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OSCE EXAMINER CHECKLIST 2016
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OSCE EXAMINER CHECKLIST
2015-2016
Authors
Dr. Zelaikha Al-Wahedi
Sr. Consultant, Family
Medicine, Primary Health Care
Corporation, Qatar
Dr. Mohamed Salem
Asst. Prof. Family Medicine,
Suez Canal University, Egypt
Dr. Amal Al-Ali
Consultant, Family Medicine,
Primary Health Care
Corporation, Qatar
Dr. Muna Taher Aseel
Consultant, Family Medicine,
Primary Health Care Corporation,
Qatar
Dr. Ahmed Mostafah
Specialist, Family Medicine,
Primary Health Care
Corporation, Qatar
Dr. Hassan Abbas
Consultant, Family Medicine,
Primary Health Care Corporation,
Qatar
Editors: May Khattab, Family Medicine Coordinator
Ady C. Effendy, Family Medicine Doc. Controller
2
Preface
We would like to present some of OSCE examiner checklist developed by Faculty
members during the PGY(4) Academic Day 2015-2016 in Family Medicine
Residency Program, PHCC-HMC, Qatar.
We also like to acknowledge the Family Medicine residents PGY(4) of Academic
Year 2015-2016 for their active participation in preparation of this work.
Dr. Zelaikha Al-Wahedi
Chair of Family and Community Medicine, PHCC-HMC
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
Men’s Health OSCEs .................................................................................................................. 67
Checklist for Erectile Dysfunction ................................................................................................. 68
Geriatric OSCEs .......................................................................................................................... 70
Checklist for Geriatric Care ......................................................................................................... 71
Checklist for Traveler’s Advice ..................................................................................................... 72
4
5
Respiratory OSCEs
6
Peak Expiratory Flow Rate (PEFR) Technique
Not
Attempted
Step/Task
1. Explain to the patient that they should be
checking their PEFR regularly, particularly if
their asthma is worse than usual.
2. Wash Hands
3. Connect a clean mouthpiece
4. Ensure the marker is set to zero
5. Stand up or sit upright
6. Take as deep a breath in as you can and
hold it
7. Place the mouthpiece in your mouth and
form as tight a seal as possible around it with
your lips.
8. Breathe out as hard as you can.
9. Observe and record the reading
10. Repeat the process 3-4 times and record the
highest reading
11. Note down the reading in a diary to allow
comparison with readings on other days
12. Once you have discussed the process with
the patient, you should show the patient how
to perform the measurement. Do this by
measuring your own PEFR.
13. Once the technique has been demonstrated,
ask the patient to show you how they would
perform the measurement themselves. Make
sure they are doing it correctly, and resolve
any mistakes which they might be making
14. Finish by asking the patient if they have any
questions or concerns about either their
asthma or taking their PEFR measurement
7
Attempted
Inadequate
Attempted
Adequate
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.
