rsm osce sheets 2009

The Ro5'al Society. of.Medicine, :Youhg Fellow's Committee

; r' OSCE DAY,2009 ,

OSCE Station: CARDIOVASCULAR EXAMINATION

Candidate Name:. . . . . .

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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 SchemeAppropriate 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:

K Sritharan OSCEssetltidls 2009

The Royal Society of NledicineYoung Fellow's Committee

' OSCE DAY 2OO9$_q::iqry-gIvltorcrxr

OSCE Station: RESFIRATORY EXAMINATION

Candidate Name:. . . . .

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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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 cvanosis. hvoercaDnic f lap >2 for

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)


Presentation of summary of findings

Aware of patients needs throughout examination * treats patient with respect

Professionalism

Global Score:

K Sritharan OSCEssentials 2009

The Royal SoCiety of MedicineYoung Fellow's Committee

OSCE DAY 2OOg

OSCE Station: ABDOMINAL EXAMII{ATIO|{

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Cand ida te Name: . . . . . . . . . . . . . . . . . . . . . .

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

habits. Plesse examine his abdomen.





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


Presents Summary of findings

Awareness of patienis needs throughout examination * treats patient with respect

Professionalism

Comments:

GlobalScore:

The Royal Society of Medicine, Young Fellow's Committee

. OSCE DAY 2OO9F-q--q-Lcrrr&{t otctr*-r

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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.


Comments:


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 ofbreast to be examined behind their headSystematically 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


Presents summary of findlngs

Awareness of patients needs throughout examination

Professionaiism

4Global Score:


The Royal Society of MedicineYoung Fellow's Committee

OSCE DAY 2OO9 l.l" RoY,qL

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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 flexionWrist flexionWrist extensionFinger extensionFinger flexionFinger abduitionThumb abduction

Exumine this patient's upper limb neurological system.


Obtains verbal consent to perform examination

Washes hands or uses alccho! gel


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


Closure: Thanks patient and restores modesty

Presents findingsAwareness of patients needs throughout examination

Professionalism

Global Score:

K Sritharan OSC Essentials 2009

The,Royal Society of MedicineYoung Fellow's Committee

OSCE DAY 2OO9F_o-qu,!-r{fo{rprctrrig

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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 offeetAssesses 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



Presents findings


Professionalism

OSCE Station: Lower Limb Neurological Examination


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:

4

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F a i l

Global Score:

K Sritharan OSCEssemials 2009

r-I The Royal Society of Medicine

Young Fellow's CommitteeOSCE 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.


Positions and adequately exposes patient (to clavicles)

Closure: Thanks patient and restores patients' modesty

Comments:

4

Clear Fass

aJ

Pass

2

Borderline

1

Fail

tr . RoYAL


Explains examinatlon and obtains verbal consent

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


Professionalism

Global Score:

The Royal Society of NledicineYoung Fellow's Committee

OSCE DAY 2OO9 rr" ROYAt

Fps Erlg]UeucrxrOSCE Station: Cranial Nerves Examination


Instruction: Please examine the patients' cranial nerves.

Comments:


Obtains verbal consent'Washes

hands or uses alcohol gel


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


Closure: Thanks patient

Presentation of fi ndings

Awareness of paiients needs throughout examination

Professionalism

4

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Global Score:

K Sritharan OscEssentidls 2009

,The,Royal Society of MedicineYoung Fellow's Committee

OSCE DAY 2OOg!-qqET_IsiVltotctr-*r:

OSCE Station: Knee Examination


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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Mark Scheme Borderline

Appropriate introduction including name and grade


Washes hands or uses aleohol gel


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


Closure: Thanks patieni and i'estores modesty


Professionalism

Global Score:


The Royal society ,of MedicineYoung FeIIow's Committee

OSCE DAY 2OO9

tation: Hip Examination


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 BorderlineAppropriate introduction including name and grade



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




Awareness of patients needs throughout examinaiion

Professionalism

Global Score:

, rur dsr r i l rc


The,Royal Society of MedicineYoung Fellow's Committee

OSCE DAY 2OO9Los"$tljtv- lrntctNt

OSCE Station: VARICOSE VEII{S EXAMINATIOI{


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.



Comrnents:

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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

Specil ic 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


Presents summary of findings

Awareness of patients needs throughout examination + treats patient with dignity

Professionalism

Global Score:

K Sritharan OSCEssentiab 2009


OSCE DAY 2OO9lgg:lg',tlvl:,olcr ur

OSCE Station: LOWER LIMB VASCULAR EXAMINATION


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.

'I i. ROYAL


Comments:



Posii ions 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 systemthe abdomen for a AAAABPIsa neurological examination of the lower l imb





Proiessionalism

Global Score:

K Sritharan OSCEssenrials 2009

The ,Royal Society of MedicineYoung Fellow's Committee

OSCE DAY 2OOg rr. ROYAL

SsqrglyfuIEDICINE

OSCE Station: Digital Rectal Examination

Candidate Name:...

Instruction: You are an FYI doctor. You have been asked to perform a digital rectal examination on q40 year old female/male with per rectal bleeding.

Comments:

Global Score:A-

Clear Pass

3

Pass

2

Borderline

I

Fail


Explains need to perform procedure, what it entails and obtains verbal consent

Requests chaperone (if appropriafe)


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

K Sritharan OSCEssentials


OSCE DAY 2OOg n" Rot'AL

F-sg-rlr!iUEDICINE

OSCE Station: History Taking


Iustruction: You are a FYL doctor. Mr(s) Jones has come into A&E. Please take a full history. Presentyour history to the examiner when you have finished.

