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UWS OSCEs

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Matt

Emeritus Staff
Emeritus Staff
Year 4, Summative (60% of term) Paediatric OSCE

Station 1:
A parent presents with her 4? week old baby who has a fever and no localising signs. Explain to the parent why you want to do a lumbar puncture on their child, what it will involve (using a model neonate), and what the contraindications. All of this is performed after adequate prompting from the examiner (initiative not required).

Explain what you would do if a lumbar puncture is not performed, or if it fails, explain what a traumatic tap is and what it means, interpret the CSF results (84 polymorphs, no gram stain, bacterial meningitis) and explain them to the parent, choose an appropriate therapy, explain what you will treat with and why, how long you will treat for and what the possible complications of meningitis are.

Impression: Communication + knowledge station. Pretty easy station since paediatric medical students are expected to know meningitis pretty well.

Station 2: Fluid charting station. Presented with a dehydrated child, have an approach to management (including ABCDE), recognise and categorise the child's level of dehydration (in this case severe), chart appropriate fluids (in this case 20mL/kg bolus of NS), take appropriate bloods (FBC, UEC, glucose, not cultures since no fever), interpret blood results and reassessment of patient's fluid status and then chart appropriate replacement fluids (in this case NS + 0.25% glucose working on 5% dehydration).

The electrolytes show a potassium of 2.5 (very low) and you have to know not to give IV potassium until the patient has passed urine.

Impression: Very easy and predictable station.

Station 3: Short answer station, answer about 5 short answer questions based mainly on lectures.

Impresssion: Students weren't expecting such lecture-oriented questioning, but if they had studied the lectures properly it would be an easy station. I don't think any of us had studied the lectures properly so many of us found it difficult.

Station 4: Respiratory examination. Basic respiratory exam, bilateral wheeze was the only significant finding for me, know how to interpret growth charts, what initial investigations to ask for, and be able to demonstrate an engaging approach to examining a child (i.e use toys etc). Know to do a blood glucose as a first line investigation if you're worried.

Impression: Predictable station, not too difficult but requires a well-practised approach to examining children.

Station 5: History taking from a mum about her 5 week old baby who has projectile vomiting. Mother describes a classical presentation of pyloric stenosis and you're job is to take a basic and thorough vomiting history and identify that all other routine history questions (e.g. surrounding distress, development, pregnancy etc are normal). Then answer the examiner's questions surrrounding differential diagnosis, investigation (examination and ultrasound), management (IV vs oral rehydration fluid), treatment (surgery), and management after treatment.

Impression: Not a difficult history station but difficult when pyloric stenosis is obvious from the first open-ended question and you spend the rest of the time asking questions and receiving answers all to the tune of very normal. The examiner's questions at the end weren't easy, not many of us knew the ins and outs of pyloric stenosis work up but most of us could give differentials and knew to ultrasound. Not many of knew whether oral rehydration or IV fluids were an appropriate initial treatment (baby sounded like it was mildly dehydrated).
 

woozy

Regular Member
wow, these are so much different from the 3rd year OSCE's I saw this week. Then again, they are only 1 rotation in.
 

Matt

Emeritus Staff
Emeritus Staff
wow, these are so much different from the 3rd year OSCE's I saw this week. Then again, they are only 1 rotation in.
I think it was a pretty well done OSCE. This is the benefit of OSCEs and mulitiple-mini interviews, you get a much more well-rounded assessment.
 

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woozy

Regular Member
I think it was a pretty well done OSCE. This is the benefit of OSCEs and mulitiple-mini interviews, you get a much more well-rounded assessment.
Yeah despite that, not all the clinical teaching staff have the same view on some of the components. I think the curriculum committee is discussing some of the osce, cEx, etc issues this thursday.
 

Matt

Emeritus Staff
Emeritus Staff
There were a couple of issues with the OSCEs, across the board. The paediatric students didn't do as well as faculty might have hoped, and there were concerns about the O&G and mental health OSCEs... not having done either of those though, I don't really know much about how they went.
 

