OSCE

Question 1

Hand Washing Station

Answer 1

Station 1: Hand washing
You are about to examine a patient. Wash your hands.

1. Thoroughly wets hands with warm water
2. Applies liquid soap or disinfectant from dispenser
3. Washes hands using technique: palm to palm
4. right palm over left dorsum and vice versa
5. palm to palm with fingers interlaced
6. back of fingers to opposing palms with fingers interlocked
7. right thumb clasped in left palm and vice versa
8. fingers of right hand clasped in left palm and vice versa
9. Rinses hands thoroughly and appropriately
10. Turns taps of with elbows
11. Dries hands with paper towel
12. Disposes of paper towel appropriately

Question 2

Chest pain history

Instructions: 56-year-old Mr Biswas Singh presents to A&E with acute onset chest pain. Please
- take a history focusing on the presenting complaint and the history of presenting complaint, but
including key aspects of other parts of the history.

Answer 2

1. Introduction, asks name and DOB, explains task, asks for consent
2. Ensures patient is comfortable
3. Asks about nature of chest pain using open questions
4. For the pain, determines: site and radiation
5. character
6. severity
7. onset and duration
8. aggravating and alleviating factors
9. associated symptoms
10. Past medical history, key aspects
11. Drug history, key aspects
12. Family history, key aspects
13. Social history, key aspects
    Examiner to ask: “Please summarise your findings and offer a differential diagnosis.”
14. Summarises key findings
15. Offers an appropriate differential diagnosis
    Examiner to ask: “What investigations would you carry out to help confirm your diagnosis?”
16. Suggests appropriate investigations, including physical examination

Question 3

Station 10: Cardiovascular risk assessment

Instructions: 45-year-old Mr Adrian Lumley is worried about having a heart attack. Assess his risk of cardiovascular disease

Answer 3

1. Introduction and orientation
2. Establishes rapport with patient
3. Empathises with patient
4. Asks about fixed risk factors: age and ethnic background
5. Asks about fixed risk factors: family history
6. Asks about hypertension
7. Asks about hyperlipidaemia
8. Asks about diabetes mellitus
9. Asks about cigarette smoking
10. Asks about alcohol use
11. Asks about exercise
12. Asks about stress
    Examiner to ask: “Please give the patient some feedback on his cardiovascular risk.”
13. Gives appropriate feedback
14. Suggests appropriate course(s) of action
15. Addresses any remaining concerns
    Examiner to ask: “What are the desirable levels of LDL, HDL, and total cholesterol?”
16. Answers correctly

Question 4

Blood pressure measurement

Answer 4

1. Introduction and orientation
2. Establishes rapport with patient and puts patient at ease
3. Correctly positions patient’s right arm
4. Correctly positions vertical column
5. Successfully locates brachial artery
6. Selects and applies appropriately sized cuff
7. Inflates cuff to appropriate level
8. Correctly positions stethoscope
9. Reduces pressure in cuff at appropriate rate
10. Accurately reports patient’s blood pressure
11. Accurately interprets the blood pressure reading for patient
    Examiner to ask: “What investigations would you carry out in a case of suspected hypertension?”
12. Suggests confirming hypertension
13. Suggests assessing for a possible secondary cause
14. Suggests assessing for end-organ damage

Question 5

Cardiovascular Examination

Answer 5

1. Introduction and orientation
2. Establishes rapport with patient
3. Positions and exposes patient
4. Inspects general appearance
5. Inspects precordium
6. Inspects both hands
7. Determines rate, rhythm, and character of radial pulse
8. Offers to record blood pressure
9. Inspects head for signs of anaemia and central cyanosis
10. Assesses jugular venous pressure
11. Assesses character of carotid pulse
12. Determines location and character of apex beat
13. Listens at all four auscultation points
14. Examines chest
15. Offers to examine abdomen
16. Tests for ankle oedema
17. Offers to palpate peripheral pulses
    Examiner to ask: “Please summarise your findings and offer a differential diagnosis.”
18. Accurately summarises key findings
19. Offers appropriate differential diagnosis

Question 6

Breathlessness history

Instructions: Take a history from 58-year-old Mr Arthur Wenzel who presents with breathlessness.

Answer 6

1. Introduction and orientation
2. Ensures that patient is comfortable
3. Establishes name, age, and occupation
4. For breathlessness, asks about: onset and progression
5. provoking and relieving factors
6. associated symptoms
7. Assesses severity of breathlessness
8. Asks about previous episodes of breathlessness
9. Asks about cigarette smoking
10. Past medical history, key aspects
11. Drug history, key aspects
12. Family history, key aspects
13. Social history, key aspects
    Examiner to ask: “Please summarise your findings and offer a differential diagnosis.”
14. Summarises key findings
15. Offers an appropriate dierential diagnosis

Question 7

Respiratory Examination

Answer 7

1. Introduction and orientation
2. Positions and exposes patient
3. Ensures patient’s comfort
4. Inspects patient’s general appearance
5. Looks into sputum pot
6. Inspects and examines hands
7. Determines rate, rhythm, and character of radial pulse
8. Tests for asterixis
9. Inspects head for signs of anaemia and central cyanosis
10. Assesses jugular venous pressure
11. Palpates cervical, supraclavicular, infraclavicular, and axillary lymph nodes
12. Palpates for tracheal deviation
13. Palpates for cardiac apex
14. Assesses chest expansion
15. Percusses chest
16. Auscultates chest
17. Tests for vocal resonance or tactile fremitus
    Examiner to ask: “Please summarise your findings and offer a differential diagnosis.”
18. Summarises key findings
19. Offers an appropriate differential diagnosis

Question 8

PEFR meter explanation
Instructions: The young Mr Ashley Bannerman has recently been diagnosed with asthma.
Explain to him how to use a PEFR meter.

