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123The Objective Structured Clinical Examination Review Mubashar Hussain Sherazi Elijah Dixon Editors | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
The Objective Structured Clinical Examination Review | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
Mubashar Hussain Sherazi Elijah Dixon Editors The Objective Structured Clinical Examination Review | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
Editors Mubashar Hussain Sherazi Mallacoota Medical Centre Mallacoota Victoria Australia Elijah Dixon Foothills Medical Centre Division of General Surgery University of Calgary Calgary Alberta Canada ISBN 978-3-319-95443-1 ISBN 978-3-319-95444-8 (e Book) https://doi. org/10. 1007/978-3-319-95444-8 Library of Congress C... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
To my affectionate and wonderful wife, Uzma, for her continued support throughout the writing of this book and within my whole life. To my lovely children, Moiz, Noor, and Muhammad, for their enduring inspiration and encouragement. Mubashar Hussain Sherazi | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
vii Statement of Purpose The Objective Structured Clinical Examination Review consists of 16 chapters, and each chap-ter is a collection of important and common case scenarios for Objective Structured Clinical Examination (OSCE). The selection of case scenarios has been customized to make this book beneficial for a wid... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
viii sonal ease and comfort. The authors and contributors of this book have tried their best not to disclose or copy any actual scenario or actual case discussion from any of the actual examina-tion. No name of any patient or doctor is thus used in this book in any scenario. Your suggestions and feedback are welcome at... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
ix Dr. Elijah Dixon for patronizing and his supervision throughout the writing of this book. Ms. Maureen K. Pierce for her guidance and her continuous support, which made it easier for me to complete many topics. Special Thanks Special thanks to Dr. Pieter Nel (Director Emergency Department, Mackay Base Hospital, Mack... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
x Mackenzie Whitfield B. Sc (Student) University of Victoria, BC, Canada Chapters: Musculoskeletal system, Respiratory system and Nervous system M. Moiz Shah Bachelor of Business Administration (student), Mount Royal University, Calgary, AB, Canada Chapters: Introduction and Ethics Acknowledgments | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
xi 1 Objective Structured Clinical Examination Introduction................... 1 Mubashar Hussain Sherazi 2 The Nervous System ................................................. 13 Asif Hashmi and Mubashar Hussain Sherazi 3 Psychiatry ......................................................... 67 Mubashar Hussain Sherazi ... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
xiii Uzma Bukhari, MBBS General Practitioner, Sahiwal, Pakistan Asif Hashmi, MBBS, FCPS, DCN, MSc HSEduc Department of Medicine, Armed Forces Hospital, KANB, Jubail, Saudi Arabia Umair Khalid, MD Child & Adolescent Unit, Mackay Base Hospital, Mackay, QLD, Australia Majid Sajjadi Saravi, MD Department of Family and Com... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
1 © Springer Nature Switzerland AG 2019 M. H. Sherazi, E. Dixon (eds. ), The Objective Structured Clinical Examination Review, https://doi. org/10. 1007/978-3-319-95444-8_1Objective Structured Clinical Examination Introduction Mubashar Hussain Sherazi Introduction to the Objective Structured Clinical Examination Since ... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
2 information) placed on the door outside of the respective sta-tion. Candidates are given a few minutes to read and prepare notes before entering each station. Candidates are expected to perform one of the following or in some stations more than one: Obtain a focused or detailed history. Focused or detailed physical e... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
3 wrinkles. Try not to wear expensive watches or jewelry. Many OSCEs instruct candidates not to wear any per-fumes; make sure you follow the instructions. For female colleagues, try to avoid extensive makeup, high heels, sandals, facial piercing, or strange hairstyles. What to Bring to the OSCE? A stethoscope (nonelect... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
4 Take a deep breath and tell yourself: “I am ready and I will do this well. ” The bell will ring or you will be asked to move to your first station. Starting the Interview: Knock on the door. Go into the room with a smile and confi-dent face. In some of the OSCE, it is required by the candidates to give two name/exam ... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
5 some concern in the start. In this situation, that concern or question should be addressed first before exploring the his-tory of present illness. Example: Station: Patient with Fatigue. The patient may ask, “Doc, why I am so tired these days?” This question/con-cern must be addressed before asking any other question... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
