The Long Case OSCE

The Ultimate Guide for Medical Students

Beth C. Walker, Marsha Y. Morgan

• Publisher: CRC Press
• Year: 2021
• ISBN:
  9781000466980
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

A solid knowledge base and good clinical skills don't necessarily guarantee examination success in the long case OSCE. This book is the ultimate guide for medical students needing to combine their knowledge and skills with an ability to interpret the clinical findings, the proficiency to present them clearly and the confidence to deal with the examiners questions.

Adopting a proven, highly effective approach, this revision aid uses role play with simulated patients to hone clinical examination and presentation skills. The fifty cases are divided into six areas: cardiology, respiratory, abdomen, neurology, musculoskeletal and surgery.

Written by successful candidates and examiners, the guide poses a number of important and commonly asked examination questions for each case to assist in preparation and confidence, and model answers are provided to ensure an understanding of exactly what is required.

Working in groups or independently, students will welcome the large, colourful format, the breakdown of marking schemes, an overview of examiners expectations, a guide to presenting clinical findings and innumerable 'insider' tips throughout.

See accompanying video here: https://www.youtube.com/watch?v=Cvr4y-NykUU

CHAPTER 1

Cardiology Station

Cases 1–9

The secret of getting ahead is getting started.

Mark Twain (1835–1910)

Cardiology Examination Example Marking Scheme

BEFORE STARTING

• Washes hands

• Introduces self to the patient and states role

• Offers explanation and obtains consent

• Exposes the patient appropriately

• Positions the patient correctly (reclined at 45°)

• Asks whether the patient is in any pain before examining

PERIPHERAL EXAMINATION

• Inspects surroundings for paraphernalia of cardiac disease, e.g. oxygen mask; glyceryl trinitrate spray

• Inspects patient from the end of the bed:

looks for dyspnoea; cyanosis; pallor; malar flush; pulsations in the neck; surgical scars, e.g. midline sternotomy; ankle oedema; obesity and cachexia

• Inspects the hands and arms:

feels for temperature and clamminess; looks for tar staining of the fingers, peripheral cyanosis and clubbing; looks for other signs of infective endocarditis, e.g. Janeway lesions, splinter haemorrhages and Osler’s nodes; measures capillary refill time

locates the radial pulse and assesses its rate and rhythm

checks for a slow-rising or collapsing pulse

checks for radio-radial delay and states would check for radio-femoral delay

locates brachial pulse and assesses its character and volume

states intention to measure the blood pressure (BP)

• Inspects the neck and face:

examines the jugular venous pressure (JVP) and measures the height from the sternal angle; states would perform hepatojugular reflex if JVP not visible

locates carotid pulse and assesses its character and volume

inspects the eyes for corneal arcus, xanthelasma and conjunctival pallor; inspects the mouth and tongue for central cyanosis; inspects state of dentition

EXAMINATION OF THE PRAECORDIUM

Inspection

• Inspects the praecordium:

looks for previous scars, visible pacemaker scar and visible apex beat

Palpation

• Locates apex beat, notes any displacement and assesses its quality (normal, tapping, thrusting)

• Palpates for thrills over the aortic and pulmonary areas

• Palpates for heaves over the left parasternal edge

• Palpates for sacral and ankle oedema

Auscultation

• Auscultates the heart sounds over the aortic, pulmonary, tricuspid and mitral areas and times these with the carotid pulse (see Figure 1)

• Performs the following manoeuvres:

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