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CLINICAL SKILLS FOR OSCEs TH E D I T I O N 00-OCSEs-Prelims_5e ccp.indd 19/03/2015 12:12 Life is short, the art long, opportunity fleeting, experiment treacherous, judgement difficult Hippocrates (c 460–370 BC) Aphorisms, Aph 00-OCSEs-Prelims_5e ccp.indd 19/03/2015 12:12 CLINICAL SKILLS FOR OSCEs TH E D I T I O N SENIOR EDITOR N ee l B ur ton BSc ( Hons) , MB B S , M R C P s ych , M A (P h i l ), A KC Tutor i n P s ych i a t r y Green Temp let on Colle g e U n i versi t y o f Ox ford STUDENT EDITOR J o h n Lee Al l en 3rd Yea r G E M S t u d en t Imperi al Colle g e Lon d on 00-OCSEs-Prelims_5e ccp.indd 19/03/2015 12:12 Fifth edition © Neel Burton, 2015 Fifth edition published in 2015 by Scion Publishing Ltd ISBN 978 907904 66 First edition published in 2003 by BIOS Scientific Publishers Second edition published in 2006 by Informa Healthcare Third edition published in 2009 by Scion Publishing Ltd Fourth edition published in 2011 by Scion Publishing Ltd All rights reserved No part of this book may be reproduced or transmitted, in any form or by any means, without permission A CIP catalogue record for this book is available from the British Library Scion Publishing Limited The Old Hayloft, Vantage Business Park, Bloxham Rd, Banbury OX16 9UX, UK www.scionpublishing.com Important Note from the Publisher The information contained within this book was obtained by Scion Publishing Ltd from sources believed by us to be reliable However, while every effort has been made to ensure its accuracy, no responsibility for loss or injury whatsoever incurred from acting or refraining from action as a result of the information contained herein can be accepted by the authors or publishers Readers are reminded that medicine is a constantly evolving science and while the authors and publishers have ensured that all dosages, applications, and procedures are based on current best practice, there may be specific practices which differ between communities You should always follow the guidelines laid down by the manufacturers of specific products and the relevant authorities in the region or country in which you are practising Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be pleased to acknowledge in subsequent reprints or editions any omissions brought to our attention Registered names, trademarks, etc used in this book, even when not marked as such, are not to be considered unprotected by law Cover design by Andrew Magee Design Limited Typeset by Phoenix Photosetting, Chatham, Kent, UK Printed in the UK 00-OCSEs-Prelims_5e ccp.indd OSCEs_5e_PGS.indd 19/03/2015 12:12 06/03/2015 15:04 15:04 Contents v Contributors ix Preface xi OSCE tips I GENERAL SKILLS II xiii Hand washing Scrubbing up for theatre Venepuncture/phlebotomy5 Cannulation and setting up a drip Blood cultures 10 Blood transfusion 12 Intramuscular, subcutaneous, and intradermal drug injection 14 Intravenous drug injection 16 Examination of a superficial mass and of lymph nodes 18 CARDIOVASCULAR AND RESPIRATORY MEDICINE 10 11 12 13 14 15 16 17 18 19 20 Chest pain history Cardiovascular risk assessment Blood pressure measurement Cardiovascular examination Peripheral vascular system examination Ankle-brachial pressure index (ABPI) Breathlessness history Respiratory system examination PEFR meter explanation Inhaler explanation Drug administration via a nebuliser 21 24 26 28 33 36 38 41 46 48 50 III GI MEDICINE AND UROLOGY 21 22 23 24 25 26 27 28 29 00-OCSEs-Prelims_5e ccp.indd Abdominal pain history Abdominal examination Rectal examination Hernia examination Nasogastric intubation Urological history Male genitalia examination Male catheterisation Female catheterisation 52 55 60 62 65 67 69 71 73 19/03/2015 12:12 vi Contents IV NEUROLOGY 30 31 32 33 34 35 36 37 38 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 examination Gait, co-ordination, and cerebellar function examination Speech assessment 75 78 81 86 89 91 95 97 100 V PSYCHIATRY 39 40 41 42 43 44 45 46 47 48 49 General psychiatric history Mental state examination Cognitive testing Dementia diagnosis Depression history Suicide risk assessment Alcohol history Eating disorders history Weight loss history Assessing capacity (the Mental Capacity Act) Common law and the Mental Health Act 103 106 111 113 116 118 120 123 125 127 130 VI OPHTHALMOLOGY, ENT AND DERMATOLOGY 50 51 52 53 54 55 56 57 Ophthalmic history Vision and the eye examination (including fundoscopy) Hearing and the ear examination Smell and the nose examination Lump in the neck and thyroid examination Dermatological history Dermatological examination Advice on sun protection 134 136 140 145 147 151 153 156 VII PAEDIATRICS AND GERIATRICS 58 59 60 61 62 63 64 65 66 67 68 69 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 Geriatric history Geriatric physical examination 00-OCSEs-Prelims_5e ccp.indd 157 159 162 166 169 173 176 179 181 184 186 188 19/03/2015 12:12 Contents