YEAR 4 OSCE LIST Comprehensive PDF

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YEAR 4 OSCE LIST Comprehensive list of potential osce stations...

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4th Year OSCE Stations * Generally, every station you should know the management

General links https://batesvisualguide.com/multimedia.aspx?categoryid=21788

Paediatrics OSCEstop Paeds history: https://oscestop.com/Peads_history.pdf PasTest Paeds OSCEs (downloaded)

No Station Important points from OSCE feedback . 1. Take a history  DDx volvulus from  Ask about colour! vomiting child  Ask about 1st passage of meconium

Notes

Date practiced

Sunflower book p. 242 (pdf page 256) -when is her first passage of meconium? http://muppits.mumus.org/wpcontent/uploads/2017/07/MUPPITS-OSCE5-Vomiting.pdf - OSCE station (history + questions + mark scheme) of vomiting https://www.msdmanuals.com/engb/professional/pediatrics/symptoms-ininfants-and-children/nausea-and-vomitingin-infants-and-children - Revision + key 1

4th Year OSCE Stations history / exam features 2.

Take a history from constipated child

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Know management of constipation

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Know about functional constipation

'Red flag' findings that indicate an underlying disorder or condition (History): -

Reported from birth/ first weeks Failure to pass meconium in first 48 hours ‘Ribbon’ stools (anorectal malformation) Neurological symptoms (e.g. leg weakness/ locomotor delay) Abdominal distension / vomiting

https://www.nice.org.uk/guidance/cg99/ch apter/1-guidance#history-taking-andphysical-examination – NICE guidance on history, diagnosis and management of constipation in children https://www.rch.org.au/clinicalguide/guidel ine_index/Constipation/ - History + examination of constipation https://www.olchc.ie/ChildrenFamily/Parent-Patient-Informationleaflets/Poo-Passport-EmergencyDepartment-.pdf - pages 4/5 have history features; page 7 for management https://learn.pediatrics.ubc.ca/bodysystems/gastrointestinal/constipation/ Revision & differentials for constipation

3.

Take a history from child with respiratory symptoms (Asthma)

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Take a focused history Know management and advice

https://www.nice.org.uk/guidance/ng80/ch apter/Recommendations#initial-clinicalassessment – NICE guidance on diagnosis, monitoring and management of asthma https://geekymedics.com/asthma/ - Asthma 2

4th Year OSCE Stations revision (signs, symptoms, diagnosis) https://geekymedics.com/inhalertechnique-osce-guide/ - Inhaler technique counselling -not necessarily asthma but must know what questions to ask about asthma

-mnemonics: CAUSES; HINDERS 4.

Take a history from child with GI symptoms (Pyloric stenosis)

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Take focused history and suggest a treatment Show empathy Make sure ask colour of vomit. Any blood or bile colour?

Sunflower book p. 237 (251 pdf page) http://muppits.mumus.org/wpcontent/uploads/2017/07/MUPPITS-OSCE5-Vomiting.pdf - OSCE station (history + questions + mark scheme) of vomiting https://www.msdmanuals.com/engb/professional/pediatrics/symptoms-ininfants-and-children/nausea-and-vomitingin-infants-and-children - Revision + key history / exam features

5.

Take a history from child with history of failure to thrive

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Take focused history Record height and weight accurately Ask about dietary intake and feeding Ask PMH of child Ask developmental history

OHCS p.264 Sunflower book p. 217 (pdf page p231) http://muppits.mumus.org/wpcontent/uploads/2017/07/MUPPITS-OSCE3

4th Year OSCE Stations 1-Failure-To-Thrive.pdf - Failure to thrive OSCE station https://www.rch.org.au/clinicalguide/guidel ine_index/Poor_growth/ - Poor Growth revision + key history & examination features https://www.nice.org.uk/guidance/ng75/ch apter/Recommendations#faltering-growthafter-the-early-days-of-life – NICE guidance faltering growth – recognition and management

https://www.rcpch.ac.uk/resources/growthcharts - Paeds growth charts QUB comments: Most students were very good and immediately focused on the relevant information. Specific comments: Most students performed well but there were exceptions. Some took too long over the growth chart-familiarise yourself with the growth chart as it is very obvious to the examiners who is familiar and who is not.

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4th Year OSCE Stations 6.

Take a history from child with jaundice symptoms

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Key questions: Stool colour, mother or baby blood group, drug history Exclude biliary atresia Ask if mom is breastfeeding Neonatal Jaundice o History taking and management station. Quite tight for time.

