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UCL MBBS (Fach) / OSCEs (Lektion)

List of OSCE stations (Year 6 Student Guide) Including: examinations -- main systems & special practical procedures procedures to explain safe prescribing written tasks acute management ethics & law communication skills Excluding data interpretations --> Data interpretations

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  • Psych AMTS --
  • Psych Consultation Alcohol und Drugs Psych Hx Illicit drugs Hx Motivational interview: 4 steps
  • Psych Consultation Suicide --
  • Psych Consultation MHA Explain and answer questions about Sections: 2-assessment (28d), 3-treatment (6 months), 4/5 holding power, 135/6 - police Treatment: only of mental health condition, maybe be forced, except ECT etc Appeal: provide list of solicitors, PALS →DoLS not applicable
  • Paeds Emergency Abdominal Pain Not tested in finals Full Hx from guardian, incl SOCRATES, bowel movements Vital signs, abdominal exams DDx: Meconium ileus, intussusception, appendicitis, mesenteric adenitis, DKA
  • Paeds Emergency Acute Asthma As per adults DR ABCDE with O2, salbuatmol / ipratropium nebs ± steroids, chest x-ray, ABG, cannula+bloods
  • Paeds Emergency Acute Psychiatric Illness --
  • Paeds Emergency Acute Stridor Keep calm, call for help: anaesthesis, ENT surgeon, paediatrician Give O2 if tolerated, no examination DDx: epiglottitis, forein body, croup, laryngomalacia /- oedema
  • Paeds Emergency Anaphylaxis As per adults: O2, adrenaline, chorphenamine, hydrocortisone; adjust doses according to age
  • Paeds Emergency Birth Asphyxia --
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  • Paeds Emergency Breathlessness DR ABCDE as per adults, not tested DDx: asthma, forein body, epiglottitis, croup, bronchiolitis, pneumonia
  • Paeds Emergency Cardiac Arrest - Basic Life Support --
  • Paeds Emergency Chest Pain Dr ABCDE As per adults Takayasu arteritis?
  • Paeds Emergency Coma / Head Injury DR ABCDE, not tested
  • Paeds Emergency Convulsion --
  • Paeds Emergency Diabetic Ketoacidosis --
  • Derm Emergency Erythroderma --
  • Paeds Emergency Febrile Neutropaenia DR ABCDE as per adult, not testes Recognise, sepsis six incl empirical ABx, positive pressure isolation
  • Paeds Emergency Head Injury DR ABCDE Not tested
  • Paeds Emergency Meningococcal Disease --
  • Paeds Emergency Near Drowning --
  • Paeds Emergency Poisoning Paracetamol - Activated charcoal, NAC Salicylate - gastric lavage, alkalinise urine, supportive TCA - Benzos - fonepezil Alcohol - gastric lavage, supportive
  • O&G Emergency Post-partum haemorrhage Code Red / 2222 DR ABCDE with Stop bleeding: oxytocin / ergometrine / manual compression Beware DIC, infection Resuscitate DDx: Thrombus (DIC), uterine hypo-/aTonia, retained Tissue, Trauma (e.g. rupture)
  • O&G Emergency Pre/-ecclampsia --
  • Derm Ermergency Generalzed Pustular Psoriasis --- DR ABCDE, cover lesions, higb dose steroids, ITU
  • Derm Emergency Pemphigus Vulgaris --
  • Derm Emergency SJS / TEN --
  • Paeds Emergency Shock DR ABCDE as per adults Smaller fluid bolus
  • Paeds Emergency Trauma (incl burns) --
  • O&G Emergency Ante-partum haemorrhage Placenta praevia - classically painless Placental abruption Miscarriage Ruptured ectopic DR ABCDE ⇒ Hx (pain? products of conception? previous complications?) ⇒ exam (abdo, speculum) ⇒ management (reassure, resuscitate, medical expulsion of PoC, surgery)
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  • O&G Skill Pelvic Examn WIPER-QQHxConsent, chaperone, close door Abdominal palpation Inspection Bimanual - cervix, uterus (size, position, mobility), adnexae Speculum - color, discharge, open/closed; take swab Talk about possible outcome, answer questions
  • Exam: Breast WIPER-QQ Inspection Positions: Lying, sitting, arms pushed into hips, arms raised Features: Symmetry, skin changes, nipple inversion, tethering, discharge, masses Palpation: Regions: Four quadrants, behind the niple, axillary tail, lymph nodes Features: Position, size, shape, consistency, mobility, tenderness, number Offer: Referral for triple assessment: clinical + imaging + tissue sample MDT discussion → Breast Hx
  • Ophthal Skill Visual Acuity --