6 Show respect. Not being judgmental in approach. Patient-centered approach. Maintains and offers confidentiality. Not be assertive, dominating, or use sarcastic language. Maintain good communication skills. Ready to educate patient. Avoid medical jargon. Willingness to discuss patient concerns. Take care of patient co... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
7 questions of your current problem so we can come to a man-agement plan. ” Review of Systems: It can be done at the end of the present illness questions: Gastrointestinal tract: Nausea, vomiting, diarrhea, constipation, change in bowel habits, acid reflux, appe-tite, blood in vomiting or bowel movements, and jaundice ... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
8 -“What was the route?” C-section (C/S), spontaneous vaginal delivery (SVD), or assisted vacuum delivery (A VD) -“How long was the labor/delivery?” (18 h is normal for primi, 12 h for multipara) -“Early gush of water?” (premature rupture of membranes) -“Any need for augmentation/induction?” -“What was the Apgar score?... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
9 “Are your parents married, divorced, or separated?” “How long you have been living in your current resi-dence? What does your parent do for work?” Education: “Which grade you are in?” “What school do you go to?” “How are your grades?” “Do you like going to school?” “Have you made any future plans in studies?” Employm... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
10 lated patient. Some patients may have positive signs, and it is very important to pick up these signs during the examination. Here are few tips to improve your physical examination skills: Practice, practice, and practice before the actual examination. An important thing to practice is explaining and taking consent ... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
11 Neck: Respirator y system: Cardiovascular : Abdomen: Neurolo gy: Labs o rdered: Imaging results/ordered : ASSESSMENT/IMPRESSION: Abdominal pain due to...... PLAN: Adm it to General Surgery under Dr...... NPO apart from meds IV fluid: D5 0. 5% NS at 125 ml/hr x 2 L EKG Urine C+ S Morphine 2 mg IV q 2-4 hr PRN pain CT... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
12 Inability to counsel the patient properly Putting patient at harm or risk Wasted too much time on history and missed most of the physical examination Missing valuable information Poor professional judgment Looked nervous and rushed through Best of luck for your OSCE. References 1. Harden RM, Stevenson M, Downie WW, ... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
13 © Springer Nature Switzerland AG 2019 M. H. Sherazi, E. Dixon (eds. ), The Objective Structured Clinical Examination Review, https://doi. org/10. 1007/978-3-319-95444-8_2The Nervous System Asif Hashmi and Mubashar Hussain Sherazi History Overview: The Nervous System In an objective structured clinical examination (O... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
14 5. What physical signs should be looked for in a particular patient? A focused history will determine the appropriate nervous system examination of the relevant part of the nervous system. Starting the Interview: Knock on the door. Enter the station. Hand-wash/alcohol rub. Greet the examiner and the patient. Give st... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
15 Ask for handedness -right or left. Right-handed individu-als have a left-dominant hemisphere, and most of the left- handed (over two-thirds) patients may also have a dominant hemisphere on the left side. Discern the main complaint of the patient. A simple ques-tion “what brings you to my clinic today?” may prompt th... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
16 If adult female, add these questions: Menstrual history (LMP), gynecology history, and obstetric history If the patient is more than 65 years old, add these questions: “Any problem with balance?” “Any difficulty with peeing/urination?” “Any issues sleeping?” “Any change in vision/hearing?” “Any recent change in memo... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
17 Tone: Muscle tone is the state of contraction of healthy muscles and can be estimated by moving the limbs passively. Ask the patient to keep the arms fully relaxed while checking the tone. Hold the patient's wrist with one hand, support the upper arm with your other hand, and flex and extend the elbow joint. Holding... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
18 Elbow Flexion (C5/6-Biceps): After supinating the forearm, hold the forearm with your right hand just proximal to the wrist and support the elbow with your left hand. The patient tries to flex the arm at elbow against resistance. Tell the patient not to let you pull her arm away from her-self (Fig. 2. 7). Repeat on... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
19 Wrist Extension (C6/7-Extensor Carpi Radialis Longus, Extensor Carpi Ulnaris): The patient holds the arm straight and is asked to make a fist. Ask the patient to cock her wrist back and not to let you push it down. Stabilize the wrist with one hand and push it down with your other hand (Fig. 2. 9). Repeat this on t... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
