Rsm Osce Sheets 2009

The Ro5'al Society.

of.Medicine

,

:Youhg Fellow's Committee

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_{OSCE DAY,2009 ,}

OSCE Station: CARDIOVASCULAR EXAMINATION

C a n d i d a t e

N a m e : . . . .

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Iugtruction: Mr Brown is a 56 year old gentleman with a history of angina on exertion and palpitations.

He is a known hypertensive

and heavy smoker. Please examine his cardiovuscuiar sysiem.

Comments:

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Mark Scheme

Appropriate introduction including name and grade Obtains verbal consent

Washes hands or uses alcohol gel Positions and adequately exposes patient Gener:sl Inspection

Examines hands for peripheral stigmata of CVS disease (for clubbing, splinter haemorrhages, caoillary relill time. nicotine

Examines radial pulse (comments on rate, rhythm and volume, collapsing pulse, radio-femoral delay)

Offers to measure BP

Examines eyes (for anaemia, xanthalassma, corneal arcus)

Assesses carotid pulse lcomments on volume, character and bruits)

es between arterial and venous pulsation)

Inspects precordium (for scars, visible apex beal

Palpates precordium (for heaves and thrills)

Localises apex beat

Auscultates in correct 4 areas

Auscultates with thetell at the apex and with patient turned on left side for MS Auscultates with the diaphragm and with patient leaning forward for AR

Auscultates the lung bases lfor inspiratory crepitations)

Examines for dependent oedema i.e. sacral and ankle Offers to assess peripheral pulses

Closure: Thanks patient, offers to dipstick urine etc Washes hands or uses aleoho! gel

Presents

summary

of findings

Aware of patients'needs throughout exarnlnation + nnaintains patients dignity Professionalism

Global Score:

The Royal Society

of Nledicine

Young Fellow's Committee

' OSCE DAY 2OO9

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OSCE Station: RESFIRATORY

EXAMINATION

C a n d i d a t e

N a m e : . . . . .

Instructionz Mr Patel is 38 year gentleman who has a history of fevers, weight loss and a persistent

cough. Please examine his respiratory system.

Adequate Closure: may offer to check sputum pot, check PEFR, thanks patient.

Comments:

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Mark Scheme

Appropriate introduction including name and grade Obtains verbal consent

Washes hands or uses alcohol gel Positions anC aCequately exposes patlent

General Inspection (including comfort, respiratory rate, use of accessory muscles, resp. paraphernalia) Examines hands for peripheral stigmata of respiratory disease (for ctubbing, nicotine staining,

I c v a n o s i s . h v o e r c a D n i c f l a p > 2 f o r

Examines eyes (for anaemia, Horner's syndrome1

Examines for central cyanosis

Offers to examine cervical lymph nodes (esp. scalene LN)

lnspects chest (for scars, deformity, asymmetry, use of accessory Checks central position of trachea

Checks position of apex beat Palpates for chest expansion

Percusses chest (correct technique + areas) Assesses for vocal + tactile fremitus Auscultes chest (correct technique * areas)

Washes hands or uses alcohol gel Presentation of summary of findings

Aware of patients needs throughout examination * treats patient with respect Professionalism

Global Score:

The Royal SoCiety

of Medicine

Young Fellow's Committee

OSCE DAY 2OOg

OSCE Station: ABDOMINAL EXAMII{ATIO|{

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C a n d i d a t e

N a m e : . . .

. . . .

Instruction: Mr Smith is 54 yeur gentleman who has a kistory of weight loss and change in bowel

habits. Plesse examine his abdomen.

Mark Scheme

Appropriate introduction including name and grade Obtains verbal consent

Washes hands or uses alcohol gel Positions and adequately exposes patient Genera! Inspect!on

Examines Hands for peripheral stigmata of abdominal disease (for ctubbing, teuconychia, ar erythema. DuDuvtren's contracture. snider naevi. DurDura, Iiver flap - >2 for Examines Eyes ifor jaundice, anaemia, xanthelasma, Kaiser-fleischer rings)

Examines oral cavity (for ulcers, angular stomatitis, telangiectasia, candidiasis, Peutz-Jehger's spots, dentition,

Offers to examine cervical lymph nodes (particularly left supraclavicular LN) Inspects chest lfor gynaecomastia, spider naevi)

nspects abdomen (for scars,

General Palpation (light and deep)

Liver Examination (palpation * percussion) Spleen Examination

Right and Left Kidney Examination

Examination for AAA (pulsatility * expansion abdominal aorta) Examination for bladder

Examines for ascites (shifting dullness o1land fluid thrill) Auscultation for bowel sounds and bruits

Offers to perform digital rectal examination

Offers to examine hernial orifices and external genitalia Washes hands or uses alcohol gel

Presents Summary of findings

Awareness of patienis needs throughout examination * treats patient with respect Professionalism

Comments:

The Royal Society of Medicine

, Young Fellow's Committee

. OSCE DAY 2OO9

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OSCE Station: BREAST E)L{MNATION

Candidate

Name:...

