Part B OSCE 3rd year paper July 2002 1. CVS examination 2. RS examination 3. Abdominal examination 4.

Sensory examination of the legs 5. Motor examination of the arms 6. Breast examination 7. Eye movements: II, III, IV, VI 8. Opthalmoscopy 9. Diagnosis of type 1 diabetes 10. Informed consent: gastroscopy 11: risk factors of CHD 12. Post-MI Rx 13. Inhaler use 14. Phlebotomy 15. Blood pressure 16. History of PR bleed 17. History of headache 18. History of weight loss 19. History of haematuria 20. 1 rest station 3 rd Year OSCE stations - 2003 1. History of chest Pain 2. CVS examination 3. Blood Pressure 4. History of Chronic Cough 5. Respiratory Examination 6. History of PR bleed 7. Abdominal examination 8. Risk factors for CHD 9. Urine Testing 10. Lower Abdominal pain 11. Type 1 Diabetes: Non-adherence 12. Breast Examination 13. Opthalmoscopy 14. Loss of conciseness 15. Phlebotomy 16. Diagnosis of Type 2 Diabetes 17. Alcohol intake 18. Sensory examination of the legs 19. Thyrotoxicosis

Year 3 OSCE 2004 17 stations plus loads of rest stations 1. EXAM Cardiovascular examination, was normal. JUST the chest (so didnt need to examine hands, face, neck, etc., just mentioned that I would) 2. EXAM Abdominal examination RIF pain appendicitis. Again, just the abdomen, so not the rest of the examination. Needed to mention guarding, percussion tenderness 3. EXAM Thyroid examination Hyperthyroid? Ask patient to drink water while you feel, etc. 4. EXAM Fundoscopy need to read words on the various parts inside a model head e.g. upper nasal quadrant, etc. Then you need to be able to identify conditions on pictures you are given 5. EXPLAIN Patient is being given cardio drugs due to recent MI. You have to tell her the side effects and tell her why she is on them Aspirin, Atenolol, Simvastatin 6. HISTORY Man with jaundice, abdo pain. He has high alcohol intake, just had a divorce. Need to ask questions around hepatitis (travel, etc.) and ask the CAGE questions 7. EXPLAIN Lady with results coming back showing she has Type II diabetes. Need to tell her the result (treat as breaking bad news) and explain the condition and treatment she gets distressed about it 8. EXPLAIN Type I diabetic, isnt adhering to treatment and you need to explore why not. Was a young patient having hypos, she doesnt like taking insulin (stigma) 9. EXAM Breast examination make sure you say that you would have a chaperone, make sure you close the curtain behind you, make sure you wash your hands, and feel properly, cause people get distracted thinking about what they are doing! 10. EXAM Sensory examination of lower limbs loss of sensation in the feet diabetes? You get a tray full of LOADS of equipment, so know what to use e.g. right size of tuning fork, cause you get 3 different sizes 11. HISTORY Old lady having blackouts, LOC. On antihypertensives - thiazide diuretics. Need to ask about the blackouts. She was standing at bus-stop on a hot day. Diagnosis was vasovagal attack, need to know the types 12. HISTORY Haemoptysis smoker. Mother had lung cancer. 13. HISTORY Haematuria. Old man, mixed in, throughout the stream, everyday, no pain 14. EXPLAIN Asthma woman who is on inhalers and not taking them properly. Adherance issues. Stigma issues. 15. EXAM blood pressure dual stethoscope so examiner can hear too. Different cuffs, so need to pick the right one. A lot of people had problems with tubes getting twisted. Ask patient if they have, in the last 30mins: had coffee, had a smoke, done excersice 16. HISTORY abdo pain, RIF, anorexia, nausea, constipation appendicitis, but know the differentials 17. EXAM venepuncture straight forward

Year 3 OSCE 2005 Data Int: 1) Thyroid results 2) Full blood count interpretation 3) Acid base balance 4) U and Es and urine dipstick interpretation 5) Breast specimen 6) Infective endocarditis- gram stain of organism and treatment 7) Gastroenteritis- gram stain and treatment and cause 8) ECG 9) Paracetomal curve 10) CXR 11) Peak Flow 12) Cranial nerve pictures 13) Visual field defects 14) Macroanatomy of the heart- hypertrophic obstructive cardiomyopathy 15) Typical antibiotics ud give, e.g. cellulites, gastroenteritis, pneumonia OSCE 10 mins: - Explaining drugs to a lady with cardiac failure- ACE inhib, B blocker, Spironolactone and frusemide - Talking to a type 1 diabetic about her glycaemic control - Telling a type 2 diabetic that she has diabetes - Cardiovascular examination - Lower limb neuro sensory and motor - Abdominal examination 5 mins: - Breast examination - History abdo pain - Consent - Fundoscopy- alien heads and different pictures - Venepuncture - Headache history - Washing your hands - Haemoptysis history

Year 3 OSCE (2006)