20 resting upon a surface, the patient is asked to move the index finger away from other fingers against resistance of examiner. Tell the patient to move her index finger away from the other fingers and not to let you oppose it (Fig. 2. 13). Abduction of Thumb (C8/T1-Abductor Pollicis Longus and Brevis): For abduction... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
21 tendon, and tap with a hammer in the antecubital fossa (Fig. 2. 15). Observe the contraction of biceps muscles and compare on both sides. Triceps Reflex (C7): Flex the elbow at a right angle, and rest the forearm in a pronated position across the patient's chest. Strike the triceps tendon just above the olecranon ... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
22 Fig. 2. 19 Testing light touch sensation using a wisp of cotton Fig. 2. 20 Testing pinprick sensation Th1 C6 C7C8C5 L1C2 C3C4 C5 Th1 Th2 Th3 Th4 Th5 Th6 Th7 Th8 Th9 Th10 Th11 Th12 L2 L3 L4 L5L1 S2 S3 S1S1S2S2S1 L5 L4L3L2L1Th12Th11Th10Th9Th8Th7Th6Th5Th4Th3Th2Th1C3C2 C4 C5 C6 C7 C8 S5S4 S3S3 L4L5Fig. 2. 18 Dermal segm... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
23 -An inability to perform this test accurately (past- pointing/dysmetria) may suggest cerebellar ataxia. Here, the movement error tends to occur at a right angle to the intended direction of movement. Dysdiadochokinesia: -Ask the patient to flex the elbow at a right angle and then alternately tap the palm of her othe... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
24 Wrap-Up To complete the examination, suggest further assessments by examining the lower limbs and cranial nerves. Thank the patient and cover her. Wrap up your findings and ask the patient if she has any concerns. Checklist: Physical Examination Upper Limb See Table 2. 2 for a checklist that can be used as a quick ... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
25 General Physical Examination: “I need to ask you a couple of questions as a part of my examination. ” (You may skip these questions if it is a history and physical station): “What is the date today?” “Do you know where are you now?” Comment: “Patient is oriented and alert. ” “Patient is in distress!” Or “patient is ... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
26 Ask the patient to walk on heels (heel-walking) to assess the dorsiflexors of feet. Ask the patient to walk on toes (toe-walking) to assess the plantar flexors of feet. Ask the patient to stand with her feet together. Hold her hands, and ask her to sit down and stand up to assess strength of proximal lower limb musc... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
27 Extension (L4/5/S1-Gluteus Maximus): In a supine patient with knee extended, raise the thigh off the bed by placing a hand under the thigh and ask the patient to push her leg straight down and try to touch the bed. You can place the left hand on the side of hip to feel the contrac-tion of the gluteus maximus (Fig. ... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
28 Inversion (L4/5-Tibialis Posterior): Ask the patient to push her foot inward against your hand. Eversion (L5/S1-Peroneus Longus and Brevis): Ask the patient to push her foot out against your hand. Big Toe Extension (L5-Extensor Hallucis Longus): Flex the big toe, pressing against the nail of the big toe (distal phal... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
29 Reflexes Explain to the patient that you will strike the tendons with a soft hammer, which is not going to hurt the patient. Ask the patient to relax. Knee Jerk (L3/4)-Passively flex the knee in a supine patient, pass your left hand under the knee, and gently tap the patellar tendon an inch above the tibial tuberosi... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
30 Sensation Sensory test with a piece of cotton on these spots: Medial side of thigh -L2 Medial femoral condyle -L3 Medial malleolus -L4 Dorsal surface of third toe -L5 Lateral surface of heel -S1 Light touch (posterior column) sensation: Touch the patient's sternum with the cotton wool wisp to show her how it feels. ... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
31 Ask patient to close her eyes and tell you if you are mov-ing her toe up or down. Move it three times and go to a proximal joint (ankle and knee) if the patient cannot feel the movement. Coordination Heel-to-shin test may only be done if gait cannot be tested. Ask the patient to lift her right leg up, place it on he... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
32 The aim of the examination is to identify and classify the gait first and then carry out appropriate relevant neurological examinations to make a clinical diagnosis. Common Causes of a Unilateral Cerebellar Lesion: Cerebellar infarction Cerebellar hemorrhage Multiple sclerosis Tumors (primary or metastasis) Cerebell... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
33 Vitals: Start with commenting on the vitals given at the door. (It should include pulse rate, blood pressure, respiratory rate, temperature, and O2 saturation. ) “Miss... vital signs are within normal range. ” Or comment if there are any abnormal findings. Observe Walking and Standing “Is it alright if I ask you to ... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
