EXAMPLE OF AN OSCE OSPE EXAMINATION BOOK - EXAMPLE OF AN OSCE

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					EXAMPLE OF AN OSCE/OSPE EXAMINATION BOOK

          Faculty of Health Sciences

  THE UNIVERSITY OF THE WITWATERSRAND




          MB BCh III / GEMP I



      Integrated Basic Medical
       and Human Sciences A
             (SCMD301)


         Block Examination Two
                Paper 3


             OSCE / OSPE

        Time: 2 hours 20 minutes


     Station allowance: 5 minutes



                                       26 August 2003
Map for area C - Green (Corridor L)




  15    16         18       20                   21       23        25

 14      17        19                                22        24        26
                            L Corridor
  13          10        8                    5                       2
  12    11         9        7            6       4        3              1
INSTRUCTIONS



YOU HAVE FIVE MINUTES TO READ THESE INSTRUCTIONS

   There are twenty six stations, of which four are REST Stations.
   Opposite is a map of your stations, take a moment to study it.
   Ten marks are assigned to each active station.
   Two short bell rings signal the start of the OSCE/OSPE, DO NOT MOVE,
    read these instructions.
   Two short bell rings after five minutes signal the start of the examination.
    REMAIN AT THE SAME STATION and start according to the instructions both
    at the station and in this book.
   A longer bell ring indicates the end of each five-minute interval when you must
    move to the next station.
   Move in a clockwise direction.
   Any candidate obstructing another may lose his or her marks for the next
    station.
   There are four stations with observers (examiners) and Simulated Patients
    (SP), please greet them and introduce yourself to both the examiner and the
    SP. Hand a label to the examiner.
   If the examiner needs to prompt you half a mark may be deducted.
   Make sure that you have attempted all the questions for a station, some may
    continue onto the next page.
   If there is a technical failure at your station you will be given time at the end to
    re-take the station.
   At those stations that need a calculator, one is provided. Do not remove it.
   At the REST stations you may review your answers and prepare for coming
    stations.
   If you require assistance (or a bathroom visit) please let an invigilator know.
   The last bell ring will be longer indicating the end of the Examination.
   Hand in this book to the invigilator for your colour coded stream, A, B or C.
   At the end of the examination you will be instructed to move to a holding
    room. Please do not attempt to communicate with students in a different
    group.



             __________________________________________
STATION 1


At this station there is a Simulated Patient from whom you should
take a history with the components listed below.

You may make notes on this page and use them to answer the
questionnaire at the next station.


  1. Personal Details




  2. Presenting Complaint




  3. General Health Status




  4. Past Medical History




  5. Systems Review
STATION 2        [10 marks]

Question 1
a)                   [½ mark]

b)                   [½ mark]

c)                    [1 mark]

Question 2           [2 marks]




Question 3
a)                   [½ mark]

b)                   [½ mark]

Question 4
Cause 1
a)                   [½ mark]

b)                   [½ mark]

Cause 2
a)                   [½ mark]

b)                   [½ mark]

Question 5            [1 mark]




Question 6
                     [2 marks]


             Marks
STATION 3                                            [10 marks]


HAND A STICKER TO THE EXAMINER

At this station there is a Simulated Patient and an
Examiner who will mark your demonstration, ask you
questions and mark the answers.


Remember: explain briefly everything you do with a commentary.



  1. Demonstrate by abdominal palpation how to confirm the
     presence of an enlarged liver
                                                 [4 marks]



  2. Demonstrate how to determine the liver span
                                                         [3 marks]



  3. Demonstrate the anterior level which the top of the diaphragm
     reaches in normal quiet respiration

                                                          [1 mark]


  4. How large is a normal adult male liver?
                                                          [1 mark]



  5. Give two causes of an enlarged and palpable liver
                                                          [1 mark]
STATION 4                                             [10 marks]


HAND A STICKER TO THE EXAMINER

At this station there is a Simulated Patient and an Examiner who
will mark your demonstration, ask you questions and mark the
answers. Explain briefly everything you do.




