Makindo Medical Notes

Related Subjects: |OSCE Eye Exam |OSCE Ear Exam |OSCE Abdominal Exam |OSCE Ascites Exam |OSCE Jaundice Exam |OSCE Testicular Exam |OSCE Inguinal Exam |OSCE Upper limb Neurology |OSCE Lower limb Neurology |OSCE Face Neurology

🟡 Clinical Pearl: Always be ready to suggest differentials and investigations. First-line tests 👉 LFTs, bilirubin, FBC. Imaging 👉 Abdominal ultrasound. In older patients with pronounced jaundice: – Painful jaundice → gallstone in CBD (choledocholithiasis). – Painless jaundice → cancer of head of pancreas (classic exam favourite). 🛠️ Management: ERCP for stone removal or stenting for obstruction.

👋 Introduction

• 🧼 Hand Hygiene: Wash your hands before beginning.
• 🙂 Patient Introduction: Introduce yourself, check name & DOB, explain the exam.
• 📝 Consent & Privacy: Gain consent, ensure good lighting & dignity with drapes.
• 📖 Context: Jaundice = yellow discoloration of skin/sclera from raised bilirubin due to liver, biliary, or haemolytic pathology.

🧰 Equipment Needed

• Gloves
• Good natural/artificial light (pen torch if needed)
• Towel or drape for dignity
• Stethoscope (if extending into abdominal exam)

📚 Background Information

🪜 Examination Steps

• 👀 General Inspection:
  • Look for cachexia (malignancy/alcoholism), jaundice in face/skin, spider naevi, palmar erythema, dilated veins.
  • Check hands for clubbing, nails for leukonychia (chronic liver disease).
• 👁️ Eye Examination: Inspect sclera for yellow discoloration (scleral icterus) – usually seen before skin changes.
• 👄 Mucous Membranes: Look under tongue & inner cheeks for yellowing – useful in darker skin tones.
• 🩺 Focused Abdomen:
  • Palpate RUQ → hepatomegaly/tenderness.
  • Percuss liver span, check for splenomegaly/ascites.
  • Cancer → hard irregular liver, Ascites → advanced cirrhosis/obstruction.
• 📋 History Adjunct:
  • Urine colour (dark) + stool colour (pale) = obstructive.
  • RUQ pain/fever = cholangitis/stone.
  • Painless jaundice + weight loss = pancreatic malignancy.

✅ Closure

• Thank patient, allow to redress, maintain dignity.
• Explain findings: “You appear jaundiced — we would need to do blood tests and imaging to find the cause.”
• Wash hands, document findings clearly.

⭐ Key OSCE Points

• Always examine in good light.
• Look at sclera and mucous membranes first (early jaundice signs).
• Systematic: General → Eyes → Skin → Mucosa → Abdomen.
• Be ready to suggest investigations + management (LFTs, US, ERCP).

🚫 Common Pitfalls

• Examining in poor light → missing subtle icterus.
• Not checking mucous membranes (can miss early jaundice).
• Rushing → skipping abdominal exam.
• Not correlating with systemic signs of liver disease.

📚 References

• Clinical Examination by Talley & O’Connor
• Geeky Medics OSCE Resources
• OSCEstop – Online practice stations