all the best with revising

OSCE JUNE 2010 (PSY, GP, GERI ET AL)

1. Videotape of a depressed pt.
From the videotape what can u comment abt the symp pt experience-early
morning wakening, poor concentration, anhedonia
What other symp of depression beside those mentioned in the video that you
want to explore? Guilt, poor motivation, appetite weight, hope, low mood,
suicidal thoughts
What 2 sleep disturbance can be expressed by psy patients beside early morning
wakening? Initial imsomnia, ?????
Is anhedonia specific for depression or can it be exhibited by pts with anxiety?

2. CXR of a pt with Hx of mastectomy. Lack of breast shadow on CXR

Dx? Pleural ef
Mx? ABCDE if pt unwell. Get surgical team to insert chest drain. Sent sample for
MC+S and patho lab. Do CT scan for other mets. Get pt back to MDT assessment

3. Pic of child with scarlet fever (pic from slides)

Write prescription
What 2 complications? Post strep GN, Meningitis
What organism? Grp A beta haem strep

4. PEWS scrore and kardex of a pt given. Pt has OA and Hx of MI. admitted due to
epigastric pain.
What is PEW score for?
Comment on BP-dropping into red zone
HR? increasing into red zone
Dx? Upper GI bleed.

Mx?

5. Abdo XR. Small bowel distention. Past Hx of appendectomy, HTN

Dx? Small bowel obstruction.
Cause?
Mx?

6.emergency contraception, 40yo. Comdom split. No other PMHx, not on

medication.
Hx? Pt suitable? Have to explain how to take it. What is the name of the drug?
When to come back see doc? How you going to ascertain if shes pregnant or not
(urine), S/E? what if vomit?

7. Wafarin. Pt experienced TIA from wafarin. Explain.

Why need wafarin? Was prescribe 2mg, do I jus go home and take the 2 blue
tables? (no, blue=3mg. brown=1mg). tmrw gp close, can I go on mon to check
my INR? No hafta go hosp. what lifestyle modification? Avoid contact sport etc.
what signs toxicity? Spontaneous bleeding etc. how often need to check INR?
Realy necessary to check INR? If miss 1 dose can compensate missed dose? No

8. pt complaining urge to push ppl to road when standing on the bus stop. Get
Hx.
Explore scheindners 1st rank sympts.
After teasing out, pt has obsession to recheck things.
Whats the Dx?

9. Chemo pt coming in with WBC <1 x 10^9

Dx? Neutropenic sepsis
Mx? Admit pt, IV abx, GSF
Pt wants to go home for a while to get things sorted. Can? No. pt is actually vr
ma fan keep insisting wanting to go home wtf. must keep to ur stand and say its
against medical advice for pt to go home

10. tibial #
Describe fracture. Angulation, spiral, ?soft tissue etc. clinical picture given. Open
fracture.
What structure damage? Common peroneal nerve.
How to Mx? Open reduction, internal/external fixation, immobalisation, rehab.
Rmbr analgesia

11. Schiz pt. previously triad on 2 anti-psy. Now being started o clozapine.
Explain to dad. Explain 1 major S/E and other minor S/E.
Rmbr its atypical other then clozapine, typical, then clozapine. 1%
agranulocytosis. Other S/E: wt gain, N+V, diarrohoes, dizziness.
Gp call you saying pt has sore throat. Wot do you do? Ask gp get full Hx,
Examination, do bloods see if patient really sufering from agranulocytosis. If yes
what do you do?

--------------------------------------------------------------

1. X-ray of pelvis. Patient details given ( 80 year old patient) Describe the clinical
entity. Will be asked one question at the end.
Fracture of left neck of femur. Intracapsular fracture.
What is the preferred treatment for this patient?
What is the peri-op management? (remember to mention consent)
2. Daughter of patient with stroke comes to enquire about care that can be given
in the community upon discharge. Answer her questions.
What are the services available?
Who can look after him when nobodys at home?

