MEDICINE STATION M1 History Taking Station - Mans Example M… · MEDICINE STATION M1 History Taking Station QUESTION Resources needed ... 2- Put the patient at ease, let him to lie

OSCE DATE ??/??/201?

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MEDICINE STATION M1

History Taking Station

QUESTION

Resources needed

One examiner Simulated patient (M/F, 20 - 30, Egyptian)

Paper and pens if students wish to make notes

Setting up the station

Examiners’ chairs should be positioned so that they can observe faces of both candidate and simulated patient.

No desk or table is necessary. If one is present, it should NOT form a barrier between the candidate and the patient.

DIAGNOSTIC HISTORY

INFORMATION FOR SITE ORGANISERS


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M1 – Instructions to the Role Player (Simulated Patient)

Patient’s name ------------------ Question 1 Setting Medical Ward Gender -----

Timing 8 minutes Age 20-30 years

Who are you?

You a faculty students (Arts)

You do not smoke

You are unmarried and you live with your parents

Your mood is anxious

You are generally quite easy to talk to

You are diabetic for thirteen years.

CURRENT HEALTH PROBLEM (COMPLAINT)

7 days ago you developed high temperature 39ºC in addition to burning micturition. You felt progressively weak and unwell

2 days ago you had severe abdominal pain, that nothing could relieve it, developed vomiting, noticed rapid breathing and your parents noticed a strange odor in your breath

You were taken to the emergency room, where blood tests were taken and frequent finger pricks for blood sugars were done. You were given some intravenous fluid and medications over the last 2 days that made you feel better.

BACKGROUND (PRESENT HISTORY):

Answer the relevant questions only when prompted by students

Diabetes was discovered in your early teenage when you passed much urine with excess thirst. You shortly felt extremely unwell with decreased consciousness and were admitted to hospital and received intravenous fluid and insulin. You were discharged after few days, on insulin shots twice daily before meals

You were advised to change the way of your life. You had to give up eating ice cream and chocolate also your family had to change their dietary habits to encourage you.

Now you are on Mixtard 100 IU using pen (which is better than syringe punctures) with dose 25 unites before breakfast and 15 before dinner.

You used to check your blood glucose at home; it usually ranges from 160-180 mg\dl

Sometimes you had palpitation, sweating and headache that may mean hypoglycemia, but you never had coma, which were relieved by sweets or sugary drinks

You have numbness and tingling in your feet

You had eye examination and urine analysis that were normal

Otherwise your health is OK

FAMILY HISTORY No family history of diabetes

You parents are alive and well


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MEDICATIONS Mixtard: 25 units before breakfast and 15 units before dinner

For the last week: Paracetamol and Antibiotics for urine infection

No allgery

FEELING AND CONCERN You heard of and saw patients with diabetic complications like amputations of legs, marked

problem with eyes, kidney disease, and you are afraid to follow the same track.

You are also disturbed very much with the attacks of hypoglycaemia that you sometimes encounter as it may lead to serious consequences

Previous Medical Problems

No significant past history of endemic diseases, operations or hospital admissions apart from

the once stated above.

If asked on anything not mentioned in the above scenario give a negative , neutral answer or

simply “I do not remember”

After ~ 6 minutes of the beginning, insist to ask the student as many questions as possible on:

Doctor, do you think I will have the silly complications of diabetes like amputations,

loss of vision and kidney failure?

How can I avoid the current acute problem in the future

Thank the student

STANDARDISATION ISSUES

As this is an exam, it is important to perform the same role time after time, and for Role Players to

perform the same role on different sites. All aspects of the script have been inserted for good

reasons. Please do not divert from the script. If confronted with questions outside the script, try to be

neutral or negative in your answer but be consistent with all the students. If there is any query of

uncertainty, please take the advice of the examiner on your station before meeting the students.


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M1 – Instructions to student

This is an 8-minute station. It is set in the Medical Ward. This is ---------------------

He/she, a known diabetic person, has come to the emergency complaining of 2-day of vomiting, fever and severe abdominal pain. The on-call registrar wants you to interview her first. In the next 8.0 minutes take a relevant history of the problem to try to reach a diagnosis. The patient is expected to ask you some questions on the last 2 minutes or so. Do your best to respond appropriately to the patients fear and queries.

