Year 4 OSCE June 2015

Year 4 OSCE June 2015


(Day 1)


Station 1 – Eye pain history
– card outside station gave no helpful information
– hx revealed ? Optic neuritis with previous hx of ? Transverse myelinitis
– Asked top differential: MS
– Asked how would manage. Fundoscopy, full neuro exam, refer to neurologist, refer for MRI (you were in gp and were expected to remember this, ie saying LP as an investigation was penalised as that would not be possible in GP setting)

Station 2 – Breathlessness history
– Angina. Awkward patient. Intentionally led towards GORD.
– Asked about management.

Station 3 – Abdo examination
– Real patient
– Asked diagnosis (renal failure) and why
– Some patients had a huge fistula, others had a peritoneal dialysis port, others had an obvious or not so obvious renal transplant

Station 4 – ABG
– Explain procedure.
– Take sample.
– Asked to explain what you’d do with it.
– Asked what you’d need to know to analyse (FiO2, temp).

Station 5 – Neuro Exam and spine exam
– Back and R Leg pain in lorry driver.
– Examine spine and lower limb sensorimotor function (focused examination, ‘rehearsed’ neuro and ortho exams ran well over time with no solid findings)
– Asked for diagnosis (disc herniation) and likely level of lesion (indicated by sensory deficit. Motor function impaired by pain).

Station 6 – Gestational diabetes counselling
– Asked what it meant for her and fetus- C sect., subsequent diabetes risk, wanted midwife led waterbirth (not a chance).
– How it would be managed.

Station 7 – Mental health history
– Anxiety and panic attacks.
– Had to agree a management plan and explain plan and most likely diagnosis to SP

Station 8 – Paeds asthma control
– Had to speak to mother and take an asthma history. Mother knew very little, less than useless information without focused probing.
– Found out control was poor.
– Asked how you’d manage it further.

Station 9 – breech presentation counselling 
– pregnant lady presented having been told baby was breech
– explain the term breech and the subsequent options regarding reaminder of pregnancy and delivery (vaginal breech, csection, ECV)

Station 10 – amenorrhoea hx
– given no helpful information on the card outside the station
– SP presenting with irregular periods, hirsutism, acne and weight gain
– asked most likely differential and why (referring to Rotterdam criteria) and appropriate investigations (FSH, LH, testosterone, sex hormone binding protein, pelvic USS, HbA1c)

Station 11 – mental health hx 
– card outside could’ve been interpreted as you were to take a paeds history
– new mum, very low, classic depression symptoms ie post natal depression
-remember to risk assess (she had considered suicide), enquire about the child (growth and general well being ie ?child abuse) and rule out bipolar/schizophrenia
– explain diagnosis to SP and explain mx plan (see again very soon, reassure, suggest CBT and possibly antidepressants)

Station 12 – paeds cardiac exam 
– Cardio exam on a healthy child (age varied)
– Card outside read the gp had heard a murmur when the child had been unwell a few weeks previously
– Asked for likely ddx (innocent murmur) and its features (soft, systolic, left sternal edge etc)

Station 13 – acute abdomen hx
– Acute LIF pain, no radiation, 2 yr hx of similar pain but not as intense, fever, intermittent loose stools
– Asked most likely ddx (if you didn’t say diverticulitis you apparently failed the station) and further mx (NBM, fluids, analgesia, abx, AXR)

Station 14 – resp exam
– Real patient
– Asked most likely differential according to positive findings (mine had bi basal end inspiratory crackles and a scar on her back – pulmonary fibrosis, scar due to wedge resection needed for initial diagnosis)

Station 15 – warfarin counselling
– Patient was in hospital recovering from a DVT
– Had recently been on a long haul flight, no other RFs
– Expected to explain the drug, mechanism of aciton, how to start dose (gradual increase under cover of LMWH), monitoring (INR), foods to avoid, other drugs to avoid (she was on ibuprofen)
– SP prompted you with questions if you forgot to mention some of the above

Station 16 – ABCDE assessment 
– Not an obvious ABCDE station
– Card outside read perform a post op assessment of the patient
– Patient had severe abdo pain with guarding, low bp, raised heart rate
– Asked most likely ddx (post op bleed) and further mx (call surgeon, get back to theatre)