OSCE Clinical Skills Assignment 5

OSCE Clinical Skills Assignment 5

Watch the following videos, then complete the required assignment. Review the document in Course Resources for instructions on accessing the videos.

Lab 1

OSCE Clinical Skills

Sore throat15:08

Upon completion of watching the video write up the scenario into a SOAP format. Is there anything you would do differently on your plan?

Lab 2

OSCE Clinical Skills

Cough 16:29

Upon completion of watching the video write up the scenario into a SOAP format. Is there anything you would do differently on your plan?

This video format is designed to help you prepare for objective structured clinical examinations, or

OSCEs.

So Ms. Chen, tell me what is your average weight that you keep.

You are going to observe and participate in a clinical encounter of a 45‐year‐old woman who comes to

the office with a complaint of a cough. As you observe the encounter, you will be asked to answer

questions while the image on the screen freezes. These questions will allow you to practice the skills of

history taking and physical examination skills as well clinical reasoning as you develop your assessment

or differential diagnosis, and plan—that is, an appropriate next diagnostic workup.

You will have time to record your findings and receive feedback.

Health History

Ms. Chen, tell me your special concerns.

I have been coughing for a week and just can’t seem to stop. I can hardly sleep at night.

Have you been bringing up any phlegm or sputum?

I’ve been coughing up a yellow‐green mucus, sometimes with pink streaks that seem to be blood.

What diagnoses are you considering at this time?

Pneumonia.

Bronchitis.

Sinus infection.

Tuberculosis.

How much pink streaking are you seeing at any one time?

Just a tinge, but maybe 3 or 4 times a day.

Have you had any fevers or chills?

Yes, I checked my temperature yesterday and it was 101°F.

What about shortness of breath?

I do feel shortness of breath when I’m working outside, but not when I’m working at my desk.

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Have you noticed any wheezing?

Just once in a while when I’m going up the stairs fast, or when I’m doing heavy work in the yard.

Have you had any of these symptoms before, or had any asthma?

No, not since I was a kid. I did have some mild asthma when I was in elementary school but luckily I

never had to go the hospital.

Any pain in your chest when you take a deep breath?

No, no pain when I breathe in or out.

You mentioned that you’re coughing a lot at night. Are you using any extra pillows?

Well, the last few nights I have been using two pillows instead of one. It seems to help me clear my

head.

Have you had any acid taste, or reflux?

No, not really.

How about any recent colds?

Well, actually last week I came down with a runny nose and a sore throat, but then my symptoms got

worse.

Have you had any sinus congestion?

Well, my sinuses do feel full a lot. Um…I first feel a drip in the back of my throat, um…but now the worst OSCE Clinical Skills Assignment 5

thing is the cough.

What about allergies when you’re outside?

Pollen and golden rod get me every spring and fall. Right now my spring allergies are almost over.

And what do you do for those?

Antihistamines usually help. Um…I do try to cut down on my smoking, but right now my symptoms now

are much worse than usual, especially with the bad cough and phlegm.

Do you have pets at home?

Yes, we have two cats. I’ll admit right now that they sleep in our bedroom.

Well, animal fur picks up allergens, you may want to consider having them sleep in a different part of

the house, or even outside.

Can you tell me if you still smoke cigarettes?

I’ve smoked two packs a day for the last 10 years. I’ve tried to stop but I work as a dispute mediator.

With all that stress I just can’t seem to quit.

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Have you had any weight loss or night sweats?

No, my weight is fine, and no night sweats.

Has anyone around you been ill? Or have you been exposed to tuberculosis?

My family and co‐workers are fine. When I was a kid though, my grandmother told me she had

tuberculosis in her 20s.

Have you been checked for tuberculosis, with a skin test like a tine test or PPD?

I did have one of those PPDs about 10 years ago when I started my current job, and it was negative.

Have you had a chest x‐ray?

No, I’ve never had a chest x‐ray.

What about any recent travel? Have you been out of the country?

Well, I did go to Shanghai a few months ago to visit my cousins…um, however this cough is much more

recent. No other travel.

I’d like to go back to the pink streaks in your sputum that you mentioned. Are you taking any

medications right now, such as aspirin or ibuprofen?

Right now I’m taking a decongestant over the counter and some ibuprofen maybe twice a day or so. I’m

not on any regular medication.

Okay, let’s talk about your general health. Do you drink alcohol?

Well, a glass of wine, 3 times a week.

Have you ever used any oral, nasal, or injection drugs such as marijuana, cocaine, amphetamines, or

heroin?

No, never, even though I know people who do.

To be thorough, given your cough, I need to ask about your sexual activity. What is your sexual

preference, men, women, or both?

Men.

Now, just a few questions about your past health…I see you are 45. Have you ever had any problems

with your heart or lungs?

No, I’m still able to work out even with the smoking. I just had that asthma a few times when I was in

grade school.

How about any surgery?

No, no surgery. I’ve never even been to the hospital.

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Okay, is there anything else that you would like me to know?

No, I think you’ve covered everything.

Okay, let’s start your physical examination.

Physical Examination

With the patient’s health history in mind, and after good hand hygiene, you are ready for the physical

examination.

Okay, your temperature is up a little at 101.5°F. Your blood pressure is 130 over 88. Your heart rate is

100 and you’re breathing at about 22 breaths a minute, which is higher than normal.

What regions of the physical examination are important in this patient? OSCE Clinical Skills Assignment 5

Head and neck, heart and lungs, extremities.

Okay, first I’d like to check your head and neck.

Examine the ears.

Palpate the sinuses.

Examine the throat and mouth.

Palpate the anterior and posterior cervical lymph nodes.

Okay, your ears look fine but your throat is a little red, otherwise it’s okay. Now I’d like to check your

lungs.

Percuss the lungs.

There is some dullness here over the base of your left lung. Can you say “99” for me a few times?

Palpate for tactile fremitus.

Auscultate the lungs.

[RALES AND RHONCHI SOUNDS]

Can you say “99” for me a few times?

99…99…99…

Listen for bronchophony, or louder transmitted voice sounds, which are abnormal.

Good, now can you whisper the number “99”?

[WHISPERING] 99…99…99…

Listen for whispered pectoriloquy, or louder whispered sounds, which are abnormal.

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Okay. Can you say the letter “E” for me 2 or 3 times?

Eeeee…Eeeee…

Listen for egophony, or “E to A” changes, which are abnormal.