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Clinical Skills Review
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Clinical Skills Review
Scenarios based on standardized patients
P R E PA R E F O R OSCEs MCCQE II CFPC certification
E D I T E D BY Zu-hua Gao MD, PhD Christopher Naugler MD, MSc
Copyright © 2013 Zuhua Gao and Christopher Naugler
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Excerpts from this publication may be reproduced under licence from Access Copyright, or with the express written permission of Brush Education Inc., or under licence from a collective management organization in your territory. All rights are otherwise reserved and no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanic, photocopying, digital copying, scanning, recording or otherwise, except as specifically authorized.
Brush Education Inc. www.brusheducation.ca contact@brusheducation.ca
Cover design by Claudia Pompeii, Obsidian Multimedia Corporation (Edmonton, Canada); Cover photo © iStockphoto.com/Marilyn Nieves
Printed and manufactured in Canada
Ebook edition available at Amazon, Kobo, and other eretailers.
Library and Archives Canada Cataloguing in Publication
Gao, Zuhua [OSCE & LMCCII] Clinical skills review : scenarios based on standardized patients / edited by Dr. Zuhua Gao MD, PhD and Dr. Christopher Naugler MD, MSc. – Third edition.
Includes index. Revision of: OSCE & LMCCII : review notes / Zuhua Gao ; Jenika Howell, Karen Naert, Denise Ng, editors. Issued in print and electronic formats. ISBN 9781550594409 (pbk.). – ISBN 9781550594539 (epub). – ISBN 9781550594836 (pdf ). – ISBN 9781 550594843 (mobi)
1. Clinical medicine – Examinations – Study guides. 2. Physicians – Licenses – Canada – Examinations – Study guides. I. Gao, Zuhua, editor II. Naugler, Christopher T. (Christopher Terrance), 1967–, editor III. Title. IV. Title: OSCE & LMCCII
R834.5.G36
2013 616.0076
C2013903322X
C20139033238
Produced with the assistance of the Government of Alberta, Alberta Multimedia Development Fund. We also acknowledge the financial support of the Government of Canada through the Canada Book Fund for our publishing activities.
I n t r o d u c t i o n
M E D I C I N E
O B S T E T R I C S A N D G Y N E CO LO G Y
P E D I AT R I C S
P R E V E N T I V E M E D I C I N E A N D CO M M U N I T Y H E A LT H
P S YC H I AT R Y A N D N E U R O LO G Y
S U R G E R Y
A b b r e v i a t i o n s
A b o u t t h e a u t h o r s
L i s t o f c a s e s
I n d e x o f c a s e s
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Contents
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List of tables
Table 1. ABG interpretation: respiratory versus metabolic acidosis Table 2. Causes of metabolic acidosis by presence or absence of an increased anion gap Table 3. Differential diagnosis of liver disease Table 4. Differential diagnosis of renal failure Table 5. Interpreting Xrays for pneumonia (patchy, diffuse infiltrate) Table 6. Medication indicated for types of pneumonia Table 7. Differential diagnosis of chest pain Table 8. Differential diagnosis of lymphadenopathy Table 9. Differential diagnosis of hilar adenopathy Table 10. Differential diagnosis of hypothyroidism Table 11. Investigations for hypercalcemia Table 12. Differential diagnosis of joint pain Table 13. Differential diagnosis of bilateral ankle edema Table 14. Differential diagnosis of bleeding disorders Table 15. Differential diagnosis of unilateral hand weakness Table 16. Differential diagnosis of menorrhagia Table 17. Differential diagnosis and treatment of vaginal bleeding during pregnancy Table 18. Differential diagnosis of vaginal discharge Table 19. Routine pregnancy monitoring and investigations Table 20. Differential diagnosis of gestational hypertension/eclampsia Table 21. Risk factors for breast cancer Table 22. Typical immunization schedule for children Table 23. Procedures for cranial nerves exam
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Table 24. Types of seizures Table 25. Glasgow coma scale Table 26. Signs of meningeal irritation Table 27. Differential diagnosis of hearing loss Table 28. Snoring: risk factors and treatment Table 29. Obstructive sleep apnea: risk factors, consequences, and treatment Table 30. Stages of change in behavior modification Table 31. Medical problems related to alcoholism Table 32. Symptoms of withdrawal from alcohol addiction Table 33. Ottawa ankle rules Table 34. Ankle sprain severity Table 35. Wrist injuries: structures that can be severed Table 36. Tetanus prophylaxis Table 37. Differential diagnosis of lung nodules Table 38. Differential diagnosis of hematuria Table 39. Summary of motor functions by Cspine level Table 40. Differential diagnosis of dysphagia Table 41. Barium swallow interpretation
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165 169 170 181 184 184 185 187 187 211 212 221 222 239 244 247 255 256
Introduction
How to use this book Clinical skills exams—sometimes called “objective structured clinical exami nations” or OSCEs—are a rite of passage for all physicians in training. These exams include the MCCQE II and the Certification Examination in Family Medicine in Canada, and equivalent exams in other countries such as the USMLE Step 2 CS in the United States. This book is designed to help you prepare for these exams. Although simply reading through the cases in this book will be useful, the best way to study for a clinical skills exam is to practice. Groups of 3 or 4 work best, assigned to the following roles: •฀Candidate: reads aloud a case from the list of cases at the back of the book. Reading aloud ensures that everyone knows the boundaries of the task. The candidate should then “perform the task” by formulating questions to ask the patient, or describing other procedures such as physical examinations or investigations, as required. •฀Examiner: uses the notes for the case to formulate one or two pertinent questions to ask the candidate and to remind the candidate of any crucial steps they may have missed. •฀Observers: help debrief the task. We recommend that observers pay particular attention to skills such as: communicating clearly and respectfully; setting appropriate priorities; engaging issues of medical ethics as needed; and resolving clinical situations that require the expertise of specialists. Work through all the cases in the book in this way, changing roles each time.
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