2003 OSCE Handbook The world according to Kelly, Marshall, Shaw and Tripp Our OSCE group, like many, laboured away through 5th year preparing for the OSCE exam. The main thing we learnt was that our time was better spent practising our history taking and examination on each other, rather than with our noses in books. We therefore hope that by sharing the notes we compiled you will have more time for practice, as well as sparing you the trauma of feeling like you‟ve got to know everything about everything on the list. You don‟t! You can‟t swot for an OSCE in a library! This version is the same as the 2002 OSCE Handbook, except for the addition of the 2002 OSCE stations. We have used the following books where we needed reference material: th Oxford Handbook of Clinical Medicine, 4 Edition, R A Hope, J M Longmore, S K McManus and C A Wood-Allum, Oxford University Press, 1998 Oxford Handbook of Clinical Specialties, 5th Edition, J A B Collier, J M Longmore, T Duncan Brown, Oxford University Press, 1999 N J Talley and S O‟Connor, Clinical Examination – a Systematic Guide to Physical Diagnosis, Third Edition, MacLennan & Petty Pty Ltd, 1998 J. Murtagh, General Practice, McGraw-Hill, 1994 These are good books – buy them! Warning: This document is intended to help you cram for your OSEC. It is not intended as a clinical reference, and should not be used for making real life decisions. We‟ve done our best to be accurate, but don‟t accept any responsibility for exam failure as a result of bloopers…. Hope it goes well, Matthew Kelly, Daniel Marshall, Rebekah Shaw and David Tripp Students at the Wellington School of Medicine 2002, 2003 Index: Topic Order Index: Topic Order ................... 2 48: Headache ......................... 56 13: Ankle Swelling ................ 98 26: Cranial Nerve Lesions ..... 56 55 & 81: Stiffness & Index: Numerical Order ........... 3 9: Abnormal Speech .............. 57 Swelling of joints ............... 98 Introductory Tips ...................... 5 83: Tremour ........................... 57 41: Falls ............................... 100 Approach to a Station .............. 5 57: Limb Weakness ............... 58 21: Common Fractures History Outline ........................ 6 151: CT/MRI of CNS ............ 59 (Radiology) and 152: Sieve ........................................ 7 Ears, Eyes and Balance ........... 62 Skeletal Radiographs ....... 101 Management Options .............. 8 104: Examination of the 153: Isotope Bone Scan ....... 101 Past OSCE Stations ................. 8 Eye and Retina ................... 62 Genito-Urinary ...................... 102 Systemic Symptoms and 7: Abnormal Pupils................ 63 107: Pelvic Exam................. 102 Signs ..................................... 13 10: Abnormal Vision ............. 63 37: Dysuria .......................... 102 42: Fever ............................... 13 34: Disturbance of Eye 135: Test and Interpret 67: Pain ................................. 14 Movement .......................... 65 Urinalysis ......................... 103 69: Pallor ............................... 14 79: Strabismus ....................... 65 45: Haematuria .................... 104 54: Jaundice........................... 15 73: The Red Eye .................... 66 88: Urinary retention ........... 105 91: Weight gain ..................... 16 35: Dizziness or vertigo ......... 68 86: Urinary frequency.......... 106 92: Weight Loss .................... 17 33: Balance ............................ 69 87: Urinary hesitancy .......... 106 40: Difficulty Sleeping .......... 18 68: Painful Ear ....................... 69 52: Incontinence of urine 66: Oedema ........................... 19 82: Tinnitus ........................... 70 and faeces ........................ 107 62: Nausea/vomiting ............. 19 38: Ear Discharge .................. 70 51: Impotence ...................... 107 40: Enlarged Lymph Nodes ... 21 4: Abnormal Hearing ............. 71 64: Nocturia ......................... 108 85: Unexplained Lump .......... 21 Psychological Medicine ........... 73 65: Nocturnal Enuresis ........ 108 63: Neck swelling, lump or 105: Higher Mental 71: Polyuria ......................... 109 pain .................................... 21 Function ............................. 73 84: Undescended Testes ...... 110 75: Shock .............................. 22 23: Confusion ........................ 73 154: IVP/MCU .................... 111 27: Dehydration ..................... 23 136: Abnormal Grief ............. 74 Blood, Endocrine and 110: Use the Ambu Bag ........ 24 11: Alcohol - Assessment ...... 75 Metabolic ............................ 113 Chest and Vascular ................. 25 12: Alcohol - Intervention ..... 76 129: Abnormal 109: Respiratory Exam .......... 