AMC Clinical (Part 2 OSCE) cheat sheet

Open with an open-ended question ('What brings you in today?'), then use the patient's own words to guide the interview.

Use a structured framework: HPC (onset, character, radiation, associated symptoms, timing, exacerbating/relieving, severity), PMH, medications, allergies, FH, SH, ROS.

For pain, quantify severity with a 0–10 scale and ask about impact on function and sleep.

Screen for red flags: weight loss, night sweats, fever, bleeding, neurological deficit, or severe pain that wakes from sleep.

Ask about over-the-counter and herbal remedies, not just prescription drugs; adherence and side effects matter.

Assess social determinants: occupation, living situation, alcohol, tobacco, recreational drugs, and safety (e.g., domestic violence).

Use the 'ICE' mnemonic: Ideas, Concerns, Expectations about the illness.

For paediatric or cognitively impaired patients, obtain collateral history from a caregiver and document source.

Wash hands, introduce yourself, confirm patient identity and consent, and provide privacy before starting.

Use a systematic approach: inspection, palpation, percussion, auscultation; compare sides.

For cardiovascular exam: palpate pulses (rate, rhythm, volume), measure JVP, auscultate with bell and diaphragm at standard sites.

For respiratory exam: assess chest expansion, percussion note, tactile fremitus, and breath sounds including crackles, wheeze, or pleural rub.

For abdominal exam: inspect, auscultate before palpating, then palpate lightly and deeply; check for organomegaly and rebound tenderness.

For neurological exam: assess mental status, cranial nerves, motor (tone, power, reflexes), sensory, and coordination/gait.

Always examine the relevant lymph node basins and perform a rectal or pelvic exam when indicated by history.

Document findings objectively (e.g., '2 cm mobile, non-tender mass in left breast upper outer quadrant') and note patient comfort.

Generate a prioritized differential diagnosis (most likely, most serious, and treatable) before ordering tests.

Use pre-test probability and test characteristics (sensitivity, specificity, likelihood ratios) to interpret results.

Apply decision rules where validated (e.g., Wells score for DVT/PE, Centor criteria for streptococcal pharyngitis, Ottawa ankle rules).

For any abnormal result, ask: Does it fit the clinical picture? Could it be a false positive/negative? What is the next step?

Consider common things commonly and rare things rarely; age, sex, and risk factors shift probabilities.

State a working diagnosis with supporting and against features, and list what would change your mind.

Use 'diagnostic time-out': reassess if the patient fails to improve or develops new symptoms.

Document the reasoning: problem list, differential, and plan for further investigation.

Use shared decision-making: explain options, risks, benefits, and elicit patient preference.

Apply the 'teach-back' method to confirm understanding of instructions.

For medication counselling: name, purpose, dose, timing, common side effects, and what to do if a dose is missed.

Provide safety-netting advice: specific symptoms that warrant urgent review and how to access care.

Address lifestyle modification with concrete, measurable goals (e.g., 150 minutes/week moderate exercise, salt <5 g/day).

Use motivational interviewing (OARS: open questions, affirmations, reflections, summaries) for behaviour change.

Consider cost, access, and adherence barriers when prescribing; simplify regimens.

Document the management plan, follow-up interval, and referrals in the patient record.