OSCE STATIONS OF SURGERY Dr. ABDULHUSSEIN AL-JABERI
[email protected]
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History
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ABDOMINAL PAIN
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit 1$%resent 1$%resent illness onset and duration 2$&ocation o pain and se#erity 3$'adiation ($)imin" related to ood *$A""ra#atin" and 'elie#in" actor +$Associated e#er and ri"ors ,$!ausea/-omitin" $han"e in bo0el motion blood in the stool $ ei"ht loss 14$%ast history o pre#ious episodes 11$%ast sur"ical and medical history 12$5ru"s history 13$6aundice 1($7ocial history alcohol smokin"
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WRITING AN OPERATION NOTE
1$5emo"raphic details 8namea"e hospital !o.9 2$7ta: details 8you your assistant and the anaesthetist9 3$5ate and location o operation ($peration title *$ndication +$ncision ,$
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WEIGHT LOSS
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit
1$5uration 2$=o0 many >"s/0eek or month 0as lost 3$&oss o appetite 0eakness and easy ati"ability ($G symptoms8dyspha"ia #omitin" diarrhea and constipation chan"e o bo0el habits *$hronic bleedin"8hematemesis malena hematuria #a"inal bleedin" hemoptysis +$)hyroto?icosis symptoms8intolerance to hot 0eather s0eatin" tachycardia palpitation ner#ousness9 ,$%ast sur"ical history 8pre#ious sur"ery tumour chemotherapy radiotherapy9 $%ast medical history85 chronic illness9 $%sycholo"ical status
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VOMITING
1$Greet patient introduce yoursel establish a plan 2$5uration 3$
+
THYROID SWELLING
1$Greet patient introduce yoursel establish a plan 2$&ocation 3$5uration ($han"e in siCe *$ %ain +$ntllerance to hot -s cold 0hether ,$An?iety sleep disturbances $%alpitations $5iarrhea 14$enstrual disturbances 11$iscarria"es and inertility 12$
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THYROID STATUS
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit 1$A"e 2$ccupation 3$5o you preer cold or 0arm room ($Gained or lost 0ei"ht recentlyD recentlyD =o0 much and o#er ho0 lon" *$Appetite +$Bo0el habit ,$han"ed o mood $%alpitations $%alpitations or chest pain $han"e in your periods8emale9 14$han"e in your appearance 11$ han"e in your #ision 12$=a#e notice alump in your neck E5oes it cause any problems 13$%ast medical and sur"ical history 1($ Any medical conditions 1*$peration on thyroid "land or radiotherapy on neck in the past 1+$edications and aller"ies
1,$Any thyroid dru"s 1$%ressure 1$%ressure symptoms8dyspha"ia stridor9 SPIES
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K_`Q D KœL ]£ FN€[ “I ›`Z_ ƒ`Q ©I žƒ`Q ]£ „ ]™] ¤`£J KœLQ ]£J ƒ\ ‰HQ žªQ }NQ K‡ŽQ †{ …HPY9 ... Q N„ Vg{— ... ˆ_ ... HL ] KSŽU •UNŽ{U š]SZ\ ]vY [ …[ KS …HPY] ƒ`Q 8 ¥ŽQ A#oid scientifc and technical lan"ua"e ¥Ž_ “U H][ ›`LO„ € …HPY[ KLg{Q[ KLSQ KTSQ Xg V_ «L\ KLQ]YQ KS‡Q Q ]^YJ „ KS€ ZQ ƒ`Q ¬‘[ `UJ ™ D N^\ …NŽ{U `UJ “U H] KS€ K]Ž § •LgI ]U Ž_ [ _`I ™ [ J HQ š]UNSQ KL\]L “U H\ š]UNSQ]\ ƒ`Q `£ H]YQ „ ›HH€ KUNSU Q ^Yg ˆ_ •Ž_ HU ŒU X]gY KLQ]Q KUNSQ ¥Ž_ “U ¡mpathy 8¡9 ƒ`Q ]{ ŒU I]{YQ –„NYQ ˆ£ “U ƒ`Q SI `PQ Kœ|[ –L{PYQ ]Y ]]L” V\]‡J NŠYQ “I ¥SZYQ[ `PQ ›HW “NŽ[ `PQ F` “I DKLQ]YQ šNŠPQ ŒY ¦`O xZ™ š]\ˆU ‰F]{YQ[ `SQ [ ƒ`SQ V{|]Q ]{J SI ¦`YQ[ š]OJ .1 –L D]{J “I }NQ “ZU[ šJ]{J wN‡U ’]U [ `UJ x™ ]‡ ¤NW N™ ]U [ `UJ xŽ\ `v § `UJ xŽ\ SI ]UH\ Y }VQ `PQ N™ ]U D ]{J x™ X SI ¦`YQ .2 wNQ …ˆZQ “‘ ]{J “I [—Q HHYQ]\ “LY^\]Q “LYŠ^gQ “L\ ©\`SQ YQ[]U ƒ`SQ `Ž .3 DˆU • _`I[ ]{J šFH” [ Qx †LQ ž LSI ˆL^~ ] `{Q K‡LY w] $ H€ ¥Q—U `PQ x™ `Ž‹ $ H€ ®IU `UJ x™ ¯N‘N\ `Ž‹ $ 12
