OSCE MASTER SHEET MPHARM1

HISTORY TAKING NICE TRAFFIC LIGHT SYSTEM

EYES RED EYE CONJUNCTIVITIS BLEPHARITIS DRY EYE HORDEOLA / STYE

EARS OTITIS EXTERNA OTITIS MEDIA IMPACTED EAR WAX

RESPIRATORY COMMON COLD FLU (INFLUENZA) COUGH RHINITIS SORE THROAT

PAEDIATRICS FEVER CHICKEN POX TEETHING COLIC HEADLICE ORAL THRUSH THREAD WORM NAPPY RASH

DERMATOLOGY DERMATITIS (ECZEMA) RINGWORM ATHLETES FOOT IMPETIGO SCABIES WARTS & VERRUCAE

GASTRO INTESTINAL COLD SORES MOUTH ULCERS DYSPEPSIA CONSTIPATION IRRITABLE BOWEL SYNDROME HAEMORRHOIDS

WOMEN'S HEALTH CYSTITIS VAGINAL CANDIDIASIS DYSMENORRHOEA

NERVOUS SYSTEM MIGRAINES INSOMNIA TRAVEL SICKNESS

Title

• PC - Presenting Complaint
• HPC - Hist
• PMH - Past Medical History
• DH - Drug History
• FH - Family History
• SH - Social History
• O/E - Concerns

Guide

• Wash hands regularly
• Avoid sharing towels, pillows, facecloths
• Clean the contaminated area daily
• Clean clothes, bed linen, towels daily and dry thoroughly

Questions

• Why do you need to check vital signs?
• Why do you need to check colour of any discharge?
• Why do you need to take a specific drug history?
• What specific questions for social and family history are relevant in an ear complaint history taking?
• Why do you need to aask if pain radiates to pinna/jaw?
• Why do you need to ask about recent upper respiratory tract infections?

Red Eye

• Cause: Red eye can be due to infection (conjunctivitis), allergies (hayfever), contact lens overuse, bad hygiene, or prolonged screen time.
• Redflags: Severe pain, vision loss, and failed treatment.
• Symptoms: Redness of the eye, watery discharge, itchiness and burning.
• Treatment: Avoid contact lenses, avoid rubbing eyes, keep eyes clean. Eye drops can be given.
• Differential Diagnosis: Check for conjunctivitis (yellow discharge, crust or eyelids sticking together).

Conjunctivitis

• Cause: Conjunctivitis can be due to allergies or a bacterial / viral infection of the eye.
• Redflags: Vision loss, eye pain, photophobia, swelling of the face, HSV, reaction to medicine.
• Symptoms: Symptoms can vary depending on the cause:
  • Bacterial: Unilateral or bilateral smelly yellow discharge, sticking together, crusty.
  • Viral: Unilateral or bilateral watery discharge. Eyes will be red, itchy, crusty.
  • Allergic: Bilateral, eyes are bloodshot and gritty, watery discharge. Sneezing.
• Treatment: Depends on cause:
  • Bacterial: Bathe eyelids in water, should resolve within a week. Chloramphenicol eyedrops can be given and used for 5 days. If no improvement within 48hours, come back.
  • Viral: No pharmacological therapy. Bathe eyelids in water, cold compress, do not wear contact lenses. Will resolve within 1-2 weeks.
  • Allergic: May change contact lenses. Cool compress and do not rub eyes. Sodium cromoglicate eye drops.
• Differential Diagnosis: Make sure the right conjunctivitis is found.

Blepharitis

• Cause: Chronic condition where eyelids become inflamed.
• Redflags: Very swollen eyelids, systemic symptoms, suspect eczema, HSV.
• Symptoms: Eyelids burn and stick together, itchy with flaky debris, both eyes affected. Conjunctivitis can be present. Very red and inflamed.
• Treatment: Good eyelid hygiene regularly (even without symptoms), eyelid bath with baby shampoo. Warm compress for 10 minutes. Eye make up can exacerbate.
• Differential Diagnosis: Stye

Dry Eye

• Cause: Dry eyes can be due to computer overuse, allergies, or structural damage.
• Redflags: Eye pain, photophobia, pupil distortion. Reaction to contact lens.
• Symptoms: Dryness, grittiness, sore, irritation, burning sensation. Both eyes are affected and can water. Eyelids can stick together when waking up.
• Treatment: Different contact lenses, reduce computer usage. Dry eye drops / spray.
• Differential Diagnosis: Conjunctivitis (check for any discharge), Blepharitis (eyelids often stuck together)

