🩺 PA OSCE Structured Script – Clinical Assessment +

Communication Blueprint

👋 Introduction and Establishing Rapport

1. Knock on the door.

2. Greet the patient warmly:

"Hello! My name is Suraj, and I am a Physician Assistant student. I’ll be working with you today
to better understand your concerns and perform a physical exam. May I come in?"

3. Confirm identity and comfort:

o "Can I confirm your full name and date of birth?"
o "What name and pronouns do you prefer I use?"
o "Are you comfortable today? Do you need anything before we start?"
4. Hand Hygiene:

"I’m going to wash my hands before we begin to maintain hygiene and safety."

🧾 Chief Complaint & History of Present Illness (HPI)

"Let’s talk about what brought you in today."

 Chief Complaint:

"What seems to be the problem today?"

"Can you describe your symptoms in your own words?"

 OLDCAARTS Framework (clarify each element professionally):

o Onset: "When did this issue begin?"
o Location: "Where exactly do you feel it?"
o Duration: "Has it been constant or on and off?"
o Character: "How would you describe it — sharp, dull, throbbing?"
o Aggravating/Alleviating: "What makes it worse or better?"
o Radiation: "Does the pain move anywhere else?"
o Timing/Progression: "Has it changed over time?"
o Severity: "On a scale of 1 to 10, how bad is it now?"
o Associated Symptoms: "Any other changes — fever, nausea, dizziness?"

🧠 Systematic History

🔄 Past Medical, Surgical, and Family History

 "Do you have any chronic health conditions or past surgeries?"

  "Any hospitalizations, transfusions, or trauma?"
 "Are there any health conditions that run in your family?"

💊 Medications & Allergies

 "What medications are you currently taking, including over-the-counter or supplements?"

 "Any known drug, food, or environmental allergies? What reaction did you have?"

💬 Psychosocial & Mental Health

 "How have you been coping emotionally?"

 "Have you felt down, stressed, or had thoughts of self-harm?"

🏡 Social History

 Occupation, living situation, education, and transportation.

 Substance use:
o Tobacco: "Do you currently smoke or have you in the past?"
o Alcohol: "How often do you drink alcohol, if at all?"
o Drugs: "Any recreational or intravenous drug use?"
 Sexual history (if relevant):

"I ask everyone this — are you currently sexually active? Are there any concerns you'd like to
discuss?"

🛌 Lifestyle & Preventive

 Diet, exercise, sleep patterns

 Immunizations and screening tests

🔍 Review of Systems (ROS) (tailored to complaint but comprehensive for OSCE)

Ask yes/no questions for:

 General: Fever, weight loss, fatigue

 Cardio: Chest pain, palpitations, edema
 Resp: SOB, cough, wheeze
 GI: Nausea, vomiting, pain, constipation
 GU: Dysuria, discharge, LMP
 Neuro: Headache, weakness, numbness
 Psych: Anxiety, depression, sleep changes

🧪 Physical Examination

"I’d like to perform a physical exam to further evaluate your condition. I’ll explain each step as we go."

Standard Flow:
  Vitals: "Let’s start with checking your vitals — temperature, blood pressure, heart rate, and oxygen."
 General Inspection: Observe posture, alertness, distress.

For Cardiovascular System:

 "I’m going to look and feel around your chest area now. Let me know if anything is painful."
 Inspection: Visible pulsations, cyanosis, edema
 Palpation: PMI, thrills

"I'm going to place my hand on your chest to check for abnormal vibrations."

 Percussion (if needed): For dullness/fluid

 Auscultation: S1, S2, murmurs

"You may feel my stethoscope — it might be a little cold. Please breathe normally."

 Special Tests:
o JVD: "Please turn your head to the left while lying at a 45° angle."
o Peripheral pulses: Rate, rhythm, symmetry
o Capillary refill: Nail beds

For Respiratory (if applicable): "Let’s check your lungs."

 Observe breathing pattern.

 Auscultation: "Take a deep breath through your mouth every time you feel my stethoscope."
 Percussion: "I’ll tap on your chest now to assess lung fields."

🧠 Clinical Reasoning & Next Steps

🧾 Differential Diagnosis

"Based on your history and exam, the possibilities include..."

 [List 2–3 based on complaint]

🧪 Recommended Testing

"I’d like to order the following tests to better understand your condition:"

 Labs
 Imaging (X-ray, ECG, echo, etc.)
 Specialized studies (if needed)

💬 Patient Education

"Let’s talk about what we’ve found and what the plan looks like moving forward."

 Name and explain condition in simple terms

 Use visuals or handouts if available
  Ask:

"Do you feel comfortable with this information?" "Do you have any concerns or questions I can
clarify?"