Pressurized Metered-Dose Inhaler
Not
Attempted
Step/Task
1. Remove cap
2. Check dose counter (if applicable)
3. Hold inhaler upright and shake well
4. Tilt the head slightly back
5. Breathe out gently, away from the inhaler
6. Put mouthpiece between teeth without biting and
close lips to form good seal
7. Start to breathe in slowly through mouth and, at
the same time, press down firmly on canister
8. Continue to breathe in slowly and deeply
9. Hold breath for about 5 seconds or as long as
comfortable
10. While holding breath, remove inhaler from mouth
11. Breathe out gently, away from the inhaler
12. If an extra dose is needed, repeat steps 2 to 10
13. Replace cap
14. If the inhaler contains corticosteroid, rinse mouth
8
Attempted
Inadequate
Attempted
Adequate
Turbuhaler
Not
Attempted
Step/Task
15. Unscrew and remove cover
16. Check dose counter
17. Keep inhaler upright while twisting grip
18. Twist around and then back until click is heard
19. Breathe out gently, away from the inhaler
20. Place mouthpiece between teeth without biting
and close lips to form a good seal. Do not cover
the air vents
21. Breathe in strongly and deeply
22. Hold breath for about 5 seconds or as long as
comfortable
23. Remove inhaler from mouth
24. Breathe out gently away from the inhaler
25. If an extra dose is needed, repeat steps 2 to 10
26. Replace cover
27. If the inhaler contains corticosteroid, rinse
mouth
9
Attempted
Inadequate
Attempted
Adequate
Accuhaler
Not
Attempted
Step/Task
1. Check dose counter
2. Open cover using thumb grip
3. Holding horizontally, load dose by sliding lever
until it clicks
4. Breathe out gently, away from the inhaler
5. Place mouthpiece in mouth and close lips to form
a good seal, keep inhaler horizontal
6. Breathe in steadily and deeply
7. Hold breath for about 5 seconds or as long as
comfortable
8. While holding breath, remove inhaler from mouth
9. Breathe out gently, away from the inhaler
10. If an extra dose is prescribed (not generally
recommended), repeat steps 3 to 9
11. Close cover to click shut
12. If the diskus contains corticosteroid, rinse mouth
10
Attempted Attempted
Inadequate Adequate
Checklist for Smoking Cessation Counseling
Not
Attempted
N
Step/Task
1
Introduce yourself to the patient and use his/her
name
Explore other patient personal details (as occupation,
residence, marital status and special habits of
medical importance as smoking and alcohol)
2
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
Attempted
Inadequate
Attempted
Adequate
Arrange for follow up plan or referral
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
5
12
Checklist for Lung Cancer Screening
STEP/TASK
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)
Clinical Management Skills:
•
Explain to the patient regarding eligibility criteria for
lung cancer screening
•
Make
appropriate
decision
based
on
patient
preferences
•
Counsel patient regarding smoking cessation:
Use the 5 As frame ( Ask-Advise-Assess-AssistArrange)
to
effectively
counsel
about
smoking
cessation
Use the 5 Rs frame if the patient is unwilling to quit
smoking(Risk-Reward-Relevancy-RoadBlocksRepetition)
13
Not
Attempted
Attempted
Attempted
Inadequate
Adequate
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
Not
Attempted
N
Step/Task
1
Introduces yourself to the patient and use his/her name
2
3
4
5
6
7
8
9
10
11
12
13
14
Explore other patient personal details (as occupation,
residence, marital status and special habits of medical
importance as smoking and alcohol)
Analyze patient complaint as regard onset , course and
duration
Explores ICE
Ask about effect of problem(s) on patient quality of life
Screen for depression
Ask about anxiety symptoms as being afraid, nervous,
worry, restless, irritable .. etc. GAD7
Ask about the nature of coronary artery disease
Ask about post-infarction symptoms as:
- Chest pain
- palpitations
- Light headedness
- Fatigue
Ask about risk factors as obesity, dietary habits, salt
intake and stressors
Ask about current medications as for antihypertensive,
anti-diabetic anti-lipids, cardio-tropics, anticoagulants
and phosphordistrase inhibitors
Ask about past history of stroke, PAD, HTN, DM and
dyslipidemia
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,
alternatives)
- Reduce
weight
(Importance,
recommended
percentage)
- Stop smoking (Importance)
- Stop or reduce alcohol intake according to patient
values
16
Attempted
Inadequate
Attempted
Adequate
- Avoid possible stresses
15
16
17
18
19
Counsel about Job ( when to return and modifications if
needed)
Advice about sex (when to resume, position, possible
complications as post coital angina and how to manage,
drug interactions and precautions)
Advice about driving (when to resume and precautions)
Advice about travelling (when to resume
precautions)
Advice and arrange for necessary investigations
(laboratory, ECG or echo or catheterization)
20
Any other questions he 1 she would like to ask.
21
Check patient understanding and capacity
22
Schedule for follow up plan
17
and
Gastrointestinal OSCEs
18
Checklist for Abdominal Pain
No
Step/Task
1
Communication:
• Candidate should introduce him/her self
• Candidate should establish an effective rapport
• Good eye to eye contact
• Candidate should encourage patient contribution
Questioning Skills
• Candidate appropriately use open and close
ended questions.
