Year2OSCEPractice2011

Set2,ExaminationStation
CandidateInstructions

ThepatientinthenextroomisGavin,whois16yearsold.Heiscomplainingofdyspnoea,cough
and tightness of the chest which has become worse during a current viral URTI. You have been
giventhispatientspastmedicalhistory.Youarenotexpectedtoaskanyfurtherhistoryfromthis
patient.

You have 8 minutes to perform a focused examination with respect to the presenting complaint.
Donotmakeanyinferencesbasedontheappearanceoftheroleplayer.

You are expected to explain to the examiner the specific findings that you are looking for during
yourexamination.

TASKS
Focusedexaminationincludingreasoningtoeachpartofexaminationtotheexaminer8minutes
Year2OSCEPractice2011
Set2,ExaminationStation

PastMedicalHistory:
Eczema2yoto12yo

Allergicrhinitis14yo-current

ViralURTIforpast3days

Meds
Loratadine10mgoncedaily

Allergies/ADRs
Eggallergy-pruritusandvomiting

PastSurgicalHistory:
Nil

Immunizations:
Uptodate
FamilyHistory:
Bothparentsaliveandwell
Maternalside-breastcancer,asthma
Paternalside-ischaemicheartdiseaseand
hypertension
Lifestyle
Smokingcurrentsmoker-5cigarettesperdayfor
2years
Alcohol3-4unitsbourbonatweekends
Dietvaried
ExerciseBMXracingonweekends
HobbiesBMXracing
Pets1cat
Demographics
Occupation
Worksastraineecarpenter
Livingarrangements
Worksastraineecarpenter

Year2OSCEPractice2011
Set2,ExaminationStation
InstructionsForExaminers

Thetaskforthecandidate
To perform a cardio-respiratory examination to try to determine the reason for this patients
dyspnoea,coughandtightnessofthechestwhichhasbecomeworseduringacurrentviralURTI.

ConductoftheStation
Ensurethatthecandidateunderstandsthetaskthathe/shehastodo.
The candidate is expected to interact appropriately with the patient including introducing
themselves,andobtainingconsentfortheexamination.

The candidate has been told to explain to the examiner the specific findings they are looking for
during their examination. They are not to make any inferences based on the appearance of the
roleplayer.
Please prompt the candidates if they are performing the examination in silence, or talking to the
patientinstead,usingthephrasesbelow:
Pleaseindicatethesignsyouarespecificallylookingfor
Pleasetalkmethroughyourexamination,asyouareperformingit.
During the course of the interview the candidate may refer to any notes they have made during
theperusaltime.

Thisisaneight(8)minutestation.

Year2OSCEPractice2011
Set2,ExaminationStation
Introduction/General
Whoandrole
Consentandwasheshands
Interactswithroleplayerappropriately
Ensurespatientincorrectpositionforexamination-supine30-45degrees
General
Well/unwell-Patientisinsomerespiratorydistress,usingaccessorymusclesofrespiration
andleaningforwardonhisarmsinthetripodposition
Talkinginsentences/wordsonly-Speaksinshortphrases
Colour-pale/jaundice/cyanosis/flushed-Nocyanosis
Vitalobservations
T37C
BP120/70
Pulse100bpmregular
RR25breaths/min
BMI20,pO293%RA
Facialsigns
anglemouth,tongue,mucousmembranesandconjunctiva-None
Peripheral
Handsnails,clubbing,endocarditissigns,pallor,cyanosis-None
Eyes-xanthelasma,conjunctivalpallor,jaundice-None
Neck-JVP,carotid,tracheadeviation-None
Feetpulsesandperipheraloedema-None
Specificsystem/area
Inspection-scarsandchestwalldeformities-Chestappearshyperinflated
Respiratorydistresssigns-Prominenceofsternocleidomastoidmuscles,subcostal
recession.
Palpation-apexbeat,thrillsandheaves-None
AuscultationCV-all4areas,ANDin3positions-lying,leftlateralandsittingforwardwhilst
breathheldafterexhalation-heartsounds,addedsoundsandmurmursHSx2+0
Palpation-sacraloedema-None
Movementofchestwall-Symmetrical
Chestwallexpansion-Normal
Lungfields-Widespread,high-pitched,polyphonicwheezeinallareasbilaterally
Percussion-lungfieldsespeciallybases-Lungsarehyperinflatedtopercussion
AdditionalIx
Urinedipstick-normal
ECG-Sinustachycardia
CXR-Hyperinflation,noinfiltrationorcollapse,normalcardiothoracicratio
PFTs-ReducedFEV1,FVC,PEFcomparedtoexpected.FEV1/FVC=65%,80%post-
bronchodilator

Year2OSCEPractice2011
Set2,ExaminationStation
MARKING

Examinersareaskedtogradestudentsperformanceonascaleof0-4intheareasonthemark
sheetincapitals.Thestandardsforawardingthesegradesare;

0=Unequivocalfail: Student was unable to demonstrate history or examination skills

without significant prompting, OR displayed unethical or
unprofessionalbehaviour.

