OSCE Notes

-YD
Hi there aspiring Medical Professionals,

I'm excited to share with you a resource that has been instrumental in
my success during the OSCE (Objective Structured Clinical
Examination). Enclosed in this PDF are some personal notes I’ve
compiled, which have proven effective in navigating the various
stations of the OSCE. Please note these are only a few stations.

As you prepare for your upcoming OSCE, remember that preparation

and practice are key.Take the time to acquaint yourself with the
dummies, sundries, and clinical scenarios, and make practicing your
clinical skills a regular habit. (Pro Tip - visualize your stuffed teddies as
patients to enhance your practice sessions)

BREATHE.
Approach each station with confidence, knowing that you've put in the
work to succeed. Stay focused, stay calm, and trust in your abilities.
Remember, this examination is just one step on your journey towards a
fulfilling career in medicine.

Wishing you all the best in your OSCE and beyond. Your dedication
and hard work will surely pave the way for a successful medical career.

All my love
-Y

Disclaimer:

Forgive me for any spelling and grammatical errors. Please note that
these are my personal notes, and while they have been helpful to me, it's
advisable to double-check information with textbooks and verified
sources.

Ps : Additional, GOLDEN materials:

- South African Family Practice Manual - BOB Mash
- Geeky Medics
Pulmonary Edema 3
HIV Counseling 8
Suicide Risk Assessments 9
Intraosseous Line 13
Upper vs Lower Motor Neuron Lesion : 14
Neurological Examination 15
Diabetic Foot Examination 23
Rectal Exam 25
Respiratory Examination 27
Primary Survey 29
Obstetric Examination 32
COMMON OSCE STATIONS 34

OSCE NOTES Y. Dindar Page 2 of 37

Pulmonary Edema
Pulmonary edema involves the accumulation of fluid in the lungs' parenchyma and
air spaces, typically resulting from heart failure and/or fluid overload. Symptoms
include shortness of breath and pink frothy sputum, while typical clinical signs
consist of tachypnea, decreased oxygen saturations, and elevated jugular venous
pressure (JVP).

General Tips for Emergency Care:

- Address problems as they are discovered, regularly reassess patients post-
intervention to monitor their response to treatment, delegate tasks effectively,
ensure continuous monitoring equipment is attached to critically unwell patients
for accurate observations, clearly communicate the frequency of relaying patient
observations to other staff members, seek senior input promptly when needed,
review available results such as laboratory investigations, follow local guidelines
and algorithms for managing specific scenarios, ensure medications and fluids are
prescribed promptly, document assessments clearly in the notes without delaying
initial clinical assessment, investigations, and interventions.

PE Scenario Initiation:
- Upon entering the room, receive a handover detailing the patient's name, age,
background, and the reason for your involvement from medical staff and nurses.
- Acknowledge the patient's symptoms, such as shortness of breath and limited
ability to speak full sentences, before beginning an initial assessment using the
ABCDE approach. Administer LMNO therapy (Lasix, Morphine, Nitrates, Oxygen)
for the patient, and coordinate with your team on vital signs and investigations.
Clearly state your treatment goals to the examiner before proceeding with the
scenario.

Patient Interaction:
Introduce yourself to the patient, Hi, My Name is Dr Y Dindar.
Assess their response level, and initiate Basic Life Support (BLS) if necessary.
- Inquire about the patient's well-being, noting symptoms like shortness of breath
and incomplete sentences, to determine airway patency before moving on to the
breathing assessment.

Airway and Breathing Assessment:

- For unconscious patients, promptly assess the airway for signs of compromise,
such as diminished breath sounds, cyanosis, see-saw breathing, or added sounds.
Inspect the mouth for obstructions like foreign bodies or secretions.
- Perform the head tilt chin lift maneuver to check for visible obstructions, utilize an
oropharyngeal airway as needed, and proceed to assess the patient's breathing
status based on respiratory rate, potential tachypnea or bradypnea, and oxygen
saturation levels requiring oxygen therapy as appropriate.

OSCE NOTES Y. Dindar Page 3 of 37

Circulation Evaluation:
Clinically evaluate the pulse for signs of tachycardia, blood pressure to rule out
hypotension contraindicating diuretic use, capillary refill time for prolonged
intervals in hypotensive patients, and assess fluid status, particularly focusing on
raised JVP indicating hypervolemia in patients with pulmonary edema.

CHF + Pulmonary Edema

Pulmonary edema involves the accumulation of fluid in the parenchyma and air
spaces of the lungs - most commonly as a result of heart failure and/or fluid
overload.

Symptoms
Typical symptoms
• Shortness of breath
• Pink frothy sputum
Signs
Typical clinical signs
• Tachypnea
• Decreased oxygen saturations
• Elevated jugular venous pressure (JVP)

General tips for applying an ABCDE approach in an emergency setting include:

• Treat all problems as you discover them.
• Reassess regularly and after every intervention to monitor a patient’s response to
treatment.
• Make use of the team around you by delegating tasks where appropriate.
• All critically unwell patients should have continuous monitoring equipment
attached for accurate observations.
• Clearly communicate how often you would like the patient’s observations relayed
to you by other staff members.
• If you require senior input, call for help early using an appropriate protocol.
• Review results as they become available (e.g., laboratory investigations).
• Make use of your local guidelines and algorithms in managing specific scenarios.
• Any medications or fluids will need to be prescribed at the time
• Your assessment and management should be documented clearly in the notes;
however, this should not delay initial clinical assessment, investigations, and
interventions.
Keep this in mind for Primary Survey, PE & any other emergency scenarios.
You can tell the examiner as you go along
1. I am reassessing after intervention and asking my team members for feedback.
2. I have asked my team members to relay any new investigation results as they
come in.

OSCE NOTES Y. Dindar Page 4 of 37

Beginning your PE scenario

Enter the room, read your case, turn to your examiner

1. “Examiner, I have already received a handover from the medical staff & nurse
who have included the name, age, background of the patient & reason why I have
been called.”

2. “Examiner, I would have already understood from the background that my

patient has shortness of breath and may not be able to complete full sentences.”

3. “Examiner, for pulmonary edema, my initial assessment will begin with the
ABCDE approach as well as medication for my patient (LMNO - lasix, morphine,
nitrates, & O2) in addition to my team's management of the vitals and
investigations. The goals of treatment are to provide symptomatic relief, improve
oxygenation, maintain cardiac output and perfusion of vital organs, and reduce
excess extracellular fluid. Any underlying cause should be identified when starting
treatment. Please state this to the examiner before you begin. You have enough
time, and this will show the examiner you already know what your plan of
management is and why!”

I will begin to demonstrate

Walk over to the dummy & introduce yourself

4. “Hi, I’m Dr. Y. Dindar I’m here to attend to your case, ok?”

(If the patient is unresponsive, immediately start BLS).

