OSCE Flashcards
Standard History Template
(6 + 3 + 1)
1) Intro and offer painkillers if they are here for pain
2) Screen for presenting complaint
What is wrong?
Okay is there anything else that you have come in for
3) Information gathering
- Tell me a bit more
- SOCRATES
Now SUMMARISE back to them (So just to summarise…)
//////////////////////////////////////////////
4) RISK FACTORS and RED FLAGS
5) Systems Review for appropriate systems
Also CONSTITUTIONAL SYMPTOMS
/////////////////////////////////
6) ICEF
What are you most hoping to get out of the doctors today?
/////////////////////////////////////////////
NOW finish the rest of the history
- PMH
- DH and ALLERGIES
- SH and FH
SAFETYNET
Obstetric History (Replaces Step 4 and 5)- before ICEF and after SOCRATES
4 PARTS- Systems Review, Questions About Current Pregnancy, Questions about Previous Pregnancy, Gynae History
HP 3 F PP 3
- Nausea and Vomiting/ Weight Loss- Hyperemesis Gravidarum
- Headache, Visual Symptoms, Epigastric Pain- Pre Eclampsia
- Reduced Fetal Movement (felt after 16 weeks)- any change in baby’s movements?
- Vaginal Bleeding (ask about latest ultrasound)
- Vaginal Discharge
- Abdominal Pain
- Chest Pain/ Swollen Leg (PE/ DVT)
- Pruritus- Obstetric Cholestasis
- Fever (Chorioamnionitis), Fatigue (Anaemia), Weight loss (Hyperemesis Gravidarum)
//////////////////////////////////////////////////
Current Pregnancy (GSS IMO)
Gestation Age
Scan Results (Ask about Status of Fetus and Placenta)
Screening- Ask about if they have opted for screening (HepB, HIV, Syphilis)
Immunisations (Flu, Whooping Cough, Hepatitis B (if at risk only))
Mental Health of Mother at the moment
Other Details
* Single or Multiple Gestation
* Folic Acid
* Mode of Delivery
* Other Illnesses during Pregnancy
//////////////////////////////////////////////////////////////
Previous Obstetric History
- Gravidity and Parity
- Pregnancies that were >24 weeks
Gestation at deliveries (preterm increases risk of subsequent preterm)
Birth weight (LGA- Gestation diabetes?)
Mode
Complications
Ask if IVF or assisted reproduction was used
- Pregnancies that were <24 weeks
Miscarriage- clarify trimester and if a CAUSE was identified
Termination of Pregnancy- Clarify gestation and method of termination
Ectopic- site and how it was managed
////////////////////////////////////////////////////////////////////
Quick Gynaecological History
- Cervical Screening (date of last screening)
- Previous Gynaecological conditions like STIs/ Malignancy/ Endometriosis
Gynae History- Ask G/P/ LMP EARLY
Gynae History, Menstrual History, Family Planning, Past Gynae History/ QUICK Obstetrics history (Current and Past Pregnancy)
Gynae Symptoms (Pain, PV bleeding, PV dscharge, Pregnancy)
- Abdominal Pain
- Vaginal Discharge
- Post coital bleeding- Cervical issues/ STI
- Intermenstrual bleeding- Contraception, STI, Fibroids, Cancers
- Post Menopausal Bleeding- Atrophic Vaginitis, HRT, Cancers (Endometrial mainly)
- Dyspareunia (Endometriosis, STI, Atrophic Vaginitis)- ask about how deep the pain is
Systemic 3- Fever, Fatigue, Weight Loss
//////////////////////////
Menstrual History
- Duration and Frequency
- Ask about Menorrhagia
- Ask about Dysmenorrhoea
- Last Menstrual Period Date
- Menarche and Menopause date
///////////////////////////////
Contraception
- which contraception and what have they previously tried
Reproductive plans- are they considering having children?
//////////////////////////////
Past Gynae History and Cervical Smear
Paeds History Taking
Establish name of who they have brought in the room with them
Say it is my usual practice to speak with the parent first and then the child
Systems Review is different
Also Extra bit for PMH and SH
Systems Review (Especially if YOUNG) (3,2,2,3)
- Diet and Water intake
- Urine Output and Stool
- Vomiting
- Cough and Coryza
- Short of breath
- Behaviour
- Movements (Seizures)
- Pain
- Weight Loss
- Fever
- Rash
////////////////////
Under PMH- (3 birth, 3 current)
- Birth (Antenatal, Natal and Post Natal)- When and How were they born
- Immunisations
- Nutrition- Feeding (How many meals a day?)
