OSCE REVISION SESSION

1st Year 2009

OSCE 101
SMILE! Introduce yourself Ask for consent Hi! My name is Georgia and I'm a first year medical student from Monash University the GP has just asked me to ask you a few questions about why you've come in today is that ok? Speak loudly you'll seem confident! But not too loudly yelling = intimidating Also have your barcode sticker ready to hand to the examiner They'll say/think something like Wow what a prepared and organised student Even if you have never heard of the procedure you're being asked to perform...

Appearing Organised = Good First Impression = Good Mark! Wash your hands or wear gloves!

General History
My PCL tutor told me last week - All you need to be able to do as an intern is take a good history So essentially, this is one of the most important skills you will learn in your medical career make sure you can do it well! It's very simple make sure you can do it in your sleep!
Presenting Complaint W W Q Q A A B Past Medical History Family History Social History Include Alcohol, Smoking, Illicit Drugs

CPR
You have entered the room to find Jennifer is unconscious on the floor. Task: Please commence immediate management including assessment and resuscitation of this patient, with verbal explanation of each step.

CPR
Put gloves on!

D anger R esponse A irway reathing B C ompressions D efibrillation

Consent??

No Response CALL AN AMBULANCE

This station requires interaction with the examiner.

General MS Exam
Joe Peters, aged 23, comes to see the doctor because he is worried about his left shoulder. Joe has noticed that sometimes throwing a baseball is painful. There has been no recent injury. He plays baseball every weekend and has recently increased his training. You are a medical student at your General Practice placement, you have been sitting in with the GP. The GP has asked you to examine Joe s shoulder. Task: Please examine Joes LEFT shoulder and explain your findings to the patient.

MS Exam
ASK
- Consent - Current Pain - If anything is uncomfortable or hurting - To remove shirt

LOOK
-Contour and posture -Skin -Swelling -Muscle bulk -Compare with other side

FEEL
Tenderness Swelling Bony landmarks Joints

MOVE

TEST

-Special tests - Passive First specific to joint: - Flexion - Shoulder: - Extension Painful Arc - Internal Rotation Empty can - External Rotation Winged scapula - Abduction - Adduction - Compare both sides - Active movement

GENERAL MS TIPS
- Ask patient to tell you if there's any pain - Always do passive movement FIRST - Have patient take their shirt off (if applicable) - Test BOTH limbs to compare

Not just Theme IV:

- anatomy - risk factors

MSE
Francis Smith is a 22 year old found wandering naked outside the local shopping centre last night. He/she was initially highly agitated but is now more settled however still refuses to say much. Francis lives locally and there is no record of previous contact with the hospital.

Please interview Francis, focusing on the history of the presenting complaint and conduct a Mental State Examination. You are not required to conduct comprehensive cognitive testing OR a COMPLETE Mini Mental State Examination. You are not required to comment on insight or judgment.

After 5 1 2 minutes you will be asked to present your mental State Examination findings to the examiner.

Tasks:
1. Take a BRIEF history of the presenting complaint. 2. Perform a relevant Mental State Examination. 3. Briefly present your Mental State Examination findings to the examiner.

MSE
A Appearance
- clothing - gate - posture

B Speech

M Affect

P Cognition

Language Clarity how clearly Quantity how much Style the way they speak

Current state, changes and shifts around 'Like the weather Observable Considered by: quality, range, reactivity, modulation, appropriateness

Eg orientation to time and place

Behaviour
- body language - social appropriateness

Mood
Lasting, pervasive state 'Like the climate Ascertained by what the person says

Thought
Stream ascertained through speech. Pressured, slow. Form Words, sentences, paragraphs etc. Flight of ideas, formal thought disorder. Content phobias, obsessions, compulsions, delusions etc. Thought alienation not perceived as one s own thoughts.

Perception
Hallucinations Illusions Misinterpretations Passivity phenomena (something is being forced upon the person by an external agent). Disordered self-awareness (depersonalisation)

BP Ear exam Eye exam (these 2 will be a bit limited without proper equipment...) MS Back and spine MS Shoulder, elbow and wrist MS Hip, knee and foot Neuro upper limb Neuro lower limb (these 2 could be combined as there is a lot of overlap?) General motor/sensory exam