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OSCE Flashcards

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1
Q

if you find a mass how do you describe it?

A 
site
size
shape
surface
edge
tenderness
consistency
mobility
pulsatile
fluctuant
is it possible to get above it
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2
Q

GI exam list

A 
Wash
consent 
initial assessment 
hands and arms 
head 
examine the mouth
lymph nodes
necklace region
legs
abdomen
palpation
liver
spleen
kidneys 
percussion
liver
spleen 
ascites
fluid 
auscultation 
arterial bruits
closure
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3
Q

GI exam hands and nails signs

A

tar staining
nail colour
nail shape
palmar erythema

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4
Q

GI exam arms

A 
bruising
scratch marks
muscle wasting
track marks 
turgor
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5
Q

GI tremors

A

flapping

fine

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6
Q

GI head look for

A 
parotid swelling
jaundice 
anaemia 
angular stomatitis 
odour
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7
Q

GI lymph nodes

A 
Virchow's 
scalene
anterior and posterior
tonsillar
submandibular 
submental
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8
Q

necklace region GI examine for

A

spider naevi
gynaecomastia
loss of body hair

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9
Q

legs GI examine for

A

peripheral oedema
loss of body hair
erythema nodosum

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10
Q

abdomen GI examine

A 
scars
pulsation
movement
skin lesions
scratch marks
abdominal shape
stoma
distended veins
petechiae
striae
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11
Q

what should you watch as you palpate the abdomen

A

face

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12
Q

what are you feeling for in a abdomen palpation

A

tension
guarding
superficial masses
rigidity

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13
Q

what arterial bruits do you check for?

A

aorta
renal arteries
liver
spleen

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14
Q

digital rectal exam procedure pathway

A

explain
chaperone
inspect perianal area

anal tone
orientation
gently sweep 90 degrees 
examine prostate gland 
note any rectal contents or masses
finger withdraw
close
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15
Q

Face examination procedure list

A 
look at face, head and neck
eyes
skull and face
nose 
ears
auriscope
palpation of skull and face
nose
ears
hearing tests
tuning fork test
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16
Q

inspection of mouth throat and neck procedure list

A 
mouth
bite
neck 
bimanual palpation of mouth 
auscultation of carotid artery
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17
Q

inspection of the face what are you looking for?

A 
expression
symmetry
swellings
hair loss
shape of face and skull
scars
skin
movements
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18
Q

what are you looking for in the eyes?

A 
lid lag
proptosis
eye movements
jaundice
anaemia
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19
Q

skull and face examine list

A

symmetry

features of cushings, acromegaly, bony changes.

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20
Q

skull and face palpation points

A 
mastoid
orbital margin
tenderness of temporal
maxilla and mandible
T-M joint
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21
Q

mouth throat and neck what are you looking for?

A 
lips
open mouth
oropharynx
tongue
 frenulum 
duct opening
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22
Q

neck examine for

A

scars, swelling, lump, movement with tongue protrusion

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23
Q

upper limb neuro looking for

A 
muscle atrophy
fasciculation 
skeletal deformity 
scars
tremor
involuntary movements
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24
Q