• Candidate ask clear questions.
• Candidate avoids leading questions and jargon
Patient Personal Information
Candidate obtain data as:
• Age
• Occupation
• Marital status
• Special habits of medical importance as
smoking and alcohol intake
Explore the Nature of Patient Problem
Candidate should ask about:
• Onset of abdominal pain
• Course (Frequency): cyclic, continue…etc
• Duration
• Radiation
• Nature of pain (dull ache, colicky or stepping)
• Severity
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
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
2
3
4
5
6
7
Not
Attempted
Attempted Inadequate
Associated Features:
Candidate should ask about
Red Flags Symptoms:
• Fever
• Anorexia
• Nausea or vomiting
• Dysphagia
• Regurgitation.
• Weight loss
19
Attempted
Adequate
8
9
10
11
12
13
14
• 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
ICE (Idea, Concern, Expectation)
Impact of disease (Physical, Social, Psychological)
Past Medical History
Candidate should ask about
• Recurrence / similar attacks in the past.
• Hospitalization
• Drug history
• Allergies
• Travel history
Lifestyle
Candidate should ask about
• Dietary habits
• Exercise
• Weight
Summarization of findings
Diagnosis
Ending Consultation
20
Endocrine OSCEs
21
Initial Examination for Diabetic Patient
Not
Attempted
Step/Task
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
Attempted
Inadequate
Attempted
Adequate
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
Step/Task
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. Charcot’s 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
Attempted
Inadequate
Attempted
Adequate
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
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
Not
Attempted
Attempted
Attempted
Inadequate
Adequate
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
STEP/TASK
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
Not
Attempted
Attempted
Attempted
Inadequate
Adequate
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
Opening Session
Candidate introduces himself to the patient
and uses his name
Data Gathering Domain
1- Complete personal history details including
Age, Occupation and Special Habits of
medical importance as Smoking and
Alcohol Intake
2- Explores Patient reason for visit and his
Ideas, Concerns and Expectations
3- 5 As Counseling Approach :
Ask
- permission from the patient to discuss
weight problem
- explore patient readiness to change
- Previous attempts or trials
Assess
- Patient health status, BMI, waist
circumference and cardiovascular risk
- Root causes of gaining weight (primary
and secondary)
- Drug history
- Effect of weight on psychosocial
functioning
- Explain to the patient his classification of
obesity according to BMI
Advise about
- Obesity risks and expected
complications
- Benefits of weight loss
- Explore all treatment options
• Life Style Modification ( Diet –
Exercise)
• Medical
• Surgical
Agree with the patient upon the
desired plan
Assist
- Address patient motives and barriers
- Arrange for follow up or referral
30
Attempted
Inadequate
Attempted
Adequate
Neurology OSCEs
31
Checklist for Headache
Not
Attempted
No
Step/Task
1
Candidate introduces himself to the patient
and uses his name
2
3
4
5
6
7
8
9
10
11
13
Explore other patient personal details
(occupation, residence and special habits of
medical importance as smoking)
Analyze patient complaint as regard onset ,
course and duration
Ask about present history details
Possible causes of headache
Red flags
Screens for depression
Explores ICE
Ask about effect of problem(s) on patient
quality of life
Ask about past history of the patient
Ask about family history of the patient
Offer appropriate explanation regarding
patient problems
Discuss management plan with patient
including:
Shared options; exercise, relaxation
tapes/techniques and Rx options e.g.
sumatriptan
Prophylaxis for migraine
Clear safety netting
Schedule for follow up plan
32
Attempted
Inadequate
Attempted
Adequate
Musculoskeletal OSCEs
33
Checklist for Back Examination
STEP/TASK
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
Not
Attempted
Attempted
Attempted
Inadequate
Adequate
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
Examination of the abdomen
35
Checklist for Knee Joint Examination
STEP/TASK
Opening Session
Candidate introduces himself to the patient
Took permission from the patient
Exposure (Hip or Above
knees/down to
heels)
Washes hands
Ask the patient to walk for you and observe any limp
or obvious deformities
Inspection (patient standing, inspect all
around patient
•
Skin – trophic, sinuses, scars
•
Muscle waste
•
Bony deformity as fixed flexion deformities.