- Development and Growth - Prenatal- any abnormal scans or screening (Height and Weight)
////////////////////////////
Under SH
HEEADSSS
- Home- who is at home, who do you get on with at home, who do you turn to when you are down
- Education and Employment- ask about that and friends at school/ how they are doing at school/ how their work is going
- Eating- worried about body shape? on a diet
- Activities and Hobbies
- Drugs/ Alcohol/ Tobacco
- Sex and Relationships, Are you in a relationship at the moment? Boy or girl? Young people are often starting to develop intimate relationships, how have you handled that part of the relationship
- Self-harm, depression and self-image
- Safety and Abuse- Do you feel safe at home and school, is anyone harming you/ making you do things you do not want to
Make sure to always ask about Family Life
Complications of Gastrectomy
Small intestine bacteria growth
Peptic Ulcer
Anastomotic Ulcer
Malabsorption
Dumping Syndrome
Bloating
Complications of bowel surgery
Ileus
Anastomotic Leak
Intestinal Obstruction/ Adhesions
Damage to other organs
Complications of cholecystectomy
CBD Injury/ bile leak (abdo pain/ fever and nausea)
Complications of biliary operation
CBD Injury/ bile leak
Anastomotic Leak
PANCREATITIS
Complications of CABG
Reperfusion Arrythmia
Post-operative ACS
Inotropes are needed after operation- may REDUCE OTHER ORGAN PERFUSION
Complications of vascular stents/ grafts
Haemorrhage
Organ Ischaemia
Contrast Complications (renal injury/ anaphylaxis)
Thyroidectomy
Hypocalcaemia
Laryngeal Nerve Damage
AIRWAY OBSTRUCTION- open wound asap
Parathyroidectomy
FACIAL NERVE DAMAGE
Orthopaedic Operation
Infection
Neurovascular Injury
Compartment Syndrome- due to increased pressure within the limb (usually leg)
TURBT/ Cystoscopy
UTI
Impotence and retrograde ejaculation
External SPhincter Damage and therefore INCONTINENCE
what can cause Jugular Foramen Syndrome (9-11)
GCA
VZV
Trauma and Neoplasm
what can cause Cn3-6 issues
Cavernous Sinus and Miller Fischer
What can cause chorea?
Stroke
huntingtons
sydenhams chorea
what can cause athetosis?
Cerebral Palsy and Neonatal Jaundice
How is Cor Pulmonale managed?
Loop Diuretic and LTOT
When should admission be considered in COPD?
O2 < 90
Confusion
Cyanosis
Comorbidity is significant (Cardiac disease)
In angina, in addition to B+C, what other drugs should be given?
Aspirin and Statin
What drug does the injectable contraceptive contain?
Medroxyprogesterone Acetate
When can an IUD be removed?
Wait until their next period at the very least before removing
When should the implantable contraceptive be inserted?
Within the first 5 days of the period, otherwise 1 week of contraception needed
What are the 2 side effects of the implantable contraceptive?
Irregular/ Heavy Bleeding- give COCP alongside to prevent this
Progestogen effects- Headache Nausea Breast Pain
What does the implantable contraceptive interact with?
Enzyme INDUCERS
so SWITCH to a method unaffected by enzyme inducers for ONE MONTH after stopping
What are the causes of hypoglycaemia?
Exogenous drugs (typically sulfonylureas or insulin)
Pituitary insufficiency
Liver failure
Addison’s disease
Islet cell tumours (insulinomas)
Non-pancreatic neoplasms
How long until Mirena can be relied upon as a contraceptive method?
7 days
What is the Acute management of heart Failure?
Oxygen and Loop ofc
NITRATES (vasodilators) if AR, MR/ MI, HTN
if HYPOTENSION- Inotropes (dobutamine) and Vasopressors (norepinephrine)
What is the chronic management of heart failure?
AB/ SS/ 3
The 3 extra managements
- LEF<35- Sacubitril Valsartan
- LEF<35 and HR>75- Ivabradine
- Wide QRS- Cardiac Resynchronisation
How is Huntington’s managed?
Tetrabenazine, Atypical Antipsychotics and SSRIs
Which arteries do LACI and PACI affecte?
LACI- Perforating
PACI- Vertebrobasilar
A patient with a history of VTE is pregnant, what should you give them?
LMWH until 6 weeks of pregnancy
How is Cirrhosis Definitively Diagnosed?
LIVER BIOPSY, but transient elastography is first line
What is the Prophylactic and Acute management of Peritonitis?
Prophylaxis=if Neutr>250- Ciproflox and Oflox (Quinolones for the Peritonitis)
Acute- CEFTRIAXONE
What are the main complications of Crohns?
Small bowel Cancer more common than Colon Cancer
Osteoporosis
What are the cranial and nephrogenic causes of Diabetes Insipidus?
Cranial- Sickle Cell and Sarcoidosis
Nephrogenic- Lithium, Hypercalcaemia and Hyperglycaemia
What is the management of DKA and HHS?
DKA
- IV Fluids
- 0.1 Insulin (stop short acting)
- DEXTROSE if Glucose <14
- Potassium if not Hypokalaemic (40mmol)
HHS
- IV fluids and Potassium
- 0.05 Insulin (ONLY if Glucose isnt falling)- otherwise CPM
What is the management of Thyrotoxicosis and Myxoedema Coma
thyrotoxicosis-
- IV Propanolol
- NG Propylthiouracil
- IV Steroids
- Lugol’s Iodine
Myxoedema coma
- IV Thyroid Replacement
- IV Fluids
- IV Steroids
What can cause Addison’s?
