OSCE MARK SHEETS!

History taking: 10 minute station

Student information: This patient has been referred to outpatients having passed some blood in the stools. Please take a history 1. Assessment of complaint i.e. nature of blood passed, associated change in bowel habit, anorexia, wt loss (3) 2. PMHx (1) 3. FHx esp. cancers (1) 4. Social history incl. Smoking, alcohol, drugs, medicines (2) 5. Systemic enquiry (1) 6. General approach to pt e.g. introduces self, rapport eye contact. Listens to answers (1) 7. Summarises and recaps (1) Total (10)

CVS examination: 5 minutes

Student information This patient gives a history of chest pain and shortness of breath Please conduct an examination of the CVs system. Describe what you are doing to the examiner as you go along. 1. general approach 2. Examination of hands 3. Pulse: rate, rhythm, character, volume 4. Mentions BP assessment 5. Looks for central cyanosis (tongue) and at dentition 6. JVP assessment 7. Palpation of precordium 8. Auscultation of all four cardiac areas 9. Listens to bases and assesses sacrum for oedema 10. Tests for ankle oedema Total (10)

Resp examination: 5 minutes

Student information: This patient has a long history of cough, sputum and shortness of breath. Please conduct an examination of the resp system. Describe to the examiner what you are doing as you go along. 1. Examination of hands 2. Peripheral and central cyanosis 3. Examination of lymph nodes: Cervical Supraclavicular 4. Inspection of chest: skin, veins, hair, movt contours 5. Chest expansion 6. Feels for trachea and apex beat 7. Percussion: technique 8. Percussion: areas percussed 9. Vocal fremitus tested 10. Auscultation: technique and areas auscultated. Total: 10

Abdominal examination: 5 mins

Student information: This patient complains of abdominal discomfort. Please perform a complete examination of the abdomen (excluding examination of the genitalia and rectum). Comment to the examiner on what you are doing and what you have found as you go along. 1. general approach to the patient (ensures comfort, courteous, checks for pain before starting the examination) (1) 2. Position of patient (supine, one pillow) and exposure of abdomen (xiphisternum to pubis, remainder covered) (1) 3. Inspection: skin, veins, hair, movement, contours (1) 4. Palpation: light (all areas) and deep (all areas) (1) Liver (1) Spleen (1) Kidneys (1) 5. Percussion of abdomen in four quadrants (1) 6. Auscultation: Bowel sounds, renal areas, femorals (1) 7. Groins (hernias). Examination of hernial orifices. (1) Total: 10

Observations: 5 minutes
Student information: please check resp rate, pulse rate, temperature and oxygen saturation. 1. Does the student introduce themselves and explain what is to be done? 2. Thermometer: is student competent in its use (shakes it down, places it sublingually, gives adequate tome, reads it carefully) 3. Thermometer: does the student get the right temperate (+/- 0.5oC) 4. Pulse rate: is the student competent (finding pulse, timing, charting in bpm) 5. Pulse rate: does the student get it right (+/- 10 bpm) 6. Oximeter: is student competent in its use (switches it on, waits for it to self calibrate, applies finger probe, waits for suitable reading) 7. Oximeter: does student get the O2 saturation right (+/- 2-3%) 8. Respiratory rate: is student competent (times it, charts it in breaths/min) 9. Respiratory rate: does student get it right (+/- 4 breaths/min) 10. Chart: does student chart the results competently and clearly Total: 10

Basic Life support: 5 mins

Student information: This patient has collapsed and you are the first to encounter them. Describe to the examiner what you are doing 1. 2. 3. 4. 5. 6. 7. safe approach: assess safety of rescuer/patient Checks response: shouts, shakes the patient Calls for help Opens airway: head tilt & chin lift/jaw thrust Assesses breathing: looks/listens/feels (no more than 10 seconds) Initiates cardiac arrest/999 call Administers 2 rescue breaths. Maintains open airway. Observes chest rise & fall. (upto 5 attempts are acceptable) 8. Assesses circulation. Palpates carotid artery (for up to 10 seconds) and looks for other signs of life 9. Commences chest compressions: 2 finger breaths above xiphisternum at rate of 100/min (120-80) to depth of 4-5cm (1/3 of chest depth) 10. Repeats CPR cycles: 15 compressions: 2 breaths Total: 10

Abdominal xray: 5mins

Student information: An elderly patient has presented with abdominal pain radiating to her back. Please report the radiograph to the examiner. 1. general approach (name, age, date of radiograph, whether AP/PA) (2) 2. bone: moderate degenerative change in lumbar spine, mild degenerative change in bot h hips (2) 3. Soft tissue: calcified AAA, calcified iliac arteries (2) 4. Bowel an gas patterns: normal gas distribution, barium in appendix (2) 5. Diagnosis: AAA: must mention its an aneurysm as both walls are visible. (2) Total: 10

