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OSCE Examiner Checklist Book As of 20 Sep 2016
OSCE Examiner Checklist Book As of 20 Sep 2016
2015-2016
Authors
Dr. Zelaikha Al-Wahedi Dr. Mohamed Salem
Sr. Consultant, Family Asst. Prof. Family Medicine,
Medicine, Primary Health Care Suez Canal University, Egypt
Corporation, Qatar
2
Preface
3
Contents
Title................................................................................................................................................ 1
Author ............................................................................................................................................ 2
Preface .......................................................................................................................................... 3
Respiratory OSCEs..................................................................................................................... 6
Peak Expiratory Flow Rate (PEFR) Technique ............................................................................ 7
Asthma Inhaler Techniques .......................................................................................................... 8
Pressurized Metered-Dose Inhaler ............................................................................................... 8
Turbuhaler ..................................................................................................................................... 9
Accuhaler ...................................................................................................................................... 10
Checklist for Smoking Cessation Counseling .............................................................................. 11
Checklist for Lung Cancer Screening ........................................................................................... 13
Cardiovascular OSCEs............................................................................................................... 14
Checklist for chest pain................................................................................................................. 15
Checklist for Post-Myocardial Infarction Counseling.................................................................... 16
Gastrointestinal OSCEs ............................................................................................................. 18
Checklist for Abdominal Pain........................................................................................................ 19
Endocrine OSCEs ....................................................................................................................... 21
Initial Examination for Diabetic Patient ......................................................................................... 22
Diabetic Foot Examination Checklist ............................................................................................ 24
Checklist for Gestational Diabetes ............................................................................................... 26
Checklist for Thyroid Gland Examination ..................................................................................... 28
Checklist for Obesity Counseling.................................................................................................. 30
Neurology OSCEs ....................................................................................................................... 31
Checklist for Headache................................................................................................................. 32
Musculoskeletal OSCEs ............................................................................................................. 33
Checklist for Back Examination .................................................................................................... 34
Checklist for Knee Joint Examination ........................................................................................... 36
Checklist of Shoulder Examination ............................................................................................... 38
Pediatric OSCEs.......................................................................................................................... 40
Checklist for Counseling on Breastfeeding ................................................................................. 41
Checklist for Vaccination Defaulters ............................................................................................. 43
Checklist for Nocturnal Enuresis .................................................................................................. 44
Checklist for Attention Deficit Hyperactivity Disorder (ADHD) ..................................................... 45
Checklist for Constipation in children ........................................................................................... 47
Gynecology & Obstetric OSCEs ............................................................................................... 48
Checklist for Pre-Marital Counseling ............................................................................................ 49
Checklist for Infertility .................................................................................................................... 51
Checklist for Menopause .............................................................................................................. 53
Checklist for Menopause and HRT .............................................................................................. 54
Psychiatry OSCEs....................................................................................................................... 55
Checklist for Depression ............................................................................................................... 56
Ethics OSCEs .............................................................................................................................. 58
Breaking bad news (IUFD) ........................................................................................................... 59
ENT OSCEs .................................................................................................................................. 61
Checklist for Ear Examination ...................................................................................................... 62
Checklist for Dizziness / Vertigo ................................................................................................... 63
Checklist for Tinnitus .................................................................................................................... 65
Mens Health OSCEs .................................................................................................................. 67
Checklist for Erectile Dysfunction ................................................................................................. 68
Geriatric OSCEs .......................................................................................................................... 70
Checklist for Geriatric Care ......................................................................................................... 71
Checklist for Travelers Advice ..................................................................................................... 72
4
5
Respiratory OSCEs
6
Peak Expiratory Flow Rate (PEFR) Technique
Not Attempted Attempted
Step/Task
Attempted Inadequate Adequate
7
Asthma Inhaler Techniques
Ask the patient to show you how they use their inhaler. Use these checklists to
teach, check and/or confirm the way your patients with asthma use their inhalers.
Assess inhaler technique at every opportunity.
1. Remove cap
8
Turbuhaler
Not Attempted Attempted
Step/Task
Attempted Inadequate Adequate
9
Accuhaler
Not Attempted Attempted
Step/Task
Attempted Inadequate Adequate
10
Checklist for Smoking Cessation Counseling
N Step/Task Not Attempted Attempted
Attempted Inadequate Adequate
1 Introduce yourself to the patient and use his/her
name
Explore other patient personal details (as occupation,
2 residence, marital status and special habits of
medical importance as smoking and alcohol)
3 Explores ICE
4 5 As Approach
Ask about:
Type of smoking
Frequency
Duration
Quitting history (and causes of failure)
Effect of smoking on patient quality of life
Advice the patient to quit smoking
Assess willing to quit
If willing, go through Assist
If not, motivate him/her through the 5 Rs as described
down
Assist the patient to quit through
- Ask for a commitment
- Set a quitting date and tell your family and doctor
- Discuss methods to help the smoker to quit:
Behavioral methods:
Smoking diary.
Progressive restriction
Find alternatives to oral and hand activity.
o Avoid smoking cues as ashtrays from surrounding
environment.
Develop social support.
o Avoid situation that will tempt you to smoke (friends,
parties).
