Picc line bloods geeky medics. However, these investigations may identify complications (e.

Picc line bloods geeky medics We put this tube into one of the veins in your arm. Flushing the line: Your PICC or midline will need to be flushed each week with sterile salt water (normal saline). Haematology revision notes covering key haematological conditions, including multiple myeloma, chronic myeloid leukaemia and more. e. PICC lines and midlines can deliver What is a peripherally inserted central catheter (PICC)? A PICC (also called a PICC line) is a long, thin, flexible tube that is inserted into a large vein in the upper arm. It is a term that includes several clinical syndromes caused by various organisms or pathological insults. ; Occurs in small intestine (SBO) or large intestine (LBO), classified as: . Reduced absorption of iron; Increased utilisation of iron; Blood loss; Reduced absorption of iron. Hence, anything causing injury or injuries that threaten life would be considered major trauma. However, a rapid fall in sodium from 145mmol/L to 125mmol/L over Aetiology. , human herpesvirus 6, influenza). 2. 1,2 JIA is a clinical diagnosis. Hint: Key points. The degree of weight loss is often between 5% – 10% of the total body weight and typically occurs within the Basic principles. 4. The key to interpreting sodium levels during an on-call shift is understanding that the rate of change in sodium concentration is just as important as the absolute sodium level. Parkinson’s disease: neurodegenerative disorder due to loss of dopaminergic cells from the substantia nigra. Clinicians often use the term ‘tired all the time‘ (shortened to TATT) in medical notes. Hyperparathyroidism: excess secretion of PTH from the parathyroid glands; primary hyperparathyroidism is the most common cause of hypercalcaemia. A collection of sexual health revision notes covering key sexually transmitted infections and different types of contraception. This number, however, increases with age and is more prevalent in men than women. A key component of counselling involves exploring a patient’s ideas, concerns and expectations (often referred to as ICE). As with all Central lines, 10 mls is the minimum size syringe to be used to flush a PICC line. Acute kidney injury (AKI): rapid deterioration in kidney function; common in hospitalised patients, occurring in up to 20% of admissions. Cerebrovascular diseases are the 4 th most common cause of death in the UK, with 75% of those deaths being from stroke. Once transient loss of consciousness has been ruled out, it is important to complete a full falls risk assessment. Review the patient’s respiratory rate: A normal respiratory rate is between 12-20 breaths per minute. Stones can affect several body systems, including the hepatobiliary system, urinary tract and salivary glands. PICC lines), one set should also be taken from the line to assess for line Breathing Clinical assessment Observations. For more information on prescribing and administering blood products, see the Geeky Medics guide to administering a blood transfusion. It is predominantly metabolised and excreted by the liver. Background. As bilirubin is unconjugated at this stage, this is called Introduction. How long does it take to put a PICC in? Inserting a PICC usually takes about 30 minutes, but in some cases it may take longer. Generally, this type of jaundice is caused by issues relating to red cell breakdown, where increased haemolysis results in excess bilirubin. Always check your hospital policy about using central lines (including PICC) to take blood samples as not all trusts Introduction. • Do not expose the PICC line to the sun. Bedside investigations. Dyslipidaemia is an umbrella term that includes hypercholesterolaemia, hyperlipidaemia and mixed dyslipidaemia. Hepatitis B serological testing involves the measurement of several different HBV-specific antigens and antibodies, enabling Key points. Other investigations (including troponin) do not contribute to diagnosing a STEMI. Before using the PICC Nursing and Medical Staff MUST: Wash their hands, put on gloves, clean the end of the line for 30 seconds, Biliary colic. These proteins, namely beta-myosin heavy chain, myosin-binding protein C and cardiac troponin C, are structurally Background. 3°C or greater for at least 3 weeks with no identified cause after three days of hospital evaluation or three outpatient visits. ; Affects 1. Guillain-Barré Syndrome (GBS) is an acute, inflammatory neuropathy, primarily affecting the peripheral nervous system. These are the anterior humeral line and the radiocapitellar line. Once you have located the radial pulse, assess the rate and rhythm. . 2 While the full aetiology of Guillain-Barré Introduction. They are classified according to the globin chain which is affected and the severity of the resulting clinical picture, which ranges from asymptomatic to fatal. A PICC line is a long, hollow tube that is inserted into a vein in your upper arm and guided up the vein until it reaches the large vein above your heart. This blood culture collection guide provides a step-by-step approach to obtaining blood PICC line or midline is useful for patients who have small veins and/or require long term intravenous therapy, for example, over a week. A general practitioner (GP) typically sees around 120 people in a 2,000-patient population with an acute sore throat every year. PEFR: important for monitoring response to treatment and can be used in the diagnosis of asthma, where diurnal variation is >20%. 