OSCE Test 2023 questions with complete solutions

General Practice 1 - A 50 year old man has been sent along by his wife. He lost his license last month for the 3rd time for 'DUI' and she has insisted that he talk to you about his alcohol use. - 0 General Practice 1 - Leon 19 yo M mother insists poorly controlled asthma, Lots of ventolin, used to be on flixotide but lost it. - Hx: Age of onset[1]FHx[1]Triggers: exercise, cold air, hayfever, dust, smoke[3]Previous hospital admissions[1]Compliance with current meds[1]Attitude towards condition[1]Able to get Leon to demonstrate how he uses his accuhaler[2]Student can demonstrate correct use of Accuhaler[2]Empathy score: 2 General Practice 1 - Your next patient comes to see you about her/his asthma. It has been worse over the past few months, and s/he is needing to use a puffer a couple of times a day. - Communicate clearly, avoid jargon[0.5]Check patient's understanding of information and instructions[0.5]Choose preventer+reliever, ICS may be combined with LABA[1]Watch technique, recognise if poor.[1]Advise use of spacer[1]Demonstrate good MDI technique: Shake[0.5]Hold correctly[0.5]Exhale[0.5]Inhale and hold[0.5]Arange appropriate follow up (1-3/52)[1]Safety net including warning signs of severe asthma and action to take[1]Advice on care of delivery device[1]Appropriate dose[1]Possible side effects, wrinsing mouth to avoid thrush[1]Written action plan[1]Empathy score: 2 General Practice 1 - Your patient is 19 and tells you that s/he has recently started a triathlon-training course but finds s/he is still getting short of breath when training, and feels his/her fitness should have improved by now. - 0 General Practice 1 - Your next patient, a middle aged woman, has had a cough for the last 3 months. - 0 General Practice 1 - Country GP. Geoff is a 39 yo bank manager. He has been seen on a number of occasions in the practice over the last five years. His BP has been measured and recorded. The best reading was 140/98 and today it is 160/105. You note his BP is taken using the right arm and the correct sized cuff is always used with the patient sitting. When his blood pressure was taken supine last visit it was 155/100 at 5 and 10 minutes. Outline your Mx plan for this patient from the General Practice viewpoint. - Able to explain to Geoff that he has moderate hypertension and it is probably time to treat him with an antihypertensive medication. [3]Management: lifestyle modification eg low salt diet, weight loss, exercise, controlling stress[3]Ix: discussed Eg: fasting BSL, fasting lipids,UEC, MSU, ECG, CXR etc [3]Able to discuss phamacotherapy eg thiazide, ACE, beta blocker, calcium channel antagonist etc[3]Empathy score: 2 General Practice 1 - Colle's fracture - gross anatomical appearance, X-ray features. - Clinical: Dinner fork deformity, soft tissue swelling, blood, ? Open[2]X-ray: #distal radius with 50% dorsal displacement, dorsal angulation, shortening, associated #distal ulna.[2]Dx: Colles'[1]Further assessment: Distal neurovascular function e.g. median nerve, check if open[1]Mx: analgesia, splint, reduction with regional/general anaesthesia, back slab[2]Position: wrist slightly flexed, ulnar deviation[2]Complications: tendon rupture, median nerve injury, vascular compromise, stiffness/OA, malunion, carpal tunnel syndrome[2]Predisposing: osteoporosis Dx with bone densitometry[2] General Practice 1 - You are seeing this patient who you know well with poorly controlled diabetes. - 0 General Practice 1 - Mabel is 50 years old with chronic headaches. Take history. Had headaches for years, treated them with aspirin/codeine. Recently headaches became 1 sided. Smoker. BP 170/100. DDx. - Establish rapport[1]Organized approach to history taking[2]Note change in Hx... red flag[1]DDx: Tension headache[1]Migraine headache[1]Sinus headache/rebound headache analgesia[1]Cervical spondylosis[1]Contemplate possibility of haemorrhage/SOL[1]Follow up need for CT[1]BP being elevated[1]Other CVS risk