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S-P-I--E-S
7²7¡))!G ³pri#acy ³ask or presence o amily members or riends ³sit do0en %²%¡'¡%)! ³ask patient 0hat he kno0s about his condition ²!-)A)! ³obtainin" o#ert permission ³respect patients ri"ht to kno0 or not to kno0 >²>!&¡5G¡ ³"i#e your patient a 0arnin" that bad ne0s are comin" ³a#oid technical and scientifc lan"ua"e ¡²¡%A)=´ ³do0nplay the se#erity o the situation or "i#e a more hopeul pro"nosis 7²7)'A)¡G´ A!5 7µ¡'´ ³summariCe the inormation in your discussion
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PYLORIC STENOSIS
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit
1$hen did the #omitin" start 2$=o0 many episodes per day 3$Any relation to eeds ($ haracter o the #omits and #olume *$!umber o 0et diapers +$!umber and character o stool any blood ,$ei"ht "ain in relation to birth 0ei"ht $Birth history $
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PEPTIC ULCER ! GALL STONE ! CHOLECYSTITIS ! DU ! PANCREATITIS
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit 1$7iteonset durationse#eritycourse 2$¶ualityuantity 3$A""ra#atin" and relie#in" actor ($'adiation *$5iCCiness +$Bleedin" %/' malena haematemesis ,$Bo0el mo#ement ·atus $µrinary symptoms $%re#ious episodes 14$edication$!7A5 11$%ast medical and sur"ical history endoscopy 12$!ausea#omitin"e#erchills 13$ei"ht loss 1($hest pain 7B5¡ cou"h =5 1*$7ocial history smokin" alcohol 1+$
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NIPPLE DISCHARGE
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit 1$!ature o the dischar"e 2$Association 0ith mass 3$µnilateral or bilateral ($7in"le or multiple duct dischar"e *$)he use o contracepti#e pills +$Association 0ith pain tenderness ,$ Association 0ith e#er $=istory o trauma $
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NEC MASS
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit 1$nset 2$'ate o "ro0th 3$Associated pain ($ Associated e#er s0eatin" ri"or *$7mokin" +$7un e?posure ,$Alcohol $tal"ia $=oarsness 14$)rismus 11$5yspha"ia 12$t loss
1
JAUNDICE
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit
1$nset 2$%ain 3$
1,$
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit 1$%ain Dcharacter se#erity location periodicity 2$5istentionDrapidsuddende"ree 3$Bo0el habit and ·atus ($t loss *$%re#ious obstruction +$ %re#ious abdomen or pel#ic operation ,$ %re#ious abdominal A $ %re#ious intra abdominal in·ammation $mmediat post operati#e state 14$¡?posure to radiation 11$%ast medical history
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INFORMED CONSENTS
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit
² e?planation o the condition and natural history and pro"nosis ² e?planation o the therapeutic options conser#ati#e sur"ical treatment !² the name o the procedure 7² side e:ect and complication8anesthetic inection bleedin"9 ¡² e?tra procedure8drain !G tube
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INCISIONAL HERNIA ! HYPERTENSIVE WRITE MEDICAL CONSULTATION
1$%atients name and A"e 2$lear consultation destination 3$ Greetin" the consultant doctor ($5uration o =) *$)he dru"/dru"s used by the patient +$)he doses o the dru"s used ,$'ecordin" the B% $Any chest pain $Any kind o dyspnoea 14$lear and direct aims o the consultation 11$ Greetin" the consultant doctor 12$!ame and position o the consultation 0riter 13$7i"nature o the consultation 0riter 1($5ate o the consultation
