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OSCEs Flashcards

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1
Q

What is the overall order of a respiratory exam?

A
  1. WINDEC
  2. Observe from bed
  3. Inspection of hands
  4. Check for asterixis
  5. Pulse rate & rythm
  6. Resp rate
  7. Face exam
  8. Visual inspection of thorax
  9. Palpation
  10. Auscultation - breath sounds and vocal resonance
  11. Ankle swelling
  12. Hand hygeine
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2
Q

What 4 things are you looking in a hand inspection for a respiratory exam?

A
  1. Smoking
  2. Clubbing
  3. Cyanosis
  4. Asterixis
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3
Q

What are you looking for in the face duirng a respiratory exam?

A

Conjunctiva pallor: anaemia
Cyanosis, inspect lips and tongue

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4
Q

What 3 things are you looking for in the respiratory visual inspection?

A
  1. Thorax shape, symmetry and deformities
  2. Scars on chest and armpits
  3. Observe expansion
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5
Q

In a respiratory exam what 4 things are you palpating for?

A
  1. Position of trachea
  2. Measurement of crico-sternal distance
  3. Tracheal tug
  4. Expansion of chest from behind
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6
Q

Where are you percussing in a respiratory exam?

A
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7
Q

Where are you ausciltating for a respiratory exam?

A
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8
Q

What do you do when percussing/ausciltating the back in a respiratory exam?

A

Ask the patient to cross their arms and place hands on shoulders

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9
Q

What is the overall order of an upper neuro exam?

A
  1. WINDEC
  2. Limb Visual Inspection
  3. Tone
  4. Power
  5. Reflexs
  6. Sensation
  7. Coordination
  8. Hand hygeine again
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10
Q

In an upper neuro exam what are you looking for in initial inspection? Hint anacronym

A

PSWIFT

  • Pronator drift
  • Scars
  • Wasting
  • Involutary movements
  • Fasiculations
  • Tremors
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11
Q

In an upper neuro exam how do you assess for tone?

A

Ask to floppy and check for tone in the elbow and wrists

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12
Q

In an upper neuro exam what are you testing for with power?

A
  • Shoulder abduction/aduction
  • Elbow extension/ flexion
  • Wrist flexion/ extension
  • Finger extension/ flexion
  • Finger abduction
  • Thumb abduction
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13
Q

In an upper neuro exam what reflexs are you testing for?

A

Biceps, triceps and supernator

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14
Q

In upper neuro exam how do you test for coordination/ proprioception

A
  1. Move thumb and down, ask them to confirm position with their eyes closed
  2. Finger - nose - finger test
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15
Q

General order of a lower neuro exam?

A
  1. WINDEC
  2. Inspection
  3. Tone
  4. Power
  5. Reflexs
  6. Sensation
  7. Coordination
  8. Joint position
  9. Gait
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16
Q

In a lower neuro exam what are you looking for inspection wise?

A

SWIFT

  • Scars
  • Wasting
  • Involuntary movements
  • Fasiculations
  • Tremor
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17
Q

In a lower limb neuro examination how do you assess tone?

A

Ask to relax legs while sitting

  1. Roll hips
  2. Lift knees
  3. Test for ankle clonus
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18
Q

What do you test for power in a lower neuro exam?

A
  1. Hip flexion/ extension
  2. Knee flexion/ extension
  3. Ankle plantar/dorsi flexion
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19
Q

How do you test reflexes in a lower limb neuro examination?

A
  • Knee - classic doctor reflex
  • Ankle - tap achilles tendon and look for gastrocnemius contraction
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20
Q

Where do you test for sesation in a lower limb neuro examination?

A
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21
Q

What do you test for coordination/ proprioception in a lower limb neuro exam?

A
  1. Heel shin test, bring heel to knee and run down the shin
  2. Big toe joint position
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22
Q

How do you test gait in an upper neuro exam?

A

Get patient to walk in a line normally

Then walk in a line heel to toe

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23
Q

What is the overall order of a CV examination?

A
  1. WINDEC
  2. Bed inspection
  3. Hand inspection
  4. Pulse and rythm
  5. Blood presure
  6. Inspection of face
  7. JVP
  8. Inspection of pericardium and auxilla for scars
  9. Palpation
  10. Ascultation
  11. Asculation for bruits over carotid arteries
  12. Asculation of lung bases
  13. Inspection of legs
  14. Hand hygeine
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24
Q

In a CV exam what are you looking for in the hands?

