CLINICAL SKILLS FOR CLINICAL CLINICAL SKILLS FOR OSCEs 5 TH Edition NEEL BURTON OVER 20,000 COPIES SOLD This full-colour fifth edition ofClinical Skills for OSCEs has been updated, revised, and extended by a dynamic team of medical students and junior doctors from all over the UK, from Aberdeen to Brighton and Cardiff to Norwich. Medical school is hard enough without having to pull together vast amounts of incomplete and often conflicting information from maladapted and sometimes unreliable resources. The purpose of this book is to save you time and trouble by gathering all the information that you need and presenting it to you in a concise, structured, and memorable fashion, freeing you to excel at your exams and become CLINICAL SKILLS FOR the best doctor that you possibly can. Co-edited by John Allen, a graduate medical student at Imperial College, and Neel Burton, a tutor at Oxford University and the winner of the BMA Young Author’s OSCE Award 2009, this new edition is bigger and better than ever before, crammed with 124 stations to cover every major clinical skill examined at medical school. What students made of previous editions: s OSCEs TH After six years at medical school I have become very accustomed to having 5 EDITION at least five or six books piled on my desk for each topic…Clinical Skills for OSCEs is the first book that I have come across where I can finally clear my 5 desk and have one book in front of me. Such a joy! The book cleverly covers everything in a clear and succinct manner. This book is very well laid out and helpful for all clinical exams. The text is 5 clear and concise and I would recommend it to any medical student preparing for OSCEs or other clinical exams. This is a really helpful tool for the OCSEs. In our final OSCE exam of the year I scored 9 excellent/good out of 13 stations – and I can honestly say that I BURTON did so because of this text. This is one of the best OSCEs books I have purchased. My only regret is that I didn’t buy it sooner. It is a comprehensive reference for anyone taking an OSCE exam. ISBN 978-1-907904-66-0 NEEL BURTON www.scionpublishing.com 9 781907 904660 Contents v Contributors ix Fifth edition © Neel Burton, 2015 Preface xi Fifth edition published in 2015 by Scion Publishing Ltd OSCE tips xiii ISBN 978 1 907904 66 0 First edition published in 2003 by BIOS Scientific Publishers Second edition published in 2006 by Informa Healthcare Third edition published in 2009 by Scion Publishing Ltd I. GENERAL SKILLS Fourth edition published in 2011 by Scion Publishing Ltd 1. Hand washing 1 2. Scrubbing up for theatre 3 All rights reserved. No part of this book may be reproduced or transmitted, in any form or by 3. Venepuncture/phlebotomy 5 any means, without permission. 4. Cannulation and setting up a drip 7 A CIP catalogue record for this book is available from the British Library. 5. Blood cultures 10 6. Blood transfusion 12 7. Intramuscular, subcutaneous, and intradermal drug injection 14 Scion Publishing Limited 8. Intravenous drug injection 16 The Old Hayloft, Vantage Business Park, Bloxham Rd, Banbury OX16 9UX, UK 9. Examination of a superficial mass and of lymph nodes 18 www.scionpublishing.com II. CARDIOVASCULAR AND RESPIRATORY MEDICINE Important Note from the Publisher The information contained within this book was obtained by Scion Publishing Ltd from sources 10. Chest pain history 21 believed by us to be reliable. However, while every effort has been made to ensure its accuracy, 11. Cardiovascular risk assessment 24 no responsibility for loss or injury whatsoever incurred from acting or refraining from action as 12. Blood pressure measurement 26 a result of the information contained herein can be accepted by the authors or publishers. 13. Cardiovascular examination 28 14. Peripheral vascular system examination 33 15. Ankle-brachial pressure index (ABPI) 36 Readers are reminded that medicine is a constantly evolving science and while the authors 16. Breathlessness history 38 and publishers have ensured that all dosages, applications, and procedures are based on 17. Respiratory system examination 41 current best practice, there may be specific practices which differ between communities. You 18. PEFR meter explanation 46 should always follow the guidelines laid down by the manufacturers of specific products and 19. Inhaler explanation 48 20. Drug administration via a nebuliser 50 the relevant authorities in the region or country in which you are practising. Although every effort has been made to ensure that all owners of copyright material have III. GI MEDICINE AND UROLOGY been acknowledged in this publication, we would be pleased to acknowledge in subsequent reprints or editions any omissions brought to our attention. 