OSCE for Registrars

Mohamed Osman Mohamed Suliman

Associate Professor of Surgery
Faculty of Medicine, University of Bahry
Consultant GIT Surgeon
National Centre for GIT & Liver Diseases
Ibn Sina Specialist Hospital & M.S.Idris Bleeding
Centre
Examiner in the Sudan Medical Specialization
Board
 OSCE

Mention the
organs labeled:
2
3
4
7
8
 Pancreas
Pancreatic psudocyst Pancreatic tumour
 A retroperitoneal mass was
detected in this 61 year old man
on CT scan.
CT shows a heterogenous right
posterior pararenal soft tissue
mass. There is a horseshoe
kidney displaced anteriorly and
to the left.
Instructions to the candidate:
-This is Mrs. Fatima Ahmed, 35-year-old female housewife.
- Take focused history from her.
- Examination of the patient is not required.
- Speak in a clear, loud enough, voice.

Instructions to the examiner:

- Do not talk to or direct the candidate.
- Follow the candidate carefully and mark the available checklist.
- Give marks according to the marking system shown in the list.
- Keep the checklist away from the candidate.
- Sum and give the total for each candidate.
- Sign the checklist.
Station 1 (Focused history for acute cholecystitis)
Total mark= 20
Information Marks
1- Greets, introduce self & take permission 1
2- Asks about the problem 1
3- Site of pain 1½
4- Character of pain 1½
5- Radiation of pain 1½
6- Aggravating factors 1½
7- Relieving factors 1½
8- Severity of pain 1
9- Fever + duration + grade 1½
10- Vomiting + duration + amount 1½
11- Appetite and food intake 1
12- Loss of weight + since when? 1
13- Presence of jaundice now + if present, intermittent or not 1
14- Previous similar attacks + since when? 1
15- Previous history of jaundice + when 1
16- The diagnosis is acute cholecystitis 1
17- Thanks the patient ½
Total mark 20
 3
2

4
What is the indication of applying this tube?

What complication that may happen if

balloon numbered (3) is inflated while
balloon (2) is not?
Because of the severity of the complication in
d) above an instrument should be at hand
near the patient. What is it?
Name another two complications that may
occur apart from the one mentioned in d).
 The examiner’s answer sheet
Answer Mark
a- Sengestaken-Blakmore tube 4
b- Numbered parts: 1= Gastric suction tube 1
2= Gasrtic balloon 1
3= Oesophageal baloon 1
4= Inlet of gastric suction tube 1
5= Inlets of gastric and oesophageal balloons 2

c- Bleeding from oesophageal and gastric varices 2

d- Migration of the oesophageal balloon upwards causing tracheal or 3
larangeal obstruction and acute respiratory obstruction

e- A pair of Scissors 2
f- Aspiration pneumonia, mucosal ulcerations, oesophageal perforation 3

Total mark 20
Instructions to candidate:
- This Mr. Ali Abdallah, he is 50-years-old. He is a driver.
- Examine his inguio-scrotal region.
- Do Not take history.
- Tell your findings in a clear loud enough voice while you
are examining the patient.

Instructions to the examiner:

- Do not talk to or direct the candidate.
- Follow the candidate carefully and mark the available
checklist.
- Give marks according to the marking system shown in
the list.
- Keep the checklist away from the candidate.
- Sum and give the total mark for the candidate.
- Sign the checklist.
 Examiner’s Checklist Ing Hernia Total marks= 20
Examination Mark
1- Greets, introduce self and take permission 1
2- Proper exposure to inguino-scrotal region (from umbilicus to mid thigh) 1
Inspection: Presence of:
3- swelling (visible swelling on right inguinal region extending down to spermatic cord) 1
4- Scar (none) 1
5- Dilated veins (none) 1
6- Visible pulsations (none) 1
7- Examines back of scrotum (normal) 1
8- Ulcers or sinuses (none) 1
9- Positive or negative cough impulse ( positive right inguino-scrotal cough impulse) 1
Palpation:
10- Spermatic cord (normal on left, thickened on right) 1
11- Both testes (both normal) 1
12- Ask to reduce the hernia or reduce it by him/herself 1
13- Determine the pubic tubercle on right side, by adductor tendon or from midline symphisis 1
pubis feeling along bone laterally
14- Find anterior superior iliac spine 1
15- Find mid-inguinal point 1
16- Close internal ring 1
17- Ask the patient to cough 1
18- Report result (no swelling appears= indirect inguinal hernia) 1
19- Release pressure and ask the patient to cough again (swelling appears= confirm finding) 1
20- Covers and thanks the patient 1
Total mark 20
Instructions to Candidate:
- This is Professor Ahmed Saeed Taha. He is sixty-
years-old. He is from Kassala.
- Take focused history from him.
Instructions to the examiner:
- Do not talk to or direct the candidate.
- Follow the candidate carefully and mark the available
checklist.
- Give marks according to the marking system shown in
the list.
- Keep the checklist away from the candidate.
- Sum and give the total mark for the candidate.
- Sign the checklist.
Examiner’s Checklist
Focused history for “Rectal Bleeding” Total Marks= 20
Information Mark
1- Greets, introduces self & takes permission ½
Asks about: 1- Problem (rectal bleeding) ½
2- Duration ½
3- Colour of blood 1½
4- Consistency, frequency & amount of stools 1½
5- Is blood mixed with stools or streaks on surface? 1
6- Tenesmus 1½
7- Incomplete evacuation 1½
8- Morning diarrhea 1½
9- Passing of mucus & blood with stools 1½
10- Feeling of sharp anal pain during the act of defecation 1
11- Feeling of anal swelling during cleaning from stools 1
12- Feeling of colicky abdominal pain ½
13- Symptoms of anaemia. Since when, if present ? ½
14- Feeling of dizziness when stands from sitting and lying positions 1
15- Haematemsis now or previously ½
16- Loss of weight. Since when? 1½
17- Appetite and food intake ½
18- History of bilharzias and dysentery ½
19- Feeling of abdominal distension or swelling ½
20- Present jaundice ½
21- Thanks the patient ½
Total Mark 20
 2
1

3
4- CO2
Each of these items is used in laproscopic
chlecystectomy.
a- Name each one of them.
b- Put their numbers in the order they are used
during surgery.
c- Mention two problems that can be caused by
each.
d- Instrument number (1) has a small inset with
a picture in a circle:
1- What is it? 2- What is its importance?