Use Self-help materials.
o Learn to do something that will distract your craving
Pharmacological methods
o Nicotine replacement therapy (gum, patch, spray and
lozenges)
o Drugs as Bupropion and Varencline
(dose, duration, effectiveness, side-effects and
precautions)
Other methods
o Smoking cessation programs.
o Acupunctures, hypnosis.
11
Arrange for follow up plan or referral
5 5 Rs Approach
(In case the patient is not willing to quit)
Risks
Emphasize disadvantages of smoking:
(Medical, social (children, pregnant wife), religious and risk
of fires)
Reward
Emphasize benefits of smoking cessation
Relevancy
- Focus on short term changes.
- Tailor to the clinical situation. e.g. asymptotic patient, or
patient with acute respiratory illness, pregnancy or
chronic disease (DM, Hypertension, Myocardial
infarction, and/or COPD).
Road Blocks
- Withdrawal symptoms.
- Weight gain.
Repetition
Repeat the information and check understanding
12
Checklist for Lung Cancer Screening
STEP/TASK Not Attempted Attempted
Attempted Inadequate Adequate
Opening Session
Introduce yourself to the patient and uses his name
Data Gathering Domain
Explore smoking history details ( type of smoking,
frequency and duration )
Calculate the smoking index
Explore patient Ideas, Concerns and Expectations
Asks about possible symptoms suggestive for lung
cancer as cough, expectoration, hemoptysis, chest
pain, dyspnea, anorexia and weight loss in the past 6
months etc.
Ask about past history of lung cancer or any organ
cancer
Ask about family history of lung cancers or cancers in
general
Assess psycho-social aspects ( depression and
anxiety)
13
Cardiovascular OSCEs
14
Checklist for chest pain
Step/Task Not Attempted Attempted
attempted inadequate adequate
- Introduces self appropriately
- Clarifies reason for visit
Obtains history of chest pain
Onset
Location
Precipitating factors
Alleviating factors
Associated symptoms
Quality
Radiation
Severity
Timing/duration
Identifies risk factors for heart disease
Past medical history
Family history of heart disease or risk
factors
Smoking history
Illicit Drug use (especially cocaine)
Hypertension
Lipids/cholesterol
Recent stressor
Exercise tolerance
Focused review of systems
Heartburn/GERD symptoms
Pain with movement/palpation
Medications
Allergies
Summarizes history
Checks for any other concerns or missed
information Ideas ,concern, and
expectation
Psychosocial assessment
Encourages patient to discuss any
additional points
Follow up
15
Checklist for Post-Myocardial Infarction Counseling
N Step/Task Not Attempted Attempted
Attempted Inadequate Adequate
1 Introduces yourself to the patient and use his/her name
Explore other patient personal details (as occupation,
2 residence, marital status and special habits of medical
importance as smoking and alcohol)
Analyze patient complaint as regard onset , course and
3
duration
4 Explores ICE
5 Ask about effect of problem(s) on patient quality of life
6 Screen for depression
Ask about anxiety symptoms as being afraid, nervous,
7
worry, restless, irritable .. etc. GAD7
8 Ask about the nature of coronary artery disease
Ask about post-infarction symptoms as:
- Chest pain
9 - palpitations
- Light headedness
- Fatigue
Ask about risk factors as obesity, dietary habits, salt
10
intake and stressors
Ask about current medications as for antihypertensive,
11 anti-diabetic anti-lipids, cardio-tropics, anticoagulants
and phosphordistrase inhibitors
Ask about past history of stroke, PAD, HTN, DM and
12
dyslipidemia
13 Ask about family history of cardiovascular diseases
Advice regarding therapeutic life style interventions:
- Exercise: (Importance, type, intensity, duration and
frequency, warming up and when to stop)
- Diet: (Importance, type, amounts and how to
prepare)
- Reduce salt intake (Importance, amount,
14
alternatives)
- Reduce weight (Importance, recommended
percentage)
- Stop smoking (Importance)
- Stop or reduce alcohol intake according to patient
values
16
- Avoid possible stresses
Counsel about Job ( when to return and modifications if
15
needed)
Advice about sex (when to resume, position, possible
16 complications as post coital angina and how to manage,
drug interactions and precautions)
17 Advice about driving (when to resume and precautions)
Advice about travelling (when to resume and
18
precautions)
Advice and arrange for necessary investigations
19
(laboratory, ECG or echo or catheterization)
20 Any other questions he 1 she would like to ask.
17
Gastrointestinal OSCEs
18
Checklist for Abdominal Pain
No Step/Task Not Attempted Attempted
Attempted Inadequate Adequate
1 Communication:
Candidate should introduce him/her self
Candidate should establish an effective rapport
Good eye to eye contact
Candidate should encourage patient contribution
2 Questioning Skills
Candidate appropriately use open and close
ended questions.
Candidate ask clear questions.