Instruction: Mrs Jones is a 40 year old lady wlto has recently noticed a lump in her breast. She is cleurly

concerned.

Perform an examination of her breasts.

Obtains verbal consent

Comments:

Mark Scheme

Appropriate introduction including name and grade

Washes hanCs or uses alcohol gel

Positions and adequately exposes patient (requests chaperone)

Inspects breasts with patient sitting relaxed (for scars, asymmetry, skin changes, discharge)

Inspects breasts with patients' hands behind their head Inspects breasts with patients' hands pushing into their hips

Asks the patient about any pain or lumps in either breast prior to commencing palpation

with hand of

breast to be examined behind their head

Systematically palpates both breasts starting with 'normal breast' first (4 quadrants, axillary Examines both axillae (normal side first)

Palpates for supraclavicular fossa lymphadenopathy Examines for hepatomegally

Percusses axial spine for tenderness Offers to percuss and auscultate chest

Closure: thanks patient, addresses any questions or concerns and is sensitive of patient's Washes hands or uses alcohol gel

Presents summary of findlngs

Awareness of patients needs throughout examination Professionaiism

4

Global Score:

The Royal Society of Medicine

Young Fellow's Committee

OSCE DAY 2OO9

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OSCE Station: Upper Limb Neurological

Examination

Candidate

Name:...

Instruction: Mr Roberts is a 70 year old retired accountant who reports weakness

in his right arm.

bow flexion Wrist flexion Wrist extension Finger extension Finger flexion Finger abduition Thumb abduction

Exumine this patient's upper limb neurological system.

Mark Scheme

Appropriate introduction including name and grade Obtains verbal consent to perform examination Washes hands or uses alccho! gel

Positions and adequately exposes patient

General Inspection of upper limb lror wasting, fasciculations, asymmetry, abnormal movements)

Assesses for pyramidal/pronator drift

Assesses tone in both arms (for rigidity and spasticity) Assesses power in both arms:

- Shoulder abduction - _{EIbow extension}

Assesses reflexes in both arms: - _{Triceps reflex}

- Biceps reflex

Assesses co-ordination in the upper limbs (i.e. dysdiadochokinesis and finger-to-nose test) Assesses sensation in both arms

Washes hands or uses alcohol gel

Closure: Thanks patient and restores modesty

Presents

findings

Awareness of patients needs throughout examination Professionalism

Global Score:

The,Royal Society

of Medicine

Young Fellow's

Committee

OSCE DAY 2OO9

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Mark Scheme

Appropriate introduction including name and grade Obtains verbal consent

Washes hands or uses alcohol gel Positions and adequately exposes patient

General Inspection of legs 6or wasting, fasciculations, hypertrophy, asymmetry)

Assesses tone in both legs including clonus Assesses power in both legs:

- _{Hip Flexion} - _{Hip Extension} - _{Knee flexion} - _{Knee extension}

Plantar flexion offeet Assesses reflexes in both legs:

- _{Knee reflex} - _{Ankle reflex}

Assesses plantar in both feet

Tests co-ordination (heel-shin iest) in both legs Assesses sensation in both legs

Assesses gait

Performs Rhomberg's test Washes hands or uses alcohol gel

Closure: Thanks patient and restores modesty Presents findings

Awareness of patients needs throughout examination Professionalism

OSCE Station:

Lower Limb Neurological

Examination

C a n d i d a t e

N a m e : . . . . .

Instruction z Mrs Smith is a 67 year old artist who reports weakness and numbness in her right leg.

Examine this patient's lower limb neurological system.

Comments:

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Global Score:

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The Royal Society of Medicine

Young Fellow's Committee

OSCE DAY 2OO9

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OSCE Station: Thyroid Examination

Candidate

Name:...

Instruction: Miss Jones is a 38 year old ludy who is complaining of weight loss, heat intolerunce and

visual problems. Please examine her thyroid gland.

