year 1 osce
TRANSCRIPT
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OSCE REVISION SESSION
1st
Year 2009
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OSCE 101SMILE!
Introduce yourself
Ask for consent
Hi! My name is Georgia and I'm a first year medical student from Monash University the GP
has just asked me to ask you a few questions about why you've come in today is that ok?
Speak loudly you'll seem confident!But not too loudly yelling = intimidating
Also have your barcode sticker ready to hand to the examiner -
They'll say/think something like Wow what a prepared and organised student
Even if you have never heard of the procedure you're being asked to perform...
AppearingOrganised = Good First Impression = Good Mark!
Wash your hands or wear gloves!
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General HistoryMy PCL tutor told me last week - All you need to be able to do as an intern is
take a good history
So essentially, this is one of the most important skills you will learn in your
medical career make sure you can do it well!
It's very simple make sure you can do it in your sleep!
PresentingComplaint
W W Q Q A A B
Family History
Social History
Past Medical History
Include Alcohol, Smoking, Illicit Drugs
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CPR
You have entered the room to find Jennifer is
unconscious on the floor.
Task:
Please commence immediate management
including assessment and resuscitation of this
patient, with verbal explanation of each step.
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CPR
D
R
A B
C
D
Put gloves on!
anger
esponseNo Response CALL AN
AMBULANCE
irway
reathing
ompressions
efibrillation
This station requires interaction with the examiner.
Consent??
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General MSExam
Joe Peters, aged 23, comes to see the doctor because he is worried
about his left shoulder. Joe has noticed that sometimes throwing a
baseball is painful. There has beenno recent injury. He plays baseball
every weekend and has recently increased his training.
You are a medical student at your General Practice placement, you
have been sitting in with the GP. The GP has asked you to examine
Joes shoulder.
Task:
Please examine Joes LEFT shoulder and explain
your findings to the patient.
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MSExam
ASK
- Consent
- Current Pain
- If anything is
uncomfortable orhurting
- To remove shirt
LOOK
-Contour and
posture
-Skin
-Swelling
-Muscle bulk
-Compare with
other side
FEEL
Tenderness
Swelling
Bony landmarks
Joints
MOVE
- Passive First
- Flexion
- Extension
- Internal Rotation
- External Rotation
- Abduction
- Adduction
- Compare both
sides
- Active movement
TEST
-Special tests
specific to joint:
- Shoulder:
Painful ArcEmpty can
Winged scapula
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GENERALMS TIPS
- Ask patient to tell you if there's any pain
- Always do passive movement FIRST
- Have patient take their shirt off (if applicable)
- Test BOTH limbs to compare
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Not just Theme IV:
- anatomy
- risk factors
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MSE
Francis Smith is a 22 year old found wanderingnaked outside the local shopping centre last night. He/she
was initially highly agitated but is now more settled however still refuses to say much. Francis lives locally
and there is no record ofprevious contact with the hospital.
Please interview Francis, focusing on the history of the presenting complaint and conduct a Mental State
Examination. You are not required to conduct comprehensive cognitive testingOR a COMPLETEMini
Mental State Examination. You are not required to comment on insight orjudgment.
After 5 12 minutes you will be asked to present your mental State Examination findings to the examiner.
Tasks:
1. Take a BRIEF history of the presenting complaint.
2. Perform a relevant Mental State Examination.
3. Briefly present your Mental State Examination findings to
the examiner.
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MSE
A B S M A T P C
Appearance
- clothing
- gate- posture
Behaviour
- body language
- social appropriateness
SpeechLanguage
Clarity how clearly
Quantity how muchStyle the way they speak
Mood
Lasting, pervasive state
'Like the climate
Ascertained by what the person says
AffectCurrent state, changes and shifts around
'Like the weather
Observable
Considered by: quality, range, reactivity, modulation,
appropriateness
Thought
Stream ascertained through speech. Pressured,
slow.
Form Words, sentences, paragraphs etc. Flightof ideas, formal thought disorder.
Content phobias, obsessions, compulsions,
delusions etc.
Thought alienation not perceived as ones own
thoughts.
PerceptionHallucinations
Illusions
Misinterpretations
Passivity phenomena (something is being forced
upon the person by an external agent).
Disordered self-awareness (depersonalisation)
CognitionEg orientation to
time and place
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BP
Ear exam
Eye exam (these 2 will be a bit limited without proper
equipment...)
MSBack and spine
MSShoulder, elbow and wrist
MS Hip, knee and foot
Neuro upper limb
Neuro lower limb (these 2 could be combined as there is a lot of
overlap?)
General motor/sensory exam
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