•
Erythema/Swelling
•
Position (degree of rotation of leg, fixed
flexion deformity)
Palpate the knee joint, start by assessing the
temperature using the back of your hands and
comparing with the surrounding areas
The main movements which should be examined
both actively and passively are:
•
flexion
36
Not
Attempted
Attempted
attempted
inadequately
adequately
•
extension
A full range of movements should be demonstrated
and you should feel for any crepitus
Tests for Patellar effusions ( Small and Large)
Anterior Drawer Test: Flex the knee to 90 degrees
and sit on the patient’s foot. Pull forward on the tibia
just distal to the knee. There should be no
movement. If there is however, it suggests anterior
cruciate ligament damage. Another test for ACL
damage is Lachman’s test.
Posterior Drawer Test: With the knee in the same
position, observe from the side for any posterior lag
of the joint, this suggests posterior cruciate ligament
damage.
Assess the collateral ligaments. Do this by
holding the leg with the knee flexed to 15 degrees
and place lateral and medial stress on the knee. Any
excessive movement suggests collateral ligament
damage
Perform McMurrays test to assess for meniscal
damage. Hold the knee up and fully flexed, with
one hand over the knee joint itself and the other
on the sole of that foot. Stress the knee joint by
medially and laterally moving the foot.
37
Checklist of Shoulder Examination
Not
attempted
No.
Step/Task
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
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
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.
2
3
38
Attempted
inadequately
Attempted
Adequately
No.
4
Step/Task
MOVEMENTS:
The resident test the active movements
and comment each time on:
- Crepitation
- Range of movements
- Pain during movements
(A) Active movements:
Abduction:
Ask the patent to carry the arm
medially across the front of the
chest.
Flexion:
Ask the patient to swing the arm
backward.
Internal rotation
External rotation
(B) Passive movements
Thank the patient and the examiner
39
Pediatric OSCEs
40
Checklist for Counseling on Breastfeeding
Step/Task
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 mother’s 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
Not
Attempted
Attempted
Attempted
Inadequate
Adequate
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
attempted
inadequatel
adequately
y
Opening Session
Candidate introduces himself to the patient and
uses his name
Data Gathering Domain
1- Complete personal history details including
name and age of the child
2- Explores mother reason for visit
3- Explores
mother
Ideas,
Concerns
and
Expectations regarding missed vaccinations
4- Ask about child present history details ( Birth
weight, Nutrition)
5- Ask about previous diseases as Measles and
Chickenpox
6- Convulsions
7- Allergies
8- CURRENT Medications
9- Management Schedule and Follow up plan
(Vaccination Schedule)
10- Check Mother Understanding
43
Checklist for Nocturnal Enuresis
No
1
2
3
4
5
6
7
Not
Attempted
Step/Task
Introduce yourself to the mother and build a
good rapport
Identify mother Ideas, Concerns and
Expectations ICE
Encourage mother to bring her son
Determines whether Enuresis is primary or
secondary?
Thorough history including
• Fluid intake
• Psychosocial stressors as divorce,
abuse, new birth, etc.
