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OSCE Samples

A 64 years old lady was suffering from endometrial carcinoma. A total abdominal hysterectomy and bilateral salpingo-oopherectomy was done 7 days back. She was well after the operation. Yesterday she suddenly died following a suspected pulmonary embolism. You were present during the resuscitation. Take an initial verbal consent for autopsy from her next of kin in a very sympathetic way. A 25 years old lady is feeling dizzy particularly after standing from a sitting position. You need to measure her blood pressure. A 50 years old gentleman is complaining that his right great toe became painful and was swollen 6 months back. 3 months back his left knee was affected. Take a relevant history to arrive at a diagnosis. A lady is there on the phone. Her 18 months old daughter is having diarrhoea. She is also having diarrhoea. Her daughter had another attack of diarrhoea 6 months back. Take history from the mother and give her relevant advice, as she is very anxious. A 35 years old alcoholic lady is complaining of loss of sensation over her lower limbs. Perform a neurological examination of her lower limbs for sensory system and reflexes and explaining to the examiner at every stage what you are going to do. A 60 years old diabetic lady does not follow doctors advice regarding her diet or her medications. She is a non-insulin dependent diabetic since last 15 years. She is now complaining increasing visual difficulty. Perform a fundoscopic examination on her and discuss your diagnosis with the examiner (manikin supplied). A 35 years old lady is suffering from panic attacks for the last 3 months. You are a psychiatric SHO. Take a relevant psychiatric history in a very sympathetic way and advise her accordingly. A 60 years old gentleman (manikin) is having increasing difficulty with passing his urine. Since last 12 hours he has not passed adequate urine. You are required to pass a per-urethral catheter. You are working in a ward. Suddenly you hear a noise of a fall from an adjacent cubicle. On entering the cubicle you find a man (manikin) lying on the floor. You are only present there. You need to assess the condition quickly and need to do what you are supposed to do in such a condition. (perform basic life support) In this OSCE station you need to perform a bimanual vaginal examination on an anatomical model assuming it to be a real patient. Describe your findings to the examiner. (Speculum examination or smear not required) A 25 years old lady is having pain over the right upper abdomen. Confirm the history from her and perform an abdominal examination to arrive at a diagnosis. Do not give more stress on the history. A 35 years old lady has been diagnosed of having an ovarian cyst on the right side. On ultrasonography the cyst is 8.5 cm in diameter. A decision to perform right ovarian cystectomy has been made. Explain the condition to the patient and

take her informed consent. She is expected to remain 5 days in the hospital after the operation and the surgeon concerned will be using a bikini incision and subcuticular wound closure using a fine prolene as suture material. A 6 weeks restricted activity is normally advised after such a procedure. You are the SHO in the department of gynaecology. Perform a cardiovascular system examination and describe whether the patient is in heart failure or not Examination of diabetic feet. Counselling for tubal sterilisation. Take a cervical smear from an anatomical model. Fix it properly and do the necessary for sending it to the laboratory. Take history from mother of a 5 year old child who is suffering from breathing difficulty. Perform a mini mental state score on an elderly demented person. Venous cannulation for intermittent drug use (on a model). A 50 years old gentleman is suffering from non-Hodgkin's lymphoma for the last 5 years. He had been taking co-proxamol and co-codamol for his pain relief. But his pain is no longer under control with the above medications. Your Consultant has decided to start him on morphine sulphate sustained release preparation 40 mg once daily. Explain the treatment to the patient. A 25 years old lady is complaining of severe headache over the occipital region since last 4 hours. Take relevant history to arrive at a diagnosis and explain to her regarding the exact nature of the problem. A young man is having pneumonia. Talk to him regarding the condition and give him relevant advice. A 28 years old lady is complaining of pain over the left knee joint following an injury during a skiing holiday and presenting to you 3 days after the injury. You are the Orthopaedic SHO in the clinic. Perform a knee examination on her and give your diagnosis. Hand Examination - Examine and describe the features and give differential diagnosis. You are working in a ward. Suddenly you hear a noise of a fall from an adjacent cubicle. On entering the cubicle you find a man (manikin) lying on the floor. You are only present there. You need to assess the condition quickly and need to do what you are supposed to do in such a condition. (perform basic life support) (Resuscitation stations have been frequently repeated) Prostate Examination - Perform a digital rectal examination on an anatomical model. A 60 years old man comes with retention of urine. Talk to the examiner as patient. At the end present the findings. Rectal Bleeding - A 47 years old man complaining of bleeding per rectum. Elicit history and discuss the differential diagnosis. Trauma Management - History of fall from a ladder. airway and breathing is normal. The patient cannot move his right knee joint. Do a secondary survey and arrive at a diagnosis and outline the management. Cardio-vascular system examination and describe whether the patient is in heart failure or not.

