OSCE Phase III 2007 Day 1

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HISTORY STATION: 3/7 Hx of diarrhoea, lethargy and weakness. Nothing specific on history, other than past medical history of non-specific colitis 10 years ago. Recent chest infection admitted to MAU and given cefotaxime (about 2/52 ago). Take history, suggest investigations and give a differential diagnosis with treatment plan, e.g. C.Diff, colitis etc. HISTORY STATION: Collapse ?cause. 6 hours ago patient collapsed in the street. History suggested a presyncopal episode followed by a collapse. No LOC, no tongue biting, no chest pain, no incontinence. Witness history also available. PMH. Type II diabetes, High BP. Current Meds: Include Gliclazide, Aspirin and a recent start of atenolol from ramipril. Suggest a differential diagnosis (e.g. Low BM, vasovagal, postural hypotension, cardiac arrythmia, and neuro cause). Also take note of alcohol history in station, which I didn’t. This may have been the cause! Summarise findings. Suggest investigations.

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HISTORY STATION: 6/24 hx of right lumbar and back pain, radiates to groin. Colicky in nature 20/10 severity. Nausea and no vomiting. Increased frequency, polydypsia, and weight loss. 3 previous episodes, in which one episode he passed a gritty substance. Given some blood results which showed normal sodium and potassium, Urea 9.0, Creatinine 120, adjusted Calcium 2.80 and low phosphate. FBC unremarkable. Summarise findings. Interpret bloods suggest a differential diagnosis and further investigations ACUTE MEDICINE: Video of Dr Fuller seeing a patient admitted with pneumonia. Written up for Co-Amoxiclav. Then given drug charts and obs chart. Asked to comment on this information. The obs chart showed a recent onset of shock, i.e. tachycardia, hypotension, sats of 78% and a continued temperature of 38. Then look at drug chart which showed coamoxiclav, and on the other side of the chart, PENICILLIN ALLERGY. Suggest a differential diagnosis (i.e. Anaphylactic shock, cardiogenic, hypovolaemic and/or septic shock) and suggest urgent treatment. Then taken to a Resus-Annie, to perform BLS. Asked a few questions. INFORMATION GIVING: Patient comes in with a 6/52 history of diarrhoea, PR bleed, mucous, abdo pain. Registrar has given you’re a note, which says that a recent sigmoidoscopy suggests ulcerative colitis. Histology is not back and a colonoscopy is still required. Tell the patient, and inform him about UC and treatment, although stress that this is not yet confirmed and he needs a colonoscopy. Asked a few questions. INFORMATION GIVING: Recently diagnosed Type II diabetic. Tell her about her diabetes and stress the importance of lifestyle modification. INFORMATION GIVING: A patient is about to be discharged, when he was given 20mg of warfarin. You wrote up the chart as 2.0mg but can appreciate that the decimal point is slightly vague. Inform the patient, apologise etc. INFORMATION GIVING: Recently diagnosed asthmatic. Nurses concerned that he will not be able to used inhalers. Inform him of why he needs the inhalers, how to use them, the side effects etc. The patient was a complete idiot and needed everything checked four times at least. He also has concerns about the use of steroids as his mum has R/A and has turned cushingoid/diabetic.

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OSCE Phase III 2007 Day 2

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EXAMN: Abdo examn – Fistula arm, RIF Mass, and scar, 2x large cystic kidneys. ?ADPKD EXAMN: Respiratory examn – Bilateral clubbing. Cyanotic. Fine inspiratory crackles. ?Pulm Fibrosis EXAMN: PVS of Legs – Unremarkable EXAMN: Cardiac Examn – Aortic stenosis

EXAMN: Visual field test on patient – Right sided homonymous hemianopia. Point on diagram and give differential diagnosis

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SKILLS: Crem form – in 6 mins!! HISTORY: Assess capacity of patient AMTS <6, post #NOF HISTORY: Assess suicidal risk of patient post 30x Paracetamol, 8x Prozac and alcohol following argument with boyfriend. No previous self harm issues, No suicidal note ACUTE MEDICINE: Transfusion reaction. Patient post transfusion, rigors and temp 39. Discuss case with examiner Urine dipstick of patient. Showed a UTI. Patient previously on penicillin. Write up prescription for new meds SKILLS: BM on manikin. BM 1.8. Given blood results which showed hyponatraemia, hyperkalaemia, hyperuraemia. Discuss causation. ?Addison’s Video of a “medical student” taking blood for IVDA with atypical mycobacterium infection. Comment on video and discuss. I.e. No informed consent, no gloves, and did not warn patient of “prick”. Discuss needlestick

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OSCE Phase III OSCE 2006 (Taken From askdoctorclarke.com)
DAY ONE:
1) Middle-aged lady with hypertension who had been treated for six months without success. She was having side-effects from her medication and didn't want to take them anymore. You had to explain about hypertension, find out why she wasn't taking her meds and formulate a suitable treatment plan with the patient. 2) 20-yr-old female recently diagnosed with epilepsy. Find out what the patient knew about the condition and answer any questions 3) Middle-aged man presenting with intermittent claudication. Take a history and then answer some questions about management. 4) Counsel a man about GORD. Explain treatment and follow-up, get him to stop smoking, reduce alcohol, avoid NSAIDs etc. 5) 60 yr old woman with rheumatoid arthritis who you're about to discharge from hospital. please talk to her and formulate a discharge plan. Take a full social history and find out how she was coping etc. 6) 25 yr old lady presenting with three month history of diarrhoea. Please take a history. She had hyperthyroidism. Some students were given a patient presenting with weakness who had the same diagnosis. 7) Watch a video of a ward round and write in the notes as if we were the FY1. 8) Asthma history with haemoptysis and chronic diarrhoea - CF

