Trial OSCE exam: 'Practice' by Victoria

You are taking part in a trial exam created by Victoria. There are 18 OSCEs in this exam (180 minutes).
 

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

Scenario:

You are a consultant at a regional ED on a Saturday afternoon. Your Resident has just handed over a 33 year old pregnant woman named Deborah.
She presented with left ileac fossa pain since morning, and recently discovered a small amount of vaginal bleeding (“spotting”) causing her to present to ED.

Your resident reports vital signs of
HR 85 BP 98/60 RR 18 SpO2 99% RA T 36.6

He also describes examination findings of a well perfused, alert lady, with some ongoing left sided abdominal discomfort , and left sided lower abdominal tenderness on abdominal examination. A bimanual exam has not been perfomed.

He also reports that the urine Full Ward Test is “normal” and the urine pregnancy test is positive, and that bloods are “sent”.

Your task is to see the patient:

Perform a focussed history
Explain the possible diagnoses to the patient
Explain the plan for further investigations and management to the patient.

Instructions for the candidate

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

You are 33 year old Aged Care Nurse called Deborah

G0P1

LMP 6 weeks and 3 days ago. You have not had an US so far

other PHX:
migraines, irregularly
chlamydia infection picked up on routine screen when you were still at uni - treated
You know you are blood group A+ (are a blood donor)

Medications: nil regular. ceased OCP 18 months ago

Allergies: nil

Presenting history:
uneventful pregnancy until this morning. (No symptoms of early pregnancy if asked)
Left sided low abdo pain present slightly when woke but became significantly worse after breakfast. hurts when you walk. Not severe, but bothersome.

No dysuria. no vomiting. no diarrhoea or constipation.
Spotting started at lunchtime and led you to present as you are “worried about your baby”

Social history:
Married for 3 years, same partner for 8 years
[ if asked, you had multiple partners in your Uni days but only one since 8y ago. the Chlamydia was picked up on a STI test you took at the outset of that relationship]
[ if asked, your partner is currently on shift and cannot come - he is a police officer]

Planned pregnancy, been trying since stopping OCP 18 months ago


You are worried about your baby and whether there is a chance of a miscarriage
Ectopic Pregnancy had not crossed your mind, you only vaguely heard about it at uni, do not have much idea what it means

You should appear distressed on hearing the possibility of ectopic or miscarriage but be able to gather yourself together if reasonable display of empathy from the candidate.

At 5 mins if not already covered, you should ask “what is the plan from here”,
and if not covered, “what tests are you going to do”.

For the examiner

Medical Expertise "PUL
Must identify the possibility of ectopic pregnancy (P/F)
Should also identify possibility of early pregnancy loss

Collected history of risk factors for ectopic (tubal surge / pref ectopic / PID / IVF)

Plan to include US, Blood group and hold and antibodies, FBE, bHCG

"
Communication "Empathy
Some statement that pt is not at fault / caused the presentation
Support Person offered
Professionalism
"
Leadership and Management
Scholarship and Teaching
Prioritisation and Decision Making "Must arrange a same day US or at least admission under O&G with purpose of same (as pt is clinically stable)
Analgesia offered

"

Domains Assessment Objectives

Medical Expertise
40%. PUL
Must identify the possibility of ectopic pregnancy (P/F)
Should also identify possibility of early pregnancy loss

Collected history of risk factors for ectopic (tubal surge / pref ectopic / PID / IVF)

Plan to include US, Blood group and hold and antibodies, FBE, bHCG

Prioritisation And Decision Making
40%. Must arrange a same day US or at least admission under O&G with purpose of same (as pt is clinically stable)
Analgesia offered

Communication
20%. Empathy
Some statement that pt is not at fault / caused the presentation
Support Person offered
Professionalism

Other Assessment Notes