OSCE REVISION QUESTIONS 2017/2018

OSCE REVISION
QUESTIONS
2017/2018

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

List of History taking, Physical examination and Clinical skills in Year 1

BLOCK 2
Clinical Skills
 BMI *
 Hand washing technique ***
None for history taking and physical examination
BLOCK 3
Clinical skills
 Wound dressing *
 CPR (in BLS)
 Splints and plaster immobilization
History taking
 History of musculoskeletal disorders (general )
 Pt with (low) back pain **
 Pt with osteoporosis *
 Pt with osteoarthritis or rheumatoid arthritis **
 Pt with polyarthralgia *
 Occupation related musculoskeletal disorder *
Physical examination
 Musculoskeletal screening examination **
 Examination of spine and hips (sometimes considered as 2 separate examination) *
 Examination of knee **
 Examination of shoulder **
 Examination of hand **
Block 4
Clinical skills
 ECG recording and interpretation ***
History taking
 Chest pain *
 SOB and heart failure – ischemic heart disease *
 Valvular disease *
 Vascular disease – atherosclerotic plaque disease *

Physical examination
 Cardiovascular examination *
 Pulse and blood pressure examination *

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

Block 5
Clinical skills
 Spirometry *
 Peak flow meter and other inhaler device *
 Oxygen therapy (BLS)
History taking
 Pt with asthma *
 Occupational history *
 OSA history *
 Chronic cough and dyspnea *
 History of URTI/LRTI *

Physical examinatiion
 ABG **
 CXR interpretation **
 Respiratory examination **

*important skills that need to be focused on

Note: This is not a prediction of the actual exam. It’s merely a framework to prepare for
OSCE

REFERENCES
 https://learnuw.wisc.edu/
 Patient- doctor handbook

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

STATION 1
Student:
A 27-year old woman comes into the office complaining of chest pain.
Obtain a complete history of this complaint.

Patient:
You are a previously healthy 27 year-old woman. You have been having chest discomfort
about twice a week for the last 2 weeks. It is sharp, associated with difficulty getting a deep
breath. It seems to come on mostly at work or when you are driving. It lasts about a half-hour
at a time. You’ve tried Tylenol, Advil, drinking cold water, and antacids without much
benefit. It doesn’t radiate. It is severe enough to interrupt your work but not excruciating.
You haven’t had any heartburn or stomach symptoms. You are concerned that it could be a
heart problem.
You smoke 15 cigarettes a day. You’re trying to quit; had cut down from 1 pack/day to ½
pack but recently went back up to ¾ PPD, ‘probably from stress.’ No drug use. You’ve never
been in the hospital or been told you had any chronic illnesses, never had anything like this
before, never had a cholesterol test.
You are separated from your husband of two years, which is very stressful. You had argued a
lot and just grown apart, no history of domestic violence. You work as a bank supervisor, no
children, not currently sexually active or using birth control. You do aerobics 3-4 times a
week and haven’t had any problems with chest pain or breathing while exercising; ‘Actually
that’s when I feel best.’
Your father had a heart attack last year when he was 64, which is one of the reasons you are
worried about these pains. He also smokes and has high blood pressure. Your mother and
older brother are healthy.
You take a multivitamin daily, no other meds, no allergies.

Examiner:
General
o Hand wash
o Introduces self appropriately
o Clarifies reason for visit
Obtains history of chest pain
o Onset
o Location/ site
o Precipitating factors
o Alleviating factors

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

o Associated symptoms
o Quality/ characteristic
o Radiation
o Severity
o Timing/duration
Identifies risk factors for heart disease
o Past medical history
o Family history of heart disease or risk factors
o Smoking history
o Illicit Drug use (especially cocaine)
o Hypertension
o Lipids/cholesterol
o Recent stressors
o Exercise tolerance
Focused review of systems
o Heartburn/GERD symptoms
o Pain with movement/palpation
o Medications
o Allergies
o Summarizes history
o Checks for any other concerns or missed information
o Overall performance
o Communication skills performance
o Ask Standardized Patient: How likely would you be to go back to him/her ?

