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: : : :
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MP3
history taking techniques tricks
) ( how to
deal with such cases .
) (
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OSCE STATION
INNOVATION : FACEBOOK
facebook.com/groups/ INNOVATION.AZHARMED
stations
Page | 2
:
observe
history
examination
x-ray
X-ray
history
stop watch
Page | 3
:
examination
.... comment
examination
Paper
examiner finding
data
stations
examination examiner
....
examiner
....
diagnosis
history
examiner
Page | 4
:
Past history
past history antenatal history Intra utrine
full sheet
antenatal history
antenatal history :
fever and rash
Page | 5
:
teratogenesis
teratogenesis
drugs Irradiation
teratogenesis malformation baby
chronic disease
Maternal disease
antenatal history
antenatal history
antenatal history History
X-ray
facial expression
Page | 6
:
) (
) (
: ) (
) ( ) ........ (
...
history
:
...
) (
)
(
stations
Page | 7
:
antenatal
)
(
: )
(
:
:
: ...
rash
:
: sore throat
sore throat
: ..
fever
:
fever fever
Page | 8
:
:
: ....
:
:
...
first trimester second
rd
... malformation
... bleeding tendency
Malformation
teratogenesis 3
...
:
Page | 9
:
irridation
...
...
:
:
antenatal history
...
....
:
:
:
:
: rash
fever
:
P a g e | 10
:
:
:
: ...
:
Maternal disease
antenatal history
antenatal history
P a g e | 11
:
natal history
Natal history
site of delivery
) ( ..
Infection
Infection neonatal sepsis
vaginal delivery cesarean section
... vaginal
duration
P a g e | 12
:
:
:
:
....
P a g e | 13
:
: ...
12
Once termination
Infection
:
12
, 12
utrine contraction separation of the placenta
Hypoxia
12
: ....
P a g e | 14
:
full term
pre term
P a g e | 15
:
neonatal history
) (
) (
) )
( ....
.... ) ....
( (
neonatal history
neonatal history
neonatal 28
Neonatal period
neonatal period
points Neonatal history
P a g e | 16
:
physiological jaundice
: ... ...
: Rh
Rh incompatibility
:
:
P a g e | 17
:
epilepsy
convulsion
:
convulsion
: :
) ( Lol
:
:
Hemophilia
bleeding bleeding
: ... duration
neonatal history
history of physiological jaundice
No history of convulsion, no history of bleeding tendency , no history of respiratory distress
P a g e | 18
:
NICU
NICU
cerebral palsy
sequelae
History of jaundice and admitted to NICU and received phototherapy
physiological jaundice
physiological
NICU NICU
direct hyperbilirubinemia
golden yellow in direct
.... Obstructive
indirect
dietic history
dietic history
:
:
:
P a g e | 19
:
On need On need
On need
:
:
:
:
....
minimum
satisfied or not
:
:
P a g e | 20
:
polyurea diarrhea
sever dehydration
Obese
diarrhea
:
:
:
:
:
:
P a g e | 21
:
:
:
:
:
Under
:
:
:
:
: ) (
diluation
:
P a g e | 22
:
concentrated formeula
100
:
:
sterilization
) (
sterilization
:
contamination
age
) ( 180
8 100 + 10 180
P a g e | 23
:
powder milk
F 60
60
F 30
30
8 100 + 10 180
120
Mursmus
concentration
: 120
120
) (
P a g e | 24
:
120
diluted
diluted
180
:
frequency
:
:
:
Under feeding
complementary P
:
supplementary
supplementary
artificial milk
P a g e | 25
:
weaning
: .........
Developmental Milestones
Social & Language
Bubbling
) ... .....
(
Double Bubbling
... :
....
...
...
P a g e | 26
:
..
!!!!!
P a g e | 27
:
mental growth
)
(
5
automatic bladder
automatic bladder evacuation of the bladder rectum
conditioned reflex
conditioned reflex
!! !! ) (
buttocks
control
control Order bladder
P a g e | 28
:
Oriented control
control
:
) (
developmental history
P a g e | 29
:
neck support
:
:
supported
:
:
:
.... !!!!!
