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Osce Exam Study Guide.pdf

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13 views6 pages

Osce Exam Study Guide.pdf

Uploaded by

liviehackett
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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OSCE EXAM STUDY GUIDE

REQUIRED Before entering the room:


-​ Get proper instruments needed for exam
Bring a stethoscope, penlight, reflex hammer, otoscope, ophthalmoscope, Snellen chart,
and measuring tape.
-​ Wash Hands
REQUIRED Initial Assessment:
-​ Provide Privacy
-​ Introduce self to the patient
-​ Identify patient using proper identifiers (VERBALIZE)
Ask name and DOB and look at their bracelet
REQUIRED History:
-​ Verbalizes Chief Complaint
“What brings you in today?”
-​ Verbalizes History of Present Illness
OLDCART
-​ Verbalizes Past Medical History
Ask about chronic illnesses (e.g., HTN, diabetes, asthma).
-​ Verbalizes Past Surgical History
-​ Verbalizes Family History
-​ Verbalizes Review of Systems
Ask general health questions by system: any fatigue, headaches, breathing issues, chest
pain, etc.
REQUIRED HEENT:
Head
-​ Level of consciousness (LOC):​
Is the patient alert, responsive, and aware of surroundings?
-​ Orientation:​
Ask: “Can you tell me your name? Where you are? What day it is?”
-​ Facial symmetry/speech:​
Look for drooping, slurred speech, and clarity.
-​ Head symmetry:​
Inspect for shape, trauma, or swelling.
-​ Palpate sinuses:​
Gently press frontal (above eyebrows) and maxillary (under cheekbones) sinuses for
tenderness.
Ears
-​ Inspect and palpate outer ear:​
Look for lesions, discharge, or redness; palpate for pain.
-​ Whisper Test:​
Cover one ear, stand behind, and whisper 2-3 words.
-​ Rinne Test:​
Strike tuning fork, place on mastoid (bone), then next to ear. Air conduction should be
longer than bone.
-​ Weber Test:​
Place the tuning fork on the center of the skull. Sound should be heard equally in both
ears.
-​ Otoscope exam:​
Gently insert an otoscope. Verbalize: no redness, discharge; visualize tympanic
membrane, landmarks.
Eyes
-​ Inspect conjunctiva:​
Pull down lower lid, look for redness, discharge.
-​ Accommodation/convergence:​
Have patient focus on finger as you move it toward the nose. Eyes should cross and
pupils constrict.
-​ Ophthalmoscope:​
Look for red reflex, optic disc (practice using model or simulated eye).
-​ Visual acuity:​
Use Snellen chart, one eye at a time, then both.
-​ Pupillary response (PERRLA):​
Pupils Equal, Round, Reactive to Light and Accommodation (direct & consensual).
-​ Cardinal Fields of Gaze:​
Trace an “H” with your finger and have the patient follow with their eyes.
Nose
-​ Inspect nasal mucosa:
Use penlight, look for color, swelling, polyps, or discharge.
Throat/Mouth/Neck
-​ Uvula:​
Ask patient to say “ah” – look for midline rise.
-​ Tonsils:​
Grade size (0-4+), note inflammation or exudate.
-​ Under tongue:​
Check for lesions, cyanosis.
-​ Mouth inspection:​
Lips (hydration, color), teeth (intact), mucosa (pink, moist), tongue (midline, color).
-​ Thyroid gland:​
Palpate from behind or front, ask patient to swallow.
-​ Lymph nodes:​
Use pads of fingers: preauricular, postauricular, occipital, tonsillar, submandibular,
submental, anterior/posterior cervical, supraclavicular.
Lungs/Thorax:
-​ Inspect chest:​
Note symmetry, deformities, scars.
-​ A/P diameter, chest expansion:​
Check for barrel chest, symmetrical rise.
-​ Tactile fremitus:​
Use ulnar edge of hand; ask patient to say “99” and feel for vibrations.
-​ Percussion:​
Compare bilaterally; note resonance or dullness.
-​ Landmarks:​
Know where to find upper, middle, and lower lobes.
-​ Auscultate lungs:​
Listen anterior and posterior; describe normal (vesicular) or abnormal (crackles,
wheezing) sounds.
Cardiovascular/Peripheral Vascular:
-​ Vital signs & SpO₂:​
Know normal values. Note if VS are WNL or abnormal.
-​ Inspect chest:​
Pulsations, heaves, visible abnormalities.
-​ Heart sound landmarks:​
Aortic (2R ICS), Pulmonic (2L ICS), Erb’s point (3L ICS), Tricuspid (4L ICS), Mitral
(5L ICS MCL).
-​ CSMT of extremities:​
Assess circulation (pulses, color), sensory (touch), movement, and temperature.
-​ Capillary refill:​
Should be <2 seconds.
-​ Arterial pulses:​
Palpate at least 5: carotid, radial, femoral, popliteal, dorsalis pedis.
-​ Peripheral edema:​
Press on shin/ankle; grade (1+ to 4+), verbalize findings.
Abdomen:
Inspect contour:​
Flat, round, distended, or scaphoid.
Auscultate bowel sounds:​
Start in RLQ, use diaphragm. Listen before palpating!
Auscultate bruits:​
Use bell over aorta, renal, iliac, and femoral arteries.
Percussion:​
Move RLQ → LLQ; listen for tympany (gas) or dullness (fluid/mass).
Light palpation:​
Same order, note tenderness, masses.
Specialty test (choose one):
●​ Rebound tenderness: Pain on release suggests peritonitis.
●​ Murphy’s sign: Pain on palpation during inhalation (gallbladder).
●​ Psoas sign: Raise leg against resistance – pain suggests appendicitis.

Musculoskeletal:
Inspect extremities:​
Look for deformity, swelling, redness.
Palpate joints:​
Check for crepitus, tenderness, swelling.
CSMT:​
Again, circulation, sensory, movement, temp for each extremity.
ROM & Strength:

●​ Head/Neck: Flexion, extension, lateral rotation, resistance.


●​ Arms/Hands: Grip strength, flexion, extension.
●​ Legs/Feet: Push/pull resistance, ROM.

Movement:​
Can the patient move all extremities on command?
Neurological:
-​ Behavior, speech, tone:​
Are they appropriate, clear, cooperative?
-​ Cranial nerve:​
Choose one to test (e.g., CN VII: facial expressions, CN II: visual fields).
-​ Motor system:​
Inspect for muscle tone, tremors, atrophy (pick UE or LE).
-​ Sensory system:​
Sharp/dull, plus stereognosis (object ID) or graphesthesia (draw on palm).
-​ DTRs:​
Attempt brachioradialis, patellar, Achilles – even if not elicited, verbalize!
-​ Gait:​
Observe walking – steady, balanced, or ataxic?
-​ Coordination:​
Rapid alternating movement (e.g., flipping palms) or point-to-point (touch nose, then
your finger).
-​ Special test:​
Romberg: Eyes closed standing, assess for swaying.​
MMSE: Brief cognitive screening (orientation, memory, attention).
Technique/Logic:
-​ Orderly flow:​
Start with general, move head-to-toe. Minimize repositioning.
-​ All components:​
Use inspection, palpation, percussion, auscultation as appropriate.
-​ Tool use:​
Know how to hold and handle each piece of equipment correctly.

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