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can be used in year 4 semester 1 and 2 if needed. sample exam question showing what to expect in the OSCE
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3.1 Postural hypotension upon standing , risk in elderly review BP, standing and sittingA positive result is:
• A drop in systolic BP of 20mmHg or more (with or without symptoms).
• A drop to below 90mmHg on standing even if the drop is less than 20mmHg (with
or without symptoms).
• A drop in diastolic BP of 10mmHg with symptoms (although clinically less
significant than a drop in systolic BP).
Dehydration – Acute kidney injury (not the key issue) (not using the ideal body weight to
access kidney function)
Creatinine clearance is worked out using the Cockcroft-Gault equation and is
currently used as the “gold standard” for calculating renal function in the context of
drug dosing; it considers the patient’s sex, age, weight and serum creatinine.
Lost weight – review the doses of medicines paracetamol, enoxaparin is OK
Problems with swallowing – drinks might not be suitable? Review Test for swallowing – SALT
(how, stages) assessment speech and language assessment. Refer to speech and language
therapist
If unable to swallow then NG tube, consider EC and so on. Licenced medicines, different
drug same mode of action but might be more suitable, Handbook of drug administration
via enteral feeding tubes. co-careldopa with co-beneldopa dispersible tablet
Paracetamol to liquid soluble tablets, suppositories etc. reduce the dose
memantine – miss a few doses OK while sorting other drugs out
Crushing use mortar or pill crusher one drug at a time,
Can also use SPC or BNF
Risk of missing doses for Parkinson’s – neuroleptic malignant syndrome
Low iron – IV ferinject calculate dosing, max 1g, over 50mins diluted 250 ml NaCL SPC more
info, access hemoglobin after 2 weeks
Fludrocortisone – unclear
3.2 Covert administration – assess mental capacity, recorded why this choice
was made, management plan reviewed – ethical issue
Incompatibility with food, safety of crushing
3.3 Error made needs to be recorded, why, action in place, let the patient know or carer
Implications of the disease – medical review, monitor the patient due to Parkinson’s
3.4 safeguarding – ask family, nurses and get the whole picture, gather more info and report
to local safeguard team, report to line manager.
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