OSCE Questions February

1- Examination 1: CVS exam pre-op on man with pacemaker and systolic murmur with ECG showing
pacemaker spike. I mentioned indications for pacemaker in surgery and diathermy - don't know if these
are standard to talk about in this station.
2- Communication 1: (with prep station before) Telephone conversation with Prof HPB surgeon about
CBD injury. I talked about the op itself, if intraoperative injury was detected +/- repaired, abdo signs,
haemodynamic stabily, drainage and how much. there was a lot of missing information which I
apologized for and formulated a plan based on finding out the missing information (e.g. amount drained
over what time, signs of peritonism and stability).
3- History2 : Communication??? Patient who is tearful post-op (gastrectomy for gastric Ca). No other
issues but worried. you are asked to come back to see him after ward round to assess.
4 - Examination 2: Hip exam - had bilateral hip OA with reduced int+ external rotation more on Right with
antalgic gait. includes discussion of findings + diagnosis and explanation of trendelenburg test.
5 - Examination 3: Abdo Exam - terrific actor who managed to reproduce RIF guarding, rebound and rigid
as a board indicating peritonism. includes differential diagnosis of RIF pain expecting structured
approach to explanation.
6 - Crit Care 1: Unmanned station with questions about a lady with NOF who comes in hypothermic.
questions about how to manage, how it affects theatres, what you would do in theatres to avoid/improve
hypothermia, what complications can happen intra/post-operatively. talked cutoffs for hypothermia temps
and bear huggers/warmed fluids, clotting, bradycardia, arrythmias, reducing operative time, etc.
7- History 2: Back pain. young lady with >9 months history of back pain resistant to conservative
management and physio with no red flag symptoms, some urinary incontinence recently and a
dermatomal/myotomal radiculopathy. when asked about diagnosis I suggested some, told need to
examine and do PR, saddle anaesthesia, anal wink and explained how I would manage based on finding
there so said if PR normal would get MRI non-urgently but if there was reduced tone then admit and do
urgent MRI with plan to decompress. I also explained pathophysiology of radiculopathy.
8 - Communication 2: Discharge letter to GP regarding Seroma. if I remember well there was also a
reduced Hb which needed checking by GP and Seroma to be reviewd in Clinic and aspirated as needed.
the plan is pretty much written in notes but just need to be efficient in summary and time is a real factor in
this station.
9 - Crit Care 2: Viva station with 2 anaesthetist. starts with hypotensive man post TURP so explained
approach to hypotension post-op with ABCs, classification of shock, choice of fluids and investigations.
Then had some blood results that showed hyponatraemia and asked to explain what I thought it was
(TURP syndrome) and what the pathophysiology behind it is and what is in the TURP fluid (glycine)
asked about complications of hyponatraemia (seizures, coma, death) and about other problems with
TURP, how I would manage it (I said loop diuretic frusemide they asked me where it acted and I said
ascending loop. also mentioned sometimes manitol is used as osmotic diuretic). they asked me about
glycine metabolism - I wasn't sure but they told me it metabolises to urea so I talked about ureamia.
10 - Communication 3: (with prep station before) Mother comes to A&E following child who was brought
in by father (divorced and not getting along) and is having splenectomy (possibly partial) after a fall and
was haemodynamically unstable. She is a mix between angry patient and breaking bad news as she is
also angry that no one waited for her consent. so I started by apologizing for not waiting, told her child
was unstable and needed immediate surgery, that waiting would have put health/life at risk, proceeded

with op. She keeps mentioning that the farther is not fit to be parent, etc. then I explained what
splenectomy is, what the consequences are and future precautions (e.g. getting vaccines, antibiotic
prophylaxis etc.)
11- Clinical safety : Scrub up and gown. easy - just went by BSS course teaching. asks you to dispose of
everything "safely" so I took off gown first, then gloves.
12 - Clinical Skills: IV cannula in A&E as part of trauma call. so besides popping in the cannula, there is
some communication as you are explaining to a patient laying next to arm what you are doing and why
and answer her questions plus get verbal consent. plus examiner is acting as HCA who doesn't know
anything so quite a few distractions. then you answer her questions of fluid choice + time to run it over
and asked to prescribe a regime.
13 - Anatomy 1 (first choice): X-ray of wrist - name carpal bones. prosection flexor compartment naming
some tendons, nerves, arteries and explaining innervation + dermatomes and clinical signs on
examination.
14 - Anatomy 2: Unmanned skeleton with numbers and questions asking about insertions/ origins/related
structures and consequences of injury in both upper limb (shoulder + humerus + elbow) and lower limb
(hip + knee).
15 - Anatomy 3: ENT prosections with questions about aortic branches, subclavian artery, common
carotid, facial artery, parotid gland.
16 - Surgical Path 1: unmanned with questions about CT of pancreatitis, CXR of ARDS/pulmonary
oedema, ECG with complete heart block, asked what findings are and about management. said that had
to have pacemaker preop for complete heart block.