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OSCE EXAMINER CHECKLIST
2015-2016
 Authors
Dr. Zelaikha Al-Wahedi
Sr. Consultant, Family
Medicine, Primary Health Care
Corporation, Qatar
Dr. Mohamed Salem
Asst. Prof. Family Medicine,
Suez Canal University, Egypt

Dr. Amal Al-Ali Dr. Muna Taher Aseel

Consultant, Family Medicine, Consultant, Family Medicine,
Primary Health Care Primary Health Care Corporation,
Corporation, Qatar Qatar

Dr. Ahmed Mostafah Dr. Hassan Abbas

Specialist, Family Medicine, Consultant, Family Medicine,
Primary Health Care Primary Health Care Corporation,
Corporation, Qatar Qatar

Editors: May Khattab, Family Medicine Coordinator

Ady C. Effendy, Family Medicine Doc. Controller

2
 Preface

We would like to present some of OSCE examiner checklist developed by Faculty

members during the PGY(4) Academic Day 2015-2016 in Family Medicine
Residency Program, PHCC-HMC, Qatar.

We also like to acknowledge the Family Medicine residents PGY(4) of Academic

Year 2015-2016 for their active participation in preparation of this work.

Dr. Zelaikha Al-Wahedi

Chair of Family and Community Medicine, PHCC-HMC

3
 Contents
Title................................................................................................................................................ 1
Author ............................................................................................................................................ 2
Preface .......................................................................................................................................... 3
Respiratory OSCEs..................................................................................................................... 6
Peak Expiratory Flow Rate (PEFR) Technique ............................................................................ 7
Asthma Inhaler Techniques .......................................................................................................... 8
Pressurized Metered-Dose Inhaler ............................................................................................... 8
Turbuhaler ..................................................................................................................................... 9
Accuhaler ...................................................................................................................................... 10
Checklist for Smoking Cessation Counseling .............................................................................. 11
Checklist for Lung Cancer Screening ........................................................................................... 13
Cardiovascular OSCEs............................................................................................................... 14
Checklist for chest pain................................................................................................................. 15
Checklist for Post-Myocardial Infarction Counseling.................................................................... 16
Gastrointestinal OSCEs ............................................................................................................. 18
Checklist for Abdominal Pain........................................................................................................ 19
Endocrine OSCEs ....................................................................................................................... 21
Initial Examination for Diabetic Patient ......................................................................................... 22
Diabetic Foot Examination Checklist ............................................................................................ 24
Checklist for Gestational Diabetes ............................................................................................... 26
Checklist for Thyroid Gland Examination ..................................................................................... 28
Checklist for Obesity Counseling.................................................................................................. 30
Neurology OSCEs ....................................................................................................................... 31
Checklist for Headache................................................................................................................. 32
Musculoskeletal OSCEs ............................................................................................................. 33
Checklist for Back Examination .................................................................................................... 34
Checklist for Knee Joint Examination ........................................................................................... 36
Checklist of Shoulder Examination ............................................................................................... 38
Pediatric OSCEs.......................................................................................................................... 40
Checklist for Counseling on Breastfeeding ................................................................................. 41
Checklist for Vaccination Defaulters ............................................................................................. 43
Checklist for Nocturnal Enuresis .................................................................................................. 44
Checklist for Attention Deficit Hyperactivity Disorder (ADHD) ..................................................... 45
Checklist for Constipation in children ........................................................................................... 47
Gynecology & Obstetric OSCEs ............................................................................................... 48
Checklist for Pre-Marital Counseling ............................................................................................ 49
Checklist for Infertility .................................................................................................................... 51
Checklist for Menopause .............................................................................................................. 53
Checklist for Menopause and HRT .............................................................................................. 54
Psychiatry OSCEs....................................................................................................................... 55
Checklist for Depression ............................................................................................................... 56
Ethics OSCEs .............................................................................................................................. 58
Breaking bad news (IUFD) ........................................................................................................... 59
ENT OSCEs .................................................................................................................................. 61
Checklist for Ear Examination ...................................................................................................... 62
Checklist for Dizziness / Vertigo ................................................................................................... 63
Checklist for Tinnitus .................................................................................................................... 65
Men’s Health OSCEs .................................................................................................................. 67
Checklist for Erectile Dysfunction ................................................................................................. 68
Geriatric OSCEs .......................................................................................................................... 70
Checklist for Geriatric Care ......................................................................................................... 71
Checklist for Traveler’s Advice ..................................................................................................... 72

4
5
Respiratory OSCEs

6
 Peak Expiratory Flow Rate (PEFR) Technique
Not Attempted Attempted
Step/Task
Attempted Inadequate Adequate

1. Explain to the patient that they should be

checking their PEFR regularly, particularly if
their asthma is worse than usual.
2. Wash Hands

3. Connect a clean mouthpiece

4. Ensure the marker is set to zero

5. Stand up or sit upright

6. Take as deep a breath in as you can and
hold it
7. Place the mouthpiece in your mouth and
form as tight a seal as possible around it with
your lips.
8. Breathe out as hard as you can.
9. Observe and record the reading
10. Repeat the process 3-4 times and record the
highest reading
11. Note down the reading in a diary to allow
comparison with readings on other days
12. Once you have discussed the process with
the patient, you should show the patient how
to perform the measurement. Do this by
measuring your own PEFR.
13. Once the technique has been demonstrated,
ask the patient to show you how they would
perform the measurement themselves. Make
sure they are doing it correctly, and resolve
any mistakes which they might be making

14. Finish by asking the patient if they have any

questions or concerns about either their
asthma or taking their PEFR measurement

7
 Asthma Inhaler Techniques
Ask the patient to show you how they use their inhaler. Use these checklists to
teach, check and/or confirm the way your patients with asthma use their inhalers.
Assess inhaler technique at every opportunity.

Pressurized Metered-Dose Inhaler

Not Attempted Attempted
Step/Task
Attempted Inadequate Adequate

1. Remove cap

2. Check dose counter (if applicable)

3. Hold inhaler upright and shake well

4. Tilt the head slightly back

5. Breathe out gently, away from the inhaler

6. Put mouthpiece between teeth without biting and

close lips to form good seal
7. Start to breathe in slowly through mouth and, at
the same time, press down firmly on canister

8. Continue to breathe in slowly and deeply

9. Hold breath for about 5 seconds or as long as

comfortable
10. While holding breath, remove inhaler from mouth

11. Breathe out gently, away from the inhaler

12. If an extra dose is needed, repeat steps 2 to 10

13. Replace cap

14. If the inhaler contains corticosteroid, rinse mouth

8
 Turbuhaler
Not Attempted Attempted
Step/Task
Attempted Inadequate Adequate

15. Unscrew and remove cover

16. Check dose counter

17. Keep inhaler upright while twisting grip

18. Twist around and then back until click is heard

19. Breathe out gently, away from the inhaler

20. Place mouthpiece between teeth without biting

and close lips to form a good seal. Do not cover
the air vents

21. Breathe in strongly and deeply

22. Hold breath for about 5 seconds or as long as

comfortable

23. Remove inhaler from mouth

24. Breathe out gently away from the inhaler

25. If an extra dose is needed, repeat steps 2 to 10

26. Replace cover

27. If the inhaler contains corticosteroid, rinse

mouth

9
 Accuhaler
Not Attempted Attempted
Step/Task
Attempted Inadequate Adequate

1. Check dose counter

2. Open cover using thumb grip

3. Holding horizontally, load dose by sliding lever

until it clicks

4. Breathe out gently, away from the inhaler

5. Place mouthpiece in mouth and close lips to form

a good seal, keep inhaler horizontal

6. Breathe in steadily and deeply

7. Hold breath for about 5 seconds or as long as

comfortable

8. While holding breath, remove inhaler from mouth

9. Breathe out gently, away from the inhaler

10. If an extra dose is prescribed (not generally

recommended), repeat steps 3 to 9

11. Close cover to click shut

12. If the diskus contains corticosteroid, rinse mouth

10
 Checklist for Smoking Cessation Counseling
N Step/Task Not Attempted Attempted
Attempted Inadequate Adequate
1 Introduce yourself to the patient and use his/her
name
Explore other patient personal details (as occupation,
2 residence, marital status and special habits of
medical importance as smoking and alcohol)
3 Explores ICE

