Year 3 OSCE July 2013

Year 3 OSCE July 2013

Station 1 – BLS, AED and unresponsive patient

– Perform BLS as usual

– Helper arrives after 1 cycle of chest compression and ventilation is completed correctly.
– Helper takes over chest compression.
– 100 compressions in 1 min.
– Use mask if offered.

Student demonstrates use of AED:
– Attach pads.
– Switch to “AUTO mode”.
– Click “Analyze”.
– While AED is analyzing; instruct helper to remove oxygen mask but continue chest compression.
– If shock rhythm is detected, charge AED.
– After AED is fully charged, check for patient surrounding for FLUID, METAL, PEOPLE and PATCHES.
– “Stay clear” and remove oxygen.
– Click “Shock”.
– Continue chest compression.

Examiner then say patient now has palpable pulse and observable breathing. Student then moves on to assessing unresponsive patient:

Equipments in station:
– Trolley: oximeter, blood pressure monitor
– Stethoscope
– Pen torch and pupil size gauge

Not sure how to complete station, but this is how I did it:
– Check ABC
– Check pupil reflex and size
– Comment on GCS
– Check BP and oximetry

Station 2 – Abdominal Exam of patient with Crohn’s
– Asked about the extra-abdominal signs of acute onset diarrhoea and vomiting.
– Dehydration, nutritional status etc.

Station 3 – History of chest pain
– SP presented with stable angina.
– Asked about differential diagnoses of chest pain.

Station 4 – Cardiovascular Examination and Mitral Stenosis
– Asked about signs in patient with mitral stenosis.

Station 5 – Paediatric cranial nerve examination
– SP were 2 5-6 year old twins.
– Tasked to complete examination of ALL cranial nerves.
– For several cranial nerves, asked to skip and move on. Advise to describe each test and follow examiner’s instruction as to which ones to skip:
I: skip smell test of each nostril
II, III, IV, VI: skip using Snellen chart and fundoscopy
VIII: skip Rinne’s, Weber’s
Not sure about the rest; could not complete

Station 6 – Venepuncture
– 15 year old girl for FBC and TFTs.

Station 7 – Alcohol History
– 66 year old male with alcohol abuse.
– Asked about Alcohol Dependence Syndrome.
– Symptoms of Alcohol Dependence Syndrome.
– Other differential diagnosis.

Station 8 – Paediatric History of Breathlessness
– 4 month old child with breathlessness, vomiting, cough and preceding coryza.
– Asked about differential diagnoses.

Station 9 – Motor examination of upper limb
– Asked to compare signs in upper and lower motor neuron lesion.
– Signs on the face – forehead sparing.
– Signs on limbs – tone, reflexes, power, muscle bulk and plantar reflex.

Station 10 – Thyroid history – chronic fatigue
– 36 year old female with 7 months history of tiredness.
– Asked about expected TFT results in hypothyroidism.

Station 11 – History of abdominal pain with constipation
– 60 year old male with 3 days history of abdominal pain
– Started as a generalized pain
– Increase in severity over the last 3 days and increasingly on the left
– Associated constipation and blood in stool

Station 12 – History of Falls
– 74 year old female with 3 falls in the last 4 months.
– Further history indicates post fall syndrome.
– Asked about leading causes of falls and differential diagnoses.