• School achievement environment
• Daytime symptoms
• Family history among parents
Asks about Red Flags / organic causes
including
• UTI (dysuria, frequency urgency and
recurrence)
• DM (polyuria, polydipsia and weight
loss)
Offer to examine the child
8
Order basic investigations as
• Blood glucose
• Urinalysis
• Ultrasound
9
10
Reassure the mother
Ask about measures as:
• Fluids restriction
• Rewards
• Punishment
• Frequent night awakening
11
Advise about available options including
• Bed wetting alarm system
• Desmopressin
• Imipramine
44
Attempted
Inadequate
Attempted
Adequate
Checklist for Attention Deficit Hyperactivity Disorder (ADHD)
No
1
2
Step/Task
Introduces yourself to the Lady and use her
name as well as her child name
Analyze mother complain as regard onset ,
course and duration
3
Ask detailed history about triad of symptoms
(Hyperactivity, Inattention and Impulsivity)
4
Ask about occurrence of symptoms in
multiple settings as school and home
5
Ask about impaired functioning i.e.: may
affect a child's schooling and relationships
with family and friends
6
Explore possible causes of the behaviour
•
Social deprivation and neglect in
childhood
•
Neurodevelopmental abnormalities
•
Mother drinking alcohol and taking
drugs such as heroin during pregnancy
7
•
Obstetric complications
•
Low birth weight of the child
Ask about growth and development history of
the child
8
Ask about Family history of ADHD
9
Explore
mothers
ideas,
concerns
and
expectations with regards to child behaviour
10
Elicits impact on family life (Social Aspect)
11
Offers appropriate explanation about ADHD
using simplified language
45
Not
Attempted
Attempted
Attempted
Inadequate
Adequate
12
Offers appropriate explanation about
management options either in primary or
secondary level including:
Family education and support
Parent training program
School education and support
Teachers may meet with parents and
physician to discuss support in school
Family and individual therapy
o Family therapy
o CBT
o Social awareness therapy
Behavioral treatment
o Rewarding good behavior and discouraging
bad behavior
Medications
•
Only in children over 6 years old
•
Methylphenidate, i.e.: Ritalin is most
commonly used and the child is
monitored for for growth and other side
effects
13
Discus prognosis with the parents (conduct
disorder, adult ADHD)
•
Prognosis is variable
•
Gradual
improvement
occurs
in
adolescence, but up to 8 in 10 children
with ADHD will continue to experience
•
Early and consistent treatment improves
this prognosis
14
Takes an appropriate decision by referral of
the case to psychiatric health setting if needed
46
Checklist for Constipation in children
STEP/TASK
1. Opening Session
Candidate introduces himself to the Mother
and uses Mother and Child
names
(Establishes rapport)
2. Data Gathering Domain
Analyses patient complain as regard
onset , course and duration
Ask
about
Possible
causes
of
Constipation
Ask about Red flags
Ask about Past history of the patient
Ask about family history of the patient
Explores ICE of Mother
3. Clinical Management Skills
Offers appropriate explanation of the
problem
Suggests
appropriate
management
options; dietary advice, fluids and future
management choices – laxatives
Educate mother regarding safety netting
47
Not
Attempted
Attempted
attempted
inadequately
adequately
Gynecology & Obstetric
OSCEs
48
Checklist for Pre-Marital Counseling
Attempted
STEP/TASK
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
Attempted
inadequately
Attempted
adequately
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
1
Communication Skills:
• Introduce yourself to the patient
• Establish an effective rapport with the
patient
• Make good eye to eye contact
Patient Personal Information
Ask about:
• Age
• Occupation
• Duration of marriage
• Special habits of medical importance as
smoking, alcohol, and caffeine consumption
Chief Complaint:
• Ask about current problem/complaint
• Define Infertility (primary or secondary)
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
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,
2
3
4
5
6
7
Not
Attempted
Attempted Inadequate
ICE (Idea, Concern, Expectation)
Impact of Disease
• Physical,
• Social,
• Psychological
51
Attempted
Adequate
8
9
10
11
12
13
14
15
Past History:
Ask about:
• Any current associated medical illness as
diabetes and/or hypertension, hyperhypothyroidism
• 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
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
Obstetric History:
Ask about:
• Previous pregnancies, if any, and its
outcome,
• Ectopic pregnancies
• Abortions,
• Post-abortive infection or puerperal sepsis
Contraceptive History:
Ask about Previous use of contraceptive
methods, particularly intrauterine system, Oral
contraception pills