:
) (
) (
P a g e | 30
:
mental
social
Mental
sphincteric control
stool
developmental history
P a g e | 31
:
staff cranial
examination
:
Abdominal Examination
abdomen
station Inspection of the abdomen
Inspection of the abdomen
contour of the abdomen
bulge scaphoid abdomen flat abdomen
sternal angle obtuse acute
epigastrium pulsation Pulsation
umblicus umblicus
shifted side down ward mid way
flat or bulge
discharge umblicus
umbilical nodule
skin
skin
o dilated tortuous vein
o scars
o abnormal pigmentation
o bleeding under the skin Purpura
abnormal rash o
divercation of recti
Inguinal region Umblicus
Hernia
genitalia
superficial palpation
P a g e | 32
:
) (
examination skull
rickets
P a g e | 33
:
General Examination
EXAMINATION OF THE HEAD
SHAPE
plagiocephaly
abnormal shape abnormal shape
coronal suture
sagittal suture
lambdoid suture
frontal bone , parietal bone , occipital bone
anterior fontanelle and posterior fontanelle
sutures
Hydrocephalus suture sutures
P a g e | 34
:
craniotabes
rickets
craniotabes
fontanelle torch transillumination test
) () / (
Macewen's sign
Macewen's sign sign percussion bone hydrocephalus sutures
fontanelle resonant
percussion
hydrocephalus
hydrocepalus dilated untortous scalp veins
scalp dilated veins scalp
...
...
ear
nose
mouth
No No
abnormality
.1 eye brow
outer third of the eye borw Lost
P a g e | 35
:
Jaundice
Jaundice
sclera
congenital glaucoma
osteogenesis imperfecta X-ray
osteogenesis imperfecta blue sclera
sub conjunctival hemorrhage
hemorrhage
bleeding tendency
.6 Pupil cataract
galactosemia
rickets
congenital rubella cataract
Pupil Light pupillary reaction
direct indirect
P a g e | 36
:
.... nystagmus
squint
lower part of the cornea covered by the lower eye lid sunset appearance
Negative
... nystagmus
divergent squint
divergent squint and no abnormal finding in the eye
ear
P a g e | 37
:
.4 discharge
ear
.5
nose
.1 nasal obstruction
.2 snoring
... unilateral or bilateral
mentally awared
Mentally not awared compression
compression
Unilateral or bilateral
.3 nasal discharge
.4 nasal bridge
depressed nasal bridge prominent nasal bridge Normal
Mouth
Mouth
.1 pallor Pallor
cyanosis cyanosis
.2 anomaly hare lip
.3 maceration
Maceration angle lip
lip
P a g e | 38
:
.4 Mouth odor
Mouth odor aceton odor DKA
.5
anomaly
.6 tongue throat
monillia
.1 black
.2 texture coarse hair
.3 integrity
) ( Normal integrity
kwashiorkor easy pickable hair
.4 anterior hair line
posterior hair line
anterior hair line normal
posterior hair line Normal
abnormal
cretinism anterior hair line
turner
P a g e | 39
:
examine head
examination skull
.1
forehead eye brow anterior hair line
Occiput
59.5
skull circumference 59.5
P a g e | 40
:
craniotabes :
.6 Hair
) (
divergent squint
abnormality
Nose snoring
bulbar affection
obstruction
One side
) ( I think
bulbar
snoring
bulbar
nasal discharge
nasal septum
ears
ear
lateral angle of the eye occiput
ear
low set ear
Low set ear
...
P a g e | 41
:
Mouth
pallor
pallor cyanosis
dryness Lips
torch
abnormal
......