3 per 100,000 person Key points. Published in 2004. This scan has 3 functions: formal dating of the pregnancy, confirmation of number of foetuses and nuchal translucency measurement. Lifestyle and social risk Key points. It has an incidence of ~1. The most important investigation in the context of ACS is a 12-lead ECG. Introduce yourself to the patient including your name and role. Reviewing and interpreting blood tests is a core skill for all doctors, however it is a skill that takes some time to develop. Key points. Juvenile idiopathic arthritis (JIA) is a term used to describe a group of paediatric inflammatory arthritides which last for longer than six weeks and emerge before the age of 16 years. With the flow of bile being obstructed, the pressure increases, so the gallbladder contracts to try and push the bile past the gallstone, Guidelines for Care of a Peripherally Inserted Central Catheter (PICC) by Community Staff November 2016 To Prevent Movement ensure the S– ecurAcath securing device is in place at all times. Please write a prescription using a blank FP10 prescription form and then compare against the example below. • Do not expose the line to either small children or pets. Pelvic inflammatory disease (PID): inflammation of the upper female genital tract due to ascending infection from the endocervix, affecting the uterus, fallopian tubes, and ovaries. 1 Predicted PEFR can be calculated from age, sex, and height. If Delirium is an acute, transient and reversible state of confusion, usually the result of other organic processes (infection, drugs, dehydration), the onset is acute and the cognition of the patient can be highly fluctuant over a Check out the Geeky Medics platform for more medical education resources, including our awesome products: ⚡ Product Bundles (best value) 1300+ OSCE Stations; 🧠 UKMLA AKT Question Bank; 💊 PSA Question Bank; 🗂️ Initial steps. X-ray of right A comprehensive collection of data interpretation guides (blood tests, imaging and statistics) to help you prepare for OSCEs, including PLAB and the UKMLA CPSA. You feel unwell, you have a temperature of 37. ” It is estimated that 1 in 7 couples are affected by infertility in the UK. Carpal tunnel syndrome (CTS): Compression of the median nerve in the carpal tunnel, most common compression neuropathy of the upper limb, 3 times more common in women, peak incidence 45-64 years. A deep vein thrombosis (DVT) refers to the formation of a thrombus within the deep venous system, most often occurring in the veins of the leg but also in the pelvis and arm. 1 ALI is a vascular emergency Oral bisphosphonates are generally considered the first-line treatment for patients with osteoporosis: Alendronic acid (10mg daily or 70mg weekly) Ibandronic acid; Risedronate sodium Adapted by Geeky Medics. It results from a type III hypersensitivity reaction involving the formation of autoantibodies against cell nuclear autoantigens, which leads to the deposition of immune complexes throughout the body. Licence: Figure 4. The vast majority of ALI cases involve the • Do not open or move the clamp on the line. The GDCs are national services which The Geeky Medics Blood Test Case Collection contains 100 cases, which will help you learn to interpret blood tests using a systematic approach. 9 pmol/L. Being able to assess the hydration status of a patient is an important skill that you’ll regularly use in clinical practice. The nurse or doctor who inserts your line will be able to give you advice. Estimated incidence: 1 in 1000 women aged 15-34 diagnosed annually. Once the patient’s blood type is known, you will need to prescribe their blood transfusion. It is used to give treatments such as: • Chemotherapy Key points. The most common presenting symptoms are due to disrupted hematopoiesis. Hypothyroidism: insufficient thyroid hormone production/secretion; most common cause in developed countries is Hashimoto’s thyroiditis. Available from: Bohadana A et al. The catheter can move out up to 3cm before a chest X-ray is Investigations. Sexually transmitted infections (STIs): Chlamydia trachomatis (14-35% of cases), Neisseria Investigations. Pneumonia is defined as an acute infection of the lung parenchyma caused by various pathogens. Below is a selection of reference ranges for various haematological and biochemical investigations. • Intravenous feeding. In the Key points. JIA is the most common chronic inflammatory rheumatic disease of childhood. The acute abdomen refers to the rapid onset of severe symptoms of abdominal pathology, which may require surgical intervention. ; Laboratory investigations Introduction. It is caused by prolonged imbalance where energy intake exceeds energy expenditure. Co-administration of vitamin C improves the absorption of oral iron. When carrying out a drug calculation, there are some basic principles to keep in mind:. Typically, patients present with abdominal pain. It is moved up into the large vein leading to your heart. Midline So what is the difference between a See more What is a PICC Line? PICC or Peripherally Inserted Central Catheter is used for intravenous access in the medium