OSCE practice

Acronym for referral symptoms (remember this in every station and situation)

BBBPPSSCLAWHV

-breathlessness

-blood loss from: mouth, stool, nose, anus, ears

-unexplained Bruising

-phlegm (yellow or green)

-pain of: chest, ear, abdomen, head

-swelling

-difficulty Swallowing

-Consciousness lost and/or recent severe injury

-lump

-appetite lost, leading to a pt not eating

-unexpected weight loss

-high temperature that is long lasting or repeated

-vaginal symptoms of infection/UT i.e. discharge with pain

Drug/health history acronym

MAPRICOTSS

-a=allergies

p=prescription meds. Do they know why they’re prescribed it?

r=recreational meds

i=inhalers

c=contraceptives

c= medical conditions

o=OTC

t=topical meds (including patches)

S=supplements (herbal, vitamins etc)

S= social history

Acronym for pt presenting pain e.g. headaches, mouth ulcers, cold sores

SOCRATES

A= associated symptoms and any other symptoms. Remember, don’t just use acronym, think outside the box too. You can also use WWHHAMAC LAP if you are stuck

When speaking to pt or hcp, what must you always do?

-ask if they have any questions or if they want you to repeat anything

Acronym for root cause analysis from near miss error or error

CHAPS

-C=conditions. (environment)

-H=health of pt and of hcp

-A=anyone else involved?

-P=prescription. Was the prescription wrong?

-S=system

For responding to symptoms, what 2 acronyms should you use?

-referral symptoms

-WWHHASMAC FLAP or SOCRATES if pain

-RSVPT= (R-redness [severe], S=sensitivity to light [photophobia], T=trauma e.g. hit, V=visual disturbance, P=pain [moderate-severe])

-ALWAYS explain condition or issue or diagnosis and side effects of product recommendation

Acronym for accuracy/final check

HELP

-H=how many?

-E=expiry date

-L=label correct

-product and PIL

Acronym for diagnosing and responding to symptoms

WWHHAS- MAC- FLAP- PALS-TAQ

-W=who is it for?

-W=what are the symptoms? Describe them e.g. type of cough, headache, spot etc. Any other symptoms. If pain or skin, SOCRATES. If eyes, RSVPT

-H=how long?

-H=history. family history, has pt had it before?

-A=action taken? relieving or exacerbating factors?

-S=severity. day-to-day activities effected? mild, mod, severe?

-M= medications they take or have taken, herbal remedies and otc/non-prescription

-A=allergies. What type of allergy?

-C= any medical conditions or previous medical conditions?

-F=further explore e.g. GI issue, ask about bowel movements, find cause etc, how does it look like? (SOCRATES)

-L=lifestyle/social history e.g. makeup products, travel

-A=age

-P=pregnancy or trying or breastfeeding

-P=product and protocol (i.e. how to use)

-Advice= practical measures e.g. lifestyle advice, hygiene

-L=length of treatment

-S=safety netting e.g. if it doesn’t get better

-T=teach back

-A=any questions?

Q=quit

Social history and lifestyle advice acronym

MOST SHADED CSH V

-M=monitoring

-O=occupation

-S=stress

-T= travel

-sleep

-hydration

-alcohol

-diet, religious diet etc

-exercise

-daily activities affected

H=home life. Do they live by themselves? married?

-Caffeine

-Smoking

VACCINES

Is sumatriptan OTC?

both depending on strength

Migraleve Pink vs Migraleve Yellow and how to take

pink=when you first develop migraine symptoms.

yellow=if migraines persist

-no more than 8 tablets in 24hrs. 1 pink then 1 yellow after 4 hours

OTC, no prescription needed. Taken for 3 days max. as it contains codeine.

-do not take paracetamol as it contains paracetamol

What to do if pt’s symptoms worsen

refer

Important side effect to mention to pt using codeine

-constipation and drug dependence

2 main goals during OSCE’s

CAUSE AND DIAGNOSIS

First-line treatment for dry mouth

lifestyle and salivary stimulants e.g. ascorbic acid (vitamin C tablets)

-non-drug advice

What is artificial saliva? What other dosage forms can saliva substitutes come in?

-Mucin Based, carboxymethylcellulose-based - gels - P meds

-o Sprays, gels, pastilles

-if pt has hyposalivation, this should be given instead of artificial stimulants

What is an example of a saliva replacement?

- bioténe oral balance saliva replacement gel. 1-2cm of gel directly on tongue before and during meals as frequently as u can

What can act as a saliva stimulant?

-Ascorbic acid or malic acid.

Second line treatment for cold sores

-products containing zinc, ammonia and phenol

How to apply aciclovir 5% w/w

-x5 daily for 5 days. Max. 10 days

-always tell pt to read PIL

cold sore lifestyle advice

-don’t share cutlery and towels

-avoid triggers e.g. stress!! Ask pt q’s to figure out triggers

What should pt avoid drinking if they have dry mouth?

-caffeine

-alcohol

When recommending product, what must you always mention? (2)

-for pt to read PIL

-How much to take and how often

What to do after any counselling or discussion with individual over the counter

-signpost to nhs website

-PIL

How to take migraleve

-take 1 Migraleve pink tablet when needed. Then, 1 yellow one after 4hrs from the pink dose. Then, every 4 hrs. Do not take more than 8 tablets in 24hrs

Can you use pulse/oxygen oximeter if they have nail polish on?

no

How to take temperature on pts

-make them stand straight, arms on their side, take temp, tell them normal range

Blood pressure lifestyle advice

-reduce alcohol intake, caffeine, more exercise, reduce stress, exercise

If pt has fever, what would you advise?

stay at home

Is caffeine a vasoconstrictor?

no

Lifestyle advice on cold

-honey and lemon for cough and sore throat (half a lemon, 1-2 teaspoons of honey)

-hydration

-steaming

-wash hands (whole family)

How long does cold usually last in children?

5-7 days to up to 2 weeks

What advice to give to pt after giving them product after due to their symptoms not relieving

-come back to the pharmacy

How can ibuprofen help with a cold?

-can relieve cold-related symptoms such as sore throat, headache, earache and lower fever

-anti fever, anti inflammatory anti-pain. Usually paracetamol first choice if they have fever

For pulse oximeter, how should patient’s arm be?

lying on flat surface

On label, 3 important things to always check that is easy to forgot/get wrong

-cautionary advisory label

-storage instructions, specific needed or may be incorrect

-apply to ‘eye’ instead of ‘eyes’ is wrong if it needs to be applied to both eyes

Does having a cold sore also include a fever?

no

Pts who have a lthc (e.g. hypertension, asthma) or over 65 should be up to date with… (2)

-monitoring

-vaccines

Diabetics should have regular…

feet and eye check ups

hypertension and hypotension number

-hypertension= 140/90 or higher

-hypotension= 90/60 or lower

If you use your salbutamol inhaler… or more a week, it is a sign that asthma isn’t controlled

-thrice or more

2 things asthmatic pt should have checked

-spirometer test every 1-2 years.

-peak flow test every day at home (twice, once in morning, three times and once in the night three times. Can also do once daily if asthma is under control. record highest score. 80-100% better than normal best shows improvement. Must record)

-asthma control test

How long do blood pressure medication side effects last?

-often within a week

How long should diarrhoea last?

5-7 days from stomach bug. More than 7 days, refer. Usually improves within 2-3 days

How long should vomiting last?

2 days

Salbutamol side effects

-headaches

-muscle cramps

-trembling (particularly in hands)

-palpitations (when your heartbeat becomes more noticeable)

What does salbutamol do? What about ICS?

-bronchodilator

-inflammatory reliever