15 Mementos for an OSCE exam Prepared by Dr. Muath Al-Rebdi. MBBS, SBFM, ABFM, TTS. Senior Registrar Family medicine. Qassim family Medicine academy, Ministry of health. (2021-1443)SUI Sleo.> Moath.99@Hotmail.com- Read (Pre-exam Candidate Orientation PDF) that release by SCFHS usually before exam. - Follow the PDF instructions -Be Organized - ask question systematic -Make your own mind map -Do mock exam before areal exam. - Don't ask questions already mention in scenario like name, age, or Job. - look at main station Task (History, examination, counselling or management). - Don'tever talk to examiner. - Don't breaking bad or counselling patient without taking full history. - Look around room you may find something that might be helpful. - if you hear clicks that means you are in right direction. - Time management (2 minutes left), if you hear it, go to the managemnt. - Start by open question then close ended questions for the rest. - Always believe simulator, he is not hiding thing. - You can ask simulator to formulate diagnosis like ( tell me , explain more, any- thing you want to add, any questions) - Follow coordinator instructions during exam. y” ~Nypes OSCE stations A- Acute stations : - Example: Chest pain (MI), abdominal pain(appendicitis), PV bleeding (ectopic preg- nancy), SOB (anaphylaxis). - Weighted score: taking Breif history, safe transportation, contacting ER and com plete and comprehensive management. - Use: 15 Mementos Guide. - Example: Uncontrolled chronic disease (DM, asthma....), symptomes to find out diag- nosis (jaundice, abdominal pain, knee pain), or labs or image result for interpretation. - Weighted score: taking details history and appropriate management for a patient. - Use: 15 Mementos Guide. - Example from up to down: Cranial nerve examination -> Mental status examination -> Eye, Ear, thyroid, breast and L.N examination -> pain or swelling (musculoskeletal and neurology system). - Weighted score: performing Physical examination. - Use: 15 Mementos Guide. - Example: Breast feeding, Smoking or alcohol cessation, disease education (epilep- sy), Travel advices. - Weighted score: taking brief history, giving extensive advices, briefly managing with safety netting. - Use: 5As Model - Example: any Cancer, HIV, hepatitis, missed abortion, death, congenital disease - Weighted score: communications skills. - Use: SPIKES Model - Example: hot topics of the year, quality, management, ethical dilemma, research, au- iting, Case Discussion. - Use: brainstorming, think outside the Box, no perfect answer, no right or wrong answer. y” ~NSecondary Task could b © = PMHx: Uncontrolled chronic disease or risk factors. ® Asystemic disease: Completed approach e.g. Parkinson disease. @ Abnormal V/S: high BP or BMI. @ Abnormal tests: IDA, high HB atc, TSH, Mammogram...etc. Education: PFM, insulin injection, fall risk, EpiPen® © Counselling: Smoking, alcohol, depression, or herbal. @ Answering patient queries e.g. what | will do if | missed OCP pill?. °° Opportunistic health promotion( screening).15 Mementos Read Case Scenario and Read Tasks Carefully. Greeting your patient, then introduce yourself. How can |help you? (chief complaint) - Tell me more...... Analysis of a chief complaint: - onset, duration, timing, course ,character, , aggravating factors, and relieving factors. Do you have associated symptoms suchas.. see appendix below. Rule outred flags. Personal History: Q1.PMHx (any similar complains, any chronic disease, any admission, any ER visit) ‘Q2.PSHx: Minor or major surgery.- Q3. Medications or allergy history. Family History: any similar conditions, any chronic disease or Cancers.15 Mementos Social History: Job, smoking, alcohol, drug abuse, travel, blood transfusion, Life stressors. ICEE: idea, concern expectations, and effect. Depression screening: low mood and loss of interest Iwill move on to perform physical examination: General patient appearance: he looks..... -V/S: Temp, BP, PR, RR, 02 sat, BMI -local examination il do some investigations or images to confirm Management: - Clarity the diagnosis: -Nonpharmacological: advi Pharmacological: prescription, referral or follow up. Closing: - Safety netting: ifyou have following symptoms ..go directly toER -Cover a secondary task e.g., Opportunistic health promotion, Obesity, smoking... -Any question.Associated symptoms r Head: Headache, Dizziness, Nausea, Vomiting, Slurred Speech, Facial Weakness, Visual Change. Extremities: Seizure, Loss of Conciseness, Sensory or Motor Deficit, Numbness, Weakness. Ear: Hearing