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.

Student consult

If you go online to ‘student consult’ (link on right hand side of page) and log in, you can access 

• Boron
  
• Kumar and clark 
• Anatomy flash cards 

My log in:

i.am.josie@gmail.com

password: medicine

(Keep it secret!)

Upcoming Exams!

This is a combination of pointers and general information. It may seem funny to think that last years questions are worth looking at, but the med school don’t tend to change their questions much, at least that was our expeiriance last year.

Some things to remember-

MIC and PPD- I know, its silly, but these lectures are worth shifting through. Look for any key words or things that come up more than once. There will probably be few ethics questions and there is usually one on the ‘role of the doctor’ ie. Gatekeeper, which will have been covered in one of your lectures? dont loose these easy marks!

The questions on the LSE, at the bottom of each case, tend to come up in the exam, and give you a good idea of what they are looking for. Some of these don’t have answers online, so if you would like to check something then give us an email or wikipedia it!

For example, this ethics question: https://mbbs.ncl.ac.uk/secure/coursematerials/doc/section/n09y1ppd1/ar01s01s06.html was in our christmas exam. Here is the answer! 

(http://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approach) 

Make sure you understand-

Blood saturation graphs (anaemia case). These are the S shaped graphs that show O2 saturation.

ECGS- learn the patterns for arythmias, heart block etc. be able to calculate beats per minute. There is a good tutorial on the LSE, and the website in the links section.

LSE tutorial: http://mbbs-tutorials.ncl.ac.uk/secure/content/ECG/index.html

Genetic code: We had a particular question that tripped a few people up. You had to translate a set of codons into mRNA from DNA. All you do is change uracil.

Osmolarity graphs with 2 solutes. Make sure you look at MTC31:membrane transport and water distribution. Make sure you get to grips with osmolarity calculations.

Here is a link to a self study guide on osmolarity-

http://edtech.clas.pdx.edu/osmosis_tutorial/default.html

http://www.rcs.rome.ga.us/hargett/biology/osmosis/osmotutc.htm

If your feeling brave you can attempt this question and email prof. Bradley (p.m.bradley@ncl.ac.uk)  to see if you get the answer right-

Study box

Attempt this problem to see if you understand the basis of membrane transport.

If lymphocytes are placed in an isotonic medium (150mM NaCl) they will maintain a constant volume. If the bathing medium is then made hypertonic by being increased to 250mM NaCl the cells will initially lose water due to osmosis and begin to shrink. However it is observed that after a while the cells  regain their original volume despite being in an hypertonic solution. This is achieved because as cell pH drops there is an activation of the enzyme carbonic anhydrase which generates H+ and HCO3- from gaseous CO2. In addition two antiports are activated.

1.   Why should cell shrinkage affect cytoplasmic pH?

2.   Which antiports would be activated and what would be the consequence?

Pedigrees. Practise how to work out the chance of traits being passed on. we will hopefully have something on this soon! keep checking back.

Embryology: Know the names and causes of all the abnormalities of gut formation

Know the development of the heart  and all the ‘holes’ like the ductus foramen

Look at all the labour and peurperim lectures, know the stages of labour and the position of the baby as it passes through each stage- in lectures LC 1.24- LC 1.27 https://mbbs.ncl.ac.uk/secure/coursematerials/doc/section/n09y1lc1/ar01s01s02.html

 There are no stupid questions, only stupid people.

And from that we can conclude that some of the people writing our exams are stupid. Just learn these answers...

The ratio of drug reps to doctors, is 1:7.5

There was a vitamin question, makes sure you know these-

Rickets- Vit D deficiency

Beriberi- thiamine deficiency

Xerophlamnia- vit A deficiency

Macroaneamia- folic acid

Liver/bone damage- vit A deficiency

Learn vaccine ages-

            Polio 12-16 years

            Tuberculosis? 12-16 years

            Rubella? 4-6 years

            Pneumonia? 75 years

            Meningitis C? 2 years

The responcibility of getting the HP vaccine lies with you, the student!

We got asked how many units of alcohol a woman is allowed a week? 14

How many units in a can of strong lager? 2.5 units

It is helpful to know how to calculate this- 

The percentage alcohol by volume (% abv) of a drink equals the number of units in one litre of that drink. For example:

Strong beer at 6% abv has six units in one litre. If you drink half a litre (500ml) - just under a pint - then you have had three units.

Wine at 14% abv has 14 units in one litre. If you drink a quarter of a litre (250ml) - two small glasses - then you have had three and a half units.