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UWS OSCEs

Matt

Emeritus Staff
Emeritus Staff
Not sure whether those response are fair or not... although I can tell you now, patients responds best to direct questions. I usually follow the do you have any medical conditions up with have you ever had a heart attack, stroke, chest infection, clot in your lungs or legs, asthma, diabetes, liver disease etc. Many people who have medical conditions will respond in the negative to the do you have any medical conditions question.
 
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Havox

Sword and Martini Guy!
Emeritus Staff
Many people who have medical conditions will respond in the negative to the do you have any medical conditions question.
I wonder why...? It's a pretty simple question really... :bored:
 
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Dave L

Regular Member
I wonder why...? It's a pretty simple question really... :bored:
If their conditions are under reasonable control and not causing any obvious symptoms, people often forget. Specific cues or prompting is often required, and OSCEs can be setup that way, with patients being instructed not to answer broad questions and only respond positively to specifics.
 

zvyx

Regular Member
I've always thought that the OSCE patients were too perfect. They seem to have insta-recall, never ramble, so attentive, etc. although it's good that they are - enough stress as it is to fit everything into 8 minutes :)
 

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Hayden

Getting busier
Emeritus Staff
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)
Just read this. Really, neurological signs point towards diabetes insipidus more than diabetes mellitus because in DM neuropathy comes late; visual disturbance however is a key (common?) finding in diabetes insipidus cause by pituitary fossa lesion.
 

woozy

Regular Member
3rd year 2011 OSCE's

1. CXR and ABG interpretation of an 85 year old woman, who presents with 3 days of fever and cough.
CXR - Check details, quality, PA Erect, inspiratory or expiratory, check adequacy of inspiration, check for rotation
X-ray details: Osteoarthritis of shoulder, pacemaker, blunting of right costophrenic angle, right lower zone pneumonia.

ABG from same patient
pH 7.25
Hypoxic
Inc PaCO2
Bicarb normal
BE 0

Had to classify: type 2 resp failure with respiratory acidosis.

2. Lower limb diabetic and vascular exam
Actually had to feel for femoral pulse, explain anatomy, etc.
Also asked for 6 things you would do or inspect for to check arterial circulation.

3. History 22 YO woman (Sales rep) who presents to the ED with Right sided abdominal pain.

On history, central abdo pain which migrated to RIF pain over the course of 2 days, 7/10 sharp pain. Pain on movement and leg extension. Bowels opened and regular, last ate this morning, vomiting (I should have asked more about this). Able to keep fluid down.
LMP: 4 weeks ago, periods regular, no previous pregnancy, etc.
Medical history: tonsiliectomy, no other known conditions
Allergies: nil
Smoking: 5 cigarettes/day
Alcohol: social
Travel: nil
Occupation: not stressed

4. BLS/ALS - You are a JMO on night shift and see a man collapsed on the floor in the hallway, you have a resuscitation cart next to you. You are by yourself.

DRSABCD

D- no danger
R - no response from patient
S - call out for MET CALL
A - vomit, clear with suction which is available and insert guadel
B - check (look, listen, feel)
C- compressions immediately.

Defib + nurse arrives
Nurse takes over compressions immediately.

You attack defib and electrodes - remember white is right, and smoke over fire.

Follow ARC guidelines. The patient was in VT, shocked immediately. Ensure oxygen is away and continue compressions until ready to shock, then clear. Pt still in VT after first shock, continue CPR after 2nd shock administer 1 mg adrenaline, after 3rd shock amiodarone.

Questions asked: The patient is now in sinus rhythm and conscious how would you manage the patient?

5. 63 or 65 year old woman presents to a general practice with facial droop, which occurred a week ago.

HPC: Left sided facial droop, slurred speech, bumping into things on the left side, L arm weakness, L leg weakness which resolved the same day.

Pre-morbid function good, ADLS and IADLS intact.
B/g: osteoarthritis and hypertension. Postmenopausal, hot flushes.
Meds:
Coversyl (ACEI)
Panadol osteo,
Glucosamine
Allergies: nil

On further questioning also takes Vitamin D

Diagnosis: TIA caused by embolic plaque.
Questions: Give other DDX, explain why palpitations may have caused this.

6. Cardiovascular exam
Pt had signs and all had murmurs
Q - what are the cardiac causes of crepitations
Q - what other systems would you test and what for: Gastro for AAA, renal bruit, liver bruit, etc. Eyes, Peripheral vascular, Respiratory, etc.

7. Communication skills: You are on the surgical team treating an elderly Philippino man with malignant lung cancer. His daughter normally translates for him, however you have called a meeting with a medical interpreter for a family conference. The test results show that his lung cancer is terminal and incurable. The daughter asks to speak to you 10 minutes before the conference about the test results.

Daughter says cultural beliefs mean that they do not want to tell their father the bad news and asks that you tell him it is just an infection, etc.

The daughter also asks why you need an interpreter this time.

Question asked by examiner: what are the reasons for a medical interpreter, why shouldn't you get a family member to interpret.


8. Communication: explain the procedures of an appendectomy surgery to a worried patient.

Patient asks a number of questions: what is envolved, risks, how the procedure is done, how long the procedure is, admission length, when she can go home, when she can look after the grandchildren, etc.

