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OsceExpress Session9 DrNikitaChoudhary(FY1) Meet the Team Nidhi Agarwal Sumedh Sridhar Sara Sabur Nikita Choudhary Shaili Kadambande FY1 Doctor (NW) Yr5 Med Student FY1 Doctor FY1 Doctor FY1 Doctor Osce Express Co-Founder Osce Express and LNR Trust LON Trust LNR Trust OsceAce Co-founder Holly Garcia Bethany Turner Nevash Maraj Vanessa Datta Fatima Ahmedi FY1 Doctor FY1 Doctor FY1 Doctor FY1 Doctor FY1 Doctor LNR Trust SY Trust NW Trust LNR Trust LNR TrustCourseOverview OSCE Express 1. 11 session guide to common OSCE finals stations 2. Delivered by Foundation Year 1 Doctors 3. Peer-Reviewed Cases + Video Guides provided to all participants (published on MedAll, osceace.com) 4. Preparation for OSCEs… 5. …And also preparation to be a safe FY1Disclaimer This course has been designed to help final year students with practical OSCE exams and is an unofficial resource that covers themes present in the University of Leicester Final OSCEs. We have nonetheless made this course as applicable to other final year OSCEs as possible, but there may be discrepancies in your University’s expectations. OSCE Express sessions are peer-reviewed by junior doctors, but we take no responsibility in the accuracy of the content, and additionally our sessions do not represent medical advice. Please use our sessions as a learning aid, and if you note any errors, do not hesitate to message us at osce.express@gmail.com Kind regards, Dr Nidhi AgarwalFY1 Sumedh SridharYr5 MedicalStudent OSCEExpressco-creatorsInToday’sSession… 01 02 Handoverand CaseandQ&A! prioritisation 01 Handoverand prioritisation Layout Linked station taken sequentially with different examiner assessing each part • First 10 minutes: station 15 (Handover). There will be a further 2 minutes reading time before starting station 16. • Second 10 minutes: station 16 (Prioritisation) Candidate stays in same room for both stations Toptips! HANDOVER ● Information-heavy station - BE SYSTEMATIC I.E. SBAR (EWS, O/E, dx) ● Write in short-form ● Tailor questions to clinical scenario - show off your clinical knowledge! ● Ask probing questions - don’t assume all information will be voluntarily given to you PRIORITISATION ● Take your time! ● Begin with most unwell patients ● What has NOT been done? ● Present like an SBAR again ● Remember your TEAM! S B A R Patient 1 EWS Initials Age O/E Dx: Patient 2 Initials EWS Age O/E Dx: Patient 3 EWS Initials O/E Age Dx: Patient 4 EWS Initials Age O/E Dx: Patient 5 Initials EWS Age O/E Dx:STATIONTIME! Examplecase-handover You are the FY1 doctor and you have just arrived for the evening shift covering the Acute Medical Unit. Your colleague has arrived to give you handover from the day and to discuss 5 relevant patients from the day. This station will last 10 minutes. You will be expected to: Effectively take part in handover from your colleague. Examplecase-prioritisation You are the FY1 doctor and you have just arrived for the evening shift covering the Acute Medical Unit. Your colleague has just completed the handover and discussion of 5 patients from the day. There is an advanced nurse practitioner, a staff nurse and 2 healthcare assistants on the ward. This station will last 10 minutes. You will be expected to: Review the results and then explain the management and prioritisation to the examiner. For each decision, you should explain your reasoning. Examplecase-results NEWS 0 Hb 145 g/L ALT 25 CXR: appears normal Patient 1 Plt 250x10^9/L ALP 60 (BP 181/90) Na+ 140mmol/l Troponin 20 -58M ECG - sinus rhythm K+ 3.9mmol/l CRP 5mg/l Creatinine 80 Urea 5.5mmol/l Hb 140 g/L BNP 3500 Patient 2 NEWS 6 WCC 7.5x10^9 ALT 28 CXR: patchy opacifications, Kerley b Na+ 140mmol/l AST 30 -71M K+ 4mmol/l ALP 40 lines, increased cardiothoracic ratio Cr 100 Bilirubin8.6 Urea 9mmol/l CRP 10mg/l NEWS 10 Hb 150g/L ALT 34 Erect CXR: free air under Patient 3 VBG: pH 7.33 WCC 14.9x10^9L AST 25 pa02 9 Platelets 300x10^9/Bilirubin8.4 diaphragm -38F paco2 6 Na+ 140mmol/l HCO3- 22 K+ 5.4mmol/L Lactate 4.8 Cl- 100mmol/L Cr 100 Urine dip-ve CRP 150mg/l ECG: SR Hb 128 g/L ALT 31 Patient 4 NEWS 6 WCC 7x10^9L AST 22 CXR: flattened diaphragms, BM 6.6 Platelets 320x10^9/L ALP 25 hyperlucent lung zones, no focal -84M Bilirubin 6 Urine MC&S - -ve Na+ 136mmol/l consolidation ECG - SR K+ 3.6mmol/L Cr 768mmol/L CRP 3mg/l Hb 145 g/L ALT 31 Patient 5 NEWS 2 WCC 13.4x10^9L AST 22 CT KUB non-contrast: left-sided Urine dip -ve Platelets 301x10^9/L ALP 25 -47F Bilirubin 6 5mm ureteric stone with mild Urine MC&S - not come yet Na+ 135mmol/l K+ 4.5 mmol/L hydronephrosis Cr 7604 mmol/L CRP 