The examiner will be monitoring you all the way around and appreciate your areas of excellence. Before your time is up make sure to tell the examiner about the diagnosis of the recent illness and what could be the precipitating factor in this patient.


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M1 – Instructions to examiner:

The Candidate has been given this information: This is an 8-minute station. It is set in the Medical Ward. This is ---------------------

He/she, a known diabetic person, has come to the emergency complaining of 2-day of vomiting, fever and severe abdominal pain. The on-call registrar wants you to interview her first. In the next 8.0 minutes take a relevant history of the problem to try to reach a diagnosis. The patient is expected to ask you some questions on the last 2 minutes or so. Do your best to respond appropriately to the patients fear and queries.

The examiner will be monitoring you all the way around and appreciate your areas of excellence. Before your time is up make sure to tell the examiner about the diagnosis of the recent illness and what could be the precipitating factor in this patient.

After 6.5 minutes, please give a 30 second warning to close the interview.

In the last minute, ask the candidate to mention the most likely diagnosis of the recent condition that directed him to the hospital and what was the precipitating factors, if not accomplished while talking with the role player.

The most likely diagnoses are 1. Uncontrolled diabetes – diabetic ketoacidosis precipitated by infection

probably urinary tract


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OSCE STATIONS M1

HISTORY TAKING

MARKING SHEET

STUDENT NAME----------------------------------------------------------------------- STUDENT ID

Conduct of examination TOTAL MARK: /4

Greets patient and introduces self ---/1

Putting patient at ease ---/1

Appropriate confidence and pace ---/1

Communication with the patient ---/1

History taking TOTAL MARK: /13

Structured, fluent technique ---/2

Covers all parts of the history ---/2

Covers relevant items in the history ---/3

Responds appropriately to patient concerns ---/3

Diagnosis and precipitating factors ---/3

Closing TOTAL MARK: /3

Checking understanding ---/1

Summarising ---/1

Explaining to the patient what happens next ---/1

GRAND TOTAL .........../20

Examinar's Name:........................................... Number..............................

Signature

SPECIFIC COMMENTS


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MEDICINE STATION M2(A) Clinical Examination Skill

QUESTION 2

Resources needed

One examiner Real patient with Hepatosplenomegaly

(M/F, 30-50 Yr, Egyptian) A bed for the patients preferable with an elevated head

A clean bed cover Paper and pens if students wish to make notes EXAMINATION GLOVES, WASHING FACILITIES OR ALCOHOL GEL


Examiner's chair should be positioned so that he can observe both candidate and patient.

A desk or a table is preferable, buy it should NOT form a barrier between the candidate and the patient.



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CLINICAL EXAMINATION SKILLS

Instructions to The Patient M2(A)

Use your own name and age

You are coming for a follow-up visit. You had a history of chronic liver

disease and you noticed that your abdomen is progressively enlarged and feel discomfort. You had seen doctors several times and you had blood tests and imaging carried out and you are maintained on some pills but

they did not help to make you completely well

The student will offer to examine you generally and your abdomen in particular

Obey his commands in lying on your back, bending you knees and taking deep breaths in and out when you are asked to do.

You may express inconvenience of pain if you feel so when the student

palpate your abdomen roughly There is no need to give the student any extra information about your

case.


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Instructions to the Candidate (Student) M2(A)

This is an 8 minute station.

It is set in a Medical Ward. This is a Real patient

He is a ~60-year-old male who has come for a follow-up visit. He has a

history, of chronic disease and noticed recently distension of his abdomen. His plasma albumin is low, liver enzymes normal and

prothrombin time mildly increased. He receives oral pills for the last 3 years

Your consultant wants you to perform appropriate abdominal inspection

and palpation to see if he has got abnormalities – in 6 minutes.

You will be presenting the findings to the examiner while you are doing the examination

then you should o Define the patient's major problem

o name 3 important investigations that should be performed for such condition


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Instructions to examiner M2(A):

This is an 8 minute station.

It is set in Medical Ward. This is a Real patient who will use his own name and age

THE PATIENT He is coming for a follow-up visit. He has a history of chronic liver disease

and he notices that his abdomen is progressively enlarging and feels

discomfort. It sometimes makes him breathless. He had seen doctors several times and he had blood tests and imaging carried out. He is maintained on some pills but they did not help to make him completely

well PLEASE EXAMINE THE ABDOMEN OF THE PATIENT BEFORE THE

FIRST STUDENT COMES IN AND CHECK THE CLINICAL SIGNS IN ORDER TO MARK THE STUDENTS’ PERFORMANCE

Stop the students if they overindulge in history taking or examination of different systems

The examiner is expected to be observing the student who should:

1- Approach the patient gently greats him and introduce himself asking politely for the

permission to examine the patient. He should state that the reason for the examination

is according to the consultant's orders.