25 137: Alcohol Withdrawal ...... 77 Biochemistry in Blood or 102: Cardiovascular Exam .... 26 138, 141, 142 & 143: Urine ................................ 113 17: Murmur ........................... 28 Overview of Anxiety 130: Abnormal Blood Chest Pain ............................. 29 Disorders ........................... 78 Count ............................... 114 16: Breathlessness ................. 29 144: Hallucinations ............... 80 131: Fluid/Electrolyte 25: Cough .............................. 30 139 & 145: Mood Disorders .. 80 Abnormalities .................. 115 93: Wheeze ............................ 31 Suicide Assessment ............... 81 132 Arterial Blood Gas ........ 118 80: Stridor ............................. 31 32: Discuss/start mood 28: Diabetes Mellitus ........... 119 49: Hoarseness ...................... 32 stabilisers ........................... 82 134: Test and Interpret 61: Nasal Obstruction ............ 32 Abdominal and Gastro- Capillary Glucose ............ 120 60: Nasal Discharge .............. 33 Intestinal .............................. 84 127: Abnormal Thyroid 77: Sore Throat ...................... 33 100: Abdominal Exam........... 84 Function ........................... 121 46: Haemoptysis .................... 34 30: Difficulty Swallowing ..... 85 43: Galactorrhoea ................ 122 70: Palpitations ...................... 34 44: Haematemesis ................. 86 76: Short Stature .................. 123 19: Claudication .................... 35 36: Dyspepsia ........................ 87 Skin ......................................... 125 53: Ischaemic Foot ................ 37 1: Abdominal Distension ....... 87 22: Common skin lesions .... 125 90: Varicose Veins ................ 37 2: Abdominal Mass ............... 88 72. Pruritus .......................... 125 56: Limb Ulcers .................... 38 24: Constipation .................... 89 39: Eczema .......................... 126 50: Hypertension ................... 39 29: Diarrhoea ......................... 89 89: Urticaria......................... 127 95: Measure Blood Pressure .. 40 58: Melena and Rectal 96: Obtain/Interpret an ECG . 41 Obstetrics and Gynaecology . 129 Bleeding ............................ 90 159: Contraception .............. 129 98: Peak flow Measurement .. 42 128: Abnormal Liver 150: Chest Radiograph .......... 43 173: Abnormal Cervical Function ............................. 92 Smear ............................... 132 133: Pulmonary Function 147: Abdominal X-ray........... 92 Report ................................ 45 163 & 156: Abnormal 48: Barium enema ................. 92 Menstruation .................... 132 155: Lung V/Q Scan .............. 45 149: Barium swallow/meal .... 93 18: CPR ................................. 46 175: Speculum Examination 133 15: Breast lump ..................... 46 Musculo-Skeletal ..................... 94 161: Dysmenorrhoea ........... 134 101: Back Examination ......... 94 157: Abnormal Vaginal Neuro-sensory.......................... 48 106: Joint Examination - Discharge or Bleeding ..... 134 103: Cranial Nerve Exam ...... 48 Hip ..................................... 94 169: Premenstrual 108: Peripheral Nervous 106: Joint Examination - Syndrome (PMS) ............. 135 System Examination .......... 49 Knee .................................. 95 162: Menopausal 8: Abnormal Sensation .......... 50 106: Joint Examination - Symptoms ........................ 136 14: Blackouts......................... 51 Shoulder ............................ 96 171: Routine Antenatal 20: Coma ............................... 52 3: Abnormal Gait ................... 96 Care ................................. 137 59: Memory Loss .................. 53 5: Abnormal Movements ....... 97 158: Assessment of Fetal 74: Seizures ........................... 54 6: Abnormal Posture .............. 97 Welfare ............................ 138 47: Head Injury ..................... 55 2 2003 OSCE Handbook 172: Shock in Pregnancy ..... 138 116 and 122: Infant and 111: Childhood 166: Pain in Abdomen in Neonatal Jaundice ............ 146 Immunisation ................... 152 Pregnancy ........................ 139 123: Neonatal Respiratory 124: Non-Accidental Injury . 155 174: Obstetric Palpation ...... 139 Distress ............................ 146 Others ..................................... 157 164: Normal Labour ............ 140 126: Projectile Vomiting ..... 146 97: Obtain informed 168: Premature labour ......... 141 118: Infant Respiratory consent ............................. 157 160: Delay in Labour .......... 141 Distress ............................ 147 31: Discuss Screening Test .. 158 167: Postpartum 120: Neonatal Central 78: Starting Medication ....... 159 Haemorrhage ................... 142 Cyanosis .........................