"spotting" questions

Today was EOS OSCE day 1 - as all of you know, we’ve had…

1.       CNS

a.        Upper motor neurone lesion - test Motor

2.       MSK

a.        Length, palpation and inspection

3.       Respi

a.        Posterior back

4.       Endocrine

a.        Hypothyroidism - plus some ECG component

If I were to add on, in the history taking…

1.       Haematology        

a.        Probably CML / Aplastic Anemia / lung Ca??

2.       GI

a.        Upper GI bleed - due to NSAIDs

What I think it will come out - in order of personal gut-feeling

1.       MSK plus CNS -
Since this is sem 5, its their last chance to ask us any sem 5 questions - they might not want to ask us back sem 3 component since it is already asked in sem 3. (the respi station was a gift)
It may look something like this;

a.        Patient complains of a fall on the shoulder while skating. X-ray suggest fracture of neck of humerus. Inspect, Palpate and test the supplying nerve.

                                                               i.      This kind of exam would test us on how to integrate the MSK component with the CNS - very interesting topic for lecturers. Study the dermatomes, plus the cunaneous nerve supply for major upper limb and lower limb.

                                                              ii.      In this case, patient may have a nerve cut / compression on the axillary nerve. Test  on the shoulder using cotton wool, or pain sensation.

b.       Spine examination plus some nerve lesions

                                                               i.      Maybe IVDP? Test for Straight leg raising, in IVDP there is paravertebral tenderness plus increased muscle tone, and some pain upon Straight-leg raising. Also, you may be asked to test the lower limb reflexes just to exclude nerve damage.

2.       MSK / CNS History station
Sure got one. They would always want to test if we can take proper MSK /CNS history. - they did not ask on day 1.

a.        The presenting complaint may look anything along the lines of…

                                                               i.      Headaches (migraines)

                                                              ii.      Fainting episodes (epilepsy)

                                                            iii.      Bone pain

1.       OA

2.       RA

3.       septic arthritis

                                                            iv.      back pain

1.       IVDP

2.       Ankylosing Spondylitis

3.       Seronegative arteropathy (if they want to be quite mean)

3.       Renal Plus GI - renal more likely since its sem 4
They may like to ask us to inspect, palpate, purcuss and auscultate for GI station.

                                                               i.      Polycystic Kidney

1.       is a favourite - since it is not extremely tender when pressed (which allows for justification of PE - rather then like, pyelonephritis where you shouldn’t really torture patient)

                                                              ii.      Gall stones?

1.       May be asked to perform murphy’s sign.  Simply calmly place 3 fingers at costal margin, ask patient to breath, and see if patient has tenderness upon inspiration. (positive)

4.       Some model examination

a.        Breast model -most likely

                                                               i.      This model actually also allows us to palpate for lymph node. The model has some lymphadenopathy on the central area, plus infraclavicular… something like that.

b.       Digital Rectal Model

                                                               i.      Actually, I think it is unlikely DRE will come out - too simple.

c.        Catheterisation model

                                                               i.      I’m betting more on stand-alone question. Its too much of a hassle to do this in PE.

d.       Antenatal model

                                                               i.      Hmm. Don’t really think so. Maybe more likely to be history taking.

5.       CVS

a.        Physical Exam

                                                               i.      They like to ask CVS in sem5 too - just more difficult and case-based.

1.       I might sound far-fetched, but they could ask something like… Pulmonary embolism, VSD, Rheumatic HD, etc etc. know the signs and symptoms and the rest should fall in naturally.

2.       Any emergency - sounding cases should start with establishing vital signs.

a.        Pulse

b.       Breathing

c.        BP

b.       history taking

                                                               i.      CVS history taking is easy, but lots of components we need to remember how to ask. Pain has 9 components - SOCRATES remember?

6.       Repro

a.        History - maternal history taking, or menstrual history.  MIGHT come together with BS.

7.       Semester 2 component
they might give sem2 stuff for “gift question”s.

a.        Blood pressure

b.       Ear (auriscope)

c.        General physical examination

                                                               i.      I think I would be pretty shocked if I saw this - where to freaking start? Don’t ask me.

8.       Cervical lymph nodes

a.        Randomly, sometimes I find that they are commonly examined - maybe its one of the ways they give us “Gift” marks.

You may also want to check - BS station.