Summary: Osce

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• 1 Psychiatry

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• What are the components of the psychiatric interview?

  - Personal data
  - Reason for referral or a call for assistance
  - History taking of the presenting complaints (specific anamnesis)
  - Mental state examination
  - Psychiatric history/previous treatment or disorders
  - Use of drugs and medicines
  - Psychiatric and somatic family history / familial predisposition
  - Biography (life history)
  - Review of systems and physical examination
  - Hetero-anamnesis
  - Any additional tests

• Which three domains are checked in the mental state examination?

  - Cognitive
  - Affective
  - Conative

• What is assessed in the cognitive domain?

  Consciousness
  - Somnolent, soporous, subcomatose
  - Stuporous
  - Narrowed consciousness
  
  Attention
  - Impossible to attract the patient's attention
  - Impossible to keep the patient's attention
  
  Concentration
  - Losing trail of thought during longer responses
  
  Orientation
  - To time, place and person
  
  Memory
  - Imprinting
  - Short and long term memory
  
  Intellectual functions
  - Judgement skills
  - Intelligence
  - Disease awareness, disease insight
  - Abstract reasoning
  - Executive functions
  
  Perception
  - Illusion
  - Hallucination
  - Derealisation
  - Depersonalisation
  - Body perception disorder
  - Body image distortion
  
  Formal thought       
  - Inhibited (delayed) thought
  - Accelerated (racing) thought
  - Circumstantial thought
  - Derailed thought, incoherence mania
  - Tangible
  
  Content-related thought
  - Thought poverty
  - Preoccupation
  - Obsession
  - Rumination
  - Referential ideas, delusional perceptions, delusions

• What is assessed in the affective domain?

  Mood
  - Euthymic
  - Gloomy
  - Anhedonic
  - Apathetic
  - Anxious
  - Dysphoric
  - Euphoric
  
  Affect
  - Normal modulation
  - Blunted affect
  - Labile affect
  - Incongruent affect
  - Forced, exaggerated or theatrical affect
  
  Somatic affective signs
  - Muscle tension
  - Blushing
  - Tachycardia
  - Breathlessness
  - Perspiring
  - Clammy hands
  
  Vegetative signs
  - Sleeping disorders
  - Intraday fluctuation
  - Loss of appetite
  - Weight loss
  - Loss of libido
  
  Suicidality 
  - Detailed plans/no detailed plans

• What is assessed in the conative domain?

  Psychomotor functions
  - Facial expressions
                   >Invariability of facial expression
                   > Delayed, little or no facial expression
                   > Exaggerated facial expressions
  - Gestures
                   > Decelerated gestures
                   > Overly lively gestures
  - Speech
  - Monotonous speech
  - Rapid variation in pitch
  
  Motivation and behaviour     
  - Loss of decorum
  - Witzelsucht
  - Inactivity, loss of initiative, lethargy
  - Avolition
  - Impulsive acts or behaviour
  - Urge-driven acts or behaviour
  - Compulsive behaviour

• What is assessed in first impressions?

  External characteristics
  - Personal grooming and hygiene: self-neglect or overly clean, bizarre clothes
  - Age: difference between apparant age and chronological age
  - Weight
  - Skin and limbs: puncture holes, scars, amputations
  
  Contact
  - Eye contact: staring or absence of eye contact
  
  Posture
  - Catatonia
  - Inconsistency between complaint and movement
  
  Presentation of complaints        
  - Inconsistency between complaint and presentation
  
  Feelings and reactions induced in the physician by the patient

• 2 Pulmonology

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• What is done during inspection of the thorax?

  1. The skin of the thorax
  - Abnormal colour
  - Skin abnormalities
  - Vascular markings
  - Scars
  
  2. The thoracic subcutis
  - Subcutaneous fat
  - Influence percussion and ausculation
  
  3. The breasts
  - Influence percussion and ausculation
  
  4. The musculature
  - Size of thoracic muscles
  - Dietary situation
  
  5. The skeleton
  - Shape of thorax
          > Anterioposterior diameter
          > Cross-sectional emasurement
          > Length
          > Curvature of the spine
          > Position of scapulae
          > Course of the ribs
          > Size of the costal triangle
  - Symmetry of thorax
  
  6. The presence and symmetry of the respiratory excursion  
  - Intercostal retractions
  - Maximum inspiration --> 5-10cm diameter change

• What physical examination findings are consistent with the common cold

  Inspection: runny nose
  Percussion: No abnormalities
  Auscultation: Usually no abnormalities, sometimes rhonchi that are cleared with coughing
  Vocal fremitus: No abnormalities
  Broncophony: No abnormalities

• What physical examination findings are consistent with pneumonia?

  Inspection: mild to severe dyspnoea
  Percussion: Dull or near normal
  Auscultation: Bronchial breath sounds, rhonchi, crackles
  Vocal fremitus: Amplified locally
  Broncophony: Amplified locally

• What physical examination findings are consistent with pleural fluid?

  Inspection: Reduced mobility o faffected side
  Percussion: Dull
  Auscultation: Reduced to absent breath sounds, sometimes pleural rub
  Vocal fremitus: Locally reduced or absent
  Bronchophony: Locally reduced or absent