Clinical Skills and OSCE Guide - Cases and Examples

Second-degree AV block Mobitz type I shows progressive P-R interval prolongation with a dropped QRS, caused by damage to the electrical pathway, and is treated with atropine after excluding causes.

Identify second-degree AV block Mobitz type II on ECG by random QRS drops with normal P waves. Recognize symptoms may include weakness, dizziness, or syncope, and manage with pacemaker therapy.

Identify torsades de pointes as QT prolongation–driven arrhythmia caused by anti-arrhythmic overdose or electrolyte changes, with twisting points on ECG and need to accelerate the heart rate to prevent arrest.

Assess tuberculosis using chest x-ray with sputum analysis and acid-fast staining, confirm with biopsy; use PPD skin test induration thresholds or IGRA blood test to detect infection.

Assess thyroid nodules with TSH and T4, ultrasound, and fine-needle aspiration for nodules >1 cm; cold nodules have malignant potential, hot nodules unlikely cancer, and use radioiodine uptake.

Master the abc sequence for emergency care—airway, breathing, circulation, disability, exposure, and fever assessment—with practical steps for choking, anaphylaxis, tension pneumothorax, ventilation, intravenous fluids, intraosseous access, and secondary survey.

Explore coagulation profiles for surgery, including pt/inr for warfarin monitoring, aptt for heparin, fibrinogen, d-dimer, and platelets; identify bleeding and thrombotic risks.

Visualize soft tissues such as the brain and spinal cord with MRI, which is not ionizing and often uses IV contrast to reveal early strokes and other neurological findings.

Deliver rapid, portable imaging to detect bone fractures and urgent chest or abdominal conditions, while minimizing ionizing radiation and noting limited soft-tissue detail.

Differentiate gonococci and meningococci infections by transmission, virulence factors (IgA protease, capsule, pili), and outcomes, noting glucose vs maltose fermentation and treatment with ceftriaxone or azithro.

Explore respiratory syncytial virus, an enveloped, single stranded RNA paramyxovirus common in children, causing apnea in newborns, with upper to lower respiratory symptoms and Palivizumab for high risk infants.

Bordetella pertussis, a gram-negative bacterium, produces pertussis toxin and causes three stages—catarrhal, paroxysmal, convalescent—with whooping cough; macrolides are recommended during the catarrhal stage.

Diagnose Legionella by silver stain, charcoal agar culture, or urine antigen; transmit via water and air, Legionnaires disease causes hyponatremia and is treated with macrolides or fluoroquinolones.

Identify Nocardia as a gram-positive aerobic bacterium with filamentous, fungus-like structure found in soil, TB-like presentation with negative PPD, and treat with folate inhibitors such as sulfonamides or trimethoprim.

Understand left- and right-sided heart failure, their pulmonary congestion and edema, and manage acute cases with oxygen, diuretics, and nitrates.

Describe how circle of Willis occlusions produce contralateral motor and sensory loss, aphasia or neglect, and visual field deficits, plus aneurysm effects on optic chiasm and third nerve.

Describe renal colic as the common presentation of kidney stones, with severe flank pain radiating to the groin and possible hematuria; calcium oxalate stones are most common.

Explain how preload, cardiac output, and afterload determine shock mechanics across cardiac shock, hypovolemic shock, and fistula-related high-output heart failure.

Diverticulitis occurs when small pockets in the sigmoid colon inflame, causing lower abdominal pain with diarrhea or constipation, fever; diagnosed by CT scan, colonoscopy, or sigmoidoscopy, and treated with antibiotics.

Urticaria presents as itchy, well-demarcated hives from mast cell degranulation, with triggers such as heat, coffee, or alcohol, possibly with angioedema; acute lasts under six weeks, chronic beyond six.

Understand psoriasis, its characteristic plaques and distribution, and the associated histology and clinical features, including nail and eye involvement. Review treatment options from topical therapies to phototherapy and systemic agents.

Learn to recognize compartment syndrome from trauma, electrical burns, or excessive fluid resuscitation, and perform escharotomy within six hours or fasciotomy for severe cases or delayed diagnosis.

Deep vein thrombosis can cause pulmonary embolism by clots reaching the lungs. The lecture covers risk factors, diagnostic tests, and treatments including noac, lmwh, warfarin, and ivc filters.

Amphotericin B and nystatin disrupt the fungal wall, with amphotericin B for systemic infections (Candida) and intrathecal use for meningitis; nystatin treats infections and oral thrush, nephrotoxicity remains a concern.

Explain how opioid receptor agonism hyperpolarizes cells to reduce release of pain mediators. Summarize key opioids and actions, from pentazocine and butorphanol to morphine and methadone, plus common side effects.

Antagonizes muscarinic receptors, an anticholinergic action that increases sympathetic drive. Use includes treating bradycardia and reducing secretions; it causes dry mouth, urinary retention, mydriasis, glaucoma risk, and hyperthermia.