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
Family History:
Ask about:
• Family history of infertility,
• Family history of Spontaneous abortion,
stillbirth, and congenital disease
Summarization
Ending consultation
52
Checklist for Menopause
No
1
Step/Task
Opening Session
Candidate introduces himself to the patient
and uses patient name (Establishes rapport)
Data Gathering Domain
Ask about personal history details (age,
2
occupation, residence and special habits of
medical importance as smoking)
3
Analyses patient symptoms as regard onset ,
4
course and duration in details
5
Screen for depression
6
Ask about Past history of the patient
7
(medical / surgical / obstetric / gynecological)
Ask about family history of the patient
Explores ICE
Clinical Management Skills
8
Offers appropriate explanation of the problem
9
Educate
patient
regarding
simple
management for her symptoms
10
Counsel patient regarding different
management options including HRT
53
Not
Attempted
Attempted
Attempted
Inadequate
Adequate
Checklist for Menopause and HRT
No
Step/Task
1
Candidate introduces himself to the patient and uses his
name
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Not
Attempt
ed
Explore other patient personal details (occupation, residence
and special habits of medical importance as smoking)
Analyze patient complaint as regard onset , course and
duration
Ask about other symptoms of menopause as Sexual
dysfunction and body aches
Ask about effect of problem(s) on patient quality of life
Ask about diet, calcium, and spices
Ask about daily activities and exercise
Ask about menstrual history details (age of menopause)
Ask about psycho-social aspects (sleep,
appetite and
interests)
Ask about contraceptive history ( use of hormonal methods )
Ask about gynecological problems and operations
(hysterectomy)
Ask about breast problems or cancers in patient
Ask about chronic medical conditions as diabetes,
hypertension, ischemic heart diseases and strokes
Ask about history of DVT
Offer appropriate explanation regarding patient problems
Ordered
appropriate
investigations
(Pap
Smear,
Mammography and lipid profile)
Discuss different methods to treat menopausal symptoms as
HRT and other drugs ( indication, contraindications and side
effects)
Schedule for follow up plan
54
Attempte
d
Inadequ
ate
Attempt
ed
Adequa
te
Psychiatry OSCEs
55
Checklist for Depression
No
Step/Task
Not
Attempt
ed
1
Introduces yourself to the patient and use his/her name
2
Encourage patient contribution
3
Respond to patient’s cues
Explore other patient personal details (as occupation,
4
residence, marital status and special habits of medical
importance as smoking, alcohol and psychoactive drugs)
5
Analyze patient complaint as regard onset , course and
duration
Ask about main symptoms of depression: PHQ9
- Mood
- Loss of interest
- Activity level
- Decrease ability to concentrate
6
- Sleep disturbance
- Change in appetite and weight
- Loss of libido
- Guilt feelings
- Suicidal thoughts and/or attempts
7
8
9
10
Ask about the presence of somatic complaints e.g.
headache, back pain, shortness of breath, etc
Ask about anxiety symptoms as being afraid, nervous,
worry, restless, irritable .. etc. GAD7
Ask about psychotic symptoms as hallucinations, delusion,
illusions
Assess patient insight
56
Attempte
Attempt
d
ed
Inadequ
Adequa
ate
te
11
Explores ICE
12
Ask about effect of problem(s) on patient quality of life
13
14
15
16
17
18
19
Ask about possible psychosocial stressors as emotional,
marital conflicts, job or economic problems
Ask about life events as death, divorce or separation
Ask about chronic medical illnesses as cancer, stroke,
thyroid, IHD, diabetes and HTN
Ask about long term use of medications as steroids, BB and
antihypertensive
Ask about past history of similar condition (or other
psychiatric illnesses)
Ask about family history of similar condition (or other
psychiatric illnesses)
Offer appropriate explanation regarding patient problems
Discuss management plan with the patient including:
Non pharmacological approach including CBT and life
20
style modifications
Medications: dose, duration and possible side effects
If there is need for referral
21
Schedule for follow up plan
57
Ethics OSCEs
58
Breaking bad news (IUFD)
Action
Step/Task
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
Encourage patients contribution
Complain or reason
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
Not Attem
attem pted
pted inade
quatel
y
Attempt
ed
adequat
ely
the last visit.
• Check how the patient is thinking or
feeling
Sharing the
information
Break the news
Show sympathy and
caring
ICE
Give information
Planning and support
Follow up and
closing
Discretionary
• Assess what the patient already
knows, is thinking or has been told.