Candidate avoids leading questions and jargon
3 Patient Personal Information
Candidate obtain data as:
Age
Occupation
Marital status
Special habits of medical importance as
smoking and alcohol intake
4 Explore the Nature of Patient Problem
Candidate should ask about:
Onset of abdominal pain
Course (Frequency): cyclic, continueetc
Duration
Radiation
Nature of pain (dull ache, colicky or stepping)
Severity
5 Precipitating/Aggravating Factors:
Candidate should ask if:
Pain worsen at night or when hungry
Pain occurs after heavy or fatty meals
Pain related to menstruation
6 Reliving Factors:
Candidate should ask if:
Pain relieved by antacid, paracetamol or other
analgesia
Pain relieved by rest
Pain relieved with eating
Pain relieved with hot water bottle
7 Associated Features:
Candidate should ask about
Red Flags Symptoms:
Fever
Anorexia
Nausea or vomiting
Dysphagia
Regurgitation.
Weight loss
19
Hematemesis
Change in bowel habits
Possible Cardiac Causes:
Retrosternal pain
Sweating
Dizziness
Possible UTI Causes
Dysuria
Frequency and nocturia
Haematuria
Dyspeptic Symptoms
Heartburn.
Flatulence
Appetite
Hepatic and Biliary Symptoms
Jaundice
Change in urine or stool colour
Biliary colic
Gynaecological Causes
Vaginal bleeding
Vaginal discharge
Pregnancy
Last menstrual period
Others:
History of abdominal or back trauma
8 ICE (Idea, Concern, Expectation)
9 Impact of disease (Physical, Social, Psychological)
10 Past Medical History
Candidate should ask about
Recurrence / similar attacks in the past.
Hospitalization
Drug history
Allergies
Travel history
11 Lifestyle
Candidate should ask about
Dietary habits
Exercise
Weight
12 Summarization of findings
13 Diagnosis
14 Ending Consultation
20
Endocrine OSCEs
21
Initial Examination for Diabetic Patient
Not Attempted Attempted
Step/Task
Attempted Inadequate Adequate
Introduction:
- Introduce yourself to the patient
- Confirm patient details name / DOB
- Explain the examination to the patient
- Gain patient consent
- Wash hands
General Examination:
- General Appearance: Describe patient
general appearance
- Gait: Comment on patient gait while walking
- Check Vital Signs and Measurements
Pulse ( rate and rhythm )
Blood Pressure ( sitting and standing )
Height, Weight and BMI
Waist circumference
Specific Examination:
Skin Examination
- Inspect sites for insulin injection (
Lipodystrophy, atrophy )
- Look for signs of insulin resistance as
acanthosis nigricans
- Comment if you noticed any features of hair
loss, granuloma annulaire, necrobiosis lipidica
diabeticorum or nail changes
Head Examination:
Face
Comment if you noticed any features of
endocrinopathies( Cushing, Hypothyroidism ),
hydration and pigmentation
Eyes
Comment if you noticed signs as xanthelasma
or arcus senilis
Check pupil reaction
Check light reflex
Check visual Field
Check visual acuity
Check ocular movements
22
Perform funduscopy
Neck Examination:
Check carotid pulse and bruit
Check for jugular venous pulsation ( at 45
degree )
Examine thyroid gland
ENT Examination:
o Perform quick ENT exam
o Look for oral cavity hygiene, dental cares and
fungal infection
Chest Examination: Examine lungs for basal
crepetations
Heart Examination: Examine for heart sounds ( S3,
S4, gallop rhythm )
Abdominal Examination: Examine for organomegly
Feet:
Inspection: inspect for edema, skin changes,
deformities, wounds, ulcers, abrasions and
fungal infections in between toes
Palpation: Feel temperature and pulses on
both sides
Sensation: perform light touch, vibration
sense, position sense
Reflexes: Check for presence/absence of
patellar and Achilles reflexes
To complete examination:
- Thank your patient
- Wash your hands
23
Diabetic Foot Examination Checklist
Not Attempted Attempted
Step/Task
Attempted Inadequate Adequate
Introduction:
- Introduce yourself to the patient
- Confirm patient details name / DOB
- Explain the examination to the patient
- Gain patient consent
- Position patient on bed at 45
- Expose patients lower legs & feet
- Wash hands
Inspection:
Inspect legs & feets thoroughly, lifting legs up to see underneath &
ensuring to look between toes
Colour Comment if you noticed any:
pallor / cyanosis /erythema (e.g. cellulitis / ischaemia)
Skin- Comment if you noticed any:
Dryness / shiny skin / hair loss Peripheral vascular disease /
Eczema / haemosiderin staining Venous disease
Hair- Comment if you noticed any
Atrophic changes as loss of hair
Nail Condition- Comment if you noticed any:
Thick, too long, ingrown, or infected with fungal disease
Ulcers Inspect between toes / heels / underneath legs and
comment if you noticed any:
Venous ulcers moderate to no pain larger /shallow associated
with venous insufficiency / varicose veins OR
Arterial ulcers very painful deep punched out appearance
associated with diabetes mellitus / peripheral vascular disease
Swelling: Comment if you noticed any:
Oedema bilateral pitting oedema e.g. venous insufficiency / heart
failure
DVT unilateral calf swelling +/- oedema pain on palpation
Calluses Comment if present, may indicate incorrectly fitting shoes
Venous filling guttering of veins / reduced visibility suggests PVD
Deformities caused by neuropathy (e.g. Charcots disease):
Comment if you noticed any:
High arches / Clawed toes / Prominent metatarsal heads
Palpation:
Feel Temperature cool (e.g. PVD) / hot (e.g. cellulitis)
Check Capillary refill normal = < 2 seconds prolongation
suggests PVD
Feel Pulses:
Dorsalis pedis artery lateral to Ext Hal Long tendon
Posterior tibial artery posterior & inferior to medial malleolus
Absent peripheral pulses is suggestive of peripheral vascular
disease
Sensation:
Monofilament
1. Provide an example of monofilament sensation on the patients
arm / sternum
24
2. With the patients eyes closed, place monofilament on the hallux &
metatarsal heads (1/2/3/5)
3. Press firmly so that the filament bends
4. Hold the monofilament against the skin for 1-2 seconds ask
patient to say when he/she feel it
Avoid testing on sites as calluses / scars, as the patient will have
reduced sensation in these areas
Vibration sensation
1. Ask patient to close his/her eyes
2. Tap the 128hz tuning fork
3. Place onto patients sternum & confirm patient can feel it buzzing
4. Ask patient to tell you when he/she can feel it on his/her foot & to
tell you when it stops buzzing
5. Place onto the distal phalanx of the great toe on each leg in turn
6. If sensation is impaired, continue to assess more proximally
e.g. proximal phalanx etc
Other tests to consider:
If abnormalities in monofilament or vibration sensation are identified,
consider carrying out these further tests.