upper limb general procedure

A 
observation 
tone
power
coordination 
reflexes 
sensation
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25
lower limbs procedure
``` observation tone power co-ordination reflexes plantar responses sensation gait ```
26
biceps reflex innervation
C5/6
27
supinator reflex innervation
C6
28
triceps reflex innervation
C7
29
sensation upper limb checks
``` light touch pinprick vibration joint position Romberg's test ```
30
lower limbs observations for
``` muscle atrophy fasciculations skeletal deformity scars tremor involuntary movements romberg's test gait ```
31
what do we check for in lower limb power?
hip knee ankle EHL
32
co-ordination test for lower limb
heel-shin test
33
knee reflexes innervation
L3/L4
34
ankle reflexes innervation
S1
35
MRC 0
no muscle contraction visible
36
MRC 3
movement against gravity but not against examiner's resistance
37
MRC 5
normal power
38
cranial nerve procedure checklist
``` smell visual acuity pupillary response visual fields visual inattention accommodation fundoscopy eye movements facial sensation palpate masseter jaw resistance corneal reflex jaw jerk reflex motor facial facial sensation hearing inspect palate cough gag reflex trapezius SCM inspection of tongue tongue motor speech ```
39
corneal reflex afferent and efferent
afferent V1 | efferent 7
40
jaw jerk reflex afferent and efferent
afferent V3 | efferent V3
41
diabetic shoe examination
``` shoes lower legs and feet observation circulatory function capillary refill sensation monofilament ankle reflex musculoskeletal function gait ```
42
arterial ulcer are often found near
the ankle
43
inspection diabetic foot
``` shoes skin colour plantar aspects toes, nails lower legs deformities ```
44
MSK checking for functions
plantarflexion and dorsiflexion inversion and eversion dorsiflexion and plantarflexion gait
45
genital examination procedure
observation | palpation
46
genital observation signs
``` hair rashes nodules swellings urethral meatus foreskin ```
47
genital palpating for
``` epididymis nodules spermatic cord swelling hernia ```
48
History taking broad categories
``` presenting complaint systemic prior medical history drugs and allergies family history social history ICE ```
49
history presenting complaint questions
``` Site onset character radiation associated symptoms timing exacerbating factors severity functional consequences ```
50
drugs history questions
``` Drugs prescription over the counter herbal medicine allergies ```
51
social history questions
``` circumstances household members work smoking drinking substance abuse exercise diet hobbies pets overseas travels ```
52
general systemic review questions
``` fatigue fever rigors weight/appetitie skin rashes sleep disturbance pruritus night sweats neck swelling ```
53
respiratory systemic review questions
``` cough sputum haemoptysis SOB wheeze chest pain sinusitis ```
54
cardiovascular systemic review questions
``` chest pain SOB palpitations ankle oedema varicose veins claudication ```
55
alimentary systemic review questions
``` appetite teeth/mouth dysphagia dyspepsia nausea fat intolerence jaundice abdominal pain distension bowe habit incontinence perinal symptoms ```
56
urinary systemic questions
``` prostate symptoms erectile dysfunction sexually active haematuria polyura nocturia oliguria dysuria frequency ```
57
nervous system systemic questions
``` speech cognitive impairment headache faints dizziness balance vision hearing weakness numbness ```
58
Peak flow explanation points
``` standing for test maximum inspiration airtight seal hold meter horizontal exhale as hard as possible best of three attempts ```
59
how to calculate PEFR
height, age, gender and predicted values charts
60
how to use pressurised meter dose inhaler
``` sit up straight and lift up chin shake inhaler breath out gently put teeth around it breath in slowly and puff hold breath for ten seconds wait 30-60 seconds before second puff ```
61
large volume spacer device instructions
remove cap shake breathing in/out slowly until clicking sound deep breath in and hold breath for 10 seconds remove 30/60 seconds before repeating
62
turbohaler device instructions
``` check dose unscrew hold vertically and rotate bae anti-clockwise and then clockwise until click breath out take strong fast breath in hold for about ten seconds breath out gentl away from mouthpiece ```