(If your patient is awake, - ask, "How are you feeling, sir?" Tell the examiner, "I’m
listening for SOB & incomplete sentences as well as anything else the patient is
feeling.").
If the patient can talk, it means the airway is patent, and you can move on to B -
breathing.

OSCE NOTES Y. Dindar Page 5 of 37

A - Airway

Unconscious patients

“Examiner, my patient is unconscious, so I will assess their airway immediately,

looking for any airway compromise, which includes:
- Diminished breath sounds
- Cyanosis
- See-saw breathing
- Or any added sounds.

“Examiner, I will inspect the mouth and look for any obstruction such as:
- Foreign bodies
- Secretions.

“Examiner, I am now doing the head tilt chin lift maneuver to look for obvious
obstruction - I don’t see anything, so I will not sweep the mouth. I will consider
using an oropharyngeal airway as a precaution - Examiner, I will move on to assess
the breathing of my patient.

B - Breathing

“Examiner, I will focus on the respiratory rate and note if the patient is tachypnoeic
or bradycardic.”
“If my patient has a respiratory rate over 20 breaths per minute, the tachypnea is a
sign of respiratory compromise in pulmonary edema.”
“If my patient is hypoxic with shallow breaths, bradypnea is a sign of impending
respiratory failure.

“Also, my patient's oxygen saturation is low when it is between 88-92%, and

hypoxemia is a clinical feature of pulmonary edema, so I will administer O2. I will
intervene by making sure my patient is in the right position, Fowler's position, and
***give OXYGEN via face mask, 40% O2 at a rate of 6-8L/min.***
Review the patient’s respiratory rate:
• A normal respiratory rate is between 12-20 breaths per minute.
• Tachypnea is a common feature of pulmonary edema and indicates significant
respiratory compromise.
• Bradypnea in the context of hypoxia is a sign of impending respiratory failure and
the need for urgent critical care review. Review the patient’s oxygen saturation
(SpO2):
• A normal SpO2 range is 94-98% in healthy individuals and 88-92% in patients
with COPD who are at high-risk of CO2 retention.
• Hypoxemia is a typical clinical feature of pulmonary edema.

OSCE NOTES Y. Dindar Page 6 of 37

C - Circulation

“Examiner, for C, circulation, I will clinically assess:

3. The pulse for tachycardia, a sign of PE: walk over, feel the pulse.
4. The blood pressure - it’s important for hypotensive patients. They cannot be
given diuretics as it will worsen the hypotension. Just turn towards the examiner &
say it.
5. Capillary refill time, which is prolonged in PE hypotensive patients - press the
dummy patient's finger.
6. Fluid assessment - I will look mainly at the JVP of a PE patient. If it is raised, it
indicates hypervolemia."

OSCE NOTES Y. Dindar Page 7 of 37

HIV Counseling
Pre-test counseling is aimed at ensuring that you make a well-informed decision
about whether to have the HIV test. It encourages you to explore the possible
impact that having the test may have on your life. Post-test counseling helps
individuals cope better with their results and encourages them to look after their
health and protect others from infection. Ongoing counseling, after knowing your
result, helps you live positively with HIV and provides support and guidance for any
problems you may face.

Introduction

Hello, I'm Dr. Y Dindar. Can you please confirm your name and age for me?

Role Explanation & Consent

I am the Doctor here today, and I would like to discuss HIV testing with you. Do I
have your consent to do so?

Confidentiality

This discussion and the results are confidential between you and me. Feel free to
interrupt me if you have any questions or need clarification.

Reason for Test

Is there a specific reason you have come in today for counseling? Have you been
tested before? If yes, when and what were the results?

Exposure Risk Assessment

Have you engaged in any sexual experiences that may put you at high risk of
getting HIV? When was the last time you had sex? Details about partners, types of
sexual activity, condom use, HIV testing of partners, high-risk areas, history of
blood transfusion, and any health problems.

Basics of the Test

Explain how the HIV test works, the types of tests done, the window period for
accurate results, and what a positive or negative test result means. Address false
positives and negatives.

Benefits and Risks of the Test

Discuss the advantages of testing such as prolonged good healthcare and

reduced anxiety, as well as the disadvantages like stigma and rejection. Ask about
coping mechanisms for a positive result and available support.
OSCE NOTES Y. Dindar Page 8 of 37
Consent

Summarize the information provided, ensure understanding, and obtain consent

for the HIV test.

PrEP Discussion

Ask what the patient knows about PrEP, any concerns or expectations, and if they
have heard or read about it before.

What is PrEP?

Explain that PrEP is a combination of two antiretroviral drugs, Tenofovir DF and

Emtricitabine, used to prevent HIV infection by stopping the virus from multiplying
in T cells. Mention its effectiveness in reducing the risk of HIV infection during
sexual intercourse.

Suicide Risk Assessments

Hello, I am Dr. Yumna Dindar, and I will be handling your medical case today.

May I confirm your name and age, Mr./Mrs./Miss ______? It's a pleasure to meet
you.

I am here to discuss the events that led to your hospital admission. Anything
shared here today will be kept confidential unless I believe another person may be
at risk. In that case, I may need to share some information. I understand that some
questions may be challenging to answer. If there's anything you prefer not to
answer right now, we can revisit it at another time. Is that alright?

The purpose of a suicide risk assessment is to:

- Determine the patient's intent
- Evaluate the seriousness and perceived seriousness of
their attempt
- Understand how they feel about the attempt during the assessment

Current episode of self-harm: Before, After, and During

Before:
1. Was there a specific trigger?
2. Was the self-harm planned or impulsive?
3. Did the patient take any final actions?
4. Were any precautions taken to avoid detection?
5. Was alcohol involved?

OSCE NOTES Y. Dindar Page 9 of 37

During:
1. What method of self-harm was used?
2. Was the patient alone?
3. Where was the patient when they self-harmed?
4. What was going through the patient's mind at the time?
5. Did the patient intend for the self-harm to be fatal?
6. What did the patient do immediately after the self-harm?

After:
1. Did the patient contact anyone following the incident? How did they get to the
hospital? Who found them?
2. How did the patient feel when they received help?
3. How does the patient feel about the attempt now? Do they regret it?
4. What is the patient's current mood?
5. Does the patient still feel suicidal?
6. If the patient were to return home today, what would they do in the next few
days?
7. If the patient were to experience similar feelings again, how might they handle it
differently?
8. What does the patient believe could prevent a future attempt?
9. Does the patient see any reason to continue living? (i.e., protective factors)
10. Is the patient willing to accept treatment?

Specific questions regarding cutting:

- Where are the cuts located?
- How many cuts are there?
- How deep are the cuts?
- What were the patient's emotions while cutting?
- How did the patient feel when they saw blood?
- What did the patient hope to achieve through cutting?

