Master Copy Student - Osce Remediation Student Guide

OSCE REMEDIATION
STUDENT GUIDE
OSCE REMEDIATION
CRASH COURSE TO PASSING THE OSCE
Hello you beautiful and capable student! We would like to formally welcome you to the very informal
Clinical Skills (CS)/OSCE 2022 remediation. Over the course of the next several sessions, you will be paired
up with a tutor and fellow student(s) who is/are also remediating. This guide has been designed by your
tutors to supplement learning materials already provided in the CS course. Any checklists provided have
been created by the tutors through cross-referencing of official CS learning materials and our own notes.
In the event of a discrepancy between this guide and your official CS learning materials, please notify Dr.
Lydia Czegledi so that this can be clarified with Dr. Leah Peters. Please note, tutor sessions have been
designed for hands-on practice; this will require you to review relevant CS learning material and objectives
as well as preview the checklists and content presented in this guide. Please remember that no question is
“silly”; these sessions are a judgement-free zone. As such, we would strongly encourage you to actively
participate and engage during sessions. Although there is a suggested rate of progression through the
topics presented, rate of progression and topics covered should ultimately be determined collaboratively
and tailored to the study group’s needs. If, at any point, you have concerns or feel you require additional
support and practice, please send Dr. Lydia Czegledi an email and we will try to accommodate your needs
to the best of our ability.
- Dr. Lydia Czegledi and Dr. Katrina Leong

OSCE REMEDIAL STUDENT GUIDE | JUNE 2022
GENERAL OVERVIEW
TOPICS TO COVER
Day Major Body System Pages

1 History Taking 101 4-11
Cardiovascular Examination
Respiratory Examination
2 History Taking – Deeper Dive 12-16
3 Abdominal Examination 17-18
4 Head and Neck Examination 19-20
5 Neurological Examination 21-25
6 MSK Examination 26-33
OSCE PRACTICE STATIONS
Some of the practice cases have been taken and modified from “OSCE and Clinical Skills Handbook” by Katrina F. Hurley.
Other practice cases are purely fictional and concocted by your tutors. These are meant to serve as opportunities for skill
consolidation and formative feedback. While there has been communication between Dr. Czegledi and Dr. Peters, this
guide (including example stations) has not been reviewed by Dr. Peters and/or Dr. Battad.
FORMAT OF TUTOR SESSIONS
• Groups of 2-3 students will be paired with a tutor to allow for hands-on practice of physical examination skills
with immediate formative feedback. These sessions will be 2-3 hours in duration. If you require additional
support and practice, please email Dr. Lydia Czegledi (czegledl@umanitoba.ca) to arrange for additional
tutoring and support.
• Where possible, sessions will be in-person to allow for hands-on experience.
• Tutors have been given practice OSCE scenarios to allow for higher fidelity practice. These formative stations
will be timed using the same breakdown (2 minutes to read the prompt, 15 minutes inside the station) as the
OSCE. This practice is completely formative and is meant to help students identify skills that require further
practice.
2
OSCE EXPECTATIONS
• Students must manage time effectively within an OSCE station. In our experience, this requires having an
analogue watch and being able to perform a physical examination in ~5 minutes (for MED 2) and ~7 minutes
(for MED 1). However, this is variable depending on individual stations. Students should remember to factor in
aspects such as closing the encounter, answering any patient and/or station questions, etc.
• In addition to demonstrating proper physical exam technique, students must demonstrate strong interpersonal
and communication skills including transitioning from open-ended to closed-ended questions, active listening
skills, and building rapport by validating feelings and acknowledging difficulties the patient is experiencing.
• Given the time constraints on an OSCE, it is generally acceptable to tell the examiner that “I would complete
this physical examination on the contralateral side for assess for symmetry but will not today for the sake of
time.”. Similarly, in the MSK exam, it is generally acceptable to say “Normally, I would assess the joint on the
contralateral side, as well as the joints above and below, but will not today for the sake of time.”. If an MSK
station requires you to assess multiple joints, this will be specified on the station prompt.
o THE EXCEPTION TO THIS: NEUROLOGICAL EXAMINATION
§ If a neurologic exam is required, students will likely be required to complete specific parts of
the neurologic exam (ex: cranial nerves, or cerebellar exam, or motor exam). This has been
designed in this manner for the express purpose of allowing sufficient time for you to
demonstrate a BILATERAL neurological assessment. It is not sufficient to demonstrate a
unilateral neurological examination in an OSCE station.
LEVEL OF OSCE EXPECTATIONS

TRAINING
MED 1 COMPLETE HISTORY
NORMAL PHYSICAL EXAM TECHNIQUE & FINDINGS
PATIENT COUNSELLING
- ex: sharing a result (ex: positive pregnancy test) and asking them how they feel about the
result.
MED 2 COMPLETE HISTORY
NORMAL PHYSICAL EXAM TECHNIQUE & ABNORMAL FINDINGS
DIAGNOSTIC INTERPRETATION
- ex: being able to read the PFT or spirometry results presented within the station.
- ex: being able to identify frank findings to the examiner, such as an obvious pneumothorax on
a CXR.
DIFFERENTIAL DIAGNOSIS FORMULATION
PRELIMINARY MANAGEMENT STEPS
PATIENT COUNSELLING
-includes sharing results, assessing for understanding and negative feelings, planning next steps
3
GENERAL OSCE APPROACH *This is a comprehensive approach to a patient

history. Remember that some stations will
1. Initiating the Session require other skills to be performed (e.g.,
o KNOCK on the door physical exam, information sharing, station
o Introduce yourself, your pronouns, and level of training questions). Therefore, we recommend that
students are familiar with each of these
o Wash/sanitize your hands
components yet tailor their approaches to a
o Ask about name preference focused history, when necessary*
o Ask permission to see the patient – “I’ve been asked by
Dr. Jane to take a history/ take a history and then do a physical exam, would that be ok with you?”
o Ensure the patient knows that an interview/exam can be paused at any time if they feel uncomfortable
2. Gathering Information/ patient history
a. Identifiers – patient’s full name and DOB
b. Chief complaint (reason for their visit or presentation)
c. History of Present Illness
i. OLD CARTS – onset, location, duration, quality, aggravating/alleviating/associated factors,
radiation, timing, severity
ii. IFFE – ideas, fears/feelings, functions, expectations
iii. General Review of Systems (ROS): weight changes, energy level, fever, sleep changes, appetite
changes
iv. System specific ROS
v. Summarize
d. Past medical history
i. Allergies to medications and the reactions to each
ii. Medical issues and current medications (both prescribed and OTC)
iii. Previous hospitalizations, illnesses, injuries, surgeries etc.
e. Family history
i. Health/cause of death of parents
ii. Hereditary diseases/illnesses
iii. Health of siblings (children/partner - if time permits)
f. Personal/social history
i. Et-OH use, smoking status, recreational substance use
ii. Hobbies, exercise, diet, supplements
iii. Alternative therapies
iv. Education, occupation, personal/religious affiliations
v. Relationships/social supports
3. Physical Examination
a. Focused/ “problem-oriented”
b. Complete/comprehensive
4. Explanation & Planning
o Provide summary; ask “Is there anything else I need to know to provide you with the best care?”
o Education
o Collaboration on treatment
5. Closing the Session
o “Do you have any questions about what we’ve covered?”
O NEXT STEPS – E.G.: FOLLOW-UP APPOINTMENTS, TESTING, ETC.
4
DAY 1
HISTORY-TAKING 101
GENERAL TIDBITS
v We’re trying to accomplish 3 things:

1. Gather information about the problem and patient
2. Establish rapport and respond to emotions
3. Provide education and collaborate on a treatment plan
v Some ways to build rapport during the patient encounter:
o “I’ve read a little bit about you already, but can you tell me what brought you in today?” – use of open-
ended question to start the encounter allows the patient to feel heard
o “I can see how distressed you’re feeling” – acknowledging emotions
o “After we’ve talked some more about your concerns, we’ll work together to see what solutions we can
come up with.” – offering support
o “I’m impressed with how you’ve been managing to cope, despite feeling so badly.” – recognizing the
patient’s strengths
v 6 components to keep in mind to facilitate the patient-centered approach:
1. Find common ground
o Ask about treatment/management preferences
o Asking “how do you feel about all of this?”
2. Health promotion/disease prevention
o Focus on risk reduction and early detection
o Facilitate access to screenings and education (pamphlets, etc.)
3. Effective Use of Resources
o Collaborating with allied health to address social determinants of health
4. Understand the dimensions of illness (IFFE)
o Patient’s ideas about the problem/treatment
o Patient’s fears/feelings
o How this problem affects their functioning
o Expectations for the appointment and treatment
5. Patient-Physician relationship
o Respectful, empathetic, use of purposeful pauses to allow patient to share
o Summarizing to assess accuracy of information gleaned and patient understanding
6. Social/developmental context
o How this condition impacts (positively or negatively) their ability to do their job, interact with their
family/friends, etc.
o Inquire about living situation
o Inquire about support systems available
• “Can you identify 3 people in your life that you could discuss this with?”
§ If not, providing access to counselling so that they have someone to talk to
§ Emphasizing that you will help in any way you can
5
GENERAL HISTORY-TAKING CHECKLIST
□ Knock on the Door!

□ “WIP”
o WASH or sanitize your hands
o INTRODUCE yourself (including name, level of training, and what you have been asked to do – take a
history, complete a physical, share results, etc).
o ASK for PERMISSION (including how the patient would like to be addressed and for permission to do
what you have been asked to do – history +/- physical exam)
□ IDENTIFIERS
o Patient’s name
o Patient’s age
o Patient’s DOB
□ HPi: OLDCARTS + déjà vu? + IFFE

o OLDCARTS
§ Onset
§ Location
§ Duration
§ Character
§ Aggravating and Alleviating Factors
§ Radiation
§ Timing (ex: time of day)
§ Severity (on a scale of 1-10)
o déjà vu?
§ “Has this ever happened to you before?”
§ “I understand this has been happening for quite some time now. Is there a particular reason
you decided to come in today?”
o IFFE
§ “Do you have any idea as to what it might be?”
§ “Are you afraid it might be something serious?”
§ “How has this been impacting your daily life?”
§ “What are you hoping to get out of this visit?”
□ ROS: General (“WEFAS”) + Specific

o “WEFAS”: weight, energy, fever/chills/night sweats, appetite changes, sleep disturbances
o System-Specific:
§ HEENT- ear aches, vision changes, sore throat,
§ NS - mood changes, headaches, dizziness, vision, hearing
§ CV - shortness of breath, chest pain
§ RSP - cough, sputum, pain/difficulty breathing
§ GI - abdominal pain, heart burn, changes in bowel functions
§ GU – LMP, discharge changes, pain/burning with urination
§ MSK - joint pain, swelling
§ Derm - rashes, sores, nails
6
□ PMHx:
o Gravida and Para
o Surgical history
o I/I – current issues and immunization status
o H – any previous hospitalizations
o Medications/OTC medications
o Allergies
□ SocHx:
o “SAD” – Smoking, Alcohol use, Drug use
o E/I – employment or income source
o Romantic relationships/ social support
o Diet, exercise, supps, vits, alternative therapies
□ FHx: Hereditary diseases in Parents, Siblings, +/- Children
□ Summarize, then collaborate on next steps or move on to examining patient.
SUGGESTED HOMEWORK: Practice writing out your history-taking outline. In the OSCE, you will have two minutes to
read the prompt and organize yourself before entering the encounter. You should be able to write out your history
outline using no more than 30 seconds of time. Once you have this framework on paper, you can refer to it when you
feel flustered within the station.
□ Knock on the Door!

□ “WIP”
□ IDENTIFIERS
□ HPi: OLDCARTS + déjà vu? + IFFE
□ ROS: “WEFAS” + System specific
□ PMHx:
o G & P’s
o S
o I/I
o Meds/OTC medications
o H
o Allergies
□ SocHx:
o “SAD” – Smoking, Alcohol use, Drug use
o E/I
o
oDiet, exercise, supps, vits,
□ FHx
□ Summarize
7
Cardiovascular History
SPECIFIC SYMPTOMS TO ASK ABOUT:
1. Chest Pain
a. Stable Angina
b. ACS/MI pain
c. MSK Pain
d. GERD Pain
2. Nausea +/- vomiting
3. Palpitations
4. Shortness of Breath
a. Exertional Dyspnea
b. Orthopnea
c. Paroxysmal Nocturnal Dyspnea (PND)
5. Peripheral Swelling/Edema
6. Syncopal episodes/pre-syncopal episodes
7. Dizziness vs Vertigo
DURING THE MEDICAL HISTORY, COMPLETE A CARDIOVASCULAR RISK ASSESSMENT:
1. Smoking status
2. Diabetes
3. Dyslipidemia
4. Hypertension
5. (+) Family History in 1st degree relative (♂ < 55 years of age and ♀ < 65 years of age)
SUGGESTED HOMEWORK:
o Practice reading ECG’s as you may be asked to demonstrate this in an OSCE station.
o Review CV1 and CV2 notes regarding JVP waveform and its relationship to systole and diastole – you should be
able to explain the JVP waveform if asked in an OSCE station.
HINT: Look up the acronym “POLICE”
8
Cardiovascular Exam
□ VITALS BP
HR Rate
*Note: You will generally NOT be Rhythm
required to perform a set of vitals
Character
but SHOULD mention them as part
of your physical exam. When in RR (“RREDS”) Rate
doubt, ask the examiner. Rhythm
Effort
Depth
Symmetry
O2 Saturation
Temperature
□ INSPECTION General
Cyanosis
Chest Wall
□ JVP Technique
Characteristics
Measurement
□ PALPATION Precordium Thrills

