OSCE A training manual for medical undergraduates

4th Edition

Ruth Bird Simon Fleming Helen Twohig Ali Majeed Introduction by: Malcolm Reed www.oscemanual.com

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OSCE A teaching manual for medical undergraduates

4th Edition Ruth Bird Simon Fleming Helen Twohig Ali Majeed www.oscemanual.com Published by: A W Majeed Cliffe Cottage 66 Ranmoor Road Sheffield S10 3HJ Copyright © 2003 First Edition 2003 Second Edition 2003 Third Edition 2006 Fourth Edition 2008 ISBN 0-9545032-0-1 www.oscemanual.com

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This book is dedicated to the memory of

Professor Alan Godfrey Johnson

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Contents

Acknowledgements Background and Design of OSCEs How to use this book Abbreviations used Gastrointestinal system General gastrointestinal history Presenting complaint - abdominal pain Presenting complaint - dysphagia Presenting complaint - dyspepsia Presenting complaint - vomiting Presenting complaint - jaundice Presenting complaint - diarrhoea Presenting complaint - constipation Presenting complaint - rectal bleeding Examination of the GI system Digital Rectal Examination Examination of a Groin Hernia Examination of a patient with acute abdominal pain Gastrointestinal Bleeding Alcohol History Cardiovascular system General cardiovascular history Presenting complaint - chest pain Presenting complaint - palpitations Presenting complaint - intermittent claudication Examination of the cardiovascular system Examination of the precordium Peripheral vascular examination Top Tips: Understanding ECGs Tachycardias Bradycardias Respiratory system General respiratory history Presenting complaint - cough Presenting complaint - shortness of breath Examination of the respiratory system Top Tips: Looking at Chest X-rays Inhaler Technique Peak Flow Measurement Neurological system General neurological history Presenting complaint - headache and facial pain Presenting complaint - sudden onset weakness Presenting complaint - collapse Examination of the cranial nerves

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Examination of the lower limbs Examination of the upper limbs Assessment of cognitive state Top Tips: Neurological Examination Musculoskeletal system Presenting complaint - joint pain Presenting complaint - back pain Examination of the musculoskeletal system (GALS) Examination of the hands Examination of the hip Examination of the knee Examination of a patient with back pain Endocrine system General endocrine history Suspected diabetes mellitus Suspected thyroid dysfunction Examination for hypothyroidism Examination for thyrotoxicosis Examination of a goitre Examination of a diabetic foot Genitourinary system General urinary tract history Presenting complaint - haematuria Sexual medical history Presenting complaint - vaginal discharge Communication Informed Consent Explaining a Procedure Breaking Bad News Consent for a Post-Mortem Drug Adherence Cardio-Pulmonary Resuscitation Adult CPR Paediatric Basic Life Support Procedures Handwash and Scrubbing Up Arterial Blood Gases Measuring Blood Pressure Intravenous Cannulation Venepuncture Male Catheterisation Routine Urinalysis General Topics Confirmation of Death and Death Certification Dermatological Examination Top-Tips: Lymph Node Examination Breast history

130 133 136 137 141 142 145 147 150 152 154 156 159 160 164 166 168 169 171 173 175 176 179 181 183 185 186 188 189 191 193 195 196 198 199 200 203 204 206 207 208 210 211 212 214 216 217

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Breast Examination Preoperative Assessment Examination of an Ulcer Examination of a lump Top-Tips: Looking at fracture X-Rays Top-Tips: Assessment of the acutely ill patient Psychiatry General Psychiatric History and Mental State Assessment Depression History Schizophrenia Assessment Deliberate Self Harm and Suicide Assessment Eyes and Fundoscopy Examination of the Eyes Fundoscopy Ear, Nose and Throat Examination of the Ears Examination of the Nose and Sinuses Examination of the Mouth Gynaecology and Obstetrics General Gynaecological History Obstetric History Bimanual and Smear Top-Tips: Antenatal Obstetrics Examination Paediatrics Neonatal examination Paediatric history References and suggested reading

219 222 224 226 228 233 248 249 252 254 256 259 260 263 265 266 267 268 270 271 274 277 280 282 283 287 290

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Acknowledgements The following are experts in their own fields of medicine and have read and amended the contents of this training manual. Their contribution is gratefully acknowledged. Mr Roger Ackroyd Consultant Surgeon, Sheffield Teaching Hospitals. Dr John West Consultant Cardiologist, Sheffield Teaching Hospitals. Dr Rod Lawson Consultant Respiratory Physician, Sheffield Teaching Hospitals. Dr Andy Gibson Consultant Neurologist, Sheffield Teaching Hospitals. Dr Mike Snaith Senior Lecturer in Rheumatology, Sheffield Teaching Hospitals. Dr Derek Cullen Retired Consultant Endocrinologist, Sheffield Teaching Hospitals. Dr Nusrat Mir Consultant Psychiatrist, Sheffield Care Trust. Miss Fiona Kew Consultant Gynecologist, Jessop Wing, Sheffield Teaching Hospitals. Mrs Helen Till Senior Resuscitation Officer, Sheffield Teaching Hospitals. Mr Senathirajah Muruganinrajah ENT Surgeon, Sheffield Teaching Hospitals NHS Trust Mr David Squirrel Consultant Ophthalmologist, Sheffield Teaching Hospitals NHS Trust Miss Julia Dicks SpR in Breast Surgery, Doncaster Royal Infirmary. Dr Gail Moss Consultant Paediatrician, Sheffield Childrens Hospital. Dr David Moore Consultant Radiologist, Sheffield Teaching Hospitals NHS Trust Dr Jon Silversides SpR in Anaesthesia, Royal Victoria Hospital, Belfast. (Author of ‘Assessment of the acutely ill patient’)

The ‘Top Tips’ and some of the text in ‘Tips and Advice’ has been adapted from the

Student BMJ with permission from the BMJ Publishing Group.

Medical mnemonics have been copied/adapted from: http://www.medicalmnemonics.com