Professional Documents
Culture Documents
Swu Osce Med
Swu Osce Med
2551
(...)
2546
4 5
14
1 2551
OSCE National Licese PIII
... 3
(Physical examination)
(Procedures skills)
Communication skills
(History taking)
Interpretation skills
Management
Key Clinical Skills (10 )
(History taking)
Consent
...
2546
(...)
3
1 (Basic science - MCQ) 3
2 (Clinical science - MCQ) 5
3 (Clinical competence MEQ ,Long cases OSCE)
1 2
3 (OSCE)
(...) 3
20
- 4
- 4
- 4
- 3
- 5
2.1
1.
2.
3.
4.
5.
National License PIII OSCE SWU
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
3.5.1
1.4 - 1.7
1. /
2.
3.
4.
5.
6.
7.
8.
9.
1.
2.
3.
4.
5.
6. Counseling
7.
8. autopsy
9.
10. /
3.2 - 3.4
/
History taking
Medicine
I.
1.
2.
3.
4.
5.
6.
7.
8.
9.
II. dyspnea
1.
2.
3.
4.
5.
6.
7.
wheezing
8.
9.
10.
11.
12.
13.
14.
III. syncope ()
1.
2.
3.
4.
5.
6.
7.
8.
IV.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
National License PIII OSCE SWU
11.
12. orthopnea PND
V.
1.
2.
3.
4.
5.
6.
7.
8. orthopnea PND
VI.
1.
2.
3.
4. colicky pain
5.
6.
VII.
1.
2.
3.
4.
5.
6.
7.
10
VIII.
1.
2.
3.
4.
5.
6.
7.
8.
9.
IX.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
X.
1.
2.
3.
4.
11
5.
6.
7.
shock
XI.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
steroid AIDS
XII.
1.
2.
3.
4.
5.
6.
7.
regurgitation
8.
9.
12
XIII.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
XIV.
1. colic
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
13
XV.
1.
2.
3.
4.
5.
6.
7.
8.
XVI.
1.
2.
3.
4.
5.
6. NSAID
7. stress
8.
9.
10.
11.
XVII.
1.
2.
3.
4.
5.
National License PIII OSCE SWU
14
6.
7.
8.
9.
10.
11.
XVIII. Headace
25 3
1
Age of onset ( , )
2
(//)
3
(//)
4
,
,
5
6
Aura
7
,
, ,
8
(throbbing pain),
(stabbing pain), (thunderclap headache),
9
, ,
, , , ,
10
, , ,
,
11
, ,
12
13
14
, ,
15
multiple partners, homosexual
National License PIII OSCE SWU
15
16
17
, ,
,
16
Surgery
I. Abdominal pain
. 40
()
1
17
Psychiatry
I. Suicide
30 ./ /
() . Paracetamol 120
1. Demographic data
2.
3. intention to die
7.
18
Physical examination
Medicine
1.vital signs
: Temperature, BP, PR , RR
2.Cardiovascular system
19
3.Respiratory System
Inspection
1. Cyanosis
2. Clubbing
3 Plethora, venous distension
4 Chest contour
5. Breathing movement rate. depth. rhythm, equality presence of paradox. accessory
muscle use
Palpation
1. Lymph node ()
2. Trache supasternl fossa
3. Chest expansion
- Apical
- Base
. Vocal fremitus expansion 1 2 3
4. subcutaneous emphysema
Percussion
1. 2
2. 2
Auscultation
1. Breath sound 2
2. abnormal bronchial breathi sounds
3. adventitious sounds crackles, wheezes. stridor. pleural rub.
mediastinal crunch
4. Voice-generated sounds
- Vocal resonance (1.2.3 2 )
- Whispering pectoriloquy ( 2 )
Egophony ( E A )
20
4.Gastroenterology
1. Observation:
- general appearance including leg edema
- (anemia. jaundice)
- oral cavity
- signs of chronic liver disease (spider nevi. palmar erthrerna. gynecomastia etc.)