2- Put the patient at ease, let him to lie down in the supine position, make sure that his

hands are clean and warm or warm them by rubbing; otherwise should apologise that

his hands are not warm enough. The abdomen is to be uncovered gently from the

suprapubic area to near the nipple line.

3- Watch the abdomen while the patient taking his normal breathing and while coughing;

looking at it tangentially from the right side and from caudally. He should ask the

patient to try to raise his head and trunk off the bed and notices divercation of the

recti abdominis muscles.

4- Superficial and deep palpation in the classic method

5- Palpation for the spleen, right and left hepatic lobes, sigmoid colon, kidneys and

masses in all areas of abdomen

6- After completing the examination the student should cover the abdomen and the

patient gently, thanking the patient that all has been done and responding to the

patient's comments or queries and stating that he would be reporting the findings to

the examiner to carry on necessary steps.

7- On commenting on inspection of the abdomen he should appreciate if the abdomen is

distended, diffusely or regionally, with full or empty flanks, the site and shape of the


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umbilicus and if there any pigmentation, scars or dilated veins, the distribution of hair

whether feminine of masculine, movement with respiration and its type, bulging at

sites of hernia orifices during coughing and divercation of recti when the patient tries

to raise his head, and lastly if there is superficial masses or visible peristalsis

Answers of the Questions

o The patient's major problem is ??Hepatosplenomegaly as a

complication of chronic liver disease. PS. If the student did not get the diagnosis, the examiner

should tell him the diagnosis in order to carry out the rest of the station for testing his knowledge

o 3 important investigations that should be performed for such condition

Blood biochemistry including liver function tests (bilirubin, enzymes, albumin, Pt/INR), P. Creatinine, electrolytes,

CBC to see if there is pan- or mono-cytopenia,

Alpha-feto protein to exclude hepatoma (HCC), Abdominal ultrasound to define anatomical and gross

pathological changes of the liver and the peritoneal cavity, to see if there are lesions suggestive of malignancy and to confirm the presence and nature of the ascitic fluid.

Liver biopsy in selected cases (probably not this case)


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OSCE STATIONS

CLINICAL SKILLS – M2(A)

MARKING SHEET

Student's Name .....................................................................

Student No.

Check Marks

Conduct of examination Total Mark: /4

Greets patient and introduces self (1) Putting him at ease (1)

Appropriate confidence and pace (1)

Communication with the patient during examination, asking for

permission to examin (1)

Clinical Examination Total Mark: /12

Uncovering the abdomen politely and appropriately at start of

examination (1)

Technique of inspection as detailed above (3)

Superficial palpation for tenderness & superficial masses (2)

Deep palpation for liver and spleen (4)

Confident presentation (2)

Closing Total Mark: /4

Covering the patient at the end of examination and thanking him for

cooperation (1)

Defining the problem of the patient (1)

3 important investigations for the case as detailed above (2)

Grand Total Total Mark: /20

Examinar's Name & Number:...................................................................

Ward....................... Date .......June, 2014 Signature

SPECIFIC COMMENTS FOR THE STUDENT:


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Data Interpretation Skills (Medicine) M3B DATA INTERPRETATION

Instructions to students-2

Data

Serum bilirubin: 6mg/dl, Direct 4.5 mg/dl

Serum Albumin: 2.6mg/dl,

AST: 168, ALT 122 IU, Alkaline Phosphatase 56 KAU (normal range 3-13)

Serum Na 125 mEq/L, Serum K: 3.4 mEq/L, S. Ca: 7.7 mg/dl

Serum Creatinine 1.9 mg/dl

Prothrombin Time 18 sec. (control: 12), INR 2.2

CBC:

Hb: 8.2 g/dl, RBCs: 2.900, PCV: 29, WBCs: 3.2 x109/cmm, Plts: 77.0 x109/cmm

HCV Ig (ELISA-III): +ve

HBsAg -ve

Anti HBc IgG: +ve

HBeAg: -ve

Anti HBe Ig -ve

Anti HBs Ig +ve


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Data Interpretation Skills (Medicine) M3B

Marking Sheet Student's Name: ................................................................................

Student No.

Data interpretation Summarizing the data and interpreting the results (0.5 marks each)

- Fluent summery, High bilirubin, High direct bilirubin, Low serum Album, High transaminases, High alkaline phosphatase, High serum creatinine, High Na & low K, Increased prothrombin time, Pancytopenia, +ve serology for HCV, -ve HBsAg while +ve HBsAb,

…………./4

Current status for HCV and HBV

- Active HCV infection while previous HBV infection now immune for HBV

…………./4

Appropriate diagnosis: - Active HCV infection. Immune for HBV. Cholestatic chronic

hepatits. Liver cell failure (execretory and synthetic functions impaired)

……/4

Appropriate next-step investigations (any 2 of the following):

- Abdominal ultrasound or CT. Alpha feto protein. Diagnostic paracentesis. Upper GIT endoscopy

……/4

Management Plan:

Conservative: salt restriction. K-rich diet. No role for interferon. Diuretics. IV albumin. Therapeutic paracentesis. Liver transplantation

……/4

Total marks for data interpretation /20

Examinar's Name & Number:...................................................................

Ward....................... Date .......June, 2013 Signature

Specific comments on the student:


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OSCE Station General Station M4A

A Clinical Examination Skills

Resources needed?

Patient:

O Real patient having diabetes mellitus for long duration -or a Role Played.

An examination couch, cotton wool pins and tuning forks. are needed with a clean cover, and preferably a box of rubber gloves


Timing 8 minutes

The couch should be positioned in such a way to allow the candidate to examine the ‘patient’ from the patient’s right side

Facilities for handwashing/alcogel should be available



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OSCE Station (General) M4A A Clinical Examination Skills

INSTRUCTIONS FOR STUDENT

This is an 8-minute station, set in the Medical Department.

This is (the real name of the patients)

He has been diabetic for more than 20 years

He complains of Numbness of his feet for the last few moths

The Consultant on charge wants you to perform the appropriate foot examination to evaluate

his case properly.

Please approach the patient and perform the appropriate foot examination in about 6

minutes. Present the important positive and negative findings to the exminer

The examiner will be watching while you are examining the case.


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INSTRUCTIONS to the PATIENT (Role Player)

Please note that you will be approached by medical students in their final

exams.

Each student may interact with you for around 8 minutes.

He is expected to examine your feet and ankles. So, be ready to take off

your socks when asked to do

For sure there will not be any painful, invasive or embarrassing procedure

during the examination.

Please cooperate with the students as much as you can but do not volunteer

to offer extra help or guidance.


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INSTRUCTIONS FOR THE EXAMINER

This is an 8-minute station, set in the renal department

The purpose is to test the examination skills of diabetic foot problems.

The patient has diabetic numbness in his feet.

The students has been given the following instructions:

This is an 8-minute station, set in the Renal Department. This is (the real name of the patient or role player) he has been diabetic for more than 20 years and complains of numbness of his

lower limbs for the last few moths The Consultant on charge wants you to perform the appropriate foot examination

to evaluate his case properly. Please approach the patient and perform the approriate examination of his lower

limbs and feet in about 6 minutes. Present important +ve and –ve findings to the examiner while you are doing examination

The examiner will be watching while you are examining the case.

Please observe the student while performing the examination for

appropriateness, completeness, and order for 6 minutes and allow him to

summerize his findings to you in 2 minutes.


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Student's Name .....................................................................

Student ID.................................................................

THE MARKING SHEET

Approach to the examination /5 Marks Student introduces himself/herself (full name) (1 mark)

Student checks the patient’s name (1 mark)

Explains purpose of examination and obtains permission (1 mark) Treats the patient with sensitivity and respect (1 mark)

Summerize the findings and closing with the patients (1 mark)

Lower Limb Examination /12 marks

Inspects the legs and feet, checks for deformity, amputations,

ulcers, areas of redness of callosities (2 marks)

Feels for the skin temperature, Joint tenderness and movement - ( 2 marks)

Examination for pitting oedema on the feet and over the shins - (2 marks)

Checks for arterial pulsations: Dorsalis pedis, anterior. and posterior tibial (2 marks)

Neurological examination of the foot: superficial and deep

sensations and ankle jerk (4 marks)

Presenting finding to the examinermarks /3 marks

Realize the patient is normal

Presenting the positive and important negative findings Self-confident and orderly presentation

Total Marks ( /20)


Signature

SPECIAL COMMENTS ON THIS STUDENT


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MEDICINE STATION M5 (B)

Communication Station

Breaking Bad News

Instruction to site organizers:

Time: 8 minutes

Resources needed

Examiner

Simulated patient (20-25-year-old female), no specification for dressing.