Cardiovascular exam Usual stuff! There wasnt any pathology for my one (that I know of! Hehe) Drug history explain to patient what each drug does (I think it was an ACE-I, betablocker, calcium channel blocker & diuretic.possibly antidiabteic drug (cant remember fully) (so make sure u know the names of these drugs e.g. propanol etc)..know the side effects. Patient will say they forget to take doses so u hav 2 give advice on how to rember e.g. keep a calander/alarm or sumthing (make it up!) Dont scare the patient with side effects!! Hehe! I think one of the drugs gives postural hyposo explain that they advise you to take it at night to avoid falling over from becoming dizzy coz she may say she just finds it easier to take them all in one go! Respiratory examination Againusual stuff! But examiner did ask me if I knew what the normal peak flow for the patient should be.so try to have a vague idea about that (dont forget to take into consideration the sex of patient) Explanation of type 2 diabetes Here u have the results of the patient blood test which suggest she has diabetes. So just explain what glucose, insulin is. Dont get too detailed. Keep it basics. Dont scare them too much with longterm complications but stress importance of lifestyleeg. Diet, exercise etc. stop smoking etc. Important to avoid cardiovascular complications etc. And dont forget to ask patient if they have any questions because it will be a lot for the patient to take in so be sympathetic blah blahyou know the drill! Hehe! Abdominal examination (RUQ) For this my patient had right iliac fossa pain.so do normal exam.usual stuff.rember to start palpation away from pain first.try to elicit guarding, rebound tenderness etc..then sugest possible differentials at the end.acute chloysystitis (so do murphys signthats what I got anyway!), appendicitis etc. Neuro examination of lower limb Usual stuff! I cant actually remember if there was a pathology in my one! Sorry! But just make sure u know dermatomes etc.dont forget reflexes! And do to 2types of sensation..wich would be light touch n vibration(you can offer to do pin prick if you wantjust to look keen! Hehe)..they might ask questions.so just know about upper and lower motor neurone signs.I couldnt get one of the reflexes but the paitent was obviously well so the examiner asked why I think she doesnt have a reflex and I was just honest and said its probably wrong technique! And she was happy about it! So dont worry if u cant get it just as long as you know that just because you cant get it doesnt mean something is wrong with patient! Hehe! Cranial nerves For this he only asked me to test neves 5 and 7 (I think thats what they usually ask newayeasiest ones 2 examine realy for them).but dont forget to do sensation for trigeminal. And mention that the 7th nerve also has supply to tongue (I think its posterior 3rdbut double check that)..

History of haemoptysis Ask usual questions you have to..I cant rember them! Hee! Sorry! But read up! So usual.duration, timing, volume, fresh blood? Etc.Family historysmoking, Shortness of breath etc..My ones wife had apparently died of lung cancer so they want to see you sympathise too! Breast examination This was the plastic model thing strapped onto a woman! (dont laugh! Hehe) so usual exam.they will ask if u found anything.where, describewhat do you think it isetc.Dont forget to do axilla check..but for me he stopped me before I did coz I think they just wanted u to say you will do it.but I suggest you attempt to do it anywayif they say dont then just stop! Obviously dont forget about the dignity of patientso cover up wen needed ,ask them to undress etc.tell them they can get dressed after you are done Otoscopy This will be a model. Hold the stupid otoscope properly! My model had a grommet insideso tell them what you see. Decribe the tympanic membrane, can you see the other stursctures, light reflex etc.Then they will show you 5 pics and ask you what they areOne was on anatomy so know where the malleous, light reflex etc is. History of chest pain Usual stuff.Ask about risk factorssmoking, family history, assoc things like S.O.B, cough etc...SOCRATES, have they tried anything.(I cant actually remember this station!! Hehe! But it was there!) Blood pressure Pick the right cuff! It wont be connected to the thing so you have to connect it yourselfexplain what you are gonna do.check for radial pulse.u know the rest! Tell them what the reading was.If it was hig or low they may ask whyso just think of a few reasons! But if the patient seems wellthen maybe its whitecoat if its high and if its low, it just mean they are athletes or sumthing Ophthalmoscopy Again like otoscopywas a model.hold the thing properlydo both eyes unless they say otherwisetell them you are testing red reflex coz I dont think you can see on dummy! There will be words written inside in the different quadrants so tell them what they areso learn the quadrants and know the technique! Coz you have to see the words to tell them!!! Then they will so some fotosso make sure you know the diabetic eye and hypertensive eyeand dont forget there are different stages for these and you have to know them! (I cant remember them! Sorry! But read them up) and make sure you have seen them before in pics Informed consent to clerk a patient This was a stubborn ass patient who didnt want med students talking to him!! (I hated hiM!! Grrr! Hehe) But anywaymain thing remain calm,.,,xplain its for teaching etc.hell say stuff like my daughter is coming in abit and I dont wan to miss her and stuffso you can just say I wont b long or Ill come back or we can stop when she can or whatever. I didnt do too well on this so Im not best person to ask! But I think main thing is how you tackle it. Dont worry if you dont get the consent. Thats not what they want. They just want to see how you handle it.

Phlebotomy Obvisouly on a dummy arm. Gloves on. Wipe area. Yournique on (dont forget that) and dont forget to take it off a ryt time. Dispose need properly.mention that you will label bottles etcdont panic if you dont get the bloodits the technique they want.offer to do it again if you dont get it first time. Alcohol history Im actually not sure what they wanted from us in this one. We just get a results sheet suggesting his alcohol marker is high (LFT) and were supposed to talk to him about it. I think you have to ask about quantity and how frequently and if he has stresses and stuff. Try to pick up on some social stuff. I think thats what they want. Hand washing Just learn the technique!! You have to do in the sink and also with the alcorub! I have no idea what the difference is in technique in both so I did the full technique for both. And with the alcorub dont forget to say that you are sterile/ready to use once its dry! With the tapdont forget to wipe with paper towel after and dispose of it etc.use elbows to close tap etc

2006 OSCEs 10 minute stations (4 rest stations) Abdo examination Cardio examination Resp examination Motor and Sensory examination of the lower limbs Type II diabetes explanation Heart failure drugs explain

5 minute stations history heamoptsis history abdo, alcoholic man, recently divorced history chest pain consent phlebotomy otoscope Fundoscopy blood pressure breast examination cranial nerve examination V and VII

hand washing