OSCE 3 tiredness weakness.pptx...............

OSCE ABOUT TIREDNESS

1. Starting the interview Appropriate introduction Confirms patient’s name and age Explains reason for consultation Obtains consent

2. Listen carefully & empathically Open question to elicit presenting complaint Allows patient to open up, listens carefully, remains silent and does not interrupt the patient Signposts: e.g. ‘Mr Gregory, thank you for telling me about this problem. I would like to ask a few more detailed questions. Is that all right?’

3. I feed weak and tired: HPI Onset (how it started) Character (what the patient means by tiredness) Time (duration) Alleviating factors Exacerbating factors Severity (in comparison with other episodes of tiredness) Asks if there is a pattern with activities/daily routine Asks about menstrual disturbances (if patient female)

4. I feed weak and tired: HPI Establishes sleep pattern Asks if patient is suffering from any other symptoms Asks about any recent illnesses Previous episodes of lethargy/tiredness Depression screening: asks about mood, previous history of depression and sleeping patterns

5. I feed weak and tired Review of systems Depression screening: asks about mood, previous history of depression and sleeping patterns Asks closed focused questions to rule out specific common causes of lethargy: Thyroid dysfunction (sweating, tremor, dry hair, neck discomfort, eye symptoms, bowel changes, menstrual irregularities) Anaemia (shortness of breath, chest pain, palpitations, menorrhagia) Diabetes mellitus (polydipsia, polyuria, recurrent infection) Cancer (weight loss, night sweats, family history of cancers, cough, diarrhoea, melaena)

6. I feed weak and tired Review of systems Hypopituitarism (loss of appetite, nipple discharge, loss of libido) Chronic kidney disease/nephrotic syndrome (ankle swelling, orthopnoea) Chronic infection (fevers) Chronic fatigue syndrome symptoms (sore throat, headaches, muscle pains, exacerbated by exertion) Obstructive sleep apnoea (unrefreshing sleep, feeling sleepy in the day, loud snoring, waking up suddenly in the night, loss of libido, irritability) Depression (mood, anhedonia, sleep, appetite, concentration)

7. Red flag Night sweats Fevers Weight loss Loss of appetite Palpable lymph nodes

8. PMH Known CVS, Respiratory, Renal, CNS Anemia Rheumatological history Cancer Liver or kidney diseases

9. Family History Cancers Endocrine disorders, especially thyroid disorders and diabetes Depression

10. Drug History Any medications Link medications to illnesses in PMH Allergy

11. Social history Smoking Alcohol Illicit drug use Ethnicity (haemophilia) Diet (spicy foods) Activities of daily living Recent travel

12. Professionalism Communication Use of non-verbal cues, e.g. good eye contact, nodding head and good body posture Non-verbal skills Avoids technical jargon

13. Professionalism Explores and responds to ICE: Ideas Concerns Expectations Shows empathy Devises holistic management plan and addresses psychosocial issues as well as medical problems Summarizes Offers to answer any questions Thanks patient

14. Professionalism Communication Use of non-verbal cues, e.g. good eye contact, nodding head and good body posture Systematic approach Explores and responds to ICE: • Ideas • Concerns • Expectations Shows empathy Non-verbal skills Avoids technical jargon Devises holistic management plan and addresses psychosocial issues as well as medical problems Summarises Offers to answer any questions Thanks patient

15. Starting the interview Checklist Appropriate introduction Confirms patient’s name and age Explains reason for consultation Obtains consent Open question to elicit presenting complaint Allows patient to open up, listens carefully, remains silent and does not interrupt the patient Signposts: e.g. ‘Mr Gregory, thank you for telling me about this problem. I would like to ask a few more detailed questions. Is that all right?’

16. Starting the interview Checklist Appropriate introduction Confirms patient’s name and age Explains reason for consultation Obtains consent Open question to elicit presenting complaint Allows patient to open up, listens carefully, remains silent and does not interrupt the patient Signposts: e.g. ‘Mr Gregory, thank you for telling me about this problem. I would like to ask a few more detailed questions. Is that all right?’