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year 5 > OSCE > Flashcards

OSCE Flashcards

1
Q

Finals Osce
- Stations 1-8

A

Finals Osce
- Stations 1-8

  1. Community Care Planning (GP)
  2. Referral and discussion (Medicine)
  3. Post-Operative Patient on Ward Round (Surg, NO SIM)
  4. Using Investigations to prescribe safely (Medicine, NO SIM)
  1. Deteriorating Patient
  2. Multi-morbidity and Polypharmacy (GP)
  3. Complication in a surgical patient
  4. Ward Round Notes (Medicine/Surgery, NO SIM)
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2
Q

Final OSCE
- Stations 9-16

A

Final OSCE
- Stations 9-16

  1. Specialties in ED
  2. Pre-operative patient (surg)
  3. Managing uncertainty (GP)
  4. Difficult conversation
  1. Physical exam (Med or surg, REAL PT)
  2. Ethics and professionalism
  3. Handover and prioritisation (Med/surg)
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3
Q

Station 1: Community Care

  1. Possible topics
  2. Scenario
  3. Points
A

Station 1: Community Care

  1. Possible topics
    - Advanced Care Planning
    - Incl. End of Life
    - Review of elderly
    - Capacity
  2. Scenario
    - In GP
    - See Patient/relative
    - Brief history
    - Discuss Care Planning
  3. Points
    - Identify need (recent admission/short-long term needs)
    - Care planning (explain, discuss short, discuss long, discuss preferences)
    - Patient-centered (establish wishes and reflect clearly)
    - Holistic (health and social, services, family/voluntary)
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4
Q

Station 2: Referral and discussion

  • Structure
  • Marks
A

Station 2: Referral and discussion

  • Structure
    1. Interpret and summarise
    2. Diagnose
    3. Given specialist: decide request
    eg. CT Scan, SPr Review, Transfer
    4. SBAR
    5. Answer questions based on referral

Marks:
1. EWS score/results
2. Logical
3. Justified
4. Unambiguous answers

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5
Q

Station 3: Post-Op Patient NO SIM

  • Structure
  • Expectations
  • Marks
A

Station 3: Post-Op Patient

  • Structure (no simulator)

5 minutes Review Obs/Drug chart
- Patient complaining of… currently NBM
- Explain approach to examiner and plan

5 minutes tasks
- eg calculate fluid balance+regime

  • Marks
    1. Interpret in context
    2. Plan to determine cause
    3. Identify likely cause and options
  1. Review charts and confirm options
  2. Clear communication and full explanation
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6
Q

Station 4: Safe prescribing NO SIM

  • Structure
  • Marks
A

Station 4: Safe prescribing

  • Structure
  • No simulator
  • BNF app and calculator

5 Minutes
- Assimilate information
- Suggest investigations with justification

5 Minutes
- Interpret results
- Write clearly-documented prescription
- Prescribe safely (patient details)

  • Marks
    1. Accurate summary
    2. Clear justification of requests
  1. Perfect prescribing
    - Linked to results (adjust)
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7
Q

Station 5: Deteriorating Patient

  • Structure
  • Marks
A

Station 5: Deteriorating Patient

  • Structure (NOT arrest)
    6 minute A-E
    4 minutes
  • clinical skill (no consent or comms)
  • Interpret result of procedure
  • Marks
    1. Initial assessment
    2. Interaction and team-working
    3. Skills
    4. Reasoning
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8
Q

Station 6: Multi-morbidity and polypharmacy

  • Structure
  • Marks
A

Station 6: Multi-morbidity and polypharmacy

  • Structure
    0. Discharge letter in reading time
    1. History
    2. Discuss medications and ADRs
    3. Suggest changes
    4. Negotiate plan with patient
  • Marks
    1. Presenting complaint and symptoms
    2. Active discussion of meds
    3. Sensitively address challenges
    4. Explain rationale for stopping
    5. Agree plan
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9
Q

Station 7: Complications in surgical patient

  • Structure
  • Marks
A

Station 7: Complications in surgical patient

  1. Structure
  • Reading time: scenario, Obs, Drugs
  • 3 minutes: Hx + Describe key examination
  • 2 minutes: Suggest Ix + interpret DDx
  • 3 Minutes: Review Ix and Rx, give Dx
  • 2 minutes: Discuss further management plan
  • Marks
    1. 4 mark history
    2. 3 Mark exam
    3. 3 mark reasoning
    4. 5 marks investigation and drugs
    5. 5 marks management
  • eg. sepsis 6, source of infection and CT
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10
Q