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HYPOTHYROIDISM
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit
1$=o0 lon" has she been ati"ued 2$=as there been a 0ei"ht "ain 3$Any s0ellin" in the lo0er le"s ($!otice any chan"e in her hair or skin any rashes *$Any history o thyroid disease in the amily +$Any joint pain or intolerance to cold ,$Any e?cessi#e intake o 0ater $5o you su:er rom constipation $%ast medical/amily history 14$Any history o thyroid disease in the amily 11$Any pre#ious medical conditions 12$n you on any other medication
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GROIN LUMP
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit 1$A"e$occupation 2$=o0 lon" ha#e you noticed the lumpE 3$ere you doin" anythin" in particular 0hen you frst noticed the lumpE ($s it painulE *$=as it increased in siCe since you frst noticed itE +$5oes it disappear i you lie do0n/ can you push it back insideE ,$=a#e you had any pre#ious lump or s0ellin"s similar to thisE $5oes it dischar"eE $=as the lump e#er become red painul or di¹cult to reduce E did you ha#e associated episodes o #omitin" or your bo0el not openin"E 14$5o you ha#e any urinary symptomsE 11$5o you su:er rom constipationE 12$ 5o you su:er rom cou"hE 13$5oes your 0ork/leisure time in#ol#e a lot o litin" E 1($5o you e#er inject dru"s in your "roinE 1*$=a#e you had any recent ni"ht s0eats/0ei"ht lossE 2*
1+$%ast medical and sur"ical history 1,$=a#e you had any tests to in#esti"ate the lumpE 1$ =a#e you had any treatment or itE GI BLEEDING
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit 1$5uration 2$¶uantity 3$Appearance ($Any clots *$Any abdominal pain +$Bo0el symptoms ,$7tool $Any chest pain/Any syncope/Any s0eatin" $ei"ht loss 14$%ast medical historyD 11$%eptic ulcer 12$li#er disease 13$Any cancer 1($%rior bleedin" 1*$ardiac disease 2+
1+$%re#ious sur"eries 1,$edications/!7A57/Aspirin 1$
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit 1$=ematemesis/malena 2$ei"ht loss 3$5i¹culty initially 0ith solids and later liuids ($%ainul dyspha"ia or painless *$5iarrhea or onstipation +$Anemia ,$
1*$%neumonia 1+$%ast medical and sur"ical history 1,$
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit 1$nset 2$)rauma 3$
13$
2
DIABETIC FOOT
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit 1$Greet patient introduce yoursel establish a plan 2$5o you ha#e diabetes 3$hen diabetes dia"nosed ($=o0 it had been dia"nosed as a diabetes *$hat is treatment he/she 0as on +$ hat is treatment he/she 0as on no0 ,$Any incident o hypo"lycemia $ Any incident o hyper"lycemia $s he /she on re"ular ollo0 up pro"ram 8diabetic clinic 9 14$=o0 he/she started the oot problem 11$5oes he/she eel his/her oot 12$hat kind o treatment he/she recei#ed
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CUSHINGS
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit 1$ei"ht "ain 2$)runcal obesity 3$uscle 0eakness ($5epression *$)hin skin +$Bruisin" ,$=yper"lycaemia $=ypertention $=eadach 14$Amenorrhoea 11$mpotance8male9 12$%atholo"ical
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CLAUDICATION!ISCHEMIC LIMB
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit 1$nset 2$5uration 3$&ocation ($'adiation *$Alle#iatin" actor +$%ro#okin" actor ,$%aresthesias $%allor $%aralysis 14$5eormitys0ellin"sti:ness 11$Amputation and ulceration 12$alkin" distance 13$¡:ects on unction 1($'educed ran"e o mo#ement 1*$'est pain and ni"ht pain 1+$ne or both le"s 1,$al buttock thi"h 1$%ast medical history85=)A5 5yslipidemia9 1$¡9 32
