OSCE 2 Study Guide

daunaib's version from 2015-05-14 03:19

Patient Consultation Checklist

Question Answer
Step 1Introduction
Step 2Patient identification
(Confirm patient's name)
Step 3Buy-in/rapport with patient
(Ask if now is a good time to talk)
Step 4Ask about how medications are taken
How often are doses missed
Step 5Assess patient knowledge of drug therapy or disease state
Step 6Fill in knowledge gaps
(Correct patient's misconceptions as needed)
Step 7Assess barriers to optimal drug therapy outcomes
(Figure out how to best make it work)
Step 8Provide accurate information
(Don't BS)
Step 9Respond appropriately to patient questions
Step 10Use appropriate persuasive techniques

Written SOAP Checklist

Question Answer
Step 1Correctly identify most important problem
Step 2Include relevant subjective information
Step 3Include relevant objective information
Step 4Provide an appropriate assessment
Step 5Provide assessment that is supported by subjective and objective data
Step 6Word assessment in a manner that allows action to be taken
Step 7Provide appropriate plan, including medication doses and frequencies
Step 8Identify specific monitoring parameters and frequency of monitoring
Step 9Identify patient-specific goals
Step 10SOAP is clear, concise, and does not contain irrelevant information

Healthcare Provider Interaction Checklist

Question Answer
Step 1Introduction
Step 2Identify purpose of interaction
Ask if HCP has time
Step 3Clarify the question
Identify the patient
Step 4Make concise, evidence-based recommendation
Step 5Support the recommendation when challenged
Step 6Incorporate patient factors
Step 7Emphasize impact of recommendation on patient wellbeing
Step 8Provide accurate information
Step 9Respond to HCP questions appropriately
Step 10Exhibit clear and concise communication in the interaction


Question Answer
Teaching points for taking a BPAvoid caffeine, smoking, or physical activity for at least 30 minutes prior
Sit in a chair for 5 minutes
Cuff should go on bare arm
Take two or three measurements and record the average
Goal of treating HTNReduce HTN-associated morbidity and mortality
(Heart attack, stroke, and heart failure)
Goal BPs according to JNC8General population:
> >60 years = <150/90

Everyone else = <140/90
Lifestyle modificationsDiet
Physical activity (3-4 sessions/week of 40+ minutes)
Weight loss
Initial choice of antihypertensivesNon-black: ACE-I, ARB, CCB, or thiazide
Black: CCB or thiazide (unless diabetic or CKD)
Hypertensive crises and definitionsUrgency: >180/110 with no end-organ damage
Emergency: >180/110 with organ damage


Question Answer
Reason for lowering LDLDecrease is associated with decrease in morbidity and mortality
Risk of elevated TGs>500 can cause pancreatitis
Lifestyle modificationsDiet (DASH diet)
>Mention AHA's website as a resource
Physical activity (3-4 days/week x 40 minutes)
Four major statin benefit groups1) Individuals with ASCVD
2) Individuals 21+ with baseline LDL > 190
3) Individuals 40-75 with diabetes and LDL 70-189
4) Individuals without ASCVD or diabetes who are 40-75 with LDL 70-189 and estimated 10-year ASCVD risk of 7.5%+
Benefits of statinsLower LDL
Pleiotropic effects (anti-inflammatory, etc.)
Only class to demonstrate reduction in CV events
Labs before statinsFasting lipid profile
Creatine kinase
High-intensity statins
Doses and solubilities
Atorvastatin 40-80mg (lipophilic)
Rosuvastatin 20mg (hydrophilic)
What to do if one statin isn't toleratedTry another!


Question Answer
GuidelinesGOLD guidelines
Stage I symptomsMay or may not have symptoms of chronic cough and sputum production
Stage II symptomsSOB on exertion and sputum production sometimes present
Stage where patients usually seek medical attention because of symptoms or exacerbation
Stage III symptomsGreater SOB, reduced exercise capacity, fatigue, repeated exacerbations that usually decrease QOL
Stage IV symptomsChronic respiratory failure; QOL significantly impaired
Exacerbations may be life-threatening
Goals of therapyRelieve symptoms
Improve exercise tolerance
Improve health status
Prevent disease progression
Prevent and treat exacerbations
Reduce mortality
Interventions to reduce exacerbationsSmoking cessation
Flu and pneumococcal vaccines
Knowledge of current therapies and inhaler techniques
Treatment with LABA +/- ICS
Possible PDE4 inhibitors
Treatments for Mild COPDSABA +/- anticholinergic
Treatments for Moderate COPDLAMA (preferred) or LABA
Treatments for Severe COPDLAMA or LABA + ICS


Question Answer
Typical TSH levels0.45-4.12
When to treatTSH > 10
TSH > 4.12 and symptomatic or evidence of ASCVD
Risks of elevated TSHIncreased risk of HF and CV mortality
Preferred agent and dosing/titrationsLevothyroxine
1.6 mcg/kg/day (using IBW) titrated 12.5-25mcg every 2 weeks

Older patients: start at 50mcg


Question Answer
Stroke risk assessment toolCHADS2
Age > 75 years
Potential anticoagulantsWarfarin
Dabigatran (Pradaxa)
Rivaroxaban (Xarelto)
Apixaban (Eliquis)
Administration rules
Dosing: 2-5mg QD; adjust based on INR
SEs: bleeding, nausea
Administration rules: Take with food QPM
Monitoring: CBC, INR (weekly until stable)
Dabigatran (Pradaxa)
Administration rules
Dosing: CrCl>30 = 150mg BID; 15-30 = 75mg BID
SEs: dyspepsia, bleeding
Administration rules: Swallow whole; keep in original container
Monitoring: CBC, SCr
Rivaroxaban (Xarelto)
Administration rules
Dosing: CrCl > 50 = 20mg QD; 15-50 = 15mg QD
SEs: Bleeding
Administration rules: with food QPM
Monitoring: CBC, SCr
Apixaban (Eliquis)
Administration rules
Dosing: 5mg BID unless >80 years, <60kg, SCr>1.5 (2.5mg BID)
SEs: Bleeding
Administration rules: NONE
Monitoring: CBC, SCr