A
  1. Tobacco staining
  2. Pallor
  3. Clubbing
  4. Sign’s of endocarditis - janeway lesions & osler’s nodes, splinter hemorrhages
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25
What does a janeway lesion look like?
26
What do osler's nodes look like?
27
What is the difference between janeway lesions and olser's nodes?
Both are violet hemhorragic lesions found on the palms, finger pads and soles of feet and signs of infective endocarditis. Difference it that olser's nodes are tender while janeway lesions are often painless
28
In a CV exam what things are you looking for in the face inspection?
1. Cyanosis - mouth and lips 2. Xanthelasma 3. Corneal arcus
29
What is xanthelasma and corneal arcus a sign of?
Lipid build up
30
What does a splinter hemorrhage look like?
31
How do you check for JVP?
Ask to lie at 45 degrees and look away from you. Look in right side. Check if they have pain in stomach, then press on right abdomen and see if it raises.
32
What do you palpate for in a CV exam?
1. Apex beat 2. Heaves 3. Thrills in 4 areas
33
Where do you feel for the apex beat?
5th intercostal space and mid clavicular line
34
How do you feel for heaves over the ventricle?
35
How do you feel for thrills?
Push fingers into these spots over each valve
36
Where do you ausciltate in a CV exam?
Over each heart valve Feel carotid pulse for assistance
37
What are carotid bruits sound like and what are they a sign of?
Sound like whistles It implies turbulant flow Sign of occlusion
38
What are the overall step for a GI examination?
1. WINDEC 2. General inspection of patient and surroundings 3. Hand inspection 4. Face inspection 5. Chest inspection 6. Abdomen inspection 7. Palpation of abdomen 8. Bounce the kidneys 9. Feel for liver 10. Palpate for spleen 11. Purcuss for borders of liver 12. Listen for bowel sounds 13. Wash hands
39
In a GI exam what are you looking for in the intial bedside inspection?
1. Demenor 2. Colour 3. Nutritional state 4. Bruising 5. Scratch marks 6. Medical appliances
40
In a GI exam what are oyu looking for in the hands?
1. Clubbing 2. Leuchonychia 3. Palmar erythema 4. Dupuyten's contractures 5. Asterixis
41
What does leuchonychia look like? What is it a sign of?
Can be many things including simple things like nail bed trauma. But it idicative of several GI problems such a liver disease or kidney disease
42
What does palmar erythema look like? What is it a sign of?
Red palms Sign of liver disease
43
What do dupuytren's contractures look like? What are they a sign of?
Thickening of skin, forms a chord and eventually causes contraction of fingers Not really sure, GI wise could be live disease as a risk factor
44
What are you looking for when examining the face in a GI exam?
1. Check eyes for jaundice (sclera), and aneamia (conjunctiva) 2. Check mouth for ulcers and perioral pigmentation
45
What does the sclera of the eye look like in jaundice?
46
What does the conjuntiva of the eyes look like in aneamia?
A is normal B is aneamic Looks pale
47
What does perioral pigmentation look like? What is it a sign of?
Vitamin deficiencies Endocrine - addisons and diabetes
48
In a GI exam what are you looking for in the chest?
1. Spider naevi 2. Gynaecomastia
49
What do spider naevi look like? What are they a sign of?
Can be benign but can be associated with liver disease
50
What does gynaecomastia look like? What is it a sign of?
Enlarged breast tissue in males. Sign of endocrine disorder
51
How do you palpate the abdomen in a GI exam?
First ask if there is any pain. Start away form the area of pain. Lightly palpate 9 areas and look for softness, tenderness or masses. Then deeply palpate 9 areas
52
How do you palpate for the liver?
Ask to breath in and move in at the same time, feel for edge to catch you hand as they breath out. Repeat as you get closer to liver position
53
How do you palpate for the spleen?
Same as for liver but on left side
54
What are you looking for in the abdomen visual examination?
1. Scars 2. Stomas 3. Distension 4. Masses 5. Abdominal movement
55
In an upper neuro exam how do you test for sensation?
Ask to close eyes Fine touch first then sharp touch. Each time you touch ask them to confirm if they can feel it. Alternate sides and check each time to make sure it feels the same.
56
In a respiratory exam what does altered vocal resonance tell you?
Increased volume over an area suggests increased tissue density (e.g. consolidation, tumour, lobar collapse). Decreased volume over an area suggests the presence of fluid or air outside of the lung (e.g. pleural effusion, pneumothorax).
57
When observing a chest what is it called of the chest wall is concave?
Pectus Excavatum
58
When observing a chest what is it called of the chest wall is convex?
Pectus Carinatum
59
What covers the breathing part in an OSCE A2E assessment? Think assessment, investigations and management
60
What covers the circulation part in an OSCE A2E assessment? Think assessment, investigations and management
Fluid if low BP Catheter and urine output if sepsis suspected
61
What covers the disability part in an OSCE A2E assessment? Think assessment, investigations and management
62
What covers the exposure part in an OSCE A2E assessment? Think assessment, investigations and management
Wouldn't be expected to know specific antibiotics at this stage
63
In OSCE A2E assessment what do you do in the case of cardiac arrest?
Shout for help, vocalise cardiac arrest. Put out a 2222 call. Ask for a crash trolley. Begin CPR.
64
What extra things do you need to think about at the end of an A2E assessment/
65
/2222 has three sub parts, what are these?
2222 medical emergency 2222 major hemhorhage 2222 cardiac arrest Note if calling a major haemorrhage, make sure to also put out another medical emergency call for more help, as a major haemorrhage only gets you a porter to run to and from the blood bank.
66
In A2E what bloods might you order in common scenarios?
FBC, U&Es, CRP, LFTs Lactate if sepsis. ABG if respiratory Clotting screen and G&S if you think there's some bleeding Blood cultures if you're doing your sepsis 6/ you think infective source Consider troponin and d-dimers if cardiac or clotting involvement is suspected.
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