What are the gadgets that can be used to help him with everyday life?
3. Video of patient describing auditory hallucinations. Transcript given at the
side.
4. Mother of a patient who was aggressive to the parents before this. Also
suspected to be schizophrenic. Was detained. Counsel the mother and answer
her questions. (based on which forms needed to be completed)
5. Chest x-ray. Patient details (was in a football match, suddenly SOB and chest
pain. ) Describe the x ray. Examiner will ask question at the end. (Pneumothorax)
What is the management of pneumothorax?
6. Patient at the night before attempted suicide by taking an overdose pills. Was
found by her husband. Assess her suicide risk. Dont have to come to a
diagnosis.
7. Patient had lung cancer, and previously had pnuemonectomy. Recently, had
symptoms. Then went to get MRI scan done. Found brain metastesis. Report to
her the results and answer her questions. (Breaking bad news)
Will I be able to drive next time?
What are my treatment options?
What is my prognosis?
What are the side efects of my treatment?
8. You are a medical student and you are asked to discuss a patients
medication(NSAIDS, steroids,diuretics) with the SHO. Patient details elderly, RA.
Answer the questions.
What are the side efects of each drug?
Patient finds it difficult to take her medication. What are the solutions?
9. Patient comes to get BP measured. Measure the estimated systolic pressure
and both systolic and diastolic blood pressure. Calculate cardiovascular disease
risk in 10 years. (back of BNF sheet provided)
10. Patient comes with urinary symptoms and had urine culture done. Antibiotic
sensitivity done. (Sensitive to trimethoprim, and resistant to a few more
antibiotics). Write her an antibiotic prescription. Answer one question at the end.
What advice will you give the patient after giving her the prescription?
11. Take a thorough history of a patient complaining of back pain. Report back to
her the clinical findings.

---------------------------------------------

Radiology
1.

Foreign body

2.

Hernia

3.

Rectal Ca

4.

Pneumothorax

5.

Small bowel obstruction

6.

Surgical emphysema

7.

Ulcerative colitis

8.

Oesophageal Ca

9.

Cardiomegaly?

10.

Haemangioma

11.

Subdural/extradural?

12.

Brain Ca

13.

Air under diaphragm

14.
20. Sorry cant remember the rest but they r all the slides shown during
the lectures so just pay attention.

JAN 2010
1.

Hangman fracture

2.

Flexion tear drop fracture

3.

Odontoid peg fracture (showing prevertebral haematoma)

4.

Tension pneumothorax

5.

CCF (Bat-wing appearance)

6.

SAH

7.

SAH

8.

Brain Ca

9.

Air under diaphragm

10.

Jeferson fracture

11.

Bifacetal dislocation

12.

Diverticulum

13.

Fractures
1. Spinal Injuries
a.

CT scanning gives better soft tissue definition than MRI

b.

An unstable fracture has to have more than two columns involved

c.
Rectal examination in manadatory when excluding cauda equina
syndrome
d.

Cervical spine injury needs only x-ray for diagnosis

e.

In patients with osteoporosis there is always a history of injury

2. With regard to hip fractures

a.

The majority of patients receive general anaesthesia for their surgery

b.

commoner in males is than in females

c.

Are normally as a result of a low energy fall

d.

20% of patients are treated non-operatively

e.
In the pre-operative period are commonly graded ASA-2 by the
anaesthetists

3. Avascular necrosis
a.

Can occur in the distal pole of displaced scaphoid fractures

b.

Is associated with osteoporotic bone

c.

Commonly occurs with Garden 1 and 2 type femoral neck fractures

d.
Is the reason why extracapsular femoral neck fractures are treated with a
sliding hip screw
e.

Is a potential complication of talar neck fractures

4. Bennets fracture
5. 2 questions of compartment syndrome. Knows about the passive extension of
toe.
6. osteomyelitis. Commoner in children?
7. osteoporosis. Thinner cortical bones in Xrays? Serum calcium raised?
8. 19 yr old came with intracapsular fracture of neck femur. What to do? DHS?
Consent to hemiarthroplasty? Analgesia?
9. scenario of child came in with high crp and esr. Then high WCC maybe. What
ug need to do after that? Cant remember what the choices? But maybe got USS
or blood culture?
10. pt involved in RTA blow to knee. What was injured? Patella? Peroneal nn?
Popliteal artery? Medial cruciate ligaments? Anterior cruciate ligaments?
11. matching scenario and what fracture? Like kick in the shin tibial fracture?
Fall from where colles fracture?
12- 20 sorry cant remember as well. I think there is questions on hip fracture
and tibial fracture again but cant remember what it is about. I have attached all
the lectures that I have got from the royal. It should be the same for those doing
fracture in other hospitals.