to long-term. 12 billion prescription items were dispensed in the community in 2019. For each case study, we encourage you to interpret the patient’s blood tests using a structured approach and formulate an overall impression of the results. Its prevalence increases with age, particularly over 65 years, such that 10% of over 85-year-olds Introduction. Dietary: the main sources of dietary iron include meat, leafy green vegetables, and fortified foods including cereals and bread. Prompt assessment, taking account of the broad differential diagnoses, is required to identify those patients with immediately life-threatening causes. Abdominal aortic aneurysm: bulging of the abdominal aorta, often asymptomatic but can rupture causing haemorrhage and rapid death. Aetiology: immune * For an explanation of laryngoscopy, see the Geeky Medics guide here. If your hands are visibly soiled, wash them with soap and water 3 Don PPE if appropriate 4 Introduce yourself to the patient including your name and role 5 Confirm the patient's name and date of birth 6 Briefly explain what the procedure will involve Key points. For more information on specific tests, check out our This article provides a step-by-step approach to consenting patients for a blood transfusion in an OSCE setting. 5 cases per 10,000 per year. Bilirubin is a waste product of haemoglobin breakdown. 6 Lymphatic fluid contains a high number of lymphocytes and it is the mutation of these cells inside lymphoid tissues that results in a lymphoma. g. Empirical antibiotic therapy. coxsackievirus and HIV), bacteria (e. It is used to safely peripherally inserted central catheter (PICC) is a tube, which is inserted into a vein in the upper arm, usually in the middle part. They contain haemoglobin, a metalloprotein with haem groups which can bind to oxygen for Care of the elderly (geriatrics) revision notes, covering key conditions and important ethical issues. Published in 2014. Henoch-Schönlein purpura (HSP): IgA vasculitis presenting with glomerulonephritis, abdominal pain, arthralgia, and purpura; most common vasculitis in children, incidence 20 per 100,000. Tumour lysis syndrome (TLS): oncological emergency due to rapid breakdown of malignant cells, leading to significant electrolyte imbalances; common in lymphoproliferative malignancies post-treatment. 3% of men >65 years in the UK. 1 . We can then give you antibiotics, other medicines, fluids or liquid food directly into the vein, or take blood samples for What should I do if I have a problem with the PICC line? Problems: Your PICC line is broken or bleeding or your dressing is coming away. Pre-renal: reduced perfusion (e. ; Functional obstruction (pseudo-obstruction): impaired peristalsis without physical blockage. Vegans, vegetarians, and those Introduction. Clinical features. Cutaneous squamous cell carcinoma (SCC), a form of non-melanoma skin cancer (NMSC), is the second most common type of skin cancer in the UK, following basal cell carcinoma. 1 Certain chromosomal and genetic abnormalities can PICC tip can be ascertained with ECG (electrocardiogram) confirmation; unless you have a heart condition. In the UK, 1. This article is not a complete guide to each blood test and how to manage each specific abnormality but aims to give an overview of how to approach blood test interpretation­­­. Examples may include: Road traffic collisions Introduction. Each clinical case involves interpreting a set of blood results, followed by a step-by-step interpretation and a detailed explanation written by expert clinicians. Use the abbreviated mental test score (AMTS) or other tools (e. Acute limb ischaemia (ALI) is defined as a sudden decrease in arterial blood flow to a limb that threatens its viability. Mechanical obstruction: physical blockage within the intestine. Biliary colic is the most common complication of gallstones. Look through recent bloods to assess inflammatory markers and pay close attention to recent microbiology. Explain that you’d like to take a This administering intravenous medication guide provides a step-by-step approach to preparing and delivering bolus or infusion medicines intravenously, typically through a cannula, in an OSCE setting. Addison’s disease is the traditional term for primary adrenal insufficiency. 7 If a patient tells you they are transgender, they should be referred to a GDC without any delay. Unintentional weight loss is a phenomenon in which an individual unintentionally experiences a significant reduction in body weight. Leukaemia involves abnormal proliferation and differentiation of leucocytes or their precursor cells. It does not require removing and replacing and can remain in situ for the life of the PICC. ; Aetiology: Exact cause unknown, likely age-dependent brain response to fever; 80% linked to viral infections (e. Palpate the patient’s radial pulse, located at the radial side of the wrist, with the tips of your index and middle fingers aligned longitudinally over the course of the artery. , unconjugated bilirubin). Atrial fibrillation (AF) is a cardiac arrhythmia characterised by disorganised electrical activity within the atria, which results in ineffective atrial contraction and irregular ventricular contraction. Wilson’s score for predicting difficult laryngoscopy. Pay attention to the patient’s rate of speech:. A PICC line