DIT and EMI breakdowns

Here is a document with lots of exciting DIT stuff in, have fun!
http://www.mediafire.com/?zlwgnzhzmhq


And this is the breakdown for both of the exam last may...
http://www.mediafire.com/?2nwwwjjifmz

Hope these are helpful!

xxx

Abdominal exams- this one is a rush!

Get used to the timings with this one- its hard to squeeze in.

Observation
1. wash hands
2. Hello, my name is X, im a first year medical student
3. can i check your name and age please? DOB
4. Would it be ok for me to examine your abdomen?
5. Do you have any pain/ nausea / vomiting
6. Do you mind if i expose your stomach
7. "Patient looks well with normal palour"
8. Have you lost any weight recently Mr X? "no signs of malnutrition"
9. no signs of scars, spider naevi, swelling, distention or dilated veins
10. Have you had any abdominal surgery?
11. there is no visable organomegaly or peristalsis
12. im going to just have a general look at you before i concentrate on your stomach

Hands
1. No clubbing, spooning, leuonchyia or dupuytren's contracture
2. No signs of palmer erythema and hands are a normal temperature
3. please can you hold your hands up and put your hands back
4. no sign of CO2 retention

Pulse
1. Pulse is regular and strong in character

Neck
1. No inflammation of the lymph nodes

Face
1. No anaemia, jaundice or corneal ulcer
2. Dental hygeine is good. There is no central cyanosis, angular stomatis or ulcer. No sign of candida infection.

Palpation
1. Do you have any pain in your abdomen? can you point to it please?
2. I will be appling some pressure, please let me know if its uncomfortable
3. Kneel at patient level, maintain eye contact
4. On palpation the abdomen shows no gaurding or rebound tenderness. No sign of organomegal or palpable masses
5. Can you take a breath in please, when i say
6.No signs of hepato or spleno megaly
7. no sign of aortic aneurism
8. please culd you lift yourself up slightly and cough "no abnormality in hernia areas. To increase the accuracy of this examinationi would ask the patient to stand and examine the hernial orcus"

Percussion
1. Hepatic dullness and gastric resonance were normal
2. im going to assess for fluid in the abdomen
3. can you roll onto your left side please (should remain resonant)
4. I would wait for 10 seconds to allow any fluid in the parietal cavity to move
5. no sign of shifting dullness
6. No fluid thrill

Ausculation
1. On auscultation bowel sounds are present with no abnormal sounds
2. there is no aortic renal or inguinal bruits

Cover patient and thank
To complete the abdominal examination i would do a rectal and external genatalia examination and a urinalysis

Summary
Mr X has presented for a routine abdominal exam. On general inspection he is no visable pain or discomfort, he is breathing normally. No sign of palour or distention. No swelling, visable organolmegaly or peristalsis. He has no peripheral stigmata that would suggest any abdominal pain.

On palpation there was no gaurding or rebound tenderness, and no palpable masses. No sign of organomegaly or aortic aneurism. On percusson everything is normal, with hepatic dullness and gastric responce. No shifting dullness or fluid thrills. Bowels sounds are normal and there are no arterial bruits.


taaadaaaa Jazz hands etc

Family study examples

I have added all the example family studies i can find to the folder that you can download from on the right hand bar --->

Marcus (the guy who organizes all of the peer education stuff) has told us that he will be having another family study session for everyone, where the girl who won the prize last year will go through her study for you all. So look forward to that!

Happy studying!

Reflections!

Its all about you!

Reflections dont have to take too much time, but are really important! If you get the three stages right, you should ace them.

Three stage reflections!

Selection- referred to  specific event in detail, describing your reaction

Integration- why did you act like this? draw on past experience and knowledge (cultural, education, beliefs, religion, family), describe lessons learned

Analysis- when and how will you apply the lessons learned?

Ie. Patient study, future as a medical student, as a doctor, other walks of life

Remember to ask WHY?

Brainstorm ideas

Religion, social class, gender, contrasting medical beliefs…

If you can’t think of any, sometimes it’s worth telling friends about your study mum and asking them to come up with some?

