2019 May Osce Flashcards
Station 1. What are the risk factors for cervical cancer?
Risk Factors of cervical Cancer
A) Modifiable Risk Factors:
- HPV Infection
- Chlamydia Infection
- Multiple Sexual partners
- Young age at coitarche
- High risk sexual partner
- Immunodeficiency/Immuncompromise
- Multiparity
- Low socioeconomic status
- Diet poor in fruits and vegetables
- Long-term use of oral contraceptives.
Non-Modifiable Risk Factors
- Maternal history of Diethylstilbesterol (DES)
- Positive family history of cervical cancer
What serotypes of HPV causes warts and cervical cancer?
HPV serotypes 16 & 18 are associated with cervical ca.
HPV serotypes 6 & 11 are associated with genital warts.
Mention the 5 levels of prevention and apply them to the prevention of cervical cancer.
Primordial:
Measures typically include laws and government policy.
Primary:
General Health Promotion:
Educate the public about risk factors of cervical factors such as early age of first coitus, excessive smoking, multiple sexual partners. The public should also be aware of symptoms of cervical cancer such as abnormal vaginal bleeding (in between periods, after sex and after menopause) and dyspareunia.
Specific Prophylaxis:
Use of human papillomavirus (HPV) vaccine. Gardasil (against HPV 6, 11, 16, and 18), cervarix (against HPV 16 and 18).
Secondary:
Early Diagnosis and Treatment:
Identify symptoms such as dyspareunia, post-coital bleeding, intermenstrual bleeding, etc. Papanicolaou (pap) smear test should be done for women of reproductive age (from 21years old), at least once every 3 years and once after
menopause, in addition to colposcopy test. In HIV-positive patients, pap smear should be done every year. Biopsy, CT scan and MRI of pelvis, full blood count, electrolyte, urea and creatinine test, urine microscopy and culture, blood grouping and crossmatching
Treatment – Surgery, radiotherapy, chemotherapy
Tertiary:
Limiting Disability
Preventing metastasis of cancer and multiple organ failure by prompt diagnosis and treatment of cancer.
Conservative – Good diet, execise, smoking and alcohol cesstion.
Quanternary:
Rehabilitation:
Physiotherapy, psychotherapy, counselling, family support and care.
A mother presents to you with her two month old baby who she gave birth to at home with the help of a traditional birth attendant (TBA). Counsel her on the need for immunization and explain to her the plan for each visit in accordance with the National Programme on Immunization.
Greet the examiner
Greet the patient
Confrim identity
Confirm language of preference
Establish rapport and introduce yourself
Assure the patient of confidentiality
Obtain consent
Ask them what they know About immunization
In simple language, explain in details the meaning of vaccination (a process of administering a vaccine in order to get immune/resistant to a particular infectious agent)
Explain to caregiver that there is availability of different vaccines for different ages according to NPI schedule.
Tell her on the benefits of vaccination which includes protection against child killer diseases, herd immunity, economic benefits to the parents by reducing hospital visits,etc
Address the myths and misconceptions on vaccination
Tell them about adverse effects though very rare following immunization (AEFI)/ complications which includes local reactions( injection site injury) and systemic reaction ( fever), anaphylaxis ( urticaria, pruritus) neurologic ( Seizure).
Advise them to report to nearby health facility if any of these complications occur
Advise them on strict adherence to NPI schedule
Evaluate their understanding by asking them to recap what you said
Encourage them to ask questions and concerns
Address their questions and concerns if any
Thank the patient and caregiver
This young man presents to you with an anterior neck swelling, bulging eyes and intolerance to heat. Perform the relevant examination.
THYROID EXAMINATION
INTRODUCTION:
Greet the examiner.
Greet the patient.
Introduce yourself and establish rapport.
Confirm patient’s identity.
Briefly explain what the examination is about.
Obtain consent.
Ask for a chaperone
To the examiner:
I would like to:
screen my patient for privacy.
adequately expose my patient (head, neck and upper chest).
place my patient in an anatomical position (sitting upright).
sanitize or wash my hands with running water and soap.
Ask to perform a quick general examination.
Points to note: Sclera jaundice, conjunctival, etc.
INSPECTION
Inspect the anterior neck at eye level.
Ask the patient to swallow (you can offer a glass of water).
Ask the patient to protrude the tongue.
PALPATION
In front of the patient:
Check for differential warmth
Tenderness
Extent of the mass
Skin attachment
Size (horizontally and vertically)
Tracheal deviation
Behind the patient:
Palpate the lobes for mass (left and right)
Consistency
Mobility of the mass
Carotid pulsation on both sides (one at a time)
Regional lymph nodes (submental, submandibular, pre-auricular, post-auricular, cervical, supraclavicular)
Palpate the scalp for metastatic mass (scalp swellings)
PERCUSSION
Retrosternal extension (over the manubriosternum, i.e. angle of Louis)
AUSCULTATION
Thyroid bruit (over the superior thyroid poles)
EYE SIGNS
Nafzigers sign – checking for exophthalmos from behind
Dalrymple sign – widening of palpebral fissure (exposure of both whites of sclera above and below the iris). Check this by asking the patient to stare at a distant object at eye level.
