CRACK THE NAC

ACRONYM &NMEMONIC GUIDE TO THE

OSCE

Why an OSCE?
Medical OSCEs are designed to test your complete skillset as a physician. History
taking, physical exam, communication skills, professionalism, technical skills,
problems solving, clinical decision making, diagnosis, treatment, and management
are all tested.

How to prepare?
Well organized study methods, repetition, simulation, rehearsal are important
ways to prepare for the exam and increase confidence while lowering anxiety. It
is also important to be well versed in the format of the exam and the methods in
which you will be scored. The OSCE will test how you perform under pressure, its
important to remember that when under stress we do not rise to the challenge,
we fall to the level of our preparation and training.

Develop a system
When preparing for the exam it is important to prepare in the manner in which
you will be examined. Find a small notebook/pad and make notes based on cases
to help guide you. Even if you are simply talking yourself through scenarios alone
in the library it is important to make notes and rehearse as you were in the real
exam situation. Follow this system over and over again until it becomes second
nature, like breathing or walking.

The Acronyms of the OSCE

Weve laid out some simple and essential acronyms to help develop your system,
when you are reading cases begin to do your best to fill in these diagnostic tools
to help guide your study and identify any weaknesses in your knowledge.

HISTORY TAKING WITH ChLORIDE FPP

Character Location
Onset
Radiation
Intensity
Duration
Events associated
Frequency
Palliative Factors
Provocative Factors

Character: Can you describe the symptoms/pain/problem

Location: Where do you feel these symptoms/pain/problem?
Onset: When did this start? How did this start? Gradual? Quick?
Radiation: Does the problem/pain/symptom radiate to any other parts of the
body?
Intensity: How would you rate the problem on a scale of 1 to 10? How is it now?
Has it increased or decreased since onset?
Duration: How long has this been happening? Does it come and go? Acute?
Chronic?
Events associated: Have you had any associated events? Trauma? Review of
Systems with possible related problems?
Frequency: How frequent is this problem?
Palliative factors: Does anything make it feel better? Rest? Medications? Etc?
Provocative factors: Does anything make it worse? Activity? Food? Allergies?
Seasonal? Etc?

Differential Diagnosis with VITAMINS C

Vascular
Infectious
Traumatic
Autoimmune/Allergic
Metabolic
Idiopathic/Iatrogenic
Neoplastic
Substances and pSychiatric
Congenital

Physical Exam with IPPA

Inspection
Palpation
Percussion
Auscultation
Remember to comment on what you are inspecting, palpating, percussing,
auscultation, and what you are looking for when doing so.

SOAP
Subjective the case presentation/history
of present illness
Objective the findings, lab results, test
results, etc
Assessment based on the S and the O
your Dx and DDx
Plan - What do you need to do to confirm
diagnosis? What are the problems you need
to address with the patient?
Medical/Social/Legal?

Other useful Mnemonics

ABCDE Assessment of skin lesions asymmetry, border
irregularity, color variety, diameter, elevation and enlargement

BEANN Diabetic complications bugs, eyes, arteries,

nephropathy, nerves

DDUV Informed consent decision making capacity, disclosure,

understanding, volunteers

DDRRIIP DDx for urinary incontinence drugs, delirium,

restricted mobility, retention, infection, impaction (stone), polydipsia

ETHNICS for cross cultural communication Explanation of Sx

(by the patient) treatment (how they have treated it so far) healers
(who they have consulted previously) Negotiate (their options)
Intervention (medical/surgical) Collaboration (with patient, family,
religion, healer, etc) Spirituality (respect their beliefs and accommodate
to them)

FIFE Feelings (what do they feel is going on) Ideas (what are their
ideas about the problem this can help address concerns/worries as
well patients are often correct about their diagnosis) Function (how has
this problem affected their day to day function) Expectations (what do
they want done).

ImPAIRED For Mainia Impulsivity, pressured speech, activity

(increased), insomnia, racing thoughts, esteem, distractible.

SEADS for MSK inspection swelling, erythema, ecchymosis,

atrophy, deformity, skin changes

TEST CA for MSK palpation tenderness, effusion, swelling,

temperature, crepitus, atrophy

SIGE CAPS For depression Sleeplessness, interest, guilt,

energy, concentration, appetite, psychomotor, suicidal ideation

SPACED Lung Hx taking Smoking, shortness of breath on

expiration, sputum, pain, pigeons (other birds), asthma, cough, chest xray, exercise tolerance, environmental exposure, dyspnea