OSCE TRANS – October 19, 2011

Surgery
1. Right breast mass
a. History – important are family history, menstrual history, past medical history, siempre HPI
din
b. PE – breast exam  describe mass in terms of consistency, mobility, location, etc.
c. Diagnostic tests
d. Diagnosis – breast cancer dawkasi super hard na
e. Management
2. Rectal bleeding
a. History
b. PE – DRE  describe anal area first; glove hands, lubricate, then insert, describe what you
felt
c. Diagnostic tests – proctosigmoidoscopy
d. Diagnosis – hemorrhoids
e. Management – hot sitz bath, diet
OB
1. Leopold’s maneuver
Face the patient’s head
a. L1 – fundus, if breech or cephalic, use two hands
b. L2 – side, where is the fetal back
c. L3 – symphysis, whether engaged or balloted, palpate with a cupped hand
Face the patient’s feet
d. L4 – perform only if the head is engaged, to know cephalic prominence  if cephalic
prominence is opposite the side of the fetal back, head is flexed
2. Insertion of speculum
a. Don’t forget the light! Position it.
b. Glove hand/s.
c. Hold the speculum with your non-dominant hand. Sometimes, you may glove only one hand,
your dominant hand, then that is the one that you will use for IE before/after pap smear.
d. Separate the labia, or depress the fourchette.
e. Insert the speculum at an oblique angle, then once inserted, position it horizontally. Then
lock.
Neuro
1. A patient enters complaining of weakness of the upper and lower extremities. Perform a complete
motor system examination.
For all extremities and muscle groups, both proximal and distal:
a. Perform motor strength testing.
b. Palpate for tone on passive movement (rigidity, spasticity, hypotonia).
c. Do not test for reflexes! Not included in the motor exam!
2. 5 signs of upper motor neuron lesion:
a. Hyperreflexia
b. Spasticity
c. (+) clonus
d. (+) Babinski
e. No muscle atrophy (initially)  disuse atrophy
Anesthesiology
1. An endotracheal tube is placed in a patient in the emergency room. Check for proper placement.
a. Auscultate the following areas, both right and left:
i. Anterior axillary line  for the lung apices
ii. Mid-axillary line  for the lung bases
iii. Epigastrium  for the GIT
2. Locate the radial vein.
 a. Place the tourniquet on the upper forearm, but preferably on the lower part of the upper
arm (for greater area of view). The radial vein is the largest most prominent vein along the
side of the radial bone.
Medicine
1. A patient entered with rashes on both feet, along the area of contact with the straps of a newly-
bought rubber slippers.
a. Inform the patient of her diagnosis: contact dermatitis
b. Plan of management:
i. Avoid rubber, since the patient is allergic.
ii. Give antihistamines for allergy.
iii. Give topical steroids for the pain, inflammation, and itch.
2. A patient entered with a complaint of joint pains particularly upon waking up in the morning.
Diagnostic tests revealed degenerative joint disease.
a. Diagnosis: osteoarthritis
b. Prescription: NSAID (naproxen, 50 mg)
3. A patient, who had been previously diagnosed with cholecystolithiasis, entered with a chief
complaint of severe abdominal pain. Yesterday, he developed fever and jaundice.
a. Diagnosis: cholangitis
b. Plan of management:
i. Antibiotics
ii. Surgery or ERCP for immediate removal of stones
Pedia
1. Perform tourniquet test for a suspected dengue patient with a BP of 100/60.
a. At what BP measure will you inflate the cuff? 100+60 = 160/2 = 80 mmHg
b. For how long? 5 minutes
c. Interpret the results: Count the number of petechial rash in a square inch over the volar
surface of the forearm, ~2-3 cm below the antecubital fossa. 20 or more petechial rash is
positive.
2. Perform skin-fold testing for a patient with diarrhea.
a. Perform the skin-fold over the abdomen. Vertical pinch, not horizontal, to avoid pinching
along the skin lines. Abnormal result is return of skin to normal >2 seconds (skin turgor >2
seconds).
3. 3 y/o, with diarrhea, good skin turgor, not irritable, no sunken eyeballs, not lethargic, no other signs
of dehydration.
a. Fluid of choice: ORS
b. Drug to give: no antibiotics  most common cause of acute watery diarrhea in children is
rotavirus (viral). Just give zinc, 20 mg/day for at least 14 days. (<6 months: 10 mg, >6
months: 20 mg)
Radio
1. X-ray shows an opacified whole right lung.
a. Diagnosis, including laterality: right atelectatic lung
b. Pointed area: left cardiac border (left ventricle) – shifted to the right