24$7ocial history8smokin" alcohol diet acti#ity cocaine/heroine abuse9 CHANGE OF BOWEL HABIT
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit 1$!ature o bo0el habit 8diarrhea constipation9 2$5uration 3$nset 8sudden "radual9 ($)enessmus *$ucus +$i"ht loss ,$!ausea /#omitin" $Blood in the stool8bri"ht red mi?ed 0ith stool dark9 $%ast history o pre#ious episodes 14$%ast sur"ical history 11$5ru"s history 12$7ocial history8smokin" alcohol9
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BREAST PAIN
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit 1$'elation to . cycle 2$%re#ious trauma 3$Any nipple dischar"e ($Any abnormality in breast *$!ipple retraction +$!odularity o breast ,$ne or both breast $Any musculoskeletal disorder $%re#ious biopsy and result 14$arital statuschildrenlactatin" menarch1st child 11$
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BREAST LUMP
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit 1$A"e 2$&ump site sin"le multiple 3$&ump onset "ro0th rate #ariations 0ith menstrual cycle ($%resence or absence o pain *$han"e in breast siCe or shape +$7kin and nipple chan"es ,$5ischar"e 8serous serosan"uinous "reen bloody milky9 $)emperature/e#er $ie"ht loss 14$Bone or abdominal pain 11$Arm s0ellin" 8lymphoedema9 12$%re#ious radiation or sur"ery 13$enstrual history8menarche menopause contracepti#e pill hormone replacement9 1($bstetric history 8breast eedin" and complication parity pre#ious mammo"rams screenin"9 1*$
1+$7ymptoms o possible metastatic disease other lump 8a?illa9 breathlessness backache headache tiredness anore?ia 0ei"ht loss jaundice
3+
Ass$ss %t&$ss 'or s(r)$ry *+ti$&t ,it GROIN HERNIA
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit 1$A"e 2$=a#e you had much trouble 0ith your "roin 3$=as it e#er "ot stuck out and become painul ($-omitin" constipation abdominal pain *$s it al0ays reducible +$edical problems ,$=eart lun" trouble $7hortness o breath and chest pain $=o0 ar can you 0alk on the ·at 0ithout stoppin" 14$an you climb a ·i"ht o stairs 11$an you dress yoursel 0ithout "ettin" 7B/chest pain 12$=a#e you had an anaesthetic beoreD "eneral local re"ional 13$5o you take any re"ular medicationD 0ararin antiplatelet a"ent 3,
3
ANAL PAIN
Greet the patient by last/frst name; introduce sel and role; shake hands dentiy and confrm problem list !e"otiate an a"enda; establish a plan or the #isit 1$5uration and onset o pain and time 2$Associated dischar"e and color 3$s the pain periodic ($%re#ious attacks o such pain *$Any associated mass +$han"e in bo0el habit ,$%ain increase by deecation $Any bleedin" on deecation $
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¡?amination º ana"ement
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ABDOMINAL EAMINATION
1$Greet patient introduce yoursel establish a plan 2$ ¡?pose rom nipple to mid$thi"h !7%¡)! 3$7tand at the oot o patient and obser#eD 8 mo#ement 0ith respiration symmetry o the abdomen9 ($ 7tand at the ri"ht side o the patient and obser#e D 8mo#ement 0ith respiration contour any scar any dilated #eins umbilicuse ¸in#erted³ e#erted or ·at pi"mentation pulsation cou"h impulse any stoma9 %A&%A)! *$Ask i there is any tenderness point +$7uperfcial palpation lookin" or any mass or tenderness 8look at the ace o the patient9 ,$5eep palpationD 7%&¡¡! ³'i"ht hand on the ri"ht iliac ossa o the patient and the let hand placed on the lateral aspect o the costal mar"in o the patient 0ith compression to0ards ri"ht hand. )he patient instructed to take deep breath ³ 'i"ht hand on the let iliac ossa o the patient and the let hand placed on the lateral aspect o the costal mar"in o the patient 0ith compression (1