Drug Advice - Patient was taking minocycline for acne. Yesterday she has read an article about the drug and its side effects. You have not read the article. She is worried now. Counsel her. Chest Examination - History of chronic obstructive airway disease. Do a chest examination and give your findings. Coma - Patient found unconscious on the road, brought to A & E by ambulance, airway and breathing normal, blood glucose normal. After entering the station assess the patient's level of consciousness. Examiner will provide you the GCS Chart. Post Natal Depression - A 27 years old lady delivered a baby 4 weeks before. She is now feeling low and her appetite has gone down. You are a psychiatric SHO, take history and explain management. Venepuncture - A 60 years old lady found to be anaemic, draw blood sample for full blood count. Talk to the examiner assuming him to be the patient. Discharge instruction Post Myocardial Infarction - Patient with uncomplicated myocardial infarction is going to be discharged and got his drugs from the pharmacy. Explain about the drugs and nothing else. (The drugs were G T N spray, atenolol and aspirin tablet). Large volume spacer - A child admitted with acute breathlessness was treated and discharged. Explain to the parents how to fit and use the spacer device and drugs. Patient complains of diarrhoea. Take history and give differential diagnosis. HRT advice - A 49 years old lady complains of 10 months of amenorrhoea, mood swings. She is feeling low and tired and having hot flushes and sweating. She is complaining of vaginal dryness and dyspareunia. She is working as a shopkeeper and not mobile. Her mother who is 78 years old is suffering from brittle bones. Talk to her whether HRT is needed or not and explain. An 18 years old known epileptic lady has come to you. She is going to another town for higher studies. She wants to know about alcohol and recreational drugs and about contraception. Talk to her about her condition and answer her queries. Basic life support - You are working in a ward. Suddenly you hear a noise of a fall from an adjacent cubicle. On entering the cubicle you find a man (manikin) lying on the floor. You are only present there. You need to assess the condition quickly and need to do what you are supposed to do in such a condition. (perform basic life support) (Resuscitation stations have repeated) A mother of a 5 years old has come and tells you that her daughter is not doing well and always seem to be lethargic since a cough and cold a week before. Take history from the mother and come to a diagnosis and explain what you are going to do. A 60 years old has peripheral vascular disease affecting his lower limbs. Examine him and give your diagnosis. A 17 years old girl has come with weight loss, apathy and depression. Talk to her very politely, take history and give diagnosis. A 19 years old lady has come to you with pain in the right lower abdomen and bleeding per vagina. Take relevant history and give your diagnosis. Do cranial nerves examiantion. A blood sample has to be drawn and relevant things to be done (model).

A man has come with a cut over his forearm. Assume that local anaesthesia has been given. You need to perform two stitches. Do it accordingly.(model). A middle aged lady has come with pain in right upper abdomen radiating towards the back. Take history and perform an abdominal examination. A 51 years old lady has come with complaint of cough and breathlessness. Examine her respiratory system and give your diagnosis. An old man is suffering from end stage metastatic prostatic carcinoma. His daughter has come. Explain her regarding the condition and tell her about terminal care. Pain right upper abdomen - history and examination. Vaginal Examination on a model. Measure B P -A 25 years old lady is feeling dizzy particularly after standing from a sitting position. You need to measure her blood pressure. Breast examination on an anatomical model. ECG - anterior M I (T - wave inversion, Q wave) and C X R showing acute L V F. Management of both. Contra indications for the use of streptokinase. Patient with whiplash injury. X-rays are normal. He is still in pain. Patient is feeling low. Talk to the patient. A patient had right hemicolectomy done 6 hours back. He suddenly collapses. Temperature, B P and pulse chart given. Call your registrar over the phone and explain. Examine hip joint of a patient. 18 years old patient recently diagnosed with epilepsy. She is on carbamazepine. Counsel her. Patient anxious about a hernia operation. Take informed consent. Manikin - Examine the fundus, talking through the procedure to the examiner. This patient complains of dizziness. Measure her blood pressure. The mother has brought her child to the A & E. You have examined the child and diagnosed as having respiratory tract infection. She is worried that her child may be suffering from meningitis. Counsel her. Manikin - You are in the ward. Suddenly you hear a patient collapsing to the floor. Perform CPR. This 56 years old woman is suffering from non-Hodgkin's lymphoma. She has had radiotherapy, chemotherapy. She has taken paracetamol, ibuprofen tablets which she says is not relieving her pain now. The consultant has decided that you start on sustained release morphine. Counsel her. Manikin - This patient sustained injury to his forearm. Deep tendon/other soft tissue injury is ruled out. Local anaesthesia has been given. Suture the wound with two sutures. Take history from a 40 years old with c/o chest pain since yesterday, unilateral, left sided. This 25 years old woman was admitted with c/o pain, lower abdominal pain. You are suspecting ectopic pregnancy. The pregnancy tests and ultrasound are planned for tomorrow morning. But the patient wants to leave the hospital today. Talk to her. This patient comes with c/o breathlessness and tightness of chest.Examine the

respiratory system and teach him to use peak flow meter. This 25 years old patient came with c/o pain right hip. Examine his hip. This patient came to undergo surgery for in growing toe nail. Pre op investigation shows increased mean corpuscular volume. He is a chronic alcoholic. Take history about alcohol intake. This patient presents with haematuria. Take history and discuss further management with patient.