2020 November Osce Flashcards
A 38 year old man complained of chest pain. Take a focused history
Introduction: Greet examiner, greet patient, introduce yourself, establish rapport and obtain consent.
B. Biodata: Name, Age, Occupation, Marital Status, Address, Religion, Tribe, Level of Education.
C. Presenting Complaints:
Chest pain……….. 3weeks duration
History of Presenting Complaint
Course
What part of your chest? (Usually retrosternal)
How does it start? Insidious or rapid onset?
Can you characterise this pain? (Usually a crushing or stabbing pain)
How long does each pain interval last?
Does it radiate to any part of your body? (Usually the jaws, neck and upper arms)
Are there any condition that worsens this pain? (Aggravated by exertion)
Any relieving factor? (Relieved by resting)
Do you have vomiting or sweating associated with this pain?
Do you have difficulty with breathing?
Causes:
Are you hypertensive?
Are you diabetic?
How often do you consume oily foods? (Dyslipidemia=> Atherosclerosis)
Do you have anxiety disorders? (R/o psychological chest pain)
Is the pain associated with food? (?Peptic ulcer disease)
Do you have ulcer? (R/o Peptic ulcer disease).
Is the chest painful to touch? (?Musculoskeletal pain)
Is the pain worsened when you move the arms? (Musculoskeletal)
Is the pain tearing, severe sharp and radiating to the back? (Aortic dissection)
Any associated wheezing or cough? (?Bronchial Asthma)
Complications:
Any difficulty with breathing/breathlessness?
Any easy fatigability?
Any exercise intolerance?
Have you ever felt pain around your calf on walking? (Intermittent claudication)
Care:
What have you done since development of symptom?
Drug History:
Are you on any routine medication?
Are you allergic to any drug?
Past Medical History
Are you hypertensive?
Are you Asthmatic?
Do you have peptic Ulcer disease?
Have you been admitted in the hospital before?
If yes, when? Why? And how long did you stay?
Have you had surgery before? If yes, what procedure was that and when?
Have you been transfused with blood before? If yes, when?
Family & Social History
Monogamous or polygamous setting?
What is your level of education?
Do you smoke cigarette?
Do you drink alcohol?
If yes, how often do you take them?
How many rooms do your apartment have?
How many windows per room and how many occupants in a room?
What’s your source of drinking water? Well, borehole, stream or spring?
What method of refuse disposal do you adopt?
What method of sewage (faecal matter) disposal do you adopt?
Review of Systems
CNS:
✓ Do you have headache?
✓ Any dizziness?
✓ Any hearing or vision imbalance?
CVS:
✓ Do you have difficulty breathing?
✓ Do you find it difficult to sleep without pillows (orthopnea)?
✓ Do you wake up in the middle of the night with chest compression (Paroxysmal Nocturnal dyspnea)?
Respiratory:
✓ Do you have cough?
✓ Any wheezing?
✓ Any chest pain?
✓ Any night sweats?
GIT:
✓ Do you experience vomiting?
✓ Any Diarrhoea?
✓ Constipation?
✓ Any stomach pains?
Urogenital Tract:
✓ Do you experience difficulty passing urine?
✓ Do you urinate more frequently than usual?
✓ Did you notice any change in the colour of your urine?
✓ Do you experience bleeding per vagina?
Thank your patient and examiner
List 5 dangers associated with animal rearing.
A greater use of feedlots leads to concentration of animal manure and a greater risk for contamination of groundwater.
● Biodegrading livestock waste also emits odorous gasses leading to air pollution.
● Causes zoonotic diseases and infections by contact with diseased animals.
● Occupational hazards of livestock rearing may lead to injuries.
● It also uses nearly 70% of agricultural land which leads to being the major contributor to deforestation and biodiversity loss.
What is zoonosis?
A zoonosis is any disease or infection that is naturally transmissible from vertebrate animals to humans
State 5 examples of zoonotic diseases.