• Assess how much the patient
wishes to know.
• Give warnings first that difficult
information coming
• Give the information simply and
honestly; repeat the important
points.
• Don’t give too much information.
• Check for understanding and
feelings as you proceed.
• Use language properly, avoid
jargons
• Allow patient feelings give time and
space, allow possible denial.
• Encourage expression of feelings ( I
am sorry that was difficult for you)
• Show acceptance, empathy and
concern,
• Be aware of unshared meanings.
• Keep pausing to give patient
opportunity to ask questions.
• Specifically elicit all the patients
concern
• Causes of IUFD
• Preventive methods.
• Check for understanding
• Plan what to do next.
• Give hopes.
• Willing to help and caring.
• Summarize and check with the
patient.
• Arrange for follow up, offer
telephone calls.
• Red flags and safety netting.
• Arrange for referral to specialist.
• Time management and
Organization.
60
ENT OSCEs
61
Checklist for Ear Examination
Step/Tas
k
No.
1
2
3
4
5
-6
-
7
7
Introduction of himselflherself, asking for permission and
of the ear examination
External ear (auricle or
- Inspect each ear and surrounding (deformity, lumps
- Palpate both mastoid processes and check for
- Gentle pulling each auricle upward and
Ear Canal
- Insert Otoscope to proper depth and inspect the external
auditory
canal (discharge or foreign bodies, redness,
EarDrum
- Check
landmar (clear, obscured,
any perforation,
the
ks
colour,
bulging)
- Light
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.
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).
Whisper
General organized
62
Not
atte
mpte
d
Att
e
m
pt
ed
in
Atte
mpt
ed
adq
uate
ly
Checklist for Dizziness / Vertigo
Not
Attempted
Step/Task
Opening Session
Introduce yourself to the patient and use patient
name (Establishes rapport)
Data Gathering Domain
Complete other details of personal history as
age, occupation, residence, marital status and
special habits of medical importance as
smoking and alcohol
Clarify what patient means exactly by
dizziness (Is it true vertigo or light headedness
or disequilibrium)
Ask about the onset and timing of the
symptoms
Ask about the course of symptoms: constant or
attacks (duration & frequency)
Assess severity of symptoms: e.g. associated
nausea and/or vomiting.
Ask about precipitating factors as change in
head position, standing, Auricle manipulation,
fatigue, valsalva maneuver, viral infection,
hyperventilation, explosion
Assess patient ideas, worries & expectations.
Assess the effect of the problem on patient's
life,
63
Attempted
Inadequate
Attempted
Adequate
Ask about history of pervious attacks
Ask about past history of ear diseases as
hearing loss, tinnitus, Fullness or stuffiness,
otalgia / discharge, pervious ear surgery.
Ask about family history of tinnitus, hearing
loss
Rule out associated brain stem symptoms as
double vision, numbness and/or weakness in
arm face and leg, difficulty in speech,
confusion or loss of consciousness, swallowing
problems.
Ask about associated symptoms as valvular
disease, palpitation, syncope on exertion,
Prolonged bed ridden, head & neck trauma,
seizures, symptoms of DM, hypertension,
anxiety, depression or panic attacks.