Heaves
Apex Beat (“LADS”) Location
Amplitude
Duration
Size
“Peripheral” Pulses Carotid
Radial pulse
Brachial pulse
Femoral pulse (describe only)
Popliteal pulse
Posterior tibealis pulse
Dorsalis pedis pulse
Peripheral Edema
PERCUSSION – nil.
□ AUSCULTATE Carotid
Aortic area
Pulmonic area
Tricuspid area
Mitral area
S3
S4
Murmurs + appropriate murmur grading
9
Respiratory History
1. Shortness of Breath
2. Cough
a. Productive vs Non-productive
b. Sputum quality and quantity
i. Color
ii. Volume
3. Hemoptysis
a. Volume
b. Frequency
c. Presence of blood clots
4. Chest Pain
5. Wheezing
6. Recent Travel
DURING THE HISTORY, COMPLETE SCREENING TO IDENTIFY POTENTIAL ETIOLOGY:
1. Special attention to the “B-symptoms” for malignancy etiology: Fever, chills, night-sweats, changes to weight
2. Detailed medication history, with particular attention to respiratory medication including puffers
3. Detailed Smoking History
4. Recent Travel
5. Environment or Occupational Exposures
a. Rural occupations/Farming
b. Welding/Painting/Wood Dust/ Grain Dust/ Heavy Metals/ Asbestos exposures
c. Pets
d. Recreational activities screen: bird breeder? sand blasting?
6. Family History
a. Allergies/Asthma
b. COPD
c. Cystic Fibrosis
d. Idiopathic Pulmonary Fibrosis
e. Pulmonary Hypertension
SUGGESTED HOMEWORK:
• Review RS1 and RS2 course material for practice on Chest XR interpretation. You should be able to demonstrate a
systematic approach to interpreting a Chest XR if asked in an OSCE station. You should be able to spot obvious findings
such as a pneumothorax or frank pneumonia or pleural effusion.
• Practice being able to differentiate obstructive vs restrictive disease processes on spirometry and PFT’s.
10
Respiratory Exam
□ VITALS BP
HR Rate
*Note: You will generally NOT be
Rhythm
required to perform a set of vitals
but SHOULD mention them as part Character
of your physical exam. When in RR (“RREDS”) Rate
doubt, ask the examiner. Rhythm
Effort
Depth
Symmetry
O2 Saturation
Temperature
Cyanosis
Abdomen/Chest Wall
Spine
□ PALPATION Trachea
Supraclavicular Lymph Nodes
Chest expansion
Tactile fremitus
□ PERCUSSION Posteriorly
Anteriorly
Laterally: RML & Lingula
Border of the Diaphragm
Diaphragmatic descent
□ AUSCULTATE Anteriorly Duration

Posteriorly (“DIPS”) Intensity
Pitch
Symmetry
Adventitial Sounds Crackles
Wheezes
Rhonchi
11
DAY 2
Pediatric History
A pediatric history will generally follow the above History 101 format but has many more components. Though it may look daunting, a history
for a well-child is certainly doable for an OSCE station. For convenience, an approach to the prenatal history in its entirety is included below.
SPECIFIC ITEMS TO COVER:
1. Introduction a. Source of milk (if infant: breastmilk vs.

a. Who is the historian? (Name, relationship) formula)
b. Child’s name and DOB b. Frequency of feeds
2. Entrance complaint/concerns c. Appetite
3. Perinatal history d. Solid foods
a. Maternal age e. Other sources of fluids e.g. water, juice
b. Gravida / Para f. Dietary restrictions
c. Presence of prenatal care 9. Development
d. Maternal illnesses during pregnancy a. Motor (fine, gross)
e. Abnormal prenatal tests b. Cognitive
f. Nutrition and exposures c. Language
4. Labour and delivery history d. Social
a. Labour e. Other behaviors/development
i. Gestational age i. Sleep
ii. Onset: Spontaneous vs. induced ii. Activity level
iii. Rupture of membranes – duration, iii. Temperament
meconium 10. Social history
iv. Complications a. Residence
v. Medications b. Caregivers
b. Delivery c. Recent changes in family e.g. death,
i. Mode: Vaginal vs. operative marriage, divorce
ii. Timing: Planned vs. emergent d. Family stability, supports
iii. Assistance e.g. forceps, vacuum e. Income / health insurance
iv. Place of delivery 11. Family history
5. Neonatal history a. Parents & siblings (age, health)
a. Apgar score b. Consanguinity
b. Weight, length, head circumferences c. Ethnicity
c. Complications e.g. jaundice, sepsis, d. Childhood deaths
hypoglycemia e. Familial predispositions
d. Interventions e.g. intubation, meds 12. ROS
e. Time spent in hospital before discharge a. Growth
6. Past medical history – see General History b. Spells e.g., fainting, seizures,
7. Immunizations unresponsiveness
8. Nutrition c. Sleep patterns including naps
12
Adolescent History (“HEADSS”)

If a teen patient is accompanied at the time of encounter, explain to the patient and caregiver that part of the appointment will
be conducted with the patient alone because it is important for them to feel comfortable providing information to ensure
optimal care. Adolescence is also a time of desired autonomy. However, address the limits of confidentiality.
“HEADSS” is the acronym that you are likely familiar with. It addresses various aspects of a teen’s social and developmental
history. You are both trying to get to know your patient, while also screening for challenges or areas of concern.
Some teens may provide vague or short answers; or may seem uninterested during the encounter. For the OSCE (and in real
life), spending a couple of minutes to build rapport will be worthwhile. As with any patient encounter, an Adolescent History
needs to be conducted in a non-judgmental and professional manner. Remember, you should still use anatomical language
even if it may make a child uncomfortable.
SPECIFIC ITEMS TO COVER / SYMPTOMS TO ASK ABOUT:
HEADSS Information of interest Possible areas of concern