Matt

Emeritus Staff
Emeritus Staff
Obstetrics and Gynaecology Viva Voce Exam, Year 4 (teaching session II)

Students are presented with a case trigger/summary and are then required to discuss differential diagnoses, important points on history, examination, investigation, management, complications, and communication. Stations were 10 minutes (2 minutes reading time, 8 minutes discussion).

This sort of exam is comparable to the idea of sitting down with a consultant/specialist while they grill you on a topic they have extensive knowledge on. Stations included:

1. Menorrhagia and dyspareunia in 34 year old woman, married and in a stable relationship with three children.

2. Pelivic pain and vaginal discharge in a 24 year old nulliparous (no children) woman who has recently begun a new relationship and who does not use any form of contraception

3. A pregnant lady presents for the first time with a reported 18 week gestation pregnancy that is measuring large for dates (24 weeks). You are required to discuss causes, investigations, management, screening and complications mostly in the setting of a twin pregnancy

4. A pregnany lady presents at 34 weeks gestation with an antepartum haemorrhage (plus history of the same in one of two previous pregnancies).


This sort of exam is benefited by the fact that there are only really 20 different significant obstetric and gynaecological conditions and about as many types of presentations. While there aren't that many conditions to know, however, you are required to know them in depth. Furthermore, you are required to demonstrate your knowledge in front of an expert who may very well belittle and patronise you if you say something silly.... which is very easy to do when you're flustered.


My impression was that this was a fair exam. I knew the first two stations well and was able to 'motor-mouth' my way through them without too much prompting. The third station was unexpected and I hadn't prepared for it properly (can't think why, I should have), the consultant picked this up pretty early, belittled my answers and destroyed the confidence I'd built. The fourth station I knew well but I felt pretty bad after the third and I don't think I did nearly as well as I could/should have.

All in all, pretty sure I passed. Hope I didn't do too badly :unsure:
 

Matt

Emeritus Staff
Emeritus Staff
Mental Health OSCE, Year 4, Teaching Session 3

1. Watch a two minute video of a 67 year old retired teaching brought in by her husband after notcing she is becoming increasingly forgetful. Video of a well-dressed and clearly spoken older aged lady with terrible long term memory, no short term memory problems and little insight. Nil confabulation and good attention/concentration

  • Present a mental status examination
  • Discuss clinical features you would seek
  • Give a Diagnosis
  • Give a Differential Diagnoses
2. Counsel a 32 year old woman who has recently been discharged from the inpatient unit for the second time following a psychotic illness.

Respond to:
  • I've been diagnosed with schizophrenia does that mean I have a split personality?
  • What causes schizophrenia?
  • I'm planing to have children, will they have schizophrenia?
  • Possibly other questions I may have forgotten.
Stations were 10 minutes with 5 minutes reading time. Station 2 seemed to be really short for me and I wonder if there weren't timing issues.
 

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woozy

Regular Member
Year 2 OSCE (Summative, 10%):

1. 58 Year woman presents with back pain.

S: Lumbar back pain
O: 3 weeks age
C: Dull and sharp pains
R: radiating down the posterior of the R leg.
A: as above
T: constant
E: Movements involving the lower back
S: 10/10

PMHx: SLE
Meds: Voltaran, Methotrexate, Prednisone (corticosteriods), etc. Patient also takes calcium supplements.
Familial history: Father CVD.
Social history: Supported by husband.
Red flags asked: post-menopausal?, IV drug user, occupation, infection, trauma.

DDx: corticosteriods use causing increased bone degeneraiton leading to compression fracture, sciatica, etc.

2. Lower limb neurological assessment, instructions noted that we were not required to perform a sensory exam: even though we we're told we would have actors, this patient had pathology. I conducted the full lower limb neurological assessment, inc gain and testing of the dermatomes. See T and O'C.