factors[1]Empathy score: 2 General Practice 1 - Examine this patient with high blood pressure - Check the pulse rate - irregularly irregular suggests atrial fibrillation. Measure the blood pressure in both arms. Check for radiofemoral delay (coarctation of the aorta). Examine the optic fundi for hypertensive retinopathy. Look for features of Cushing's syndrome or virilization. Palpate the abdomen for renal enlargement (adult polycystic kidney disease) and for the abnormal pulsation of an abdominal aortic aneurysm. Listen for bruits over the renal arteries (renal artery stenosis). Examine the heart for the heave of left ventricular hypertrophy and for a fourth heart sound. Look for evidence of heart failure (raised JVP, basal lung crackles, ankle oedema). Perform microscopic examination of the urine, looking for red cell casts. General Practice 1 - 56 yo F. Fatigue over 2-3/12. Aunt had thyroid problem. Weight gain. Ix, Meds, Explain. - Hx: HxPC, PMHx, Med, Allergy, FHx, SHx, smoking/etoh, systems review[4]Screen for DM, Anaemia, Depression, Hypothyroid[2]Goitre, skin, voice, cold[1]Ix: BSL, TSH, FBC/ferritin/Fe, UEC[2]Explain/reassure[1]Commence oral thyroxine. Suggested dose 50-100 mcg daily[1]Recheck TFTs in 6-8 weeks and check thyroid antibodies[1]Empathy score: 2 General Practice 1 - Your last patient has been feeling unwell for about 3 days with a cough and fever. S/he thinks it's flu, but feels really unwell, and is sometimes a bit breathless. On examination you hear crackles in the left lower and mid zones. - 0 General Practice 1 - A 32 year old woman comes to see you, she is a smoker and wants to quit. - 0 General Practice 1 - You are seeing Bianca a 20 yr old university student. She complains of fatigue and lassitude for the last six months 1. Take a short history from Bianca. You may ask the examiner for the examination findings when you have completed this. 2. The examiner will then ask you to discuss the likely cause of her symptoms and any Investigations you might like to order. - Relationships/occupation/social[1]Diet + exercise[1]Smoking/EtOH[1]Allergies/medication[1]Menstrual[1]Depression? Mood/sleep/appetite[1]Hypothyroid: weight gain, cold intolerance[1]Red flag symptoms: weight loss, night sweats[1]Likely Dx: Fe deficient anaemia.[1]Psychosocial/depression (common)[1]Ix: FBC, Fe studies, TFTs, UEC, BSL, LFTs[2]Empathy score: 2 General Practice 1 - Your patient tells you s/he has the 'flu'. S/he has had a head cold and sore throat, and now a persistent productive cough for 5 days. S/he says s/he wants something to get rid of it fast as s/he is travelling overseas for work next week. - 0 General Practice 1 - After your last consultation you made a note that you need to talk with this obese patient about losing weight next time you see them. You did not mention this to the patient. - 0 General Practice 2 - Your next patient is a 20-year-old student, who works part time as a waiter. S/he comes in with a 4-day history of a sore throat - "the worst I've ever had". S/he says s/he has a fever and a headache, and feels quite tired. - 0 General Practice 2 - Your patient comes in and tells you s/he feels dreadful - headache, feeling really clogged up, and a toothache. S/he says she had a head cold about 10 days ago, which s/he thought had finally gone, but then this started 2 days ago - 0 General Practice 2 - Your patient comes in with knee pain. It's been present really for about six months. It's getting worse - thought it was just part of getting old, but now worried it is gout or that really bad arthritis that cripples you - 0 General Practice 2 - A patient comes to see you for a 'Progress certificate' for their Worker's Compensation claim. S/he says the back pain is about the same, but s/he's getting increasingly frustrated about his/her slow recovery. S/he wonders if acupuncture will help. - 0 General Practice 2 - Your patient tells you s/he has done his/her back in again. S/he says s/he was lifting some groceries out