Well,I have just passed my second part of my first professional exams.
Here are some question being asked:
Long Osce (1+14mins)
1. Patient came in with Left lower limb pain.Take a focus history and perform relevant examination. Examiner will ask you a few question
-Patient came in with intermittent claudication for 6 months.Diagnosis: Chronic Limb Ischaemia.
-We are expected to assess the risk factors,current status,differential diagnosis and complication of the patient.
-We were asked to perform ankle brachial pressure index and interpret the results.
-Management of the patient.
2.Patient came in with unstable gait.Examine the patient gait and perform relevant examination.
-Diagnosis:Parkinson Disease
-Patient has shuffling gait,stupor position,forward pulsion,festination and turned en block.
-Patient also has thalidomy scar and deep brain stimulator (as well as the scars)
-We are expected to look for other signs of parkinsonism,e.g micrographia,glabella tap,barbinski,cerebellar signs (to rule out parkinson plus syndrome) and others
-We are expected to assess the functional status of the patient,e.g buttoning,open the door etc
-Management of Parkinson disease.Remember to start with dopamine agonist and its examples.
3. Patient came in with multiple swollen joint pain.Take a focused history and perform relevant examination and patient will ask you a few questions
-Diagnosis: Gouty arthritis
-We are expected to ask for presenting complain,risk factor,firrential diagnosis,current status and complications of gouty arthiritis
-Perform GALS screening and look for tophi.(Quite obvious in our case)
-Assess the functional status,e.g buttoning,use the key etc
-Counsel the patient on what is gouty arthritis,is it curable,how to start the medicaiton and their side effect.Remember start with NSAID's first,if failed proceed to colcicine.Allopurinol only can be initiated after 4 weeks of acute attack and patient has more than 2 attacks in a year.
4.Patient,Para 1,just given birth 4 weeks ago, came in complained of 4 weeks of lethargic and loss of appetite.Take a focused history and assess the risk factor of the patient.Examiner will ask you a few questions.
-Diagnosis:Post-partum depression
-Assess the risk factor,differential diagnosis,and criteria of post-partum depression.Patient has poor support,previous history of depression
-Advise the patient on contraception.-Well,you are not suppose to prescribe OCP to them as it will cause further depression on these patients.
5.Patient is a 32 weeks primigravida lady with uterine contraction.Take a focused history and perform abdominal examination.Examiner will ask you a few questions.
-Diagnosis:False labour
-History:to rule out other causes of preterm labor.
-Abdominal examination:The usual obstetrics antenatal examination,SFH,leopolds maneuver.
-If it is preterm contraction,management for it.Give tocolytic,MgSO4 and dexamethasone.Call for NICU team.
-Investigation: Look for PPROM-pooling of fluid over posterior fornix,GBS swab.
6.Patient is a 10 years old child presented with fever and joint pain for 4 days.Take a focused history from mother.
-Diagnosis:Rheumatic fever
-History: Asked about the presenting complain and mother will tell you it is a migratory polyarthritis.Further history will reveal that has sore throat3 weeks prior to that and they live in a crowded house with low social economic status.Ask relevant questions to rule out other differentials,such as septic arthritis,kawasaki,dengue,JIA,HSP.
-Examiner will ask about jones criteria and how to diagnose rheumatic fever based on the criterias given.
That's all for long OSCE now. I will write on short OSCE's and others if I'm free.Overall,the long OSCE was quite easy to score if you have a clear set of mind to think within that 15mins.You will have more than enough time to ask questions and do PE.Our batch has more physical examinations and history stations compared to previous groups,most probably all of the counselling questions were asked in MEQ.
Here are some question being asked:
Long Osce (1+14mins)
1. Patient came in with Left lower limb pain.Take a focus history and perform relevant examination. Examiner will ask you a few question
-Patient came in with intermittent claudication for 6 months.Diagnosis: Chronic Limb Ischaemia.
-We are expected to assess the risk factors,current status,differential diagnosis and complication of the patient.
-We were asked to perform ankle brachial pressure index and interpret the results.
-Management of the patient.
2.Patient came in with unstable gait.Examine the patient gait and perform relevant examination.
-Diagnosis:Parkinson Disease
-Patient has shuffling gait,stupor position,forward pulsion,festination and turned en block.
-Patient also has thalidomy scar and deep brain stimulator (as well as the scars)
-We are expected to look for other signs of parkinsonism,e.g micrographia,glabella tap,barbinski,cerebellar signs (to rule out parkinson plus syndrome) and others
-We are expected to assess the functional status of the patient,e.g buttoning,open the door etc
-Management of Parkinson disease.Remember to start with dopamine agonist and its examples.
3. Patient came in with multiple swollen joint pain.Take a focused history and perform relevant examination and patient will ask you a few questions
-Diagnosis: Gouty arthritis
-We are expected to ask for presenting complain,risk factor,firrential diagnosis,current status and complications of gouty arthiritis
-Perform GALS screening and look for tophi.(Quite obvious in our case)
-Assess the functional status,e.g buttoning,use the key etc
-Counsel the patient on what is gouty arthritis,is it curable,how to start the medicaiton and their side effect.Remember start with NSAID's first,if failed proceed to colcicine.Allopurinol only can be initiated after 4 weeks of acute attack and patient has more than 2 attacks in a year.
4.Patient,Para 1,just given birth 4 weeks ago, came in complained of 4 weeks of lethargic and loss of appetite.Take a focused history and assess the risk factor of the patient.Examiner will ask you a few questions.
-Diagnosis:Post-partum depression
-Assess the risk factor,differential diagnosis,and criteria of post-partum depression.Patient has poor support,previous history of depression
-Advise the patient on contraception.-Well,you are not suppose to prescribe OCP to them as it will cause further depression on these patients.
5.Patient is a 32 weeks primigravida lady with uterine contraction.Take a focused history and perform abdominal examination.Examiner will ask you a few questions.
-Diagnosis:False labour
-History:to rule out other causes of preterm labor.
-Abdominal examination:The usual obstetrics antenatal examination,SFH,leopolds maneuver.
-If it is preterm contraction,management for it.Give tocolytic,MgSO4 and dexamethasone.Call for NICU team.
-Investigation: Look for PPROM-pooling of fluid over posterior fornix,GBS swab.
6.Patient is a 10 years old child presented with fever and joint pain for 4 days.Take a focused history from mother.
-Diagnosis:Rheumatic fever
-History: Asked about the presenting complain and mother will tell you it is a migratory polyarthritis.Further history will reveal that has sore throat3 weeks prior to that and they live in a crowded house with low social economic status.Ask relevant questions to rule out other differentials,such as septic arthritis,kawasaki,dengue,JIA,HSP.
-Examiner will ask about jones criteria and how to diagnose rheumatic fever based on the criterias given.
That's all for long OSCE now. I will write on short OSCE's and others if I'm free.Overall,the long OSCE was quite easy to score if you have a clear set of mind to think within that 15mins.You will have more than enough time to ask questions and do PE.Our batch has more physical examinations and history stations compared to previous groups,most probably all of the counselling questions were asked in MEQ.
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