My Chest, it is paining. OSCE by Katrina Romualdez

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


You are the ED consultant in an urban tertiary hospital on a busy Monday. A nurse has asked you to see a 55/F who is a triage category 2 chest pain, who has been waiting for 30 minutes and wants to leave. The nurse has discussed your ED's accelerated diagnostic protocol for chest pain with her. Her vital signs are normal, she has no pain, and her initial ECG is normal. Your nurse has done bloods including a troponin.

Instructions for the candidate

Assess her risk for significant coronary artery disease and discuss further investigation and management as appropriate. You are not required to examine her --there are no abnormalities in her physical examination.

Domains being examined

  • Medical Expertise
  • Prioritisation And Decision Making
  • Communication
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

Profile: 55/F executive with active and healthy lifestyle
PHx: Hypertension (new diagnosis)
Medications: Nil --attempting lifestyle modifications for the past 6 months (weight loss and exercise)
Family Hx: Father died of an MI at 65
Alcohol: weekends, 1-2 glasses of wine
Drugs: Nil

Presenting history: 20 minutes of central chest pain with no radiation during a business meeting. No other associated symptoms. Convinced by co-workers to seek treatment. Resolved before leaving for hospital.

Manner: impatient at first, in denial re: significance of event, amenable to staying for further investigation or follow-up if candidate makes reasonable argument for it. Will absolutely REFUSE admission to hospital.

For the examiner

Domains Assessment Objectives

Medical Expertise
- Take a concise, focused history re: chest pain and determine that the patient is a candidate for accelerated diagnostic pathway for chest pain
- If initially recommends admission (patient will refuse), optimises treatment and follow-up (aspirin if no CIN, GP/Cardiology follow-up, stats re: risk)

Prioritisation And Decision Making
- Recognises need for shared decision making with patient and optimises investigation and management to fit individual patient

- Open-ended questions for history
- Clear, layperson language

Other Assessment Notes

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Is the patient age 55? In 'Scenario' 65/F was written but I think it is typo.

Jae Lee at 20:24 19 Mar 2016  

sorry for the delayed response. Scenario description now fixed!

Katrina Romualdez at 10:25 01 Nov 2016