Answer 8

1. Introduction and orientation
2. Checks patient’s understanding of asthma
3. Explains importance of PEFR meter
4. Explains when PEFR meter is to be used
5. Explains and demonstrates how to: attach a clean mouthpiece
6. slide the marker down to the bottom of the numbered scale
7. stand or sit up straight
8. hold the meter horizontal
9. take as deep a breath as possible
10. seal lips around mouthpiece
11. exhale as hard as possible into the meter
12. read and record the meter reading
13. Asks patient to carry out procedure
14. Explains need to repeat procedure at least three times
15. Checks score against peak flow chart or previous readings

Question 9

Use of Inhaler

Answer 9

1. Introduction and orientation
2. Checks patient’s understanding of asthma
3. Explains what inhaler device is
4. Explains when to use inhaler device
5. Explains and demonstrates how to: vigorously shake inhaler
6. remove cap from mouthpiece
7. hold inhaler
8. position inhaler
9. breathe out completely
10. breathe in deeply and simultaneously activate inhaler
11. hold breath for 10 seconds before breathing out
12. repeat procedure after one minute if required
13. Asks patient to carry out procedure

Question 10

Abdominal pain history

Instructions: 54-year old Mr Adam Smith presents to A&E with acute onset abdominal pain.
Take a history.

Answer 10

1. Introduction and orientation
2. Asks about nature of abdominal pain. Determines: nature
3. site
4. onset
5. duration
6. radiation
7. aggravating and alleviating factors
8. associated symptoms and signs
9. Enquires specifically about: fever
10. loss of weight or anorexia
11. dysphagia
12. indigestion
13. nausea, vomiting, and haematemesis
14. diarrhoea or constipation
15. melaena or rectal bleeding
16. steatorrhoea
17. jaundice
18. genitourinary symptoms
19. Past medical history, key aspects
20. Drug history, key aspects
21. Family history, key aspects
22. Social history, key aspects
    Examiner to ask: “Please summarise your findings and offer a differential diagnosis.”
23. Summarises key findings
24. Offers an appropriate differential diagnosis
    Examiner to ask: “What investigations would you carry out to help confirm your diagnosis?”
25. Orders appropriate investigations, including physical exam

Question 11

Abdominal Exam

Answer 11

1. Introduction and orientation
2. Exposes patient appropriately
3. Positions patient appropriately and ensures that he is comfortable
4. Inspects general appearance
5. Inspects abdomen
6. Inspects and examines hands
7. Inspects sclera and conjunctivae
8. Inspects mouth
9. Palpates neck for lymphadenopathy
10. Inspects upper body
11. Abdomen: light palpation
12. Abdomen: deep palpation
13. Palpates for liver edge
14. Palpates for tenderness over gallbladder region
15. Palpates for enlarged spleen
16. Ballots each kidney in turn
17. Percusses liver area
18. Percusses suprapubic area
19. Auscultates for abdominal sounds
20. Auscultates for aortic and renal artery bruits
21. Suggests examining the groins and genitals
22. Suggests carrying out a digital rectal examination
    Examiner to ask: “Please summarise your findings and offer a differential diagnosis.”
23. Summarises key findings
24. Offers an appropriate differential diagnosis

Question 12

Rectal Exam

Answer 12

1. Introduction and orientation
2. Indicates need for chaperone
3. Indicates appropriate position for patient to take
4. Dons gloves
5. Inspects anus and surrounding skin
6. Lubricates index finger of right hand
7. Gently inserts finger into anal canal
8. Indicates need to test anal tone
9. Rotates finger through entire circumference
10. Palpates prostate gland
11. Gently withdraws finger and examines glove
12. Cleans off lubricant on the anus and anal margin
13. Disposes of gloves appropriately
    Examiner to ask: “Please summarise your findings and offer a differential diagnosis.”
14. Summarises key findings
15. Offers an appropriate differential diagnosis

Question 13

ECG Interpretation

Answer 13

Check patient name and DOB
Time and Date ECG taken
Rate - 25mm/s and 1cm/mV
Rhythm - electrical activity?
Regular/irregular?
Rate? regular -300/ no. squares between QRS or irregular - count QRS in 30 and x10
P waves? Are they followed by QRS complexes?
PR interval 0.12-0.2 (half a large square to a whole large square)
QRS interval under 0.1 (half a large square)
Check leads -
ST elevation… 1mm for limb leads
2mm for V1-V6 need to be in adjacent leads