Screening for mental health disorders that increase suicide risk:

Depression:
- Anhedonia: "Do you feel that you no longer enjoy activities you once did?"
- Low mood: "How have your moods been recently?"
- Fatigue: "How have your energy levels been lately?"

Psychosis:
- Thought insertion: "Have you ever experienced thoughts of harm that weren't
your own?"
- Auditory hallucinations: "Do you hear voices instructing you to harm yourself that
others can't hear? How do you differentiate between these voices and your own
worries?"

OSCE NOTES Y. Dindar Page 10 of 37

Anorexia:
- "How would you describe your eating habits?"
- "Do you believe you are eating enough currently?"
- "What is your appetite like now?"
- "Have you lost weight recently?"
- "Are you content with your current weight?"

Previous self-harm episodes:

- Has the patient self-harmed before?
- What methods were used?
- Did they receive support from family or agencies after self-harming?

Past psychiatric history:

- Does the patient have any psychiatric diagnoses?
- Have they been hospitalized for psychiatric reasons previously?

Past medical history:

- Inquire about any relevant medical history that may impact the current self-harm
episode (e.g., bleeding disorders, liver issues).
- Chronic pain and illness are additional suicide risk factors.

Drug history:
- Investigate the patient's drug history as it could be relevant to the self-harm
episode (e.g., interactions, overdoses).

Family history:
- Has anyone in the patient's family attempted or completed suicide?
- Are there any psychiatric conditions present in close family members?

Social history:
- A thorough social history can help identify social risk factors for suicide.

Living situation:
- Who does the patient live with?
- Where do they reside?
- Does the patient have a strong support system?
- Can the patient manage daily activities independently?
- If the patient has children, investigate potential neglect or thoughts of harm
toward them.
- Note: If there are safeguarding concerns, they should be addressed promptly.

Occupation:
- What is the patient's occupation?
- If unemployed, inquire about financial coping.
- Does the patient have any debt?

OSCE NOTES Y. Dindar Page 11 of 37

Alcohol:
- Particularly important if alcohol was involved in the self-harm incident.
- Does the patient consume alcohol?
- How much alcohol is consumed weekly?
What is the drinking pattern
- Express gratitude to the patient for sharing their experiences and being open
during the consultation.
- Offer insights on how their alcohol consumption and recreational drug use may
be influencing their mental health.
- Collaborate with the patient to develop a personalized management plan tailored
to their needs and goals.
- Acknowledge that in certain situations, a different approach may be necessary
for optimal care.

Closing the consult:

- Adhere to proper hygiene protocols by disposing of personal protective
equipment and washing hands.
- If discharge without follow-up is deemed appropriate for a low-risk patient,
ensure a comprehensive safety plan is established and appropriate resources are
provided.

Safety plan:
- Encourage the involvement of their support system, clarifying who they have
confided in already.
- Identify potential triggers and work together to address them proactively.
- Highlight the importance of avoiding excessive alcohol consumption during times
of stress.
- Collaborate with the patient to identify individuals they can reach out to if they
experience distress again.
Recommend seeking assistance from various resources, including their personal
network, GP, local support services, emergency departments, and mental health
services for self-referral, offering contact information as needed.

OSCE NOTES Y. Dindar Page 12 of 37

Intraosseous Line
Hello, examiner.

Today, I will demonstrate the procedure for an intraosseous line.

Before I begin, the indications for this procedure are a temporary alternative to
venous catheterization when peripheral and central venous access are difficult,
especially in emergency situations such as shock or cardiac arrest.

The absolute contraindications are:

- Bone fracture, burns, or infections at the site
- Previous attempts in the same location
- Also, osteoporosis

Complications of this procedure may include:

- Extravasation of fluid into soft tissues due to poor control during insertion,
resulting in the needle not entering the bone.
- Bleeding leading to compartment syndrome
- Infection, such as osteomyelitis
- Skin sloughing
- Fat embolism
- Damage to the growth plate

Introducing yourself to the mom: "Hi Mom, I'm Dr. Y. Dindar. I will now explain the
procedure and its necessity.” Explain procedure …………….

I will wash my hands and wear my PPE, including an apron, eye protection, and
gloves. My equipment includes:
- Antiseptic solution
- Rolled-up towels
- Intraosseous needle
- Syringes (10 mL)
- Sterile saline for flushes
- Sterile gauze (e.g., 10 cm × 10 cm squares)
- IV connection tubing and fluids

Additionally, I will ensure that my fluid set is pre-flushed to expel any air bubbles
and check for any holes.

Approaching the child:

- I will ensure proper lighting.
- Position the child, who should be no more than 6 years old, in a supine position,
keeping them warm.

OSCE NOTES Y. Dindar Page 13 of 37

Inspecting the leg:
- Check the uninjured leg for previous injuries, infections, or site entries.
- Pat the leg dry and clean.
- Prop it at a 30-degree angle under a rolled towel and slightly turn it.

Palpating for the correct anatomical site for insertion:

- Locate the tibial tuberosity and the medial part of the leg.
- Find the midpoint and go 2 cm below.

Next steps:
- Ensure that equipment is nearby.
- Clean the site outwardly in circular motions and let it dry.
- Insert the needle perpendicularly, applying pressure as you rotate it towards the
cortex to feel for the "pop" and loss of resistance.
- The upright position of the needle without support indicates proper placement.
- Confirm correct intramedullary placement by aspirating free-flowing blood
(marrow).
- If no marrow is aspirated, push 5 to 10 mL of normal saline through the needle.
- In case of resistance or local swelling, remove the needle and try another site.
- Attach the pre-flushed IV line to the needle, checking for backflow below the
heart before allowing the fluid to run.
- Secure the needle with sterile gauze and tape.

Look for a more permanent venous entry site as this is only viable for 12 hours.

Upper vs Lower Motor Neuron Lesion :

- An upper motor neuron lesion occurs when there is damage to the neural
pathway above the anterior horn of the spinal cord or the motor nuclei of the
cranial nerves. Conditions associated with upper motor neuron lesions include
tumors, stroke, ALS, polio, and cervical spine injury.

- A lower motor neuron lesion refers to damage affecting nerve fibers traveling
from the anterior horn of the spinal cord to the corresponding muscles.
Conditions linked to lower motor neuron lesions include motor neuron disease,
peripheral neuropathy, poliomyelitis, and spinal cord injury with nerve root
compression. Lower motor neurons regulate movement in various body parts
such as the arms, legs, chest, face, throat, and tongue. Examples of diseases
involving both upper and lower motor neurons include multiple sclerosis.