Proprioception
1. Hold the distal phalanx of the great toe by its sides
2. Demonstrate movement of the toe upwards & downwards to
the patient (whilst they watch)
3. Then ask patient to close their eyes & state if you are moving the
toe up or down
4. If the patient is unable to correctly identify direction of movement,
move to a more proximal joint ( ankle > knee > hip)
Ankle jerk reflex
1. Dorsiflex the foot
2. Tap tendon hammer over the achilles tendon
3. Observe the calf for contraction normal reflex
Ankle jerk reflex may be absent in advanced peripheral neuropathy
Gait:
Observe the patient walking, assessing:
- Symmetry / balance
- Turning quick / slow / staggered
- Abnormalities broad based gait / foot drop / antalgia (may
suggest ongoing Charcot joint
Examine footwear:
Note pattern of wear on soles asymmetrical wearing
suggestive of gait abnormality
Ensure the shoes are the correct size for the patient
Note any holes / material inside the shoes that could
cause rubbing / foot injury
To complete the examination:
Thank patient
Wash your hands
Say you would
- Perform a full neurovascular assessment of the limbs
if indicated
- Advice on the importance of glycemic control & good
foot care
25
Checklist for Gestational Diabetes
STEP/TASK Not Attempted Attempted
Attempted Inadequate Adequate
Opening Session
Introduces yourself to the patient and uses her
name
Explore other personal details ( occupation,
residence and special habits of medical
importance as smoking and alcohol)
Data Gathering Domain
Ask about Present Obstetric History Details :
1. Gestational age by last menstrual
period or by ultrasound
2. Previous pregnancies and labors
1. Number of previous pregnancies
2. Number of abortions
3. Complications during
pregnancies as diabetes
4. Complications during labor
5. Mode of previous deliveries (
vaginal, caesarian)
6. Status of living births ( full term
or preterm)
7. Weight of living births at delivery
Ask about Contraceptive History Details
3. Method of previous contraception
4. Duration of use
5. Complications
Ask about Past History Details
6. Chronic diseases
7. Medications
8. Hospitalization and surgeries
Ask about Family History Details
9. Chronic diseases as diabetes
26
Ask about the Impact of Problem on the
patient
Ideas, Concerns and
Expectations ( ICE )
Impact of diabetes on mother
and fetus
Assess Psycho-Social Aspects ( Depression and
Anxiety)
Clinical Management Skills
Offer explanation regarding blood sugar results
Order 75 gm oral glucose tolerance test (OGT)
to screen for DM
Interpret readings of 75 gm oral glucose
tolerance test (OGT)
Establish diagnosis of patient problem
Take the appropriate workup plan for the
patient including :
Diet counseling
Blood sugar monitoring
Explain available approved
medications including insulin therapy
Referral for women hospital
Follow up
27
Checklist for Thyroid Gland Examination
Opening Session
1- Candidate introduces himself to the patient
2- Candidate obtains permission to examine the
patient
3- Candidate explains examination details to the
patient
4- Candidate washes his/her hands
Hand Examination:
1- Candidate should first feel hands for any
sweating.
2- Candidate should look for any tremor - placing a
piece of paper on the backs of the patient's
outstretched hands may show this.
3- Candidate should check patient nails for any
thyroid acropatchy - similar to clubbing, or
onycholysis
4- Candidate should observe for any palmar
erythema which may occur in hyperthyroidism.
5- Candidate should feel the pulses bilateral and
assess the presence of water-hammer pulse
Eye Examination
1- Confrontation Test
2- Lid lag test
Lower Limb :
1. Candidate should check for peritibial oedema
2. Candidate should test ankle jerk reflex
28
Inspection of Thyroid Gland:
1- The patient should be seated in a comfortable
position with the neck in a neutral or slightly
extended position.