Jan 2010
1. Spinal trauma :a. burst fracture is anterior and posterior column fracture
b. 20% fracture of vertebra is regarded as unstable
c. cauda equine start at L3

d. transverse fracture regarded as unstable

2. SUFE
3. Bennets fracture. What is it.
4. Acute haematogenous osteomyelitis
5. 2 yr old 24 hr limping, esr high, crp high, temp 38 degrees celc. Next most
appropriate investigations?
a. urinalysis
b. uss of pelvis
c. CXR
d. x ray of pelvis

6. 19 yr intracaps frac, which next step?

a. DHS
b. hemiarthroplasty
c. wait next 24 hrs for surgery
7. Colles fracture.
a. ulnar deviated
b. volar displacement
c. dorsal angulated
8.

Complications of fractures

a.

Volkmann contracture follows compartment syndrome of the forearm.

b.
The median nerve is most common at risk in fractures of the humeral
shaft.
c.
Avascular necrosis of the distal pole of the scaphoid may follow its
fracture.
d.

Fat embolus occurs around 7-10 days after fracture.

e.

Pelvic fractures are not life threatening.

9.

With regard to hip fractures

a.

20% of patients are treated non-operatively.

b.

The mortality in males is greater than in females.

c.
In the pre-operative period are commonly graded ASA-2 by the
anaesthetists
d.

The majority of patients receive general anaesthesia for their surgery

e.

Are normally as a result of a low energy fall outdoors

10. pt involved in RTA blow to knee. What was injured? Patella? Peroneal nn?
Popliteal artery? Medial cruciate ligaments? Anterior cruciate ligaments?
11. matching scenario and what fracture? Like kick in the shin tibial fracture?
Fall from where colles fracture?
12. which is high energy injury?
a. hip frac in >65
b. phalangeal injury young males
c. shaft of femur frac
d. etc

PSYCHIATRY
1.
Overvalued ideas : patients have insight? Poor prognosis? Not delusional in
nature?
2.

Lithium toxicity : fine tremor? Polyuria? Tardive dystonia?

3.

Low T3 level, ask to choose which scenario which is related.

4.
Pt run out of a drug( name not given) with withdrawal symptoms: anxiety,
etc. name the drug.
5.

Schizophrenia: lifetime prevalence 1%?

6.

Alzheimers dementia: low GABA? Low cholinergic?

7.

Anankastic personality

8.
2nd person auditory hallucination, cant remember what else: alcohol
dependence? Schizophrenia?

9.
Scenario schizophrenia treated with olanzapine then switch to haloperidol
but no benefit. What next? Procyclidine? Clozapine?
10.

On clozapine, what should be monitored? Red cells? White cells?

11.
Antisocial personality admitted to A&E with overdose. What will be
beneficial? CBT? In patients?
12.
Presented with anxiety speaking in front of public. Talk to the boss?
Psychotherapy? SSRI?
13.
Mental Health Act. What are needed to admit patient? Psychiatrist? Social
worker and GP? Psychiatric nurse?
14.
Severe depression recently. What event is significant? Lost job a year ago?
Swine flu 3 months?
15.

Negative symptoms of schizophrenia.

16.

Feature separating depression from anxiety? Anhedonia? Poor Sleep?

17.

Features of schizophrenia? 3rd auditory hallucination? Visual hallucination?

18.

Type of perception. Thought echo?

19.
Scenario: patient seeing things like something crawling on the wall.
Reptiles. Schizophrenia? Delirium?
20.

Lewy body dementia.

21.
Sorry cant remember the rest. But I think there is another questions on
lithium, bipolar, then other drugs.