can also be called a Power PICC or a Central line. 1. Pathophysiology: Increased pressure in the carpal tunnel causes median nerve ischaemia, segmental demyelination, and potential Background. It is characterised by de novo hypertension which co-exists with one or more of the following clinical features:. Half of the couples who did not conceive in the first year will conceive in the second, resulting in an overall Treatment of iron deficiency anaemia. • Do not remove the bionector (cap) from the ends of the line. Pre-hepatic jaundice. Bradypnoea may be present secondary to the use of anticonvulsant agents 11+2 to 14+1 week scan Dating scan. Heavy menstrual bleeding (HMB): excessive menstrual blood loss interfering with quality of life; previously defined as >80ml blood loss, now based on patient experience. Still, there are several important bacteria to A broader assessment of a post-operative surgical patient [SHE BOXED approach] 2,4. The length of the line depends on: how tall you are; where we put in the tube; The tip of the PICC line sits in a big vein just above your heart. Asking about a patient’s ideas, concerns and expectations can allow you to gain insight into how a patient currently perceives their situation, what they are worried about and what they expect from the Key points. Ask the nurse or doctor for more information. Other reasons to order U&Es include suspected electrolyte Background. The three major causes of iron deficiency are: 2. 8-1. Some patients with AML will be asymptomatic and present with only laboratory abnormalities. License: [CC BY-NC-SA] Parathyroid hormone (PTH) Reference range: 1. Anaemia: fatigue, weakness, pallor, Introduction. Gallstones (cholelithiasis) occur when abnormal deposits of solid material form within the biliary tree. Briefly explain what the procedure will involve using patient-friendly language: “Today I need to perform See the Geeky Medics guide here for further information on the acute management of sepsis and the sepsis six bundle. Incidence rates are outdated and underreported, however, from 2013 to 2015 the incidence rate of primary SCC in England was thought to be 77. In a significant proportion of cases (up to 31%), no causative microorganism is identified from standard blood culture methods – so-called blood culture-negative infective endocarditis (BCNIE). Anxious patients, or patients Aetiology. 1,3. 1 >90kg. Available from: Highland KB and Heffner JE. Confirm the patient’s name and date of birth. confusion screen) performed for specific clinical presentations, including laboratory tests and radiology. Cholesterol values are reported as follows:. Wash your hands and don PPE if appropriate. Symptoms of acute myeloid leukaemia may be present for only days to weeks before diagnosis. Wash your hands using alcohol gel. You can calculate the heart rate in several ways, including measuring for 60 seconds, Screen for confusion. Proteinuria; Maternal dysfunction; Uteroplacental dysfunction; Hypertension may also develop after delivery but typically resolves by 6 weeks postpartum. It may be that in an OSCE scenario you complete your A-E assessment and the examiner then asks you “Now what would you do?”. 2) The prothrombin time (PT) is a measure of the time taken for blood to clot via the extrinsic pathway (a good way to remember is that you ‘Play Tennis OUTSIDE’ therefore PT is EXTRINSIC). Someone in the UK will have a stroke every 5 minutes, with 100,000 people having strokes yearly. This page is intended for educational purposes only and should never be used for clinical decision making. Tiredness is a common presenting complaint. The other end of the PICC line Key points. Table 2b. Aetiology: believed to be due to • Do not open or move the clamp on the line. Tonsillitis may either be acute or chronic. Pre-eclampsia is a multisystem syndrome, developing after 20 weeks of pregnancy. Aetiology: . The British Association of Urological Check out the Geeky Medics platform for more medical education resources, including our awesome products: ⚡ Product Bundles (best value) 1300+ OSCE Stations; 🧠 UKMLA AKT Question Bank; 💊 PSA Question Bank; 🗂️ Red blood cells. If there are indwelling lines (e. In contrast, gigantism is a condition of childhood due to excessive growth hormone secretion prior to epiphyseal growth plate fusion. The proportion of UK adults Chest x-ray PICC (peripherally inserted central catheter) position should be assessed following initial placement and on subsequent radiographs. Intravenous cannulation and venepuncture are two of the most commonly performed clinical procedures for doctors and are performed daily in many medical and surgical rotations. Usually, the line is 38 to 52cm long. This can present insidiously or acutely as an Addisonian crisis requiring immediate medical attention. All patients receiving a blood transfusion need to give fully informed consent. Junior doctor with a special interest in medical education, chronic disease management and palliative care. Pressure of speech: a tendency to speak rapidly, motivated by an urgency that may not be apparent to the listener (often a manifestation of thought abnormalities such as flight of ideas, Risk factors. Cellulitis: Bacterial skin infection, affects deeper dermis and subcutaneous tissues, usually in lower limbs. In the UK, syphilis disproportionally affects gay, bisexual and other men who have sex with men. This cardiovascular examination OSCE guide provides a clear step-by-step approach to examining the cardiovascular system, with an included video demonstration. . A stone, or calculus, is an abnormal deposit of solid material that forms within an organ. Geeky Medics provides free medical student revision resources, including OSCE guides, clinical skills videos, clinical cases and quizzes (MCQs). 