General

Question 1

Dr. Hillier’s 5 components of counseling

Answer 1

1. Explanation
2. Recommendations
3. Follow up
4. Expectations
5. Handouts/Diary

Question 2

Dr. Hillier’s handout suggestions

Answer 2

Caringforkids CPS
sexualityandU
Canadian TB standard
Your best shot CPS
Children new to Canada CPS

Question 3

How do you start every OSCE station?

Answer 3

Wash hands

GROWTH: Ht/Wt/HC/BMI+Plot
VITALS: HR, RR, BP, Temp, O2S
CONFIDENTIALITY

Question 4

Counseling template

Answer 4

SPIKES:
S - Set up the interview: people, location, privacy, interruptions
P - Perception - Assess:
“What have you been told about your medical situation so far?”
“What is your understanding of the reasons the test was done?”
I - Invitation: follow patient’s agenda, not yours. Establish goals for counseling, ask if they have questions frequently.
K - Knowledge: Share results, explain using non-technical words. Small chunks, check understanding.
E - Emotion/Empathy: Ask them, share emotion with them, reassure as appropriate. Establish supports.
“This is not your fault, not related to anything that you did or didn’t do”
“We will work together as a team to help you through this”
S - Strategy and Summary:
-Patient’s expectations -Investigations -Treatment options -Referrals
-Follow-up

Question 5

General history template

Answer 5

HISTORY
Assure confidentiality

HPI
-happened before?
-why presenting today -"PQRST+assoc symptoms" -constitutional: including jts -w/u, treatment
-what do they think is happening
PMH -meds -PSH
ALLERGIES -type of rxn -epipen
IMMUNIZA TIONS -booklet
ID
-travel, sick contacts, day care, unusual locales, pets
PREG, L&D
DEV
-Young: eat/sleep/play -Older: school
FHx
-sudden death
PYCHOSOCIAL -Effect of illness -Financial
-Living environment -Stressors
-Violence HEADS

CULTURAL COMPETENCE
-Meaning of illness: explanatory model, patient agenda (“how can I be most helpful?”), current care (non-medical, advisors) -Social context: environment control(money, transport), environment change(origins, moving reasons, adjustment), stressors & support, literacy/language(use interpreter, not family)

REVIEW OF SYSTEMS:
Gen: fx, anthropometrics, activity
Eyes: vision-, cross, red, pain,drain
Ears: hear-, pain, drain
Nose: Drain, d/c, sinusitis
Throat: tooth pain, ST, hoarse, lesion
Neuro: sz, LOC
Psych: mood, sleep
Resp: cx, wheeze, apnea, cyanosis, SOB
CV: murmurs, C.P.
GI: feeds/appetite, jaundice, vx, dx, constipation, bloody stool, AP
 GU: freq, dysuria, UO, hematuria
Heme: bleeding, anemia, jaundice, swollen glands Endo: change in habitus, wght gain
Derm: rashes
MSK: jt swell, tender, weak

Question 6

General physical template

Answer 6

PHYSICAL
ABCDDDEFGs
“wght IV O2 monitors” General appearance Anthropometrics
VS

Question 7

DDx acronym

Answer 7

DDX: "Foreign CINEMA HDTV Scan"
Foreign body FB
Congenital, cardiac, crazy(mood, anxiety, psychotic, somatoform, Munchausen) Infection, inflammatory, idiopathic, iatrogenic, infiltrative
Neoplastic, nutritional, neuromuscular
Endocrine
Metabolic
Autoimmune
Hereditary
Drugs, degenerative
Trauma
V ascular
SCAN: abuse, neglect

Question 8

General work up

Answer 8

WORK-UP
B/W
Urine
CSF
Stool
Swabs: throat, STI, wound
EKG, EEG
Imaging
-XR;
UGIS"w SBFT" -U/S, echo
-CT, MRI -nuclear, PET

Question 9

General management

Answer 9

Consent!
ABCDEFG
wght, O2, monitors, IV
Admit(say it!)
Stop offending agent Reasses(say it!)
Activate -transport

-ICU, consults
-drugs that take time to arrive
Involve the pt
Follow-up
-RTER instructions -medic-alert -immunizations
COUNSELING
“Where are you at w xxx?” -time for q’s
ADVERSE EFFECTS -always say allergy
TELEPHONE -get call-back info

Question 10

MUSTS for physical exam

Answer 10

• Precautions
• Wash hands
• Consider chaperone (“confidentiality” of the physical exam part)
• Introduction
• Confirm name of patient, age etc
• Explanation of what you are going to do
• Ensure dressed appropriately, examine from the right side of bed
• Comment general assessment of growth parameters, vs and review chart
• ABCs

Question 11

Eye exam

Answer 11

Ambylopia/strabismus
General - orbit, lids, conjunctiva, cornea, iris, pupil for asymmetry/size/shape/reaction to light 
Alignment
Head posture 
Corneal light reflex 
Cover-uncover
Red reflex 
Fundoscopy 
Acuity 
Fields EOM

Question 12

Back exam

Answer 12

-Inspection
• General appearance of patient/body habitus of patient
• General inspection of the back
o Looking from multiple angles
o Lordosis, kyphosis
o Shoulder heights, flank asymmetry, sacral dimples similar heights
• Examination of the skin
o Birthmarks, rashes (psoriasis, SLE), neruofibromas, eccymoses/trauma o Looks at hands, ears, scalp psoriasis too
o Stigmata of other disease (IBD example)
o Spinal dysraphism (tuft of hair, swelling etc)
-Palpation
• Instruct patient to tell if causes any pain/try to look at patient while palpating also
• Palpate each spinus process
• Palpation of paraspinal muscles
• Palpation over SI joint
-Range of Motion C Spine
• Extension
• Flexion
• Lateral flexion
• rotation
Thoracic/lumbar
• flexion
o Adam forward bend test scoliosis • extension

• lateral flexion
• rotation -Special Tests
• gait
• Adam forward bend test
o patient instructed to bend forward knees straight, look from side for asymmetric rib hump? scoliosis
• schober
o AS, measurement of lumbar spine flexion
o At sacral dimples, 10cm above and 5 cm below, bend forward distance between two lines
should increased by at least 5 cm • chest expansion
o in AS limited expansion of chest (measure on inspiration/expiration) • leg length discrepancy
o patient lying supine measure from asis to medial malleoulus
o Discrepancy can cause pain
• sciatica
o straight leg raise to elicit pain (normal raise to 90)
• Provocative test of SI joint
o Faber test: patient supine have foot to opposite knee, hold opposite hip and press down on knee = pain
o gaenslen: allow one leg to hang off table while supine, bring opposite knee to chest:? pain o compression test: lying lateral decubitus, compress hip girdle? pain