Year 4 OSCE June 2017

Year 4 OSCE June 2017

Station 1- Depression Hx
– Was difficult to know if was an alcohol dependence hx, or depression.
– Turned out to be depression and when asked pt, had core symptoms of depression w/ key event being losing his job I think
– Asked about management.
– Remember comment on biopsychosocial issues- wife (relationship counselling), career (job applications).

Station 2- Abdo Exam
– Peritonitic septic patient.
– Could not fully examine patient- generalised peritonitis and tenderness.
– Ddx. Appedicitis/Diverticular disease.
– Asked about Ix. and Mx. Don’t forget imaging eg. erect CXR for perforation and then sepsis six.
– Also don’t forget to mention would like a senior review of Pt.
*Remember septic Pt.s need O2 regardless of whether or not they are hypoxic.

Station 3- Paeds occular cranial nerve
– Patient was ?9yo girl/boy with vision changes.
– Careful – called eye exam on instructions
– Remember to cover each eye/test each eye separately when testing for acuity.
– Also in a paediatric eye exam/occular cranial nerve examination it was expected of you to test for a squint.
– Asked about differentials in addition to what further examinations you would like to do – otitis media/vestibular myelitis/space occupying lesion/meningitis/encephalitis and would like to complete a full examination of the rest of the CNs, a full neurological examination and an ENT examination.

Station 4- Dysphagia Hx
– Diagnosis was oesophageal cancer.
– Asked differentials.
– Asked diagnostic investigation.

Station 5- Triple Swabs
– 30/40yo female with discharge.
– Difficult station, most were rushed for time.
– Remember good communication throughout.
– Asked about management for discharge. This threw a lot of people.
– The Pt. was symptomatic w/ PID thus she needed Abx therapy immediately as opposed to waiting for the MCS to come back. Furthermore one could also mention that they would do contact tracing. However time was a big factor in this station and not many people (me included) made it this far.
*Also asked time needed for results (2-3 days).

Station 6- T2DM counselling
– Questions on cut off of T2DM and when to start second drug.
– Questions on management- lifestyle e.g. smoking cessation, decrease BMI (although explain what this is as not everybody knows!) and pharmacological management – start metformin
– Remember leaflet.

Station 7- Angina/MI Hx
– SP tried to present the case as GORD.
– SOB in current episode and previous episodes.
– Differentiated by asking Nausea/Vomit and hx of exertional chest pain.
– ECG – most (including myself) though it was anterior STEMI, it was actually LBBB.
– Rx of MI.

Station 8- Placenta praevia counselling
– Pt was 36/37 weeks gestation I think, thus had to explain the absolute indication for Caesarean section after explanation of placenta praevia, as there’s no chance of it moving up.
– Remember can draw a diagram of uterus and location of placenta etc. to help w/ explanation and there is paper on side in station for you to do this.
– Also, need to safety net e.g. No sex, any PV bleeding, come immediately to MAU
– Pt asked me if they needed to be admitted – something to read up on; I’m not sure but I think a contributing factor is how close they live to the hospital so could ask the pt this in response.
– Difficult to know how much to explain Caesarean section w/ it’s associated risks and complications etc.

Station 9- Psychosis in young male
– Tricky as history was a collateral history from mother, thus had to word questions carefully when asking about +ve/-ve symptoms etc.
– Asked for a differential.. Schizophrenia, Temporal lobe epilepsy.

Station 10- Surgical Hx & Rx of Bowel Obstruction
– Asked to interpret abdo. X ray and subsequent Ix. and Mx.
– Closed loop large bowel obstruction.
– ABC approach w/ Drip and Suck and CT abdo before going to theatre.

Station 11- Child abuse Hx & safeguarding
– Very difficult station – I don’t think anybody was expecting.
– ICE v. important and when asked, pt divulged her worries and concerns.
– Key points I think were the immediate protection of the child involved i.e. keep child away from abuser ‘Uncle Mike’ and to try and ascertain if Uncle Mike had any exposure/access to any other children.
– Asked about management – Involve paediatrician w/ child protection links, social worker and also police?

Station 12- Hand Exam RA
– Lots of signs in keeping w/ RA.
– Asked about management (DMARDs, involvement of multidisciplinary team etc).

Station 13- Breast Exam
– Present findings.
– Asked about findings in breast cancer.

Station 14- Optic Neuritis Hx
– 40yo female with eye pain and visual disturbance.
– Colour blindness.
– Nil redness.
– Nil neurological signs.
– Dx- Optic neuritis.
– DDx- Transverse myelitis, Glaucoma.
– Ix- MRI (demyelination) and CSF (oligoclonal banding).
[Consider ophthalmology referral to exclude any eye pathology before being seen by neurologist].

Station 15- Bronchiectasis Hx
– Weird history.
– As a child had episode of respiratory illness, but since then has not had respiratory disease until 7 yrs ago.
– Productive cough with heavy sputum production, remember to ask about amount of sputum produced.
– Shown normal CXR.
– Would ask for HRCT to confirm Dx (honeycombing).
– Mx. Chest physio, sputum MCS, Abx.

Station 16- Post Menopausal bleed counselling
– Given results and asked to interpret and explain management to patient.
– Therefore needed to know at what thickness you do a pipelle biopsy and how this is done. Eg. can usually be done in clinic, speculum is inserted and biopsy performed, not usually painful but can cause cramping etc.
– And what management thereafter comprises.