3rd Year Osce Stations 1k453i

Part B OSCE 3rd year paper July 2002 1. CVS examination 2. RS examination 3. Abdominal examination 4. Sensory examination of the legs 5. Motor examination of the arms 6. Breast examination 7. Eye movements: II, III, IV, VI 8. Opthalmoscopy 9. Diagnosis of type 1 diabetes 10. Informed consent: gastroscopy 11: risk factors of CHD 12. Post-MI Rx 13. Inhaler use 14. Phlebotomy 15. Blood pressure 16. History of PR bleed 17. History of headache 18. History of weight loss 19. History of haematuria 20. 1 rest station 3 rd Year OSCE stations - 2003 1. History of chest Pain 2. CVS examination 3. Blood Pressure 4. History of Chronic Cough 5. Respiratory Examination 6. History of PR bleed 7. Abdominal examination 8. Risk factors for CHD 9. Urine Testing 10. Lower Abdominal pain 11. Type 1 Diabetes: Non-adherence 12. Breast Examination 13. Opthalmoscopy 14. Loss of conciseness 15. Phlebotomy 16. Diagnosis of Type 2 Diabetes 17. Alcohol intake 18. Sensory examination of the legs 19. Thyrotoxicosis

Year 3 OSCE – 2004 17 stations plus loads of rest stations 1. EXAM – Cardiovascular examination, was normal. JUST the chest (so didn’t need to examine hands, face, neck, etc., just mentioned that I would) 2. EXAM – Abdominal examination – RIF pain – appendicitis. Again, just the abdomen, so not the rest of the examination. Needed to mention guarding, percussion tenderness 3. EXAM – Thyroid examination – Hyperthyroid? Ask patient to drink water while you feel, etc. 4. EXAM – Fundoscopy – need to read words on the various parts inside a model head e.g. upper nasal quadrant, etc. Then you need to be able to identify conditions on pictures you are given 5. EXPLAIN – Patient is being given cardio drugs due to recent MI. You have to tell her the side effects and tell her why she is on them – Aspirin, Atenolol, Simvastatin 6. HISTORY – Man with jaundice, abdo pain. He has high alcohol intake, just had a divorce. Need to ask questions around hepatitis (travel, etc.) and ask the CAGE questions 7. EXPLAIN – Lady with results coming back showing she has Type II diabetes. Need to tell her the result (treat as breaking bad news) and explain the condition and treatment – she gets distressed about it 8. EXPLAIN – Type I diabetic, isn’t adhering to treatment and you need to explore why not. Was a young patient having hypo’s, she doesn’t like taking insulin (stigma) 9. EXAM – Breast examination – make sure you say that you would have a chaperone, make sure you close the curtain behind you, make sure you wash your hands, and feel properly, cause people get distracted thinking about what they are doing! 10. EXAM – Sensory examination of lower limbs – loss of sensation in the feet – diabetes? You get a tray full of LOADS of equipment, so know what to use e.g. right size of tuning fork, cause you get 3 different sizes 11. HISTORY – Old lady having blackouts, LOC. On antihypertensives - thiazide diuretics. Need to ask about the blackouts. She was standing at bus-stop on a hot day. Diagnosis was vasovagal attack, need to know the types 12. HISTORY – Haemoptysis – smoker. Mother had lung cancer. 13. HISTORY – Haematuria. Old man, mixed in, throughout the stream, everyday, no pain 14. EXPLAIN – Asthma – woman who is on inhalers and not taking them properly. Adherance issues. Stigma issues. 15. EXAM – blood pressure – dual stethoscope so examiner can hear too. Different cuffs, so need to pick the right one. A lot of people had problems with tubes getting twisted. Ask patient if they have, in the last 30mins: had coffee, had a smoke, done excersice 16. HISTORY – abdo pain, RIF, anorexia, nausea, constipation – appendicitis, but know the differentials 17. EXAM – venepuncture – straight forward