OHCS: Page 294 + 295 http://muppits.mumus.org/wpcontent/uploads/2017/07/Jaundice-ABOSepsis-OSCE-Jamie-Tan.pdf - Jaundice OSCE station (involved) https://almostadoctor.co.uk/encyclopedia/n eonatal-jaundice - Neonatal jaundice revision  ddx: breast milk jaundice breast milk - common - benign - no causes could be identified - 10% can be jaundiced up to 1 month of age - usually due insufficient intake of milk and food - must ask colour of urine and stool - ask about progression -vomiting, crying, rash, fever -must ask about rash!!- si of coagulapathy -ask about infectious contact – previous medical hx -social hx: smoking -developmental hx- any concern about history

5

4th Year OSCE Stations ix: direct bilirubin/ indirect bilirubin mg: reassurance, will go away after 1 month 7.

Child BLS

 Make sure check responsiveness  Check debris in mouth  Relate with scenario. If in house, call neighbour  As per algorithm. Very short station. Use time at end of station to assess for underlying causes / advise parent.

tx: increase feed, phototherapy

OHCS: Page 180 -wash mouth -ensure safety -must check debris in mouth! -must verbalise your step -100 compression per minute -call arrest team -check 10 second for breath -check brachial pulse -above xiphisternum

Done: Orange 17/01/21

-if one rescuer – 30compression-2 breath -if 2 rescuer: 15:2 8.

Complete drug Kardex (2015)

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Use addressograph / write name Sign rather than initial Capital letter MICROGRAMS Fill in DRUG ALLERGY column! Know how to cancel Know what preparation to give. Eg; suspension, capsule or tablet. If too young, give suspension

https://bnf.nice.org.uk/guidance/prescriptio n-writing.html - NICE guidance on prescription writing -always fill drug allergy column

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4th Year OSCE Stations 

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9.

Video – Absence seizure attack

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May be asked to draw up oral medication. E.g., preparing Amox 250mg oral suspension Ascertain weight from nurse or use formula (2 x (age + 4)) Make sure check right medication and expiry date with nurse Interact with simulated nurse Able to recognise and make diagnosis Know investigation and treatment If frequent and affects schooling, give AED May have simulated patient Communicate management

https://geekymedics.com/fits-faints-andfunny-turns-in-childhood/ - History + Epilipsy syndromes https://learn.pediatrics.ubc.ca/bodysystems/nervous-syste/approach-to-thechild-with-a-seizure/ - Detailed history + approach to seizure child https://www.youtube.com/watch?v=891HN0HlVE&ab_channel=PassMRCPCHLondonPaediatricsTraineesCommittee MRCPCH Seizure History OSCE video https://www.youtube.com/watch? v=H3iLQi6wt94&ab_channel=mrturcios1 – Video of absence seizure -complex – movement of eye and lips -simple: just loss of awareness -age-4-14

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4th Year OSCE Stations -day dreaming - can be interrupted – gradually with warning

10. Prescribe IV fluids in children

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11. Discussion of NAI with consultant over the phone 12. Demonstrate

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May asked to give bolus May asked to give fluid for pre op Know when to give K+ and glucose supplement Give K+ supplements only after having the blood results Usually only needs 0.9% saline +/- 5% glucose Prescribe as per the patient’s weight as on chart Remember to make sure the fluid balance chart is a Pediatric one Electrolytes before starting and every 24 hours Use SBAR Will be given pictures. Recognise features of NAI Management plan: Admit child, contact and inform social service, perform ABC, COAG, skeletal survey or CT scan survey Asked to explain to parents

-absence seizure – cannot be interrupted -don’t do anything especially out something inside mouth, or let them on their own in the bath tub -combine maintenance together -with ongoing losses to make sense of duration -weigh patient everyday -dose for K+ -1mmol/kg

Done 12/01/21 Practice again

-know xray of NAI -introduce yourself, then tell situation immediately -bucket handle # (avulsion #) is an example

-encourage patient to stand up 8

4th Year OSCE Stations how to use inhaler + spacer

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13. Completing growth charts

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14. Video – Child with croup

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Shake inhaler before use Brush teeth or drink water after using. May cause thrush if using steroid Regularly clean spacer using water and let it dry. Don’t wipe. Don’t forget to ask patient to demo to you Consider pre-term. Draw arrow to show correction of gestational age Know causes of asymmetric growth / small for gestational age / IUGR Failure to thrive Take a history from a concerned parent, look at the clinical photograph provided and comment on it Plot the most recent measurements on the growth chart and give the most likely diagnosis Common presentation Asked diagnosis and management Able to describe. Eg, mention child is not cyanosed. Generally, child alert and smiling. Count RR Is it moderate / severe croup? Know management (Oral Dexamethasone or neb Budesonide) Other Mx, probably discharge from ED + safety netting + parental advice

https://www.youtube.com/watch? v=Qbn1Zw5CTbA&ab_channel=JulietteAnde rson – video of baby with Croup