4 5 As Approach
Ask about:
• Type of smoking
• Frequency
• Duration
• Quitting history (and causes of failure)
• Effect of smoking on patient quality of life
Advice the patient to quit smoking
Assess willing to quit
If willing, go through Assist
If not, motivate him/her through the 5 Rs as described
down
Assist the patient to quit through
- Ask for a commitment
- Set a quitting date and tell your family and doctor
- Discuss methods to help the smoker to quit:
Behavioral methods:
Smoking diary.
Progressive restriction
Find alternatives to oral and hand activity.
o Avoid smoking cues as ashtrays from surrounding
environment.
Develop social support.
o Avoid situation that will tempt you to smoke (friends,
parties).
Use Self-help materials.
o Learn to do something that will distract your craving
Pharmacological methods
o Nicotine replacement therapy (gum, patch, spray and
lozenges)
o Drugs as Bupropion and Varencline
(dose, duration, effectiveness, side-effects and
precautions)
Other methods
o Smoking cessation programs.
o Acupunctures, hypnosis.

11
Arrange for follow up plan or referral

5 5 Rs Approach
(In case the patient is not willing to quit)
Risks
Emphasize disadvantages of smoking:
(Medical, social (children, pregnant wife), religious and risk
of fires)
Reward
Emphasize benefits of smoking cessation
Relevancy
- Focus on short term changes.
- Tailor to the clinical situation. e.g. asymptotic patient, or
patient with acute respiratory illness, pregnancy or
chronic disease (DM, Hypertension, Myocardial
infarction, and/or COPD).
Road Blocks
- Withdrawal symptoms.
- Weight gain.
Repetition
Repeat the information and check understanding

12
 Checklist for Lung Cancer Screening
STEP/TASK Not Attempted Attempted
Attempted Inadequate Adequate
Opening Session
Introduce yourself to the patient and uses his name
Data Gathering Domain
• Explore smoking history details ( type of smoking,
frequency and duration )
• Calculate the smoking index
• Explore patient Ideas, Concerns and Expectations
• Asks about possible symptoms suggestive for lung
cancer as cough, expectoration, hemoptysis, chest
pain, dyspnea, anorexia and weight loss in the past 6
months …etc.
• Ask about past history of lung cancer or any organ
cancer
• Ask about family history of lung cancers or cancers in
general
• Assess psycho-social aspects ( depression and
anxiety)

Clinical Management Skills:

• Explain to the patient regarding eligibility criteria for
lung cancer screening
• Make appropriate decision based on patient
preferences
• Counsel patient regarding smoking cessation:
Use the 5 As frame ( Ask-Advise-Assess-Assist-
Arrange) to effectively counsel about smoking
cessation
Use the 5 Rs frame if the patient is unwilling to quit
smoking(Risk-Reward-Relevancy-RoadBlocks-
Repetition)

13
Cardiovascular OSCEs

14
 Checklist for chest pain
Step/Task Not Attempted Attempted
attempted inadequate adequate
- Introduces self appropriately
- Clarifies reason for visit
Obtains history of chest pain
• Onset
• Location
• Precipitating factors
• Alleviating factors
• Associated symptoms
• Quality
• Radiation
• Severity
• Timing/duration
Identifies risk factors for heart disease
• Past medical history
• Family history of heart disease or risk
factors
• Smoking history
• Illicit Drug use (especially cocaine)
• Hypertension
• Lipids/cholesterol
• Recent stressor
• Exercise tolerance
Focused review of systems
• Heartburn/GERD symptoms
• Pain with movement/palpation
• Medications
• Allergies
• Summarizes history
• Checks for any other concerns or missed
information Ideas ,concern, and
expectation
• Psychosocial assessment
• Encourages patient to discuss any
additional points
• Follow up

15
 Checklist for Post-Myocardial Infarction Counseling
N Step/Task Not Attempted Attempted
Attempted Inadequate Adequate
1 Introduces yourself to the patient and use his/her name
Explore other patient personal details (as occupation,
2 residence, marital status and special habits of medical
importance as smoking and alcohol)
Analyze patient complaint as regard onset , course and
3
duration
4 Explores ICE
5 Ask about effect of problem(s) on patient quality of life
6 Screen for depression
Ask about anxiety symptoms as being afraid, nervous,
7
worry, restless, irritable .. etc. GAD7
8 Ask about the nature of coronary artery disease
Ask about post-infarction symptoms as:
- Chest pain
9 - palpitations
- Light headedness
- Fatigue
Ask about risk factors as obesity, dietary habits, salt
10
intake and stressors
Ask about current medications as for antihypertensive,
11 anti-diabetic anti-lipids, cardio-tropics, anticoagulants
and phosphordistrase inhibitors
Ask about past history of stroke, PAD, HTN, DM and
12
dyslipidemia
13 Ask about family history of cardiovascular diseases
Advice regarding therapeutic life style interventions:
- Exercise: (Importance, type, intensity, duration and
frequency, warming up and when to stop)
- Diet: (Importance, type, amounts and how to
prepare)
- Reduce salt intake (Importance, amount,
14
alternatives)
- Reduce weight (Importance, recommended
percentage)
- Stop smoking (Importance)
- Stop or reduce alcohol intake according to patient
values

16
 - Avoid possible stresses
Counsel about Job ( when to return and modifications if
15
needed)
Advice about sex (when to resume, position, possible
16 complications as post coital angina and how to manage,
drug interactions and precautions)
17 Advice about driving (when to resume and precautions)
Advice about travelling (when to resume and
18
precautions)
Advice and arrange for necessary investigations
19
(laboratory, ECG or echo or catheterization)
20 Any other questions he 1 she would like to ask.

21 Check patient understanding and capacity

22 Schedule for follow up plan

17
Gastrointestinal OSCEs

18
 Checklist for Abdominal Pain
No Step/Task Not Attempted Attempted
Attempted Inadequate Adequate
1 Communication:
• Candidate should introduce him/her self
• Candidate should establish an effective rapport
• Good eye to eye contact
• Candidate should encourage patient contribution
2 Questioning Skills
• Candidate appropriately use open and close
ended questions.
• Candidate ask clear questions.
• Candidate avoids leading questions and jargon
3 Patient Personal Information
Candidate obtain data as:
• Age
• Occupation
• Marital status
• Special habits of medical importance as
smoking and alcohol intake
4 Explore the Nature of Patient Problem
Candidate should ask about:
• Onset of abdominal pain
• Course (Frequency): cyclic, continue…etc
• Duration
• Radiation
• Nature of pain (dull ache, colicky or stepping)
• Severity
5 Precipitating/Aggravating Factors:
Candidate should ask if:
• Pain worsen at night or when hungry
• Pain occurs after heavy or fatty meals
• Pain related to menstruation
6 Reliving Factors:
Candidate should ask if:
• Pain relieved by antacid, paracetamol or other
analgesia
• Pain relieved by rest
• Pain relieved with eating
• Pain relieved with hot water bottle

7 Associated Features:
Candidate should ask about
Red Flags Symptoms:
• Fever
• Anorexia
• Nausea or vomiting
• Dysphagia
• Regurgitation.
• Weight loss