OSCE NOTES Y. Dindar Page 14 of 37

Neurological Examination
"Hi, my name is Dr. Yumna Dindar, and I will be attending to your medical case
today." (1 mark, introduce yourself and role)

"Can I confirm your name & age, Mr./Mrs./Miss ………… ? Nice to meet you.”
(1 mark, treat patient respectfully & courteously)

"I would like to emphasize that everything we do today is confidential. I would also
like to give you the option of a chaperone now or at any time during the exam if
you feel uncomfortable." (1 mark, emphasize confidentiality)

"Today, I would like to perform an upper limb examination on you. This will involve
you having to expose your upper body. The examination will involve me first
looking at the upper limbs, then feeling, and finally asking you to do some
movements. Is that ok?"

Gather Equipment

- Tendon hammer
- Neurotip
- Cotton wool
- Tuning fork (128Hz)

Wash Hands

Instruct the patient to sit or lie at a 45-degree angle.

"Are you in any pain?"

General Inspection

Clinical Signs

Perform a brief general inspection of the patient, looking for clinical signs
suggestive of underlying pathology:
- Scars
- Wasting of muscles: suggestive of lower motor neuron lesions or disuse atrophy.
- Tremor: there are several subtypes including resting tremor and intention tremor.
- Fasciculations: small, local, involuntary muscle contraction and relaxation which
may be visible under the skin. Associated with lower motor neuron pathology (e.g.,
amyotrophic lateral sclerosis).
- Pseudoathetosis: abnormal writhing movements (typically affecting the fingers)
caused by a failure of proprioception.
- Chorea: brief, semi-directed, irregular movements that are not repetitive or
rhythmic but appear to flow from one muscle to the next. Patients with
Huntington’s disease typically present with chorea.
- Myoclonus: brief, involuntary, irregular twitching of a muscle or group of muscles.
OSCE NOTES Y. Dindar Page 15 of 37
- Tardive dyskinesia: involuntary, repetitive body movements which can include
protrusion of the tongue, lip-smacking, and grimacing. This condition can develop
secondary to treatment with neuroleptic medications including antipsychotics and
antiemetics.
- Hypomimia: a reduced degree of facial expression associated with Parkinson’s
disease.
- Ptosis and frontal balding: typically associated with myotonic dystrophy.
- Ophthalmoplegia: weakness or paralysis of one or more extraocular muscles
responsible for eye movements. Ophthalmoplegia can be caused by a wide range
of neurological disorders including multiple sclerosis and myasthenia gravis.

Objects or Equipment - Look

- Walking aids: the ability to walk can be impacted by a wide range of neurological
pathology.
- Prescriptions: prescribing charts or personal prescriptions can provide useful
information about the patient’s recent medications.

Summary of the Exam Ahead

1. Pronation drift
2. Tone
3. Power
4. Shoulder
5. Elbow
6. Wrists
7. Fingers
8. Thumb
9. Bicep reflex
10. Supinator brachioradialis reflex
11. Tricep reflex
12. Sensations
13. Dermatomes
14. Light touch sensation
15. Pin prick sensation
16. Vibration sensation
17. Proprioception
18. Coordination finger-to-nose test
19. Dysdiadochokinesia
20. End - summary

OSCE NOTES Y. Dindar Page 16 of 37

Pronator Drift

Assessment

Checking for pronator drift is a useful way of assessing for mild upper limb
weakness and spasticity:

- Ask the patient to hold their arms out in front of them with their palms facing
upwards and observe for signs of pronation for 20-30 seconds.
- If no pronation occurs, ask the patient to close their eyes and observe once again
for pronation (this typically accentuates the effect due to the reliance on
proprioception alone).

Interpretation

- If the forearm pronates, with or without downward movement, the patient is

considered to have pronator drift on that side.
- The presence of pronator drift indicates a contralateral pyramidal tract lesion.
- Pronation occurs because, in the context of an UMN lesion, the supinator
muscles of the forearm are typically weaker than the pronator muscle.

Tone

Assessment

Assess tone in the muscle groups of the shoulder, elbow, and wrist on each arm,
comparing each side as you go:

1. Support the patient’s arm by holding their hand and elbow.

2. Ask the patient to relax and allow you to fully control the movement of their arm.
3. Move the muscle groups of the shoulder (circumduction), elbow (flexion/
extension), and wrist (circumduction) through their full range of movements.
4. Feel for abnormalities of tone as you assess each joint (e.g., spasticity, rigidity,
cogwheeling, hypotonia).

- Spasticity is associated with pyramidal tract lesions (e.g., stroke). It is "velocity-

dependent," meaning the faster you move the limb, the worse it is. There is
typically increased tone in the initial part of the movement which then suddenly
reduces past a certain point (known as “clasp knife spasticity”).
- Rigidity is associated with extrapyramidal tract lesions (e.g., Parkinson’s disease).
It is "velocity independent," meaning it feels the same if you move the limb rapidly
or slowly. Cogwheel rigidity involves a tremor superimposed on the hypertonia,
resulting in intermittent increases in tone during movement of the limb. This
subtype of rigidity is associated with Parkinson’s disease. Lead pipe rigidity
involves uniformly increased tone throughout the movement of the muscle. This
subtype of rigidity is typically associated with neuroleptic malignant syndrome.
Spasticity and rigidity both involve increased tone.

OSCE NOTES Y. Dindar Page 17 of 37

Power

Assessment

- You must stabilize and isolate the relevant joint for each assessment to ensure
you can accurately measure and compare muscle strength.
- As a result, you should only assess one side at a time.
- At each stage in the assessment, you should compare like for like.
- Use the MRC muscle power assessment scale for scoring muscle strength.

21. Shoulder abduction - C5: axillary nerve - Deltoid - Flex elbows & abduct their
shoulders 90° - Chicken like - Apply downward resistance on the lateral side of the
upper arm

22. Shoulder abduction - C6/7 thoracodorsal nerve - Teres major, latissimus dorsi,
and pectoralis major - To bring 45° their elbows closer to their body: - “Now bring
your elbows a little closer to your sides.” - Apply upward resistance on the medial
side of the upper arm whilst asking the patient to maintain their arm’s position:
“Don’t let me pull your arms away from your sides.”

23. Elbow flexion - C5/6 (musculocutaneous and radial nerve) - biceps brachii,
coracobrachialis, and brachialis - Ask the patient to flex their elbow: “Put your
hands up like a boxer.” - Apply resistance by pulling the forearm whilst stabilizing
the shoulder joint: “Don’t let me pull your arm away from you.”

24. Elbow extension - C7 (radial nerve) - Triceps brachii - With the patient’s elbows
still in the flexed position, apply resistance by pushing the forearm towards the
patient whilst stabilizing the shoulder joint: “Don’t let me push your arm towards
you.”

25. Wrist extension - C6 (radial nerve) - Extensors of the wrist - “Hold your arms
out in front of you, with your palms facing the ground.” - “Make a fist, cock your
wrists back and don’t let me pull them downwards.”

