I still feel a bit woozy OSCE by Michael

 
You have 3 minutes reading time. This OSCE will run for a maximum of 7 minutes.

Scenario:

A 24-year-old male presents to your ED with a dull throbbing headache, mild vertigo, poor concentration and clumsiness. He reports a head injury 3 days prior while playing rugby, and was assessed in your department at the time.

Instructions for the candidate

You are the consultant in the turnaround area of your ED. You are to take a history and provide a management plan.

Domains being examined

  • Medical Expertise
  • Communication
  • Health Advocacy
 
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

You sustained a heavy tackle at rugby 3 days ago with a brief loss of consciousness (few seconds). You were seen in the ED, and had an x-ray of your neck. After a period of observation you were discharged home.

Since discharge you have had a constant, dull, bitemporal headache, partially relieved by paracetamol. You have had some mild vertigo with rapid movements. You feel like you cannot concentrate. You feel a little unsteady on your feet, and have dropped simple things with a feeling of clumsiness.

You have not had significant head injury before, you have no significant medical history and take no medications. Social alcohol use, non-smoker, no allergies. No illicit drugs.

Your physical examination is normal.

Your concerns are:
- You think a brain scan (CT) is merited given ongoing symptoms post injury
- You are upset that you think something may have been missed on the first presentation
- If asked why concerned: You had a friend who was in a car crash and they didn't diagnose his intracranial bleed for 2 days (but he's fine)
- If time: You want to know about return to sport and work

You are amenable to a good explanation of post-concussion syndrome as long as appropriate follow up is discussed.

For the examiner

None

Domains Assessment Objectives

Medical Expertise
Sound knowledge of post-concussion syndrome, expected duration and management options

Communication
Clear and appropriate explanation of issues
Adequately address concerns

Health Advocacy
Appropriate advice including when to return to sport, work, etc, avoidance of alcohol, etc.

Other Assessment Notes


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