19
 • Hematemesis
• Change in bowel habits
Possible Cardiac Causes:
• Retrosternal pain
• Sweating
• Dizziness
Possible UTI Causes
• Dysuria
• Frequency and nocturia
• Haematuria
Dyspeptic Symptoms
• Heartburn.
• Flatulence
• Appetite
Hepatic and Biliary Symptoms
• Jaundice
• Change in urine or stool colour
• Biliary colic
Gynaecological Causes
• Vaginal bleeding
• Vaginal discharge
• Pregnancy
• Last menstrual period
Others:
• History of abdominal or back trauma
8 ICE (Idea, Concern, Expectation)
9 Impact of disease (Physical, Social, Psychological)
10 Past Medical History
Candidate should ask about
• Recurrence / similar attacks in the past.
• Hospitalization
• Drug history
• Allergies
• Travel history
11 Lifestyle
Candidate should ask about
• Dietary habits
• Exercise
• Weight
12 Summarization of findings
13 Diagnosis
14 Ending Consultation

20
Endocrine OSCEs

21
 Initial Examination for Diabetic Patient
Not Attempted Attempted
Step/Task
Attempted Inadequate Adequate

Introduction:
- Introduce yourself to the patient
- Confirm patient details – name / DOB
- Explain the examination to the patient
- Gain patient consent
- Wash hands

General Examination:
- General Appearance: Describe patient
general appearance
- Gait: Comment on patient gait while walking
- Check Vital Signs and Measurements
• Pulse ( rate and rhythm )
• Blood Pressure ( sitting and standing )
• Height, Weight and BMI
• Waist circumference

Specific Examination:
Skin Examination
- Inspect sites for insulin injection (
Lipodystrophy, atrophy )
- Look for signs of insulin resistance as
acanthosis nigricans
- Comment if you noticed any features of hair
loss, granuloma annulaire, necrobiosis lipidica
diabeticorum or nail changes
Head Examination:
Face
Comment if you noticed any features of
endocrinopathies( Cushing, Hypothyroidism ),
hydration and pigmentation

Eyes
Comment if you noticed signs as xanthelasma
or arcus senilis
Check pupil reaction
Check light reflex
Check visual Field
Check visual acuity
Check ocular movements

22
 Perform funduscopy
Neck Examination:
Check carotid pulse and bruit
Check for jugular venous pulsation ( at 45
degree )
Examine thyroid gland
ENT Examination:
o Perform quick ENT exam
o Look for oral cavity hygiene, dental cares and
fungal infection
Chest Examination: Examine lungs for basal
crepetations
Heart Examination: Examine for heart sounds ( S3,
S4, gallop rhythm )
Abdominal Examination: Examine for organomegly
Feet:
• Inspection: inspect for edema, skin changes,
deformities, wounds, ulcers, abrasions and
fungal infections in between toes
• Palpation: Feel temperature and pulses on
both sides
• Sensation: perform light touch, vibration
sense, position sense
• Reflexes: Check for presence/absence of
patellar and Achilles reflexes
To complete examination:
- Thank your patient
- Wash your hands

23
 Diabetic Foot Examination Checklist
Not Attempted Attempted
Step/Task
Attempted Inadequate Adequate

Introduction:
- Introduce yourself to the patient
- Confirm patient details – name / DOB
- Explain the examination to the patient
- Gain patient consent
- Position patient on bed at 45°
- Expose patients lower legs & feet
- Wash hands

Inspection:
Inspect legs & feets thoroughly, lifting legs up to see underneath &
ensuring to look between toes
Colour – Comment if you noticed any:
pallor / cyanosis /erythema (e.g. cellulitis / ischaemia)
Skin- Comment if you noticed any:
Dryness / shiny skin / hair loss – Peripheral vascular disease /
Eczema / haemosiderin staining – Venous disease
Hair- Comment if you noticed any
Atrophic changes as loss of hair
Nail Condition- Comment if you noticed any:
Thick, too long, ingrown, or infected with fungal disease
Ulcers – Inspect between toes / heels / underneath legs and
comment if you noticed any:
Venous ulcers – moderate to no pain – larger /shallow – associated
with venous insufficiency / varicose veins OR
Arterial ulcers – very painful – deep punched out appearance –
associated with diabetes mellitus / peripheral vascular disease
Swelling: Comment if you noticed any:
Oedema – bilateral pitting oedema – e.g. venous insufficiency / heart
failure
DVT – unilateral calf swelling +/- oedema – pain on palpation
Calluses – Comment if present, may indicate incorrectly fitting shoes
Venous filling – guttering of veins / reduced visibility suggests PVD
Deformities caused by neuropathy (e.g. Charcot’s disease):
Comment if you noticed any:
High arches / Clawed toes / Prominent metatarsal heads

Palpation:
Feel Temperature – cool (e.g. PVD) / hot (e.g. cellulitis)
Check Capillary refill – normal = < 2 seconds – prolongation
suggests PVD
Feel Pulses:
Dorsalis pedis artery – lateral to Ext Hal Long tendon
Posterior tibial artery – posterior & inferior to medial malleolus
Absent peripheral pulses is suggestive of peripheral vascular
disease

Sensation:
Monofilament
1. Provide an example of monofilament sensation on the patients
arm / sternum

24
2. With the patients eyes closed, place monofilament on the hallux &
metatarsal heads (1/2/3/5)
3. Press firmly so that the filament bends
4. Hold the monofilament against the skin for 1-2 seconds – ask
patient to say when he/she feel it
Avoid testing on sites as calluses / scars, as the patient will have
reduced sensation in these areas
Vibration sensation
1. Ask patient to close his/her eyes
2. Tap the 128hz tuning fork
3. Place onto patients sternum & confirm patient can feel it buzzing
4. Ask patient to tell you when he/she can feel it on his/her foot & to
tell you when it stops buzzing
5. Place onto the distal phalanx of the great toe on each leg in turn
6. If sensation is impaired, continue to assess more proximally –
e.g. proximal phalanx etc
Other tests to consider:
If abnormalities in monofilament or vibration sensation are identified,
consider carrying out these further tests.
Proprioception
1. Hold the distal phalanx of the great toe by its sides
2. Demonstrate movement of the toe “upwards” & “downwards” to
the patient (whilst they watch)
3. Then ask patient to close their eyes & state if you are moving the
toe up or down
4. If the patient is unable to correctly identify direction of movement,
move to a more proximal joint ( ankle > knee > hip)
Ankle jerk reflex
1. Dorsiflex the foot
2. Tap tendon hammer over the achilles tendon
3. Observe the calf for contraction – normal reflex
Ankle jerk reflex may be absent in advanced peripheral neuropathy
Gait:
Observe the patient walking, assessing:
- Symmetry / balance
- Turning – quick / slow / staggered
- Abnormalities – broad based gait / foot drop / antalgia (may
suggest ongoing Charcot joint
Examine footwear:
Note pattern of wear on soles – asymmetrical wearing –
suggestive of gait abnormality
Ensure the shoes are the correct size for the patient
Note any holes / material inside the shoes that could
cause rubbing / foot injury
To complete the examination:
Thank patient
Wash your hands
Say you would…
- Perform a full neurovascular assessment of the limbs –
if indicated
- Advice on the importance of glycemic control & good
foot care

25
 Checklist for Gestational Diabetes
STEP/TASK Not Attempted Attempted
Attempted Inadequate Adequate
Opening Session
Introduces yourself to the patient and uses her
name
Explore other personal details ( occupation,
residence and special habits of medical
importance as smoking and alcohol)
Data Gathering Domain
Ask about Present Obstetric History Details :
1. Gestational age by last menstrual
period or by ultrasound
2. Previous pregnancies and labors
1. Number of previous pregnancies
2. Number of abortions
3. Complications during
pregnancies as diabetes
4. Complications during labor
5. Mode of previous deliveries (
vaginal, caesarian)
6. Status of living births ( full term
or preterm)
7. Weight of living births at delivery
Ask about Contraceptive History Details
3. Method of previous contraception
4. Duration of use
5. Complications
Ask about Past History Details
6. Chronic diseases
7. Medications
8. Hospitalization and surgeries
Ask about Family History Details
9. Chronic diseases as diabetes