Here are mine, I Followed the 3 stages quite strictly. They seem to like that.

Communications with mother and family 

I was surprised by Naomi’s trust, openness and they way she was immediately at ease. Difficult topics were easily discussed and the interviews were very relaxed. During my medical education I have always assumed that patients will withhold information unless asked, and have been wary of intruding with probing questions. From this experience I can derive that patients attitudes to consultation are very diverse, and that different people will be comfortable with different approaches. I can apply this knowledge in future by giving time when first meeting patient to adapt my consulting style to that which they are most comfortable. 

Interactions with family and culture 

I was surprised that Naomi’s ethnicity, classed by her as ‘other’, was different to what I imagined from her accent and environment. As her origin was not immediately evident I felt unsure bringing it up. Would I come across as ignorant?  I had thought that I would find it easy to discuss ethnicity as I was educated in a culturally aware school and grew up in a diverse environment. However, I learned that often patients would not see their ethnicity to be an issue, despite the fact that it may be medically significant. This experience has allowed me to gain confidence in breaching the subject of ethnicity, and in discussing it with patients in a way that  demonstrates that I have no prejudice. 

Professionalism and attachment 

I immediately built up strong repore with my study family. The strength of the relationship between my partner, the family and I became apparent when Naomi and Andrew gave their baby our names!  We were incredibly touched by this gesture. The family was very similar to my own, and Naomi offered support as an adult medic. I recognised this situation as similar to one that I experienced on my hospital work experience when I befriended a patient who subsequently became ill, and found it very upsetting. This made me wary of becoming too attached and viewing Naomi as a ‘mother figure’. I have learned that becoming emotionally involved with a patient strays close to the boundaries of professionalism but can also bring great reward. In future I will aim to be able to step back from work and separate myself from the experiences and lives of my patients, while also building  up repore. 

Family study

Hello chaps!

Thanks for coming along to the session on Thursday, here is some of the stuff we went over!

/Users/Josievallely/Documents/Family Study Powerpoint For Peer Ed

View more presentations from Josie.

Teamwork with partner 

ICE- asking why?

Nearly every single feedback form I read said “ICE in more detail- ask why?”

The mother was worried because the baby was not kicking

Why was she worried?

What did she think this may signify?

Why did they think in that way?

What did they expect would happen?

The mother did not want to go to antenatal classes

Why not?

Why did she think they would make her worry?

The mother was concerned about downs syndrome due o her age

Has she got expeiriance of downs syndrom children?

How would it effect her pregnancy?

How would it impact her life?

Mum got on well with the midwife

Why is that important to her?

The mum felt lucky not to have morning sickness

How would it have effected her?

ALWAYS ASK- WHY DID YOU FEEL LIKE THAT?

Methodology

Gathering information

This study was essentially qualitative. Information was obtained from:

Semi-structured interviews. My partner and I took turns at asking questions (open and closed) and taking down notes.

Observing- General observations were helpful in drawing a picture of the family and Loretta’s experience. 

GP notes and antenatal records

Textbooks, Internet, lectures and seminars helped to prepare questions for each visit. 

Data triangulation was achieved by comparing information gathered from the family with GP and antenatal records, and talking to Loretta’s GP. 

Ethical issues - We made sure that the family was aware that all information would be confidential, and names would be anonymised. We stressed that should Loretta not wish to participate in the study anymore, she could withdraw at any point. Informed consent was obtained before viewing any records and discussing sensitive issues. 

Communications station..

This can be one of the scary OSCE stations, because it hard to know what to expect. Here are some ideas of some things you could ask, in some sort of structure. Remember to look on the right hand side at the bottom for previous posts on chest exam.

Other osce tips

- dress smart and comfy

- Wash your hands!!!

- thank the patient

- smile

- dont let one station put you off- its ok to fail one or two

- learn the script, you wont have to look for things at this stage

Communication station

NB:  it can be helpful in this station to take a pen and paper and jot down the patients name and age for your summary.

“Hi, my name Is .......... and im a first year medical student.

Can I just ask your name?

And how old are you?

Are you currently employed? What is your occupation?

