Showing posts with label Osce Past Year. Show all posts
Showing posts with label Osce Past Year. Show all posts

Tuesday, August 11, 2020

ATLS overview (OSCE)

Definition: 

  1. ATLS : life threatening with pulse
  2. ACLS(cardiac): life threatening, no pulse

Common emergency cases:  (ATOMTC)

  • Airway obstruction
    • Tension pneumothorax - silent chest, trachea deviated
  • Open wound
  • Massive hemothorax
  • Tracheobronchio dissociation/ fistula
    • empysema
    • crepitus, poor air entry
    • corrective surgery
    • do X-ray - is it hyperventilated?
  • Cardiac tamponade - JVP, increase HR, muffled heart sound
    • Pericardial effusion?

OSCE ATLS steps: 

1. What to do when the patient came in with emergency? (DR. AVPU)
  1. Danger
    • access the situation, ensure you are safe first
  2. Response & role
    • check for patient response and 
    • ask someone around you(assistants)to help
      • prepare airway apparatus +cervical support
      • chest tube, needle tube, SP02
      • IV line - for fluid & BT & crossmatch
    Check their response to... 
  1. Alert
  2. Verbal
  3. Pain
  4. Unconscious


2. If all above indicates emergency case signs proceed with   ABCDE

Airway       - jaw thrust - open the mouth and inspect for foreign substances (yonker suction could help 
                       removing them) - check for gag reflex - 
                   - cervical support - can be confirmed by using the NEXUS criteria 
                  

 (cervical spine evaluation in trauma)
             
Breathing   - ventilation,
      • inspection: check for ATOMTC (common emergency cases, in first paragraph)
      • palpation: trachea location, rib intact? fracture?
      • percussion: hyper-resonance? dull?
      • auscultation: Air entry? Heart rhythm, HR?                        
                    - check Respiratory rate
                    - intubate if needed

Circulation - bleeding
      • IV 2 large bonula
      • IL warm NS
      • BT urgent panel
      • inspect head to toe for bleeding
        • EENT, abdomen (peritonitis), pelvis(spring fracture), genitalia (hematoma, scrotum, perianal bleeding, urethral)
        • peripheral bleeding (fracture)
Disability   - pupil
      • GCS scale!   
      • Trauma - Trauma Assessment - Glasgow Coma Scale      
Exposure    - environmental - do they need a blanket? (hypothermia?)
      • log roll for back examination (examine the spine - stepping sign)/ rectoperitoneal bleeding / prostate high riding / pelvic injury / abdominal injury / thoracolumbar injury
      • DRE? anal tone lac? 

Simple Management mnemonic:

2(CBD, NG tube)
+
2(X-ray : chest and pelvic)
+
2(drugs and analgesia IPTT)
+
2 investigation(ECG, FAST u/s)

other links:

Friday, August 7, 2020

Breaking bad news: Down syndrome

How to explain to the parents about Down Syndrome?

First, you will need to know what is the problem and understand before explaining to them.
The parents will be worried, anxious and some might even cry upon receiving the news. Be ready to comfort them and help them through this journey of hardship but understanding their children together. 
As a doctor, you are to tell them the truth and at the same time, comfort and reassurance. 

https://canadiem.org/breaking-bad-news/



So.. how should you start your conversation?

1: Express your concern

- Greet the parents, introduce who you are and why are you here. 

Setting
- Before telling them about their child's condition, 
    ask if they need someone to accompany them or if their family member is here (if they are alone).
Example: Before we go ahead, can I just ask, would you like to be with someone now? 

 
Perception
- Ask what they realise that is abnormal about their child.
    - This helps us to understand how much they know about the situation, so we know where to start.