26
 Ask about the Impact of Problem on the
patient
• Ideas, Concerns and
Expectations ( ICE )
• Impact of diabetes on mother
and fetus
Assess Psycho-Social Aspects ( Depression and
Anxiety)
Clinical Management Skills
Offer explanation regarding blood sugar results
Order 75 gm oral glucose tolerance test (OGT)
to screen for DM
Interpret readings of 75 gm oral glucose
tolerance test (OGT)
Establish diagnosis of patient problem
Take the appropriate workup plan for the
patient including :
Diet counseling
Blood sugar monitoring
Explain available approved
medications including insulin therapy
Referral for women hospital
Follow up

27
 Checklist for Thyroid Gland Examination

STEP/TASK Not Attempted Attempted

Attempted Inadequate Adequate

Opening Session
1- Candidate introduces himself to the patient
2- Candidate obtains permission to examine the
patient
3- Candidate explains examination details to the
patient
4- Candidate washes his/her hands
Hand Examination:
1- Candidate should first feel hands for any
sweating.
2- Candidate should look for any tremor - placing a
piece of paper on the backs of the patient's
outstretched hands may show this.
3- Candidate should check patient nails for any
thyroid acropatchy - similar to clubbing, or
onycholysis
4- Candidate should observe for any palmar
erythema which may occur in hyperthyroidism.
5- Candidate should feel the pulses bilateral and
assess the presence of water-hammer pulse
Eye Examination
1- Confrontation Test
2- Lid lag test
Lower Limb :
1. Candidate should check for peritibial oedema
2. Candidate should test ankle jerk reflex

28
Inspection of Thyroid Gland:
1- The patient should be seated in a comfortable
position with the neck in a neutral or slightly
extended position.
2- Have the patient swallow a sip of water, watching
for the upward movement of the thyroid gland.
Palpation of Thyroid Gland:
(Anterior Approach or Posterior Approach)
Note: There is no data comparing palpation using
the anterior approach to the posterior approach so
examinee should use the approach that they find
most comfortable.
1. Candidate should attempt to locate the thyroid
isthmus by palpating between the cricoid
cartilage and the suprasternal notch.
2. Candidate has to slightly retract the
sternocleidomastoid muscle with one hand while
using the other to palpate the thyroid.
3. Candidate should then has the patient swallow a
sip of water as he palpates, feeling for the
upward movement of the thyroid gland.
Percussion of Thyroid Gland:
Candidate should percuss the manubrium for a
retrosternal enlargement
Auscultation of Thyroid Gland :
Candidate should auscultate the thyroid gland for
possible bruit
Lymph nodes Examination:
Candidate should palpate regional lymph nodes for
consistency and mobility

29
 Checklist for Obesity Counseling
STEP/TASK Not Attempted Attempted
Attempted Inadequate Adequate
Opening Session
Candidate introduces himself to the patient
and uses his name

Data Gathering Domain

1- Complete personal history details including
Age, Occupation and Special Habits of
medical importance as Smoking and
Alcohol Intake
2- Explores Patient reason for visit and his
Ideas, Concerns and Expectations
3- 5 As Counseling Approach :
Ask
- permission from the patient to discuss
weight problem
- explore patient readiness to change
- Previous attempts or trials
Assess
- Patient health status, BMI, waist
circumference and cardiovascular risk
- Root causes of gaining weight (primary
and secondary)
- Drug history
- Effect of weight on psychosocial
functioning
- Explain to the patient his classification of
obesity according to BMI
Advise about
- Obesity risks and expected
complications
- Benefits of weight loss
- Explore all treatment options
• Life Style Modification ( Diet –
Exercise)
• Medical
• Surgical
Agree with the patient upon the
desired plan
Assist
- Address patient motives and barriers
- Arrange for follow up or referral

30
Neurology OSCEs

31
 Checklist for Headache
No Step/Task Not Attempted Attempted
Attempted Inadequate Adequate
Candidate introduces himself to the patient
1 and uses his name
Explore other patient personal details
2 (occupation, residence and special habits of
medical importance as smoking)
Analyze patient complaint as regard onset ,
3 course and duration
Ask about present history details
Possible causes of headache
4
Red flags
5 Screens for depression

Explores ICE
6
Ask about effect of problem(s) on patient
7 quality of life

Ask about past history of the patient

8
9 Ask about family history of the patient
Offer appropriate explanation regarding
10
patient problems
Discuss management plan with patient
including:
Shared options; exercise, relaxation
11 tapes/techniques and Rx options e.g.
sumatriptan
Prophylaxis for migraine
Clear safety netting
13 Schedule for follow up plan

32
Musculoskeletal OSCEs

33
 Checklist for Back Examination

STEP/TASK Not Attempted Attempted

Attempted Inadequate Adequate

Opening Session
1. Introduce yourself to the patient
2. Obtain permission to examine the patient
3. Explain examination details to the patient
4. Wash your hands
Patient Standing
Inspection:
Gait (patient without shoes)
Back for scoliosis, lordosis, swelling,
masses, color, & scars.
Palpation: Palpate the following landmarks:
Spine land marks: C7, T3 (scapular spine),
T7 (inferior angle of scapula) & L4 (iliac
bone).
Skin for hotness, tenderness (infection,
fracture, ) & masses.
Muscle spasm.
Sacroiliac joints.
Percussion: For deep tenderness
Movement:
Toe-walk S1
Heal - walk L5
Squat & rise L4
Movement: flexion, extenuation, lateral
flexion.
Patient Sitting:
Inspection: scoliosis, muscle wasting.

Movement:
Rotation

34
 Extend knees role out disc prolapse.
Knee reflex.
Patient Supine:
Examine free side first.
Movement:
Straight leg raising test (S L R) Active,
passive & crossed SLR
Bragard test.
Lasegue test.
Figure of four (sacro-iliac joint)
Power:
Hip flexion. L1 - L2
Knee flexion; L5 – S1
Knee extension: L3 – L4
Foot planter flexion. S1
Foot dorsi flexion. L4 – L5
Big toe dorsi flexion
Foot inversion: L4 – L5
Foot eversion: L5 – S1
Reflexes:
knee reflex: L3 – L4 (if not done while
patient is sitting)
Ankle reflex: S1
Sensation:
Medial side of foot. L4
Dorsum of foot. L5
Lateral side of foot: S1
Patient Prone:
Femoral nerve stretch. L4
Compress midline as in CPR

Examination of the abdomen

35
 Checklist for Knee Joint Examination
STEP/TASK Not Attempted Attempted

attempted inadequately adequately

Opening Session

Candidate introduces himself to the patient

Took permission from the patient

Exposure (Hip or Above knees/down to

heels)

Washes hands

Ask the patient to walk for you and observe any limp

or obvious deformities

Inspection (patient standing, inspect all

around patient

• Skin – trophic, sinuses, scars

• Muscle waste

• Bony deformity as fixed flexion deformities.

• Erythema/Swelling

• Position (degree of rotation of leg, fixed

flexion deformity)

Palpate the knee joint, start by assessing the

temperature using the back of your hands and

comparing with the surrounding areas

The main movements which should be examined

both actively and passively are:

• flexion

36
 • extension

A full range of movements should be demonstrated

and you should feel for any crepitus

Tests for Patellar effusions ( Small and Large)

Anterior Drawer Test: Flex the knee to 90 degrees

and sit on the patient’s foot. Pull forward on the tibia

just distal to the knee. There should be no

movement. If there is however, it suggests anterior

cruciate ligament damage. Another test for ACL

damage is Lachman’s test.