34 pursuits) rather than smooth following of the finger. This happens because of insertion of saccades into pursuits. Nystagmus: Horizontal nystagmus tends to be more spe-cific in cerebellar disease. Cerebellar dysarthria: Speech may have a “scanning” character and appears to be broken into syllables. Ask the patient t... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
35 Intention tremors and rebound effect in both arms. Past-pointing during finger-to-nose test. Dysdiadochokinesia -meaning she was very slow and haphazard when asked to perform rapidly alternating movements with both arms. “I could not elicit a pendular jerk although knee reflexes were preserved on either side. ” Ques... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
36 Color Vision Generally color vision is not assessed in OSCE settings. Visual Fields The visual field is the extent of the field of vision in each eye. It is limited by the margin of the orbit, nose, and cheek. The extent of the patient's visual field is compared in each eye separately with those of examiner's by a s... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
37 Testing Eye Movements The eye movements are pursuits (slow, following move-ments), saccades (fast, jerky movements), and conjugate eye movements. Pursuit movements are slow movements that depend upon fovea and occipital cortex. The patient is asked to keep her head still and visually follow your finger as it moves h... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
38 Third nerve palsy, however, may be incomplete or partial when the pupil on the affected side remains reactive to light (pupillary-sparing). This may happen with vascular lesions such as hypertension and diabetes, which tend to damage the interior of the nerve sparing the pupillary constricting fibers on its surface.... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
39 Compare one side to the other by asking the patient if it feels the same on both sides. Pinprick (Spinothalamic) Sensation: For pinprick, repeat the steps used for light touch, but this time using the sharp end of a pin. Ask the patient “close your eyes and say 'sharp' every time you feel it sharp or 'blunt' if you ... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
40 Auditory Testing Gross hearing testing with whispered or conversational sounds is very difficult to quantify and may be interpreted erroneously. Ask the patient if she can hear her telephone ring and has she noticed a change in her hearing recently? Assess each ear separately. Explain to the patient that she is requ... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
41 -In conductive deafness in right ear, bone conduction will be better than air conduction (Rinne negative in right ear), and Weber's test will be lateralized to the right side through bone conduction.-In mild sensorineural deafness in right ear, air conduc-tion will be better than bone conduction (Rinne's test positi... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
42 Position testing (Hallpike's maneuver) Caloric test Fistula test Glossopharyngeal (Cranial Nerve IX) Glossopharyngeal (CN-IX) is not tested in OSCE settings. Vagus (Cranial Nerve X) Motor nerve for muscles of palate, pharynx, and larynx. Damage to the vagus nerve is assessed through its palatine branches by assessme... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
43 Vital Signs: HR, 89/min, regular; BP, 150/85 mm Hg; temp, 36. 8 °C; RR, 17/min; O2 saturation, 99% Take a focused history and perform a focused physical examination. Please do not perform rectal, genitourinary, or breast examination. Differentials: Transient ischemic attack (TIA) versus stroke (throm-botic, embolic,... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
44 History of Present Illness: Onset: “Did the symptoms start suddenly or gradually?” Course: “Are the symptoms changing with time? Are these getting worse or getting better?” Duration: “How long?” Site: “Which side? Or both?” -Face -Arm -Leg -Whole one side Severity of symptoms: “How weak is it? Able to move at all? O... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
45 Inspection: Face/eyes/limbs/gait Cranial Nerve Examination: II/III/IV/V/VI/VII/VIII/X/ XI Muscle Tone: Upper and lower limbs Muscle Power: Upper and lower limbs Reflexes: Babinski's extensor Sensory: Light touch and pinprick Two-point discrimination Cerebellar Examination Cardiovascular: Listen for the heart sounds ... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
46 Vitals: Start with commenting on the vitals given at the door. (It should include pulse rate, blood pressure, respiratory rate, temperature, and O2 saturation. ) “Miss... vital signs are within normal range. ” You should do a full neurological examination in all patients who complain of facial weakness. If the patie... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
