From StudyingMed

< OSCE
Jump to: navigation, search
  • Common conditions:
    • Ear infection
    • Cold
    • Flu
    • Arthritis

Things to note in an interview

  1. What does interviewer do at the beginning?
  2. What is interviewer's first question?
  3. What are they asking about and how do they ask?
  4. How does the interviewee respond?
  5. Any notable non-verbal behaviours on either part?
  6. What happens at the end of the exchange?

Areas to improve

  • Opening - introduction, ask name/age/occupation, if roleplay then check gender
  • Open questioning -- always start general, get as much information in their own words as possible.
  • Ask permission/consent
  • Ending
    • do it formally
    • thank them
    • ask "is there anything else of concern?"
  • Don't just ask about the diseases
    • Ask what the impact is on their life
    • Must have been difficult, didn't get a lot of sleep (empathy)
    • Show concern.
  • Don't give advice

Characterising the presenting complaint

SOCRATES (for DISEASE history):

  • Site (especially pain)
  • Onset
  • Character
  • Radiation
  • Associated symptoms
  • Timing
  • Exacerbating or relieving factors
  • Severity/intensity (possibly a rating)

Then address the ILLNESS history:

  • Expectations
  • Concerns
  • Feelings
  • Impact on daily life.

Remember that a full history includes past and present history, and psychosocial history.

Past history

(doesn't include allergies!)

  • Significant illnesses they have had previously
  • Many ways to ask e.g. hospitalisations, operations, time off work etc
    • Go through a list of common diseases (in case they forgot)
      • Diabetes
      • Asthma
      • Heart disease
      • High BP
      • Cholesterol
  • Also find out if it still affects them now
    • Eg if going for operation - need to check that they're fit for the operation
    • Also look for complications related
    • REALLY understand the person's general health

Examination

  1. Observe
  2. Palpation
  3. Percussion (tapping)
  4. Auscultation (stethoscopes)

Or: Look, Feel, Move, Measure

Observing patients

  • Guy in bed
    • Disabled?
    • Unconscious/asleep
    • Breathing apparatus - talking is hard
    • Lots of gadgets attached to him
  • Very thin girl... eating disorder?
    • Extremely thin
    • Low muscle mass
    • But otherwise happy
    • Not about to drop dead
    • Work out who you don't let go home
    • Note that anorexia is potentially quite dangerous

Main factors when observing

  • Alert? Conscious? (Basic)
  • Stature
  • Posture
  • In pain?
  • Skin tone/colour... pale? cyanosis (blue from low oxygen)? flused?
  • Swollen
  • Emotions/pain/body language/expression
  • Breathing/wheezing
  • Intubation/casts
  • Rashes
  • Machines/instruments
  • Books/flowers/how they're dressed (SOCIAL OBSERVATION)
  • Cigarettes, inhalers, sputum jars
  • Medical and social pointers
  • Wellness overall

Never forget the value of inspection and observation

Skin lesions

  • Check the Blackboard links under OSCE. This tells you what is examinable.
  • Colour, Size, Shape, Site, Texture, Tenderness, Type of lesion, Surrounding tissue

Colour

  • pigmentation (freckles, melanoma)
    • hyperpigmented
    • hypopigmented
    • not pigmented
  • erythematous
    • redness (rashes)
    • blanches - press + loses colour (white)
  • purpura (purpuric) - purple rash that doesn't blanch (e.g. meningococcal)
    • small = petechiae
    • big = purpura
    • not usually raised
    • pathology of purpura vs bruise = ?

Size

  • Estimate the size.

Shape

  • Solitary/multiple
  • Solitary - round, oval, annular (ring), polygonal
  • Multiple - Pattern:
    • Linear: one line OR multiple lines
    • Annular: multiple ringlike OR many lesions becoming a ring
    • Serpiginous

Site

  • State the site

Texture

  • Smooth/rough/crusted/scaley/fleshy (e.g. wart)

Tenderness

  • This involves palpation.

Type of lesion

  • macules - flat lesions <1cm
  • papules - flat lesions >1cm
  • plaques - palpable lesions <1cm
  • nodules - palpable lesions >1cm
  • vesicles - small blister
  • bulla - large blister
  • pustule - full of pus
  • erosions - superficial loss of tissue
  • ulcers - deep loss of tissue; circumscribed

Surrounding tissue

  • State whether normal or abnormal