Trial OSCE exam: 'Trial Number 1 April 16th' by Karen Robins-Browne

You are taking part in a trial exam created by Karen Robins-Browne. 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:

Your registrar comes to you with an ECG of a 76yo lady who had an unconscious collapse at church. She had stood for hymns, felt lightheaded and then collapsed. There was no seizure activity. She did not sustain any injuries.

View attached:   Attachment 1

Instructions for the candidate

Explain to the registrar the findings on the ECG and formulate a management plan.

Domains being examined

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

For the actor

You are a junior ED registrar. You can provide a summary of the patient. You do not think there is anything wrong with the ECG.

She is a well, independent lady from home with good supports. She has fainted previously, but not for a long time. She has a past history of controlled hypertension, glaucoma and impaired glucose tolerance. She is on aspirin, perindopril and atorvastatin. She has no allergies. She currently feels well.

Her vitals are: HR 78 BP 130/50 RR 16 SaO2 98% RA T 36.7. She is hydrated. She has no murmur, lung fields are clear. Examination is unremarkable. There is no postural drop in BP.

Her bloods revealed slight renal impairment consistent with previous. Hb 98, Hct/PCV 0.32. WCC normal. Other results unremarkable. Urinalysis showed leucs + with no nitrites (no symptoms). CXR clear.

For the examiner

ECG is largely benign with only a first degree block.

Domains Assessment Objectives

Medical Expertise
Assessment of syncope, risk factors and relevant risk scores

Prioritisation And Decision Making
Appropriate management plan

Health Advocacy
Appropriate risk stratification and advice for patient

Scholarship and Teaching
Well structured ECG explanation and guidance of junior doctor

Other Assessment Notes

Use of syncope risk stratification (eg Boston or San Francisco criteria).

Good reference: http://xa.yimg.com/kq/groups/14639670/273327953/name/Evidence+Based+Approach+to+Syncope+2010.pdf