OSCE objective structured clinical examination

Osce

1. OSCE FOR FINAL MBBS

2. OSCE Objective Structured Clinical Examination

3. STATIONS Observed stations/ Skill station Clinical scenarios IMNCI Counselling Recent advances

4. STATION - 1 SKILL STATION

5. MEASUREMENT OF BP Introduces himself to patient and explains procedure Chooses the right size of cuff Positioning of the patient Initial palpatory systolic BP, then auscultatory Reconfirms reading Writes down/ says whether BP is normal Thanks the patient

6. MEASUREMENT OF HEAD CIRCUMFERENCE Introduces oneself and explains procedure Identifies the most prominent part of the occiput Uses a flexible tape Measures between the most prominent part of the occiput and the supraorbital ridge over the temporal area by overlap method. Thanks the parent

7. ELICIT KNEE JERK Introduces oneself and explains procedure Exposes leg adequately Proper position of the leg Looks for quadriceps contraction and extension of leg Grades the reflex Thanks the patient

8. MEASURE THE HEIGHT OF THE CHILD Introduces oneself and explains procedure Makes child stand with feet together; heels, buttocks, shoulders and occiput touching the rod Asks child to look straight with Frankfurt plane being horizontal Scale is brought to touch the vertex and reading is taken Thanks the patient

9. EXAMINATION OF THE ABDOMEN Introduces self and explains procedure Stands at the right of the patient Cleans hands with sterilium and warms them, flexes the knee Inspection – shape, scars, sinus, veins, umbilicus, genitals, hernial orifices Palpation – superficial and deep, liver, spleen, bimanual palpation Auscultation for bowel sounds and bruits Thanks patient  

10. STATION 2 CLINICAL SCENARIOS

11. Child with edema and hypertension Acute post streptococcal glomerulonephritis Hematuria, oedema and hypertension RBC casts and dysmorphic or crenated RBCs Hypertensive encephalopathy, cardiac failure, acute renal failure

12. Child with fever and altered sensorium Acute pyogenic meningitis CSF analysis Ensure that there is no local infection over LP site and no features of raised ICP IV Ceftriaxone

13. Infant with febrile seizures Simple febrile seizure 6 months to five years CSF analysis; grant marks even if they write ‘no investigations’. Any benzodiazepine Clobazam intermittent prophylaxis is family history of seizures and recurrent.

14. Infant with cyanosis Cyanotic spell POMPS – Position, oxygen, morphine, propranolol, soda bicarb , and surgery if need be Tetralogy of Fallot Cyanotic spells, infective endocarditis, cerebral abscesses, cerebral thrombosis

15. STATION 3 IMNCI

16. Lethargic neonate Classify as serious bacterial infection Treatment – give 1 st dose of IM ampicillin and gentamicin Prevent low sugar by breast feeding, EBM or with animal milk with added sugar by NG tube Prevent hypothermia by skin to skin contact Refer urgently to hospital

17. Neonate with yellowish discolouration of skin Classify as jaundice Advice – home care for the neonate and when to return immediately Follow up in two days’ time

18. Infant girl with cough and tachypnoea Classify – pneumonia Treatment – oral amoxycillin for 5 days and relieve cough with safe home remedies Advice the mother when to return immediately Follow up in two days

19. Infant with non-invasive loose stools Classify – severe dehydration Treatment – give first dose of IM ampicillin and gentamicin Give fluid as for severe dehydration (plan C) if weight is normal for age If the child has another severe classification or low weight for age – refer urgently to hospital During transport advice the mother to give breast milk, sips of ORS and to keep the baby warm

20. STATION 4 COUNSELLING

21. Counsel the mother whose child has anemia Introduces oneself Asks for blood loss, worm infestation Explains that it is nutritional anemia and tells mother to give iron for 3 months Explains how iron should be given Dietetic advice (red meat, liver, dates, jaggery etc.) Asks if she has questions

22. Counsel mother whose infant has acute watery diarrhea Introduces oneself Advices to continue breast feeding Advices ORS and home available fluids and food Advice how to prepare ORS About zinc Advices about danger signs Asks whether mother has understood and has any questions

23. Counsel mother whose infant has febrile seizures Introduces oneself Reassures mother about benign nature of condition Asks for developmental history and family history Explains about use of antipyretics and tepid sponging Intermittent prophylaxis Asks whether mother has understood and if any questions

24. Counsel mother being discharged with normal neonate Introduces oneself Explains exclusive breast feeding and NO other feeds and duration of breast feeding Advice burping Advices about immunization Advices about danger signs Asks if she has understood and whether she has questions

25. STATION 5 RECENT ADVANCES

26. RNTCP What is the recent change in the RNTCP guidelines as regards dose regimen? Daily dose regimen

27. NRP Q. Resuscitation of babies born through meconium stained liquor  Need for tracheal suctioning only in non-vigorous babies, NOT as a routine Pulse oxymetry monitoring ECG

28. Vaccines Current recommendation for polio vaccine Use of injectable polio vaccine Recommendation 6 and 14 weeks 0.1 ml ID

29. Thank you