Papers & pen may be required by the student.


Examiner’s chair should be positioned so that he/she can observe faces

of both student & simulated patient.

A desk or table is necessary with a chair on each side.


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OSCE st. Number: M5(B) Examining for breaking bad news.

Instruction to the Role Player:

Your name is Rehab Saleh, a 22-yr-old art student living in Mansoura city.

You were generally well until you accidentally discovered a small lump in your

neck4 weeks ago.

You became very much worried about it and you saw your doctor who performed

some blood tests. You were then referred to have a sampled taken from the neck

swelling.

You know that this lump is inside your thyroid gland but you are not sure about

its nature

Your concern is that this lump may be cancer and you are afraid that it may

threaten your life.

You come here today to know about the result of the pathology of the mass and

ask the doctor what to do next

You should express extreme anxiety and sadness when you hear that it is a

malignant cancer in your thyroid gland.

Ask about the treatment options for this disease and itse response.

Ask if the chemotherapy or radiotherapy will cause some disfigurement in your

shape and whether they affect your health or lifestyle

At the end of the interview you thank the student for his kind help and support.


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OSCE st. Number: M5(B)

Instruction to student:

Time: 8 minutes

Rehab saleh is a 22-year-old student who presented to the outpatient clinic 2 weeks

before, complaining of neck swelling. The consultant examined her carefully & detected

a hard mass in her right thyroid lobe. The mass was investigated including blood testing

& neck ultrasound. A biopsy was taken. Rehab is diagnosed as having papillary

carcinoma of the thyroid. The pathology report was refered back to the clinic.

Rehab is here today clearly to ask about the results of her investigation. You are the

junior doctor in- charge today and your consultant asks you to answer Rehab's queries.

Be informative and be ready for any further inquires.


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OSCE St. Number: M5(B) Examining for breaking bad news.

Instruction to examiner:

Time: 8 minutes

The student has already given the following instruction:

OSCE st. Number: 5

Rehab saleh is a 22 years old student who presented to the gp outpatient

clinic 2 weeks before, complaining of neck swelling. Her GP examined her

carefully & detected a hard mass in her RT. thyroid lobe. The mass was

investigated including blood testing & neck ultrasound. A biopsy was taken.

Rehab is diagnosed having papillary carcinoma of the thyroid. The

pathology report was refered back to the clinic. You are the doctor in-

charge today.

Rehab is here today clearly to ask about the results of her investigation.

Be informative and be ready for any further inquires.

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Please let the student start immediately. You don’t need to repeat the instruction

unless the student completely freezes.


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OSCE ST. NUMBER: M5(B)

Examining for breaking bad news. MARKING SHEET

STUDENT NAME-----------------------------------------------------------------------

Student No.

Put a mark in the box of each section and a global mark at the bottom

Opening the interview: / 5

Introduces him/herself (full name).

Uses the patient’s name.

Demonstrates awareness of confidentiality.

Establish the reason for contact.

Listen attentively to the patient’s statement without interruption.

Presenting medical information: / 5

Gives sensible, clear & informative data.

Demonstrates a scientific realistic view about the patient’s illness.

Acknowledges concern by repeating, reflecting or summarizing.

Expresses the interest to clarify any unclear point or medical terms.

Awareness of time limitations.

Obtaining the patient’s thoughts and responding appropriately : / 5

Uses listening skills and empathy.

Encourages patient to speak (verbal, nods, not interrupting).

Displays interest & attention (eye contact, posture, not fidgeting).

Picks up cues or hints about patient’ thoughts & concerns.

Avoids premature or false reassurance.

Gives explanatory, simple and clear answers.

Building & maintaining the relations: / 5

Responding to the situation rather than appearing to follow set

formula of questions & answers.

Acknowledges verbal or non verbal cues about feelings.