21. Abdominal pain history 52 22. Abdominal examination 55 23. Rectal examination 60 Registered names, trademarks, etc. used in this book, even when not marked as such, are not 24. Hernia examination 62 to be considered unprotected by law. 25. Nasogastric intubation 65 Cover design by Andrew Magee Design Limited 26. Urological history 67 27. Male genitalia examination 69 28. Male catheterisation 71 29. Female catheterisation 73 Typeset by Phoenix Photosetting, Chatham, Kent, UK Printed in the UK 00-OCSEs-Prelims_5e ccp.indd 5 19/03/2015 12:12 OSCEs_5e_PGS.indd 4 06/03/2015 15:04 vi Contents IV. NEUROLOGY 30. History of headaches 75 31. History of ‘funny turns’ 78 32. Cranial nerve examination 81 33. Motor system of the upper limbs examination 86 34. Sensory system of the upper limbs examination 89 35. Motor system of the lower limbs examination 91 36. Sensory system of the lower limbs examination 95 37. Gait, co-ordination, and cerebellar function examination 97 38. Speech assessment 100 V. PSYCHIATRY 39. General psychiatric history 103 40. Mental state examination 106 41. Cognitive testing 111 42. Dementia diagnosis 113 43. Depression history 116 44. Suicide risk assessment 118 45. Alcohol history 120 46. Eating disorders history 123 47. Weight loss history 125 48. Assessing capacity (the Mental Capacity Act) 127 49. Common law and the Mental Health Act 130 VI. OPHTHALMOLOGY, ENT AND DERMATOLOGY 50. Ophthalmic history 134 51. Vision and the eye examination (including fundoscopy) 136 52. Hearing and the ear examination 140 53. Smell and the nose examination 145 54. Lump in the neck and thyroid examination 147 55. Dermatological history 151 56. Dermatological examination 153 57. Advice on sun protection 156 VII. PAEDIATRICS AND GERIATRICS 58. Paediatric history 157 59. Developmental assessment 159 60. Neonatal examination 162 61. The six-week surveillance review 166 62. Paediatric examination: cardiovascular system 169 63. Paediatric examination: respiratory system 173 64. Paediatric examination: abdomen 176 65. Paediatric examination: gait and neurological function 179 66. Infant and child Basic Life Support 181 67. Child immunisation programme 184 68. Geriatric history 186 69. Geriatric physical examination 188 00-OCSEs-Prelims_5e ccp.indd 6 19/03/2015 12:12 Contents vii VIII. OBSTETRICS, GYNAECOLOGY, AND SEXUAL HEALTH 70. Obstetric history 189 71. Obstetric examination 192 72. Gynaecological history 195 73. Gynaecological (bimanual) examination 198 74. Speculum examination and liquid based cytology test 200 75. Breast history 203 76. Breast examination 207 77. Sexual history 210 78. HIV risk assessment 214 79. Condom explanation 215 80. Combined oral contraceptive pill (COCP) explanation 217 81. Pessaries and suppositories explanation 220 IX. ORTHOPAEDICS AND RHEUMATOLOGY 82. Rheumatological history 222 83. The GALS screening examination 226 84. Hand and wrist examination 229 85. Elbow examination 232 86. Shoulder examination 233 87. Spinal examination 236 88. Hip examination 239 89. Knee examination 242 90. Ankle and foot examination 245 X. EMERGENCY MEDICINE AND ANAESTHESIOLOGY 91. Adult Basic Life Support 247 92. Choking 250 93. In-hospital resuscitation 252 94. Advanced Life Support 255 95. The primary and secondary surveys 258 96. Management of medical emergencies 260 – acute asthma 260 – acute pulmonary oedema 260 – acute myocardial infarction 261 – massive pulmonary embolism 262 – status epilepticus 262 – diabetic ketoacidosis 262 – acute poisoning 263 97. Bag-valve mask (BVM/’Ambu bag’) ventilation 266 98. Laryngeal mask airway (LMA) insertion 267 99. Pre-operative assessment 269 100. Syringe driver operation 273 101. Patient-Controlled Analgesia (PCA) explanation 275 102. Epidural analgesia explanation 276 103. Wound suturing 278 00-OCSEs-Prelims_5e ccp.indd 7 19/03/2015 12:12 viii Contents XI. DATA INTERPRETATION 104. Blood glucose measurement 280 105. Urine sample testing/urinalysis 282 106. Blood test interpretation 284 107. Arterial blood gas (ABG) sampling 290 108. ECG recording and interpretation 294 109. Chest X-ray interpretation 306 110. Abdominal X-ray interpretation 311 XII. PRESCRIBING AND ADMINISTRATIVE SKILLS 111. Requesting investigations 315 112. Drug and controlled drug prescription 318 113. Oxygen prescription 323 114. Death confirmation 325 115. Death certificate completion 326 XIII. COMMUNICATION SKILLS 116. Explaining skills 330 117. Imaging tests explanation 333 118. Endoscopies explanation 337 119. Obtaining consent 339 120. Breaking bad news 340 121. The angry patient or relative 341 122. The anxious or upset patient or relative 342 123. Cross-cultural communication 343 124. Discharge planning and negotiation 344 00-OCSEs-Prelims_5e ccp.indd 8 19/03/2015 12:12 18 Station 9 Examination of a superficial mass and of lymph nodes Before starting • Introduce yourself to the patient. • Confirm his name and date of birth. • If allowed, take a brief history from him, for example, onset, course, effect on everyday life. • Explain the examination and obtain consent. Clinical Skills for OSCEsClinical Skills for • Consider the need for a chaperone. • Ask the patient to expose the lump completely; for example, by undoing the top button of his shirt.