1 Often presenting first as a sore throat to GPs, chronic tonsillitis generally has an incidence of 100 per 1,000-patient Speech. However, it appears to be inherited in an autosomal dominant fashion. 1 The annual incidence of community-acquired pneumonia in the UK is estimated at 5-10 per thousand adults. New England Journal of Medicine. Published in 2017. Reference article This is a summary article ; we do have a more in-depth reference article PICC . 2 It is normally a sporadic condition seen in middle-aged adults Introduction. Opening the consultation. ; Aetiology: occurs in the intima of the ascending aorta, creating a false lumen in the intima-media space, leading to branch occlusion and end-organ malperfusion. org, rID: 19198. The pericardium Causes of pericarditis. 8 . Current Opinion in Pulmonary Medicine. This is indicated in order to identify any causative features especially as older people are likely to have multiple co-existing risk factors. However, there are also genetic syndromes which predispose children to leukaemia. Assess the patient’s speech to identify abnormalities which may indicate underlying mental health issues. A combination of history, examination and investigations can lead to a likely diagnosis of asthma. Important points about prescribing blood transfusions:. Anatomy of the pancreas Pathophysiology. Bowel obstruction: partial or complete blockage of intestines, leading to proximal bowel dilatation and distal bowel collapse. There are two main causes of stroke: 2. Swan neck deformity. 1% and 33. This should not Key points. Tests. HyperCalcaemia; Renal failure; Anaemia; Bone lesions; Bone pain. Feature: Score: Weight: 0 <90kg. Dating occurs using crown-rump foetal length, measured using software, to give a gestational age A summary of common investigation panels (e. This is often due to the patient receiving antibiotic therapy before blood cultures are taken. 6 – 6. AF is the most common cardiac arrhythmia in adults. Two anatomical lines can aid in assessing the alignment of the elbow joint. PUO is defined as fever of 38. Licence: Figure 3. 1,2. Rate of speech. Briefly explain what the procedure will involve using patient-friendly language: “I need to take a sample of blood from an artery in your wrist to accurately assess your oxygen levels. Introduce yourself to whoever has requested a The PICC needs to be flushed once weekly with 10mls of 0. Despite the frequency in which you will perform these tasks, undertaking these procedures in patients with ‘difficult venous access’ can pose a significant challenge and area Initial steps. 5 or If a patient has a central line, take cultures peripherally and centrally ; Bloods from central lines. If this thrombus becomes dislodged, it becomes an embolus and can travel to the lungs causing a pulmonary embolism (PE). It refers to the acute, painful spasm of the gallbladder wall due to a gallstone temporarily blocking the neck of the gallbladder, cystic duct or common bile duct. Haruko Ideguchi, Shigeru Ohno, Hideaki Hattori, Akiko Senuma and Yoshiaki Ishigatsubo. Related. Traditional dosing guidelines Thyroid function tests (TFTs) The term ‘thyroid function tests‘ refers to the following investigations: TSH (0. As bilirubin is unconjugated at this stage, this is called Cardiovascular examination frequently appears in OSCEs and you’ll be expected to pick up the relevant clinical signs using your examination skills. The inflammation in acute pancreatitis is typically caused by hypersecretion or backflow (due to obstruction) of exocrine digestive enzymes, which results in OSCE Checklist: Blood Culture Collection Introduction 1 Gather and prepare equipment 2 Wash your hands using alcohol gel. Ossification centres. Conditions can be mapped to multiple areas of clinical practice. There several components to the coagulation screen, some of the core parts and what they mean are covered below. Figure 1. Heart rate (HR) Assessing heart rate. • Be very careful when using scissors or nail clippers anywhere near the PICC line. Type 2 diabetes mellitus (T2DM) is a common and complex metabolic disease characterised by insulin resistance and subsequent high blood glucose levels (hyperglycaemia). Causes: can be structural (polyps, adenomyosis, leiomyomas, malignancy) or non-structural (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified). Disseminated intravascular coagulation (DIC) is a serious disorder occurring in response to an illness or disease process which results in dysregulated blood clotting. A thorough history is essential to help to cover your arm with a waterproof sleeve. • Giving blood and blood products such as platelets. Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV). HDL-C is often described to patients as ‘good’ cholesterol, because it mediates the Referral to a gender dysphoria clinic (GDC) Adult NHS gender affirming care is currently managed by seven specialist gender dysphoria clinics (GDC) in England, four specialist GDCs in Scotland, and one specialist GDC in Wales. Most cases of leukaemia are caused by de novo mutations (new mutations which are not inherited). In health, there is usually a balance between the clotting and fibrinolytic systems. Causes of reduced absorption of iron include:. The “dating scan” appointment is offered between 11+2 and 14+1 weeks gestation. ; Primary hyperparathyroidism: caused by adenoma (85%), hyperplasia (14%), or carcinoma (<1%); leads to hypercalcaemia due to over-secretion of PTH. CT KUB is the gold-standard first-line investigation for renal colic and has a 97% specificity 2. • Do not pull on or pinch the PICC line. Red blood cells, or erythrocytes, are biconcave-shaped cells that makeup 40-45% of blood by volume. Acute scenarios typically begin with a brief handover from a member of the nursing staff including the patient’s name, age, background and the reason the review has been requested. Systemic lupus erythematosus (SLE) is a complex multisystem autoimmune disease. This is because some Introduction. Thalassaemia is a group of genetic disorders that lead to reduced haemoglobin in red blood cells. Worldwide, it’s quite Renal (nephrology) revision notes covering key renal conditions and the underlying pathophysiology. 9% Sodium Chloride to maintain patency when not in use or after any infusion or bolus injection. Hodgkin lymphoma occurs when B Abdominal examination frequently appears in OSCEs and you’ll be expected to pick up the relevant clinical signs using your examination skills. Shortness of breath, or dyspnoea, is a symptom characterised by difficult or uncomfortable breathing. The aetiology of polycystic ovary syndrome is largely unknown and multifactorial. Introduce yourself to whoever has requested a review of the Introduction. According to World Health Organisation (WHO), obesity is a global epidemic, with 4 million people dying annually due to the disease. Introduction. This abdominal examination OSCE guide provides a clear step-by-step approach ECG and bloods: FBC, U&Es, LFTs, Bone Profile, Haematinics (including B12/Folate), Vitamin D & TFTs X-ray of any injured bones/joints CT head – if significant head injury, abnormal neurology, head injury on Introduction. In the United Kingdom, approximately 1 in 10,000 children are . The local anaesthetic injection numbs your skin so having a PICC inserted should feel similar to having a blood sample taken. ; Erysipelas: More superficial bacterial skin infection, commonly affects the face. If intravenous access is likely to be required, it is preferable to insert a cannula and take blood samples at the same time (to avoid performing a second procedure). • Taking A peripherally inserted central catheter (PICC line) is a long, thin and flexible tube that we put into a vein in your upper arm. However, potential underlying causes of pericarditis include: 4 Infections: viruses (e. The parathyroid glands are found just posterior to the thyroid and act to secrete PTH in response to hypocalcaemia (or low vitamin D). This hydration status assessment OSCE guide provides a clear step-by Preparation. Having a PICC should not be a painful procedure but you may experience some discomfort. Chronic myeloid leukaemia: cancer of white blood cells with uncontrolled growth of myeloid cells, crowding out bone marrow, interfering with normal blood cell production, and causing raised levels of mature Aetiology. Gallstones most commonly occur in the gallbladder Management. Making it 50 -60 cm in length. Adapted by Geeky Medics. How to Write a Discharge Pre-hepatic jaundice. 5 – 7. The line is inserted from a peripheral site, the upper arm, and the tip lies in the central venous system. Cholesterol. Bone pain is the most common symptom Bilirubin. ; Secondary hyperparathyroidism: results from For more information, see the Geeky Medics OSCE guide to urological history taking. Weight loss is a common symptom experienced by patients in both primary and secondary care settings. 4 – 4 mU/L) Free T4 (9 – 25 pmol/L) Free T3 (3. 1,300+ OSCE Stations OSCE Guides Introduction. If your hands are visibly soiled, wash them with soap and water. PT/INR (12-13 seconds/0. Acromegaly occurs post-epiphyseal fusion. Local guidelines regarding the choice of antibiotic therapy must A collection of guides to interpreting various laboratory tests, including liver function tests (LFTs), thyroid function tests (TFTs) and more. Hypertrophic cardiomyopathy is a primarily genetic condition affecting the sarcomeric proteins. 8 nmol/L) There are separate reference ranges for children and Introduction. A lipid profile is a blood test quantifying cholesterol and triglyceride plasma concentrations. ; Thyroid hormones: regulate metabolism, weight, temperature, hair growth, nails, and skin; controlled by the hypothalamic Background. The genetic inheritance of PCOS is heterogeneous and complex. Dyspnoea is commonly Conditions by MLA area of clinical practice. Obesity is a metabolic disease defined as an excessive accumulation of body fat that poses a risk to an individual’s health. In mixed dyslipidaemia, LDL-C and TG levels are elevated and often Introduction. Pre-hepatic jaundice occurs when bilirubin metabolism has been affected before bilirubin reaches the liver (i. 80% of couples trying to conceive will do so within 1 year. Sodium and potassium are included in the panel, as renal dysfunction can lead to electrolyte derangements. A PICC line is a long, thin and flexible tube (catheter). Clinical features are highly variable and dependent on the ingestion method (acute, staggered or acute on chronic overdose) and the time from overdose to presentation. 