🚨 Red Flags / When to Seek Emergency Care

"It’s important you seek care immediately if you notice:"

 Sudden chest pain, difficulty breathing, fainting

 Worsening symptoms despite treatment

📅 Follow-Up Plan

 Reassess in 2–4 weeks

 Earlier if worsening
 Reinforce:

"Please don’t hesitate to call us if anything feels off or different."

✅ Closure

"Thank you for your time today, [Patient Name]. I appreciate your openness and trust. We’ll follow up after
your tests. Please reach out if anything changes or if you have questions."

"Would you like me to go over anything again?"

🧾 SOAP Note Template (Final Summary)

Subjective:

 CC, HPI (OLDCAARTS), ROS

Objective:

 Vitals, PE findings, diagnostics ordered

Assessment:

 Working diagnosis + differentials

Plan:

 Labs/Imaging
 Meds prescribed
 Education provided
 Red flag symptoms reviewed
  Follow-up timing

Signature:
Suraj Dhankikar, PA-S

Would you like me to deliver this in a Word or PDF format, or would you prefer it directly integrated with
your documentation system? I can also prepare checklists for different system exams (CV, Resp, GI, Neuro) if
helpful for OSCE prep.
🫀 Cardiovascular System Exam Checklist
🧍 General Inspection

 Assess for distress, cyanosis, pallor, edema

 Look for scars (e.g., sternotomy), chest wall abnormalities
 Observe JVD with patient at 45°

"I'm looking at your chest and neck area to see if there are any signs that might indicate fluid overload or poor
circulation."

✋ Palpation

 PMI (apex beat): 5th ICS MCL

 Heaves/thrills: Left sternal border
 Peripheral pulses: Radial, brachial, carotid, femoral, popliteal, dorsalis pedis, posterior tibial
 Capillary refill

"I’m going to place my fingers gently on your chest and feel your pulse in different places. This helps us check
circulation and heart function."

👂 Auscultation

 Auscultate heart sounds: APTM (aortic, pulmonic, tricuspid, mitral)

 Use bell & diaphragm
 Listen for murmurs, rubs, gallops
 Assess carotid bruits

"You’ll hear my stethoscope in a few spots—it might be a little cold. Please breathe normally while I listen."

🧪 Special Tests

 JVD: Measure at 45° with ruler

 Homan's sign: If DVT suspected
 Ankle-Brachial Index (if PAD suspected)

🫁 Respiratory System Exam Checklist

🧍 General Inspection

 Respiratory rate, use of accessory muscles

  Cyanosis, tracheal deviation
 Chest wall movement

"I’m observing your breathing pattern and chest movements while you breathe normally."

✋ Palpation

 Chest expansion symmetry

 Tactile fremitus (“say ‘99’” with hands on posterior chest)
 Tracheal position

"I’ll place my hands on your chest to feel the way air moves when you speak. Please say ‘99’ every time you
feel my hands."

🎯 Percussion

 Percuss anteriorly and posteriorly

 Compare bilaterally

"I’ll gently tap on your chest and back. This helps identify air, fluid, or solid areas in the lungs."

👂 Auscultation

 Listen to breath sounds (anterior, posterior, lateral)

 Use diaphragm; compare sides
 Ask for deep breaths through mouth

"Each time you feel the stethoscope, take a deep breath through your mouth."

🧪 Special Tests

 Egophony: “Say 'E'” → becomes 'A' in consolidation

 Bronchophony: “Say '99'” → louder in consolidation
 Whispered pectoriloquy

🍽 Gastrointestinal System Exam Checklist

🧍 General Inspection

 Observe abdominal shape, scars, movements, pulsations

  Patient supine, draped, with knees flexed

"I’m going to examine your abdomen now. Please lie flat and relax with your knees slightly bent."

✋ Palpation

 Light palpation: all 4 quadrants

 Deep palpation: check for masses or tenderness
 Liver edge, spleen, kidneys
 Rebound tenderness (Rovsing’s)
 Murphy’s sign (RUQ – gallbladder)
 McBurney’s point (appendix)

"Let me know if you feel any discomfort as I gently press around your belly. This helps localize any tenderness
or swelling."

🎯 Percussion

 General percussion of quadrants

 Liver span (MCL, right side)
 Splenic dullness (Traube’s space)

👂 Auscultation

 Bowel sounds (use diaphragm, RLQ first)

 Bruits: aortic, renal, iliac, femoral arteries

"I’ll listen to your abdomen now for any sounds coming from your intestines and blood vessels."

🧪 Special Tests

 Psoas sign: Raise leg against resistance

 Obturator sign: Rotate flexed hip
 Fluid wave/shifting dullness (ascites)
 CVA tenderness: Tap flank gently

🧠 Neurological System Exam Checklist

🧍 Mental Status
  Orientation (person, place, time)
 Memory, attention, language
 Abstract thinking (“What does ‘a rolling stone gathers no moss’ mean?”)