1=Marginalfail: Student lacked a comprehensive approach, and/or needed
considerablepromptingtocompletethetask.

2=Borderlinepass: Student performed a systematic examination or history but did not

complete some components in a number of areas of the marking
guide.

3=Clearpass: Student had a systematic approach, required little or no prompting,
was confident and completed most components of the marking
guide.

4=Highpass: Student had a high level of proficiency, well above what would be
expectedofastudentinYear2.

Examiners are required to make an overall judgement about the students performance in each
area on the marking sheet. The specific items listed are there to remind examiners about issues
which might be considered. It is not intended that these items should rigidly translate into a
score.
It would be helpful, particularly when feedback is being given to poorly performing students, if
there is some notation in the comments column. Also examiners may find it helpful, when
considering what grade to award, to have indicated in the comments column when items were
omittedorwhenpromptingwasrequired.
GlobalScore.Thismarkdoesnotformpartofthestudentsoverallmark.Thescoreshouldreflect
thestudentsempathyandoverallperformance,andisfromtheexaminersperspectiveonly.
Year2OSCEPractice2011
Set2,ExaminationStation
DDX
1. Asthma(mostlikelygivenHx,examinationandreversibilityofPFTs)
2. COPD(unlikelygivenageexceptinalpha1antitrypsindeficiency)
3. AtypicalPneumonia
4. Lobar/Bronchopneumonia
5. Pneumothorax

ass Mark = 13/20 ass/ lall
(Clrcle as approprlaLe)

CommenLs (essenLlal lf Lhe candldaLe has falled Lhe sLaLlon)

Clobal Score - from examlners only- score 0 1 2 3 4


!
leaLure CommenL
Score
(please flll ln clrcle)
Introduction/General 0 1 2 3 4
Who and role
ConsenL and washes hands
lnLeracLs wlLh role player approprlaLely
Lnsures paLlenL ln correcL poslLlon for
examlnaLlon- suplne 30-43 degrees
General 0 1 2 3 4
Well/unwell
1alklng ln senLences/words only
Colour- pale/[aundlce/cyanosls/flushed
vlLal observaLlons- 1/8/pulse lncl
rhyLhm/88/8Ml/pC2
laclal slgns- angle mouLh, Longue, mucous
membranes and con[uncLlva
erlpheral 0 1 2 3 4
Pands nalls, clubblng, endocardlLls slgns,
pallor, cyanosls

Lyes- xanLhelasma, con[uncLlval pallor,
[aundlce
neck- !v, caroLld, Lrachea devlaLlon
leeL pulses and perlpheral oedema
Speclflc sysLem/area 0 1 2 3 4
lnspecLlon
- scars and chesL wall deformlLles
-resplraLory dlsLress slgns

AusculLaLlon
Cv- all 4 areas, Anu ln 3 poslLlons- lylng, lefL
laLeral and slLLlng forward whllsL breaLh
held afLer exhalaLlon
- hearL sounds, added sounds and murmurs
8S- lung flelds
Speclflc sysLem/area conL. 0 1 2 3 4
alpaLlon- apex beaL, Lhrllls and heaves,
sacral oedema
ChesL wall expanslon

ercusslon- lung flelds especlally bases
Year2OSCEPractice2011
Set2,ExaminationStation
InstructionstoStandardisedPatient

You are playing Gavin- a 16 year old man, who has been complaining of dyspnoea, cough and
tightnessofthechestwhichhasbecomeworseduringacurrentviralURTI.ThestudentsareNOT
expectedtotakeanyfurtherhistoryfromyouregardingyoupresentingcomplaint.Howeverthey
areexpectedtointeractappropriatelywithyouasapatient.

The students should commence with introducing themselves and obtaining verbal consent to
examineyou.Theyshouldalsoensureyouarecomfortableontheexaminationcouch.

Iftheyfailtointroducethemselves-pleaseaskWhoareyouexactly?
Iftheyfailtoaskforyourconsent-pleaseaskWhatexactlyareyougoingtobedoing?

Thestudentsshouldstartwithaperipheralexaminationofyourhands,lowerlegs,face,eyesand
mouth-beforemovingontoyourheartandlungs.

Youwillberequiredtoexposureyouchesttoallowthestudentstoexamineyourcardiovascular/
respiratorysystem(heartandlungs).

Thisexaminationwilltakeeight(8)minutes.

During this time the students are expected to explain to the EXAMINER the specific findings that
theyarelookingfor.Theywillbetalkingtotheexaminer,asrequestedandyouarenotexpected
torespondtotheircomments.