Invitation
Tell them about the news:
Example: Unfortunately, I do not have good news, I am sorry to tell you that... ...
*wait for them to react before you continue your explanation*

πŸ‘‡

2. Explain and educate

Knowledge
- Explain the nature of down syndrome. definition, symptoms and signs
- Genetic Issue
- Intellectual Aspect
- Health Aspect
    - To tell them their child would probably need a lot of follow up on potential health issues
    - TO explain the prognosis is poor
        - average lifespan is around 50-60years old, 
        -possible health issues of the heart, gastrointestinal, eyes and bones, 

πŸ‘‡

3. Advice the parents

- Their character and behaviour infront of the child
    - try to be encouraging to the child
    - be patient and kind
-To discover the child's talent
    - the child might not do well in studying but might excel in cooking, music or sports
- Diet
    - to ensure good nutrition provided and not neglect the child
    - they need the same/ more attention compare to normal children of the same age. 
- Advice to look for special care school
    - there are special school's which teaches kids who have the same problem
    - opportunity to know other parents who face the same issue and share experiences

πŸ‘‡

4. Future follow up 

- to come regularly for normal vaccination
- to check calcium development regularly
- ensure proper growth and reach their age milestone
- Series of check up for their child in the future : Eye checkup, bone density, X-ray, echocardiogram, etc. 

πŸ‘‡

5. Encourage the parents to join a parents group

Summary
- we can give them leaflets (if available) to understand down's syndrome better
- provide reliable sources (websites) so they can read to help with the understanding

- encourage them to not give up and keep persevering till the end. the child is a gift from god, and we are to take care of them with love and care. 
Example: Don't blame yourself. There is nothing that could have been done to stop this from happening. What you need to do now is to... ... 
πŸ‘‡
-Reassurance
Example: 
    - I understand you are worried but...
    Do you need some time to rest?
    We will keep an eye on your child for his (results), so we can provide the treatment earlier. 
    The doctor/professor who is in charge of your child is an expert on this syndrome and would try 
       his/her best to help your child. 
    - I will give you a follow up date with us in the clinic, will you be available on the ... ...?

πŸ‘‡

6. Empathy (throughout the whole session)

** Always ask if they understand what you are trying to say before going to the next point.
**ask if they have questions to ask you concerning their child and their worries. 
Example: Do you understand what I am trying to explain? 
                Do you have any questions?

- Look them in the eye while you are talking and show that you care about them.
- If there is a break down (crying), pause the conversation and try to offer tissue or suggest them to come at a later date with their family/support.
- Have empathy and to try answer their questions at the same time.  


Thursday, May 21, 2020

OSCE VIDEO 1 (epr malaysia)

This is a sample video which can be helpful for you to imagine how it is like during the exam.
Just for your reference, 
and
credits to the students, doctors and the volunteer from IMU. 
Thank you for making this video. 






Question in the video



**P/s: this is exactly what happens to my OSCE exam when I took EPR OSCE on 2019. Although the venue is different (in USM), the way they conduct the exam is the same.

There will always be a doctor in each room to evaluate your performance and ask you questions after you finish the task.

Make sure you organise your time well. For sample questions you can refer to my other posts here.



Good luck!

Tuesday, May 5, 2020

Orthopedic OSCE notes

 My Pocket Notes: Orthopedics OSCE



I always have this pocket notes in handy so I can study them without bringing the books along. They are useful when I need a quick glance and remember them quickly.
Especially the day before exam when we need to read a lot of information,
could not afford to waste any of those precious time for revision!





If you do not understand what I wrote about in the notes, you probably need to reflect and start studying the real books instead !


Sunday, May 3, 2020

Community Medicine - Pre-pregnancy care

Some of my friends asked what is included in this section during my exam, so i decided to share with the others what I know about it. 

Community Medicine is concerned with the prevention of disease, the determinants and natural history of disease in populations, and the influence of the environment and of society on health and disease.

and one of the most common problems in community medicine is 

Pre-Pregnancy Care. 



1. Access risk


  • age : <18 or >35
  • lifestyle: smoking, drinking, substance abuse, etc.
  • Sexual history
  • BMI: obese? lack nutrition?
  • Pets : cats or birds
  • Past history : hypertension, DM, infectious disease(hepatitis, HIV)


Specifically for woman with history of 

- Diabetes
- Seizure
- Hypertension
- Heart disease

you will need to counsel them about the risk for their child and to themselves if they are going to get pregnant with the disease they have. Table below will help you to get an idea what you should counsel them. Each of the patient are different, and it is important that you are able to convey the message clearly.