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4th Year OSCE Stations 15. Hypoglycaemi a explanation

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Communication skill Assess baseline understanding of patients (Use ICE) Encourage parents to bring sugary supplement Give further resource

-there is only two type of hypo’s: mild and severe/moderate

16. Prescribing ibuprofen 17. Drug – trimethoprim 18. Prescribing – amoxicillin and paracetamol

Identify Scarlett Fever  Write a prescription for the relevant drug

19. Drug chart – flucloxacillin 20. Limping Child

1. Take history, request and asses relevant scans 2. Diagnosis: Slipped Upper Femoral Epiphysis

21. Epipen communicatio n

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Explain using an Epipen to grandparent Be sure to confirm what relationship is to patient. Offer written information and ensure enough supply of epi pens at grandparent house

It is obvious when a student has not held an Epipen before”. All would do well to learn a lesson from this-be fully familiar with all relevant equipment and techniques. Finally, avoid jargon when you are describing a 10

4th Year OSCE Stations 22. Febrile seizure

(child spends lots of time there when parents are working)  Invite questions

technique to a member of the public

23. Bilious vomiting 24. Constipation 25. GORD 26. Broncheolitis 27. Acute epiglotitis 28. Neonatal jaundice (breastfeeding) [Jan 2011, June 2012, June 2013] 29. Failure to thrive (coeliac disease) [June 2009, June 2016 (growth chart provided)] 30. Vomiting 31. Diarrhoea (toddlers diarrhoea) 32. Hypoglycaemia 33. Innocent murmur 34. Gastroenteritis 35. Coeliac disease 36. Mother with doll (6/12) and Hx suggesting intussusception

Done: ORANGE 17/01/21

Done: GREEN 02/12/2020 Note: - Ask about meconium - Ask about health visitor + social worker

37. Social – GI symptoms with no organic cause 38. Crying child or “colic” – general history taking and differential diagnosis 39. Febrile convulsions 11

4th Year OSCE Stations 40. Breath holding attacks 41. Seizures especially absence seizures 42. Anaphylaxis 43. Septic shock 44. Meningitis/meningococcal septicaemia/petechial rash

DONE: RED 26/11/20 (look up and redo)

45. Nephrotic syndrome with picture of oedematous child 46. HSP 47. Video of child with absence seizures [Jan 2009] 48. Video of croup – identify features, distressed baby signs, management 49. Complete growth chart [Jan 2010 (preterm and SGA), Jan 2012] Prescribing: 50. Completing kardex and drawing up oral meds [Jan 2009, June 2009, Jan 2011] 51. IV fluid bolus [June 2010, Jan 2011, June 2012, June 2013] 52. Treatment for meningitis in a baby 53. Salbutamol [June 2014] 54. IV antibiotic (septicaemia) [June 2015] 55. ibuprofen, trimethoprim, amoxicillin, flucloxacillin, salbutamol 56. Drug chart [June 2010, June 2011 (fluccloxacillin), June 2012 (paracetamol, stop amoxicillin)] 57. Drug chart for UTI [Jan 2010] 58. NAI and discussion with consultant (SBAR, photographs provided) [Jan 2009, Jan 2012, June 2014] Explain/demonstrate: 59.  Hypoglycaemic episodes to mother 60.  Inhaler/spacer device (MDI) to a parent so they could teach their child [Jan 2009, June 2010, June 2013, June 2015] 12

4th Year OSCE Stations 61. EpiPen [June 2013, June 2016] Counselling: 62. Cystic fibrosis genetics 63.  Down syndrome 64.  DMD genetics 65.  VSD mx 66.  UTI Rx factors for recurrent UTI and Mx of UTI 67.  New acute presentation of diabetes/diabetic teenager social factors 68.  Breast feeding Examination:  Child or neonate  Eye or ear examination  Urine dipstick testing  Child development  Congenital dislocation of the hip  Head circumference measurement (x3 – take largest)  Resp examination in older child (asthma, bronchiectasis, CF)  IM injection for suspected meningitis  Neuro examination eg child with cerebal palsy

Psychiatry No.

Station

Important points from OSCE feedback

Notes

Date practiced + grade

13

4th Year OSCE Stations 1.