● African sleeping sickness - wild animals and domestic livestock
● Angiostrongyliasis- rats and cotton rats
● Anisakiasis-whales, dolphins, seals
● Anthrax-herbivores like cattle, sheep, goat, horses, pigs
● Baylisascariasis- Raccoons
● Bubonic plague- Camels, rabbits, hares, sheep
● Bird flu-chickens
● Chagas disease- kissing bugs (armadillo triatominae)
● Ebola fever - Fruit bat
● Lassa fever-multimammate rat
What is the full name of the current pandemic?
Severe acute respiratory syndrome coronavirus 2 (SARS COV-2)
List the levels of prevention
Primordial: Governement policies
Primary level : Health promotion and specific prophylaxis
Secondary level: Early diagnosis and treatment
Tertiary level: Limiting disability and
Quantenary: rehabilitation
Apply the levels of preventions to the current pandemic
Primordial
Government policies
Primary
a. General health promotion
It’s targeted towards the whole community and healthy individuals.
Aim is to educate them on the cause (SARS COV2) and ways of transmission (Respiratory droplets, human-human & contact with contaminated surfaces) through fliers, television, radio, awareness on social media platforms etc It can also be spread during coughing talking and sneezing.
b. Specific prophylaxis
Vaccine
Pfizer-BioNTech COVID-19 vaccine
Moderna’s COVID-19 vaccine
AstraZeneca’s COVID-19 vaccine
Janssen’s COVID-19 vaccine
Novavax’s COVID-19 vaccine
Teach the general public on preventive measures like washing of hands regularly/use of hand sanitizer, social distancing , use of face mask, face shield, avoid overcrowding, maintain proper ventilation
Secondary
a. Early diagnosis & treatment
Screening for symptoms like
Fever, cough, new loss of taste or smell, sore throat, nasal congestion, nausea or vomiting , fatigue, diarrhea, headache etc. and testing of suspected individuals.
Lab investigations are Enzyme Linked ImmunoSorbent Assay, Reverse Transcriptase -Polymerase Chain Reaction.
Treatment: *Chloroquine + Oseltamavir for mild cases.
*for moderate to severe, along with the above combination, Ritonavir + Lopinavir is used along with preferred antibiotics azithromycin + steroid
Supportive treatment, oxygen therapy.
Tertiary Limiting disability
The aim is to prevent development of complications like;
i) Pneumonia
ii) Hypoxemic respiratory failure/acute respiratory distress syndrome (ARDS)
iii) Diffuse alveolar damage
iv) Secondary bacterial infections
v) Sepsis and septic shock
vi) Cardiac injury
vii) Cardiomyopathy
viii) Arrhythmia
ix) Sudden cardiac death
x) Acute kidney injury
xi) Liver dysfunction
xii) Multiorgan failure
xiii) Thromboembolism
xiv) Gastrointestinal bleeding etc.
These can be achieved by oxygen administration, IVinfusion, dialysis, use of antibiotics, monitoring of vital signs, antiarrhymic drugs etc
Quantenary
Rehabilitation
Aid recovery by physiotherapy, psychotherapy, vocational therapy and counselling family for social support.
Targeted towards recovering individuals
Physiotherapy
Vocational therapy - by helping patients to return back to their job by providing a letter of recovery
Social support - reuniting them with their family and the community.
A patient presenting with weight loss, abdominal pain and anorexia. Perform a focused abdominal examination.
Normal abdominal exam
An instrument was placed inside an envelope. Instructions said: open the envelope, take two minutes to observe the instrument carefully , return it back and answer the questions below.
Name of instrument?
Two-way Foley catheter
How many ports does it have? 2 way Foley catheter
2
List two surgical indications for the above
Resting of bladder after surgery
Monitoring of urine output
Where will you not use the above in case of pelvic fracture?
