Headache OSCE Year 4

Headache OSCE Year 4


welcome to our year four OSCE training
material these OSCE videos have been produced to help here for students with
their performance during their examination these videos have been
created by the department of medical education and our authentic eight-minute
OSCE stations these videos demonstrate a good passing student but feedback will
be given to all students within the video on how they can improve their
performance this station is the pediatric station and it is important to
use the time that you have 90 seconds to read your candidates instructions fully
you will have a piece of paper with the candidate instructions on the floor
please use that and it is a good idea to think about the targeted questions that
you want to ask to the mother of a twelve-year-old who is having recurrent
headaches start to think about the possible differential diagnosis and what
questions might lead you into the different diagnosis you can underline
key features such as the headache and the fact that this child is 12 you can
also note down some questions that you don’t want to forget to ask
start station hello is mrs. Joe yes hello I’m Elizabeth cross I’m one of the
four key medical students from brightness are six medical school so are
you here to talk about sound Jones your little boy yes yes so George told me he
was worried that these really bad headaches okay and when did they start
start about six weeks ago okay and do they come on at any particular time of
the day no just kind of doing the daily during the day and how long would they
last for sometimes giving several hours to three hours okay and did he say
particularly where he feels the headaches and his head not specifically
no justice in his head okay and you say that they move anywhere into his neck
and as he said that anything makes them a lot worse okay and he said that makes
them better at all no no so he as he trying medications are sort of
painkillers I tried to be a cow pool but no he tends to be sick and throw that
outside I think it’s really working okay and does he does he always get the
sickness with the headaches you should yes does he always warm it yeah he
usually does woman and then the headache gets better he says okay and does a
report that they ever get worse was bending down or lying down as they
report that they’re worse with coffee and as he forces any problem with his
vision he said he’s had some sort of spots in front of his eyes and I never
said the school will he has trouble seeing the blackboard from the back of
the class okay and the spots they get super high does he just get those with
the headache yes Russian response fashion sports okay and
and in the class we can’t see the blackboard yeah the back of classroom
like the back but if he moves to the front does he find that that’s better
yeah okay does he mean glasses at all tested while ago yes okay and they were
okay they were getting okay as he had knee problems with this sort of balance
at all no and if I’m gonna speak to anybody fourteen hearing problems no and
does he have any medical problems at all nobody’s generally fit and healthy
because of all these headaches okay well does he take any regular medications at
all no other than the Cal Poly are giving but it’s not working and is he
any allergies to anything and is other any metal forms around the family you
always bother give me headaches or anything like that I get I get migraines
and my mom gets migraines – okay and so he’s at school at the moment yes
yeah I just start a new school okay when did he stop but same time was the
headache start of it okay and how’s he getting on there he’s settling in just
about he’s a bit further to travel so he’s finding a little bit stressful I
think it’s a longer day okay as you had to miss any school no okay and do you
sort of have any ideas about what could be going on here why I’ve come to see
the GP okay and you particularly concerned about anything what does that
he’s not he’s been fine performance and he’s getting these headaches sorry and
is he had immunization yes yeah okay I think that’s all the
questions or minutes and so a full neurological examination is normal so
could you please explain your differential diagnosis to Simon’s mother
okay yes so from what you told me today about the headache and its associated
sorts of nausea and sickness and that he’s getting some visual problems of the
head akin and they knew yourself and your mother suffer from migraines and
you know this was Alma coincided with him starting school I think probably the
most likely diagnosis might be my migraine and another potential cause of
the headaches might be something that we call a stress headache or a tension
headache and as the name suggests that can come on when sort of people you know
start a new school and are quite stressed like it sounds he is at the
moment so I think they’re probably the most likely diagnosis from what you’ve
told me in the examination findings could you please explain to some other
away serious condition like a brain tumor is unlikely okay and so I think
that something quite serious like a brain tumor is very unlikely in this
situation mainly because the history that you’re giving is a very classical
history of a you know migraine or attention headache and some of them were
worrying symptoms that would be suggestive of brain she would aren’t
there in your son’s case and also his neurological examination just completely
normal which is very reassuring to and could you please explain to some mother
highly we treat son said yes so in in terms of treating they had taken if it
is a migraine or attention headache and some of the best way to treat it is what
we will call conservative management so that’s trying to avoid triggers for the
headaches in science considers remaining it might
be an you know the stress associated the new school so he might needed a little
bit more support settling in or piecing all his homework and things like that
and then if there’s any way with the traveling time I know it’s hard to avoid
a long commute but I mean maybe he needs to get to bed earlier to make up for any
lot of sleep and things like that yeah and then I mean things like staying well
hydrated things like that and then you can try simple painkillers as you have
been doing so it’s things like paracetamol and and if we find those
things aren’t working then there are other treatments we can consider to stop
the pain or to try to prevent the headaches from happening in the first
place there’s no further questions so the
feedback I would give this student regarding their performance on this
headache station would be that she gave a very good focused history around the
pain particularly looking but things that might trigger it things that made
it better she also asked questions around raised intracranial pressure such
as bending down and coughing she did explore the eyesight problem at school
but as you can see later on didn’t bring that into her differentials nor her
management it was good that she asked the mother about her own concerns and
worries about the possible diagnosis so when looking at the dike the
differential diagnosis the student came up with only two migraine and a stress
headache and I think it would have been appropriate in fact in view of the fact
that she actually gained that history to mention that possibly there were some
eyesight problems and that might have been the cause
the headache concentrating on the blackboard at school when she explained
to the mother the fact that a brain tumor was unlikely it might have been
helpful just to explain to the mother which symptoms went against a brain
tumor the fact that there wasn’t headaches in
the morning there was no headaches on bending down and on coughing her
management was very good in the fact that she started with conservative
management first and then moved on to possible medication so overall this was
a good performance from the student

Leave a Reply

Your email address will not be published. Required fields are marked *