Posterior Drawer Test: With the knee in the same

position, observe from the side for any posterior lag

of the joint, this suggests posterior cruciate ligament

damage.

Assess the collateral ligaments. Do this by

holding the leg with the knee flexed to 15 degrees

and place lateral and medial stress on the knee. Any

excessive movement suggests collateral ligament

damage

Perform McMurrays test to assess for meniscal

damage. Hold the knee up and fully flexed, with

one hand over the knee joint itself and the other

on the sole of that foot. Stress the knee joint by

medially and laterally moving the foot.

37
 Checklist of Shoulder Examination
Not Attempted Attempted
No. Step/Task attempted inadequately Adequately
1 The patient is asked to expose the upper
chest.
The patient is asked to sit.
The resident stands at the back of the
patient and also at front and sides
2 INSPECTION (during standing and lying
flat)
Inspect both shoulders from:
• Above
• Sides
• Front
In reference to the opposite side for:
• Shape and contour of the bone
and alignment
• Size
• Color of the skin
• Wasting of muscles
• Scares
• Inspect the axilla
• Inspect for fracture of clavicle
3 PALPATION:
The resident palpate the following joints
and comment each time on:
• Tenderness
• Hotness
• Swelling
• (both sides)
The anterior and lateral aspects of the
glenohumeral joint by the index and
middle finger of right hand while
supporting the shoulder with left hand.
The upper humeral shaft and head with
axilla with middle and index fingers of
right hand while raising the arm with the
left hand.
The acromio-clavicular joint by putting
middle and index finger of right hand
above it.
The whole of the clavicle by the tips of
middle three fingers of left hand while
standing behind the patient.

38
No. Step/Task
4 MOVEMENTS:
The resident test the active movements
and comment each time on:
- Crepitation
- Range of movements
- Pain during movements

(A) Active movements:

Abduction:
Ask the patent to carry the arm
medially across the front of the
chest.
Flexion:
Ask the patient to swing the arm
backward.
Internal rotation

External rotation

(B) Passive movements

Thank the patient and the examiner

39
Pediatric OSCEs

40
 Checklist for Counseling on Breastfeeding
Step/Task Not Attempted Attempted
Attempted Inadequate Adequate
Opening Session
- Introduces yourself to the patient and uses her name
- Explore other personal details ( as occupation,
residence and special habits of medical
importance as smoking and alcohol)
Data Gathering Domain
- Explore mother’s ideas concerns & expectations
(ICE)
- Ask about Past History Details
o Chronic diseases
o Medications
- Obtain brief obstetric history (if she have twins)
- Ask about contraception experience and plan
- Ask about previous experience of breast feeding
(duration and difficulties)
- Assess Psycho-Social Aspects ( Depression and
Anxiety)
Education and Technique
- Educate mother about importance of breast
feeding (psychological, economic, immunity, less
allergy and contraception ..etc.)
- Assess current mother knowledge and practices
toward sound breastfeeding (positioning and
attachment)
- Encourage breast feeding considering that:
1. Breast feeding should be initiated as soon after
delivery
2. During the first 2 weeks, feed on demand
3. Nurse baby 10 minutes at least on the first breast
then as long as he want on the second breast
4. Alternate which breast you start with each time

41
5. Always keep nipple dry
6. No bottles should be offered to the baby
7. Milk supply improved by adequate sleep, fluids,
relaxed environment, reduced stress
8. Signs of baby satisfaction with breast feeding
(weight gain, bowel habits and sleeping)
- Advice regarding sound breast feeding technique:
Ensure privacy
The mother should sit comfortably with back
supported
The baby should have a large part of the areola in
his mouth
For working mother welling to breast fed, pumping
technique should be discussed
- Ask mother to demonstrate technique and give her
your feedback
- Answer any inquiries might be raised by mother
and give her reassurance & support

42
 Checklist for Vaccination Defaulters
STEP/TASK Not Attempted Attempted

attempted inadequatel adequately

Opening Session

Candidate introduces himself to the patient and

uses his name

Data Gathering Domain

1- Complete personal history details including

name and age of the child

2- Explores mother reason for visit

3- Explores mother Ideas, Concerns and

Expectations regarding missed vaccinations

4- Ask about child present history details ( Birth

weight, Nutrition)

5- Ask about previous diseases as Measles and

Chickenpox

6- Convulsions

7- Allergies

8- CURRENT Medications

9- Management Schedule and Follow up plan

(Vaccination Schedule)

10- Check Mother Understanding

43
 Checklist for Nocturnal Enuresis
No Step/Task Not Attempted Attempted
Attempted Inadequate Adequate

Introduce yourself to the mother and build a

1
good rapport

2 Identify mother Ideas, Concerns and

Expectations ICE
3 Encourage mother to bring her son
4 Determines whether Enuresis is primary or
secondary?
5 Thorough history including
• Fluid intake
• Psychosocial stressors as divorce,
abuse, new birth, etc.
• School achievement environment
• Daytime symptoms
• Family history among parents
6 Asks about Red Flags / organic causes
including
• UTI (dysuria, frequency urgency and
recurrence)
• DM (polyuria, polydipsia and weight
loss)
7 Offer to examine the child
8 Order basic investigations as
• Blood glucose
• Urinalysis
• Ultrasound
9 Reassure the mother
10 Ask about measures as:
• Fluids restriction
• Rewards
• Punishment
• Frequent night awakening

11 Advise about available options including

• Bed wetting alarm system
• Desmopressin
• Imipramine

44
 Checklist for Attention Deficit Hyperactivity Disorder (ADHD)
No Step/Task Not Attempted Attempted
Attempted Inadequate Adequate

Introduces yourself to the Lady and use her

1
name as well as her child name

2 Analyze mother complain as regard onset ,

course and duration
3 Ask detailed history about triad of symptoms
(Hyperactivity, Inattention and Impulsivity)
4 Ask about occurrence of symptoms in
multiple settings as school and home
5 Ask about impaired functioning i.e.: may
affect a child's schooling and relationships
with family and friends
6 Explore possible causes of the behaviour
• Social deprivation and neglect in
childhood
• Neurodevelopmental abnormalities
• Mother drinking alcohol and taking
drugs such as heroin during pregnancy
• Obstetric complications
• Low birth weight of the child
7 Ask about growth and development history of
the child
8 Ask about Family history of ADHD
9 Explore mothers ideas, concerns and
expectations with regards to child behaviour
10 Elicits impact on family life (Social Aspect)
11 Offers appropriate explanation about ADHD
using simplified language

45
12 Offers appropriate explanation about
management options either in primary or
secondary level including:

Family education and support

Parent training program
School education and support
Teachers may meet with parents and
physician to discuss support in school
Family and individual therapy
o Family therapy
o CBT
o Social awareness therapy
Behavioral treatment
o Rewarding good behavior and discouraging
bad behavior
Medications
• Only in children over 6 years old
• Methylphenidate, i.e.: Ritalin is most
commonly used and the child is
monitored for for growth and other side
effects
13 Discus prognosis with the parents (conduct
disorder, adult ADHD)
• Prognosis is variable
• Gradual improvement occurs in
adolescence, but up to 8 in 10 children
with ADHD will continue to experience
• Early and consistent treatment improves
this prognosis
14 Takes an appropriate decision by referral of
the case to psychiatric health setting if needed

46
 Checklist for Constipation in children
STEP/TASK Not Attempted Attempted

attempted inadequately adequately

1. Opening Session

Candidate introduces himself to the Mother

and uses Mother and Child names

(Establishes rapport)

