Clinical.Skills.for.OSCEs.2006.Burton.Birdi.OCR

Clinical Skills for OSCEs Second Edition Edited by Neel L Burton BSc MBBS (Land) AKC Senior House Officer in Psychiatry The Warneford Hospital Oxford, UK and Clinical Skills Tutor Department of Psychiatry University of Oxford, UK Kuldip Birdi BSc (Hans) Final year medical student Guy's, King's, and St Thomas' School of Medicine, King's College London, London, UK Foreword by Lord McColl of Dulwich informa healthcare Life is short, the art long, opportunity fleeting, experiment treacherous, judgement difficult Hippocrates (c 460-370 Be) Aphorisms, Aph Contributing authors Neell Burton asc MBSS (lond) AK( Senior House Officer in Psychiatry The Warneford Hospital, Oxford, UK "d Clinical Skills Tutor Department of Psychiatry University of Oxford, Oxford, UK Kuldip Birdi osc (Hons) Final year medical student Guy's, King's, and st Thomas' School of Medicine Kings' College London, London, UK Nicholas ( Stacey BSC MRCS AK( Senior House Officer in Orthopaedics Guy's and 51 Thomas' Hospitals, London, UK Akbar H de' Medici PhD MRCS Senior House Officer in Vascular Surgery University College Hospitals, london, UK co ~oo6 Informa UK ltd First published in the United Kingdom in 200~ by Bios Second Edition published in the United Kingdom in 2006 by Informa Healthcare Park Square, Milton Park Abingdon Oxon OX14 4RN Informa Healthcare is a trading division of Informa UK ltd Registered Office: )7/41 Mortimer Street, london W17 )jH Registered in England and Wales Number 107~954 Tel: +44 (oho 7017 6000 Fax: +44 (0)20 7017 6699 E·mail: info.medidne@tandf.co,uk Website: www.tandf.co.uk/medicine All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any m@anS,@I@ctronic.mechanical, photocopying, recording, or otherwise, without the prior permission of the publish@( or in accordance with the provisions of the Copyright Designs and Patents ACl1988 or under Ihe terms of any licence permitting limited copying issued by the Copyright licensing Agency 90 Tottenham Court Road, london W1P olP Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention Although every effort has been made to ensure that drug doses and other information are presented accurately in this publication, the ultimate responsibility rests with the prescribing physician Neither the publishers nor the authors can be held responsible for errors or for any consequences arising from the use of information contained herein For detailed prescribing information or instructions on the use of any product or procedure discussed herein, please consult the prescribing information or instructional material issued by the manufacturer A CIP record for this book is available from the British library library of Congress Cataloging·in·Publication Data Data available on application ISBN-lo: 184184 616) ISBN·l): 978 84184 616) Distributed in NOith and South America by Taylor & Francis 6000 8roken Sound Parkway, NW, (Suite )00) Boca Raton, Fl ))487, USA Within Continental USA Tel: (800) ~72 77)7: Fax: (800) )74 )401 Outside Continental USA Tel: (s61) 994 0555; Fax: (s61) )61 6018 Email: orders@crcpress.com Distributed in the rest of the world by Thomson Publishing Services Cheriton House North Way Andover Hampshire SPI0 5BE, UK Tel: +44 (0)1264 ))2424 Email: tps.tandfsatesorder@thomson.com Composition by Phoenix Photosetting, Chatham Kent, UK PrInted and bound by MPG Books ltd, Bodmin, Cornwall, UK Foreword by Professor The lord McColl of Dulwich CBE Foreword by Professor Sir Cyril Chantler Preface to the First Edition Preface to the second Edition Acknowledegements OSCE tips "' x x; xiii xiv xv General skills , , , 3· 4· 5· ,.•• ••9· '0 u " '3· '4· '5· Blood pressure measurement Hand washing Venepuncture Cannulation and setting up a drip Blood transfusion Intramuscular, subcutaneous, and intradermal injection techniques Intravenous drug injection Blood glucose measurement and interpretation Arterial blood gas sampling and interpretation Urine sample testing and interpretation Scrubbing up for theatre Male catheterisation Female catheterisation Examination of a superficial mass and of lymph nodes Chest X-ray interpretation Cardiovascutar ,.,••• '9· '0 m~icine Chest pain history Cardiovascular risk assessment Cardiovascular examination Peripheral vascular system examination Ankle-brachial pressure index (ABPl) ECG recording and interpretation , , '3 '5 '0 n '5 "'9 3' 33 39 4' 43 45 5° 5' Respiratory medicine , n .3 u » '4· ,'5· Breathlessness history Respiratory system examination PEFR meter explanation Inhaler use explanation Drug administration via a nebuliser GI medicine and urotogy '7· , '9· 30 Abdominal pain hislory Urological history Abdominal examination Male genitatia examination 5\ ·5 ·9 "" 75 , n 80 , vi I Clinical Skills