Discuss MHO with patient or relative

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2.

Counselling a patient who is on Clozapine

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Know questions for risk assessment Know MHO process and forms May have to consult relative. E.g., Mother of a patient who was aggressive to parents. He was suspected schizo and detained Ask her if there’s any questions to ask and address concern Discussing detention under mental health order o Explain to parent you want to detain child o Relative discussing detention

Form 1: relative Form 2: Form 3: GP Form 4: no such thing Form 5: -inpatient (48 hours) Form 6: nurse if no SHO around Form 7: SHO (48 hours)

If the patient who is on clozapine develops sore throat, he needs:o Urgent clinical assessment o FBC, WCC

different preparation includes depot

26/11/20 Grade: Orange

s/e: salivation, dizzy, stiffness in leg, weight gain, n&v complication: agranulocytosis, 14

4th Year OSCE Stations

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o Depending on result may refer to specialist Explain clozapine and side effects

myocarditis duration: min 6 months start low dose and adjust accordingly. previous antipsychotics tapered down slowly work by unterrupting the chemical imbalance test: fbc, bp, bmi blood test every week at the start of tx. alcohol: stop caffeine: avoid major changes smoking: inform clinic if planning to stop driving: don’t (sedation) warn on interaction pregnancy contraindicated interaction with other drugs warning

3. 4.

Explaining Olanzapine to patient’s mother- for side effects Side effects of Risperidone communication

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15

4th Year OSCE Stations 5.

Video of antipsychotic induced parkinsonism (2015)

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6.

Video of Parkinsons’s

7.

Suicidal risk assessment

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Outside station was quite sly and said to watch the video and comment on the psychological condition even though the answer was a medication side effect. Was asked to pick out three signs that suggested this diagnosis, what medications the patient was likely to be using and the indications for using these medications.  Need to stop the offending drug on the Kardex State 3 abnormalities Treatment Side effects o Posture: stooping, leaning forward o Slowness of movement: bradykinesia o Gait: small step, hesitancy, hurrying gait (festination) o Tone: cork-screw rigid 

Before, during, after

QUB comments: - Need to know how to describe the signs (types of movements) - Need to know how to discontinue drugs on the Kardex (including signing and dating)

Form V- for patients in ward 16

4th Year OSCE Stations (2015)

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Don't forget illicit drug use + alcohol Decide management (Low/high risk)

QUB comments: Start from open q: what has been troubling you? – the nurse has raised concerns about you been discharged put patient at ease ask about current event, did he seek help – how does he feel after help arrive - Suicide note? - substance intoxication - must assess psychosis - any psychiatric problem in the past - any illicit drug - assess current mood - exclude psychosis - assess current suicidal ideation - view about future follow up: Lifeline; Samaritans, Follow up GP -

8.

Explaining Bipolar Affective Disorder and its medication (Lithium)

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Know mood stabilisers and its side effects for each drug Explaining lithium to patient’s mother- patient had lithium toxicity

Duration: at least 3 years, warn of rebound mania if noncompliance S/e: early – tremor, dry mouth metallic taste, thirst

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4th Year OSCE Stations late term: weight gain, thyroid kidney problem Toxicity is: worsening tremor, blurred vision, slurred speech, ataxia, confusion Monitor: kidney, thyroid, pregnancy, serum lithium Li: every week for 4 weeks, and then monthly and then 3 monthly. Missed dose Interaction

9.

Video – Major depressive disorder

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Report signs and symptoms

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Differentiate between what we hear and what we see

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If there is TLNWL, do risk assessment

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Consider hypothyroidism as DDx

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Video of patient describing early morning wakening and depression?

-there is different between loss of interest and loss of experience of pleasure (anhedonia)

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4th Year OSCE Stations  

10.

Video – Patient with auditory hallucination (Schizophrenia)

Video of patient with major depressive disorder Depressive illness videomental state

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11.

Explaining to patient about SSRI

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Remember 1st rank symptoms Able to describe ASEPTIC

ICE Know different side effects and contraindication

Psych – SSRI Counselling 1. Ask a very quick few questions to gain impression of seriousness of depression, then: 2. Standard SSRI counselling points slightly complicated by patient reluctance to start the medication at end of

-serotonin level -s/e: drymouth, dizziness, drowsiness, sexual dysfunction, anxiety and agitation –usually all s/e will go away -monitor every 1-2 weeks – review – BP -contraindication/caution: acute angle glaucoma, diabetes, cardiac disease, hx of mania and current sui...