vii VIII OBSTETRICS, GYNAECOLOGY, AND SEXUAL HEALTH 70 71 72 73 74 75 76 77 78 79 80 81 Obstetric history Obstetric examination Gynaecological history Gynaecological (bimanual) examination Speculum examination and liquid based cytology test Breast history Breast examination Sexual history HIV risk assessment Condom explanation Combined oral contraceptive pill (COCP) explanation Pessaries and suppositories explanation 189 192 195 198 200 203 207 210 214 215 217 220 IX ORTHOPAEDICS AND RHEUMATOLOGY 82 83 84 85 86 87 88 89 90 Rheumatological history The GALS screening examination Hand and wrist examination Elbow examination Shoulder examination Spinal examination Hip examination Knee examination Ankle and foot examination 222 226 229 232 233 236 239 242 245 X EMERGENCY MEDICINE AND ANAESTHESIOLOGY 91 92 93 94 95 96 97 98 99 100 101 102 103 00-OCSEs-Prelims_5e ccp.indd Adult Basic Life Support 247 Choking250 In-hospital resuscitation 252 Advanced Life Support 255 The primary and secondary surveys 258 Management of medical emergencies 260 – acute asthma 260 – acute pulmonary oedema 260 – acute myocardial infarction 261 – massive pulmonary embolism 262 – status epilepticus 262 – diabetic ketoacidosis 262 – acute poisoning 263 Bag-valve mask (BVM/’Ambu bag’) ventilation 266 Laryngeal mask airway (LMA) insertion 267 Pre-operative assessment 269 Syringe driver operation 273 Patient-Controlled Analgesia (PCA) explanation 275 Epidural analgesia explanation 276 Wound suturing 278 19/03/2015 12:12 viii Contents XI DATA INTERPRETATION 104 105 106 107 108 109 110 Blood glucose measurement Urine sample testing/urinalysis Blood test interpretation Arterial blood gas (ABG) sampling ECG recording and interpretation Chest X-ray interpretation Abdominal X-ray interpretation 280 282 284 290 294 306 311 XII PRESCRIBING AND ADMINISTRATIVE SKILLS 111 112 113 114 115 Requesting investigations Drug and controlled drug prescription Oxygen prescription Death confirmation Death certificate completion 315 318 323 325 326 XIII COMMUNICATION SKILLS 116 117 118 119 120 121 122 123 124 Explaining skills Imaging tests explanation Endoscopies explanation Obtaining consent Breaking bad news The angry patient or relative The anxious or upset patient or relative Cross-cultural communication Discharge planning and negotiation 00-OCSEs-Prelims_5e ccp.indd 330 333 337 339 340 341 342 343 344 19/03/2015 12:12 Contributors ix Sara Ahmadi 4th Year Medical Student University of Oxford Jane Hamilton 4th Year Medical Student University of Glasgow John Lee Allen 3rd Year GEM student Imperial College London Randeep Singh Heer 3rd Year Medical Student King’s College London Daniel Ashmore 5th Year Medical Student University of Leeds Patrick Holden 3rd Year Medical Student University of Cambridge Vartan Balian House Officer (FY1) Warrington & Halton NHS Foundation Trust Benjamin Huggon 1st Year Medical Student University of Oxford Daniel Campbell 5th Year Medical Student Barts and the London School of Medicine and Dentistry (QMUL) Anthony Carver House Officer (FY1) East Kent Hospitals University NHS Foundation Trust Mohsin Chaudhary 5th Year Medical Student St George’s Hospital Medical School Christopher Chopdar Independent Psychiatrist Oxford Akbar de’ Medici Associate Director Institute of Sport, Exercise and Health (UCL) Patrick Elder 2nd Year Medical Student University of Warwick Naomi Foster 4th Year Medical Student University of Dundee Sadhia Khan 5th Year Medical Student University of Manchester Guglielmo La Torre 2nd Year Medical Student Brighton and Sussex Medical School Lilian Lau 3rd Year Medical Student University of Leicester Lucy Li 5th Year Medical Student University of Edinburgh David Liddiard Osteopath Function Health, New Zealand Katherine Mackay 5th Year Medical Student University of Oxford Genevieve Marsh-Feiley 2nd Year Medical Student University of Aberdeen Jacob Matthews 5th Year Medical Student University of Birmingham Jay Goel 2nd Year Medical Student Barts and the London School of Medicine and Dentistry (QMUL) Jonathan Mayes 4th Year Medical Student Newcastle University Ali Rezaei Haddad 2nd Year Medical Student University of Warwick Philip McElnay NIHR Academic Clinical Fellow in Cardiothoracic Surgery Newcastle University 00-OCSEs-Prelims_5e ccp.indd 19/03/2015 12:12 ... 01-OCSEs-General _Skills_ 5e ccp.indd • • • • Phlebitis Thrombophlebitis Septic thrombophlebitis Local infection 18/03/2015 13:18 10 Station Clinical Skills for OSCEs Blood cultures Before... the patient is infected with Clostridium difficile 01-OCSEs-General _Skills_ 5e ccp.indd 18/03/2015 13:18 Station 1 Hand washing Clinical Skills for OSCEs Figure 1. Ayliffe hand washing technique:... needle into the vein at an angle of 30–45 degrees to the skin 01-OCSEs-General _Skills_ 5e ccp.indd 18/03/2015 13:18 Clinical Skills for OSCEs Station 3 Venepuncture/phlebotomy • Keeping the needle
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