Asked to distinguish between UMN and LMN, 3 examples of lower limb UMN signs. Hyperreflexia, Hypertonia, Fasciculations.

3. 4X YO woman out with daughter when she suddenly losses consciousness.

S: N/a
O: Sudden and unexpected. No aura or warning signs.
C: loss of consciousness, you should ask if it was witnessed, it was important to distinguish 'blackout' and 'loss of consciousness', etc which the patient used interchangably, for this interview i asked if anyone witnessed the event, the interviewer said yes and i proceeded to interview the daughter about the LOC. Other students were given bonus marks for getting the patient to define what they meant when using those terms, apparently only 1 student asked out of the 30 of us. I also asked about the context in which this occured: the patient was sitting, which was a key diagnostic indicator.
R: N/A no other features
A: None reported by patient or daughter. Patient had no aura, or contractions, loss of continence.
T: A few minutes
E: None known
S: N/A

H of PC: 2 other recent episodes of syncope, in the last month, including one fall, one other witnessed by husband.
PHX: Heart attack 10 years ago, patient unable to describe any details about this.
Meds: Lipitor
FHX: Diabetes in the family... can't remember

Students: from the prompts and direct questioning of the students by the markers it seems we were required to ask questions to help distinguish between: vasovagal, cardiogenic syncope, and epilepsy in the interview.

DDx: Cardiogenic syncope.

4. Respiratory exam.

Patient: was wearing pants, bed was completely flat with no pillows.

Full respiratory exam from T & O'C performed, i forgot to add neurological signs such as wrist tenderness, finger abduction, and adduction. Apparently later in the day there was a patient with pulmonary hypertrophic osteoarthropathy. Also say the examinations you would like to perform but can't since the patient is wearing pants, the bed isn't at the right angle etc, such as JVP, checking for oedema, peripheral pulses. Some students we're asked to proceed straight to chest, or to skip certain parts of the exam due to time constraints or by taking too long. Most students we're still examining the back when told to stop.

We we're then asked what are some possible DDx: of hyperreasonance. Pleural effusion, pneumonia, etc.

Also what other exams we would like to perform: Cardio of course, GIT possibly, since the patient possibly had gynaecomastia on inspection.

5. Patient presents with polyuria.

Needed to distinguish between pathology and inc frequency from excessive fluid intake. The patient also had nocturia.

Patient also had: visual disturbances (blurred vision at times) and tingling/numbness of the left foot.

FHX: Sister and Aunt with type II mature onset diabetes.

Questions asked:
Fasting and non-fasting blood glucose: 4-6mmol/ and 4-8mmol i think.

Also to explain to the patient what BSL's are, there levels and why it is important to maintain BSL in this range. Explain the inc in urination as well.
DDX: Diabetes mellitus (mature onset, type II) given possible diabetic retinopathy and neuropathy/peripheral signs.

6. Venipuncture for FBC.

Remember to keep looking and talking to the actor and actor and not the venipuncture arm.

Some students complained that they we're unfamiliar with the equipment, since we we're asked to use rubber torniquets which aren't used at Blacktown MDH. Also vaccutainer syringes we're different from BMDH.

Most students we're unfamiliar with filling out the pathology request form and asking the patient to sign the form, etc.

1. Wash hands
2. Introduce self to patient.
3. Check patient's details and wrist band, check for allergies
4. Explain procedure, reasons why
5. Contraindications/preferred arm be sure to gain consent only 3 students out of 30 or so at BMDH asked last year for spirometry!
6. Gather equipment - other equipment such as syringes were there a lot of students choose to use the 'open' method which requires the use of a syringe and changing needles, this is not the preferred method. Also the wrong tubes we're also present. Some students choose the grey vaccutainer for HB1AC (blood glucose) and not the purple FBC ones! Clean site, etc...
7. Wash hands/glove up
8. Procedure - remember to remove the torniquet as soon as the needle is in. Also cotton-ball + tape for Pt
9. Safe disposal of sharps!!! Don't forget!!!
10. Write details on Vaccutainer, and path form, send to pathology.
 