Year 3 OSCE 2005 Data Int: 1) Thyroid results 2) Full blood count interpretation 3) Acid base balance 4) U and E’s and urine dipstick interpretation 5) Breast specimen 6) Infective endocarditis- gram stain of organism and treatment 7) Gastroenteritis- gram stain and treatment and cause 8) ECG 9) Paracetomal curve 10) CXR 11) Peak Flow 12) Cranial nerve pictures 13) Visual field defects 14) Macroanatomy of the heart- hypertrophic obstructive cardiomyopathy 15) Typical antibiotics u’d give, e.g. cellulites, gastroenteritis, pneumonia OSCE 10 mins: - Explaining drugs to a lady with cardiac failure- ACE inhib, B blocker, Spironolactone and frusemide - Talking to a type 1 diabetic about her glycaemic control - Telling a type 2 diabetic that she has diabetes - Cardiovascular examination - Lower limb neuro sensory and motor - Abdominal examination 5 mins: - Breast examination - History abdo pain - Consent - Fundoscopy- alien heads and different pictures - Venepuncture - Headache history - Washing your hands - Haemoptysis history

Year 3 OSCE (2006) Cardiovascular exam – Usual stuff! There wasn’t any pathology for my one (that I know of! Hehe) Drug history – explain to patient what each drug does (I think it was an ACE-I, betablocker, calcium channel blocker & diuretic….possibly antidiabteic drug (cant fully) (so make sure u know the names of these drugs – e.g. propanol etc)…..know the side effects. Patient will say they forget to take doses so u hav 2 give advice on how to rember – e.g. keep a calander/alarm or sumthing (make it up!) Don’t scare the patient with side effects!! Hehe! I think one of the drugs gives postural hypo…so explain that they advise you to take it at night to avoid falling over from becoming dizzy… coz she may say she just finds it easier to take them all in one go! Respiratory examination Again…usual stuff! But examiner did ask me if I knew what the normal peak flow for the patient should be….so try to have a vague idea about that (don’t forget to take into consideration the sex of patient) Explanation of type 2 diabetes Here u have the results of the patient blood test which suggest she has diabetes. So just explain what glucose, insulin is. Don’t get too detailed. Keep it basics. Don’t scare them too much with longterm complications but stress importance of lifestyle…eg. Diet, exercise etc. stop smoking etc. Important to avoid cardiovascular complications etc. And don’t forget to ask patient if they have any questions because ‘it will be a lot for the patient to take in’ so be sympathetic …blah blah…you know the drill! Hehe! Abdominal examination (RUQ) For this my patient had right iliac fossa pain….so do normal exam….usual stuff….rember to start palpation away from pain first….try to elicit guarding, rebound tenderness etc…..then sugest possible differentials at the end….acute chloysystitis (so do murphy’s sign…that’s what I got anyway!), appendicitis etc…. Neuro examination of lower limb Usual stuff! I cant actually if there was a pathology in my one! Sorry! But just make sure u know dermatomes etc….dont forget reflexes! And do to 2types of sensation..wich would be light touch n vibration…(you can offer to do pin prick if you want…just to look keen! Hehe)…..they might ask questions….so just know about upper and lower motor neurone signs…….I couldn’t get one of the reflexes but the paitent was obviously well so the examiner asked why I think she doesn’t have a reflex and I was just honest and said its probably wrong technique! And she was happy about it! So don’t worry if u cant get it just as long as you know that just because you cant get it doesn’t mean something is wrong with patient! Hehe! Cranial nerves For this he only asked me to test neves 5 and 7 (I think that’s what they usually ask neway…easiest ones 2 examine realy for them)….but dont forget to do sensation for trigeminal. And mention that the 7th nerve also has supply to tongue (I think its posterior 3rd…but double check that)…..

