OSCE Day 1
Station 1 : Primary Care Medicine. A young male adult (Damn, I forgot to ask his name. I only introduced myself to him) presented with history of back ache for 3 days. After detailed history and physical examination, you have made the diagnosis of muscle sprain. However he requested for an x-ray. How do you respond?
Station 2 : Rest Station
Station 3 : Ophthalmology. Picture of cataract given (My friends answered with complete full mark i.e. posterior capsular cataract). We were asked about the findings and give the diagnosis. Then we were asked to list one local cause and 2 systemic causes. We were also asked to name two procedures that can be used to treat the condition and list 4 complications that may arise from the procedures.
Station 4 : Radiology. We were provided with two exhibits. The first one is a PA erect chest x-ray with haziness and consolidations all over the lung fields – diagnosis: miliary TB. Then what is the other test to confirm the diagnosis? – Sputum culture and sensitivity or smear to look for acid fast bacilli (choose one).
The second exhibit shows the x-ray of knee joints from two views, AP and lateral. A male patient in his 30’s presented with history of sudden pain on the left thigh associated with swelling while he was playing badminton. Comment on the findings (AP view, no visible fracture but there is multiple cystic lesions on the distal part of the left femur. Lateral view, there is spiral fracture at the distal part of the femoral shaft of the left lower limb). What is the diagnosis? (Pathological fracture secondary to aneurysmal bone cyst).
Station 5 : Surgery. You as an HO in the ward saw Mr. Z unconscious following a surgery. Re-assess the Glasgow Coma Scale (GCS) level. It was written on the question “Treat mannequin as a real patient”. After assessing, summarize the findings (supposed to be at the minimum, because a mannequin will surely not respond to any stimulus. Hence it will be 3 over 15.) . Then the examiner will give you another set of finding and asks you what is the GCS? Finally you will be ask what is the GCS level that you would intubate the patient? (I answered less than 8. But please check because I’m not sure. Some of my friends said 8 and below.)
Station 6 : Primary Care Medicine – Drug Prescription. 2 year old (weight and height provided) presented with history of fever. Prescribe antipyrexia for this patient from what is listed. Tablet Paracetamol, Syrup Paracetamol, Tablet Aspirin, Soluble tablet aspirin. (I’m sorry I can’t recall the dosage.)
Station 7 : Rest station.
Station 8 : Ophthalmology. Do visual acuity test. Since the test was done in limited, confined space, mirror had to be used. ( I knew the “patient”. She is a doctor. lol)
Station 9 : Psychiatry. Patient presented with history of low mood for three months, and had suicide intention for two weeks. Assess the suicidal risk in this patient. Use SAD PERSONS scale, and “SAMPAH”mnemonics to assess whether the suicide was well planned or just to gain attention from others. [S – Suicidal note. A – Avoidance (e.g. want to commit it in a locked room) M – Method (e.g. overdose, hanging, or slit wrist etc) P – Plan (when, where) A – Arrangement (I think it’s redundant, but that’s what the mnemonic is) H – Hint (e.g. by writing will, buy insurance).]
Station 10 : Orthopaedic Surgery. Patient had a fall and suffered anterior dislocation of the shoulder on the left arm. Ask for written consent for this patient for the close manipulation and reduction (CMR).
OSCE Day 2
Station 1: Primary Care Medicine. Patient presented with urethral discharge and back ache for 3 days. Obtain the sexual history and advise the patient accordingly.
Station 2: Rest Station
Station 3: Otorhinolaryngology (ENT). Two exhibits. First, acute tonsilitis – we were asked about the clinical findings based on McIsaac score. Then we were asked about the first line antibiotics and duration of treatment. Second exhibit showed picture of ear toileting. Questions, what’s the indications, precaution, and complications of the procedure?
Station 4: Anaesthesiology. Patient presented with trauma due to MVA. Suddenly developed respiratory difficulty. We were given arterial blood gases (ABG) results and had to interpret. Then followed by the management of the patient (ATLS – primary survey). After intubation and ventilation, another set of ABG results given for interpretation. Lastly, patient was put under FiO2 0.8. What does this indicates?
Station 5: Emergency Medicine. There’s video showing patient with signs of paradoxical breathing. Asked about the diagnosis and further management of this patient.
Station 6: Otorhinolaryngology (ENT). Two exhibits. First: Inflammed inferior turbinate and it’s management (medical and surgical). Second:Cholesteatoma, the complications, and whether the hearing loss secondary to it is reversible or not.
Station 7: Rest Station
Station 8: Anaesthesiology. Venopuncture for full blood count and renal profile. (Missed a lot of marks here. Silly mistakes, should have scored full mark!)
Station 9: Obstetrics and Gynaecology (O&G). Running commentary on how to prepare for episiotomy repair and demonstrate on how to do the suturing.
Station 10: Emergency Medicine. CPR and then given an ECG. What’s further management? (Follow the algorithm). If VF or pulseless VT, defibrillate. If otherwise PEA or asystole, continue CPR and at the same time ask for assistant to give IV adrenaline 1ml. (I failed miserably despite practicing it so many times)
P/s:credits to owner blog of http://beyond-mbbs.blogspot.com/
-Unlucky students
Unlucky Student 