2. Scenario

If a lady is just here to ask your(GP) opinion about the pregnancy plan you will need to ...

1. General screening
  -  History taking: past history, medications, surgical history, family history and related OBGYn history
  - physical examination
  - access the risks
2. Lab test: Blood tests - blood glucose,etc.
3. Access knowledge about health, pregnancy and child care
4. Referral if there are any abnormalities with the blood test

3. Counsel content:


1. about birth and pregnancy

  • folic acid 3 months before pregnancy, stop anti epileptic meds
  • breast feed knowledge
  • child birth preparation
2. lifestyle changes
  • diet : control/refrain from smoking, alcohol, substance abuse, caffeine use
  • social life: extreme activities
3. Genetic factor: anyone from the household has genetic disease ?

4. Family planning : COCP

5. Screening: pap smear, STI, DM, Hypertension

Try to calm the lady to reduce their anxiety (if there are any complications that could effect the pregnancy). Always ask if they are comfortable to proceed with the consultation or they need their family to be with them.

6. Are they fit to get pregnant? Do they need constant follow up? 

Set up a follow up date if they really need one. 

Remember to always be caring and be patient with your patients. πŸ˜€

Reference:
1. https://www.ncbi.nlm.nih.gov/pubmed/6585101

Tuesday, March 31, 2020

2019 OSCE past year - EPR

OSCE Question 2019 - EPR Part II

HI again, this is the PART II for past year questions on 2019. The Part I post only explains the past year questions that I took during December 2019 in Hospital USM December.

In this is the post I will talk about the past year OSCE (Examination for Provisional Registration Malaysia) from USM - February session and IMU- July session. 

I am still wondering why there are 3 session of osce on year 2019, but its good news for us unemployed graduates. Not sure if it will be the same for this year 2020, but unlikely. 

P/S:
It would not be as detail as the last post, as I wasn't taking exams for these two session.
But I would like to thank the one who shared his/her experience and topics with us the next batch.
Thank youπŸ’“


USM EPR II (Feb 2019)

1, ECG. Describe findings - Atrial fibrillation
- further investigation and management

2. OGTT. 
- explain procedure to patient and interpret the result

3. Postnatal discharge. advice the mother

4. Dengue (with blood result)
 - describe findings
 - diagnosis, what test to confirm (at least 3))
- other 3 Differential diagnosis
- management

5. Measure BP of 8 year old boy, with family history of hypertension
 - demo: which cuff, and why
 - explain how you do the whole procedure
 - BP 125/80, is it normal or hypertensive? 

6. Insert ET tube in manikin. name all instruments, explain and demo, contradictions

7. Primary support (Basic trauma life support)

8. X- ray (Small Intestinal Obstruction)

9. PTSD (a victim who survived in a flood) - interview the patient and give diagnosis

10.Demo Cathether insertion
 - take chief complain and diagnose patient (BPH)

11. Insert Ryle's tube on manikin
 - steps, how do you know if the tube is rightly placed?

12. CTG- cardiotopography
 - describe (FHR, variability, acceleration and deceleration)
- next management

13. Bimanual examination
 - describe suprapubic mass

14.X ray (Galaezi fracture) and label

15: perform lower limb neuro examination

16. Perform eye movement test (H test)
 - any squint, ptosis, diplopia?
- Diagram was given, describe finding (Lateral rectus palsy) 


IMU (July 2019)

1. CPR
2. Febrile seizure
3. Nephritis for children
4. Rib Fracture
5. Posterior Cruciate Ligament (PCL) reconstruct
6. Abdominal pain - peritonitis
7. ECT - Electroconvulsive therapy
8. third degree heart block
9. Thalassemia
10. Deep Vein Thrombosis (DVT)
11. Abortion
12. Pregnancy Full Physical Examination
13. Tuberculosis (TB) radiology interpretation
14. Cholesteatoma
15. Suture
16. Back pain differential diagnosis


So,  that is all the questions I get from year 2017, 2018 and 2019. You can click on the link to go back to the page where they are shared.
2017: https://yu4med.blogspot.com/2020/03/past-year-for-epr-osce-2017.html
2018: https://yu4med.blogspot.com/2020/03/past-year-epr-osce-2018.html
2019 Part I : https://yu4med.blogspot.com/2020/03/past-year-osce-topics-usm-2019.html

Good luck Doctors!