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

STATION 2
Student:
Perform a knee examination.
Patient:
Normal findings
Examiner:
Refer Pt-Dr hand book

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

Station 3

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

Student:
Perform a respiratory examination
Patient:
Normal findings
Examiner:
Refer Pt-Dr handbook

Prepared By: Slocahnah Sree Kumar

OSCE REVISION QUESTIONS 2017/2018

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

Station 4
Student:
Advise patient on how to use an asthma inhaler
Patient:
Follow student’s instruction
Examiner:
o 1 Washes hands
o 2 Introduces themselves
o 3 Confirms patient details
o 4 Checks understanding of inhalers
o 5 Explains what an inhaler device is
o 6 Explains when an inhaler should be used
o 7 Asks patient to summarize the key points (then goes on to demonstrate each of the
steps below)
o 8 Prepares inhaler
o 9 Exhales fully
o 10 Tightly seals lips around mouthpiece
o 11 Breathes in slowly through mouth and presses down on canister
o 12 Continues to inhale slowly and deeply
o 13 Holds breath for approximately 10 seconds
o 14 Removes inhaler and exhales gently
o 15 Asks patient to repeat the above steps and observes technique
o 16 Gives feedback on patient’s technique & re-demonstrates if required
o 17 Summarizes key points
o 18 Provides an opportunity for the patient to ask questions
o 19 Provides information if available
o 20 Thanks patient
o 21 Washes hands

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

Station 5
Student:
Explain how you will perform ECG on a patient
Patient:
Follow student’s instructions
Examiner:
o 1 Washes hands
o 2 Introduces themselves & confirms patient details
o 3 Explains procedure & gains consent
o 4 Gathers equipment
o 5 Positions patient supine at 45 degrees
o 6 Exposes patient’s upper body
o 7 V1 - 4th intercostal space - right sternal edge
o 8 V2 - 4th intercostal space - left sternal edge
o 9 V4 - 5th intercostal space - mid-clavicular line
o 10 V3 - Halfway between V2 & V4
o 11 V5 - Anterior axillary line - in line with V4
o 12 V6 - Mid-axillary line - in line with V4
o 13 RED lead - Right arm - ulnar styloid process
o 14 YELLOW lead - Left arm - ulnar styloid process
o 15 GREEN lead - Left leg - at the ankle
o 16 BLACK lead - Right leg - at the ankle
o 17 Turns on the ECG machine
o 18 Politely asks patient to remain still and not talk during the recording
o 19 Presses record on the ECG machine
o 20 Thanks patient
o 21 Detaches electrodes
o 22 Removes adhesive pads
o 23 Labels ECG with patient’s details

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

SET 2

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

Station 1
Student:
You are required to take a history from a patient with low back pain. Please summarize your
findings.
Patient:
You are: A patient attending your local GP practice

Your name: Mr Gary Smith

Your age: 26

Your occupation: Apprentice mechanical engineer

Role Player Key Information

History of the presenting complaint (SOCRATES+):
PC Presenting
Pain and stiffness in the lower back.
complaint:
S (site): The pain is felt in your lower back (lumbar spine).
The pain started about 1 months ago, and came on gradually. The
O (onset and
pain and stiffness have increased gradually over the past 1 months
progression):
and this is why you have chosen to come to see the GP now.
C (character): The pain is dull and aching in nature.
Occasionally the pain radiates to your buttocks. You have no pain
R (radiation): anywhere else in your back, or in your lower limbs (e.g. thighs,
knees, etc.)
You feel a bit like you ‘have the flu’. You are more tired than usual.

You have not noticed any redness of your eyes or changes in your
A (associated vision. You have no changes in bowel habit or abdominal pain. You
symptoms): have no skin or nail changes, patches of active psoriasis or other
rashes. You have had no recent infections – e.g. gastrointestinal,
sexually transmitted, respiratory or otherwise. You have no pain,
stiffness, redness or swelling in any of your other joints.
T (timing/previous The pain is worst in the morning, and gradually improves over the
episodes): day. It is also made worse by rest e.g. sitting down for your lunch
hour.

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

E
Rest makes the pain and stiffness worse. You have not noticed any
(exacerbating/relieving
other exacerbating factors.
factors):
In the morning, when the pain is the worst, you would give the pain
S (severity):
a score of 7/10 (10 being extremely severe pain).
You have been late to work because you could not 'get going' in the
morning because of the stiffness. You are worried that this will
+ (functional aspects):
affect your progression through your apprenticeship as you have
lots of early morning starts.
Remainder of history
Psoriasis.
Past medical history Asthma (mild and well controlled).

No known drug allergies (NKDA).

