My OSCE learning points

My case for the prefinal dated on 01/12/2023, is a 60 year old woman with chief complaints of shortness of breath and cough since 10 days.

E-log link : https://89aishwaryamuttamsetty.blogspot.com/2023/11/a-75-yo-female-with-sob-and-cough.html

OSCE learning points :

1) I have learnt the differential diagnosis between bronchial and cardiac asthma. 

(Cardiac asthma - wheezing and sudden SOB associated with pink sputum, can never be able to do heavy work as before, associated with rales on auscultation. Occurs mainly due to left heart failure.)

(Bronchial asthma shows only white mucus on coughing, SOB and only acute exacerbations occasionally, with associated wheezing. Occurs due to bronchospasm, inflammation of the airways and excessive mucus production. Easily resolvable.)

2) I have learnt how metabolic syndrome, diabetes mellitus and obesity can invariably cause bronchial asthma.

3) I have also learnt the various biomechanisms related to adipokines causing reduced insulin sensitivity in the cells of the body.

4) Learnt to differentiate between rapid, short acting insulin ( clear in appearance), whereas NPH, which is an intermediate acting insulin, is cloudy in appearance (due to presence of buffers like Zinc and protamine)

5) Learnt the steps of management of asthma :

- beta 2 agonists (levosalbutamol, terbutaline) through metered dose inhaler.

- long acting beta 2 agonists (salmeterol, formeterol), anti cholinergics (Ipratropium bromide) through metered dose inhaler or nebulization.

- corticosteroids administered through nebulization ( budesonide).

- Intravenous administration of corticosteroids, which is the first and foremost important step in hospital related management (IV hydrocortisone or prednisolone).

6) I've also learnt the importance of following up the patient's diet plan post treatment, such as monitoring to make sure her diet has half a plate of fresh fruits and vegetables to combat obesity and associated insulin resistance.