History of haemoptysis Ask usual questions you have to…..I cant rember them! Hee! Sorry! But read up! So usual….duration, timing, volume, fresh blood? Etc….Family history…smoking, Shortness of breath etc…..My ones wife had apparently died of lung cancer so they want to see you sympathise too! Breast examination This was the plastic model thing strapped onto a woman! (don’t laugh! Hehe) so usual exam….they will ask if u found anything….where, describe…what do you think it is…etc….Dont forget to do axilla check..but for me he stopped me before I did coz I think they just wanted u to say you will do it….but I suggest you attempt to do it anyway…if they say don’t then just stop! Obviously don’t forget about the dignity of patient…so cover up wen needed ,ask them to undress etc….tell them they can get dressed after you are done Otoscopy This will be a model. Hold the stupid otoscope properly! My model had a grommet inside…so tell them what you see. Decribe the tympanic membrane, can you see the other stursctures, light reflex etc….Then they will show you 5 pics and ask you what they are…One was on anatomy …so know where the malleous, light reflex etc is…. History of chest pain Usual stuff….Ask about risk factors…smoking, family history, assoc things like S.O.B, cough etc...SOCRATES, have they tried anything….(I cant actually this station!! Hehe! But it was there!) Blood pressure Pick the right cuff! It wont be connected to the thing so you have to connect it yourself…explain what you are gonna do….check for radial pulse….u know the rest! Tell them what the reading was….If it was hig or low they may ask why…so just think of a few reasons! But if the patient seems well…then maybe its ‘whitecoat’ if its high and if its low, it just mean they are athletes or sumthing Ophthalmoscopy Again like otoscopy…was a model….hold the thing properly…do both eyes unless they say otherwise…tell them you are testing red reflex coz I don’t think you can see on dummy! There will be words written inside in the different quadrants so tell them what they are…so learn the quadrants and know the technique! Coz you have to see the words to tell them!!! Then they will so some fotos…so make sure you know the diabetic eye and hypertensive eye…and don’t forget there are different stages for these and you have to know them! (I cant them! Sorry! But read them up) and make sure you have seen them before in pics Informed consent to clerk a patient This was a stubborn ass patient who didn’t want med students talking to him!! (I hated hiM!! Grrr! Hehe) But anyway…main thing remain calm,.,,xplain its for teaching etc….he’ll say stuff like my daughter is coming in abit and I don’t wan to miss her and stuff…so you can just say I wont b long or I’ll come back or we can stop when she can or whatever. I didn’t do too well on this so I’m not best person to ask! But I think main thing is how you tackle it. Don’t worry if you don’t get the consent. That’s not what they want. They just want to see how you handle it.

Phlebotomy Obvisouly on a dummy arm. Gloves on. Wipe area. Yournique on (don’t forget that) and don’t forget to take it off a ryt time. Dispose need properly….mention that you will label bottles etc…don’t panic if you don’t get the blood…it’s the technique they want….offer to do it again if you don’t get it first time. Alcohol history I’m actually not sure what they wanted from us in this one. We just get a results sheet suggesting his alcohol marker is high (LFT) and we’re supposed to talk to him about it. I think you have to ask about quantity and how frequently and if he has stresses and stuff. Try to pick up on some social stuff. I think that’s what they want. Hand washing Just learn the technique!! You have to do in the sink and also with the alcorub! I have no idea what the difference is in technique in both so I did the full technique for both. And with the alcorub don’t forget to say that you are sterile/ready to use once its dry! With the tap…don’t forget to wipe with paper towel after and dispose of it etc….use elbows to close tap etc…

2006 OSCEs 10 minute stations (4 rest stations) • • • • • •

Abdo examination Cardio examination Resp examination Motor and Sensory examination of the lower limbs Type II diabetes explanation Heart failure drugs explain

5 minute stations • • • • • • • • • •

history – heamoptsis history – abdo, alcoholic man, recently divorced history – chest pain consent phlebotomy otoscope Fundoscopy blood pressure breast examination cranial nerve examination – V and VII

• hand washing