Exam (elaborations)
Osce- abdominal pain
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A step by step detailed guide on answering OSCE station specific to a patient with abdominal pain and scoring those extra points.
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Abdominal Pain50 year old lady with sever abdo pain. Take History. LIF pain gradually getting
worse over last 3 days. No radiation. No bowel symptoms, pre menopausal
No risk of pregnancy. Previous 2 pregnancies both older now and delivered
SVD. Nausea no vomiting. No PV bleeding. Give differential…?diverticulitis,
?fibroids, ?ovarian cyst… no convinced these are right!
1) Introduce yourself
2) Explain your going to take medical history and ask for consent
3) Ensure they are comfortable
4) Name/age/occupation
5) Establishes presenting complaint
6) Ask about nature of abdo pain (open questions)
Nature
Site
Onset
Duration of symptoms and treatment
Radiation
Aggravating/relieving factors
Associated symptoms and signs
Pain scale
7) Establishes dietary (spice, caffeine) and bowl habit: excludes passage of blood and mucus
8) Ask about abdominal cramps and bloating
9) Colour and consistency of stool and urine
10) In addition ask about
Fever
Poor appetite/ Weight loss/ anorexia
Dysphagia
Indigestion
Nausea/ Vomiting/ Haematemesis (fresh blood or coffee ground, number and
volume)
Diarrhoea/constipation (how often opening bowel)
Reflux/indigestion/ heart burn (dyspepsia, retrosternal burning/ water brash)
Maleana or rectal bleeding (fresh blood PR) (if bleeding establishes/include
symptoms of anaemia)
Steatorrhoa
Jaundice
Genital urinary symptoms : frequency, dysuria, haematuria
Menses : menarche, menopause, length of menstrual periods, amount of bleeding,
pain, intermenstrual bleeding, LMP, dyspareunia
11) PMHX
Previous episodes of abdominal pain, recent infections
Known hiatus hernia, GI inflammation, gastritis
Establishes past history of bowl problems and outcome
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