Year 4 OSCE June 2013

Year 4 OSCE June 2013

Station 1 – Antenatal history and explanation of growth chart showing IUGR
– Woman suffered domestic violence, was a smoker, drank alcohol and had a previous SGA baby.

– What caused the IUGR in this case?
– What would you do now?
– This was so difficult. Nobody expected this.

Station 2 – Consent for and perform PR exam
– The patient was young and had painless bleeding with blood on surface of stool – suggesting haemorrhoids

– Explain your technique and findings.
– What is most likely?
– What further investigations would you do now? e.g. proctoscopy, rigid sig

Station 3 – Perform ABG
– Make sure to check patient details from sheet on desk (easily not seen) and check wristband
– Make sure to do Allen’s test.

No questions.

Station 4 – Hyperthyroidism history
– Real variation in how helpful SP was – for me he practically gave me the diagnosis in the first sentence but others struggled to get the info from him/her.

– What are your differentials and why?
– What tests would you do?

Station 5 – Take history and discuss treatment options for lady with heavy periods
– She had already tried mefanemic acid/tranexamic acid without much relief. US normal suggesting DUB rather than pathology. She had been sterilised therefore contraception was not an issue.
– Went through medical and surgical options and had to answer her questions, come to agreement.

Station 6 – CV exam on real patient with murmur
– The patient had aortic stenosis. It was always going to be AS or MR I think, one of the common ones.

– What is the problem and why do you think this?
– What investigations will you do to confirm?

Station 7 – Paediatric history
– From mother of 7 week old baby
– Baby had vomiting.
– Quite a GORDy sounding history but had dropped centiles on growth chart and referred by health visitor.

– What are your differentials and why?
– What investigations would you do and why?
– Interpret this blood gas – what is the diagnosis?

Station 8 – Explain impaired OGTT to pregnant woman
– Had to explain what gestational diabetes was, go through treatment, risk to baby, risk to mother, what the future risks regarding diabetes were.

No questions.

Station 9 – Pre-op assessment on woman with previous DVT
– Had to ask about PMHx, previous ops, hospital stays etc. The SP my group had was very difficult to get info from and I only got there cos I was expecting a DVT. She also had worries about MRSA which you didn’t get if you didn’t ICE her!
Questions: what would you do to reduce DVT risk after this operation? What resources could you use? (we were puzzled by this – most said hospital guidelines and NICE guidelines)

Station 10 – Psychiatric history and risk assessment
– Manic patient
– Brilliantly acted by the SP. He was manic. Had to take a history including past history.

– What risks are there, to who, and how severe?
– What might make admission necessary?
– We weren’t allowed to use the risks.
– What is the diagnosis according to ICD-10.

Station 11 – Cannulation
– Had to explain and consent and insert cannula. Again, remember wristband and personal details on sheet! The sheet is easy to miss as the table is covered with stuff!

No questions.

Station 12 – Acute abdomen – gallstone disease
– Woman with very obvious gallstone pain.
– We were all undecided on whether it was acute cholecystitis or just biliary colic.

– What are your differentials and why?
– What tests would you do?
– How would you manage this lady?

Station 13 – History from woman with iron-deficiency anaemia
– She had change in bowel habit and blood in stools.

– What are your differentials?
– If abdo exam is normal, what do you want to do now? PR! and investigations.

Station 14 – Paeds cranial nerves on child with headaches and previous abdo pain
– Asked to do cranial nerves APART from taste, some other type (I can’t remember which) and only do light touch part of any sensory testing.
– Nobody finished this, there just wasn’t enough time.

– What did you find relevant to the history? (nothing as they were volunteers!)
– What could be the cause of headaches? (vision problems, raised ICP, migraine, abdominal migraine given the abdo pain, also need to rule out meningitis if acute).

Station 15 – Hand examination on patient with sore joints
– This was OA – which threw lots of people as we were anticipating RA.

– What is the diagnosis and why?
– What are the radiological findings of this condition?
– How would you manage it? (so conservative, medical, surgical)