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Matt

Emeritus Staff
Emeritus Staff
Sounds like a very fair and very well-rounded year 2 OSCE. I'm impressed. Thank you, Woozy.
 

Hayden

Getting busier
Emeritus Staff
Thanks for posting your OSCEs Woozy, it's good because it helped me review stuff as well. I have a few comments:

When you write "DDx", you know that stands for differential diagnosis? So that means a list of possible diagnoses... a DDx is never a single option...

In Station 1, were you asked to give a list of possible diagnoses? Because the one you stated certainly isn't the only possibility...

In Station 3, what is sitting down a key diagnostic indicator for? And you gave a single diagnosis at the end... sitting down certainly doesn't rule out vasovagal syncope or epilepsy, or a number of other options... And what do you mean by "contractions"?

In Station 4, careful because wrist tenderness (HPOA) is not a neurological sign, it's part of a paraneoplastic syndrome. Also, hyperresonance is not a sign associated with pneumonia or pleural effusion, it is associated with increased air - so more likely COPD, pneumothorax. As far as "other exams" go, you should also say spirometry.

In Station 5, that's an interesting station, so you were asked to take a history and counsel on BGLs as well? I wouldn't have thought there would be time to do both properly... Also, those BGLs are actually normal. The retinopathy and neuropathy associated with T2DM are actually fairly late stage complications, if they were caused by diabetes her BGLs would most likely be haywire. I'd be more inclined to think of central diabetes insipidus (?cranial lesion causing blurred vision +/- paraesthesia) in the setting of normal BGLs in this case. You should enquire about the timing of the visual disturbance and paraesthesia. And we don't call it "mature onset" diabetes, just type 2.

In Station 6, regarding the "preferred" method - is that a school thing? My hospital doesn't mind, actually some of my DEM supervisors preferred the syringe-and-transfer method because it's less likely to haemolyse the sample...

Otherwise, these OSCEs seem to be harder than the ones I remember from my second year, so well done for getting through them.

Year 2 OSCE (Summative, 10%):

1. 58 Year woman presents with back pain.

S: Lumbar back pain
O: 3 weeks age
C: Dull and sharp pains
R: radiating down the posterior of the R leg.
A: as above
T: constant
E: Movements involving the lower back
S: 10/10

PMHx: SLE
Meds: Voltaran, Methotrexate, Prednisone (corticosteriods), etc. Patient also takes calcium supplements.
Familial history: Father CVD.
Social history: Supported by husband.
Red flags asked: post-menopausal?, IV drug user, occupation, infection, trauma.

DDx: corticosteriods use causing increased bone degeneraiton leading to compression fracture, sciatica, etc.

2. Lower limb neurological assessment, instructions noted that we were not required to perform a sensory exam: even though we we're told we would have actors, this patient had pathology. I conducted the full lower limb neurological assessment, inc gain and testing of the dermatomes. See T and O'C.

Asked to distinguish between UMN and LMN, 3 examples of lower limb UMN signs. Hyperreflexia, Hypertonia, Fasciculations.

3. 4X YO woman out with daughter when she suddenly losses consciousness.

S: N/a
O: Sudden and unexpected. No aura or warning signs.
C: loss of consciousness, you should ask if it was witnessed, it was important to distinguish 'blackout' and 'loss of consciousness', etc which the patient used interchangably, for this interview i asked if anyone witnessed the event, the interviewer said yes and i proceeded to interview the daughter about the LOC. Other students were given bonus marks for getting the patient to define what they meant when using those terms, apparently only 1 student asked out of the 30 of us. I also asked about the context in which this occured: the patient was sitting, which was a key diagnostic indicator.
R: N/A no other features
A: None reported by patient or daughter. Patient had no aura, or contractions, loss of continence.
T: A few minutes
E: None known
S: N/A

H of PC: 2 other recent episodes of syncope, in the last month, including one fall, one other witnessed by husband.
PHX: Heart attack 10 years ago, patient unable to describe any details about this.
Meds: Lipitor
FHX: Diabetes in the family... can't remember

Students: from the prompts and direct questioning of the students by the markers it seems we were required to ask questions to help distinguish between: vasovagal, cardiogenic syncope, and epilepsy in the interview.