82mg/lExampleanswerHandover:receivinghandover… S B A R Sudden-onset, 10/10 tearing central chest Sciatica NEWS 0 ECG normal Patient 1 pain whilst lifting heavy boxes. Not Hypertension BP 181/90 Bloods requested inc. trop -58M improving with analgesia, N+V. (Difference in arms by >20mmHg) CT angio - not requested Dx: Radiating to his back. Mainly back hurts now. O/E CR normal, L radial pulse weaker, MSK and neuro normal Nursing home resident, sudden-onset Hypertension NEWS 6 CXR - requested Patient 2 SOB and O2 sats 88%. T2DM (O2 sats 95% on 15L oxygen ABG - not done -71M No chest pain. HF - on oral furosemide 20mg RR 19 Bloods on admission - no BNP Chronic cough. No previous hx of DVTs or PEs HR 90 Dx: No fevers recorded. BP 120/65 Peripheral oedema increasing. Temp 36.8, confused) PND/orthopnoea O/E - crackles B/L, raised JVP, p+s oedema Patient 3 Sudden-onset 10/10 generalised Crohn’s NEWS 10 Bloods requested abdominal pain post colonoscopy for Migraines (4L nasal cannula, O2 sats 94% ECG - done -38F Crohn’s investigation. Feeling nauseous RR 20 Urine dip -ve but not vomited. HR 110 VBG - done Dx: BO yesterday pre-colonoscopy BP 91/58 Erect CXR - done Temp 38.3) Blood cultures - not done No O/E - patient very rigid CT abdo with contrast - not done Patient 4 A/W Delirium ?source but middle of night HT NEWS 6 LSBP had a fall whilst going to the toilet. Alzheimer’s (O2 sats 96% ECG -84M Witnessed by nurse as assisting COPD RR 16 Confusion screen - CXR from No presyncope AF HR 89 admission Dx: Lightheaded BP 140/90, Medication r/v No focal neuro Temp 36.6 No seizure features Confused) No head injury BM 6.6 No O/E Patient 5 Sudden-onset, loin to groin, 9/10 pain. Nil NEWS 2 Urine dip - +ve haematuria Tried analgesia but not working. (HR 101 Urine MC&S - sent -47F No LUTS Temp 38.2) Bloods requested Slight haematuria 2 days back, BO CT KUB non-contrast - requested Dx: AnalgesiaPrioritisation S B A R Patient 1 Sudden-onset, 10/10 tearing central chest Sciatica BP 181/90 Bloods requested inc. trop pain whilst lifting heavy boxes. Not Hypertension (Difference in arms by >20mmHg) CT angio - not requested -58M improving with analgesia, N+V. Analgesia Dx: ?dissection Radiating to his back. Mainly back hurts O/E CR normal,L radial pulse weaker, MSK and Antihypertensive now. neuro normal ?MI NEWS 6 CXR - requested Patient 2 Nursing home resident, sudden-onset Hypertension (O2 sats 95% on 15L oxygen ABG - not done SOB and O2 sats 88%. T2DM RR 19 Bloods on admission - no BNP -71M No chest pain. HR 90 Furosemideinfusion Dx: ?APE Chronic cough. HF - on oral furosemide 20mg BP 120/65 Catheter No fevers recorded. No previous hx of DVTs or PEs Temp 36.8, confused) ?Pneumonia Peripheral oedema increasing. O/E - crackles B/L, raised JVP, p+s oedema PND/orthopnoea Patient 3 Sudden-onset 10/10 generalised Crohn’s NEWS 10 Bloods requested - not G+S abdominal pain post colonoscopy for Migraines RR 20asal cannula, O2 sats 94% Urine dip -ve -38F Crohn’s investigation. Feeling nauseous HR 110 VBG - done Dx: Dx: ?perforation but not vomited. BP 91/58 Erect CXR - not done BO yesterday pre-colonoscopy Temp 38.3) Blood cultures - not done ?Crohn’s exacerbation No O/E - patient very rigid CT abdo with contrast - not done IV abx Patient 4 A/W Delirium ?source but middle of night HT (O2 sats 96% ECGP had a fall whilst going to the toilet. Alzheimer’s RR 16 Confusion screen -84M Witnessed by nurse as assisting HR 89 Medicationr/v Dx: ?postural HT No presyncope COPD BP 140/90, Lightheaded AF Temp 36.6 ?vasovagal No focal neuro Confused) No seizure features BM 6.6 No head injury No O/E NEWS 2 Urine dip - +vehaematuria Patient 5 Sudden-onset, loin to groin, 9/10 pain. Nil (HR 101 Urine MC&S - sent Tried analgesia but not working. Temp 38.2) Bloods requested -47F No LUTS CT KUB non-contrast - requested Dx: ?renal colic Slight haematuria 2 days back, BO Analgesia - diclofenac PR D/W urology ?pyelonephritis Prioritisationcontinued… - Most unwell patient (s) include patients 1 and 3 due to AR and perforation respectively - Sort out jobs for most unwell patient (s) - Remember ANP can assess, manage and prescribe! - Nurses and HCAs fantastic for clinical skills - If >1 unwell patient → use your team! - Patient 1 - you could prescribe analgesia and antihypertensive, request CT angiogram - Patient 3 - ANP can assess and do clinical skills (nurse) - Patient 2 - You can do ABG and prescribe furosemide I.V., catheter by HCA - Patient 4 - other HCA can do LSBP and ECGQuestionsabouthandoverand prioritisation?Morepracticecasescomingsoon!Feedback Thanks ! Follow us for updates @osce.express Cases: osceace.com/osceexpress