2- Have the patient swallow a sip of water, watching
for the upward movement of the thyroid gland.
Palpation of Thyroid Gland:
(Anterior Approach or Posterior Approach)
Note: There is no data comparing palpation using
the anterior approach to the posterior approach so
examinee should use the approach that they find
most comfortable.
1. Candidate should attempt to locate the thyroid
isthmus by palpating between the cricoid
cartilage and the suprasternal notch.
2. Candidate has to slightly retract the
sternocleidomastoid muscle with one hand while
using the other to palpate the thyroid.
3. Candidate should then has the patient swallow a
sip of water as he palpates, feeling for the
upward movement of the thyroid gland.
Percussion of Thyroid Gland:
Candidate should percuss the manubrium for a
retrosternal enlargement
Auscultation of Thyroid Gland :
Candidate should auscultate the thyroid gland for
possible bruit
Lymph nodes Examination:
Candidate should palpate regional lymph nodes for
consistency and mobility
29
Checklist for Obesity Counseling
STEP/TASK Not Attempted Attempted
Attempted Inadequate Adequate
Opening Session
Candidate introduces himself to the patient
and uses his name
30
Neurology OSCEs
31
Checklist for Headache
No Step/Task Not Attempted Attempted
Attempted Inadequate Adequate
Candidate introduces himself to the patient
1 and uses his name
Explore other patient personal details
2 (occupation, residence and special habits of
medical importance as smoking)
Analyze patient complaint as regard onset ,
3 course and duration
Ask about present history details
Possible causes of headache
4
Red flags
5 Screens for depression
Explores ICE
6
Ask about effect of problem(s) on patient
7 quality of life
32
Musculoskeletal OSCEs
33
Checklist for Back Examination
Opening Session
1. Introduce yourself to the patient
2. Obtain permission to examine the patient
3. Explain examination details to the patient
4. Wash your hands
Patient Standing
Inspection:
Gait (patient without shoes)
Back for scoliosis, lordosis, swelling,
masses, color, & scars.
Palpation: Palpate the following landmarks:
Spine land marks: C7, T3 (scapular spine),
T7 (inferior angle of scapula) & L4 (iliac
bone).
Skin for hotness, tenderness (infection,
fracture, ) & masses.
Muscle spasm.
Sacroiliac joints.
Percussion: For deep tenderness
Movement:
Toe-walk S1
Heal - walk L5
Squat & rise L4
Movement: flexion, extenuation, lateral
flexion.
Patient Sitting:
Inspection: scoliosis, muscle wasting.
Movement:
Rotation
34
Extend knees role out disc prolapse.
Knee reflex.
Patient Supine:
Examine free side first.
Movement:
Straight leg raising test (S L R) Active,
passive & crossed SLR
Bragard test.
Lasegue test.
Figure of four (sacro-iliac joint)
Power:
Hip flexion. L1 - L2
Knee flexion; L5 S1
Knee extension: L3 L4
Foot planter flexion. S1
Foot dorsi flexion. L4 L5
Big toe dorsi flexion
Foot inversion: L4 L5
Foot eversion: L5 S1
Reflexes:
knee reflex: L3 L4 (if not done while
patient is sitting)
Ankle reflex: S1
Sensation:
Medial side of foot. L4
Dorsum of foot. L5
Lateral side of foot: S1
Patient Prone:
Femoral nerve stretch. L4
Compress midline as in CPR
35
Checklist for Knee Joint Examination
STEP/TASK Not Attempted Attempted
Opening Session
heels)
Washes hands
Ask the patient to walk for you and observe any limp
or obvious deformities
around patient
Muscle waste
Erythema/Swelling
flexion deformity)
flexion
36
extension
damage.
damage
one hand over the knee joint itself and the other
37
Checklist of Shoulder Examination
Not Attempted Attempted
No. Step/Task attempted inadequately Adequately
1 The patient is asked to expose the upper
chest.
The patient is asked to sit.
The resident stands at the back of the
patient and also at front and sides
2 INSPECTION (during standing and lying
flat)
Inspect both shoulders from:
Above
Sides
Front
In reference to the opposite side for:
Shape and contour of the bone
and alignment
Size
Color of the skin
Wasting of muscles
Scares
Inspect the axilla
Inspect for fracture of clavicle
3 PALPATION:
The resident palpate the following joints
and comment each time on:
Tenderness
Hotness
Swelling
(both sides)
The anterior and lateral aspects of the
glenohumeral joint by the index and
middle finger of right hand while
supporting the shoulder with left hand.
The upper humeral shaft and head with
axilla with middle and index fingers of
right hand while raising the arm with the
left hand.
The acromio-clavicular joint by putting
middle and index finger of right hand
above it.
The whole of the clavicle by the tips of
middle three fingers of left hand while
standing behind the patient.