to0ards ri"ht hand. )he patient instructed to take deep breath &-¡' ³=and in the '< 0ith fn"ers pointin" to0ards the let a?illa ³ith e?piration slide the hand nearer the ri"ht costal mar"in ³)he ed"e o the li#er strikes the hand as the patient inspire >5!¡´7 ³Bimanual $ou"h implse at the hernia orifce %¡'µ77! $7plenic siCe 14$&i#er spanD percussion o the ri"ht side o the chest start at ourth intercostals space to obtain resonant note then 0ork do0n0ards to determine li#er dullness 11$&ook or the ascitesD 8shitin" dullness transmitted thrill9 Aµ7µ&)A)! 12$Bo0el sounds 13$'enal bruits 1($5on»t or"et 8e?ternal "enitalia supracla#icular &! back %' hernia orifce9 (2
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THYROID EAMINATION
1$Greet patient introduce yoursel establish a plan 2$nspection 3$Asked patient to s0allo0 ($ Asked patient to protrude the ton"ue *$bser#ed or restlessness a"itation sittin" unstill +$bser#ed or lethar"y hypotonia speech and #oice ,$Body build and temperature $oist palms skin $
2($Auscultate or bruit #ascular "oiter 2*$&ooked or =orners syndrome SUBMANDIBULAR GLAND EAMINATION
1$Ask patient to suck lemon 2$nspection o the ·oor o the mouth 3$Ask patient to open mouth 0idely and raise the tip o the ton"ue to0ards roo o mouth ($ Bimanual palpation o the "land usin" "lo#es *$%atients head ·e?ed and inclined to the a:ected side +$nde? fn"ers inserted in the mouth and fn"ers o the other hand beneath the ja0 ,$¡?amine other side or comparison
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SMALL BOWEL OBSTRUCTION MANAGEMENT
1$A$B$$5$and ·uid resuscitation 2$=istory and physical e?amination 3$!.%.. and !.G.) ($atheterise *$- ·uid8'&!7>9 +$Anal"esia and antiemetic
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RTA MANAGEMENT
1$ntroduce yoursel Greet ¡stablish a plan 2$Ask or $spine precaution 3$ Ask or 2 lar"e bore - line ($ Ask or 2monitors appropriate ·uid boluses *$heck air0ays cyanosis +$nspect chest ,$%alpate chest or subcutaneous emphysema ¼ ribs $Auscultate chest or air entry $
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Py/ori0 St$&osis 0o(&s$/i&)
Brie o#er#ie0 o the fndin"s normation o dia"nosis !atural history o condition n#esti"ation i reuired )reatment and pro"nosis
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PREOPERATIVE ASSESSMENT "SURGERY FITNESS#
1$=7)'´ Dpre#ious sur"ery / anaesthetic µ admission e?ercise tolerance medication smokin" respiratory symptoms. 2$%=´7A& ¡½A!A)!D cardiorespiratory si"ns 80heeCe cou"h dyspnoea heart murmur dysrhythmia9 3$¡G½' ($B&5 %'<&¡D =b &<)'<)7¡ coa"ulation blood su"ar ABG ¡=
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PERIPHERAL VASCULAR SYSTEM "ISCHEMIC LIMB# EAMINATION
1$ntroduce yoursel Greet ¡stablish a plan 2$G¡!¡'A&8look around bed or aids o?y"en or medication ¾G)! spray¿ look at the patient as a 0hole D 0ell / un0ell pain/ pain$ree 7B cyanosis obesity 3$7kin and !ailsD colour ulceration "an"rene di"ital amputation/ tissue loss oedema hair loss #enous "utterin" scar muscle 0astin" ($&ooked or pressure points and bet0een the toes80eb spaces9 *$%alpationD temperature pittin" oedema capillary refll time .%µ&7¡7 D aortic$emoral$ popliteal$5%$%) +$Bur"er test ,$ !umbness paresthesia and absent sensation $Auscultation 8aortic$renal$iliac$emoral9 $AB%$A'5-A7µ&A'$!¡µ'&GA&$ AB5!A& ¡½A!A)!