Washes hands or uses alcohol gel

Positions and adequately exposes patient (to clavicles)

Closure: Thanks patient and restores patients' modesty

Comments:

4

Clear Fass

Pass

2

Borderline

1

Fail

Mark Scheme

Appropriate introduction including name and grade Explains examinatlon and obtains verbal consent

General + Local Inspection (for scars, sinuses, swellings, skin changes, facial asymmetry) * Inspection on

Tonsue protrusion + Swallow test

[nspects Hands (for sweating, palmar erythema, thyroid acropachy, onycholysis, vitiligo, tremor and HR) Palpates neck lump from behind (and repeats palpation with swallow tests + tongue protrusion and from the

Palpates for centrally located trachea

Percusses for retrosternal extension Auscultates for a thyroid bruit

Examines for thyroid eye disease (for tid tag, Iid retraction, chemosis, proptosis, hair loss eyebrows and

Offers to examine foi'i

- _{Pretibilal mrxoedema} - _{Proximal myopathy} - _Reflexes

Washes hands or uses alcohol qel

Presents findings and comments on further management Awareness of patients needs throughout examination Professionalism

The Royal Society

of Nledicine

Young Fellow's Committee

OSCE DAY 2OO9

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OSCE Station: Cranial Nerves Examination

Candidate

Name:...

Instruction: Please examine

the patients' cranial nerves.

Comments:

Mark Scheme

Appropriate introduction including name and grade Obtains verbal consent

'Washes

hands or uses alcohol gel Positions and adequately exposes patient

General Inspection (for facial asymmetry, ptosis, squint, exophthalmos)

Asks about sense of smell Offers to test visual acuitv

Test of visual fields (including assessment for a central scotoma) Test of pupillary light reflex

Test of accommodation reflex Offers to perform fundoscopy

Assessment of eye movements (looks for nystagmus * asks about diplopia)

Offers to test corneal reflex Assessment of jaw reflex

Assessment of muscles of mastication (pterygoids, masseter and temporalis) Assessment of muscles of facial expression

Offers to assess tast€-over the anterior 2/3rds ofthe tongue

Offers to perform otoscopy, assess hearing and perform Weber's * Rinne's tests Assessment of movement of soft palate

Offers to test the gag reflex

Inspection of the tongue for wasting, fasciculations Examination of tongue movements

Assessrnent cf sternocleidomastoid and tr apezius muscles Washes hands or uses alcohol gel

Closure: Thanks patient Presentation of fi ndings

Awareness of paiients needs throughout examination Professionalism

4

2

Global Score:

,The,Royal

Society of Medicine

Young Fellow's Committee

OSCE DAY 2OOg

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OSCE Station: Knee Examination

Candidate

Name:...

Instruction: Mrs Bean is a long distance runner who complains of left knee pain and crepitations.

Please examine her knees.

Measurernent for quadriceps wasting

Awareness of paiients needs throughout examination

Comments:

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ROYAI-Mark Scheme

Appropriate introduction including name and grade Obtains verbal consent

Washes hands or uses aleohol gel Positions and adequately exposes patient

Inspection whilst standing (for scars, sinuses, swelling, deformity, quadriceps wasting)

Assessment of gait

Position the patient lying down and ensure the patient is comfortable

Inspection whilst lying down lfor scars, sinuses, swelling, deformity, quadriceps wasting) Palpation of knee (for temperature, joint line tenderness, swelling in posterior fossa)

Measurement of knee flexion + assessment of crepitus Measurement of knee extension

Assessment of extensor lag on straight leg raising Assessment for posterior sag

Performance of anterior draw or Lachman's test and posterior draw test Performance ofvalgus and varus stress test

Performance of McMurrav's test

Offer to examine the hip and ankle joints and assess the neurovascular status ofthe legs Washes hands or uses alcohol gel

Closure: Thanks patieni and i'estores modesty Presentation of fi ndings

Professionalism

Global Score:

The Royal society ,of Medicine

Young FeIIow's Committee

OSCE DAY 2OO9

tation: Hip Examination

C a n d i d a t e

N a m e : . . . . .

Instructiol: Mr Jones is a 48 year old labourer

Please examine Mr Jones' hips.

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who complains of a painful hip on weigltt bearing.