Station 8: Ward Round Notes NO SIM

  • Structure
  • Marks
A

Station 8: Ward Round Notes

  • Structure
    0. Drug and obs charts
    1. 10 minute video
  • 2 minute warning
  • EWS and Bloods included already
  • Marks
    0. Headed and signed
  1. Symptoms
  2. Exam findings
  3. Concise summary and clinical findings
  4. Highlight safety issues
  5. Succinct
  6. Accurate and logical
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11
Q

Station 9: ED Specialties
- Structure
- Marks

A

Station 9: ED Specialties

  • Structure
    0. Any Y4 ED presentation
    1. History
    2. Explain DDx, Ix, Mx
    3. Answer qs
  • Marks
    1. Skilled history no sig omissions
    2. Excellent interaction
    3. Confident and accurate
    4. Assured answers
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12
Q

Station 10: Pre-Op Clinic
- Structure
- Marks

A

Station 10: Pre-Op Clinic

  • Structure
    0. History and symptoms
    1. Indications, benefits, risks
    2. Recovery time
  • LoStay/mobilisation/work/routine
    3. Investigations required
    4. Peri-op information giving
  • Nil By Mouth, Analgesia etc.
  • Marks
    1. Fluent history
    2. Good risks/benefits
    3. Skilled peri-op management
    4. Good answers to qs
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13
Q

Station 11: Managing uncertainty
- Structure
- Marks

A

Station 11: Managing uncertainty

  • Structure

5 minutes
1. History
2. Interpret exam findings

5 minutes
1. Explain DDx
2. Suggest management

  • Marks
    1. Depth of Hx and Red Flags
    2. Clear DD with no jargon
    3. Organised data gathering
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14
Q

Station 12: Difficult Conversation

  • Structure
  • Marks
A

Station 12: Difficult Conversation

  • Structure
    0. Palliative care conversation (ED, clinic, hospice)
  • Patient/relative/peer/carer
  • Introduce and establish
    1. PERCEPTION
    2. Results
    3. Next steps
    4. Symptom relief advice
    5. Guidance may be signposted
    6. Questions
  • Marks
    0. Communication
    1. Content
    2. Clarity
    3. Next steps communications
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15
Q

Station 13: Physical Exam
- Structure
- Systems
- Marks

A

Station 13: Physical Exam

  • Structure

8 minutes
- Pt has presented with ‘Sx’ please examine ‘…’ system
- ‘I would complete my exam with:…’
2 minutes
- Questions
1. DDx
2. Ix
3. Mx

Systems:
1.Abdo, CVS, resp,
2. Diabetic foot, thyroid, hands
3. Ortho: hip, knee, shoulder, spine
4. Vasc, neuro

  • Marks
    1. Structured with positive findings
    2. Important negative findings
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16
Q

Station 14: Ethics and Professionalism

  • Structure
  • Topics
  • Marks
A

Station 14: Ethics and Professionalism

  • Structure
    8 minute consultation with simulator
    2 minutes questions from examiner
  • Topics
    1. Raising and acting on concerns
    2. Confidentiality
    3. Consent and mental capacity
    4. Duty of candour
    5. Safeguarding
    6. Conflict of interest
  • Marks
    1. Skilled and fluent opening
    2. Perception baseline
    3. Empathy to concern and requests
    4. Answer examiner with justification
    5. Reflective
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17
Q

GP/Admin Stations

A

1 Community Care Planning (GP)
6 Multi-morbidity and Polypharmacy (GP)

11 Managing uncertainty (GP)
14 Ethics and professionalism

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18
Q

Surgical Stations

A
  1. Post-Operative Patient on Ward Round (Surg, NO SIM)
  2. Complication in a surgical patient
  3. Pre-operative patient (surg)
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19
Q

Ward Skills

A
  1. Referral and discussion (Medicine)
  2. Using Investigations to prescribe safely (Medicine, NO SIM)
  3. Ward Round Notes (Medicine/Surgery, NO SIM)
  4. Ethics and Professionalism
  5. Handover and prioritisation (Med/surg)
20
Q

Acute Skills

A
  1. Deteriorating Patient
  2. Specialties in ED
  3. Physical exam (Med or surg, REAL PT)
21
Q

Station 1. ACP
- Conversation points
- Diagnoses with palliative needs
- Life-prolonging treatments

A

Station 1. ACP
- Conversation points
1. Current clinical picture
2. Disease trajectory
3. Holistic approach
4. Short-term needs and wishes
5. Long-term needs and wishes
- ADRT
- LPA
- IMCA
6. Anticipation of future ‘events’
7. Management options