Explore feelings with sensitivity & tact.

Admires the effect of the situation on patient’s life & carrier.

Ends by a summarizing clear take home message.

TOTAL: / 20


Signature


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OSCE Station 10

Uroradiology U10

Instruction for the students:

A 50 year old male patient presented to Mansoura UNC with recurrent attaches of hematuria and

occasional right loin pain for 6 months. The urine was smoky in colour and analysis shows pus cell 20-

30/ HPF and RBCs 30-40/ HPF.

The media shown on the computer is the patient’s KUB (1 view) and IVU (intravenous urography – 2

views) as investigatory tools.

Comment on the KUB regarding

Adequacy of the film

Bony skeleton for any abnormalities

Soft tissue shadow of internal organs

Any pathologic findings

Comment on IVU

Define the calyces, renal pelvis and ureter in film no1

Define any hydronephrotic changes in film no1

Presence of any pathologic finding and its location in the pelvicalyceal system in film no1

Comment on the pelvicalyceal syatem (regarding hydronephrotic changes) in film no 2


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OSCE Station 10

Uroradiology - U10

Instructions to Examiner (Medicine) Answers

The candidate is given the following: A 50 year old male patient presented to Mansoura UNC with recurrent attaches of hematuria and occasional

right loin pain for 6 months. The urine was smoky in colour and analysis shows pus cell 20-30/ HPF and RBCs 30-40/ HPF.

The media shown on the computer is the patient’s KUB (1 view) and IVU (intravenous urography – 2 views) as

investigatory tools.

Comment on the KUB regarding

Adequacy of the film

Bony skeleton for any abnormalities

Soft tissue shadow of internal organs

Any pathologic findings

Comment on IVU

Define the calyces, renal pelvis and ureter in film no1

Define any hydronephrotic changes in film no1

Presence of any pathologic finding and its location in the pelvicalyceal system in film no1

Comment on the pelvicalyceal syatem (regarding hydronephrotic changes) in film no 2

LET HIM START IMMEDIATELY AND FLIP THE SCREENS FOR HIM ON DUE TIME

Comment on the KUB: 12 marks

Adequacy of the film;

the patient is centralized or not 1 mark

The last 2 ribs and the lower border of symphysis pubis are visualized or not

1 mark

Is there gases in the plain film 1 mark

Comment on the bony frame works:

any abnormalities or fractures 1mark

any spondoyletic changes in the vertebra 1 mark

Comment on the soft tissue shadows of:

kidney (present or absent, if present is it normal size , enlarged or small)

1 mark

psoas line (present or not apparent) 1 mark

bladder shadow 1 mark

Comment on presence of a radio-opaque shadow in the region of the left kidney

5 marks

Comment on IVU: (8 marks)

The student should point the calyces, renal pelvis and the ureter 2marks

There is mild hydronephrotic changes 2 marks

The stone is located in the right renal pelvis 2 marks

The left kidney is perfect without hydronephrotic changes 2marks


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OSCE Station 10

Uroradiology U10

Marking Sheet Student's Name: ........................................................

Student No.

Comment on the KUB: /12 marks

Adequacy of the film;

patient is centralized?

The last 2 ribs and the lower border of symphysis pubis are visualized?

Is there gases in the plain film?

1 mark

1 mark

1 mark

Comment on the bony frame works:

any abnormalities or fractures?

any spondoyletic changes in the vertebra ?

1mark

1 mark

Comment on the soft tissue shadows of:

kidney (present or absent, if present is it normal size , enlarged or small)

psoas line (present or not apparent)

bladder shadow

1 mark

1 mark

1 mark

Comment on presence of a radio-opaque shadow in the region of the left kidney 5 marks

Comment on IVU: /8 marks

The student should point to the calyces, renal pelvis and the ureter 2 marks

There is right mild hydronephrotic changes 2 marks

The stone is located in the right renal pelvis 2 marks

The left kidney is perfect without hydronephrotic changes 2mark

TOTAL /20 marks

Examinar's Name & Nu..................................................... Exam Dpt: ?? / ?? / ?? 8 Date: ??/??/201? Signature:

SPECIFIC COMMENTS

Documents

MEDICINE STATION M1 History Taking Station - Mans Example M… · MEDICINE STATION M1 History Taking Station QUESTION Resources needed ... 2- Put the patient at ease, let him to lie