*4
P$*ti0 U/0$r1 MANAGEMENT +&2 *ysi0+/ $3+4i&+tio& +&2 COUNSELING
A!AG¡¡!) &e#el o consciousness Air0ays Breathin" irculation -italsD pulse B% )emp '' !% %=´7A& ¡½A!A)! ash hands 7olicit consent or e?amination ¡nsure that the patient is properly draped 'ele#ant "eneral hydration pulse nspection Auscultation %ercussion %eritoneal si"ns %alpation 'ectal e?am 8not actually perormed but the intention #oiced9 Gi#e attention to patient»s physical comort -erbaliCe the maneu#ers on the e?amination µ!7¡&!G ¡?plain seriousness o the condition illin" to e?plain the matter to the "irlriend ¡?plain %¡%) µ&¡' and complications norm about endoscopy and admission to hospital 7tatin" =.pylori as a probable cause and ci"arette$smokin" as an a""ra#atin" actor ounsel on smokin" cessation *1
*2
PANCREATITIS MANAGEMENT
1$A$B$$5$¡$ and ·uid resuscitation 2$=istory8 establish causeD "allstone alcohol trauma steroids mumps autoimmunity hyperlipidaemia hypercalcaemia ¡'% dru"s scorpion #enom9 3$%hysical e?amination ($ Arterial blood "ases Dassess %=%2 *$ Blood profle D B &<) 7¡ µ'¡A A&Bµ!G&µ7¡ *$µ/7 ¸) scan at *$, days
*3
MVA Tr+(4+1 EAMINATION AND MANAGEMENT
Greet the patient by last/frst name; introduce sel and role dentiy and confrm problem list Ask or #ital si"ns ash hands 7olicit consent or e?amination ¡?plain about the procedures to be perormed Ask or $spine precautions Ask or D 2 lar"e bore -»s ?y"en onitors Appropriate ·uid boluses heck air0ays 'eco"niCe cyanosis nspect chest %alpate chest$let subcut emphysema Auscultate chest$no air entry on the ri"ht
primary sur#ey -erbaliCe the maneu#ers on the e?amination Gi#e attention to patient»s comort and modesty MANAGEMENT OF GASTROINTESTINAL HAEMORRHAGE
1$µse the AB approach ensure air0ay breathin" and circulation 2$ide$ bore cannulae or central #enous catheter 3$'apid inusion o colloid to correct hypotension ($¡stimation o =b and clottin" status and blood or crossmatchin" *$onitorin" o B% %'µ%/h and o?y"en saturations +$ %ass !G )ube ,$ommence inusion o %% or antacids $Gi#e <<% i %) is abnormal and "i#e platelets i thrombocytopaenia is present $Gi#e blood 0hen a#ailable i B% is not maintained by clear ·uids 14$Gi#e unmatced blood $#e i necessary i the bleedin" is massi#e 11$orrect coa"ulopathies 12$nter#ene early in cases 0ith chronic disease or atherosclerosis as these patients don»t tolerate hypotension 0ell 13$ ¡ndoscopy ater patient stabiliCe
**
*+
GI B/$$2i&) MANAGEMENT +&2 PHYSICAL EAMINATION
A!AG¡¡!) 7aety precautions Air0ay mana"ement Breathin"$ "i#e o?y"en irculationD Ask or #ital si"ns 2 lar"e bore - lines 7tate to "i#e - ·uids 8normal saline/ 'in"er lactate9 5ra0 blood or B lytes r µr %)/%)) "lucose cross$match ($+ units ardiac monitor/12 lead ¡>G ntend to insert eep !%/!G tube %=´7A& ¡½A!A)! ash hands 7olicit consent or e?amination Assess le#el o consciousness -7 ¡?amine e?tremities ral e?am &ook or si"ns o chronic li#er disease 8palmer erythema clubbin" spider an"ioma "ynecomastia jaundice testicular atrophy ascitis hepatosplenome"aly9 ¡?amine abdomenD inspection auscultation palpation 8li"ht/deep9 percussion *,
Gi#e attention to patient»s physical comort ¡nsure that the patient is properly draped -erbaliCe the maneu#ers on the e?amination ntend to perorm 5'¡ G+// Sto&$. Pro5i2$ i&iti+/ 4+&+)$4$&t +&2 *$r'or4 + 'o0(s$2 $3+4i&+tio&