  • Diagnoses with palliative needs
    1. Advanced, progressive, incurable
    2. Frailty and co-morbidity
    3. Risk of sudden death
    4. Sudden catastrophic condition
    5. Extremely premature neonates
    6. Withdrawing life support
  • Life-prolonging treatments
    1. ABx
    2. CPR
    3. Dialysis
    4. Nutrition/Fluids
    5. Ventilation
22
Q

EoL Help
- Appetite
- Breathing
- Sleep
- Restlessness
- Skin change
- Continence

A

EoL Help

  • Appetite
    1. Straw/spoon
    2. Damp sponge
    3. Ice chips
    4. Lip balm
  • Breathing
    1. Change position onto side
    2. Secretions medications
  • Sleep
    1. Speaking quietly
    2. Holding hand
    3. Playing music
  • Restlessness
    1. Speak clearly
    2. Repeated reassurance
    3. Not correcting
    4. Check bladder/bowels
  • Skin change
    1. Gentle massage
  • Continence
    1. Cleaning bedding
    2. Pads/catheter
23
Q

Station 10: Pre-Op

  • Considerations
A

Station 10: Pre-Op

  1. Understanding of meeting
    - Symptoms
    - Indications, benefits, risks
    - LoStay/mobilisation/work/drive
  2. Investigations and why
  • CVS: exercise tolerance
  • Resp: lie flat, chronic cough
  • GI: GORD, PO N&V
  • Preg, gluc, bloods, ECG/ECHO
  • G&S vs XMatch
  1. Lead up/day of
    - Nil By Mouth/analgesia/ward
    - Meds to stop & Allergies
24
Q

Station 10: Pre-Op
- Hip Replacement

  1. Indications
  2. Prior mx
  3. Benefits
  4. Risks
  5. Preparation

A. Anaesthetic
B. LoStay
C. Mobilisation
D. Drive
E. Work

A

Station 10: Pre-Op
- Hip Replacement

  1. Indications
    - OA
    - RA
    - NoF
    - Septic
    - Dysplasia
    - Severe pain, swelling, stiff, LoF
  2. Prior mx
    - PT
    - Steroid
  3. Benefits
  4. Risks
    - Dislocation/leg length
    - Infection
    - Neurovascular damage
    - DVT
    - Fracture
  5. Preparation
    - Activity eg. swim
    - PT

A. Anaesthetic
- GA/Spinal
- Epidural

B. LoStay
3-5 days

C. Mobilisation
- Frame/crutches
- PT/OT

D. Drive
- 6 weeks

E. Work
- 6 weeks light duties/office

25
Q

Station 10: Pre-Op
- Knee Replacement

  1. Indications
  2. Prior mx
  3. Benefits
  4. Risks
  5. Preparation

A. Anaesthetic
B. LoStay
C. Mobilisation
D. Drive
E. Work

A

Station 10: Pre-Op
- Knee Replacement

  1. Indications
    - OA
    - Gout
    Sports injury
  2. Prior mx
    - Weight loss
    - Swimming/walking/cycling
    - Walking aids
    - Pain relief/steroid
    - Arthroscopy/osteotomy/microfracture
  3. Benefits
    - 20 years knee
  4. Risks
    - DVT
    - Infection
    - Neurovascular
    - Pain/stiffness/LoF
  5. Preparation
    - Exercises
    - Smoking cessation
    - Weight management
    - Stock food, easy to reach, transport, work arr.

A. Anaesthetic
- GA/Spinal

B. LoStay
- 1-3 days
- PT/OT
- 10 days stitches/clips

C. Mobilisation
- 6 weeks without aid (3 partial)
- 3 months heavy lifting

D. Drive
- 8 weeks

E. Work
- 6-23 weeks

26
Q

Station 10: Pre-Op
- Colostomy/Ileostomy

  1. Indications
  2. Prior mx
  3. Benefits
  4. Risks
  5. Preparation

A. Anaesthetic
B. LoStay
C. Mobilisation
D. Drive
E. Work

A

Station 10: Pre-Op
- Colostomy/Ileostomy

  1. Indications
    - Bowel/Anal/Gynae Ca
    - Crohn’s/UC
    - Diverticulitis
    - Neurology/Hirschsprung’s
    - Ischaemic bowel
  2. Prior mx
    - Disease dependent
    - Medical
    - Partial colectomy/J-pouch
    - Stoma nurse
    - Laxatives/bowel prep
  3. Benefits
  4. Risks
    - Infection
    - Dehydration
    - Blockage/obstruction
    - Hernia/prolapse/retraction
    - Skin damage
  5. Preparation

