Year 5 OSCE April 2017

Year 5 OSCEs April 2017

Day 1

Station 1 – Pernicious anaemia hx
– >50y old, had been told that he was anaemic when he went to donate blood. Came in to discuss this.
– Had to take a hx and give Ix.
– Family history of vitiligo and stomach cancer.
– They then gave you blood results which showed a macrocytic anaemia.
– Asked management.

Station 2 – Hip exam
– Hip OA, then DDx.
– Then interpret a hip Xray which was OA.
– Asked management.

Station 3 – Thrush secondary to diabetes
– Woman came in for triple swabs results following PV bleed.
– Husband had had an affair.
– Had to explain she had thrush from the results and she asked if it was an STI.
– Had to spot that the urinalysis results showed glucose 2+ and protein 1+ and explain it could be diabetes.
– Suggested she should go to GUM clinic for full STI screen and blood test to check for diabetes.

Station 4 – Cancelled Operation 
– Explain to a patient that her operation had been cancelled.

Station 5 – Hypomagnasemia prescribing
– With guidelines.

Station 6 – Cardiac arrest & defib
– Had two helpers: nursing student and nurse.
– Student nurse was ‘on her first day’ so had no training making the task more difficult.

Station 7 – Triadic interview depression 
– Old woman with her daughter.
– Old woman had lost her husband and was now unkempt & depressed.
– Stockpiling amitriptyline.
– Rule out psychotic depression and risk assess.
– She had no insight.
– Asked Mx and DDx.

Day 2

Station 1 – Migraine Hx
– Left sided temporal migraine, had started the previous evening.
– Also some visual disturbance in right eye – seemed like an aura.
– Some disturbed speech and tingling on face when episode started.
– Asked DDx and Mx?
– Some people said TIA. It was migraine with aura and she was on COCP – had to stop COCP and give Mx options for a migraine.

Station 2 – Raised PSA and PR exam 
– Had to tell a patient they had a raised PSA and possible causes.
– Then do PR on model – was smooth but enlarged.
– Explain it was most likely BPH and talk through Mx.

Station 3 – ABCDE urosepsis 
– On real pt and given Ix results at end of assessment.
– DDx, Mx and Ix.

Station 4 – ABCDE acute heart failure post op 
– Not asked to do ABCDE, just take a Hx from a post op pt who was SOB.
– Asked for Ix – they gave you an ECG if you asked (showed AF) and ABG (showed slightly low Hb, low O2, normal pH, raised Cr).
– Had to give Mx e.g. Stop fluids, give furosemide

Station 5 – Ethics and duty of candour 
– Talk to nurse – she had taken smears off two patients and hadn’t labelled them.
– She said they were both low risk of cervical cancer and tried to convince you that it was ok to label with the names (even if they were incorrect).
– You had to talk to her about being honest and bringing the patients back to tell them and repeat their smear.

Station 6 – PE anticoagulation counselling 
– She had previously been on warfarin over 20 years ago for a PE.
– Didn’t want to be on warfarin because of INR blood tests.
– Some people convinced her to take warfarin and counsel, some people counselled her on NOACs and said they’d run it past their senior.

Station 7 – Hypothyroidism Mx
– A hypothyroid patient had been taking 100micrograms of levothyroxine.
– Brief outside the door said her TSH was low so you had to realise that we were over treating her.
– Then tell her you want to reduce the dose to 75 micrograms. She felt good on that dose of levothyroxine and was concerned she’d gain weight if you lowered her dose.
– Had to convince her to reduce the dose and explain risks of over treating her eg thyrotoxicosis.