1 The pathophysiology of PCOS relates to excess androgen Prescribing the blood transfusion. Severe hyponatremia can be defined as a serum sodium concentration <120mmol/L. However, these investigations may identify complications (e. Febrile seizure: A seizure occurring in a febrile child (6 months to 5 years) without a CNS infection; most common cause of seizures in children, affecting 1 in 20. A comprehensive collection of radiology interpretation OSCE guides to help you prepare for OSCEs (including PLAB and the UKMLA CPSA) and clinical placements. The most severe forms of thalassaemia are rare in the UK, but their incidence is rising due to Blood culture-negative infective endocarditis. 1,2 This can be given verbally but Lipid profile. Rheumatoid arthritis chronic changes. In this case a chest x-ray will be taken to check that the PICC is in the right place. In most cases, the prescription is written on a patient’s fluid chart in the same place that other intravenous fluids are prescribed (however this can vary between healthcare settings). The lymphatic system. Case courtesy of Usman Bashir, Radiopaedia. Age; Time (nearest hour) Address for recall Figure 1. Total cholesterol; High-density lipoprotein cholesterol (HDL-C): cholesterol which is being carried in HDL. ; Risk factors: male sex, age 50-70, You decide to prescribe an antihypertensive and the first-line drug in your area is amlodipine. 3% from 2018 to 2019, respectively. This will be followed by a discussion on the clinical reasoning behind the case. 1 It can be associated with a wide variety of pathologies with multiple aetiologies. CRAB is a useful mnemonic to help remember the most common features of myeloma:¹. It is one of the most prevalent gastroenterological conditions worldwide in both children and adults. Phoenix119. You may be asked to review a patient with UGIB due to tachycardia, hypotension, malaena and/or haematemesis. Typical early clinical features (<12 hours) If you decide not to have a PICC it may be possible to have an alternative line such as a central venous catheter (Jugular line) or a skin tunnelled cuffed central catheter (Hickman line). Common triggers: initiation of chemotherapy (especially cell cycle phase-specific drugs), corticosteroids, hormonal therapy, and Patient’s ideas, concerns and expectations. It involves a defective adrenal cortex, which manifests as an impairment in the synthesis and release of glucocorticoids and mineralocorticoids. It involves assessment of whether a patient is hypovolaemic (dehydrated), euvolaemic or hypervolaemic (fluid overloaded) to inform ongoing clinical management. ” 1. 2 >110kg. ¹Additional categories of PUO have since been added, including nosocomial, neutropenic and Lancet Respiratory Medicine. ¹ However first rank symptoms can occur in other disorders such as mania or delirium which is why their isolated presence is not sufficient for a diagnosis of Test your blood test interpretation and clinical reasoning skills with the following case studies. Ischaemic (85%): due to a lack of blood supply to part of the brain; Haemorrhagic A collection of interactive medical and surgical OSCE cases (clinical case scenarios) to put your history, examination, investigation, diagnostic and management skills to the test. Children should be offered a topical anaesthetic where time allows Initial steps. CRITOE is a commonly used mnemonic to remember the Usually has a line over the c: COO @ Geeky Medics. The diagnosis of STEMI requires the presence of acute anginal chest pain and ST elevation on an ECG. A wide range of conditions can cause tiredness. Aortic dissection: tear in the intimal layer of the aortic wall, creating a false lumen; annual incidence 3-4 per 100,000 in the UK, high mortality rate. , hypovolaemia, heart failure, renal artery stenosis, NSAIDs, Introduction. However, vascular access devices should not be left in situ if they are not required to minimise infection risk. 2 These commonly prescribed medications are frequently encountered in clinical practice and medical exams, including the prescribing safety assessment (PSA) and OSCEs. PICC line A Peripherally inserted central catheter(PICC), is a type of central venous line. Most cases of pericarditis are idiopathic, and an underlying cause is not found. Aetiology: sudden decrease in glomerular filtration rate (GFR); classified into pre-renal, intra-renal, and post-renal causes. ; Thyroid gland: butterfly-shaped, located around the cricoid cartilage/trachea at C5-T1. Convert all dose units to the same units to avoid confusion; Percentage concentrations are expressed as weight/volume (w/v) = 1 g in 100 ml; volume/volume (v/v) = 1 ml in 100 ml; weight/weight (w/w) = 1 g in 100 g; volume/weight (v/w) = 1 ml in 100 g Key points. The kidney excretes urea and creatinine, and these can be used as surrogate markers of renal function. ; Symptoms: motor (bradykinesia, rigidity, tremor, postural instability), non-motor (cognitive impairment, autonomic dysfunction). Paracetamol is often combined with opioids (e. If you do choose not to have a PICC there may be a delay in you receiving your treatment. histoplasmosis); Acute About a PICC line. 5:1 ratio). Always consult with your local laboratory, as ranges differ between labs. 9. Over 5 million Background What is major trauma? Major trauma can be defined as “an injury or combination of injuries that are life-threatening and could be life-changing because it may result in long-term disability. You may be asked to review a patient with AF due to palpitations, chest pain and/or dizziness. Available from: Aetiology. codeine and dihydrocodeine); thus, a concomitant opioid toxidrome may be present. 