&e#el o consciousness Air0ays Breathin" irculation 8 - line9 -italsD pulse B% )emp '' !% ash hands 7olicit consent or e?amination ¡nsure that the patient is properly draped 'ele#ant "eneral hydration pulse nspection Auscultation %ercussion %eritoneal si"ns %alpation 'ectal e?am 8not actually perormed but the intention #oiced9 Gi#e attention to patient»s physical comort -erbaliCe the maneu#ers on the e?amination >ey %ointsD µ!7¡&!G ¡?plain seriousness o the condition 5iscussed helpin" 0ith note to be o: 0ork *
¡?plain "all bladder stone and complications norm about µ/7 and admission to hospital Ad#ised may need sur"ery i the duct or "allbladder is inected FOOT ULCER EAMINATION
1$ntroduce yoursel Greet ¡stablish a plan 2$nspection/"eneral/"ait shoes heels 3$Any oot ulcer or deormity ($nspection/skin/#ascular insu¹cieny$ hairlessness pallor *$'ubor at pressure points +$7kin breakdo0n 8portal or inection9 ,$5iabetic dermopathy 8bro0n macules 9o#er shins $nection cellulites8 erythema s0ellin"9 $Gan"rene 14$eb space cracked inected ulcer maceration 11$)oe nails dystrophic in$"ro0n paronychia onychomycosis 12$%alpation pulsesD emoral$popliteal ¸%)$5% 13$)emp$capillary refll 1($Ausculation/bruits emoral popliteal
*
+4
Dys*+)i+ PHYSICAL EAMINATION
ashin" hands 7olicitin" consent or e?amination heck mouth or loss o enamel heck throat heck cer#ical lymph nodes AB5D looks or epi"astric tenderness/mass li#er Auscultate chest -erbaliCe the maneu#ers on the e?amination Gi#e attention to patient»s physical comort ¡nsure that the patient is draped properly
+1
DVT *$r'or4 + 'o0(s$2 *ysi0+/ $3+4i&+tio&
ash hands 7olicit consent or e?amination ¡?plain the procedures to be perormed heck le" or tenderness and s0ellin" and colour 8patient»s le" 0ill be red and 0arm to simulate a deep #ein thrombosis or cellulitis; i the le" is touched by e?aminee the patient 0ill complain o se#ere pain9 heck the pulse o oot to confrm "ood arterial circulation heck or =o:man»s si"n 8cal pain 0ith dorsi·e?ion o ri"ht oot9 &isten to the lun"s in our places -erbaliCe the maneu#ers on the e?amination Gi#e attention to patient»s physical comort
+2
C/+(2i0+tio&1 *ysi0+/ $3+4i&+tio&
ash hands 7olicit consent or e?amination ¡nsure that the patient is properly draped Ask or blood pressure omment on chan"es in skin color or temperature omment on loss o hair or dystrophic nails Abdominal aortic area Bilateral
pre#iously palpable pulse ater 0alkin" e?recise9 Gi#e attention to patient»s physical comort -erbaliCe the maneu#ers on the e?amination
+(
CERVICAL L.N EAMINATION
1$ ¡?amination o cer#ical &.!. rom behind 2$
++
BREAST LUMP 6 NIPPL DISCHARGE INSPECTION
1$nspection both breasts or siCe 2$7ymmetry 3$7kin chan"es ($on"enital anomalies *$!ipple and areola presence or absence +$olour symmetry ,$5ischar"e nature rom 0hich duct $'etraction 5istraction 5e#iation o nipple $%eu de oran"e 14$nspectionBreasts 11$ nspection a?illa and supracla#icular ossa and arms s0ellin"s 12$¡nlar"ement 5istended #eins asted muscles 13$'aisin" arms abo#e head or mass 1($%ress arms a"ainst hips or mass
+,
ABDOMINAL MASS EAMINATION
1$ntroduce yoursel to the patient 2$Ask or a nurse chaperone 3$btain consent ($¡nsure adeuate pri#acy comort and e?posure *$Ask the patient 0hether they ha#e any pain +$ash hand ,$!7%¡)!$%A&%A)!$ %¡'µ77! A!5 Aµ7µ&)A)!$o the abdomen $A77D8 site scar siCe shape surace$re"ular / irre"ular ed"e tenderness temperature consistency can you "et abo#e / belo0 it E pinch skin o#er it lit head o: the bed 8tense the rectus sheath9 to determine mobility / f?ity o mass cou"h impulse reducibility / compressibility ·uctuance pulsatility e?pansibility does it mo#e 0ith respiration can it be balloted percuss the lump auscultate o#er the lump palpate or re"ional &! 8in"uinal and a?illary9. $)=A!> )=¡ %A)¡!)
