OSCE Hi Guys, Got this from a third yr, as they were accidentally told some of the marking criteria

for the OSCE last yr in VS. The following marking scheme is not the actual marking scheme, but it gives you a rough idea, for some of the OSCE stations, what they are looking for. Dont base your revision solely on this! Marks awarded are indicated in brackets. Good luck Simon
Musculoskeletal System Examination for Neck and Shoulder Stiffness 1. Introduce yourself, confirm patient details, explain procedure (1) 2. Obs from side and back, for normal lordotic curve, scars, skin changes, swelling, muscle wasting (2). 3. Active neck movements - flex, ext, lat flex, rot, nod of head (5). 4. Passive movements - supporting head advising Pt of the procedure. Comment on range of movements (3). 5. Palpation of cervical spine (2). 6. Shoulder active movements - flex, ext, abduc, adduc, int/ext rot. Passive movements (3). 7. Feeling for joint crepitus & temp (2). 8. Compare range of movements with opp side (1). 9. Test power (3).

GI Tract Examination 1. Introduce yourself, confirm patient details, explain procedure (1) 2. Inspection of hands, face & mouth for scars of GI system disease (3). 3. Inspection of abdo - Pt placed in correct position (as flat as possible) (1) - Inspect from side to end of bed, report on absence / presence of signs (2). - Adopts correct position to examine abdo (sit down) (1). 4. Superficial palpation performed correctly, beginning away from site of pain, watching the patients face (4). 5. Deep palpation & tests for rebound tenderness (2). 6. Feel for liver (2). 7. Feels for spleen (2). 8. Auscultation (2cm to Rt & above umbilicus) of bowel sounds and around, sounds in 10sec = ok (1). 9. Looks for lymph nodes (1). Respiratory System Examination 1. Introduce yourself, confirm patient details, explain procedure (1) 2. Inspect hands for finger clubbing, temp, tremor, tobacco stains (2). 3. Inspection of mouth & eyes commenting on whether Pt is breathless at rest or not, count no. of breaths per min (2). 4. Inspection of chest wall shape, examine from back and side (2).

5. Assessment of chest wall expansion (watch thumbs separated when hands on chest. Do in 2 front, 2 back) (2). 6. Percussion of chest wall, across chest, parallel ribs, front and back. NB: dull sounds over liver and heart (3). 7. Auscultation of chest (front, back & in mid-axilla region), report on vesicular breath sounds. (2) 8. Vocal resonance (99 or 111 over chest, as 7) (1). 9. Look for lymph nodes in root of neck, from behind (2). NB: vocal fremitus/resonance can be decreased/increased but no added sounds. CNS Examination 1. 2. 3. 4. 5. Introduce yourself, confirm patient details, explain procedure (2) Pt relaxed and placed in correct position (1) Inspection - look for muscle wasting, hypertrophy, fasciculation (3) Test tone - compare Rt & Lt, report findings (2) Test power - compare Rt & Lt, grip (1), wrist flexion & extension (1), pronation, & supination (1) elbow flexors/extensors (1), shoulder abduction/adduction (1), report findings (2). 6. Reflexes - reinforce reflexes if necessary to compare Rt & Lt. Biceps (1), Triceps (1), Supinator (1). Report findings (2). NB: Power & reflexes normal and symmetrical. CVS Examination 1. 2. 3. 4. 5. 6. Introduce yourself, confirm patient details, explain procedure (2) General obs hands - clubbing, temp, anaemia, splinter haemorrhages, scars, cap refill (2) Obs face - central cyanosis, dyspnoea, arcus, xanthelasma, pallor flush, anaemia (eyes) (2) Radial pulses - rate, rhythm, character, vessel wall (4) JVP (3) Precordium Pt @ 45 - looks for scars, visible pulsation (2). Apex beat - position & character (2). RV, LV haeve or thrills (3). 7. Auscultation - apex (bell). Using diaphragm - lower Lt sternal edge (Tricuspid valve), Upper Lt sternal edge (pulmonary valve), Upper Rt sternal edge (aortic valve) (4). 8. Report on heart sounds, presence of murmurs (2) 9. Roll Pt onto Lt - auscultate (1) 10. Lean Pt forward - auscultate (1). Communication Skills Introduction (1) Ascertain id of pt (1) Obtain info re present complaint, including psycho & social dimensions. Qts clear & understandable to pt (4) Appropriate mix of open/closed qts (2) Structure of qts such that relevant info likely to be obtained (1) PMH & allergies (1) Lifestyle qts (1) DH- street drugs, current medication what drug, how many/day, no. times/day, dose (1) FH (1) Systemic enquiry (1) Explore pt ideas about illness (1) Summary clarifies info, allows pt to ask further qts (1) Marks for excellence good rapour (2)

CNS motor examination lower limb Introduces self, confirm pt details, explain procedure (2) Observation looks for signs of muscle wasting, fasciculation, scars (2) Tone Tests tone (2) Muscle power flexion/extension foot, flexion/extension knee, flexion / extension / adduction / abduction / internal / external rotation of hip (4) Reflexes knee jerk (3), ankle jerk (3), plantar response babinski (3) Test for Clonus (2) Locomotion examination of knee Introduces self, confirm pt details, explain procedure (1) Inspection of both legs include skin changes, muscle wasting (2) Inspection of knee joints for presence of effusion (patella tap), scars, inflammation or deformity (2) Check temp of both joints with hand (1) Test active movements flex / ext / no rotation, compare both sides (2) Test passive movements as active (2) Test for crepitus in passive movements, both knees (1) Make assessment of ligament stability collaterals (medial/lateral) and cruciates (ant/post) (4) Tests muscle power (3) Combined communication skills & CVS examination x2 As communication examination Example - Take BP placing cuff correctly on arm (2), inflate cuff checking radial pulse (2), reports finding to pt explaining significance (2), allows pt to ask qts (2)

Hip examination Introduces self, confirm pt details, explain procedure Observe gait Palpation over joint Perform trendelenberg test Measure apparent (umbilicus to medial malleolus) & true (ASIP to medial malleolus) length of legs Active movements flex, ext, add, abd, rot (straight leg move ankle) Passive movements flex, abd (hand on contr-lateral ASIP), add (hand on ipsilateral ASIP), rot (roll leg) Test power

Coordination Rhombergs test Gait Finger nose test Move finger to nose, eyes open Do again with eyes closed, watch action Pt standing, feet together & hands at side Push them gently, assuring to watch them

Hand palm test As rapidly as possible, eyes open Do again, eyes closed

Heel tapping test Rapidly

Marks for excellent technique Renal urine examination PR examination CPR station MUST NOT FAIL!!!!!