Listens effectively

Comments:

Global Seore:

4

Actor Global Score of Consultation:


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

Identif ies 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



OSCE DAY 2OA9 n. RoYAt

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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 acolonoscopy/bronchoscopy/OGD/ERcP and you have been asked to explain the proced,ure to him. Theexaminer will advise you which procedure the patient will be undergoing.


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 appropriatelyExplains 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 willbe available and restrictions on lifestvle (i.e, drivins. exercise. workChecks 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:




OSCE DAY 2OO9

OSCE Station: Communication - Drug Addict


Instruction: You are a FYI doctor in General Practice and have been asked to see Mr Jones. He appearsto be quite agitated and is. demanding to speak to a doctor urgently. You have 7 minutes to take a historyand 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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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

Clear -Uass .Cass .ti{]t'&e!"{Ixre

The,Royal Soiiety of MedicineYqung 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 fatigueand painless bright red rectal bleeding 2 weeks ago. An outpatient barium enema was performed anddemonstrated an 'apple core'lesion in his sigtnoid colon. Please discuss these results with the patient andthe necessary follow up. Youhave 7 minutes to discuss the results and further management.

Comments:

Global Score in Breaking Bad News:

43

Global Score in Negotiating Management Plan:

43


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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



Prof'essionalism


QSCE DAY 2OO95_o.*entglv{i,DlctNi'

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OSCE Station: Communication - Autopsy

Candidate Name:. . . . . .

Instruction: You are an FYI doctor in A&E and have been involved in an unsuccessful resuscitation on a7-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:



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


Fluency/avoids jargcn and repetition

4

Clear Pass

)

Borderline

3

Pass

1

Fail


The Royal Society,of MedicineYoung Fellow's Committee

oscE Dey 2009 rr ' RovAl,

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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 cameinto the practice a week ago with vague abdominal discomfort and was seen by the senior partner. Bloodtaken at that time shows a mild enaemia, high MCV and a raised gamma-GT. He looks tired, unkempt andsmells of alcohol.You have 7 minutes to discuss the results and neeotiate manasement.

Mark SchemeApprcpriate 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



Professionalism

Comments:

Global Score:

Actor Giobal Score for Communication Skills (ability to empathise, establish a rapport and offer explanation):

1


dscE DAY zoosiqqr:r-:tNILptclNE

OSCE Station: ECG Interpretation


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

7

Borderline

1r

Fail

rl. RoYAt-

Mark SchemeConfirms 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-wavesSummarises findings

Correct interpretation of ECG

Comments of further management

Global Score:

Pass


The:Royal Society of MedicineYoung Fellow's Committee

F*o-ct:!::-gNlEDICI NE

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OSCE Station: Peak Expiratory FIow Rate Measurement


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

BorderlineMark SchemeAppropriate 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


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


Closure:- Addresses any quest ions or concerns- Arranges a follow-up appointment- Offers information leaflets

Awareness oipatients needs throughoiit examination

Professionalism

I( Siitharan OSCEssentiak 2409

Global Score:

The Royal So0iety of MedicineYoung Fellow's Committee

OSCE DAY 2OO99q-grurA,irurcrxr,

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OSCE Station: Measurement of Ankle Brachial Pressure Index


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:


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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 signalreturnsCleans 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


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


Professionalism

Global Score:


The Royat Society of MedicineYoung Fellow's Committee

OSCE DAY 2OOg!g-qlgry.gNIe ltcrr"*c

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

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Explains procedure and obtains verbal consent

Checks indication for urinary catheter lnsertion

Washes hands or uses alcohol qel


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


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


Technical performance

Professionalism

Global Score:

fhe Royal SoCiety of MedicineYoung Fellow's Committee

OSCE DAY 2OO9 ri. Ro)',{t

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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 dayhistory offrequency and dysuria.

Comments:

4

Clear Pass

J

Pass

2

Borderline

I

Fail


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


Discusses findings with patient and further management

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

Closes consultation appropriately

Summarises findings to the examiner

Professionalism

Global Score:

The Royal Society of MedicineYoung Fellowos Committee

OSCE DAY 2AO9

OSCE Station: Verification + Certification of Death

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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 SchemeAppropriate introduction to nursing staff including name and grade

Elicits appropriate details: time of death; persons present; when last seen alivel duration ofdeathRequests 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 appearuntil 3 hours after death), post-mortem staining (due to hvpostasis) and decreasedDocuments 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:

K Slitharan OSCEssentials 2009

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BIRTHS AND DEA S REGISTRATION ACT 1953(Fomr prescribed by Regi ion ofBirths and Deaths Regulations 1987)

MEDICAL CERTIF TE OF CAUSE: OF DEATI-IFor 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

Date of death ; rs s tated to me. . . . . . . . . . e

Place of death . . . . . . . . . . . .

Last seen a l ive by r re . . . . . . . . . . . . . .

23A

The certified cause ofdeath takes acconnt ofinfonnationobtained from post-mortem.

Infomration from post-mortetr may be available laterPost 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 duringt l te above narnecl deceased's last i l lness, and that theparticulals and cause of death above written are trueto the best of rny knowledge and belief.

day of . . . . . . . . . . Age as stated to me

day of

rtng

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Tltese particulars not lo beentered in death register

Approximate intervalbetween ollset and dea(h

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

Qualifications as registeredby Geueral Medical Counci l . . ._.. .

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

Date