Urethral injury
What size is the above
18 (Usually written on the body)
A 3 year old was brought by his mother with cough for several days and vomiting. Take a detailed history.
Introduction: Greet the examiner, greet the caregiver/patient, introduce yourself, establish rapport and obtain consent.
Biodata: Name, Age, Sex, child/sibling number, Class, Family setting, Address, Religion,
Tribe, Informant (Occupation, Educational Status, etc.)
Presenting Complaint (s):
“Cough and vomiting”
“Chief Complaint and Course”
Cough:
•Was the onset sudden or gradual? •How long has it lasted?
•Is it episodic or persistent?
•How frequent are the coughing spells?
•How long does each coughing spell last?
•When did it start?
•Has the cough worsened, remained the same or relieved since onset?
•Does it produce sputum?
•What is the color of the sputum – yellowish, whitish, greenish, rusty brown?
•What is the consistency – thick, jelly-like or frothy?
•What is the odor like –foul-smelling or odorless?
•What time of the day or night is the cough or sputum production most severe?
•How much sputum is produced – copious or little?
•Does the sputum have traces of blood?
•Any associated chest pain and/or breathlessness with this cough?
Vomiting
When did it first start?
Was it gradual or sudden?
Is it projectile (forceful) or effortless?
Has it worsened, gotten better or remained unchanged since onset?
Does it occur more in the morning, afternoon or night?
How many times do you vomit in a day?
Is the vomiting constant or intermittent?
What does the vomitus contain – digested food, undigested food, mucus or fluid?
What is the color – bright red, coffee appearance, bile-stained?
Any specific odor – foul smell or odorless?
What is the volume in each episode? (Estimate the volume in liters or ml with containers or cups around)
Is there anything that triggers (aggravates) or relieves it?
Causes/Risk factors:
• History of contact with someone who has cough?
• Does the patient live in an overcrowded environment?
• History of BCG vaccination at birth?
• Is the patient homeless?
• Does the patient consume unpasteurized milk?
• Any history of cigarette smoking from parents?
• Any long-term use of steroids?
• Is the patient on any chemotherapeutic drugs?
Complications:
When did the child last pass urine? (to rule out dehydration or acute renal failure)
• Is the urine output reduced?
• Is the child still feeding?
• Any reduction in daily activities of the child?
• Is there history of irritability? Convulsions? Altered consciousness?
Care received:
What has been done so far?
Past Medical History
Any rash in recent 4weeks?
Any recent history of cough?
Difficulty breathing?
Any recent history of ear discharge?
Any history of increased urination? (this can be ascertained even though an infant, such as by diaper checking)
Any history of bone pain or swelling in the infant?
Pregnancy, Birth and Neonatal History:
Was there any adverse event during the pregnancy?
During labour/birth?
Immunization History:
Has the child received all immunization till date? Check left upper arm for BCG scar
Ask for immunization against rotavirus, measles? ask for immunization card.
Developmental Milestone:
Ask questions on when the child achieved these:
Smiles in response to face, voice.
Head control
Sitting with or without support
Crawling
Standing
Walking
Pincer grip
Running, etc.
Nutritional History (<5yrs):
Was the child exclusively breastfed for six months?
What is the method of feeding the child? Feeding bottle, cup and spoon?
Who prepares the child’s food?
Does the caregiver wash his/her hands before preparing the child’s food?
Any recent oral intake of seemingly undercooked or unpasteurised foods?
Does the child eat stored food?
How is the food stored?
I will then ask for the pre-illness 24hours dietary recall.
Family/Social History
Is there anyone in the household with similar illness?
What is the source of drinking water for the child?
What is the method of sewage disposal?
Systemic Review
Thank your patient and examiner.
A patient presented to the ER complaining of right iliac fossa pain for 2 days, pain is sharp stabbing in nature which increased in severity today. He also had nausea and vomiting with no fever. Perform an abdominal examination on the patient.
When palpating make sure u look at the patients face for any grin or pain
