Subaqua Sternal Rubs

Had my OSCE yesterday. And not to further antagonize the worry-worts, but I did rather well without doing much studying (maybe an hour and a half in total).

The OSCE is the final practical exam for Advanced Clinical Skills/Physical Diagnosis. It consists of 7 stations - 4 patient history and/or physical in 7 minutes or less stations, as well as 3 ancillary stations (EKG, X-Ray and Prescription Writing). My patients included a "frozen shoulder" after playing tennis, an HIV+ flight attendant having diarrhea for two weeks, a middle-aged male with angina, and a female with monthly abdominal "bloating." The "standardized patients" were very good - they were flown in from Grenada, so we had seen a couple of them before (like my oil-down woman), but that was cool. I missed a couple of points on the abdominal exam, because the tutor thought I should do every abdominal exam in the book, even if they weren't consistent with the patient's symptoms. Oh well. All the patients complimented me on my bedside manner, thoroughness, and style. Nice to hear just before going into clinical rotations. (I think this is half the point of the OSCE…)

For my X-Ray interpretation, I had an IVP which showed unilateral hydronephrosis (backing up of urine into the bladder). A couple of people were complaining that the x-ray was unfair because it didn't have the little clock on it to show how long after the injection of the dye the x-ray was taken. Come on people, really. What they really should have been complaining about was the EKG station - the quality of the copy was so poor that the leads weren't labeled, and it was hard to count boxes for heart rate, etc., since they didn't come out either. Though it really didn't matter that much, since the tracing was pretty obvious with the P-R interval shortening, the peaked bimodal QRS's, and possibly some T-wave inversions (but I couldn't tell which leads since they weren't labeled…) I finally diagnosed a case of Wolfe-Parkinson-White syndrome. For my prescription I got a patient with angina again, so I prescribed sublingual nitroglycerin as needed for pain. Actually, I used some medical abbreviations like PRN, SL, q5, call 911, etc. In retrospect, maybe I should have spelled it out. Hopefully, they use the same abbreviations in Scotland where the Clinical Skills Chairman is from!

With that exam down, only two more to go: final exams in Pathophysiology and Pharmacology in two weeks. Ahh! Better start studying.

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