Hospital teaching

Ok, so this morning was our penultimate hospital teaching session before the OSCE, and we were taking history and examination from patients on the surgical floor. My patient was a nice old guy who had Parkinson's and a history of prostate cancer, cataracts, atrial fibrillation (irregular heart beat) and probable bleeding from his 'back passage' which he was going to have laser'd. So this was all going ok, and I did the examination.

Come feedback time, we were all critiqued for not examining every system, not probing harder, not doing a full systemic enquiry - I don;t know if we have become to OSCE oriented that we try to do all histories in 5 minutes, and have parred each examination to the minimum.

We then had a masterclass on Jugular Venous Pulses (JVP)
starting with the normal pulse, and the items we need to describe about each pulse:

• Rate
• Rhythm
• Strength
• Volume
  
• Character
• Collapsing
• Can you feel the vessel wall?

When it came to JVP, we had to list all the ways to increase the JVP so you can tell that it is the JVP that you are seeing:

• Tilt patient's bed backward so they are lying at nearer 30 degrees than the recommended 45 degrees.
  
• Compare timing of breathing (JVP is higher on expiration)
• Look for bi-phasic nature of pulsation
• Increase pressure my pressing on abdomen over liver
• Check for landmarks - the two heads of sternocleidomastoid, carotid artery, external jugular vein

All in all it was a good session. This afternoon's PBL had a distinct end of term feel about it, with references to Crufts, prostatic discharges and revision avoidance tactics. But hey thats what you get for studying at *****************.