Asks patient about site of pain, degree of pain and effect on mobility

Comments:

Mark Scheme

Appropriate introduction including name and grade Obtains verbal consent

Washes hands or uses alcohol gel

Positions (standing initially) and adequately exposes patient

Inspection of patient standing up (for scars, sinuses, muscle wasting, increased lumbar lordosis, scoliosis)

Performanee of Trendelenberg test Assessment of Gait

Positions patient lying down and ensures patient is comfortable Palpation of greater trochanter for tenderness

Assessment for lixed flexion deformitv (Thomas' test) Measurement of hip flexion

Nleasurement of hip extension Measurement of hip external rotation Measurement of hip internal rotation Measurement of hip adduction Measurement of hip abduction

Offers to examine joint above and joint below

Offers to examine the neurological and vascular supply of the lower limb Washes hands or uses alcohol gel

Closure: Thanks patient and restores modesty Presentation of fi ndings

Awareness of patients needs throughout examinaiion Professionalism

Global Score:

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The,Royal Society of Medicine

Young Fellow's Committee

OSCE DAY 2OO9

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OSCE Station: VARICOSE VEII{S EXAMINATIOI{

Candidate

Name:...

Instructionz Mrs Forrester is a 33 year old teacher who complains of prominentveins and swelling of

her ankles natably qt the end of the day. Perform an examination of her varicose veins.

Obtains verbal consent

Washes hands or uses alcohol gel

Comrnents:

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Mark Scheme

Appropriate introduction including name and grade

Positicns (standing) and adequately exposes patient both legs Asks if patient has any pain

General Inspection (for varicose veins, spider veins, venous eczema, lipodermatosclerosis, ankle swelling, scars, ulcers - saitor) from front and behind

Specilic Inspection of Long Saphenous Vein Specific Inspection ofShort Saphenous Vein

Palpates fortemperature, oedema, and along course oflong and short saphenous veins Examination for saphenovarix at SFJ and feels for cough impulse at SFJ and SPJ Performs Tap Test

Performs Tourniquet Test

Auscultates any obvious varicosities for bruits (AV malformation) Offers to use hand-treld Doppler to assess for SFJ and SPJ incompetence Offers to perform Perthes Test

Offers to examine lower limb pulses and ABPIs.

Offers to perform an abdominal, digital rectal and PV examination Closure: Thanks the patient and restores their modesty

Washes hands or uses alcohol gel Presents summary of findings

Awareness of patients needs throughout examination + treats patient with dignity Professionalism

Global Score:

The Royal Society of Medicine

Young Fellow's Committee

OSCE DAY 2OO9

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OSCE Station: LOWER LIMB VASCULAR EXAMINATION

Candidate

Name:...

Instructionz Mr Jones, a 65 year builder, complains of short distance intermittent calf claudication. He

is a known diqbetic and hypertensive. Examine his lower limb vascular system.

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Washes hands or uses alcohol gel

Comments:

Mark Scheme

Appropriate introduction including name and grade Obtains verbal consent

Posiiions and adequately exposes patient

lnspection (for gangrene, ulcers, skin colour, hair toss, amputation, scars)

Palpation for skin temperature transition comparing both sides Assess capillary refill time

Palpation of both femoral pulses Auscultation for femoral bruits

Palpation of both dorsalis pedis pulses Palpation of both posterior tibial pulses

Performance of Buerger's test (comments on Buerger's angle) Offers to: - _Examine - _Examine - Measure - Perform - Perform

reriainder of peripheral vascular system the abdomen for a AAA

ABPIs

a neurological examination of the lower limb Washes hands or uses alcohol gel

Closure: Thanks patient and restores modesty Presentation of fi ndings

Awareness of patients needs throughout examination Proiessionalism

Global Score:

The ,Royal Society of Medicine

Young Fellow's

Committee

OSCE DAY 2OOg

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fuIEDICINE

OSCE Station: Digital Rectal Examination

Candidate

Name:...

Instruction: You are an FYI doctor. You have been asked to perform a digital rectal examination on q

40 year old female/male with per rectal bleeding.