2. Data Gathering Domain

Analyses patient complain as regard

onset , course and duration

Ask about Possible causes of

Constipation

Ask about Red flags

Ask about Past history of the patient

Ask about family history of the patient

Explores ICE of Mother

3. Clinical Management Skills

Offers appropriate explanation of the

problem

Suggests appropriate management

options; dietary advice, fluids and future

management choices – laxatives

Educate mother regarding safety netting

47
Gynecology & Obstetric
OSCEs

48
 Checklist for Pre-Marital Counseling

STEP/TASK Attempted Attempted Attempted

inadequately adequately

Opening Session
1. Candidate should introduce himself to the
client(s)
2. Candidate should confirm client(s) details
3. Candidate must ensure privacy

History Taking:
1. Candidate should obtain relevant socio
demographic data as age, education,
occupation, consanguinity to the partner,
sequence of marriage.
2. Candidate should obtain relevant medical /
surgical / psychological histories:
a. Ask about systemic illness such as:
hypertension, diabetes mellitus, heart
problems, epilepsy, etc.
b. Ask about previous surgical history
(date, type, where it was done).
c. Ask about history of blood transfusion
(date, frequency, place, etc.).
d. Ask about history of STI or genital
lesions.
e. Ask about current medications.
3. Candidate should obtain relevant family
history of chronic or genetic diseases.
4. Candidate should assess risky behaviours
such as smoking, alcohol consumption or
substance abuse.
5. Candidate should explore if client(s)
previously married, if they have any children
and history of baby with congenital
abnormality

49
Physical Examination
1- Candidate should assess client(s) general
appearance.
2- Candidate should obtain baseline
measurements and vital signs (as height,
weight, BMI, blood pressure and pulse).
3- Candidate should explore relevant general
examination details depending on client(s)
history.
Laboratory Tests
Candidate should request the following lab
tests:
• Fasting or Random Blood Sugar
• CBC.
• Blood grouping and Rh.
• Hb electrophoresis.
• Sickling test.
• Rubella antibodies IgG (for females).
• VDRL test for syphilis
• HIV test.
• HBsAg.
• Anti HCV antibodies.
• Other tests for molecular genetic diseases:
- Cystic Fibrosis (CF).
- Homocystinurea*.
- Spinal Muscular Atrophy (SMA)(optional)*.
Management Plan
1- Candidate should offer counselling to client(s)
if needed .
2- Candidate should provide clients with
premarital educational materials which
includes the following information:
Concept and aim of premarital
screening.
Common haemoglobinopathies in Qatar.
Sexually Transmitted Infections (STIs).
Healthy lifestyle.
Various methods of contraception.
3- Candidate should offer to provide
vaccinations if indicated.
4- Candidate should offer treatment if required.
5- Candidate should schedule for revisit or
referral accordingly

50
 Checklist for Infertility
No Step/Task Not Attempted Attempted
Attempted Inadequate Adequate
1 Communication Skills:
• Introduce yourself to the patient
• Establish an effective rapport with the
patient
• Make good eye to eye contact
2 Patient Personal Information
Ask about:
• Age
• Occupation
• Duration of marriage
• Special habits of medical importance as
smoking, alcohol, and caffeine consumption
3 Chief Complaint:
• Ask about current problem/complaint
• Define Infertility (primary or secondary)
4 Male / husband Infertility
Ask about:
• Occupation (radiation exposure)
• Previous marriages and offspring
• History of previous or known infertility in
husband
• Libido and erectile dysfunction in husband
• Chronic diseases as DM, HTN..
• History of sexual transmitted diseases
• Surgeries for varicocele
• Semen analysis
5 Present History:
• Analyse patient complaint (onset, course
and duration)
• Ask about:
Recent cervical smear findings,
Breast changes as milk-like discharges,
Hirsuitism
Wight loss or gain
Acne on face and chest,
Hot flushes,

6 ICE (Idea, Concern, Expectation)

7 Impact of Disease
• Physical,
• Social,
• Psychological

51
8 Past History:
Ask about:
• Any current associated medical illness as
diabetes and/or hypertension, hyper-
hypothyroidism
• Drug intake prescribed as non-steroidal
anti-inflammatory drugs (NSAIDs), sex
steroids and cytotoxic drugs or recreational
as marijuana and cocaine,
• Pelvic infection, tuberculosis, bilharzias,
• Ovarian cyst,
• Surgeries as appendectomy, laparotomy,
caesarean sections, and cervical conisation.
• Rubella status
9 Menstrual History:
Ask about:
• Age of menarche,
• Regular/irregular cycle
• Frequency
• Amount
• Any associated symptoms as premenstrual,
painful menstruation or intermenstrual
spotting.
• History of primary or secondary amenorrhea
10 Obstetric History:
Ask about:
• Previous pregnancies, if any, and its
outcome,
• Ectopic pregnancies
• Abortions,
• Post-abortive infection or puerperal sepsis
11 Contraceptive History:
Ask about Previous use of contraceptive
methods, particularly intrauterine system, Oral
contraception pills
12 Sexual History:
Ask about:
• Coital frequency,
• Timing in relation to the cycle,
• Use of vaginal lubricant before, or vaginal
douching after coitus,
• Loss of libido,
• Difficult or painful coitus
13 Family History:
Ask about:
• Family history of infertility,
• Family history of Spontaneous abortion,
stillbirth, and congenital disease
14 Summarization
15 Ending consultation

52
 Checklist for Menopause
No Step/Task Not Attempted Attempted

Attempted Inadequate Adequate

1 Opening Session

Candidate introduces himself to the patient

and uses patient name (Establishes rapport)

Data Gathering Domain

Ask about personal history details (age,

2 occupation, residence and special habits of

medical importance as smoking)

3 Analyses patient symptoms as regard onset ,

4 course and duration in details

5 Screen for depression

6 Ask about Past history of the patient

7 (medical / surgical / obstetric / gynecological)

Ask about family history of the patient

Explores ICE

Clinical Management Skills

8 Offers appropriate explanation of the problem

9 Educate patient regarding simple

management for her symptoms

10 Counsel patient regarding different

management options including HRT

53
 Checklist for Menopause and HRT
No Step/Task Attempte Attempt
Not
d ed
Attempt
Inadequ Adequa
ed
ate te
Candidate introduces himself to the patient and uses his
1 name

Explore other patient personal details (occupation, residence

2
and special habits of medical importance as smoking)

Analyze patient complaint as regard onset , course and

3 duration
Ask about other symptoms of menopause as Sexual
4 dysfunction and body aches

Ask about effect of problem(s) on patient quality of life

5
6 Ask about diet, calcium, and spices
7 Ask about daily activities and exercise
8 Ask about menstrual history details (age of menopause)
Ask about psycho-social aspects (sleep, appetite and
9 interests)
10 Ask about contraceptive history ( use of hormonal methods )
Ask about gynecological problems and operations
11 (hysterectomy)
12 Ask about breast problems or cancers in patient
Ask about chronic medical conditions as diabetes,
13 hypertension, ischemic heart diseases and strokes
14 Ask about history of DVT
15 Offer appropriate explanation regarding patient problems
Ordered appropriate investigations (Pap Smear,
16
Mammography and lipid profile)
Discuss different methods to treat menopausal symptoms as
HRT and other drugs ( indication, contraindications and side
17
effects)
18 Schedule for follow up plan

54
Psychiatry OSCEs

55
 Checklist for Depression
No Step/Task Attempte Attempt
Not
d ed
Attempt
Inadequ Adequa
ed
ate te
1 Introduces yourself to the patient and use his/her name

2 Encourage patient contribution

3 Respond to patient’s cues

Explore other patient personal details (as occupation,
4 residence, marital status and special habits of medical
importance as smoking, alcohol and psychoactive drugs)
Analyze patient complaint as regard onset , course and
5
duration
Ask about main symptoms of depression: PHQ9
- Mood
- Loss of interest
- Activity level
- Decrease ability to concentrate
6 - Sleep disturbance
- Change in appetite and weight
- Loss of libido
- Guilt feelings
- Suicidal thoughts and/or attempts
Ask about the presence of somatic complaints e.g.
7
headache, back pain, shortness of breath, etc
Ask about anxiety symptoms as being afraid, nervous,
8
worry, restless, irritable .. etc. GAD7
Ask about psychotic symptoms as hallucinations, delusion,
9
illusions