First read the clinical scenario


You are in casualty when a hijack victim is brought in by
ambulance following a stabbing to the anterior right chest. The
patient is becoming increasingly breathless and you note a
respiratory rate of 35 bpm. The trachea is clearly deviated to the
patient’s left.



  1. What might be reasonably considered the cause of the
     patient’s breathlessness?
     (The examiner will tell you if you don’t know the answer.)
                                                            [1 mark]



  2. Demonstrate how you might confirm the diagnosis when
     standing behind the patient only. Clearly state what you
     would expect to find in this case as you demonstrate your
     examination.
                                                     [7 marks]



  3. Which side of the chest shows the same pathology on the
     radiograph and why? Give two reasons.
                                                    [2 marks]
STATION 5




            REST STATION
STATION 6                                     [10 marks]




AT THIS STATION THERE IS A POWERPOINT LOOP.



THERE ARE FOUR SLIDES IN THE LOOP.



USE THE SLIDES TO ANSWER THE QUESTIONS ON THE
FOLLOWING PAGE.




F5                INITIALISES THE LOOP



PAGE UP           MOVES BACK



PAGE DOWN         MOVES FORWARDS



ESC and then F5   STOPS AND THEN RESTARTS THE LOOP AT
                  THE FIRST SLIDE
STATION 6                                              [10 marks]



QUESTIONNAIRE


Slide 2

1.   What is the pathological term given to the macroscopic
     appearances shown in both Figs 1 and 2?                    [2 marks]




Slide 3

2.   What is the pathological name for the disease process
     seen in both Figs 3 and 4?                                 [2 marks]



3.   What are the main types of cells in the center of the
     pulmonary structure shown in Fig 4?                        [2 marks]



4.   At what age is this disease process commonly
     encountered?                                               [2 marks]



Slide 4


5.   What disease process is illustrated in Fig 5               [2 marks]




                                                        Marks
STATION 7



At this station there is a Simulated Patient from whom you should
take a history with the components listed below.

You may make notes on this page and use them to answer the
questionnaire at the next station.




  1. Personal Details




  2. Presenting Complaint




  3. General Health Status




  4. Systems Review
STATION 8                                               [10 marks]



QUESTIONNAIRE

Question 1
a)                                                        [½ mark]

b)                                                        [½ mark]

Question 2
a) (i)                                                    [½ mark]

     (ii)                                                 [½ mark]

b)                                                        [½ mark]

Question 3
a)                                                        [1 mark]



b)                   Yes                  No              [½ mark]


c)                                                        [½ mark]

Question 4
                                                           [1 mark]

Question 5

1.                                                        [½ mark]

2.                                                        [½ mark]
            Continued on next page. Please turn over.
STATION 8 continued




Question 6
a)                            [½ mark]

b)                            [½ mark]

c)                            [½ mark]

Question 7                    [1 mark]


Question 8                    [1 mark]




                      Marks
STATION 9


AT THIS STATION THERE IS A POWERPOINT LOOP.



THERE ARE FIVE SLIDES IN THE LOOP.



USE THE SLIDES TO ANSWER THE QUESTIONS ON THE
FOLLOWING PAGE.




F5                INITIALISES THE LOOP



PAGE UP           MOVES BACK



PAGE DOWN         MOVES FORWARDS



ESC and then F5   STOPS AND THEN RESTARTS THE LOOP AT
                  THE FIRST SLIDE
STATION 9                                              [10 marks]


QUESTIONNAIRE


Slide 2

1.                                                         [½ mark]
      Which lymph station is 1?