Stellwag’s sign – infrequent blinking
Mobius sign – loss of convergence
Von Graefe’s sign (lid lag) – lid lag on downward gaze.
Joeffery sign – absence of wrinkling on forehead when patient looks up with the head stabilized.
Ophthalmoplegia
HANDS: Palm (warm and moist), Fine tremors, Pulse (fast and bounding), Blood pressure (elevated), Proximal myopathy of upper limbs
LEGS: Pretibial myxoedema, Ankle reflex, Proximal myopathy of lower limbs, Sweaty soles.
Thank the patient and the examiner
A 22 year old G1P0 presents to you with cyesis at 34 weeks of gestation. Take a focused history.
A. INTRODUCTION: Greet the examiner, greet the patient, introduce yourself, establish rapport and obtain consent.
B. BIODATA: Name, Age, Occupation, Marital Status, Address, Religion, Tribe, Level of Education
C. REPRODUCTIVE PROFILE:
Ask about:
Gravidity (how many times has she been pregnant, including current
pregnancy, regardless of the outcome)
Parity (how many pregnancies has she carried beyond 28 weeks)
Last menstrual period
Gestational age
Expected date of delivery
D. PRESENTING COMPLAINT(S):
- Usually present for antenatal booking or routine antenatal visit.
- If there are any complaints, analyze the symptoms as already stated in the introduction to clerking.
Section A (Chief Complaint and Course)
Section B (Causes, Complications, Care Received)
E. HISTORY OF INDEX PREGNANCY:
• Is this her first booking or a routine antenatal visit?
• Is the pregnancy planned (desired) or not?
• When was the pregnancy confirmed?
• Where was it confirmed?71
• How was it confirmed?
• Is this assisted conception (in-vitro fertilization) or via coitus?
F. INDICATIONS FOR BOOKING (PREGNANCY SYMPTOMS)
ENQUIRE ABOUT:
Early morning nausea and vomiting
Breast fullness and tenderness
Increased frequency of urination
Cravings
Mood swings
Tiredness
Weight gain
Vaginal discharge
Fetal movements, etc.
G. INVESTIGATION
Ask for the results of her booking investigations (routine visit) or inform that the following tests will be done:
Ultrasound (1st trimester)
Packed cell volume (anemia)
HIV screening
Hepatitis B surface antigen (hepatitis B)
Hepatitis C virus (HCV)
Venereal Disease Research Laboratory test (VDRL)
Blood group-rhesus incompatibility
Genotype
Urinalysis
Random blood sugar (diabetes)
Malaria parasite test (malaria)
Weight
Height
Blood pressure
H. TREATMENT
Ask about shot of tetanus toxoid (TT)
Ask about intermittent preventive therapy for malaria (fansidar)
Enquire about routine antenatal drugs (fersolate, multivitamins, folic acid)
Enquire about other possible drugs the woman could be taking (oral hypoglycemics, anti-hypertensive, anticonvulsants, etc.)
I. PAST OBSTETRIC HISTORY (for the purpose of the exam, your
questions should be a summary of her past pregnancies)
Antenatal:
Was she booked for antenatal care in the previous pregnancies?
Was she treated for malaria in previous pregnancy?
Did she carry all to term?
Any miscarriages or preterm delivery
Natal:
Problems associated with labor
Method of delivery
Complications during delivery
Postnatal
Postpartum complications (postpartum hemorrhage)
Birth weight and sex of child/children
Any post-natal complications that affected the child/children?
J. GYNAECOLOGICAL HISTORY
• Age of menarche
• Ask about cycle length and duration, regularity of menstrual flow
• Enquire if she experiences any of the following:
− Menorrhagia (heavy bleeding)
− Dysmenorrhoea (painful menstruation)
− Hypomenorrhoea (short or scanty bleeding)73
− Dyspareunia (painful intercourse)
• Any history of Sexually Transmitted Diseases
• Ask if she has been screened for cervical cancer (pap smear)
• Enquire about contraceptive use
• Any history of abortion.
K. DRUG HISTORY:
Any drug allergies? All current medications including herbal concoction.
L. PAST MEDICAL AND SURGICAL HISTORY:
Diabetes, hypertension, epilepsy, asthma, sickle cell, blood transfusion,
tuberculosis, any recent surgeries, etc.
M. FAMILY AND SOCIAL HISTORY:
Any hereditary disease in the family?
Diabetes or gestational diabetes in the family
What is the living condition?
Twinning in the maternal bloodline
Maternal alcohol and tobacco usage?
Enquire about domestic violence
N. SYSTEMIC REVIEW: (Two questions from each system)
Central Nervous System: Headache, fainting spells, dizziness, abnormal gait, neck stiffness, insomnia, irritability, anxiety, etc.