Saturday, March 28, 2020

USM OSCE - EPR 2019 Dec

Past Year Topics for USM OSCE - 2019 - Part I

Hi all, in this post I am going to share the topics they have on year 2019 for Examination for Provisional Registration-/EPR. (the year I took my exams😁Thank God I passed)

** EPR is a special exam where International Medical Graduates must take to get full licence to work in Malaysia. 

So I will provide more details on how the questions were asked and what I experienced specifically for the USM December 2019 session. However I won't be able to recall the questions fully word by word, but will try my best to explain what was being asked.
The other session for 2019 are USM-Feb  and IMU-July will be posted in another post.

Reminder:

You have 1 minute to read the questions outside the room and once the bell rang, you have 9 minutes to finish the station. the second bell will ring, and you will have to move to the next station quickly to read the next question.

USM (December 2019)

Emergency medicine
1. Patient involve in motor vehicle accident, access the patient and do immediate management
   - Emergency management of Pneumothorax
   - Name all the equipment needed in ED (we have to name the equipments shown on the table)
   - explain the safe triangle position in detail
   - perform the procedure from the safe triangle


Orthopedics
2. Patient involve in motor vehicle accident and have problem walking, you are require to do a lower limb PE
  -  identify short limb gait (at least that is what I think it is) ** real patient walking
  - so I proceed with full lower limb physical examination and LLD(Limb Length Discrepancy) diagnosis
  - Physical examination necessary to identify LLD

3. Hip X-ray with a problem, patient short history provided
   -  Describe the X-ray, give a diagnosis and explain your further management
   - identify all structures shown in the picture and explain their functions.

P/S: remember to check patient name and date


Internal medicine
4. Patient with chest pain and SOB, take the history and explain further management if needed
  - history taking and I suspect its AMI

5. Interpret chest X-ray and give diagnosis with treatment + physical examination of the chest
   - Tips: there is a mass in the chest x-ray

P/S: treatment plan must be specific***


Surgery
6. Patient present with mass at inguinal area, diagnose and focus physical examination
  - Inguinal Hernia - after history taking, ask for permission to do examination
  - physical examination is done on the manikin. (you can refer to this to understand the scoring)

** The examiner asked the differences of direct and indirect hernia physical examinations and their respective treatments.

7. Pneumoperitoneum - X- ray interpretation and management plan
  - management is specific

Tips: if you plan to have iv fluid, what do you want to do? (is it fluid bolus? how much you want to give? how long you plan to administer the fluid? etc.)


Pediatrics

8. Growth Chart interpretation
  - scenario given was about short stature. (explain the cause, QOL, management)

 Tips: calm the child down first so they can cooperate

9. Lumbar Puncture Consent from Parents
  - get the consent is the aim. make sure you explain all about lumbar puncture from the cause to the treatment values.
   - reassure the patient


OBGYN

10. Bimanual Examination
   - there is a huge mass in the manikin.
   - explain your examination specifically on inspection and palpation,
  - the examiner will ask for your diagnosis and your management plan for the patient

11. Patient complain is stomach pain and discomfort (a little aggitated)
  - After history taking, i suspect its a Placenta Abruption case.
  - the examiner asked for our diagnosis
  - present your case from history taking
remember to include: Gestational age calculation, GPO - all OBGYn necessary history
  - treatment plan

*P/S: I finish this station when the bell rang for us to leave the room. We only have 9 minutes to do all the above, make sure you manage your time well. 


Anesthesiology

12. Patient need to prep for surgery, as a junior doctor apply adequate oxygenation before anesthesiologist arrive.

  - full airway assessment and use the Bag valve mask (if  you observe well, you will see it lying on the table beside the manikin) -explain the indication and possible complications.

*P/S:   - the procedure was easy as i did a lot during my internship in china (finish smoothly in a few minutes), but the examiner asked a lot of questions and fully utilized the 9 minutes. Be ready to answer a lot of questions and make sure you know what and why you do what you have done.


