OSCE

Question 1

Deppression Questions

Answer 1

• Motivation
• concentration
• sleep
• appetite
• mood out of 10

Question 2

Falls History

Answer 2

Important

• Ask about previous falls (>2 in the previous year = significant)

Circumstances

• Before
• During
• After

Systems review

• vision
• cognition
• continence

Risk Factors

Intrinsic

• female gender
• neurological disease
• cognitive decline
• visual deficit
• muscle weakness

Extrinsic

• polyppharmacy
• bifocals
• waling aids
• footwear
• home hazards

Question 3

Gait History

Answer 3

• pain
• symptoms related to balance/vision
• chrnology and time cause of gait decline
• history of falls in the last 6 months and mechanism
• history of fractures
• past history of meurological and MSK disorders including orthopaedic procedures
• full medication review
• impact of function and ADL
• uisual level of physical functioning
• review of comorbidities and their impact on gait
• assessment of fear of falling

Question 4

Dizziness history

Answer 4

Is it:

• Vertigo (illusion of movement)
• presynchope (lightheadedness)
• disequilibrium (unsteadiness)
• psychogenic (eg anxiety related)
• mixed (more common in elderly)

Key components of history

• onset (acute, intermittent or chronic)
• timecourse
• exacervationg factors (possition, rolling in bed, standinjg up, activity)
• relieving factors
• history of head trauma/surgery
• history of migraine or other neurological diagnosis
• associated brainstem symptoms (vommiting/blurred vision)
• associated otological symtpms (tinnitus, hearing loss)
• stroke risk factors
• medication history

Question 5

Syncope History

Answer 5

• age
• precipitants, positions (lying, standing), and activity at time of event
• prodromal symptoms such as nausea, pallor and light headedness
• collateral history from eye witness about duration of event or associated movements (myoclonus, seizure avtivity)
• past medical history
• family history of sudden death or fainting
• drug history ( antihyertensives, antiarythmics, druggs afffecting QT interval)

Question 6

Syncope Exam

Answer 6

• cardiac examination - pulse reate and rhythm and murmurs
• neurological examination - usually normal
• physical geatures of associated diseaes (eg parkinsons)
• lying and standing BP

Question 7

syncope investigations

Answer 7

• basic bloods checking for anaemia, dehydration
• ecg: baseline rhythm, rate, qrs morphology, qt interval, axis
• 2hr ecg monitoring : arythmia, cardiac slowin gor paus and av conduction defects

diagnosis uncertain?

• echocardiography - structural hear disease
• implantable loop recorder - subcutaneous arrhythmia monitoring
• exercise stress
• cardiac catheterisation
• head tilt table test and carotid sinus