Ask about drugs history
Clinical Management Skills
Offer appropriate explanation regarding the
nature of the problem
Arrange for appropriate workup plan for the
patient to reach a diagnosis (as audiometry,
neuroimaging and vascular imaging)
Schedule the follow up
64
Checklist for Tinnitus
No
1
Step/Task
Opening Session
Candidate introduces himself to the patient and
uses patient name (Establishes rapport)
Data Gathering Domain
2
Explore
other
personal
history
details
(
occupation, residence and special habits of
medical importance as smoking and alcohol)
3
Analyses patient complaint as regard onset ,
course and duration in details
4
Ask about present history details:
(Description of tinnitus)
o Pitch (quality of sound loudness)
o Location ( Unilateral or bilateral )
o Timing ( Intermittent or continuous )
o Associated events:
-
Hearing change, previous chronic noise
exposure, acoustic trauma, otitis media,
head or neck trauma, dental treatment
-
Use of a medication known to cause
tinnitus
o Associated symptoms
Headaches, Hearing loss, Noise
annoyance, intolerance, or pain, Tempromandibular joint or neck pain, Vertigo
and hallucinations
o Impact of tinnitus
Percent of time the patient is aware of or
annoyed by tinnitus (e.g., interference
with daily activities, sleep, work, or
leisure; auditory perceptual difficulties;
65
Not
Attempted
Attempted
Attempted
Inadequate
Adequate
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
Men’s Health OSCEs
67
Checklist for Erectile Dysfunction
Not
attempted
STEP/TASK
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
Attempted
inadequate
Attempted
adequately
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
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 ( ShoppingCooking-Laundry-Telephone-Manage
Money-Taking Medicines-climb stairs-Walks
to Toilet )
2. Physical Health Assessment
• Chronic Conditions
• Specific Geriatric Conditions ( FallsDementia-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
Attempted
inadequately
Attempted
adequately
Checklist for Traveler’s Advice
STEP/TASK
Not
Attempted
Opening Session
1- Candidate should introduce himself to the client(s)
2- Candidate should establish doctor-patient relationship
History Taking:
• Candidate should obtain information about travelling and
the trip details
( Date of travel, Place, Duration of trip, Reason, Mean of
travel)
• Candidate should ask about history of
( Medical illnesses, Drug history, Allergic history,
Vaccination history)
• Let patient to express his/her concern and/or ask
questions
Motion Sickness:
• Candidate should discuss and explain motion sickness to
the client
• Candidate should advice the client to apply measures to
prevent motion sickness as: ( Avoiding fatty foods before
departure, sitting between wings, Closing eyes
• If he/she developed motion sickness before, Candidate
should advice the client to take antihistamine e.g.
(Phenergan) 30-60 min before departure.
Preventive Measures regarding Food Borne Diseases /
Traveler’s Diarrhea:
• Candidate should advice the client to be sure of water
sanitation
• Candidate should advice the client to avoid unpasteurised
milk
• Candidate should advice the client to eat only cooked
vegetables and avoid as much salads.
• Candidate should advice the client to peel all fruits,
including tomatoes.
• Candidate should advice the client that
Antibiotic prophylaxis should not be used routinely in
persons at risk of developing traveller’s diarrhoea
Antibiotics (usually a quinolone) should be used to
reduce the duration and severity of traveller’s
diarrhoea
Loperamide (Imodium) can be used with antibiotics for
most adults.
Endemic Diseases in the Country of Travel
Candidate should provide the client with information regarding
diseases that might be endemic in certain areas as typhoid,
yellow fever, hepatitis, malaria and AIDS
72
Attempted
Inadequate
Attempted
Adequate
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.
General Preventive Measures
• Candidate should advice the client as possible to stay
away from areas that has overcrowdings and could
transmit droplet and airborne diseases
• Candidate should advice the client to wear masks when
needed
• Candidate should advice client to cover mouth when
coughing or sneezing
• Candidate should advice the client to contain any sputum
in waste bags
• Candidate should advice the client to frequently wash
hands
• Candidate should advice the client to avoid swimming in
lakes or rivers
• Candidate should advice the client to use safe traffic and
transportations
• Candidate should advice the client to carry enough
medications for chronic diseases if he/she had
• Candidate should advice the client to wear, if possible,
medical bracelet
• Candidate should advice the client to seek medical advice
if needed from trustable source as teaching hospitals
• Candidate should advice the client to use medical kit to
store essential drugs, e.g. chloroquine, bactrim,
paracetamol, oral rehydration, insulin & syringe,
Phenergan.
• Candidate should advice the client that traveling to highaltitude areas should be advised to ascend slowly (1,000 ft
per day above 8,000 ft) and allow time to acclimatize while
rapid descent should be advised if significant illness
develops
• Candidate should advice the client to take acetazolamide
(formerly Diamox), at a dosage of 125 to 500 mg twice
daily for persons traveling to high-altitude areas
• Candidate should advice the client regarding measures to
prevent get lag
73
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