DDx: Cardiogenic syncope.

4. Respiratory exam.

Patient: was wearing pants, bed was completely flat with no pillows.

Full respiratory exam from T & O'C performed, i forgot to add neurological signs such as wrist tenderness, finger abduction, and adduction. Apparently later in the day there was a patient with pulmonary hypertrophic osteoarthropathy. Also say the examinations you would like to perform but can't since the patient is wearing pants, the bed isn't at the right angle etc, such as JVP, checking for oedema, peripheral pulses. Some students we're asked to proceed straight to chest, or to skip certain parts of the exam due to time constraints or by taking too long. Most students we're still examining the back when told to stop.

We we're then asked what are some possible DDx: of hyperreasonance. Pleural effusion, pneumonia, etc.

Also what other exams we would like to perform: Cardio of course, GIT possibly, since the patient possibly had gynaecomastia on inspection.

5. Patient presents with polyuria.

Needed to distinguish between pathology and inc frequency from excessive fluid intake. The patient also had nocturia.

Patient also had: visual disturbances (blurred vision at times) and tingling/numbness of the left foot.

FHX: Sister and Aunt with type II mature onset diabetes.

Questions asked:
Fasting and non-fasting blood glucose: 4-6mmol/ and 4-8mmol i think.

Also to explain to the patient what BSL's are, there levels and why it is important to maintain BSL in this range. Explain the inc in urination as well.
DDX: Diabetes mellitus (mature onset, type II) given possible diabetic retinopathy and neuropathy/peripheral signs.

6. Venipuncture for FBC.

Remember to keep looking and talking to the actor and actor and not the venipuncture arm.

Some students complained that they we're unfamiliar with the equipment, since we we're asked to use rubber torniquets which aren't used at Blacktown MDH. Also vaccutainer syringes we're different from BMDH.

Most students we're unfamiliar with filling out the pathology request form and asking the patient to sign the form, etc.

1. Wash hands
2. Introduce self to patient.
3. Check patient's details and wrist band, check for allergies
4. Explain procedure, reasons why
5. Contraindications/preferred arm be sure to gain consent only 3 students out of 30 or so at BMDH asked last year for spirometry!
6. Gather equipment - other equipment such as syringes were there a lot of students choose to use the 'open' method which requires the use of a syringe and changing needles, this is not the preferred method. Also the wrong tubes we're also present. Some students choose the grey vaccutainer for HB1AC (blood glucose) and not the purple FBC ones! Clean site, etc...
7. Wash hands/glove up
8. Procedure - remember to remove the torniquet as soon as the needle is in. Also cotton-ball + tape for Pt
9. Safe disposal of sharps!!! Don't forget!!!
10. Write details on Vaccutainer, and path form, send to pathology.
 
Last edited:

zvyx

Regular Member
pretty comprehensive wooz, I would just like to comment that they seemed to mixed it up a little. even though I was in the same group as wooz (coincidence much), my respiratory exam examiner asked me instead what dull sounds upon repercussion would mean, instead of hyperresonance (I said oedema and consolidation). I'm impressed you got through the exams all in time (well it sounded like you did) - I only just finished the respiratory with the exception of telling them what I would do next (which funnily enough was not asked in either exam by examiners), and only finished about 3/4 of the lower limb, missing out on the ankle and plantar reflexes, and co-ordination (though I may have compensated for that by the gait analysis and heel-to-toe test that I did at the beginning).