You take regular PRN co-codamol for the pain. You have a
Drug history salbutamol inhaler which you use for exacerbations of your asthma.
(including allergies You have not used it in 3 months. You have an emolient (E45) and
and immunisations). mild steroid cream (you cannot remember the name) for your
psoriasis when it flares up. Usually it affects your elbows mostly. It
tends to be well controlled. You take no other prescription or over-
the-counter (OTC) medications.
Mother: psoriasis, rheumatoid arthritis.
Family history: Father: hernia repair (aged 50).

Social history T – tobacco (i.e. smoking). You smoke 10 cigarettes a day, for 10
(TOASTED) years.
O – occupation. You are an apprentice mechanical engineer.
A – alcohol. You drink 4-5 pints on a Saturday evening with
friends.
S – social (and sexual relationships, if relevant). You live alone in a
flat. Your hobbies include playing pool with friends at the local bar
and swimming. You do not have a partner and have not had sex for
one year. Your last STI check was clear.
T – travel abroad – no recent foreign travel.
E – exercise – you swim 2 times a week.
D – diet – you are not overweight and try to eat a balanced diet.
ICE:
I - Ideas You are concerned that you could have ‘slipped a disc’.
You are finding it difficult to get to work on time and have been
late on one or two occasions. You do not want the back problems to
C - Concerns
start affecting your work and progress through your engineering
apprenticeship.

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

You would like some painkillers to get rid of the pain, but you are
not thinking of having to take them long term as you do not like to
E - Expectations take medication if you can avoid it. You don't want to miss much
time off work for any more doctors appointments so you would like
a solution today.
Examiner:
History with 1 month of low back pain
‘Please complete this form using black or blue pen only.
DATE

STUDENT

MATRIK NO.

EXAMINER

Points (0,1)
Skills

1. Uses open – ended questions to obtain history of symptoms

2. Determines the onset, duration and location of back pain

3. Is the pain present during the night?

4. Does the pain interfere with activities of daily living?

5. Is there a history of constitutional symptoms(e.g. fever, weight loss)

6. Has he experienced recent difficulties with his urinary stream?

7. Does he have risk factors for infection (e.g. recent surgery)

8. Is there a history of osteoporosis or of risk factors for osteoporosis?

9. Are there neurological deficits (e.g. lower limb weakness or /and
paraesthesiae)

10. Enquire about response of pain to analgesics and/or anti-inflammatory drugs

Scoring
Total (out of 10 points)
6 or more points to pass
Pass Fail (Must re-sit CEX)

Signed and chop:

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

Station 2

Student:
Perform an examination of the arm and shoulder. Please include the special tests.
Patient:
Normal findings
Examiner:
Refer Pt-dr handbook

Shoulder Examination
‘Please complete this form using black or blue pen only.
DATE

STUDENT

MATRIK NO.

EXAMINER

Skills Points
( 0 or 1 )
1. Inspect both shoulders

2. Palpate for tenderness over appropriate areas

3. Assess range of adduction and abduction

4. Assess range of flexion and extension

5. Assess range of internal and external rotation

6. Assess range of passive movements

7. Performs test for rotator cuff impingement

8. Performs test for anterior instability

Scoring
Total (out of 8 points)
5 or more points to pass

Pass Fail (Must re-sit CEX)

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

Station 3

Student:
You are required to perform a cardiology examination on the patient. Summarise your findings.
Patient:
Normal findings
Examiner:
Refer Pt-Dr handbook

Examination of the heart – pericordium and related structures

‘Please complete this form using black or blue pen only.

Points (0,1)
Skills

1. Position the patient correctly

2. Locate the apex beat

3. Localise the apex beat by counting rib-spaces and aligning it relative to the mid-
clavicular line

4. Feel for an impulse at the left sternal edge with the heel of your hand.
5. Listen with the “bell” at the apex and pulmonary area, to comment on the first and
second sounds, and any added sounds.
6. Listen with the “diaphragm” at the:
 Apex
 Pulmonary area
 Aortic area
 Tricuspid area
 Comment on any murmurs
7. Roll the patient to the left lateral position and listen with the bell in the mitral area for
a diastolic murmur
8. Sit the patient upright and forward in end expiration and listen over the aortic area and
left sternal edge, with the diaphragm.