1. Home Who, where Negative relationships with family
2. Education School, grade Learning problems, absenteeism/attendance
3. Activities Hobbies, sports, physical activity Seatbelt use, helmet use etc.
4. Drugs Alcohol & drugs Driving under the influence
• First time, frequency, quantity, type, route Interfering with school, activities, relationships
• Interest in quitting
• Friends’ use
• How are drugs being obtained
5. Sexuality Gender Unprotected sex
Sexual orientation Previous unwanted sex
Romantic interest(s) Missed periods
Sexual intercourse (See 5 P’s)
Contraception
6. Suicidality Mood Depression or other mood disorder
Self-harm, suicidal ideation Active SI, SH
5 P’s: Sexual and Contraceptive History

Partners Romantic vs. Sexual, current sexual activity, gender of partners
Structure of current relationship (monogamous, open, etc.)
Practices Type(s) of sexual intercourse

High risk sexual encounters (e.g. exchange of fluids, sex work)
Role in sexual encounters (receptive vs. insertive)
Satisfaction
Protection Type and frequency of protection
Past History Age of onset of sexual activity

Past STIs (type, duration, treatment)
History of sexual assault/abuse
Pregnancy GP status
Plans for pregnancy 13
Menstrual history
Prenatal History
A prenatal history will generally follow the above History 101 format, which an emphasis on obstetric history, the current
pregnancy, and social history. For convenience, an approach to the prenatal history in its entirety is included below. For the
OSCE, you will of course not be asked to perform a physical exam requiring vaginal/pelvic exam. But you could be asked about
appropriate lab investigations – see below.
1. Pregnancy history
a. Patient’s age
b. GTPAL status
c. Mode of past deliveries
1st visit prenatal labs:
d. Overall health of previous pregnancies
2. Current pregnancy Bloodwork: CBC, blood type with Rh status,
a. When/how did patient find out they were pregnant? glucose
b. LNMP à Be able to provide EDD Serology: Syphilis, HIV, Varicella, Rubella, Hep B
c. Planned vs unplanned Cultures: Gonorrhea, chlamydia
d. Does partner/family know? Urine: UA and Culture
e. Symptoms / Body changes
f. Patient concerns
g. Experience so far overall 1st Ultrasound is an anatomy scan usually done
3. Past Medical history at 18-21 weeks. Often it is the only US done in a
a. HTN or DM (specifically ask about these) normal pregnancy
b. Other medical conditions
Other genetic screening tests are available, but
c. Medications including prenatal vitamins + folic acid these are time sensitive. Refer to CS1 Women’s
d. Past surgeries Reproductive Health Session for more info.
4. Family history
a. Congenital abnormalities
b. Hereditary health conditions
c. Twins in the family Follow up frequency:
5. Lifestyle and social history
a. Current living arrangement • Every 4 weeks until 28 weeks
b. Social supports • Every 2 week until 36 weeks
c. Employment/income • Every 1 week until delivery
d. Hobbies/activities
e. Stress
f. Safety
g. Substance use (including tobacco and alcohol)
14
Psychiatric History
The psychiatric history is one of the most challenging histories to obtain – both in content and technique. Since there is no
physical exam, you are tasked with obtaining a lot of key information. A complete encounter will consist of 3 parts: History,
Suicide Risk Assessment, and Mental Status Exam. Be sure to read the station prompt careful to determine which of these skills
are being assessed. As with the Adolescent History, it is worthwhile to spend a minute or two trying to develop rapport with
your patient. Come up with common catch phrases that normalize patient experiences. In this type of history, it is also
important to discuss confidentiality and the limits of confidentiality. Recognize the patient’s verbal/non-verbal signs; consider
matching them. For example, if a patient with depression is talking softly and slowly, it is better to speak in the same manner.
A. HISTORY
1. HPI as in History 101

a. Tailor specific questions depending on symptom/entrance complaint (e.g., SIGECAPS, DIG FAST)
2. Past Psychiatric History
a. Age at first symptoms, first contact with psychiatry/mental health
b. Psychiatric hospitalizations
c. Psychotropic medications (past/current and adherence)
d. Recent pregnancy (recall postpartum psych conditions)
e. Suicide attempts including method, medical attention, and date of last attempt
3. Collateral history – Consider mentioning to the examiner
4. Past personal and developmental history
a. You are trying to get a sense of past relationships, major events, family structure; that could help explain
presentation
b. Depending on patient’s age, consider asking about childhood, adolescence, adulthood
c. If stuck, ask about “love, work, play” (relationships, employment/education, activities)
5. Family history of Psychiatric illness
6. Psychiatric ROS – You are looking for any co-existing psychiatric conditions
a. Depression
b. Anxiety
c. Psychosis
d. Substance use – Type, route, frequency, first use, last use, perceived benefits
7. IFFE
15
B. SUICIDE RISK ASSESSMENT
SAD PERSONS:
1. SAD PERSONS (These are risk factors for suicide)
2. Indirect vs. Direct Approach Sex = Male
a. Indirect Example: “Sometimes people in your situation feel that their life is
Age > 60
not worth living. Is this something you can relate with?”
b. Direct Example: “Have you had thoughts of killing yourself / taking your life?” Depression
3. If suicidal ideation is present: Previous attempts
a. Frequency
b. Duration EtOH abuse
c. Pervasiveness (constant, comes and goes) Rational thinking loss
d. Impulsivity of patient
Suicide in family
e. Extent and details of suicide plans
f. Extent and details of actions taken Organized plan
No spouse/supports
Serious illness / pain
C. MENTAL STATUS EXAM (‘ASEPTIC’)
You may recall that the MSE is something you are completing while obtaining a history. It is often referred to as the “physical
exam of psychiatry”. Be familiar with at least some or all its components – these are fair game ;)
1. Appearance / behavior
2. Speech
3. Emotions (Mood vs. Affect)
4. Perception
5. Thought content and process
6. Insight and Judgment
7. Cognition
SUGGESTED HOMEWORK:
o PEDS: Practice writing out all 12 components of the pediatric history or feel free to create your own checklist. On a
real exam, you should be able to do this in 30-45 seconds.
o ADOLESCENT: Practice the uncomfortable teen questions (often these are about sex, drugs, mood).
o PRENATAL: Review the formula for EDD; become familiar with 1st visit routine tests.
o PSYCH: Practice discussing confidentiality and its limits.
16
DAY 3
GI / Abdominal History
1. Abdominal pain
a. Location (quadrant and/or flank)
b. Association with meals
2. Dysphagia
a. Solid vs liquid vs both
3. Nausea +/- Vomiting
4. Bowel habits
a. Diarrhea, constipation, obstipation
b. Change in frequency, quantity, quality/character
5. GI bleeding
a. Melena, hematochezia
b. Coffee-ground emesis, hematemesis
DURING THE HISTORY, COMPLETE SCREENING TO IDENTIFY POTENTIAL ETIOLOGY:
1. B-symptoms that may suggest cancer: fever, night sweats, weight loss
2. Mimickers: Myocardial infarct, ruptured aneurysm, obstetric emergencies
3. Family history
a. Cancers
b. Genetic syndromes related to GI
c. Inflammatory bowel disease
d. Autoimmune disease
4. Social history
a. Sick contacts, incarceration
b. Recent travel
c. History of drug use
d. History of alcohol use
e. Sexual practices, tattoos, body piercings
5. Medication/supplement use
a. NSAIDs, aspirin
b. Caffeine
c. Antibiotics
6. Diet and exercise
17
Abdominal Exam
□ VITALS BP Please refer to CV and RSP exam checklist.
HR
RR
O2 Saturation
Temperature
Skin
Umbilicus
Shape of abdomen
Flanks
Movement
□ AUSCULTATE Bowel sounds
Vascular bruits Aortic

