The OSCE

OSCE day 1

It was Ankylosing Spondylitis. Shoot. I was almost sure it was Rheumatoid Arthritis.

1 down. 9 to go. The 1st of the OSCEs (oral exams) were held in UCD this morning. It consisted of a 10-minute history taking session with an actor who had a ‘disease’ that had to be figured out by a comprehensive ‘interrogation’. Easy?

He had back pain on a background of Crohn’s disease. Simple and innocuous enough. There was something not adding up to the whole picture though. He had a history of trauma which caused a prior back injury, but it didn’t really explain the sudden onset of pain with a severity of 8/10.

After the patient revealed he had morning stiffness lasting a couple of hours every day, the only thing that I could think of was Rheumatoid Arthritis (RA). I thought I had it in the bag.

Rookie mistake. I suddenly remembered the list of seven diagnostic criteria required for RA, AFTER leaving the examination room. Brilliant. I had only gone through it the night before. I was sure I had it nailed. He had only ONE out of the seven symptoms…Shoot

It didn’t help that my patient played the uncooperative role. He didn’t answer any of my questions voluntarily unless prompted further. It made things worse. Nerves were already taking over from the beginning. I loathe the fact that many of my other classmates got patients who told them everything even without them asking. Shoot.

It wasn’t all bad though. I did manage to get almost all of the symptoms except the parasthesia he suffered intermittently. And allergies. Come to think of it, I think I forgot to ask him to describe the pain. Shoot

It’s over though. Hopefully it serves as a lesson to me. NEVER RUSH INTO THINGS!

I end this post with a quote from my beloved Clinical Examination textbook :

“Never miss an opportunity to inspect a patients’ faeces…”

Faeces.

PS: The guy beside me is probably suffering from COPD or Asthma judging from his unproductive cough and expiratory wheeze.

OSCE day 2

Another day of OSCEs. This time it was physical exams, ENT and ophthalmology.

Physical exams was a screw-up. I had to have picked Dr Maurice Stokes as an examiner, no favours there. I had to do a peripheral vascular and neurology exam on the lower limb. For some inadequate reason, my nerves inadvertently gave in (again).

Overall, I breezed through neuro, as I had a lot of practice beforehand. But peripheral vascular disease was a tough one. I couldn’t even remember if the posterior tibial pulse was on the medial or lateral side of the malleolus. I ended up palpating both sides, luckily finding it on the medial side and earning another ‘tick’ in the assessment box.

I forgot the fine touch test, as well as temperature assessment. However, in truth it was a botched up attempt to intergrate both systems together, as evident with awkward moments total silence when I was trying to figure out what to do next. Alas, I can’t really complain.

Smack in the middle of the ICCI library yet again. Supposedly studying for the remaining two days of exams. I’m dreading Friday. Obstetrics, Gynaecology, Paediatrics and Psychology in one go. 75%. If I pass, might as well skip the finals and hop on an early flight home.

This post has been completely pointless. An almost diary-like entry despite earlier intentions of NOT trying to do so. Figures. Then again. It’s my blog. It’s relatively anonymous. There you have it.

Cheers