OSCE Prep

Question 1

Associated Symptoms Respiratory Exam

Answer 1

• Cough
  
  • Duration?
  • Productive? - Amount? Blood? Colour?
  • Chest tightness? (Acute bronchitis)
  • Worse at night? (CHF)
  • ACE inhibitor?
• SOB
  
  • Do you wake up at night gasping for air?
  • Worse when you lie down?
  • Do you become SOB when walking up a flight of stairs? How many?
• Wheezing?
  
  • Worse at night, or during the day?
  • Does it get worse with cold exposure? (Asthma)
• Chest Pain
  
  • Worse of inspiration with a stabbing pain? (Pleuritis or rib fracture)

Question 2

Past Medical History Respiratory Exam

Answer 2

• COPD?
• Previous Pneumonia?
• Asthma? - What puffers? How do you use them?
• Previous history of lung cancer?
• Previous TB?
• Cardiovascular disease?
• DVT ot PE?
• Diabetes?

Question 3

Family history Respiratory Exam?

Answer 3

• Malignancy?
• Asthma?
• Atopic Dermatitis?
• Seasonal allergies? Which ones?

Question 4

Associated Symptoms Cardiac Exam

Answer 4

• Chest Pain or Tightness
  
  • OPQRST
  • Nause/vomiting?
• SOB
  
  • Do you wake up at night gasping for air?
  • Worse when you lie down?
  • Do you become SOB when walking up a flight of stairs? How many?
• Palpitations
  
  • Affected by sleeping?
  • Occurring at work?
  • Duration?
  • Regular rapid-pounding sensation in neck?
  • Do you become lightheaded?
  • Can you tap out the rhythm for me?
• Fatigue?
  
  • Onset? Sudden or progressive
  • Recovery period?
  • Does resting help?
  • How is it affected by physical or mental acitivty
  • Any associated muscle weakness?
  • Any acute infectious symtpoms?
  • Any recent medication changes?
  • Blood loss?

Question 5

Associated Symptoms Head and Neck exam

Answer 5

• Epistaxis
  
  • Anterior vs. posterior (ENT emergency)
    
    • Did you see it first (anterior) or taste it first (posterior)
    • Did it come out of one side (anterior) or both sides (posterior)
    • If already packed anteriorly as this slowed or stopped the bleeding (anterior) or does it contine to bleed briskly (posterior_
• Ear
  
  • Subjective hearing loss?
  • Ear infections?
  • Recent upper respiratory tract infection?
  • Otorrhea (discharge)?
• Nose
  
  • Sinus congestion
  • Infections (acute or chronic)
  • Nasal obstruction?
  • Rhinorrea
  • Lack of smell?
  • Dizziness?
• Throat
  
  • Nuchal rigidty?
    *

Question 6

Peripheral Vascular Exam Associated Symptoms

Answer 6

• Claudication
  
  • Intermittent
    
    • Leg pain/cramping on exertion, relived by rest <10mins
    • Noticed any coldness, numbness or pallor in legs or feet>
    • Notice less harid over anterior tibial surfaces?
    • Is pain worse on standing or lying down

Question 7

Past Medical History Peripheral Vascular Exam

Answer 7

• Peripheral Arterial Disease Risk Factors:
  
  • DM, Hypertension, Dyslipidemia, CAD
• Peripheral Vascular Disease Risk Factors:
  
  • Virchows Triade - statsis, endithelial injury, and hypercoagulability

Question 8

Associated Symptoms Abdominal Exam

Answer 8

• Abdominal Pain
  
  • OPQRST
  • Worst while lying down (GERD)
• Altered Bowel Movements
  
  • Sensitivity to certain foods?
  • When was your last bowel movements?
  • Have you been passing gas?
  • Describe stool - melena (black, tarry); hematochezia (bright red blood), hemorrhoid (with wiping).
• Orthostatic intolerance
  
  • Dizziness on standing up? (Could be do to GI blood loss)
• Pruitus
• Jaundice
  
  • Onset
  • Duration
  • Pale Stools
  • DArk urine
  • Skin changes
  • Sclera
• Nausea
  
  • Sensitivity to certain foods
  • Provoking/relieving factors
  • Loss of appetite?
  • Epigatric pain?
• Vomiting?
  
  • Vomiting or dysphagia (difficulty swallowing)
  • Amount? Blood? Colour? Odour?

