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OSCE Script I. Blood Pressure and JVP determination Greet Patient and Ask Permission o Magandang umaga po.

Ako po si _____, estudyante ng medisina. o Ano po ang pangalan ninyo? o Nandito po ako ngayon upang i-eksamin ang inyo pong blood pressure at pati na rin po ang pulso po ninyo sa leeg. o Si Dr/Dra ay nandito upang obserbahan ang pagkuha ko po ng inyong blood pressure at ugat sa leeg. o Maari ko po bang gawin ang pag-eexamin sa inyo? Greet o o o Preceptor and Ask Permission Good morning doctor. My name is Dan Sison. With your permission maam/sir, I would begin examining the patients BP and JVP? o Thank you.

Palpatory Method o Inform preceptor of what you are doing o Doctor, I will now begin BP determination using the palpatory method o Do the following: Place the arm on table or armchair Pakilagay lamang po ang kamay ninyo sa mesa Wrap the cuff around the arm correctly Feel for the radial or brachial pulse Inflate the cuff correctly Deflate the cuff about 2mm per beat Give the correct palpatory BP in mmHg Doctor, the patient has ___ for the left/right arm

Auscultatory Method o Inform preceptor of what you are doing Doctor, I will now begin BP determination using the auscultatory method o Do the following: Place the arm on table or armchair Pakilagay lamang po ang kamay ninyo sa mesa

Wrap the cuff around the arm correctly Feel for the radial or brachial pulse Place the stethoscope over the brachial pulse Inflate the cuff 30 mmHg above the palpatory BP reading Deflate the cuff about 2mm per beat Give the correct auscultatory BP in mmHg Doctor, the patient has ___ for the left/right arm

Neck Exam o Inform preceptor of what you are doing Doctor, I will now begin the jugular venous pressure determination. o Do the following: Position the patient properly I-checheck na po natin ang ugat po ninyo. Ilagay lang po natin ang unan. Kumportable po ba kayo? Visualize the jugular vein properly Itagilid po natin ng kaunti ang ulo natin sa may kaliwa. Salamat po. Identify the points of measurement Sternal angle of Louie Identify the highest point of pulsation of right IJV Measure the JVP correctly (Use RULER!) Doctor, I will now measure the JVP of the patient. Doctor, the neck veins are (distended/not distended) and the JVP measures ___ cm above the sterna angle. Palpate the liver and elicit a hepato-jugular reflux Doctor, I will now palpate the liver and try to elicit a hepato-jugular reflux. Kakapain ko lang po ang inyong atay at didiinan ko lamang po ng kaunti upang mas makita ko po ang pagbabago sa ugat po ninyo sa leeg. Doctor, the patient has (positive/negative) hepato-jugular reflux. Able to locate and palpate the carotid pulse Kakapain ko na po at pakikinggan ang mga ugat po sa inyong leeg. Listened for carotid bruits Doctor, upon auscultation, it was noted that the patient (have/doesnt have) bruits.

II. Peripheral Vascular Exam

Greet Patient and Ask Permission o Magandang umaga po. Ako po si ____, estudyante ng medisina. o Ano po ang pangalan ninyo? o Narito po ako ngayon upang gawan po kayo ng masusing pagexamin sa inyo pong puso at pagdaloy po ng inyong dugo. o Si Dr/Dra ay nandito upang obserbahan ang pagkuha ko po ng inyong blood pressure at ugat sa leeg. o Maari ko po bang gawin ang pageexamin sa inyo? Greet o o o Preceptor and Ask Permission Good morning doctor. My name is Dan Sison. With your permission maam/sir, I would begin examining the patient? o Thank you.

General Survey o Is the patient: Conscious Alert Ambulatory Coherent Oriented Cardiorespiratory distress o HEENT Check for lesions for on the skin Check eyes for pallor, jaundice and conjunctival abnormalities Maari po ba kayong tumingin sa taas? Baba? Check ears and nose Check cyanosis on the lips, oral mucosa and tongue (Use PENLIGHT!) Paki-bukas po ang inyong bibig? Maari ninyo po bang ilabas ang inyo pong dila? Doctor, (theres/theres no) CYANOSIS present in the lips, oral mucosa and tongue of the patient. Check for clubbing Maaari ko po bang tignan ang inyo pong mga daliri? Doctor, the patient (presents/doesnt present) CLUBBING in the fingers and toes o Palpation of the peripheral pulses Brachial Radial Femoral Popliteal Posterior Tibial

Dorsalis Pedis Assess rate, strength and rhythm of the pulses Papakiramdaman ko na po ang ibat-ibang pulso po sa katawan ninyo. Doctor, the patient has (symmetric/asymmetric) pulses in the upper and lower extremities, (normal/increased/decreased) RATE. It is (full/normal/bounding/weak) in STRENGTH and has (regular/irregular) RHYTHM. Palpate extremities for edema Pitting vs. Non-pitting edema Doctor, the patient (presents/doesnt present) with EDEMA in the extremities.

Inspection and palpation of the thorax o Demarcate the border of the clavicle Identify sterna angle of Louie o Identify the apex beat and the point of maximal impulse Palpate apex beat and PMI o Note the presence and absence of heaves and thrills Along the 2nd ICS (R/L) parasternal border o Note the presence of abnormal pulsations Doctor, the patient has (symmetric/asymmetric) chest (with/without) a midline trachea, (R/L) precordial BULGE [if present], with (dynamic/adynamic) precordium. The patient (present/doesnt present) subcostsal retractions, Harrisons groove or use of accessory muscles. Apical impulse is located at the ____ ICS, (R/L) (PSB/MCL/AAL/MAL). The PMI (coincides/doesnt coincide) with the apex beat. The patient (presented/didnt present) any HEAVES, THRILLS and ABNORMAL PULSATIONS. Auscultation o Position the patient properly Supine 30 o Identify the auscultatory areas Aortic 2nd ICS UPPER LEFT PSB Pulmonic 2nd ICS UPPER RIGHT PSB Tricuspid LOWER LEFT PSB Mitral 5th ICS LOWER LEFT MCL Use BOTH bell and diaphragm! o Correctly describe the character of the S1 Distinct/Indistict Soft/Loud o Correctly describe the character of the S2

o o

Correctly describe the murmur if present Systolic/Diastolic/Holosystolic Describe the rate and rhythm of the heart sounds Normal/tachycardic/bradycardic rate Regular/Irregular rhythm The HEART RATE is ____beats/min (normal/tachyucardic/bradycardic) and has a (regular/irregular) RHYTHM. Doctor, the patient (presents/doesnt present) DISTINCT HEART SOUNDS. The S1 and S2 is (distinct/indistinct) and is heard best at the (apex/base). Theres (is/isnt) appreciable S3 or S4 at the apex in the left lateral decubitus position. A murmur can be appreciated with a GRADE of (1/66/6) with a VOLUME (crescendo/decrescendo) PITCH, TIMING (systolic/diastolic/holosystolic) LOCATION/RADIATION.

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