Surgery OSCE

Question 1

Presenting Complaint

Answer 1

Right Sided Thyroid Nodule

Question 2

Presenting Situation

Answer 2

A 45-year-old male presented to surgery with right-sided thyroid masses by PCP (primary care physician). I have been feeling tired for the past few months and is very concerned

Question 3

Opening Statement

Answer 3

I have been feeling tired and my PCP found a mass on my thyroid

Question 4

How long have you been feeling tired?

Answer 4

2 months

Question 5

Any weight gain

Answer 5

gained 5 pounds

Question 6

Any trouble waking up

Answer 6

Have trouble waking up despite getting 8 hours of sleep

Question 7

Have any pain

Answer 7

No

Question 8

Have difficulties swallowing

Answer 8

No

Question 9

Pain in the ears

Answer 9

No

Question 10

Any anxiety or depression

Answer 10

No

Question 11

Any tremors

Answer 11

No

Question 12

Changes in neck over the past month

Answer 12

No

Question 13

Noticed any changes in vision

Answer 13

No

Question 14

Any sensitivity to temperature

Answer 14

I am sensitive to cold temperature

Question 15

How often you have a bowel movement

Answer 15

Once a day

Question 16

Any vomiting or diarrhea

Answer 16

No

Question 17

Any weight loss

Answer 17

No

Question 18

Any changes in the color of bowel movement

Answer 18

No changes

Question 19

Any past skin disorders

Answer 19

Had radiation for acne as a teenager

Question 20

Any changes in hair

Answer 20

Barber mentioned that my hair is getting thinner

Question 21

Any allergies

Answer 21

No

Question 22

Are you able to feel the mass in neck

Answer 22

No

Question 23

Any chronic medical conditions

Answer 23

No

Question 24

Any long term medications the patient is on

Answer 24

No

Question 25

Any surgical history

Answer 25

pilonidal cyst removal at 16 and wisdom teeth removed at 17

Question 26

Are you married

Answer 26

Yes been married for 15 years

Question 27

Do you have children

Answer 27

No

Question 28

Any unprotected sexual encounters in the past two years.

Answer 28

No

Question 29

Do you drink?

Answer 29

Yes I drink a glass of wine with meals on the weekend mostly dinner

Question 30

Do you smoke currently

Answer 30

No

Question 31

Do you have a smoking history

Answer 31

Yes I smoke a pack of cigarettes a day for 10 years.

Question 32

Do you do illicit drugs

Answer 32

No

Question 33

Any family medical history

Answer 33

Your mother had a goiter in her teens but was treated with medications a long time ago. The father has no medical history. Both parents are currently healthy.

Question 34

How old are you

Answer 34

45 year old

Question 35

Date of birth

Answer 35

January 7th 1979

Question 36

Differential diagnosis

Answer 36

Benign Thyroid Nodule with Goiter
Malignant Thyroid Nodule
Hypothyroidism
Anemia

Question 37

Question regarding the malignant mass can be suspected for cancer

Answer 37

Can this be cancer?

Question 38

Question testing the empathy of suspected malignant mass

Answer 38

Doc tell me straight I am going to die from this?

Question 39

Thyroid Exam Finding

Answer 39

A firm 2.0 cm nodule is noted in the lower Rt. Lobe of the thyroid.

Question 40

Size of the thyroid (Thyroid Exam Finding)

Answer 40

The thyroid is approximately 27 gms in size (slightly enlarged)

Question 41

Neck Exam Finding

Answer 41

No masses or enlarged lymph nodes are identified in the posterior auricular, preauricular, submandibular, sternocleidomastoid, supraclavicular or posterior triangle lymph nodes

Question 42

Cardiac Exam Finding

Answer 42

Tachycardic, regular rate and rhythm without murmurs, gallops, or regurgitation

Question 43

Any lab work that was done by the PCP

Answer 43

No

Question 44

When was the right-sided thyroid nodule discovered by the PCP

Answer 44

4 weeks ago and referral was made 3 1/2 weeks ago

Question 45

Pulmonary Exam Finding

Answer 45

Tachypneic, breath sounds, equal bilaterally and clear without rales or Ronchi