OSCE Flashcards
1
Q
Finals Osce
- Stations 1-8
A
Finals Osce
- Stations 1-8
- Community Care Planning (GP)
- Referral and discussion (Medicine)
- Post-Operative Patient on Ward Round (Surg, NO SIM)
- Using Investigations to prescribe safely (Medicine, NO SIM)
- Deteriorating Patient
- Multi-morbidity and Polypharmacy (GP)
- Complication in a surgical patient
- Ward Round Notes (Medicine/Surgery, NO SIM)
2
Q
Final OSCE
- Stations 9-16
A
Final OSCE
- Stations 9-16
- Specialties in ED
- Pre-operative patient (surg)
- Managing uncertainty (GP)
- Difficult conversation
- Physical exam (Med or surg, REAL PT)
- Ethics and professionalism
- Handover and prioritisation (Med/surg)
3
Q
Station 1: Community Care
- Possible topics
- Scenario
- Points
A
Station 1: Community Care
- Possible topics
- Advanced Care Planning
- Incl. End of Life
- Review of elderly
- Capacity - Scenario
- In GP
- See Patient/relative
- Brief history
- Discuss Care Planning - 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)
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
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
- Review charts and confirm options
- Clear communication and full explanation
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
- Perfect prescribing
- Linked to results (adjust)
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
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
9
Q
Station 7: Complications in surgical patient
- Structure
- Marks
A
Station 7: Complications in surgical patient
- 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
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
- Symptoms
- Exam findings
- Concise summary and clinical findings
- Highlight safety issues
- Succinct
- Accurate and logical
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
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
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
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
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
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
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
18
Q
Surgical Stations
A
- Post-Operative Patient on Ward Round (Surg, NO SIM)
- Complication in a surgical patient
- Pre-operative patient (surg)
19
Q
Ward Skills
A
- Referral and discussion (Medicine)
- Using Investigations to prescribe safely (Medicine, NO SIM)
- Ward Round Notes (Medicine/Surgery, NO SIM)
- Ethics and Professionalism
- Handover and prioritisation (Med/surg)
20
Q
Acute Skills
A
- Deteriorating Patient
- Specialties in ED
- 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
- Understanding of meeting
- Symptoms
- Indications, benefits, risks
- LoStay/mobilisation/work/drive - 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
- Lead up/day of
- Nil By Mouth/analgesia/ward
- Meds to stop & Allergies
24
Q
Station 10: Pre-Op
- Hip Replacement
- Indications
- Prior mx
- Benefits
- Risks
- Preparation
A. Anaesthetic
B. LoStay
C. Mobilisation
D. Drive
E. Work
A
Station 10: Pre-Op
- Hip Replacement
- Indications
- OA
- RA
- NoF
- Septic
- Dysplasia
- Severe pain, swelling, stiff, LoF - Prior mx
- PT
- Steroid - Benefits
- Risks
- Dislocation/leg length
- Infection
- Neurovascular damage
- DVT
- Fracture - 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
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
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
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
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
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
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
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
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
Stations to Prep:
1,3,8,10,14
Stations to Prep:
1. Community Care Planning (GP)
3. Post-Operative Patient on Ward Round (Surg, NO SIM)
8. Complication in a surgical patient
10. Pre-operative patient (surg)
14.
Ethics and professionalism
30
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
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
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
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)
5. 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
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
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
Station 1: CCP
- What to talk about
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
Station 1: ACP
- When to use DOLS
- Principle for DOLS
- Oversight authority
- Length
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
2. Hospital/care home (managing authority)
- Lack capacity
- Least restrictive, best interests
- Length
1. Urgent 7 days
35
Station 1:
CGA Components
Station 1:
CGA Components
1. MDT Assessment
2. Problem list
- Physical
- Cognitive
- Affective/spiritual
- Social/financial/environmental
3. Solution list
36
37
Multimorbidity
- Must hits
Multimorbidity
- Must hits
1. Missing PMH, DH, Allergy, SH
2. ICE
3. Shared decision making
38
Care planning Vs ACP
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
Identifying palliative patients
- Three triggers
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
Average GP deaths
- Pie pieces
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
Frailty assessments
- Two theories
Frailty
- Summary
1. Cumulative deficits (EFI)
2. Phenotype (CFS)
CFS 1-3 are not frail. 4 is pre-frail
42
5Is (6Is)
- Of frailty
6Is of frailty
1. Instability
2. Immobility
3. Intellectual impairment
4. Incontinence
5. Inadequate oral intake
6. Iatrogenisis (polypharmacy)
43
Dementia under delirium
- Proportion
Dementia under delirium
- Proportion
70% of delirium has a dementia
44
CAM4
- Delirium criteria
CAM4
- Delirium criteria
1. Acute onset/disorganised
2. Inattention
3. Disorganised thinking
4. Altered level of consciousness
45
Severe frailty
- Clear question
Severe frailty 7+
- Clear question
1. Wipe your bum test
46
5 disability pathways to death
5 disability pathways to death
0. No disability
4. Progressive severe disability
1. Disability
2. Accelerated disability
3. Catastrophic disability
47
ACP
- REDMAP Framework
ACP
- REDMAP Framework
1. Ready
2. Expect
3. Diagnosis
4. Matters
5. Action
6. Plan
