Slide 1

OSCE TipsWASH YOUR HANDS as you walk into the station, may be hidden

After being briefed by the examiner and asked to locate a landmark FIRST INTRODUCE YOURSELF TO THE PATIENT AND GET CONSENT

WASH OUT

Just be courteous

If you dont know, just try and move onHEAD & NECK:SURFACE ANATOMYSCMFacial musclesTheir actionsC7External occipital protuberanceMastoid processMandibular angleTempero-mandibular jointZygomatic arch

CHEST:SURFACE ANATOMYANTERIORSuprasternal notchTrachea palpable at this point

Sternal angleArticulation between manubrium and body of sternumPlane through TIV / TV vertebral discBifurcation of tracheaBeginning and end of arch of aortaSeperates superior and inferior mediastinum

Counting ribs:start from sternal angle (level with rib 2) and move inferio-laterally down the chest wallBottom of rib cage anteriorly is rib 10

Costal marginSternal angle

Heart borders

Heart valves

LUNGSSuperiorlyReach above rib 1 (Apex of the lung)2 cm above clavicle (Parietal pleura)

Inferiorly(Lung)VI > VIII > X at Midclav, midaxil, posteriorly(Parietal pleura) reflects onto the diaphragmVIII > X > XII at Midclav, midaxil, posteriorlyLung does not fill the pleural cavity the costo-diaphragmatic recess

Auscultation points:AnteriorlyIntercostal space 2, (4), 6 for Upper, (Middle) and lower lobesPosteriorlyIntercostal space 2, 7 for Upper and lower lobes, near the midlineAsk patient to put hands on their head to remove obstruction of scapula from lower lobeIn this case medial margin of the scapula will allign with oblique fissure

Move laterally for anterior ascultationMiddle lobe not seen posteriorly, only in right lung9

ABDOMEN:SURFACE ANATOMYASIS (anterior superior iliac spine)

Transpyloric planeTranspyloric plane- hand below xiphoidOr midway between jugular notch and pubic symphysisL1

Mid inguinal point vs midpoint of inguinal ligamentMid point of inguinal ligament- tubercle and ASIS (deep inguinal ring)Mid inguinal point- symphysis and ASIS (fem artery)

Vertebral landmarksPSIS-S2T3- spine of scapulaT7- bottom of scapulaL4- iliac crest

Styloid processesHeads of ulna/ radiusUlna?

Ulna head-proneUlna styloid- supinePeripheral pulses

Liver biopsyLiver biopsy9th IC, mid axillary

Aspiration and chest drainAspiration and chest drain2nd IC mid clavicular4/5th Intercostal anterior axillary line

Recommended resources https://www.youtube.com/watch?v=Q-kpk0tjTgQ

https://www.youtube.com/watch?v=6lMKauO44rA