Trial OSCE exam: 'way to go' by Neeraj Shrestha

You are taking part in a trial exam created by Neeraj Shrestha. There are 9 OSCEs in this exam (90 minutes).
 

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

Scenario:

You are asked by a nurse to assess Mr Philps, an admitted 87-year-old patient in ED. During bed changes she noticed that his penis looked abnormal, and he was complaining of discomfort. He was admitted under medicine for community acquired pneumonia. He has been stable and is waiting for a bed on the ward.

View attached:   Attachment 1

Instructions for the candidate

You are to perform a focused assessment of the patient. You are then to explain any abnormalities found to the patient and outline the management approach.

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

Patient: Lucas Philps
You are a lucid and relatively well 87-year-old. You have an IDC for prostatism, which was changed at the nursing home earlier in the day before coming to hospital. You have never had this condition before. It is somewhat uncomfortable.

Prompts: "What can we do to fix it?" "Are you going to inform the nursing home?" "I'm upset with the nursing home to let this happen"

For the examiner

This could also be played as an in-house iatrogenic event if the IDC were inserted after arrival. This could extend to dealing with quality improvement.

Domains Assessment Objectives

Medical Expertise
Management of paraphimosis

Communication
Clear explanation of condition and management options

Health Advocacy
Follow up of cause and care at nursing home to prevent future recurrences (adverse event reporting)

Other Assessment Notes

1. Identify paraphimosis
- likely iatrogenic after IDC insertion

2. Sensible management approach
- Consider penile block
- Pressure / pressure bandage
- Ice glove
- Direct manual reduction +/- babcock clamps
- Sugar or hyaluronidase
- Multiple puncture (ow!)
- Progression to dorsal slit

3. Dealing with complaint / adverse event
- Adverse event reporting
- Communication with nursing home

Image lifted from Roberts & Hedges Clinical Procedures in Emergency Medicine 6ed 2014