Year 5 OSCE April 2014

Year 5 OSCE April 2014

Day 1

Station 1 РSkill РSpeculum & Swabs (with SP and examiner acts as chaperone)
– 2 black swabs (1 high vaginal for BV, TV etc. & 1 endocervical for gonorrhoea) & a yellow / red endocervical swab for chlamydia.
– Make sure you label the black swabs at the start , because if you run out of time at the end, there is no way of knowing which black swab was high vaginal and which one was endocervical
– Patient will ask when results come back.
– Examiner asks how you would treat STIs.

Station 2 – Hand examination (with real patient)
– Rheumatoid Arthritis
– Patient comes in with “hand pain”.
– You must examine both hands.
– There was a pillow present to rest patients hands on.
– There are several different patients with varying signs.
– Don’t forget to examine elbows, as mine had big lump on elbow.
– Was asked what dd’s for elbow lump & how I could test for this.
– Was asked what my dd’s were for hand pathology & how I could investigate for these.
– Was asked to assess how the patient’s hand problems affected his life.
– Was asked to test the motor function of patients median nerve.

Station 3 – Psych history (with SP)
– Severe depression with high risk suicide intent
– Patient comes into GP requesting more temazepam for sleep.
– Take focused history on his BZD use and ask why he needs them….SP will then go on to discuss his mood. He was severely depressed after separation from wife. Also financial and job worries. He wanted more BZDs as he had made a plan to hang himself in 2 days time & needed alcohol and BZDs to go through with plans.
– Was asked what my dd’s were & how I would proceed.

Station 4 – Gastro history (with SP)
– Flare up of UC ? Toxic megacolon
– Patient comes into GP to discuss worsening of symptoms (increased bowel frequency, bright red pr bleed, weight loss & general malaise)
– Was asked what I thought was going on & what I would like to do. I said it was a severe exacerbation & needed admission.
– I was then asked what investigations I would do on admission & how I would manage him.

Station 5 – Neuro exam (with real patient)
– Post-stroke
– There are several different patients with varying signs.
– Notes on door states that examiner will instruct you whether you need to do upper or lower. There were varying different instructions (upper limb only / lower limb only / upper & lower motor only etc.)
– There was hardly any time in this station, so was only asked to summarise my findings & give dd’s.

6) Peripheral arterial examination (with real patient)
– Patient has come in with lower limb “pain”. Notes on door said patient will instruct you where the pain is.
– There are several different patients with varying signs.
– Summarise findings & give dd’s.
– What further investigation could you do.

7) Assessmen tof acute breathlessness in GP
– NSAID related acute asthma exacerbation (with SP)
– Patient started feeling breathless 3 days ago and he believes his asthma has deteriorated. chest tightness but no pain. Dry cough , no expectoration. Has taken salbutamol but no benefit.
– On further questioning he injured his ankle 7 days ago & has been taking ibuprofen regularly.
– Was asked what dd’s I had and what further things I would like to know. when I mentioned peak flow I was given a summary sheet with assessment findings on it. I was then asked what further things I would do based on findings.
– The sheet showed a moderate severity PEFR with only slightly deranged observations.
– Was asked how I could manage this patient following current guidelines. He could have been managed in the practice.
– I was also asked where you can access guidelines.

Day 2

1) Hospital ABCDE assessment (with SP)
– PE following leg fracture.
– Patient was acutely breathless. Follow ABCDE format, starting with a focused history. Also do bedside obs.
– Make sure you ask for relevant investigations (ECG, ABG, CXR etc.) & the examiner will hand you them to interpret.
– Was asked what dd’s were, what further investigations I would do & how I would manage the patient.

2) Skill (with SP)
– Take a cross-match from a severely anaemic patient, as she requires urgent blood transfusion
– Notes on door states that somebody has already taken a sample but it was rejected by the lab as the patient details on the pink EDTA tube was not filled in by hand.
– Instructions are on back of the blood transfusion request form.
– Need to confirm 3 personal details with patient before taking sample (name, DOB, address, hospital number etc.)
– Patient is clearly unwell & does not give consent easily. Wants to know why blood sample needs to be taken again.
– Fake arm present to take blood from.

3) Neuro history (with SP)
– Blurred / loss of vision in left eye.
РDiagnosis Рtemporal arteritis. Many people thought this was TIA.

– Patient had 2 episodes of blurred vision in left eye. On further questioning she also reports a low grade headache on left hand side, parietal / temporal region and some mild muscle aches in between her shoulder. PMH hypertension and on 2 anti-hypertensives.
– Was asked what dd’s are and what I would like to do for this lady.
– Ask about limb weakness and speech changes.
– Urgent assessment needed. Was asked what investigations I wanted to do.

4) Counselling (with SP)
– Patient had recent diagnosis of AF & needed to be commenced on warfarin.
– Patient had no idea why she needed warfarin or what the benefits were. She was worried about it being “rat poison”.
– SP kept talking all through consultation, so was hard to give all info in time limit. She asked whether she needed to start it immediately.
– Was also provided with letter from consultant explaining percentage risk of stroke in 1 year without warfarin, using CHADS2 VASC. Can communicate this risk to patient. Letter also explained percentage risk of bleeding with warfarin, using HAS-BLED score.

5) Neck examination (with real patient)
– There are several different patients with varying signs.
– Notes on door said patient had found “lump in her neck”. In station, was not allowed to ask patient where lump was.
– Was asked what my findings were, what my dd’s were & what further investigations I could do.
– Was asked what other types of lumps can be found in the neck.

6) Cardio examination (with real patient)
– There are several different patients with varying signs.
– Notes on door state you are in a pre-op assessment unit.
– Was asked what my findings were, what my dd’s were & what further investigations I could do.

7) Abdo & stoma examination (with real patient)
– There are several different patients with varying signs.
– Patient not lying flat so make sure you do that first. Patient has stoma which is covered so cannot see contents.
– Do full abdo exam first, then do focused stoma exam.
– Was asked what type of Stoma this was (nephrostomy / urostomy / ileostomy / colostomy etc.) and what I was looking for on examination of stoma.