Comments:

Global Score:

-Clear Pass

3

Pass

2

Borderline

I

Fail

Mark Scheme

Appropriate introduction including name and grade

Explains need to perform procedure, what it entails and obtains verbal consent Requests chaperone (if appropriafe)

Washes hands or uses alcohol gel

Prepares equipment - gloves + lubricating jelly + tissue

Positions patient appropriately (left lateral decubitus position with knees drawn to chest) Examines perianal region (for skin tags, warts, fistulae, excoriation, prolapsed piles)

Technical performance of rectal examination (examines anterior, posterior and lateral walls)

Assists patient with clothing and ensures they are comfortable following the procedure Washes hands

Discusses the findings + further management with the patient; Addresses patients ICE Summary of consultation

Offers io documents lindings

Awareness of patients needs throughout consultation and maintains their dignity Professionalism

The Royal Society of Medicine

Young Fellow's Committee

OSCE DAY 2OOg

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OSCE Station: History Taking

C a n d i d a t e

N a m e : . . . . .

Iustruction: You are a FYL doctor. Mr(s) Jones has come into A&E. Please take a full history. Present

your history to the examiner when you have finished.

Listens effectively

Comments:

Global Seore:

4

Actor Global Score

of Consultation:

Mark Scheme

Appropriate introduction including name and grade Explains the purpose of the consultation

Establishes and maintains a rapport with the patient icieniifi es preseniing corrrpiaint

Explores presenting complaint and associated symptoms Acknowledges seriousness and severity of symptoms

Acknowledges patients' feelings/concerns and responds appropriately Determines past medical history

Determines drug history Identifies any allergies

Explores social and family history Performs appropriate systems enquiry

Appropriate use of open, closed and clarifying questions

Addresses patient's ideas, concerns and expectations Appropriate use of body language

Appropriately closes cons ultation Summarises history

Offers differential diagnosis and suggests options for further management Professionalism

The Royal Society of Medicine

Young Fellow's Committee

OSCE DAY 2OA9

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OSCE Station: Communication: Explaining a Procedure

Candidate

Instluction: You are an FYI in General Practice. Mr Bird has been referred for a

colonoscopy/bronchoscopy/OGD/ERcP

_{and you have been asked to explain the proced,ure}

_{to him. The}

examiner

will advise you which procedure

the patient will be undergoing.

Mark Scheme

Appropriate introduction including name and grade Establishes _{and maintains a rapport with the patient} Explains the purpose of the consultation

Checks patient's prior understanding of the procedure/operaiion Elicits patient's concerns

Acknowledges patients' feelings/concerns and responds appropriately Explains indication for the procedure/operation

Explains preparation required before procedure/operation Explains procedure,/operation

the

Explains likely outcome after the procedure i.e. discharge date, follow-up, when results will be available and restrictions on lifestvle (i.e, drivins. exercise. work

Checks patient's understanding of the procedure/operation Summarises the key points of the consultation

Encourages and addresses questions and concerns Discusses and negotiates a subsequent management plan Offers information leafl ets

Listens effectivelv

Appropriate use of non-verbal and verbal cues Fluency ofconsultation * avoids jargon and repetition Professionalism

Comments:

Global Score:

Actor Global Score of Consultation:

The Royal Society of Medicine

Young Fellow's Committee

OSCE DAY 2OO9

OSCE Station: Communication

- Drug Addict

Candidate

Name:...

Instruction: You are a FYI doctor in General Practice and have been asked to see Mr Jones.

He appears

to be quite agitated and is.

demanding

to speak to a doctor urgently. You have 7 minutes

to take a history

and provide appropriate

management.

Esiabiistres and maintains rappoii ivith patient

Comments:

Global Score of Negotiating Plan:

Patient Global Score of Communication

Skills:

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-Mark Scheme

Appropriate introduction including name and grade

Acknowledges and responds to patients' feelings appropriately Establishes patient's agenda

Establishes own agenda Negotiates compromise Elicits details of past history Elicits details of drug use Elicits details of past treatment

Appropriate use of open/clarifying/closed questions Fluency/avoids jargon and repetition

Professionalism

The,Royal Soiiety of Medicine

Yqung Fellow's Committee

OSCE DAY 2OO9

OSCE Station: Communication - Colon Cancer

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Candidate Name:

Instruction: As an FYI in General Practice, you are asked to see Mr Mukhurji. He presented with fatigue

and painless bright red rectal bleeding 2 weeks ago. An outpatient barium enema was performed and

demonstrated

an

'apple

core'lesion in his sigtnoid colon. Please discuss these

results with the patient and

the necessary

_{follow up. Youhave 7 minutes to discuss}

the results and further management.