- signs of hepatic encephalopathy(flapping fetor hepaticus)
- abdominal contour and superficial dilated veins ()
2.
- bowel sound
- (bruit or venous hum)
3. -
- light palpation (all quadrants)
- deep palpation (all quadrants)
- examination of liver (describe size. span liver dullness, consistency, edge surface,
tender. etc.)
- examination of spleen (supine and right lateral decubitus )
- bimanual palpation of kidney
- examination of hernia
4. ExamInation of ascites
- fluid thrill
- shifting dullness
5. Rectal examination
5. Cranial Nerve
CN I
(, )
CN II
1. Visual acuity (Pocket near vision chart)
- chart 14
- Chart
2. Visual field (Confrontation test)
- 1
- VF
-
- peripheral field quadrant
3. Fundoscopic examination
-
21
- lens *
- ophthalmoscope ophthalmoscope
disk refraction potic fundi *
()
- *
-*
CN III. IV. VI
1. Exophthalmos
- exophthalmos
2. Puplliary
- pupil
- direct reflex consensual reflex
3. Extraocular movement
- : 5
4. Ptosis
- 2
5.Accommodation
- : convergence miosis
CNV
1. Motors
1.1 Temporalis muscle
- temporal fossa 2 muscle atrophy
- 2
1.2 Masseter muscle
- mandible 2 muscle atrophy
- 2
1.3 Latefal pterygoid muscle
- jaw deviation
-
-
2 Facial sensation
2.1 skin sensation
- (V1) (V2) (V3) 2
2.2 corneal reflex
-
- cornea upward, medial
3. Jaw jerk
- reflex
22
6.Motor Function
.
1. Observe : abnormal movement muscle wasting. fasciculation.
fasciculation
2. Pronator drift : forearm
flexion pronation. finger flexion 2 rebound
3. Muscle tone passive movement joint
- Shoulder joint forearm --
-Elbow joint shake hand -
- Radio-ulnar joint -
-Wrist joint forearm shake hand -.
4. power
- deltoid
- biceps
- triceps
- brachioradialis
- pronator
- supinator
- wrist flexion
-wrist extension
- hand grip ( 2 )
-finger extension
- finger abduction ( 2 )
- finger adduction
- opponens
5. Deep tendon reflex
- Biceps biceps tendon
-Triceps triceps tendon (2 )
- Brachioradialis brachioradialis tendon (2 )
- Finger PIP joint
6. Hoffmann Trommer sign
- extend wrist MCP. PIP joint distal phalanx
palmar flexion
23
1.
-
-
2.Bicetp jerk
- pronation
- biceps tendon
3.Brahiosradialis jerk
- pronation
- radius 2
4.Triceps jerk
-
- triceps 2
24
5.Finger jerk
- supinate
-
6.Knee jerk
- flexion
- pateliar tendon
7.Ankle jerk
- externa; rotation
- dorsiflex
- Archilles tendon
8.()
-
-
8. Cerebellar Function
1. Nystagmus
-, -
2. Tone
- shoulder joint
- elbow joint
- radloulnar joint
- wrist joint
3. Co-ordination ( )
3.1 Finge-to-finger 2
3.2Finger-to-nose
3.3 Finger-to-nose-to-finger
4. Co-ordination
Heel-to-knee
5. Alternate movement ( )
5.1 2
5.2 .-
6. Alternate movement
( )()
7. Tandem walking
25
Vibration sensation
1.
- 128 Hz
-
- ( sternum
clavicle )
2. Vibratory
-
2
- 2 )
position sensation
1.
-
2. position sensation
- proximal phalanx
distal phalanx extend reflex
- 2
26
11.Hearing
1.
- 256 Hz
-
-
2. Webers test
-
-
-
lateralization to the..(left or right)
3. Rinnes test
- mastoid
-
-
-
12.
-
-
-
- , 2
(lobe) trapezius muscle
-
-
-
-
27
-
-
-
- ,
-
-
-
-
-
-
bruit
13. Trousseau
1.
2.