Venepuncture was the most difficult exam for us as a grade I think - too many people (including myself) who had too little experience with different types of equipment used in Campbelltown Hospital - different type of tourniquet, different type of needle, it threw some of us off a fair bit. I only just remembered how to tie the disposable type of tourniquet that was in the exam, in the moment whilst walking to the patient with it in hand, I'm sure many people racked their heads for a good 15-20 seconds or weren't even shown it previously.

walking away from it, I would say it was significantly more difficult than 1st year, maybe it was just the venepuncture that affected my judgement of the difficulty. Seemed to have a lot more time last year, maybe that's a good thing since I covered things comprehensively? I wish, haha...

edit: for DDx'es in the history stations, I ended up with:
Back pain - osteoporosis (primary, was only asked to give my primary dx), based on meds, age and sex, description of pain, length of time, onset, past hx of fracture, use of calcium supplements (although that would help alleviate the osteoporosis, I thought this indicates that a GP had noted her as a risky candidate for osteoporosis); others I was thinking at the time included osteoarthritis, and ankylosing spondylitis (which on hindsight wasn't appropriate)

Loss of consciousness - cardiogenic, vasovagal, syncope; cardiogenic more likely due to setting and past history, and thus primary dx
The actor forgot that she had had a heart attack before and said she had no medical conditions or diseases, I asked about meds and she said she took aspirin, a few seconds later my examiner interrupts and says "she had a heart attack 10 years ago"...

Polyuria - my patient was quite forthcoming with her other symptoms, but when i asked her (twice, spaced out between screening questions) about anything else she'd like to tell me, she didn't reveal the neurological signs. Definitely was my fault though, I didn't ask closed questions about those signs. Due to lack of neurological signs, and no change in appetite, my primary dx was Diabetes insipidus (argh!), quickly followed by diabetes mellitus type II (I realised it matched up a lot better even without neurological signs, due to age, weight, two out of three classical signs)
 
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leegan

Member
I think zyvx beat me to saying most of the things. :lol:

Hi Hayden,
Ill try to give a little bit of an overview from my side. I went to a different hospital for the exam but shouldn't differ too much.
I was asked for primary dx and ddx
I gave compression of the nerve root. Didnt specify which and wasn't asked.
I also gave in to the fact that SLE could have joint involvement but was put off my the fact that it was acute upon picking up a basket
In retrospect would have considered pathological fracture although unlikely.
Also rambled a little about the possibility of previous work related ergonomic injury but again unlikely due to acute nature

Re Station 3 Im not quite sure what you're getting at so Ill leave that for someone else except contractions might be convulsions

Re Station 4 Over at Camden we were asked what causes dullness to percussion not hyperresonance. I hence gave the responses pleural effusion and consolidation due to pneumonia. Im not sure if wooz actually was talking about pancoasts syndrome which is not HPOA but Im not sure. Question about that though, would strength of the upper arms simply by testing shoulder abduction be enough to test for pancoasts because I did that in favor or finger abduction and I didnt test for HPOA

Re Station 5 Yeah, I wasnt expecting a counsel in as well as history but yes. I was given 1-2 minutes to do the counsel. I wasn't given an BSL and patient denied any other late stage diabetes complications but did have poorly controlled hypertension, and poor compliance with discontinuation of antihypertensive medication for a month approximately (forgot the name)so I went first for hypertensive damage possibly associated with diabetes due to family history. However in quarantine I heard a number of suggestions of diabetes insipidus. I found no indications of anything causing an onset but then again I could be wrong.

Re Station 6 Yeah thats also varied based on hospitals and the tutors. However I thought that if you use the blood transfer device wouldnt the blood be rendered unusable within a short period of time or was that for blood cultures?


