CHAPTER

2
Specimen OSCEs

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SPECIMEN OSCEs

Introduction
There are 92 stations in this book, ranging from simple skills that can be tested in a preclinical anatomy or physiology department to complex skills involving patients with disease. To introduce some challenge to your revision, we have arranged them into a number of examinations of increasing complexity. We have assumed a 5-year medical course with:

Limited clinical exposure and skills teaching in the rst 2 years. A concentration on basic clinical skills and cardiorespiratory and gastrointestinal disease in Year 3 (corresponding to junior medicine and surgery). More detailed and specialized learning in Year 4, including locomotor and neurological disease. Preparation for practice and acquisition of complex clinical management skills in Year 5.

Each specimen examination tests a variety of types of skill, and the different body systems, to mimic the variety that you will meet in real exams. If you would prefer to concentrate your revision on a particular skill type or a particular system, skip directly to Chapters 38, which are organized along those lines.

Skills exams early in the course (Years 12)

18 Medical schools differ greatly in the amount of skills teaching they offer in the early years. If you have not been taught skills, you are most unlikely to be tested on them. Exams A and B include skills that could be tested at this stage of training.

Exam A
Skill Explain 24-h urine Page 296 System Genitourinary Type Communication Comment Communication skills could be tested on a procedure like this that requires little specialized knowledge At this stage, the emphasis would be on recognizing anatomical landmarks rather than disease

Chest radiograph Page 176

Respiratory

Interpretation

Measure blood pressure Page 85 Venepuncture Page 262

Cardiovascular

Examination

General

Procedure

SPECIMEN OSCEs

Exam A (contd)
Skill Lower cranial nerves Page 118 System Neurological Type Examination Comment Examination of individual nerves could be taught and tested as an exercise in applied anatomy

Exam B
Skill Teach inhaler technique Page 286 Measure blood glucose Page 204/254 Vision Page 113 Record an ECG Page 224 Basic life support Page 259 System Respiratory Type Communication Comment

Endocrine/ Metabolic

Interpretation/ Procedure

This could be used both to test skill at a procedure and knowledge of basic biochemistry Another test of applied anatomy/physiology

Neurological Cardiovascular General

Examination Procedure Procedure

A skill that many lay people acquire and one that will certainly be expected of a junior medical student

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Skills exam in year 3 (junior medicine/surgery)

See Chapter 1, Table 1.1 (page 45) for a detailed specimen examination. There is likely to be a strong emphasis on basic history-taking at this stage in your training. Physical examination will probably be tested on volunteers, to demonstrate basic clinical method rather than skill at eliciting abnormal physical signs. Here are two more short circuses.

Exam C
Skill Examine the abdomen Page 104 Cough and breathlessness Page 35 System Gastrointestinal Respiratory Type Examination History

SPECIMEN OSCEs

Exam C (contd)
Skill Present the history Page 33 Cerebrospinal fluid Page 187 Examine the neck Page 145 System Respiratory Neurological Endocrine/Metabolic Type History Interpretation Examination

Exam D
Skill Heart examination Page 87 Lethargy Page 74 Present the history Page 33 Urinalysis Page 165 Examine the hands Page 151 System Cardiovascular General General Genitourinary Locomotor Type Examination History History Interpretation Examination

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Skills exam in the middle clinical year

By this stage, you should be consolidating and broadening your skills and beginning to diagnose the abnormal. You will have studied some more specialized clinical disciplines such as rheumatology, ophthalmology and neurology.

Exam E
Skill Alcohol history Page 78 Present the history Page 33 Lymph node examination Page 142 System General General Haematological Type History History Examination

SPECIMEN OSCEs

Exam E (contd)
Skill Intravenous injection Page 227 Blood count Page 190 Hearing Page 116 Thirst and polyuria Page 66 Examine the hands Page 151 Aspirate knee joint Page 257 System Cardiovascular Haematological Neurological Endocrine/Metabolic Locomotor Locomotor Type Procedure Interpretation Examination History Examination Procedure

Exam F
Skill Chronic headache Page 46 Present the history Page 33 Heart examination Page 87 Suture skin Page 264 Deliberate self-harm Page 198 Examine the motor system in the arms Page 121 Skin rash Page 83 Shoulder examination Page 148 Venous cannulation Page 246 System Neurological Neurological Cardiovascular General Endocrine/Metabolic Neurological Type History History Examination Procedure Interpretation Examination

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Haematological Locomotor Genitourinary

History Examination Procedure

SPECIMEN OSCEs

Final skills examination

You are likely to be tested on physical examination of patients with abnormal signs, more complex communication and attitudinal issues, procedures that you will be called upon to perform as a house ofcer and histories. Some stations are likely to test skills that you were taught in the earlier years of training.

Exam G
Skill Examine the skin Page 157 Explain statin therapy Page 277 Blood transfusion Page 249 Criminal activity Page 332 Sensory examination Page 125 Death certication Page 269 System General Cardiovascular Haematological Respiratory Neurological General Endocrine/Metabolic Locomotor Type Examination Communication Procedure Attitude Examination Procedure History History

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Back pain Page 69 Present the history Page 33

Exam H
Skill Suspected hypovolaemia Page 160 Endoscopy Page 292 Write a prescription Page 238 Risk of infection Page 339 Peripheral vascular examination Page 91 Arterial blood sampling Page 266 System General Gastrointestinal Respiratory Infectious diseases Cardiovascular Type Examination Communication Procedure Attitude Examination

General

Procedure

SPECIMEN OSCEs

Exam H (contd)
Skill Arterial blood sampling Page 266 Abdominal pain Page 40 Present the history Page 33 System General Genitourinary Locomotor Type Procedure History History

Exam I
Skill Examine higher cortical function Page 109 Discuss HIV testing Page 322 Advanced life support Page 231 Problems with your colleague Page 344 Examine the neck Page 145 Diagnostic pleural aspiration Page 234 Diarrhoea Page 37 Present the history Page 33 System Neurological Type Examination

Infectious diseases Cardiovascular General Endocrine/Metabolic Respiratory Gastrointestinal Gastrointestinal

Communication Procedure Attitude Examination Procedure History History

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Structured oral examination

What some medical schools call an OSCE, others call a viva or structured oral. This tests your ability to apply knowledge, and may also test your attitudes. If you are coming up to a viva, you could use the following stations to support your revision.

SPECIMEN OSCEs

History Cough and breathlessness Diarrhoea Abdominal pain Skin rash Thirst and polyuria Back pain Pyrexia

Page 35 Page 37 Page 40 Page 63 Page 66 Page 69 Page 72

Interpretation skills All but one of the stations is in structured oral format. Procedures Write a prescription Blood transfusion Communication Discuss a do not resuscitate order Discuss with a carer Cross-cultural communication
Page 238 Page 249 Page 282 Page 289 Page 315

Attitudes All the stations are in structured oral format.

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Long and short case format

Although this book is orientated towards the OSCE style of examination, it can help you prepare for more traditional examinations, both by giving a description of core clinical skills and describing techniques and approaches that are very relevant to long and short cases. For example:

History Erectile dysfunction Chronic headache Collapse

Page 42 Page 46 Page 53

Examination All stations describe the core clinical skills that you will be called upon to demonstrate in traditional clinical examinations; many of them are extended into the common pathologies that you will encounter in such examinations.