2.    Which lymph station is 2?                            [½ mark]



3.    Which lymph station 8?                               [½ mark]



4.    Which lymph station is 4?                           [ ½ mark]



Slide 3

5.    Name the upper horizontal plane                     [1.0 mark]



6.                                                        [1.0 mark]
      Name the lower horizontal plane



7.    Which structure attached to the liver does the
      upper plane go through?                             [1.0 mark]


          Continued on next page. Please turn over.
STATION 9 (continued)



Slide 4

8.    Name the three middle regions: 2, 5 and 8           [3 marks]

      2

      5


      8

Slide 5

9.    Identify the part of the large bowel indicated by   [½ mark]
      the arrow


10.   Identify the part of the large bowel indicated by   [½ mark]
      the arrow


11.   Identify the part of the large bowel indicated by   [½ mark]
      the arrow


12.   Identify the part of the large bowel indicated by   [½ mark]
      the arrow




                                                  Marks
STATION 10




             REST STATION
STATION 11                                           [10 marks]


HAND A STICKER TO THE EXAMINER



At this station there is a Simulated Patient and an Examiner who
will mark your demonstration, ask you questions and mark the
answers. Explain briefly everything you do and ensure that you
give the correct instructions to the Simulated Patient.




First read the clinical scenario:



The patient has come to you with a respiratory problem; you decide
it would be useful to carry out a flow volume loop on the patient.


  1. Generate a flow-volume loop for the Simulated Patient.
                                                         [5 marks]


  2. Using the flow-volume loop generated on screen for the
     Simulated Patient, identify how you would read off the
     following variables from the loop:

             a.   FVC
             b.   FEV1
             c.   PEFR
             d.   Predicted values
                                                         [4 marks]



  3. Name a respiratory disorder that results in an FEV1: FVC ratio
     of less than 0.8?
                                                           [1 mark]
STATION 12



AT THIS STATION THERE IS A POWERPOINT LOOP.



THERE ARE SIX SLIDES IN THE LOOP.



USE THE SLIDES TO ANSWER THE QUESTIONS ON THE
FOLLOWING PAGE.




F5                INITIALISES THE LOOP



PAGE UP           MOVES BACK



PAGE DOWN         MOVES FORWARDS



ESC and then F5   STOPS AND THEN RESTARTS THE LOOP AT
                  THE FIRST SLIDE
STATION 12                                               [10 marks]


Slide 2

1.   Name two accessory muscles of respiration which
     may be brought into action in this patient.            [2 marks]




Slide 3

2.
a)   How is the patency of the structure in A
     maintained?                                             [1 mark]



b) How is the patency of the structures in B
   maintained?                                               [1 mark]



Slide 4

3.
a)   Name one feature that you would look for in order
     to confirm pneumothorax.                                [1 mark]



b) Is the diagnosis of pneumothorax likely? Give a
   reason for your answer.                                   [1 mark]


          Continued on next page. Please turn over.
STATION 12 (continued)


Slide 5

4.
a)   Identify X                                                 [½ mark]



b) Identify Z                                                   [½ mark]



c)   Name the vessels that carry oxygenated blood
     from the lungs to the left side of the heart.              [1 mark]




Slide 6

5.
a)   At what vertebral level does the trachea divide?           [1 mark]



b) If a foreign body is inhaled it is more likely to enter
   the right main bronchus than the left. What is the
   anatomical reason for this?                                  [1 mark]




                                                        Marks
STATION 13




AT THIS STATION THERE IS A POWERPOINT LOOP.



THERE ARE THREE SLIDES IN THE LOOP.



USE THE SLIDES TO ANSWER THE QUESTIONS ON THE
FOLLOWING PAGE.




F5                INITIALISES THE LOOP



PAGE UP           MOVES BACK



PAGE DOWN         MOVES FORWARDS



ESC and then F5   STOPS AND THEN RESTARTS THE LOOP AT
                  THE FIRST SLIDE
STATION 13                                               [10 marks]


Slide 2

1.        What is this method of quantifying the disease
          called?                                            [1 mark]



2.        What pathological change is being estimated?       [1 mark]



3.        At what level does this measurement become
          pathologically significant?
          Tick correct answer.                               [1 mark]
a)        20%
b)        40%
c)        60%
d)        80%

4.        With what aetiological agent is this disease
          strongly linked?                                   [1 mark]



Slide 3

5.        What is the name given to this preparation and
          what organ is represented?                         [1 mark]



6.        What pathological process is present in the area
          between the arrows at A?                           [1 mark]



             Continued on next page. Please turn over.
STATION 13 (continued)




7.   What segment of the airways conduction system
     is affected in this disease?                    [1 mark]



8.

a)   What pathological lesion is indicated by the    [1 mark]
     arrow at B?



b)   What complication can the lesion at B undergo [2 marks]
     and what is the clinical consequence?