👀 Cranial Nerves (II–XII)

 CN II: Visual fields, fundoscopic exam

 CN III, IV, VI: EOM, pupils (PERRLA)
 CN V: Facial sensation, jaw clench
 CN VII: Smile, puff cheeks, close eyes tight
 CN VIII: Hearing (whisper/Rinne/Weber)
 CN IX/X: Say "ah", gag reflex
 CN XI: Shoulder shrug, head turn
 CN XII: Tongue movement

✋ Motor Exam

 Strength (0–5 scale): upper and lower limbs

 Tone: resistance to passive movement
 Pronator drift

"I’m going to check your muscle strength now. Please push and pull against my hands."

🔄 Reflexes

 Biceps, triceps, brachioradialis

 Patellar, Achilles
 Babinski (plantar reflex)

"I’ll gently tap to check your reflexes. Let me know if anything feels uncomfortable."

⚖️Coordination & Gait

 Finger-to-nose, heel-to-shin
 Rapid alternating movements
 Romberg test
 Observe gait: walk normal, heel-to-toe

"I’m assessing your balance and coordination. Please close your eyes and stand still. Now walk heel-to-toe
across the room."
🧪 Sensory Testing

 Light touch, pinprick, vibration

 Proprioception (big toe)
 Dermatomes (if relevant)

"Now I’m going to use this soft tool and this sharp one to test your sensation. Please tell me what you feel."
PA OSCE System Exam Checklists

Cardiovascular System Exam Checklist

General Inspection
 Look for distress, cyanosis, pallor, peripheral edema
 Inspect for chest wall scars or deformities
 Observe jugular venous distention (JVD) with patient at 45 degrees

"I'm observing your chest and neck to check for signs that may suggest heart or circulation issues."

Palpation
 Palpate PMI (5th ICS MCL)
 Check for thrills or heaves
 Palpate peripheral pulses (radial, brachial, carotid, femoral, popliteal, dorsalis pedis, posterior tibial)
 Check capillary refill

"I'll gently place my fingers to assess your pulse and check blood flow to different areas."

Auscultation
 Listen at APTM (Aortic, Pulmonic, Tricuspid, Mitral) locations
 Use diaphragm and bell
 Listen for murmurs, rubs, gallops
 Auscultate carotid arteries for bruits

"I'm going to listen to your heart sounds at different points. Please breathe normally."

Special Tests
 Measure JVD
 Homan's sign for DVT if indicated
 Ankle-Brachial Index if PAD suspected

Respiratory System Exam Checklist

General Inspection
 Observe respiratory effort, rate, accessory muscle use
 Inspect for cyanosis or tracheal deviation
"I’m observing how you breathe to assess for any difficulty or abnormal patterns."

Palpation
 Chest expansion (posterior and anterior)
 Tactile fremitus ("Say '99'")
 Tracheal deviation

"I'll place my hands on your chest and back. Please say '99' every time you feel my hands."

Percussion
 Percuss all lung fields, anterior and posterior
 Compare bilaterally

"I'll tap gently over your chest to detect any abnormal sounds suggesting fluid or air changes."

Auscultation
 Listen to breath sounds anteriorly, posteriorly, laterally
 Compare side to side

"Each time you feel the stethoscope, take a deep breath through your mouth."

Special Tests
 Egophony ("Say 'E'")
 Bronchophony ("Say '99'")
 Whispered pectoriloquy

Gastrointestinal System Exam Checklist

General Inspection
 Observe contour, scars, peristalsis, pulsations

"I’m inspecting your abdomen to look for any visible abnormalities."

Palpation
 Light palpation of all quadrants
 Deep palpation for masses
 Liver edge, spleen, kidney palpation
 Check for rebound tenderness
 Murphy's sign, McBurney's point tenderness
"I’ll gently press on different parts of your abdomen to check for tenderness or swelling. Let me know if
anything feels painful."

Percussion
 General abdominal percussion
 Liver span, splenic dullness

"I'll tap gently across your abdomen to listen for changes that help us assess organ size and detect fluid."

Auscultation
 Bowel sounds (RLQ first)
 Vascular sounds (aortic, renal, iliac, femoral)

"I'll listen to your abdomen for bowel activity and blood flow sounds."

Special Tests
 Psoas sign
 Obturator sign
 Fluid wave
 Shifting dullness
 CVA tenderness

Neurological System Exam Checklist

Mental Status
 Orientation (person, place, time)
 Short-term memory, concentration, language, abstract reasoning

"I'm going to ask you some quick questions to check your memory and thinking."

