Warning! This article is full of medical goobledegook!  

I went as an examiner for the Sem 3 OSCE yesterday. The scenario for the simulated patient was this: He is a man who has been diagnosed with right bronchial carcinoma (lung cancer) who now presented with massive right pleural effusion (fluid filling the sac atound the lung). The students were asked to perform an inspection of the chest and describe the expected findings; palpate (or feel) for the trachea and describe it’s position and finally percuss (to tap) the chest wall and report the expected findings.

I am happy to say that the bloopers were few. The students were VERY GOOD! I was impressed. In fact, out of the 50 odd students that came into my station, only one failed. Still, there were a few ‘ooops’. I have divided them into the various stages of the exam.

Introduction:

1. In a very determined effort to economize on time, one student went: “GoodmorningMrXYZIamABCa2ndyearmedicalstudenttodayIwouldliketoperforman examination ofyourchestandIwillbeinspectingittouchingyourneckandtappingonyour chestisitokwithyou?Goodareyoucomfortable?Iwillnowproceedtoexposeyourchest….“!!!

2. “Sir, how may I undress you?” (He meant “address”)

3. “I will now open your chest to examine you.”

4. “I will now take off all your clothes.”

To the question: What do  you expect to see in this patient on inspection?

1. “I will see a tumor or many swellings growing out of his chest”!

2. “Since he has massive pleural effusion, I expect to see a scar some where” (not sure what scar she meant)

3. A student was confused between bronchial carcinoma and bronchial asthma and proceeded to enumerate all the symptoms of asthma!!

During percussion (tapping) of the chest:

1. One male student was going from left to right and back of the patient in an attempt to percuss both sides of the chest! Sigh.

To the question: What are the components of Horner’s Syndrome? (the given answers were miosis (constricted pupil), enophthalmos (sunken eyeball), anhydrosis (lack of sweating) and ptosis (drooping eyelid).

1. One student took the middle path and said “Miodriasis” – possibly a combination of the words ‘miosis’ and ‘mydriasis’ (which means dilated pupil).

2. Another girl said “that mio-something lo”

3. One confused girl said the “eye balls will bulge out, or protrude out“; a sign known as ‘exophthalmos’ which is the opposite of enophthalmos.

4. Another said “the orbit will slowly sink inside the head“. (too many horror movies I gather)

All in all, I think the students did very well. Most of them were competent and confident, and that bodes well for their future.

Fri, 120107 @ 1632; work’s done and I am looking forward to the weekend.