OSCE and learning points

General Medicine

OSCE

1) Metabolic syndrome and cardiometabolic phenotype

Metabolic syndrome is a cluster of conditions that occur together , increasing the risk of heart disease, stroke and type 2 diabetes.

These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.

They typically have apple-shaped bodies, they have larger waists and carry a lot of weight around their abdomens (truncal obesity). 

2) Hb1AC testing and biochemical reaction for Hb1AC formation

Glycated haemoglobin is formed when a ketoamine reaction occurs between glucose and the N-terminal aminoacid of the β chain of hemoglobin. The amount of glycohemoglobin generated is proportional to the mean blood glucose during the 8–10 weeks before the test. Thus, the glycohemoglobin level  is a useful indicator of long-term blood glucose.

3) Insensible loss of fluid

It termed insensible as we are not aware of this fluid loss. It occurs through transepidermal diffusion where water passes through the skin and is lost by evaporation and evaporative water loss from the respiratory tract. Normal value is upto 800ml per day.

4) Edema vs Lymphedema

Edema:

Rapid onset

Bilateral, symmetrical 

Deep pitting

Shiny appearance of skin

Lymphedema:

Slow onset

Unilateral or bilateral but not symmetrical 

Non pitting or pitting that displaces with difficulty 

Thick skin

Positive stemmers sign (fold of skin at the base of second toe cannot be pinched and lifted).

Learning points

1) I learnt the clinical approach for diagnosing a disease.

2) About syncope and its causes

3) The importance of early identification of and screening of metabolic syndrome.

 

4) Role of insensible loss of fluid in causing dehydration and fluid electrolyte imbalances.