Hordeola/Stye

• Cause: Bacterial infection of the eyelid.
• Redflags: Large & painful, very swollen eyelids, HSV infection, persisted for a few days.
• Symptoms: Swollen bump on eyelid. Pus filled spot which is sore to touch on eyelash follicle.
• Treatment: Resolved after a few days. Warm compress 5-10 mins, 3-4 times daily. Do not puncture. Do not use contact lenses.
• Differential Diagnosis: Blepharitis (red and itchy)

Otitis Externa

• Cause: Inflammation of the external ear canal, due to bacterial infection.
• Redflags: Child, perforated ear drum, fever, cellulitis, smelly discharge (perforated), excessive swelling, pain in jaw/sinuses/teeth, watery discharge (CSF).
• Symptoms: Ear pain, itching, discharge, tender pinna. Ear canal and external ear become red and swollen (looks like eczema), and hearing loss.
• Treatment: Keep ears clean and dry, acetic acid OTC.
• Differential Diagnosis: Otitis Media (red and bulging TM) , Eczema.

Otitis Media

• Cause: Inflammation of middle ear, due to bacterial infection.
• Redflags: No improvement within 3 days. Severe systemic infections. Suspected meningitis (blotchy rash, high fever, vomiting, stiff neck, confusion).
• Symptoms: Earache (pulling ear), fever, congestion, cough, running nose. Tympanic membrane red and bulging.
• Treatment: Lots of fluids and rest
• Differential Diagnosis: Otitis Externa (discharge)

Impacted Earwax

• Cause: Build up of wax.
• Redflags: Perforated ear / TM, ear surgery, treatment failed, severe pain, vertigo.
• Symptoms: Hearing loss, discomfort, pain, tinnitus, itchiness
• Treatment: Soften ear wax drops (olive oil, sodium bicarbonate). Irrigation / micro suction
• Differential Diagnosis: Otitis Externa (discharge), Media (Red and bulging)

Common Cold

• Cause: Viral infection of upper respiratory tract.
• Redflags: Chronic conditions, shortness of breath, chest pain, wheezing.
• Symptoms: Sore throat, hoarseness, congestion, sneezing, cough, headache, mild fever.
• Treatment: Good hygiene, infection control, fluids (warm) + rest, steam inhalation, analgesia (paracetamol, ibuprofen), antihistamines, decongestants (ephedrine).
• Differential Diagnosis: COVID (loss of taste), Flu (high fever, fatigue), Infection (severe sore throat, high fever, no cough, crackles on lungs)

Flu (Inlfluenza)

• Cause: Viral infection of upper respiratory tract.
• Redflags: Chronic conditions, diabetes, pregnant, meningitis (blotchy rash, stiff neck, confusion), shortness of breath, chest pain, prolonged symptoms, recently travelled.
• Symptoms: Circulating in community, rapid onset, sore throat, high fever, fatigue, weakness, headache, cough, insomnia, eye pain.
• Treatment: Can take several weeks, infection control, fluids + bed rest (no work), treat symptoms (analgesia, warm fluids, steam inhalation, decongestants).
• Differential Diagnosis: Common cold (congestion), infection (crackles on lungs).

Cough

• Cause: Symptom of respiratory tract infections.
• Redflags: Shortness of breath, wheezing, chest pain, chest tightness (suggests lower RTI / bronchitis). Phlegm is green, fever, breathlessness (suggests pneumonia).
• Symptoms: Chesty (phlegm produced), Dry (no phlegm, tickly, non productive).
• Treatment: Hydration, avoid smoke/ dust. Resolves within 3 weeks.
  • Chesty: Robitussin syrups, glycerol (calpol)
  • Dry: Cough suppressant (robitussin), codeine, sedating antihistamines, demulcents (cough sweets to soothe irritation), warm fluids.
• Differential Diagnosis: See red flags.

Rhinitis

• Cause: Inflammation of nasal membrane due to allergies or irritants.
• Redflags: Pregnancy, infection (cough, fever, discharge), drug induced.
• Symptoms: Nasal (sneezing, itching, congestion), Eyes (itching, redness, swelling).
• Treatment: Avoid irritants, use masks, saline wash, antihistamines, corticosteroid spray.