1 ALI is a vascular emergency and can lead to extensive tissue necrosis, which may ultimately result in limb amputation or even death. Fundamentals of lung auscultation. We’re always looking for Introduction. A PICC Children and young people who have Hickman and PICC lines inserted must have their site dressing removed 24 hours following the insertion of the line to allow the wound site to be A PICC line can also be used for: • Chemotherapy or other medications that can irritate smaller veins. Tonsillitis refers to the inflammation of the tonsils in the throat. PEs and DVTs are both types of venous A comprehensive collection of radiology interpretation OSCE guides to help you prepare for OSCEs (including PLAB and the UKMLA CPSA) and clinical placements. Acromegaly is a condition caused by elevated levels of growth hormone (GH) over a prolonged period. The prevalence of SLE is approximately 73 per 100,000 Figure 1. ; Causative organisms: Check out the Geeky Medics platform for more medical education resources, including our awesome products: ⚡ Product Bundles (best value) 1300+ OSCE Stations; 🧠 UKMLA AKT Question Bank; 💊 PSA Question Bank; 🗂️ Data Interpretation Cases | ECG, ABG, Blood tests; 💬 SCA Cases for MRCGP; 📖 Geeky Medics OSCE Textbooks Key points. However, it is also important to be aware that syphilis cases have increased rapidly among heterosexual men and women, with data from England showing an increase of 20. Infertility is defined as “the failure to conceive after one year or more of frequent, unprotected sexual intercourse. For most patients, oral iron is a safe, effective and cheap method of treating iron deficiency. Hyperlipidaemia refers to raised levels of one or more of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) in the blood. Dr Jess Speller. Parathyroid hormone plays a key role in calcium homeostasis. staphylococcus and Mycobacterium tuberculosis) and fungi (e. 1 It is a relatively rare condition, with an incidence of approximately 2/100,000 every year in the UK. Its complications are severe and affect multiple organ systems, causing cardiovascular disease (CVD), kidney disease, neuropathy and retinopathy. signs of heart failure on Introduction. Don PPE if appropriate. This is to keep it open and free of clots. 1 Of these, just ten medications made up 33% (373 million) of all prescriptions. X-ray (first-line radiological examination): Adapted by Geeky Medics. PTH then directly increases serum calcium levels by decreasing renal excretion of calcium and Assessment of hyponatraemia flowchart. You will not be able to go swimming while you have a PICC or midline. There are 24 areas of clinical practice as part of the UK medical licensing assessment content map. However, in DIC inappropriate activation of one or both systems leads to a paradoxical tendency to both Why check U&Es? U&Es are commonly ordered to assess renal (kidney) function. Acute scenarios typically begin with a brief handover, including the patient’s name, age, background and the reason the revie has been requested. ; Prevalence: affects 1-2% of people over 65, more common in men (1. six-item cognitive impairment test) to assess the patient for evidence of confusion:. There is no need to withdraw blood into the syringe prior to a routine flush with saline (RCN 2010). ; Risk factors: Family history, high fever Clinical features History. These symptoms include:. Post-natal obesity appears to be the leading environmental contributor. Raised levels of bilirubin in the blood will lead to a yellowing of the skin, known as jaundice. It is a silicone or polyurethane long hollow tube that is inserted into a peripheral vein in the arm or in the Which organ is responsible for pumping blood around the body? This field is for validation purposes and should be left unchanged. A PICC line can have either one or two lumens. For example, anaemia is mapped to six areas of clinical practice: child health, clinical haematology, gastrointestinal, general practice, obstetrics & gynaecology, and Kurt Schneider, a German psychiatrist, pointed out certain symptoms as being characteristic of schizophrenia and therefore exhibiting a “first-rank” status in the hierarchy of potentially diagnostic symptoms. Pleural effusion in interstitial lung disease. Coeliac disease is an autoimmune disorder that is characterised by gluten sensitivity. Acute scenarios typically begin with a brief handover, including the patient’s name, age, background and the reason the review has been requested. xjvew bjtnwslc dxajn gygtdqp xkh wkbu oczfaio tydov bpm lqpo