A. Anaesthetic
- GA

B. LoStay
- Open/Lap
- 3-10 days
- Drip, catheter, oxygen, large output

C. Mobilisation
- 6-8 weeks usual activities
- 3 months heavy lifting
- low fibre diet

D. Drive
- At least 6 weeks

E. Work
- When ready

27
Q

Station 10: Pre-Op
- Hernia repair

  1. Indications
  2. Prior mx
  3. Benefits
  4. Risks
  5. Preparation

A. Anaesthetic
B. LoStay
C. Mobilisation
D. Drive
E. Work

A

Station 10: Pre-Op
- Hernia repair

  1. Indications
    - Inguinal/femoral/para-umbilical
  2. Prior mx
  3. Benefits
  4. Risks
    - Wound infection
    - Recurrence
    - Pain
  5. Preparation
    - Bath or shower
    - Arrange to be collected

A. Anaesthetic
- Local/regional
- GA

B. LoStay
- Day case
- 1-2 hours
- E&D

C. Mobilisation
- 24hrs looked after, mild laxative
- 48hrs dressing
- 10 days dissolve stitches
- 1-2 weeks light activity
- 4-6 weeks lifting

D. Drive
- 1-2 weeks

E. Work
- 1-2 weeks

28
Q

Station 10: Pre-Op
- Abortion

  1. Indications
  2. Prior mx
  3. Benefits
  4. Risks
  5. Preparation

A. Anaesthetic
B. LoStay
C. Mobilisation
D. Drive
E. Work

A

Station 10: Pre-Op
- Abortion

  1. Indications
    - Prior to 24 weeks
    - Post 24 weeks risk to mother’s life
    - Grave permanent physical/mental injury
    - Child serious disabilities
  2. Prior mx
    - Medical (12 weeks over phone)
    - Medical 12-20 weeks longer process
  3. Benefits
  4. Risks
    - 1/1000 haemorrhage
    - 10/1000 damage to cervix
    - 4/1000 damage to uterus
    - Uterus infection
  5. Preparation
    - USS, blood tests

A. Anaesthetic
- Local/sedation
- GA

B. LoStay
- Day case

C. Mobilisation
- Immediate
- 7-14 days bleeding

29
Q

Stations to Prep:

1,3,8,10,14

A

Stations to Prep:

  1. Community Care Planning (GP)
  2. Post-Operative Patient on Ward Round (Surg, NO SIM)
  3. Complication in a surgical patient
  4. Pre-operative patient (surg)

14.
Ethics and professionalism

30
Q

Station 10: Pre-Op
- Valve replacement

  1. Indications
  2. Prior mx
  3. Benefits
  4. Risks
  5. Preparation

A. Anaesthetic
B. LoStay
C. Mobilisation
D. Drive
E. Work

A

Station 10: Pre-Op
- Valve replacement

  1. Indications
    - Narrowing/leaking
  2. Prior mx
    - TAVI
    - Balloon valvuloplasty
  3. Benefits
  4. Risks
    - 1/50 death
  5. Preparation
    - Smoking/weight loss
    - Dentistry
    - Bloods/ECG, ECHO

A. Anaesthetic
- GA
- By-pass

B. LoStay
- 1 Day ICU
- 5-10 hospital

C. Mobilisation
- 15 days limited
- 2-6 weeks cardiac rehab
- 2-3 months

D. Drive
- At least 4 weeks

E. Work
- A few weeks -
- 3 months manual labour

31
Q

Station 10: Pre-Op
- Cholecystectomy

  1. Indications
  2. Prior mx
  3. Benefits
  4. Risks
  5. Preparation

A. Anaesthetic
B. LoStay
C. Mobilisation
D. Drive
E. Work

A

Station 10: Pre-Op
- Cholecystectomy

  1. Indications
    - Gallstone pain
    - Pancreatitis
  2. Prior mx
    - Low fat diet
    - Oral Dissolution (Bile acids)
    - ESWL (extracorporeal shockwave lithotripsy)
  3. Benefits
  4. Risks
    - Non-resolution
    - Post-op pain
    - DVT
  • Anaesthetic risks
  • Wound infection/leak
  • Bile acid leak (1/100)
  • Bile duct damage (1/500)
  • Organ damage (1/1000)
  1. Preparation
    - Smoking/weight loss
    - NBM