Comments:

Global Score

in Breaking

Bad News:

4 3

Global Score

in Negotiating

Management

Plan:

4 3

Actor Global Score

of Consultation:

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Mark Scheme

Appropriate introduction including name and grade Establishes and maintains rapport with patient Listens eifectiveiy

Establishes patient's ideas, concerns and expectations

Acknowledges patients' feelings/concerns and responds appropriately Shows appropriate skills in breaking bad news

Appropriate use ofbody language

Checks patient's prior understanding ofcolonoscopy and bowel cancer ns reason for colo

Describes colonoscopy clearly (preparation required, the procedure & complications Discusses and negotiates subsequent management plan

Summarises key points of consultation and checks patient's understanding Offers information leaflets and arranges follow-up

Addresses any questions and concerns

Appropriate use of open/clarifying/closed questions Fluency/avoids jargon and repetition

The Royal Society of Medicine

Young Fellow's Committee

QSCE DAY 2OO9

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OSCE Station: Communication - Autopsy

C a n d i d a t e

N a m e : . . . .

Instruction: You are an FYI doctor in A&E and have been involved in an unsuccessful

resuscitation

on a

7-year old boy (David) wlto collapsed

whilst playingfootball. You are asked

to speak to Mr Steinberg,

the

father, about the autopsy.

You have

7 minutes

to discuss

this matter

with the father.

Professionalism

Comments:

Global Score

for Negotiating Plan:

Patient's Global Score of Communication Skills/Consultation:

Mark Scheme

Appropriate introduction including name and grade Estatriisires ai-rd ir-rainiains rapport v*ith patient

Offers condolences and ensures appropriate environment for consultation Acknowledges and responds to patients' feelings

Establishes patient's agenda Establishes own agenda Negotiates compromise

Discusses reasons for coroner PM/demonstrates knowledge Explains in terms acceptable to relative what a post-mortem w Does not guarantee an autopsy will be done

Elicits and addresses parent's concerns and suggests appropriate support Appropriate use of open/clarifying/closed questions

Fluency/avoids jargcn and repetition

4

Clear Pass

)

Borderline

3

Pass

1

Fail

The Royal Society,of

Medicine

Young Fellow's Committee

oscE Dey 2009

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OSCE Station: Communication - Ncohol Abuse

Candidate

Instruction: You are a FYl doctor in General Practice. You are asked to see Mr Adam Smilh. He came

into the practice a week ago with vague abdominal discomfort and was seen by the senior partner. Blood

taken at that time shows a mild enaemia,

high MCV and a raised gamma-GT.

He looks tired, unkempt

and

smells of alcohol.

You have 7 minutes to discuss

the results

and neeotiate

manasement.

Mark Scheme

Apprcpriate intrcduction including name and grade Establishes and maintains rapport with patient Listens effectively

Acknowledges and responds appropriately to patients' feelings Establishes patient's ideas, concerns and expectations (ICE) Elicits CAGE/Alcohol historv

El!cits socia!/forensic historv

Discusses lifestyle and potential stressors

Offers information and negotiates further management (i.e. counselling, rehabilitation and Summarises key points in the consultation and checks patient's understanding

Appropriate use of open/clarifying/closed questions Fluency/avoids jargon and repetition

Professionalism

Comments:

Global Score:

Actor Giobal Score for Communication Skills (ability to empathise,

establish

a rapport and offer explanation):

The Royal Society of Medicine

Young Fellow's Committee

dscE DAY zoos

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OSCE

Station:

ECG

Interpretation

C a n d i d a t e

N a m e : . . . . .

Instruction: Mr Smith is a 56 year old gentleman who presents

to A&E ruith chest pain. Yoa are asked

to interpret his ECG. Discuss your lindings with the A&E Registrar.

Comments

4

Clear Pass

Borderline

Fail

RoYAt-Mark Scheme

Confirms the following before proceeding: Pafient's name and DOB

Date and time investigation performed

- _{Patient's symptoms at time of investigation i.e. chest pain or painfree} Checks calibration of the ECG i.e. strip recorded at a setting of 25mm/sec Calculates Rate Comments on Rhythm Determines Axis Coinments on: - _PRinterval - ST segments QT interval T-waves Summarises findings

Correct interpretation of ECG Comments of further management

Global Score:

Pass

The:Royal Society

of Medicine

Young Fellow's

Committee

F*o-ct:!::-g

OSCE Station: Peak Expiratory FIow Rate Measurement

C a n d i d a t e

N a m e : . . . . .

Instructionz Miss Pollen, a 26 year old PE teaclter, has recently

wheeze suggestive of asthmu. Please measure her Peak Expirutorlt

management.