3. arm cuff
4. Apply pressure 10-20 . 2-3
1. (carpal spasm)
- adduction thumb
- fIexoim metacarpophalangeal joints
-flexion wrist joint
-flexion elbow joint
accoucheurs hand
2. carpal spasm 4
Grade 1
Grade 2
Grade 3 grade 2 1
Grade 4 grade 2 1
National License PIII OSCE SWU
28
3. 5
1.
- ()
-
-
-
2. grade 1 2 4 , grade 3 4
14. Chvostek
1.
2. Chvostek I ( facial nerve ) facial nerve
2-3 .. zvgomatic arch
1.
2.
Grade 1
Grade 2 alae nasi
Grade 3 alae nasi orbicularis oculi
Grade 4
1.
- ()
-
-
-
2. grade 1 25
29
1.
2.
3.
4. Homans sign active passive dorsiflexion
4.1
4.2 dorsiflexion
4.3
16.Musculoskeletal System
Inspection
1.Posture:
2.Gait:
3.Derfromity Sign on inflammation: ,
()
Palpation
1.
2.swelling):
synovium
3. (tenderness):
4.(range of motion)
:
:
Special tests ()
1. Carpal tunnel syndrome
1.1 Tinesls test: median nerve distribution
1.2 Phalens test: 1 median nerve distribution
2. Sacroiliitis
: Sign of 4:
fix
SI joint
National License PIII OSCE SWU
30
3. Spondyloarthropathy
3.1 Schobers testjModified Schobers test: L5
posterior iliac spine 2 10 ..
( modfied Schobers test L5 5 ..)
13 ..Schobers test 20 .. modified Schobers test
31
Surgery
1. Breast nass
60 2
1 Doctor-patient relationship
1.
2.
3.
4.
2
1.
2.
3. axilla
4.
3
1.
2.
3. 4 quadrant
4. nipple discharge
5. axilla
6. supraclavicular lymph node
ENT.
25
1. Rinne test
2. Weber test
3. Bing test
4. Schwabach test
5.
1 Doctor-Patient Relationship
1.
2.
National License PIII OSCE SWU
32
3. /
4.
2 /
1. Rinne test 1
mastoid
2. Weber test
3. Bing test mastoid
4. Schwabach test
4.1 mastoid mastoid
4.2 mastoid
mastoid
5.
1. Rinne test
2. Weber test
3. Bing test
4. Schwabach test
. Conductive hearing Lt, Normal hearing Rt
33
Eye- ENT.
1. / 1
1 Doctor-Patient Relationship
1.
2.
3. /
4.
2 /
1. /
2. Alcohol
3. /
4.
5.
6. /
fulcrum
Fix
7. foreign body upper palpebral
conjunctival
8. foreign body foreign body
9.
Antibiotic eye drop remove F.B.
10.
11.
12. Antibiotic /
National License PIII OSCE SWU
34
1.
,
2.
10% Xylocaine ( 5% cocaine) + Ephedine pack
5 10 ()
3.
Nasal speculum
4.
Chloramph oint Vaseline guaze
5.
bayonet forcep Vaseline gauze 10 - 15 cm.
speculum gauze
6.
speculum forcep
7.
guaze
8.
guaze
9.
Posterior packing Foleys cath.
10. bleed admit 2
Pediatric
National License PIII OSCE SWU
35
1. 1 12
BCG, HBV3 , DPT3 , OPV3 , MMR1
,
Medicine
1. Fist aid management of injury pateint
1 . 25
1.
2.
36
1 ( 15-20 1
)
2 (fang mask)
echymosis, petechiae
37
()
VCT
VCT VCT
NSAIDs
38
2. airway management
15
( )
1.
2. head-tilt chin-lift techniques
finger sweep
( finger sweep )
3. 10 look-listen-feel
4. mouth-to-mouth 2 ( )
5.
6. xyphoid process
7. abdominal thrust x 5
8. head-tilt chin-lift techniques
9. mouth-to-mouth 2 ( )
10. carotid ( )
11. recovery position
3. airway mangement
22 10
diazepam 20
(
)
39
stylet
Lidocaine gel
(face mask) ambu bag
5.