Treatment chart: 5 mins

Student information: as per separate sheet 1. Lost of potential interactions: SOCRE 2 MARLS FOR 3 OR MORE, 1 MARK FOR 2 - Amidarone/Digoxin - NSAIDs/Warfarin - Amiodarone/Warfarin - Diuretic causing decrease in K+/Digoxin 2. Monitoring required: SCORE 2 MARKS FOR 3 OR MORE, 1 MARK FOR 2 INR for warfarin Pulse for Digoxin/Amiodarone Blood for Digoxin Thyroid function/LFTs/Pulmonary function/Eyes for Amiodarone effects Chest Xray for Heart failure

3. Potential ADRs responsible clinical state a. NSAIDs causing GI bleeds b. Digoxin toxicity causing nausea 4. Further information required to adjust pts prescription a. Renal function tests b. Patients cognitive state and compliance attitudes 5. a. b. c. Counselling points: SCORE 2 MARKS FOR 2 OR MORE, 1 MARK FOR 1 Warfarin booklet/risks of OTC medicines e.g. aspirin, NSAIDs Avoidance of UV light with Amiodarone Potassium rich diet

Total Marks: 10

Suturing: 5 mins
Student information: None 1. 2. 3. 4. 5. 6. 7. 8. 9. Explains to patient what is going to happen (2) Mentions skin preparation (1) Mentions local Anaesthetic (1) EXAMINER: please ask what anaesthetic must not be used on fingers (Adrenaline containing preps) (1) Opening of suture packet (1) Putting needle in needle holder (1) Use of forceps during procedure (1) Tying of knots (1) Closure of skin 2 sutures maximum (1)

Total marks: 10

BLOOD PRESSURE: 5 mins

Student information: This patient complains of chest pain. Please take the blood pressure. 1. General approach to patient, ensuring comfort, courteous, rapport and eye contact 2. Choose correct cuff size for the patient (mentions it if not available) 3. Puts cuff on correctly 4. Fells brachial pulse and places stethoscope correctly 5. Pumps up cuff until pulse disappears 6. Slowly lowers the column of mercury 7. Records the results mention patient position 8. Gets the correct answer (w/in 6mm of examiners reading) systolic BP 9. Gets correct answer (w/in 6mm of examiners reading) diastolic BP 10. Expresses results in 2mm units. Total marks: 10

Ophthalmoscopy: 5 mins
Student information: the person has been complaining of headaches for about 4 months and recently had blurred vision. Using the ophthalmoscope, please examine the fundi and tell the examiner what you are doing as you go along. 1. Student comments that would self and explains what she is going to do (1) 2. Does the student use the right eye to pts right eye and left eye to pts left eye (2) 3. Does student appear optimally positioned in relation to pt and appear comfortable (1) 4. Does student begin by eliciting red reflex (1) 5. Does the student initially focus on anterior structures before concentrating on the fundus (1) 6. Does the student appear to focus on the disc (1) 7. Appears to examine the surrounding structures (1) 8. Gives adequate description of the fundus using the correct terminology (1) 9. Gives an adequate attempt at diagnosis(1) Total marks: 10

Obtaining Blood glucose: 5 mins

Student information: On the patient describe and demonstrate how you would obtain a sample for a BM stick using the equipment provided. DO NOT actually take a sample. Using the solutions and the meter provided, find out the blood glucose of the test sample and describe to the examiner what you are doing as you go along. 1. 2. 3. 4. 5. 6. 7. Explanation of technique to patient and approach (2) Cleanses finger (1) Stabs side of fingers. Milks finger to obtain good drop of blood (2) Turns meter on inserts strip correctly into meter (2) Applies food drop to reagent strip (1) After 45 seconds, reads off correct results (1) Disposes of sharps correctly (1)

Total marks: 10

PEFR: 5 Mins
Student information This patient has asthma. Please check PEFR. Then demonstrate ho wo to use a MDI and check their technique 1. 2. 3. 4. 5. 6. 7. 8. general approach to patient. Explains procedure clearly. (1) Measures PEFR with Wrights meter. Demonstrates best of three. (2) Shakes container and removes cap of MDI (1) Exhales gently (1) Places mouthpiece in mouth and closes lips (1) Inhales and presses canister whilst breathing in (1) Hold breath for 10 seconds (1) Checks pts technique. (2)

Total Marks: 10

Venesection: 5mins
Student information: This arm belongs to a patient with presumed renal failure. Please take some bloods for Urea, creatinine, and electrolyte measurement. Speak to the examiner as if they were the patient. 1. Addresses the patient and informs them of what is to happen and asks for consent (1) 2. Applies the tourniquet, feels the veins, cleans with sterile swab (1) 3. Assemblers needle, holder, vacutainer correctly (1) 4. Enters vein and withdraws blood (2) 5. Removes tourniquet (1) 6. Removes needles from vein and applies pressure (1) 7. Disposes of sharps adequately (1) 8. Mentions labelling the vacutainers (prompt the student) (2) Total marks: 10