63
peripheral respiratory procedure
``` intro handwash consent observation hand and arms capillary refill tremor pulse respiratory rate head and eyes neck lymph nodes ```
64
finger clubbing signs
nail angle nailbed fluctuation nail curvature increased bulk of soft tissue
65
hand and finger signs for peripheral respiratory examination
tair staining warmth of hands peripheral cyanosis finger clubbing
66
central chest respiratory examination
``` inspection for scars, skeletal and lesions palpation for chest expansion percussion auscultation vocal resounance ```
67
first heart sound is the
ventricular systole
68
second heart sound is the
ventricular diastole
69
peripheral pulses check
``` carotid brachial radial femoral popliteal posterior tibial dorsalis pedis ```
70
3rd heart sound may be a sign of
left ventricular failure or mitral regurgitation
71
4rth heart sound may be
left venrticular hypertrophy
72
peripheral CV procedure points
``` hands and arms pulse head chest ascites lower limbs pitting oedema varicose veins JVP ```
73
peripheral CV hands and nails signs
``` tar staining warmth of hands cyanosis clubbing splinter haemorrhages capillary refill tremor ```
74
when checking pulse what do you comment on
Rate rhythm volume character
75
head CV signs
malar flush conjunctivae, Xanthelasmata, corneal arcus tongue and lips for central cynaosis, angular stomatitis and sore red tongue
76
signs of arterial disease lower limbs
cold, hairless, increased capilarry refill, ulcers
77
JVP notes
45 degrees double venous flickering between sternal and clavicular heads of SCM nromally 4cm
78
precordium examination procedure points
``` inspection tracheal palpation apex beat heaves thrills auscultation radiation left sided diastolic murmurs ```
79
when auscultating the valves remember to palpate
carotid pulse
80
aortic stenosis radiation point
listen over aortic valve again and both carotid arteries
81
mitral regurgitation radiation point
listen over apex and L axilla for pansystolic murmur
82
aortic stenosis and mitral regurgitation are what sort of murmurs?
systolic
83
mitral stenosis radiation murmur points
roll onto left side and listen over apex
84
aortic regurgitation radiation murmur points
ask patient to sit up and leand forward and ask them to take a deep breath in and out
85
mitral stenosis and aortic regurgitation are what sort of murmurs
diastolic
86
why do we palpate before taking a blood pressure?
to avoid an auscultatory gap
87
red lead in ECG attaches to
right wrist
88
Yellow lead in ECG attaches to
left wrist
89
green lead to the ECG
left ankle
90
black lead attaches to the ECG
right ankle
91
V/C 1 attaches to the ECG
4rth intercostal space right of the sternum
92
V/C 2 attaches to the ECG
4th intercostal spcae left of the sternum
93
V/C 3 attaches to the ECG
midway between leads 2 - 4
94
V/C 4 attaches to the ECG
5th intercostal space midclavicular
95
V/C 5 attaches to the ECG
lead as the anteriror axillary line
96
V/C 6 lead ECG attaches to
lead 4 mid axillary line horizontal too
97
ARI BAR for ECG interpretation
``` any electrical activity? Rate irregular or regular QRS complexes Broad or Narrow Atrial activty? relationship between atrial activty and ventricular activty? ```
98
how to calculate rate ECG
count off 30 large squares and number of QRS complex then multiply by ten
99
nromal QRS complex should be less then
<0.12 secs
100
blood glucose monitoring procedure
prepare patient, make sure their hands are washed lot number should match lot number on machine prepare lancet put on gloves insert strip into machine puncture onto side of finger read of results, dispose of lancet inn bind and read off results
101
IM injection procedure points
``` consent check prescription hand hygiene draw air into syringe puncture top of vial and inject air change needle remove air disinfect skin 30 seconds stretch skin and 90 degree angle like a dart aspirate inject wait for ten seconds dispose of need ```
102
subcutaneous injection procedure points
``` consent prescription check draw air puncture vial and inject air withdraw fluid purge air scoop cap disinfect site pinch 45 degree angle stabilise needle inject wait ten seconds ```
103
what do you never do with a subcutaneous injection
aspirate
104
