A step by step detailed guide on answering OSCE station specific to a patient with kidney failure, considering the differentials and scoring those extra points.
Man with 1 month Hx of nausea and lethargy. Blood results from 2 months
ago showed hyperkalaemia and renal failure. Was on NSAIDs for OA and
bendroflumethiazide for BP. Got a bit confused by this station. Think they
were looking for management of hyperkalaemia and renal failure. Monitoring
and stopping NSAIDs just now. Repeat bloods etc…
History taking – patient with deteriorating renal function. Asked patient about
symptoms of renal failure (the P’s!) and about other risk factors e.g. diabetes. Patient
was on high-dose NSAIDs for arthritis. Then shown blood results and an ECG which
showed hyperkalaemia. Asked about ways of lowering the potassium and further
management of the patient (senior help, fluids and catheterisation to monitor the
urine output, referral to renal team ?dialysis).
1) Appropriate introduction ( full name and role)
2) Explains purpose of interview to patient
3) Establishes duration of present illness
4) Establishes/excludes symptoms of uraemia and renal failure
a. Nausea and vomiting (confused, anxious, sleepy)
b. Pruritus
c. Hip coughs
d. Oliguria in last week
e. Peripheral oedema
5) Establishes associated malaise, lethargy, weight loss, anorexia
6) Urological history
a. Pain: for any pain ask about site, radiation, intensity, character, onset, duration,
relieving and aggravating factors and associated symptoms
b. Fever
c. Frequency
d. Urgency
e. Dysuria
f. Haematuria
g. Nocturia
h. Hesitancy and terminal dribbling if male
i. Poor stream
j. Incontinence
k. Back pain, leg weakness, weight loss, anorexia
l. Vaginal/ urethral discharge
m. Genital sores
n. Testicular masses, testicular pain
o. Sexual dysfunction
p. Sexual contacts
7) Malignant renal tumor - establishes history of night sweats, dull loin pain, swelling
8) Nephrotic syndrome- establishes history of poor urine output for several days, associated
history of exertional dyspnoea, previous cardiac history and symptoms, any drug treatment.
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