A metastatic Melignancy
What are the causes of Delayed Puberty?
BRAIN (low Gonadotrophin)-
- Hypothyroidism
- Coeliac, CF
- Pituitary Disease
(and Kallman)
GONADs (High Gonadotrophin)
- Klinefelters (Tall)
- Turners
- Noonans
- Prader Willi
- CAH and Hypogonadism
Management of DDH and Perthes
DDH- Pavlik if Young, Surgery if Old
Perthes- Cast and Surgery if > 6yo
What do you look out for in NIPE in the face?
Upslanting Palpebral Fissures, flattened nasal bridge, Low set ears- Downs Syndrome
Epicanthal Folds, Smooth Philtrum, Low Nasal Bridge- Foetal Alcohol Syndrome
Management of HIE
Oxygen
Antiepileptics
INOTROPES
Controlled Hypothermia
What are the Rf for Pseudogout
haemochromatosis
hyperparathyroidism
low magnesium, low phosphate
acromegaly, Wilson’s disease
Psychiatric History
Presenting Complaint and WHO PROMPTED them to come in
HPC- Ask about TRIGGERS and TIMEFRAME
Systems Review for Psych
- Psychosis
- Depression
- Memory
- RISK
PMH- (previous psych and SUICIDE ATTEMPTS)
Drug History- Check COMPLIANCE
Family History of SUICIDE as well
SOCIAL History
- SOCIAL CIRCUMSTANCES-
Friends, Family, Finances, Relationships
EDUCATION
FORENSICS HISTORY
Childhood and Upbringing- any child abuse?
Pre-morbid Personality
Subfertility History
How long have they been trying/ Any previous investigations/ management?
COITUS
- Frequency
- Any difficulties/ Pain
- Relating it to FERTILE DAYS
Partners (ask about both
- Age/ Occupation
- BMI
- PMH/ DH
- Smoking/ Alcohol
- Previous Children
Women’s Gynaecological Health
- also look for PCOS and Prolactinoma
///////////////
Due to:
Hypergonadotrophic Hypogonadism/ Hypogonadotrophic Hypogonadism
Any Gynae Symptoms
Mechanical/ Timing
ED/ Ejaculation
Delirium/ Dementia
SOCRATES
Gradual confusion- Alzheimer’s, Step Wise= Vascular
Associated Symptoms-
- Psychiatry
- Changes in Behaviour (Aggression/ Calling Out)
- Sleeping (awake at night= Alzheimers), fluctuating consciousness (DELIRIUM)
ICEF
PMH- Vascular Diseases, Head Injuries, Infection, Parkinson’s (PHIV)
Drug History
FMH
SH (Home, Walking, Working, Effect, Carer)- (HWWEC)
- Living situation
- MOBILITY and WALKING AIDs
- Working/ Driving
- Effect on LIFE
- If Talking to Carer ask about THEIR NEEDS
Also RISK
Paediatric Soiling/ Enuresis
Toilet Training
School Toilet Behaviour
Ask about life at home
Soiling- Diarrhoea/ Constipation? and any Pain?
Enuresis- Have they ever had a dry night?
DIFFERENTIALS
- Primary
- NEUROLOGICAL conditions
- Urinary/ GI infection
Paediatric Low Weight
Ask about Growth Chart
LOW Input- ask DETAILS about diet
Use- Activity Level
Output- Ask about Wet nappies/ stools
DIFFERENTIALS
- Cystic Fibrosis
- Cardiac Cause if Sweating when breathing
- Primary Ciliary Dyskinesia or other Genetic Cause
Paediatric Weight Gain
Input
Use
Output
DIFFERENTIALS
- Cushing’s
- Hypothyroidism
- Prader Willi
Paediatric Walking/ Sitting Delay
Ask about:
Mobility
Hand Dominance
Balance Issues
Behaviour Issues
NEUROLOGICAL ISSUES
Paediatric Speech Delay
Ask About:
Senses- Hearing, Speech
Communication- Non-verbal Communication, Comprehension, Social Responses (how does he act in new situations)
Paediatric Issues with Puberty/ Amenorrhoea
Ask about Puberty signs
ICP (Headaches, Visual Changes)
Familial Puberty/ Height
Cystic Fibrosis
Thyroid Disease
Anorexia
Crohn’s
Paediatric Behaviour Issues
ADHD- poor concentration/ hyperactive
Conduct- aggressive/ cruel/ hostile
Autism- Poor social interaction/ restricted interests/ repetitive behaviours/ difficulties recognising emotions
Paediatric Allergies
Ask about
Triggers
What the Reaction is
ANAPHYLAXIS
Atopy history in child and family
Ask about HOME and SMOKING
Dermatology History taking
PC
HPC
Derm Symptoms (Bleeding, Itchiness, Pain, Blisters, CONSTITUTIONAL and JOINT PAIN)
Systems Review (Resp, GI, Peripheral Oedema, Confusion (for Meningococcal Sepsis))
ICE
PMH (including CONTACT HISTORY and DERM HISTORY and WHAT TREATMENTS they have tried)
DH
SH (Travel History and Sun exposure)
Also remember Occupation
