Tiêu đề Excellence Skill (Clinical Examination).pdf ✅

Excellence for MRCS OSCE By Dr. Rifat & Dr. Hasnat 1 CLINICAL EXAMINATION TABLE OF CONTENTS S/L TOPICS PAGE NO 01 Superficial Lump Examination 05 02 Thyroid Examination 10 03 Parotid Gland Examination 16 04 Submandibular Gland Examination 22 05 Breast Examination 28 06 Inguinal Hernia Examination 34 07 Hydrocele Examination 39 08 Chest Examination 44 09 Cardiovascular Examination 49 10 Abdominal Examination 58 11 CCrISP (Care of Critically Ill Surgical Patient) 69 12 Cranial Nerve Examination 76 13 Cerebellar Examination 85 14 Chronic Lower Limb Ischaemia 91 15 Varicose Vein Examination 96 16 Arteriovenous Fistula Examination 104 17 Shoulder Examination 110 18 Hand Examination 115 19 Hip Examination 123 20 Knee Examination 128 21 Ankle Examination 135 22 Foot Drop Examination 140 23 Spine and Lower Limb Examination 145 24 Diabetic Foot Examination 151
Excellence for MRCS OSCE By Dr. Rifat & Dr. Hasnat 2 BASIC CONCEPTS ON EXAMINATION STATIONS « Each station will last for ten minutes. « You will get three clinical examination stations in the exam. « One minute to read the stem that will be written on the door of the examination room. « You will get six minutes to examine the patient. « Three minutes to present your case and answer the cross questions. « The patient could be real patient or an actor. (Actor mostly) « If the patient can’t speak English, you will find a translator there definitely. « You will not be provided by pen and paper. « You will get all the instruments there but those will be kept off side of your eyes. So before starting the examination you will have to gather all the instruments; so ask the examiner. « Each station contains 20 marks. « One examiner (Surgeon examiner) is present in each clinical examination station: responsible for 20 of 20marks and he will evaluate you on three main items. These are- clinical examination, presentation, knowledge and patient communication skills.
Excellence for MRCS OSCE By Dr. Rifat & Dr. Hasnat 3 BASIC APPROACH TO CLINICAL EXAMINATION Wash your hands ü Timing: It’s better to wash before touching the patient for clinical examination but most of the candidates wash their hands immediately after entering into the exam hall to avoid risk because it carries mark. Greet the patient and introduce yourself ü Hello, good morning, I am Dr Nahid Hasan Rifat/Dr X (If your name is written in the stem), one of the exam candidates for today. Confirm patient name and age ü May I confirm your name and age, please? ü Alternatively check the wrist band of the patient and say, “Nice to meet you Mr./Ms. X) ü Don’t ask-DOB - Just to be familiar with the patient (you don’t have to remember the name and age, also you don’t have to mention during presentation) Explain examination in layman language and get verbal consent ü Today I’ve been asked to examine your knees that would include looking, walking, feeling, moving and also some special tests, are you OK with this? Chaperon ü Ask the patient (better)/ examiner for a chaperon if you are going to examine the private parts like genitalia or female breast, chest for CVS etc. (It’s better to ask in every station to avoid losing marks). Exposure ü Ask patient politely to remove his or her clothes and if you have to keep patient underwear for patient dignity e.g., hip examination informs the examiner. Don’t forget to offer for support. ü Don’t expose unnecessarily of one body part while examining other system. Ask patient for any pain ü If there is any pain then ask for pain killer to your examiner. ü If patient still complains about pain; skip the step and consider it as a positive finding. During examination ü Recall about hand washing, patient position, explain every step to the patient if possible. ü Always look at the face during elicitation of any tenderness, not towards the site of examination. Assurance ü Ask for permission to examine the patient from the back. ü Before moving any limb ask the patient if there is any pain at hip or shoulder ü Try to protect the patient from falling during walking. ü Try to encourage the patient after completing a successful step and reward him that he is doing fine. Review patient chart or files if present. ü Mostly in CCrISP Thank the patient ü Ask him to cover himself and help him for redress if needed. Wash your hands (end of examination).
Excellence for MRCS OSCE By Dr. Rifat & Dr. Hasnat 4 Tell the examiner ü To complete my examination, I would like to perform.... (Related Other examinations). For an example, in case of orthopaedics- mention to examine the upper and lower joints. Present your case ü Mention positive and important negative signs. Examiner will ask you about provisional and differential diagnosis. ü Questions are-D/Dx, how to investigate and sometime ask about treatment. (Fixed questions) ü Examiner will ask you few more questions if time permits even though that questions are not given in your question script (that won’t carry marks). N.B. You are not allowed to wear gloves during examination of patient (Not even during genitalia examination for Hernia/Hydrocele); you can have gloves only during oral examination (Parotid, submandibular examinations)