Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved. Page 1 BATES’ VISUAL GUIDE TO PHYSICAL EXAMINATION OSCE 1: Chest Pain This video format is designed to help you prepare for objective structured clinical examinations, or OSCEs. You are going to observe and participate in a clinical encounter of a patient who comes to the office with a complaint of chest pain. As you observe the encounter, you will be asked to answer questions while the image on the screen freezes. Such questions will allow you to practice history taking and physical examination skills as well as your clinical reasoning skills in developing an assessment or differential diagnosis and a plan—that is, an appropriate next diagnostic workup. You will have time to record your findings and receive feedback. Health History Tell me your special concerns today. I’m a little worried because I have been having sharp pains in my chest for the last two weeks. What findings might be important to look for as you observe this patient? Level of distress. Labored breathing. Skin color: central and peripheral cyanosis. Respiratory rate. Two weeks ago I was reading a story in the paper about a car crash, when I noticed sharp pains in my left chest. I was sweating and short of breath for about 5 minutes. And my heart felt like it was racing. What possible causes of chest pain are you considering? Angina. GERD. Panic attack. Musculoskeletal chest wall pain. Can you tell me how severe the pain was, on a scale from 1 to 10, with 1 being very faint and 10 being severe? Downloaded From: https://batesvisualguide.com/pdfaccess.ashx?url=/data/multimedia/ by a Molloy College User on 01/17/2020 Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved. Page 2 I was 5 over 10. Did it move into your neck or down your left arm? No, no it was just in my chest. How have you been since then? I’ve had two other episodes, one of them was about 10 days ago when I was lifting some books, the other was about 5 days ago when I was talking with my sister about our father’s death. He died 3 months ago in a car crash. Did you have any other symptoms when you had these chest pains? Yes, I had the same sweating and shortness of breath, with some light‐headedness during the most recent one. What was the level of pain? The same, about 5 out of 10 for about 5 minutes. Then the pain just went away while I was sitting there. I keep feeling so lost and panicked since my father died.