OSCEs

• The 5 methods of taking temperature are

  Rectal

  axillary

  tympanic

  skin

  oral
• Tympanic = preferred over 3 months. 

  Rectal = most accurate but poorly tolerated. 

  Axillary = less accurate (affected by ambient temperature), preferred under 3 months. 

  Skin = unreliable, affected by ambient temperature. 

  Oral = difficult technique, not recommended.
• Hypothermia = 35 or lower

  Normal Temperature Range = 36.5-37.5

  Fever = 38 or higher
• Factors that affect temperature change:

  Diurnal variation - lowest before waking, highest in evening

  Ovulation - can increase by 0.5C

  Drugs - illegal

  Thyroid - hypo or hyper

  Infection - causes fevers or chills

  Body habitus - obesity or anorexia
• Factors affecting Pulse Oximetry:

  Nail polish - paint

  Skin colour - make it a race thing

  Incorrect use - stupid student

  Poor circulation - also causes cold limbs

  Vasoconstriction - opposite of vasodilation

  Low Blood Pressure - could also cause fainting

  Reynaud’s Syndome - spasm of small arteries causing pale fingers
• DDx of illnesses causing low Pulse Oximeter reading:

  COPD - likely to cough up pink phlegm

  Heart failure - can affect right and left

  Anemia - low blood iron

  Haemorrhage  - bleeding out

  Pneumonia - really really really bad chest infection

  Pneumothorax - inhaled a foreign body
• Causes of Bradycardia:

  Beta blockers - and other medications

  Fitness - if you’re an elite athlete 

  Hypothermia - excessive cold

  Dysrhythmia - irregular heartbeat

  Hypothyroidism - can also cause weight gain and sluggishness
• Causes of Tachycardia

  Dexamphetamine - a medication you’re prescribed (and other medications too)

  Hyperthermia - overheating

  Hyperthyroidism - can cause bulging eyes

  Anxiety - what Loretta gets

  Pain - ouch

  Fever - hot forehead and sweats

  Sepsis - when response to infection damages own tissues

  Heart failure - which can affect the left and right of this organ

  Hypoxia - low O2 in blood

  Hypotension - low bp

  Pregnancy - would only affect women
• The sites for checking the pulse are:

  Carotid

  Brachial

  Radial

  Femoral

  Popliteal

  Dorsalis pedis

  Posterior tibial
• What do the following characteristics of pulse tell you:

  Fast rate - tachycardic

  Slow rate - bradycardic

  Irregular rhythm - dysrhythmia

  Bounding - hyperdynamic circulation

  Collapsing - aortic regurgitation

  Pulsus alternans - heart failure

  Anacrotic - aortic stenosis
• A postural drop is

  A drop of more than 20 mmHg systolic

  Or more than 10 mmHg diastolic

  When standing
• Causes of blood pressure misreadings include:

  Undersized cuff causing an increase

  Oversized cuff causing a decrease

  White coat hypertension = doctor anxiety

  Human error = bad student
• Xanthomata - build up of cholestorol under the skin, usually on the elbows and knees

  
• Decreased capillary return can be due to

  dehydration - not enough water

  hypoxemia - low O2 in blood

  hypovolemia - low volume of blood
• Diaphoresis, aka sweating, can be due to:

  Hyperthyroidism - also causes bulging eyes

  Heart Failure - can affect the right side or the left side of this organ

  Hypertension - high blood pressure

  Tachycardia - fast heart rate

  Myocardial infarction - heart attack
• Pallor, aka pale skin, can be caused by:

  Anaemia - reduced O2 carrying capacity of blood

  Congestive heart failure - when the right side of this organ fails and builds up into the lungs

  Poor perfusion - reduced blood delivery to a site
• Clubbing can result from:

  Heart Failure - can affect the right and left of this organ.

  Cystic fibrosis - genetic condition causing mucus accumulation in organs.