Cranial Nerves (II-XII)

 CN II: Visual fields, fundoscopic exam
 CN III, IV, VI: EOM, pupils PERRLA
 CN V: Facial sensation, jaw strength
 CN VII: Facial movements (smile, frown, close eyes)
 CN VIII: Whispered voice test, Rinne/Weber tests
 CN IX, X: Uvula elevation, gag reflex
 CN XI: Shoulder shrug, head turn
 CN XII: Tongue protrusion
Motor Exam
 Strength testing (upper and lower extremities)
 Tone
 Pronator drift

"I'm checking your muscle strength and coordination. Please push and pull against my hands."

Reflexes
 Deep tendon reflexes (biceps, triceps, brachioradialis, patellar, Achilles)
 Babinski response

Coordination
 Finger-to-nose
 Heel-to-shin
 Rapid alternating movements
 Romberg test

"I’m checking your coordination and balance. Please stand with your feet together and eyes closed."

Sensory Exam
 Light touch, pinprick, vibration, proprioception

"I'm going to touch different areas. Please tell me what you feel."
PA OSCE System Exam Flashcards (Condensed Version)

Cardiovascular System (CV)

 Inspect: Distress, cyanosis, edema, chest scars, JVD
 Palpate: PMI, thrills, peripheral pulses, capillary refill
 Auscultate: APTM areas, murmurs, carotid bruits
 Special: JVD measurement, Homan's sign, ABI

Respiratory System (Resp)

 Inspect: Respiratory effort, tracheal deviation, cyanosis
 Palpate: Chest expansion, tactile fremitus, tracheal shift
 Percuss: Anterior/posterior fields bilaterally
 Auscultate: Breath sounds (ant/post/lat), deep breaths
 Special: Egophony, bronchophony, whispered pectoriloquy

Gastrointestinal System (GI)

 Inspect: Abdomen contour, scars, pulsations
 Palpate: Light & deep quadrants, liver, spleen, Murphy’s, McBurney's
 Percuss: General, liver span, splenic dullness
 Auscultate: Bowel sounds, vascular bruits
 Special: Psoas, obturator, fluid wave, shifting dullness, CVA tenderness

Neurological System (Neuro)

 Mental Status: Orientation, memory, attention
 Cranial Nerves II-XII: Visual fields, EOMs, facial sensation/movement, hearing, gag reflex, shoulder
shrug, tongue movement
 Motor Exam: Strength 0-5, tone, pronator drift
 Reflexes: Biceps, triceps, brachioradialis, patellar, Achilles, Babinski
 Coordination: Finger-to-nose, heel-to-shin, RAMs, Romberg
 Sensory: Light touch, pinprick, vibration, proprioception
Pro Tips Before Exam:

 Always introduce yourself clearly and confirm patient identity.

 Explain each step before touching or testing.
 Reassure, instruct, and thank the patient throughout.
 Always assess both sides for symmetry!
 Wash hands before and after contact.

You’ve Got This! OSCE Excellence Awaits! 🚀📈

PA OSCE One-Page Printable Cheat Sheet

🩺 Cardiovascular (CV)

 Inspect: Cyanosis, edema, scars, JVD @ 45°

 Palpate: PMI, thrills, radial/carotid pulses, cap refill
 Auscultate: APTM w/ bell & diaphragm
 Special: JVD measure, Homan’s, ABI

🫁 Respiratory (Resp)

 Inspect: Effort, symmetry, cyanosis, tracheal shift

 Palpate: Expansion, fremitus (“99”), trachea
 Percuss: Compare sides ant/post
 Auscultate: Ant/Post/Lat (deep breaths)
 Special: Egophony (“E → A”), Bronchophony, Whispered Pectoriloquy

🍽 Gastrointestinal (GI)

 Inspect: Contour, scars, pulsation

 Palpate: Light + deep, liver, spleen, McBurney’s, Murphy’s
 Percuss: Liver span, splenic dullness
 Auscultate: Bowel sounds (start RLQ), aortic/renal/femoral bruits
 Special: Psoas, Obturator, Fluid wave, Shifting dullness, CVA tap

🧠 Neurological (Neuro)

 Mental: Orientation x3, memory

 Cranial Nerves: II–XII (visuals, EOM, face, hearing, gag, shrug, tongue)
 Motor: Strength 0–5, tone, pronator drift
 Reflexes: Biceps, triceps, patellar, Achilles, Babinski
 Coordination: Finger-to-nose, heel-shin, RAMs, Romberg
 Sensory: Touch, pinprick, vibration, proprioception

✅ KEY REMINDERS

 Introduce → Identify → Explain → Consent → Wash hands

 Instruct patient clearly: “Now I’ll…” / “Please…” / “Let me know if…”
 Always compare bilaterally & observe symmetry
 Thank patient & ensure comfort at end

GOOD LUCK — YOU’VE GOT THIS! 💪🧠🩺