Abdo Assessment And History Osce Flashcards
What is the first step of this osce, what will you verbalise?
Consider the possible dangers, ask if the scene is safe and gel hands (gloves)
After making sure the scene is safe, what is the next step?
Gaining consent from the patient and explain the process of assessment - what you are going to be doing.
Before beginning any hands on assessment, what assessment do we need to verbalise?
End of bed assessment
After the end of bed assessment, what is the next thing we do?
Primary survey - ABCDE
With the primary survey what are we assessing?
Airway (is it open), breathing (are they breathing, have a quick listen is it equal), Circulation (feel for a pulse) Disability (pupils), expose and examine
As well as the primary survey what are we also verbalising?
where they are on the AVPU scale - Alert, Voice, Pain, Unresponsive
What structure model do we use for taking a history from this patient
SOCRATES
What does socrates stand for?
Site, onset, character, radiation, associated symptoms, time, exacerbating/ alleviating symptoms, severity.
After using Socrates to take a basic history take, what do we move on to?
Past medical history
What does past medical history involve asking?
Any active problems?
Is there any previous problems/ investigations that have taken place?
When was the last hospital admission and what was it for?
When was the last GP visit?
After PMH what is next?
Drug history and allergies.
As part of drug history what things do we ask?
What prescribed medication are they on?
Do they take any over the counter medication?
Do they use any herbal medicine?
Do they use recreational drugs?
Do they have any allergies and if so what reaction do they get?
After DMx, what section is covered next in the history take?
Family history
What do we ask in regards to family history?
Do their parents/grandparents/ siblings have any conditions?
Has there been any unexpected deaths within the family?
What is the life status of their parents and grandparents.
What did they die of?
After family history what is the last section within the history take?
Systems review
What does system review involve?
Asking questions about the other body systems -
Bowel habits — has there been any changes with their bowel movements? Is there any blood present in the stool? Is there an odour from the stool? What colour is the stool?
Urine habits — has there been any changes with their urine output?, is there any pain when they go to the toilet?, what colour is their urine?, is there an odour from the urine?
Vomit — have they vomited? Do they feel nauseas? Have they vomited up any blood? How frequent have they vomited? How much have they vomited?
Fever/ general wellbeing — how long have they been feeling unwell? Do they feel dizzy? Do they feel more tired and fatigued than normal?
What acronym do we follow when doing an abdominal assessment?
, inspection, Auscultation palpation,percussion
In regards to the auscultation process what do you have to do?
Listen for bowel sounds in the four quadrants - verbalise and ask if they are present.
On inspection what are we looking for?
Scars or hernias, guarding, spider naevi, distension/ ascities
On palpation what do we do?
Starting away from where the pain is —
Lightly palpate the 9 areas
Deep palpate the 9 areas
Identify where the pain is
Check for appendicitis
Mcburneys/ rovsings/ rebound tenderness/ Murphy’s
On percussion what do we do?
Percuss the 9 areas listening for any abnormalities
What must you make sure you do throughout the osce?
verbalise what you are doing !!
After percussion what must you not to forget to look at?
Odema in the legs and ankles
Temp in legs
Distal pulses
What test do you use for the gall bladder?
Murphy’s sign
Place hand on right costal margin, mid clavicular line
Ask pt to take deep breath in
Push down
Pain?
What is the rovsings sign
For appendicitis
Palpate the left lower quadrant - opposite to site of appendix
Painful - positive
