OSCE

Question 1

Before each OSCE station, what do you do?

Answer 1

1. Wash hands
2. Introduce yourself
3. Confirm name + DOB of patient
4. Consent

Question 2

What is part of a general examination?

Answer 2

1. Inspect bed for clues
2. General appearance (well/ill, conscious/unconscious)
3. Vital signs - HR, RR, sats, BP, temp, glucose, GCS
4. Colour (pallor, cyanosis, jaundice)
5. Fluid status
6. Nutritional status
7. Lymph nodes
8. Hands and nails
9. Tongue and eyes
10. Skin

Question 3

What must be asked before each history/examination?

Answer 3

What they want to be called

Question 4

What must be asked before any examination?

Answer 4

Are you in any pain?

Question 5

How to present in OSCEs?

Answer 5

I would complete my examination by examining X, Y, Z.

In summary, today I exmained Mr/Ms X’s Y system.
-Major findings
-Additional findings - important positive and relevant negative
-Differentials

Further investigations

Question 6

How to exacerbate AS?

Answer 6

Carotids while holding breath

Question 7

How to exacerbate AR?

Answer 7

Forward, expirate, left 4th space.

Question 8

How to exacerbate MS?

Answer 8

45 degrees rolled left, apex.

Question 9

How to exacerbate MR?

Answer 9

Left axilla.

Question 10

What is part of the optic nerve examination?

Answer 10

1. Visual acuity → Cover each eye, hold up fingers.
2. Visual fields → Sit 1m from patient, cover an eye and move hands from each (repeat on each eye)
3. Inattention → Hold hands in patient’s periphery, maintaining eye contact. Move hands separately then together and ask them which moves.
4. Light reflexes → Each pupil, then consensual reflexes, then swinging light.
5. Accommodation → Focus on distance then your finger 30cm from their nose.

Question 11

GALS examination - initial Qs?

Answer 11

• Any pain or stiffness in your joints, muscles or back?
• Can you completely dress and undress yourself without any difficutly?
• Can you walk up and down the stairs without any difficulty?

Question 12

Murphy’s sign?

Answer 12

Palpate costal margin as they breathe out then breathe in (pain is positive)

Question 13

GI exam - what to offer?

Answer 13

ISHRUG (inguinal lymph nodes, stool sample, hernias, rectal examination, urinalysis and genitalia examination)

Question 14

Trendelenburg’s test?

Answer 14

Hip examination:

Hands on both ASIS, get patient to stand on one leg, then the other one leg.

Question 15

Thomas’ test?

Answer 15

Hip exam:

Supine on bed. Hand under lumbar spine and flex hip fully.

Positive - Contralateral leg raises off bed if positive.

Question 16

McMurray’s test?

Answer 16

Knee exam:

Flex hip to 90 degree and maximally flex knee. Externally rotate knee while extending (then internally rotate)

Question 17

Lachman’s test?

Answer 17

Knee exam:

Flex knee to 20 degrees, put one hand under tibia with thumb of tibial tuberosity and other hand on thigh then pull anteriorly on tibia

Question 18

MRC grading of motor power?

Answer 18

• 0/5 - No muscle contraction.
• 1/5 - Flicker of contraction, no movement.
• 2/5 - Contraction with active movement only when gravity is eliminated.
• 3/5 - Movement against gravity only without applied resistance.
• 4+ - Indicate reduced power but presence of movement against slight, moderate and strong resistance.
• 4/5 - Movement against gravity with reduced power against resistance.
• 5/5 - Movement against gravity with full power against resistance.

Question 19

How to assess capacity?

Answer 19

1. Able to understand verbal/written information needed to make the decision?
2. Are they able to retain this information long enough to make this decision?
3. Are they able to weigh up the pros and cons of a decision?
4. Are they able to communicate their decision?

Question 20

Obs/gynae history?

Answer 20

MOCCP:

1. Menstrual history → Duration, frequency, volume, pain, date of last period, age of menarche, menopause?
2. Obstetric history → G+P, previous pregnancies (age, weight, delivery, complications)
3. Contraception → Type + previous use
4. Cervical screening → Up to date? Last date? Any abnormal?
5. Past gynaecological history → Gynaecological conditions/surgery, HRT?