Sore Throat

• Cause: Lower RTI due to common cold, influenza, or bacterial infection (streptococcus).
• Redflags: Bacterial infection (swollen lymph glands, fever, no cough), prolonged fever, fatigue, no improvement after 1 week, difficulty breathing, severe pain. Tonsillitis, scarlet.
• Symptoms: Sore throat
• Treatment: Sucking lozenges, frozen desserts, avoid hot drinks (if strep), hydration, analgesia, gargle salt water.

Fever

• Cause: body is fighting an infection.
• Redflags: Dehydrated, seizure, lost consciousness, non-blanching rash, meningitis (stiff neck, very fatigued), over 5 days, symptoms worsening. NICE traffic light system.
• Symptoms: body temperature above normal (>38ºC).
• Treatment: Dress to avoid overheating/shivering (light layers + room warm), drink fluids, monitor for a non-blanching rash,can give paracetamol (calpol).
• Differential Diagnosis: Meningitis (stiff neck, confusion, lethargic), Glandular fever (sore throat, large tonsils), Scarlet fever (cheeks flushed + hot to touch).

Chicken Pox

• Cause: Contagious bacterial infection
• Redflags: Weeping, oozing, crusting, lethargy, low urine output, immunocompromised.
• Symptoms: Small red spots on body, quickly develop into itchy vesicles.
• Treatment: All spots crust in 7days, crusts fall off within 2weeks. Drink lots of fluids, keep nails short, non infectious after all lesions have crusted over. Calamine lotion.

Teething

• Cause: First teeth emerging through gums.
• Redflags: Systemic illness (high fever, distressed, prolonged symptoms)
• Symptoms: Pain, biting, drooling, sucking, decreased appetite, less sleep.
• Treatment: Massage the gums, chilled teething ring, calpol for pain, teething gels (not adult).
• Differential Diagnosis: Otitis Media (ears are red, TM bulging), UTI (diarrhoea, smelly urine).

Colic

• Cause: No cause found.
• Redflags: Infant is unwell, 4months+, anxious parent.
• Symptoms: Healthy but recurrent prolonged crying, fussing and irritability with no cause.
• Treatment: Resolves before 6mo old. Reassure it is common. Warm bath, white noise.

Headlice

• Cause: Insects which nest on human scalp and suck blood.
• Redflags: Treatment failure. Secondary infection (weeping, oozing, crusting)
• Symptoms: Live lice visible (combing). Itchy scalp. Class / family have lice.
• Treatment: Resolves in 7days. Hedrin 4% lotion to dry hair is the best treatment.
• Extra: Presence of eggs only does not mean live lice or treatment failure. Detection combing can be on dry or wet hair.

Oral Thrush

• Cause: Fungal infection of the mouth.
• Redflags: Immunocompromised (age, diabetes, pregnant)
• Symptoms: Pain, loss of taste, white patches on cheeks / gums / tongue.
• Treatment: Oral hygiene, Miconazole gel applied to mouth.

Thread Worm

• Cause: Tiny worms which infect gut, spread from other people.
• Redflags: Treatment failure. Secondary infection (weeping, oozing, crusting)
• Symptoms: Long white worms noticed in feces, perianal itch.
• Treatment: Mebendazole given to all house members. Hygiene measures, shower every morning, separate towels, wash underwear, bed linen and clothes everyday, wash hands regularly, frequently disinfect toilet seat. Can go to school but be clean.

Nappy Rash

• Cause: Prolonged contact with urine and feces, aggravated by friction.
• Redflags: Inflammation or severe rash, signs of candidiasis (sharp redness)
• Symptoms: Red, irritated area in the nappy region.
• Treatment: Nappies with greater absorbency, do not wear nappies (air dry), bathe once a day, barrier cream (bepanthen), alcohol free baby wipes.
• Differential Diagnosis: Candidiasis (sharp redness).

Dermatitis (Eczema)

• Cause: Skin reacts to an allergen / irritant, becoming inflamed and itchy.
• Redflags: Severe dermatitis, secondary infection (weeping, oozing, crusting).
• Symptoms: Itchy red rash with vesicles. Allergic (Itching + Scaling), Irritant (Burning, stinging, well defined edges on areas exposed to irritant).
• Treatment: Avoid contact with irritants, avoid scratching, topical corticosteroid + emollients used. Emollients are appropriate for long term.

