Semester 12 OSCE Exam “ Compiled by Dr. Henry Yao 2010 Semester 12 2 ae 1) Vascular disease. Take a history of someone with PVD and answer questions on images showing which arteries is occluded. 2) Arterial blood gas 3) Thyroid history and examination + questioning on haematoma post-thyroidectomy and. ( management 4) Diarrhoea history and answering questions 5) Counsel patients on OCP use. Need to know all the different kinds of OCP and advantages and disadvantages — > 6) Radiology station kidney ston and management and 2 more | can’t remember 7) Adverse reaction to medication in elderly patients. Given a list of medication. Patient presents with nausea unwell after being started on a few new medication. 8) Obstructive sleep apnoea (patient presents with tiredness and falling asleep ~ note: diagnosis is not given to you, you have to come up with it) ~ take a history and answer questions on diagnosis. and management Can't remember the last 2 stations. 2009 Semester 12 MEU Stations (horrible stations, with insufficient time) DN Sem 1) Epilepsy hea oo ‘* History ~ temporal lobe epilepsy, chronic SFIu cop | Mol OPP shat Ebay © Management | 20n = GP P10 magena gts ER 2) Benign positional vertigo | Ses ere aie ~ GP. Chote result © Mx History taking ee THESES fete Lietmye € 3)/ Hyperemesis gravida? | Padnsoresl bey < we S's 8/52 pregnant Me Ri ont; Goce ini eg maenef AA © rule out other causes Sciteg dT f= penom aD A suggests non-pharmacological and pharmacological treatments - “8°52 ( ay" Asthma om _ (CA Interpret FEV results WAC er © Assess puffer usage technique we © Explain how to use correctly and demonstrate using a spacer » 5) Radiology station * Pneumothorax ie © Intracranial haemorrhage 1 ‘© Nephrotic syndrome 0 Coro | Sem& ~ - 2) mapevre a \ y | 2) dado exam Lee colt oot | 4) etyspregia, + ee 90 wy 9 pa > Ulney weme x . | 6) Gere nyperchawae 100 fest | TW cornmmaker “heroliele Snsy | Stecrorsay est aaeScaih we ‘on ’ urge ype age fons ey ‘cauelteClinical School Stations 1) Malaria + Recent traveller to Thailand ‘* Present with 1/52 symptoms of fever, headache, malaise + Questions about most likely diagnosis (malaria) ‘+ Investigations to confirm diagnosis (thick and thin blood films, LFTs, etc...) ‘| Management 2) Cardiovascular Examination ‘+ Ejection systolic murmur best heard over aortic region, radiating to carotids ‘© Questions regarding differentiation of AS from MR ‘+ Interpret ECG showing first degree heart block and inverted and peaked T waves 3). Basic life support (procedural station) ‘+ Patient in ward unresponsive with noisy breathing ‘* Recognise obstruction as a cause ‘Important to call a MET call, secure airway with manoeuvres ‘* Patient stops breathing -> call code blue, need to commence CPR and answer some questions regarding technique 4) Pancreatitis, * History —female patient, abdominal pain radiating through to back, nausea and vomiting, previous right upper quadrant pain, no alcohol intake + Most likely diagnosis is pancreatitis from a biliary cause + investigations to confirm — amylase/lipase, plan abdominal and chest erect film, U/S biliary tree, LFTs, ERCP/MRCP 5) Oesteoarthritis ‘© Right hip pain, physical examination of hip joint, lower limbs and back, with special tests * Then interpretation of a hip X-ray showing narrowed joint space, osteophytes, subcondular sclerosis and cysts © Treatment of OA hip 2008 Semester 12 MEU Stations 1) Imaging station © Small bowel obstruction in 25yo male = Multiple air-fluid levels / dilated bowel loops = What management = What differentials (adhesions, he had past appendicectomy) © CXR - ?TB (dilated hilar region, cavitating lesions, diffuse patchy opacities © CT brain — sound like left parietal infarct?? 2) Counselling on high grade dysplasia CIN Ill ©. Give patient test resultsReassure it’s not cancer Need further testing Talk about HPV Assure patient that partner wasn’t unfaithful Talk about colposcopy Asked questions about difference of management between CIN | and CIN Il and the rationale for recalling patients with CIN | in one year (that immune system kicks in and cause the dysplasia to regress) 3) Erectile dysfunction © History © Questions = What contributed to his ED (B-blockers, hypertension) = What will you treat with (viagra, lose weight, control DM) 4) 16 year old girl presents with epilepsy and binge drinking © History to ascertain her “issues” ‘© This one was hard —dunno whether it’s chronic disease history, alcohol history or adolescent HEADSSS screen © Remember to reassure patient that everything is confidential unless she is at risk of being harmed, wants to harm someone or herself 5) Crohn's disease ‘+ History (no psychosocial aspect??) o000000 * Patient comes in for FU in outpatients © Just clerk the chronic disease history © She doesn’t have any active disease © Question © What blood test would you like to do if she has terminal ileitis © What other medications would you try her on if mesalzine and prednisolone fails Clinical School Stations 1) Surgical Station - Carpal Tunnel Syndrome © Other's thyroid, hernias including