Osce

Front 1

Medical history intro

Back 1

Hello, my name is ben. I am a pharmacy student at the university of sunderland. Can i ask your name and age please?. Nice to meet you. Just to et you know ive washed my hands and everything discussed will remain confidential. IS it ok i make notes? Whats been bothering you?

Front 2

Steps for medical history:

Back 2

Polly has pretty damn fine sexy stockings

Presenting medical complaint, history of presenting medical complaint

At this point O P Q R S T U

Onset, Pain, Quality/quantity, radiation, severity, timing, UR ideas.

Past medical history
drug history
At this point COPHAC
Current medication
Other medications
Past medications
Hypersensitivity reactions
Concordance.

Family history
Alchohol use
Smoking use
Social history [LOT][Lifestyle, Occupation, Travel]

THEN RED FLAGS (ALL FOR THE RELRVANT STATION AND COVER MOST FOR OTHERS

Front 3

RESPIRATORY RED FLAGS

Back 3

WBBCCC

Wheezing, Blood sputum, breathlessness, cough (>3weeks), Chest pain, calf tenderness

Front 4

GI red flags

Back 4

WSIANBS

Weight loss (unintended), Swallowing (painful/difficult), Indigestion/heartburn (consistent), Abdominal pain, Nausea/ vomiting, Bowel habits altered, stool blood appearance.

Front 5

MISC red flags

Back 5

VMTAP

Visual distubrances
Migraine
Trauma (Recent)
Ankle swellign
palpitations

Front 6

MUR intro

Back 6

Hello, my name is ben, i am a student pharmacist at the university of sunderland. Can i ask for your name and age please? Is it ok if i conduct a Medicine review? Is it ok if i take notes? everything discussed will remain confidential. I have washed my hands. is it ok if i pick up your medicine during this.

Front 7

MUR

Back 7

Allergies
Current meds

OTher meds (OTC, CREAMS, insulin, recreational)
PAst meds (recent 6 months-1 years)
Hypersensitivity
Adverse reactions
Concordance

Dose
Frequency
Route
Brand

Demonstrate technique and give 3 bits of advice for each med

Front 8

EVOHALER Demonstration

Back 8

Remove cap. Shake, Exhale, FIt mouth over mouthpiece. ACtuate whilst inhaling deeply. Hold breath for 10 seconds. Exhale.

Front 9

EVOHALER advice

Back 9

May use with a spacer device.

Requires carefulactuation/inhalation coordination.

Dexterity aids available

If any mist coming out of inhaler/mouth afterwarads syggests incorrect use

Front 10

Accuhaler demonstration

Back 10

Hold flat. Open disc. Prime with lever. Exhale. Fit mouth to mouthpiece. Suck. Hold then exhale slowly. Close disc.

Front 11

Accuhaler advice

Back 11

Has a dose counter.

Do not store in humidenvironment [e.g. Bathroom].

Rinse mouth after use.

Requires adequate inspiratory flow.

Front 12

Turbohaler demonstration

Back 12

Unscrew & remove cap. Hold upright. Twist base until 'click'. Exhale. Fit mouth to mouthpiece. Suck. Hold then exhale slowly.

Front 13

Tubrohaler advice

Back 13

Has a dose counter. Do not store in humidenvironment [e.g. Bathroom]. Rinse mouth after use. Dexterity aids available. Retain upright. Not possible to double dose.

Front 14

Handihaler demonstration

Back 14

Open inhaler. Remove capsule frompackaging. Insert capsule. Close device. Hold upright. Push button. Exhale. Fit mouth to mouthpiece. Suck. Hold then exhale slowly.

Front 15

handihaer advice

Back 15

Do not store in humid environment [e.g. Bathroom]. Rinse mouth after use. Wash mouthpiece monthly. Requires adequate inspiratory flow. Only expose capsules for use. May have no taste evident.

Front 16

How to use a spacer

Back 16

Take at least two deeply heldbreaths per puff of inhaler. Or breath through mouthpiece. Wash once a month; leave to drip dry. Replace yearly.

Front 17

Physical examination into

Back 17

Hello my name is Ben, i am a student at the university of sunderland, can i ask your name and age pelase? Just to let you know ive washed my hands and anything discussed here wil remain confidential. If you feel discomfort at any point just let me know.

