OSCE Teaching: Session 1

1
OSCE Teaching Session 1

• Batool Hariri and Noor Jawad
• 4th year medics

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Outline of Session

• Intro to the sessions
• General advice
• Times and dates for future sessions
• Respiratory Examination
• Break
• Respiratory Histories

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GENERAL ADVICE
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So Far

• 6 week BSc Foundation course end of 1st 10
  week firm
• Starting to think about EXAMS!
• Dont panic there is still time but start NOW!

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Yr3s a JokeNO!

• Makes up 40 of MTAS, 60 in yr5
• OSCE 20 (15/15)
• EMQ 20
• Yr3 is IMPORTANT!
• Dont panic coz easiest year so far.

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Yr3 Exam Dates

• OSCE 20th May 2008
• EMQ 29th May 2008
• Longest holiday ever!

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EMQs

• Diseases in Green Books
• Eponymous diseaseshuh?
• WebCT, discussion board
• Wednesday morning lectures
• PasTest books
• Histories examinations useful for EMQs
• FUN!
• Muslim Medics here to help

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OSCEs are FUN!

• Easier way more fun than EMQ exam
• But need to practice
• Not going to pass OSCE by reading books
• More students failed OSCE than EMQ!
• Look out for Muslim Medics Mock OSCE
• Sunday 4th May 2008

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OSCE Structure 2008

• Last year 5 x 10min stations 10 x 5min
  stations
• This year it has changed!
• Rumour has it that it will be 12 x 10min?
• Mike Schachter - Presentation on 5th March 2008
• ALL MUST GO!

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Clinical Skills

• Clinical skills BP, cannulation, ECG, CXR,
  procedures
• See Green Book
• Practice at sites
• Do OSCE style!
• - Time each other (5min)
• - Start with introduction
• Dont spend too much time in the clinical skills
  lab

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Examinations

• Examine patients each other
• Observe one another
• - Dont forget intro
• - Time each other (5min)
• - Need to look slick!
• Advice/help OSCE tutors Muslim
  Medics OSCE sessions
• Examinations Dont forget neck, thyroid breast

12
Histories

• Most difficult no formal teaching
• Last year 5/15 stations
• Practice, practice, practice
• Observe each other taking Hx from patient, give
  each other feedback
• Role plays in pairs/small groups PasTest or
  CO/KC
• Muslim Medics OSCE sessions
• Histories Dont forget urology neurology

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Do I need to attend firms?

• YES!
• BUT be selective
• - Be seen by consultant/team
• - Examine/Take Hx from patients
• Take EMQs on ward with you
• Quiz each other from CO/KC
• Practice OSCE/EMQs in small groups/pairs
• FUN!

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Aims of OSCE Sessions

• Help prepare you for the OSCEs
• 1/week
• Will cover examinations, histories and more
• Timetable to be finalised and then circulated
• Invite friends/enemies
• Give us feedback
• Let us know what YOU want

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Time/Date of Sessions

• Wednesday? 4-7pm?
• Any other suggestions

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Finally

• Feel free to contact us
• - Batool Hariri (bh04)
• - Noor Jawad (nj104)
• QUESTIONS?

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RESPIRATORY EXAMINATION
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Principle of the resp exam

• Inspect
• Palpate (not quite, but its chest expansion)
• Percussion
• (Tactile Vocal Fremitus)
• Auscultation
• It takes ages!

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The Respiratory Examination

• Intro, consent etc.
• Inspection
• Hands
• CO2 retention flap
• Pulse and RR
• Eyes
• Mouth
• Trachea

• Inspect chest
• Chest expansion
• Percussion
• Tactile vocal fremitus
• Auscultation
• Lymph nodes
• Sacral oedema
• To complete my examination...

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Volunteer!
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A few questions...

• Common chest wall abnormalities?
• Why check for a resting tremor in the hands?
• Why check for small muscle wasting in the hands?
• What are the respiratory causes of clubbing? (3)
• Why check for CO2 retention flap?
• What could cause tracheal deviation?
• What happens to the percussion note in pneumonia,
  pleural effusion or pneumothorax?
• What are the 3 types of breath sounds?
• What lymph nodes are you feeling for? (8 groups)

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Now its my turn...
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Issues in the resp exam

• Inspection as a whole and just the chest
• HR and RR and the same time!
• Tracheal tug, deviation and cricosternal distance
• Palpation of the apex beat?
• When to check the lymph nodes
• To complete my examination...