Renal arteries
Friction rubs
□ PERCUSSION General
Liver Liver span
Ascites: Shifting Dullness
Spleen General
Castell’s sign
Traube’s space
□ PALPATION General
Liver Hook maneuver

Bimanual exam
Ascites: Fluid wave
Spleen
Abdominal aorta
SUGGESTED HOMEWORK:
o Practice the flow of an abdominal exam – there’s a lot to cover, and we also don’t want to move the patient
around too much or unnecessarily.
o Med 2s: Be familiar to differential diagnoses for quadrant-specific pain. You should have a basic understanding of
how to manage common presentations.
18
DAY 4
Head & Neck History
1. Recent or past head/ear trauma

2. Important to specific unilateral vs bilateral symptoms
3. Occupational exposures – noise, particulate matter
4. Vestibular symptoms such as vertigo and imbalance
RECALL HEADACHE “RED FLAGS”:
Red flags!
SNOOP MRI or CT
Systemic Constitutional symptoms

Neurologic Confusion, LOC
Focal neuro SSx
Papilledema, meningismus, seizures
Onset is new or sudden e.g. > 40 years
e.g. Thunderclap headache
Other associated Head trauma
conditions / features Illicit drug use, toxic exposure
Worse in the AM
Worse with Valsalva
Worse with cough, exertion, sex
Previous headache Worsening severity
history with change in Increasing frequency
status New clinical features
SUGGESTED HOMEWORK:
• Ensure you know anatomical boundaries and are comfortable describing them for the anterior and posterior triangle
of the neck.
• Be able to verbalize lymph node groupings as you demonstrate their palpation.
• Be able to describe a normal-appearing optic disc – it can be helpful to search images and practice verbalizing normal
findings.
• Please review how to use findings on Weber and Rinne test to differentiate sensorineural from conductive hearing
loss.
19
Head & Neck Exam

HR
RR (“RREDS”)
O2 Saturation
Temperature
□ HEAD Face Inspect Scalp, hair, eyebrows, face

Palpate Scalp, Temporal and Masseter muscles
Eyes Inspect Eyelids, eyelashes, periorbital area, conjunctivae, sclera
Assess CN II (Optic)
- Visual acuity
- Visual Fields by confrontation
- Fundoscopy
CN III (Oculomotor), IV (Trochlear), VI (Abducens)
- EOM’s
- Accommodation reflex
- Pupillary light reflex
Ears Inspect External ears, TM’s using Otoscope
Assess CN VIII (acoustic or vestibulo-ocular)
- Whisper test
- Weber test (256 or 512 Hz)
- Rinne test
Sinuses Palpate Frontal and maxillary
Nose Inspect Septum and nares bilaterally
Assess Nasal Patency bilaterally
Mouth Inspect Pharynx, tonsils, buccal mucosa, gums/dentition, salivary
glands, tongue, under the tongue
□ NECK Neck Inspect Skin

Masses
Lymph Nodes Palpate Preauricular
Postauricular
Occipital
Posterior cervical
Cervical/tonsillar
Submandibular
Submental
Cervical chain
Supraclavicular
Trachea Inspect & Palpate Tracheal tug/position
Thyroid Identify Thyroid and cricoid cartilage
Inspect Using tangential lighting and swallowing water technique
Palpate
Auscultate *Only if appears enlarged, would be looking for bruit*
20
DAY 5
Nervous System History
SPECIFIC QUESTIONS TO ASK:
1. Location of symptoms
a. Focal vs. diffuse
b. Symmetrical vs. asymmetrical
2. Neuro-specific symptoms/issues:
a. Cognition including language and memory
b. Senses (Smell, Vision, Taste, Hearing, Touch)
c. Dizziness vs syncope
d. Numbness, tingling, pain
e. Weakness
f. Strength/Movement
g. Gait
3. Associated risk factors for disease
(e.g., For stroke: áCholesterol, álipids, HTN, FHx stroke)
DISCRETE COMPONENTS OF A NEUROLOGICAL EXAM:
1. Cranial nerve testing

2. Reflexes
3. Motor exam (tone & power)
4. Sensory exam
5. Coordination
6. Gait assessment
21
Neurological Exam
HR
RR (“RREDS”)
O2 Saturation
Temperature
□ CRANIAL NERVES I Olfactory
II Optic Visual acuity
Visual Fields by confrontation
Fundoscopy
III Oculomotor Inspect

IV Trochlear EOMs
VI Abducens Accommodation reflex
Pupillary light reflex
Swinging light test
V Trigeminal Inspect
Motor testing
Corneal reflex
Jaw jerk reflex
Touch: V1 forehead, V2 cheek, V3 chin (light, pain, temp)
VII Facial Frontalis

Orbicularis oculi
Buccinator
Orbicularis oris
Anterior 2/3 tongue for taste
VIII Vestibulocochlear Inspect

Whisper test
Weber test: Normal = NO lateralization
Rinne test: Normal = Air > Bone
For simplicity, can use 512 Hz tuning fork for both tests
IX Glossopharyngeal Often IX and X are assessed together

X Vagus Palatal elevation
Articulation
Gag reflex
IX Posterior 1/3 tongue for taste
XI Spinal Accessory Inspect

Trapezius
SCM
XII Hypoglossal Inspect

Tongue side-to-side
Tongue into cheek
22
□ REFLEXES Biceps (C5/6) Contraction of biceps Grading:
Flexion at elbow 0: Absent
1+: Diminished
Brachioradialis (C5/6) Supination of forearm 2+: NORMAL
Flexion at elbow 3+: Brisk, NO clonus
4+: Hyperactive WITH clonus
Triceps (C6/7) Contraction of triceps
Extension at elbow
Patellar (L2-4) Contraction of quadriceps

Extension at knee
Ankle (L5/S1) Contraction of calf

Plantarflexion
Plantar (L5/S1) Normal response is downward

flexion of toes
Abnormal is upgoing toe
(Babinski sign)
□ MOTOR Inspection Muscle bulk