Inierprets recorded PEFR against predicted value using chart

Cornments:

2

developed

FIow Rate

a nocturnal

and discuss

couglr and

her further

Mark Scheme

Appropriate introduction including name and grade

Obtains verbal consent and outlines nature ofthe consultation Checks patients' untierstanding of PEFR and asthma

Explains reason for measuring PEFR and how to measure PEFR Washes hands or uses alcohol gel

Shows patient how to prepare PEFR meter (mentions disposable mouthpiece + zeroes meter) Positions patient i.e. standing

Expt"irr th"t p"tLntihould take a deep breath and form a tight seal with their lips around the mouth

hotdins meter horizontal and taki eare not to obstruct scale with fi Explains how to read meter and the need to zero dial prior to next attempt Checks patient understanding of technique

Asks patient to perform PEFR and checks technique P-eco:'ds best of 3 PEFR- readings (in lr'min)

Comments o" vatu. of pffn obtained and explains results to patient in context of asthma f*ptui^ need to keep PEFR diary and advises when to take readings

Washes hands or uses alcohol gel Closure:

- A d d r e s s e s a n y q u e s t i o n s o r c o n c e r n s - Arranges a follow-up appointment - Offers information leaflets

Awareness oipatients needs throughoiit examination Professionalism

I( Siitharan OSCEssentiak 2409

Global Score:

The Royal So0iety

of Medicine

Young Fellow's Committee

OSCE DAY 2OO9

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OSCE Station: Measurement

of Ankle Brachial Pressure

Index

Candidate

Name:...

Instruction'. Mr Jones is a 67 year accountant with a history of right foot rest pain. He is diabetic,

Irypertensive and has chronic renal failure. Please messure ltis ankle pressare bracltiai indices.

Comments:

Mark Scheme

Appropriate introduction including name and grade E-p

Washes hands or uses alcohol gel

Fositions and adequately exposes patient (supine with shoes, socks and proximally constricting clothing

Ensures that legs have been rested for >20 mins

Selects appropriate sized BP cuffand places around arm Palpates brachial artery and applies ultrasound gel

Uses Doppler probe (at approx 45 degrees) to locate brachial pulse

lnflates cufftill Doppler signal disappears, deflates and records pressure at which signal returns

Cleans gel and offers to repeat process for other arm States would use higher of 2 brachial systolic readings to ca

Selects appropriate size cuff for patients calf and places above the malleoii

Locates Dorsalis Pedis @P) pulse by palpation or applies ultrasound gel and uses Doppler Continues as for brachial pulse and records DP pressure

Repeats for Poste Tibial (PT) pulse and records PT pulse pressure Uses the higher of the fwo readings when calculating ABPIs for the ankle Offers to repeat for other leg

Cleans ultrasound gel from skin and restores patients' modesty Washes hands or uses alcohol gel

Calculates and documents ABPIs in patient's notes Closure:

- Advises patient of their results in the context of their symptoms. - Addresses any questions or concerns

- Thanks the patient

Presentation of findings with interpretation of results Awareness of patients needs throughout examination Professionalism

Global Score:

The Royat Society

of Medicine

Young Fellow's Committee

OSCE DAY 2OOg

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OSCE Station:Urinary Catheterisation

Candidate Name:

Instruction: Mr Smith is post-op day 1 incisional hernia repair and is clinically in acute urinary

retention. Please insert a urethral urinaw catheter.

States that iCeally would allow 5mins for LA to take effect prior to catheter insertion

Comments:

7

'ri. RoYAL

Mark Scheme

Appropriate introduction including name and grade Explains procedure and obtains verbal consent Checks indication for urinary catheter lnsertion Washes hands or uses alcohol qel

Positions and adequately exposes patient

Ensures privacy and patients dignity is preserved (requests chaperone iffemale patient) Prepares procedure trolley/equipment maintaining asepsis

Washes hands or uses alcohol gel and puts on sterile gloves Performs catheter insertion maintaining asepsis

Advances catheter to hub/till urine flows

Inflates catheter balloon with water in accordance with manufacturer's guidelines Attaches catheter to-leg bag/drainage system

Ensures patient is comfortable (foreskin is reptaced), the area !s dry and assists patient with CIears and disposes of clinical waste appropriately

Washes hands or uses alcohol gel Closure:

- _{Advises patient of further management} - _{Addresses any questions or concerns}

Documents procedure in notes (including date, time, catheter type, amount of water institted in balloon, of foreskin where approDriate

Awareness of patients needs throughout examination Technical performance

Professionalism

fhe Royal SoCiety

of Medicine

Young Fellow's Committee

OSCE DAY 2OO9

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OSCE Station:

Urinalysis

Candidate

Name:...

