ENDO OSCE

Question 1

Please carry out urinalysis (20)

Answer 1

1. introduce
2. explain procedure and gain consent
3. apron
4. gloves
5. collect sample
6. note colour and clarity
7. note odour
8. check container contains the correct testing strips
9. check expiry date
10. remove test strip without touching the sides
11. replace container top immediately
12. dup test strip - emerse it all
13. tap strip on side of container
14. immediately commense timing of strip, using a watch with a seconds hand
15. commence reading strip at correct time
16. read strip against bench marker only
17. record results at correct times
18. record results on correct form
19. dispose of equiptment
20. wash hands

Question 2

Please carry out capillary blood glucose measurement (17)

Answer 2

1. collect BG monitor, testing strips, automatic lancing device, cotton wool, disposable gloves and apron, sharps disposal bin
2. ensure chip inside glucose monitor has same LOT number as testing strips
3. wash and dry hands
4. put on gloves and apron
5. introduce
6. explain procedure
7. wash patients hand with soap and water, rinse and dry
8. remove one test strip from container and replace lid
9. hold test strip with grey electrode faceing upwards and insert this electrode into the monitor - the monitor will ask you to aply a drop of blood
10. using the lacing device, obtain a drop of blood from the patient (use sides of fingers)
11. place lancing device into sharps bin
12. bring the end of the test strip to lightly touch the drop of blood, hold until the meters says yes
13. meter will display result
14. remove test strip and dispose in clinical waste bag
15. apply cotton wool
16. wipe over external surfaces of meter with an alcowipe

Question 3

Please carry out a thyroid examination.

Answer 3

1. hand washing, explanation, consent
2. general examination - clothing, hair, skin, pulse, tremor, sweatiness, eye disease (exopthalmos and lid lag), slow relaxing reflexes
3. inspection - neck from the front and the sides (symmetry?), movement of the thyroid on swallowing water, deep breathing to check for stridor
4. palpatation
   from behind - thyroid to cervical nodes

thyroid - size, symmetry of lobes, tenderness, movement, texture (hard / soft), presence of nodules (multiple, solitary)

cervical lymph nodes - submental, submandibular, pre-aurcular, post-auricular, ocicpital, deep cervical, supraclavicular

5. auscultate for bruits

Question 4

Please carry out a diabetic foot, lower limb examination.

Answer 4

1. general - visible + motility problems
2. legs preparation - adequate exposure at least to above the knee, remove shoes and socks
3. vascular / skeletal - inspect, examine both feet, heels, plantar surface and between toes
4. palpate - temperature, pulses (dorsalis pedis and posterior tibial)
5. neurological - muscle wasting (motor), temperature and sweating (autonomic)
6. test sensation - pressure, 10g monofilament to points on each foot, apex of 1st and 3rd toes, and 1st/3rd/5th metatarsal heads
7. footwear - suitability, wear patterns

RISKS

• lower = able to detect one pulse per foot, able to feel microfilament, no deformity
• moderate = unable to detect both pulses in a foot / unable to feel microfilament / foot deformity/ unable to see or reach foot
• high = previous ulceration / amputation / absent pulses + unable to feel filamnet