of the car boot. When s/he turned s/he felt the pain suddenly in her/his back, and found it difficult to straighten up. You know this patient has a history of chronic lower back pain. - 0 General Practice 2 - Examine this patient who complains of a blocked nose - Inspect the external nasal pyramid for asymmetry or evidence of trauma. Using your thumb, lift the nasal tip to inspect the nostrils, e.g. septal haematoma following a blow to the nose. Ask the patient to sniff while gently occluding each nostril in turn. In children hold a mirror or metal spatula under their nostrils, looking for two patches of condensation from expired air - the 'mirror test'. Examine the anterior nasal cavity, especially the position of the septum and size of the inferior turbinates, using a large speculum on an otoscope. Look for nasal polyps, foreign bodies (especially in children) or other soft tissue swellings. Refer to visualize the postnasal space (nasopharynx): with endoscopy in adults and older children, or lateral soft tissue X-ray in young children/infants (adenoidal hypertrophy). Consider further investigations, such as allergy testing (allergic rhinitis) and a CT scan of the paranasal sinuses (chronic rhinosinusitis). General Practice 2 - Patient presents to GP practice with a diffuse maculopapular rash, they think it might be an allergic reaction - Hx of allergy, arthralgia, rash onset + distribution, fever/recent illness, new foods, recent meds, contacts-plants/chemicals[4]Angioedema symptoms - wheeze, cough, face swelling[1]Urticaria, explain most likely viral, unlikely to be allergy, explain further tests not usually helpful[2]Non-sedating antihistamine[0.5]Calamine/other topical[0.5]Tepid baths[0.5]Likely to resolve in 2/52[0.5]Return if symptoms persist[1]May Ix if rash persists[1]Suggest diary to see if pattern develops[1]Empathy score: 2 General Practice 2 - Patient presents to your GP practice complaining of a plantar wart. During the exam you notice an irregular pigmented lesion. Discuss. - Previous sun exposure[1]Previous skin problems or operations[1]Bleeding/itching/change in size[2]Duration of facial lesion[1]Advise of Dx of plantar wart[1]Offer cryotherapy or 'paint' for wart[1]Advise patient of Dx of melanoma[2]Advise need for review and explain potential seriousness of lesion.[2]Highlight urgency for this review[1]Empathy score: 2 General Practice 2 - Examine this patient who complains of being dizzy and lightheaded - Is the patient pale (anaemia) or sweating (cardiac disease, anxiety, labyrinthitis)? Check pulse, blood pressure lying and standing, and temperature (dysrhythmias, hypotension or viral infection). Look for a facial palsy (cholesteatoma). Examine the ears (cholesteatoma). Examine for nystagmus. Carry out the Dix-Hallpike test. Perform Romberg's test (sensory ataxia). Carry out Unterberger's test (labyrinthitis, vestibular disease). Watch the patient walk: slow, fast and turn, heel to toe (cerebellar disease). General Practice 2 - Examine this patient who complains of earache - Carry out a general examination, looking for evidence of systemic upset (acute otitis media). Inspect and palpate the pinna and surrounding area (acute mastoiditis, acute otitis externa, trauma (haematoma), previous surgery). Inspect both external auditory meati for signs of discharge, crusting and excoriation (acute otitis media, acute otitis externa). Feel the tragus for tenderness (acute otitis externa). Using the otoscope, examine the external auditory meati (lift the pinna upwards and backwards to straighten the canal). Inspect the tympanic membrane for surface appearance and integrity. If the view is obscured with wax/debris, consider manual removal or microsuction. Ask the patient to open and close the jaw while you palpate the temporomandibular joints, listening for a click (temporomandibular joint dysfunction). Examine the throat (referred pain from the oropharynx). Consider other investigations such as audiology (hearing test).