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Any Questions?
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RESPIRATORY HISTORY
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Resp Hx 1

• Introduce self consent
• Patient name, age occupation
• PC
• Cough
• Dyspnoea
• Wheeze
• Sputum
• Haemoptysis
• Chest pain

• CVS ankle swelling, orthopnoea, PND,
  palpitations, syncope
• Fever
• Night sweats
• Weight loss
• General swelling

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Resp Hx 2

• HPC
• Explore PC
• PMH
• Happened before
• Major illness or ops
• THREADSMJ cholesterol
• Previous pneumonia
• DH
• Allergies

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Resp Hx 3

• FH
• TB, lung disease, heart disease, passive smoker,
  cancer
• SH
• Smoking, Alcohol, Drugs, Travel
• Family, Home, Stairs
• Occupation exposure to dust, animals, pollen,
  chemicals (asbestos)

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Resp Hx 4

• Systems Review
• General weight loss, night sweats, fatigue,
  fever, appetite
• CVS chest pain, SoB, ankle swelling,
  palpitations, PND, orthopnoea, syncope
• GI abdo pain, bowel motions, nv, rectal
  bleeding, haematemesis, weight change, swallowing
  
• GU water works, frequency, haematuria,
  dysuria, menstrual cycle
• Neuro headache, dizziness, hearing, vision,
  pins needles
• Musc joint pain/swelling/stiffness

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Resp Hx 5

• Concerns
• Summarise
• Anything to add?
• Thank you
• Do you have any questions?

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Volunteer!
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Dyspnoea - Questions

• Onset
• Duration
• Progression variability
• Aggravating relieving factors
• Occurs at rest or on exertion
• Associated symptoms, e.g. cough, sputum,
  orthopnoe, PND, chest pain, leg pain

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Dyspnoea - Questions

• Exercise tolerance quantified in terms of

• distance patient can walk on flat/up hill/stairs
• if immobile define by activities of daily living
  (eating, washing self)
• what causes the patient to stop (angina,
  claudication, SoB)

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Dyspnoea - Causes
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Cough

• Onset
• Duration
• Character (productive?)
• Timing - morning vs night (asthma)
• Associated symptoms, e.g. sputum, wheeze (COPD,
  Asthma), haemoptysis

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Sputum

• Colour
• Blood
• Volume
• Consistency (runny or viscous)

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Wheeze

• Onset
• Duration
• Timing

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Chest Pain

• SOCRATES!
• Principally pleuritic pain, i.e. sharp pain which
  is worsened by deep inspiration and is said to
  catch the patient as they take a deep breath.

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Volunteer!
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Asthma Hx

• PC/HPC
• Duration/initial diagnosis of asthma
• Normal asthma control, i.e. medication
  frequency of use, normal PEFR
• Precipitating factors, e.g. cold weather, pets,
  work, infection, emotion, exercise
• Exercise tolerance
• Days per week of school/work and disturbed sleep
• Previous hospital admissions ventilation in the
  past?
• Duration and nature of present illness
• Associated symptoms nocturnal cough, sputum,
  wheeze, chest pain, fever, general well being

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Asthma Hx

• PMH
• Pneumonia, TB, previous ops
• Atopic disease, e.g. eczema
• Acid reflux
• DH
• Inhalers etc
• Other than for asthma
• Allergies
• SH
• Smoking, Alcohol, Drugs, Occupation
• FH
• Asthma in family, eczema, hay fever

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Volunteer!
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Haemoptysis - Questions

• Onset
• Duration
• Previous
• Frequency
• Volume (on tissue, cups, buckets)
• Fresh or altered blood
• Associated symptoms

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Haemoptysis - Causes

• Infective Fever, weight loss, night sweats,
  malaise, anorexia, recent travel
• Heart failure Frothy, pink sputum, CVS symptoms
• PE Fever, swollen leg (DVT), fhx, OCP, smoking,
  long distance travel, major op or fracture,
  malignancy, pregnancy/obesity
• Cancer Weight loss, fatigue, anorexia,
  haemoptysis, fhx, smoking

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Volunteer!
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Questions?