Front 18

General inspection

Back 18

Im looking at the general health of the patient. They are not in any obvious pain or distress, skin tone is normal i.e not pale/flushed/signs of cyanosis. Observing their breathing for any signs of strain, doesnt seem to be any. no obvious use of accessory muscles to breath which may suggest COPD. Would also measure respiratory rate

Front 19

Hand inspection

Back 19

Start by feeling the temperature of the skin, checking for poor perfusion or infection. THen check capillary refill by squeezing end of finger for 5 seconds and observing the blood return within 2 seconds, indicates normal perfusion. Check for tar stains around the fingers which may indicate the patient is a smoker. Next check for fine tremor in the hands by asking the patient to hold them outright, palms facing the ground- fine tremor is a sign of b2 agonist overuse. CHeck for asterixis by getting the patient to hold their hands out and check for CO2 flaps, a sign of CO2 retention. Check the radial pulses comparing for rate and rythm.
Check for clubbing by asking them to hold their fingers together and loking for a diamond shape gap, if there isnt one could be a sign of pulmoary fibrosis or other chronic disease

Front 20

Face inspection

Back 20

Observe skin tone for signs of pallor or cyanosis. Looking if the patient has pursed lips or nasal flaring which could be signs of strained breathing that occurs in COPD patients. Open mouth and look under tongue for any signs of central cyanosis. Look at the eye for any yellowing of the sclera which would indicate jaundice. Compare the eyes to eachother, looking for any significant difference in pupil size or in terms of one eyelid drooping. Could indicate horners sign wich could indicate a apical lung tomour. FInally, look under the lower eye lid for pale conjuctiva,a sign of anemia

Front 21

Chest inspection

Back 21

First ask the patient to expose chest.
Observe symmetry of the chest wall and its movement during breathing. INspect for any signs of bruising, scarring, recent injury/surgery. COnduct the examination on both the anterior and posterior sides of the patient.

Front 22

Palpation of the patient.

Back 22

Firstly palpate the lymph nodes, which if raised may indicate infection. Start with the cervical nodes on both sides of the neck. Palpate the supraclavicular lymph nodes above the shoulds and finally the axilla lymph nodes within the arm pits ( look up locations ask othe rpeople which ones they did)

THEN assess the alignment of the trache (may be uncomfortable, tell me at any time). If it was deviated from a central position it could indicate a pneumothorax (air in pleural cavity, haemothorax or possible presence of a tumour.

I would then palpate both the anterior, sides and posterior of the chest, Firstly for tenderness, by running my open hands over the skin. Secondly to examine chest expansion i would examine the movement and distance between my ahnds thumbs during inhalation and expiration. FInally, i would exam vocal fremitus by asking the patient to repeat 99 during palpation with an open palm. Differences in skin resonance might indicate consolidation of fluids

Front 23

Percussion of the chest

Back 23

Purpose is to identify areas of tympany and dullness. where dullness may indicate underlying fluid accumulation and consoldiation. I would compare the soudns form one side to its mirror position, listening to any differences in tone. Percuss on both anterior and posterior of the chest. In the latter case ensuring the patients arms were folded in front of them.

Front 24

Auscultation of the chest

Back 24

During auscultation i would ask the patient to breath through their mouth. I would listen at a range of positions using the diaphragm of the stethoscope, assessing the sound over a full inspiration and expiration cylce. At each point get the patient to say 99, againt listening for any difference sin tone or volume which be be suggestive of consolidation. WHile listening to the locations on the psoterior, i would ask them to cross their arms in front of them. front, back , sides.

Bronchial/vesicular sound is normal.
Wheeze, crepitations or pleural rub is not

Front 25

Wheeze

Back 25

Continuous musical tones, sign of collapsed airway lumen

Front 26

Crepitations

Back 26

Crackling noise, signifies opening of collapsed airways

Front 27

pleural rub

Back 27

squeaking/ grating sound. sign of inflammed pleura (infection)

Front 28

Additional checks of respiratory examinatiom

Back 28

Inspect and palpate both legs of the patient, assessing temperature (for perufsion.infection), looking for any swelling. (odema/heart failure) and inflammation, and questioning regarding tenderness and pain (e.g calf pain suggestive of DVT > pulmonary embolism) a difference between the legs may be suggestive of a injury or DVT. A further additional check is looking at the base of the back for the characteristic swelling of sacral oedema, a sign of heart failure

Front 29

EASi breath demonstration

Back 29

One inhalation ONCE daily at the same time each day.

Slide cover down until you hear a click. breath out as far as possible.

Put mouthpiece in your mouth and take one long steady deep breath in and hold breath for 3-4 seconds.

Close
remove inhaler from your mouth and breathe out slowly.
Slide cover up to close + cover mouthpiece

Front 30

Easi breathe counselling

Back 30

Don't keep in bathroom/humid area.

Adequate inspiratory flow

dont cover vents on top
Dose counter on apparantly?
Hold upright

Front 31

Respimat counselling

Back 31

when twist the bottom to release dose, keep cap on top?

Clean once a week inside and out with a damp cloth.

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Front 32

nodes

Back 32

submental underchin

Submandibular under jaw bone

cervical down line where jvp wouldbe

supraclavicular above collar bone

would check auxilarry

Front 33

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Back 33

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