Endocrine System: Excessive weight gain, abnormal hair distribution, cold/heat intolerance, increased frequency of urination, increased thirst, increased appetite, neck swelling, etc.
Respiratory System: Shortness of breath, cough, sore throat, tachypnea, bradypnea, catarrh, sputum, labored breathing, etc.
Cardiovascular System: Palpitation, orthopnea, chest pain, cyanosis, dizziness, syncope, shortness of breath on exertion, etc.
Digestive System: Loss of appetite, nausea, diarrhea, constipation, difficulty in swallowing, painful swallowing, blood in stool, dark stool, abdominal pain, abdominal swelling, etc.
Genito-Urinary System: Absence of urine, painful urination, blood in urine, loin pain, urinary urgency, weak erection, painful menstruation, vaginal discharge, heavy menstruation, etc.
Hematologic System: Nose bleeds, jaundice, weakness, rashes, easy bleeding, itching, tiredness, malaise, etc.
Musculoskeletal System: Joint pain, joint swelling, joint stiffness, muscle wasting, paralysis, bone pain, bone discharge, limb deformity, numbness, etc.
Thank your patient and examiner.
This 24 year old young man presents to you with complaints of feeling generally unwell. Perform a general examination on him.
THE GENERAL EXAMINATION
A. INTRODUCTION:
Greet the examiner.
Greet the patient.
Introduce yourself and establish rapport.
Confirm patient’s identity.
Briefly explain what the examination is about.
Obtain consent.
Ask for a chaperone.
To the examiner:
I would like to:
screen my patient for privacy.
adequately expose my patient (e.g. from nipple line to mid-thigh).
place my patient in an anatomical position (e.g. with the body supine, the arms at the sides and the palms facing upwards).
sanitize or wash my hands with running water and soap.
B. INSPECTION:
Inspect from the side to the foot of the bed or from head to toe.
Points to note:
Is the patient calm or restless?
Is the patient obese or wasted?
Are there scars, lumps, rashes, ulcers, dilated veins, etc.
Are there oxygen mask, nebulizers, Intravenous cannula, catheters, etc.?
Points to note:
Is the patient calm or restless?
Is the patient obese or wasted?
Are there scars, lumps, rashes, ulcers, dilated veins, etc.
Are there oxygen mask, nebulizers, Intravenous cannula, catheters, etc.
C. PALPATION:
Hair: touch and check for texture
Face: with the dorsum of your hands on the cheeks, feel for warmth.
Eyes: with your thumbs, depress the lower eyelids to check for conjunctival pallor; assess for sclera jaundice.
Mouth-check for pallor, cyanosis, dehydration and ulcers using the following commands: “Please open your mouth, stick out your tongue and raise it up.”
Lymph nodes: submental, submandibular, pre-auricular, post-auricular, cervical, supraclavicular, infraclavicular, axillary, epitrochlear, inguinal, popliteal.
Hands: check for pallor, finger clubbing, capillary refill, warmth, palmar erythema.
Leg: palpate for pedal edema.
Thank the patient and the examiner
A 50 year old known diabetic woman presents to you with yellowing of the sclera, intense pruritus and cola-like urine. Laboratory investigations show markedly elevated alkaline phosphatase (ALP). What type of jaundice does this woman have
Post-hepatic (obstructive) jaundice
- A 50 year old known diabetic woman presents to you with yellowing of the sclera, intense pruritus and cola-like urine. Laboratory investigations show markedly elevated alkaline phosphatase (ALP). What is the likely diagnosis?
Ca head of pancreas
A 50 year old known diabetic woman presents to you with yellowing of the sclera, intense pruritus and cola-like urine. Laboratory investigations show markedly elevated alkaline phosphatase (ALP) Describe her stools
Stools are typically pale or clay-coloured due to the absence of bile pigment. They’re also bulky and oily due to fat malabsorption.
Mention two investigations that should be done for patient A
Investigations:
Laboratory Investigations: Liver Function Tests, Coagulation studies, Viral serology, Full Blood Count
Imaging studies: Abdominal Ultrasound, CT-scan, MRI, Magnetic Resonance Cholangiopancreatograp
What is the most fatal complication that can arise after a surgery with general anaesthesia?
Complications during surgery: Hemorrhage and Hypotension due to coagulopathy which may lead to shock, Heptotoxic anaesthetic agents.
A 50 year old known diabetic woman presents to you with yellowing of the sclera, intense pruritus and cola-like urine. Laboratory investigations show markedly elevated alkaline phosphatase (ALP). Mention 2 Differential diagnosis
Gallstones,
strictures,
cholangiocarcinoma,
drug-induced cholestasis.
Picture of a sachet containing type types of tablets red and yellow
Picture of combined oral contraceptive pills (COCP)
Mention 5 side effects of COCs
Weight gain
Chloasma
Nausea
Loss of libido
Depression
Breast tenderness
DVT
MI
