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.