10 Assess patient insight

56
11 Explores ICE

12 Ask about effect of problem(s) on patient quality of life

Ask about possible psychosocial stressors as emotional,

13
marital conflicts, job or economic problems

14 Ask about life events as death, divorce or separation

Ask about chronic medical illnesses as cancer, stroke,

15
thyroid, IHD, diabetes and HTN
Ask about long term use of medications as steroids, BB and
16
antihypertensive
Ask about past history of similar condition (or other
17
psychiatric illnesses)
Ask about family history of similar condition (or other
18
psychiatric illnesses)

19 Offer appropriate explanation regarding patient problems

Discuss management plan with the patient including:

Non pharmacological approach including CBT and life
20 style modifications
Medications: dose, duration and possible side effects
If there is need for referral

21 Schedule for follow up plan

57
Ethics OSCEs

58
 Breaking bad news (IUFD)
Action Step/Task Not Attem Attempt
attem pted ed
pted inade adequat
quatel ely
y
Establish rapport • Call by name.
• Introduce yourself.
• Eye to eye contact.
• Verbal and non verbal cues
• Active listening.
• Silence.
Consultation tips • Empathy.
• Respect.
• Interest
• confidentiality
Complain or reason • Encourage patients contribution
for attendance
Steps and skills for breaking bad news
Preparation: • Allow uninterrupted time
• Use a comfortable, quite
environment.
• Invite spouse, relative, and friend
as possible.
Take good history: • Present pregnancy: gravidity and
parity, LMP, EDD.
• Abnormal symptoms like abdominal
pain, PV bleeding, or discharge,
burning micturition, polyurea,
polydypsia, fever, rash, headache,
dizziness, blurring of vision.
• Previous pregnancy.
• Past Medical and Surgical history.
• Trauma history
• Drug history.
• Social history: smoking, personal
resources, family support.
• Family history.
Examination • General, vital signs, Temp, BP
• Abdomen for fundal height, foetal
heart sounds.
• LL oedema
Begin the session • Summarize the findings, check with
the patient.
• Discover what has happened since

59
 the last visit.
• Check how the patient is thinking or
feeling

Sharing the • Assess what the patient already

information knows, is thinking or has been told.
• Assess how much the patient
wishes to know.
• Give warnings first that difficult
information coming
Break the news • Give the information simply and
honestly; repeat the important
points.
• Don’t give too much information.
• Check for understanding and
feelings as you proceed.
• Use language properly, avoid
jargons
Show sympathy and • Allow patient feelings give time and
caring space, allow possible denial.
• Encourage expression of feelings ( I
am sorry that was difficult for you)
• Show acceptance, empathy and
concern,
• Be aware of unshared meanings.
• Keep pausing to give patient
opportunity to ask questions.
ICE • Specifically elicit all the patients
concern
Give information • Causes of IUFD
• Preventive methods.
• Check for understanding
Planning and support • Plan what to do next.
• Give hopes.
• Willing to help and caring.
Follow up and • Summarize and check with the
closing patient.
• Arrange for follow up, offer
telephone calls.
• Red flags and safety netting.
• Arrange for referral to specialist.
Discretionary • Time management and
Organization.

60
ENT OSCEs

61
 Checklist for Ear Examination
Att Atte
Not e mpt
Step/Tas atte m ed
No.
k mpte pt adq
d ed uate
1 Introduction of himselflherself, asking for permission and in ly
of the ear examination
2 External ear (auricle or
- Inspect each ear and surrounding (deformity, lumps
- Palpate both mastoid processes and check for
- Gentle pulling each auricle upward and
3 Ear Canal
- Insert Otoscope to proper depth and inspect the external
auditory
canal (discharge or foreign bodies, redness,
4 EarDrum
- Check landmar (clear, obscured, any perforation,
the
bulging) ks colour,
- Light
5 Assess Hearing (Distinguish between a sensonueral and
hearing
loss}
Rinne
- Strike the tuning fork to make it vibrate
- Place the fork on the mastoid, pressing
- Hold the fork about three inches away from
-- - Explanation: normally, the patient should hear the tuning fork
in front and quieter behind -ve test). Positive Rinne test: bone
conduction> air conduction.
6 Weber
- Strike the tuning fork to make it vibrate.
- Place the fork in the middle of the forehead or the
- Ask the patient if he can hear the sound equally in both ears/
on one
- Explanation: normally should hear the sound equally in both
(Unilateral conductive loss, the Weber will localize to the
Unilateral sensoneural loss, the Weber will localize to the
unaffected ear).
7 Whisper
7 General organized

62
 Checklist for Dizziness / Vertigo
Step/Task Not Attempted Attempted
Attempted Inadequate Adequate
Opening Session

Introduce yourself to the patient and use patient

name (Establishes rapport)

Data Gathering Domain

Complete other details of personal history as

age, occupation, residence, marital status and

special habits of medical importance as

smoking and alcohol

Clarify what patient means exactly by

dizziness (Is it true vertigo or light headedness

or disequilibrium)

Ask about the onset and timing of the

symptoms

Ask about the course of symptoms: constant or

attacks (duration & frequency)

Assess severity of symptoms: e.g. associated

nausea and/or vomiting.

Ask about precipitating factors as change in

head position, standing, Auricle manipulation,

fatigue, valsalva maneuver, viral infection,

hyperventilation, explosion

Assess patient ideas, worries & expectations.

Assess the effect of the problem on patient's

life,

63
 Ask about history of pervious attacks

Ask about past history of ear diseases as

hearing loss, tinnitus, Fullness or stuffiness,

otalgia / discharge, pervious ear surgery.

Ask about family history of tinnitus, hearing

loss

Rule out associated brain stem symptoms as

double vision, numbness and/or weakness in

arm face and leg, difficulty in speech,

confusion or loss of consciousness, swallowing

problems.

Ask about associated symptoms as valvular

disease, palpitation, syncope on exertion,

Prolonged bed ridden, head & neck trauma,

seizures, symptoms of DM, hypertension,

anxiety, depression or panic attacks.

Ask about drugs history

Clinical Management Skills

Offer appropriate explanation regarding the

nature of the problem

Arrange for appropriate workup plan for the

patient to reach a diagnosis (as audiometry,

neuroimaging and vascular imaging)

Schedule the follow up

64
 Checklist for Tinnitus
No Step/Task Not Attempted Attempted
Attempted Inadequate Adequate
1 Opening Session
Candidate introduces himself to the patient and
uses patient name (Establishes rapport)

Data Gathering Domain

2 Explore other personal history details (
occupation, residence and special habits of
medical importance as smoking and alcohol)
3 Analyses patient complaint as regard onset ,
course and duration in details
4 Ask about present history details:
(Description of tinnitus)
o Pitch (quality of sound loudness)
o Location ( Unilateral or bilateral )
o Timing ( Intermittent or continuous )
o Associated events:
- Hearing change, previous chronic noise
exposure, acoustic trauma, otitis media,
head or neck trauma, dental treatment
- Use of a medication known to cause
tinnitus
o Associated symptoms
Headaches, Hearing loss, Noise
annoyance, intolerance, or pain, Tempro-
mandibular joint or neck pain, Vertigo
and hallucinations
o Impact of tinnitus
Percent of time the patient is aware of or
annoyed by tinnitus (e.g., interference
with daily activities, sleep, work, or
leisure; auditory perceptual difficulties;