DAY 2:
1) Cardiac examination. 2) Peripheral vascular examination of lower limbs 3) GI examination. The man had RIF pain. He consented to examination but was in a lot of discomfort. Give analgesia and come back, do examination formulate a plan. 4) Please perform an examination of this patient's sensation in their legs. Patient had below knee sensory neuropathy. Asked about possible causes. 5) Another GI examination. Large scar RIF. Mass RIF. Patient had a transplanted

kidney. 6) Respiratory examination. 7) Fundoscopy and pupillary reflexes. Remember to say you want a darkened room. Had to find a word in each quadrant of the eye on a model. 8) Examine this patient's visual fields. Bitemporal hemianopia. ?Cause 9) Perform an ECG on this patient. Given a print out to interpret - inferior MI 10) Take blood and request blood transfusion 11) TTO 12) Please take a history from this patient and assess her for an anaesthetic (she was having an ankle fracture operated on). Consider investigations and pre-op drugs, taking into consideration the antibiotic allergy.

OSCE Phase III OSCE 2005 (Taken From askdoctorclarke.com)
Day 1 - History taking and communication skills
Station 1 - "take history from lady with weight loss" on simple questioning she described classical symptoms of thyrotoxicosis, including family history of autoimmune disease, and change in menstrual cycle which we had to specifically ask for. Otherwise pretty straighforward, examiner said she wasn't allowed to say much. Station 2 - We were given a scenario whereby a woman with DVT after a long haul flight was prescribed warfarin, unfortunately we had apparently failed to make the decimal point clear and she was given 20 mg of warfarin instead of 2mg. She had a known previous bleeding DU. We basically had to explain what had happened and act appropriately. The response we got was very variable but revolved around whether we admitted it was our fault or not. If you did not she went mad! Station 3 - scenario in GP practice. A gentleman with urinary symptoms, take a history (nocturia, polyuria etc etc) and PMH of UTI as a child. Takes NSAID for lower mechanical back pain. Present it back to examiner. Look at some blood results and say he was in renal failure. Then asked about possible causes, marks for saying previous renal damage as a child, exacerbated by benign prostatic hypertrophy (he described classical symptoms) and exacerbated by NSAID use. Asked what would do next. Marks for asking for help from renal physician at hospital. Station 4 - Tell a woman her mother had a DNR order placed on her at ward round that morning. All communication skills based. Station 5 - Take a history from this lady with recurrent falls. Describes symptoms of polymyalgia rheumatica, "what investigations would you like to do?" Station 6 - Take a history from this man. V vague, has urinary symptoms of frequency and nocturia, had a renal USS found incidental large AAA. Take a history for 8 mins, than counsel him about possible treatment plans. Station 7 - Counsel this man on smoking cessation Station 8 - Take a history from this woman. Classical symptoms of GORD. Landlady of pub (lots of alcohol and curries). Concerned it could be Mi - had to reassure her to get mark. Examiner questioned about possible investigations, specificity of H Pylori serology and CLO tests.

Day 2 Examinations and clinical skills
Station 1 - Cannulation. then given obs chart of patient - v tachycardic, hypotensive and asked to prescribe fluids on a chart. Had to check for patient ID on wrist band Station 2 - take blood cultures, actor there who told you he had been unwell and had to explain that needed blood cultures etc, then asked to take blood cultures from a mannekin, watching for aseptic technique etc. Then given blood results, grown a bug, and it's sensitivities, asked to explain to patient, then to write him up for antibiotics (he was allergic to penicillin on questioning). Station 3 - Scenario where Mrs Smith has "just gone off - have a look at her ECG first"

showed inferior infarct. then asked to show what would do next - BLS on mannekin, asked when would stop resus. Station 4 - examine the eye movement, reflexes and perform fundoscopy. Actor for movements and reflexes then a strange new model for fundoscopy with eyes on a stick where you could read words when using high refractive error on the opthalmoscope. Station 5 - Perform respiratory examination - patient with ? bronchectasis. Lots of signs. Station 6 Perform CVS examination Lots of signs again and big loud murmur (patients and therefore murmurs changed every 4 people or so) Station 7 - Examine lower peripheral vascular system. What investigations would you like to perform if pulses not palpable Station 8 - Examine this gentlemans legs. When asked to stand he developed whopping varicose veins, had lipodermatosclerosis and the works. Asked to examine him fully. Examiner v impressed if controlled with tourniquay. Asked what investigations would like to do. Asked about possible treatment (wanted conservative treatments first) and asked to describe procedure of high tie, stripping and stab avulsions. Station 9 - asked to examine rheumatoid hands (again was well impressed, as examiner said where would you like to start? I replied I usually examine the skin, elbows and ears at the end but would you like me to do this first? He asked why these were pertinent, and pretty much gave me all the marks before I laid hands on the patient - thanks for the top tip! (They were rheumatoid hands by the way and the patient divulged multiple joint involvement. Station 10 - Asked to do abdo exam. Patient had major lymphadenopathy and good signs, but again rotated around. Station 11 - Scenario whereby patient receiving blood and spiked a temp. Bleeped to ward. What do you do? Had to act out stopping blood, checking in notes that received correct bag, examine patient, sending bloods to lab etc. Station 12 - Asked to perform an ECG on this patient. Given an ECG machine from the dark ages with needle drawn traces. Machine set to print only 9 leads, asked if happy with trace and what would like to improve upon. Told not to comment on the actual reading. Station 13 - Given 2 mins to read some patient details, then asked to complete the crem form. Had to ask to see body and check fro pacemaker etc and given info regarding what was written on the death certificate.

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