A. Anaesthetic
- GA
- + Local, meds

B. LoStay
- Lap: day case
- Open: 4-5 days

C. Mobilisation
- Lap 15 days normal (shower next day)
- Open 3 months normal (4-6 weeks light)

D. Drive
- Lap normal
- Open 6 weeks

E. Work
- Open 3 months manual labour

32
Q

Station 10: Pre-Op
- Tonsillectomy

  1. Indications
  2. Prior mx
  3. Benefits
  4. Risks
  5. Preparation

A. Anaesthetic
B. LoStay
C. Mobilisation
D. Drive
E. Work

A

Station 10: Pre-Op
- Tonsillectomy

  1. Indications
    - Recurrent infection
    - Obstructive sleep apnoea
  2. Prior mx
    - ABx treatment/prophylaxis
    - Observation
  3. Benefits
  4. Risks
    - Bleeding
    - Re-operation for bleed
    - Infection
    - Anaesthetic risk
  5. Preparation
    - Pregnancy test

A. Anaesthetic
- GA

B. LoStay
- Day-case/Overnight

C. Mobilisation
- Minimum 6 hours
- 24 hours N&V
- peak pain day 3

D. Drive
- No public transport on day

E. Work
- 2 weeks off school

33
Q

Station 1: CCP
- What to talk about

A

Station 1: CCP
- What to talk about

  1. Identify need
    - recent admission
    - short-term needs
    - long-term needs
  2. Care planning
    - Explain
    - Short term
    - Long term
    - Preferences
  3. Patient-centered
    - Establish wishes
    - Reflect clearly
  4. Holistic
    - Health
    - Social
    - Available services
    - Family
    - Voluntary
34
Q

Station 1: ACP
- When to use DOLS
- Principle for DOLS
- Oversight authority
- Length

A

Station 1: ACP

  • When to use DOLS
    1. Lack’s capacity for aspect of care
    2. Continuous supervision in restricted space
    3. State involvement in care
  • Principle for DOLS
    1. Avoid DOLS
    2. Proportionate response to likelihood of harm
  • Oversight authority
    1. Local authority (supervisory body)
  • Mental disorder
  • Mental capacity
  • Best interests
  1. Hospital/care home (managing authority)
    - Lack capacity
    - Least restrictive, best interests
  • Length
    1. Urgent 7 days
35
Q

Station 1:
CGA Components

A

Station 1:
CGA Components

  1. MDT Assessment
  2. Problem list
    - Physical
    - Cognitive
    - Affective/spiritual
    - Social/financial/environmental
  3. Solution list
36
Q
A
37
Q

Multimorbidity
- Must hits

A

Multimorbidity
- Must hits

  1. Missing PMH, DH, Allergy, SH
  2. ICE
  3. Shared decision making
38
Q

Care planning Vs ACP

A

Care planning Vs ACP

  1. ACP is legally binding when still has capacity
  2. ACP has three components
    - Advanced statements (preferences)
    - ADRT (Legal)
    - LPA (Legal OPG)
39
Q

Identifying palliative patients
- Three triggers

A

Identifying palliative patients
- Three triggers

  1. ‘Surprise’ question
  2. Patient choice
  3. Prognostic indicators
    -phenotypes
    - eg. GSF PIG (Gold standards framework: Proactive Identification Guidance)
40
Q

Average GP deaths
- Pie pieces

A

Average GP deaths
- Pie pieces

  1. 8 frailty
  2. 5-6 organ failure
    Eh. NYHA 3 or 4
  3. 5 Cancer
  4. Sudden expected deaths
41
Q

Frailty assessments
- Two theories

A

Frailty
- Summary

  1. Cumulative deficits (EFI)
  2. Phenotype (CFS)

CFS 1-3 are not frail. 4 is pre-frail

42
Q

5Is (6Is)
- Of frailty

A

6Is of frailty

  1. Instability
  2. Immobility
  3. Intellectual impairment
  4. Incontinence
  5. Inadequate oral intake
  6. Iatrogenisis (polypharmacy)
43
Q

Dementia under delirium
- Proportion

A

Dementia under delirium
- Proportion

70% of delirium has a dementia

44
Q

CAM4
- Delirium criteria

A

CAM4
- Delirium criteria

  1. Acute onset/disorganised
  2. Inattention
  3. Disorganised thinking
  4. Altered level of consciousness
45
Q

Severe frailty
- Clear question

A

Severe frailty 7+
- Clear question

  1. Wipe your bum test
46
Q

5 disability pathways to death

A

5 disability pathways to death

  1. No disability
  2. Progressive severe disability
  3. Disability
  4. Accelerated disability
  5. Catastrophic disability
47
Q

ACP
- REDMAP Framework

A

ACP
- REDMAP Framework

  1. Ready
  2. Expect
  3. Diagnosis
  4. Matters
  5. Action
  6. Plan

year 5 (4 decks)

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