Patient Centred Objective Structured Clinical Examination

 I am Saranya ,currently an intern posted in the department of General Medicine 

Greetings to all my readers

What can you expect out of this blog :

 This blog is an objectively structured clinical examination example based on a real time patient whom I got acquainted to , during my General Medicine rotational internship posting .

The essence of this is to assess the clinical competence by reviewing the case reports shared below and to discuss, understand the patient problems, the related pathophysiology ,the core pharmacology  needed to correct the dictation, and data analysis of patients so as to develop my clinical competency in comprehending clinical cases .

Instead of dealing with questions based on virtual case vignettes, this is a more close-to-real experience approach.

I shall at first share the link to the blog about the patient based on whom the OSCE questions shall be about

A quick glance through that blog would set the stage right to attempt the below stated questions :

Link : https://drsaranyaroshni.blogspot.com/2023/07/55-year-old-lady-with-difficulty-in.html

1.  

" As the Disease proceeds , the hand fails to answer with exactness to the dictates of the will " 

        -James Parkinson

Copyright of source Preserved

Image Credits : Reynolds-Finley Historical library ,University of Alabama ,Birmingham ( which preserves and showcases the original copy of the Essay written by James Parkinson in 1817 )

It has been more than 200 years since the first case of this disease had been documented , via a comparative study try to document the signs and symptoms which were talked about at that time ,and the ones which are considered in today's day, with highlight upon any new additions or any deletions and studies supporting the same.

2.

What all would you assess from a patient through his gait, appearance, body language and non verbal communication?

In other words , from the time the patient comes in through the doors of the physician's office till he/she sits himself on the chair and begins narrating his complaints ... what all clues can he/she already have given to your  " Clinician's eye " ?

 A video related to this case has been attached herein :

https://youtu.be/Equma9NCeCw

3. 

According to epidemiological data , what is the usual age of onset of Idiopathic Parkinson's Disease in an individual  ?

Onset at what age and less would  be considered as  Young Onset Parkinsonism ?

What could be the etiology in such cases ?

Reference to our patient : Our patient is a 55 year old , presented to us with complaints of difficulty in walking since the past 6 months.

4.

What all in the hand if the patient would guide more towards the diagnosis of Parkinson's Disease ? 

What activities would you ask the patient to show in order to gather more points proving your Diagnosis?

Drawing a tangent from this case , in general which all Systemic pathologies can be suspected by hand and nail findings ?

5.

What is the chemistry and balance of the neurotransmitters which get deranged in a patient of Parkinsonism ?

According to the above said pathophysiology , list out the rationale of the drugs which would be needed to correct the derangement 

6.

Though at first it may sound whack ,but a lot of research and documentation has already been done and is still on progess regarding certain Trained Dogs ,  and rarely some humans ,for instance Mrs.Joy Milne , a 72 year old Scottish lady  who can " smell" the Parkinson's Disease .

Attached herein , are a few studies and research articles regarding the same , review the literature ,analyze the data and state your opinion .

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6487465/

https://www.bmj.com/content/378/bmj.o2247

https://www.apdaparkinson.org/article/the-smell-of-parkinsons-disease/

7. 

As a good clinician, we should always have more of a holistic thinking whereby we can list out differentials which can lead to the presentation that our patient has and then narrow down to the final diagnosis.

This would prevent missing out on any of the possiblities.

Very much like what Sherlock Holmes says

 " Keep everyone in the suspect list , eliminate factors and what remains is the truth "

Out of the investigations listed herein , what all parameters if deranged would manifested with -

* Tremors

* Limb weakness

* Spasticity

* Lethargy 

* Incoherence

Write about them and their respective mechanisms to lead to the symptom.

8.

Treatment given to our patient.

Give a brief note about " on and off phenomenon " which is seen in patients after undergoing this therapy.  

According to recent evidence based studies, which are the other newly developed pharmacological molecules which help patients suffering from the "on and off phenomenon "

9.

Give a note about Tertiary level of prevention in Parkinson's Disease ( I.e Rehabilitation and Quality of Life Improvement in the patients ).

Several publications portray the role of  regular aerobic exercises in maintaining satisfactory neouroplasticity of the Basal Ganglia , " Mediterranean Diet " ,diets low on dairy ,alcohol , high in caffeine, helping in slower progression of the degenerative process;

REFERENCE:

 https://n.neurology.org/content/99/7_Supplement_1/42

Do you think adopting these measures in the mainstream treatment protocols along with more empathizing care giver models would ensure better outcome  or are these things which look good only on pen and paper with negligible practical worth   ?