OSCE Flashcards
Smear test results
Introduce self
Confirm ID
Explain confidentiality
Do you know why you are here today
The results show HPV positive, cytology negative.
I want to reassure you that this does not mean cancer, the smear test is a screening test which picks up on possible problems long before they become cancer and allows us to monitor you.
Explain HPV - virus, which is associated with several types of cancer including cx. It’s really common and usually (90%) the body clears the virus on it’s own without any treatment, within 2 years.
Because of this, we don’t offer any treatment but we will wat to do another smear in a year to check if the HPV has gone and check the cells again.
If it has gone we will do routine 3 year smear.
If it hasn’t we will do another smear in a year again as we know most people will clear within two years.
If the HPV is still there in 2 years we would offer to examine you like at the smear test but with a special pair of binoculars to see if there are any worrying cells and treatment if needed at the same time under local anaesthetic so it is comfortable for you.
HPV+ve, CIN 1/2/3
As above the results show some abnormal cells.
I want to reassure you that this does not mean cancer, the smear test is a screening test which picks up on possible problems long before they become cancer and allows us to monitor you.
CIN 1 - coloscopy and watchful wait
CIN 2/3 colposcopy and 6/12 TOC with GP practice.
Because you have abnormal cells we would like to offer to examine you, in the same was as at the smear test but with a special pair of binoculars to see if there are any change, usually we offer treatment if needed at the same time under local anaesthetic so it is comfortable for you and then a smear with your GP practice in 6/12 to check the abnormal cells have gone.
Confirm PMHx (smears, gravity/parity, immune status, smoker, contraception, STI screen up to date)
Condoms and PIL
Emergency contraception station
Introduce self
Confirm ID
Explain confidentiality
How can I help
I’ll need to find out a bit more about to you make sure I offer you the right treatment for you
LSI - with who / up to date with screen / consensual
LMP
Other UPSI this cycle
Any other EC this cycle
Contraception (hormonal/condoms)
How would you feel if you were to become pregnant?
PHMx
O&G hx,
- smears, gravity/parity, periods (inc HMB/dysmen), contraception use, current breast feeding
Meds
Allergies
Social hx
Sexual hx, partners in 3/6/12 months, STI screen, BBV Qs.
Future contraceptive plans
examine: BMI (>26 or 70kg 3mg LNG)
Explain options
IUD effective immediately, long term contraception
LNG - can q/s straight away, time dependent
UPA 5/7 delay q/s, express milk if breastfeeding
Shared plan: PT today and 3/52 Retreat if vomits STI screen Condoms PIL Last date to return for IUD
Skin osce
Introduce self
Confirm ID
Explain confidentiality
How can I help
HPC
(duration, itch, colour change, discharge, pain, bleeding, tried any tx, had previously or other skin problems)
O&G Hx
(smear, gravity/parity, surgeries)
Sexual Hx - STI screen up to date
PMHx esp (immune, thyroid, problems with skin/eyes/joints)
Meds/allergies
Social
(esp smoking, changes to skin care/products)
FHx
(esp autoimmune)
Offer examination
Explain likely Dx and further Ix, tx plan and f/u and results process if biopsy. Offer screen Vaccines if eligible PIL Condoms if needed
STI OSCE
Introduce self
Confirm ID
Explain confidentiality
How can I help
HPC
(duration, pain, dysuria ect )
O&G Hx
(smear, gravity/parity, surgeries, contraception)
Sexual Hx
(STI screen up to date, BBV, partners in 3/6/12 month)
PMHx esp (esp eyes/joints)
Meds/allergies
Social
(drugs, ETOH, smoking)
Offer examination (wash hands, chaperone, PPE)
Examine (male or female), micro/culture, urine for NAAT, Udip
Bloods
Info about condition if known or to await tests Tx options (inc info about vomiting) Abstinence P/N Vaccines/PEP/PrEP PIL Condoms
Points in all patient facing OCSEs
Introduce self
Confirm ID
Explain confidentiality
Explore ideas, concerns and expectations
Hx
Examine
Dx
Tx options
Patient information leaflet (probably)
Condoms (probably)
menopause new starter
Symptoms inc impact on life (VMS/urogential
PMHx (inc liver/breast/migraine/bone/cvd risk, hysterectomy)
FHx,
o&g hx (smears, contraception, uterus present, menstrual hx, LMP)
How’s the sex life
meds/allergies.
Smoking/ETHO/lifestyle.
BP/BMI,
patient’s goals, ICE
Examine: BP/BMI
Tx options
Lifestyle- exercise, weight, ETOH intake, multivits/herbal (black cohosh/red clover)
Hormonal
Best evidence base
Uterus/no uterus
LMP - <1yr sequential monthly bleed, IUS if wants bleed free >1yr continuous
Risks - breast (4 more combined related to duration of use, 4 less oestrogen only), VTE (oral 1.2-2 x, transdermal nil), CVD, endometrial (lower with continuous)
Benefits - VMS, bone whilst using not long term dementia no evidence
SEs bleeding, hormonal changes (hair/skin/mood)
F/U 3/12 sooner if needed other options can be discussed at r/v