for OSCEs 3" 3'· )) 34· Reclal eltamination Hernia examination Abdominal X-ray interpretation Nasogastric intubation Neurology 35· 36 37· 38 3'· ,,, " '0 43· History of headaches History of "funny turns" Cranial nerve examination Motor system of the upper limbs examination Sensory system of the upper limbs examination Motor system of the lower limbs examination Sensory system of the lower limbs eltamination Gait and co-ordination examination (and cerebellar function) Speech assessment Psychiatry 44 45 46 47 48 49 so 51 52 Hearing and the ear Vision and the eye (induding fundoscopy) Smell and the nose Thyroid examination Paediatrics 57· 58 59· 60 6, 6, 63· 64 OS " '5 ,8 '0' '"3 ,.6 ,oS m u5 u, "0 '" '" '" General psychiatric history 129 Mental state eltaminalion 132 Cognitive assessment, the Folstein Mini-Mental State Examination (MMSE) 138 Depression history 139 Suicide risk assessment 141 Alcohol history 1·43 Capacity and its assessment 145 Common law and the Mental Health Act 147 Eating disorders history 151 ENT and ophthalmotogy 53· 54· 55· 56 8, Paediatric history Developmental assessment Neonatal examination The six-week surveillance review Paediatric examination; cardiovascular system Paediatric examination; respiratory system Paediatric examination; abdomen Paediatric examination: gait and neurological function Infant and child Basic Life Support Child immunisation programme '53 '55 '58 '6, ,63 ,6, ,6, m '75 ,8, '" ,85 ,88 '9' '93 '97 Contents I vii Geriatrics 67· 68 Geriatric history Geriatric physical examination Dermatology '99 ,"' '03 'os Dermatological history Dermatological examination Ad ice on sun protection '09 Obstetrics gynaecology, and sexual health "3 69· W 7" 7'· 7J 74· 75· 76 n 78 79· 80 8, 8' 8, Obstetric history Examination of the pregnant woman Gynaecological history Gynaecological (bimanual) examination Cer ical smear test and liquid based cytology test Breast history Breast examination Pessaries and suppositories explanation Sexual history HtV risk assessment Condom explanation Combined oral contracepti e pill (COCP) explanation Orthopaedics and rheumatology 84· 85· 86 87· 88 89· 90 9'· 9'· Rheumatological history The GALS screening examination Hand and wrist examination Elbow examination Shoulder examination Spinal examination Hip examination Knee examination Ankle and foot examination >07 m "5 ,,8 "0 '" "4 "7 '30 '33 '35 '"'4' '39 '45 '47 '49 '5' '55 '57 '59 ,6, ,65 '69 Emergency medicine and anaesthesiology 93 94 95 96 97 98 99 100 Adult Basic life Support In.hospital resuscitation Advanced life Support The primary and secondary surveys Bag· alve mask ventilation laryngeal mask insertion Oxygen prescription Wound suturing '" '80 '84 '89 '9' '93 '95 '97 viii I Clinical Skills for OSCEs 101 102 Syringe driver operation Pre-operative assessment ' '0' Administrative skills '0' 103 104 105 '0' '09 Drug and contlolled d,ug prescription Death confirmation Death certificate completion Communication skills 106 107 108 109 110 111 112 Explaining skills Obtaining consent Breaking bad news The angry patient or relative The anxious or upset patient or relative Cross-cultural communication Discharge planning and negotiation '>0 ", , ,,, ", ", 3" ,' 330 Foreword Ecclesiastes' comment that "Of making many books there is no end and much study is a weariness of the flesh" is as true as ever, but this book is so brilliant and useful that it is well worth all the hard work which went into its production This second edition is a tribute 10 the success of its predecessor, II is easy to read and understand and informs in an unforgettable way The senior author was wise and humble enough to recruit a student to help with this new edition, thus preserving the essential character of this down to earth practical guide very much in touch with problems as seen by students The old examinations were notoriously subjective but not without their humour When patients with vesico-colic fistulae pass flatus during micturation it makes a curious whistling noise An examiner in the old days asked a candidate what he would think if the patient told him that he whistled when he micturated The candidate replied "I would be thinking that he was a very happy man!" OSCEs involve a much more objective and fairer system allowing the candidates to show a greater variety of skills to many more examiners and with a much greater emphasis on kindly and sensible communication At the end of the day clinical skills in history taking and physical examining will always be highly relevant in practising first class medicine This splendid book will help to continue this all important theme Professor The lord McColl of Dulwich CBE Shadow Minister for Health Professor of Surgery Chairman of Mercyships UK President of The leprosy Mission