Questions: what are the most common post op risk factors of surgery.
 
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Matt

Emeritus Staff
Emeritus Staff
Probably on the more difficult side with the communication stations. But sounds like a very fair and appropriate OSCE.
 

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zvyx

Regular Member
haha I had a feeling wooz would get to this before I did :)

how did you feel about the exam? I thought it was very interesting to hear other people's comments and compare with last year's osce - a lot more people were running out of time in exams due to uncertainty and breaking out of routine for investigation of the positive signs, which I thought made it more interesting. unfortunately my cardiac exam patient was in fairly bad shape :(
I found the communications pretty straightforward, I think I stumbled most on my histories - didn't ask enough in the time frame; I got the cardinal picture fairly well and some risk factors, but didn't have much time to elucidate else - when I was chatting with others I realised I had forgotten to ask a couple of questions. Oh well, tis over now.
 

woozy

Regular Member
Edit: 8. Patient is distressed and anxious about the operation and states "that i've never had an operation before...i'm worried about it".
 

Havox

Sword and Martini Guy!
Emeritus Staff
Year 2 2011

Stations:
Blood Cultures
Take a history of a woman presenting with lymphadenoma and weight loss. 3 differentials. - Lymphoma
Lower limbs Neuro Exam - Give a cause of an absent patella reflex
Gastro exam. 4 differentials of hepatomegaly - Congestive Heart Failure, Viral Hepatitis, Alcoholic Hepatitis, Hepatic Sclerosis
Woman presents with central chest pain - must remember to take history of risk factors present, ex-smoker, moderate drinker, poor diet/exercise and high stress job. Provide simple advice on improving health outcomes. Give most likely cause - Angina.
Woman presents with shortness of breath. Take a history and give 3 differentials. Give most likely cause - COPD.
 
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Chezza

Regular Member
UWS OSCE's: Year 2, 2011.
6 Stations, 8 minutes per station. 3 Histories, 2 clinical examinations, 1 procedural skills. 10% weighting.

Histories (3)
-
As worded by the patient/actors:

-Woman with small, rubbery lump in neck and underneath the arms (on both sides). Mother had breast cancer. Patient is presenting with unintentional weight loss. Appetite isn't increased. Take history, give 3 differentials + likely diagnosis

- Woman with chest pain - relieved within 20 minutes without medication. Has had it before, started a month ago. Exercise triggers problem. Task history and ask about risk factors -
ex-smoker, moderate drinker, not a diabetic, poor diet/exercise and high stress job.
List modifiable risk factors + likely cause.

- Woman with shortness of breath. Gradually getting worse. Stopped smoking 5 years ago - 20 cigarettes a day. Has a cough - grey sputum, 5mLs. History of bronchitis. No pain anywhere. Take history, 3 differentials and likely cause.

Examinations (2)
-
- GIT Examination + 4 differentials for hepatomegaly
-Lower limb neuro exam - patient had absent knee reflex. Nerve roots involved in knee reflex + is absent knee reflex caused by an upper or lower motor lesion?

Procedural skills (1)
-
- Perform blood cultures (with nurse there to assist you)
 
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woozy

Regular Member
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.
Only two stations, not four-five like the others?
 

Matt

Emeritus Staff
Emeritus Staff
Yes, in my year at least.
 

_philanderer_

Regular Member
We should try to find someone who's done the Oncology OSCE too, although it's more like a formal CEX, it's still set up something like an OSCE too.
 

Kyle

Old Man MSO
Emeritus Staff
We should try to find someone who's done the Oncology OSCE too, although it's more like a formal CEX, it's still set up something like an OSCE too.
We had an oncology osce?
 

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woozy

Regular Member
2012 Year 4 Term 1 OSCEs:

Psychiatry:
1) Video MSE of a depressed girl, give differentials and clinical features that you would look for.
2) 77 year old man fell and broke hip, MMSE 30/30, got surg, next day MMSE 18/30, agitated, visual hallucinations of a vicious dog. The nurse asks if he has schizophrenia. Explain: 1) why its not schizophrenia and what it is relating back to history/MMSE 2) your management

Obs/Gyn:
Routine antenatal care; pelvic pain (ectopic); CTG & partogram of obstructed labour; STI overview & management (no specific STI knowledge required); 20 true/false questions on four topic areas. Some of the examiners are not very helpful.

Paediatrics:
-Examination of a newborn baby.
-Limp Hx, osteomyelitis.
-Explain diagnosis of asthma, management of asthma, and how to use spacer.
-Charting IV fluids
 

_philanderer_

Regular Member
Oncology Blacktown formal mini-CEX:
1. History: Glioblastoma multiforme (GBM) + Read MRI with lesion in Broca's area (correlate with history).
OR
2. History: Adrenocortical carcinoma + Read/Interpret CT scan.
 

_philanderer_

Regular Member
Blacktown has an OSCE-like mini-CEX where all the students meet at Liverpool Cancer Care Clinic and rotate through 2 OSCE-like stations. But in actual fact they mark it as a mini-CEX
 

woozy

Regular Member
Oncology Bathurst: Hx and Examination of an oncology patient. Present findings. Give most likely DDx.
 

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