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    8 views23 pages

    Osce Medschool Bro

    Uploaded by

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    Copyright:

    © All Rights Reserved
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    Bsc OOOO OOOO RO ES I INITIAL S12) Iams PY) HYGIENE {Yj 2. INTRO & INSTRUCTION Rae ONAN [vj1. INTRODUCTION i) Introduce yourself iii) Explain purpose [¥j2. PRESENTING COMPLAINT (PC) i) Identify main concern (signs, symptoms, etc.) [vj 3. HISTORY OF PC i) "SOCRATES" ii) Ask about other related Site signs & symptoms + Onset + Character + Radiation + Associations + Time course + Exacerbating/relieving factors » Severity [vj4. PAST MEDICAL HISTORY i) Surgical History __ iii) Allergies ii) Existing conditions iv) Medications (dosage + freq) eee e cere ween eee eeecauesascenreceereceeuscr scores esenessouesee, [vj5. FAMILY HISTORY i) Known genetic conditions ii) Common conditions in the family (i.e. diabetes) iii) Ask about health of parents, siblings, etc. (¥j6. SOCIAL HISTORY i) Smoking & Alcohol iv) School/work/hobbies ii) Illicit drug use v) Living arrangements it) Diet & Activity vi) Ask about driving [vj8. SUMMARY i) Summarize & repeat complete history ii) Clarify if you missed any details iii) Ask patient for any final questions & thank them Scanned with CamScanner [Vj MALE SEXUAL HISTORY i) Testicular swelling/pain iv) Urethral discharge ii) Itching/sore genital skin v) Dysuria iii) Skin lesions vi) Systemic symptoms [vj FEMALE SEXUAL HISTORY i) Abdominal/pelvic pain v) Systemic symptoms ii) Vaginal bleeding/discharge vi) Menstrual history iii) Dyspareunia vii) OB history iv) Vulva changes/itches iii) GYN hist. My BOTH i) Last sexual contact ii) HIV risk assessment iii) Focused PMHx PW SYSTEM REVIEW QUESTIONS _ « Chest pain - Syncope - SoB - Leg pain or swelling + Palpitations | + Cough (blood) + Unusual phlegm production + Wheeze - Loss of consciousness + Weakness/ + Headaches numbness + Change in vision - Dizziness - Nausea/vomiting + Heartburn - Difficulty swallowing . Change in + Abdominal pain bowel habits + Muscle/joint/bone + Pain/swelling/stiffness + Unusually dry mouth/eyes + Fever + Skin changes (rash) - Excess sweating + Fatigue Weight loss/gain Scanned with CamScanner [vj 1. SPECIFIC OBSERVATIONS Cyanosis iv) Shortness of breath v) Edema vi) Specific cues (ECG, Meds, IV) [Vj 2. HAN DS *IE = Infective Endocarditis” i) Clubbing vi) Signs of IE Palmar crease pallor + Janeway lesions iii) Tar stains « Osler nodes iv) Xanthomata * Splinter hemorrhages v) Capillary refill time (< 2 secs) (v3. PULSE & BP i) Radial Pulse (rate, rhythm, strength) __ iii) Take BP ii) Radial- Radial delay & Radial-! Femoral delay [Vj 4. NECK i) Carotid (palpate & auscultate) J ONE AT A TIME (45°, head left, sternal angle, < 4cm) %& [vj 5. FACE i) Eyes (conjunctival pallor, xanthalasma) ii) Mouth (central cyanosis, high-arched palate, I/gum hygiene) (Wj 6. CHEST i) Inspect (wall deformities, scars, pulsations) ii) Palpation (apex, heaves, thrills) iii) Auscultate (APTM #2245) oy iv) Maneuvers + listen to M with bell + Left lateral decubitus ==> mitral regurgitation + Lean forward + breathe out => friction rubs [vj 7. BACK i) Inspect & Palpate (sacral edema) Auscultate lung fields eB eccerecccccesecceoscseses Oe ceewrerecsccrccccecsccsccceecsee [vj 8. LEGS i) Inspect (trophic changes, varicose veins, swelling) ii) Palpate (pedal edema, temperature, pulses) Scanned with CamScanner NW i) Patient at 45°, turn head to left, ii) Look for JVP (between medial r end of clavicle under the medial f\ sternoclemastoid) iii) Measure vertical distance between the sternal angle & top pulsation point 1) iv) Normal < 4cm x = Aortic 2nd intercostal space P2 = Pulmonic 2nd intercostal space alll" = Tricuspid 4th intercostal space = Mitral 5th intercostal space CAPT. M #2245 + Blood Pressure + Urine Dipstick + 12-lead ECG + Troponins (MI) w M Cold + white + painful limbs Acute limb ischemia C/P + neck, jaw or Acute coronary L-arm pain Impending sense of doom Unilateral leg swelling Sudden onset throbbing C/P. radiating to scapula Syncope/Presyncope on exertion syndrome Cerebral hypoxia DVT (risk of PE) Thoracic AA Aortic Stenosis Scanned with CamScanner [vj 1. SPECIFIC OBSERVATIONS i) Cyanosis iv) Shortness of breath v) Cough, wheeze, or stridor vi) Surroundings (02, sputum, cigs) [vj2. HANDS i) Clubbing gy ) Skin changes (bruising, thinning, tar stains) iii) Capillary refill time (< 2 secs) iv) Tremor (fine & flapping/asterixis) gy (¥j3. PULSE i) Radial Pulse (rate, rhythm, strength) ii) Respiratory rate eee ccc cecccccccccecescscses Be cccereccccccrccscecevcceceereees (vj 4. NECK Normal i) JVP (45°, head left, sternal angle, < 4cm) ? fingers n, cricosternal distance) yy [vj 5. FACE i) Eyes (conjunctival pallor, xanthalasma, Horner's) (V6. ANTERIOR CHEST _ i) Inspect (wall deformities, scars, pulsations) ) Palpation (apex, chest expansion, RV heave) i) Percuss (supra/infra clavicular, chest wall, axilla) iv) Vocal Resonance (say "99") y) Auscultate (deep breaths i in + out through mouth) eee cereecccecevcseseseseserercoces Oe eececccccccacecccceseces iv 7. BACK *pt cross arms + lean forward* @ i) Inspect (wall deformities, scars, recessions) ii) Percuss (anterior/middle/lower lobes) i) Vocal Resonance (say "99") ) Auscultate (deep breaths in & out through mouth) (vi8. LEGS i) Inspect (signs of DVT, erythema nodosum) ii) Palpate (pedal edema, temperature, pulses) Scanned with CamScanner : + Conduct on each finger : « Normal = small diamond- : shaped window : + Clubbing = NO window - Chest X-Ray + ABG ~ + Sputum Sample + Spirometry ie ‘hold for at least 30s ¥ f w ‘SYMPTOMS _ POTENTIAL Dx Hemoptysis B p TB, Lung cancer, PE . b Lung cancer, COPD (end eid aos B> r stage), Cor pulmonale Sudden onset C/P =f Spontaneous pneumothorax, PE Sudden onset dyspnea Fy» Spontaneous pneumothorax, PE : 3) Anaphylaxis, foreign Sudden onset stridor a Pobje elacute’epialotitis Scanned with CamScanner [vj 1. SPECIFIC OBSERVATIONS i) Confusion iv) Abdominal distention & ascites v) Hyperpigmentation vi) Specific cues (stoma & drains) (Vj 2. HANDS Clubbing Palms (pallor, erythema, Dupuytren's contracture) Nails (koilonychia, leukonychia) Tremor (flapping tremor/asterixis) Ore cecccerecccccccecer Pree eererececcccccrcceccscrceeecoeel (Vj 3. PULSE ) Radial Pulse (rate, rhythm, strength) ii) Respiratory rate (vj4. ARMS & AXILLA i) Bruising, spider nevi, stretch marks) fy Axilla (acanthosis nigricans, hair loss) [Vj 5. FACE i) Eyes (conjunctival pallor, jaundice, Kayser-Fleischer) Mouth {stomatitis, glossitis, candidiasis, ulcers) Cee ceccccccccsccccccecccnecoccreccses ee ccccccovcccee ecco (Wj 6. NECK & CHEST i) Neck (lymphadenopathy & left supraclavicular node) ii) Chest (spider nevi, gynecomastia, hair loss) (¥j7. ABDOMEN i) Inspect (scars, distention, striae, Cullen's/Grey Turn) ii) Palpation (9 quadrants: superficial mp deep) Py iii) Liver: Palpate & Percuss (RIF =p Rt. costal margin) iv) Spleen: Palpate & Percuss (RIF mpLft. costal margin) v) Ballot kidneys (push fingers together on breath in) vi) Palpate aorta (width < 3cm) ,y fiurn pt to side, wait 30s vii) Shifting dullness (percuss Unhbilicus mp Lft. flank) viii) Auscultate (bowel sounds, aortic & renal bruits) [vj 8. LEGS i) Palpate (pitting edema) Scanned with CamScanner SPIDER NEVUS (estrogen metabolites) 9 QUADRANTS ; ne Right Epigastri Lett kato eae 5 hypochondriac ‘ 6 KAYSER-FLEISCHER Umbilical RINGS region (copper deposition) Ci Hypogastric Cec ec ccoresscccececescauneprasesctesacesesaseseeoss McBurney's Point Rovsing Sign + Hernia exam Virchow's ©: DRE Node : 3 . External genetalia Sudden onset abdominal Abdominal distension pain Shoulder tip pain Hematemesis Escalating intensity Peritonism abdominal pain Scanned with CamScanner i) Sears iv) Fasciculations ii) Muscle wasting v) Chorea & Clonus iii) Tremor vi) Pronator Drift i) Support patient's limb & ask them to relax ii) Move each muscle group with varying velocity iii) Access for spasticity, rigidity, hypotonia i) Shoulder ABduction (C5) & ADduction (C6/7) ii) Elbow Flexion (C5/6) & Extension (C7) iii) Wrist Extension (C6) & Flexion (C6/7) iv) Finger Extension (C7) & ABduction (T1) v) Thumb Abduction (T1) i) Test Reflexes - Biceps (C5/6) + Brachioradialis (C5/6) + Triceps (C7) ii) See back of page for grading chart i) Dermatomes (C3 -T1) - Light touch (dorsal columns & spinothalamic tract) - Pin-prick sensation (spinothalamic tract) ii) Vibration 1 + Patient eyes closed & ask if they feel tuning fork on fingers iii) Proprioception + Hold distal phalanx by its sides & move thumb "upwards" & "downwards" with eyes closed i) Finger-to-Nose Test (dysmetria, intention tremor) ii) Dysdiadochokinesia (alternating movements) Scanned with CamScanner LSet L Shad -Ue Scanned with CamScanner [vj 1. SPECIFIC OBSERVATIONS i) Scars iv) Fasciculations ii) Muscle wasting v) Chorea & Clonus vi) Access Gait + Romberg's Test (Wi2. TONE i) Support patient's limb & ask them to relax ii) Move each muscle group with varying velocity iii) Access for spasticity, rigidity, hypotonia [vj 3. POWER i) Hip Flexion (L1/2) & Extension (L5/S1/S2) ii) Knee Flexion (S1) & Extension (L3/4) Ankle Dorsiflexion (L4/5) & Plantarflexion (S1/2) ) Big Toe Extension (5) (vj4. REFLEXES i) Test Reflexes + Knee (L3/4) + Ankle (S1) « Plantar/Babinski (L5/ $1) ii) See grading on previous page fy ‘(¥5. SENSATION i) Dermatomes (L1 -S1) - Light touch (dorsal columns & spinothalamic tract) + Pin-prick sensation (spinothalamic tract) ii) Vibration § 128-Hz + Patient eyes closed & ask if they feel tuning fork on toes iii) Proprioception - Hold distal phalanx by its sides & move big toe "upwards" & "downwards" with eyes closed [vj 6. COORDINATION i) Toe-to-Finger Test (dysmetria, intention tremor) ii) Heel-to-Shin Test (lower limb ataxia = cerebellar) Scanned with CamScanner Sudden onset "Worst headache ever" a Progressive loss of Neck stiffness 6 consciousness History of malignancy Constitutional symptoms Neurological changes after trauma ROMBERG'S i) Patient eyes closed Maintain erect posture : iii) Assess for 60s : NEG POS 9 STAY CLOSE TO PATIENT { ep ececccecoee wy — gp _/

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