OSCE 1

Question 1

Give a checklist of things you should ask in a history of jaundice.

Answer 1

1. Appetite and weight change.
2. Abdominal pain, altered bowel habit.
3. GI bleeding.
4. Pruritis, dark urine, rigors.
5. Drug and alcohol history.
6. PMH e.g. pancreatitis, biliary surgery.
7. Previous jaundice or hepatitis.
8. Blood transfusions.
9. Family history.
10. Sexual history.
11. Travel history and immunisations.
12. Skin tattooing.

Question 2

Describe the steps for a full abdominal examination.

Answer 2

1. Wash hands.
2. Introduction, explanation and consent.
3. End of bed inspection.
4. Hand inspection.
5. Liver flap inspection.
6. Pulse.
7. Head inspection.
8. Lymph node exam.
9. Examine legs.
10. Position patient supine and expose.
11. Warm up hands and ask if patient is in any pain.
12. Abdomen inspection.
13. Superficial and deep palpation (looking at patient’s face).
14. Liver and spleen edge.
15. Roll onto right side and look for spleen edge.
16. Bullot kidneys.
17. Percuss liver and spleen.
18. Perform shifting dullness test.
19. Auscultate.
20. Hernia and PR.
21. Thank and discuss findings.
22. Wash hands.

Question 3

How would you know if a patient’s airway is patent?

Answer 3

If they are speaking it is patent.

Question 4

What would you do if a patient’s airway is not patent?

Answer 4

Consider suction, head tilt chin lift, intubation.

Question 5

What do you assess in breathing?

Answer 5

Pulse oximetry, RR, chest exam (tracheal deviation, inspection, expansion, percussion, auscultation), calves.

Question 6

What do you assess in circulation?

Answer 6

Blood pressure, heart rate, cap refill, auscultate (heart), IV access.

Question 7

What would you do to assess disability?

Answer 7

Glucose, temperature, AVPU, pupil reactivity, pain.

Question 8

What would you do for everything else?

Answer 8

Exposure (if necessary but avoid heat loss), focused exam of relevant systems?

Question 9

What would you do if a patient was hypotensive?

Answer 9

Give fluids.

Question 10

What would you do if a patient was hypoxic?

Answer 10

Give 15L/min oxygen through non-rebreather mask.

Question 11

What would you do if a patient was having an asthma attack?

Answer 11

Give nebulised salbutamol.

Question 12

At what stage would you give analgesia?

Answer 12

D.

Question 13

Describe the stages of a cardiovascular exam.

Answer 13

1. Wash hands.
2. Introduction, explanation, consent.
3. End of bed inspection.
4. Inspect hands.
5. Feel radial pulse, looking for delay and collapsing pulse.
6. Take blood pressure.
7. Examine head.
8. Examine JVP.
9. Feel carotids.
10. Inspect precordium.
11. Palpate apex beat.
12. Check for thrills and heaves.
13. Auscultate the precordium (whilst feeling carotids).
14. Do manoeuvres.
15. Auscultate carotids.
16. Inspect lower limbs.
17. Check temp, cap refill time, between toes, under limbs.
18. Palpate pulses.
19. Oedema test.
20. Buerger’s test.
21. Thank patient and explain findings.
22. Wash hands.

Question 14

Describe the stages of a respiratory exam.

Answer 14

1. Wash hands.
2. Introduce, explain, consent.
3. End of bed inspection.
4. Check hands.
5. CO2 flap and B-agonist tremor.
6. Take pulse and resp rate.
7. Examine face.
8. JVP.
9. Lymph nodes.
10. Inspect chest.
11. Palpate trachea and do frontal chest expanion.
12. Percuss and auscultate front.
13. Do back chest expansion.
14. Percuss and auscultate back and sides.
15. Check legs.
16. Thank and discuss findings.
17. Wash hands.