                                           Marks
STATION 14



AT THIS STATION THERE IS A POWERPOINT LOOP.



THERE ARE FIVE SLIDES IN THE LOOP.



USE THE SLIDES TO ANSWER THE QUESTIONS ON THE
FOLLOWING PAGE.




F5                INITIALISES THE LOOP



PAGE UP           MOVES BACK



PAGE DOWN         MOVES FORWARDS



ESC and then F5   STOPS AND THEN RESTARTS THE LOOP AT
                  THE FIRST SLIDE
STATION 14                                          [10 marks]



Slide 2

1.
a) What two features do you wish to comment on when
   listening to breath sounds during auscultation ?           [2 marks]




b) Are you listening to normal breathing or bronchial
   breathing?                                                 [½ mark]



Slide 3


2.
a)
      What abnormality can you identify on the chest          [½ mark]
      radiograph?




b)
      What type of breathing can you hear over the abnormal    [1 mark]
      area?




c)    Name one condition in which you may hear this type of
      breathing.                                              [½ mark]


            Continued on next page. Please turn over.
STATION 14 continued

Slide 4
3.

a)    What added sound can you hear?                        [1 mark]


b)    How is this sound generated?                          [½ mark]



c)    Name one condition in which you may hear this sound   [½ mark]



d)    What is the difference between stridor and a          [1 mark]
      wheeze?


Slide 5

4.

a)    What added sound can you hear?                        [1 mark]



b)    Name one condition in which you may hear these
      sounds                                                [½ mark]



c)    Name two other added sounds you may hear during
      auscultation of the chest
      i)                                                    [½ mark]

      ii)                                                   [½ mark]


                                                  Marks
STATION 15


AT THIS STATION THERE IS A RADIOGRAPH VIEWING BOX.
ANSWER THE QUESTIONS RELATING TO THE CHEST
RADIOGRAPHS.




EXAMPLE OF A BASIC DIAGRAM TYPE TO BE USED IN Q1 d).
STATION 15                                          [10 marks]


CHEST RADIOGRAPH No. 1
1.
a)  What is the most important thing to check when       [½ mark]
    viewing a chest radiograph?

                                                         [½ mark]
b)   i) Is this patient male or female?


     ii) Give a reason for your answer                   [½ mark]


c)   Identify the structures, spaces or shadows labelled [2 marks]
     1–4

     1.

     2.

     3.

     4.

d)   In the box below draw a basic diagram with labels [2 marks]
     to illustrate how a PA film is taken (don’t forget the
     beams!)




            Continued on next page. Please turn over.
STATION 15 (continued)


CHEST RADIOGRAPH No. 2
2.
a)  What view is this?                                  [½ mark]



b)   Identify the structures labelled 1 and 2           [2 marks]

     1.

     2.

CHEST RADIOGRAPH No. 3

3.   Compare radiograph 1 with radiograph 3.

     Give two reasons why this AP chest radiograph is   [2 marks]
     different from chest radiograph 1.

     i)

     ii)



                                                Marks
STATION 16



AT THIS STATION THERE IS A POWERPOINT LOOP.



THERE ARE SIX SLIDES IN THE LOOP.



USE THE SLIDES TO ANSWER THE QUESTIONS ON THE
FOLLOWING PAGE.




