fine Crackles Decreased
Acute Asthma Inflammatory disease of the airways of the lungs. Reversible airflow obstruction, and easily triggered bronchospasms Increased SOB and resp rate Central Decreased expansion symmetrically Hyper resonant Red Flag - Silent Chest
Reduced Vesicular breath sounds
Expiratory Wheeze
Decreased/Absent

Diabetes

Drug/Class C/Is/Cautions Preg Likely interactions
Metformin Acute metabolic acidosis No issues
Gliclazide Ketoacidosis
Risk of Hypos
Risk of neonatal hypos
Sitagliptin Ketoacidosis Avoid
Pioglitazone Bladder Cancer
Heart failure
Macroscopic Haematuria
Avoid

Hypertension

Drug/Class C/Is Preg Likely interactions
ACEi/ARBS
Ramipril
Age
Afro-caribbean
Angioedema
Avoid unless essential
Calcium channel blocker
Amlodipine
Unstable angina
Aortic Stenosis
Cardiogenic Shock
Manf says avoid - unless critical to managing HTN
Beta-blocker
Bisoprolol
Asthma
Peripheral Arterial Disease
Uncontrolled heart failure
AV blocks
Can cause growth restriction
Labetalol usually used
?Digoxin
Diuretic - Thiazide like
Indapamide
Addisons
?Gout
Avoid

Anticoagulation

Drug/Class C/I Preg Likely interactions
LMWH ?Needlephobia Preferred option
DOAC Pregnancy Avoid Most things
Warfarin + LMWH bridge Pregnancy No
Avoid in first and third trimesters
Might be able to manage