+
OSCE OF ARAB BOARD IN FINAL EAM. 7889-78:8-78::
+
SLIDS IN ARAB BOARD OSCE
,4
7889 - s/i2$s
1$ =istory ammo"raph a breast 8fndin" pro"nosis9 2$ =istory ) scan plan ?$ray85? treatment pro"nosis9² chronic calcifed pancreatitis 3$ =istory Abd. ?$ray barium 8fndin" 5?9 ² si"moid #al#ulus ($ =istory ross patholo"y operati#e #ie0 8fndin" 5?9 ² a stomach *$ =istory sotop scan 8describe 5? treatment9² G'A-¡7 +$ =istory ) scan8describe 5?9 pancreatic pseudocyst ,$ =istory abd ?$ray8fndin" 5? treatment9 ² duodenal atresia $ =istory '%¡'% 8describe 5?9 ² B5 injury $ =istory Barium s0allo0 8describe 5? causes treatment9² Cenker di#erticulum 14$ =istory ) scan 8describe 5? treatment9² adrenal tumor 11$ =istory ) scan an"io"ram8describe 5? treatment9 12$ =istory lo0er limb ulcer8 describe causes treatment9 13$ =istory ace tumor8describe 55? treatment9²7 1($ =istory stoma 8describe 5? treatment9² parastomal hernia ,1
1*$ =istory barium s0allo0 8fndin" 5? treatment causes9² achalasia 1+$ =istory ½' 8describe treatment 55?9² plural e:usion E a E fstula E 1,$ =istory ) scan ¡'%8 describe 5? treatment9²ca head o pancreas 1$ =istory ½$ray cross patholo"y 8fndin" 5? treatment9² small bo0el obstruction 1$ =istory ) scan operati#e8 describe 5? treatment9² li#er =. cyst 24$=istory)scan operati#e8describe 5? pro"nosis treatment9 ² a "allbladder
,2
78:8 - s/i2$s
1$=ydrocoele 2$B5 injury 3$artrio#enus fstula ($a breast *$¡sopha"al atresia +$e"acolon ,$Appendicular abscess $ di#erticulosis and fstula $si"moid #al#ulus 14$paroted tumor 11$splenectomy 12$5 13$%rolaps pills 1($klatskin tumor 1*$A.% resection 1+$Gastrostomy eedin" tube 1,$treachiostomy 1$!ecrotiCin" asciitis 1$ound dehisces 24$=.cyst li#er and spleen
,3
78:: - s/i2$s
1$leomyosarcoma 2$lun" abscess 3$ori"n body ($ splenic abscess *$perorated 5µ +$sebaceous cyst ,$lymphedema $Burn $clet lip and palate 14$B 11$5.oot 12$a "allbladder 13$ascial 0ound 1($ #enous ulcer 1*$o#arian teratoma 1+$dermoid cyst 1,$adrenal mass 1$melanoma 1$hairy ne#us 24$poplital artery aneurysm
,(
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