Oh yes and re to wooz
for station 3 i got a different hx although I think there were variations. My patient had a prodrome. Mother had diabetes but no knowledge of fathers past medical history. I think mother died of stroke. I wasnt allowed to interview the daughter but the patient told me what the daughter said. This one seemed very vauge.
I ended up going with vasovagal for my primary and cardiac and stroke as differentials
for station 4 the examiner did get me to skip stuff and told me not to talk to the patient. Then again i did take a full minute taking pr and rr.... I wonder if that was it
re to zyvx I dunno if I said this to you but none of my examiners asked me what extra I wanted to do. As soon as the last minute bell went off I motormouthed through what I wanted to do briefly demonstrating each if possible. Somehow I still managed to miss babinski :cry:
 

dotadude

Member
OSCE Station 1: Peripheral Vascular Disease:
OSCE Station 2: Respiratory Exam:
OSCE Station 3: Spirometry:
OSCE Station 4: Thyroid Neck Lump:
OSCE Station 5: Communication-Epilepsy:
OSCE Station 6: ECG-Chest Xray:
OSCE Station 7: Diabetes clinic:
OSCE Station 8: Lower Limb Neuro Exam:
 

Matt

Emeritus Staff
Emeritus Staff
I remember hearing a little bit about the third year OSCE, thought it sounded very fair and heard the students were quite satisfied with it. Would be good to know a bit more about the stations if you remember, Dota?

Thanks for the feeding back to the UWS students, Hayden. :)
 
Year 1 Formative OSCE:

Station 1:

Patient complaining of palpitations. Take a history. Asked about what aspects of the history would indicate to you whether the palpitations were serious or not.

Station 2:

Perform a respiratory examination. Real patient with actual symptoms, some of which have nothing to do with resp. Asked at the end whether the patient had crepitations, which was difficult to ascertain and I said it was 'slight crackles.'

Station 3:

Patient complaining of abdominal pain, also has difficulty opening bowels, however, opening bowels slowly does away with the pain (patient is constipated). Take a history. Most likely cause, being the hypertension medication she was taking, I forgot to ask about. Oh well.

Station 4:

Perform a cardiovascular examination. Expected to report certain findings, such as the rate and rhythm of the radial pulse. Question about what a pansystolic murmur might indicate asked at end.
 

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Matt

Emeritus Staff
Emeritus Staff
Quite a difficult OSCE for first years! Lucky its only formative.
 

Havox

Sword and Martini Guy!
Emeritus Staff
Year 1 Formative OSCE:

Station 1:

Patient complaining of palpitations. Take a history. Asked about what aspects of the history would indicate to you whether the palpitations were serious or not.

Station 2:

Perform a respiratory examination. Real patient with actual symptoms, some of which have nothing to do with resp. Asked at the end whether the patient had crepitations, which was difficult to ascertain and I said it was 'slight crackles.'

Station 3:

Patient complaining of abdominal pain, also has difficulty opening bowels, however, opening bowels slowly does away with the pain (patient is constipated). Take a history. Most likely cause, being the hypertension medication she was taking, I forgot to ask about. Oh well.

Station 4:

Perform a cardiovascular examination. Expected to report certain findings, such as the rate and rhythm of the radial pulse. Question about what a pansystolic murmur might indicate asked at end.
Station 2: Didn't have a real patient here.

Station 3: Also asked for provisional ddx with reasons and mechanism. Though when I asked about taking medications the patient said no, which I thought was weird since they were meant to be taking hypertensives...?

Station 4: Asked what a pansystolic murmur at the apex may indicate. Asked what further examination I would perform.
 
Same with station 3. I asked about medications too, but I did not ask what medications she may be taking for any other conditions, which is I think what the money question was.
 

Havox

Sword and Martini Guy!
Emeritus Staff
Same with station 3. I asked about medications too, but I did not ask what medications she may be taking for any other conditions, which is I think what the money question was.
Actually I asked that, alongside "Do you have any other medical conditions?" and the answer was still no. I wonder if my volunteer made a mistake. I only found out about hypertensives from other people.
 

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