 

I’m just here for you to have a chat with about anything that might be worrying you health wise. Is there anything specifically that you have come to see me about?

 

Listen, noises, demonstrate interest and respect.

 

Ok, so. Summarise…. Is there anything else?

 

Cab you give me a timeline of when you started feeling this way? When did it start and what did you notice changing that made you decide to come and see me?

 

Condition-

What makes it worse?

What makes it easier to deal with?

Have you been taking anything for it?

Pain? Where does it spread, what kind of pain?

 

Remember to use silence!

Remember to clarify ambiguous statements

 

Ok, so let me check over those details again, please correct me if I’m wrong summarise.

 

So have you any ideas about what could be causing this?

Where did you get this information?

Is there anything you are particularly worried about concerning your problem?

What would like to achieve from this consultation, what are our goals?

 

Ok, i'm just going to ask you a little about you’re past medical history. Is there anything that you have been to see a doctor about previously that you think could be related to this?

Recent surgery?

Any long-term conditions like asthma or high blood pressure?

Are you on any medication?

Do you take any over the counter or alternative medicine, vitamin supplements?

Do you have any allergies?

Are there any conditions that run in your family?

Do you mind if we discuss a little about your family life?

 

Who lives at home with you?

Do you care for anyone?  How does that make you feel? Is it stressful?

Can you cope at home?

Do you smoke? How much?

Do you drink? How much?

 

Have you been on holiday anywhere recently? This might sound like a funny question, but there are lots of different health risks in other countries that I have to take into account.

 

Summarise

 

And a little about you personally?

Has your current condition been making your personal life any more difficult?

Do you enjoy your job? Is it stressful / tiring

Have you experienced any weight loss recently?

Have you felt unusually down or despondent?

 

Summarise

You have been experiencing….

You would like to have XYZ sorted

 

Ok, thank you for coming to see me, I hope this has been helpful for you; I will pass this information onto the GP.

OSCE Time!

CHEST EXAM

Introduction

1. Wash hands
2. Hi, im ..........., im a first year medical student and im just going to do a routine chest examination on you today, is that ok?
3. Can I check your name and date of birth?
4.  Do you mind if I just uncover your chest?
5. get the patient to sit at 45 degree angle
6. If you have any questions, feel free to ask

 

Inspection

7. Mr X looks generally well, there are no signs of discomfort or difficulty in his breathing. He isn’t using any accessory muscles and his respiratory rate is normal. Chest expansion looks symmetrical.
8. Im just going to have a general check over you before I concentrate on your chest.

Feet

9. No sign of pedal oedema

 

Hands

10. No Nicotine stains, Clubbing or Peripheral cyanosis. Normal hand temperature
11. Please can you hold your arms up and put your hands back, like this.
12. “There is no tremor flap that would indicate CO2 retention”

 

Face

13. Eyes - “no signs of anaemia or jaundice”
14. Mouth – “no central cyanosis”

 

Neck

15.  “patient does not have raised JVP and there are no signs of infection or inflammation”

 

Chest

16. The chest looks normal with no scars, spider nervae, gynamaastia or hair loss.

 

 

Palpation

17.  “the trachea is central the apex beat can be found in the  5^th intercostal space on midcavicular line- There is no mediastinal shift”
1. “chest expansion is symmetrical”
18.  “vocal fremitus is normal”

Percussion

19.   “on percussion, lungs are symmetrical and  hepatic dullness and gastric resonance are present in the correct areas”

 

Ausculatation

20.   “breath sounds are vesicular and symmetrical, there are no crackles or wheezes.

21.  “I would repeat auscultation on patients back to assess inferior lobes”

22.  Thankyou very much Mr X.

Summary

23.  Mr X has presented for a routine chest examination. On general inspection he loks generally well, with no respiratory distress. His chest expansion is symmetrical with no accessory muscle use. There are no concerning peripheral stigmata. No medisatinal shift is detactble and vocal fremitis is normal. On percussion lungs are symmetrical and hepatic dullness and gastric resonance are present in the correct areas. Breath sounds are normal vesicular with no wheezes or crackles. Mr X has a healthy chest.