Instruction: You are a GP trainee, You are asked to dipstick the urine of a patient who describes a 2 day

history offrequency and dysuria.

Comments:

4

Clear Pass

Pass

2

Borderline

I

Fail

Mark Scheme

Appropriate introduction including name and grade

Briefly describes and glves reason for procedure and obtains consent to proceed Checks patients name and date of birth

Washes hands or uses alcohol gel, puts on gloves and gown

Takes urine sample and assesses appearance (colour, turbidity) and odour Immerses all pads of urine dipstick in urine specirnen bottle for l.-2 seconds Starts timing and keeps urine dipstick horizontal at all times

Closes urine specimen bottle and puts aside

Reads dipstick against colour chart on bottle at time indicated on chart

After reaCing, discards urine dipstick and gloves appropriately in clinical waste Washes hands or uses alcohol gel

Discusses findings with patient and further management

Documents the findings in the patients in the patients notes +/- offers to send urine for if annropriate

Closes consultation appropriately Summarises findings to the examiner Professionalism

The Royal Society of Medicine

Young Fellowos

Committee

OSCE DAY 2AO9

OSCE Station: Verification + Certification of Death

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Nirorctrr:

Instruction:

1. You are the FYI doctor on-call and are bleeped

to the ward to verify the death of a patient.

The date is today.

2. You are the patient's usual doctor and are asked to complete

a death certificate

with the

information provided. You are based at Hope Hospital and the consultant is Dr Dye.

Comments:

Mark Scheme

Appropriate introduction to nursing staff including name and grade

Elicits appropriate details: time of death; persons present; when last seen alivel duration of death

Requests hospital notes and drug chart Confirms patient's identity band Examines patient to assess:

i.e. gentle shake/sternal rub) + absence of spontaneous movements - Looks for absent respiratory effort (1 minute)

- Palpates major pulse (carotid/femoral) for 1 minute - Auscultates praecordium for heart sounds (for 3 minutes) - Auscultates lungs for breath sounds (for 3 minutes)

- Inspects eyes for fiiEd, dilated pupils + absent corneal reflexes (requests pen torch) - Requests opthalmoscope to perform fundoscopy for tracking/rail roading

- Examines trunk for other features of death i.e. muscle tone for rigor mortis (does not appear

until 3 hours after death), post-mortem staining (due to hvpostasis) and decreased

Documents above in notes (includes above details, time, date and signature)

Legible writing/avoids abbreviations

Correct patient detailslDate/time anci signature Part 1a (disease causing death)

Part lbic (disease underlying this -ifnot in la) Part 2 (contributory diseases)

Residence and consultant

Global Score:

a) o I o I

_(,

ts

B I R T H S

A N D D E A

S REGISTRATION

ACT 1953

M E D I C A L C E R T I F

TE OF CAUSE: OF DEATI-I

For use only by a Registered Medical practitionef W FIAS BEEN IN ATTENDANCE during the deceased,s last illness, and to be dclivcred by hirn ith to thc Registral of Births and Deaths

Name of deceased D a t e o f d e a t h ;r s s t a t e d t o m e . . . e P l a c e o f d e a t h . . . . L a s t s e e n a l i v e b y r r e . . . .

2

3

The certified cause ofdeath takes acconnt ofinfonnation obtained from post-mortem.

Infomration from post-mortetr may be available later Post rnortem not being held.

I have reported this death to the Coroner for further action. (See overleafl

f This does not tnean the mode of dying, such as heart .failure, asphyxia, asthenia, I hereby certify t.hat I was in rnedical attendance during

t l t e a b o v e n a r n e c l d e c e a s e d ' s l a s t i l l n e s s , a n d t h a t t h e particulals and cause of death above written are true to the best of rny knowledge and belief.

d a y o f . . . _{A g e a s s t a t e d t o m e}

day of

.:

;

Tltese particulars not lo be

entered in death register Approximate interval between ollset and dea(h

it nteans lhe disease, injury, or contplication whiclt cqused death. Qualifications as registered

by Geueral Medical Council ..._...

For deaths in hospital: l?lease give the name ofthe consultant respousible for tlie