9. Auscultate the carotid arteries for bruits and/or radiated murmurs.

10. Percuss the lung bases to assess for pleural effusions

11. Auscultate the lung bases for crepitations

Scoring
Score 1 for murmurs if none present
Total (out of 15 points)
9 or more points to pass

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

Station 4
Student:
Interpret the following arterial blood gas results.

o pH: 7.49 (7.35-7.45)

o pO2: 7.5 (10–14)
o pCO2: 3.9 (4.5–6.0)
o HCO3:  22 (22-26)
o BE: -1 (-2 to +2)
o Other values within normal range

Examiner:

o This is type 1 respiratory failure. The PO2 is low with a low CO2.
o The accompanying alkalosis is a response, due to the patient blowing off CO2 due to her likely
high respiratory rate

Interpretation of Arterial Blood Gases

‘Please complete this form using black or blue pen only.

Points (0,1)
Skills

1. Identify the patient and date of the Arterial Blood Gas (ABG)

2. Identify the Fraction of Inspired Oxygen (FiO2)

3. Determine if the pH is normal (7.35-7.45); low (<7.35) indicating
acidosis; or high (>7.45) indicating alkalosis

4. Determine if the PaCO 2 is normal (35-45 mmHg); low (<35)

indicating hypocapnia; or high (>45) indicating hypercapnoea.

5. Determine whether the PaCO2 is appropriate, or inappropriate for the pH

6. Determine if the PaO2 is low (<80 mmHg.) indicating hypoxaemia

7. Identification of Type I or Type II respiratory failure

8. Calculate the Alveolar-arterial (A-a) gradient

Scoring
Total (out of 8 points)
5 or more points to pass
Pass Fail (Must re-sit CEX)

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

Station 5
Student:
Take a complete history from the patient

Name Akmal Hafiz

DOB 14/03/97 (21 years)
Occupation Student
History I have exams coming up and I am very anxious about them. I
believe I have the u and I need antibiotics otherwise I will not be
able to revise. I claim that it just will not go (if pressed has lasted 3
months and is only getting worse). I feel breathless a lot of the time,
especially outside in the cold or at night where my chest feels a
little tight too. Nights are really bad because I also cough so much
but I don't bring up any sputum or blood. I always get infections
every winter, I don't know why, but I wasn't this bad last winter. If
specifically asks admits to an odd sound when I breathe out which I
cannot describe. Denies any history of eczema, fever, contact with
animals, and contact with people with similar symptoms, travel,
fainting and any other symptoms.
Past Medical History Hay fever. Nil else including no recent surgery
Drug History Paracetamol for recent symptoms. Nil else
Family History Younger sister with eczema. Nil else.
Social History Moved to a new at in 2 months ago (October) where a flat mate
currently smokes. I believe I would have good support from flat
mates should I have an asthma attack. Nil smoking, drugs, alcohol.
Patient:

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

Introduces yourself
Confirms name & age of patient
Explains reason for consultation & builds rapport
Gains consent
Asks open question
Asks about onset (gradual/sudden)
Asks about duration and changes to breathlessness
Enquires about exacerbating factors including exertion, chemicals/pollen, lying at
Asks about variability over the day: constant/progressively worse/worse in the
morning or night and seasonal variation
Enquires about severity by asking about exercise tolerance on at and upstairs and
on rest
Asks about any recent illness or surgery or previous shortness of breath
Asks for cough and sputum and if present explores further
Asks for orthopnoea and paroxysmal nocturnal dyspnoea and if present explores
further
Asks for added breath sounds such as wheeze and if present explores further
Asks for chest pain and characterises chest pain if present
Asks for any fever or contact with anyone with similar symptoms or sick animals
Asks for any palpitations or dizziness
Checks for red flags: haemoptysis, weight loss, night sweats and hoarseness
Checks if patient is current or ex-smoker and number of pack years
Asks about past medical history (specifically hay fever, eczema)
Asks about any family history of disease (specifically eczema, asthma)
Establishes any drugs or over the counter medication patient is on
Asks if patient has any allergies or any new pets
Asks if patient drinks or takes recreational drugs
Elicits patients occupation

Examiner:

Asks if patient has travelled anywhere

recently
Explores impact of shortness of breath on
activities of daily living
Explores and responds to ideas
Explores and responds to concerns
Explores and responds to expectations
Shows empathy
Avoids jargon
Summarises back to patient
Thanks patient
Patient global score
Gives reasonable differential diagnosis (asthma, pneumonia, allergic rhinitis)

Prepared By: Slocahnah Sree Kumar

 OSCE REVISION QUESTIONS 2017/2018

References:
1. http://www.mockosce.com/index.php?title=Patient_(RheumHx1)
2. http://osce-stations.blogspot.my/p/histories.html
3. Patient-Doctor Handbook

Prepared By: Slocahnah Sree Kumar