F5                INITIALISES THE LOOP



PAGE UP           MOVES BACK



PAGE DOWN         MOVES FORWARDS



ESC and then F5   STOPS AND THEN RESTARTS THE LOOP AT
                  THE FIRST SLIDE
STATION 16                                            [10 marks]


QUESTIONNAIRE



Slide 2

1.   Which region(s) of the pharynx have become [1 mark]
     swollen and red?




Slide 3

2.   What structure does the infection travel through to   [1 mark]
     reach the structure in Fig 1?



Slide 4

3.

a)   What bones are responsible for enabling the           [1 mark]
     structure in Fig 1 to function normally.



b)   What is the innervation of the membrane over the      [1 mark]
     structure in Fig 1?


          Continued on next page. Please turn over.
STATION 16 (continued)



Slide 5

4.

a)   Identify the tissue in Fig 2.                               [1 mark]



b)   Describe the pathological change in the structure [2 marks]
     in Fig 2.




Slide 6

5.

a)   What is the innervation of the structure in Fig 2?          [1 mark]



b)   What is the arterial blood supply to the structure in Fig   [1 mark]
     2?




c)   What is the function of this structure?                     [1 mark]




                                                        Marks
STATION 17




             REST STATION
STATION 18


At this station there is a Simulated Patient from whom you should
take a history with the components listed below.

You may make notes on this page and use them to answer the
questionnaire at the next station.




      1.   Personal Details




      2.   Presenting Complaint




      3.   General Health Status




 THE PATIENT IS COMING BACK TO HER DOCTOR
       AT THE BANK. SHE IS NERVOUS!
STATION 19                                              [10 marks]


QUESTIONNAIRE

  Question 1


  a)                                                          [½ mark]

  b)
                                                              [½ mark]

  Question 2


       YES                             NO      N              [½ mark]


  Question 3


  a)                                                          [½ mark]


  b)                                                          [½ mark]


  c)                                                          [½ mark]


  Question 4

       i)                                                      [1 mark]


                                                               [1 mark]
       ii)


       iii)                                                    [1 mark]
              Continued on the next page. Please turn over.
STATION 19 (continued)

                                 [2 marks]
 Question 5




 Question 6


 a)                              [½ mark]


 b)                              [½ mark]

 Question 7


      i)                         [½ mark]


      ii)                        [½ mark]




                         Marks
STATION 20                                                        [10 marks]


HAND A STICKER TO THE EXAMINER

At this station there is a Simulated Patient and an Examiner who
will mark your demonstration, ask you questions and mark the
answers. Explain briefly everything you do.

1.
a)   How many neurones make up a reflex arc?                            [½ mark]

b)   How many synapses are there in a reflex arc?                       [½ mark]

2.   Complete the following table:



REFLEX           NERVE               NERVE
                 ROOTS
                 C5 (C6)             Musculo-Cutaneous                  [½ mark]



Triceps Jerk                         Radial                             [½ mark]




3.   Demonstrate the KNEE JERK REFLEX with the patient in [6 marks]
     the SUPINE position. Explain briefly everything you do.


4.
a)   If you are unable to elicit a reflex or the reflex appears to be   [1 mark]
     sluggish, what can you ask the patient to do to try and
     reinforce the reflex?



b)   What types of lesions are associated with brisk reflexes?          [1 mark]
STATION 21                                            [10 marks]

HAND A STICKER TO THE EXAMINER

At this station there is a Simulated Patient and an Examiner who
will mark your demonstration, ask you questions and mark the
answers. Explain briefly everything you do.

FIRST READ THE CLINICAL SCENARIO:

The patient presents with a four day history of fever, productive
cough (yellow sputum) and right sided chest pain on inspiration.


1.   What is the most likely cause of the right-sided chest pain?
                                                            [1 mark]

THE EXAMINER WILL SHOW YOU A CHEST RADIOGRAPH

2.   What pathological condition might this patient have?
                                                             [1 mark]

3.   What is the most likely causative organism?
                                                            [½ mark]

Demonstrate using the FRONT of the Simulated Patient only the
examination technique to confirm:

a)   reduced aeration on the right                        [1½ mark]

b)   increased vocal fremitus on the right                [2 marks]


5.   What type of breathing would you expect to hear on
     auscultation over the affected area?
                                                             [1 mark]

6.   What condition results in ‘stony dullness’ and
     Give two pathologies that may result in it.
                                                            [3 marks]
STATION 22




There is a data sheet and three figures from a patient who presents
with the problem described below.



