Year 4 OSCE June 2016
Station 1 – Gout History and Management
– Take a history and had a classic history of Gout.
– Task involved explaining diagnosis to patient and treatment options.
– Patient was already on OTC Painkillers.
– No questions asked.
Station 2 – Paeds Respiratory Exam
– Note said had a history of pneumonia
– Resp exam on 10y/o boy.
– Then CXR interpretation – showed consolidation in line with pneumonia.
– Asked “what would you do next?”
Station 3 – Diabetes Counselling
– Management and complications of diabetes type 2 – rushed for time.
– Patient has a sheet with her ‘results’, which was a HbA1c % (and the equivalent mmol/l), which was above(?) the threshold for treatment with metformin (on top of diet and exercise).
Station 4 – Gastrointestinal Exam
– Actor patient obviously ‘in pain’.
– Task was do a GI examination, patient had LIF pain and guarding (pretty well acted by the patient).
– Asked about DDx and given a sheet that showed tachy, hypertension, pyrexic
– Asked about management (initiate sepsis 6).
Station 5 – Antenatal Examination
– Post dates baby.
– Asked to examine and how you would manage post-dates; questions on induction of labour and complications.
Station 6 – Suicide History Risk Assessment
– 19y/o girl, overdose paracetamol (which was below the treatment threshold)
– Asked about her risk, how you would manage her.
– This was an obviously low risk patient (no previous attempts, no other mental health hx, no pre-planning, no note left, obvious trigger (breaking up with her boyfriend), regretted afterwards etc).
Station 7 – Hyperthyroid History
– Classic history (besides the patient being a male).
– Young man with weight loss and a tremor – FHx of hyperthyroidism.
– Asked about Dx and causes and what investigations you would do.
-Asked what specific antibody you would test for (in Graves Disease) (Anti-TSH Ab).
Station 8 – Miscarriage Counselling
-Had to give woman options (conservative, medical, surgical). No questions.
-The woman ideally wanted a procedure where she would not have to come back for follow up – (as she apparently had a small child at home who she didn’t want to leave alone)
-This station was unexpected by most of the cohort.
Station 1 – Paeds History
– 7 weeks P/C vomiting since birth.
– Gave red book w/ growth chart if asked for.
– Asked about Dx and DDx, what investigations you would do.
– Given capillary gas (with ranges) and asked to interpret.
-The 02 concentration was below normal – was asked why this was (?because it was a cap blood gas sample, not an ABG).
Station 2 – Cardiovascular Exam
– Everyone’s was different, all pathology. AS, MR, metallic heart valve.
– Asked to present findings and what the main diagnosis of the patient.
Station 3 – Morphine Counselling
– Patient was prescribed modified release tablets and PRN morphine solution – counsel patient.
– ICE – asked about driving whilst on morphine.
– -as already on medication for constipation, advised morphine may make problem worse and may require changing/modifying dose of laxative.
– No questions.
Station 4 – Cannulation procedure
– As ever, don’t forget to look/ask for the sheet with patient information on (which was somewhat concealed).
– Patient declines local anaesthetic.
– No questions.
– Students who had been in Shrewsbury had both Stoke and Shrewsbury cannulas and packs in the station.
Station 5 – Pre op assessment
– Patient was well – had to ask about previous clots in legs/warfarin use and would have told you 15 years ago he had a DVT.
– ICE patient and said he was worried about MRSA.
– Questions asked: how would you manage the patient’s risk?
– What resources would you use?
Station 6 – IUGR History
– Woman was pregnant second trimester – had a scan and midwife referred as baby was “small for dates”.
– In history, given customized growth chart that showed two previous pregnancies with SGA, and one had learning disabilities (ICE – she was worried about).
– She was a smoker.
-Interestingly, both her previous SGA babies were with another partner. ?Perhaps this makes constitutional delay in this pregnancy less likely.
– Asked Dx and potential causes, and how you would manage it.
Station 7 – TIA history
– Woman with husband who had an episode of right sided weakness last week, doesn’t remember how long.
– Testing triadic interviewing, husband and wife differed on things such as duration.
– Husband said it lasted 40minutes.
– On ICE complained of palpitations ?AF.
– Asked about Dx, what investigations you would do.
Station 8 – Bulimia Nervosa (History+Management)
– On superficial questioning, a young girl, around 6 weeks postpartum, with reflux and concerns about her weight.
– Many people did not manage to get from the patient that it was self-induced vomiting!
– Patient did reveal this if ICEd.
– Task was to tell patient diagnosis and how you would manage her.
– No questions from examiner.