Symmetry
Abnormal movements or positioning
Tone Assess for normal tone

Test for hypertonia
- Spasticity: Velocity DEPENDENT
- Rigidity: Velocity INDEPENDENT
Power UPPER C5 Elbow flexion Grading:

C6 Wrist extension 0: No muscle contraction at all
C7 Elbow extension 1: Flicker or fasciculation
C8 Finger flexion 2: Movement when gravity
T1 Finger abduction absent
3: Movement against gravity
LOWER L2 Hip flexion 4: Movement with gravity and
L3 Knee extension some resistance
L4 Ankle dorsiflexion 5: Movement with resistance
L5 Great toe extension
S1 Ankle plantarflexion
Pronator drift
□ SENSORY Sensation Light

Pinprick
Temp
Vibration
23
Proprioception
Romberg test
□ CO-ORDINATION Inspection Speech

Nystagmus
Head bobbing
Non-rhythmic movements
Gross Finger-to-nose
Heel-shin
Fine Rapid alternating movements

Thumb to fingers
Toes to heel
□ Gait Walk straight

Tiptoes
Heels
Tightrope/tandem
24
FIGURE 1: UPPER AND LOWER EXTREMITY DERMATOMES. ADAPTED FROM "DERMATOMES" BY DR. M.
DOMINGUEZ, 2019, MED BULLETS STEP 1. RETRIEVED FROM
HTTPS://STEP1.MEDBULLETS.COM/NEUROLOGY/113038/DERMATOMES.
COPYRIGHT 2019 BY LINEAGE. ACCESSED 25 MAY 2022
Test findings in NORMAL and ABNORMAL hearing:
Normal Conductive HL Sensorineural HL

Weber NO lateralization Lateralization to BAD ear Lateralization to GOOD ear
Rinne AC > BC BC > AC AC > BC
SUGGESTED HOMEWORK:
o Practice dermatomes and myotomes – know them forwards and backwards!

o Review how to localize lesions; motor and somatosensory pathways
o Review components of the Glasgow Coma Scale (GCS)
o Review components of the diabetic neurovascular exam
o Med 2s: UMN vs. LMN lesions
25
DAY 6
MSK History
SPECIFIC QUESTIONS TO ASK:
1. Mechanism of Injury:
a. Duration of symptoms: acute, subacute, chronic?
b. Event: acute or repetitive?
c. Onset: Sudden or gradual?
d. Who, what, when, where, why?
e. Symptoms at time of injury?
e.g. Swelling, discoloration, deformity, noise?
e.g. Could they bear weight immediately post-injury?
f. Pain/issue immediately above/below injury OR on contralateral side?
g. Kinetic chain: Injury in one part of limb may be accompanied by injuries elsewhere
2. When completing OLDCARTS, be specific about “Pain” including TYPE and INTENSITY
Type of pain Feels like:

Bone Deep, boring, localized
Vascular Diffuse, aching, poorly localized
Muscle Usually hard to localize, dull, aching
May with contraction/stretching
Peripheral nerve pain Sharp or burning
CNS/PNS Numbness, tingling (paresthesia/dysesthesia), hyperalgesia, allodynia
3. Important to ask about what they’ve already tried to alleviate symptoms

• OTC medications and dosing
• Use of crutches, braces, etc.
• Physiotherapy, OT, massage therapy interventions
4. VERY IMPORTANT to explore impact on functioning

a. Are they still able to go to work?
b. Is this injury impacting their social life and contributing to social isolation?
5. Review of systems should be complete, but with special emphasis on dermatologic and neurological involvement.
26
Skin changes Neurologic manifestations
• Malar Skin (SLE) • Sensory complaints: Paresthesia
• Scaly rash & pitted nails (Psoriatic arthritic) • Weakness
• Papules, pustules, vesicles • Bowel/bladder (Enquire if suspect radiculopathy)
• Papules on soles & palms, erosions or scales on the penis o Cauda equina
(reactive arthritis) o Myelopathy
• Maculopapular rash
• Ischemic changes
• Alopecia
• Red, burning eyes (Ankylosing spondylitis)
• Diarrhea & Abdominal pain (Reactive arthritis)
• Urethritis (Reactive arthritis)
• Raynaud’s phenomena
REMINDER ON TERMINOLOGY:
Þ Allodynia: Pain due to normally non-painful stimuli

Þ Hyperalgesia: Increased sensitivity
Þ Paresthesia: Abnormal sensation whether spontaneous or provoked (NOT unpleasant)
Þ Dysesthesia: Abnormal sensation whether spontaneous or provoked (UNPLEASANT)
Þ Somatic pain: Severe chronic or aching pain, but inconsistent with injury or pathology to specific anatomical structures
o Cannot be explained by physical cause
Valgus Distal segment is angled AWAY from midline e.g. knock-kneed position
Varus Distal segment is angled TOWARD midline e.g. bow-legged position
Proximal Closer to any point of reference
Distal Further from any point of reference
Volar PALMAR surface of hand/forearm
Dorsal POSTERIOR/back surface of hand/forearm
Medial TOWARD midline e.g. ulnar
Radial AWAY from midline e.g. radial
Abduction Motion AWAY from midline
Adduction Motion TOWARD midlines
Pronation Palm facing down
Supination Palm facing up
27
BE AWARE OF RED FLAGS THAT MAY INDICATE MORE SINISTER ETIOLOGY:
• Cancer: fevers, chills, night sweats, weight loss, night pain, fatigue
• Cardio: SOB, CP, leg pain, discolored feet
• Psych: recent emotional changes
• Neuro: change in speech, swallowing, vision, sudden weakness, bowel or bladder dysfunction
BE SUSPISCIOUS OF INFLAMMATORY ETIOLOGY WHEN THERE IS JOINT PAIN +:
• Tenderness, warmth, redness

• Systemic features à Fever, chills, rash, anorexia, weight loss, weakness
• Symptoms from other organ systems
*Note: examination of any joint will follow a similar approach. For this guide, we’ve included checklists for only some joints.
Please review your CS learning materials for physical examination for other learning objectives and joints. Students should always
state that they would “examine the contralateral side as well as the joints above and below if time permitted” in an OSCE.
SUGGESTED HOMEWORK:
• Practice verbalizing that you would examine the joint above + below, but that you “will not demonstrate this
today for the sake of time”.
• Practice conducting a neurovascular assessment with each MSK exam – this requires verbalizing and
demonstrating your dermatomes and myotomes! It’s also necessary to review peripheral nerves (median,
radial, ulnar in the hands for example) to be able to demonstrate a complete neurovascular assessment.
• It’s important that you are comfortable demonstrating examination of the wrist, elbow, shoulder, knee, and
lower back/spine.
OSCE EXPECTATION: a neurovascular status exam must be completed with each MSK exam! IF you don’t feel you will
have sufficient time within the station to demonstrate this, you MUST verbalize that you would “complete a
neurovascular exam if time permitted” to show your understanding that this component of the MSK exam is required.
28
MSK Exam – “Look, Feel, Move, Special Tests”

