GP-OSCE-summary - List of all the topics examinable for 4th year medicine GP OSCE PDF

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List of all the topics examinable for 4th year medicine GP OSCE ...

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GP OSCE Clinical skills 1. 2. 3. 4. 5. 6. 7. 8. 9.

BP measurement IM injection Venepuncture Urinalysis Prescription writing Breast Exam Knee Exam Diabetes food exam using monofilament, glucometer Peak flow measurement

Clinical workshop and lectures 

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Semester 1: 1. Contraception 2. RTI 3. Dermatology 4. Hypertension 5. Sore throat 6. Definitions, community and morbidity, anticipatory care 7. Breaking bad news 8. Behaviour change 9. Common presentations- thyroid, diabetes, skin lesions, psych 10. Red flags Semester 2 1. Asthma 2. Diabetes 3. Depression 4. UTIs 5. Patient safety/ Communication/ Attitude awareness

Communication skills

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General fundamentals of communication (Calgary Cambridge model…agenda setting, open question, non-verbal communication, safety netting, ideas, concerns, expectations) Breaking bad news… Preparation, pt’s understanding, more info/explaination, warning shot, offer denial, explain if requested, listen to concerns, encourage ventilation of feelings, summarise, offer further supports Attitude awareness Behaviour change *cycle of change Fitness to drive (for DM & CVS)

Potential scenarios 1. Contraception  Patient wants to start OCP- ask relevant history, examine (BMI, BP) and advise re management- type of OCP, how to use, effects on period, missed pills, side effects

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 ‘Do not protect against STIs’  Emergency contraception  opportunistic sexual health promotion Respiratory and sore throat  Pneumonia, sinusitis, rhinitis, tonsillitis, glandular fever  Ask brief history and examine (e.g. vitals, auscultation of chest, throat, lymph nodes)  Advise re fluids, rest, prescribe appropriate antibiotic/analgesia Dermatology  Common skin conditions – eczema, acne, psoriasis  History, counsel patient or relative re concerns and outbreaks  Further management  ? skin cancer Hypertension  >ABPM readings, explain diagnosis of hypertension  Management re lifestyle, antihypertensive? - What areas would the patient be willing to make changes in - Fruit and veg >5 - Salt < teaspoon - Fibre - Alcohol - Cease smoking - Exercise dynamic  Measure BP in clinic today  Annual review of hypertensive patient - Hx- open question ‘Tell me a bit about what your understanding of you diagnosis of hypertension and changes/ treatment’ - Symptoms of htn- headaches, vision - Complications- neuro, CVS (eyes) - Lifestyle- *smoking - Medications- AEs - Exam- BP & urinalysis +/- fundoscopy, ECG - Bloods- glucose, lipids, Egfr, creatinine, electrolytes More cardiac  Hypercholesterolaemia, explain results and advise re lifestyle and statin  R/V post discharge from hospital with MI Symptoms, functioning, support, meds, mood  Atrial fibrillation  warfarin, INR explanation  LFTs Asthma  Patient presenting for the first time with asthmatic symptoms - Arrange PEFR diary/spirometry trial of rx - 200mg BD beclomethasone and salbutamol - Inhaler technique - Show PEFR - Action plan - Advise re triggers - vs COPD in adult, viral wheeze in child  Review of patient with asthma - Control of symptoms - Aggravating factors (triggers and smoking)

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Medications o Compliance o Understanding o Technique o Difficulties with treatment o SEs PEFR check o Technique demonstration, check o When to use, rationale for diary o Early morning and early evening, sometimes also before certain meds Action plan Rhinitis

