Year 5 OSCE April 2015

Year 5 OSCE April 2015

Day 1

Station 1 – Abdominal exam and stoma (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.
– Some patients had a PEG tube as their only sign.
– Asked DD, asked what could be the cause of the stoma. I suggested tumour, Inflammatory bowel disease etc.

Station 2 – Parkinson’s examination (real patient)
– Instructions stated that patient has a tremor and to examine it.
– Asked to summarise examination findings, give differential diagnoses and therapeutic options.
– Some patient had no tremor, just carry on and don’t be off put by this.

Station 3 – DNAR Counselling and Breaking Bad News (With SP)
– Patient was in last days of life and had metastatic prostate cancer
– Pt too unwell to be discharged home
– Had to break bad news to daughter to tell her that her father was in last days of life
– Had to explain DNAR
– She asked what a syringe driver was
– She asked whether she should tell her brother to come back from Holland
– Had to explain why farther wasn’t been given IV fluids and food
– Pt asked if her dad would no longer be a priority as DNAR was in place

Station 4 – Make up Amoxicillin for IV Administration (With SP)
– Had to make up amoxicillin in 10ml water for injection
– Make you sure you confirm patient identity (3 point verification)
– Check allergy status
– Comment on cannula site (thrombophlebitis)
– Stop infusion of fluids whilst administering as there is a bag running through

Station 5 – COPD Management (With SP)
– Patient with acute infective exacerbation of COPD
– Poor exercise tolerance, sleeping with multiple pillows
– The sheet showed a moderate severity PEFR with only slightly deranged Observations approx 66% of normal.
– Was asked how I could manage this patient following current guidelines. He could have been managed in the practice.
– Asked about which abx,
– For a moderate severity, review in 24 hours and give oral pred.

Station 6 – Counselling of patient on the COCP, Salbutamol and Sodium Valproate (with SP)
– This was the strangest station I’ve done at Keele
– Scenario tells you pt attended last week for review of the COCP
– ICE patient and you find out that she is trying to get pregnant whilst also taking sodium valproate
– Asthma control is sufficient (symptoms on less than 2 days a week)
– Look valproate in pregnancy up in BNF (which is available in the station) and advise is to refer to neurology
– I suggested that neurology would likely wean valproate and start lamotrigine and that she should look out for rashes once she starts (steven johnson)
– Advised not to get pregnant in the mean time
– Others gave advise on contraception, folic acid etc.

Station 7 – ABCDE (on normal real patient)
– Had severe pancreatitis
– Hx – severe pain in RUQ, radiating to back, coffee ground vomit.
– PMH: Hypertension, Type II Diabetes Mellitus
– Drugs: Ramipril, Aspirin, Metformin
– DD – Pancreatitis, Biliary colic, perforated duodenal ulcer, MI,
– Some students given results as you went through ABCDE, others gave you them all at the end.
– Had to give most likely differential
– Asked what investigations
– Shown blood results and interpret – I think we were meant to comment on Glasgow criteria.
– Hand over using SBAR. Hand Reg is in theatre, tell him its urgent and he needs to review patient as soon as possible or ring HDU

Day 2

Station 1 – Patient with psychotic depression (with SP)
– Note on door tells you pt has polymyalgia rheumatica
– Initially I asked about symptoms and she tells you she has pain everywhere
– She also has severe depression and believes doctors are trying to kill her
– She has suicidal ideas and if you ask her what she will do if you let her leave she replies ‘I will end it all’
– Asked about risk assessment and treatment
– Use BioPhychoSocial approach, mention Mental health act as you can’t let her leave.

Station 2 – Skill – cannulation (with SP)
– Confirm identity
– Sheet on the table which is easy to miss has pt’s details.

Station 3 – Cardio exam (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.

Station 4 – Knee exam (with real patient)
– Patient has OA,
– A few patient found examination very painful so ask if it is ok to continue before you do anterior draw test etc
– Asked about differentials, investigations, X-ray features of OA

Station 5 – Fluid prescribing (with SP)
– Post operative patient after hysterectomy
– Make sure you confirm identity
– BP dropping and Pulse tachycardic
– Had to take focused hx, and mentioned exam (you’re given sheet with exam findings)
– prescribe appropriate fluids (I.e. fluid bolus)
– Then asked about DD, Investigations and what you would do next (I.e. refer to Reg)
– I also mentioned that I would have a low threshold to activate major haemorrhage protocol and that I would bleep the anaesthetist to give them a heads up in case pt needed to go back to theatre.

Station 6 – Medication history (With SP)
– Note on door tells you to take a drug history
– Pt has about 20 drug packets with him, you have to write them all down including dose and how many times daily on a clerking sheet. On the clerking sheet don’t forget patient demographics a the top and to sign it at the bottom.
– When taking hx he has a reduced exercise tolerance, is SOB and has a productive cough with green sputum.
– He doesn’t know why he is on most of the drugs
– He isn’t taking his Furosemide regularly because it makes him urinate frequently
– Ask SE for each drug
– Some students stopped some drugs or changed frequency.

Station 7 – Abdo history – diverticulitis (with SP)
– Pt had severe pain in LIF
– Also had recent episode of diverticulitis
– Also had experienced lots of stress recently as husband had left her
– DD, Investigations, Had to say ‘would admit to hospital’, and then asked how diverticulitis is managed (abx, pain relief, fluids)