anatomy 2) Neurological examination of lady with unsteady gait > test ‘© Remember MS as primary differential 3) Chest pain radiating to the back © Interpret ECG and CXR 4) Procedure ~ ABGs © Need to explain procedure to actor/actress then do procedure © Pick the right equipment2007 Semester 12 MEU Stations 1) Alcohol history 2) Migraine ‘© 6months of worsening migraine © Take a history ~ young girl taking OCP © Ask about triggers — including caffeine, lack of sleep, analgesic abuse, life stressors 3) Radiology © Acute pulmonary oedema © Thoracolumbar spine ~ multiple myeloma or prostate mets ©. Small bowel obstruction © Osteoporotic crush fractures 4) Abnormal blood test ~ Fe deficiency anaemia ind out the cause © Take a history to elicit symptoms and Symptoms of malabsorption Patient presented with loose bowel motion and abdominal pain Questions * What are the 3 likely diagnosis, the most likely. = Give 3 tests to look for the conditions. 5) Given cholesterol results © Explain and discuss a management plan 200 ‘al School Stations 1) Chest pain * Acute onset chest pain * Diagnosis of aortic dissection * Look at ECG and CXR (widened mediastinum) 2). Respiratory examination ‘© Patient presents with 6 months of worsening dyspnoea © Doa respiratory examination Pulmonary fibrosis and scleroderma patient 3) Blood transfusion Communicate with patient © Perform venepuncture ¢Fillin blood transfusion form © What are some of the transfusion reactions 4) Surgical station © Canbe different © Thyroid lumps, cholecystitis, venous ulcer disease, peripheral vascular disease, arthritis, melanoma, inguinal hernias all came out © Be prepared for them ALL2006 Semester 12 MEU Stations 1) Rheumatoid arthritis, chronic disease and coping 2), Motivation interviewing ~ smoking cessation 3) Radiology © Gallbladder US © CAR=coif lesion 4) Pap smear procedure 5) Explain hypercholesterolaemia, what levels are required Clinical School Stations 1) History of palpitations ~ AF, management 2) History of gastroenteritis ~ prostatitis, DDx 3) Examination of peripheral neuropathy 4) Surgical station 2005 Semester 12 MEU Stations 1) Dysuria history ‘© Young woman presenting with dysuria © ODx-UTIor STO 2) Headache — migraine 3) Radiology © Hip X-ray ~ fractured NOF © CTabdomen © Paediatric CXR 4) Death certification and confirmation 5) Explain T2DM diagnosis and treatment to patient Clinical School Stations 1) History of chest pain 2) Examination ~ RA hands (coping and management) 3) Blood transfusion 4) Surgical station 2004 Semester 12 1) Advise ~stop smoking 2) Management ~ HTOA Overweight NonCl 3) AF ~Hx of palpitations and ECG 4) Parkinson's : Video 5) AB6) Surgery station: short cases ~ Goitre, groin lump, SBO, PVD 7) Unmanned : XR ~ C-spine, CT head, AXR ~ SBO, CT-Aortic dissection 8) Unmanned: Confusion DDx, Mx plan and Ix 9) Drug chart 10) Abstract — Calculate RR, AR,NNT, likelihood ratio ther possible cases Medical and Surgical Cases 1) Interview: Dx eg Difficulty swallowing, RIF pain 2) Interview: Mx eg DM, asthma, epilepsy 3) Info giving: eg Breast cancer, genetic test; warfarin; consent; OM 4) Physical examination — Abdo, RS, CVS 5) Procedure: IV, ABG, IDC, Suturing, ECG 6) Surgical medium case(19min) — Assess patient with surgical problem 7) Unmanned station: Xray 8) Unmanned station: Lab results 9) Unmanned station: Written communication skills; Evidence-based practice exercise General practice © Hypertension — management * Diabetes ~ management © Starting warfarin therapy * Motivational interviewing —smoking, alcohol, weight loss, physical exercise © Women with tiredness — medical problem vs social issues * OCP management Procedural Skills © Arterial blood gas * Cross matching blood © Basic life support © NG tube insertion ‘© Urinary catheterisation © Plastering © Lumbar puncture © Pap smear = Genital swabs * Blood cultures * WV cannulation © Sulturingsuoeniied 'odo>’neyn euseue adosu45 ypepeny vou sh outst ojsas800 onunrsideauo> ews 309530 sues a0 Nc au oyun ot pur ssoutee BUA -NADGO (wages ve) suei0d noe nes 0 weRn=) Inq waygost JoNnOUE I U9FB14 8) YORZUTYSD IES “wrojad oom nok ein suonednseau ¢ uN “q = 2vnaig fou Buses) patou was¥09 yew InOA ABM opus sey waned ~ (uve) oddns a 38 “T 6008 ZF 9s 243350 ‘uapio MOM nok eu “suosputs aun jos wos BUEN eunsioud “see smo ssheuun “areuuou ng ewapa0 are YO WaReE > ‘woudeu sea ou vo 335 ‘evoqioueud w9sue, FaMONF ID “e ones ABOREY *S S uruepises srouayodiy ~A2¥6¥8348 BuLNE “unsp wos papuaesns (vorteuiens pur 54 on) ew “E 600g 21 was Tr 350_year( that immune system kiksin and causes the dyplasi to regres) 2.6m of worsening migraine take aha young gl onthe OCP) ask or tsgrs inclusingcafeine, lack ef sleep, analgesic abuse, le stressors Muitine myeloma? Or prostate nts? ntact pt presented spt ‘Qs what are the 3 key cholesterol results explain and cuss a management san Cama schoo 3 tadilegy-gallbadder US, eat lesion 4. Papsmear procedure 5. Elan hyperchoestercleme, what levels are requires ines senook 1. Ms of palptations: AF, managernent 2 Hv of stron tit, OOx 5 snot ar 4 surgeats 2005 sem 12