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Extra resources for OSCEs for Medical and Surgical Finals (Hodder Arnold Publication)
To palpate the abdomen you need to get onto your knees, or raise the level of the bed, ensuring that your forearm and hand are flat against the patient’s abdomen. Do not forget to state at the end of your examination that you would like to examine the rectum and genitalia, and look at the observation chart and dipstix test the urine. e. systemic signs of liver failure. ) Splenomegaly Bruising and purpura may be a clue. ) Renal masses The presence of an A-V fistula should be a clue. (Causes: unilateral enlargement is due to a renal cyst, hydronephrosis, a renal neoplasm, and polycystic kidneys.
It is useful to rehearse a model presentation for each type of examination so that in the OSCE your presentation as well as examination will flow easily, and all you will need to do is substitute into your model any clinical findings and think about differential diagnoses. For examination stations, the global score, if applicable, is made up of five components. The examiner will be looking for a slick examination; you should look as though you have done it on countless previous occasions. The examiner will be assessing your competence at picking up clinical signs, which is a reflection of your exposure to clinical medicine.
Recording the posterior tibial and dorsalis pedis systolic pressures is similar, but the cuff is applied mid-calf, and you should explain to the patient that it might feel uncomfortable. Sometimes it is difficult to locate the foot pulses by palpation or with the Doppler probe and if, for example, the posterior tibial pulse is proving difficult, move on to the dorsalis pedis quickly and return to the posterior tibial if time permits. The ABPI for the posterior tibial pulse is posterior tibial systolic pressure/highest brachial systolic pressure.