OSCE Pertinent Positives and Negatives

GI Bleed pertinent negatives

CP, SOB, HA, fever, chills, cough, dizziness, lightheadedness, h/o GI bleeding, abdominal pain, back pain, hematochezia, melena or N/V/D

Kidney stone pertinent negatives

CP, SOB, HA, fever, chills, cough, dysuria, hematuria, frequency, flank pain or urinary retention. No other complaints.

Trauma (Falls)(10)

Height and duration of fall Surface Fallen upon Position pt found in Cause of fall LOC? Current LOC? +- Trauma Center Criteria +- NVD +- SOB +- C/P

Syncope (9)

How long did it last? Cardiac Rhythm Events leading up to event Pt ill recently? +- NVD +- SOB +- C/P LOC Blood Sugar

Cardiac Arrest (9)

Position Pt found in cardiac rhythm witnessed vs unwitnessed precipitating complaints pt down time +- Pulses +- rigor/lividity signs of trauma, od, airway, hypoglycemia DNR?

Psych (10)

Position pt found in +- hallucinations LOC +- trauma +- OD +- hypoglycemia Prior hx pupils normal mental status? Pt trying to harm self?

Syncope/seizure pertinent negatives

Prodromal chest pain, SOB, dizziness, lightheadedness or palpitations. Pt. denies any CP, SOB, HA, N/V/D, fever, chills, cough, visual changes, tongue biting, bowel/bladder incontinence or head injury.

CVA (15)

Progression and duration of symptoms Pt normal mental status LOC +- NVD +- SOB +- C/P Airway +- Neuro deficits +- facial droop +- trouble speaking +- trouble swallowing pupils Hx =grips equal blood sugar

Chest Pain pertinent negatives

SOB, HA, fever, chills, cough, N/V/D, diaphoresis, jaw pain, back pain, lower extremity pain/swelling, recent travel, recent surgery, recent prolonged immobilization. Pt denies experiencing any rippin or tearing sensation in the chest, back, abdomen or pelvis

Overdose (11)

What, when, how many, why ALOC? +- NVD +-SOB +-C/P +-Pupillary Status +- Track marks Respiratory Effort Cardiac Rhythm Blood Sugar +- Alcohol Hx of overdose

Siezure (14)

Witnessed? what did it look like and duration? Current LOC? +- NVD +- SOB +- C/P Hx of seizures? Pt on meds and compliant? Airway? Cardiac Rhythm Blood Sugar =grips and push/pulls +- Oral trauma +- Incontinence Pupillary status

Musculoskeletal pain pertinent negatives

fall, paresthesias, focal weakness, sensory deficit. Pt. w/ full ROM in affected extremity.

General Weakness (9)

# of events Time of events Duration of events and symptoms +- NVD +- C/P +- SOB Cardiac Rhythm Neuro Deficits Blood Sugar

Childbirth (11)

+- H20 Break H20 break clear? Need to bear down +- prenatal care +- complications expected Para/Gravida Expected due date length of contractions time between contractions multiple children? APGAR at 1 and 5 min

TIA/CVA/paresthesias/facial droop/speech changes/CIMS pertinent negatives

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ALOC (11)

AEIOU-TIPS Progression of deterioration cardiac rhythm +- trauma +- OD Pupillary Status +-NVD +-SOB +-c/p normal mentation? Blood Sugar

Vaginal Bleeding (7)

Amount of blood Duration Last Menstrual Period? +- Pregnancy and trimester? +- NVD +- C/P +- SOB

Diabetic (11)

Blood Sugar? Hx of Diabetes? Previous episodes? Is this episode similar? Pts current mental status Pts normal mental status Pt compliant with meds? Pt eaten today? What? +- NVD +- SOB Recent illness?

SOB pertinent negatives

CP, HA, fever, chills, cough, back pain, N/V/D, abdominal pain, lower extremity pain/swelling, recent travel, recent surgery, recent prolonged immobilization, hematochezia, melena, dizziness or lightheadedness

General Pertinent Negatives

CP, SOB, HA, fever, chills, cough, N/V/D, abdominal pain, dizziness or lightheadedness

Abdominal pain pertinent negatives- FEMALE

CP, SOB, HA, fever, chills, cough, N/V/D, changes in bowel habits, dysuria, hematuria, frequency, flank pain, or vaginal discharge

Abdominal pain pertinent negatives- MALE

CP, SOB, HA, fever, chills, cough, N/V/D, changes in bowel habits, dysuria, hematuria, frequency, flank pain, testicular pain or penile dicharge

Fall pertinent negatives

Chest pain, SOB, dizziness, lightheadedness, or palpitation. Pt. did not hit their head. Pt. denies any LOC, HA, fever, chills, cough, N/V/D, visual changes, neck pain, dysuria, hematuria, frequency, bowel/bladder incontinence or retention, abdominal pain,. Pt. denies other bodily pain or injury.

Trauma (Assault, GSW) (8)

Description of mechanism (type) +-LOC Duration of LOC Size and location of wounds Current LOC +-NVD +-SOB +-C/P

Burns (8)

Extent of burns (%) +- Inhalation injury MOI +- associated trauma +- evolving airway edema +- potential toxic exposure cardiac rhythm +- burn center criteria

Back pain pertinent negatives

Fall/trauma, chest pain, SOB, HA, fever, chills, cough, N/V/D, bowel or bladder incontinence/retention, saddle anesthesia, paresthesias, focal weakness, sensory deficit, gait dysfunction, hematuria or dysuria. No radiation of pain into lower extremities.

Epistaxis pertinent negatives

HA, dizziness, lightheadedness, fever, chills, cough, N/V/D, neck pain. Pt. DOES OR DOES NOT take Coumadin/Warfarin or Plavix.

Trauma (MVA)(9)

Head to toe Est speed of impact Extent of pax compartment steering wheel dash or windshield damage

C/P (8)

OPQRST +- SOB +-NVD Cardiac Rhythm +- home meds and effect Hx worse on inhale or exhale lung sounds

SOB (13)

PASTE sudden or gradual? Hx? +- c/p and which came first/worse +- ALOC +- home meds and effect +- NVD did pt wake up? how many word sentences +- peripheral edema better or worse? cardiac rhythms compared to past episodes?

Abd Pain (9)

PQRST ABD exam findings +- NVD +- SOB +- Pregnancy Last menstrual period +- Vaginal bleeding regular BM and urine? +- associated complaints