intradermal injection procedure points
``` consent check prescription perform hygiene disinfect site attach needle to syringe draw up air inject air into the vial purge air position needle at ten degrees inject forming bleb dispose of needle ```
105
reagent strip leucoytes sign
UTI
106
reagent strip protein sign
UTI, renal disease, hypertension, pre-eclampsia, CCF, vascular disease
107
reagent strip blood signs
renal disease, urological disease, UTI, menstruation
108
ketones regent strip signs
uncontrolled diabetes, fasting
109
nitrite regent strip signs
UTI
110
pH acidic regent strip sign
diabetes, starvation, renal disease and dehydration
111
PH alkaline regent strip sign
UTI
112
low gravity regent strip sign
renal abnormality
113
high gravity regent strip sign
dehydration
114
presence of glucose regent strip sign
cushing's syndrome, diabetes, stress, surgery, acute pancreatitis
115
urinalysis dip stick procedure points
observe urine for colour, clarity and odour expiry date of strips immerse regent strip fully briefly run edge of strip against trim note time hold horizontally note results
116
yellow urine signs
bilirubin, medication, laxatives
117
smoky red urine
intact red cells
118
red urine
blood, beetroot
119
related symptoms psych questions
“What other changes have your partner/ family/ friends noticed in you?”
120
exploring psychosis psych Q's
“Have you seen or heard anything that other people have not been aware of?” “Have you heard any people talking when there was nobody around?”
121
past psych history points
Past episodes/ diagnoses / contacts Previous treatments (psychological, drug and physical) Inter-episode functioning Previous admissions to hospital Attempted suicide/ repeated DSH Previous detentions under Mental Health Legislation
122
FH psych questions
FH, quality of relationships, circumstances, health problems
123
past medical pysch questions
head injuries, development, endocrine, liver damage, vascular risk factors
124
alcohol history
regular or intermittent, amount, pattern, dependence and impact
125
personal history pysch
early life school, occupation, relationships, financial, friendships, hobbies, interests
126
forensic history psych
contact with the police/charges
127
pre-morbid personality psych Q's
how would your best friend describe you as a person?
128
GALS MSK
pain or stiffness in joints or back? can you dress yourself without difficulty? can you walk up and down stairs?
129
MSK history related symptoms
pain, stiffness, swelling , deformity, discolouration
130
red flags MSK
worsening pain, night pain, non mechanical pain, general malaise, febrile, rigors, weight loss, anorexia, night sweats, history of malignancy
131
PMH MISTI THREAD
MI Stroke Thrombosis Icterus | TB Hypertension, Rheumatic fever, Epilepsy, Asthma, diabetes
132
menstrual history
last menstrual period? cycle contraception/sexually active last smear
133
related symptoms menstruation
pelvic pain, bleeding, prolapse, menorrhagia
134
obstetric history
parity, FH, other children, type of delivery, weight and sex of the baby, any complications, other pregnancies and outcomes, due date
135
children and poo history taking
frequency, size, shape appearance, consistency, difficulty passing, pain on passing, blood or mucous
136
paed key stages Q's
``` birth history PMH immunisations development (walking, word support) allergies, drugs feeding, weight, bowel habits ```
137
social history paeds
nursery and potential infective contacts, parents smoking, alcohol, drugs, occupation and stress
138
key sexual history Q's
``` Genital skin changes testicle pain Vulval itching or soreness Dysuria Abnormal vaginal discharge Abnormal vaginal bleeding Dyspareunia Abdominal or pelvic pain Systemic symptom ```
139
vaginal discharge Q's
smell, volume, colour, consistency
140
sexual contact Q's
``` last encounter casual or recurrent nationality, drug use, men who have sex with men, sex work type of sex contraception ```
141
sexual history PMH
history of STI's, immunisations
142
spikes model for breaking bad news
STEP 1: SETTING UP the Interview STEP 2: Assessing the Patient’s PERCEPTION STEP 3: Obtaining the Patient’s INVITATION STEP 4: Giving KNOWLEDGE and Information to the Patient STEP 5: Addressing the Patient’s EMOTIONS with empathic responses STEP 6: Strategy and Summar
143
vaginal speculum exam points