47 Question: What is your clinical diagnosis? Answer: “My patient appears to have Bell's palsy on the... side. ” Question: What is Bell's palsy? Answer: “It is a paralysis of one side of the face due to peripheral facial nerve dysfunction. It typically comes on over 12-36 h. Many patients experience pain around the ear... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
48 History: Headache: Migraine Candidate Information: A 33-year-old female comes to your clinic with recurring headache. Vital Signs: Temp, 36. 7 °C; HR, 80; BP, 110/65; RR, 16 Please take a detailed history. No examinationis required for this station. Differential: Immediately consider the common differential of heada... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
49 Alleviating Factors: “Did you try any medication? What were the results?” Aggravating Factors: Bring up with bright lights (migraine) Eating (jaw claudication) Alcohol (cluster headache) Lying down or bending forward or on coughing or lifting weight (increase intracranial pressure [ICP]) Certain foods (migraine) Eye... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
50 mostly in the form of fully reversible visual symptoms including positive features (e. g., flickering lights, spots, or lines) and/or negative features (i. e., loss of vision or homon-ymous visual symptoms). Other patients may experience fully reversible unilateral sensory symptoms including posi-tive features (i. e... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
51 Neonates: group B streptococci, L. monocytogenes, Escherichia coli Hospital-acquired and post-traumatic meningitis: Klebsiella pneumoniae, E. coli, Pseudomonas aerugi-nosa, Staphylococcus aureus Starting the Interview: Knock on the door. Enter the station. Hand-wash/alcohol rub. Greet the examiner and the patient. G... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
52 Inspection: face, eyes, limbs, gait (papilledema) Meningeal: Stiff neck with passive movements (moving chin toward chest) Kernig's sign: Pain and resistance on passive knee exten-sion when hip fully flexed (Fig. 2. 59a, b). Brudzinski's sign: Abrupt neck flexion in the supine patient resulting in involuntary flexio... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
53 Bleeding tendency (systemic anticoagulation, thrombocytopenia) Clinical signs of raised intracranial pressure: -Altered level of consciousness -Focal neurology -Recent seizures Brain stem signs (pupillary changes/posturing/irregular respiration) Abnormal CT head (Arnold-Chiari malformation) Cardiopulmonary compromis... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
54 Opening: “Good morning/good afternoon. I am Dr....I am your attend-ing physician. Are you Miss... ? And you are 28 years old? I understand you here because you were diagnosed to have seizures. I am going to ask you few questions. I will be happy to answer your questions and concerns. ” History of Present Illness: (H... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
55 Question: I have just been diagnosed as having epilepsy. I want to know what can I do and cannot do? Answer: “People with seizures should try to lead as normal a life as possible. There are, however, some safety precau-tions that should be taken to avoid injury. These include avoiding potentially dangerous activitie... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
56 Further Reading: See Table 2. 4 for comparison between symptoms of syncope and seizure and Table 2. 5 for compari-son between seizure and pseudoseizure. History and Examination: Dizziness: Benign Paroxysmal Positional Vertigo Candidate Information: A 54-year-old woman presents to your clinic complaining of dizzine... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
57 spinning motion with their hand. Avoid asking a lead-ing question using the word “spinning. ” -Light-headedness: Ask “Did you feel faint or is there a feeling of black out?” -Disequilibrium: Ask “Do you feel unsteady on your feet or off balance?” Timing and onset: “When did the symptoms start?” Time course: “Is it w... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
58 Focal neurologic signs and symptoms Risk factors for cerebrovascular disease Progressive unilateral hearing loss Suspected developmental defects such as Arnold-Chiari Magnetic resonance imaging is more appropriate than computed tomography for diagnosing vertigo because of its superiority in visualizing the posterior... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
59 Stroke and Transient Ischemic Attacks (TIA): “Cerebrovascular events can affect the brainstem resulting in vestibular symptoms due to involvement of the vestibular nuclei. Vertigo is of sudden onset and may be sustained for hours. The presence of focal neurological symptoms and signs help in localization. ” Brainste... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
60 Secondary Survey: (When the patient is hemodynamically stable) History: -Allergy: “Do you have any known allergies?” -Medication: “Do you take any regular or prescribed medications?” -Previous medical history: “Do you have any known medical conditions?” -Last meal: “When was the last time you ate or drank something?... | Mubashar Hussain Sherazi Elijah Dixon - The Objective Structured Clinical Examination Review-Springer 2018.pdf |
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