The Unofficial Guide to Passing OSCEs (Unofficial Guides) - Softcover

Qureshi BM BSc (Hons) MSc MPhil MRCPCH, Zeshan

Softcover

ISBN 10: 0957149905 ISBN 13: 9780957149908

Verlag: UGTM (Unofficial Guide to Medicine), 2020

Inhaltsangabe

OSCE examinations are used worldwide as a critical part of medical student assessment, yet there is often little preparation for them provided by medical schools. The Unofficial Guide to Passing OSCEs is intended to fill this gap. It includes over 100 scenarios, covering medical history taking, clinical examination, practical skills, communication skills, plus specialties, meaning that everything is covered in one place. To bring the cases to life, over 300 full color clinical photos are included, including patients with features of important diseases. It also includes clear outlines of how to relay the assessment of a patient to an examiner or to other doctors on a ward round. This book has relevance beyond examinations, for post graduate further education and as a day-to-day reference for professionals.

Über diesen Titel

Über die Autorin bzw. den Autor

Zeshan Qureshi is a Paediatric Registrar, London Deanery, UK

Auszug. © Genehmigter Nachdruck. Alle Rechte vorbehalten.

The Unofficial Guide to Passing OSCEs

By Zeshan Qureshi

Zeshan Qureshi

Copyright © 2012 Zeshan Qureshi
All rights reserved.

ISBN: 978-0-9571499-0-8

Contents

1. History Taking (Zeshan Qureshi, Seb Gray, Selina Hennedige-Gray), 
2. Clinical Examination (Zeshan Qureshi), 
3. Orthopaedic Examinations (Mark Rodrigues), 
4. Communication Skills (Zeshan Qureshi, Seb Gray, Selina Hennedige-Gray), 
5. Practical Skills (Zeshan Qureshi, Seb Gray, Selina Hennedige-Gray), 
6. Radiology (Mark Rodrigues), 
7. Obstetrics and Gynaecology (Matthew Wood), 
8. Psychiatry (Sabrina Qureshi and Zeshan Qureshi), 
9. Paediatrics (Seb Gray and Zeshan Qureshi), 
10. Prescribing (Mark Rodrigues and Constantinos Parisinos), 
11. Critical Appraisal (Zeshan Qureshi), 
12. Hospital Letters (Zeshan Qureshi), 

CHAPTER 1

History Taking

Some topics are more likely to surface than others are, and many history taking scenarios have not been mentioned here. After completing a year of attachments, the hope is that you will have accumulated enough neuronal connections to cope with any situation thrown at you! When in doubt or under stress, go back to the basics. The simple history taking format and SOCRATES should never be forgotten, and always remember the importance of communication. Maintain good eye contact, ask a mixture of open and closed questions, and you are already halfway there.

For every OSCE station in the finals, remember the following tips:

• Introduce yourself and wash your hands

• Ensure that patient dignity is preserved in the context of the task

• Explain what you are going to do and offer information leaflets, particularly when counselling a patient

• Gain consent

• If you don't know the answer to any question, then admit this, and say you will speak to a colleague and find out the answer

• Thank the patient at the end of the consult

This chapter contains notes on the following histories:

1.1 Cardiovascular History: Chest Pain

1.2 Respiratory History: Productive Cough

1.3 Gastrointestinal (GI) History: Abdominal Pain

1.4 Gastrointestinal (GI) History: Diarrhoea

1.5 Neurological History: Headache

1.6 Vascular History: Intermittent Claudication

1.7 Orthopaedic History: Back Pain

1.8 Haematology History

1.9 Breast History

1.10 Genitourinary Medicine: Sexual History

1.11 Genitourinary Medicine: Vaginal Discharge

Station 1: CARDIOVASCULAR HISTORY: CHEST PAIN

Mrs Jones is a 60 year-old lady who presented with a two-hour history of shortness of breath, central chest pain and sweating. Please take a history from Mrs Jones and then present your findings.

Pain History ('SOCRATES' mnemonic)

• Site: Central/left/right sided chest pain?

• Onset: Sudden or gradual? What was the patient doing when it came on?

• Character: Gripping? Crushing? Tearing? Burning? Cramping? Heavy? Tight?