On the questionnaire opposite are a series of questions based on
this patient’s problem.




A 58-year-old woman presents to her family doctor with tiredness
and headaches for the last three months. She has also noticed a
change in her bowel habits from once daily and formed to two -
three times daily and semi-formed.



Figs 1 and 2 are two obvious clinical findings found by the doctor
on general inspection and Table 1 gives the haematological indices
from a routine blood test and Fig 3 is the blood smear from the
same patient.
STATION 22                                              [10 marks]


1.   Describe the findings in Figs 1 and 2                      [2 marks]

     Fig 1.


     Fig 2.

2.   What are the FBC indices indicative of in conjunction       [1 mark]
     with the clinical findings?



3.   Describe the appearances of the red cells in the
     patient’s smear shown in Fig 3 and identify the cells b
     and c

a)                                                              [2 marks]


b)   Cell B                                                      [1 mark]


c)   Cell C                                                      [1 mark]


4.   What is the most likely cause of this patient’s problem?    [1 mark]



5.   Complete the table below using the symbols N, ,          [2 marks]

                            Transferrin          Ferritin

PATIENT RESULTS




                                                Marks
STATION 23




At this station there is a Simulated Patient from whom you should
take a history with the components listed below.

You may make notes on this page and use them to answer the
questionnaire at the next station.



      1.   Personal Details




      2.   Presenting Complaint




      3.   General Health Status




      4.   Past Medical History




      5.   Current Treatment
STATION 24                                           [10 marks]



QUESTIONNAIRE

  Question 1


  i.                                                        [1 mark]


  ii.                                                       [1 mark]


  Question 2


  a)                                                       [½ mark]


  b)                                                       [½ mark]



  c)                                                        [1 mark]


  Question 3


                                                           [½ mark]

  Question 4


  a)    i)                                                 [½ mark]


                                                           [½ mark]
        ii)

              Continued on next page. Please turn over.
STATION 24 continued



 Question 4 (continued)


 b)                                                        [½ mark]
      i)


                                                           [½ mark]
      ii)



 Question 5

 a)                                                        [1 mark]


 b)                                                        [1 mark]


 Question 6


 a)                                                        [½ mark]

 b)
      Would you hear these sounds bilaterally or
      unilaterally ? Tick the correct box.
                                                           [½ mark]
            bilaterally         unilaterally

 Question 7


                                                           [½ mark]



                                                   Marks
STATION 25



You are provided with:



Exhibit A: Gram-stain of the patient’s sputum


Exhibit B: The patient’s chest radiograph


On the questionnaire opposite are a series of questions based
on this patient’s problem.



A 65 year old man with fever and a productive cough was
admitted to hospital after he became increasingly short of
breath. He had a temperature of 38.5oC, a pulse rate of 120
beats / minute, and a respiratory rate of 22 breaths / minute.
Chest examination revealed reduced expansion on the right,
and dullness to percussion and absent breath sounds in the
right midzone.     The patient’s cough was productive of
purulent, green coloured sputum.

Blood gases on arterial blood collected while the patient was
breathing room air confirmed a hypoxia and respiratory
acidosis.
STATION 25                                              [10 marks]


1.
a)   What is your clinical diagnosis?                         [1 mark]




b)   What is the most likely causative agent?                 [1 mark]




2.   List 3 other bacteria that are associated with this
     disease in the community setting?                       [3 marks]

     i)


     ii)


     iii)

3.   What other microbiological investigations may have
     been helpful in the diagnosis of this patient’s
     condition?                                              [2 marks]




            Continued on next page. Please turn over.
STATION 25 (continued)



4.   What antibiotic/s would you recommend for the
     treatment of this patient?                         [2 marks]




5.   How can this disease be prevented?                  [1 mark]




                                                Marks
STATION 26




             REST STATION




                 End

				
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