PERTH28 Oct 2006 OSCE QUESTIONS

1 . 23 yr old woman,husband away on outstation trip. Just delivered her first child. You have examined him - he has epicanthic fold, hypotonia and you notice a gap between his first & second toe. You suspect that the baby has Down syndrome. Explain to the mum and answer any questions she may have.

2. 28 yr female 32 weeks pregnant. She is a front seat passenger in a car that was involved in an accident.She has abdominal tenderness but is able to sit up and talk to you. Take relevant history,ask examiner about her examination findings and explain your diagnosis and management plan to patient.

3. 32 weeks primigravid with breech presentation on routine examination.Talk to patient,take brief focussed history and explain to the patient your management.

4. 2 year old boy (Jamie) has jammed his hand in the car door. He cried for sometime and then turned blue and his hand twitched for few seconds. His concerned father is there in ED talk to him. Please take a relevant history and explain your diagnosis and further management.

5. 3 year old girl(Lisa) with snoring and disturbed sleep at night. Frequent middle ear infections .Losing weight. O/E: Irritable,enlarged tonsils and white retracted tympanic membrane. Your task: Talk to her mum and explain your management plan to her.

6. 18 year university student come to you(a general practitioner at the Student HealthService) for a prescription of oral contraceptive pills. Take relevant history and explain to her how to take oral contraception(don’t forget 7 day rule)

7.Photo of right leg venous ulcer. Talk to the patient. History – fractured leg 20 yrs ago. Had surgery & developed blood clots in leg. Needed injections on belly to thin blood. Also well-controlled diabetes. Advice - your management.

8. 65 yr happily married in Orthopaedic ward for after total knee replacement surgery. Was cheerful in evening though confused you for the consultant. Visited by wife and he became aggressive and accused her of having an affir with his best friend. Quite abusive ,restless and aggressive. Your registrar is busy in theatre and has asked the nurses to give 5mg of olanzepine wafer and to call you(the orthopaedic resident) . Take relevant history and perform relevant examination. And order any necessary investigation. Answer any questions from examiner.

(Need to exclude hypoxia – pulmonary embolism, pneumothorax, fat embolism)

9. Photo of left neck swelling(supraclavicular).Take history and give differential diagnosis to examiner. Ask examiner for any relevant clinical examination findings and explain your management plan to the patient. Order any investigation you would like to confirm your diagnosis.

10. 62 year old with chest discomfort a few days ago. ECG normal at that time but you organize a stress ECG and the results have come back to you showing ST segment changes in anterior limb leads. Patient lives in country 2hrs from nearest hospital. Your task would be to manage him.

11. Lady in 30’s Ht 175cm and Wt 95kg. Experienced shortness of breathing at work yesterday. Now comes to see you (her GP). Take relevant history and manage.

(Need to exclude pulmonary embolism)

12. Lady in 30’s comes to you complaining of SOB and insomnia. You have investigated her - ECG ,bloods (eg thyroid function test, Hb) - everything is normal. You suspect that she has Gen Anxiety disorder. Talk to patient about the diagnosis and management

13. 24 year has just donated blood. You are her GP. She has been contacted by the Blood Bank and informed that she is Hepatitis C positive and has been asked to see you her GP. Advice her and answer any questions she may have.

14. 20 yr with abdominal pain(right sided),vomited twice with pain but pain decreased now. Still uncomfortable. Ask relevant findings from examiner and answer any questions including investigation and management plan.

15. 60 year man with pain on chewing and headache on right side of head You are suspecting temporal arteritis. Explain to patient any further investigation you would like her to have, your treatment and any referral you would make.

16. University student presents with fever for 2 weeks and feeling very tired. O/E you find enlarged and inflamed tonsils. Take relevant history ask examination finding from examiner and explain the diagnosis and management plan to patient.

(Infectious mononucleosis/Glandular fever)