65
 effects on general health)
5 Ask about past history of tinnitus and other
chronic conditions
6 Ask about family history of tinnitus, hearing loss,
or neurofibromatosis
7 Explores patient ideas, concerns & expectations
– ICE
8 Assess psycho-social aspects ( sleep, appetite
and interests)
Clinical Management Skills
9 Offer appropriate explanation regarding the
nature of the problem (eye, ear,
musculoskeletal, neurological and vascular)
10 Arrange for appropriate workup plan for the
patient to reach a diagnosis (as audiometry,
neuroimaging and vascular imaging)
11 Schedule the follow up

66
Men’s Health OSCEs

67
 Checklist for Erectile Dysfunction
STEP/TASK Not Attempted Attempted
attempted inadequate adequately
Initially establish good rapport.
Explore, reasons for vitamin need
Create favourable and professional
environment
Explore patient ICE and Impact of the
problem
Ask straightforward inquiries about sexual
function
Onset of dysfunction. Course and Duration.
Explore the details of patient sexual life e.g.,
Type : Premature Ejaculation, Impotence,
Poor Sustained Erection,)
Presence of Nocturnal or early morning
erection
Degree and timing of the dysfunction;
consistency of dysfunction, occasional, or
situational. e.g., No sustained erection with
detumescence after penetration is most
commonly due to anxiety or the vascular
steal syndrome.
Does the patient have other sexual relations
currently?
If yes, with men or women or both?
If not, when did the patient last sexual
intercourse with wife?
Does the patient satisfied with the frequency
and quality of his sexual experience?
Presence of depression (Loss of libido and
lack of interest in any sexual activity), or
Performance anxiety, or Lack of sensate
focus (preoccupied with financial pressures,
travails of the business world).
Presence of fatigue before sexual act
Lack of privacy.
Have unresolved anger with his wife.
Presence of associated Symptoms; STD's.
Presence of Vascular insufficiency (PAD)
symptoms

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 Presence of Autonomic neuropathy
(retrograde ejaculation).
Evidence of hyperprolactinemia,
hyperthyroidism, hypothyroidism, and
testicular disease.
Presence of Prostatic operation or
prostatism
Presence of Risk factors: Chronic disease;
DM, HTN, obesity, MS, dyslipidemia, CV
disease, spinal cord or back injury, Smoking.
Ask about substance abuse; Excessive
alcohol consumption. Recreational
substances.
Use of Antihypertensive drugs (e.g,
thiazides, CCB, ACEi) or Use of
Antidepressants, Anti androgens such as
GnRH agonists and 5-alpha-reductase
inhibitors, Spironolactone, Sympathetic
blockers such as clonidine, guanethidine, or
methyldopa.
Use of Dinitra
Explore wife age, pre or menopausal symptoms,
any other chronic problems, loss of libido?
Explain to the patient causes and management
of his problem
Order basic investigations
Manage the case through pharmacological and
non-pharmacological approaches

69
Geriatric OSCEs

70
 Checklist for Geriatric Care
STEP/TASK Not Attempted Attempted
attempted inadequately adequately
Opening Session
Candidate introduces himself to the patient and uses
his name
1. Functional Assessment
• Activity of daily living (Eating -Dressing -
Bowel Control )
• Instrumental daily living ( Shopping-
Cooking-Laundry-Telephone-Manage
Money-Taking Medicines-climb stairs-Walks
to Toilet )
2. Physical Health Assessment
• Chronic Conditions
• Specific Geriatric Conditions ( Falls-
Dementia-Incontinence-Visual or Hearing
Impairment)
• Medications side effects and poly pharmacy
3. Nutritional Status
• Income sufficient to buy food items
• Eating habits
• Taste and smell sensation
• Denture use
• Alcohol intake
• Vitamin deficiency symptoms
4. Psycho Social Assessment
• Anxiety symptoms
• Depression Screening
• Caregivers
5. Mini Cognitive Assessment ( Dementia )
• Repeating three un related words
• Draw clock 10 minutes after 11
• Recall the previous three words
6. Home environment arrangement
Safety regarding Stairs, Bathrooms, Kitchen
and Light
7. Screening
Vision ( if symptomatic)
Hearing ( Referral to Audiometry )
Osteoporosis ( DEXA Scan )
8. Select lab tests
9. Arrange for follow up

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 Checklist for Traveler’s Advice

STEP/TASK Not Attempted Attempted

Attempted Inadequate Adequate
Opening Session
1- Candidate should introduce himself to the client(s)
2- Candidate should establish doctor-patient relationship
History Taking:
• Candidate should obtain information about travelling and
the trip details
( Date of travel, Place, Duration of trip, Reason, Mean of
travel)
• Candidate should ask about history of
( Medical illnesses, Drug history, Allergic history,
Vaccination history)
• Let patient to express his/her concern and/or ask
questions
Motion Sickness:
• Candidate should discuss and explain motion sickness to
the client
• Candidate should advice the client to apply measures to
prevent motion sickness as: ( Avoiding fatty foods before
departure, sitting between wings, Closing eyes
• If he/she developed motion sickness before, Candidate
should advice the client to take antihistamine e.g.
(Phenergan) 30-60 min before departure.
Preventive Measures regarding Food Borne Diseases /
Traveler’s Diarrhea:
• Candidate should advice the client to be sure of water
sanitation
• Candidate should advice the client to avoid unpasteurised
milk
• Candidate should advice the client to eat only cooked
vegetables and avoid as much salads.
• Candidate should advice the client to peel all fruits,
including tomatoes.
• Candidate should advice the client that
Antibiotic prophylaxis should not be used routinely in
persons at risk of developing traveller’s diarrhoea
Antibiotics (usually a quinolone) should be used to
reduce the duration and severity of traveller’s
diarrhoea
Loperamide (Imodium) can be used with antibiotics for
most adults.
Endemic Diseases in the Country of Travel
Candidate should provide the client with information regarding
diseases that might be endemic in certain areas as typhoid,
yellow fever, hepatitis, malaria and AIDS

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 Specific Preventive Measures :
Vaccination :
Candidate should provide the client with vaccines if needed for
the following diseases typhoid fever, yellow fever, hepatitis A
vaccine
Chemoprophylaxis for malaria
Candidate should provide the client with chemoprophylaxis if
needed for malaria
Preventive Measures against Mosquito Bites:
Candidate should advice the client to avoid mosquito bites
through:
( Wearing long-sleeved clothing and long trousers, Use of
mosquito net during sleeping, Appropriate use of insecticides
Prophylactic Measures for STDs: Candidate should avoid
risky behaviors as unprotected sex.

General Preventive Measures

• Candidate should advice the client as possible to stay
away from areas that has overcrowdings and could
transmit droplet and airborne diseases
• Candidate should advice the client to wear masks when
needed
• Candidate should advice client to cover mouth when
coughing or sneezing
• Candidate should advice the client to contain any sputum
in waste bags
• Candidate should advice the client to frequently wash
hands
• Candidate should advice the client to avoid swimming in
lakes or rivers
• Candidate should advice the client to use safe traffic and
transportations
• Candidate should advice the client to carry enough
medications for chronic diseases if he/she had
• Candidate should advice the client to wear, if possible,
medical bracelet
• Candidate should advice the client to seek medical advice
if needed from trustable source as teaching hospitals
• Candidate should advice the client to use medical kit to
store essential drugs, e.g. chloroquine, bactrim,
paracetamol, oral rehydration, insulin & syringe,
Phenergan.
• Candidate should advice the client that traveling to high-
altitude areas should be advised to ascend slowly (1,000 ft
per day above 8,000 ft) and allow time to acclimatize while
rapid descent should be advised if significant illness
develops
• Candidate should advice the client to take acetazolamide
(formerly Diamox), at a dosage of 125 to 500 mg twice
daily for persons traveling to high-altitude areas
• Candidate should advice the client regarding measures to
prevent get lag

73

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