OSCE

Question 1

What are the 2 cranial nerve examinations

Answer 1

Trigeminal nerve - 5 (cotton/pin prick)
Facial nerve - 7
(motor functions|)

Question 2

What do you assess when doing the trigeminal nerve (5) exam

Answer 2

• Sensory functions -> cotton/pinprick sensation
• demonstrate on neck - so they know what it feels like
  • forehead - Ophthalmic V1
  • cheek - Maxillary V2
  • jaw - Mandibular V3
• Motor functions
  • pt to clench + feel masseter + temporalis bilaterally
  • ask pt open mouth whilst you push jaw up

- Asses reflexes
 • Jaw jerk?
•  Corneal reflex
 ∙ explain procedure + get consent
 ∙ depress lower eyelid + pt look up
 ∙  touch edge cornea with cotton
 ∙  normal = direct blinking

Question 3

What do you assess when doing the facial nerve (7) exam

Answer 3

• inspect sig facial asymmetry
• inspect motor functions
  • Raise eyebrows
  ▸ raise eyebrows as if surprised
  • close eyes
  ▸ scrunch eyes + don’t let me open them
  ▸ assess power
  • blown out cheeks
  ▸ blow out cheeks + don’t let me deflate them
  • smiling
  ▸ smile
  ▸ check asymmetry
  • pursed lips
  ▸ try and whistle
  ▸ check asymmetry

inspect sensory changes
• taste changes
▸ any changes to taste recently (7 supplies taste sensation to anterior 2/3 of tongue)
• hearing changes
▸ any noises sound louder than normal

Question 4

When checking lymph nodes, what do you check lumps for

Answer 4

- size
▸ <2mm - insig
▸ changed size over time
- multiple?
- consistency
▸ hard/rubbery/soft
- tender
▸ non-tender = malignant
- mobility
▸ fixed/mobile
- erythema on overlying area

Question 5

If infected or draining an infected organ, node will become….

Answer 5

• firm
• tender
• enlarged
• warm
• mobile
• overlying skin can be inflamed _ red

Question 6

Lymph node may indicate

malignancy if …

Answer 6

• firm
• non-tender
• matted
• fixed
• progressively enlarging

Question 7

Gain consent for XLA

Answer 7

• introduce me, pt name + DOB
• review MH, DH
• Explain procedure
  I. “Today we will be extracting ___”
  II. “You’ll be awake at all times + maintain verbal contact”
  III. “You won’t feel any pain during the procedure but will feel pushing +
  pressure
  IV. Provide patient option of no treatment
• Give benefits with continuing with procedure
  I. Relief of pain
  II. Removal of infection

Risks associated with procedure..
I. Bleeding
II. Bruising
III. Infection
IV. Pain
V. Swelling
VI. Fracture of tooth
VII. Damage to adjacent teeth
VIII. Dry socket (if smoker/ contraceptive pills/ NUG)
IX. Surgical procedure
i. Cut in the gum
ii. Bone removal
iii. Stiches required

X. Mandible
i. Temporary/ permanent loss of sensation to chin, lip & tongue

XI. Maxilla

i. Fracture of maxillary tuberosity
ii. OAC

8. “Do you have any questions?…”
9. If patient happy to proceed, sign & date

Question 8

Post Op instructions for XLA

Answer 8

• For next few hours, until the numbness wears off:
o Avoid eating
o Be careful not to bite tongue, cheek, lip
o Nothing hot or cold.

• For the rest of the day:
o Avoid any physical work or exercise
o NO rinse mouth/spit for rest of day
o Clean your teeth as usual- be careful not interfere with surgical area.

• After 24 hours
o Salt water rinses for 1 week, 4x a day (after meals)

• For 24 hours:
o Avoid alcohol

• For first few days:
o Soft diet for first few days.
o Do not use a straw

• For 48 hours
o Avoid smoking

• Bleeding:
o May get blood in the saliva for 2 days - normal
o if starts bleeding put clean gauze + apply biting pressure for 20
minutes.
o If bleeding is persistent call number

• Pain and swelling is normal.
o For pain relief may take appropriate pain killers normally take

• Take any antibiotics prescribed and finish course
• Don’t drink alcohol with metronidazole.
• May suffer sensitivity of surrounding teeth, clean well.
• If sutures used will dissolve in 3-4 weeks
• May feel sharp fragments around socket- don’t worry, will disappear.

Question 9

What do you give for angina

Answer 9

Glyceryl trinitrate spray
400 micrograms / dose

sublingual

Question 10

how does GTN spray work + what are possible side effects of using GTN spray

Answer 10

potent vasodilator for coronary artery

dizziness
headaches

Question 11

What do you give for MI

+ if unresponsive after that

Answer 11

oral aspirin (anti-platelet) crushed/chewed
300mg
NOT FOR KIDS <18

start BLS

Question 12

what do you give for asthma

Answer 12

salbutamol blue inhaler / reliever for asthma
inhalation
through large volume spacer?
100 micrograms/actuation or 10 puffs

Question 13

symptoms of severe asthma

Answer 13

Inability to complete sentences in one breath
○ Respiratory rate >25 per minute
○ Tachycardia (HR >110 per minute)
○ PEFR <50%

Question 14

symptoms of life threatening asthma

Answer 14

Cyanosis, exhaustion, confusion, decreased level of consciousness
○ Respiratory rate <8 per minute
○ Bradycardia (HR <50 per minute)
○ PEFR <33%

Question 15

symptoms of anaphylaxis

Answer 15

- Difficulty breathing (stridor & wheezing), rhinitis, 
urticaria (rash) tachycardia, 
abdominal pain, vomiting, 
diarrhoea, 
sense of impending doom & flushing

Question 16

how does salbutamol work

Answer 16

B2 agonist
bronchodilator

smooth muscle relaxant

Question 17

what do you give for anaphylaxis

Answer 17

Adrenaline IM (repeat every 5 minutes if req.)
6 months - 5 years = 0.15ml
6  - 11 years = 0.3ml
12+ years = 0.5ml (0.5ml of 1:1000 solution)

Question 18

how does adrenaline work

Answer 18

alpha receptor agonist
B1 agonist

B2 agonist
mast cells stabilisation
glucose elevation