  Infective endocarditis - viral or bacterial agent causing inflammation of inner heart lining

  Cirrhosis - severe scarring of the liver.
• Splinter haemorrhages can result from:

  Infective endocarditis - typically bacterial inflammation of inner heart lining.

  Sepsis - body’s response to infection causing tissue damage.
• The image is of Osler Nodes which can arise from Infective Endocarditis

  
• A collapsing pulse can indicate:

  Fever - high temp

  Pregnancy - little baby in ya

  Aortic Regurgitation - backflow in the main cardiac artery

  Patent Ductus Arteriosus - fails to close in foetal hearts

  Anaemia - low O2 carrying capacity of blood

  Arteriovenous Fistula - abnormal connection between artery and vein.

  Thyrotoxicosis - caused by too much thyroid hormone
• Radial-Radial Delay can indicate:

  Subclavian artery stenosis - narrowing of this blood vessel in the shoulder, such as from compression by a cervical rib.

  Aortic dissection - killed Berserk guy

  Aortic coarctation - narrowing of the main cardiac artery
• Central Cyanosis is caused by Hypoxaemia and can indicate:

  Shunting - blood bypassing from one location to another such as seen in Tetralogy of Fallot.

  Pulmonary Embolism - clot in lungs

  Heart Failure - progresses from right to left in this organ.

  Asthma - four eyes can’t breathe

  Pneumonia - very nasty lung infection

  Carbon Monoxide Poisoning - nearly killed Perth friend
• Pre-hepatic jaundice can be caused by sickle cell anaemia (more common in Africa).
• Intrahepatic jaundice can be caused by hepatitis (viral, alcohol, NAFLD) or cirrhosis (liver scarring)
• Post-hepatic Jaundice can be caused by gall stones (causes severe pain radiating to back) or a tumour (benign or malignant).
• Poor dental hygiene can cause endocarditis
• A high arched palate can indicate:

  Marfan Syndrome - genetic condition affects connective tissue. This places people at risk of mitral or aortic valve prolapse, aortic dissection (killed berserk guy) and pneumothorax (collected air in pleural space)
• Caridac Hypertrophy can be caused by:

  Acromegaly - pituitary gland producing too much growth hormone in adulthood.

  Hypertension - high blood pressure.

  Aortic Stenosis - compression or narrowing of the main heart artery.
• Raised JVP can indicate:

  Right heart failure - occurs in this organ before progressing to the left side.

  Pulmonary hypertension - high BP in the blood vessels leading to the lungs

  Interstitial lung disease - from long-term exposure to a toxic inhalant.

  Chronic Obstructive Pulmonary Disease - inflam lung disease that isn’t asthma.

  Tricuspid regurgitation - a specific heart valve causing backflow.

  Rheumatic heart disease - complication of a fever that shares a name with a type of arthritis.

  Cardiac tamponade - compression of the heart due to fluid build up in the pericardium.
• Carotid bruits can indicate:

  Carotid stenosis - narrowing of the same arteries from atherosclerosis (plaque build up) or surgery (from resulting scars)

  Aortic stenosis - narrowing of the main cardiac artery
• Thrills indicate a heart murmur caused by an incompetent heart valve
• Thrills indicate a heart murmur caused by an incompetent heart valve
• Heaves indicate right ventricular hypertrophy and/or pulmonary hypertension
• Displacement of the apex beat from its usual location can occur due to ventricular hypertrophy.
• Displacement of the apex beat from its usual location can occur due to ventricular hypertrophy.
• The purpose of the dynamic manoeuver where you roll the patient to the left is that thrills are more easily palpable at the apex of the heart
• Sacral Oedema is an indicator of heart failure
• Changes to the colour of the limbs, loss of hair and atrophied muscles can indicate arterial and venous insufficiency 
• Poor wound healing results from poor perfusion
• The 6 P’s of Arterial Insufficiency

  Pain

  Poikilothermia

  Pulselessness

  Palor

  Paresthesia

  Paralysis

  
  

  In Venous insufficiency, you will get warmth instead of poikilothermia.