( )
(ambu bag & mask) oxygen
ambu bag ambu bag 1/3-1/2 bag
6.
laryngoscope () blade
epiglottis
glottis ()
stethoscope
ambu. bag
syringe cuff
6. (chest X-ray)
3. ACLS
1. 42 type 1 DM 10 NPDR DN 2 severe
rheumatoid arthritis 3 2
2 15
1. ABCD
Airway (RA risk atlantoaxial subluxation) Breathing ()
Circulatio ( pulse / apex)
EKG VT
40
Defibrillation
( biphasic defibrillator/cardiovertor)
2. CPR 5 cycle
( CPR median nipples)
3. Pulseless electrical activity; PEA ( normal EKG pulse)
4. Adrenaline 1 mg IV CPR 5 cycle
5. check EKG pulse 5 (EKG asystole)
6. Adrenaline atropine 1 mg CPR 5 cycles
7. Check EKG pulse
(EKG-normal sinus, pulse + check 5H, 5T asystole)
2. 68
Management ( endotracheal tube , monitor BP
pulse oximetry)
check airway, breathing, conscious, circulation
Key : , SpO =70%
2
CPR (chest compression + ambu) 2
Key : 180 /mm BP = 90/40
management
Key : Paddle EKG lead EKG
EKG
Key : regular, wide complex tachycardia
P BP management
Key : synchronized cardioversion
defibrillation/cardioversion unit
synchronized
100 J (monophasic)
jelly paddle paddle 2 jelly paddle
paddles right upper sternum clavicle apex
paddle 2-3 cm.
charge apex paddle
fully charged clear
paddle 25 lb/paddle discharge/shock paddle 2
cardiac rhythm, P, BP
Key :
National License PIII OSCE SWU
41
1. electrolytes imbalance
2. ischemic heart disease
3. pneumothorax
lab : K = 7.0 meq/l
Key :
1. 10 % Ca gluconate
2. Insulin + 50% glucose 50 cc / 7.5% NaHCO3 50 cc
3. Kayexalate
4.
; BYRD
16 (tidal volume) 400 cc.
- = 1:2 air-mixed
1.
2.
(sensitivity, effort)
3.
4.
5.
400 cc.
6. 16 /
expiratory time
7. I:E = 1:2
I : E 1 : 3
expiratory flow rate
8. air-mixed
FiO2 1.0
FiO2 1.0
National License PIII OSCE SWU
42
1. ,
2.
3.Hyperextend
4.
5. Modified Allens test ( radial ulnae artery
ulnae artery )
22 24 syringe 5 .
6. heparin 0.5 . syringe heparin
syringe radial artery
7. 1-3 . syringe
5
8. syringe
6. subcutaneous
; 50
NPH 14 U sc ac insulin
1.
2.
3.
4.
insulin ()
insulin
insulin insulin
*
5. insulin 70% alcohol
6.
*
7. syringe insulin
8. insulin syringe
syringe insulin
National License PIII OSCE SWU
43
9. insulin syringe
insulin syringe
10.
11. syringe
12. 70% alcohol
13.
14. syringe
45-90
15. syringe
16.
7.
1. 45
2. ascites shifting dullness
3. sterile
5. 70% alcohol povidine 2-3
5.
6. peritoneum
7. 18-20 G syringe 10 cc.
8. peritoneum (Z track
technique)
9. ascites
10. ascites
11. specimen
(albumin, cell count, cell differential, culture hemoculture)
44
1
2
3
4
5
6
7
8
9
10
L3-L4 (
Iliac crest )
spinal needle No.18-21
set povidine 70% alcohol
18 1%xylocaine 5 ml 22
interspinous ligament
styletbevel stylet
spinal manometer three way stopcock
spinous process
guard
,subcutaneous, interspinous ligament ligamentum flavum()
subarachnoid space stylet
opened pressure spinal manometer
CSF sterile 3-4
1 culture
2 protein&sugar
3 cell
9. MDI
1.