SHOULDER
□ VITALS BP Please refer to the sections above.
HR
RR (“RREDS”)
O2 Saturation
Temperature
□ LOOK “SEEAADSS”
Posture
□ FEEL/PALPATION Bony Landmarks Looking for temperature changes and areas of tenderness:
Sternoclavicular joint – clavicle –acromioclavicular joint – coracoid
process – acromion – scapular spine, superior angle, along medial
edge, inferior angle – greater tuberosity – glenohumeral joint line --
bicipital groove.
*Normal finding: healthy coracoids are tender to palpation.
Soft Tissue Landmarks Supraspinatus – infraspinatus – trapezius – biceps – deltoid – triceps –
pecs – Sternocleidomastoids
□ MOVE ACTIVE ROM IF Active ROM is restricted, test PASSIVE ROM:
External rotation - “90° with arm ABducted to 90°”, overhead to reach
base of neck/T4
Internal rotation – “90° with arm ABducted to 90°”, underarm reach
to ~T8 or inferior angle of scapula
Forward Flexion – 150-170°
Extension - 60°
PASSIVE ROM Noting clicks or crepitus:
External rotation
Internal rotation
Shoulder Forward Flexion
Shoulder Extension
□ SPECIAL TESTS Rotator Cuff Painful arc
Tendinitis/Impingement Hawkin’s Impingement Sign
Rotator Cuff Tears Supraspinatus (ABduction)
Drop Arm Test
Empty Can Test
Infraspinatus & Teres Minor (External Rotation)
Pain with Resisted external rotation
Subscapularis (ADduction & Internal Rotation)
Gerber Lift-Off Test
Shoulder Instability Sulcus Sign
Anterior Apprehension & Relocation Test
AC Joint Pathology Scarf Sign
Biceps Tendon Yergason’s Test
□ NEUROVASCULAR Pulses Radial, ulnar, brachial pulses
STATUS Sensation C4 – T1 distribution
Power C5 – T1 distribution
Reflexes Biceps (C5/6), Brachioradialis (C5/6), Triceps (C6/7)
29
ELBOW
HR
RR (“RREDS”)
O2 Saturation
Temperature
□ LOOK “SEEAADSS”
Carrying Angle Normal carrying angle: 5° for males, 10-15° for females
Cubitus valgus vs Cubitus Varus
□ FEEL/PALPATION Bony Landmarks Looking for temperature changes and areas of
tenderness:
Medial epicondyle – lateral epicondyle – radial head –
olecranon process and olecranon fossa – olecranon
bursa – distal biceps tendon
Soft Tissue Landmarks Biceps, forearm
Flexion: 0 -145°
Extension: 0-10°
Pronation/Supination: 75-85°
Flexion
Extension
Pronation/Supination
□ SPECIAL TESTS Lateral Epicondyle (Tennis Elbow) Mills Test
Cozen’s Test
Medial Epicondyle (Golfer’s Elbow) Pain at epicondyle with resisted wrist flexion
Pain at epicondyle wit passive wrist extension
Lateral Collateral Ligament Elbow flexed to 20-30°, pain with varus stress applied
to forearm
Medial Collateral Ligament Elbow flexed to 20-30°, pain with valgus stress applied
to forearm
□ NEUROVASCULAR Pulses Radial, ulnar, brachial pulses
STATUS Sensation C4 – T1 distribution
Power C5 – T1 distribution
30
WRIST
HR
RR (“RREDS”)
O2 Saturation
Temperature
□ LOOK “SEEAADSS” Swelling, erythema, ecchymosis, atrophy, asymmetry, deformity
(step deformity), skin changes, surgical scars
Resting Hand Position Looking for evidence of rotational deformity, swan neck
deformity, ulnar or radial deviation
□ FEEL/PALPATION Bony Landmarks Looking for temperature changes and areas of tenderness:
Radio-carpel joint – midcarpal joint – distal radial ulnar joint –
ulnar styloid – radial styloid – Lister’s tubercule – base of 1st
carpometacarpal joint – scaphoid – carpel tunnel
Soft Tissue Landmarks Palmar fascia
Triangular fibrocartilage complex (TFCC)
Flexion: 90°
Extension: 70°
Radial Deviation: 15-25°
Ulnar Deviation: 20-30°
Flexion
Extension
Radial Deviation
Ulnar Deviation
□ SPECIAL TESTS Carpel Tunnel Phalen’s Test
Tinel’s Test
De Quervain’s Finkelstein’s Test
Tenosynovitis
Triangular fibrocartilage Push Off Test – pain on ulnar aspect of wrist when patient tries to
complex push themselves off of a chair using both hands
□ NEUROVASCULAR Pulses Radial, ulnar pulses