26. Finger extension - C6/7 (median nerve) - flexors of the wrist - With the patient
still holding their arms out in front of them - “Ok now point your wrists downwards
and don’t let me pull them up.”

27. Finger abduction - T1 (ulnar nerve) - First dorsal interosseous (FDI) - Abductor
digiti minimi (ADM) - Ask the patient to abduct their fingers against resistance. You
should assess abduction in FDI and ADM separately using the equivalent finger of
your own to apply resistance: - “Splay your fingers outwards and don’t let me push
them together.”

OSCE NOTES Y. Dindar Page 18 of 37

28. Thumb abduction - T1 (median nerve) - Abductor pollicis brevis - Ask the
patient to turn their hand over so their palm is facing upwards and to position their
thumb over the midline of the palm. Advise them to keep it in this position whilst
you apply downward resistance with your own thumb: - “Point your thumbs to the
ceiling and don’t let me push them down.”

Then test for reflexes

- Use a tendon hammer

- The muscle must be completely relaxed
- If absent, you must do the reinforcement maneuver by asking the patient to
clench their teeth

Bicep reflex C5/6 - Biceps brachii tendon which is typically found at the medial
aspect of the antecubital fossa. - Place the thumb of your non-dominant hand over
the tendon and then tap your thumb with the tendon hammer. - Observe for a
contraction of the biceps muscle and associated flexion of the elbow.

Supinator (brachioradialis) reflex (C5/6) - Locate the brachioradialis tendon which

can be found on the posterolateral aspect of the wrist approximately 4 inches
proximal to the base of the thumb. - With two fingers positioned over the tendon,
tap your fingers with the tendon hammer. - Observe for a contraction of the
brachioradialis muscle and associated flexion, pronation or supination of the
forearm at the elbow.

Triceps reflex (C7) - Position the patient’s arm so that the triceps tendon is relaxed:
this is commonly achieved by resting the patient’s elbow in 90º flexion on their lap
or by supporting the patient’s forearm. - Locate the triceps tendon, which can be
found superior to the olecranon process of the ulna. - Tap the tendon with the
tendon hammer and observe for a contraction of the triceps muscle.

Hyperreflexia vs. Hyporeflexia

Hyperreflexia is typically associated with upper motor neuron lesions (e.g., stroke,
spinal cord injury) due to the loss of inhibition from higher brain centers which
normally exert a degree of suppression over the lower motor neuron reflex arc.

Hyporeflexia is typically associated with lower motor neuron lesions (e.g., brachial
plexus pathology or other peripheral nerve injuries) due to loss of the efferent and
afferent branches of the normal reflex arc.

In cerebellar disease, reflexes are described as ‘pendular,’ which means less brisk
and slower in their rise and fall. This sign is, however, very subjective and often
reflexes appear to be ‘normal’ in cerebellar disease.

OSCE NOTES Y. Dindar Page 19 of 37

Sensation

It’s easy to get bogged down in examining sensation, but the key points are as
follows:
- Check at least one modality each from the dorsal columns and spinothalamic
tracts.
- Ensure the patient has their eyes closed for the assessment.
- Demonstrate normal sensation on the patient’s sternum.
- Assess sensation across each of the upper limb dermatomes (see below),
comparing left to right at equivalent regions as you progress.

Dermatomes

It’s important to avoid assessing sensation close to dermatomal boundaries to

minimize the risk of misinterpretation. Here are some locations you can use to
assess each of the upper limb dermatomes:
- C5: the lateral aspect of the lower edge of the deltoid muscle (known as the
“regimental badge”).
- C6: the palmar side of the thumb.
- C7: the palmar side of the middle finger.
- C8: the palmar side of the little finger.
- T1: the medial aspect antecubital fossa, proximal to the medial epicondyle of the
humerus.

Light Touch Sensation

Light touch sensation involves both the dorsal columns and spinothalamic tracts.
- Ask the patient to close their eyes and touch their sternum with the wisp of
cotton wool to provide an example of light touch sensation.
- Ask the patient to say “yes” when they feel the sensation.
- Using the wisp of cotton wool, begin to assess light touch sensation across each
of the upper limb dermatomes, comparing each side as you go by

asking the patient if it feels the same.

Pin-Prick Sensation

- Pin-prick (pain) sensation involves the spinothalamic tracts.

- Repeat the previous assessment steps used for light touch sensation, but this
time using the sharp end of a neuro-tip.
- If loss of sensation is noted distally, test for “glove” distribution of sensory loss
(associated with peripheral neuropathy) by moving distal to proximal.

OSCE NOTES Y. Dindar Page 20 of 37

Vibration Sensation

Vibration sensation involves the dorsal columns.

- Ask the patient to close their eyes and to let you know both when they can detect
vibration and when it stops.
- Tap a 128 Hz tuning fork and place it onto the patient’s sternum to check they are
able to feel it vibrating. Then grasp the ends of the tuning fork to cease vibration
and see if the patient is able to accurately identify that it has stopped.
- Tap the tuning fork again and place it onto the interphalangeal joint of the
patient’s thumb. If the patient is able to accurately identify when the vibration
begins and when it stops at this point in both upper limbs, the assessment is
complete.
- If vibration sensation is impaired at the interphalangeal joint of the patient’s
thumb, continue to sequentially assess more proximal joints (e.g., carpometacarpal
joint of the thumb → elbow joint → shoulder joint) until the patient is able to
accurately identify vibration.

Proprioception

Proprioception, also known as joint position sense, involves the dorsal columns.
- Begin assessment of proprioception at the interphalangeal joint of the thumb by
holding the distal phalanx of the thumb by its sides (avoid holding the nail bed as
this can allow the patient to determine direction based on pressure).
- Demonstrate movement of the thumb “upwards” and “downwards” to the patient
whilst they watch.
- Ask the patient to close their eyes and state if you are moving their thumb up or
down.
- Move the thumb up or down 3-4 times in a random sequence to see if the patient
is able to accurately identify joint position with their eyes closed.
- If the patient is unable to correctly identify the direction of movement, continue to
sequentially assess more proximal joints (e.g., carpometacarpal joint of the thumb
→ wrist → elbow → shoulder).

Patterns of Sensory Loss

- Mononeuropathies result in a localized sensory disturbance in the area supplied

by the damaged nerve.
- Peripheral neuropathy typically causes symmetrical sensory deficits in a ‘glove
and stocking’ distribution in the peripheral limbs. The most common causes of
peripheral neuropathy are diabetes mellitus and chronic alcohol excess.
- Radiculopathy occurs due to nerve root damage (e.g., compression by a
herniated intervertebral disc), resulting in sensory disturbances in the associated
dermatomes.
- Spinal cord damage results in sensory loss both at and below the level of
involvement in a dermatomal pattern due to its impact on the sensory tracts
running through the cord.
- Thalamic lesions (e.g., stroke) result in contralateral sensory loss.
- Myopathies often involve symmetrical proximal muscle weakness.
OSCE NOTES Y. Dindar Page 21 of 37
Coordination

Finger-to-Nose Test

Assessment

The finger-to-nose test is a convenient method of assessing upper limb co-

ordination:
- Position your finger so that the patient has to fully outstretch their arm to reach it.
- Ask the patient to touch their nose with the tip of their index finger and then
touch your fingertip.
- Ask the patient to continue to do this finger-to-nose motion as fast as they are
able to.

Interpretation

When patients with cerebellar pathology perform this task they may exhibit both
dysmetria and intention tremor:
- Dysmetria: refers to a lack of coordination of movement. Clinically, this results in
the patient missing the target by over/undershooting.
- Intention tremor: a broad, coarse, low-frequency tremor that develops as a limb
reaches the endpoint of a deliberate movement. Clinically, this results in a tremor
that becomes apparent as the patient’s finger approaches yours. Be careful not to
mistake an action tremor (which occurs throughout the movement) for an intention
tremor.
The presence of dysmetria and intention tremor is suggestive of ipsilateral
cerebellar pathology.

Dysdiadochokinesia

Describes the inability to perform rapid, alternating movements, which is a feature

of ipsilateral cerebellar pathology.

Assessment

- Ask the patient to place their left palm on top of their right palm.
- Then ask them to turn over their left hand and touch the back of it onto their right
palm.
- Now ask them to return their left hand to the original position (left palm on right
palm).
- Ask the patient to now repeat this sequence of movements as fast as they are
able until you tell them to stop. It is often useful to demonstrate the sequence of
movements to the patient to aid understanding.
- Observe the speed and fluency by which the patient is able to carry out this
sequence of rapidly alternating movements.
- Repeat the assessment with the other hand.

OSCE NOTES Y. Dindar Page 22 of 37

Interpretation

Patients with cerebellar ataxia may struggle to carry out this task, with their
movements appearing slow and irregular. The presence of dysdiadochokinesia
suggests ipsilateral cerebellar pathology.

Thank the Patient, Dispose PPE

Example Summary

“Today I examined Mr. Smith, a 32-year-old male. On general inspection, the

patient appeared comfortable at rest, with normal speech and no other stigmata of
neurological disease. There were no objects or medical equipment around the bed
of relevance.” “Assessment of the upper limbs revealed normal tone, power,
reflexes, sensation, and coordination.” “In summary, these findings are consistent
with a normal upper limb neurological examination.” “For completeness, I would
like to perform the following further assessments and investigations.” Further
assessments and investigations: - Full neurological examination including the
cranial nerves, lower limbs, and cerebellar assessment. - Neuroimaging (e.g., MRI
spine and head).

Diabetic Foot Examination

Hello, my name is Dr. Y. Dindar, and I will be overseeing your medical evaluation
today.

May I kindly confirm your name and age, Mr./Mrs./Miss…? It's a pleasure to meet
you.

Before we proceed, I want to assure you that everything we discuss and do today
remains strictly confidential between us. Additionally, if at any point during the
examination you feel uncomfortable, please don't hesitate to let me know. You also
have the option of having a chaperone present if you wish.

Today, I'll be conducting a diabetic foot examination on your lower limbs. This will
involve examining your legs and feet, feeling for any abnormalities, and asking you
to perform some movements. Are you comfortable with this?

Let's gather the necessary equipment:

- Monofilament
- Tuning fork (128 Hz)
- Reflex hammer

Wash hands
Ensure adequate lighting and privacy.

OSCE NOTES Y. Dindar Page 23 of 37

You may now remove your shoes and lie down on the bed, exposing your legs up
to mid-thigh.

While you move to the bed, I'll be observing:

- Any signs of pain
- Your posture
- Your stance

I'll also be assessing your gait, looking for any signs of conservative gait strategy
or foot drop, which are common in diabetic patients. Additionally, I'll observe your
speed, stance, steps, and turning ability, as these can provide valuable insights
into your condition.

Do you experience any pain?

Now, let's begin the examination:

Inspection:
- I'll be checking for bilateral symmetry in your legs and feet.
- I'll look for hyperpigmentation, hair distribution or loss, dryness of the skin, and
any signs of peripheral cyanosis or pallor.
- I'll carefully examine your feet, including the areas between the toes, for wounds,
ulcers, corns, calluses, scars, and signs of infection or deformities like clawing,
tophi, or Charcot's deformity.
- I'll also assess for conditions like hallux valgus, arterial ulcers, venous ulcers,
venous guttering, and gangrene.

Palpation:
- I'll check the temperature of your limbs, comparing both sides for any significant
differences.
- I'll assess your pulses at the dorsal pedis and posterior tibialis locations on both
sides.
- I'll check for any signs of edema and assess for pitting.

Percussion:
- I'll test your knee and ankle reflexes to assess neurological function.

Sensation:
- I'll evaluate deep sensation using a tuning fork on your big toe or malleolar area.
- I'll perform a soft touch test using cotton wool, starting with your sternum and
arm to demonstrate, then lightly touching both legs and asking if you can feel it.

Monofilament:
1. I'll demonstrate the sensation of the monofilament on your arm or sternum.
2. With your eyes closed, I'll apply the monofilament to specific locations on your
feet and ask you to report when you feel it, ensuring consistent pressure and
avoiding calluses or scars.
OSCE NOTES Y. Dindar Page 24 of 37
Proprioception:
- I'll check your ability to move your toes up and down.

Shoe Inspection:
- I'll examine your footwear, noting any asymmetrical wear patterns, ensuring
proper fit, and checking for any potential hazards inside the shoes.

Additionally, I'll perform:

- Blood glucose testing
- Urine dipstick analysis

Now, for a brief summary:

"Today, I examined Mr. Smith, a 64-year-old male. Upon inspection, there were
notable signs of peripheral arterial insufficiency and peripheral neuropathy. Further
assessments and investigations are recommended."

Further assessments and investigations may include:

- Bedside capillary blood glucose testing
- Serum HbA1c measurement
- Further neurological examination
- Peripheral arterial examination
- Venous examination of the lower limbs
- Foot care advice, including podiatry input and footwear recommendations
- Calculation of diabetic foot risk using assessment tools.

Rectal Exam
Greetings, my name is Dr. Y. Dindar, and I'll be overseeing your medical evaluation
today.

May I kindly confirm your name and age, Mr./Mrs./Miss…? It's a pleasure to meet
you.

Before we proceed, I want to emphasize that all aspects of our examination today
are strictly confidential between us. Additionally, to ensure your comfort and
privacy, a member of our staff will be present throughout the examination as a
chaperone. Is that arrangement acceptable to you?

Today, I'd like to conduct a rectal examination based on your signs and symptoms.
This will involve you removing your lower garments, including your underwear. I'll
gently insert a finger into your anus to assess for any abnormalities. While this may
feel uncomfortable, it shouldn't be painful, and you can request to stop at any
time. Are you comfortable proceeding with this examination?

Let's ensure we're in a private setting with good lighting and minimal noise, and
our chaperone is present.

OSCE NOTES Y. Dindar Page 25 of 37

Are you currently experiencing any pain?

Please remove your pants and underwear and lie down on your left side, with your
hips and knees flexed and your buttocks at the edge of the bed.

Now, I'll wash and sanitize my hands, ensuring they are warm, and then put on
gloves for the examination.

General Examination:
- I'll note your general condition and check vital signs such as pulse and
temperature.

Inspection:
- I'll lift the right buttock to inspect for any skin excoriation, skin tags, external
hemorrhoids, anal fissures, external bleeding, or anal fistulas.
- I'll ask you to cough or strain to assess rectal descent, prolapse, incontinence,
and internal hemorrhoids.

Palpation:
- I'll apply lubricant to my gloved finger and the anal verge.
- Please breathe through your mouth and relax.
- I'll gently and slowly insert my finger into your anus, palpating the anal canal for
any pain, tenderness, tone of the external sphincter, and rectal contents.
- I'll palpate the anterior wall and prostate, describing their size, shape,
consistency, and any nodules or masses.
- I'll also palpate the lateral and posterior walls and perform a bimanual palpation.
- I'll assess anal tone by asking you to bear down on my finger.
- Afterward, I'll remove my finger, noting the color and presence of stool, blood,
pus, or mucus, and dispose of the glove.

To conclude, I'll ensure you're clean and covered.

In summary, based on our examination, I'll provide a brief overview of our findings.

If a lesion is detected:
- How would you describe the lesion?
- What is its proximity from the anal verge?
- Can you describe its size, shape, and consistency?
- What is the structure of the lesion (e.g., nodule, ulcer, tumulating mass)?

OSCE NOTES Y. Dindar Page 26 of 37

Respiratory Examination
Hello, I'm Dr. Y. Dindar, and I'll be overseeing your medical evaluation today.

May I kindly confirm your name and age, Mr./Mrs./Miss…? It's a pleasure to meet
you.

Before we begin, I want to stress that all aspects of our examination today are
entirely confidential between us. Additionally, you have the option of having a
chaperone present at any time during the exam, and you're welcome to stop or
express any discomfort you may feel.

Today, I'd like to conduct a respiratory exam based on your signs and symptoms.
This will involve you removing your shirt (for males; females do not need to remove
their bra). I'll be inspecting you from the end of the bed, checking your vitals,
conducting a general examination, inspecting your chest, and listening to your
lungs. Is that acceptable to you?

Let's ensure we're in a private setting and position you at a 45-degree angle,
exposing your chest and torso by removing your shirt.

General Examination:
I'll assess your overall condition, level of consciousness, and whether you're
comfortable or in distress. I'll also observe your surroundings for any oxygen
devices or pumps.

Vital Signs:
I'll check your pulse, blood pressure, respiratory rate, and temperature.

Hands:
I'll examine your hands for clubbing, pallor, wasting, skin changes, cyanosis,
tobacco stains, fine tremor, and asterixis.

Head & Neck:

I'll inspect for any wasting, abnormal appearance, and signs of jaundice or pallor in
your eyes.

Axilla Lymph Nodes:

I'll examine the lymph nodes in your axilla.

Lower Limbs:
I'll check for edema and signs of deep vein thrombosis.

OSCE NOTES Y. Dindar Page 27 of 37

Chest Inspection:
From the foot of the bed, I'll look for signs of distress, including harsh or fast
breathing, use of accessory muscles, nasal flaring, pursed lips, and abnormal
breathing patterns. I'll also assess symmetry, rise of the chest, shape
abnormalities, distended veins, and scars.

Palpation:
I'll gently palpate your chest, feeling for any abnormalities, tenderness, or signs of
emphysema. I'll assess the trachea for deviation, cricosternal distance, apex beat,
chest expansion, and vocal fremitus.

Percussion:
I'll percuss various areas of your chest, comparing side to side, and assess cardiac
and liver dullness.

Auscultation:
Using a stethoscope, I'll listen to your breathing in different areas of your chest,
assess air entry, breath sounds, and vocal resonance.

Examination of the Back of the Chest:

I'll ask you to fold your arms across your chest for inspection, palpation,
percussion, and auscultation of your back.

To conclude, I'll summarize our findings, thank you for your cooperation, ensure
you're adequately covered, and discuss any further assessments or investigations
if necessary.

When presenting our findings, I'll use "reduced breath sounds" rather than
"reduced air entry".

For additional time, we can perform a lymph node examination.

OSCE NOTES Y. Dindar Page 28 of 37

Primary Survey
The primary survey's objective is to swiftly identify and address immediate life-
threatening conditions in the patient.

Prior to Arrival:

Before the patient's arrival, I would have activated the trauma team and briefed
them accordingly. Additionally, I would pre-prepare medication and equipment for
prompt action upon the patient's arrival.

- Activate Trauma Team based on the criteria for Trauma Team Activation.
- Conduct a pre-arrival briefing for the team with a synthesized plan.
- Utilize a pre-arrival checklist to facilitate role and task allocation.
- Estimate the child's weight using a specific formula.
- Prepare age and weight-appropriate doses of medication referencing resources
like the Monash Drug book.
- Ensure equipment is suitable for the patient's age.
- Ensure all trauma team members wear personal protective equipment and lead
aprons.

On Arrival:

Upon the patient's arrival, I will receive a handover from the ambulance staff and
initiate the primary survey.
- Obtain a comprehensive handover from the ambulance staff.
- Initiate the primary survey.
- Gather further information from parents or caregivers if available.
- Ensure dedicated support is available for parents or caregivers.

The primary survey's priorities include assessing and managing:

- Catastrophic hemorrhage
- Airway (with C-spine control)
- Breathing
- Circulation
- Disability
- Exposure/Environment

Bleeding/Hemorrhage:

Assess for catastrophic bleeding:

- Apply pressure, compression, and packing for torso injuries.
- Apply a tourniquet for limb injuries.

OSCE NOTES Y. Dindar Page 29 of 37

Airway:

- Assess the airway, neck, and Glasgow Coma Scale (GCS).

- Engage the patient:
"Hello, can you hear me? I'm Dr. Dindar. You've been in an accident."
- Ensure adequate C-spine control.
- Use the Glasgow Coma Scale (GCS) to assess neurological status.

