OSCE finals

Question 1

What must you remember to ask in respiratory chest pain

Answer 1

• Signs & Sx of DVT - erythema, leg pain, swelling
• Exclude PE - haemoptysis, cough, SOB
• RF of VTE: malignancy, surgery, immbolity, smoking, thrombophilia
• Systemic sx - weight loss, fever, night sweats

Question 2

How do you proceed if you need to consnet a non-capacitous disabled adult brought in with carer

Answer 2

• introduce/talk to patient
• ask if carer if there is a way of communicating/what disability they have
• is there an LPA in place - if so, consent the LPA

Question 3

What must you remember with self-harm history

Answer 3

• thoroughly explore intent
• ask about drugs and alcohol
• previous support/mental health input

Question 4

How do you take an Obstetric history

Answer 4

• HPC
• Systems review
  
  • systemic: fever, rigors, sweats, weight loss, fatigue, rash, bruising
  • PV bleed: IMB, PCB, PMB
  • PV discharge
  • Pain: cyclical or dyspareunia
  • Pregnancy
    
    • chance of pregnancy
• Current preg
  
  • Foetal movements
  • contraction
  • PV loss
  • pre-eclapmsia sx
  • 1st dayof LMP
  • Scans
  • Ix
  • Problems
• Previous obstetric
  
  • GP
  • Children
  • Miscarriages or terminations

Question 5

How do you take a paeds historuy

Answer 5

• HPC
• Systems review
  
  • ​general: fever, behaviour, activitiy, rashes, development, last feed, last motion
  • CVS: noisy breathing…
  • GI
  • GU: wet nappies, dysuria
• BIND
  
  • ​Birth
  • Immunisations
  • Nutrition
  • Development
• Social
  
  • family unit - who’s at home
  • social sevcies involvement

Question 7

What are some long term consequences of coeliac

Answer 7

• increased riks of B12, folate and iron deficiency
• rash
• T cell lymphoma
• Osteoporosis
• Oesophageal cancer

Question 8

What can you do for coeliac patients

Answer 8

• prescirbe gluten free food
• give hope, especially in young patients
  
  • emphasise that coeliac doesn’t mean you can’t lead a normal life

Question 9

What safety netting advice can you give to stable angina patients

Answer 9

GTN

• take one puff - wait 5
• if persistent, take another - wait 5
• if not aborted, call (((

Continue to exercise even if it causes chest pain

Question 10

What are some important points to assess asthma control

Answer 10

• Symptoms
  
  • nightime sx
  • no. of times per day reliever is used
  • asthma sx during day - has it affected daytime activities
  • admissions
• Adherence
  
  • are you taking inhalers correctly
• review asthma sx

Question 11

How do you explain chronic kidney disease? assess RF for progression? Risks

Answer 11

• Chronic kidney disease (CKD) is a long-term condition where the kidneys don’t work as well as they should.
• risk factors afffecting progression
  
  • smoking
  • NSAIDs
  • DM
  • HTN
  • Maintain healthy diet
  • reduce salt
  • exercise
• complications
  
  • increased risk of AKI
  • Bone
  • Blood
  • Dialysis

Question 12

How do you systems review rheum

Answer 12

• weight loss
• rash
• ulcers
• hair changes
• nodules
• diarrhoea
• fever

Question 13

What are key sx to review with

a) every patient
b) ladies

Answer 13

a

• bowels and bladder
• similar episodes

b

• MOSC
  
  • Menstrual periods, menstrual/gynae sx
  • obstetric hx
  • sexual hx and smears/mammograms
  • contraception
• smears and mammograms
• bleeding disorders/PMH or DH of blood thinning

Question 15

How do you consent for a procedure

Answer 15

• why are you here
• what have you been told
• brief HPC and red flags
• What the procedure is
• What you’re going to do
• Risks
• Follow up
• How will they receive results
• Questions

Question 16

How do you cousel on mirena

Answer 16

• explore patient perceptions
• explain how it works
• explain the pros
  
  • reversible
  • localised hormones, reduced cancer risk
• explain cons
  
  • irregular bleeding for the first few months
  • initial period like pain
  • SE:
    
    • headaches
    • acne
    • breast tenderness
    • no STI protection
• Explain risks
  
  • infection
  • expulsion
  • perforation
• Explain procedure
  
  • have you had a smear before?
  • -ve pregnancy test and bimanual before
• post procedure
  
  • light bleeding
  • can check position themselves
• explains removal after five years

Question 17

What are the endocrine systems review questions

Answer 17

• heat intolerance
• sweating
• fatigue
• termore
• neck swelling
• weight gain or loss
• omsotic symptoms

Question 18

What must you remember in spine exam

Answer 18

gait

chest expansion

Question 19

What are the concluding bits for resp

Answer 19

• cervical nodes
• oedema
• sputum pot
• peak flow

Question 20

what are some bits often forgotten in cardio

Answer 20

ausculatate left axilla for mitral incompetence

lung bases

palpate carotids

state - femoral pulses

Bits

• BP both arms
• lying and standing BP
• 12 lead ecg
• opthalmoscopy

Question 21

How do you accentuate various murmurs

Answer 21

Held inspiration increases R sided murmurs

Held expiration increases L sided murmurs

Bell - apex - roll - mitral stenosis

Diaphragm - lean forward - aortic regurg

Question 22

How can you open a consultation

Answer 22

I’m going to explain this to you in a second, but i would just like to double-check what you’ve been told.