2.
3.
4.
5.
6.
7.
8.
2
1
10
2 puff 1
2
- 1
inhaled steroid bronchodilator
inhaled steroid
2. T-piece
1 T-piece 22 .
6 12 T-piece 22 .
3. Nebulizer ( bubble Jet)
4. oxygen flow > 6 Lpm ( 6 ) >10 Lpm ( 1
5. T-piece 15 . ETT
6. Nebulizer
46
Surgery
Excission
excision subcutaneous mass
1
1. Betadine solution
2.
2
1.
2. push air
3.
4. negative pressure
5. ( field block )
3
1.
2. forceps
3. ( elliptical incision )
4.
2. Dressing wound
. Dressing post operative thyroidectomy proper sterile technique
disposable
47
3.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
cutting
1 /3
silk
holder
forcept
vertical mattress
half bury
4. BK amputation stump
- Anterior bandage 2
-
- distal stump stamp
eg. Distal medial
distal ulnar
5. Digital block
1.
2. Sterilized alcohol, plaint
3. landmark
4. superficial landmark neurovascular digit
5.
- Syringe 10 ml.
- 25
6. periosteal point dorsum & point volar
48
1. 55 5
PE Left knee : mild swelling and inflammation, crepitation, varus deformity
Film= OA knee
1 /
1.
2. /
2.1
2.2 x-rays
2.3 50
2.4
2.5 crepitus
3.
3.1 Isometric exercise
3.2 Isotonic exercise
3.3 , , ,
4.
4.1
4.2
4.3
4.4
4.5 lateral wedge
4.6 knee brace
4.7 gait aid
cane
49
2. 42
hypertension, DM
(BMI) = 24.5 kg/m2 Blood pressure 150/95 mm. Hg
FBS
Chest X-ray EKG
hypertension
( 45 55 / // /
/ HDL )
1. 1 2
cholesterol
2. 1 6
National License PIII OSCE SWU
50
3. 1 2
4. 3 30
1 LDL 160 mg/dl
51
3.
1.
2.
3. 5 ( 1 = 3 )
4. / /
5.
5.1
5.2
5.3 ( hind milk )
6. 2 3
7. ( 4C ) 24 48
8.
9. ( 14 C ) 3
10. /
11.
4.
Advice
.
1.
(2), (2)
(2 ) COPD (3 )
2.
3.
- 2
-
-
-
5.
STAR
Set a quit date
2
52
Anticipate challenges 4D
Deep breath
Drink water
Do something
Delay
Remove tobacco product
Arrange
Relevance
Risks
Rewards
Reloadblocks
Repetition
53
6. 55 5 1-2
6.
1.
, , , ,
2.
54
3.
4.
5.
6.
6. 25
Chick list
1.
Alcohol 70%
Rabies
Immunoglobulin
2. vaccine
Human diploid
cell vaccine Purified vero vaccine Purified
chicken embryo cell vaccine
(deltoid muscle) 1 dose 0,3,
7,14,28 0
3. Rabies immunoglobulin (RIG)
4. 0, 1, 6
( 2 )
National License PIII OSCE SWU
55
5.
ampicillin
amoxycillin metronidazole
Clindamycin
6.
7.
,
56
8. 65 1 5
Paracetamol
Check list
.
1. NSAID
1.1 60
1.2
1.3 (Antacids), H2 antagonist
Omeprazole
1.4
1.5
2.
3. drug interaction
ASA coumadin
.
1. NSAID
2.
3.
4. NSAID Indomethacin
5. NSAID
.
(CBC, urinalysis,lives
enzymes, electrolyts, BUN, creatinine, stool ocult blood
9. 28 1 ,
AFB + 3
Chick list
1.
1.1
1.2
1.3
1.4
2.
2.1
57
( 6 )
2.2
2.3
breast feeding
rifampicin
3.
3.1
3.2
3.3
3.4
4.
. /
, Chest X-ray
.
Chest X-ray, tuberculin test
58