38
No. Step/Task
4 MOVEMENTS:
The resident test the active movements
and comment each time on:
- Crepitation
- Range of movements
- Pain during movements
External rotation
39
Pediatric OSCEs
40
Checklist for Counseling on Breastfeeding
Step/Task Not Attempted Attempted
Attempted Inadequate Adequate
Opening Session
- Introduces yourself to the patient and uses her name
- Explore other personal details ( as occupation,
residence and special habits of medical
importance as smoking and alcohol)
Data Gathering Domain
- Explore mothers ideas concerns & expectations
(ICE)
- Ask about Past History Details
o Chronic diseases
o Medications
- Obtain brief obstetric history (if she have twins)
- Ask about contraception experience and plan
- Ask about previous experience of breast feeding
(duration and difficulties)
- Assess Psycho-Social Aspects ( Depression and
Anxiety)
Education and Technique
- Educate mother about importance of breast
feeding (psychological, economic, immunity, less
allergy and contraception ..etc.)
- Assess current mother knowledge and practices
toward sound breastfeeding (positioning and
attachment)
- Encourage breast feeding considering that:
1. Breast feeding should be initiated as soon after
delivery
2. During the first 2 weeks, feed on demand
3. Nurse baby 10 minutes at least on the first breast
then as long as he want on the second breast
4. Alternate which breast you start with each time
41
5. Always keep nipple dry
6. No bottles should be offered to the baby
7. Milk supply improved by adequate sleep, fluids,
relaxed environment, reduced stress
8. Signs of baby satisfaction with breast feeding
(weight gain, bowel habits and sleeping)
- Advice regarding sound breast feeding technique:
Ensure privacy
The mother should sit comfortably with back
supported
The baby should have a large part of the areola in
his mouth
For working mother welling to breast fed, pumping
technique should be discussed
- Ask mother to demonstrate technique and give her
your feedback
- Answer any inquiries might be raised by mother
and give her reassurance & support
42
Checklist for Vaccination Defaulters
STEP/TASK Not Attempted Attempted
Opening Session
weight, Nutrition)
Chickenpox
6- Convulsions
7- Allergies
8- CURRENT Medications
(Vaccination Schedule)
43
Checklist for Nocturnal Enuresis
No Step/Task Not Attempted Attempted
Attempted Inadequate Adequate
44
Checklist for Attention Deficit Hyperactivity Disorder (ADHD)
No Step/Task Not Attempted Attempted
Attempted Inadequate Adequate
45
12 Offers appropriate explanation about
management options either in primary or
secondary level including:
46
Checklist for Constipation in children
STEP/TASK Not Attempted Attempted
1. Opening Session
(Establishes rapport)
Constipation
problem
47
Gynecology & Obstetric
OSCEs
48
Checklist for Pre-Marital Counseling
Opening Session
1. Candidate should introduce himself to the
client(s)
2. Candidate should confirm client(s) details
3. Candidate must ensure privacy
History Taking:
1. Candidate should obtain relevant socio
demographic data as age, education,
occupation, consanguinity to the partner,
sequence of marriage.
2. Candidate should obtain relevant medical /
surgical / psychological histories:
a. Ask about systemic illness such as:
hypertension, diabetes mellitus, heart
problems, epilepsy, etc.
b. Ask about previous surgical history
(date, type, where it was done).
c. Ask about history of blood transfusion
(date, frequency, place, etc.).
d. Ask about history of STI or genital
lesions.
e. Ask about current medications.
3. Candidate should obtain relevant family
history of chronic or genetic diseases.
4. Candidate should assess risky behaviours
such as smoking, alcohol consumption or
substance abuse.
5. Candidate should explore if client(s)
previously married, if they have any children
and history of baby with congenital
abnormality
49
Physical Examination
1- Candidate should assess client(s) general
appearance.
2- Candidate should obtain baseline
measurements and vital signs (as height,
weight, BMI, blood pressure and pulse).
3- Candidate should explore relevant general
examination details depending on client(s)
history.
Laboratory Tests
Candidate should request the following lab
tests:
Fasting or Random Blood Sugar
CBC.
Blood grouping and Rh.
Hb electrophoresis.
Sickling test.
Rubella antibodies IgG (for females).
VDRL test for syphilis
HIV test.
HBsAg.
Anti HCV antibodies.
Other tests for molecular genetic diseases:
- Cystic Fibrosis (CF).
- Homocystinurea*.
- Spinal Muscular Atrophy (SMA)(optional)*.
Management Plan
1- Candidate should offer counselling to client(s)
if needed .
2- Candidate should provide clients with
premarital educational materials which
includes the following information:
Concept and aim of premarital
screening.
Common haemoglobinopathies in Qatar.
Sexually Transmitted Infections (STIs).
Healthy lifestyle.
Various methods of contraception.
3- Candidate should offer to provide
vaccinations if indicated.
4- Candidate should offer treatment if required.
5- Candidate should schedule for revisit or
referral accordingly
50
Checklist for Infertility
No Step/Task Not Attempted Attempted
Attempted Inadequate Adequate
1 Communication Skills:
Introduce yourself to the patient
Establish an effective rapport with the
patient
Make good eye to eye contact
2 Patient Personal Information
Ask about:
Age
Occupation
Duration of marriage
Special habits of medical importance as
smoking, alcohol, and caffeine consumption
3 Chief Complaint:
Ask about current problem/complaint
Define Infertility (primary or secondary)
4 Male / husband Infertility
Ask about:
Occupation (radiation exposure)
Previous marriages and offspring
History of previous or known infertility in
husband
Libido and erectile dysfunction in husband
Chronic diseases as DM, HTN..
