OSCE

OSCE

1. Initial presentation

   • Pain
     • SOCRATES
       • MSK
       • CVS
       • RESP
         • Observe their actions - Whether or not they become breathless - whether or not they have a cough - whether or not they have a wheeze - Pursed Lip Breathing
           • Checking for stridor - ask the patient to cough - then breathe in deeply - try to listen in for a grating sound
         • Look - Are they discoloured - any deformities in the chest - Erythema Nodosum - clubbing of the hands
         • Important Past history
           • Any previous surgery/travel
           • Medication/Past illnesses and current
           • Occupation/Activity levels
           • Social - Pets/Work/Smoking
         • Physical examination/Touch or do
       • GI
         • Further Examination
           • Soft and deep palpation of the abdomen
             • Check the aorta for bulging - may possibly be AAA
             • The liver may be palpable - hepatomegaly - could be a result of portal hypertension - hormonal imbalance - inflammed due to hepatitis - enlarged/fatty liver
             • Spleen may be palpable in spleenomegaly
           • Auscultate for the normal bowel sounds - whether they are present or absent
           • Any guarding/wincing during the palpation - possibly even rebound tenderness which is when they will immediately tense in response to the pain from the palpation
           • Look - check for any unusual bulging or distension - possibly any discoloration - Yellowing indicating jaundice - Cyanosis will indicate issues around blood supply
       • General - Vital signs
   • Shortness of breath
     • Tolerance to activity
   • Change in bowel habit
   • Syncope
   • Cough
     • Characteristics
       • Production - whether it is purulent - Haemoptysis - Whether or not it causes any pain
         • How Much ? How often ? Characteristics
       • Whether or not it changes with posture ? Whether or not it is better or worse during any times of the day ?