Question 9

Diabetic History Assoicated Symptoms

Answer 9

• General
  
  • DM1 or DM2? Age of dianosis?
  • How were you diagnosed?
• Glycemic Control
  
  • Do you keep track of your surgars? When do you check them? How often?
  • Do your surgars tend to be high or low? When are they high or low? Do you keep a book with your measurements?
  • Polydipsia, polyuria, polyphagia, hospitalization? (High surgar symptoms)
  • Are you able to manage lows by yourself? Any seizures (Low surgar symptoms)
• Management
  
  • Diet
  • Exercise
  • Self-care - hygiene - checking for ulcers and sensation?
• Microvascular complications
  
  • Neuropathy
    
    • Peripheral - loss of sensation in extremities? Pins and needles sensation?
    • Autonomic - orthostatic vitals - do you feel lightheaded when standing quickly?
    • Gastroparesis - Nausea/vomiting?
  • Retinopathy
    
    • Are you being followed by an ophthalmologist?
  • Nephropathy
    
    • Are you seeing an nephrologist? Frothy urine? Dialysis?
• Macrovascular Complications
  
  • CAD - Angina? MI?
  • Cerebrovascular - Transient ischemic attack? Stroke?
  • Peripheral Vascular - Claudication? ED?

Question 10

Diabetic History Big 6

Answer 10

• PMHx
  
  • Metabolic Syndrome
  • Autoimmune disease
  • MI
  • Recent Infections
• PSHx
• FMHx
  
  • CAD, DM, Cerebrovascular accidents
• Social Hx
  
  • Alcohol, smoking?
  • Finances and supports - Do you have trouble making ends meet? What are your living arrangements>
• Medications and Allergies
  
  • Insuline, oral hypoglycemic meds, or combination
  • Other meds?
  • How long have you been taking each? Dose? Any dose changes?

Question 11

Cushing Syndrome History

Answer 11

• Skin: Oily; thin skin with acne; diaphoretic; hirsutism; easy bruising and ecchymosis; decreased libido
• Femal Virilisation: Temporal balding; deepened voice; ciltoral hypertrophy
• Immune suppression: Thrush; Fungal Infection
• Weight Changes: Wudden weight gain; increased fat pads; skinny limbs
• Psychiatric distrubances: Mood changes and lability; depression; anxiety; panic attacks; irritability; psychosis
• Head and neck: Red complexion; moon face; glaucoma; thick neck
• Cardiovascular: CAD
• Abdominal: Striae; GI bleeds; menstrual irregularities
• MSK: Osteoporosis; proximal muscle weakness

Question 12

HPI and Associated Symptoms Renal Examin

Answer 12

• Pain
  
  • OPQRST
  • Scrotal pain? (epididymitis)
  • Flank pain?
• Urinary Changes
  
  • FUND - Frequency, urgency, nocturia, dysuria
  • WISE - weak, intermittent, straining, incomplete emptying
  • Amount, blood, colour, odour
  • Any discharge?
• Bowel changes?
• Inflammation/ blood at meatus
• Sexual history
• Previous pregnancy?
• Menstrual history

Question 13

HPI and Associated Symptoms Hypervolemia

Answer 13

• PND - do you wake up in the middle of the nigh gasping for air?
• Orthopnea - How many pillows do you use when you sleep
• SOB on exertion?
• Recent weight gain? Was it intentional?
• Increased Sodium Intake?

Question 14

HPI and Associated Symptoms Hypovolemia

Answer 14

• Any trauma and overt signs of bleeding?
• Burns?
• Recurrent vomiting or diarrhea?
• Polyuria?
• Excessive sweating?
• Any melena stools?
• Excessive thirst?
• Presyncope?
• Any recent weight loss? Was it intentional?
• Decreased sodium intake?

Question 15

Newborn Screening History

Answer 15

• Did you have prenatal screening tests done?
• Did you have any complications in your pregnancy? Maternal diabetes? Pre-eclampsia?, etc?
• How was the labour and delivery - At how many weeks was your child born? Any complications? What was the method of delivery?
• APGAR scores?
• Newborn screening? Any positive results?
• Audiology testing?
• Jaundice. Did your child need any treatment for jaundice?
• Growth?
• Breast feeding?
• What colour is the stool?
• How often does your infant sleep? (expect 16-22 hrs/day)