History of sexual transmitted diseases
Surgeries for varicocele
Semen analysis
5 Present History:
Analyse patient complaint (onset, course
and duration)
Ask about:
Recent cervical smear findings,
Breast changes as milk-like discharges,
Hirsuitism
Wight loss or gain
Acne on face and chest,
Hot flushes,
51
8 Past History:
Ask about:
Any current associated medical illness as
diabetes and/or hypertension, hyper-
hypothyroidism
Drug intake prescribed as non-steroidal
anti-inflammatory drugs (NSAIDs), sex
steroids and cytotoxic drugs or recreational
as marijuana and cocaine,
Pelvic infection, tuberculosis, bilharzias,
Ovarian cyst,
Surgeries as appendectomy, laparotomy,
caesarean sections, and cervical conisation.
Rubella status
9 Menstrual History:
Ask about:
Age of menarche,
Regular/irregular cycle
Frequency
Amount
Any associated symptoms as premenstrual,
painful menstruation or intermenstrual
spotting.
History of primary or secondary amenorrhea
10 Obstetric History:
Ask about:
Previous pregnancies, if any, and its
outcome,
Ectopic pregnancies
Abortions,
Post-abortive infection or puerperal sepsis
11 Contraceptive History:
Ask about Previous use of contraceptive
methods, particularly intrauterine system, Oral
contraception pills
12 Sexual History:
Ask about:
Coital frequency,
Timing in relation to the cycle,
Use of vaginal lubricant before, or vaginal
douching after coitus,
Loss of libido,
Difficult or painful coitus
13 Family History:
Ask about:
Family history of infertility,
Family history of Spontaneous abortion,
stillbirth, and congenital disease
14 Summarization
15 Ending consultation
52
Checklist for Menopause
No Step/Task Not Attempted Attempted
1 Opening Session
Explores ICE
53
Checklist for Menopause and HRT
No Step/Task Attempte Attempt
Not
d ed
Attempt
Inadequ Adequa
ed
ate te
Candidate introduces himself to the patient and uses his
1 name
54
Psychiatry OSCEs
55
Checklist for Depression
No Step/Task Attempte Attempt
Not
d ed
Attempt
Inadequ Adequa
ed
ate te
1 Introduces yourself to the patient and use his/her name
56
11 Explores ICE
57
Ethics OSCEs
58
Breaking bad news (IUFD)
Action Step/Task Not Attem Attempt
attem pted ed
pted inade adequat
quatel ely
y
Establish rapport Call by name.
Introduce yourself.
Eye to eye contact.
Verbal and non verbal cues
Active listening.
Silence.
Consultation tips Empathy.
Respect.
Interest
confidentiality
Complain or reason Encourage patients contribution
for attendance
Steps and skills for breaking bad news
Preparation: Allow uninterrupted time
Use a comfortable, quite
environment.
Invite spouse, relative, and friend
as possible.
Take good history: Present pregnancy: gravidity and
parity, LMP, EDD.
Abnormal symptoms like abdominal
pain, PV bleeding, or discharge,
burning micturition, polyurea,
polydypsia, fever, rash, headache,
dizziness, blurring of vision.
Previous pregnancy.
Past Medical and Surgical history.
Trauma history
Drug history.
Social history: smoking, personal
resources, family support.
Family history.
Examination General, vital signs, Temp, BP
Abdomen for fundal height, foetal
heart sounds.
LL oedema
Begin the session Summarize the findings, check with
the patient.
Discover what has happened since
59
the last visit.
Check how the patient is thinking or
feeling
60
ENT OSCEs
61
Checklist for Ear Examination
Att Atte
Not e mpt
Step/Tas atte m ed
No.
k mpte pt adq
d ed uate
1 Introduction of himselflherself, asking for permission and in ly
of the ear examination
2 External ear (auricle or
- Inspect each ear and surrounding (deformity, lumps
- Palpate both mastoid processes and check for
- Gentle pulling each auricle upward and
3 Ear Canal
- Insert Otoscope to proper depth and inspect the external
auditory
canal (discharge or foreign bodies, redness,
4 EarDrum
- Check landmar (clear, obscured, any perforation,
the
bulging) ks colour,
- Light
5 Assess Hearing (Distinguish between a sensonueral and
hearing
loss}
Rinne
- Strike the tuning fork to make it vibrate
- Place the fork on the mastoid, pressing
- Hold the fork about three inches away from
-- - Explanation: normally, the patient should hear the tuning fork
in front and quieter behind -ve test). Positive Rinne test: bone
conduction> air conduction.
6 Weber
- Strike the tuning fork to make it vibrate.
- Place the fork in the middle of the forehead or the
- Ask the patient if he can hear the sound equally in both ears/
on one
- Explanation: normally should hear the sound equally in both
(Unilateral conductive loss, the Weber will localize to the
Unilateral sensoneural loss, the Weber will localize to the
unaffected ear).
7 Whisper
7 General organized
62
Checklist for Dizziness / Vertigo
Step/Task Not Attempted Attempted
Attempted Inadequate Adequate
Opening Session
or disequilibrium)
symptoms
hyperventilation, explosion
life,
63
Ask about history of pervious attacks
loss
problems.