Loss, Tinnitus, Ear Pain Or Discharge, Vertigo, Diseq © Nose: Nose Discharge or Congestion, Sneezing, Cough, Itching, Ep Anosmia, Fascial Headache. Throat: Sore Throat, Hoarsens, Choking, Dysphagia, Cough... Chest pain, Dyspnea, palpitation, orthopnea, PND, fainting and LL. Edema. SOB, cough, cough with sputum, hemoptysis, chest pain, fever. , Upper: Heartburn, Epigastric Pain, Nausea, Vomiting, Early Satiety, Hematemesis. Lower: Jaundice, abdominal Pain, Constipation, Diarrhea, Melena, change in urine or stool color. Dysuria, Frequency, Urgency, Drippling or Retention, Weak Stream, (USE), Incomplete Emptying, Straining, Nocturia, Incontinence, Flank, or Suprapubic Pain.Associated symptoms , Menarche, LMP, Regularity of Menstrual Period, Dysmenorrhea, Dyspareunia, Vaginal Bleeding or Discharge, Contraception, weight gain, Hirsutism. LMP, Numbers of GPA (Gravida, para, abortion), type of delivery, any antenatal or postnatal complications. Type of delivery, birth weight, nutrition, activity, feeding, vaccination, care giver. Mood, interest, stress, appetite, sleep, energy, concentration, Phobias, worries, hallucination, delusion, functioning, drug abuse, suicidal. Sexual dysfunction: libido, Erectile dysfunction, early morning or nocturnal erection, premature ejaculation, gynecomastia, small testes, spouse relationship. STDs: multi-partner, Genital discharge, wart, ulcer or LN enlargement, N mouth ulcer, Barrier using. Pain: Site, frequency, timing, character, Radiation, severity,, swelling, redness, Hx of trauma. Site, size, number, painful, surface, redness, hotness, skin changes. Fever, night sweeting, changes of weight or appetite, anorexi arthralgia, fatigue lymph node enlargement.Taga JSaiy plooll ip51 pi gyylizall ip5t ehudis aye pi pyyoll cay (Guyipll sgSdI) Telos) yosi cass/Tuus TAS ye sisi tisa5 ySo0/2ys spas SgSaiull Julai Jaani asS Sie JS Soyo pS Selon lay io $adAsi GUI alog foyji Gl clusdl Lolo Jio ajaloe yalyel cya) Jo Buu: w culaaLall pil yb) ysljcMl alesis sea yt sh ciopt gla Guus too yobol wake tas go ato Yelobl yd cdo, Sagas gl yo Sta yg gh pasa /2yus SAdsLas Sys cane gh Zar seplilall daytilh SaliLall 4 dmybitio Wiel 4 Jo - TaLiLall 6 plygl gl dinjo Wlsol yo Sixty aol Jo- 15 Arabic Mementossgelaiill tl Sayall lloyd Saal Faas Aba Sage ls S91 gbolad oS Jas pail gl Sysha0 call Jo Spoulellna at ta glo au a SUS all us 2590 al lo le Stall oS@ cil Jo US ALESiull yaad Sloss Jl eLuabilly gins Joo Telaljo cies 4919) csLoMlol yo asiil a3)! SJ eai5l yl gue ors cLlaclg igi poral yi ayi Ayal plall fst -1 jlaaU gypusll yorall-3 ayguall esloitell -2 __agsapull ya 0) onoll Jal yo dahil gi Jullaill pos cllac! satel ai te eos sal al os ay bel eS efile |3}- pt soulagogill yay clyde! glial gill ALSudiall Axil - &yS4all cstogaail aay cllaai 3g SUlgan gi elaie gi dala gi uid ub =(e male m= =n(@ man @ me(@ (O = 15 Arabic MementosdinlooJ! yaljcill ( .aagll qh Hoes pS! 6 dss) glpaiul ylié ddgo glo gulp ; poll 44 si «Juoii .2Sjo)I gi yubus yladé. cg ylaas lids lb alpbil 2 aos -Ojl9i pac ylg2 «93M yo caljlysl gl pll quis gould ylada :y3l pullld yladid wiley a8o.da5 gullac .Ailll 6 yléialgl gw ail JB saagil 6 gan. oS dpb dine Gli 6 pil ago 26 p85 dais «clits cli] GUS) pgill cli] GUIS) .ylAa5 ord jorall V6 all -J2 Nl 44 pjgi cal yladiay Gulu gi uegll glade Joo 4 pll.p> go aS poly go da5 35 yuaill 6 Gd _pasiall 6 dylyo liz gail drool yuly 4 all fio posal jlo) cl - gyal go p> .erdl pul] .ddga> eobyll Jésul pall ALuol loss! 0x50) jlaal) Jaa) - Shull 8 p> «Joull 69 hard Joull 6 pSaill pac Jgii Gis «gull 6 dylyo oil pros pula] Joul 6 ps Joull 6 gual Joull 6 uuliisl byl Jésul gl job Jauslol alow 6 pull Soul 6 yulus.Jolsil$4ygall pLAdil ass 84g 45] 10 Séyga Jal cuils Vio «Joa gilgo pladisul dso cs jlal gi cayji gloall pill 2ygall pull pouiull gi jgll 6 dalyj (esd Laoilg Gulu] Yartlg sNgill) 2c $699 jy) cils (io GaMigll 22) Lol Jos cslacldo gi .csloVgll egi sb Littl clay aijg lS pS TéoMgll cuils Lass © Ale yc Jogsuall yo lyebill. sail 4S )U) Lis poill Si dyosis wsllogo doth clioiull aljo ulill cluiil sdiei dogogo ye cludsl gous 18 gl juSaill dyis agblei yLoiil jlsai agai ail juli Laio ygysinuy (agi go 4dMoll ayyuull o3all «slo aod ayeyI aod :jrall Gol 44 gad gail 6 ALBIII . Gyain caloyai gi Jullgi gl ealjlp1 ulduloll 9203; Slyoul | dyuuiall ddiloll VW alg | gilgo pladinul .dygad culayai dyglaalll 9321 «lool gl poi Lali! Sade3 415 jas .aldg ojo pS .ailso: plill Gylow ydj2i alall 96 j483 01) yljaol aol .plgo.asac aoa .ailSo :pygill sJoliall 6 all ing dzodsll gf yjgll 6 284 alll 8 Gyoi dyhs5 _pauall 6 cul Laiil iors