GCS:
Moderate injury: 13-15 (Best Response: 15)
Moderate injury: 9-12
Severe: <8 (Comatose <8, Totally Unresponsive: 3)

Assessing the Airway:

- Check for facial fractures, blood, vomit, teeth, soot, burns, and head or neck
swelling.
- Assess the airway and chest for TWELVE-C:
◦ Tracheal deviation
◦ Wounds
◦ Emphysema (subcutaneous)
◦ Laryngeal tenderness/crepitus
◦ Venous distension JVP
◦ Esophageal injury
◦ Carotid hematoma/bruits/swelling

Manage airway obstruction:

- Position head neutrally.
- Suction blood or vomit.
- Administer high-flow oxygen.
- Perform a jaw thrust or use an oropharyngeal airway.
- Apply a hard cervical collar.

Breathing:

- Assess respiratory rate, effectiveness, and signs of injury.

- Examine for seat belt marks, bruises, wounds, and evaluate chest expansion.
- Request a chest X-ray and blood glucose level.
- Auscultate for breath sounds and added sounds.
- Percuss the chest for resonance or dullness.

OSCE NOTES Y. Dindar Page 30 of 37

Circulation:

- Assess for pulse rate, skin color, capillary refill, external bleeding, and intra-
thoracic, abdominal, and pelvic bleeding.
- Assess pelvic stability.
- Establish two wide-bore IV lines and apply an ECG monitor.
- Manage hemorrhagic shock:
◦ Identify and stop the source(s) of bleeding.
◦ Administer an initial fluid bolus followed by blood products if necessary.
◦ Repeat fluid bolus if circulation remains unstable.

Disability:

- Assess for traumatic brain injury using the AVPU scale:

◦ A = Alert
◦ V = Responds to Voice
◦ P = Responds to Pain
◦ U = Unresponsive
- Evaluate pupil response and limb movements.

Exposure & Environment:

- Remove clothing to assess for other injuries.

- Prevent hypothermia by limiting exposure and warming fluids.
- Arrange for necessary imaging and tests.

OSCE NOTES Y. Dindar Page 31 of 37

Obstetric Examination
"Hello, my name is Dr. Y. Dindar, and I'll be taking care of you today."

"May I please confirm your name and age, Mr./Mrs./Miss...? It's a pleasure to meet
you."

"I want to emphasize that everything we discuss and do today is entirely

confidential between you and me. Additionally, I'd like to offer you the option of
having a chaperone present at any time during the examination. If you ever feel
uncomfortable, please don't hesitate to let me know."

"Today, as part of your pregnancy assessment, I'll need to examine your abdomen.
This will involve exposing your abdomen area. Although it might be slightly
uncomfortable, it shouldn't cause any pain. If you have any concerns or want me
to stop at any point, please inform me. Do you understand everything I've
explained? Are you comfortable with me proceeding with the examination?"

Before we start, I'll need you to empty your bladder."

"I'll ask you to lie down now and ensure you're comfortable. I'll position you in the
left lateral position, tilted 15 degrees to avoid compression of the abdominal aorta
and inferior vena cava by the gravid uterus."

"I've ensured we have a private setting with good lighting and minimal noise.
You're lying down comfortably with a pillow under your head and arms at your
side. My hands are clean and warm."

General Inspection:
- "From the end of the bed, I'm checking for any obvious scars, signs of pain,
jaundice, anemia, pallor, or edema."
- "I'm closely inspecting your abdomen for its shape, fetal movements, surgical
scars, linea nigra, striae gravidarum, and other relevant signs."

Vital Signs:
- "I'm monitoring your pulse, blood pressure, respiratory rate, and temperature.”

OSCE NOTES Y. Dindar Page 32 of 37

Palpation:
- "I'm palpating the level of the fundus to estimate the size of your uterus in
weeks."
- "I'm checking for any abdominal tenderness and performing light palpation over
each of the nine abdominal regions."
- "Now, I'm palpating your uterus to identify its borders and measure the
Symphysial Fundal Height."
- "I'm applying firm pressure to the uterus to assess the fetal presentation and
determining the fetal lie using various grips."
- "I'm also assessing the level of fetal engagement."
- "Throughout the palpation, I'm observing for myometrium, liquor volume,
estimated fetal weight, and fetal movements."

Auscultation of Fetal Heart:

- "Using a Pinard stethoscope, I'm locating and identifying the fetal heartbeat."

Summary:
"Today, I examined Mrs. Smith, a 28-year-old female at 36 weeks gestation. She
appeared comfortable at rest, and there were no signs of edema or discomfort.
Symphysial-fundal height measured 36cm, consistent with her gestational age.
The fetus is in a longitudinal lie with a cephalic presentation. The fetal head was
three-fifths palpable. Overall, these findings suggest a normal obstetric abdominal
examination."

"I'd like to conduct further assessments and investigations, including assessing

the fetal heartbeat, measuring blood pressure, urinalysis, speculum examination if
necessary, and an ultrasound scan to ensure the well-being of the fetus."

"Thank you for your cooperation. Is there anything else I can assist you with?”

OSCE NOTES Y. Dindar Page 33 of 37

COMMON OSCE STATIONS

COUNSELLING

1. Sexual assault

2. IPV

3. Smoking cessation

4. Alcohol cessation

5. Drug adherence

6. Weight loss

7. Consent taking

8. TOP

9. Inhaler technique

10. HIV counseling (pre/post)

11. Breaking bad news

OSCE NOTES Y. Dindar Page 34 of 37

 B. EMMERGENCIES

12. SVT

13. AF

14. MI

15. Choking

16. CPR ( adult and neonate)

17. Seizures

18. Epistaxis

C.WRITTEN

19. X-RAYS

20. ECG

21. Urinalysis

22. Prescription writing

23. Skin slides (Dermatology)

24. Eye slides

25. Cardiotocogram

26. Parthogram

27. Road to health chart

28. Maternal care

29. PEFR

OSCE NOTES Y. Dindar Page 35 of 37

 D. MANAGEMENT OF CHRONIC CONDITIONS

30. Diabetes

31. Hypertension

32. Asthma

33. HIV

34. COPD

35. TB

36. Obesity

37. Stroke

38. CKD

E. EXAMINATIONS

39. Knee joint

40. Upper limb neurological exam

41. Lower limb neurological exam

42. Shoulder join

43. Hip joint

44. Ankle injury joint

45. Respiratory system exa

46. Mental state examination =MMSE

47. Cardiovascular system examination

48. Abdominal exam

49. Breast exam

50. Vaginal exam

51. Examination of the new born

OSCE NOTES Y. Dindar Page 36 of 37

52. Diabetic foot in the exam

53. Cranial nerve exam

54. Fundoscopy

55. Pediatric Px using IMCI

F. PROCEDURES

56. Lumbar puncture

57. Intubation

58. Intercostal drain

59. Intraosseos line

60. Pap smear

61. ECG leads

62. Pacing

63. Abnormal delivery

64. CVP line

OSCE NOTES Y. Dindar Page 37 of 37