Psychiatry

13. The patient is very sad and depressed. If you have good observation, you will see a plaster on her wrist.

 - The patient has history of suicide, so after accessing the patient and confirm it is related to suicide, I used the suicide risk assessment to confirm the diagnosis.
 - the examiner will ask how you come out with your diagnosis, luckily i still remember the specific components for the assessment. (the examiner asked how I get the score)


ENT

14. ASOM
 - acute suppurative otitis media

* I am very thankful to be able to work as a clinic assistant for an ENT doctor for almost a year. 
Really grateful I know how to use the equipment, give diagnosis, explain the cause, complication and management to the patient very quickly and specifically. I spend a lot of time sitting outside the station to wait for the next bell to ring.πŸ˜„Thank you Doctor Koay! 


Radiology

15. Two CT was showed
 - I suspect it's a CT with Epidural hematoma and subdural hematoma
 - we are require to explain the CT in detail to support our diagnosis

 *P/S: this is the only station I don't know if what i did is right or wrong. because he is not satisfied with the answer i gave, and when I asked the other students, they say the same thing.. 
 Until now I still don't know what the doctor showed us, because I forgot how the CT looks like... (sad)


Community Medicine

16. Consultation on family planning
 -  asking for pregnancy advice and how to have a healthy

*P/S: the patient has diabetes after minutes of asking... So I have to quickly brief her the pros and cons on the complication of pregnancy while having an uncontrolled diabetes situation. 


If you have more questions can leave a comment below, I will try to reply as soon as possible.
Good luck!



2018 OSCE Past Year for EPR

Past year OSCE 2018

This is the past year topics asked in USM 2018 and specifically for those who took the examination for provisional registration. I didnt have the past years from those who took the exam in IMU, so if there is anyone who took the exam that year and would like to share, you are welcome to share it in the comments.^^



If you are interested in what they asked in 2017, refer to the previous post.


USM EPR OSCE questions 2018

Gynecology
1. COCP
2. Speculum Examination and high vaginal swab

Pediatrics
3. ORS usage advice for children
4. G6PD counseling

Orthopedics
5. neurovascular examination (lower limbs)
6. Elbow Joint Dislocation (interpret the X-ray)

Psychiatry
7. PTSD

Emergency Medicine
8. CPR
9. Mallampati classification + Airway assessment

Internal Medicine
10. Hypertension
11. GI perforation
12. Pneumoperitonium

Opthamology
13. Visual Acuity Test (patient with hypertension and diabeter)

Surgery
14. DRE
15. Colonoscopy consent

Others
16. ABG interpretation and Heart attack evaluation

Saturday, March 21, 2020

2017 OSCE Past year

Past Year Questions Year 2017


The topics below are the topics from the students who took the  Examination for Provisional Registration(EPR) OSCE on 2017. I do not have the specific questions but having a main topic is sufficient for me to prepare for exam after knowing the rating rubrics for osce.

Study each topic in detail to make sure you get it.
&
Hopefully it is helpful for you!

P/S: For reference only!

IMU July 2017 OSCE

1. Hemiplegia
2. IDA
3. Cataract
4. AOM (Acute Otitis Media)
5. Rib Fracture
6. Diabetis Mellitus foot ulcer
7. MMSE + Bipolar
8. Constitutional Small gestational Age (SGA)
9. Thalassemia
10. Hepatomegaly
11. PUD
12. Contraceptive methods
13. Nephrotic Syndrome
14. Gall bladder Stone
15. Break bad news (Patient diagnosed cancer)

USM Jan 2017 OSCE

1. Schizophrenia
2. Bipolar
3. GCS and its usage
4. Snellen Chart
5. Nephritis
6. Hepatomegaly
7. Septal Deviation
8. Hemiplegia
9. COPD and Lipoma
10. choledolithiasis
11. Diverticulitis
12. HPN + IUCD
13. Fundal height (Prenatal check up)
14. Dysfunctional Uterine bleeding
15. Knee Physical Examination

Good luck!