Ringworm

• Cause: Fungal infection of skin
• Redflags: Failed treatment, immunocompromised, secondary infection, multiple circles.
• Symptoms: Red circle patch, defined border around infection. Itchy.
• Treatment: Minimise cross contamination, clean area daily, topical antifungal, corticosteroids.
• Differential Diagnosis: Eczema, psoriasis.

Athletes Foot

• Cause: Fungal infection of feet.
• Redflags: Treatment fails, immunocompromised, extensive foot involvement.
• Symptoms: White, cracked, skin between the toes. Can be itchy, smelly and bleeding.
• Treatment: Minimise contamination. Terbinafine products (lamisil), if inflamed, a corticosteroid can be used.

Impetigo

• Cause: Common contagious bacterial skin infection.
• Redflags: Widespread impetigo, systemic symptoms, treatment fails.
• Symptoms: lesions appear around the nose and mouth.
  • Non-bullous: Lesions are vesicles which rupture (looks like “cornflakes”). Healing occurs without scars within 2-3 weeks.
  • Bullous: Lesions are fluid filled vesicles. Heals without scars within 2-3 weeks.
• Treatment: Good oral hygiene. Hydrogen peroxide 1% cream for 5 days.

Scabies

• Cause: Highly contagious - scabies mite burrows into skin, lays eggs, allergic reaction.
• Redflags: Immunocompromised, secondary infection, eczema, treatment failure.
• Symptoms: Itching, especially at night. Vesicles due to burrows are seen (finger webs, wrists, genitalia, head, neck, hand palms). Mite burrows are fine gray lines.
• Treatment: Wash clothes/towels, avoid contact with others, treat all family. Permethrin 5% cream is applied to cool dry skin. Sedating antihistamines. Apply on day 1, then again 7 days after on the whole body.

Warts & Verrucae

• Cause: Harmless skin growth due to a viral infection (HPV).
• Redflags: other type of wart, infants, immunocompromised, diabetic.
• Symptoms: Warts: Firm, raised, rough, black dots, cauliflower appearance on hands/knees. Verruca: Found on soles of feet, causes pain whilst walking.
• Treatment: Months to treat. Avoid contamination. Salicylic acid, petroleum jelly can help.
• Differential Diagnosis: Fungal infection (smelly), Corn (no black dots, painful under pressure).

Cold Sores

• Cause: HSV triggered by stress, illness, sun, or weak immune system.
• Redflags: Systemic infection (fever, nausea), genitals involved, extensive outbreak, pregnant, immunocompromised, sores spread to eyes.
• Symptoms: Prodromal phase (burning, tingling, itchy), lesions which crust within a few days and resolve within a week. No scars if not picked/squeezed.
• Treatment: Avoid trigger factors, do not share towels etc. Paracetamol for pain. Aciclovir only if early (prodromal phase)

Mouth Ulcers

• Cause: Minor trauma (biting/braces/hot food), stress, infections.
• Redflags: Ulcers last >3 weeks, painless ulcer, fever.
• Symptoms: Painful white sores with distinct red border, inside mouth. Discomfort eating.
• Treatment: Avoid trigger foods, hydrocortisone tablets in contact with ulcer (5 day treatment), benzydamine / chlorhexidine mouthwash.
• Differential Diagnosis: Oral thrush (white patches that wipe away)

Dyspepsia (Indigestion)

• Cause: Acid reflux, NSAIDs, spicy food, alcohol, stress, H. pylori infection.
• Redflags: ALARM, severe pain, vomiting, treatment failure, children, black stool
• Symptoms: Feeling full, nausea, belching, abdominal discomfort.
• Treatment: Healthy diet, exercise, avoid triggers, antacids (esomeprazole, gaviscon).
• Differential Diagnosis: GORD (acid reflux, heartburn), gallstones (post meal pain)

Constipation

• Cause: lifestyle (low fibre diet, dehydration, lack of exercise, stress), medications
• Redflags: Pain on toilet, sudden change in bowel habit, over 2 weeks, blood in stool.
• Symptoms: Infrequent and difficult defecation, bloating, feeling incompletely empty.
• Treatment: Increase fibre uptake, follow toilet routine, fluids, bulk forming laxative (fybogel).
• Differential Diagnosis: IBS (constipation + diarrhoea), hypothyroidism (fatigue)

Irritable Bowel Syndrome (IBS)

• Cause: Gut-brain interaction failure due to stress, diet, infection.
• Redflags: Blood in stool, fever, vomiting, severe pain, FMH of bowel disease.
• Symptoms: Abdominal pain relieved by defecation, change in bowel habits (frequency, formation), bloating, lethargy, headache.
• Treatment: Avoid triggers, improve diet, Peppermint oil, laxatives, anti-diarrhoea, or anti spasmodics.