: shunt
bypass CSF lateral ventricle Peritoneum
shunt scalp valves
shunt ventricluo peritoneum shunt hydro cephalus
Occiput most prominent part of the bone
skull circumferences
) : (
skull circumference
15
fontanelle sutures
P a g e | 42
:
jaundice
lower fornix jaundice
jaundice chronic hemolytic anemia
Liver affection biliary system affection
just Lower fornix compensation Liver
tinge of jaundice
Puffiness
no abnormal finding detected
Nose
depressed nasal bridge
nasal discharge snoring
bone zygomatic bone hyper active bone marrow Prominent
upper jaw
Hyper active bone marrow
upper jaw lower jaw
upper jaw prominent Lower jaw
Lips
pallor
tongue
hemosidrosis
iron deposit skin
muddy coloration
Muddy collection pallor jaundice iron deposit
iron deposit
Iron deposit
inspection examination of the abdomen spleen
Hypersplenism spleen
P a g e | 43
:
LIMBS EXAMINATION
rickets
finding rickets rickets
rickets
Mineral part
rickets defective on mineralization
defect bone mineralization
Mineral part
P a g e | 44
:
bone bone
) KuRr)uJ)|)KK))m)a)J
bone
) csJ))K|cKt)UP)UKXK[)a
bone
bone bone
bone
trunk
bowing
P a g e | 45
:
curvature tibia
tibia curve
curvature tibia
anterior curvature lateral
ribs
ribs bone
ribs diaphragm
all the time Lower part of the ribs
ribs .... groove sulcus
horizontal sulcus Harrison's sulcus
negative pressure of the thorax ribs
longitudinal sulcus
Mineral part of the bone
Integrity of the bone
deformity
bone
P a g e | 46
:
cartilage
cartilage
cartilage
Over growth of the cartilage cartilage proliferation
bone Over growth of the cartilage
Over growth of the cartilage
broadening
broadening ... cartilage
cupping X-ray
broadening cartilage proliferation cupping of the bone
pressue effect
broadening
tibia fibula
emberyology tibia medial malleolus
fibula lateral malleolus
malleoli 2 separate bones
cartilage
cartilage
proliferation of the cartilage tibia Medial malleolus
lateral malleolus fibula
broadening
P a g e | 47
:
muscles
ATP muscle power
generalized muscle weakness and hypotonia
generalized muscle weakness and hypotonia delayed motor development
Hypotonia
P a g e | 48
:
kyphosis
kyphosis
correctable kyphosis
rickets
Marfan sign
retraction
Harrison's sulcus
kyphosis
kyphosis
Umblical hernia Pot belly abdomen
extermities
Upper limb broadening
trunk bone deformity
lower limb Marfan sign
Genu valgum deformity
P a g e | 49
:
clubbing
color pallor jaundice cyanosis
pallor jaundice cyanosis
edema dorsum of the hand and the dorsum of the foot
edema
edema level Unilateral bilateral pitting non pitting
abnormal movement chorea
P a g e | 50
:
frame
NECK EXAMINATION
examine the neck
examination of the neck
goals examination of the neck
.1 shape of the neck
.2
webbing
webbing fold of the skin
webbing syndrome
.3
neck pulsation
Pulsation neck
.4
swelling
swelling Neck
swelling
swelling thyroid swelling butterfly shaped
thyroglossal cyst hyoid bone cyst in the middle line
lymph node
examination of the neck
P a g e | 51
:
pulsation swellings
pulsation
Pulsation Pulsation
arterial pulsation venous pulsation
Pulsation ) ( 45
venous pulsation Normal level of the clavicle
45
Neck
pulsation
) (
arterial pulsation
venous wave
P a g e | 52
:
Pulsation venous
Pulsation arterial pulsation
neck
pulsation
swelling
swelling
thyroid
thyroglossal cyst
lymph node
neutral position
Inspection neck
lymph node
Lymph node
Lymph node of the neck
P a g e | 53
:
thyroid swelling
bruit thyroid
aortic stenosis along the carotid artery root of the neck
systolic murmur propagated to the neck
root of the neck propagation of the arotic stenosis
comment
venous pulsation arterial pulsation webbing Normal shape of the neck
horizontal group
post auricular preauricular jugulo digastric submandibular submental .... horizontal group
occipital
P a g e | 54
:
longitudinal group
upper deep cervical Lower deep cervical
supra claviclar lymph node
Lymph node site group
size
lymph node
underlying muscle
) ( sternomastoid muscle
Lymph node horizontal and vertical
contraction Muscle
P a g e | 55
:
P a g e | 56
:
venous pulsation
level venous pulsation
Lymph node
Lymph node
Lymph node
:
) tone
......... (
Mandibule
P a g e | 57
:
Post auricular
occipital
Upper deep cervical upper deep cervical
lower deep cervical lower deep cervical
supra clavicular
jugulo digastric lymph node
freely mobile
not tender
firm in consistency
auscultation
neck murmur propagated to the neck
P a g e | 58
:
exposure axilla
anterior fold of the axilla rubbing lymph node
epitrochlear
P a g e | 59
:
exposure
Inguinal lymph node semi flexion
Inguinal ligament
inguinal ligament
Skin examination
Purpura
.... skin examination
.1 color of the skin
Pallor jaundice cyanosis
.2 skin texture
goose skin
P a g e | 60
:
dehydrated
.4 skin rash
macule Not raised above the surface of the skin .... discoloration
Papule
papule
serous fluid
vesicle
vesicle secondary bacterial infection Pus Pustule
Pustule vesicle
crust
crust deep injury Inflammatory scar
rash
P a g e | 61
:
rash Infectious
chicken pox
.5 abnormal pigmentation
abnormal pigmentation hyper pigmented
hypo pigmented
.6 scar
inflammatory scar scar
scar
scar
petechiae Purpura
.8 edema
edema
edema
dorsum of the hand Pitting edema
dorsum of the foot Pitting edema
20-30
chin of the tibia
chin of the tibia
edema
P a g e | 62
:
edema
abdominal wall cone
skin examination
positive data
color of the skin pallor Jaundice cyanosis
Normal color
normal texture, normal skin elasticity, no rash, no abnormal pigmentation , no scars
fallot tetralogy
squatting position
: fallot
: ""
... cyanosis
fallot cyanosis
squatting position
P a g e | 63
:
heart
sub valvular stenosis
sub valvular pulmonary stenosis thrill
Murmur
ejection systolic
ejection systolic
murmur
murmur systole
heart sounds Murmur
NEUROLOGICAL EXAMINATION
duchenne myopathy
X-linked
X-linked common
male female
common in male
duchenne myopathy
ATP energy supply of the muscle
P a g e | 64
:
endoplasmic reticulum
endoplasmic reticulum generator Muscle
generator
mitochondrium ATP
ATP muscle
endoplasmic reticulum
endoplasmic reticulum
creatine creatinine
creatine creatinine
ATP
...... creatine phosphokinase
P a g e | 65
:
proximal muscle
18 20
muscle disease
Upper motor neuron lesion lower motor neuron lesion
Lower motor neuron lesion
Muscle weakness
hypo tonia
Hypo reflexia
pseudo hypertrophy
P a g e | 66
:
reflexes
Motor system reflexes
motor system inspection, palpation, percussion, power,
P a g e | 67
:
Inspection muscle status spastic hemi plegia flexed right upper limb
and hyper extended right lower limb, no wasting, no trophic changes or deformity
comment Inspection
palpation clasp knife spasticity on the right side with normo tonia on the left side
percussion No fasciculation, no myotonia
power
complete paralysis of the right side of the body with normal power on the left side of the body
Motor system
coordination
Motor system
coordination
............ coordination
hemiplegia ........ coordination on the left side is intact and on the right
side not examined
examine!!!!!
examination paralysed
reflexes
Patient by inspection, by palpation, by
percussion, power
coordination
coordination .............
reflexes superficial and deep
reflexes
A B
A superficial deep reflexes B
P a g e | 68
:
superficial reflexes
positive babiniski on right side
negative on left side ) negative ( planter response on the left side
abdominal reflex is lost on the right side
superficial reflexes
deep reflexes
hyper reflexia on the right side
hyper reflexia Upper limb Lower limb
reflexes Upper limb triceps , brachio radialis and biceps
centres
biceps centre brachio radialis centre triceps centre
examination of the motor system
muscle state atrophy pseudo hypertrophy
P a g e | 69
:
muscle tone
examination muscle tone
wrist shoulder
gower method
gower sign
lower limb tone
hypo tonia
examination
generalized hypo tonia ... muslce tone bilateral
Proximal more than distal
P a g e | 70
:
sensations
superficial deep
pathological reflexes embryological
superficial refelexes
abdominal reflex
planter Upper motor lower motor
deep tendon reflexes
upper limb
triceps , brachio radialis and biceps
triceps elbow
120 reflex brachio radialis and biceps
tendon tricepis and brachio radialis
index of your finger bicepis
brachio radialis reflex supination
P a g e | 71
:
)
(
ankle eversion
P a g e | 72
: