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OSCE Tips – Leyi Yang and Jordi Ford M&M Contents HISTORY STATIONS EXAMINATIONS EXPLANATION DATA PRESCRIBING ETHICS GENERAL HINTS STATIONS INTERPRETATION AND TIPS STATIONSHistories MSK Ageing and Complex Health • Lower back pain (chronic or acute) • Falls history • Joint tenderness • Parkinson’s disease • Joint swelling • Dementia (collateral) • Red joint • Stroke Psychiatry Special Senses • Low mood • Headache • Anxiety • Seizure • Overdose • Weakness • Self harm • Sore eye/ear • Red eye/ear • Hand – OA/RA/PA examinations MSK & Rheum • Any pain? Previous • Shoulder – Surgery? impingement/rotator cuff tears/adhesive capsulitis/OA • Look • Spine – Ank Spond/Sciatica • Feel • Hbursitis/OAanteric • Move • Knees – ACL/PCL tears/OA • Special Tests • Elbow/Ankle + Foot • Joint above/below • GALS • Neurovascular status Special Senses • Eye • Ear • Nose • Mental State Exam • Neurological Exams examinations • UL/LL/Cranial Nerves Explanations Drugs Conditions • Epilepsy • Psychiatry drugs • Methotrexate • MS • Steroids • Depression • Bisphosphonates • Anxiety • Levodopa • Bipolar • Arthritis • Ankylosing Spondylitis • Stroke • Dementia • Parkinson’s Disease • Glaucoma • CataractData interpretations • AP/PA • Patient details 1.Site (which bone and which part of the bone) • Date/Time 2.Type (transverse, oblique, spiral) • Penetration 3.Simple or comminuted • (I would like to see a previous X-ray if available) 4.Displaced? 5.Angulated? (the direction of the distal bone and degree of angulation in relation to the proximal bone should be stated. ） 6.Is the bone of normal consistency? 7.Soft tissue (open fracture?) Joint Fluid Colour Clarity Neut Crystals Symptoms Count Normal Colourless Translucent <25% Negative Non-inflammatory Straw Translucent <25% Negative Localised joint pain e.g. OA/Trauma like/yellow Pain on movement, worse at the end of the day Crepitus Inflammatory Yellow Cloudy >50% Needle negative A single hot, swollen and tender joint birefringent crystals (metatarsophalangeal joint at the base of RA/Gout/Pseudogout rhomboid positively the big toe) birefringent crystals OR A single hot, swollen and tender join (knee joint) Septic Yellow Cloudy/Opaque >75% Negative Associated fever and other systemic Green features (e.g. tachycardia, hypotension)Prescribing Tips Common Drugs Try to know way around BNF Antipsychotics Polypharmacy Antidepressants Rheumatoid drugs Pain relief Antibiotics for eye/ear infectionsEthics DVLA • Mental Health Act • syncope • Epilepsy • Mental Capacity Act • DNACPR Must inform the DVLA if you have an epilepsy diagnosis. Must be seizure free for 6 or more months (One off) or 12 or more months if more than 1 seizure. • strokes • glaucoma • Stay Calm! • Act confident General hints & • Make sure to use that 1 Tips minute • Don’t dwell on past stations Any Questions?