Abdo Assessment And History Osce

Question 1

What is the first step of this osce, what will you verbalise?

Answer 1

Consider the possible dangers, ask if the scene is safe and gel hands (gloves)

Question 2

After making sure the scene is safe, what is the next step?

Answer 2

Gaining consent from the patient and explain the process of assessment - what you are going to be doing.

Question 3

Before beginning any hands on assessment, what assessment do we need to verbalise?

Answer 3

End of bed assessment

Question 4

After the end of bed assessment, what is the next thing we do?

Answer 4

Primary survey - ABCDE

Question 5

With the primary survey what are we assessing?

Answer 5

Airway (is it open), breathing (are they breathing, have a quick listen is it equal), Circulation (feel for a pulse) Disability (pupils), expose and examine

Question 6

As well as the primary survey what are we also verbalising?

Answer 6

where they are on the AVPU scale - Alert, Voice, Pain, Unresponsive

Question 7

What structure model do we use for taking a history from this patient

Answer 7

SOCRATES

Question 8

What does socrates stand for?

Answer 8

Site, onset, character, radiation, associated symptoms, time, exacerbating/ alleviating symptoms, severity.

Question 9

After using Socrates to take a basic history take, what do we move on to?

Answer 9

Past medical history

Question 10

What does past medical history involve asking?

Answer 10

Any active problems?
Is there any previous problems/ investigations that have taken place?
When was the last hospital admission and what was it for?
When was the last GP visit?

Question 11

After PMH what is next?

Answer 11

Drug history and allergies.

Question 12

As part of drug history what things do we ask?

Answer 12

What prescribed medication are they on?
Do they take any over the counter medication?
Do they use any herbal medicine?
Do they use recreational drugs?
Do they have any allergies and if so what reaction do they get?

Question 13

After DMx, what section is covered next in the history take?

Answer 13

Family history

Question 14

What do we ask in regards to family history?

Answer 14

Do their parents/grandparents/ siblings have any conditions?
Has there been any unexpected deaths within the family?
What is the life status of their parents and grandparents.
What did they die of?

Question 15

After family history what is the last section within the history take?

Answer 15

Systems review

Question 16

What does system review involve?

Answer 16

Asking questions about the other body systems -
Bowel habits — has there been any changes with their bowel movements? Is there any blood present in the stool? Is there an odour from the stool? What colour is the stool?
Urine habits — has there been any changes with their urine output?, is there any pain when they go to the toilet?, what colour is their urine?, is there an odour from the urine?
Vomit — have they vomited? Do they feel nauseas? Have they vomited up any blood? How frequent have they vomited? How much have they vomited?
Fever/ general wellbeing — how long have they been feeling unwell? Do they feel dizzy? Do they feel more tired and fatigued than normal?

Question 17

What acronym do we follow when doing an abdominal assessment?

Answer 17

, inspection, Auscultation palpation,percussion

Question 18

In regards to the auscultation process what do you have to do?

Answer 18

Listen for bowel sounds in the four quadrants - verbalise and ask if they are present.

Question 19

On inspection what are we looking for?

Answer 19

Scars or hernias, guarding, spider naevi, distension/ ascities

Question 20

On palpation what do we do?

Answer 20

Starting away from where the pain is —
Lightly palpate the 9 areas
Deep palpate the 9 areas
Identify where the pain is
Check for appendicitis
Mcburneys/ rovsings/ rebound tenderness/ Murphy’s

Question 21

On percussion what do we do?

Answer 21

Percuss the 9 areas listening for any abnormalities

Question 22

What must you make sure you do throughout the osce?

Answer 22

verbalise what you are doing !!

Question 23

After percussion what must you not to forget to look at?

Answer 23

Odema in the legs and ankles
Temp in legs
Distal pulses

Question 24

What test do you use for the gall bladder?

Answer 24

Murphy’s sign
Place hand on right costal margin, mid clavicular line
Ask pt to take deep breath in
Push down
Pain?

Question 25

What is the rovsings sign

Answer 25

For appendicitis
Palpate the left lower quadrant - opposite to site of appendix
Painful - positive