  • Ophthal Skill Fundoscopy WIPER-QQInspection of the external eyeRed reflexFundoscopy proper Prep: Dim light, ask to look in the distance, (dilate pupil with mydriatic / ophtalmoplegic agent, e.g. ) Optic disc: Contour, Colour, Cupping Vessels: Superior & inferior arcade Macula: drusen in dry AMD Findings: Diabetic retinopathy: grade I-IV or  background, pre-/proliferative Hypertensive retinopathy: A/V nipping +  Papillitis / papilloedema: DDx, increased ICP, due to SOL, hydrocephalus, venous sinus thrombosis, meningitis etc Optic atrophy: pale disc ⇒ DDx MS, ant ischaemic optic neuropathy
  • Ent Neck Exam Palpate the lymph nodes, look into nose and pharynx; ± otoscopy
  • ENT Skill Hearing Assessment Rinne & Weber for conductive vs sensorineural hearing loss Incl otoscopy Refer for audiometry: classical patterns for presbycusis etc
  • Cardiovascular exam End of the bed Patient: comfortable? Scars? Paraphernalia: cardiac monitor, GTN spray, fluid restriction General examination Hands: cap refill, temperature, radial pulses (incl delay); IE, tendon xanthemata; clubbing Arm: Collapsing pulse, brachial pulse, BP, JVP, carotid pulse Face: pallor, corneal arcus, xanthelasmata, cyanosis, dentition, hydration status Praecordium Inspection: scars, pacemakers, visible heaves / thrills / apex beats Palpation: apex beat (5th ICS, MCL; left-lateral → expiration); heaves / thrills Auscultation: 7 regions, manoeuvers, radiation, in-/exspiration; HS's + murmurs Extras Heart failure: Lung bases & sacral oedema; ankle oedema Check for AAA Peripheral pulses Offer: ECG, echo, urine output
  • Respiratory exam End of the bed Patient: resp distress (acc muscles, posture) Paraphernalia: inhalers, sputum pot, medicines, oxygen General exam Hands: Pedal oedema; temperature, perfusion, pulse; tar stain, clubbing; CO2 retention, arthropathy; resp rate; JVP Face: Pallor, Horner's (miosis, ptosis, anhydrosis); cyanosis; trachel deviation / tug Chest Inspection: scars, symmetry, deformities Palpation: apex beat; expansion Percussion Auscultation: breath sounds (vesical vs bronchial); wheeze, stridor, crackles Extras Cervical / axillary lymphadenopathy Peak flow, sputum pots, O2 sats
  • Exam: Higher cognitive function Estimation of distance and size Verbal fluency: name animals Tapping exercise Drawing a clock, putting in hands at 5:30
  • Geri Falls Assessment --
  • Exam: Musculoskeletal system & specific joints GALS: 3 questions: climb stairs, get dressed, pain Walking Spine Arms Legs General structure Look: Scars, erythema, deformity, swelling, trauma, skin Feel: Temperature, tenderness, effusion Move: Active → passive Function / Special tests Hand -  Rheumatoid, Dupuytrens, OsteoarthritisElbow - Epicondylitis, ruptured biceps tendon, fractures, + rareShoulder - Frozen shoulder, impingement, rotator cough tear, tendinitisSpineHip Walk, leg-length discrepancy (measure!); Trendelenburg sign Look, feel, move Special tests: Thomas's test (fixed flexion deformity); Patrick's / FABER test (OA hip / sacroilliac joint) Knee Walk, valgus / varus deformity, Baker's cyst, popliteal aneurysm Look, feel (effusion), move Special tests: anterior / posterior drawer test (cruciate ligaments); collateral ligaments; MacMurray's test (meniscus) Ankle
  • Psych Focused Hx Depression, incl post-natal Schizophrenia Anxiety Mania Drugs & Alcohol Template Presenting complaint Cardinal symptoms DDx: drugs, physical illness, other psych illness -- psychotic, affective etc Premorbid personality Past / familiy psych history Social hx Risk assessment Insight
  • O&G Focused Hx Prolapse Endometrial Cancer Post-natal Depression Heavy bleeding APH Pre-ecclampsia etc
  • Opthal Emergency Acute Angle Closure Glaucoma --
  • Geri Palliative Prescribing Rationalize drugs as far as possible Syringe driver for symptoms, usually 40 ml water for injection  / 24hr Pain: Diamorphine, 1.5x as strong as morphine SC Nausea: Cyclizine 150mg Agitation: Midazolam 10-20mg, titrated up to 20-60mg Secretion: Hyoscine hydrobromide 20-120mg Beware precipitation, how to write it up?
  • Geri Emergency Delirium --
  • Onc Emergency Cord Compression Symptoms: back pain, bilateral leg neurology (numbness, paraesthaesia, weakness), saddle anaesthesia, sphincter disturbance (rectal incontinence, urinary retention) Causes: Mets from prostate, breast, lung; primary malignancy; TB, abscess Tx: dexamethasone, palliative radiotherapy, neurosurgery
  • Onc Emergency Neutropaenic Sepsis --
  • Onc Emergency GI Obstruction --
  • O&G Consultation Pregnancy-Induced Hypertension --

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