Guidelines For Individually Assigned OSCE Case Studies ✓ Solved

A Guidelines For Individually Assigned Osce Case Studies

A. GUIDELINES FOR INDIVIDUALLY-ASSIGNED OSCE CASE STUDIES: 1. Student will develop and complete My Checklist and Patient Notes of assigned case scenarios per week using the templates for My Checklist and Patient Note which will be submitted in the Blackboard under Assignment Tab with heading OSCE case studies. 2. The completed My checklist and Patient Notes for all weekly-assigned case scenarios will be submitted on or before the given deadline. 3. All assigned case scenarios can be retrieved from Mastering the USMLE Step 2 CS Clinical Examination; Reteguiz (rd edition , ISBN-13: , the course supplemental reference material. 4. Assigned Case Scenarios: 1. 46-year-old woman complaining of fatigue and weight gain 2. 65-year-old woman complaining of hearing loss 3. 20-year-old woman complaining of a cough for 4 days 4. 25-year-old man complaining of a sore throat 5. 68-year-old man requesting pain medications 6. 50-year-old woman requesting a blood pressure check 7. 55-year-old man complaining of chronic abdominal pain 8. 48-year-old man with chest pain 9. 25-year-old woman with leg pain 10. 35-year-old man with a chronic cough. USE EACH OF THE ABOVE CASE SCENARIOS AS YOUR PATIENTS AND USE THE BELOW TABLE. FOR EACH PATIENT, WRITE YOUR NARRATIVE NOTES AFTER ENCOUNTERED WITH YOUR PATIENT Data Gathering (DG)/MY CHECKLIST: Chief Complaint: History of Present Illness.

The Examinee: Past Medical History: Family History: Social History: Review of Systems: Physical Examination. The Examinee: Communication Skills. The Examinee: Required elements/grading rubric of the Patient Note 1. Subjective: State the patient’s chief complaint, reason for visit and/or the problem for which the patient sought consultation. a. History of Present Illness includes detailed symptom description, past medical history, family history, social history, and relevant review of systems.

2. Objective: a. Using problem-focused examination evaluates pertinent systems and records findings. b. Performs appropriate diagnostic studies if available and records results of previous diagnostic studies.

3. Assessment: a. Diagnosis/es with pathophysiology derived from data b. Differential diagnoses with pathophysiology prioritized – (minimum of 3) c. Health risks/needs assessment.

4. Plan: a. Diagnostic studies with rationale b. Therapeutic treatment plan with rationale c. Determines appropriateness of care provider and necessary referrals d. Health promotion and community resources considered.

WRITE YOUR NURSING NARRATIVE NOTES ON YOUR SUBJECTIVE DATA GATHERED FROM THE PATIENT, PATIENT RESPONSE TO YOUR QUESTIONS, WHAT YOU OBSERVED, DIAGNOSTICS THAT YOU WILL ORDER AS NP, YOUR PLAN AND EXPRESS YOUR EMPATHY.

Paper For Above Instructions

In the context of the OSCE (Objective Structured Clinical Examination), each of the provided case scenarios represents a unique opportunity for students to engage with clinical practice through structured patient encounters. The following paper summarizes the responses for each assigned scenario by applying a consistent format across the cases, capturing subjective and objective data, assessments, and plans in a comprehensive manner.

Case 1: 46-Year-Old Woman Complaining of Fatigue and Weight Gain

Chief Complaint: Fatigue and significant weight gain over the past month.

History of Present Illness: The patient reports feeling excessively tired and has gained about 15 pounds unintentionally. She mentions that she has not changed her diet or exercise routine significantly. There are no associated symptoms like fever or acute illness. Her fatigue has affected her daily activities and work performance.

Past Medical History: Non-contributory, no significant illnesses reported.

Family History: Mother has a history of hypothyroidism.

Social History: Works in an office job, sedentary lifestyle, no tobacco use, occasionally drinks alcohol.

Review of Systems: No notable negatives except for fatigue. No chest pain, shortness of breath, or gastrointestinal complaints.

Physical Examination: General appearance is fatigued, thyroid examination is normal, no signs of lymphadenopathy detected, abdomen soft, no organomegaly.

Communication Skills: Patient was engaged and responsive. Demonstrated empathy by acknowledging her concerns.

Assessment: Possible hypothyroidism given family history and symptoms. Differential diagnoses include Depression, Cushing's syndrome, and Sleep apnea.

Plan: Order TSH and free T4 levels, discuss lifestyle changes, consider diet and exercise modifications, follow up after lab results.

Case 2: 65-Year-Old Woman Complaining of Hearing Loss

Chief Complaint: Hearing loss over the past six months.

History of Present Illness: The patient reports gradual loss of hearing, primarily in the left ear. Difficulty understanding speech, especially in noisy environments. Denies recent infections or trauma.

Past Medical History: Hypertension, managed with medication.

Family History: No significant hearing loss in the family.

Social History: Lives alone, retired school teacher, non-smoker.

Review of Systems: No dizziness, tinnitus, or ear pain.

Physical Examination: Ear examination shows normal external structures; tympanic membrane appears intact. Hearing tests will be performed.

Communication Skills: Patient was patient throughout the examination and asked pertinent questions.

Assessment: Presbycusis (age-related hearing loss) considered. Differential diagnoses include Earwax impaction, Otosclerosis, and Acoustic neuroma.

Plan: Refer to audiology for hearing assessment, educate on potential for hearing aids, follow up for a comprehensive evaluation.

Case 3: 20-Year-Old Woman Complaining of a Cough for Four Days

Chief Complaint: Persistent cough.

History of Present Illness: The patient has had a dry cough for the last four days, which worsens at night. No fever, but she feels mild fatigue. No exposure to sick contacts noted.

Past Medical History: No chronic conditions, up to date on vaccinations.

Family History: Non-contributory.

Social History: College student, non-smoker, does not consume alcohol.

Review of Systems: No other systemic complaints, denies chest pain or hemoptysis.

Physical Examination: Respiratory exam reveals clear lung sounds without wheezing. Throat appears mildly inflamed.

Communication Skills: Patient was articulate and engaged; rapport was established easily.

Assessment: Likely viral upper respiratory infection. Differential diagnoses include Allergic rhinitis, Bacterial pneumonia, and Asthma exacerbation.

Plan: Provide symptomatic treatment with cough suppressants, recommend fluids and rest, and advise to follow up if symptoms persist beyond a week.

Case 4: 25-Year-Old Man Complaining of a Sore Throat

Chief Complaint: Sore throat for three days.

History of Present Illness: The patient describes a sharp pain in the throat that worsens with swallowing. No cough or fever, but a slight headache has developed.

Past Medical History: No known allergies or chronic illnesses.

Family History: No relevant family history.

Social History: Works in construction; non-smoker.

Review of Systems: No significant negatives except for pain during swallowing.

Physical Examination: Mild erythema seen in the throat; no signs of exudate. Lymph nodes palpated and tender.

Communication Skills: Patient was nervous but relaxed after reassurance.

Assessment: Likely viral pharyngitis or streptococcal infection. Differential diagnoses include Infectious mononucleosis, Allergic reaction, and Gastroesophageal reflux.

Plan: Perform rapid strep test, provide throat lozenges, and discuss symptom management.

Case 5: 68-Year-Old Man Requesting Pain Medications

Chief Complaint: Chronic pain management.

History of Present Illness: The patient has chronic back pain post-injury five years ago, episodic exacerbations.

Past Medical History: Chronic lower back pain, hypertension.

Family History: No significant family history noted.

Social History: Retired, does not smoke or drink.

Review of Systems: Pain assessment 7/10; no neurological deficits noted.

Physical Examination: Tenderness in lower back, range of motion limited due to pain.

Communication Skills: Patient expressed concern for pain management effectively.

Assessment: Chronic pain likely musculoskeletal in nature. Differential diagnoses include Degenerative disc disease, Spinal stenosis, and Osteoarthritis.

Plan: Consider non-opioid analgesics, refer for physical therapy, and initiate pain management strategies.

Case 6: 50-Year-Old Woman Requesting a Blood Pressure Check

Chief Complaint: Routine blood pressure check.

History of Present Illness: The patient is concerned due to family history of hypertension. No current symptoms.

Past Medical History: No chronic conditions.

Family History: Parents both have hypertension.

Social History: Moderate exercise, non-smoker.

Review of Systems: Denies any cardiovascular symptoms.

Physical Examination: Blood pressure reading: 130/85 mmHg, within normal limits for age.

Communication Skills: Patient was receptive and asked relevant questions.

Assessment: Blood pressure within normal range, educational opportunity presented. Differential diagnoses are less applicable here.

Plan: Encourage lifestyle modifications, regular monitoring recommended.

Case 7: 55-Year-Old Man Complaining of Chronic Abdominal Pain

Chief Complaint: Chronic abdominal pain.

History of Present Illness: Patient reports persistent abdominal pain for several months. Pain is dull, located centrally, and improves with meals. No associated weight loss or changes in bowel habits.

Past Medical History: Gout, no surgical history.

Family History: Father had colon cancer.

Social History: No smoking, moderate alcohol intake.

Review of Systems: Denies nausea or vomiting. No hematemesis noted.

Physical Examination: Soft abdomen, tenderness in the epigastric region, bowel sounds normal.

Communication Skills: Open conversation led to thorough exploration of history.

Assessment: Likely peptic ulcer disease. Differential diagnoses include Gastritis, Cholecystitis, Pancreatitis.

Plan: Schedule for an upper GI series, educate about dietary changes.

Case 8: 48-Year-Old Man with Chest Pain

Chief Complaint: Chest pain.

History of Present Illness: The patient describes a squeezing sensation in the chest, worsened with exertion.

Past Medical History: Hypertension and hyperlipidemia.

Family History: Family history of heart disease noted.

Social History: Smokes occasionally, sedentary lifestyle.

Review of Systems: Examined for shortness of breath, which was not reported.

Physical Examination: Blood pressure 150/90 mmHg, EKG performed shows no acute changes.

Communication Skills: Patient was anxious, reassuring communication was conducted.

Assessment: Angina vs. myocardial infarction, requires prompt evaluation. Differential diagnoses include Pulmonary embolism, Aortic dissection, Gastroesophageal reflux disorder.

Plan: Refer to ER for further cardiac evaluation.

Case 9: 25-Year-Old Woman with Leg Pain

Chief Complaint: Leg pain after exercise.

History of Present Illness: The patient reports pain in her left leg only occurring after running.

Past Medical History: No major illnesses.

Family History: Non-contributory.

Social History: Fitness enthusiast, runs regularly.

Review of Systems: No swelling or redness observed.

Physical Examination: No edema, capillary refill was normal.

Communication Skills: Engaged predominately over physical activity history.

Assessment: Possible stress fracture or muscle strain. Differential diagnoses include Compartment syndrome, Peripheral artery disease.

Plan: Advise rest, possible imaging upon further assessment.

Case 10: 35-Year-Old Man with a Chronic Cough

Chief Complaint: Chronic cough for three months.

History of Present Illness: Patient describes a dry cough, worse at night, no hemoptysis, recent URI.

Past Medical History: Seasonal allergies.

Family History: No significant pulmonary history.

Social History: Ex-smoker.

Review of Systems: Negative for fever, chills, or weight changes.

Physical Examination: Lung sounds clear; throat and nasal passages are slightly inflamed.

Communication Skills: Patient expressed concerns effectively, engaging in dialogue.

Assessment: Likely post-viral cough. Differential diagnoses include Asthma, GERD, and allergies.

Plan: Recommend antihistamines, monitor and follow up in two weeks.

References

• Reteguiz, L. (Year). Mastering the USMLE Step 2 CS Clinical Examination. [Publisher].
• American College of Physicians. (2022). Guidelines for Management of Chronic Pain.
• National Institutes of Health. (2023). Diagnosis and Treatment of Common Respiratory Conditions.
• Mayo Clinic. (2023). Hypothyroidism Treatment: Changes in Care.
• American Academy of Family Physicians. (2021). Chronic Cough: An Overview of the Latest Guidelines.
• World Health Organization. (2022). Hypertension and Its Influence on Health.
• American Heart Association. (2023). Understanding Chest Pain and Heart Disease.
• Cleveland Clinic. (2023). Assessing Risk Factors for Heart Disease.
• U.S. Department of Health & Human Services. (2023). Chronic Pain Management Strategies.
• Centers for Disease Control and Prevention. (2022). Recommendations for Routine Health Screenings.