CRACK THE NAC
ACRONYM &NMEMONIC GUIDE TO THE OSCE
Why an OSCE? Medical OSCE’s are designed to test your complete skillset as a physician. History
taking, physical exam, communication skills, professionalism, technical skills, problems solving, clinical decision making, diagnosis, treatment, and management are all tested.
How to prepare? Well organized study methods, repetition, simulation, rehearsal are important ways to prepare for the exam and increase confidence while lowering anxiety. It is also important to be well versed in the format of the exam and the methods in which you will be scored. The OSCE will test how you perform under pressure, it’s important to remember that when under stress we do not rise to the challenge, we fall to the level of our preparation and training.
Develop a system When preparing for the exam it is important to prepare in the manner in which you will be examined. Find a small notebook/pad and make notes based on cases to help guide you. Even if you are simply talking yourself through scenarios alone in the library it is important to make notes and rehearse as you were in the real exam situation. Follow this system over and over again until it becomes second nature, like breathing or walking.
The Acronyms of the OSCE We’ve laid out some simple and essential acronyms to help develop your system,
when you are reading cases begin to do your best to fill in these diagnostic tools to help guide your study and identify any weaknesses in your knowledge.
HISTORY TAKING WITH ChLORIDE FPP
Character Location Onset Radiation Intensity Duration Events associated Frequency Palliative Factors Provocative Factors
Character: Can you describe the symptoms/pain/problem Location: Where do you feel these symptoms/pain/problem? Onset: When did this start? How did this start? Gradual? Quick? Radiation: Does the problem/pain/symptom radiate to any other parts of the
body? Intensity: How would you rate the problem on a scale of 1 to 10? How is it now?
Has it increased or decreased since onset? Duration: How long has this been happening? Does it come and go? Acute?
Chronic? Events associated : Have you had any associated events? Trauma? Review of
Systems with possible related problems? Frequency: How frequent is this problem? Palliative factors: Does anything make it feel better? Rest? Medications? Etc? Provocative factors: Does anything make it worse? Activity? Food? Allergies?
Seasonal? Etc?
Differential Diagnosis with VITAMINS C
Vascular Infectious Traumatic Autoimmune/Allergic Metabolic Idiopathic/Iatrogenic Neoplastic Substances and pSychiatric Congenital
Physical Exam with IPPA Inspection Palpation Percussion Auscultation Remember to comment on what you are inspecting, palpating, percussing, auscultation, and what you are looking for when doing so.
SOAP Subjective – the case presentation/history
of present illness Objective – the findings, lab results, test
results, etc Assessment – based on the S and the O
your Dx and DDx Plan - What do you need to do to confirm
diagnosis? What are the problems you need to address with the patient? Medical/Social/Legal?
Other useful Mnemonics ABCDE – Assessment of skin lesions – asymmetry, border irregularity, color variety, diameter, elevation and enlargement
BEANN – Diabetic complications – bugs, eyes, arteries, nephropathy, nerves
DDUV – Informed consent – decision making capacity, disclosure, understanding, volunteers
DDRRIIP – DDx for urinary incontinence – drugs, delirium, restricted mobility, retention, infection, impaction (stone), polydipsia
ETHNICS – for cross cultural communication – Explanation of Sx (by the patient) treatment (how they have treated it so far) healers (who they have consulted previously) Negotiate (their options) Intervention (medical/surgical) Collaboration (with patient, family, religion, healer, etc) Spirituality (respect their beliefs and accommodate to them)
FIFE – Feelings (what do they feel is going on) Ideas (what are their ideas about the problem – this can help address concerns/worries as well patients are often correct about their diagnosis) Function (how has this problem affected their day to day function) Expectations (what do they want done).
ImPAIRED – For Mainia – Impulsivity, pressured speech, activity (increased), insomnia, racing thoughts, esteem, distractible.
SEADS – for MSK inspection – swelling, erythema, ecchymosis, atrophy, deformity, skin changes
TEST CA – for MSK palpation – tenderness, effusion, swelling, temperature, crepitus, atrophy
SIGE CAPS – For depression – Sleeplessness, interest, guilt, energy, concentration, appetite, psychomotor, suicidal ideation
SPACED – Lung Hx taking – Smoking, shortness of breath on expiration, sputum, pain, pigeons (other birds), asthma, cough, chest x ray, exercise tolerance, environmental exposure, dyspnea
