GIT OSCE
History taking
Cardinal symptoms
Pain
Subtopic
Questions to ask: SOCRATES
Dysphagia
Do you have problems initiating swallowing?
Heartburn
S retrosternal
O Post-meals
C Burning
R Travels UP eso.
A Waterbrash, Acid regurg (sour/bitter)
T Eating habits
E Bending, lying supine, reduced eso. sphinter tone.
Transient relief with antacids
Dyspepsia
GERD/malignancy
Ulcers
Duodenitis/Gastritis
Appetite and weight change
Questions to ask:
- Intentional?
- Amount loss?
- Rate of weight loss?
Causes:
LoA
Dysphagia
Associated pain with eating
Throwing up
Shitting
Distention of abdomen
Jaundice
Questions to ask
Pruritis?
Urine color?
Stool color/float?
Subtopic
Overview
Examination:
1) WIPE
Make sure to test
PERSON
PLACE
TIME
2) General observation
Surroundings
O2
Walking aids
Catheter bag (if yes, comment on urine)
Distress button
Patient
Acute abdomen? Shallow breathing + lying still
Jaundice?
Distention?
Weight/wasting?
Scars?
Skin? Pruritis, tattoos, needle tracks
Kidney dish (for vomitting)?
Cannula?
Colostomy bag?
3) Upper limb
Temperature!
Nails
Deficiencies:
Leukonychia (albumin)
Koilonychia (Fe def. anemia)
Clubbing
CLD
Malnutrition
Capillary refill time
Peripheral cyanosis
Palm
Erythem (estrogen excess)
Pallor
Dupuytren's
Asterixis
Elbow
Dermatitis herpetiformis (IBS)
Arm
4) Face/Neck
Eyes
Scleral icterus
Conjunctival pallor
Xanthelasmata
Keyser-Fleischer rings
Parotids
Pt. to clench teeth
Palpate behind massater
Mouth
Lips
Angular stomatitis (B2)
Oral mucosa
Leukoplachia
Candidiasis
Ulcers
Gingivitis (hypertrophy of gums)
Scurvy (Vit C)
Poor dental hygiene
Teeth
Lead poisoning (Blue line at gm margin)
Dental carries
REAL OR FAKE
Tongue
Glossitis (Vit B's - folate, thiamine)
Central cyanosis
Glossitis
Dry - sjogren's, dehydration
Breath
Fetor hepaticus,
Uremic breath
Neck
Cervical LN
Virchow's (L supraclavicular)
JVP
EXPOSE.
PT SUPINE.
5) Inspection of torso
CHECK FOR PAIN!!!
Then get on your knees, fool.
6) Light palpation/Deep palpation
Masses?
Rigidity? (involuntary)
Guarding? (voluntary)
Rebound?
7) Organ by organ inspection
Palpation --> Percussion; EXCEPTION: SPLEEN
8) Auscultation
Bowel sounds - Just lateral to umbilicus:
- Normal (gurgling)
- Borborygmus (Flatulence)
- Tinkling (obstruction)
- Absent (severe obstruction)
Bruits:
- AAA - Just superior to umbilics
- RAA - 2-3 cm superior and lateral to umbilicus
9) Reverse WIPE:
- Wash your filthy hands.
- Thank the patient.
- AND FOR THE LOVE OF GOD MAN, GIVE THE PATIENT HIS
DAMN SHIRT BACK
- Summarize findings.
HERNIAS
DRE
GENITALIA