Haemorrhoids (Piles)

• Cause: Increased pressure in rectal veins due to strain, pregnancy, sitting too long.
• Redflags: unclear diagnosis, severe pain, persistent bleeding, black stools.
• Symptoms: Bleeding after passing stool, itching, discomfort, pain, lump around anus, swelling, mucus discharge.
• Treatment: Increase fibre and fluids, avoid straining, topical creams (hydrocortisone), pain relief (paracetamol). Severe cases may need surgery.

Cystitis

• Cause: Inflammation of bladder due to infection from sex, tampon, wiping.
• Redflags: blood, more than few days, immunocompromised, children
• Symptoms: Need to pee lots, pain/burning during urine, cloudy/bloody urine which smells. Lower abdominal pain, nausea, tiredness.
• Treatment: Fluids, hot water bottle, no sex, paracetamol, cranberry juice, shower no bath
• Differential Diagnosis: Kidney infection (fever), chlamydia (discharge)

Vaginal Candidiasis

• Cause: Fungal infection from Candida, due to weakened immune system.
• Redflags: Under 16, Pregnant, Diabetic, severe infection, systemic (fever, nausea) suspected chlamydia (smelly grey discharge) /gonorrhoea (purulent discharge)
• Symptoms: Itchy, sore, irritation, thick white discharge, pain in sex/urinating
• Treatment: Avoid irritants & tight clothing. Clotrimazole (pessary) or fluconazole (tablet)
• Differential Diagnosis: STIs (abnormal discharge), dermatitis (irritation from soaps)

Dysmenorrhoea

• Cause: Painful periods due to uterine contractions. Primary vs Secondary (infection)
• Redflags: Irregular periods, smelly discharge, many blood clots, severe pain.
• Symptoms: Painful cramps in lower abdomen, spread to lower back and thighs. Headache, nausea, diarrhoea, tiredness, feeling faint.
• Treatment: Exercise, heat pad, ibuprofen (/paracetamol), contraceptive pill if severe.

Migraines

• Cause: Triggered from stress, alcohol, no exercise. Migraine hits when starting to relax.
• Redflags: Cluster headache, sore jaw, severe eye pain, meningitis (rash, stiff neck), confusion, poor balance. Lasts more than a few days. Sudden pain.
• Symptoms: Change in mood, one sided pain, pulsating pain, nausea, photophobia, see zig zags / flickering lights.
• Treatment: identify triggers (diary), eye test needed, simple analgesia (paracetamol/ ibuprofen), sumatriptan if migraine confirmed, prochlorperazine (for nausea)

Insomnia

• Cause: Stress, anxiety, depression, poor sleep hygiene, caffeine/alcohol use.
• Redflags: Sudden severe sleep disturbances, excessive daytime sleepiness, hallucinations, sleep apnoea(breathing difficulty), weight loss, neurological symptoms.
• Symptoms: Difficulty falling or staying asleep, waking up too early, feeling unrefreshed, irritability, difficulty concentrating, daytime fatigue.
• Treatment: Improve sleep hygiene (consistent routine, no screens before bed, avoid caffeine/alcohol, no heavy meals). Antihistamine (nytol, phenargen) short term, if still concerned see doc.

Travel Sickness

• Cause: Mismatch between visual input and inner ear balance signals. Common in cars, boats, and planes.
• Redflags: Persistent vomiting, dehydration, dizziness lasting beyond travel, severe headache, confusion, fainting, treatment failure.
• Symptoms: Nausea, dizziness, sweating, pale skin, increased saliva, headache, fatigue. Symptoms ease after stopping movement.
• Treatment: Sit in the front seat or face forward, keep eyes on the horizon, improve ventilation, stay hydrated, and eat light meals. Hyoscine (4hr journey) / Cinnarizine, Promethazine (sedating, longer term)