64
Checklist for Tinnitus
No Step/Task Not Attempted Attempted
Attempted Inadequate Adequate
1 Opening Session
Candidate introduces himself to the patient and
uses patient name (Establishes rapport)
65
effects on general health)
5 Ask about past history of tinnitus and other
chronic conditions
6 Ask about family history of tinnitus, hearing loss,
or neurofibromatosis
7 Explores patient ideas, concerns & expectations
ICE
8 Assess psycho-social aspects ( sleep, appetite
and interests)
Clinical Management Skills
9 Offer appropriate explanation regarding the
nature of the problem (eye, ear,
musculoskeletal, neurological and vascular)
10 Arrange for appropriate workup plan for the
patient to reach a diagnosis (as audiometry,
neuroimaging and vascular imaging)
11 Schedule the follow up
66
Mens Health OSCEs
67
Checklist for Erectile Dysfunction
STEP/TASK Not Attempted Attempted
attempted inadequate adequately
Initially establish good rapport.
Explore, reasons for vitamin need
Create favourable and professional
environment
Explore patient ICE and Impact of the
problem
Ask straightforward inquiries about sexual
function
Onset of dysfunction. Course and Duration.
Explore the details of patient sexual life e.g.,
Type : Premature Ejaculation, Impotence,
Poor Sustained Erection,)
Presence of Nocturnal or early morning
erection
Degree and timing of the dysfunction;
consistency of dysfunction, occasional, or
situational. e.g., No sustained erection with
detumescence after penetration is most
commonly due to anxiety or the vascular
steal syndrome.
Does the patient have other sexual relations
currently?
If yes, with men or women or both?
If not, when did the patient last sexual
intercourse with wife?
Does the patient satisfied with the frequency
and quality of his sexual experience?
Presence of depression (Loss of libido and
lack of interest in any sexual activity), or
Performance anxiety, or Lack of sensate
focus (preoccupied with financial pressures,
travails of the business world).
Presence of fatigue before sexual act
Lack of privacy.
Have unresolved anger with his wife.
Presence of associated Symptoms; STD's.
Presence of Vascular insufficiency (PAD)
symptoms
68
Presence of Autonomic neuropathy
(retrograde ejaculation).
Evidence of hyperprolactinemia,
hyperthyroidism, hypothyroidism, and
testicular disease.
Presence of Prostatic operation or
prostatism
Presence of Risk factors: Chronic disease;
DM, HTN, obesity, MS, dyslipidemia, CV
disease, spinal cord or back injury, Smoking.
Ask about substance abuse; Excessive
alcohol consumption. Recreational
substances.
Use of Antihypertensive drugs (e.g,
thiazides, CCB, ACEi) or Use of
Antidepressants, Anti androgens such as
GnRH agonists and 5-alpha-reductase
inhibitors, Spironolactone, Sympathetic
blockers such as clonidine, guanethidine, or
methyldopa.
Use of Dinitra
Explore wife age, pre or menopausal symptoms,
any other chronic problems, loss of libido?
Explain to the patient causes and management
of his problem
Order basic investigations
Manage the case through pharmacological and
non-pharmacological approaches
69
Geriatric OSCEs
70
Checklist for Geriatric Care
STEP/TASK Not Attempted Attempted
attempted inadequately adequately
Opening Session
Candidate introduces himself to the patient and uses
his name
1. Functional Assessment
Activity of daily living (Eating -Dressing -
Bowel Control )
Instrumental daily living ( Shopping-
Cooking-Laundry-Telephone-Manage
Money-Taking Medicines-climb stairs-Walks
to Toilet )
2. Physical Health Assessment
Chronic Conditions
Specific Geriatric Conditions ( Falls-
Dementia-Incontinence-Visual or Hearing
Impairment)
Medications side effects and poly pharmacy
3. Nutritional Status
Income sufficient to buy food items
Eating habits
Taste and smell sensation
Denture use
Alcohol intake
Vitamin deficiency symptoms
4. Psycho Social Assessment
Anxiety symptoms
Depression Screening
Caregivers
5. Mini Cognitive Assessment ( Dementia )
Repeating three un related words
Draw clock 10 minutes after 11
Recall the previous three words
6. Home environment arrangement
Safety regarding Stairs, Bathrooms, Kitchen
and Light
7. Screening
Vision ( if symptomatic)
Hearing ( Referral to Audiometry )
Osteoporosis ( DEXA Scan )
8. Select lab tests
9. Arrange for follow up
71
Checklist for Travelers Advice
72
Specific Preventive Measures :
Vaccination :
Candidate should provide the client with vaccines if needed for
the following diseases typhoid fever, yellow fever, hepatitis A
vaccine
Chemoprophylaxis for malaria
Candidate should provide the client with chemoprophylaxis if
needed for malaria
Preventive Measures against Mosquito Bites:
Candidate should advice the client to avoid mosquito bites
through:
( Wearing long-sleeved clothing and long trousers, Use of
mosquito net during sleeping, Appropriate use of insecticides
Prophylactic Measures for STDs: Candidate should avoid
risky behaviors as unprotected sex.
73