7. Diabetes  Explaining OGTT  Explaining blood glucose/ HbA1c  results and rationale for further management – lifestyle/medication  R/V of diabetic patient  Along with diabetic foot/glucometer (machine, guidelines for pricking finger, calibration)  False raised HbA1C - Iron/ B12/ Folate deficiency anaemia - Chronic opioid/alcohol intake - Asplenia  False reduced HbA1C - Pregnancy - Splenomegaly - Anaemia due to blood loss 8. Depression  New patient presenting with symptoms of depression- characterise symptoms, management?  R/V of patient with diagnosis of depression- symptom improvement/deterioration, adherence to treatment 9. UTIs  UTI history, urinalysis, prescribe antibiotics/ negotiate delayed prescription  Pyelonephritis fever, loin pain, rigors, vomiting, blood in water  Check glycosuria  E-Module points 50% of patients presenting with symptoms of UTI may recover without antibiotic treatment and symptoms can resolve on their own, recommending a non-pregnant patient with uncomplicated cystitis to delay antibiotic treatment by 2 days can significantly reduce antibiotic consumption, with one study showing 25% reduction in this context - UTI usually lasts between 3-10 days in a non-pregnant female - ‘I’m confident you’ll get rid of this by yourself. I will give you a prescription but you would only take the antibiotic if after 2 days its not getting better or if you get worse then start taking it immediately - Shared decision making  - Most patients who present with UTI do so to receive reassurance about their condition rather than specifically to obtain an antibiotic

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‘In these days of overuse of antibiotics we try to keep their use to a minimum’ Little things 1. Fluid intake/drink water >3L in 24 hours 2. Cranberry juice (sometimes people find it effective, some studies support it, others don’t, no harm anyways) 3. Can try an alkalising agent e.g. potassium citrate solution (urine less acidic which is what makes urine burn)

Summary of the recommended first line antibiotics for adult UTI (2013) Antibiotic Nitrofurantoin Trimethoprim Fosfomycin -

Dose and Duration Current Resistance Prevalence a 50 mg QDS, 3 days female, 7 days male 3% 200 mg BD, 3 days female, 7 days male 28% 3g STAT n/a b ie. recommend nitrofurantoin well tolerated and still effective against ESBL producing E.coli, and pulmonary reactions to it are extremely rare Resistance to nitrofurantoin remains low as narrow spectrum of activity, distributes only in the urine and limited clinical indication (UTI) only Also 7 day course for GU malformation, immunosuppression, relapse of same organism, recurrent UTI different organisms Can use AST results to guide future prescribing for UTI

10. Breast  

Brief history for risk factors for breast cancer, breast exam, explain findings, further management (know pathway for referral to symptomatic breast unit) Explain mammography

11. Knee 

History of knee complaint, knee exam, explain findings and further management (e.g. analgesia, referral) 12. Hidden agenda  Ask about other concerns, stresses, particularly in histories related to vague symptoms e.g. headache, GI upset  Can screen for depression by PHQ-2 questions 13. Breaking bad news  As it relates to any of the clinical scenarios e.g. diagnosis of diabetes, cancer, htn  When you went for this test had you any worries as to what you thought it might be/was there anything you feared 14. Behaviour change  As a component of a situation e.g. smoking cessation, diet, exercise  Pre-contemplative stage ask them about the pros and cons - Do you think it has any impacts  ‘Listen if ever you do consider that you want to stop smoking I'm here to help, lots of things on the market now that we can prescribe’  Other common GP presentations (less probable) 1. Fatigue 2. Thyroid (Hypo or hyper)  TFTs 3. Gastroenteritis

4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Appendicitis/ IBS Antenatal check 6 week check Headache HRT Back pain Anaemia STI symptoms Osteoporosis (with back pain and knee pain) Falls

Flu vaccine, venepuncture and prescription writing as an add on to any clinical scenario Prescriptions for UTI antibiotics, anti-hypertensives, analgesia, anti-depressant, diabetic meds, metformin

Communication tips     

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‘Tell me a bit more’ ‘What do you think it might be’ ‘Have you been taking anything for it?’ When prescribing anything—any allergies? 3 Questions- ICE - I'm going to ask about your headaches - I'm going to ask what’s going on in your head - About your life at the minute ‘I can see this is very distressing for you’ ‘I can tell this is taking its toll on you’ Verbalising something for the first time  helps a lot We have an open door here for you 'This must be really difficult for you' '...