• Radiation: Up into the jaw and/or down the left arm? Into the right arm? Through to the back?

• Associated Symptoms:

• Shortness of Breath: Orthopnoea, paroxysmal nocturnal dyspnoea. How many pillows do they sleep on? Exercise tolerance: what is their current exercise tolerance? What stops them exercising at that point? What is normal for them?

• Autonomic Symptoms: Nausea, vomiting, sweating

• Palpitations: Were they regular or irregular? Did they start and stop suddenly? Did they precede any chest pain or come after it?

• Pre Syncope and Syncope: Did the patient feel dizzy or light headed? Was their level of consciousness affected?

• Ankle Swelling: Unilateral or bilateral?

• Calf Swelling: Any swelling or rashes noticed in the legs? If so, any pain/redness/tenderness?

• Haemoptysis: May be suggestive of a pulmonary embolism or pneumonia. It is also associated with mitral stenosis, lung cancer, and tuberculosis. Pink frothy sputum is associated with pulmonary oedema

• Sputum: Amount, colour, and frequency

• Trauma: Any recent chest trauma?

• Timing:

• How long does it last? If they have had multiple episodes, are they getting longer in duration or more frequent?

• Exacerbating and Relieving Factors:

• Exercise: Is the pain associated with exercise? What is the relationship?

• Food: Does the pain come after eating large meals, or certain foods? Is the pain relieved by antacids? Associated water brash (hypersalivation often post reflux)?

• Position: Does the pain vary with lying flat/sitting forward?

• GTN: Is the pain relieved by GTN? (angina or oesophageal spasm may be relieved, though for oesophageal pain typically takes considerably longer; i.e. 10 minutes, so also ask how long it took the pain to subside)

• Analgesia: Is the pain relieved by paracetamol/ morphine?

• Is the pain pleuritic?

• Is there any pain on movement or any tenderness on pressing? (suggestive of a musculoskeletal cause)

• Severity: Score out of 10 (with 10 being the worst possible pain and 0 being pain-free). How bad is their pain now? How bad was it at its worst?

Has the patient had anything like this before? If the patient has had a previous heart attack/angina, is this the same type of pain?

Past Medical History

Enquire about the following conditions:

• Myocardial infarction (and any previous cardiac procedures)

• Diabetes mellitus

• Hypercholesterolaemia

• Peripheral vascular disease

• Stroke

• Rheumatic fever

Medication History

• Allergy history including reactions to previous contrast agents. Particularly consider cardiovascular medications such as ACE inhibitors and beta-blockers

Social History

• Smoking status (past, present or never): How many? What? For how long? Then calculate number of pack years (1 pack year = 20 cigarettes/day for 1 year)

• Passive smoking

• Diet

• Exercise

• Housing and stairs: to assess effect of any symptoms on day-to-day life

• Alcohol intake and substance misuse e.g. cocaine

Family History

Enquire about 1st degree relatives:

• Coronary artery disease

• Stroke

• Sudden death

• Hypercholesterolaemia

• Diabetes mellitus

• Cardiomyopathy

• Congenital heart disease

If diseases with stronger genetic associations are suspected e.g. Marfan's syndrome, Hypertrophic Obstructive Cardiomyopathy, also take an extended family history (uncle, aunt, cousins)

Risk Factors for Pulmonary Embolism

Long haul flights, recent surgery, immobility, previous PE/DVT, family history of PE/DVT, malignancy, obesity, pregnancy, oestrogen therapy, genetic/acquired thrombophilia

Risk assessment by calculating the Well's score can help guide clinical decisions:

Differential Diagnosis

Cardiac Causes

• Acute Coronary Syndrome (ACS):

• Pericarditis: Pleuritic chest pain worse on lying supine....

Details zur Ausgabe

• Verlag: UGTM (Unofficial Guide to Medicine)
• Erscheinungsdatum: 2020
• Sprache: Englisch
• ISBN 10: 0957149905
• ISBN 13: 9780957149908
• Einband: Taschenbuch
• Auflage: 3
• Anzahl der Seiten: 288
• Kontakt zum Hersteller: Nicht verfügbar
• Verantwortliche Person: Nicht verfügbar