exposure, look, once speculum inserted comment on appearance, colour, secretions and volume
144
speculum CI
placenta praevia
145
hip MSK look
look; deformity, symmetry, scars, swelling, length
146
Hip MSK feel
temperature over greater trochanter, apparent leg length, true leg length
147
hip move
Thomas test, flexion, rotation, abduction and adduction, Trendelenburg
148
types of gait
antalgic; painful Trendelenburg; weak abductors waddle ataxic; wide and clumsy high stepping; foot drop
149
elbow look
anatomical position, scar, swelling, sinuses, rashes nodules, bursitis, wasting, bruising
150
knee feel
temperature, baker's cysts, effusion
151
passive knee movements
leg raise, flexion, lateral and medial stress, posterior sag and anterior draw test
152
active knee movements
flexion, extension, leg raise
153
IV infusion
add medication to bag with label clamp tubing hand hygiene gloves and remove cover from spike port remove cap from spike using aseptic technique spike the spike pot squeeze drip chamber, invert tubing and prime tubing close of roller clamp to cease flow when air is cleared. program pump draw up flush consent/ explain/gloves clean port 15 seconds flush 5ml start infusion/remove gloves/ fluid prescription sheet
154
drops per minute equals
(Volume needed * drops per ml delivered) / duration of the infusion
155
foot look
; nails, skin, scars, wounds, calluses, wasting, shoes, toe alignment, arch, Achilles tendon
156
foot feel
temperature, MTP joints, subtalar, midfoot, tarsal and ankle, pulse dorsalis and posterior tibialis
157
foot passive move
dorsiflexion, plantar flexion, inversion and eversion and toe
158
bolus via cannula
``` identify/ intro/ consent/site hygiene/gloves draw medication prepare 2 flushes disinfect IV cannula for 15 seconds flush 5ml deliver bolus flush close cap dispose/hygiene/ gloves aftercare/document/reassess ```
159
anteversion refers too
forward tilt of the angle of the long axis of the uterus and vagina
160
retroversion refers too
backward tilt of the angle between the long axis of the uterus and vagina
161
anteflexed refers too
forward tilt flexion angle between cervix and body of the uterus
162
retroflexed refers too
backward tilt of the flexion angle between cervix and body of the uterus
163
pelvic bimanual examination look
hair, skin, discharge, prolapse (cough)
164
pelvic bimanual examination palpate
tenderness, feel cervix, P fornix, lift uterus and bimanual palpate, lateral fornixes
165
phlebotomy
``` name/consent/explain site/hygiene apply tourniquet palpate and then clean hygiene apply gloves bevel up traction insert 15-30 degrees introduce tube with other hand release tourniquet invert tube remove needle pressure to site removal/hygiene/label aftercare ```
166
order of tubes
silver (blood culture)->gold (culture)->light blue (sodium citrate mix 3-4)->black (sodium citrate 8-10), red serum plastic (5-6)->gold routine (5-6)->green(8-10)->lavender (8-10)->pink (blood grouping 8-10)->grey (8-10)->dark blue (8-10)
167
obstetric points
inspection, palpation, measure fundal height, feel presenting part and engagement, foetal heart
168
measuring fundal height for obstetrics
peak to pubic symphysis
169
position of patients for obstetrics
left laterally
170
feel shoulder
temperature, tenderness, SC->AC, humorous tuberosity, spine of scapula, joint lines, muscles, sensation in badge area
171
passive movement shoulder
crepitus flexion, extension, abduction, rotation, painful arc, scapula movement
172
feel for spine msk
midline spinous processes, sacroiliac joints, paraspinal muscle tenderness and tone
173
cervical spinal assess
flexion, extension, ear to shoulder and rotation
174
lumbar spinal assess
flexion, extension, lateral flexion
175
thoracic spinal asses
sitting rotation
176
hand look
scars, skin, rashes, nails, deformity, Heberden’s nodes (DIP), bouchard’s (PIP), palmar thickening, swellings
177
hand feel
pulse, temperature, sensation, muscle bulk, tenderness, bimanual joints, wrist joints
178
hand move
straighten and fist, passively move fingers, prayer sign and tinel’s test, power (extension, abductor pollicis brevis, interossei)
179
hand function
power grip, pincer grip, elbow
180
hand tests
tinel's median nerve tapping and Phalen's full flexion for 60 seconds

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