STATUS Hands warm.
Capillary refill should be less than 3 seconds.
Sensation Radial nerve – dorsal interweb of thumb and index
Median nerve – radial aspect of distal index finger
Ulnar nerve – ulnar aspect of distal pinky
Power C5 – wrist flexion
Radial nerve – wrist extension
Median nerve – Thumb ABduction
Ulnar nerve – Finger ABduction
31
KNEE
HR
RR (“RREDS”)
O2 Saturation
Temperature
□ LOOK Gait
(with knees fully Resting Position while Genu varum vs valgum vs recurvatum
extended) standing
“SEEEAADSS”
□ FEEL/PALPATION Bony & Looking for temperature changes and areas of tenderness:
(patient laying Soft Tissue Landmarks Quadriceps muscle – quadriceps tendon – patella – patellar tendon
supine with knees – tibial tuberosity – suprapatellar pouch (evidence of
extended, then thickening/swelling) – popliteal fossa (baker’s cyst) – tibiofemoral
again with knees joint line – lateral & medial collateral ligaments – femoral condyles
flexed) – tibial condyles
Effusion Testing Patellar Ballottement
Bulge Sign
Extension: 5-10° hyperextension
Flexion: ~135°, or almost touching heel to buttock.
Extension
Flexion
□ SPECIAL TESTS ACL Anterior Drawer Test: ≥1.5cm of movement in indicative of ACL
tear
PCL Posterior Drawer Test: ≥ 1cm is indicative of a PCL tear
MCL Apply valgus stress: (+) if pain or laxity on medial side
LCL Apply varus stress: (+) if pain or laxity on lateral side
Menisci McMurray’s Test: (+) if pain or clicking along joint line
- Medial meniscus: pain with external rotation of knee
- Lateral meniscus: pain with internal rotation of knee
□ NEUROVASCULAR Pulses Popliteal, posterior tibealis, dorsalis pedis pulses
STATUS Feet warm. Peripheral capillary refill < 3 sec bilaterally.
Sensation L1 Groin, upper thigh
L2 Medial mid-thigh
L3 Medial femoral condyle/knee
L4 Medial malleolus
L5 Shin + Dorsal foot (1st webspace)
S1 Heel/Lateral foot
S2 Popliteal fossa
Power L2 Hip flexion
L3 Knee Extension
L4 Ankle dorsiflexion
L5 Great Toe extension
S1 Ankle Plantar flexion
Reflexes Patellar (L2-4), Ankle (L5/S1), Plantar (L5/S1)
32
LUMBAR SPINE
HR
RR (“RREDS”)
O2 Saturation
Temperature
□ LOOK Gait Antalgic? Trendelenburg? Unstable? Foot slap or drop?
(patient standing) Posture while standing Lordosis, Kyphosis, Scoliosis
“SEEEAADSS”
□ MOVE ACTIVE ROM IF Active ROM is restricted, note which plane of motion causes pain:
(patient standing) Extension: bend backwards while supporting the waist
Flexion: observing for complete reversal of lordosis
Side Flexion: using hands to slide down leg to touch knees
NOTE: if complete reversal of lordosis is not observed with forward flexion,
can demonstrate the SCHOBER’s test to quantify (in cm) amount of
movement restriction. Important to mention during the OSCE, but “not
complete for the sake of time”.
PASSIVE ROM NOT Relevant to lumbar spine assessment.
□ FEEL/PALPATION Bony & Looking for temperature changes and areas of tenderness:
(patient laying prone) Soft Tissue Landmarks Lumbar spinous processes – interspaces – lateral masses/paraspinal
muscles – iliac crests (L4/L5 interspace) – Posterior-superior iliac
spine – sacrum – Anterior-superior iliac spines.
□ PERCUSSION Spinous Processes & Assessing for tenderness/pain if not previously identified with
(patient laying prone)Lateral Masses palpation.
□ SPECIAL TESTS Femoral Nerve Stretch Anterior thigh pain with knee passively flexed to the thigh and hip
(patient laying) (Prone) passively extended.
Leg Length Discrepancy True discrepancy measure from: ASIS to medial malleolus
(Supine)
Straight Leg Raise Testing L5-S1 for sciatic nerve root pain
(Supine) Pain at 30-70° of passive hip flexion with maintained knee extension
FABER Test (Supine) May provoke back pain/posterior hip pain due to SI joint pathology.
IF CONCERNS ABOUT SENSATION in the perianal area (S2-S4)
CAUDA EQUINA: DIGITAL RECTAL EXAM for rectal tone
□ NEUROVASCULAR Pulses Femoral, popliteal, posterior tibealis, dorsalis pedis pulses.
STATUS Peripheral capillary refill < 3 seconds bilaterally.
Sensation T12 Inguinal ligament
L1 Groin, upper thigh
L2 Medial mid-thigh
L3 Medial femoral condyle/knee
L4 Medial malleolus
L5 Shin + Dorsal foot (1st webspace)
S1 Heel/Lateral foot
S2 Popliteal fossa
Power L2 Hip flexion L3 Knee Extension
L4 Ankle dorsiflexion L5 Great Toe extension
S1 Ankle Plantar flexion
Reflexes Patellar (L2-4), Ankle (L5/S1), Plantar (L5/S1)
33

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OSCE REMEDIATION

- Dr. Lydia Czegledi and Dr. Katrina Leong

Day Major Body System Pages

2 History Taking – Deeper Dive 12-16

3 Abdominal Examination 17-18

4 Head and Neck Examination 19-20

5 Neurological Examination 21-25

6 MSK Examination 26-33

OSCE PRACTICE STATIONS

FORMAT OF TUTOR SESSIONS

LEVEL OF OSCE EXPECTATIONS

MED 1 COMPLETE HISTORY

NORMAL PHYSICAL EXAM TECHNIQUE & FINDINGS

MED 2 COMPLETE HISTORY

NORMAL PHYSICAL EXAM TECHNIQUE & ABNORMAL FINDINGS

DIFFERENTIAL DIAGNOSIS FORMULATION

PRELIMINARY MANAGEMENT STEPS

GENERAL OSCE APPROACH *This is a comprehensive approach to a patient

O NEXT STEPS – E.G.: FOLLOW-UP APPOINTMENTS, TESTING, ETC.

v We’re trying to accomplish 3 things:

□ Knock on the Door!

□ HPi: OLDCARTS + déjà vu? + IFFE

□ ROS: General (“WEFAS”) + Specific

□ FHx: Hereditary diseases in Parents, Siblings, +/- Children

□ Summarize, then collaborate on next steps or move on to examining patient.

□ Knock on the Door!

DURING THE MEDICAL HISTORY, COMPLETE A CARDIOVASCULAR RISK ASSESSMENT:

HINT: Look up the acronym “POLICE”

□ PALPATION Precordium Thrills

DURING THE HISTORY, COMPLETE SCREENING TO IDENTIFY POTENTIAL ETIOLOGY:

□ AUSCULTATE Anteriorly Duration

SPECIFIC ITEMS TO COVER:

1. Introduction a. Source of milk (if infant: breastmilk vs.

Adolescent History (“HEADSS”)

SPECIFIC ITEMS TO COVER / SYMPTOMS TO ASK ABOUT:

HEADSS Information of interest Possible areas of concern

5 P’s: Sexual and Contraceptive History

Practices Type(s) of sexual intercourse

Protection Type and frequency of protection

Past History Age of onset of sexual activity

SPECIFIC ITEMS TO COVER / SYMPTOMS TO ASK ABOUT:

SPECIFIC ITEMS TO COVER / SYMPTOMS TO ASK ABOUT:

1. HPI as in History 101

Serious illness / pain

C. MENTAL STATUS EXAM (‘ASEPTIC’)

DURING THE HISTORY, COMPLETE SCREENING TO IDENTIFY POTENTIAL ETIOLOGY:

□ AUSCULTATE Bowel sounds

Vascular bruits Aortic

Liver Hook maneuver

1. Recent or past head/ear trauma

RECALL HEADACHE “RED FLAGS”:

Systemic Constitutional symptoms

Head & Neck Exam

□ HEAD Face Inspect Scalp, hair, eyebrows, face

□ NECK Neck Inspect Skin

DISCRETE COMPONENTS OF A NEUROLOGICAL EXAM:

1. Cranial nerve testing